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FireFit 2005 Conference Christopher Speed, MND APD Dana Farber Cancer Institute

FireFit 2005 Conference Christopher Speed, MND APD Dana Farber Cancer Institute. Nutrition Revolutions 1970’s Type of fat (“saturated fat”) 1980’s Amount of fat (“low fat”) 1990’s Low carbohydrate 2000’s Optimum eating pattern (“Mediterranean-type”). C A N C E R. 4 Pillars of Health.

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FireFit 2005 Conference Christopher Speed, MND APD Dana Farber Cancer Institute

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  1. FireFit 2005 Conference Christopher Speed, MND APD Dana Farber Cancer Institute

  2. Nutrition Revolutions 1970’s Type of fat (“saturated fat”) 1980’s Amount of fat (“low fat”) 1990’s Low carbohydrate 2000’s Optimum eating pattern (“Mediterranean-type”)

  3. C A N C E R 4 Pillars of Health Wise Eating Blood Pressure Cholesterol Weight Fitness/activity Stress Smoking Keep Fit Manage Stress Don’t Smoke

  4. The Serious Pain of Obesity Former severely obese patients: • 100% preferred to be deaf, dyslexic, diabetic, or have heart disease or bad acne than to be obese again • Leg amputation was preferred by 91.5% and blindness by 89.4% • 100% preferred to be a normal weight person rather than a severely obese multimillionaire Rand CSW, Macgregor AMC. Int J Obes. 1991;15:577–579.

  5. So What Defines Optimal Nutrition for Cardiovascular Disease and Cancer Prevention? Fat Carbohydrate Protein Alcohol Sodium

  6. Seven-Countries Study: Dietary Total Fat and 10-year CHD death rate, 1958-1974 Men, age 40-59 yr at entry E. Finland USA 10-yr CHD deaths/1000 Holland Rome W. Finland Belgrade Italy (rural) Croatia Serbia Corfu Croatia Japan Serbia Crete Dietary Total Fat (% energy) Keys A. Harvard U. Press, 1980.

  7. Fat: Quality more Important than Quantity Quality Fats: Monounsaturated and Polyunsaturated

  8. Healthy Fats Monounsaturated Fats • Olive, canola and peanut oils • Nuts (almonds,cashews,peanuts,filberts, macadamias,pecans,pistachios) • Avocados • Peanut butter and other nut butters

  9. Randomized Clinical Trials of Polyunsaturated Fats CVD N Yrs % Fat Cholesterol 6 5 4 8 34 39 46 39 -15% -14% -15% -13% 676 412 393 846 Finnish Hospital ‘79 Oslo ‘ 70 MRC Soy Oil ‘68 Los Angeles ‘69 (Dayton) -43%* -25%* -12% -34%* Linoleic was major fat that replaced saturated, but alpha linolenic acid also increased. *P < 0.05 Sacks F. Am J Med. 2002; Dec 30; supplement.

  10. Clinical Trials of Fish Oil After Myocardial Infarction • GISSI (Lancet 1999;354:447) • 1g/d n-3 PUFA for 3.5 years • 5666 fish oil, 5658 control • CVD Death reduced by 30% • DART (Burr et al. Lancet 1989;ii:757 • 1015 fish oil, 1015 control • 0.3g/d n-3 PUFA for 2 years • IHD death reduced by 33% • Non-fatal CVD not reduced

  11. Healthy Fats Polyunsaturated Fats Omega 6’s • Corn, safflower, sunflower, soybean • Walnuts Omega 3’s • Fatty fish: salmon, sardines, bluefish, herring, tuna, mackerel • Flaxseeds, canola oil, wheat germ

  12. Limit Unhealthy Fats: Trans Fats and Saturated Fats

  13. Trans Fats Nurses’ Health Study: the nurses who ate 3% daily calories from trans fat were 50% more likely to develop CHD over 14 yrs than those who ate < 1% of daily calories from trans fats

  14. Saturated Fats and CAD • In Key’s 7 Country study, direct correlation between intake of saturated fats and increased risk of CHD

  15. Saturated Fats and CAD Ni-Ho San Study Japan Hawaii California • Sat fat (% E) 7 23 26 • Alcohol (%E) 8.9 3.7 2.5 • Chol (mg/dl) 181 218 228 • >120% wt. 22% 56% 63% Kato.1973

  16. Saturated Fat and CAD Ni-Ho San Study Age adjusted CAD rates (per 1000 person yr) • Japan 1.6 • Hawaii 3.0 • California 3.7

  17. Nurses’ Health StudyReplacing Saturated or Trans Fat: Change in CHD N=80,052 women, 939 cases. Adjusted for CHD risk factors, dietary monounsaturated, polyunsaturated and trans fatty acids. Sat Carb (5% Energy) Sat Mono (5% energy) Sat Poly (5% Energy) Trans Cis Unsat (2% Energy) -80 -70 -60 -50 -40 -30 -20 -10 0 10 Change in CHD Risk (%) Hu, F et al. N Engl J Med 1997

  18. Dietary Fat, Carbohydrate and Risk of Type 2 Diabetes in the Nurses Health Study 40 2% isoenergetic substitutions 20 0 -20 -40 -60 trans poly Sat poly Carb poly Sat mono Salmerone et al., AJCN 2001; 73:1019

