The document provides an art history commentary and visual companion to philosophical aesthetics texts discussed in class. It summarizes major developments in art like naturalism, abstraction, conceptual art, and challenges the idea of artistic genius. Over 50 artworks are discussed, from prehistoric cave paintings to modern abstract works, relating them to philosophers like Plato, Hegel, Kant, and Gadamer to illustrate key concepts in aesthetics through history. The presentation aims to give students a deeper understanding of how philosophical ideas are expressed through actual artworks.
Este documento resume las carreras de un día de competencia en el Club Hipico de Antofagasta. Incluye detalles sobre cada carrera como los caballos participantes, jinetes, preparadores, y comentarios. Las opciones de ganador favorito se proporcionan para cada carrera.
With all of the media attention to resveratrol, here is an easy to read summary. As a biochemist and wife of an immune cancer survivor, I continue to search for the best supplementation to bolster my families immune system.
Quick Fact: One ounce of Jus contains 275 times the amount of resveratrol in red wine. In another words, you would have to drink [35] 8-ounce glasses of red wine to equal the amount of one ounce of Jus. www.myjus23/joanette
This document summarizes information about childhood obesity, including:
- Childhood obesity is a worldwide epidemic, with over 30% of US adults and children overweight or obese. Obesity rates have increased across genders, ages, races and education levels.
- The costs associated with obesity have risen substantially, both in direct healthcare costs and indirectly through lost economic productivity. Risk of obesity is higher among teens without insurance or with Medicaid.
- Factors contributing to the rise in childhood obesity include decreased physical activity, increased consumption of calorie-dense foods, increased screen time, and environmental/socioeconomic factors. Breastfeeding has been shown to decrease risk of obesity later in childhood.
- Obesity
This document provides an overview of childhood obesity including prevalence, risks, environmental and genetic factors, critical periods of development, diet, physical activity, and recommendations for prevention. Some key points:
- Rates of childhood obesity in the US have increased 2-3 fold over the last 25 years. Approximately 18.8% of US children ages 6-11 are overweight.
- Risk factors for childhood obesity include family history, low income, lack of physical activity, excess calorie intake, excessive screen time, and lack of breastfeeding.
- Critical periods for the development of obesity are gestation, ages 5-6, and adolescence. Early life nutrition and growth patterns can impact future health.
The Grace Company of Computer Skills provides training on computer skills. The document discusses obesity in children and adolescents. It defines obesity as excessive fatty tissue accumulation that hinders the body's functioning. Key markers of obesity include BMI, waist circumference, and waist-to-height ratio. Childhood obesity is a serious global health challenge, with over 170 million children estimated to be overweight worldwide. Risk factors include ethnicity, parental obesity, and severity of obesity as a child.
This document discusses obesity in teens and children. It finds that Mexican-American and non-Hispanic black youth have higher rates of overweight than white youth. Adolescents and older adults are more likely to be overweight than younger groups. Obesity results from long-term energy imbalance where calories consumed exceed calories used. Having two overweight parents significantly increases a child's risk of becoming overweight themselves. Measuring tricep skinfold thickness from ages 3 to 17 showed children of two obese parents were three times as fat as children of two lean parents by age 17.
The document provides an art history commentary and visual companion to philosophical aesthetics texts discussed in class. It summarizes major developments in art like naturalism, abstraction, conceptual art, and challenges the idea of artistic genius. Over 50 artworks are discussed, from prehistoric cave paintings to modern abstract works, relating them to philosophers like Plato, Hegel, Kant, and Gadamer to illustrate key concepts in aesthetics through history. The presentation aims to give students a deeper understanding of how philosophical ideas are expressed through actual artworks.
Este documento resume las carreras de un día de competencia en el Club Hipico de Antofagasta. Incluye detalles sobre cada carrera como los caballos participantes, jinetes, preparadores, y comentarios. Las opciones de ganador favorito se proporcionan para cada carrera.
With all of the media attention to resveratrol, here is an easy to read summary. As a biochemist and wife of an immune cancer survivor, I continue to search for the best supplementation to bolster my families immune system.
Quick Fact: One ounce of Jus contains 275 times the amount of resveratrol in red wine. In another words, you would have to drink [35] 8-ounce glasses of red wine to equal the amount of one ounce of Jus. www.myjus23/joanette
This document summarizes information about childhood obesity, including:
- Childhood obesity is a worldwide epidemic, with over 30% of US adults and children overweight or obese. Obesity rates have increased across genders, ages, races and education levels.
- The costs associated with obesity have risen substantially, both in direct healthcare costs and indirectly through lost economic productivity. Risk of obesity is higher among teens without insurance or with Medicaid.
