ricardo uauy md phd institute of nutrition university of chile institute of nutrition university of...
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Ricardo Uauy MD PhDRicardo Uauy MD PhD Institute of Nutrition University of Chile Institute of Nutrition University of Chile www.inta.clwww.inta.cl
y London School of Hygiene and Tropical Medicine y London School of Hygiene and Tropical Medicine University of London University of London www.lshtm.ac.ukwww.lshtm.ac.uk
UNUUNU IUNSIUNS
Dieta , Nutrición , Actividad Física Dieta , Nutrición , Actividad Física y Prevención de Enfermedades y Prevención de Enfermedades
CrónicasCrónicas
inta
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0
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20 40 60 80 100 120
AÑOS DE VIDA
1930
19651995
Ideal Actual
EXPECTATIVA DE VIDA EN EXPECTATIVA DE VIDA EN AMERICAAMERICA
Po
rcen
taje
Po
rcen
taje
140
FuturoFuturo
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Causas de Muertes según región de OMS
OMS 2001
Crónicas NT
AccidentesInfecciosas y perinatales
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CHILE
0
20
40
60
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100
1970 1975 1980 1985 1995
MEXICO
1970 1975 1980 1985 1995
0
20
40
60
80
100
0
20
40
60
80
100
GUATEMALA
1970 1975 1980 1995
URUGUAY
0
20
40
60
80
100
1970 1975 1980 1985 1995
ENFERMEDADESENFERMEDADESINFECCIOSASINFECCIOSAS
TUMORESTUMORES
ENFERMEDADESENFERMEDADESCARDIOVASCULARESCARDIOVASCULARES
CAUSASCAUSASPERINATALESPERINATALES
ACCIDENTESACCIDENTES
OTRAS OTRAS CAUSASCAUSAS
inta
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0
25
50
75
100
20 40 60 80 100 120
AÑOS DE VIDA
1930
1965
1995
NUTRICION A TRAVES DEL CICLO VITAL
%
Muertes Infantiles:Muertes Infantiles:Bajo Peso al nacer Bajo Peso al nacer DCP y retraso talla. DCP y retraso talla. Infección/diarreasInfección/diarreasDéficit de Déficit de micronutrientesmicronutrientes
Muertes Prematuras:Muertes Prematuras:Cardiovasculares Cardiovasculares CáncerCáncerObesidad, DiabetesObesidad, DiabetesHiperlipidemíaHiperlipidemíaOsteoporosisOsteoporosis
Prevención de Discapacidad
Física y Mental
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0 100 200 300
Corazon
AVE
Cancer
Diabetes
CanadaNicaraguaMexicoChileArgentina
Muertes ECNT en las Americas (45-64 años)
Mortalidad x 105 ajustada por edad
OPS 2000
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!!!Eureka ! He descubierto el gen que nos lleva a pensar que todo esta causado por
los genes.
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Mortalidad por ECNT en México (45-64 años de edad)
Infarto del Miocardio
Cirrosis
Diabetes
Hipertensión
Cerebrovasculares
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Norte Centro México, D.F. Sur Nacional
%
25,433,1
23,130,4
24,832,7
22,1 26,9 23,530,3
58,154,3
60,557,1
56,7
54,8
61,460,8
59,757,5
14,813,1
14,712,5
15,913
13,912,4
14,612,7
0
20
40
60
80
100
120
Grasa CHO Proteína
1988 1999 1988 1999 1988 1999 1988 1999 1988 1999
Cambios Dietarios en México 88/99Cambios Dietarios en México 88/99
Norte Centro México, D.F. Sur Nacional
Grasa CHO Proteina% Calorías
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Desarrollo cerebral
Crecimiento físico y composición corporal
Programación metabólica
CHO, Lípidos Proteinas
Hormonas y receptores
Dieta tempran
a
Immunidad
Capacidad de Trabajo Físico
Diabetes ObesidadCardiovasculares
Infarto Cerebral Hipertensión
CáncerEnvejecimiento
Capacidad de conocer y aprender
Corto plazo
Largo plazo
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El origen de los problemas
Obesidad
Diabetes
Cancer
Alergias
Infarto
Colesterol
Stress
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www.who.int/hpr/nutrition/ExpertConsultationGE.htm
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1Background11 The global burden of chronic diseases12 The double burden of diseases in the developing world23. The current state of food supply at the global levelI Diet, nutrition and chronic diseases in a life course context Interactions between early and later factors throughout the life course --- Intervening throughout life
4. A summary of population nutrient recommendations for preventing chronic diseases
4.1 Nutrient recommendations for the prevention of excess weight gain and obesity 4.2 Nutrient recommendations for the prevention of diabetes 4.3 Nutrient recommendations for the prevention of cardiovascular diseases 4.4 Nutrient recommendations for the prevention of cancer 4.5 Nutrient recommendations for the prevention of dental diseases 4.6 Nutrient recommendations for the prevention of osteoporosis
5. Recommended action6. Integrated strategies for action
www.who.int/hpr/nutrition/ExpertConsultationGE.htm
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15
Indice de Masa Corporal en población adulta
%
IMC Bajo Peru
TunisiaColombia
BrazilCosta Rica
CubaMorocco
ChileMexico
TogoZimbabwe
ChinaMali
GhanaHaiti
SenegalEthiopia
India
