Salt, Sugar & Fat Graham MacGregor Professor of Cardiovascular - - PowerPoint PPT Presentation

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Salt, Sugar & Fat Graham MacGregor Professor of Cardiovascular - - PowerPoint PPT Presentation

Jan 01, 2024 229 likes •595 views

Salt, Sugar & Fat Graham MacGregor Professor of Cardiovascular Medicine Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK Major Underlying Factors Causing

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Graham MacGregor Professor of Cardiovascular Medicine Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK

Salt, Sugar & Fat

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Major Underlying Factors Causing Death - Worldwide

GBD 2013 Risk Factors Collaborators. Lancet 2015;385:117 Number of Deaths in thousands

Low physical activity High total cholesterol Alcohol and drug use High fasting plasma glucose High BMI Air pollution Tobacco smoke High systolic BP Dietary risks

2,000 4,000 6,000 8,000 10,000 12,000

Sexual abuse and violence

Unhealthy diet High systolic BP High BMI High plasma glucose High cholesterol

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Processed foods and soft drinks

Fat (saturated) Sugar Calorie Dental caries Cholesterol Blood Pressure Obesity Type 2 Diabetes Cancer Salt Heart disease Stroke

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Systolic BP & Stroke Deaths

Systolic BP (mmHg)

The risk starts at systolic 115 mmHg (83% adults)

120 125 135 148 168 2 4 8 16 32

Risk

MacMahon et al. Lancet 1990;335:765-74

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Cerebral haemorrhage Mid line shift due to raised pressure

Brain (cross section)

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Atheroma in carotid artery

Plaque Ulcerated Plaque Fissured Plaque with Thrombosis

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Strategy

Reduction in population BP Better control of raised BP Massive Reduction in Strokes, Heart Failure, Heart attacks BP – 2nd biggest cause of death in the world

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What puts up population BP?

  • Salt intake
  • Lack of Fruit and vegetables
  • Weight
  • Lack of Exercise
  • (Alcohol excess)
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CASH Strategy for Reducing Salt in UK (2003)

www.actiononsalt.org.uk

Table/Cooking (15%) Natural (5%) Food industry (80%) 0.9 0.5 4.6 40% reduction No reduction 40% reduction

Salt intake

Reduction needed

9.5

1.4 0.5 7.6

6.0

Source g/d

Target intake g/d

Total

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Fantastic for Public Health

Very little cost

Food industry slowly reduce

  • No rejection by public

No need to change diet

Hidden Salt in food

e.g. processed, fast, takeaway, restaurant food

↓ BP

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The voluntary ‘carrot and stick’ approach

food industry try

www.actiononsalt.org.uk

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0.6 0.7 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6

Impact of incremental targets

  • n salt in bread

He et al. JHH 2014;28:345

Target

(g/100g) 1.1 2010 1.0 2012 0.9 2017

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*** *** *** ***

7 8 9 10

*

50 100 150 200 250 126 128 130 132 70 72 74 76

Deaths per 100,000 per year Blood pressure (mmHg) Salt intake (g/d)

(from 24h UNa)

IHD Stroke

2003 2006 2008 2011

Salt Intake, BP and CVD Mortality in England 2003─2011

He et al. BMJ Open 2014; 4:e004549

* P<0.05 *** P<0.001

≈18,000 (9,000 fatal) CVDs prevented

NICE: http://guidance.nice.org.uk/PH25

≈ £1.5 billion healthcare savings per year

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Countries with salt targets

Argentina Belgium Bulgaria Chile Greece Hungary Netherlands Paraguay Portugal South Africa

(29/30 companies preferred regulation)

Regulated Voluntary

Australia Brazil Canada Ireland Italy Kuwait New Zealand Norway Poland Turkey UK USA

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Why are we getting so fat?

11 bananas or 18 oranges

  • r half a marathon

A Big Mac, large chips and coca cola

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Food/soft drink industry

Calorie-dense Cheap Profitable Transient satiation/ fullness

Calorie intake ↑ Obesity/type 2 diabetes ↑

“Brilliant” marketing Any time Everywhere

Eat more

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Consequence of Obesity

  • Type 2 Diabetes
  • CVD (↑BP, cholesterol)
  • Cancer (Breast; Colon;

Uterus; Esophagus; Kidney; Pancreas)

  • Fatty liver
  • Osteoarthritis
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Who is responsible?

