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1、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; w
2、e are heterotrophsWhy we eat what we eatImage courtesy of EconomicreasonsMediaandmarketingIcantaffordtobuyfreshfruitIdonthavetimetocookwellhavetakeouttonightItsasuperfoodIwillbehealthierifItakeamultivitaminpillCarbohydratesarebadCarbohydratesaregoodIneedtodetoxOrganicishealthierAre you what you eat?
3、 Your nutritional status has three parts:What you eat dietquantityandnutritionalqualityWhat you are bodyandtissuesizeandcompositionWhat you can do functionalcapacitiesfrommoleculartosociallevels,includingphysicalandenzymaticactivitiesLecture OutlineWhatwegetfromfoodMacronutrients,micronutrientsandph
4、ytonutrientsHowdietaffectshumanhealthNutritionresearchDietarydeficienciesDietandchronicdiseasesMediaandmarketingWhatcanscientistsdo?Image courtesy CDC and Mary Anne Fenley (number 13053)What is food? Food comes from plants: leaves, fruits, shoots, roots and seeds Themeatinourdietcomesfromanimalsthat
5、eatplantsWhat we get from foodMacronutrientscontainenergy(calories)Carbohydrates,fatsandproteinsfuelsandbuildingblocksFiberbowelhealth,satiationMicronutrientsVitamins,tracemineralsPhytonutrientsProtectivefunctionsCarbohydrates include sugars, starches and celluloseCarbohydratesaresugars.Theycanexist
6、asmonomerslikeglucoseanddimerslikesucroseCarbohydratescanalsobelongpolymers.Starchisapolymerofglucosejoinedwithanalphalinkage.CelluloseisapolymerofglucosejoinedwithabetalinkageglucosesucrosestarchcelluloseNot all carbohydrates are easily digested and assimilatedInyourbody,sucroseandsomestarchesareco
7、nvertedintoglucoseMammalsdonotproduceanenzymethatbreaksthebondsincellulose,soitisnotabsorbedbutpassesthroughthegutundigestedSome animals carry cellulose-digesting bacteria in their gut, but we dontSomestarchesarenotdigestedCarbohydrate metabolismMikael HggstrmEverycellinyourbodyusesglucosetoproducee
8、nergy(ATP).Excessglucoseisstoredasglycogen(short-termstorage)orfatSugars fuel plant and animal cellsCytoplasmGlucosePyruvateATPPlant cellAnimal cellMitochondriaVacuoleNucleusNucleusPlantandanimalcellscontainmitochondria.GlucosefuelstheformationofATP,cellularenergy,withinthemitochondriaInthecytoplasm
9、,glucoseisconvertedtopyruvate,whichentersthemitochondriaandthroughthetricarboxylicacidcycleproducesaprotongradientthatdrivesATPsynthesisSome carbohydrates are soluble dietary fibersSolubleorviscousfibersarephysiologicallyactive.Theydecreaseuptakeoffatsandsugarsfromtheintestine,andarefermentedbyintes
10、tinalbacteriaintobeneficialshort-chainfattyacids(e.g.butyrate)Viscousfibersincludegums,pectinsandmucilages,andtheycanfeelstickyormucuslike.Thegel-likematrixtheyformisessentialtotheirfunctionintheintestineinulinOats,okraandlegumeseedsaregoodsourcesofsolublefibreSome carbohydrates are insoluble dietar
11、y fibersManyinsolubledietaryfibersareinertbutneverthelessmaybebeneficialtointestinalhealthInsolublefibersincludecellulosesandlignin.TheymayhelpwithafeelingofsatiationWholewheatfoodsorwheatbran,manyvegetables,andfruitskinsaregoodsourcesofinsolublefiberProteins are polymers of amino acidsGASTCVLIMPFYW
12、DENQHKRThesidechain,R,ofanaminoaciddeterminesitschemicalproperties.ProteinpropertiesarespecifiedtheiraminoacidcompositionThenitrogen-containingaminogroupisanimportantfeatureofaminoacidsProteins have many roles enzymes, muscle, etc.Musclemeat,milkandeggsareconcentratedsourcesofanimalproteinwidelyused
13、asfood,buteveryanimalandplantcellcontainsprotein.LegumeseedsareparticularlyproteinrichProtein metabolismMikael HggstrmSomeingestedproteinsarebrokendowntoaminoacids,thenrecombinedtoformnewproteins;e.g.muscle,redbloodcellsMostareusedasanenergysourceExcessaminoacidscanbeusedasanenergysource,withnitroge
