Dietary guidelines are right

38,389 views

Published on

Dietary guidelines are accused to be the key reason for obesity and diabetes epidemic. This slide deck shows why they are not. Junk food diet is the key reason.

Published in: Health & Medicine
5 Comments
18 Likes
Statistics
Notes
  • Even if whole grains and fruit and vegetables are recommended, onewill not tell you that grains have various antinutrients that bind unto minerals to prevent absorption. You're forgetting once again that it's not about avoiding what is detrimental, it's about optimum nutrition, because this is still malnourishment if they're avoiding thebad foods and not eating the foods that have a synergistic effect for optimal nutrition. And remember carbs, without any exercise to counterbalance the consumption is still problematic, whether or not it has its fiber
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • @undefined What do you mean by vit C intervention, I did not have them in my deck nor in the comment
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Mann et al. 1993 found a 'healthy user' group following dietary guidelines had significantly lower IHD than friends/ family members.
    However, this volunteer group, who should have had all the advantages (pre-existing disease excluded) had equal mortality. Following dietary guidelines was significantly associated with non-IHD mortality.
    Shai et al. has 5 year follow up after 24mth low-carb diet showing improvements in metabolic risk factors are retained better by this group than other arms. This speaks to long-term effect.
    The vit C measures you mention are not really comparable, and vit C as intervention is not comparable to carbohydrate restriction.
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • 1) We don't know. No direct head to head studies with morbidity endpoints exist apart from Med Diet (Predimed)
    2) You mean heathy user bias? Reverse causality bias is also possible, ie. people at higher risk (genetic, previous other disease) may have changed diet to nearer to recommended. In my opinion, these more or less outweigh each other
    3) I come back to this some day to show how there is no morbidity/mortality trials with low carb or paleo diets (in contrast to studies included in Gillies 2007 meta-analysis). Short term surrogate marker studies are as prone to bias as are prospective cohorts. Have a look for example to surrogate outcomes like BP or endothelial function with supplemented vitamin C. Works well in short term RCTs but no benefit in morbidity/mortality RCTs. I would not trust short term RCTs unless cohorts and other type of evidence is line with short term RCTs
    4) Most people can digest and do well with oats, barley, rye, quinoa, beans, brown rice, berries and fruit. These are healthy fiber, magnesium, vitamin and fytochemical rich carbs.
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • 1) is a 20% reduction in DM2 really the best these diets can do? That still leaves us with a higher rate than previous generations eating more animal fat.
    2) who eats exactly according to DR? Who would follow it well in a study? Certain classes and types are more likely to prefer this diet which will be associated with other behaviours and, indeed, beliefs.
    3) you have left out comparisons with LCHF and paleo diets. Anything looks good next to the SAD, but, as said, a 20% reduction in DM2 is not much to brag about.
    4) counsels of perfection - can anyone buy or digest brown rice, pumpernickel bread, and pearl barley? Define whole or refined carbs clearly for the average consumer.
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total views
38,389
On SlideShare
0
From Embeds
0
Number of Embeds
29,036
Actions
Shares
0
Downloads
125
Comments
5
Likes
18
Embeds 0
No embeds

