You are what you eat?Plants,food,andhumanhealthWhy we eat what we eatSensual/physiologicalreasonsSocial/emotionalreasonsThatsmellsgoodThatlooksgoodThattastesgoodImhungryItsmywifesfavoritedishItsatraditionaldishImdepressedItsmybirthdayImtiredUnlike plants, we cant make our own food, so we must eat; we are heterotrophsWhy we eat what we eatImage courtesy of acclaimclipart.comEconomicreasonsMediaandmarketingIcantaffordtobuyfreshfruitIdonthavetimetocookwellhavetakeouttonightItsasuperfoodIwillbehealthierifItakeamultivitaminpillCarbohydratesarebadCarbohydratesaregoodIneedtodetoxOrganicishealthierAre you what you eat? Your nutritional status has three parts:What you eat dietquantityandnutritionalqualityWhat you are bodyandtissuesizeandcompositionWhat you can do functionalcapacitiesfrommoleculartosociallevels,includingphysicalandenzymaticactivitiesLecture OutlineWhatwegetfromfoodMacronutrients,micronutrientsandphytonutrientsHowdietaffectshumanhealthNutritionresearchDietarydeficienciesDietandchronicdiseasesMediaandmarketingWhatcanscientistsdo?Image courtesy CDC and Mary Anne Fenley (number 13053)What is food? Food comes from plants: leaves, fruits, shoots, roots and seeds ThemeatinourdietcomesfromanimalsthateatplantsWhat we get from foodMacronutrientscontainenergy(calories)Carbohydrates,fatsandproteinsfuelsandbuildingblocksFiberbowelhealth,satiationMicronutrientsVitamins,tracemineralsPhytonutrientsProtectivefunctionsCarbohydrates include sugars, starches and celluloseCarbohydratesaresugars.TheycanexistasmonomerslikeglucoseanddimerslikesucroseCarbohydratescanalsobelongpolymers.Starchisapolymerofglucosejoinedwithanalphalinkage.CelluloseisapolymerofglucosejoinedwithabetalinkageglucosesucrosestarchcelluloseNot all carbohydrates are easily digested and assimilatedInyourbody,sucroseandsomestarchesareconvertedintoglucoseMammalsdonotproduceanenzymethatbreaksthebondsincellulose,soitisnotabsorbedbutpassesthroughthegutundigestedSome animals carry cellulose-digesting bacteria in their gut, but we dontSomestarchesarenotdigestedCarbohydrate metabolismMikael HggstrmEverycellinyourbodyusesglucosetoproduceenergy(ATP).Excessglucoseisstoredasglycogen(short-termstorage)orfatSugars fuel plant and animal cellsCytoplasmGlucosePyruvateATPPlant cellAnimal cellMitochondriaVacuoleNucleusNucleusPlantandanimalcellscontainmitochondria.GlucosefuelstheformationofATP,cellularenergy,withinthemitochondriaInthecytoplasm,glucoseisconvertedtopyruvate,whichentersthemitochondriaandthroughthetricarboxylicacidcycleproducesaprotongradientthatdrivesATPsynthesisSome carbohydrates are soluble dietary fibersSolubleorviscousfibersarephysiologicallyactive.Theydecreaseuptakeoffatsandsugarsfromtheintestine,andarefermentedbyintestinalbacteriaintobeneficialshort-chainfattyacids(e.g.butyrate)Viscousfibersincludegums,pectinsandmucilages,andtheycanfeelstickyormucuslike.Thegel-likematrixtheyformisessentialtotheirfunctionintheintestineinulinOats,okraandlegumeseedsaregoodsourcesofsolublefibreSome carbohydrates are insoluble dietary fibersManyinsolubledietaryfibersareinertbutneverthelessmaybebeneficialtointestinalhealthInsolublefibersincludecellulosesandlignin.TheymayhelpwithafeelingofsatiationWholewheatfoodsorwheatbran,manyvegetables,andfruitskinsaregoodsourcesofinsolublefiberProteins are polymers of amino acidsGASTCVLIMPFYWDENQHKRThesidechain,R,ofanaminoaciddeterminesitschemicalproperties.ProteinpropertiesarespecifiedtheiraminoacidcompositionThenitrogen-containingaminogroupisanimportantfeatureofaminoacidsProteins