ScienceCafé Zeist: Voeding 10-11-11

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Over bewezen en onbewezen gezondheidsclaims, en over de echte risico’s van onze voeding.
Deze avond vertelt prof. Verhagen over zin en onzin in onze voeding. “Gelukkig is nu in de wet geregeld dat gezondheidsclaims op voedingsmiddelen wetenschappelijk bewezen moeten zijn. Veel onzinclaims zullen hierdoor op termijn verdwijnen. De schappen zullen er straks weliswaar anders uitzien, maar niet leger worden.”
En hij vertelt dat onze voeding nog nooit zo veilig is geweest. “De echte gezondheidsrisico’s van onze voeding zit niet in allerlei chemische stofjes, maar in te veel eten en vooral in verkeerd eten. Meer nog: een snufje risico hoort er bij. Een beetje risico kan wellicht nodig zijn net als op andere terreinen.“

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  • De richtlijnen zijn gebaseerd op alle relevante onderzoeken (circa 500 literatuur referenties), inclusief eerdere deeladviezen van de Gezondheidsraad. De richtlijnen zijn erop gericht om via een goede voeding chronische aandoeningen te helpen voorkomen, met name overgewicht, hart- en vaatziekten, diabetes, en bepaalde vormen van kanker.
  • Kwalitatief: gelden voor de Nederlandse bevolking vanaf 12 maanden
  • Wordt er voldoende groente gegeten? Hier ziet u voor de verschillende leeftijdsgroepen en beide geslachten het percentage dat aan de aanbeveling voor groente voldoet. Dit loopt op met de leeftijd. Afhankelijk van de leeftijdsgroep eet 1-14% van de bevolking voldoende groente. (De mediane inname voor groente loopt op met de leeftijd van ongeveer 80 naar 140 gram. )
  • Wordt er voldoende fruit geconsumeerd? Hier een zelfde figuur. 3 tot 26% voldoet aan de aanbeveling voor fruit. Jongste kinderen en oudste volwassen eten meer fruit, vrouwen eten meer fruit dan mannen. (Mediane consumptie is minder dan 1 stuks per dag (62-89g voor kinderne en 61-145 gram voor volwassenen. )
  • Veel Nederlanders gebruiken supplementen. Dit varieert tussen de 27 en 56%. Het gebruik is het hoogste onder jonge kinderen en vrouwen gebruiken meer supplementen dan mannen Er worden met name multivitamines mineralen gebruikt. (Meer gebruik in de winter dan in de zomer) Gebruik van vit d supplementen wordt oa aanbevolen voor vrouwen boven de 50 jaar. Dit wordt door 37% in de winter en 28% gedaan.
  • Worden de goede vetten gegeten? Hier ziet u het percentage dat aan de aanbeveling voor verzadigde vetzuren voldoet. De aanbeveling is om beneden de 10En% te blijven. Slechts 8-14 % voldoet hieraan. Dit is lager in de oudere bevolkingsgroepen. Tranvetzuren staat hier weergegeven. Het percentage dat benenden de aanbeveling van 1En% blijft is meer dan 95%. Dit is enorm verbeter in de afgelopen jaren. In 2003 rapporteerden we voor jongwassenen nog een percentage van 28%. Bronnen vv: zuivel 30, vlees 19, vetten 14, koek en gebak10 Bron transvetzuren nu 34%.
