1. Healthy eating for middle-years Professor Tom Sanders Nutritional Sciences Division

2. Major causes of premature death in middle-aged subjects Smoking related illness Alcoholism Diet related disease – cardiovascular disease and type 2 diabetes Cancer 2

3. Storing fat in the wrong place Metabolic syndrome

4. Coronary Heart Disease Type 2 Diabetes High LDL-C Metabolic Syndrome

6. What is driving obesity Decreased physical activity Increased energy intake among the susceptible Increased access to high energy density foods especially outside the home

7. Effect of fat additions on energy density

9. SCRATCH COOKING COMPONENT COOKING READY MEALS TAKE-AWAYS SNACKING ‘ON THE HOOF’ DELIVERYQSRRESTAURANT High skill base, time consuming, “food” focused Convenient social e.g. primary products, traditional grocery e.g. prepared vegetables, prepared meat/fish, sauces, pizza e.g. Sandwiches, Sushi © Worldpanel TM division of TNS 2003 Slow Food Fast Food Physical inactivity Physical activity

12. What we know about obesity management Calorie intake must be decreased (no clear difference between fat and carbohydrate calories) Portion control is crucial Avoid temptation – “Willpower lasts 2 weeks and is soluble in alcohol”

13. Fat patterning associated with metabolic syndrome

14. Obesity and metabolic syndrome Obesity contributes to causing metabolic syndrome Physical activity is protective A diet high in rapidly absorbed carbohydrate (both starch and sugar) makes metabolic syndrome worse

15. 15 Healthy artery Atherosclerosis (chronic) Thrombosis (acute)

16. 16

19. Dietary factors contributing to raised blood pressure Overweight Excess alcohol intake Low intake of fruit and vegetables High salt intakes 19

21. Dietary factors influence blood cholesterol Overweight High intake of saturated fat Unfiltered or boiled coffee (usually not significant unless large amounts consumed Cholesterol in foods such as eggs (small effect) 21

24. 24 Iso et al. Circulation 2006;113:195-202. Intake of long chain n-3 fatty acids in 41,578 Japanese men and women and risk of CHD over 10 years

25. 25 Risk of sudden death adjusted for risk factors in men enrolled in the Physicians Health Study

26. GISSI_HF Lancet 2008 Editorial “A simple and safe treatment with n-3 PUFA can provide a small beneficial advantage in terms of mortality and admission to hospital for cardiovascular reasons in patients with heart failure in a context of usual care. George Davey Smith Lancet Jan 2009 “A reasonable interpretation of the GISSI- HF trial would be that the modest estimated effect of fish oil requires replication.”

27. 27 UK government recommendation on intakes in relation to reducing risk of cardiovascular disease Aim to consume two portions of fish per week one of which should be oily Providing ~3g long-chain n-3 PUFA/week or 0.45g/d

28. Effect on risk of CHD events of replacing 5% energy saturated fatty acids from pooled analysis of 11 cohort studies Jakobsen M et al. Am J Clin Nutr 2009;89:1-8.

29. Dietary advice to prevent heart disease Avoid overweight/obesity Replace sources of saturated fat with unsaturated fat (i.e. liquid oils for hard fats) Eat more fish especially oil fish and less fatty meat Cut down on salt Avoid excessive consumption of sugar sweetened drinks and alcohol 29

30. 21 st November 2006: FDF GDA Briefing

31. Cheddar Reduced fat cheddar A B