- Factors contributing to the rise in childhood obesity include decreased physical activity, increased consumption of calorie-dense foods, increased screen time, and environmental/socioeconomic factors. Breastfeeding has been shown to decrease risk of obesity later in childhood.
- Obesity
This document provides an overview of childhood obesity including prevalence, risks, environmental and genetic factors, critical periods of development, diet, physical activity, and recommendations for prevention. Some key points:
- Rates of childhood obesity in the US have increased 2-3 fold over the last 25 years. Approximately 18.8% of US children ages 6-11 are overweight.
- Risk factors for childhood obesity include family history, low income, lack of physical activity, excess calorie intake, excessive screen time, and lack of breastfeeding.
- Critical periods for the development of obesity are gestation, ages 5-6, and adolescence. Early life nutrition and growth patterns can impact future health.
The Grace Company of Computer Skills provides training on computer skills. The document discusses obesity in children and adolescents. It defines obesity as excessive fatty tissue accumulation that hinders the body's functioning. Key markers of obesity include BMI, waist circumference, and waist-to-height ratio. Childhood obesity is a serious global health challenge, with over 170 million children estimated to be overweight worldwide. Risk factors include ethnicity, parental obesity, and severity of obesity as a child.
This document discusses obesity in teens and children. It finds that Mexican-American and non-Hispanic black youth have higher rates of overweight than white youth. Adolescents and older adults are more likely to be overweight than younger groups. Obesity results from long-term energy imbalance where calories consumed exceed calories used. Having two overweight parents significantly increases a child's risk of becoming overweight themselves. Measuring tricep skinfold thickness from ages 3 to 17 showed children of two obese parents were three times as fat as children of two lean parents by age 17.
This document summarizes research on childhood obesity in the United States. It finds that obesity rates are higher among some racial/ethnic groups and older adolescents. Obesity results from long-term energy imbalance where calories consumed exceed calories used. Factors like diet, exercise, genetics, and environment contribute to obesity. Body mass index (BMI) is used to determine weight categories for adults and BMI-for-age for children/teens. Childhood obesity increases risk of adult obesity and chronic diseases. Parental obesity and other socioeconomic factors influence childhood obesity risk. A study found children of obese parents had much higher skin fold thickness, indicating higher body fat levels.
This document discusses obesity in children. It defines obesity and related terms like overweight, defines it using BMI percentiles. It discusses the pathogenesis involving hormones like leptin and ghrelin. Risk factors include genetic predisposition and lifestyle factors. Obesity can cause medical conditions like diabetes, hypertension, fatty liver disease. Evaluation involves history, exam and investigations. Management focuses on diet modification, physical activity and lifestyle changes.
The document discusses how Ronald McDonald may become the new Joe Camel as a mascot associated with unhealthy products like tobacco was, noting parallels between current debates around limiting fast food advertising to children and past debates around tobacco advertising; it also outlines strategies used successfully to curb tobacco use through public health campaigns and regulations that could potentially serve as models to address rising obesity levels.
Slideshow is from the University of Michigan Medical
School's M1 Human Growth and Development sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1GrowthDevelopment
The document summarizes obesity trends and statistics in the United States. It finds that approximately 66% of American adults are overweight or obese, with obesity rates doubling over the past 30 years. Obesity is associated with increased risk of diseases like hypertension, diabetes, and certain cancers. Minority groups and those of lower socioeconomic status tend to have higher obesity rates. Maintaining a healthy diet and active lifestyle can help address the national challenge of obesity.
The document discusses weight management and obesity. It states that 61% of Americans are overweight or obese. Being overweight or obese increases the risks of various health conditions such as diabetes, heart disease, and certain cancers. It provides information on assessing healthy weight ranges and body composition, including referencing body mass index (BMI) and waist-to-hip ratio. Risk factors for obesity include genetics, environment, lifestyle, and certain medical conditions or medications. Effective weight management involves setting realistic goals, making sustainable lifestyle changes, and focusing on overall wellness rather than any single number on the scale.
The document discusses weight management and obesity. It states that 61% of Americans are overweight or obese. Being overweight or obese increases the risks of various health conditions such as diabetes, heart disease, and certain cancers. It discusses various methods for assessing weight and body fat levels, including body mass index (BMI), waist-to-hip ratio, and body fat percentage. Risk factors for obesity include genetics, environment, lifestyle, and certain medical conditions or medications. Managing weight healthily involves setting realistic goals, making lifestyle changes, and focusing on long-term improvements rather than quick fixes.
The document discusses the obesity epidemic among children and youth. It notes that obesity rates have tripled for adolescents over the last two decades and may shorten lifespans. Factors contributing to rising obesity rates include increased food portion sizes, more time spent in sedentary activities like screen time, and physical education being reduced in many schools. Both environmental and genetic factors play a role in obesity, but genetics alone do not explain the large increases in prevalence seen in recent decades.
