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onzinnige voeding Prof.dr. Hans Verhagen
[object Object],[object Object],[object Object],[object Object],[object Object]
Voeding is hot
Nieuws 1 week September 2007
“ voeding is net als voetbal” –  “iedereen (w)eet ervan”
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
‘ 1870 ’: 10* to high iron values published ( ,  wrong) 1929 Discovered only in   1937   : correct values
Chemicaliën ,[object Object],Pesticiden Verpakkingsmaterialen Microbiologie Natuurlijke toxines
1990’s ,[object Object],[object Object],[object Object]
General Food Law Verordening EC 178/2002
Risk analysis Risk assessment Risk management Risk communication Risk analysis paradigm
Risk analysis Risk assessment Risk management Risk communication Risk analysis paradigm
Ons voedsel is veilig √
[object Object],[object Object],[object Object],[object Object],[object Object]
Voeding = totaal van voedsel
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
[WHO: Global Health Risks, 2009] Voeding
Obesity in NL  1981-2003
Energy in Energy balance Energy out
Children: 60 kcal / day = difference 60 kcal 1,5 1 1  hour ½  hour
Advies Richtlijnen Goede Voeding  Gezondheidsraad  2006 http://www.gr.nl/pdf.php?ID=1478&p=1
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Richtlijnen Goede Voeding 2006
“ Richtlijnen Voedselkeuze”
Voedselconsumptiepeiling  ,[object Object],[object Object]
Voldoende groente? *= < 14 jaar: minstens 150 gram; 14+ jaar: minstens 200 gram
Voldoende fruit? *= < 9 jaar: minstens 150 gram; 9+ jaar: minstens 200 gram
Gebruik van voedingssupplementen ,[object Object],[object Object],[object Object]
Goede vetten? ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Claims
EU Regulation 1924/2006
LIFESPAN EXTENSION COMPLEX “ performance” “ antioxidants”
EU Regulation 1924/2006 ,[object Object],[object Object],[object Object],[object Object],[object Object]
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 ,[object Object],[object Object],[object Object],[object Object],What it contains Article 14
EU Regulation 1924/2006 ,[object Object],[object Object],[object Object],[object Object],What it contains + Vit C Light
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 ,[object Object],[object Object],[object Object],[object Object],What it contains Article 14
Health claims  should be substantiated Health claims  should be substantiated Health claims  should be substantiated Health claims  should be  substantiated authorities scientists industry consumers
ILSI Europe 2001 - 2005 EFSA 2007
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Scientific and technical guidance (July 2007)
[object Object],[object Object],[object Object],[object Object]
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 ,[object Object],[object Object],[object Object],[object Object],What it contains Article 14
[object Object],[object Object],[object Object],[object Object],EU Regulation 1924/2006:   List of Article 14 and 13.5 claims dossiers
21 August 2008: EFSA adopts first opinions on health claims made on foods relating to disease risk reduction and children’s health
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
EFSA health claim rejections 'shock' industry
Industry: “EFSA verdicts on food claims  send  shockwaves  through the industry” Consumer organizations: “ welcome   EFSA approach” Scientists: “generally  support   for EFSA opinions”
March 2009: EC validates  21 EFSA health claim Opinions
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
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 ,[object Object],[object Object],[object Object],[object Object],What it contains Article 14 Based on  newly developed  scientific  data Reduction  of disease  risk claims +  claims growth and  development of children
[object Object],[object Object],[object Object],[object Object],[object Object],EU Regulation 1924/2006:  List of Article 13. 1  claims “ Dossiers” papers etc
Claims received by category
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
(geen) vitamine C :  scheurbuik James Lindberg 1747
Oxidative damage / oxygen paradox O 2 respiration ROS damage energy protective regulatory
The antioxidant hypothesis Oxidative stress Endogenous ROS Exogenous ROS vitC/vitE SOD/CAT/GSH-Px Carotenoids Flavonoids … ..
