role of nutrients for health and well- being – the view of ... · healthy life depends on several...
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Healthwise Congres
Role of nutrients for health and well-being – the view of an ingredient supplier
Dr. Manfred EggersdorferNutrition Science & Advocacy DSM
October 31, 2014
To start with a motivating quote
When diet is wrong,medicene is of no use.
When diet is correct,medicine is of no need.
Life expectancy: Japanese females andIceland men living longest of all
Top 10 countries; life expectancy in years
Women
1. Japan 87.02. Spain 85.13. Switzerland 85.14. Singapore 85.15. Italy 85.06. France 84.97. Australia 84.68. Rep of Korea 84.69. Luxembourg 84.110.Portugal 84.0
….
Men
1. Iceland 81.22. Switzerland 80.73. Australia 80.54. Israel 80.25. Singapore 80.26. New Zealand 80.27. Italy 80.08. Japan 80.09. Schweden 80.010.Luxembourg 79.7
….
Source: WHO 2014
Netherlands 83 Netherlands 79
Leading risk factors for disease: example Netherlands (2010)
Source: GBD Country Report Netherlands
Micronutrientrelated
More than 40% of nutrition related diseases take place before the age of 70.
Approximately one third of cancers can be prevented
Up to 80% of heart disease, stroke and diabetes type 2 deaths are preventable.
Source WHO
Healthy life depends on several factors –nutrition being an important one
• Genetics• Life-course
events• Education• Employment• Lifestyle• 1000 days
window• Nutrition
Ageingtrajectory
Nutrition and lifestyle are modifiable risk factors
People expect quality and all nutrients in their food
Slide 8
Vitamins
Vitamin AVitamin E Vitamin CVitamin DVitamin B1Vitamin B2Vitamin B6 Vitamin B12 …
Omegas
DHA EPAARA
Carotenoids
B-caroteneLuteinZeaxanthin
…
Enzymes
Phytase…
Minerals
CalciumMagnesiumIron ZincIodineSelenium…
Amino acids
MethionineLysine…
Fibers
Page 9
Little compliance with food guidelines - people eat the ‘wrong things’!
>75%
Population % below reference value
50 - 75%
25 - 50%
5 - 25%
<5%
Men Women Men Women Men Women Men WomenMen Women
Adapted from Krebs-Smith et al. 2010 JN
A large majority of the population does not meet the nutritional recommendations set by the food pyramid
Germany
The Netherlands
United States
United Kingdom
Barbara Troesch, Birgit Hoeft, Michael McBurney, Manfred Eggersdorfer and Peter Weber Published in British Journal of Nutrition 2012, 108, pp692-698
Micronutrient intake is a topic in Western countries
The consequences: inadequate micronutrient intake affects health and performance
Impaired functions, higher risk for non-communicable diseases
Long term health, wellness, vitality
Metabolic response
A balanced intake of all essential nutrients is required for long-term health, healthy aging and risk reduction of NCDs
Nutrient status
Desirable
Insufficient
Deficient Deficiencydisease
Adapted from B. Ames
Example of a deficiency disease – which is still an issue in major parts of the world
• The average life time costs (including quality of life and life expectancy) for a child with an NTD amounts to : € 242,948
• Food fortification with folic acid is a cost effective and humanitariancountermeasure(Jentik et al. (2008))
The impact and solution
Several hundreds of millions Euros of savings were estimated as cost benefit for folic acid fortification – next to the ethical aspects.
• 300,000 to 400,000 worldwide(Christianson A, et al., (2006))
• ~4,500 in Europe (J Behav Med 25:411–424)
• 100,000 in China (N Engl J Med 341:1509–1519)
Babies born annually with NTD
In the light of many countries experiences with folic acid fortification it is timely to advocate in countries with no fortification.
Many countries (in red) have mandatory fortification of food with folic acid in place
http://www.eurocat-network.eu/preventionandriskfactors/folicacid/folicacidmandatoryfortification
The following countries have mandatory fortification of food with folic acid.
