Abstract of Presentations
Dietary Targets of Health
Professor J. Bruce GERMAN1,2
1Foods for Health Institute, University of California, Davis, CA 95616
2Department of Food Science & Technology, University of California, Davis, CA 95616
 
The emerging theme in diet and health is diversity. Humans are not the same. Individuals do not respond to diet the same and they do not aspire to the same lifestyles. Individuals differ in their nutritional needs and in their responses to foods. Therefore, a personalized approach to diet will be central to any solution to solving the problems of human health and the opportunity for diet to become an effective means to prevent disease. Diagnosing and curing diseases have well established scientific strategies and commercialization models. Preventing diseases do not. Prevention practically means improving the health of healthy individuals. Diagnostics of disease employ markers of dysfunction. Assessment of health will require measures of processes, status of structures and performance of complex systems. The measurement of function, is necessary to the scientific evaluation of individual health status and to the commercial documentation of effectiveness of foods. Yet, the challenge is greater. Each person’s health is determined by overall diet, not just individual foods or even meals. Assembling the breadth of health status represents a new set of opportunities for the healthcare and food industries to develop new assessment, monitoring, dietary management, and food products to move individuals away from disease and toward their personal goals for health.
 
Glycaemic Index and Prebiotic Developments, Weight Management and Health Claims

Professor Jeyakumar HENRY

Director, Clinical Nutrition Research Centre, 14 Medical drive, Singapore, and Director, Functional Food centre, Oxford OX3OBP, UK
 
Diet plays an important role in our lives. It plays an even more significant role in obesity and weight management. There has been an increased understanding of how obesity may have a major influence on chronic disease such as diabetes, hypertension, cardiovascular disease and cancer. The science of nutrition is the confluence of two major interests in our society-food and health. Growing demand for products and food ingredients that help reduce the risk of developing chronic diseases are sometimes known as ‘functional foods’. Food Chemists have typically categorised dietary carbohydrates into simple sugars and complex carbohydrates on the basis of their degree of polymerisation. This form of classification of Carbohydrates is a well established concept in Food Science. However, the effect of Carbohydrate on health may be better categorised according to their physiological response, notably their ability to raise blood glucose. The blood glucose response varies substantially among different carbohydrate containing foods and cannot be predicted by their gross chemical composition alone. This concept is now defined as the Glycaemic Index (GI). The role of Pre and Probiotics in health and well being has emerged a major topic of research. Using clinical studies, epidemiological observations and intervention trials, the presentation will highlight how functional foods can improve glucose control, increase satiety and minimise the risk of adipose tissue accretion, and reduce blood pressure. Novel applications of pre and probiotics include its potential ability to change Micro biota, leading to new novel treatments for obesity and Fatty liver syndrome. The extensive collaboration of food manufacturer’s with Nutritionists has enabled the development of a series of ingredients that may also improve insulin secretion, reduce glucose uptake and alter carbohydrate breakdown. Given the unique opportunity that exists for developing and marketing functional foods for the elderly, it is necessary to evolve a robust system of evaluation and substantiation of functional foods. Since 2002, the European Food Safety Authority (EFSA) has acted as an agency charged to improve food safety and consumer protection. From 2010, several functional foods have been evaluated by EFSA for substantiation of health claims. Amongst the 40,000 odd claims evaluated by EFSA, a very small fraction has been approved. The presentation will share some of the opportunities and challenges we face in Asia in substantiating health claims, taking into account the experiences and pitfalls of the EFSA model.
 
Powerpoint
 
Create an Enabling Environment for Healthy Eating in Hong Kong - Perspective of the Centre for Food Safety
Dr. Yuk Yin HO, JP

Consultant (Community Medicine) (Risk Assessment and Communication)

Centre for Food Safety, Hong Kong Special Administrative Region

 

Unhealthy diet is one of the leading causes of major non-communicable diseases worldwide. To tackle this global challenge, the government has a central role to play, in cooperation with other stakeholders, to create an environment that empowers and encourages behavioural changes to make positive, life-enhancing decisions on healthy diets. Among various dietary recommendations, excessive intake of fats (including saturated fat and trans fat), sugars and sodium should be avoided. In Hong Kong, the Centre for Food Safety (CFS), together with other government departments and stakeholders, strives to create an environment that will enable and support changes in behaviour so that the healthy choice becomes the easier choice. To achieve this goal, the CFS adopted a multi-pronged approach that encompasses legislation, monitoring, product reformulation and consumer education.

