Post on 27-May-2015
description
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onzinnige voeding
Prof.dr. Hans Verhagen
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1.Inleiding2.Voeding en gezondheid3.Gezondheidsclaims4.Voor- versus nadelen
van voeding5.Tot slot
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Voeding is hot
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“voeding is net als voetbal” –
“iedereen (w)eet ervan”
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Mythes in de voeding: spinazie en ijzer
gekookte groenten mg/100 g
Wortelen bospeen 0.2
Bloemkool 0.3
Snijbonen 0.5
Sperziebonen 0.8
Boerenkool 1.0
Doperwten 2.0
Spinazie 2.4
Snijbiet 4.0
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‘1870’: 10* to high iron values published
(,, wrong)
Discovered only in 1937 : correct
values
1929
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Chemicaliën
Dioxines/PCBsPesticiden Verpakkingsmaterialen
Microbiologie Natuurlijke toxines
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1990’s
•BSE
•Dioxins
•………etc
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General Food Law
VerordeningEC 178/2002
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Risk analysis
Risk assessment
Risk manageme
nt
Risk communicati
on
Risk analysis paradigm
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Risk analysis
Risk assessment
Risk manageme
nt
Risk communicati
on
Risk analysis paradigm
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Ons voedsel is veilig
√
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1.Inleiding2.Voeding en gezondheid3.Gezondheidsclaims4.Voor- versus nadelen
van voeding5.Tot slot
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Voeding = totaal van voedsel
National Institutefor Public Healthand the Environment 23
Deaths by broad cause groupestimates for 2002
Injuries (9.1%)
Noncommunicableconditions (58.6%) of which 50% are due to CVD
Communicable diseases, maternal
and perinatal conditions and
nutritional deficiencies
(32.3%)
Total deaths: 57,027,000
Source: WHO
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[WHO: Global Health Risks, 2009]
Voeding
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Obesity in NL 1981-2003
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Energy in
Energy balance
Energy out
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Children: 60 kcal / day = difference
60 kcal
1,5
1
1 hour
½ hour
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Advies Richtlijnen Goede Voeding
Gezondheidsraad 2006
http://www.gr.nl/pdf.php?ID=1478&p=1
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1. Zorg voor een gevarieerde voeding.2. Zorg dagelijks voor voldoende lichaamsbeweging.3. Gebruik dagelijks ruim groente, fruit en volkoren
graanproducten.4. Eet regelmatig (vette) vis.5. Gebruik zo weinig mogelijk producten met een hoog
gehalte aan verzadigd en transvet.6. Beperk frequent gebruik van gemakkelijk vergistbare
suikers en dranken met een hoog gehalte aan voedingszuren.
7. Beperk de inname van keukenzout.8. Bij alcoholgebruik: wees matig.
Richtlijnen Goede Voeding 2006
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“Richtlijnen Voedselkeuze”
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Voedselconsumptiepeiling
www.voedselconsumptiepeiling.nlwww.rivm.nl/VCP
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Voldoende groente?
*= < 14 jaar: minstens 150 gram; 14+ jaar: minstens 200 gram
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Voldoende fruit?
*= < 9 jaar: minstens 150 gram; 9+ jaar: minstens 200 gram
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Gebruik van voedingssupplementen
• Veel Nederlanders gebruiken supplementen
• Multi vitamines/mineralen
• Vitamine D suppletie aanbevolen voor vrouwen boven de 50
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Goede vetten?