  • Donkere achtergrond resultaat van gevoeligheidsanalyse bij lage dosering (500) al toename van probability of CRkanker
  • Donkere achtergrond resultaat van gevoeligheidsanalyse bij lage dosering (500) al toename van probability of CRkanker
  • The life expectancy will increase if more people meet the recommendations for a healthy diet. With increasing consumption of fruit, vegetables and fish relatively more health gain can be achieved. With a lowering saturated and trans fatty acid consumption, most health gain is already achieved
  • The life expectancy will increase if more people meet the recommendations for a healthy diet. With increasing consumption of fruit, vegetables and fish relatively more health gain can be achieved. With a lowering saturated and trans fatty acid consumption, most health gain is already achieved
  • The life expectancy will increase if more people meet the recommendations for a healthy diet. With increasing consumption of fruit, vegetables and fish relatively more health gain can be achieved. With a lowering saturated and trans fatty acid consumption, most health gain is already achieved
  • ScienceCafé Zeist: Voeding 10-11-11

    1. 1. onzinnige voeding Prof.dr. Hans Verhagen
    2. 2. <ul><li>Inleiding </li></ul><ul><li>Voeding en gezondheid </li></ul><ul><li>Gezondheidsclaims </li></ul><ul><li>Voor- versus nadelen van voeding </li></ul><ul><li>Tot slot </li></ul>
    3. 3.
    4. 4. Voeding is hot
    5. 5. Nieuws 1 week September 2007
    6. 6.
    7. 7.
    8. 8. “ voeding is net als voetbal” – “iedereen (w)eet ervan”
    9. 9.
    10. 10.
    11. 11. Mythes in de voeding: spinazie en ijzer gekookte groenten mg/100 g Wortelen bospeen 0.2 Bloemkool 0.3 Snijbonen 0.5 Sperziebonen 0.8 Boerenkool 1.0 Doperwten 2.0 Spinazie 2.4 Snijbiet 4.0
    12. 12. ‘ 1870 ’: 10* to high iron values published ( , wrong) 1929 Discovered only in 1937 : correct values
    13. 13.
    14. 14. Chemicaliën <ul><li>Dioxines/PCBs </li></ul>Pesticiden Verpakkingsmaterialen Microbiologie Natuurlijke toxines
    15. 15.
    16. 16. 1990’s <ul><li>BSE </li></ul><ul><li>Dioxins </li></ul><ul><li>……… etc </li></ul>
    17. 17. General Food Law Verordening EC 178/2002
    18. 18. Risk analysis Risk assessment Risk management Risk communication Risk analysis paradigm
    19. 19. Risk analysis Risk assessment Risk management Risk communication Risk analysis paradigm
    20. 20. Ons voedsel is veilig √
    21. 21. <ul><li>Inleiding </li></ul><ul><li>Voeding en gezondheid </li></ul><ul><li>Gezondheidsclaims </li></ul><ul><li>Voor- versus nadelen van voeding </li></ul><ul><li>Tot slot </li></ul>
    22. 22. Voeding = totaal van voedsel
    23. 23. Deaths by broad cause group estimates for 2002 Injuries (9.1%) Noncommunicable conditions (58.6%) of which 50% are due to CVD Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (32.3%) Total deaths: 57,027,000 Source: WHO
    24. 24. [WHO: Global Health Risks, 2009] Voeding
    25. 25. Obesity in NL 1981-2003
    26. 26. Energy in Energy balance Energy out
    27. 27. Children: 60 kcal / day = difference 60 kcal 1,5 1 1 hour ½ hour
    28. 28. Advies Richtlijnen Goede Voeding Gezondheidsraad 2006 http://www.gr.nl/pdf.php?ID=1478&p=1
