1. Using nutrition to modulate health effects of environmental pollutants Michelle A. Mendez Dept of Nutrition UNC-Chapel Hill

2. NUTRITION MATTERS: Deaths attributed to 19 leading factors 9 of top 19 global causes of death are nutritional -------------------------------------- Source: WHO Global Burden of Disease http://www.who.int/healthinfo/global_burden _disease/global_health_risks/en/index.html

3. Top 10 causes of disability-adjusted life years lost in high-income countries

4. Recent evidence: Diet may also interact with contaminants to affect health Benefits: Diet may help to reduce negative health effects of certain contaminants Risks: Diet can also be a source of contaminants, or may strengthen risk of contaminant exposure Minimizing risks and maximizing benefits is essential

5. Fruits, vegetables and related nutrients may reduce contaminant risks Mechanisms may involve antioxidant vitamins (e.g. vitamins C & E) as well as other components of fruits and vegetables A few examples - air pollution Guxens et al 2012 in Spain - higher exposure to air pollution in pregnancy associated with lower infant mental development scores only if mothers had low F&V intakes Raaschou-Nielsen et al 2012 in Denmark - residential air pollution associated with a 25% increase in cardiovascular mortality overall, 45% if consumed <200grams/day of F&V

6. Fruits, vegetables and related nutrients may reduce contaminant risks (cont) Folate Gamble et al 2006 found folate supplements to increase metabolism/excretion of arsenic in a population with contaminated water in Bangladesh Arsenic is a carcinogen recently found to increase risk of diabetes and perhaps hypertension, as well as impaired child neurodevelopment Also influences epigenetics (DNA methylation) Vitamin C Duarte-Salles et al found higher intakes of vitamin C during pregnancy to eliminate a 100g reduction in birth weight associated with exposure to dietary PAHs in a Spanish population

7. Other potentially beneficial dietary factors Omega-3 fatty acids e.g. in fatty fish May help to reduce risk of atherosclerosis associated with contaminants found in the environment such as PCBs (polychlorinated biphenyls)

8. Other potentially beneficial dietary factors Breastfeeding May reduce effects of prenatal exposure to chemicals such as tobacco Mendez et al 2008 found a 4-fold increase in overweight among children whose mothers smoked in early pregnancy, but no increase among those breastfed for 6mo or more

9. Potentially harmful dietary factors Excessive dietary fat, energy density May increase impact of obesogenic chemicals May cause cardiovascular disease, cancers Contaminants in the food chain Packaging products, additives e.g. bisphenol A, phthalates: may be obesogens, carcinogens, or affect neurodevelopment Water pollutants, widely used chemicals e.g. arsenic, mercury, pesticides, flame retardants: may be carcinogens, neurotoxins, diabetogens or obesogens Air pollutants, cooking/combustion products e.g. acrylamide, PAHs from high temp cooking, smoking, traffic: may be carcinogens, neurotoxic or affect growth

10. High-fat diet may strengthen effects of and obesogenic chemicals Wei et al 2012 found Typical weight gain in mice fed a normal diet, slight increase if fed BPA Excess weight gain with a high fat diet, significantly increased if also fed BPA Similar dependence on a high-fat diet has been suggested for other chemical obesogens (e.g. discussed in Hennig article)

11. High-fat diet may strengthen effects of and obesogenic chemicals We found in a study from Spain that prenatal exposure to the pesticide DDT (which persists in the environment) was Associated with a 2-fold increase in overweight at age 6y among children consuming a higher-fat diet Not associated with overweight at age 6y among children who were consuming a lower-fat diet Source: Valvi, Mendez et al, Environmental Health Perspectives 2012

12. Balancing the risks and benefits Potentially reducing health effects of contaminants provides one more reason for a healthy diet Rich in fruits, vegetables, whole grains, and omega-3 fatty acids Lower in saturated, trans and omega-6 fatty acids AND low dietary contaminants! Important to start this diet as early as possible to maximize long- term health and development Diet during pregnancy, sustained breastfeeding, and beyond