Download Session 5: Where do mushrooms fit into dietary advice?

Session 5
Where Do Mushrooms Fit into Dietary
Advice?
• Moderator: Roger Clemens, DrPH, Adjunct Professor of
Pharmacology and Pharmaceutical Sciences, School of Pharmacy,
University of Southern California
• Barbara Schneeman, PhD, former Food and Drug
Administration
• David Law, MBA, President and CEO Gourmet Mushrooms,
Sebastopol, CA
• Victor Fulgoni, PhD, Senior Vice President, Nutrition Impact,
Battle Creek, MI
Where Do
Mushrooms Fit?
Roger Clemens, DrPH, CFS, CNS
USC School of Pharmacy
[email protected]
Barbara Schneeman, PhD
• Professor Emerita, Department of Nutrition, UC Davis
• Director of the Office of Nutrition, Labeling, and
Dietary Supplements in the Center for Food Safety
and Applied Nutrition at the FDA
• Chair of the Department of Nutrition, UC Davis
• Dean of the College of Agricultural and Environmental
Sciences, UC Davis
• Dietary Guidelines Advisory Committees (1990, 1995)
• Food and Nutrition Board of the National Academies
of Science
David Law
• President, CEO and co-founder of Gourmet
Mushrooms
• Degrees in Biology (BS; University of Oregon),
Finance (MBA, University of WisconsinMadison), and Real Estate (MS, University of
Wisconsin-Madison)
Victor Fulgoni III, PhD
• Senior Vice President, Nutrition Impact
• Vice President, Food and Nutrition
Research, Kellogg
• Vice President, Nutrition, EDTA
Where are mushrooms in DG?
• No mention of mushrooms as part of a
healthy diet consistent with the dietary
guidelines except as a source of
vitamin D.
• DGAC recognized mushrooms as
one of the “best” sources
of vitamin D.
Advice to Dietitians?
• Eat Right With Color
Campaign Launched For
National Nutrition Month
(March 2011)
Health Canada (2007)
Vegetable Curry with
Mushrooms
•
•
•
•
125 mL (½ cup) fresh spinach
(1 cup) carrot, cauliflower, mushrooms, green
beans, onion
about 90 mL (6 Tbsp) chickpeas
15 mL (1 Tbsp) peanut oil
Where are mushrooms in DG?
• Work Group 1:
– Environmental Determinants of Diet and Health and
Sustainability and Food Safety
• Work Group 2:
– Dietary Patterns and Quality and Optimization through
Lifestyle Behavior Change
• Work Group 3:
– Foods, Beverages, and Nutrients and Their Impact on
Health Outcomes
Call for “white” vegetables
• "White Vegetables: A Forgotten Source of
Nutrients"
– No guidelines or recommendations for white
vegetables, such as potatoes, cauliflowers, …
mushrooms …
– These foods may help meet short fall
nutrients, such as fiber, potassium and
magnesium
– [Mushrooms] provide an excellent partner to
encourage vegetable consumption
Weaver CM, Marr ET. Adv Nutr 2013;4(3):318S-26S
Mushrooms & Nordic Diet
• New Nordic Diet
– characterized by a high content of fruits
and vegetables (especially berries,
cabbages, root vegetables and legumes),
fresh herbs, potatoes, plants and
mushrooms from the wild countryside,
whole grains, nuts, fish and shellfish,
seaweed, free-range livestock (including
pigs and poultry) and game.
Mithril C et al., Public Health Nutrition 2012;16:777–85
Where do mushrooms fit?
• How should mushrooms be
considered within dietary guidelines?
• Are all mushrooms the same?
• For consumer education, should
mushrooms be considered a
vegetable?
DIETARY GUIDANCE
Barbara Schneeman, Ph.D.
University of California, Davis
Objectives


What are the various ways that consumers receive
dietary guidance information related to health?
How is this dietary guidance developed?
Government-sponsored activities
related to dietary guidance




Dietary Guidelines for Americans (DGA)
Use of the current DGA for nutrition education and
activities
Nutrition-related claims in the labeling of foods
NHANES: What We Eat in America
What are the Dietary Guidelines?





