A Kína Tanulmány

A legnagyobb epidemiológiai vizsgálat a táplálkozás és a

krónikus betegségek összefüggésében

Heath Trends since 1950Heath Trends since 1950• Overweight, obesity, NIDDM• Dementias (AD = ‘Type 3 diabetes’)• Hypertension: 25% of US adults (USDA 2000)• Pre-hypertension: 30% of US adults• (AR)MD• Eosinophilic GI disorders; ‘explosive growth’ (Noel

et al ’04)

• Non-tobacco related cancers: 100% increases• lymphoma, leukaemia, melanoma, germ cell

tumours in teens & young adults (NCIC ‘04)

• ADD/ADHD/dysphasia/dyspraxia (U. Washington ’05)

Rising health costsRising health costs

£ billion 1960 1970 1980 1990 1994

EU 5 17 107 291 410 US 10 31 108 390 617

UK 1 2 13 33 46

WHO 2000WHO 2000

Rising health costsRising health costs

£ billion 1960 1970 1980 1990 1994

EU 5 17 107 291 410 US 10 31 108 390 617

UK 1 2 13 33 46

% GDP 1960 1970 1980 1990 1994 EU 3.7 5.4 7.2 7.3 7.8 US 5.2 7.3 9.3 12.7 14.3 UK 3.9 4.5 5.6 6.0 6.9

WHO 2000WHO 2000

20062006

19.719.7

Iatrogenic Deaths (USA)Iatrogenic Deaths (USA)

• Total > 250,000 / year (3rd leading c.o.d)

• 7,000 - medication errors (in hospitals)• 20,000 - other hospital errors• 80,000 - hospital-acquired infections • 106,000 - adverse effects of drugs• 12,000 - unnecessary surgery

Starfield B et al: JAMA 284:483-5 2000

Reduced energy Reduced energy expenditureexpenditure

1600

1800

2000

2200

2400

2600

2800

60 65 70 75 80 85 90 95Year

kcal

per

day

DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

1940 50 60 70 80

Obesogenic culture (AHA ’03)

Avge US adult sedentary 8 hours / day, < 2,000 steps / day (NYS Public Health Assocn ‘05)

Amish 16,000 steps /day: obesity 9% women, 0% men (Bassett et al ’04)

Positive energy balancePositive energy balance

1600

1800

2000

2200

2400

2600

2800

60 65 70 75 80 85 90 95Year

kcal

per

day

DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

1940 50 60 70 80

1952

1952

2001

The Western Diet

• High fat & refined carbs• High calorific density• Low micronutrient / calorie ratios Type

B malnutrition

• Foods which are energy-dense & low fibre: do not satiate ‘passive over-eating’ (‘up-sizing’) overweight

Hardee’s ‘Monster Thickburger’Hardee’s ‘Monster Thickburger’

1420 calories, 107 g fat: $5.491420 calories, 107 g fat: $5.49

PepsiPepsi

PizzaPizza

Real World Pyramid

Dietary shift 1950 - 1997Dietary shift 1950 - 1997

• World consumption of calories from meat increased 36%• “ “ calories from vegetable oil increased 46.2% • US & EU “ sugars and starches increased 35%

• World consumption of calories from complex carbohydrates fell 38%

• UK consumption of fresh vegetables fell 24%

• Per capita income closely related to energy availability • In countries where per capita income increased, so did average

caloric consumption • High-income nations derive most energy from sugars and fats –

poorer nations catching up rapidly

(USDA, Worldwatch, FSA, Drewnowski ’77 & ‘03)

Nutrition in children & AdolescentsNutrition in children & Adolescents

• Most commonly eaten foods: bread, savory snacks, crisps, chips, boiled, mashed and jacket potatoes, biscuits, chocolate confectionery.

• 5 veg / fruit per day: < 50%• 0 fruit per day: 20 - 30%• 0 veg per day: 4%• Dieting: 15% girls, 3% boys

National Diet & Nutrition Survey National Diet & Nutrition Survey 20002000

DIETARY SHIFTDIETARY SHIFT

• Flavonoids 75%

• Vit C 50-60%

• Omega-3 50%

• Methyl groups 95%

• Carotenoids 40%

• Phospholipids 50% since 1900

• Selenium 50% ” 1960 (UK)

• Prebiotic fiber 50% ” 1960 (Fr)

• Sterols 66% ” 1960 (SA)

since Stone Age

% Depletion Vitamins% Depletion Vitamins

C E A B1 B2 C E A B1 B2 NiacinNiacin FolateFolate B6 B12 B6 B12------------------------------------------------------------------------------------------------------------------------------------------37 68 55 32 31 27 34 54 1737 68 55 32 31 27 34 54 17%

(USDA 1997)

Fat - but Fat - but starvingstarving

• W.H.O. ‘02: ‘Globally, overweight greater health problem than underweight.’

• W.H.O./F.A.O ’03: ‘Poor diet the major cause of degenerative disease’.

• U.N. ’06: Overweight but malnourished• 40-60% hospital admissions malnourished (1-3)

• 25-30% malnourished in the community J Nutr Hlth Ageing 3:133-139, ‘99

• > > 3.6 million malnourished in UK (BANT ’07)

MICRONUTRIENTSMICRONUTRIENTS CALORIESCALORIESMALNUTRITIONMALNUTRITION

TYPE A

MICRONUTRIENTSMICRONUTRIENTS CALORIESCALORIESMALNUTRITIONMALNUTRITION

TYPE A

TYPE B