• 8-14% voldoet aan aanbeveling (<10 En%)
• 95-99% voldoet aan aanbeveling (<1 En%)
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1.Inleiding2.Voeding en gezondheid3.Gezondheidsclaims4.Voor- versus nadelen
van voeding5.Tot slot
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Claims
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EU Regulation 1924/2006
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LIFESPAN EXTENSION COMPLEX
“performance”
“antioxidants”
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EU Regulation 1924/2006
General principles
• Claims ≠ false, misleading
• Claims ≠ prevent, treat or cure disease
• Scientifically justified
• Benefit from normal consumption of food
National Institutefor Public Healthand the Environment 41
Health claims
Function claimsBased on generally accepted scientific data
Based on newlydeveloped scientific data
Reduction of disease risk claims+ claims growthand developmentof children
What it does
EU Regulation 1924/2006
Nutrition claims
• content claims• Comparative claims
What it contains
Article 14Article 13.5Article 13.1
National Institutefor Public Healthand the Environment 42
Nutrition claims
• content claims• Comparative claims
What it contains
EU Regulation 1924/2006
+ Vit C
Light
National Institutefor Public Healthand the Environment 43
Health claims
Function claimsBased on generally accepted scientific data
Based on newlydeveloped scientific data
Reduction of disease risk claims+ claims growthand developmentof children
What it does
EU Regulation 1924/2006
Nutrition claims
• content claims• Comparative claims
What it contains
Article 14Article 13.5Article 13.1
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Health claims should be substantiated
Health claims should be substantiated
Health claims should be substantiated
Health claims should be
substantiated
authorities
scientists
industry
consumers
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- All pertinent scientific data in favourin favour + not in favour
(totality of the scientific data ; weighing of the evidence.)
- characteristics of the food required.
- Human data required.
- Study group(s) representative for the target population.
- Claimed effect must be relevant for human health.
- Causal relationship food consumption - health outcome in humans.
- effect can reasonably be achieved as part of a balanced diet.
Scientific and technical guidance (July 2007)
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3 levels of evidence:
• a cause and effect has been established
• insufficient evidence for cause and effect ….
• a cause and effect has not been established
National Institutefor Public Healthand the Environment 48
EU Regulation 1924/2006
Nutrition claims
• content claims• Comparative claims
What it contains
Health claims
Function claimsBased on generally accepted scientific data
Based on newlydeveloped scientific data
Reduction of disease risk claims+ claims growthand developmentof children
What it does
Article 14Article 13.5Article 13.1
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● Industry send application to Member State / EC
● EFSA assessment and opinion
● EC/MS: decide on authorisation of claims
● Community list of article 14 and 13.5 claims
EU Regulation 1924/2006:
List of Article 14 and 13.5 claims
dossiersdossiers
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21 August 2008: EFSA adopts first opinions on health claims made on foods relating to disease risk reduction and children’s health
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Claim OK * Plant sterols & cholesterol lowering & heart disease
* wording
Cause & effect OK * Linoleic acid, alpha-linolenic acid & growth-dev. kids
Amount can be consumed by diet
Cause & effect not OK Food suppl. & growth-dev. Kids
Cause & effect not OK Food suppl.-soy-flax & bone
Cause & effect not OK Dairy foods & body weight in kids and adolescents
Cause & effect not OK Dairy (milk – cheese) & dental health kids
Cause & effect not OK Food suppl. (prickle pear cactus) & blood lipid parameters
Cause & effect not OK Food suppl (CLA, polyols, extracts) & body weight
EFSA Opinions article 14 – August 2008
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EFSA health claim rejections 'shock' industry
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Industry: “EFSA verdicts on food claims send shockwaves through the industry”
Consumer organizations: “welcome EFSA approach”
Scientists: “generally support for EFSA opinions”
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March 2009: EC validates
21 EFSA health claim Opinions
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EU Regulation 983/2009: 7 permitted claims; 14 rejected claimsEU Regulation 984/2009: 2 rejected claims
EU Regulation 1024/2009: 2 permitted claims; 14 rejected claimsEU Regulation 1025/2009: 2 rejected claims
October 2009: Regulations on article 14/13.5 claims
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National Institutefor Public Healthand the Environment 60
Health claims
Function claimsBased on generally accepted scientific data
Based on newlydeveloped scientific data
Reduction of disease risk claims+ claims growthand developmentof children
What it does
EU Regulation 1924/2006
Nutrition claims
• content claims• Comparative claims
What it contains
Article 14Article 13.5Article 13.1
Based on newlydeveloped scientific data
Reduction of disease risk claims+ claims growthand developmentof children
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EU Regulation 1924/2006:
List of Article 13.1 claims
●Member States send to EC lists by 31 Jan 2008
total ~ 44.000 ● EC: Compilation > 4.400
● EFSA Opinion
● EC to adopt list by 31 Jan 2010
“Dossiers”
papers etc
“Dossiers”
papers etc
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Claims received by categoryClaims received by category
Probiotics8%
Diets1%
Fibre3%
Foods8%
Macronutrients9%
Minerals5%
Botanicals45%
Vitamins5%
Other substances16%
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3 levels of evidence:
• a cause and effect has been established
• insufficient evidence for cause and effect ….