This document summarizes trends in childhood obesity in the United States. It finds that obesity rates have doubled in children ages 2-5 and tripled in children ages 6-11 and 12-19 between 1976-2008. Currently, around 32% of children and adolescents are overweight or obese. Obesity rates vary significantly by race and ethnicity, with non-Hispanic black and Hispanic youth having higher rates. Childhood obesity is associated with serious health risks that often continue into adulthood such as cardiovascular disease, diabetes, and psychological issues. A multifaceted response is needed that addresses individual, family, community and societal factors contributing to the current obesogenic environment experienced by many youth.
Management Of Obesity In Family Practice Cme 30 May08Gauranga Dhar
The document discusses obesity management in family practice. It defines obesity as a BMI of 30 kg/m2 or higher and notes that obesity is now a global epidemic according to the WHO. The management of obesity involves assessment to determine the degree and overall health status, followed by management focusing on weight loss, weight maintenance, and controlling other risk factors like cardiovascular disease and diabetes. Lifestyle and diet changes, physical activity, and behavior modification are emphasized as the primary non-pharmacological treatment approaches.
This document summarizes trends in dietary intake and physical activity in the US based on NHANES data from 1971-2010. It finds that from 1971-2000, calorie intake and carbohydrate intake increased for both men and women, while fat and saturated fat intake decreased. From 2000-2010, calorie intake decreased while carbohydrate intake decreased and fat, saturated fat, and protein intake increased. From 2007-2008 to 2009-2010, calorie intake decreased for both sexes, while carbohydrate intake decreased and protein intake patterns differed between men and women. Overall it shows changes in macronutrient distribution and energy intake over time in the US.
1) Childhood obesity has more than doubled in the past few decades and poses significant health risks.
2) Early identification of excessive weight gain is important through tracking BMI percentiles over time.
3) Pediatricians should discuss healthy eating and physical activity with families during routine visits to promote prevention and early recognition of obesity issues.
The document discusses a federal grant of nearly $1 million given to Traverse City, Michigan to increase physical activity and improve nutrition in schools. It notes that Michigan has high rates of childhood obesity and related health issues. The grant funds additional physical activities before, during and after school, as well as equipment, nutrition education, and staff training. It highlights the importance of a community-wide effort to address obesity and promote healthy lifestyles for children.
This document discusses obesity, its prevalence, and management. It notes that obesity produces complications like hypertension, diabetes, and heart disease. The prevalence of obesity is increasing globally and is a leading risk factor for death. Obesity is defined as abnormal growth of adipose tissue due to enlarged fat cells or increased fat cell number. The document discusses factors contributing to obesity like diet, physical inactivity, and genetics. It also outlines methods for measuring obesity and classifications based on BMI. Prevention and treatment options for obesity like diet, exercise, and surgery are mentioned.
Physical activity, early life events and the nutritional status of Maya childrenInes Varela-Silva
This document summarizes research on physical activity levels, early life events, and the nutritional status of Maya children in Merida, Mexico. The study found that 21.8% of children were stunted and 33% were overweight/obese. 70% of mothers were below the 5th percentile for height. Shorter stature in children was associated with lower activity levels. While children were generally highly active, girls and stunted children showed the lowest physical activity. The research suggests negative intergenerational effects on growth among the Maya.
The document discusses a proposed ban by New York City Mayor Michael Bloomberg to restrict the use of food stamps to purchase sugar-sweetened beverages. The proposal has generated controversy with opposition from anti-hunger groups and the USDA Food and Nutrition Service. There are also discrepancies in how the Food and Nutrition Act of 2008 defines terms like "food" and "staple foods". Recommendations include amending the law for clarity, allowing New York a waiver to test the proposal, and ensuring all nutrition programs have uniform nutritional standards.
The document discusses the growing epidemic of childhood overweight and obesity in the United States. Some key points:
- The percentage of overweight children has more than doubled from the late 1970s to 2000, and tripled for adolescents. Close to 1 in 5 children are now overweight or obese.
- This increase in overweight is associated with significant health impacts, including increased risk for conditions like hypertension, diabetes, and heart disease. Medical costs of obesity are substantial.
- Factors contributing to the rise in childhood overweight include decreases in physical activity and increases in caloric intake from foods like snacks, soft drinks and fast food. Children on average spend much more time engaged in sedentary activities now compared to the past.
Service providers who receive high nutrition risk referrals, particularly Registered Dietitians, need to be knowledgeable about general and clinical pediatric nutrition as well as counselling skills for working with families and children.
