Tackling Chronic Diseases: the Potential of Preventive Medicine through Improvements to Diet

1. Tackling Chronic Diseases: the Potential of Preventive Medicine through Improvements to Diet Cathie Martin, MA, PhD, Professor Department of Metabolic Biology John Innes Centre Norwich Research Park, United Kingdom Niels Bohr Professor, Department of Plant Biology and Biotechnology Copenhagen University, Denmark May 2009

2. Leading causes of death worldwide, 2005 Respiratory 7% Injuries 9% Diabetes 2% Other chronic disease 9% Communicable diseases maternal and perinatal nutritional deficiencies 30% Cancer 13% Cardiovascular disease 30% Source: World Health Organisation

3. 2005

4. Facts: • The total number of people dying from chronic diseases is twice the number of people dying from infectious diseases including HIV/AIDS. • 80% of mortality from chronic disease occurs in low and middle income countries • The poor are more vulnerable to chronic disease because of increased exposure to risks and decreased access to health care • Chronic diseases cause poverty • Without action deaths from chronic diseases will increase by 17% between 2005 and 2015 (WHO report 2005)

5. Chronic Conditions: • Cardiovascular disease (CVD) • Diabetes • Obesity • Cancers • Respiratory diseases

6. Chronic conditions, including cardiovascular diseases (CVD), diabetes, obesity, cancers and respiratory diseases, account for 59% of the 57 million deaths annually and 46% of the global burden of disease. Of those with chronic conditions 60% are between the ages of 18 and 64. 90% of seniors have at least one chronic disease and 77% have two or more chronic diseases.

7. Globally, chronic disease is projected to cause 388 million deaths in the next 10 years

8. Socio-Behavioural Risk Factors for Chronic Disease

9. OBESITY Obesity is a major emerging disease, particularly afflicting the poor. Obesity has a strong correlation with the incidence of several degenerative diseases, such as type II diabetes, glucose intolerance, cardiovascular disease, and cancer.

10. Obesity is reaching epidemic proportions

11. Even in Italy obesity is becoming a problem particularly in the young

15. What can plant science do to combat chronic disease? Emphasise the good things in food

16. EU: FP6 Objectives: To generate defined dietary material (model foods) to test the impact of specific flavonoids on cardiovascular and age-related degenerative diseases in a whole food context using animal model systems. To find out what foods are good for you

17. Control line (r1) Genotype: p1r1c1A1 Flavo-enriched line (ACR) Genotype: p1R1C1A1 8-week treatment (~15 mg/kg/day) Effects on ex vivo myocardial infarction Effects on vascular reactivity Special diets Introduction of 20% of corn seeds powder in a standard pellet formula

18. Non-ischemic Zone (blue) Group r1 Infarcted zone (white) Ischemic viable zone (red) + = Risk Zone Group ACR Example of TTC staining for infarct size determination Marie-Claire Toufektsian, Michel de Lorgeril

19. Infarct Size Marie-Claire Toufektsian, Michel de Lorgeril

20. Anthocyanins offer cardioprotection against ischaemia/reperfusion injury

21. National Cancer Institute and National Research Council in the US recommend: 5 servings of fruit and/or vegetables per day (www.5aday.org)

22. Out of 15,000 surveyed only 23% Americans achieved this intake More worryingly the numbers attaining 5-a-day have decreased over the past 10 years

23. Using genetic engineering techniques we can develop healthier foods, rapidly

25. del/ros (line N) del/ros (line C) WT del/ros (line N)

26. Antioxidant capacity of purple compared to red tomatoes Eugenio Butelli, Cathie Martin

28. Purple tomato – supplemented pellets Red tomato – supplemented pellets p53-/p53- knockout mice Life span, pathology

29. Lucilla Titta, Marco Giorgio

30. So what can society do about chronic disease?

31. Grand challenges in chronic non-communicable diseases: The top 20 policy and research priorities for conditions such as diabetes, stroke and heart disease. Nature, 450, 494-496 22 November 2007 Sponsored by the Oxford Health Alliance

32. Many chronic conditions could be prevented: • 36 Million of the projected deaths from chronic disease could be avoided by 2015 • 50% of avoided deaths would be in people <70 years old • Economic impact would be enormous: calculated loss in national income to chronic disease in UK is: $33Billion

33. Commentary posted by Rachel Nugent Alas, this Grand Challenge has no money, no Foundation, no benefactor. Indeed, it is a kind of reverse Grand Challenge, as it consists of scientists telling us what needs to be done to address chronic NCDs and hoping that someone will pony up the money to do it.

34. Increase the availability and consumption of healthy food

35. We need to start by ensuring that children eat well

36. Jamie Oliver

37. …….we need second generation GMOsto help combat chronic disease

38. One important feature of the tomato study was that it showed that genetic modification is not just a generic technology that is either good or bad, but that very different things can be done with genetic modification of plants—including the development of products that have very real advantages for consumers. This displaces the debate from ‘it is alright for them’.

39. Research on functional foods is best undertaken by publicly-funded organisations: • To promote consumer confidence in the results • To access and assess the entire range of health-promoting phytonutrients not just those of commercial interest

40. But the regulatory burden is too costly for ‘not-for-profit’ organisations to bring improved GMO products to the consumer • The social burden is also very heavy in undertaking this research: One really has to wonder exactly who this tomato will benefit, asked VAS's biosecurity representative, SimonaCapogna. It will undoubtedly help those who hold the patent, those firms that sell it (at an inflated price) and those researchers who use it as a career move or who buy shares in biotech firms…… Detractors do not believe it is possible to use GM technology for the ‘common good’.

41. The Future?