14、nexcretedinurineAssimilationofaminoacidsintoproteinsLipids- fats and oilsLipidsarehydrocarbons,energy-richcompounds.Likegasoline,lipidsreleaseenergywhenoxidized.Plantsandanimalsstoreenergyaslipids,andlipidsarealsonormalcomponentsofeverycellandthebasisofthecellmembranes.Atroomtemperature,fatsaresolid
15、andoilsareliquid,butbotharelipidsManyanimal-derivedfoodsarehighinfatOilsarelipidsextractedfromplantseedsorfruitsFatty acids have acidic groups attached to fatty hydrocarbon tailsCCCCHHHHHHHHCCCCHHHHHHThehydrocarbontailissaturatedwhenitincludesamaximalnumberofhydrogenatoms,andunsaturatedwhencarbon-ca
16、rbondoublebondsarepresentSaturatedeachcarbonisboundtotwohydrogensUnsaturateddoublebondsbetweencarbonsarepresentAcidgroupFattytailFatty acids are saturated, monounsaturated or polyunsaturatedSaturatedfattyacid(SFA)abundantinanimalfats(meatandbutterfat)Monounsaturatedfattyacid(MUFA)abundantinsomeoils(
17、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
18、fatsOleicacid,acisfatElaidicacid,atransfatAsstraightermolecules,transfatspacktogethermoretightlyandsohaveahighermeltingpointthancorrespondingcisfats,illustratedbythedifferencebetweenmargarineandoliveoilTransfatscanbelessexpensivetoproducethanothersolidfats,andbecamewidelyusedintheprocessedfoodindust
19、riesOmega-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.Althoughthehumanb
20、odycansynthesizelipids,afewlong-chainfattyacidsareproducedinefficientlyornotatallandmustbeingestedthroughthedietEssentialfattyacidsincludesomen-3andn-6fattyacidsAlpha-linolenicacid(ALA)Eicosapentaenoicacid(EPA)Docosahexaenoicacid(DHA)Linoleicacid(LA)Arachidonicacid(AA)3Omega-3 and omega-6 fatty acid
21、sOmega-3Omega-6Omegaornreferstothelastcarbon.N-3fattyacidshaveadoublebondatthethirdcarbonfromtheend,n-6fattyacidshaveadoublebondatthe6thcarbonfromtheendN-3 and n-6 fatty acids are eicosanoid precursorsn-6LinoleicAcidn-3Alpha-linolenicacidPro-inflammatoryn-6derivedeicosanoidsAnti-inflammatoryn-3deriv
22、edeicosanoids6-DesaturationElongation5-DesaturationDietEicosanoidsareafamilyofsignalingmoleculeswithdiversefunctionsAhighratioofn-3ton-6fattyacidsmaypromotehealthDietary n-3 fatty acids can protect against chronic diseasesDocosahexaenoicacid(DHA)-linolenicacid(ALA)Eicosapentaenoicacid(EPA)ALAmustbea
23、ssimilatedthroughthediet.DHAandEPAareproducedfromALAwithlowefficiencyDHAandEPAareproducedbymarinealgaeandaccumulateinsomefish,makingfishgoodsourcesofbeneficialn-3fattyacidsN-3fattyacidshavebeenshowntohaveprotectivefunctionsforcardiovasculardisease,and,inrats,protectagainstneurodegenerationMicronutri
24、ents vitamins are essential small moleculesVitaminsareessentialnutrientsthatweneedtoeatbecausewecannotsynthesizethemVitamin A Vitamin C, ascorbic acidVitamin B1, thiamine Vitamin B3, niacineVitamin B9, folateVitamin DFortifiedfoodsVitamin EVitamin KWhenexposedsosunlight,humanscanmakevitaminDtosupple
25、mentdietarysourcesSeveral dietary minerals are essential for human healthIron (Fe) isassimilatedasheme(fromanimals)andnon-heme(fromplants)forms;non-hemeiron,arelessefficientlyassimilated.Leafygreensandbeansaresourcesofnon-hemeironBrazilnutsareanunusuallygoodsourceofselenium (Se).TheSecontentoffoodsd
26、ependslargelyonsoilcontentPotassium(K+)helpsmaintainosmoticbalanceandisabundantinfruits,beans,potatoesCalcium(Ca2+)isabundantinmilk-productsandgreenleafyvegetablesZinc(Zn2+)isfoundinanimal-derivedfoods,beansandnutsMineral nutrition depends upon soil composition and bioavailabilityZn2+Zn2+Soilavailab