60 50 40 30 20 100
10 20 30 40 50 60
<16 16-16.9 17-18.4 >25
IMC Alto
%
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Ingesta de Energía
Gasto Energético
Energía dietaria ilimitada
La actividad es menor que el gasto
Ingesta de Energía
Gasto Energético
Energía dietaria limitada
Ingesta iguala gasto
Ingesta=Gasto Ingesta>Gasto
Reservas de Energía Reservas de Energía
Hombre Primitivo Hombre Moderno
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Hombre Moderno
Necesita un Cambio Conductual
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Aumentar actividad física para igualar ingesta
Ingesta de Energía
Gasto
Energía dietaria ilimitada
Ingesta=Gasto
Reservas de Energía
Ingesta de Energía
Gasto
Ingesta=Gasto
Reservas de Energía
Disminuir la ingesta para igualar actividad física
Energía dietaria ilimitada
Hombre Moderno: Necesita un
Cambio Conductual
Ingesta de Energía
Gasto Energético
Energía dietaria ilimitada
La actividad es menor que el gasto
Ingesta>Gasto
Reservas de Energía
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www.who.int/hpr/nutrition/ExpertConsultationGE.htm
Energy dense foods are high in fat &/or sugar. Low energy density (or energy dilute) foods are high in fibre and water, such as fruit, legumes, vegetables & whole grain cereals, as well as lean meat and fish.
Evidence Decreases risk None Increases risk
Convincing Regular physical activityHigh dietary NSP (fibre) intake
Increased intake energy-dense foodsSedentary lifestyles
Probable Home and school environments that support healthy food choices for children**Promoting linear growth
Heavy marketing of energy-dense foods** and fast-foods Adverse socio-economic conditions (for women in developed world) Sugar-sweetened drinks /juices
Possible Low glycemic index foodsBreastfeeding
Protein content of the diet
Large portion sizesHigh proportion of food prepared outside the home (western countries)Restraint/disinhibition eating pattern
Nutrient recommendations for the prevention of excess weight gain and obesity
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Calidad de las Grasas en la Nutrición
• Saturadas (C12:0, C14:0, C16:0, C18:0)• Ac grasos trans (grasas hidrogenadas) • Ac grasos monoinsaturados (18:1)• Saturadas/AG Mono Insaturadas/AG Poli Insaturadas • Colesterol
• Ac grasos esenciales w -3 y w -6• AGPI de cadena larga (AA,EPA,DHA) • Ac grasos trans conjugados (CLAs)
• Densidad energética (grasas y carbohidratos)
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Cazador-recolector
AgricultorIndustrial
Tiempo (años)
% energía
Grasa dietaria durante la evolución del hombre
Grasa Total
Saturada
Trans
Omega-6
Omega-3
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– Use aceites vegetales en su forma natural, líquida
– Evite grasas hidrogenadas o las parcialmente hidrogenadas, especialmente las margarinas duras y las mantecas vegetales.
– Restringa la ingesta de alimentos procesados especialmente los preparados con aceites hidrogenados: galletas, queques, pasteles, frituras, alimentos fritos, y alimentos envasados.
– Lea las etiquetas. Identifique y evite los alimentos que contengan aceites hidrogenados o parcialmente hidrogenados o altos en acidos grasos trans.
Para reducir el riesgo de un infarto…..
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www.who.int/hpr/nutrition/ExpertConsultationGE.htm
Nutrient recommendations for the prevention of Cardiovascular Disease Evidence Decreased risk No relationship Increased risk
Convincing Fruits, berries, and vegetablesFish and fish oils (EPA and DHA)Linoleic acidPotassium Regular physical activityLow to moderate alcohol intake (for CHD)
Vitamin E supplements Myristic and palmitic acids Trans-fatty acidsHigh sodium intake OverweightHigh alcohol intake (for stroke)
Probable -linolenic acid Oleic acid Non-starch polysaccharides (NSPs)Whole grain cereals Nuts (unsalted)FolatePlant sterols/stanols
Stearic acid Dietary cholesterolUnfiltered boiled coffeeBeta carotene supplements
Possible Flavonoids Soy products
Fats rich in lauric acid Impaired fetal nutrition
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Prevalence of diabetes in the Americas
1997 2025
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www.who.int/hpr/nutrition/ExpertConsultationGE.htm
Evidence Decreased risk No relationship Increased risk
Convincing Voluntary weight loss in overweight & obese people
Overweight and obesity Abdominal obesityPhysical inactivityMaternal diabetes
Probable Non-starch polysaccharides (NSPs)
Saturated fatsIntrauterine growth retardation (IUGR)
Possible n-3 fatty acidsLow glycaemic index foodsExclusive breastfeeding
Total fat intakeTrans fatty acids
Nutrient recommendations for the prevention of Diabetes
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Calorias que no aportan nutrientesAminas
Heterocíclicas
Grasas Saturadas Aumentan el Riesgo Cardiovascular
Grasas trans aumentan riesgo de cancer
Aliños cargados de grasas hidrogenadas