Federal nutrition policy established jointly by USDA & HHS
Updated every 5 years
Provide science-based advice for ages 2 and over to help
reduce risk of chronic disease & promote health
Foundation for Federal nutrition programs, nutrition education
programs, and a basis for research priorities
Ensure that messages and materials are consistent through-out
the Federal government and that government speaks with
“one nutrition voice”
Development of Dietary Guidelines Policy
Development of the DGA
N
E
and Communications
L
UTRITION VIDENCE
IBRARY
Public meeting(s)
and comments
Development of Dietary Guidelines Policy
Development of the DGA
N
E
and Communications
L
UTRITION VIDENCE
IBRARY
Public meeting(s)
and comments
and Policy
Use of
Development ofDevelopment
Dietary Guidelines
N
E
and Communications
the DGA
L
UTRITION VIDENCE
IBRARY
DGA WORKGROUP
REVIEW
Public meeting(s)
and comments
What is considered by the DGAC?


Previous DGA
New scientific literature



Suitable recommendations or reports from authoritative
sources (i.e. National Academy of Sciences).
Data Analyses e.g.



New systematic reviews or updates by the USDA Nutrition
Evidence Library (NEL)
Obesity, food safety, food supply, intakes of foods and/or
nutrients (e.g. comparison of actual intakes with
recommendations from NHANES-WWEIA)
Food pattern modeling analysis
Public comments
Developing the USDA Food Guides
USDA Food Guides
Considerations






Recommendations in DGA
Nutrient requirements
Shortfalls in the diet of
Americans
Food supply
Nutrient contribution
Menu modeling analysis
Results of Nutrition Labeling and
Education Act of 1990
Mandatory
Voluntary
Authorization of Health claims
and
Nutrient Content claims
Nutrition Facts

Scientific basis for mandatory nutrients


Voluntary nutrients




Allowed in Code of Federal Regulations (e.g.
vitamins and minerals)
Use of % Daily Value


Surgeon General Report Nutrition and
Health; NAS reports; DGA; USDA food
intake survey
Guide for high/low
Nutrient content claims
Voluntary nutrient labeling for raw
produce
Serving Size (RACC)
Considerations for Updating
Nutrition Facts






Dietary Reference Reports and related IOM reports
Relevant Authoritative Statements
NHANES information on nutrient intake and food
consumption patterns
Dietary Guidelines for Americans 2010
Relevant scientific literature
Advanced Notice of Proposed Rule Making
 (Revision
of Reference Values and Mandatory Nutrients.
Docket No. 2006N-0168 (2007)
Results of Nutrition Labeling and
Education Act of 1990
Mandatory
Voluntary
Authorization of Health claims
and
Nutrient Content claims
Barbara Schneeman 2013
Process for Evaluation of
Health Claims at FDA
CFSAN/Office of Nutrition, Labeling and Dietary Supplements
January 2009
Guidance for Industry
Evidence-Based Review System for the Scientific
Evaluation of Health Claims
Summary

What are the various ways that consumers receive
dietary guidance information related to health?
Dietary Guidelines for Americans
 Use of DGA to develop education materials and activities
 Nutrition labeling including claims


How is this dietary guidance developed?
Systematic reviews of scientific evidence
 Use of appropriate authoritative statements and reports
 Data analysis of NHANES, including What We Eat in
America
 Analysis of public comments