27、ilitystronglyaffectsplantnutritionalqualityAssimilationefficiencySequestrationintograinorotherfoodAssimilationefficiencyandbioavailabilityMineralavailabilityinthesoilandbioavailabilityinthegutarethemajorfactorsthataffectdietaryuptakeThe bioavailability of some minerals interferes with their assimila
28、tionHambidge, K.M. (2010). Micronutrient bioavailability: Dietary Reference Intakes and a future perspective. The American Journal of Clinical Nutrition. 91: 1430S-1432S.Phytateisabundantinseeds;itsnegativechargebindspositivelychargedionsandinterfereswiththeirassimilationSeleniumuptakeintothegutisen
29、hancedwhenitisinanorganicformNonhemeironfromplantsisnotassimilatedasreadilyashemeironfrommeatFe+Zn+Zn+Zn+Zn+Zn+Zn+Fe+SeSePhytonutrients can have long-term health benefitsSomeplant“secondarymetabolites”arephytonutrientsAlthoughphytonutrientshavenotbeenshowntobeessentialforhumanhealthinthesamewaythatv
30、itaminsandmineralsare,theymaybeimportantforlong-termhumanhealthPhoto-synthesisCarbohydratemetabolismFattyacidmetabolismNitrogenmetabolismTerpenesAlkaloidsPolyketidesFlavonoidsQuinonesCoumarinsTanninsGlycosinolatesCyanogenicglycosidesPrimary metabolitesCorecompoundsfoundinmostorganismsSecondary metab
31、olitesOfteninvolvedindefenseorinteractionswithpollinatorsandofteninonlyafewspeciesPhytonutrients: flavonoids, anthocyanins and related compoundsHesperetin aflavanonefoundincitrusfruitsCurcumin fromthespiceturmerichasantioxidantandanti-inflammatorypropertiesCyanodin-glucoside,areddishcoloredanthocyan
32、inwithnumeroushealthbenefitsQuercitin aflavonoidfoundinmanyplantsGenisteinanisoflavonoidfromsoybeansEpigallocatechin gallate (EGCG),aflavonoidfromgreenteathatmayhelpeliminateimmortalityfromsomecancercellsPhytonutrients: carotenoidsReprinted from Cazzonelli, C.I. and Pogson, B.J. (2010). Source to si
33、nk: 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-caroteneisconvertedtovitaminAafteringe
34、stionlycopeneluteinCarotenoids 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 Ca
35、se-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,andEmayprotectey
36、esLuteinandzeaxanthinaccumulateinthemacula,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 fascinati
37、on 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-canceractivitiesIsothiocyanatessuchassulforaphanearederivedfro
38、mcruciferousvegetablesandhaveanti-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 la
39、beling guideFoodswhosehealthbenefitsgobeyondtraditionalnutrientsaresometimescalledfunctionalfoods.ClaimsforhealthbenefitsbeyondconventionalnutritionarestringentlyregulatedInJapan,morethan700functionalfoodsarelabelledFOSHUFoodsforSpecifiedHealthUse*Plantsterolsareshowntoreducebloodcholesterol,andhigh
40、cholesterolisariskfactorinthedevelopmentofcardiovasculardisease“BENECOLSpreadsaretheonlyproductsintheU.S.thatcontainPlantStanolEsters,adietaryingredientthatlowerscholesterolandmayreducetheriskofheartdiseasewhenusedaspartofalowsaturatedfat,lowcholesteroldiet.”As an example, in the EU and US, some foo
41、ds containing plant sterols can make specific health claimsIntestinal bacteria are an important part of nutritionIntestinal lumen100,000,000,000,000bacterialiveinthehumanintestine(thatsmorethanthenumberofyourcellsinyourbody)Intestinalbacteriahelptodigestfoodthatyourownenzymescannot,allowingittoenter
42、yourbloodstreamGut bacteria affect nutrient assimilation rodent studiesGermfreemice(artificiallyrearedwithoutgutbacteria)needtoeatalotmorefoodtotakeinenoughcaloriesbecausetheyarelessefficientatassimilatingfood.Eventhoughtheyeatless,thenormalmicehave40%morebodyfatthanthegermfreemiceTransferringbacter
43、iafromthenormalmousetothegerm-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.