    29. 29. <ul><li>Zorg voor een gevarieerde voeding. </li></ul><ul><li>Zorg dagelijks voor voldoende lichaamsbeweging. </li></ul><ul><li>Gebruik dagelijks ruim groente, fruit en volkoren graanproducten. </li></ul><ul><li>Eet regelmatig (vette) vis. </li></ul><ul><li>Gebruik zo weinig mogelijk producten met een hoog gehalte aan verzadigd en transvet. </li></ul><ul><li>Beperk frequent gebruik van gemakkelijk vergistbare suikers en dranken met een hoog gehalte aan voedingszuren. </li></ul><ul><li>Beperk de inname van keukenzout. </li></ul><ul><li>Bij alcoholgebruik: wees matig. </li></ul>Richtlijnen Goede Voeding 2006
    30. 30. “ Richtlijnen Voedselkeuze”
    31. 31. Voedselconsumptiepeiling <ul><li>www.voedselconsumptiepeiling.nl </li></ul><ul><li>www.rivm.nl/VCP </li></ul>
    32. 32. Voldoende groente? *= < 14 jaar: minstens 150 gram; 14+ jaar: minstens 200 gram
    33. 33. Voldoende fruit? *= < 9 jaar: minstens 150 gram; 9+ jaar: minstens 200 gram
    34. 34. Gebruik van voedingssupplementen <ul><ul><li>Veel Nederlanders gebruiken supplementen </li></ul></ul><ul><ul><li>Multi vitamines/mineralen </li></ul></ul><ul><ul><li>Vitamine D suppletie aanbevolen voor vrouwen boven de 50 </li></ul></ul>
    35. 35. Goede vetten? <ul><li>8-14% voldoet aan aanbeveling (<10 En%) </li></ul><ul><li>95-99% voldoet aan aanbeveling (<1 En%) </li></ul>
    36. 36. <ul><li>Inleiding </li></ul><ul><li>Voeding en gezondheid </li></ul><ul><li>Gezondheidsclaims </li></ul><ul><li>Voor- versus nadelen van voeding </li></ul><ul><li>Tot slot </li></ul>
    37. 37. Claims
    38. 38. EU Regulation 1924/2006
    39. 39. LIFESPAN EXTENSION COMPLEX “ performance” “ antioxidants”
    40. 40. EU Regulation 1924/2006 <ul><li>General principles </li></ul><ul><li>Claims ≠ false, misleading </li></ul><ul><li>Claims ≠ prevent, treat or cure disease </li></ul><ul><li>Scientifically justified </li></ul><ul><li>Benefit from normal consumption of food </li></ul>
    41. 41. Health claims Function claims Based on generally accepted scientific data Based on newly developed scientific data Reduction of disease risk claims + claims growth and development of children What it does EU Regulation 1924/2006 Article 13.5 Article 13.1 <ul><li>Nutrition </li></ul><ul><li>claims </li></ul><ul><li>content claims </li></ul><ul><li>Comparative claims </li></ul>What it contains Article 14
    42. 42. EU Regulation 1924/2006 <ul><li>Nutrition </li></ul><ul><li>claims </li></ul><ul><li>content claims </li></ul><ul><li>Comparative claims </li></ul>What it contains + Vit C Light
    43. 43. Health claims Function claims Based on generally accepted scientific data Based on newly developed scientific data Reduction of disease risk claims + claims growth and development of children What it does EU Regulation 1924/2006 Article 13.5 Article 13.1 <ul><li>Nutrition </li></ul><ul><li>claims </li></ul><ul><li>content claims </li></ul><ul><li>Comparative claims </li></ul>What it contains Article 14
    44. 44. Health claims should be substantiated Health claims should be substantiated Health claims should be substantiated Health claims should be substantiated authorities scientists industry consumers
    45. 45. ILSI Europe 2001 - 2005 EFSA 2007
    46. 46. <ul><li>All pertinent scientific data in favour + not in favour </li></ul><ul><li>(totality of the scientific data ; weighing of the evidence.) </li></ul><ul><li>characteristics of the food required. </li></ul><ul><li>Human data required. </li></ul><ul><li>Study group(s) representative for the target population. </li></ul><ul><li>Claimed effect must be relevant for human health. </li></ul><ul><li>Causal relationship food consumption - health outcome in humans. </li></ul><ul><li>effect can reasonably be achieved as part of a balanced diet. </li></ul>Scientific and technical guidance (July 2007)