This is the third of five self-directed training modules available in PowerPoint presentations that have been developed and evaluated to respond to this need
Childhood obesity is defined as a BMI at or above the 95th percentile. Rates of childhood obesity have risen dramatically since the 1970s, with over 12 million children now considered obese. Potential causes include increased availability of unhealthy foods, large portion sizes, lack of physical activity, and excessive screen time. Consequences range from physical health issues to psychological effects. Prevention requires making healthy choices more available and accessible to children.
This document summarizes research on childhood obesity in the United States. It finds that obesity rates are higher among some racial/ethnic groups and older adolescents. Obesity results from long-term energy imbalance where calories consumed exceed calories used. Factors like diet, exercise, genetics, and environment contribute to obesity. Body mass index (BMI) is used to determine weight categories for adults and BMI-for-age for children/teens. Childhood obesity increases risk of adult obesity and chronic diseases. Parental obesity and other socioeconomic factors influence childhood obesity risk. A study found children of obese parents had much higher skin fold thickness, indicating higher body fat levels.
This document discusses obesity in children. It defines obesity and related terms like overweight, defines it using BMI percentiles. It discusses the pathogenesis involving hormones like leptin and ghrelin. Risk factors include genetic predisposition and lifestyle factors. Obesity can cause medical conditions like diabetes, hypertension, fatty liver disease. Evaluation involves history, exam and investigations. Management focuses on diet modification, physical activity and lifestyle changes.
The document discusses how Ronald McDonald may become the new Joe Camel as a mascot associated with unhealthy products like tobacco was, noting parallels between current debates around limiting fast food advertising to children and past debates around tobacco advertising; it also outlines strategies used successfully to curb tobacco use through public health campaigns and regulations that could potentially serve as models to address rising obesity levels.
Slideshow is from the University of Michigan Medical
School's M1 Human Growth and Development sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1GrowthDevelopment
The document summarizes obesity trends and statistics in the United States. It finds that approximately 66% of American adults are overweight or obese, with obesity rates doubling over the past 30 years. Obesity is associated with increased risk of diseases like hypertension, diabetes, and certain cancers. Minority groups and those of lower socioeconomic status tend to have higher obesity rates. Maintaining a healthy diet and active lifestyle can help address the national challenge of obesity.
The document discusses weight management and obesity. It states that 61% of Americans are overweight or obese. Being overweight or obese increases the risks of various health conditions such as diabetes, heart disease, and certain cancers. It provides information on assessing healthy weight ranges and body composition, including referencing body mass index (BMI) and waist-to-hip ratio. Risk factors for obesity include genetics, environment, lifestyle, and certain medical conditions or medications. Effective weight management involves setting realistic goals, making sustainable lifestyle changes, and focusing on overall wellness rather than any single number on the scale.
The document discusses weight management and obesity. It states that 61% of Americans are overweight or obese. Being overweight or obese increases the risks of various health conditions such as diabetes, heart disease, and certain cancers. It discusses various methods for assessing weight and body fat levels, including body mass index (BMI), waist-to-hip ratio, and body fat percentage. Risk factors for obesity include genetics, environment, lifestyle, and certain medical conditions or medications. Managing weight healthily involves setting realistic goals, making lifestyle changes, and focusing on long-term improvements rather than quick fixes.
The document discusses the obesity epidemic among children and youth. It notes that obesity rates have tripled for adolescents over the last two decades and may shorten lifespans. Factors contributing to rising obesity rates include increased food portion sizes, more time spent in sedentary activities like screen time, and physical education being reduced in many schools. Both environmental and genetic factors play a role in obesity, but genetics alone do not explain the large increases in prevalence seen in recent decades.
This document summarizes trends in childhood obesity in the United States. It finds that obesity rates have doubled in children ages 2-5 and tripled in children ages 6-11 and 12-19 between 1976-2008. Currently, around 32% of children and adolescents are overweight or obese. Obesity rates vary significantly by race and ethnicity, with non-Hispanic black and Hispanic youth having higher rates. Childhood obesity is associated with serious health risks that often continue into adulthood such as cardiovascular disease, diabetes, and psychological issues. A multifaceted response is needed that addresses individual, family, community and societal factors contributing to the current obesogenic environment experienced by many youth.
Management Of Obesity In Family Practice Cme 30 May08Gauranga Dhar
The document discusses obesity management in family practice. It defines obesity as a BMI of 30 kg/m2 or higher and notes that obesity is now a global epidemic according to the WHO. The management of obesity involves assessment to determine the degree and overall health status, followed by management focusing on weight loss, weight maintenance, and controlling other risk factors like cardiovascular disease and diabetes. Lifestyle and diet changes, physical activity, and behavior modification are emphasized as the primary non-pharmacological treatment approaches.