Argentina Ghana Oman
Australia GrenadaPalestine, Occupied Territory
Bahrain Guadalupe ParaguayBarbados Guatemala Puerto RicoBelize Guyana QatarBolivia Haiti Saudi ArabiaBrazil Honduras South AfricaCanada Indonesia St VincentChile Iran SudanColombia Iraq TurkmenistanCosta Rica Jamaica UruguayCote d'Ivoire Jordan USACuba Kuwait YemenDominican Republic Mexico
Ecuador Morocco
El SalvadorNew Zealand
Fiji Nicaragua
However two third of the countries miss the opportunity of fortification
Vitamin A
-Carotene
Thiamine
Riboflavin
Niacin
Vitamin B5
Vitamin B6
Vitamin B12
Folate
Biotin
Vitam
in C
Vitam
in D
Vitamin E
Vitamin K
Dietary AO
Multivitam
in
PUFA
Aging Cancer
Dementia
Bone Health
Hypertension Diabetes
CVD
COPD
AMD
Insufficient intake of essential nutrientsincreases risk for non-communicable diseases
Source: internal data DSM
17
Example Vitamin D: the inadequate statusimpacts a number of body functions
Classical role of vitamin D: bone health
• Improves bone mineral density through calcium absorption and deposition
• Necessary to prevent rickets & osteomalacia
Emerging health benefits of vitamin D
• Muscle - Reduces risk of falling by improving muscle strength
• Immunity - Strengthens the immune system - Reduces risk of multiple sclerosis
and diabetes type • Cardiovascular - Lowers blood pressure• Cancer - Inhibits cell proliferation
osteoporotic
normal
18
Vitamin D comes from different sourcesSerum level is an indicator for individual status
25(OH)D serum level (nmol/L) is
a sensitive indicator of Vitamin D status(IOM 1997)
Four ranges are suggested to assess the individual status:
< 25 25 - 50 50 - 75 > 75
deficient insufficient (in)adequate desirable
(nmol/L)
Major cirulating form
SunFood Supplements
7-Dehydro-cholesterol
Vitamin D
Liver
25(OH)D
Kidney
1,25(OH)2D Active form
2
2
7
2 2
1
2
3
6
1
2
1
2
1
1 6
1
32
< 25
25-50
50-75
> 75
No info
Vitamin D levels in nmol/l
Deficient
Insufficient
(In)adequate
Desirable
Vitamin D status in Europe
Reference:E. M. Brouwer-Brolsma, H. A. Bischoff-Ferrari, R. Bouillon, E. J. M. Feskens, C. J. Gallagher, E. Hypponen, D. J. Llewellyn, E. Stoecklin, J. Dierkes, A. K. Kies, F. J. Kok, C. Lamberg-Allardt, U. Moser, S. Pilz, W. H. Saris, N. M. van Schoor, P. Weber, R. Witkamp, A. Zitterman, L. C. P. G. M. de Groot, Osteoporosis Int 2012
(boxes indicate studies in elderly)
One in three women and one in five men over the age of 50 years will sustain an osteoporotic fracture
3.5 million new osteoporotic fractures occur each year in Europe
In women, the incidence of fractures is higher than the total incidence of cancer, heart infarction, stroke or diabetes
Osteoporotic fractures accounts for more days spent in hospital than many other diseases, including diabetes, myocardial infarction and breast cancer.