 

Consumers require accurate and standardised information on the nutrient content of food to make healthier and informed food choices. A mandatory Nutrition Labelling Scheme was implemented in Hong Kong on 1 July 2010. Supplementing this scheme,  the CFS has conducted a number of studies to assess the nutrient contents of local foods, including prepackaged food and non-prepackaged food. Besides publicizing these findings, CFS set up a Nutrient Information Inquiry System, a searchable nutrient database containing about 7000 food items that the public can browse and search for information about a specific food or nutrient and estimate the nutrient intake from selected foods using the available data. Members of the food trade bear the ultimate responsibility to provide healthier food options. To facilitate them, CFS developed trade guidelines that encourage and assist food industries to reduce fats, sugars and sodium content in their food products. CFS also set up working groups with members of the trade to map out action strategies. Last but not least, consumer education plays an indispensable role. Publicity and Education Campaign on Nutrition Labelling has been conducted with the provision of a wide range of resource materials and activities targeting public-at-large and education stakeholders to help consumers make informed food choices.
 
Good Fats and Bad Fats: What is the Evidence?
Professor Kay-Tee KHAW
University of Cambridge, United Kingdom

 
High dietary fat intake, in particular saturated fat intake, has long been implicated as a cause of several chronic diseases such as heart disease and certain cancers. However, a meta-analysis of prospective cohort studies concluding that there is no significant evidence that dietary saturated fat is associated with increased risk of cardiovascular disease has renewed debate. Randomized trials are not always conclusive. The Women’s Health Initiative (WHI) found no difference in cardiovascular outcomes in women randomized to a low fat diet compared to controls. However, though the intervention group lowered total fat intake, the polyunsaturated fat/saturated fat ratio in the WHI trial was unchanged. It is notable that trials reporting significant differences in cardiovascular outcomes altered dietary fatty acid composition such as unsaturated/saturated fat ratios rather than simply lowering total fat intakes.

Observational studies using self-reported dietary instruments have limitations assessing accurately intake of different fats. More recent studies using blood fatty acid profiling (phospholipid fatty acid, PFA) may provide a more objective and accurate biomarker of intake of different fats. One example, the prospective EPIC-Norfolk study over 13 years of follow up indicated that plasma concentrations of saturated PFA were significantly associated with increased CHD risk (Odds Ratio 1.75, 95% CI 1.27-2.41, P<0.0001), in top compared to bottom quartiles(Q), and omega-6 polyunsaturated PFA concentrations were inversely related (OR 0.77, 0.60-0.99, P<0.05) after multivariable adjustment.

A recent randomized trial in high risk individuals reported lower cardiovascular event risks in individuals randomized to a Mediterranean diet supplemented with either extra virgin olive oil (HR 0.70, 95% CI 0.54-0.92), or supplemented with mixed nuts, (HR 0.72 (95% CI 0.54-0.96) compared to those given advice to reduce dietary fat.

These studies highlight the need to understand in much more detail the metabolism, interactions, and biological effects of different fatty acids and add to the accumulating evidence that different fats have very different health effects. Dietary recommendations should consider not just total fat intake but profile of fats. Current evidence indicates more attention should be focussed on saturated to unsaturated fatty acids ratios rather than total fat intake.

References:

Howard BV, Van Horn L, Hsia J et al. Low fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative randomized controlled dietary modification trial. JAMA 2006:295:655-66.

Khaw KT, Friesen MD, Riboli E, Luben R, Wareham N. Plasma phospholipid fatty acid concentration and incident coronary heart disease in men and women: the EPIC-Norfolk prospective study. PLoS Med 2012;9:e1001255.

Estruch R, Ros E, Salas-Salvado J et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. New Engl J Med 2013; 368:1279-90.
 