This document summarizes trends in dietary intake and physical activity in the US based on NHANES data from 1971-2010. It finds that from 1971-2000, calorie intake and carbohydrate intake increased for both men and women, while fat and saturated fat intake decreased. From 2000-2010, calorie intake decreased while carbohydrate intake decreased and fat, saturated fat, and protein intake increased. From 2007-2008 to 2009-2010, calorie intake decreased for both sexes, while carbohydrate intake decreased and protein intake patterns differed between men and women. Overall it shows changes in macronutrient distribution and energy intake over time in the US.
1) Childhood obesity has more than doubled in the past few decades and poses significant health risks.
2) Early identification of excessive weight gain is important through tracking BMI percentiles over time.
3) Pediatricians should discuss healthy eating and physical activity with families during routine visits to promote prevention and early recognition of obesity issues.
The document discusses a federal grant of nearly $1 million given to Traverse City, Michigan to increase physical activity and improve nutrition in schools. It notes that Michigan has high rates of childhood obesity and related health issues. The grant funds additional physical activities before, during and after school, as well as equipment, nutrition education, and staff training. It highlights the importance of a community-wide effort to address obesity and promote healthy lifestyles for children.
This document discusses obesity, its prevalence, and management. It notes that obesity produces complications like hypertension, diabetes, and heart disease. The prevalence of obesity is increasing globally and is a leading risk factor for death. Obesity is defined as abnormal growth of adipose tissue due to enlarged fat cells or increased fat cell number. The document discusses factors contributing to obesity like diet, physical inactivity, and genetics. It also outlines methods for measuring obesity and classifications based on BMI. Prevention and treatment options for obesity like diet, exercise, and surgery are mentioned.
Physical activity, early life events and the nutritional status of Maya childrenInes Varela-Silva
This document summarizes research on physical activity levels, early life events, and the nutritional status of Maya children in Merida, Mexico. The study found that 21.8% of children were stunted and 33% were overweight/obese. 70% of mothers were below the 5th percentile for height. Shorter stature in children was associated with lower activity levels. While children were generally highly active, girls and stunted children showed the lowest physical activity. The research suggests negative intergenerational effects on growth among the Maya.
The document discusses a proposed ban by New York City Mayor Michael Bloomberg to restrict the use of food stamps to purchase sugar-sweetened beverages. The proposal has generated controversy with opposition from anti-hunger groups and the USDA Food and Nutrition Service. There are also discrepancies in how the Food and Nutrition Act of 2008 defines terms like "food" and "staple foods". Recommendations include amending the law for clarity, allowing New York a waiver to test the proposal, and ensuring all nutrition programs have uniform nutritional standards.
The document discusses the growing epidemic of childhood overweight and obesity in the United States. Some key points:
- The percentage of overweight children has more than doubled from the late 1970s to 2000, and tripled for adolescents. Close to 1 in 5 children are now overweight or obese.
- This increase in overweight is associated with significant health impacts, including increased risk for conditions like hypertension, diabetes, and heart disease. Medical costs of obesity are substantial.
- Factors contributing to the rise in childhood overweight include decreases in physical activity and increases in caloric intake from foods like snacks, soft drinks and fast food. Children on average spend much more time engaged in sedentary activities now compared to the past.
Service providers who receive high nutrition risk referrals, particularly Registered Dietitians, need to be knowledgeable about general and clinical pediatric nutrition as well as counselling skills for working with families and children.
This is the third of five self-directed training modules available in PowerPoint presentations that have been developed and evaluated to respond to this need
Childhood obesity is defined as a BMI at or above the 95th percentile. Rates of childhood obesity have risen dramatically since the 1970s, with over 12 million children now considered obese. Potential causes include increased availability of unhealthy foods, large portion sizes, lack of physical activity, and excessive screen time. Consequences range from physical health issues to psychological effects. Prevention requires making healthy choices more available and accessible to children.
1. Sugar — the bitter truth
Robert H. Lustig, M.D.
Division of Endocrinology
Department of Pediatrics
University of California, San Francisco
UCSF Pediatric Advances, May 29, 2009
But is it?
The CDC says that the childhood obesity Secular trends in childhood obesity
epidemic is slowing down—
down— prevalence in U.S. 1999-2006
Severely Obese:
BMI for Age > 97th %ile
Obese:
BMI for Age > 95th %ile
Overweight:
BMI for Age > 85th %ile
Ogden et al. JAMA 299:2401-2405, 2008 Ogden et al. JAMA 299:2401-2405, 2008
But is it? But is it?
