Reviewing the latest research into nutritional benefits ...d3hip0cp28w2tg.cloudfront.net/uploads/2015-11/gary-frost-1.pdf · Gary Frost Imperial College London . Trends in disease

Reviewing the latest research into

nutritional benefits for cardio health

Food Matters Live 2015

Gary Frost Imperial College London

Trends in disease

Current Recommendation

• Plenty of fruit and vegetables

• Plenty of starchy foods such as bread, rice, potatoes and pasta.

Choose wholegrain varieties wherever possible

• Some low fat milk and dairy products

• Some meat, fish, eggs, beans and other non-dairy sources of

protein

• Only a small amount of foods and drinks high in fats and/or

sugar.

• Choose options that are lower in fat, salt and sugar whenever

you can.

• Want to add to this in a constructive way

Overweight

Overweight

How do we turn this tanker

around?

Whole system approach food

environment

How can we design foods and

the environment to maintain

body weight?

Energy intake remains a massive

problem

Appetite regulation

• Suppressing appetite is not easy

• Fundamental to survival

• Lessons from dietary fibre

• We need to understand the relationship between

food and circuits that control appetite

• We need high quality randomised control trials

Overall scheme of metabolic map

Myocardial

infarctions

Heart

failure

Cardiac

dysfunction

dyslipidaemia

Metabolically

healthy

High cholesterol High glucose Hypertension

Brain

disorders Nephropathy Atherosclerosis Stroke Retinopathy

Risk factors of the ‘metabolic syndrome’

Pathologies resulting from the ‘metabolic syndrome’

Visceral

adiposity

LDL elevated

Glucose toxicity

Fatty liver

gut

inflammation

endothelial

inflammation

systemic

Insulin resistance

systemic

inflammation

Hepatic IR

Adipose IR

Muscle metabolic

inflexibility

adipose

inflammation

Microvascular

damage

Myocardial

infarctions

Heart

failure Cardiac

dysfunction

Brain

disorders

Nephropathy

Atherosclerosis

β-cell failure

Reversible process

β-cell Pathology

High cholesterol

High glucose

gluc Risk factor

Hypertension

dyslipidaemia

ectopic

lipid overload

Irreversible process

Hepatic

inflammation

Stroke

IBD

fibrosis

Retinopathy

Metabolically

healthy

Nakatsuji, Metabolism 2009

Caloric excess

Portfolio or dietary patterns may be more important

than individual nutrients

• Dietary approaches to stop hypertension

• Mediterranean Diet

• Portfolio Diet

• Diabetes prevention study

• Holistic view of diet may be more powerful in

prevention of coronary heart disease than a

single nutrient focus

Body composition

BMI: 30.2 BMI: 29.1

Body Fat Mapping • Total adipose tissue

• Regional adipose tissue:

– Subcutaneous

•Peripheral

•Abdominal

– Internal

•Peripheral

•Abdominal

– Inter-muscular (EMCL)

– Intramyocellular (IMCL)

– Pericardial

– Hepatic (IHCL)

–Pancreatic

Waists are getting bigger

Targeting the colon

How do you target different adipose tissue deposits?

Fermentable carbohydrates may offer a way forward

Wider aspects on microbiota

Estruch R et al. N Engl J Med 2013;368:1279-1290.

Kaplan–Meier Estimates of the Incidence of Outcome Events in the Total Study Population.

Have we got a full understanding?

High levels of triglyceride in the plasma changes the behaviour of monocytes

Antioxidants, polyphenols and CHD

Current evidence is clear there is no benefit of vitamin

supplementation in the prevention or management of heart

disease

Breading in functionality

Summary

• We should not throw out current dietary guidelines with a hard

evidence base.

• Need systems that will enhance compliance

• Energy intake remain the biggest public health problem with no

solution

• There needs to be focus afford on novel solutions to aid reduction in energy

intake

• Understanding basic biology may lead to new understanding and better

targeting of lipid

• Novel foods and novel ingredients may play a role but the evidence

base needs to be strong

• Novel food systems producing the same product but with reduced

cardiovascular health is very important