have many roles enzymes, muscle, etc.Musclemeat,milkandeggsareconcentratedsourcesofanimalproteinwidelyusedasfood,buteveryanimalandplantcellcontainsprotein.LegumeseedsareparticularlyproteinrichProtein metabolismMikael HggstrmSomeingestedproteinsarebrokendowntoaminoacids,thenrecombinedtoformnewproteins;e.g.muscle,redbloodcellsMostareusedasanenergysourceExcessaminoacidscanbeusedasanenergysource,withnitrogenexcretedinurineAssimilationofaminoacidsintoproteinsLipids- fats and oilsLipidsarehydrocarbons,energy-richcompounds.Likegasoline,lipidsreleaseenergywhenoxidized.Plantsandanimalsstoreenergyaslipids,andlipidsarealsonormalcomponentsofeverycellandthebasisofthecellmembranes.Atroomtemperature,fatsaresolidandoilsareliquid,butbotharelipidsManyanimal-derivedfoodsarehighinfatOilsarelipidsextractedfromplantseedsorfruitsFatty acids have acidic groups attached to fatty hydrocarbon tailsCCCCHHHHHHHHCCCCHHHHHHThehydrocarbontailissaturatedwhenitincludesamaximalnumberofhydrogenatoms,andunsaturatedwhencarbon-carbondoublebondsarepresentSaturatedeachcarbonisboundtotwohydrogensUnsaturateddoublebondsbetweencarbonsarepresentAcidgroupFattytailFatty acids are saturated, monounsaturated or polyunsaturatedSaturatedfattyacid(SFA)abundantinanimalfats(meatandbutterfat)Monounsaturatedfattyacid(MUFA)abundantinsomeoils(olive,canola)Polyunsaturatedfattyacid(PUFA)abundantinsomefishandseedoils(sunflower,soybean)Polyunsaturated fatty acids can be hydrogenated to produce trans fatsH2Mosttransfatsareindustrialproductsandwereveryrareinthehumandietuntilabout100yearsago.Trans fats have higher melting temperatures than cis fatsOleicacid,acisfatElaidicacid,atransfatAsstraightermolecules,transfatspacktogethermoretightlyandsohaveahighermeltingpointthancorrespondingcisfats,illustratedbythedifferencebetweenmargarineandoliveoilTransfatscanbelessexpensivetoproducethanothersolidfats,andbecamewidelyusedintheprocessedfoodindustriesOmega-3 (n-3) and omega-6 (n-6) fatty acids are specialAdapted from Kris-Etherton, P.M., Harris, W.S., Appel, L.J. for the AHA Nutrition Committee. (2003). Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Arterioscler. Thromb. Vasc. Biol. 23: e20-e30.Althoughthehumanbodycansynthesizelipids,afewlong-chainfattyacidsareproducedinefficientlyornotatallandmustbeingestedthroughthedietEssentialfattyacidsincludesomen-3andn-6fattyacidsAlpha-linolenicacid(ALA)Eicosapentaenoicacid(EPA)Docosahexaenoicacid(DHA)Linoleicacid(LA)Arachidonicacid(AA)3Omega-3 and omega-6 fatty acidsOmega-3Omega-6Omegaornreferstothelastcarbon.N-3fattyacidshaveadoublebondatthethirdcarbonfromtheend,n-6fattyacidshaveadoublebondatthe6thcarbonfromtheendN-3 and n-6 fatty acids are eicosanoid precursorsn-6LinoleicAcidn-3Alpha-linolenicacidPro-inflammatoryn-6derivedeicosanoidsAnti-inflammatoryn-3derivedeicosanoids6-DesaturationElongation5-DesaturationDietEicosanoidsareafamilyofsignalingmoleculeswithdiversefunctionsAhighratioofn-3ton-6fattyacidsmaypromotehealthDietary n-3 fatty acids can protect against chronic diseasesDocosahexaenoicacid(DHA)-linolenicacid(ALA)Eicosapentaenoicacid(EPA)ALAmustbeassimilatedthroughthediet.DHAandEPAareproducedfromALAwithlowefficiencyDHAandEPAareproducedbymarinealgaeandaccumulateinsomefish,makingfishgoodsourcesofbeneficialn-3fattyacidsN-3fattyacidshavebeenshowntohaveprotectivefunctionsforcardiovasculardisease,and,inrats,protectagainstneurodegenerationMicronutrients