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Poses on WHO guidelines on healthy eating

Fruity Healthy Better Be

The World Health Organisation (WHO) issued its guidelines on healthy eating last year, where the WHO's international expert panel who drafted the report has placed sweetened soft drinks as a contributory factor in the global pandemic of obesity and recommended that sugar should not account for more than ten percent (10%) of a healthy diet.

The Sugar Industry (according to a report carried in Vol. 48 of Diabetes Voice of May 2003) has labelled this as scientifically flawed.

A copy of the relevant Diabetic Voice has been sent to our medical advisory panel for use in this page.

The article titled WHO threatened reads;

WHO threatened

The sugar industry has reacted angrily to the publication of World Health Organization (WHO) guidelines on healthy eating.

The report, Diet, Nutrition and the Prevention of Chronic Diseases, has also been heavily criticised by the soft drinks industry.

The guidelines, which are based on the findings of a WHO panel of international experts points to sweetened soft drinks as a contributing factor in the global pandemic of obesity.

They recommend that sugar should account for no more than 10% of a healthy diet. The sugar industry has labelled the results as scientifically flawed. They argue that a quarter of our food and drink intake can safely consist of sugar.

Obesity is taking over from tobacco as the principal threat to public health in developed countries and is becoming a growing problem in developing countries.

Research findings on diabetes

His and hers diabetes

Research results show that the spouses of people with Type 2 diabetes have an increased risk of developing diabetes (Diabetes Care 2003, 26: 710-712). A sample of spouses of people with Type 2 diabetes was compared with spouses of people without diabetes.

The ethnicity of the spouses was similar, but they were genetically different. The results show that a shared environment during married life may contribute to the risk of developing Type 2 diabetes.

Researchers also identified a trend in spouses of people with diabetes towards higher blood pressure, significantly higher levels of serum triglycerides and body mass index (BMI). Almost one in five spouses of people with diabetes had evidence of impaired glucose tolerance (IGT).

The findings have important implications for screening: it is argued that these spouses should be classified as being at high risk for diabetes.

Sleep well and avoid diabetes

Recently published results suggest that irregular sleep may indirectly affect diabetes by promoting weight gain. Sleeping five hours or less or nine hours or more each night may increase your risk of developing diabetes (Diabetes Care 2003; 26: 380-384).

Researchers found that women who slept five hours or less every night were 34 per cent more likely to develop diabetes than women who slept for seven or eight hours each night. However, risk is not related just to lack of sleep.

Women who slept nine hours or more each night were 35 per cent more likely to develop diabetes. It is not clear why sleeping too little might be linked to diabetes, though one theory involves leptin, a protein hormone with important effects in regulating body weight and metabolism. It was found that too little sleep may reduce levels of leptin.

This may cause people to gain weight and develop diabetes. It was suggested that too much sleep may increase diabetes risk because people who sleep a lot tend to have poorer health in general. They may also have sleep apnoea, a condition that prevents restful sleep and which may also increase diabetes risk.

Short thighs linked to greater risk of diabetes

A report at the American Heart Associations' 43rd Annual Conference on Cardiovascular Disease Epidemiology and Prevention stated that people with short upper legs are more likely to have impaired glucose tolerance (IGT) or diabetes (American Heart Association).

Researchers used data on 8738 black, white and Hispanic men and women from the Centers for Disease Control's Third National Health and Nutrition Examination Survey (NHANES III). People with IGT had average thigh length of 39.1 cm; those with diabetes, 38.4 cm and those with normal glucose tolerance, 40.1 cm.

The study supports the theory that factors influencing growth in the womb and during childhood may contribute to the development of IGT and diabetes (see article by Chittaranjan Yajnik in this issue of Diabetes Voice).

Seasons and ethnicity influence birth weight 
and infant growth

A study published in the May issue of the Journal of Nutrition (J Nutr 2003: 133; 1415-1418) reports that the season in which a baby is born may influence the baby's birth weight. It can also affect how quickly the baby gains weight during the first four months of life. Researchers found significant differences among US ethnic groups.

Black babies born in summer and autumn had lower birth weights and lower rates of weight gain than those born in the winter and spring. Weight gain for black and Puerto Rican infants during the first four months of life was significantly lower for those born in autumn compared to those born in spring and summer. This was not observed in white babies.

The variation between ethnic groups could be related to healthcare access. Researchers suggested that higher levels of prenatal and infant care among whites may have evened out seasonal differences in that group.

This research could be important because weight gain in early infancy may predict obesity, diabetes, and other cardiovascular health problems in later life (see article by Chittaranjan Yajnik in this issue of Diabetes Voice). Previous research showed that rapid early infancy weight gain increases the risk of being overweight at age 7 by more than 25 per cent.

(Courtesy Diabetes Voice Vol 48)

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Good news for obese people

Researchers from Imperial College London and Hammersmith Hospital, have discovered that obese people have low levels of the hunger-regulation gut hormone PYY3-36.

In addition, single injections of PYY3-36 significantly reduced perceived appetite and calorie consumption in overweight volunteers. The results could have significant implications for the treatment of obesity. The results were published in the September 4, 2003 issue on New England Journal of Medicine.

According to the journal article PYY3-36 is a naturally occurring hormone released from the gut in response to eating, signalling to brain that a meal has been eaten. Deficiency of PYY3-36 in obese subject could lead to their eating more food before feeling 'full' contributing to their obesity.

