Paul Clayton

1. - Weight Management - cardiovascular disease & diabetes Paul Clayton Sundevollen 20/5/07

2. 1897

3. 1919

4. Korea 1951

5. Fife 1953

6. California 1955

7. 1957

8. 1957

9. 1957

10. 2001

13. ob/ob normal Ob /

14. 1885: first automobile (Karl Benz)

15. 1912: first traffic jams

16. 1929: first parking problems

18. Reduced energy expenditure 1940 50 60 70 80 DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

19. Positive energy balance 1940 50 60 70 80 DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

26. Obesogenic culture (AHA ’03) Avge US adult sedentary 8 hours / day, < 2,000 steps / day (NYS Public Health Assocn ‘05) Amish 16,000 steps /day: obesity 9% women, 0% men (Bassett et al ’04)

28. Positive energy balance 1940 50 60 70 80 90 2000 DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

29. AHA 2002: ‘obesogenic culture’ • Fewer bus-stops, remote parking • Exercise to be mandatory at all levels of educational system • No ‘junk foods’ to be sold / served in schools • ‘baby bells’: constructive inconvenience

30. Why is weight gain so easy? • Multiple satiation mechanisms • Protein: amino acids (fish > whey > casein) • Fats: fatty acids (distal jejeunum) • Carbs: glucose (Hoodia) • Fermentable carbs: SCFA (propionic) • Insufficient calorific throughput • High calorific density • Instant gratification

31. Positive energy balance 1940 50 60 70 80 DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

32. Overweight but starving • W.H.O. ‘02: ‘Globally, overweight more of a health problem than underweight.’ • U.N.O. ’06: ‘Overweight but malnourished’ (=Type B malnutrition) • 40-60%hospital admissions malnourished(US/UK) • And in the community (USDA and other surveys)

33. MALNUTRITION TYPE A MICRONUTRIENTS CALORIES

35. MALNUTRITION TYPE A TYPE B MICRONUTRIENTS CALORIES

37. Vitamins C E A B1 B2 NiacinFolate B6 B12 --------------------------------------------------------------------- 37 68 55 32 31 27 34 54 17 % Percentage of Population Depleted In Vitamins (USDA 1997)

38. * Gregory et al 2000. National Diet and Nutrition Surveys, HMSO

39. * Gregory et al 2000. National Diet and Nutrition Surveys, HMSO

40. DIETARY SHIFT • Flavonoids 75% • Vit C 50-60% • Omega-3 50% • Methyl groups 95% • Carotenoids 40% • Phospholipids 50% since 1900 • Selenium 50% ” 1960 (UK) • Prebiotic fiber 50% ” 1960 (Fr) • Sterols 66% ” 1960 (SA) since Stone Age

41. WHO Technical Report Series 916 • ‘Diet, Nutrition and the Prevention of Chronic Diseases’ • Report of Joint FAO / WHO Expert Consultation Geneva May 2003

42. RSM 2005: Pathogenic culture? heart disease, stroke, cancers, kidney disease, blindness, Alzheimer’s • Type 2 diabetes • Osteoporosis • ARMD • Neurodegenerative disease • Lymphoma, leukaemia, melanoma, germ cell tumours in teens & young adults • ADD / ADHD / dysphasia / dyspraxia • Allergy, asthma

43. Type B Malnutrition worsens with age • Reduced activity / calorie requirements • Institutional diet • Financial hardship • Poor dentition • Swallowing problems (xerostomia) • Loss of sense of taste

44. Type B Malnutrition worsens with age • Progressive depletion of anabolic factors (vits C, B’s, D; Zn, Cu, Se, Fe, Ca, Mg; amino acids etc) • Progressive depletion of anti-catabolic factors (vit E; Zn, Cu, Mn, Se; sterols, flavonoids, carotenoids etc)

45. Type B Malnutrition worsens with age • Progressive depletion of anabolic factors  decreased tissue repair, damage clearance etc • Progressive depletion of anti-catabolic factors   increased free radical activity, hexosylation, nitrosation, inflammation = CATABOLIC DOMINANCE

46. Multiple agent intervention • CDD’s have multiple patho-aetiology • CAD risk factors: hypertension, smoking, inactivity, obesity LDL / HDL, LDL-ox.lag, HbA1c, hyperHc, ICAM-1, VCAM-1, VWF etc • Reduced risk: lycopene, quercitin, omega 3, methyl groups, alcohol, lutein, vitamin E, soy etc

47. CVD: HOW DRUGS WORK

48. CVD: HOW DRUGS WORK

49. CVD: HOW DRUGS WORK

50. CVD: HOW DRUGS WORK