vitamins are essential small moleculesVitaminsareessentialnutrientsthatweneedtoeatbecausewecannotsynthesizethemVitamin A Vitamin C, ascorbic acidVitamin B1, thiamine Vitamin B3, niacineVitamin B9, folateVitamin DFortifiedfoodsVitamin EVitamin KWhenexposedsosunlight,humanscanmakevitaminDtosupplementdietarysourcesSeveral dietary minerals are essential for human healthIron (Fe) isassimilatedasheme(fromanimals)andnon-heme(fromplants)forms;non-hemeiron,arelessefficientlyassimilated.Leafygreensandbeansaresourcesofnon-hemeironBrazilnutsareanunusuallygoodsourceofselenium (Se).TheSecontentoffoodsdependslargelyonsoilcontentPotassium(K+)helpsmaintainosmoticbalanceandisabundantinfruits,beans,potatoesCalcium(Ca2+)isabundantinmilk-productsandgreenleafyvegetablesZinc(Zn2+)isfoundinanimal-derivedfoods,beansandnutsMineral nutrition depends upon soil composition and bioavailabilityZn2+Zn2+SoilavailabilitystronglyaffectsplantnutritionalqualityAssimilationefficiencySequestrationintograinorotherfoodAssimilationefficiencyandbioavailabilityMineralavailabilityinthesoilandbioavailabilityinthegutarethemajorfactorsthataffectdietaryuptakeThe bioavailability of some minerals interferes with their assimilationHambidge, K.M. (2010). Micronutrient bioavailability: Dietary Reference Intakes and a future perspective. The American Journal of Clinical Nutrition. 91: 1430S-1432S.Phytateisabundantinseeds;itsnegativechargebindspositivelychargedionsandinterfereswiththeirassimilationSeleniumuptakeintothegutisenhancedwhenitisinanorganicformNonhemeironfromplantsisnotassimilatedasreadilyashemeironfrommeatFe+Zn+Zn+Zn+Zn+Zn+Zn+Fe+SeSePhytonutrients can have long-term health benefitsSomeplant“secondarymetabolites”arephytonutrientsAlthoughphytonutrientshavenotbeenshowntobeessentialforhumanhealthinthesamewaythatvitaminsandmineralsare,theymaybeimportantforlong-termhumanhealthPhoto-synthesisCarbohydratemetabolismFattyacidmetabolismNitrogenmetabolismTerpenesAlkaloidsPolyketidesFlavonoidsQuinonesCoumarinsTanninsGlycosinolatesCyanogenicglycosidesPrimary metabolitesCorecompoundsfoundinmostorganismsSecondary metabolitesOfteninvolvedindefenseorinteractionswithpollinatorsandofteninonlyafewspeciesPhytonutrients: flavonoids, anthocyanins and related compoundsHesperetin aflavanonefoundincitrusfruitsCurcumin fromthespiceturmerichasantioxidantandanti-inflammatorypropertiesCyanodin-glucoside,areddishcoloredanthocyaninwithnumeroushealthbenefitsQuercitin aflavonoidfoundinmanyplantsGenisteinanisoflavonoidfromsoybeansEpigallocatechin gallate (EGCG),aflavonoidfromgreenteathatmayhelpeliminateimmortalityfromsomecancercellsPhytonutrients: carotenoidsReprinted from Cazzonelli, C.I. and Pogson, B.J. (2010). Source to sink: regulation of carotenoid biosynthesis in plants. Trends Plant Sci. 15: 266-274 with permission from Elsevier. Corn photo by Doug Wilson. Carotenoidsinclude-carotene,theprecursortovitaminA,butalsolutein,zeaxanthinandlycopene,whichhavehealth-promotingbenefits-caroteneisconvertedtovitaminAafteringestionlycopeneluteinCarotenoids are more than just vitamin A precursorsCarotenoids may help prevent age-related macular degenerationAge-Related Eye Disease Study Research Group. (2007). The Relationship of Dietary Carotenoid and Vitamin A, E, and C Intake With Age-Related Macular Degeneration in a Case-Control Study: AREDS Report No. 22. Arch Ophthalmol. 