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Dr Cameron Mitchell Liggins Institute University of Auckland 16:30 - 16:50 Nutrition and Health 2016 – Nutrients v Food Nutrition and Health 2016 – Nutrients v Food Cameron Mitchell PhD Rotorua GP CME meeting Friday, 10 June, 2016 Disclosure • I have received research funding from: Fonterra, Dairy Farmers of Canada, Nestle • I have acted as a consultant for: Goodman Fielder • I have received speaking honoraria from: National Fitness Products (Canada) Nutrients vs Food Vitamin Deficiencies Ricketts Scurvy Vitamins vs. Fruit and vegetables Vitamins all cause mortality Macpherson et al. Am J Clin Nutr 2012;97:437-444 Fruit and vegetables all cause mortality Wang X et al. BMJ 2014; 349 :g4490 What is so good about produce? • Phytochemicals • Satiety • Fibre • Very difficult to over dose Fibre 10% Risk reduction for each 10g increase in daily fibre intake Yang Yang et al. Am. J. Epidemiol. 2015;181:83-91 Fibre supplement All cause mortality is not related to 10 year average fibre supplement use once adjusted for potential confounders Pocobelli et al. Am J Clin Nutr. 2010;91(6):1791-800 Why if Fibre good for you? • Lowers energy density of food • Helps to manage blood glucose • Improves bowel health Fish consumption Zhao et al. Eur J Clin Nutr. 2016;70(2):155-61 Omega-3 consumption Rizos et al. JAMA. 2012;308(10):1024-1033 Fish oil in NZ PRACTICE CHANGER Stop recommending omega-3 fatty acid supplements for cardiovascular protection. They have no significant impact on all-cause mortality, acute myocardial infarction, sudden death, or stroke.1 STRENGTH OF RECOMMENDATION A: Based on a meta-analysis of randomized controlled trials (RCTs). Rizos E, Ntzani E, Bika E, et al. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and metaanalysis. JAMA. 2012;308:10241033. Fam Pract. 2013 Aug; 62(8): 422–424. Albert et al. Sci Rep. 2015;70:7928 Nuts and mortality Mayhew et al. Br J Nurtr. 2016;115(2):212-25 Trans fat de Souza et al. BMJ. 2015;351:h3978 Nutrient density • More: protein, fibre, vitamins and minerals • Less: saturated fat, sugar and sodium • 15% reduction in all cause mortality Streppel et al. Eur J Clin Nutr. 2014;68(6):741-7 Food processing Anthony Fardet et al. Adv Nutr 2015;6:629-638 Modern Food The future of food? Take home points • Recommend foods rather than nutrients • Whole foods are best • Be weary of supplements • “Nutraceuticals” may be coming but not it is not time to abandon food yet