Toward a nutrition-driven economy:Can dietary supplements aid productivity?

Adam Drewnowski, PhDDirector

Center for Public Health Nutrition UW Center for Obesity Research

Nutritional Sciences Program Professor of Epidemiology, University of Washington, Seattle, WA, USA

International Alliance of Dietary/Food Supplement Associations, IADSAAnnual Meeting, London, June 19, 2018

Nutrition, Sustainable Development Goals (SDGs), and workplace productivity

SDG 1: No poverty

• Poverty cannot be overcome without a healthy and well-nourished labor force.

• Workplace health promotion - healthy diets and healthier lives – can improve productivity.

• Investing in nutrition provides health and economic benefits.

SDG 2: Zero hunger

• If done right, global food systems should produce enough nutritious foods for all.

• But current agriculture produces cheap sugar, oil, and grain calories – and not enough nutrient-rich foods.

• Empty calories cost less; nutrient-rich foods cost more.

Making nutrient-rich diets more availableHow to provide optimal nutrition for all

5

Do all nutrients come from “real” foods?Nutrition experts still insist that all nutrients come from “real” foods, preferably unprocessed and home made. How realistic is that?

Tiger prawnsBlueberriesStrawberriesThree grain breadGreenhouse tomatoesKale

Food, health and incomes: UK 1935• That diet quality follows a

social gradient is not new.• Better diets were linked to

higher SES back in 1935• Fruit, vegetables, fish were

eaten by the rich.• Sugar, bread and lard were

eaten by the poor.• Not a lot has changed.

Food, health and incomes: Asia 2015

Nutrientdeficiencies

Calcium deficiency in Vietnam: NIN data

0 100 200 300 400 500 600 700 800 900 1000

NationalRed river delta

N midlandsN Central

Central HighlandsSoutheast

Mekong Delta

RuralUrban

PovertyNon poverty

Calcium intakes mg/d

Recommended: 1000 mg/d

Meat and fish; less dairy: Vietnam

0

100

200

300

400

500

600

700

800

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1000

poverty non-poverty

consum

ption

seafoodfishmilk, freshmilk/cheesemeats/eggsfats/oilssaucessugarfruitsvegetablesnutstubers/beans/tofuOtherWheatRice

0

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1981-5 1987-9 2000 2010

Inta

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ay

Nut/sesame

Milk/egg

Fats/oils

Fruits

Fish

Meat

The main public health question:

How to improve dietary nutrients-to-energy ratio?

Three important concepts • Energy density:

Defined as dietary energy per unit weight of food (kcal/100g or MJ/kg).

• Nutrient density:Defined in terms of nutrients per 100 kcal, 100g, or a serving of food.

• Energy and nutrient cost:Defined in terms of calories or nutrients per penny.

Energy-dense foods taste better • We like foods that are energy dense and/or sweet.• Dry starches, sugars, and fats are energy dense; kale is not.• Energy-dense refined grains, fats, and sweets are inexpensive.• Energy-dense foods can also be nutrient-poor.

Energy-dense foods are easy to overeatHigh energy density –Low volume (low water content)

Low energy density –High volume (water content) -- and higher cost

Energy-dense foods are cheaper• A city of 20 million needs 40,000 tons/d of food.

– Each person consumes 2,000 kcal/d of food.– Dietary energy density is 100 kcal/100g: – So each person needs 2kg/day

• But if dietary ED is 500 kcal/500g– Each person needs 400 g/day of food.

• A city of 20 million will need 8,000 tons/d of food.– The foods will be energy-dense grains, fats, and sweets– Economic cost will be less (food and transport)– Diet quality will be less (reduced nutrient to calorie ratio)

• This will impact health and productivity.