Powerpoint
 
Nutritional Factors and Risk of Diabetes in Chinese
Professor Xu LIN, MD., PhD.
Professor, Principal Investigator, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences (CAS) Key Laboratory of Nutrition and Metabolism, CAS
With rapid nutrition transition, characterized by increased energy intake from red meat and dietary fat, cardiometabolic diseases like metabolic syndrome (MetS), type 2 diabetes (T2D) have been increasing in an alarming rate in Chinese population in last few decades. However, few studies have systematically investigated the impacts of changing macronutrient and micronutrient statuses and also modifying effects of genetic variants on pathogenesis of metabolic diseases. Therefore, we established a population-based cohort study among 3,289 Chinese residents aged 50–70 years from urban and rural areas of Beijing and Shanghai. Our baseline data showed that approximately 70% of the study participants had vitamin D deficiency [25(OH)D <50 nmol/l] and low plasma 25(OH)D level was associated with an increased risk of MetS and insulin resistance. While elevated ferritin level was associated with a high risk of diabetes independent of inflammatory markers, adipokines and metabolic syndrome. Moreover, circulating 25(OH)D, ferritin and erythrocyte polyunsaturated fatty acid levels could be modified by genes variants in related metabolic pathway(s). By utilizing gas chromatography, we have recently detected a total of 28 erythrocytes fatty acids in our study population. Compared to Northern residents, those living in the south had higher erythrocyte n-3 fatty acids, but lower n-6 fatty acids. Increased erythrocyte docosahexaenoic acid (DHA) was associated with a reduced risk of MetS. However, the significant association between FADS1-rs174550 and plasma HDL cholesterol was modified by erythrocyte PUFA levels (18:2n-6 and 18:3n-3). Moreover, higher trans-18:1, a possible marker of dairy intake, was associated with lower risks of T2D, whereas higher trans-18:2 levels were associated with dyslipidemia. Erythrocyte 16:1n-7, a fatty acid almost exclusively derived from de novo lipogenesis (DNL), was associated with higher MetS risk and unfavorable profiles of plasma inflammatory markers. In fact, DNL may be activated by the high-carbohydrate intake (accounting for 60% of total energy in the current study) and involved in the pathogenesis of metabolic disorders. Accordingly, we observed that erythrocyte 16:0, 16:1n-7, 16:1n-9, and 18:1n-9 were associated a higher risk of MetS or T2D after 6 years of follow-up. Besides observational studies, we also conducted nutritional intervention trials among individuals with T2D or MetS. We have found that cardiometabolic benefits of flaxseed, walnuts, brown rice or low carbohydrate diet among individuals with obesity and related metabolic disorders. Collectively, all the efforts are made to obtain better knowledge about what are the major nutrition/lifestyle and genetic factors attributing to the epidemic of metabolic diseases in Chinese population.
 
Salt: Time for Action in Hong Kong

Professor Graham MACGREGOR

Barts and London School of Medicine and Dentistry, Wolfson Institute of Preventive Medicine, Charterhouse Square, London, EC1M 6BQ
g.macgregor@qmul.ac.uk
A reduction from the current high level of salt intake of 9-12g per day in most countries in the world, to the recommended level of less than 5-6g per day has been shown to lower blood pressure, causing major reductions in the risk of strokes, heart attacks and heart failure, and may have other beneficial effects on health.
Cost effective analyses have repeatedly shown that salt reduction is more cost effective than tobacco control in reducing cardiovascular disease – the leading cause of death and disability worldwide. Direct evidence now comes from the UK, where an effective policy to reduce salt resulted in reduction of salt intake of 9.5g to 8.1g/day within six years of the start of this programme, with further reductions now being made. NICE calculated that the salt reduction programme cost approximately £5 million per year, and has already resulted in health care saving costs of £1.5billion per year. A ratio of £1 spent for £300 saved.
There is no other public health policy that has been shown to be so cost-effective. The WHO has recommended salt reduction as one of the top three priority actions to tackle the global non-communicable disease crisis. All countries need to adopt a coherent and workable strategy to reduce salt intake in their whole population. This can be done by a combined policy of getting the food industry to slowly decrease the huge amounts of salt that they add to foods, to make the public much more aware of the harmful effects of salt on health, and to use less salt in their own cooking, and at the table.
A modest reduction in salt intake, therefore, across the whole population will result in major improvements in public health and have large economic benefits for all countries around the world.
 
