BadenweilerNutrition and Physical Activity26.02.2007 B. Kurth The Impact of Unhealthy Diets Dr. Bärbel-Maria Kurth Badenweiler, Germany Conference from.

BadenweilerNutrition and Physical Activity 26.02.2007 B. Kurth

The Impact of Unhealthy DietsDr. Bärbel-Maria Kurth

Badenweiler, GermanyConference from 25 – 27 February 2007

Prevention for HealthNutrition and Physical Activity – A Key to Healthy Living


Dietary Habits and Health What do we know? What is recommended ?

Epidemiological Background in Europe Knowledge of Dietary Habits European Activities for HarmonisationNational Activities Nutritional Report of the Netherlands:

„Our Food-Our Health“ Health and Nutritional Surveys in

Germany

Vision for Europe European Public Health Nutritional

Concept


Dietary Habits and Health What do we know?

4BadenweilerNutrition and Physical Activity 26.02.07 B. Kurth

Evidence for relationships between nutrients and several chronic diseases (adapted from RIVM 2004, WHO 2003)

Obesity Type 2 Cardiovascular Cancer Dental Osteo-

diabetes diseases disorders porosis Energy and fats High intake of energy-dense food Saturated fatty acids Trans fatty acids Dietary cholesterol Myristic acid and palmitic acid Linoleic acid Fish and fish oil (EPA and DHA) Phytosterols and phytostanols α-Linolenic acid Oleic acid Nuts (unsalted)

Carbohydrates High intake of dietary fibre Free sugars Sugar-free chewing gum Wholemeal cereal products

Vitamins Vitamin D Folic acid

Minerals High sodium intake Products preserved in salt and salt Potassium Calcium Fluoride

convincingly increases risk; probably increases risk; convincingly decreases risk; probably decreases risk


Evidence for relationships between foods and several chronic diseases (adapted from RIVM 2004, WHO 2003)

convincingly increases risk; probably increases risk; convincingly decreases risk; probably decreases risk

Obesity Type 2 Cardiovascular Cancer Dental Osteo- diabetes diseases disorders porosis Meat Canned meat Fruit and vegetables Fruit and vegetables Non-alcoholic beverages Sugar-sweetened soft drink and fruit juice Very hot beverages (and food) Unfiltered boiled coffee Alcoholic beverages High alcohol intake Low to moderate alcohol intake Others Hard cheese Exclusive breastfeeding


Recommendations for „healthy diet“:

Balanced diet: British Journal of Nutrition, Vol. 92 supplement 2, October 2004 or Dietary Guidelines for Americans: www.helathierus.gov/dietary guidelines or the nutritional pyramid of the US Department of Agriculture: www.mypyramid.gov

EURODIET recommends: “Guidelines should first be developed for individual member states.”


The 5 a day initiative: (Started by the NIH, USA)Model projects in several European Countries

Promoted by many organisations, WHO, the European Commission, the World Cancer Research Fund,the German Cancer Society, the IARC


Epidemiological Background in Europe


Knowledge of Dietary Habits

European Nutrition and Health Report 2004(Forum of Nutrition, Vol. 58):

Summarising National Nutrition ans Health Reports:

•Too high intake of fat, especially saturated fat•Generally too high intake of alcohol, especially for men•Too high availability of meat and meat products•In some countries low availability of fruits and vegetables•Generally inadequate intake of some vitamins and minirals•Alarming high prevalence of overweight and obesity


European Activities for Harmonisation

EURODIET project (2000):Methodological differences between the European countries in approaches to dietary surveys have a remarkable influence on the results and their comparability.

European projects: Developing standardised method for dietary surves:EFCOSUM (European Food Consumption Survey Method) EFCOVAL (European Food Consumption Validation) Establishing a European nutritional data base:EuroFir-Projekt (European Food Information Resource Network) EUROFOODS-ENFANT (European Network on Food and Nutrition Tables


National Activities Nutritional Report of the Netherlands


Our food, our healthHealthy diet and safe food in the Netherlands (2006)


Our food, our healthHealthy diet and safe food in the Netherlands (2006)

Goals:

Stopping the further increase of the prevalence of overweight in the population

Balanced Diet:Proper composition of fatty accids in the dietregular fish consumption,adequate fruit and vegetables intake


Priority 1: The promotion of healthy diet, which involves a two-pronged approach:

Healthy diet

Promotion of a healthy composition of diet

Reduction of overweight and obesity


National Activities Health and Nutritional Surveys in Germany


Health and Nutritional Surveys in Germany

Knowledge of the composition of diet


Main sources of energy intake in Germany (National Health Survey 1998, German Population 18-80 years)

0 5 10 15

Potatoes

Fruit

Cereals

Beer

Plant oil/fat

Meat

Sausage

Sweets

Bread

Milk, Milkprod

Men

0 5 10 15

Animal Fat

Cakes

Meat

Sausage

Cereals

Plant oil/fat

Fruit

Sweets

Bread

Milk, Milkprod

Women


Intake below recommended level (National Health Survey 1998, German Population 18-80 years)

0 20 40 60 80 100

Dietary fiber

Vitamin D

Vitamin E

Folate

Calcium

Iron

Men Women


Percentage of adults which consume more than 400 g fruits and vegetables per day (excluding juices) (National Health Survey 1998, German Population 18-80 years)

0 10 20 30 40 50 60 70

18-24

25-34

35-44

45-54

55-64

65-79

Age

%

Men Women


National Health Survey for children and adolescents (0-17 years)Germany 2003-2006 (KiGGS)

The survey was conducted from May 2003 till May 2006 in 167 cities and communities (Sample Points).

Boys and girls aged 0 to 17 years were chosen randomely from population registries.


