BadenweilerNutrition and Physical Activity B. Kurth The Impact of Unhealthy Diets Dr. Bärbel-Maria Kurth Badenweiler, Germany Conference from 25 – 27 February 2007 Prevention for Health Nutrition and Physical Activity – A Key to Healthy Living

BadenweilerNutrition and Physical Activity B. Kurth Dietary Habits and Health  What do we know?  What is recommended ? Epidemiological Background in Europe  Knowledge of Dietary Habits  European Activities for Harmonisation  National Activities  Nutritional Report of the Netherlands: „Our Food-Our Health“  Health and Nutritional Surveys in Germany Vision for Europe  European Public Health Nutritional Concept

BadenweilerNutrition and Physical Activity B. Kurth Dietary Habits and Health  What do we know?

4 BadenweilerNutrition and Physical Activity B. Kurth Evidence for relationships between nutrients and several chronic diseases (adapted from RIVM 2004, WHO 2003)

5 BadenweilerNutrition and Physical Activity B. Kurth Evidence for relationships between foods and several chronic diseases (adapted from RIVM 2004, WHO 2003)

6 BadenweilerNutrition and Physical Activity B. Kurth Recommendations for „healthy diet“: Balanced diet: British Journal of Nutrition, Vol. 92 supplement 2, October 2004 or Dietary Guidelines for Americans: guidelines or the nutritional pyramid of the US Department of Agriculture: EURODIET recommends: “Guidelines should first be developed for individual member states.”

7 BadenweilerNutrition and Physical Activity B. Kurth The 5 a day initiative: (Started by the NIH, USA) Model projects in several European Countries Promoted by many organisations, WHO, the European Commission, the World Cancer Research Fund, the German Cancer Society, the IARC

BadenweilerNutrition and Physical Activity B. Kurth Epidemiological Background in Europe

9 BadenweilerNutrition and Physical Activity B. Kurth Knowledge of Dietary Habits European Nutrition and Health Report 2004 (Forum of Nutrition, Vol. 58): Summarising National Nutrition ans Health Reports: Too high intake of fat, especially saturated fat Generally too high intake of alcohol, especially for men Too high availability of meat and meat products In some countries low availability of fruits and vegetables Generally inadequate intake of some vitamins and minirals Alarming high prevalence of overweight and obesity

10 BadenweilerNutrition and Physical Activity B. Kurth European Activities for Harmonisation EURODIET project (2000): Methodological differences between the European countries in approaches to dietary surveys have a remarkable influence on the results and their comparability. European projects: Developing standardised method for dietary surves: EFCOSUM (European Food Consumption Survey Method) EFCOVAL (European Food Consumption Validation) Establishing a European nutritional data base: EuroFir-Projekt (European Food Information Resource Network) EUROFOODS-ENFANT (European Network on Food and Nutrition Tables

BadenweilerNutrition and Physical Activity B. Kurth National Activities Nutritional Report of the Netherlands

12 BadenweilerNutrition and Physical Activity B. Kurth Our food, our health Healthy diet and safe food in the Netherlands (2006)

BadenweilerNutrition and Physical Activity B. Kurth Our food, our health Healthy diet and safe food in the Netherlands (2006) Goals: Stopping the further increase of the prevalence of overweight in the population Balanced Diet:  Proper composition of fatty accids in the diet  regular fish consumption,  adequate fruit and vegetables intake

14 BadenweilerNutrition and Physical Activity B. Kurth Priority 1: The promotion of healthy diet, which involves a two-pronged approach: Healthy diet Promotion of a healthy composition of diet Reduction of overweight and obesity

BadenweilerNutrition and Physical Activity B. Kurth National Activities Health and Nutritional Surveys in Germany

BadenweilerNutrition and Physical Activity B. Kurth Health and Nutritional Surveys in Germany Knowledge of the composition of diet

17 BadenweilerNutrition and Physical Activity B. Kurth Main sources of energy intake in Germany (National Health Survey 1998, German Population years)

18 BadenweilerNutrition and Physical Activity B. Kurth Intake below recommended level (National Health Survey 1998, German Population years)

19 BadenweilerNutrition and Physical Activity B. Kurth Percentage of adults which consume more than 400 g fruits and vegetables per day (excluding juices) (National Health Survey 1998, German Population years)

20 BadenweilerNutrition and Physical Activity B. Kurth National Health Survey for children and adolescents (0-17 years) Germany (KiGGS) The survey was conducted from May 2003 till May 2006 in 167 cities and communities (Sample Points). Boys and girls aged 0 to 17 years were chosen randomely from population registries.

