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SUPERIOR HEALTH COUNCIL
Dietary Guidelines 2016
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Introduction
Methodology
Energy
Proteins
Fats
Carbohydrates and fibres
Alcohol
N.M. Delzenne, UCL
SUPERIOR HEALTH COUNCIL
Energy balance
Energy intake
(food and beverages)
Digestible carbohydrates
Lipids
Energy expenditure
(4 Kcal/g)
NEAT*
(9 Kcal/g)
Proteins (+/- 4 Kcal/g)
Dietary fibers (+/- 2 kcal/g)
(Ethanol (+/-7 Kcal/g))
(polyols, organic acids)
* NEAT : non exercise thermogenesis
Von Loeffelholz C 2010
SUPERIOR HEALTH COUNCIL
Energy Dysbalance
Metabolic diseases risk
Undernutrition
OBESITY
BMI (kg/m2) <18,5
Waist circ.(cm)
Waist/hip ratio
18,5-24,9
25-29,9
30-34,9
>80/94 (F/M)
35-39,9
>40
>88/102(F/M)
>0.85/90 (F/M)
2014 : mean BMI 26,3 kg/m2; 29% are overweighed and
16% are obese (from 3 to 64 years old); from 35 years old,
more than 1/3 of the population is overweighed…
SUPERIOR HEALTH COUNCIL
How to calculate the adequate energy
intake? A quantitative approach
Aim : to compensate the energy expenditure by energy intake
in order to keep a « healthy BMI » of 22,5 kg/m2 (EFSA 2013).
Energy expenditure TEE=BMR (or REE) x PAL
TEE : total energy expenditure; Resting energy expenditure (REE);
physical activity level (PAL)
BMR and REE are measured (indirect calorimetry) and can be
calculated upon equations (eq from Henry et al 2005 : avoids
overestimation of BMR; no consensus in case of obesity (Miffin et al 1990
recommended by EFSA)
SUPERIOR HEALTH COUNCIL
Mean recommended intake in energy for adults (calculated on factorial method;
based and on REE (resting energy expenditure) calculated with the 5 mostly used
equations) (source EFAS 2013)
Age
years
PAL <1.4 Inactivity (bed resting)
PAL 1,4 : sedentarity, low activity
sitting at work without physical
exercise
PAL 1,6 : moderately active
sitting with few movements and
light sport activity
PAL 1,8 : active
standing at work, with movements
PAL >2 : very active
intense physical activity or working
PAL > 1,7 decreases the risk
of OW/ obesity and related metabolic risks
and of sarcopenia
man
women
SUPERIOR HEALTH COUNCIL
Mean recommended energy intake for
specific groups
• Tables for babies (kcal(kJ)/day (and/day x kg) and for children
and adolescents. Energy need calculated taking into account
TEE and energy need for growth (De Butte 2015).
• Pregnant and lactating women (dietary energy supplement as
compared to the energy need before pregnancy (in kcal/d) :
+70 kcal (1st sem.) , +260 (2nd sem.), +500 (3rd sem. and
lactation).
• More precise calculation of energy need per individual, taking
into account the « real life » (tools : tables of calculation of
BMR (Henry 2005); estimated PAL for several activities;
example of typical days with a mix of activities).
SUPERIOR HEALTH COUNCIL
Carbohydrates and fibers
Chemical structure, food source, and physiological effects
depending on their behavior in the GI tract are key arguments to
consider carbohydrates and fibers in the same chapter.
Carbohydrates
•
Digestible
Digestible
(Lactose)
Non (partly)digestible
Gut
microbiota
Non fermentable
(0 kcal/g)
Provide monomers
(glucose,fructose…)
as energy source
(4 kcal/g)
Fermentable
Dietary fibers
(+/- 2 kcal/g)
SUPERIOR HEALTH COUNCIL
Carbohydrates and fibers
Chemical structure, food source, and physiological effects
depending on their behavior in the GI tract are key arguments to
consider carbohydrates and fibers in the same chapter.