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Resveratrol antioxidante en vino tinto
Sulforafanos de la coliflor previene ciertos canceres
Fibra y Genisteina en porotos
Fitoquímicos en frutas y verduras protegen de CV y Cáncer
Grasas Omega-3 del pescadoprotegen el Corazón
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www.who.int/hpr/nutrition/ExpertConsultationGE.htm
Nutrient recommendations for the prevention of Cancer Evidence Decreased risk Increased risk
Convincing
Physical activity (colorectum) Overweight and obesity (oesophagus, colorectum, breast, endometrium, kidney)Alcohol (oral cavity, pharynx, larynx, oesophagus, liver, breast)Some mycotoxins (aflatoxin, ochratoxins)Chinese-style salted fish (nasopharynx)
Probable Fruit and vegetables (oral cavity, oesophagus, stomach, colorectumPhysical activity (breast)
Preserved meat (colorectum)Salt preserved foods & salt (stomach)Very hot (thermally) drinks and food (oral cavity, pharynx, oesophagus)
Possible/ Insufficient
Fibre, soya, fish, n-3 fatty acids, carotenoids, vitamins B2, B6, folate, B12, C, D, E,
calcium, zinc, selenium, non-nutrient plant constituents (e.g. allium compounds, flavonoids, isoflavones, lignans)
Animal fats, heterocyclic amines, polycyclic aromatic hydrocarbons, nitrosamines
A protective effect of fruit and vegetable intake has been suggested by many case-control studies but has not been supported in several large prospective studies, suggesting that if a benefit does exist it is likely to be modest.
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USTED PUEDE VIVIR MAS Y MEJOR CAMBIANDO UNA DE ESTAS
TRES COSAS :
MADRE PADRE DIETA y Actividad Fisica
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• Consuma diferente tipo de alimentos durante el día
• Aumente el consumo de frutas,verduras y legumbres
• Prefiera los aceites vegetales y disminuya las grasas
• Prefiera carnes como pescado, pavo y pollo
• Aumente consumo de leche, prefiera baja en grasa
• Reduzca el consumo de sal
• Modere el consumo de azucar
• MANTENGASE ACTIVO y CUIDE SU PESO
Guías Alimentarias para Vivir Mas y Mejor
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Ayudar al individuo
Cambiar el ambiente
Puska 2001
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Costo de la obesidad en USA fue estimada en $117 billones en el 2000. Los costos de salud dan cuenta de la mitad de los costos -- $61 billones – del total
Tienen mayor riesgo de muerte, de desarrollar Enf Crónicas-NT y otras condiciones que requiren atención de salud.
Tienen problemas con sus actividades diarias y en su empleo. El gasto en salud y los costos en licencias laborales contribuyen a los costos
El manejo y control adecuado de la obesidad puede reducir los gastos. Por ejemplo, si se promueve una mayor actividad física en forma mantenida.
Se ha estimado que el aumentar la actividad física en los 88 millones de Americanos inactivos mayores de 15 años podrían reducir los gastos de salud en hasta $77 billones.
La Obesidad es Costosa
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El Abogado dice: consigne que mi cliente apuntó directamente al dependiente de McDonald’s que lo obligo a comer de más
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EVOLUCION DE LA NUTRICION HUMANA
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0
2000
4000
1900 1950 2000
Gasto energético Gasto energético diáriodiário
Aerobics Center Longitudinal Study - Cooper Clinic
• < 500 kcal menos por dia que hace 100 años • 180.000 kcal por año que hace 100 años
Kcal/dKcal/d
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• Caminar 15 km/sem
• 3 km por dia 30 min
• 1 km a cada 10 min
• 100m a cada 1 min
PARA SER ACTIVO
Agita São Paulo
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.
.
.
..
.
.
.
1
.
POR SU SALUD...
Muévase pues!EQUIPO DE CICLISMO
Muévase pues!
MOVÁMONOSCOSTA RICA”
URUGUAI EMMOVIMENTO
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Agita
MundoAgita
Mundo
World Health Day
April 7th - 2002
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AumentAumente su e su Actividad Actividad
Física DiariaFísica Diaria
AumentAumente su e su Actividad Actividad
Física DiariaFísica Diaria
** ****
ACTUAL
IDEAL
• >20 min 30
min
• 30 min 45
min
• 45 min 60
min
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45
Year1920 1940 1960 1980 2000
0
50
100
150
200
250
300
350
400
Death rate of CHD (per 100,000)
Men 40-49
Men 50-59 yrs.
Women 40-49
Women 50-59
Changing rates of coronary heart disease in Norway.
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WHO Strategy: Diet, Physical Activity, and Health
Consultation Process and Preparation of Final Report
ReferenceGroup
ReferenceReferenceGroupGroup SecretariatSecretariatSecretariat
World Health Assembly 2004World Health Assembly 2004
Executive Board 2004Executive Board 2004
Consultation ProcessConsultation Process
UNAgencies Member
statesCivil
societyPrivate sector
Ph
ase I
Ph
ase I
IP
hase I
II