125: 1225-1232. http:/www.nei.nih.gov/photo/eyedis/images/EDA17_72.jpgl Image courtesy CDC and Mary Anne Fenley (number 13053)Age-relatedmaculardegenerationisaleadingcauseofsightlossDietshighinlutein,zeaxanthin,zincandvitaminsC,andEmayprotecteyesLuteinandzeaxanthinaccumulateinthemacula,givingitanorangecolor.TheyarethoughttoabsorbhighenergylightandprotecttheretinafromdamagePhytonutrients: allyl sulfides and isothiocyanates Photos by Tom Donald, and Bruce Fritz ,and Jocelyn Eason, Plant and Food, New Zealand; Talalay, P. (2005). A fascination with enzymes: The journey not the arrival matters. J. Biol. Chem. 280: 28829-28847.Onion(Allium cepa)Garlic(Allium sativum)Broccoli(Brassica oleracea)Cabbage(Brassica oleracea)Diallyl disulfideAlliumspeciesproduceallylsulfideswithanti-canceractivitiesIsothiocyanatessuchassulforaphanearederivedfromcruciferousvegetablesandhaveanti-canceractivitiesWhat are “functional foods” and how are they regulated? Yamada, K., Sato-Mito, N., Nagata, J. and Umegaki, K. (2008). Health claim evidence requirements in Japan. J. Nutr. 138: 1192S-1198S; EU Directorate General for Health and Consumers; FDA food labeling guideFoodswhosehealthbenefitsgobeyondtraditionalnutrientsaresometimescalledfunctionalfoods.ClaimsforhealthbenefitsbeyondconventionalnutritionarestringentlyregulatedInJapan,morethan700functionalfoodsarelabelledFOSHUFoodsforSpecifiedHealthUse*Plantsterolsareshowntoreducebloodcholesterol,andhighcholesterolisariskfactorinthedevelopmentofcardiovasculardisease“BENECOLSpreadsaretheonlyproductsintheU.S.thatcontainPlantStanolEsters,adietaryingredientthatlowerscholesterolandmayreducetheriskofheartdiseasewhenusedaspartofalowsaturatedfat,lowcholesteroldiet.”As an example, in the EU and US, some foods containing plant sterols can make specific health claimsIntestinal bacteria are an important part of nutritionIntestinal lumen100,000,000,000,000bacterialiveinthehumanintestine(thatsmorethanthenumberofyourcellsinyourbody)Intestinalbacteriahelptodigestfoodthatyourownenzymescannot,allowingittoenteryourbloodstreamGut bacteria affect nutrient assimilation rodent studiesGermfreemice(artificiallyrearedwithoutgutbacteria)needtoeatalotmorefoodtotakeinenoughcaloriesbecausetheyarelessefficientatassimilatingfood.Eventhoughtheyeatless,thenormalmicehave40%morebodyfatthanthegermfreemiceTransferringbacteriafromthenormalmousetothegerm-freemouserestoresitsabilitytoassimilatefood,andincreasesitsbodyfatGut bacteria are different in different individuals and affect assimilationLey, R.E., Bckhed, F., Turnbaugh, P., Lozupone, C.A., Knight, R.D. and Gordon, J.I. (2005). Obesity alters gut microbial ecology. Proceedings of the National Academy of Sciences of the United States of America. 102: 11070-11075. Turnbaugh, P.J., Ley, R.E., Mahowald, M.A., Magrini, V., Mardis, E.R. and Gordon, J.I. (2006). An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 444: 1027-1131.Thegutbacteriatransferredintothegerm-freemiceaffectedtheirweightgain;micethatreceivedbacteriafromobesemicegainedmoreweight(greaterabilitytoharvestenergyfromtheirfood)RecipientObesedonorGreaterweightgainRecipientNormaldonorNormalweightgainGut microbes (microbiota) affect human healthReprinted by permission from Macmillan Publishers Ltd: Spor, A., Koren, O. and Ley, R. (2011). Unravelling the effects of the environment and host genotype on the gut microbiome. Nat Rev Micro. 