    47. 47. <ul><li>3 levels of evidence: </li></ul><ul><li>a cause and effect has been established </li></ul><ul><li>insufficient evidence for cause and effect …. </li></ul><ul><li>a cause and effect has not been established </li></ul>
    48. 48. EU Regulation 1924/2006 Health claims Function claims Based on generally accepted scientific data Based on newly developed scientific data Reduction of disease risk claims + claims growth and development of children What it does Article 13.5 Article 13.1 <ul><li>Nutrition </li></ul><ul><li>claims </li></ul><ul><li>content claims </li></ul><ul><li>Comparative claims </li></ul>What it contains Article 14
    49. 49. <ul><li>Industry send application to Member State / EC </li></ul><ul><li>EFSA assessment and opinion </li></ul><ul><li>EC/MS: decide on authorisation of claims </li></ul><ul><li>Community list of article 14 and 13.5 claims </li></ul>EU Regulation 1924/2006: List of Article 14 and 13.5 claims dossiers
    50. 50. 21 August 2008: EFSA adopts first opinions on health claims made on foods relating to disease risk reduction and children’s health
    51. 51. EFSA Opinions article 14 – August 2008 Claim OK * Plant sterols & cholesterol lowering & heart disease * wording Cause & effect OK * Linoleic acid, alpha-linolenic acid & growth-dev. kids Amount can be consumed by diet Cause & effect not OK Food suppl. & growth-dev. Kids Cause & effect not OK Food suppl.-soy-flax & bone Cause & effect not OK Dairy foods & body weight in kids and adolescents Cause & effect not OK Dairy (milk – cheese) & dental health kids Cause & effect not OK Food suppl. (prickle pear cactus) & blood lipid parameters Cause & effect not OK Food suppl (CLA, polyols, extracts) & body weight
    52. 52. EFSA health claim rejections 'shock' industry
    53. 53.
    54. 54. Industry: “EFSA verdicts on food claims send shockwaves through the industry” Consumer organizations: “ welcome EFSA approach” Scientists: “generally support for EFSA opinions”
    55. 55. March 2009: EC validates 21 EFSA health claim Opinions
    56. 56. EU Regulation 983/2009: 7 permitted claims; 14 rejected claims EU Regulation 984/2009: 2 rejected claims EU Regulation 1024/2009: 2 permitted claims; 14 rejected claims EU Regulation 1025/2009: 2 rejected claims October 2009: Regulations on article 14/13.5 claims
    57. 57.
    58. 58.
    59. 59.
    60. 60. Health claims Function claims Based on generally accepted scientific data Based on newly developed scientific data Reduction of disease risk claims + claims growth and development of children What it does EU Regulation 1924/2006 Article 13.5 Article 13.1 <ul><li>Nutrition </li></ul><ul><li>claims </li></ul><ul><li>content claims </li></ul><ul><li>Comparative claims </li></ul>What it contains Article 14 Based on newly developed scientific data Reduction of disease risk claims + claims growth and development of children
    61. 61. <ul><li>Member States send to EC lists by 31 Jan 2008 </li></ul><ul><ul><ul><ul><ul><li>total ~ 44.000 </li></ul></ul></ul></ul></ul><ul><li>EC: Compilation > 4.400 </li></ul><ul><li>EFSA Opinion </li></ul><ul><li>EC to adopt list by 31 Jan 2010 </li></ul>EU Regulation 1924/2006: List of Article 13. 1 claims “ Dossiers” papers etc
    62. 62. Claims received by category
    63. 63. <ul><li>3 levels of evidence: </li></ul><ul><li>a cause and effect has been established </li></ul><ul><li>insufficient evidence for cause and effect …. </li></ul><ul><li>a cause and effect has not been established </li></ul>
    64. 64.