No notes for slide

Dietary guidelines are right

  1. 1. Following dietary guidelines is associated with reduced risk of type 2 diabetes, coronary heart disease and obesity. Scientific evidence [Updated May, 2016] Registered dietitian, M.Sc, MBA Reijo Laatikainen www.twitter.com/pronutritionist Page 1
  2. 2. 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
  3. 3. 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): 893–905 and Evidence Analysis Manual. Academy of Nutrition and Dietetics January 2012 Hierarchy of evidence in nutrition science
  4. 4. 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
  5. 5. Their claim: This food pyramid is the root cause of OBESITY EPIDEMIC ”Carbs are bad” ”Carbs are bad”
  6. 6. Dietary macronutrients and long term weight change Systematic review by Fogelholm et al 2013 6
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. Carbs and weight management Systematic review by Hauner et al 2012 www.pronutritionist.net11
  12. 12. 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
  13. 13. 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
  14. 14. Their claim: This food pyramid is the root cause of TYPE 2 DIABETES EPIDEMIC ”Carbs are bad” ”Carbs are bad”
  15. 15. 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
  16. 16. 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;27:251–260
  17. 17. 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.”
  18. 18. 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 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.
  19. 19. 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)
  20. 20. 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
  21. 21. Their claim: This food pyramid is the root cause of ATHEROSCLEROSIS (through small LDL particles) ”Carbs are bad” ”Carbs are bad”
  22. 22. Recommended dietary pattern and coronary heart disease (CHD) Meta-analysis by Mente et al. 2009 www.pronutritionist.net22
  23. 23. 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
  24. 24. 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 men’s results. All presented results statistically significant
  25. 25. Meta-analysis of 15 cohorts on recommended diets Sivu 25 Schwingshackl L, Hoffmann G. Diet quality as assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension score, and health outcomes: a systematic review and meta-analysis of cohort studies. J Acad Nutr Diet. 2015 May;115(5):780-800.e5 n = 1,020,642 Diabetes CVD Cancer All cause mortality Generally recommended diets* -22% -22% - 15% -22% *) Healthy Eating Index (HEI) or Alternative Healthy Eating Index (AHEI) or DASH diet Note: people in the cohorts did not follow analysed diets strictly but merely belonged to the “somewhat adherent” categories. Therefore realeffects for ideal adherence might be even higher.
  26. 26. Analysis of 304 systematic reviews and meta-analyses published between 1950-2013*: Dietary guidelines are right Sivu 26 Fardet A, Boirie Y. Associations between food and beverage groups and major diet-related chronic diseases: an exhaustive review of pooled/meta-analyses and systematic reviews. Nutr Rev 2014;72(12):741-62 ”… these results substantiate certain a priori nutritional recommendations that are sometimes based on assumptions about the foods that should be included in a balanced diet or on characteristics of “healthy” foods” [review focused on obesity, cancer, type 2 diabetes and cardiovascular disease] *) Included study designs 1) interventional study, 2) longitudinal study, 3) case-control study, 4) cross-sectional study, and 5) ecological study
  27. 27. What they usually DON’T 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
  28. 28. In Nordic countries: only 0,3 % adhere strictly to recommendations and 9-24 % of the populations have somewhat “healthy” diet 28 Nordic monitoring of diet, physical activity and overweight. First collection of data in all Nordic Countries 2011.
  29. 29. More than 90% of children in US have poor diet*. Only 0.1% has ideal diet. 29 Mozaffarian D et al. AHA Statistical Update. Heart Disease and Stroke Statistics—2015 Update. Circulation. 2015;131:00-00. *) Poor diet: 0-1 dietary goals met Intermediate diet: 2-3 goals met Ideal diet: 4-5 goals met. Dietary goals were: • Fruits and vegetables: >4.5 cups/d • Fish: More than two servings/wk • Fiber-rich whole grains at least 3 servings per/d • Salt intake less than 3,75 g/d • Sugar-sweetened beverages: <450 kcal/wk (~ <1 liter/wk)
  30. 30. More than 65% of adults in US have poor diet*. Only 0.4-0.6% has ideal diet. 30 Mozaffarian D et al. AHA Statistical Update. Heart Disease and Stroke Statistics—2015 Update. Circulation. 2015;131:00-00. *) Poor diet: 0-1 dietary goals met Intermediate diet: 2-3 goals met Ideal diet: 4-5 goals met. Dietary goals were: • Fruits and vegetables: >4.5 cups/d • Fish: More than two servings/wk • Fiber-rich whole grains at least 3 servings per/d • Salt intake less than 3,75 g/d • Sugar-sweetened beverages: <450 kcal/wk (~ <1 liter/wk)
  31. 31. 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 31 SoFAS: Solid fats and sugar. Source: USDA dietary guidelines, chapter 5
  32. 32. Are our current diets really lower in fat than ever (as it often claimed by low carb proponents)? Case US Data from NHANES studies and U.S. Department of Agriculture (USDA) Page 32
  33. 33. NHANES studies 1971-2010 Absolute intake in grams. Data is based on self-reports which usually underestimate real intake 33
  34. 34. Intake of fat, carbohydrates and protein (grams/day/person) NHANES Ford ES, Dietz WH. Trends in energy intake among adults in the United States: findings from NHANES. Am J Clin Nutr. 2013 Apr;97(4):848-53.
  35. 35. Data from USDA (1971-2006) Absolute availability per person in grams. Data is based on balance sheets (food availability) which may overestimate consumption of all macronutrients due to incomplete correction of food waste 35
  36. 36. 0 100 200 300 400 500 600 gramspercaptia/day Fat, protein and carbohydrate availability in US (grams/day/person) USDA Carbohydrates Total fat Source: USDA, http://www.ers.usda.gov/ Protein
  37. 37. Is there any data that supported the notion of decreased fat intake in US? Yes. Only data that supports this notion is data that is presented as percentage of total energy intake (E%). But this is misleading because the increased intake of carbohydrates over the time, and thus increased intake of total calories, drives the percentage of fat calories down. 37
  38. 38. NHANES studies 1971-2010 Percentage of energy intake 38
  39. 39. Intake of fat, carbohydrates and protein (percentage of energy intake/day/person) NHANES Ford ES, Dietz WH. Trends in energy intake among adults in the United States: findings from NHANES. Am J Clin Nutr. 2013 Apr;97(4):848-53.
  40. 40. Conclusion • There is no decrease in fat intake in US population during the past four decades. • Intake of carbohydrates has increased and intake protein has remained rather stable during the same time period. Therefore the percentage of total calories from fat has decreased. • US population has not followed low fat diet but has only increased carbohydrate intake. • It’s misleading to claim that US population had followed low fat diet as it was described in dietary guidelines in 1980s. • US population has adopted higher carbohydrate intake without any decrease in fat consumption 40
  41. 41. The real problem: Western crappy diet is one of the key reasons for obesity and type 2 diabetes epidemic I’m indeed loving it
  42. 42. Western diet, the junk food diet, that many follow is associated with increased risk of type 2 diabetes in prospective cohorts Page 42 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;27:251–260 “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 = 1.33–1.57, P < 0.005) (Fig. 3).
  43. 43. 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 43 Mozaffarian D et al. Changes in diet and lifestyle and long-term weight gain in women and men. NEJM. 2011;364:2392-404.
  44. 44. 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 44
  45. 45. A bonus. Why there is then so much controversy around the guidelines? Let’s give a word to Seth Yoder @thescienceofnutrition 45
  46. 46. 46 Read this text and you know. Worth your 20 minutes.
  47. 47. Disclaimer I’m 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, “Paleolithic” and vegan diets can be healthy if food choices are right. 47
  48. 48. 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 48

×