9: 279-290.Thegutmicrobiotaareanindicatorofandcontributortowell-beingThephytonutrientequolisproducedfromsoybeansbytheactionofcertainintestinalbacteria;onlysomepeopleproduceequol,dependingupontheirgutmicrobiotaEquol,abeneficialphytonutrient(forsomepeople!)Assimilation of nutrients from food is a complex processProcessingMouthStomachIntestineBloodMaceration-amylase digestion of starchCell wall fragments and cellulose expelledDigestion of polymers to monomersAssimilationintobloodLipasesChemical contributions from bacteriaFeedbackandhomeostasismechanismsSummary what we get from foodFood provides fuelCaloriesareanindicationofthechemicalenergystoredinfoods.OurbodiesconvertfoodsintoATP,theenergythatdriveschemicalreactions,movement,nerveactivitiesetc.Food provides building blocksFoodprovidestherawmaterialssuchasaminoacidsneededforgrowthandrepairofourbodiesFood provides essential small moleculesVitamins,mineralsandphytonutrientsarenecessarymoleculesthatwemustassimilatethroughoutdiet.Somearecofactors,somebindoxygen,someactasantioxidantsoranti-inflammatoryagentsHow nutrition research is conductedHowdoscientistsdeterminehowmuchandwhatkindsoffoodsareoptimalforhumanhealth?Volunteers,whoarewillingtoeatregimenteddietsandhavetheirbodysfunctionsmonitored,areindispensablePhotos by Stephen Ausmus, Peggy Greb, Brian Prechtel and Stephen AusmusAn early experiment- James Linds studies of scurvySutton, G. (2003). Putrid gums and Dead Mens Cloaths: James Lind aboard the Salisbury. JRSM. 96: 605-608. Trhler U (2003). James Lind and scurvy: 1747 to 1795. JLL Bulletin: Commentaries on the history of treatment evaluation (link)1749.Afterseveralmonthseatingonlygruel,muttonbrothandboiledbiscuits,sailorsexperienced“.putrid gums, the spots and lassitude, with weakness of the knees”.JamesLindsupplementedthedietofsixpairsofsicksailorswith:cider,vinegar,seawater,elixir of vitriol (dilutesulphuricacid),ortwoorangesandalemon.Thosereceivingfruitrecoveredquickly,but50yearspassedbeforethetreatmentwaswidelyincorporatedintonavalpracticeMorethanhalfof18thcenturysailorsdiedfrommalnutritiononlongvoyagesTypes of human nutritional studiesEpidemiological Compareeatinghabitsanddiseaseincidencebetweenpeoplefromdifferentregions(e.g.FranceandJapan)Retrospective “case control”Howdothedietaryhistoriesofpeoplewithadiseasecomparetothoseofasimilardemographicgroupwithoutthedisease?Epidemiological cohortCollectdataaboutdietaryhabitsoflargenumbersofpeoplebeforediseasesareevident,andlookforpatternsamongstthosethateventuallydevelopdiseaseClinical intervention Providematcheddietswithsinglevariabletomatchedexperimentalandcontrolgroupstodetermineeffectsondisease(requiresinformedconsentandadequatenumberstoprovidestatisticalpower)Inthe21stcentury,ethicalguidelinesregulatehumanexperimentationQuestionnaire-based studies are augmented by lab studiesAdapted from Traka, M.H., and Mithen, R.F. (2011). Plant science and human nutrition: Challenges in assessing health-promoting properties of phytochemicals. Plant Cell 23: 24832497.Epidemiological, cohort studiesHuman interventionAnimal modelsCell cultureRegionaldietsFoodsurveysHowdoesXaffectcellviability?HowisX takenupandmetabolized?HowisXtakenupandmetabolizedinvivo?HowdoesadietenrichedforXaffecthealthintheanimalmodel?HowisXassimilated,andhowdoesadietenrichedforXaffecthealthinhumans?Human intervention studies are convincing, but complex, expensive and difficult!Summary how