44、 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.T
45、hegutbacteriatransferredintothegerm-freemiceaffectedtheirweightgain;micethatreceivedbacteriafromobesemicegainedmoreweight(greaterabilitytoharvestenergyfromtheirfood)RecipientObesedonorGreaterweightgainRecipientNormaldonorNormalweightgainGut microbes (microbiota) affect human healthReprinted by permi
46、ssion 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-beingThephytonutrientequolisproducedfromsoybeansbytheactiono
47、fcertainintestinalbacteria;onlysomepeopleproduceequol,dependingupontheirgutmicrobiotaEquol,abeneficialphytonutrient(forsomepeople!)Assimilation of nutrients from food is a complex processProcessingMouthStomachIntestineBloodMaceration-amylase digestion of starchCell wall fragments and cellulose expel
48、ledDigestion of polymers to monomersAssimilationintobloodLipasesChemical contributions from bacteriaFeedbackandhomeostasismechanismsSummary what we get from foodFood provides fuelCaloriesareanindicationofthechemicalenergystoredinfoods.OurbodiesconvertfoodsintoATP,theenergythatdriveschemicalreactions
49、,movement,nerveactivitiesetc.Food provides building blocksFoodprovidestherawmaterialssuchasaminoacidsneededforgrowthandrepairofourbodiesFood provides essential small moleculesVitamins,mineralsandphytonutrientsarenecessarymoleculesthatwemustassimilatethroughoutdiet.Somearecofactors,somebindoxygen,som
50、eactasantioxidantsoranti-inflammatoryagentsHow nutrition research is conductedHowdoscientistsdeterminehowmuchandwhatkindsoffoodsareoptimalforhumanhealth?Volunteers,whoarewillingtoeatregimenteddietsandhavetheirbodysfunctionsmonitored,areindispensablePhotos by Stephen Ausmus, Peggy Greb, Brian Prechte
51、l 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 (lin
52、k)1749.Afterseveralmonthseatingonlygruel,muttonbrothandboiledbiscuits,sailorsexperienced“.putrid gums, the spots and lassitude, with weakness of the knees”.JamesLindsupplementedthedietofsixpairsofsicksailorswith:cider,vinegar,seawater,elixir of vitriol (dilutesulphuricacid),ortwoorangesandalemon.Tho
53、sereceivingfruitrecoveredquickly,but50yearspassedbeforethetreatmentwaswidelyincorporatedintonavalpracticeMorethanhalfof18thcenturysailorsdiedfrommalnutritiononlongvoyagesTypes of human nutritional studiesEpidemiological Compareeatinghabitsanddiseaseincidencebetweenpeoplefromdifferentregions(e.g.Fran
54、ceandJapan)Retrospective “case control”Howdothedietaryhistoriesofpeoplewithadiseasecomparetothoseofasimilardemographicgroupwithoutthedisease?Epidemiological cohortCollectdataaboutdietaryhabitsoflargenumbersofpeoplebeforediseasesareevident,andlookforpatternsamongstthosethateventuallydevelopdiseaseCli
55、nical intervention Providematcheddietswithsinglevariabletomatchedexperimentalandcontrolgroupstodetermineeffectsondisease(requiresinformedconsentandadequatenumberstoprovidestatisticalpower)Inthe21stcentury,ethicalguidelinesregulatehumanexperimentationQuestionnaire-based studies are augmented by lab s
56、tudiesAdapted 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 cultureRegionaldietsFoodsurveysHowdoesXaffectc
57、ellviability?HowisX takenupandmetabolized?HowisXtakenupandmetabolizedinvivo?HowdoesadietenrichedforXaffecthealthintheanimalmodel?HowisXassimilated,andhowdoesadietenrichedforXaffecthealthinhumans?Human intervention studies are convincing, but complex, expensive and difficult!Summary how can we unders
58、tand results from nutritional studies? Nutritionisanactivesciencewithanevergrowingbodyofdata.UnderstandingtherolesofanyonefoodornutrientrequiresevaluatingalloftheavailabledataStudiesmaybeweightedbythetypeofstudyandthenumberofpeopleorsamplesstudiedIfafoodprovidesasmallbenefittosomeindividuals,canweme