  • Public
  • Government
  • Food industry

Food industry must reduce salt, fat & sugar content of foods

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Change food environment

  • Reformulation Voluntary/regulatory
  • Ban unhealthy food advertising &

promotions

  • Tax - High salt, sugar, fat foods
  • Subsidise healthy food, e.g. fruit & veg
  • Restrict availability
  • Reduce portion size
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Sugar- Impact on health

  • The major cause of dental decay

(caries)

  • Major source of hidden & empty

calories

  • Leads to obesity & diabetes
  • Direct toxic effects?
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Added Sugar Similar to Salt

  • Pure, white
  • Makes inedible food palatable
  • Only recently part of human diet
  • Sensitivity of taste receptor depends
  • n intake
  • Hidden
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Hidden Sugar (tsp)

x11 x9 x7 x6 x4 x6 x5 x4

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Sugar: Spinning a web of influence

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  • Liquid: easy to reduce
  • Solid: ↓portion size, polyols, insoluble fibre
  • Incremental targets, aim 50% reduction
  • Artificial sweeteners?: Need to ↓sweetness

Incremental sugar targets like salt

This will ↓calorie intake by >100 Kcal/person/d

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Battenberg Genoa Red velvet Lemon Swiss roll Chocolate cake bar Ginger Cupcake/fairy cakes Fruit Swiss roll Coconut Iced Madeira Brownies Fruit Chocolate Swiss roll Victoria Coffee and walnut Fruited Madeira Bakewell Lemon Carrot White chocolate Almond Angel Chocolate Coffee Walnut Chocolate muffins Madeira Plain with chocolate Blueberry muffins

Sugars (g/100g) Different cakes

Sugar in cakes

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Plain with chocolate Chocolate cake bar Cupcake/fairy cakes Coffee and walnut Red velvet Chocolate Brownies White chocolate Chocolate Swiss roll Chocolate muffins Coconut Walnut Iced Madeira Coffee Victoria Battenberg Angel Bakewell Almond Lemon Carrot Madeira Ginger Fruited Madeira Blueberry muffins Lemon Swiss roll Fruit Fruit Swiss roll Genoa

Energy (kcal/100g) Different cakes

Energy in cakes

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Cupcakes / fairy cakes 30 40 50 Cupcakes / fairy cakes 375 400 425 450 475 500

Energy (kcal/100g) Sugars (g/100g)

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  • Fat: Major calorie contributor
  • Easy to reformulate (2.5 X calorie/g)
  • ↓ Sat fat → ↓ LDL cholesterol
  • Incremental targets, aim ↓ 20%

Calorie / Fat

This will ↓calorie intake by >100 Kcal/person/d

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Obesity plan by AoS for UK 2015

  • 1. Incremental reduction

3. 20% sugar levy (+reformulation) ─ soft drinks Sugar 50% ↓ Fat (Sat) 20% ↓ 2. Only healthy foods promoted/advertised

↓100 Kcal/person/d ↓100 Kcal/person/d ↓ 100

Kcal/person/d 4. Public sector strict guidelines 5. Uniform colour-coded labelling

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UK Obesity Plan 2017

  • Tax on sugar-sweetened drinks (opportunity to

reformulate)

  • 20% voluntary sugar reformulation by 2020 (PHE)
  • Targets to be set for calorie reduction (fat)
  • No restrictions on marketing or promotion
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UK Sugar levy 2018

>8 g/100 ml (8% sugar) tax 24p /L 5-8 g/100 ml (5-8% sugar) tax 18p /L <5 g/100 ml (<5% sugar) No tax

Nearly all branded & supermarket own label have reformulated <5 g/100 ml Only Coca Cola/Pepsi have kept full sugar drinks

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Fantastic for Public Health

Very little cost

Food industry slowly reduce salt, sugar & fat

  • No rejection by public

No need to change diet

Reformulation of unhealthy food

e.g. processed, fast, takeaway, restaurant food

↓ BP, obesity & cholesterol

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  • Incremental taxes on unhealthy foods
  • Ban all marketing of unhealthy foods

The last chance saloon

If industry does not respond