can we understand results from nutritional studies? Nutritionisanactivesciencewithanevergrowingbodyofdata.UnderstandingtherolesofanyonefoodornutrientrequiresevaluatingalloftheavailabledataStudiesmaybeweightedbythetypeofstudyandthenumberofpeopleorsamplesstudiedIfafoodprovidesasmallbenefittosomeindividuals,canwemeasureit,andhowdoweinterpretthisinformation?Howdowedecidewhatissufficientevidencetomakearecommendation?How diet affects human healthDietarydeficienciesleadtodisabilityanddeathDietisafactorinsomechronicdiseasesMetabolicsyndromeType2diabetesCardiovasculardiseaseCancerPhoto credit: IRRIMore than one billion people are chronically hungry, and more than two billion people do not get adequate vitamins or minerals in their dietwww.wfp.orgChildren are particularly vulnerable to dietary deficienciesImage courtesy CDC/ Dr. Lyle Conrad (number 6901) Image courtesy CDC (number 6903)CropfailuresespeciallyinvulnerableregionscanleadtofaminesWar,conflictandcorruptioncaninterferewithfooddistributionPovertycontributestochronicmalnutritionb.usuhs.mil/biochem/nutrition/NOTES/Vitamin A deficiency is a leading cause of blindness100millionchildrenareVitaminAdeficientUpto500,000childrenbecomeblindeveryyearandhalfofthesediewithin12monthsoflosingtheirsightImprovingdietaryintakeofcarotenescanreducechildmortalityby25%WHO dataOccurrenceofVitaminAdeficiency(VAD)Many people suffer deficiencies of other vitamins and mineralsImage courtesy CDC (number 6179) Image courtesy CDC (number 3998) Image courtesy CDC (number 2435)Pellagraisadeficiencyofniacin(vitaminB3)Inflamed,scorbuticgumscausedbyvitaminCdeficiencyNutritionalRicketsisaconditioninwhichbonesaretoosoftduetoadeficiencyofvitaminDAnemiacausedbyirondeficiencyaffectshalfofallpre-schoolagedchildrenDietary deficiencies are also widespread in the developed worldPercent of US individuals 2 years not meeting 100% of the US recommended daily allowancesZinc73.3Calcium65.1Vitamin A56.2Vitamin B6 (pyridoxal phosphate)53.6Iron 39.1Vitamin C37.5Vitamin B9 (Folate)33.2Vitamin B1 (Thiamine)30.2Data from Cordain, L., Eaton, S.B., Sebastian, A., Mann, N., Lindeberg, S., Watkins, B.A., OKeefe, J.H. and Brand-Miller, J. (2005). Origins and evolution of the Western diet: health implications for the 21st century. Am.J. Clin. Nutrit 81: 341-354.15%24%UShouseholdsexperiencingfoodhardship(notenoughmoneyforfood)in2010Householdswithout/withchildrenFood fortification programs have helped limit nutrient deficienciesSince1924inUSSince 1933 in USSince1940inUS(enrichedwithBvitaminsandiron)MargarineinEurope(VitaminsAandD)Committee on Use of Dietary Reference Intakes in Nutrition Labeling (2003) Dietary Reference Intakes: Guiding Principles for Nutrition Labeling and Fortification. The National Academies Press.Photo credit: Neil Palmer (CIAT).Biofortification is breeding or growing plants for increased nutrient contentIron-biofortifiedriceDietary deficiencies - Summary HalfthepeopleontheplanetarethoughttosufferfromatleastonenutritionaldeficiencyWomen,childrenandthepooraredisproportionallyaffectedFoodenrichment,fortificationandbiofortificationprogramscanhelpInparallel,effortsareunderwaytomakedietaryvarietymorewidelyavailableandaffordableChronic diseases are a leading cause of deathChronicdiseasesareprojectedtocause388milliondeathsinthenext10yearsChronicdiseasesincludecardiovasculardisease,cancer,diabetesandrespiratorydiseasesGlobally,chronicdiseaseskillmorethantwiceasmanypeopleasinfectiousdiseasesincludingHIV/AIDSWorld