Secular trends in childhood obesity Secular trends in childhood obesity
prevalence in U.S. 1999-2006 prevalence in U.S. 1999-2006
Blacks and Latinos are increasing
Severely Obese: Severely Obese:
BMI for Age > 97th %ile BMI for Age > 97th %ile
Obese: Obese:
BMI for Age > 95th %ile BMI for Age > 95th %ile
Overweight: Overweight:
BMI for Age > 85th %ile Whites are decreasing BMI for Age > 85th %ile Whites are decreasing
Ogden et al. JAMA 299:2401-2405, 2008 Ogden et al. JAMA 299:2401-2405, 2008
2. So is the epidemic of childhood obesity really slowing down? So is the epidemic of childhood obesity really slowing down?
• The prevalence of obesity amongst Whites is decreasing, but • Despite the economic downturn of 2008,
amongst Blacks and Latinos (and Asians) is increasing McDonald’s revenues and stock price continues to rise;
and Coke and Pepsi still fared better than the S&P 500
• Minorities compose an increasing percentage of American children
annually McD
• This JAMA paper analyzed mean data from all ages 2-19; Coke
but in the 2-5 year old age range, things are just getting worse
Pepsi
S&P 500
The First Law of Thermodynamics Total Caloric Intake
Cheap food?
↑ 275 kcal in teen boys
Weight Gain
Calories
Calories In
Out
Children 2-17 yrs, CSFII (USDA) 1989-91 vs. 1994-95
http://www.usda.gov/cnpp/FENR%20V11N3/fenrv11n3p44.PDF
Prevalence of Obesity Compared to Percent
Fat Intake: Grams Calories from Fat Among US Adults
↑ 5 g (45 cal) in teen boys
Percent
Children 2-17 yrs, CSFII (USDA) 1989-91 vs. 1994-95 Year
3. Beverage Intake
Carbohydrate Intake: Grams
↑41% soft drinks
↑ 57 g (228 cal) in teen boys
↑35%
fruit drinks
Children 2-17 yrs, CSFII (USDA) 1989-91 vs. 1994-95
Children 2-17 yrs, CSFII (USDA) 1989-91 vs. 1994-95
Beverage Intake Meta-Analysis of Soft Drinks and Obesity
Meta-
↑41% soft drinks
88 cross-sectional and longitudinal studies regressing
soft drink consumption with —
↑35%
fruit drinks • energy intake r = 0.16 (P < 0.001)
• body weight r = 0.08 (P < 0.001)
• milk and calcium intake r = -0.12 (P < 0.001)
• adequate nutrition r = -0.10 (P < 0.001)
Those studies funded by the beverage industry demonstrated
smaller effects than independent studies
Children 2-17 yrs, CSFII (USDA) 1989-91 vs. 1994-95
One can of soda/day = 150 cal x 365 d/yr 3500 cal/lb = 15.6 lbs/yr!
Vartanian et al. Am J Public Health epub March 2007; 10.2105/AJPH.2005.083782
Curtailing soft drinks limits childhood obesity High Fructose Corn Syrup
Current US annual
consumption of
Obesity Prevalence (%)
HFCS
• 63 pounds per
person
James et al. BMJ 328:1237, 2004
4. High Fructose Corn Syrup is 42-55% Fructose;
42- USA Today, Dec 9, 2008 P. 7D
Sucrose is 50% Fructose
Glucose Fructose
Sucrose
Press Release, February 6, 2008 Secular trend in fructose consumption
Unlikely Duo Opposes San Francisco Soft Drink Tax Plan
Corn Refiners and CSPI Agree High-Fructose Corn Syrup No Worse Than Sugar
Natural consumption of fruits and vegetables
WASHINGTON—The nonprofit Center for Science in the Public Interest has long supported • 15 gm/day
small taxes on soft drinks to help pay for bike paths, nutrition education, and other obesity-
prevention programs. But CSPI opposes a measure proposed by San Francisco Mayor Gavin
Prior to WWII (estimated):
Newsom because it would tax only drinks made with high-fructose corn syrup and not drinks
made with other forms of sugar. Less surprisingly, the Corn Refiners Association also opposes • 16-24 gm/day
the measure, but the two groups cosigned an unusual joint letter to Mayor Newsom urging him
to reconsider his plan. 1977-1978 (USDA Nationwide Food Consumption Survey):
• 37 gm/day (8% of total caloric intake)
“We respectfully urge that the proposal be revised as soon as possible to reflect the scientific
evidence that demonstrates no material differences in the health effects of high-fructose corn
syrup and sugar,” wrote CSPI executive director Michael F. Jacobson and Corn Refiners 1994 (NHANES III):
Association president Audrae Erickson. “The real issue is that excessive consumption of any • 54.7 gm/day (10.2% of total caloric intake)
sugars may lead to health problems.”