59、asureit,andhowdoweinterpretthisinformation?Howdowedecidewhatissufficientevidencetomakearecommendation?How diet affects human healthDietarydeficienciesleadtodisabilityanddeathDietisafactorinsomechronicdiseasesMetabolicsyndromeType2diabetesCardiovasculardiseaseCancerPhoto credit: IRRIMore than one bil
60、lion 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)Cropfailuresespeciallyin
61、vulnerableregionscanleadtofaminesWar,conflictandcorruptioncaninterferewithfooddistributionPovertycontributestochronicmalnutritionb.usuhs.mil/biochem/nutrition/NOTES/Vitamin A deficiency is a leading cause of blindness100millionchildrenareVitaminAdeficientUpto500,000childrenbecomeblindeveryyearandhal
62、fofthesediewithin12monthsoflosingtheirsightImprovingdietaryintakeofcarotenescanreducechildmortalityby25%WHO dataOccurrenceofVitaminAdeficiency(VAD)Many people suffer deficiencies of other vitamins and mineralsImage courtesy CDC (number 6179) Image courtesy CDC (number 3998) Image courtesy CDC (numbe
63、r 2435)Pellagraisadeficiencyofniacin(vitaminB3)Inflamed,scorbuticgumscausedbyvitaminCdeficiencyNutritionalRicketsisaconditioninwhichbonesaretoosoftduetoadeficiencyofvitaminDAnemiacausedbyirondeficiencyaffectshalfofallpre-schoolagedchildrenDietary deficiencies are also widespread in the developed wor
64、ldPercent 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,
65、 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 pr
66、ograms 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 Fo
67、rtification. The National Academies Press.Photo credit: Neil Palmer (CIAT).Biofortification is breeding or growing plants for increased nutrient contentIron-biofortifiedriceDietary deficiencies - Summary HalfthepeopleontheplanetarethoughttosufferfromatleastonenutritionaldeficiencyWomen,childrenandth
68、epooraredisproportionallyaffectedFoodenrichment,fortificationandbiofortificationprogramscanhelpInparallel,effortsareunderwaytomakedietaryvarietymorewidelyavailableandaffordableChronic diseases are a leading cause of deathChronicdiseasesareprojectedtocause388milliondeathsinthenext10yearsChronicdiseas
69、esincludecardiovasculardisease,cancer,diabetesandrespiratorydiseasesGlobally,chronicdiseaseskillmorethantwiceasmanypeopleasinfectiousdiseasesincludingHIV/AIDSWorld Health Organization (2011). Global status report on noncommunicable diseases 2010. (Geneva, Switzerland: World Health Organization).Chro
70、nic diseases affect all income levels80%ofmortalityfromchronicdiseaseoccursinlowandmiddleincomecountriesThepooraremorevulnerabletochronicdiseasebecauseofincreasedexposuretorisksanddecreasedaccesstohealthcareChronicdiseasescausepovertyWorld Health Organization (2005). Preventing Chronic Diseases: A V
71、ital Investment.There is a strong connection between diet and chronic diseaseUnhealthyeatingPhysicalinactivityColoncancerProstatecancerType2diabetesKidneydiseaseCardio-vasculardiseaseHighbloodpressureLungcancerObesityHighbloodcholesterolBreastcancerGlobally,morepeopleareoverweightthanundernourished6
72、5%oftheworldspopulationliveincountrieswhereoverweightandobesitykillsmorepeoplethanunderweightSource: WHOMetabolic syndrome: a set of related conditions that predispose ill healthPhoto credits: Amanda Mills and James Gathany, Centers for Disease ControlThekeycomponentisalargewaistcircumferenceplustwo
73、outoffourof: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 Z
74、immet, 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 syndromeAlargewaistcircumferenceis
75、alsoknownasan“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., Vi
76、llareal, 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
77、 permission from Oxford University Press.MRIscansofawomanandmanshowingfatinwhite.Subcutaneousfatisoutsidetheabdominalwall,whereasvisceralfatiswithinit,surroundingtheorgansVisceralfatsecretesinflammatorycompoundsthatcontributetolipidoxidationandthedevelopmentofinsulininsensitivityScans show cross-sec