Since it works by affecting appetite, PYY3-36 will not be a wonder weight loss during for those with unhealthy lifestyles. Nevertheless, it holds promise for those at risk of obesity-associated disorders, such as type 2 diabetes.

There are also hints that some diets may promote the production of PYY3-36, offering the prospects of dietary based approaches to PYY3-36 mediated weight loss. The investigators are conducting further researches.

Sanath Mahawithanage

Lecturer, Department of Applied Nutritio, Wayamba University of Sri Lanka.

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Dr. Nandakumar replies Dr. Atukorale:

on nutritional value of eggs

Dr. A. Nandakumar (veterinary surgeon) replying to Dr. D. P. Atukorale's article in the Health watch on Feb. 6 2004 on "Nutritional value of eggs" says. "Most Sri Lankans and people world over have avoided eggs from early 70s due to the unwarranted fears of cholesterol created by health professionals.

Now, when the perceptions of egg, by consumers and health professionals is in the process of a 360 degree turn due to the recent research developments, there are a few who are sitting direct contrast to the majority of the studies.

One should not be prejudiced of one's own thinking but should also accept the recent research developments.

Since everyone seems to reply the same nutritional message "less than 300 mg per day of dietary cholesterol and no more than 3 to 4 eggs per week" recommended by the American Heart Association (not by research) consumers and health professionals assume that surly the recommendations must be science based and proven safe and effective.

But as we are learning about many aspects of the more traditional, conventional wisdom in nutrition, the proscriptions against eggs and dietary cholesterol are coming under increasing scrutiny as new research not only question the validity of the old concept but presents documented evidence that the beliefs don't hold up well to rigorous scrutiny.

My articles are based on recent scientific evidence from various journals, research papers and data's from reputed universities who have been working on egg nutrition, and not inaccurate statements made as mentioned by Dr. Atukorale.

My references also include from Hu et al. JAMA 1999; 281:1387 - 1394, JAMA 274: 1049, N Engl. J. Med. 1997; 337:1491-1499, BMJ 1996.BMJ 313:84-90, J Clin Epidemiol 1996; 49:211-216, MBJ, JAMA, American Journal of cardiology 69 (12), 1015-1021. Journal of nutrition 126, 1515-1533, American J. Cil Nutr 1982:36:617-625 and many more.

Other materials have also been collected from proceedings of the World Poultry Congress 2000, International symposiums on eggs and egg products, World poultry Science, poultry international (highly accepted magazines in the poultry industry). As such, Dr. Atukorale referring that these recent developments, not appearing in the above magazines BMJ, JAMA, NEMJ are inaccurate and false.

Readers could also get valuable information on eggs from the following web sites.

1.www.americanheart.org 2) www.Nutrition and eggs.co.uk 3) www.aeb.org/food/eggs.

Choline lecithin and Lutein

Dr. Atukorale has mentioned that choline is not necessary for human and is only a compound essential for animals. In 1998, the National Academy of Science USA, issued a report identifying choline as a required nutrition for humans and recommended a adequate intake (AI) amount.

The AI for children ranges from 125 mg per day in young children. For adults, the AI values are 425 mg per day for women and 550 mg per day for men. It is said that during pregnancy and breast feeding, more choline may be required to the mothers' reserves are depleted. An adequate supply is critical because choline is essential for normal brain development.

Dr. Atukorale also goes to say that he is yet to come across any medical literature which says lutein reduces heart disease. But during the 40th annual International Egg Commission Conference held in Seville, Spain Dr. Don McNamara of the Egg Nutrition Center Washington has revealed that, egg yolk is a best source of lutein and has been found to reduce the risk of heart disease. (Currently may not have much scientific evidence) It is also a known fact that lutein and Zeaxanthin is associated with a reduction in the risk of cataract and reduction in the risk for age related muscular degeneration.

A recent research paper released in the web www.eurekalert. (Kansas State University Nutrition Research finds: Eggs have a lipid that lowers cholesterol absorption) has indicated that a phospholipid or lecithin, found in egg markedly inhibits the cholesterol absorption.

Dr. Koo who has carried the experiments at Kansas State University says "less absorption means less cholesterol introduced in the blood". He also goes to say that substantial amount of cholesterol does not go in to the blood.

Dr. Atukorale could get in touch with Dr. Koo Yonghzhi Jiang by [email protected]. I am of the opinion, that it is not necessary for all recent research papers should compulsorily appear in BMJ, JAMA, Lancet, NEJM or AHJ.

Prospective studies

The two studies referred in the article "Nutritional values of eggs" by Dr. Atukorale in the Health Watch column are not the only studies undertaken in the past. Over the years there have been numerous reports that egg consumption is not related to either plasma cholesterol levels or coronary heart disease (CHD). Data from the Framingham Heart Study, The Multiple Risk factor Intervention Trial (MRFIT),

The Alpha-Tocopherol, Beta-carotene Cancer prevention Study, The Nurses Health Study (JAMA 1999;281:1387-94. Referred by Dr. Atukorale),

The health Professionals follow up study all reported that dietary cholesterol intake was not related to either plasma cholesterol levels or coronary heart disease. And surely, if eggs increased the risk of CHD then countries with a high per capita consumption should have high rates of CHD.

The countries with a highest per capita egg intake are Japan, then Spain and France.

(To be continued)

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