Mushroom and Health Summit
The Impending Myco-cultural
Revolution
David Law
Gourmet Mushrooms, Inc.
Trumpet Royale Mushroom
Culinary Varieties
Alba
Clamshell
Trumpet
Royale
Forest
Nameko
Brown
Velvet
Pioppini
Maitake
Frondosa
Nebrodini
Shiitake
2011
2010
2000
1990
1980
China, mainland
65%
65%
57%
31%
28%
Italy
United States of
America
10%
11%
2%
4%
3%
5%
5%
9%
16%
17%
Netherlands
4%
4%
6%
7%
5%
Poland
3%
2%
3%
5%
2%
Spain
2%
2%
2%
4%
3%
France
1%
2%
5%
9%
12%
Canada
1%
1%
2%
3%
2%
91%
91%
85%
78%
72%
% World
Food and Agriculture Organization of the
United Nation
Mushrooms
Production
Area
Harvested
Yield
Rice
Production
Area
Harvested
Yield
Advantage
Ratio
2011
2010
2000
1990
1980
1970
(Tonnes, 000)
7719
7450
4209
2071
1259
790
(Hectares, 000)
21
3693
20
3665
10
4370
5
4219
4
2995
4
2017
(Hg/Ha)
(Tonnes, 000)
722560 701048 599355 518569 396871 316346
(Hectares, 000)
163147 161666 154060 146960 144412 132873
44
43
39
35
27
24
(Hg/Ha)
(Mushroom vs.
Rice)
83
85
112
120
109
85
Asparagus
Production
8197
7483
4640
(Tonnes, 000)
Areaand Agriculture Organization of the United Nation
Food
2013
1253
1114
Production (1000
tons)
Hectares (1000)
Tons/ha
$/kg
Revenue/ha
Mushroom
Rice
Asparagus
7719
21
367.57
722560
163147
4.43
8197
1465
5.60
2.57
0.45
2.2
$
944,659 $
1,993 $
12,309
Global
Crisis in Agriculture
75 million
7 billion
•
9 billion,
10 billion
increased meat
consumption
• Biofuel
Terraculture
Mycoculture
Gourmet Mushrooms, Inc. video
Sebastopol, California
Fruit
Mushroom
Vegetable
Grain
Protein
Dairy
Victor L. Fulgoni, III, PhD
Nutrition Impact, LLC
September 10, 2013
Colleagues:


Theresa A. Nicklas - USDA/ARS Children’s Nutrition
Research Center, Baylor College of Medicine, Houston, TX

Carol E. O’NeiI -LSU AgCenter, Baton Rouge, LA.
Funding Sources


Mushroom Council and USDA

NHANES 2001-2010 were used for these
analyses
 Exclusion criteria included <19 years of age, unreliable
records, and pregnant and/or lactating females
 N=24,807

Mushroom consumers (N=2,399) were defined as
those with intake of 281 food codes which
included mushrooms using single 24-hr recall
◦ Mushroom amount determined using EPA Food
Commodity Ingredient Database
◦ Foods ranged from predominantly (<50%) mushrooms
(n=29), those with 20-50% mushrooms (n=18), foods
10-19% mushrooms (n=40), and other foods with lesser
amounts of mushrooms (N=194)


Demographic differences among mushroom
consumers and non consumers were assessed by Zscores
Regression analysis were used to assess differences
in consumers and non-consumers in nutrient
intakes, food group intakes, diet quality [measured
using Healthy Eating Index-2005(HEI)], and
cardiovascular risk factors
◦ Covariates for energy, HEI, and cardiovascular risk factors
included gender, race/ethnicity, age, poverty income ratio,
physical activity level (categorized as sedentary, moderate or
vigorous), current smoker, and alcohol consumer
◦ Covariates for intake variables included those above and
energy intake
Results
Demographics Associated with Mushroom Consumption1
Nonconsumer
Consumer
(n=22,408)
(n=2,399)
2
2
LSM
SE
Variable
LSM
SE
Age
46.6
0.3
45.1
0.4
Gender - Female (%)
50.6
0.4
53.0
1.3
Non-Hispanic White (%)
70.5
1.5
78.4
1.4
Poverty Income Ratio
3.0
0.0
3.4
0.1
Smoker Current (%)
24.8
0.5
20.2
1.3
Physical Activity - Sedentary (%)
29.7
0.6
23.2
1.3
Attended College (%)
54.4
0.8
68.4
1.5
Alcohol Consumer (%)
25.7
0.7
36.4
1.1
1
2
Differences assessed using Z-score
LSM: Least square mean; SE: Standard error
P-value
0.0022
0.0863
0.0001
<0.0001
0.0015
<0.0001
<0.0001
<0.0001
Results: Demographics
Mushroom consumers (as defined here) as compared to
non-consumers:


