Following dietary guidelines is associated with reduced risk of type 2 diabetes, coronary heart disease and obesity. Scientific evidence Registered dietitian, M.Sc, MBAReijo Laatikainenwww.twitter.com/pronutritionist презентация

diabetes, coronary heart disease and obesity. Scientific evidence Registered dietitian, M.Sc, MBA Reijo Laatikainen www.twitter.com/pronutritionist

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and “Paleolithic“ diet communities and by some “nutrition authors” maintain that dietary guidelines have made us fat and sick:
“Dietary guidelines have caused the obesity epidemic”
“Dietary guidelines are not based on scientific evidence”
“Dietary guidelines are the reason for type 2 diabetes epidemic”
And so forth

Quite often these accusations are not addressed adequately. Consequently, many people buy in the claims.

This deck is about science. What does the high quality data show about the evidence of dietary guidelines?

studies

4. Cross-sectional and case-control cohorts

5 Ecological & animal studies

Strength of evidence

Meta-analyses of 1,2 & 3

Modified from: Micha & Mozaffarian. Lipids. 2010; 45(10): 893–905 and
Evidence Analysis Manual.
Academy of Nutrition and Dietetics
January 2012

Hierarchy of evidence in nutrition science

little. All are rather high in carbs: DASH Low GI diet Prudent diet pattern High quality diet pattern Healthy diet pattern Healthy Eating Index … and so on.

EPIDEMIC

”Carbs are bad”

”Carbs are bad”

al 2013

weight gain

Fogelholm M et al.  Dietary macronutrients and food consumption as determinants of long-term weight change in adult populations: a systematic literature review.Food Nutr Res. 2012;56

Number of studies showing reduced risk of weight gain in long term: 4

Number of studies showing increased risk of weight gain in long term: zero

with weight gain

Number of studies showing reduced risk of weight gain in long term: 13

Number of studies showing increased risk of weight gain in long term: zero

Fogelholm M et al.  Dietary macronutrients and food consumption as determinants of long-term weight change in adult populations: a systematic literature review.Food Nutr Res. 2012;56

weight

Number of studies showing increased risk of weight gain in long term: 3

Fogelholm M et al.  Dietary macronutrients and food consumption as determinants of long-term weight change in adult populations: a systematic literature review.Food Nutr Res. 2012;56

determinant of weight gain

Fogelholm M et al.  Dietary macronutrients and food consumption as determinants of long-term weight change in adult populations: a systematic literature review.Food Nutr Res. 2012;56

Hauner H et al. Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases. Ann Nutr Metab. 2012;60 Suppl 1:1-58

drinks increase the risk of weight gain

Hauner H et al. Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases. Ann Nutr Metab. 2012;60 Suppl 1:1-58

2 DIABETES EPIDEMIC

”Carbs are bad”

”Carbs are bad”

Alhazmi et al. 2014, Ye et al.2013 and meta-analysis of RCTs by Gillies et al 2007 Systematic review by Hauner et a. 2012

www.pronutritionist.net

diabetes

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“The results indicated that dietary patterns consisting of healthy foods and/or nutrient choices and had higher energy contributions from whole grain products, fruit and vegetables may decrease the risk of type 2 diabetes.”

Alhazmi A., et al. he association between dietary patterns and type 2 diabetes: a systematic review and meta-analysis of cohort studiesJ Hum Nutr Diet 2014;27:251–260

reduced risk of type 2 diabetes

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Esposito et al., Which diet for prevention of type 2 diabetes? A meta-analysis of prospective studies. Endocrine. 2014 Apr 18

“The results of our study demonstrate that several healthy diets are equally and consistently associated with a 20 % reduced risk of future type 2 diabetes.”

reduced risk of T2D, weight gain and CVD

Cohorts: whole grain users (48-80 g/day vs ”low users”)
Relative risk of T2D ↓ by 28 %
Relative risk of CVD ↓ by 21 %
Weigh 0,4 kilos less

RCT:t (21 trials): Whole grain diet vs control diet
0,72 mmol ↓ LDL
0,93 mmol ↓ fP-Glc

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Ye E et al. Greater whole-grain intake is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain. J Nutr. 2012 Jul;142(7):1304-13.

diabetes

Gillies et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ 2007;334:29


(The Da Qing IGT and Diabetes Study. Diabetes Care1997; 20: 537-544, Wein et al Aust N Z J Obstet Gynaecol. 1999;39:162-6., Jarrett et al. 1979)

type 2 diabetes.

Hauner H et al. Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases. Ann Nutr Metab. 2012;60 Suppl 1:1-58

(through small LDL particles)

”Carbs are bad”

”Carbs are bad”

al. 2009

www.pronutritionist.net

Med Diet and low GI/GL diet

Mente A et al. Arch Intern Med. 2009 Apr 13;169(7):659-69.

High quality diet= a dietary pattern characterized by consumption of
foods recommended in dietary guidelines

reduced risk of cardiovascular, cancer and all cause death

Sivu

Reedy J et al. Higher Diet Quality Is Associated with Decreased Risk of All-Cause, Cardiovascular Disease, and Cancer Mortality among Older Adults. J Nutr 2014; February 26, online

n = 492 823, 86 419 deaths, 15 years of follow up.

Many follow junk food diet (“Western diet pattern”)

Mostly refined carbs, sugar, butter, fatty cheese and processed/red meat

9-24 % of the populations have somewhat “healthy” diet

Nordic monitoring of diet, physical activity and overweight. First collection of data in all Nordic Countries 2011.

grains, solid fats and sugars than recommended and < 50 % of the recommended fruit & whole grain intake

SoFAS: Solid fats and sugar. Source: USDA dietary guidelines, chapter 5

reasons for obesity and type 2 diabetes epidemic

I’m indeed loving it

with increased risk of type 2 diabetes in prospective cohorts

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Alhazmi A., et al. he association between dietary patterns and type 2 diabetes: a systematic review and meta-analysis of cohort studiesJ Hum Nutr Diet 2014;27:251–260

“By contrast, there was evidence of an increased risk of type 2 diabetes by comparing the highest and lowest adherence to unhealthy dietary patterns intake when all studies were pooled (RR = 1.44, 95% CI = 1.33–1.57, P < 0.005) (Fig. 3).

of obesity in prospective cohorts while recommended food items seem to protect from weight gain

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Mozaffarian D et al. Changes in diet and lifestyle and long-term weight gain in women and men. NEJM. 2011;364:2392-404.

of weight gain, type 2 diabetes and deaths. Dietary guidelines are supported by scientific evidence.

Guidelines have never recommended use of refined carbs, ie. low fiber grains, cereals and sugar, which clearly are bad for health

Majority of people do not adhere to dietary guidelines. Substantial part of western populations follow western diet pattern characterized with “junk food”.

Claiming that people receive heart attack or become obese and diabetic by following dietary guidelines is unfounded

the only way of healthy eating.

There are several variants of healthy diets. For example, low carb, “Palaeolithic” and vegan diets can be healthy if food choices are right.

BigStockPhoto. Snapshots from papers and sites referred to.

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