  19. Abundance of Plant FoodsFruits, Vegetables, Nuts

  20. Fruits and Vegetables and Coronary Heart Diseasefrom NHS and HPFS • Men and women eating 8+ servings of fruits and vegetables a day had a 20% lower risk of developing CHD compared to those in the lowest quintile (< 3 servings/day) • Contributing most to the protective effect: Green leafy vegetables Vitamin C rich fruits Joshipura,2001

  21. Fruit and Vegetables and Coronary Heart Disease Joshipura et al; Ann Int Med 2001

  22. Fruit and Vegetable Intake and Ischemic Stroke: NHS and PHFS • Those in highest quintile (median of 5 serv for men and 5.8 serv for women) had a 31% lower risk compared to those in the lowest quintile (< 3 serv/day) • Contributing most to protective effect: cruciferous vegetables, green leafy vegetables, citrus fruit and citrus fruit juice

  23. Fruit and Vegetables and Ischemic Stroke Joshipura et al; JAMA, 1999

  24. Typical Nut Consumption Source:USDA Economic Research Service, 1997 Data (Nutrition Insights No. 23, Dec. 2000)

  25. Nut Consumption Lowers Risk of Heart Disease: (Nurses Health Study, 1980-97) Frequency Relative Risk CI 1oz serving Almost never 1.0 - 1/mo -1/wk 0.89 (0.79-1.01) 2-4/week 0.77 (0.59-0.99) 5+/week 0.68 (0.77-0.98) Hu et al, 1997

  26. Relative Risk of Type 2 Diabetes According to Frequency of Nut Consumption, Stratified by BMI P for Trend =0.003 P for Trend = .003 P for Trend = 0.001 P for Trend = .01 P for Trend = .02 P for Trend = 0.02 0.75 0.75 0.55

  27. Nut Consumption and Risk of Obesity (BMI≥30)

  28. Carbohydrates • In the average Westernised diet, carbohydrates contribute at least halfthe calories • Half of these calories come from just seven sources

  29. Carbohydrates 7 main sources of carbohydrate • Bread (15%) • Soft drinks and sodas (9.5%) • Cakes, cookies and donuts (7%) • Sugars, syrups, jams (6%) • White potatoes (5%) • Ready-to-eat cereals (5%) • Milk (5%)

  30. Carbohydrates How do we measure its effect on our body? Glycemic Index = type of carbohydrate Glycemic Load = type of carbohydrate + amount of carbohydrate

  31. Risk of CHD According to Glycemic Load Nurses’ Health Study 1984 -1994 RR of CHD Glycemic Load Quintiles Liu 2000

  32. Relative Risk of NIDDM by Different Levels of Cereal Fiber and Glycemic Load WOMEN Relative Risk <2.5 g/day (ref) 2.5 -5.8 g/day Cereal Fiber >5.8 g/day >165 165-143 <143 Glycemic Load Salmeron, Willett. JAMA 1997;277:472

  33. Fiber • Nurses’ Health Study(n=75,521 women) highest quintile whole grain consumption • 25% reduction in CHD • 30% reduction in ischemic stroke • 40% reduction in diabetes. • Iowa Women’s Health Study(n=35,000 women 55yo+) highest quintile • 30% reduction in coronary death • 20% reduction in diabetes

  34. Obesity: Diet Intervention to Support Long Term Weight Loss

  35. Why Are We Gaining Weight? • Data from NHANES I, II, III (1971-1994) • Total mean energy intake has increased approximately 300 kcal • Exercise/physical activity has declined Briefel et al. 1995

  36. Low-Fat Weight Loss Trials 100 NDH (1968) (35 vs 30% E) 95 Boyd (1990) (37 vs 21% E) 90 85 Jeffery (1995) (33 vs 26% E) 80 Black (1994) (40 vs 21% E) Body Weight (kg) 75 Sheppard (1991) (38 vs 20% E) 70 Kasim (1993) (36 vs 17% E) 65 60 Simon (1997) (34 vs 18% E) 55 Knopp (1997) (27 vs 22% E) 50 McManus (2001) (35 vs 20% E) 0 6 12 21 Length of Follow-up (months) 26.062

  37. Moderate Fat Weight Loss Trials Study Population • Randomized, prospective 18 month trial in a free-living population • 101 overweight men and women • mean BMI: 33.5 kg/m2 • mean age: 44 yrs • all subjects had reported numerous previous weight loss attempts

  38. Nutrient Goals For The Diets MOD FAT LOW FAT • Calories 1200-1500 1200-1500 • Fat (%) 35% 20% -Sat 5% 5% -Mono 15-20% 7-8% -Poly 10% 7-8%

  39. Nutrient Goals For The Diets MOD FAT LOW FAT • Protein (%) 15-20% 15-20% • CHO(%) 45-50% 60-65% • Fiber (gms) 25 25 • Cholesterol(mg) <200 <200

  40. PARTICIPATION RATES

  41. Weight Loss at 18 Months(Active Participants throughout Entire Trial) n=25 n=10

  42. FOOD ANALYSIS IJO, 2001

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