Slightly younger

More likely non-Hispanic White

With higher income

Smoked less

With higher education

Reported were less sedentary

Consumed alcohol more often
Results
Energy and Macronutreint Intakes Associated with Mushroom Consumption1
Nonconsumer
Consumer
(n=22,408)
(n=2,399)
LSM2
SE2
Variable
LSM
SE
P-value
Energy (kcal)3
Protein (g)
Total fat (g)
Total monounsaturated fatty acids (g)
Total polyunsaturated fatty acids (g)
Total saturated fatty acids (g)
Total sugars (g)
Dietary fiber (g)
2162
82.9
82.3
30.3
17.4
27.1
124
16.0
10
0.3
0.3
0.1
0.1
0.1
1
0.1
2307
85.3
82.3
30.1
17.8
26.8
115
16.6
26
0.8
0.6
0.3
0.2
0.3
2
0.2
<0.0001
0.0051
0.9819
0.2768
0.1273
0.3782
<0.0001
0.0312
1
Adjusted for gender, race/ethnicity, age, poverty income ratio, physical activity level (categorized as sedentary,
moderate or vigorous), current smoker, alcohol consumer, and energy intake
2
LSM: Least square mean; SE: Standard error
3
Adjusted for gender, race/ethnicity, age, poverty income ratio, physical activity level (categorized as sedentary,
moderate or vigorous), current smoker, alcohol consumer, and energy intake
Results: Intakes
Mushroom consumers (as defined here) as
compared to non-consumers had:


Higher energy intake

More protein

Less total sugars
Results
Vitamin Intakes Associated with Mushroom Consumption1
Nonconsumer
Consumer
(n=22,408)
(n=2,399)
LSM2
SE2
Variable
LSM
SE
Vitamin A, RAE (mcg)
621
9
631
16
Vitamin C (mg)
87.6
1.4
92.7
2.6
Vitamin D (D2 + D3) (mcg)
4.7
0.1
4.7
0.2
Vitamin E as alpha-tocopherol (mg)
7.4
0.1
7.8
0.1
Thiamin (Vitamin B1) (mg)
1.6
0.0
1.8
0.0
Riboflavin (Vitamin B2) (mg)
2.2
0.0
2.3
0.0
Niacin (mg)
24.7
0.1
26.0
0.3
Folate, DFE (mcg)
540
4
573
10
Vitamin B12 (mcg)
5.4
0.1
5.2
0.1
Total choline (mg)
333
2
342
5
1
P-value
0.6264
0.0797
0.7490
0.0278
0.0001
0.0193
0.0006
0.0027
0.0609
0.0683
Adjusted for gender, race/ethnicity, age, poverty income ratio, physical activity level (categorized as sedentary,
moderate or vigorous), current smoker, alcohol consumer, and energy intake
2
LSM: Least square mean; SE: Standard error
Results
Mineral Intakes Associated with Mushroom Consumption1
Nonconsumer
Consumer
(n=22,408)
(n=2,399)
LSM2
SE2
Variable
LSM
SE
Calcium (mg)
933
6
937
15
Phosphorus (mg)
1357
5
1378
13
Magnesium (mg)
293
2
297
3
Iron (mg)
15.5
0.1
16.0
0.2
Zinc (mg)
12.3
0.1
11.6
0.1
Copper (mg)
1.3
0.0
1.4
0.0
Selenium (mcg)
110
0
119
1
Potassium (mg)
2728
13
2725
22
Sodium (mg)
3479
11
3774
33
1
P-value
0.7645
0.1279
0.2958
0.0226
<0.0001
<0.0001
<0.0001
0.8939
<0.0001
Adjusted for gender, race/ethnicity, age, poverty income ratio, physical activity level (categorized as sedentary,
moderate or vigorous), current smoker, alcohol consumer, and energy intake
2
LSM: Least square mean; SE: Standard error
Results: Intakes
Mushroom consumers (as defined here) as
compared to non-consumers had:


Higher B vitamin intakes (thiamin, niacin, and folate)