• a cause and effect has not been established
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• Calcium & bones• Calcium, vitD & bones• Fluoride & teeth• Magnesium & energy, cell division, electrolyte• Biotin, niacin & energy• Selenium & antioxidant, immune, ….• VitC & antioxidant• Sugar-free chewing gum & teeth• Betaglucans & cholesterol • …… etc
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• Probiotics ≠ strengthen immune system
• >100 probiotics insufficiently characterised
• Botanicals ≠ characterised, poor data
• Taurine ≠ energy, performance
• Glucosamine, shark cartilage ≠ joint health
• …… etc
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3 levels of evidence:
• a cause and effect has been established
• Insufficient evidence for cause and effect ….
• a cause and effect has not been established
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Oxidative damage / oxygen paradox
O2
respiration ROS
damageenergy protectiveregulatory
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The antioxidant hypothesis
Oxidative stress
Endogenous ROSExogenous ROS
vitC/vitESOD/CAT/GSH-Px
CarotenoidsFlavonoids
…..
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Antioxidant studies in vitro/animals
In vitro:
- effects- high doses- many parameters- many studies- many papers- mechanistic research
Animal in vivo:
- effects- high dose- many parameters- many studies- many papers
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1. in vitro/animal studies 2. studies in humans
1. observational studies
2. intervention studies
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Dietary antioxidants & disease - results from observational studies
vitamin C vitamin E carotenoids fruits & vegetables
lung cancer
breast cancer
colorectal cancer
prostate cancer
gastric/oeso- phagal cancer
coronary heart disease
F F V
Verhagen et al. Nutrition Today Dec 2006
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Sies, H. (1988) Nature 332, 495
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Dietary antioxidants & disease - results from intervention studies
vitamin C vitamin E β-carotene combi of aox
lung cancer
breast cancer
colorectal cancer
prostate cancer
gastric/oeso- phagal cancer
coronary heart disease
Verhagen et al. Nutrition Today Dec 2006
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Conclusions Antioxidants
Antioxidants are
great for rats !
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More is Not Always Better
79Morris & Tangney, JAMA 2011, 305, 1348
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ongezonde voeding
Functionele voedingsmiddelen en voedingssupplementen vormen geen oplossing voor de gezondheidsproblemen door een ‘ongezonde voeding’.
