Dietary guidelines are right

Following dietary guidelines is associated with reduced risk of type 2 diabetes, coronary heart disease and obesity. Scientific evidence Registered dietitian, M.Sc, MBA Reijo Laatikainen www.twitter.com/pronutritionist Page 1

Why this slide deck? Numerous accusations by some representatives of low carb 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? 2

1. Randomized mortality & morbidity trials 2. Prospective cohorts 3. Randomized risk marker studies 4. Cross-sectional and case-control cohorts 5 Ecological & animal studies Strengthofevidence Meta-analyses of 1,2 & 3 Modified from: Micha & Mozaffarian. Lipids. 2010; 45(10): 893905 and Evidence Analysis Manual. Academy of Nutrition and Dietetics January 2012 Hierarchy of evidence in nutrition science

Commonly recommended dietary patterns have many names and their quality varies 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. 4

Their claim: This food pyramid is the root cause of OBESITY EPIDEMIC Carbs are bad Carbs are bad

Dietary macronutrients and long term weight change Systematic review by Fogelholm et al 2013 6

Prudent diet, healthy diet and Med Diet reduce the risk of weight gain 7 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

Fiber rich carbohydrates associated with lower body weight and refined carbs with weight gain 8 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

Meat is associated with weight gain. Dairy is associated with lower weight 9 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

No evidence that share of carbs in a diet is a determinant of weight gain 10 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

Carbs and weight management Systematic review by Hauner et al 2012 www.pronutritionist.net11

Intake of carbs is not associated with with risk of obesity. 12 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

Fiber rich carbs are associated with reduced risk of obesity. Sugary drinks increase the risk of weight gain 13 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

Their claim: This food pyramid is the root cause of TYPE 2 DIABETES EPIDEMIC Carbs are bad Carbs are bad

Type 2 diabetes Meta-analyses of prospective cohorts by Esposito et al. 2014, 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.net15

Healthy dietary pattern is associated with reduced risk of type 2 diabetes Page 16 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;27:251260

DASH, Med Diet and healthy dietary pattern are all associated with reduced risk of type 2 diabetes Page 17 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.

Systematic review of prospective cohorts and RCTs: whole grains associated with 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 Page 18 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.

Meta-analysis of RCTs: recommended diet reduces the risk of type 2 diabetes 19 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)

Share of carbs per se is not associated with risk of type 2 diabetes. 20 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

Their claim: This food pyramid is the root cause of ATHEROSCLEROSIS (through small LDL particles) Carbs are bad Carbs are bad

Recommended dietary pattern and coronary heart disease (CHD) Meta-analysis by Mente et al. 2009 www.pronutritionist.net22

Meta-analysis: risk of coronary heart disease reduced by High quality diet, 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

Pooled analysis of 2 prospective cohorts. Healthy diets are associated with reduced risk of cardiovascular, cancer and all cause death Sivu 24 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. Total mortality CVD mortality Cancer mortality Healthy Eating Index -22% -15% - 24% Mediterranean diet -27% -20% -20% DASH diet -17% -14% -20% Results shown are for males. Results for women in line with mens results. All presented results statistically significant

What they usually DONT tell: Most people NEVER followed the pyramid. Many follow junk food diet (Western diet pattern) Mostly refined carbs, sugar, butter, fatty cheese and processed/red meat

In Nordic countries: only 0,3 % adhere strictly to recommendations and 9-24 % of the populations have somewhat healthy diet 26 Nordic monitoring of diet, physical activity and overweight. First collection of data in all Nordic Countries 2011.

An average person in US eats > 2 times more refined grains, solid fats and sugars than recommended and < 50 % of the recommended fruit & whole grain intake 27 SoFAS: Solid fats and sugar. Source: USDA dietary guidelines, chapter 5

The real problem: Western crappy diet is one of the key reasons for obesity and type 2 diabetes epidemic Im indeed loving it

Western diet, the junk food diet, that many follow is associated with increased risk of type 2 diabetes in prospective cohorts Page 29 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;27:251260 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 = 1.331.57, P < 0.005) (Fig. 3).

Analysis of 3 cohorts: Western diet is associated with increased risk of obesity in prospective cohorts while recommended food items seem to protect from weight gain Page 30 Mozaffarian D et al. Changes in diet and lifestyle and long-term weight gain in women and men. NEJM. 2011;364:2392-404.

Conclusion Different universally recommended dietary patterns are associated with reduced risk 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 31

Disclaimer Im not saying the recommended diet would be superior or 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. 32

Wellcome aboard! http://twitter.com/pronutritionist http://www.facebook.com/pronutritionist http://www.pronutritionist.net Reijo Laatikainen, RD, MBA Images bought and licensed from BigStockPhoto. Snapshots from papers and sites referred to. Page 33

Dietary guidelines are right

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