(KiGGS) : Self-administered Questionnaire: parents, children, adolescents

Physical Health, Diseases

Mental Health, Problems

Social Health, Living conditions

Lifestyle, Health Behaviour,Health Risks

Health Care


(KiGGS): Physical Measurements and Tests

anthropometry

vision tests

blood pressure, heart rate

motor activity, co-ordination

sonography of the thyroid gland


National Health Interview and Examination Survey of Children and Adolescents (KiGGS)


Percentage of boys and girls with daily fruit consumption (KiGGS results)

0

10

20

30

40

50

60

70

80

3-6 y. 7-10 y. 11-13 y. 14-17 y. 3-6 y. 7-10 y. 11-13 y. 14-17 y.

Boys Girls

%


0

10

20

30

40

50

60

70

3-6 y. 7-10 y. 11-13 y. 14-17 y. 3-6 y. 7-10 y. 11-13 y. 14-17 y.

Boys Girls

%

Percentage of boys and girls with daily vegetable consumption (KiGGS results)


0,0

10,0

20,0

30,0

40,0

50,0

60,0

3 - 6 y. 7 - 10 y. 11 - 13 y. 14 - 17 y. 3 - 6 y. 7 - 10 y. 11 - 13 y. 14 - 17 y.

Boys Girls

%

Percentage of boys and girls with daily soft drinks consumption (KiGGS results)


Outlook: EsKiMo -The Eating study as a KiGGS Module

A nutrition survey in 2006 in a subsample of KiGGS

Parents of children aged 6-11 years filled in a 3 day dietary record

Participants aged 12-17 years were interviewed at home (diet history)


Health and Nutritional Surveys in Germany

Overweight and obesity


Prevalence of Obesity (95% Confidence Interval) National Health Surveys from 1984 to 1998, Men

Alte Bundesländer Neue Bundesländer

1984 1987 1991 1998 1992 199810%

15%

20%

25%

30%

H. Knopf, G. Mensink, E. Bergmann, Th. Lampert


(KiGGS): Prevalence of overweight and obesity Children and adolescents 3-17 years

Clear increase over reference data from 1985-1999.No differences between boys and girls.

Overweight Subgroup: Obesity

10%

3%

Prevalence of overweight

Boys Girls Total 0%

4%

8%

12%

16%

20%

24%

15 15 15

Prevalence of obesity

Boys Girls Total 0%

4%

8%

12%

16%

20%

24%

6.3 6.4 6.3


Boys Girls Total

0%

4%

8%

12%

16%

20%

24%

15 15 15


(KiGGS): Prevalence of overweight by age groups

Strong increase in primary school age, afterwards only a slight further increase.

10%


Boys Girls

0%

4%

8%

12%

16%

20%

24%

3-6 yrs 7-10 yrs 11-13 yrs 14-17 yrs

8.9

16

1817

9.3

15

1917


(KiGGS): Prevalence of obesity by age group

Strong increase in primary school age, especially in boys.

3%

Prevalence of obesity

Boys Girls

0%

4%

8%

12%

16%

20%

24%

3-6 yrs 7-10 yrs 11-13 yrs 14-17 yrs

2.5

7.0 7.08.2

3.3

5.77.3

8.9


(KiGGS): Prevalence of obesity by socioeconomic status

Obesity is more prevalent in children coming from families with lower socioeconomic status.

obesity, stratified by socioeconomic status

low middle high

0%

4%

8%

12%

16%

20%

24%

3-6 yrs 7-10 yrs 11-13 yrs 14-17 yrs

4.4

9.8

1214

3.0

6.3 5.97.5

1.33.0 3.6

5.2


(KiGGS): Prevalence of obesity by migration status

Children with migration background show higher obesity prevalences

obesity, stratified by migration status

migration backgroundno migration background

0%

4%

8%

12%

16%

20%

24%

3-6 yrs 7-10 yrs 11-13 yrs 14-17 yrs

4.9

11 10 9.4

2.4

5.4 6.48.3


Vision for EuropeEuropean Public Health Nutritional Concept


European Community Health Indicator Project (ECHI)

European Community Health Indicator Project (ECHI),collecting comparable health indicators for application in all European countries “short list”: Indicators recommended as basis for European data collection.


European Community Health Indicators (ECHI-shortlist) for Nutrition & Health

Health Determinants Health Effects

Total Energy IntakeBody Mass Index, Prevalence of Overweight and Obesity

►

Consumption and availability of vegetables

► Self-perceived health ►

Consumption and availability of fruits

► Blood pressure

Alcohol consumption (Hazardous alcohol consumption)

► Diabetes, Prevalence ►

Physical Activity ► Cardiovascular Morbidity ►

Health Interventions: Health Promotion

Alcohol-related deaths

Policies on healthy nutrition Limitations in physical functions ►

Policies and practices on healthy lifestyle

Life expectancy and

Disability-free life expectancy (DFLE)


European Community Health Indicators (ECHI) referring to nutrition

Available ECHI-indicators Limited available (Coverage/Comparability/Time)

BMI, Prevalence of Overweight and Obesity

Total Energy Intake

Diabetes (Mortality, Hospital disch.) Consumption and availability of vegetables and fruits

Alcohol consumption Alcohol-related deaths

Self-perceived health Limitations in physcial functions

Life expectancy and DFLE Blood pressure

Cardiovascular Mortality Cardiovascular Morbidity

Physical activity


European Health Interview Survey

In case that recommended indicators will be integrated the comparability of food patterns will be achieved.

Result: •Setting European Priorities•European recommendations for balanced Diet•European activities for healthy diet

and…..


Our food, our health

Healthy diet and safe food in Europe

BadenweilerNutrition and Physical Activity26.02.2007 B. Kurth The Impact of Unhealthy Diets Dr. Bärbel-Maria Kurth Badenweiler, Germany Conference from.

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