biorci - izsto · dietary reference intakes: the essential guide to nutrient requirements....
TRANSCRIPT
Felicina Biorci
Prof a.c. Alimentazione e Fisiologia del Movimento – SUISM Torino
Nutrizionista c/oCentro di Medicina Preventiva e dello Sport dell'Università degli Studi di Torino
Early childhood health and nutrition is a true
reflection of countries’ level of development.
In Italy today, out of every 100 children in the third grade, nearly 24 are overweight (23.6%) and more than 12
Childhood obesity is a signicant health, social and economic problem of increasing importance for Western countries. In terms of childhood obesity alone, the prevalence in Europe today is 10 times greater than in the ’70s WHO, 2008
Values reported in the tables of this chapter refer to the following documents: Italian Nutrition Society, “L.A.R.N.”, 1996 update; FAO Nutrition and consumer protection division, “Nutritional requirements reports”; Food and Nutrition Board (Institute of medicine of the National Academies), “DietaryReference Intakes”, 2006.
In developed countries, the main protein disorder is tied to excessive consumption of proteins in the diet, rather than a shortage of them. In fact, the food normally consumed in Western families contains an amount of protein that is 3-4 times greater than the level considered adequate to satisfy the needs of pre-school- and school-age children. Protein-rich diets do not provide significant benefits and, on the contrary, can have negative effects. The liver and kidneys might not be capable of metabolizing too-high a level of amino acids. This could cause the appearance of metabolic acidosis and there could be high levels of ammonia and urea in the blood. Finally, a relationship has been found between high protein consumption in pre-school-age (age 2) children and obesity during school-age (age 8). This is an important, but still preliminary observation which needs to be confirmed by further research.
Recently, the vegetarian eating style has increased in popularity, with 10% of the population opting to exclude animal foods from their diet EURISPES 2016
The scientific literature shows that the reduction or exclusion of animal foods may reduce the risk of Coronary Heart Disease (CHD) and Type 2 Diabetes (T2D) through modifiable factors such as body mass, serum glucose, blood pressure and serum lipid profile. These disorders contribute to a high mortality rate in Western countries
World Health Organization . Global Status Report on Non Communicable Diseases 2014. WHO;
Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Tonstad
S, et al. Diabetes Care. 2009 May; 32(5):791-6.
Review Vegetarian and vegan diets in type 2 diabetes management.Barnard ND,
et al. Nutr Rev. 2009 May; 67(5):255-63.
Vegetarian diets and blood pressure among white subjects: results from the
Adventist Health Study-2 (AHS-2).2012 Oct; 15(10):1909-16.
Effects of plant-based diets on plasma lipids. Am J Cardiol. 2009 Oct 1;
104(7):947-56.
Since 1988, and recently with the position paper of 2009, the American Dietetic Association has established that vegetarian diets are sustainable and safe for all age groups and in all physiological conditions, from childhood to old age, in athletes, and during pregnancy and lactation
Position of the American Dietetic Association: vegetarian diets.J Am Diet Assoc. 1988 Mar; 88(3):351.Position of the American Dietetic Association: vegetarian diets.Craig WJ, Mangels AR, American Dietetic Association.J Am Diet Assoc. 2009 Jul; 109(7):1266-82.
Health Implications of Vegetarian Diets
Vegetarian diets are often associated with a number of health advantages, including
lower blood cholesterol levels, lower risk of heart disease, lower blood pressure levels,
and lower risk of hypertension and type 2 diabetes
Vegetarians tend to have a lower body mass index (BMI) and lower overall cancer
rates. Vegetarian diets tend to be lower in saturated fat and cholesterol, and have
higher levels of dietary fiber, magnesium and potassium, vitamins C and E, folate,
carotenoids, flavonoids, and other phytochemicals.
However, vegans and some other vegetarians may have lower intakes of vitamin B-12,
calcium, vitamin D, zinc, and long-chain n-3 fatty acids
Unbalanced vegetarian diets could be lacking in nutrients that are poorly represented in vegetal foodstuffs or with a low bioavailability (e.g., iron, zinc, vitamin D, ω3 polyunsaturated fatty acids). However, only Cbl seems to be virtually absent in vegetables and its shortage can have serious implications.
Review Chemistry behind Vegetarianism.Li DJ Agric Food Chem. 2011 Feb 9; 59(3):777-84.