Health Organization (2011). Global status report on noncommunicable diseases 2010. (Geneva, Switzerland: World Health Organization).Chronic diseases affect all income levels80%ofmortalityfromchronicdiseaseoccursinlowandmiddleincomecountriesThepooraremorevulnerabletochronicdiseasebecauseofincreasedexposuretorisksanddecreasedaccesstohealthcareChronicdiseasescausepovertyWorld Health Organization (2005). Preventing Chronic Diseases: A Vital Investment.There is a strong connection between diet and chronic diseaseUnhealthyeatingPhysicalinactivityColoncancerProstatecancerType2diabetesKidneydiseaseCardio-vasculardiseaseHighbloodpressureLungcancerObesityHighbloodcholesterolBreastcancerGlobally,morepeopleareoverweightthanundernourished65%oftheworldspopulationliveincountrieswhereoverweightandobesitykillsmorepeoplethanunderweightSource: WHOMetabolic syndrome: a set of related conditions that predispose ill healthPhoto credits: Amanda Mills and James Gathany, Centers for Disease ControlThekeycomponentisalargewaistcircumferenceplustwooutoffourof:highfastingglucose,highserumtriglyceride,highbloodpressure,orlowHDLcholesterolMetabolic syndrome has genetic and environmental contributionsEckel, R.H., Grundy, S.M. and Zimmet, P.Z. (2005). The metabolic syndrome. The Lancet. 365: 1415-1428 , adapted from Cameron, A.J., Shaw, J.E. and Zimmet, P.Z. (2004). The metabolic syndrome: prevalence in worldwide populations. Endocrinology and Metabolism Clinics of North America. 33: 351-375.NativeAmericansarehighlysusceptibleFrenchwomenarethethinnestinEuropeA large waist is the major component of metabolic syndromeAlargewaistcircumferenceisalsoknownasan“appleshape”Reproduced from Han, T.S., Sattar, N. and Lean, M. (2006). Assessment of obesity and its clinical implications. BMJ. 333: 695-698, with permission from BMJ Publishing Group Ltd.Abdominal fat produces harmful inflammatory cytokinesReprinted from Racette, S.B., Weiss, E.P., Villareal, D.T., Arif, H., Steger-May, K., Schechtman, K.B., Fontana, L., Klein, S., Holloszy, J.O. and Group, T.W.U.S.o.M.C. (2006). One year of caloric restriction in humans: Feasibility and effects on body composition and abdominal adipose tissue. J. Gerontol. A: Biol. Sci. Med. Sci. 61: 943-950 by permission from Oxford University Press.MRIscansofawomanandmanshowingfatinwhite.Subcutaneousfatisoutsidetheabdominalwall,whereasvisceralfatiswithinit,surroundingtheorgansVisceralfatsecretesinflammatorycompoundsthatcontributetolipidoxidationandthedevelopmentofinsulininsensitivityScans show cross-section of abdomenCytokine production by visceral fat contributes to chronic diseaseAbdominal fatMuscleLiverExcessfatintheabdomencausesthelivertoreleaseglucose,andlowerstherateofuptakebymuscle,contributingtothedevelopmentoftype2diabetesglucosereleaseglucoseuptakeReproduced from Han, T.S., Sattar, N. and Lean, M. (2006). Assessment of obesity and its clinical implications. BMJ. 333: 695-698, with permission from BMJ Publishing Group Ltd.Diabetes is two diseases, type 1 and type 2; Type 2 is increasing rapidlySource: International Diabetes FoundationTypeIdiabetes,10%oftotal,isanautoimmunediseasethatcausesalossofinsulinproduction,andisusuallydiagnosedduringchildhood20072025(projection)Type2diabetesisalargelyaconsequenceofpoordiet,obesity,andphysicalinactivity,andisusuallydiagnosedinadulthood.TheincidenceofType2diabetesisincreasingrapidlyDiabetes