NAV publiekslezingVoedingswetenschap: stroomopwaarts of

stroomafwaarts ?

Jaap Seidell, VU University, Amsterdam

Gezond voedsel

• Welk voedsel maakt mensen dik en ziek?

• Waarom eten mensen massaal ongezond voedsel?

• Waarop moet preventief beleid zich richten?

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

Wat maakt ons dik en ziek?

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).

Mediterranean diet

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.

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).

Purpose type 3 processed foods

• Durable, accessible, convenient, attractive, ready-to-eat or ready-to-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 fast-food 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

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:e009892

©2016 by British Medical Journal Publishing Group

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)

Wat doet ultra-processing met voedsel

Effect van ultra-processing

Ultra-processing of processed food

Waarom eten we ongezond voedsel?

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.

Lower price

Increase

portions

Alter taste to

maximize

consumption

Increase

availability

Maximize profits

from agriculture

and industry

Max. intake of

high-sugar

and high-fat

food and

caloric intake

Increase

obesity and

NCD’s

motivation tactics behavior impact

After: Brownell KD. Food fight, 2004

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.

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;87:1107-1117

©2008 by American Society for Nutrition

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

Conclusie: beleid en onderzoek moeten

zich meer richten op voedselomgevingen

met minder ultra processed food.

Erró. Foodscape, 1964

Stockholm, Moderna Museet

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.

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

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.

Personalized nutrition: fundamental different individual nutrient requirements?

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.

Conclusie: nadruk op stroomafwaartseindividuele benadering is duur en niet efficiënt

Stroomopwaartse preventie van welvaartsziekten

Amsterdam Healthy Weight Programme

18-1-2017

Risk factors

limited education migrant background poverty

problems accumulate in lower-class suburban areas

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

Approach

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

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

Voedsel: niet alleen nutriënten maar ook sociaal-cultureel en psychisch van groot belang.

Conclusies

• Welvaartsziekten grotendeels toe te schrijven aan (over)consumptie van ultra-processed foods.

• Beleid en onderzoek richten op minimaliseren impact van ultra-processed 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).