    65. 65. <ul><li>Calcium & bones </li></ul><ul><li>Calcium, vitD & bones </li></ul><ul><li>Fluoride & teeth </li></ul><ul><li>Magnesium & energy, cell division, electrolyte </li></ul><ul><li>Biotin, niacin & energy </li></ul><ul><li>Selenium & antioxidant, immune, …. </li></ul><ul><li>VitC & antioxidant </li></ul><ul><li>Sugar-free chewing gum & teeth </li></ul><ul><li>Betaglucans & cholesterol </li></ul><ul><li>…… etc </li></ul>
    66. 66. <ul><li>Probiotics ≠ strengthen immune system </li></ul><ul><li>>100 probiotics insufficiently characterised </li></ul><ul><li>Botanicals ≠ characterised, poor data </li></ul><ul><li>Taurine ≠ energy, performance </li></ul><ul><li>Glucosamine, shark cartilage ≠ joint health </li></ul><ul><li>…… etc </li></ul>
    67. 67. <ul><li>3 levels of evidence: </li></ul><ul><li>a cause and effect has been established </li></ul><ul><li>Insufficient evidence for cause and effect …. </li></ul><ul><li>a cause and effect has not been established </li></ul>
    68. 68. (geen) vitamine C : scheurbuik James Lindberg 1747
    69. 69. Oxidative damage / oxygen paradox O 2 respiration ROS damage energy protective regulatory
    70. 70. The antioxidant hypothesis Oxidative stress Endogenous ROS Exogenous ROS vitC/vitE SOD/CAT/GSH-Px Carotenoids Flavonoids … ..
    71. 71. Antioxidant studies in vitro /animals In vitro : - effects - high doses - many parameters - many studies - many papers - mechanistic research <ul><li>Animal in vivo: </li></ul><ul><li>- effects </li></ul><ul><li>- high dose </li></ul><ul><li>- many parameters </li></ul><ul><li>- many studies </li></ul><ul><li>many papers </li></ul>
    72. 72. 1. in vitro /animal studies  2. studies in humans 1. observational studies 2. intervention studies
    73. 73. Dietary antioxidants & disease - results from observational studies F F V Verhagen et al. Nutrition Today Dec 2006 vitamin C vitamin E carotenoids fruits & vegetables lung cancer breast cancer colorectal cancer prostate cancer gastric/oeso- phagal cancer coronary heart disease
    74. 74. Sies, H. (1988) Nature 332, 495
    75. 75. Dietary antioxidants & disease - results from intervention studies Verhagen et al. Nutrition Today Dec 2006 vitamin C vitamin E β - carotene combi of aox lung cancer breast cancer colorectal cancer prostate cancer gastric/oeso- phagal cancer coronary heart disease
    76. 76.
    77. 77. Conclusions Antioxidants Antioxidants are great for rats !
    78. 78. More is Not Always Better
    79. 79. Morris & Tangney, JAMA 2011, 305, 1348
    80. 80. ongezonde voeding Functionele voedingsmiddelen en voedingssupplementen vormen geen oplossing voor de gezondheidsproblemen door een ‘ongezonde voeding’.
    81. 81.