21 BadenweilerNutrition and Physical Activity B. Kurth (KiGGS) : Self-administered Questionnaire: parents, children, adolescents  Physical Health, Diseases  Mental Health, Problems  Social Health, Living conditions  Lifestyle, Health Behaviour, Health Risks  Health Care

22 BadenweilerNutrition and Physical Activity B. Kurth (KiGGS): Physical Measurements and Tests  anthropometry  vision tests  blood pressure, heart rate  motor activity, co-ordination  sonography of the thyroid gland

23 BadenweilerNutrition and Physical Activity B. Kurth National Health Interview and Examination Survey of Children and Adolescents (KiGGS)

24 BadenweilerNutrition and Physical Activity B. Kurth Percentage of boys and girls with daily fruit consumption (KiGGS results)

25 BadenweilerNutrition and Physical Activity B. Kurth Percentage of boys and girls with daily vegetable consumption (KiGGS results)

26 BadenweilerNutrition and Physical Activity B. Kurth Percentage of boys and girls with daily soft drinks consumption (KiGGS results)

27 BadenweilerNutrition and Physical Activity B. Kurth Outlook: EsKiMo -The Eating study as a KiGGS Module  A nutrition survey in 2006 in a subsample of KiGGS  Parents of children aged 6-11 years filled in a 3 day dietary record  Participants aged years were interviewed at home (diet history)

BadenweilerNutrition and Physical Activity B. Kurth Health and Nutritional Surveys in Germany Overweight and obesity

29 BadenweilerNutrition and Physical Activity B. Kurth Prevalence of Obesity (95% Confidence Interval) National Health Surveys from 1984 to 1998, Men Alte BundesländerNeue Bundesländer H. Knopf, G. Mensink, E. Bergmann, Th. Lampert

30 BadenweilerNutrition and Physical Activity B. Kurth (KiGGS): Prevalence of overweight and obesity Children and adolescents 3-17 years Clear increase over reference data from No differences between boys and girls. Overweight Subgroup: Obesity 10% 3%

31 BadenweilerNutrition and Physical Activity B. Kurth (KiGGS): Prevalence of overweight by age groups Strong increase in primary school age, afterwards only a slight further increase. 10%

32 BadenweilerNutrition and Physical Activity B. Kurth (KiGGS): Prevalence of obesity by age group Strong increase in primary school age, especially in boys. 3%

33 BadenweilerNutrition and Physical Activity B. Kurth (KiGGS): Prevalence of obesity by socioeconomic status Obesity is more prevalent in children coming from families with lower socioeconomic status.

34 BadenweilerNutrition and Physical Activity B. Kurth (KiGGS): Prevalence of obesity by migration status Children with migration background show higher obesity prevalences

BadenweilerNutrition and Physical Activity B. Kurth Vision for Europe European Public Health Nutritional Concept

36 BadenweilerNutrition and Physical Activity B. Kurth European Community Health Indicator Project (ECHI) European Community Health Indicator Project (ECHI), collecting comparable health indicators for application in all European countries “short list”: Indicators recommended as basis for European data collection.

37 BadenweilerNutrition and Physical Activity B. Kurth European Community Health Indicators (ECHI-shortlist) for Nutrition & Health Health Determinants Health Effects Total Energy Intake Body Mass Index, Prevalence of Overweight and Obesity ► Consumption and availability of vegetables ►Self-perceived health ► Consumption and availability of fruits ►Blood pressure Alcohol consumption (Hazardous alcohol consumption) ►Diabetes, Prevalence ► Physical Activity►Cardiovascular Morbidity ► Health Interventions: Health Promotion Alcohol-related deaths Policies on healthy nutritionLimitations in physical functions ► Policies and practices on healthy lifestyle Life expectancy and Disability-free life expectancy (DFLE)

38 BadenweilerNutrition and Physical Activity B. Kurth European Community Health Indicators (ECHI) referring to nutrition Available ECHI-indicatorsLimited available (Coverage/Comparability/Time) BMI, Prevalence of Overweight and Obesity Total Energy Intake Diabetes (Mortality, Hospital disch.)Consumption and availability of vegetables and fruits Alcohol consumptionAlcohol-related deaths Self-perceived healthLimitations in physcial functions Life expectancy and DFLEBlood pressure Cardiovascular MortalityCardiovascular Morbidity Physical activity

39 BadenweilerNutrition and Physical Activity B. Kurth European Health Interview Survey In case that recommended indicators will be integrated the comparability of food patterns will be achieved. Result: Setting European Priorities European recommendations for balanced Diet European activities for healthy diet and…..

40 BadenweilerNutrition and Physical Activity B. Kurth Our food, our health Healthy diet and safe food in Europe