DIET AND LIFESTYLE
S. A. Udipi
Professor & Head
Dept. of Food Science and Nutrition,
S.N.D.T. Women’s University
Food and Man
• Food occupies a central position in life.
- beyond appeasement of hunger.
- part of our value systems.
- symbol of hospitality, pleasure, love,
security.
- symbolize status and power.
- emotional connotations.
Indian modern society – a paradox
• One end of the spectrum – a scene of
plenty , at the other end, food and
nutritional security are unfulfilled dreams
• Nutrition a critical component of risk
reduction and treatment
• India faces double burden of malnutrition
• Undernutrition in pregnancy – increased
risk of NCDs?
Globalization Diet and Lifestyle
Nutrition Transition
Changing dietary and life style patterns
Widespread flow of
information, ideas, lifestyles
Advertising
Product marketing
Increasing array of
Cultural globalization
manufactured goods
Cross-cultural interaction
Increasing world trade
Migration
Global markets
Global trading system
Globalization
• Nutrition transition towards diets with high
proportions of salt, saturated fats, sugar
• Availability and use of drugs
• Consumption of alcohol and tobacco
products
• Results in profound , complex changes in
nature of society
• Brings new opportunities and risks
Frequency of Consumption of Foodstuffs
by Call Center Employees (n=1400)
Food items
Daily
2-3 x /week
1x/week
1 x/fortnight
Fried snacks
24.0
27.1
22.0
7.7
Pizza/burger
3.8
12.7
28.0
14.6
Icecream
6.6
9.1
27.6
13.7
Chocolate
20.5
18.5
16.4
12.6
Mithai
6.9
10.9
16.7
11.6
Biscuits
32.4
18.7
15.2
10.8
Wafers/chips
26.9
20.6
17.0
12.8
Soft drinks
25.4
20.4
19.4
9.6
Juices
25.4
21.3
15.7
13.4
Alchohol/Beer
3.1
4.5
9.6
8.4
Leafy vegetables
29.3
31.4
19.5
9.4
Fruits
41.7
24.3
16.1
8.8
Non vegetarian foods
19.9
20.9
15.3
6.5
Consequences of Job on Eating
Patterns
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Overeating
Eat less than usual
Irregular meal timings
Skipping meals
Eat out more
Consume fried foods
Consume tea/coffee
Consume soft drinks
-
35%
35.2%
61.1%
56.9%
61.8%
50.0%
53.5%
40.1%
Percent Infants consuming various energy dense foods
Foodstuff
%Infants
Chocolates
56.7
Marie biscuit
48.8
Glucose biscuit
47.0
Wafers/chips
43.9
Icecream
39.6
Cakes and pastries
33.5
Milk shakes
19.5
Soft drinks
16.5
Pizza
14.0
Imported fruit purees
12.8
Noodles
11.0
French fries
9.1
Pasta
8.5
Burger
7.3
Imported vegetable puree
7.3
Number of Feeds / week given to Infants
Foods
Underweight
(n=2)
Normal
weight (n=83)
Overweight
(n=33)
Obese
( n=46)
Cereals
16.5 ± 0.4
19.2± 0.5
20.5± 0.6
22.1 ± 0.6
Halwa
0.0
2.0 ± 0.6
3.5 ± 0.4
4.6 ± 0.8
Vegetables
0.0
8.8± 0.5
8.4 ± 0.5
9.7 ± 0.6
Potato/sweet potato
7.0±0.0
5.3±0.3
6.2±0.2
7.3±0.3
Fruits
10.5±0.5
10.4±0.4
11.7±0.5
11.6±0.4
Fruit juices
0.0
5.3±0.2
4.5±0.3
9.7±0.5
Animal milk/Infant
formula
14.0±1.0
20.0±0.9
24.0±1.1
26.8±0.9
Paneer and Cheese
0.0
4.9±0.3
6.6±0.4
9.0±0.5
Non-vegetarian foods
4.5±0.4
10.8±2.8
12.1±0.9
12.4±0.8
Energy dense foods
3.0±0.0
8.4±0.4
9.9±0.5
12.0±0.7
Biscuits
7.0±0.0
8.1±0.4
8.5±0.4
10.5±0.3
Diet Patterns of 2-5 yr old children
• 41-53% children offered food as a reward
• Foods offered – chocolates, pizzas, burgers
• 48-50% children watch television while eating ,
4-6% study while eating
• 50-57% children 3-5 yrs of age eat out
• (1-3 x / week)
• Fast foods, carbonated drinks, milk shakes, ice
cream, fruit juice, other sweetened beverage
Frequency of Consumption of various Foods
Items
Daily
1-2 x /week
Pulav/Biryani
Cheese
4.3
11.3
31.7
40.2
Paneer
Potato, yam
2.7
20.6
43.3
47.5
Banana, chickoo, custard apple
35.8
45.3
Carbonated beverages
Chips, wafers, farsan
2.4
11.4
16.1
11.8
Fruit based beverages
Pastries, cakes
Chocolates
2.9
4.8
18.6
22.2
24.2
46.7
Instant noodles
4.4
44.4
Diet, Obesity, Diabetes and CVD
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Carbohydrate ,glycemic load
Dietary fat and fatty acids
Fibre
Sodium
Western style vs Mediterranean,
Paleolithic diets
Glycemic Index, Glycemic Load
Higher glycemic load( incl. intake of starches with high GL)
glucose response
Serum Insulin levels
Urinary C- peptide
Glycated Hb
Blood pressure
Impaired fibrinolysis, thrombosis
hs- CRP( independent of BMI, total
energy intake, other risk factors)
Mediterranean diets and Health
• Meta- analysis –mortality evaluated
Total mortality
8 cohorts, 9 studies
514816 subjects, 33576 deaths
Cardiovascular
mortality
3 cohorts, 4 studies
404491 subjects, 3876 fatal events
Cancer
5 cohorts, 6 studies
incidence/mortality 521366 subjects, 10929 events
Parkinson’s ,
Alzheimer’s
2 cohorts, 3 studies
133626 subjects, 783 cases
Outcomes
• A 2-point increase in score significantly
assoc with reduced risk of mortality from
any cause
• Greater adherence risk of mortality from
cardiovascular disease, neoplasm,
reduced incidence of Parkinson’s,
Alzheimer’s
Sofi et al. (2008) 337:1344-1351
Paleolithic diets - benefits
• In Type 2 diabetics(comparison with Diabetic
diet for 3 months)
- improved glycemic control,
- lower HbA1c levels,
- decline in insulin levels,
- lower TAG levels( abdominal fat?)