Higher copper and selenium but less zinc intakes

Higher sodium intakes
Results
Diet Quality (HEI-2005) and Sub-Component Scores Associated with Mushroom
Consumption1
Nonconsumer
Consumer
(n=22,408)
(n=2,399)
LSM2
SE2
Variable
LSM
SE
P-value
Healthy Eating Index
51.3
0.2
52.5
0.4
0.0033
HEI Component 1 (Total Fruit)
HEI Component 2 (Whole Fruit)
HEI Component 3 (Total Vegetable)
HEI Component 4 (Drk Grn and Org Veg)
HEI Component 5 (Total Grains)
HEI Component 6 (Whole Grains)
HEI Component 7 (Milk)
HEI Component 8 (Meat and Beans)
HEI Component 9 (Oils)
HEI Component 10 (Saturated Fat)
HEI Component 11 (Sodium)
HEI Component 12 (SoFAAS)
1
2.17
1.95
3.01
1.18
4.17
1.08
4.92
7.98
5.76
5.86
3.95
9.28
0.03
0.03
0.02
0.02
0.02
0.02
0.05
0.04
0.04
0.04
0.03
0.09
2.24
2.03
3.53
1.36
4.34
1.02
5.13
7.94
5.82
5.93
3.19
9.92
0.06
0.06
0.04
0.04
0.03
0.04
0.10
0.10
0.12
0.11
0.08
0.21
0.2638
0.2138
<0.0001
0.0004
<0.0001
0.2161
0.0237
0.7185
0.6347
0.5848
<0.0001
0.0024
Adjusted for gender, race/ethnicity, age, poverty income ratio, physical activity level (categorized as sedentary,
moderate or vigorous), current smoker, and alcohol consumer
2
LSM: Least square mean; SE: Standard error
Results: Diet Quality
Mushroom consumers (as defined here) as
compared to non-consumers had:


Slightly higher HEI -2005

Higher sub-component scores for total vegetables, dark
green and orange vegetables, total grains, and SoFAAS
(empty calories)

Lower sub-component scores for sodium
Results
Odds Ratio and Confidence Limits of Being Obese, Overweight or Either
Associated with Mushroom Consumption1
Nonconsumer
Consumer
(n=22,408)
(n=2,399)
Risk Factor
2
OR
LCL3
UCL3
OR
Obese
4
5
Overweight
Overweight or Obese6
1.00
0.97
0.87
1.09
1.00
1.00
0.90
0.87
0.80
0.78
1.00
0.98
1
Adjusted for gender, race/ethnicity, age, poverty income ratio, physical activity level (categorized as
sedentary, moderate or vigorous), current smoker, and alcohol consumer
2
OR: Odds ratio
3
4
LCL: Lower 95th percentil confidence limit; UCL: Upper 95th percentil confidence limit;
Obese defined as BMI ≥ 30; 5 Overweight defined as 25<BMI≤ 30
6
Overweight/Obese defined as BMI ≥ 25
Results
Odds Ratio and Confidence Limits of Metabolic Syndrome and Sub-Components
Associated with Mushroom Consumption
Nonconsumer
Consumer
(n=22,408)
(n=2,399)
Risk Factor
OR2
LCL3
UCL3
OR
Metabolic Syndrome4
1.00
0.85
0.73
0.99
Blood Pressure Elevated5
1.00
0.93
0.81
1.07
1.00
0.93
0.80
1.08
1.00
0.95
0.82
1.10
1.00
1.00
0.97
0.87
0.80
0.76
1.16
0.98
Glucose (Fasting) Elevated6
HDL- Cholesterol Reduced
7
Tryglycerides (Fasting) Elevated
Waist Circumference Elevated9
8
1
Adjusted for gender, race/ethnicity, age, poverty income ratio, physical activity level (categorized as
sedentary, moderate or vigorous), current smoker, and alcohol consumer
2
OR: Odds ratio
3
4
5
LCL: Lower 95th percentil confidence limit; UCL: Upper 95th percentil confidence limit;
Metabolic syndrome defined as ≥3 of the risk factors below
Blood pressure elevated defined as systolic BP ≥130 mmHg or diastolic BP ≥85 mmHg or use blood
pressure lowering medication
6
Glucose elevated (fasting) defined as ≥100 mg/dL for males and <50 mg/dL for females
7
HDL-cholesterol reduced defined as <40 mg/dL for males and <50 mg/dL for females
8
Triglycerides (fasting) elevated defined as ≥150 mg/dL or use of medication to treat elevated triglycerides
9
Waist circumference elevated defined as >102 cm for males and >88 cm for females
Results: Risk Factors
Mushroom consumers (as defined here) as
compared to non-consumers had:


Lower risk (-13%) of being overweight/obese

Lower risk (-15%) of having metabolic syndrome apparently
driven by reduced risk (-13) of elevated waist size




The NHANES is a cross-sectional study, and the data
cannot be used to draw causal relationships
Further, 24-hour dietary recalls have several inherent
limitations: they depend on memory and subjects may
under- or over-report
The mushroom definition used here came from a very
diverse group of foods (next month at Academy of
Nutrition and Dietetics Food and Nutrition Conference
and Exposition we will present results using a more
limited mushroom definition)
While numerous covariates were used in regression
analyses residual confounding may still exist
Mean mushroom consumption, defined as all foods with mushrooms, was 20.6±0.11
g/d during the period 2001-2010; there was no significant changes in consumption
over time.