Antioxidant studies  in vitro /animals In vitro :   - effects - high doses - many parameters - many studies - many papers - mechanistic research ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
1. in vitro /animal studies     2. studies in humans 1. observational   studies 2. intervention   studies
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
Sies, H. (1988)  Nature  332, 495
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
Conclusions Antioxidants Antioxidants are  great for rats !
More is Not Always Better
Morris & Tangney, JAMA 2011, 305, 1348
ongezonde  voeding Functionele voedingsmiddelen en  voedingssupplementen vormen geen oplossing voor de gezondheidsproblemen door een ‘ongezonde voeding’.
[object Object],[object Object],[object Object],[object Object],[object Object]
risk only (safety)     balance of risks and benefits
Benefits CVD, cancer, etc ↓ Risks pesticides
Benefits Coronary heart disease ↓ Risks Neurological damage  in the fetus (MeHg)
[object Object],[object Object],[object Object]
Model  &  Werkelijkheid Courtesy: Johan Schefferlie
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
Folic Acid ,[object Object],[object Object],[object Object],[object Object]
* Many assumptions and uncertainties Folic acid fortification of flour Results in  incidence *
Net health benefit >>>  net health risk Folic acid fortification of flour Results in  DALY’s Net health benefit >>>  net health risk
 
Low calorie sweeteners ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Low calorie sweeteners ,[object Object],[object Object],[object Object],[object Object]
“ Life would be pretty dull without risk” “voluntary risk taking and its pleasures”* ,[object Object],[object Object],[object Object],[object Object],*Lupton & Tulloch, Health, Risk and Society, 4 [2002] 113-124
Food and nutrition Medicine Economics and Marketing-Finance Risk not accepted Risk accepted Risk a neccesity
[object Object],[object Object],[object Object],[object Object],[object Object]
Health gain with optimal diet:   http://www.rivm.nl/bibliotheek/rapporten/350080001.html
Health gain with optimal diet:   http://www.rivm.nl/bibliotheek/rapporten/350080001.html
140.000 sterfgevallen/20 jaar = 7.000 / jaar
Health gain with optimal diet: http://www.rivm.nl/bibliotheek/rapporten/350080001.html Net Present Value  
2004 2006
Eating  too  much food safety Eating  wrong ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],unhealthy  diet
unhealthy  diet food safety Why are we so scared about our food ???
Benefit-risk analysis Benefit-risk assessment Benefit-risk management Benefit-risk communication Benefit-risk analysis paradigm
Evidence based nutrition Evidence based decisions
Dank u wel voor uw aandacht !
© ============================================= 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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ScienceCafé Zeist: Voeding 10-11-11

  • 2.
  • 3.
  • 5. Nieuws 1 week September 2007
  • 6.
  • 7.
  • 8. “ voeding is net als voetbal” – “iedereen (w)eet ervan”
  • 9.
  • 10.
  • 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. ‘ 1870 ’: 10* to high iron values published ( , wrong) 1929 Discovered only in 1937 : correct values
  • 13.
  • 14.
  • 15.
  • 16.
  • 17. General Food Law Verordening EC 178/2002
  • 18. Risk analysis Risk assessment Risk management Risk communication Risk analysis paradigm
  • 19. Risk analysis Risk assessment Risk management Risk communication Risk analysis paradigm
  • 20. Ons voedsel is veilig √
  • 21.
  • 22. Voeding = totaal van voedsel
  • 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. [WHO: Global Health Risks, 2009] Voeding
  • 25. Obesity in NL 1981-2003
  • 26. Energy in Energy balance Energy out
  • 27. Children: 60 kcal / day = difference 60 kcal 1,5 1 1 hour ½ hour
  • 28. Advies Richtlijnen Goede Voeding Gezondheidsraad 2006 http://www.gr.nl/pdf.php?ID=1478&p=1
  • 29.
  • 31.
  • 32. Voldoende groente? *= < 14 jaar: minstens 150 gram; 14+ jaar: minstens 200 gram
  • 33. Voldoende fruit? *= < 9 jaar: minstens 150 gram; 9+ jaar: minstens 200 gram
  • 34.