78、tion of abdomenCytokine production by visceral fat contributes to chronic diseaseAbdominal fatMuscleLiverExcessfatintheabdomencausesthelivertoreleaseglucose,andlowerstherateofuptakebymuscle,contributingtothedevelopmentoftype2diabetesglucosereleaseglucoseuptakeReproduced from Han, T.S., Sattar, N. an
79、d 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,isanautoimmunediseasetha
80、tcausesalossofinsulinproduction,andisusuallydiagnosedduringchildhood20072025(projection)Type2diabetesisalargelyaconsequenceofpoordiet,obesity,andphysicalinactivity,andisusuallydiagnosedinadulthood.TheincidenceofType2diabetesisincreasingrapidlyDiabetes interferes with the regulation of glucose levels
81、Intestinal lumenDietary sugarsPancreas cellInsulinWhite adipose tissueGlucoseistakenupintothebloodstreamGlucosetriggersinsulinproductionbypancreatic-cellsInsulinregulatesbloodglucoselevelsbypromotinguptakeintomuscleandwhiteadiposetissue,blocking release bytheliverandblocking further uptake fromthein
82、testineMuscleLiverType 1 diabetes is caused by a loss of insulin productionIntestinal lumenDietary sugarsPancreas cellWhite adipose tissueGlucoseistakenupintothebloodstreamType1diabetescancauseveryhighbloodglucoselevels,leadingtotissuedamage.TypeIdiabetescanbemanagedbyinjectedinsulin10%ofdiabetesisT
83、ype1MuscleType1diabetesinvolvestheautoimmunedestructionofcellsproducinginsulininthepancreasType 2 diabetes is caused by insulin resistanceIntestinal lumenDietary sugarsPancreas cellInsulinWhite adipose tissueGlucoseistakenupintothebloodstreamGlucosetriggersinsulinproductionbypancreatic-cellsInsulinr
84、esistancemeansthatglucoseisnotclearedfromthebloodanduptakefromtheintestineisnotswitchedoff.Injectedinsulindoesnotefficientlymanagetype2diabetes90%ofdiabetesisType2MuscleMetabolic syndrome and type 2 diabetes are preventable and reversiblePhoto credits: CDC/ Amanda Mills, Amanda Mills, Amanda MillsMa
85、intainahealthyweightExercisefrequentlyDontsmokeThenot-so-secret“secret”Cardiovascular diseaseCardiovasculardiseases(CVDs)arethenumberonecauseofdeathgloballyCVDsincludestroke,heartattack,atherosclerosisandhighbloodpressure30%ofallglobaldeaths-17.3millionpeoplewerefromCVDsin2008By2030,23.6millionpeopl
86、ewilldiefromCVDsOver80%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 systemBl
87、oodpassesfromtheintestinethroughtheliver,whichremovesanyingestedtoxinsandprocessesingestedfatsTheheartpumpsbloodthroughalltheorgansandtissuesBloodisoxygenatedbypassingthroughthelungsArteriescarryoxygenatedbloodunderhighpressureCVDs result from elevated blood pressure and plasma fat levelsBloodpressu
88、reisaffectedbydissolvedsolutesincludingsodiumandglucose,andatherosclerosis(thickeningandhardeningduetofattydeposits)Dietaryfatsmovethroughthebloodaslipoproteins,composedoftriglyceride,cholesterolandproteins.Ahigh-fatdietleadstoelevatedbloodplasmafatlevelsLDL(lowdensitylipoproteins)arehighincholester
89、olandcandamagethecardiovascularsystemHDL(highdensitylipoproteins)helpremoveexcesscholosterolfromthebodyElevated blood plasma lipid levels contribute to CVD DyslipidemiaistoomuchfatcirculatinginthebloodandisaconsequenceofgeneticfactorsanddietLDL (low density lipoproteins)60mg/dLor1.56mmol/LExcessivea
90、mountsofplasmafatfromapersonwithdyslipidemiaHealthy levels of plasma lipidsTriglycerides150mg/dLor1.7mmol/LTotal cholesterol 30) in U.S. AdultsIntheUS,morethan72millionadultsareobeseObesityincreasesmedicalcostsbyanaverageof$1429perpersonperyearTargetedobesitylevelsof15%arecurrentlymetbyzerostatesSim
91、ilar trends are found around the worldConclusions and challengesMake the healthy choices the easy choicesEncouragephysicalactivity(e.g.buildbicyclelanesandsafe,accessibleparks)EnsurehealthyfoodsareaffordableandavailableHelpconsumersmakeinformeddecisionsHowcanwechangepeopleshabitstoreducetheincidenceofchronicdiseases?
