ScienceCafé Zeist: Voeding 10-11-11

1

onzinnige voeding

Prof.dr. Hans Verhagen

2

1.Inleiding2.Voeding en gezondheid3.Gezondheidsclaims4.Voor- versus nadelen

van voeding5.Tot slot

4

Voeding is hot

8

“voeding is net als voetbal” –

“iedereen (w)eet ervan”

11

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

12

‘1870’: 10* to high iron values published

(,, wrong)

Discovered only in 1937 : correct

values

1929

14

Chemicaliën

Dioxines/PCBsPesticiden Verpakkingsmaterialen

Microbiologie Natuurlijke toxines

16

1990’s

•BSE

•Dioxins

•………etc

17

General Food Law

VerordeningEC 178/2002

18

Risk analysis

Risk assessment

Risk manageme

nt

Risk communicati

on

Risk analysis paradigm

19

Risk analysis

Risk assessment

Risk manageme

nt

Risk communicati

on

Risk analysis paradigm

20

Ons voedsel is veilig

√

21



22

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

24

[WHO: Global Health Risks, 2009]

Voeding

24

25

Obesity in NL 1981-2003

26

Energy in

Energy balance

Energy out

27

Children: 60 kcal / day = difference

60 kcal

1,5

1

1 hour

½ hour

28

Advies Richtlijnen Goede Voeding

Gezondheidsraad 2006

http://www.gr.nl/pdf.php?ID=1478&p=1

29

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

30

“Richtlijnen Voedselkeuze”

31

Voedselconsumptiepeiling

www.voedselconsumptiepeiling.nlwww.rivm.nl/VCP

32

Voldoende groente?

*= < 14 jaar: minstens 150 gram; 14+ jaar: minstens 200 gram

33

Voldoende fruit?

*= < 9 jaar: minstens 150 gram; 9+ jaar: minstens 200 gram

34

Gebruik van voedingssupplementen

• Veel Nederlanders gebruiken supplementen

• Multi vitamines/mineralen

• Vitamine D suppletie aanbevolen voor vrouwen boven de 50

35

Goede vetten?

• 8-14% voldoet aan aanbeveling (<10 En%)

• 95-99% voldoet aan aanbeveling (<1 En%)

36



37

Claims

38

EU Regulation 1924/2006

39

LIFESPAN EXTENSION COMPLEX

“performance”

“antioxidants”

40


General principles

• Claims ≠ false, misleading

• Claims ≠ prevent, treat or cure disease

• Scientifically justified

• Benefit from normal consumption of food


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


Nutrition claims

• content claims• Comparative claims

What it contains

Article 14Article 13.5Article 13.1


Nutrition claims


What it contains


+ Vit C

Light


Health claims




What it does


Nutrition claims


What it contains


44

Health claims should be substantiated



Health claims should be

substantiated

authorities

scientists

industry

consumers

46

- 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)

47

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



Nutrition claims


What it contains

Health claims




What it does


49

● 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

50

21 August 2008: EFSA adopts first opinions on health claims made on foods relating to disease risk reduction and children’s health

51

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

52

EFSA health claim rejections 'shock' industry

54

Industry: “EFSA verdicts on food claims send shockwaves through the industry”

Consumer organizations: “welcome EFSA approach”

Scientists: “generally support for EFSA opinions”

55

March 2009: EC validates

21 EFSA health claim Opinions

56

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


Health claims




What it does


Nutrition claims


What it contains




61

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

62

Claims received by categoryClaims received by category

Probiotics8%

Diets1%

Fibre3%

Foods8%

Macronutrients9%

Minerals5%

Botanicals45%

Vitamins5%

Other substances16%

63



• insufficient evidence for cause and effect ….


65

• 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

66

• Probiotics ≠ strengthen immune system

• >100 probiotics insufficiently characterised

• Botanicals ≠ characterised, poor data

• Taurine ≠ energy, performance

• Glucosamine, shark cartilage ≠ joint health

• …… etc

67



• Insufficient evidence for cause and effect ….


69

Oxidative damage / oxygen paradox

O2

respiration ROS

damageenergy protectiveregulatory

70

The antioxidant hypothesis

Oxidative stress

Endogenous ROSExogenous ROS

vitC/vitESOD/CAT/GSH-Px

CarotenoidsFlavonoids

…..

71

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

72

1. in vitro/animal studies 2. studies in humans

1. observational studies

2. intervention studies

73

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

74

Sies, H. (1988) Nature 332, 495

75

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

77

Conclusions Antioxidants

Antioxidants are

great for rats !

78

More is Not Always Better

79Morris & Tangney, JAMA 2011, 305, 1348

80

ongezonde voeding

Functionele voedingsmiddelen en voedingssupplementen vormen geen oplossing voor de gezondheidsproblemen door een ‘ongezonde voeding’.

82



83

risk only (safety)

balance of risks and benefits

84

BenefitsCVD, cancer, etc ↓

Riskspesticides

85

BenefitsCoronary heart disease ↓

RisksNeurological damage

in the fetus (MeHg)

86

- Benefit-risk assessment- Scenario studies- Modelleren van effecten

87

Model & Werkelijkheid

Courtesy: Johan Schefferlie

88

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

89

Folic Acid

●Neural Tube Defects (benefit)●Masking B12-deficiency (risk)●Colorectal Cancer (benefit and risk)●Folate deficiency (benefit)


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*


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

93

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

94

Low calorie sweeteners

Benefits

Reduced energy intake

Reduced body weight/weight balance

Reduced caries

95

“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

97



98

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:

99


sat.fat

transfat

fruit

vegetables

fish

-100 -50 0 50 100

deaths in next 20 years (x 1000)


http://www.rivm.nl/bibliotheek/rapporten/350080001.html

100

140.000 sterfgevallen/20 jaar= 7.000 / jaar

101

sat.fat

transfat

fruit

vegetables

fish

-3 -2 -1 0 1 2 3

costs in next 20 years (billion euros)


http://www.rivm.nl/bibliotheek/rapporten/350080001.htmlNet Present Value


102

2004 2006

103

Eating too

much

food safety

Eating wrong

•Fruits•Vegetables•Fish•TFA•SAFA

•Salt/sodium •Fibre•PUFA•Vitamins•Minerals• ….etc

unhealthy diet

104

unhealthy diet

food safety

Why are we so scared about our food ???

105

Benefit-risk analysis

Benefit-risk assessment

Benefit-risk manageme

nt

Benefit-risk communicati

on

Benefit-risk analysis paradigm

107

Evidence based nutrition

Evidence based decisions

108

Dank u wel voor uw aandacht !

109

©=============================================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 [email protected]://www.rivm.nl/en/aboutrivm/organization/vgc/cvg/index.jsp============================================

ScienceCafé Zeist: Voeding 10-11-11

Health & Medicine

Transcript of ScienceCafé Zeist: Voeding 10-11-11