  • 35.
  • 36.
  • 39. LIFESPAN EXTENSION COMPLEX “ performance” “ antioxidants”
  • 40.
  • 41.
  • 42.
  • 43.
  • 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. ILSI Europe 2001 - 2005 EFSA 2007
  • 46.
  • 47.
  • 48.
  • 49.
  • 50. 21 August 2008: EFSA adopts first opinions on health claims made on foods relating to disease risk reduction and children’s health
  • 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. EFSA health claim rejections 'shock' industry
  • 53.
  • 54. Industry: “EFSA verdicts on food claims send shockwaves through the industry” Consumer organizations: “ welcome EFSA approach” Scientists: “generally support for EFSA opinions”
  • 55. March 2009: EC validates 21 EFSA health claim Opinions
  • 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.
  • 58.
  • 59.
  • 60.
  • 61.
  • 62. Claims received by category
  • 63.
  • 64.
  • 65.
  • 66.
  • 67.
  • 68. (geen) vitamine C : scheurbuik James Lindberg 1747
  • 69. Oxidative damage / oxygen paradox O 2 respiration ROS damage energy protective regulatory
  • 70. The antioxidant hypothesis Oxidative stress Endogenous ROS Exogenous ROS vitC/vitE SOD/CAT/GSH-Px Carotenoids Flavonoids … ..
  • 71.
  • 72. 1. in vitro /animal studies  2. studies in humans 1. observational studies 2. intervention studies
  • 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. Sies, H. (1988) Nature 332, 495
  • 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.
  • 78. More is Not Always Better
  • 79. Morris & Tangney, JAMA 2011, 305, 1348
  • 80. ongezonde voeding Functionele voedingsmiddelen en voedingssupplementen vormen geen oplossing voor de gezondheidsproblemen door een ‘ongezonde voeding’.
  • 81.
  • 82.
  • 83. risk only (safety)  balance of risks and benefits
  • 84. Benefits CVD, cancer, etc ↓ Risks pesticides
  • 85. Benefits Coronary heart disease ↓ Risks Neurological damage in the fetus (MeHg)
  • 86.
  • 87. Model & Werkelijkheid Courtesy: Johan Schefferlie
  • 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.
  • 90. * Many assumptions and uncertainties Folic acid fortification of flour Results in incidence *
  • 91. Net health benefit >>> net health risk Folic acid fortification of flour Results in DALY’s Net health benefit >>> net health risk
  • 92.  
  • 93.
  • 94.
  • 95.
  • 96. Food and nutrition Medicine Economics and Marketing-Finance Risk not accepted Risk accepted Risk a neccesity
  • 97.
  • 98. Health gain with optimal diet:   http://www.rivm.nl/bibliotheek/rapporten/350080001.html
  • 99. Health gain with optimal diet:   http://www.rivm.nl/bibliotheek/rapporten/350080001.html
  • 100. 140.000 sterfgevallen/20 jaar = 7.000 / jaar
  • 101. Health gain with optimal diet: http://www.rivm.nl/bibliotheek/rapporten/350080001.html Net Present Value  
  • 103.
  • 104. unhealthy diet food safety Why are we so scared about our food ???
  • 105. Benefit-risk analysis Benefit-risk assessment Benefit-risk management Benefit-risk communication Benefit-risk analysis paradigm
  • 106.
  • 107. Evidence based nutrition Evidence based decisions
  • 108. Dank u wel voor uw aandacht !
  • 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 ============================================

Notas del editor

  1. 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.
  2. Kwalitatief: gelden voor de Nederlandse bevolking vanaf 12 maanden
  3. 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. )
  4. 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. )
  5. 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.
  6. 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%.
  7. Donkere achtergrond resultaat van gevoeligheidsanalyse bij lage dosering (500) al toename van probability of CRkanker
  8. Donkere achtergrond resultaat van gevoeligheidsanalyse bij lage dosering (500) al toename van probability of CRkanker
  9. 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
  10. 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
  11. 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