Powerpoint
 
Daily Reference Intake Development in USA from the perspective of a member of the Institute of Medicine
Professor Judith S. STERN
I believe “follow the science.” This is not always the case. For this talk, I am using sodium as an example. I don’t believe that we have “followed the science” with respect to sodium and salt.
I am a member of the Institute of Medicine (IOM) and I have read all the reports that IOM has released on sodium. I am also a coauthor of a number of papers published in peer-reviewed journals. I am quoting from publicly available information not proprietary information.
First, a definition: According to Wikipedia (April 1, 2013), the daily reference intake (DRI) is “the daily intake of a nutrient that is considered to be sufficient to meet the requirements of 97-98% of healthy individuals in every demographic in the United States”. It is used for nutrition labeling. Unfortunately it is based on the 1968 recommended dietary allowances and things have changed since 1968. The current RDA/RDI is 500 mg which is supposedly the “safe minimum intake.”
In 2010, IOM released a document entitled “Strategies to reduce sodium intake in the United States (http://www.rap.edu/atalog.php?record_id=12818).” Several of the chapters are about the challenges of reducing sodium intake. Two examples are: “Sodium intake reduction: an important but elusive public health goal”, “Taste and flavor roles of sodium in foods: a unique challenge to reducing sodium intake”. Why reduce sodium intake? There is a link between sodium intake and blood pressure. If you are salt-sensitive, reducing sodium/salt in your foods to control blood pressure is one strategy. But the DASH diet funded by US government showed that that a balance between sodium, potassium, magnesium and calcium lowers systolic and diastolic blood pressure. Another strategy is not to salt your food. In the United States, we also recommend that people should eat more fruits and vegetables. Americans don’t eat enough vegetables. The problem is that vegetables don’t taste very good without salt. Image the taste of broccoli or cauliflower without salt. Italians eat vegetables but they salt their vegetables. Chinese eat vegetables but they use soy sauce or oyster sauce. Another strategy proposed by IOM is to “develop salt substitutes.” Sugar substitutes have not worked in controlling obesity. I don’t think that salt substitutes will work either. My conclusion is that salt intake has not been changed for thousands of years and that it is probably biologically regulated.
 
Dietary Reference Intake Development in China

Professor Yuexin YANG 

Chinese Nutrition Society, Chinese Centre for Disease Control and Prevention.

 

Chinese Recommended Daily Allowance (RDA) was established at first time in 1936 in China.  And then, the RDA were supplemented and updated in 1952, 1962, 1976, 1988 and 2000 by Chinese Nutrition Society (CNS) according to the science development and nutritional status of Chinese residents at different periods.

 

In the year 2000, the RDA of nutrients has expanded to Dietary Reference Intakes (DRIs) which include Estimated Average Requirement (EAR), Recommended Nutrient Intake (RNI), Adequate Intake (AI) and Tolerable Upper Intake Level (UL).

 

CNS has been responsible for the DRI development and revision since 1951, recent work on DRIs from the beginning of 2010 to the end of 2013. Expert committee of DRIs is composed of 7 Expert Review Panels under the CNS, such as the definitions and procedures for working panel, vitamins panel and phytochemicals panel.  Each expert panel works on one nutrient, and is responsible for: (1) reviewing the scientific literature concerning the specific nutrients, food component, function  for each life-stage; (2) considering the roles of nutrients in decreasing the risk of chronic diseases and health conditions; (3) evaluating possible criteria or indicators of adequacy and providing a rationale for the choice of each criterion; (4) estimating the average requirement for each nutrient reviewed for each  life-stage; (5) interpreting the current data on nutrient intakes population groups and (6) reviewing the food resource for each nutrient or component.  In the last revision of Chinese DRIs, some new definition and phytochemicals will be reviewed by committee. The final stage of developing a DRI involves internal and external review by scientists and other related organizations before the DRIs are released. Chinese DRIs (2013) will be released and published in the second half this year.

 
Key words: Chinese DRIs, evaluating criteria, procedure, last edition
 
 
 
Key Sponsor:
Co-Sponsors:
 
Organizers:
Co-Organizer: Department of Medicine & Therapeutics, CUHK
 
Secretariat:
Ms. Julia Ip (Centre for Nutritional Studies, The Chinese University of Hong Kong)
Rm. 902 9/F., Tung Ming Building, 40-42 Des Voeux Road Central, Hong Kong
Tel.: +852 3178 9211      Fax: +852 3178 9214      Email: FoodHealth@cuhk.edu.hk