interferes with the regulation of glucose levelsIntestinal lumenDietary sugarsPancreas cellInsulinWhite adipose tissueGlucoseistakenupintothebloodstreamGlucosetriggersinsulinproductionbypancreatic-cellsInsulinregulatesbloodglucoselevelsbypromotinguptakeintomuscleandwhiteadiposetissue,blocking release bytheliverandblocking further uptake fromtheintestineMuscleLiverType 1 diabetes is caused by a loss of insulin productionIntestinal lumenDietary sugarsPancreas cellWhite adipose tissueGlucoseistakenupintothebloodstreamType1diabetescancauseveryhighbloodglucoselevels,leadingtotissuedamage.TypeIdiabetescanbemanagedbyinjectedinsulin10%ofdiabetesisType1MuscleType1diabetesinvolvestheautoimmunedestructionofcellsproducinginsulininthepancreasType 2 diabetes is caused by insulin resistanceIntestinal lumenDietary sugarsPancreas cellInsulinWhite adipose tissueGlucoseistakenupintothebloodstreamGlucosetriggersinsulinproductionbypancreatic-cellsInsulinresistancemeansthatglucoseisnotclearedfromthebloodanduptakefromtheintestineisnotswitchedoff.Injectedinsulindoesnotefficientlymanagetype2diabetes90%ofdiabetesisType2MuscleMetabolic syndrome and type 2 diabetes are preventable and reversiblePhoto credits: CDC/ Amanda Mills, Amanda Mills, Amanda MillsMaintainahealthyweightExercisefrequentlyDontsmokeThenot-so-secret“secret”Cardiovascular diseaseCardiovasculardiseases(CVDs)arethenumberonecauseofdeathgloballyCVDsincludestroke,heartattack,atherosclerosisandhighbloodpressure30%ofallglobaldeaths-17.3millionpeoplewerefromCVDsin2008By2030,23.6millionpeoplewilldiefromCVDsOver80%ofCVDdeathstakeplaceinlow-andmiddle-incomecountriesSource: World Health Organization; Kim, A.S. and Johnston, S.C. (2011). Global variation in the relative burden of stroke and ischemic heart disease / clinical perspective. Circulation. 124: 314-323.The cardiovascular systemBloodpassesfromtheintestinethroughtheliver,whichremovesanyingestedtoxinsandprocessesingestedfatsTheheartpumpsbloodthroughalltheorgansandtissuesBloodisoxygenatedbypassingthroughthelungsArteriescarryoxygenatedbloodunderhighpressureCVDs result from elevated blood pressure and plasma fat levelsBloodpressureisaffectedbydissolvedsolutesincludingsodiumandglucose,andatherosclerosis(thickeningandhardeningduetofattydeposits)Dietaryfatsmovethroughthebloodaslipoproteins,composedoftriglyceride,cholesterolandproteins.Ahigh-fatdietleadstoelevatedbloodplasmafatlevelsLDL(lowdensitylipoproteins)arehighincholesterolandcandamagethecardiovascularsystemHDL(highdensitylipoproteins)helpremoveexcesscholosterolfromthebodyElevated blood plasma lipid levels contribute to CVD DyslipidemiaistoomuchfatcirculatinginthebloodandisaconsequenceofgeneticfactorsanddietLDL (low density lipoproteins)60mg/dLor1.56mmol/LExcessiveamountsofplasmafatfromapersonwithdyslipidemiaHealthy levels of plasma lipidsTriglycerides150mg/dLor1.7mmol/LTotal cholesterol 30) in U.S. AdultsIntheUS,morethan72millionadultsareobeseObesityincreasesmedicalcostsbyanaverageof$1429perpersonperyearTargetedobesitylevelsof15%arecurrentlymetbyzerostatesSimilar trends are found around the worldConclusions and challengesMake the healthy choices the easy choicesEncouragephysicalactivity(e.g.buildbicyclelanesandsafe,accessibleparks)EnsurehealthyfoodsareaffordableandavailableHelpconsumersmakeinformeddecisionsHowcanwechangepeopleshabitstoreducetheincidenceofchronicdiseases?