•
Digestible
Sugars
Digestible
Carbohydrates
Sugars
ü WHO « Free sugar »
added in diet/drinks (added
sugars) or present in honey,
sirups, juice…
ü Arguments to avoid excess
-Cariogenic (10% AET) (?)
Provide monomers -Nutritional dysbalance(Ca) in
(glucose,fructose…) children (> 25% AET) (?)
-Body weight (> 20% AET )
as energy source
(?)
(4 kcal/g)
SUPERIOR HEALTH COUNCIL
Carbohydrates and fibers
Chemical structure, food source, and physiological effects
depending on their behavior in the GI tract are key arguments to
consider carbohydrates and fibers in the same chapter.
•
Carbohydrates
Digestible
Digestible
indigestible
Polyols in diet
ü « Naturals » or additives
ü If >10% in foodstuffs
must refer to laxative properties
Provide monomers
(glucose,fructose…)
as energy source
(4 kcal/g)
polyols
SUPERIOR HEALTH COUNCIL
Carbohydrates and fibers
Chemical structure, food source, and physiological effects
depending on their behavior in the GI tract are key arguments to
consider carbohydrates and fibers in the same chapter.
Carbohydrates
•
Digestible
Non (partly)digestible
Diversity
Complexity
Gut
microbiota
Non fermentable
(0 kcal/g)
Fermentable
Dietary fibers
(+/- 2 kcal/g)
SUPERIOR HEALTH COUNCIL
Dietary fibers : not only carbohydrates…
Definition of dietary fibers
(Directive 90/496/CEE- Codex 2010)
Polymers of carbohydrates (DP min
3)
Neither digested nor absorbed in the
intestine
-naturally present in foodstuffs
-obtained from raw material which
demonstrated a »physiological
benefit »
- +other non digestible components,
namely associated (extracted) with
CHO polymers
lignin
Physiological effects : lipid and glucose homeostasis,
gut health (microbiota, pH, transit…), satiety
Expected health effect against obesity, some cancers
Inflammation, infections
SUPERIOR HEALTH COUNCIL
Dietary recommandations in dietary fibers
30 g per day for the adults (lack of qualitative recommandations
concerning the dietary fibers…).
Children : 2g/MJ and per day from 1 year old
EFSA, 2010
Dietary fibers
Girls (g/d)
Boys (g/d)
< 1 year old
No advice
No advice
1–3
10
10
4–6
14
14
7 – 10
16
16
11 – 14
19
19
15 – 17
21
21
?
SUPERIOR HEALTH COUNCIL
Recommendations for dietary carbohydrates
For children > 1year, adolescents and adults
ü carbohydrates must represent >50% total energy intake (TEI)
ü mostly by eating dietary fiber- and micronutrients-rich foods
like cereals, potatoes, legumes/beans, fruits, vegetables
ü added sugars should not represent more than 10% of the TEI
ü Limit intake in polyols to max 20-40 g per day
ü Minimal intake : 130 g/day for adults (IOM 2002/2005) (does
not cover energy needs in case of inadequate intake of proteins
and lipids). EFSA (2010) : minimum 45% of TEI as
carbohydrates
SUPERIOR HEALTH COUNCIL
Dietary carbohydrates in Belgium : a gap
with the recommandations
ü 2004 : carbohydrates : 46% TEI (>15 yrs old)
-24% as polysaccharides (mostly cereals (bread,pasta, rice…) or
potatoes;
-20% as mono- and disaccharides (sodas and syrups- sugar and
sweets- fruits- milk products, and juices)
ü 15-18 years old : 50,1 % of TEI as carbohydrates (25% as
polysaccharides-)
What to eat ? Whole grain cereals, legumes/beans, potatoes,
vegetables, fruits (5 a day, or at least 200g fruits and 200 g
vegetables a day); limit free sugar and sodas, avoid adding sugars
In food products; increase (progressively) dietary fiber-rich foods