NAV publiekslezing Voedingswetenschap: stroomopwaarts of stroomafwaarts? Jaap Seidell, VU University, Amsterdam

Transcriptie

1 NAV publiekslezing Voedingswetenschap: stroomopwaarts of stroomafwaarts? Jaap Seidell, VU University, Amsterdam

2 Gezond voedsel Welk voedsel maakt mensen dik en ziek? Waarom eten mensen massaal ongezond voedsel? Waarop moet preventief beleid zich richten?

3 Stroomopwaarts ->->-> ->->->Stroomafwaarts

4 Wat maakt ons dik en ziek?

5 Voedselverwarring? True Health Initiative: Ruim: minimaal bewerkte groenten en fruit, bonen en peulvruchten, noten en zaden, volkoren granen, water. Dierlijke producten (minimaal bewerkt) alleen van dieren gevoerd met gezond en lokaal voer. Mijdt: fast-food, junkfood, zwaar bewerkt voedsel, suikerhoudende drank (en geraffineerde zetmeelrijkeproducten). (energie% macronutriënten geen maat voor kwaliteit voedingspatroon).

6 Mediterranean diet

7

8 WHO: ultraprocessed foods Ultra-processed food and drink products (UPP) are ready-to-eat or drink formulations based on refined substances with a careful combination of sugar, salt and fat, plus several additives. They include sugary drinks, snacks, and fast foods. WHO and the World Cancer Research Fund conclude that sugary drinks, energy-dense snacks and fast food are key drivers of obesity, diabetes, cardiovascular diseases and some cancers.

9 Processed food categories Type 1: Unprocessed or minimally processed foods that do not change the nutritional properties of the food. Type 2: Processed culinary or food industry ingredients such as oils, fats, sugar and sweeteners, flours, starches, and salt. These are depleted of nutrients and provide little beyond calories (except for salt, which has no calories). Type 3: Ultra-processed products that combine Type 2 ingredients (and, rarely, traces of Type 1).

10 Purpose type 3 processed foods Durable, accessible, convenient, attractive, ready-to-eat or readyto-heat products. Formulated to reduce microbial deterioration ('long shelf life'), to be transportable for long distances, to be extremely palatable ('high organoleptic quality') and often to be habit-forming. Typically they are designed to be consumed anywhere in fastfood establishments, at home in place of domestically prepared and cooked food, and while watching television, at a desk or elsewhere at work, in the street, and while driving

11 The dietary content in added sugars regressed on the dietary contribution of ultra-processed foods evaluated by restricted cubic splines. Eurídice Martínez Steele et al. BMJ Open 2016;6:e by British Medical Journal Publishing Group

12 Ultra-processed foods made up over half of total calorie intake (just under 60%) and contributed almost 90% of energy intake from added sugars (US)

13 Wat doet ultra-processing met voedsel

14 Effect van ultra-processing

15

16 Ultra-processing of processed food

17

18

19

20 Waarom eten we ongezond voedsel?

21 Fat, sugar and salt: These are nutrients that have been so important to us in our evolutionary history that natural selection favored genetic variations that: 1. Enable us to taste these nutrients. 2. Make our brains respond with a "reward. The reward center of the brain gives us a little jolt of endorphins for our reward. 3. Make our brains remember what we did to get that reward, and make us want to do it again (dopamine). Reward-seeking actions can become unbelievably powerful.

22

23

24

25 motivation tactics behavior impact Lower price Maximize profits from agriculture and industry Increase portions Alter taste to maximize consumption Max. intake of high-sugar and high-fat food and caloric intake Increase obesity and NCD s Increase availability After: Brownell KD. Food fight, 2004

26 Carlos Monteiro: ultra processed foods High energy density, hyper-palatability, marketing in large and super-sizes, aggressive and sophisticated advertising, all undermine the normal processes of appetite control, cause over-consumption, and therefore cause obesity, and diseases associated with obesity.

27

28 Evolution of daily energy intakes, dietary energy density, and daily intakes of selected vitamins per quartile of energy cost (EC) of diets of adults living in France. Nicole Darmon, and Adam Drewnowski Am J Clin Nutr 2008;87: by American Society for Nutrition

29

30

31

32 RESULTS: APPROXIMATELY 175,000 CARDIOVASCULAR DISEASE (CVD) DEATHS MIGHT BE EXPECTED IN 2030 IF CURRENT MORTALITY PATTERNS PERSIST. HOWEVER, HALVING THE INTAKE OF GROUP 3 (PROCESSED) FOODS COULD RESULT IN APPROXIMATELY 22,055 FEWER CVD RELATED DEATHS IN 2030

33 Conclusie: beleid en onderzoek moeten zich meer richten op voedselomgevingen met minder ultra processed food.

34 Erró. Foodscape, 1964 Stockholm, Moderna Museet

35 Stroomopwaarts versus stroomafwaarts Stroomafwaarts: vooral individueel behandelen van mensen met welvaartsziekten of biologische risicofactoren daarvoor. Stroomopwaarts: vooral collectief behandelen van oorzaken van ongezonde leefstijl zoals fysieke, sociaal-economische en culturele factoren.

36 Toekomst preventie en behandeling welvaartsziekten: stroomopwaarts of stroomafwaarts? Medicatie (= primaire preventie volgens Hartstichting): 1 miljoen t2 diabeten 4,5 miljoen gebruiken bloeddrukverlagers 1,3 miljoen statines >1 miljoen antidepressiva

37 Voorbeeld stroomafwaartse benadering: personalized nutrition Personalized nutrition is the application by individuals of their knowledge of nutrigenomics to their everyday decisions about nutrition. The goal is to maximize their own and their family s long-term health based on their knowledge of nutrition and their unique genetic makeup. Advances in nutrigenomics promise a new understanding of the connections between nutrients and long-term health. But the impact in the marketplace depends on whether consumers learn about the connections between specific nutrients and their own genetic makeup and change their habits in light of this information.

38 Personalized nutrition: fundamental different individual nutrient requirements?

39

40

41

42 Personalized nutrition should be based on: Health literacy: the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Food literacy: understanding the impact of your food choices on your health, the environment, and our economy. Self-management skills: the personal application of behavior change tactics that produces a desired change in behavior.

43

44 Conclusie: nadruk op stroomafwaartse individuele benadering is duur en niet efficiënt

45 Stroomopwaartse preventie van welvaartsziekten

46

47

48

49 Amsterdam Healthy Weight Programme

50 Risk factors limited education migrant background poverty problems accumulate in lower-class suburban areas

51 A healthy future Mission: a healthy weight for all children in Amsterdam in 2033 Vision: healthy weight is a collective responsibility and a healthy choice is the easy choice Strategy: healthier behavior in a healthier environment

52 Approach long-term sustainable inclusive (of people and domains) sharing responsibility (everyone is needed) learning by doing

53 Action Healthy parenting Healthy schools Healthy neighbourhoods (volunteers, shop owners, neighbours) Designing a moving city Comprehensive care of children already overweight or obese Lobbying the food industry

54

55

56 Voedsel: niet alleen nutriënten maar ook sociaalcultureel en psychisch van groot belang.

57 Conclusies Welvaartsziekten grotendeels toe te schrijven aan (over)consumptie van ultra-processed foods. Beleid en onderzoek richten op minimaliseren impact van ultraprocessed foods. Beleid gericht op creëren gezondere voedselomgeving (stroomopwaarts) efficiënter dan individueel behandelen gevolgen daarvan (stroomafwaarts). Personalized nutrition meer richten op sociale, culturele en psychologische determinanten van gedrag (ipv biomedische gevolgen daarvan).