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1.Inleiding2.Voeding en gezondheid3.Gezondheidsclaims4.Voor- versus nadelen
van voeding5.Tot slot
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risk only (safety)
balance of risks and benefits
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BenefitsCVD, cancer, etc ↓
Riskspesticides
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BenefitsCoronary heart disease ↓
RisksNeurological damage
in the fetus (MeHg)
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- Benefit-risk assessment- Scenario studies- Modelleren van effecten
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Model & Werkelijkheid
Courtesy: Johan Schefferlie
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Folic acid deficiency
Down syndrome
Neural tube defectsNeural tube defectsHigh blood pressure during
pregnancy
Colon cancer
Spontaneous abortion
Lung cancer
Schisis
Prostate cancer
Pancreas cancer
Oesophageal cancer
CVD
Osteoporosis
Leukemia
Breast cancer
Alzheimer’s
Parkinson
Depression Masking vit. BMasking vit. B1212 deficiency deficiency
Neurotoxicity
Zinc absorption
Epilepsy
Hypersensitivity
Twins births
Stimulation of celproliferation in existing cancer
Folic Acid
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Folic Acid
●Neural Tube Defects (benefit)●Masking B12-deficiency (risk)●Colorectal Cancer (benefit and risk)●Folate deficiency (benefit)
National Institutefor Public Healthand the Environment 90
70 μg 140 μg 280 μg
420 μg NTD -37% (-83) -53% (-118) -67% (-150) -74% (-166) B12 1% (53) 2% (76) 3% (121) 4% (166) CRC -4.1% (-405) -7.6% (-749) -4.5% (-445) 19.9% (1954) -2.5% (-243) 5.3% (518) 47.3% (4643) 99.5% (9763)
* Many assumptions and uncertainties
Folic acid fortification of flourResults in incidence*
National Institutefor Public Healthand the Environment 91
70 μg 140 μg 280 μg 420 μg NTD 5474 7710 9812 10855 B12 -53 -76 -120 -165 CRC 2217 4146 167 -21740 Total 7662 11812 9899 -11006
Net health benefit
>>> net health risk
Folic acid fortification of flourResults in DALY’s
Net health benefit
>>> net health risk
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Low calorie sweeteners
Benefits
Reduced energy intake
Reduced body weight/weight balance
Reduced caries
Risks
None (only perception; E-numbers)
ADIs established
Non-effects CVD cancer Diabetes / metabolic
syndrome gout
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Low calorie sweeteners
Benefits
Reduced energy intake
Reduced body weight/weight balance
Reduced caries
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“Life would be pretty dull without risk”
“voluntary risk taking and its pleasures”*
● Three dominant discourses:
1. Self improvement2. Emotional engagement3. Control
*Lupton & Tulloch, Health, Risk and Society, 4 [2002] 113-124
9696
Food and nutrition
Medicine
Economics and Marketing-Finance
Risk not accepted
Risk accepted
Risk a neccesity
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1.Inleiding2.Voeding en gezondheid3.Gezondheidsclaims4.Voor- versus nadelen
van voeding5.Tot slot
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sat.fat
transfat
fruit
vegetables
fish
-0,5 -0,25 0 0,25 0,5
life years
scenario-0worst-case recommended
http://www.rivm.nl/bibliotheek/rapporten/350080001.html
Health gain with optimal diet:
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Health gain with optimal diet:
sat.fat
transfat
fruit
vegetables
fish
-100 -50 0 50 100
deaths in next 20 years (x 1000)
scenario-0worst-case recommended
http://www.rivm.nl/bibliotheek/rapporten/350080001.html
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140.000 sterfgevallen/20 jaar= 7.000 / jaar
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sat.fat
transfat
fruit
vegetables
fish
-3 -2 -1 0 1 2 3
costs in next 20 years (billion euros)
scenario-0worst-case recommended
http://www.rivm.nl/bibliotheek/rapporten/350080001.htmlNet Present Value
Health gain with optimal diet:
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2004 2006
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Eating too
much
food safety
Eating wrong
•Fruits•Vegetables•Fish•TFA•SAFA
•Salt/sodium •Fibre•PUFA•Vitamins•Minerals• ….etc
unhealthy diet
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unhealthy diet
food safety
Why are we so scared about our food ???
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Benefit-risk analysis
Benefit-risk assessment
Benefit-risk manageme
nt
Benefit-risk communicati
on
Benefit-risk analysis paradigm
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Evidence based nutrition
Evidence based decisions
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Dank u wel voor uw aandacht !
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©=============================================Prof.Dr. Hans Verhagen Head, Centre for Nutrition and HealthNational Institute for Public Health and the Environment (RIVM)PO Box 1 3720 BA Bilthoven The Netherlands Tel +31 30 274 3391 Hans.Verhagen@rivm.nlhttp://www.rivm.nl/en/aboutrivm/organization/vgc/cvg/index.jsp============================================