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Megacities are future obesity hotspotsEnergy-dense foods that are nutrient-poor will impact productivity

Nutrition Reviews, Volume 66, Issue 1, 1 January 2008, Pages 23–39, https://doi.org/10.1111/j.1753-4887.2007.00003.x

Nutrient density of foods: NRF9.3

https://doi.org/10.1111/j.1753-4887.2007.00003.x

0

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-200 -100 0 100 200 300NRF9.3 per 100 kcal

Ener

gy d

ensi

ty (k

cal/1

00g)

Dairy Meat Eggs Beans Grains Fruits Vegetables Fats Sugars

Low-cost sweets, fats can be nutrient-poor

Nutrient poor

0

100

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0.1 1 10 100Energy cost ($/1000 kcal)

Ener

gy d

ensi

ty (k

cal/1

00g)

Dairy Meat Grains Fruits Vegetables Fats Sugars

Sweets, fats cost less: nutrients cost more

Expensive

Cheaper

-150

-100

-50

0

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0.1 1 10 100

Energy cost ($/1000 kcal)

Nut

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den

sity

(NR

9.3

per 1

00 k

cal)

Dairy Meat Eggs Beans Grains Fruit Vegetables Fats Sugars

Nutrient-rich foods cost more

Nutrient rich and expensive

What is nutrient rich and cheap?

What are the links between workplace nutrition and productivity?

How is productivity defined• Absenteeism (days off, sick leave)• Presenteeism (lower performance)• Days of work lost• Employee health cost• Early retirement• Turnover• Short- and long-term disability

Mental Health

Musculoskeletal disorders

Communicable diseases

Noncommunicable diseases

Diets and lifestyle

D epression, stress, anxiety, m igraine, insom nia,

substance abuse, narcolepsy,

Rheum atoid arthritisColitis, C rohn/s, IB SG out, chronic pain

InfluenzaH epatitis C

H erpes zoster, H IV

O besity, T2D , H ypertension,

CV D , Cancer

D iet, nutrition,Physical activ ity, Sm oking,

A lcohol

Chief obstacles to workplace productivity

Stress reduction, meditationAmazon, Salesforce:

Private transportation fleets:Microsoft, Google

Free nutrient-rich foodGoogle, Microsoft:

Diet quality can depend on where you live and work

This is where spatial epidemiology science crosses into public policy –

and urban planning

• Spatial analyses of measuredheights and weights for 59,767 insured adults.

• Data from health insurance.• King Co. is one of the healthiest

counties in WA State - but localdisparities by census tract (CT) exist.

• Crude obesity rates ranged from 5% to 30% depending on where people lived.

• Similar spatial data obtained for type II diabetes and for metabolic syndrome.

• Drewnowski, Rehm, Arterburn Int J Obesity Sept 2013

Seattle obesity patterns by census tract

Tax assessor data become SmartMaps of wealth

30

What you eat depends on where you liveSoda (SSB) and salad consumption (servings per week) by Seattle census block

HEI 2010

We can map obesity in Seattle by census blockMicrosoft

Amazon

Obesity, NCDs and

workplace productivity are inversely linked

This is where spatial epidemiology crosses into public policy –

and economics

Which city will Amazon pick for HQ2?

What is the leading indicator of?Worker nutrition status and health

Labor force productivity

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Amazon will pick least obese

• NCDs are the largest cause of death in the world, affecting economic growth, productivity, social welfare, education and quality of life.

• Health of the labor force can have profound economic consequences for the region.

• There are links between dietary nutrient density, body weight, and economic outcomes.

Prevent NCDs, increase productivity

Thank you

The two forms of malnutrition are linked to nutrients-to-calorie ratio

• Too many calories; not enough nutrients– Overweight – Obesity– Vitamin/mineral deficiencies– Overfeeding/Undernutrition

• Not enough calories or nutrients– Wasting – Stunting– Vitamin/mineral deficiencies– Undernutrition

Energy-dense foods are cheaperAre poverty and obesity linked by easy access to palatable, cheap energy-dense foods?

Drewnowski & Specter, Am J Clin Nutr 2004;79:6-16