The letter goes on to explain that high-fructose corn syrup and sucrose, or table sugar, are
Adolescents:
similar in composition and that several studies have shown that the two types of sugars are • 72.8 gm/day (12.1% of total caloric intake)
similarly metabolized by the body. • 25% consumed at least 15% of calories from fructose
Bray, Am J Clin Nutr 86:895, 2007; Vos et al. Medscape Med J 10:160, 2008
The perfect storm from three political winds The perfect storm from three political winds
1. Richard Nixon and USDA Secretary Earl Butz (1973)
• food should never be an issue in a presidential election
5. The perfect storm from three political winds
1. Richard Nixon and USDA Secretary Earl Butz (1973)
• food should never be an issue in a presidential election
2. The advent of High Fructose Corn Syrup
• invented in 1966 in Japan
• introduced to the American market in 1975
Juice is sucrose:
Change in BMI z-score in lower socioeconomic status
z-
children versus number of fruit juice servings per day
Sucrose
High Fructose Corn Syrup
Faith MS et al. Pediatrics 118:2066, 2006
The perfect storm from three political winds
MOST FRUCTOSE ITEMS
1. Richard Nixon and USDA Secretary Earl Butz (1973)
• food should never be an issue in a presidential election
2. The advent of High Fructose Corn Syrup
• invented in 1966 in Japan
Sucrose
• introduced to the American market in 1975
JUICE
3. The USDA, AMA, and AHA call for dietary fat reduction
High Fructose Corn Syrup • Early 1970’s: discovery of LDL
• Mid 1970’s: Dietary fat raises LDL (A B)
• Late 1970’s: LDL correlated with CVD (B C)
• 1982: If A B, and B C, then A C,
therefore no A, no C
6. Seven Countries
The macronutrient wars 1970-1980
1970-
Correlation of CHD with dietary fat
1972, 1986
Seven Countries
The low-fat craze
low-
Correlation of CHD with dietary fat
The content of low-fat home-cooked food can be controlled
But low-fat processed food means substitution with carbohydrate
Which carbohydrate?
Either
• High fructose corn syrup (55% fructose)
• Sucrose (50% fructose)
e.g. Nabisco Snackwells® Oreos
Page 262: (—2g fat, +13g CHO (+4g sugars))
Diet
Fructose is not glucose
Adulteration of our food supply
Addition of fructose • Fructose is 7 times more likely than glucose
to form Advanced Glycation End-Products (AGE’s)
• palatability (esp. with decreased fat)
• browning agent • Fructose does not suppress ghrelin
Removal of fiber • Acute fructose does not stimulate insulin (or leptin)
• shelf life
• Hepatic fructose metabolism is different
• freezing
• Chronic fructose exposure promotes the
Substitution of trans-fats Metabolic Syndrome
• hardening agent, shelf life Elliot et al. Am J Clin Nutr, 2002
Nutr, Le and Tappy, Curr Opin Clin Nutr Metab Care, 2006
Tappy,
Bray et al. Am J Clin Nutr, 2004
Nutr, Wei et al. J Nutr Biochem, 2006
Biochem,
• now being removed due to CVD risk Teff et al. J Clin Endocrinol Metab, 2004
Metab, Johnson et al. Am J Clin Nutr 2007
Gaby, Alt Med Rev, 2005 Rutledge and Adeli, Nutr Rev, 2007
Adeli,
Brown et al. Int. J. Obes, 2008
Obes,
8. Ethanol is a carbohydrate Ethanol is a carbohydrate
CH3-CH2-OH
Acute ethanol exposure Acute fructose exposure
Ethanol is a carbohydrate • CNS depression
• Vasodilatation, decreased BP
• Hypothermia
• Tachycardia
CH3-CH2-OH • Myocardial depression
• Variable pupillary responses
• Respiratory depression
• Diuresis
But ethanol is also a toxin • Hypoglycemia
• Loss of fine motor control
11. Relations between fructose, uric acid and
hypertension in NHANES IV adolescents
P = 0.01
S Nguyen et al. J Pediatr (in press)
Relations between fructose, uric acid and
hypertension in NHANES IV adolescents
P = 0.0495
S Nguyen et al. J Pediatr (in press)
12.
13. Fructose increases de novo lipogenesis, triglycerides
lipogenesis,
Fructose increases de novo lipogenesis in normal adults and free fatty acids in normal adults
Hellerstein et al. Ann Rev Nutr 16:523, 1996 Faeh and Schwarz, Diabetes 54:1907, 2005
ALT (U/ml)
Sugar sweetened beverages (kcal/day)
14.
15. Why is exercise important in obesity?
Because it burns calories?
So what’s with Colorado?
what’
Why is exercise important in obesity?
Because it burns calories?
Because it improves skeletal muscle insulin sensitivity
Because it reduces stress, and resultant cortisol release
Because it makes the TCA cycle run faster, and
detoxifies fructose, improving hepatic insulin sensitivity
So what’s with Colorado?
what’ Why is fiber important in obesity?