Mushroom consumers were younger, more likely to be non-Hispanic White, less likely
to smoke or be sedentary, and had higher education and incomes than nonconsumers.

When compared with non-consumers, mushroom consumers had higher energy,
protein, thiamin, niacin, folate, copper, selenium, and sodium intakes and lower
intakes of total sugars, added sugars, and zinc.

HEI-2005 scores were higher in mushroom consumers; total vegetable, dark
green/orange vegetables, whole grains, and milk sub-scores were also higher in
consumers; the sodium sub-score was lower in consumers.


Mushroom consumers had
◦ Lower risk of being overweight/obese [odds ratio (OR) of 0.87 with 95 th percentile
confidence intervals (CI) of 0.78-0.98, p<0.05]
◦ a lower risk of metabolic syndrome (OR: 0.85; CI of 0.73-1.0, p<0.05) apparently
driven by reduced risk of elevated waist size (OR: 0.87; CI: 0.76-0.99)
Mushroom: Enlightened Opportunities
Rescued from the Dark
Roger Clemens, DrPH, CFS, CNS
USC School of Pharmacy
[email protected]
Dietary Guidance
• What are the various ways that consumers receive
dietary guidance information related to health?
– Dietary Guidelines for Americans
– Use of DGA to develop education materials and activities
– Nutrition labeling including claims
• How is this dietary guidance developed?
– Systematic reviews of scientific evidence
– Use of appropriate authoritative statements and reports
– Data analysis of NHANES, including What We Eat in
America
– Analysis of public comments
Scientific Evidence
Mushroom Sustainability
 World mushroom production continues to grow
 Mushroom production concentrated in few
countries (China, Italy, USA, Netherlands,
Poland, Spain, France, Canada)
 Mushroom cultivation
•
Agricultural waste  environmental friendly (minimal
water and soil amendments/nutrients)  high yield
(1500 tons/acre)
 Mushrooms represent nutritious food and
augment other foods (e.g., vegetables with color)
Mushrooms and Nutrient Intake
 Mean mushroom consumption, defined as all foods with
mushrooms, was about 21 g/d during the period 20012010; there was no significant changes in consumption
over time.
 Mushroom consumers were younger, more likely to be
non-Hispanic White, less likely to smoke or be
sedentary, and had higher education and incomes than
non-consumers.
Mushrooms and Nutrient Intake
 When compared with non-consumers, mushroom
consumers had higher energy, protein, thiamin, niacin,
folate, copper, selenium, and sodium intakes and lower
intakes of total sugars, added sugars, and zinc.
 Healthy Eating Index (HEI)-2005 scores were higher in
mushroom consumers; total vegetable, dark
green/orange vegetables, whole grains, and milk subscores were also higher in consumers; the sodium subscore was lower in consumers.
Mushrooms and Nutrient Intake
 Among mushroom consumers, total grain, non-whole
grain, total vegetables, and milk consumption was
higher than in non-consumers;
 Non-consumers of mushrooms had higher intakes of
legumes and white potatoes than mushroom consumers
 Mushroom consumers had
 Lower risk of being overweight/obese
 Lower risk of metabolic syndrome (apparently driven
by reduced risk of elevated waist size)
Where do mushrooms fit?
 How should mushrooms be considered within
dietary guidelines?
 Are all mushrooms the same?
 For consumer education, should mushrooms be
considered a vegetable?
Where are mushrooms in DG?
• Work Group 1:
– Environmental Determinants of Diet and Health and
Sustainability and Food Safety
• Work Group 2:
– Dietary Patterns and Quality and Optimization through
Lifestyle Behavior Change
• Work Group 3:
– Foods, Beverages, and Nutrients and Their Impact on
Health Outcomes