Some researchers claim that the currently recommended intake levels may not be sufficient for an adequate daily intake, with particular regard to aging and the physiological reduction in absorptive capacity. With senescence, the epithelial cells of the stomach reduce their ability to biosynthesize the transporter proteins of Cbl. The gastric secretion ability is necessary both for the dissociation of Cbl from foods and for the binding to the carriers. For these reasons, the American Institute of Medicine recommends a supplementation of Cbl for people of 50 years of age and older. The development of blood and cognitive disorders are rather common aspects found among the elderly population.Review Vitamin B12 sources and bioavailability. Watanabe FExp Biol Med (Maywood). 2007 Nov; 232(10):1266-74.
Oral cobalamin therapy for the treatment of patients with food-cobalamin malabsorption.Am J Med. 2001 Aug; 111(2):126-9.
Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Institute of Medicine of the National Academies; Washington, DC, USA: 2006.
Review Haemoglobin, anaemia, dementia and cognitive decline in the elderly, a systematic review.BMC Geriatr. 2008 Aug 8; 8():18.
Purpose: to evaluate studies on the dietary intake and the nutritional or health status of vegetarian infants, children, and adolescents.
The American Academy of Pediatrics (AAP) and the Academy of Nutrition and Dietetics (AND) advocate appropriately planned vegetarian and vegan diets as healthful and nutritionally adequate for individuals during infancy, childhood and adolescence Kleinman RE (2013) Pediatric Nutrition, 7th ed.
American Academy of Pediatrics, Elk Grove Village
Position of the American Dietetic Association (2009)
Vegetarian diets. J Am Diet Assoc 109(7): 1266–
1282.
The German Nutrition Association does not recommend a vegan diet in infancy, childhood, and adolescents due to the higher risk of nutrient deficiencies
DGE Deutsche Gesellschaft für Ernährung Vegane
hrung: Nährstoffversorgung und
Gesundheitsrisiken im Säuglings- und Kindesalter.
DGE info 2011(4/2011): S 48–53
Purpose: to evaluate studies on the dietary intake and the nutritional or health status of vegetarian infants, children, and adolescents.
age range from 0 to 18 yearsmedian sample size was 35between 1981 and 2013
Body height, body weight, or body mass index (BMI) was similar to their omnivorous counterparts The intakes of macronutrients met the reference values in both groups.Results on micronutrient intakes were heterogeneous:Intake of folate in vegetarians exceeded the references (up to 200%) Vitamin D intake was found below the reference values in both groupsIn some vegetarians, vitamin B12 (<1 µg/ d) and calcium intakes were below both the references and the omnivores´ intakes [33, 34, 36]. The bone formation markers osteocalcin, C-terminal telopeptide of type ɪcollagen, and bone alkaline phosphatase were 10–20% lower in vegetarians than in their omnivorous counterparts [31, 34].
The blood lipid profile was more favourable in vegetarian participants with significantly lower total cholesterol, triglycerides, and low-density lipoprotein cholesterol [35].
[37, 38]. In both groups, the intakes of energy and protein met the reference valuesIn vegetarians, vitamin C intake exceeded the reference values (70 mg/ d).
Blood sample analysis showed a higher prevalence of iron deficiency in vegetarians than in omnivores (mean serum ferritin: 9.61 vs 36.1 µg/L) [38]
Two studies from SlovakiaIn one study: body weight and height were similar in vegetariansand in omnivores, while in the other study, vegetarians´ weight was 4 kg lower than omnivores´ weight. Serum iron (mean: 16.0 µmol/L) and haemoglobin levels (mean: 135.4 g/L) indicated iron deficiency anaemia in 58% of the vegetarians, whereas iron deficiency was less common (9%) in omnivores (mean serum iron: 22.5 µmol/L, haemoglobin: 142.0 g/L). In vegetarians, but not in omnivores, albuminaemia (38%) and protein deficiency (12%) was found [28].Blood levels of total cholesterol, LDL cholesterol, and saturatefatty acids were significantly lower in vegetarians [28, 29]In 50 British vegetarians: body weight, body height, upper arm circumference, and skinfold thicknesses showed a similar physical development
References were met for all nutrient intakes in both groups, witthe exception of zinc (84% of the references in vegetarians and 94% in omnivores).
The daily intakes of energy, protein, and vitamin B12 tended to be lower in vegetarians The iron status in vegetarians was lower than in omnivores (blood haemoglobin: 118.6 vs 124.1 mg/L)
The German study: physical development in both groups as appropriate.Most of the examined biomarkers of iron status (haemoglobin, erythrocytes, erythrocyte volume, serum ferritin, and haematocriwere similar in vegetarians and controls for all ages.
