DIET AND LIFESTYLE

1. DIET AND LIFESTYLE S. A. Udipi Professor & Head Dept. of Food Science and Nutrition, S.N.D.T. Women’s University

2. 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.

3. 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?

4. Globalization Diet and Lifestyle Nutrition Transition Changing dietary and life style patterns Widespread flow of information, ideas, lifestyles Product marketing Advertising Cultural globalization Increasing array of manufactured goods Cross-cultural interaction Increasing world trade Migration Global trading system Global markets

5. 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

6. Frequency of Consumption of Foodstuffs by Call Center Employees (n=1400)

7. Consequences of Job on Eating Patterns • Overeating - 35% • Eat less than usual - 35.2% • Irregular meal timings - 61.1% • Skipping meals - 56.9% • Eat out more - 61.8% • Consume fried foods - 50.0% • Consume tea/coffee - 53.5% • Consume soft drinks - 40.1%

8. Percent Infants consuming various energy dense foods

9. Number of Feeds / week given to Infants

10. 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

11. Frequency of Consumption of various Foods

12. Diet, Obesity, Diabetes and CVD • Carbohydrate ,glycemic load • Dietary fat and fatty acids • Fibre • Sodium • Western style vs Mediterranean, Paleolithic diets

13. 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)

14. Mediterranean diets and Health • Meta- analysis –mortality evaluated

15. 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

16. 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

17. 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.

18. 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)

19. 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.

20. Physical Activity& Blood Coagulation Source: DeSouza et al (1998) Arterioscler Thromb Vasc Biol. 18:362-68

21. Exercise and Blood Pressure

22. 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

23. Exercise and Vascular Remodelling Dinenno et al (2001) J Physiol. 534:287-95.

24. Benefits of Exercisecontd • 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

25. 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