    82. 82. <ul><li>Inleiding </li></ul><ul><li>Voeding en gezondheid </li></ul><ul><li>Gezondheidsclaims </li></ul><ul><li>Voor- versus nadelen van voeding </li></ul><ul><li>Tot slot </li></ul>
    83. 83. risk only (safety)  balance of risks and benefits
    84. 84. Benefits CVD, cancer, etc ↓ Risks pesticides
    85. 85. Benefits Coronary heart disease ↓ Risks Neurological damage in the fetus (MeHg)
    86. 86. <ul><li>Benefit-risk assessment </li></ul><ul><li>Scenario studies </li></ul><ul><li>- Model leren van effecten </li></ul>
    87. 87. Model & Werkelijkheid Courtesy: Johan Schefferlie
    88. 88. Folic acid deficiency Down syndrome Neural tube defects High blood pressure during pregnancy Colon cancer Spontaneous abortion Lung cancer Schisis Prostate cancer Pancreas cancer Oesophageal cancer CVD Osteoporosis Leukemia Breast cancer Alzheimer’s Parkinson Depression Masking vit. B 12 deficiency N eurotoxicity Zinc absorption Epilepsy Hypersensitivity Twins births Stimulation of celproliferation in existing cancer Folic Acid
    89. 89. Folic Acid <ul><li>Neural Tube Defects (benefit) </li></ul><ul><li>Masking B12-deficiency (risk) </li></ul><ul><li>Color ectal Can cer ( benefit and risk ) </li></ul><ul><li>Folate deficiency (benefit) </li></ul>
    90. 90. * Many assumptions and uncertainties Folic acid fortification of flour Results in incidence *
    91. 91. Net health benefit >>> net health risk Folic acid fortification of flour Results in DALY’s Net health benefit >>> net health risk
    92. 93. Low calorie sweeteners <ul><li>Benefits </li></ul><ul><li>Reduced energy intake </li></ul><ul><li>Reduced body weight/weight balance </li></ul><ul><li>Reduced caries </li></ul><ul><li>Risks </li></ul><ul><li>None (only perception; E-numbers) </li></ul><ul><li>ADIs established </li></ul><ul><li>Non-effects </li></ul><ul><li>CVD </li></ul><ul><li>cancer </li></ul><ul><li>Diabetes / metabolic syndrome </li></ul><ul><li>gout </li></ul>
    93. 94. Low calorie sweeteners <ul><li>Benefits </li></ul><ul><li>Reduced energy intake </li></ul><ul><li>Reduced body weight/weight balance </li></ul><ul><li>Reduced caries </li></ul>
    94. 95. “ Life would be pretty dull without risk” “voluntary risk taking and its pleasures”* <ul><li>Three dominant discourses: </li></ul><ul><li>Self improvement </li></ul><ul><li>Emotional engagement </li></ul><ul><li>Control </li></ul>*Lupton & Tulloch, Health, Risk and Society, 4 [2002] 113-124
    95. 96. Food and nutrition Medicine Economics and Marketing-Finance Risk not accepted Risk accepted Risk a neccesity
    96. 97. <ul><li>Inleiding </li></ul><ul><li>Voeding en gezondheid </li></ul><ul><li>Gezondheidsclaims </li></ul><ul><li>Voor- versus nadelen van voeding </li></ul><ul><li>Tot slot </li></ul>
    97. 98. Health gain with optimal diet:   http://www.rivm.nl/bibliotheek/rapporten/350080001.html
    98. 99. Health gain with optimal diet:   http://www.rivm.nl/bibliotheek/rapporten/350080001.html
    99. 100. 140.000 sterfgevallen/20 jaar = 7.000 / jaar
    100. 101. Health gain with optimal diet: http://www.rivm.nl/bibliotheek/rapporten/350080001.html Net Present Value  
    101. 102. 2004 2006
    102. 103. Eating too much food safety Eating wrong <ul><li>Fruits </li></ul><ul><li>Vegetables </li></ul><ul><li>Fish </li></ul><ul><li>TFA </li></ul><ul><li>SAFA </li></ul><ul><li>Salt/sodium </li></ul><ul><li>Fibre </li></ul><ul><li>PUFA </li></ul><ul><li>Vitamins </li></ul><ul><li>Minerals </li></ul><ul><li>… .etc </li></ul>unhealthy diet
    103. 104. unhealthy diet food safety Why are we so scared about our food ???
    104. 105. Benefit-risk analysis Benefit-risk assessment Benefit-risk management Benefit-risk communication Benefit-risk analysis paradigm
    105. 106.
    106. 107. Evidence based nutrition Evidence based decisions
    107. 108. Dank u wel voor uw aandacht !
    108. 109. © ============================================= Prof.Dr. Hans Verhagen Head, Centre for Nutrition and Health National Institute for Public Health and the Environment (RIVM) PO Box 1 3720 BA Bilthoven The Netherlands Tel +31 30 274 3391 [email_address] http://www.rivm.nl/en/aboutrivm/organization/vgc/cvg/index.jsp ============================================

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