- lower body weight, WC, diastolic BP
Jonsson et al. (2009) Cardiovasc Diabetol 8:35-49
School age children, physical activity &
sleep
Negative correlation between :
• Total number of hours children sleep and
BMI.
• Duration of walking and BMI, mode of
transport to reach school.
• Total time spent in play and BMI.
• Attending tuition classes and BMI.
Physical activity
• Intensity (degree / extent of exertion -- %
of heart rate or lung volume VO2
• Duration ( length of time)
• Frequency ( # of times a given activity is
performed)
Benefits of Exercise
• More effective fibrinolytic profile*
• Plasma fibrinogen (75% VO2 max for 30
mins)*
• Risk of thrombus formation*
• Long term exercise regimen (60% VO2 max,
30 mins)**
• Platelet adhesiveness, aggregability
• Tissue plasminogen activator, Plasminogen
activator inhibitor-1
*El Sayed et al (1999) Thromb Res; 96:467-472.
** Wang et al (1995) Arterioscler Thromb Vasc Biol; 15:1668-1674.
Physical Activity& Blood Coagulation
Postmenopausal
sedentary women
Plasminogen
activator Inhibitor
Tissue Plasminogen
activator (U/mL)
Sedentary
14.5 ± 1.2
1.3 ± 0.1
Physically active
6.5 ± 1.1
2.7 ± 0.4
(AU/mL)
Source: DeSouza et al (1998) Arterioscler Thromb Vasc Biol. 18:362-68
Exercise and Blood Pressure
Rowland (2001)
systolic and diastolic in hypertensives
& normotensives ( Adults n=1076)
IzqueiredoPorrera et al
(2000) exercise
rehabilitation 6
mos, 3 x
Decrease in systolic BP, no change
in diastolic ( older adults 54-84 yrs n=48)
Jakes et al (2003)
Increased time of TV viewing–
increase in BP
Increased level of vigorous activity –
lower diastolic BP ( middle age & older adults
45-74 yrs, n= 15,515).
routine daily
exercise thro’out
life time
Physical Activity & Vascular remodelling
• Angiogenesis – growth of new capillaries from
existing ones – increases perfusion in
cardiovascular tissues & cells, reduces effects of
ischemia.
• Vasculogenesis – formation of new blood
vessels in original position and growth of
endothelial progenitor cells (EPCs).
• Arteriogenesis – modification of pre-existing
arterioles, affecting size, length & diameter of
arterioles
Exercise and Vascular Remodelling
Group
Lumen diameter of
femoral artery (mm)
Endurance trained 9.62 ± 0.12
Sedentary
9.03 ± 0.13
Dinenno et al (2001) J Physiol. 534:287-95.
Arterial wall (intimamedia) thickness
(mm)
4.6 ± 0.1
4.7 ± 0.10
Benefits of Exercise
•
contd
Miyachi et al (1998) -- Endurance training – arteriogenesis
increased CSA (16%) of ascending aorta
24% CSA of abdominal aorta,
20% increase in blood flow
Kleim et al (2002) -- Angiogenesis in rats
Increased blood vessel density in caudal
forelimb muscle
facilitated better oxygen transport
Decreased diffusion time
Improved glucose uptake
Laufs et al (2004) -- Elevated a subset of bone marrow
derived EPCs
enhanced angiogenesis
We may / may not consume more energy per se
BUT
The composition of what we eat is markedly different compared to
the assumed hunter, gatherers on which human appetites and
metabolism, physiology evolved
•
Comparison of ED of diets:
African diets
- 450kJ/100g
Average British Diet – 670kJ/100g
Av. Fast food outlet -- 1100 kJ/100g
•
More sedentary lifestyles
Gardner and Rhodes (2009) Adv Exp Med Biol; 646:83-93.
You are what you eat