Germany: Health care cost impact of low vitamin D status
Net socio-economic benefit ranges from* : 585 mio €Including medical and therapeutic costs for prevention, treatment and supplementation costs vitamin Dup to 778 mio €Including societal perspective, e.g. family care, reha costs
24 Hip and vertebral fractures have the most „cost-intense“ medical implications• Number osteoporosis patients: 8-10 mio (2010)*• Number of hip and vertebral fractures p.a.: 150.000*
Optimized vitamin-D status reduces number of fractures by 20 %• Reduction of 5.478 hip fractures and 18.420 less vertebral fractures
(in osteoporosis-diagnosed population)
Source: * Sproll 2011
Costs of vit D supplementation for women > 55 with low vit D status: 180 -200 mio EUR
25
Magnitude of vitamin D considering additional health benefits
Bone fractures
20 %
Cardio Vascular Diseases
20 %
Multiple Sclerosis
50%
Diabetes
25%
Cancer and others
25 %
Source: Grant et al 2009
Risk reduction by optimal vitamin status:
26
Large health care cost savings could be achievedwith adequate vitamin D status
Source: vitamin D and socioeconomic costs, T. Sproll
Adequate levels can be achieved with voluntary food fortificationand/or supplementation for risk groups with costs of only20-30 EUR/person per year
Zittermann 2010 Germany: € 37,5 bn/y overall perspective,including direct and indirect costs and implications
Grant et al 2009 17 countries in Europe: € 187 bn/y direct and indirect cost savings (= 16,7 % of total health care costs)
Example omegas: required over the life cycle
Slide 27
Brain & Eye Health
• Reduced cognitive decline
• Lower risk of dementia
• Lower risk of age-related macular degeneration
Seniors
Heart Health
• Lowers triglycerides
• Increases HDL
• Improves blood vessel function
• Normal cardiac function
Adults
Brain/eye development
• Improves visual acuity
• Promotes cognitive development
• Reduces risk of overweight and obesity
Infants & Toddlers
Maternal health
• Promotes maternal DHA status
• Increases DHA content of breast milk
• Supports normal gestation period
• Promotes fetal brain and eye development
Pregnancy
Omegas play a vital role over the full life cycle
So, are pregnant women consuming therecommended intakes of DHA?
Recommended DHA intake for pregnant andlactating women =
at least 200 mg DHA per day
Koletzko et al, Br J Nutr 2007; 98:873-877.
However only median intake of 75 mg DHA/day reported!
Cosatto et al, Nutrients 2010; 2(2): 198-213
Achieving the recommended intake of 200 mg DHA is a challenge
30
So using fortified foodsor taking a supplementwith DHA may be a wisechoice!
• High-dosage supplementation of long-chain polyunsaturated fatty acids (particularly DHA) in mothers, started at mid-pregnancy, has been associated with long-term positive effects on intelligence quotient scores of neurodevelopment. (Early Human Development 86 (2010) S3–S6)
• Five-year-old children whose mothers received modest DHA supplementation versus placebo for the first 4 months of breastfeeding performed better on a test of sustained attention.
• This, suggests that DHA intake during early infancy confers long-term benefits on specific aspects of neurodevelopment. (J Pediatr 2010)
3rd month 6th month
9th month at birth
Youngson (1995) Encyclopedia of family health
Cognitive health benefits of DHA supplementation during pregnancy & lactation
LC-PUFAs support growth and development
DHA and AA are important for fetal development
• DHA is essential for development of fetalbrain and retina.
• AA is important for normal development of organs and cells.
• PUFAs are not synthesized by the fetus, but taken from maternal blood supply and accumulated in the fetus during gestation.
Cunningham and McDermott, 2008
Long-chain polyunsaturated fatty acids (LC-PUFA), Docosahexaenoic acid (DHA)Arachidonic acid (AA), Prostaglandin E2 (PGE2)
LC-PUFAs are needed for growth of the placenta. Further demands are made on the mother's fatty acid supply as the placenta and the fetus grows.
• Education in healthynutrition
• Incentive programs
• Food fortification
• Biofortication
• Supplementation
Not one solution will eliminate deficiencies and inadeqate intake - it is about the right ratio between the approaches, depending on the country, nutrition status and other factors
Solutions are available ....
Roadmap for a nutritious diet for all
Nutrition for a healthy life
Current status
1. Assess micronutrient intake & status in different regions/population groups
2. Explore impact on health and risk for nutrition-related diseases
3. Assess impact on health care and economic development
4. Develop, advocate and facilitate adequate fortification and supplementation tailored to countries and populations
Thank [email protected]
Who has health has hope,who has hope has everything
Please visitwww.vitaminsinmotion.com