At the age of 12 months, vegetarians showed higher blood concentrations of iron than omnivores (15.7 vs 11.3 µmol/L), but lower values of transferrin (347.0 vs 377.5 mg/ dL)
Belgium study: 38 lacto-ovo-vegetarian aged 6–17.Data of 2837 omnivorous children from a study on physical education were used as references.Vegetarians´ TEI was below the references (up to 2648 kJ lower) at all ages.In general, physical and sexual development was within the normal range, but vegetarians´ skinfold thicknesses (triceps and subscapular) were lower and body weight of 10–17-year-old vegetarians was lower (−11 kg) than in omnivores. Vegetarians performed worse than omnivores on the standing long jump and the sit-up-test, and their heart recovery rate was also inferior. However, since vegetarians achieved better results in endurance sports, vegetarians were classified as fit as omnivores
The two studies on vegan children included 39 and 404 children and were conducted in Great Britain and the USA in 1988 and 1989, respectively [24, 39].The prospective long-term British study examined 39 vegan children starting from age 1 to 7 years, but had no control grouThese children had been exclusively breastfed on average for 6 months by their vegan mothers; most children were given vitamin B12 and vitamin D supplements. After weaning, main protein sources were wholegrain, legumes, and soy. The physical and cognitive development was age appropriatebut body height and weight tended to be below the 50th percentile of the references.The intakes of energy (up to 300 kcal/ d lower), calcium (52% of references), and vitamin D fell below the reference values, whereas vitamin B12 (280% of references, including supplements) and iron intake (142% of references) exceeded the references [24].
Vegan diet
Discussion: Our systematic review shows that the literature available is insufficient to draw up-to-date conclusions on health effects of vegetarian or vegan diets in infants, children, and adolescents in developed countries
As a tentative conclusion:most studies presented here did not show detrimental effect of vegetarian diets in children but even
pointed to beneficial health outcomes compared to omnivore diets, such as favourable lipid profile, antioxidant status, or dietary fiber intake as well as tendencies towards a lower risk of overweight.
Increased health risks of vegetarian diets were particularly reported for iron status.Studies in children on vegan diets are scarce and the two studies identified in this review did
not analyse biomarkers. Carefully conducted prospective studies in infants, children, and adolescents on vegan or
vegetarian diets compared with omnivorous control groups are urgently needed.
Preschool children (6 months-3 years). From the limited data available, it would seem that children whofollow a LOV diet have similar growth to OMN children. By contrast, preschool children on a macrobiotic diet werer eported to have significantly lower growth than those on other vegetarian diets.
Children (4-10 years). LOV children have similar growth to OMN children [25-27]. Non-macrobiotic VEGchildren tend to grow at standard rates [25;28], while macrobiotic children grow more slowly.B12: normal range in LOV, low status in macrobiotic persons.
BACKGROUND & AIMS: A Mediterranean-like dietary pattern has been shown to be inversely associated with many diseases, but its role in early obesity prevention is not clear. We aimed to determine if this pattern is common among European children and whether it is associated with overweight and obesity.
RESULTS:High scores were inversely associated with overweight including obesity (OR = 0.85, 95% CI: 0.77; 0.94) and percent fat mass (β = -0.22, 95% CI: -0.43; -0.01) independently of age, sex, socioeconomic status, study center and physical activity. High fMDS at baseline protected against increases in BMI (OR = 0.87, 95% CI: 0.78; 0.98), waist circumference (OR = 0.87, 95% CI: 0.77; 0.98) and waist-to-height ratio (OR = 0.88, 95% CI: 0.78; 0.99) with a similar trend observed for percent fat mass (p = 0.06).CONCLUSIONS:Although a Mediterranean dietary pattern is inversely associated with childhood obesity, it is not common in children living in the Mediterranean region and should therefore be advocated as part of EU obesity prevention strategies.
METHODS:Recruited 16,220 children aged 2-9 years from study centers in 8 EU countries. Weight, height, waist circumference, and skinfolds were measuredDiet: parental questionnaire reporting children's usual consumption of 43 food items.Adherence to a Mediterranean-like diet: food frequency-based Mediterranean Diet Score (fMDS)
The MD: great amount of
vegetables, fruits, bread and other forms of cereal, rice, beans and nuts. It also includes virgin ol-oil as the principal source of fat, moderate amounts of dairy products (basically cheese and yogurt), moder-amounts of fish, red meat in low amounts
Key point – infanzia & adolescenza�Nessuna revisione a favore di dieta vegetariana, vegana,
mediterranea o onnivora
�Nessuna revisione contro
�Conclusioni trasversali: più sana la dieta con pesce & legumi vs carne (Incidenza K, fx cognitive, BMI)
10/20 = 50% carni
4.5/20 = 22.5% pesce
5.5/20 = 27.5% latticini
0.5/20 = 2.5% legumi