Four factors increase the hepatic TCA cycle
Cold Thyroid hormone
Altitude Exercise
16. Why is fiber important in obesity? Why is fiber important in obesity?
“When G-d made the poison, he packaged it with the antidote.” “When G-d made the poison, he packaged it with the antidote.”
Fiber:
1. Reduces rate of intestinal carbohydrate absorption,
reducing insulin response
2. Increases speed of transit of intestinal contents to ileum,
to raise PYY3-36, and induce satiety
3. Inhibits absorption of some free fatty acids to the colon,
which are metabolized by colonic bacteria to short-
chain fatty acids (SCFA), which suppress insulin
Chronic ethanol exposure Chronic ethanol exposure Chronic fructose exposure
• Hematologic disorders • Hematologic disorders
• Electrolyte abnormalities • Electrolyte abnormalities
• Hypertension • Hypertension • Hypertension
• Cardiac dilatation • Cardiac dilatation
• Cardiomyopathy • Cardiomyopathy • Myocardial infarction
• Dyslipidemia • Dyslipidemia • Dyslipidemia
• Pancreatitis • Pancreatitis • Pancreatitis (2o dyslipidemia)
• Malnutrition • Malnutrition
• Obesity • Obesity • Obesity
• Hepatic dysfunction (ASH) • Hepatic dysfunction (ASH) • Hepatic dysfunction (NASH)
• Fetal alcohol syndrome • Fetal alcohol syndrome • Fetal insulin resistance
• Addiction • Addiction • Habituation, if not addiction
What’s the difference?
What’ What’s the difference?
What’
Calories 150 150 Calories 150 150
Percent CHO 10.5% (sucrose) 3.6% (alcohol) Percent CHO 10.5% (sucrose) 3.6% (alcohol)
Calories from Calories from
fructose 75 (4.1 kcal/gm) fructose 75 (4.1 kcal/gm)
other carbs 75 (glucose) 60 (maltose) other carbs 75 (glucose) 60 (maltose)
alcohol 90 (7 kcal/gm) alcohol 90 (7 kcal/gm)
1st pass GI metabolism 0% 10% 1st pass GI metabolism 0% 10%
Calories reaching liver 90 92 Calories reaching liver 90 92
17. What’s the difference?
What’
Fructose is a carbohydrate
Calories 150 150
Percent CHO 10.5% (sucrose) 3.6% (alcohol)
Calories from
fructose 75 (4.1 kcal/gm)
other carbs 75 (glucose) 60 (maltose)
alcohol 90 (7 kcal/gm)
1st pass GI metabolism 0% 10%
Calories reaching liver 90 92
Fructose is a carbohydrate Fructose is a carbohydrate
Fructose is metabolized like fat Fructose is metabolized like fat
(corollary: a low fat diet isn’t really low fat,
because the fructose/sucrose doubles as fat)
Summary
• Fructose (sucrose vs. HFCS) consumption has increased
Fructose is a carbohydrate in the past 30 years, coinciding with the obesity epidemic
• A calorie is not a calorie, and fructose is not glucose
• You are not what you eat, you are what you DO with what you eat
• Hepatic fructose metabolism leads to all the manifestations of the
Fructose is metabolized like fat Metabolic Syndrome:
hypertension
de novo lipogenesis, dyslipidemia, and hepatic steatosis
inflammation
hepatic insulin resistance
obesity
Fructose is also a toxin hyperglycemia
CNS leptin resistance, promoting reward and
continuous consumption
• Fructose is a dose-dependent chronic hepatotoxin
(it’s “alcohol without the buzz”)
18. Collaborators
Childhood Obesity 2010:
The next generation in prevention and UCSF Dept. of Pediatrics
Chaluntorn Preeyasombat, M.D.
management Elvira Isganaitis, M.D.
Michele Mietus-Snyder, M.D.
Andrea Garber, Ph.D., R.D.
• SF Childhood Obesity Task Force Joan Valente, Ph.D.
• Sponsored by SF Dept. of Public Health Cam-Tu Tran, M.D.
Kristine Madsen, M.D., M.P.H.
• Training Day for Childhood Obesity Stephanie Nguyen, M.D.
• Saturday, Feb. 27, 2010, 8AM-5PM Carolyn Jasik, M.D., M.P.H.
UCSF Dept. of Epidemiology and Biostatistics
• Milton Marks Auditorium (Civic Center) Ann Lazar, Ph.D.
Peter Bacchetti, Ph.D.
• State of the art Saunak Sen, Ph.D.
• Theory, and tools to use in practice UC Berkeley Dept. of Nutritional Sciences
Jean-Marc Schwarz, Ph.D.
• CME offered Sharon Fleming, Ph.D.
Lorene Ritchie, Ph.D.