Healthwise Congres

Role of nutrients for health and well-being – the view of an ingredient supplier

Dr. Manfred EggersdorferNutrition Science & Advocacy DSM

October 31, 2014

To start with a motivating quote

When diet is wrong,medicene is of no use.

When diet is correct,medicine is of no need.

Healthy living - the good newsdeclining late - life mortality

Source: Nature 2008, 451, 644-647

Life expectancy: Japanese females andIceland men living longest of all

Top 10 countries; life expectancy in years

Women

1. Japan 87.02. Spain 85.13. Switzerland 85.14. Singapore 85.15. Italy 85.06. France 84.97. Australia 84.68. Rep of Korea 84.69. Luxembourg 84.110.Portugal 84.0

….

Men

1. Iceland 81.22. Switzerland 80.73. Australia 80.54. Israel 80.25. Singapore 80.26. New Zealand 80.27. Italy 80.08. Japan 80.09. Schweden 80.010.Luxembourg 79.7

….

Source: WHO 2014

Netherlands 83 Netherlands 79

Gain in life years is not matched by gainof years in good health (1990 -2010)

Source Lancet 2012

Leading risk factors for disease: example Netherlands (2010)

Source: GBD Country Report Netherlands

Micronutrientrelated

More than 40% of nutrition related diseases take place before the age of 70.

Approximately one third of cancers can be prevented

Up to 80% of heart disease, stroke and diabetes type 2 deaths are preventable.

Source WHO

Healthy life depends on several factors –nutrition being an important one

• Genetics• Life-course

events• Education• Employment• Lifestyle• 1000 days

window• Nutrition

Ageingtrajectory

Nutrition and lifestyle are modifiable risk factors

People expect quality and all nutrients in their food

Slide 8

Vitamins

Vitamin AVitamin E Vitamin CVitamin DVitamin B1Vitamin B2Vitamin B6 Vitamin B12 …

Omegas

DHA EPAARA

Carotenoids

B-caroteneLuteinZeaxanthin

…

Enzymes

Phytase…

Minerals

CalciumMagnesiumIron ZincIodineSelenium…

Amino acids

MethionineLysine…

Fibers

Page 9

Little compliance with food guidelines - people eat the ‘wrong things’!

>75%

Population % below reference value

50 - 75%

25 - 50%

5 - 25%

<5%

Men Women Men Women Men Women Men WomenMen Women

Adapted from Krebs-Smith et al. 2010 JN

A large majority of the population does not meet the nutritional recommendations set by the food pyramid

10

People make wrong choices in nutrition

© 2011 Institute of Food Technologists

Germany

The Netherlands

United States

United Kingdom

Barbara Troesch, Birgit Hoeft, Michael McBurney, Manfred Eggersdorfer and Peter Weber Published in British Journal of Nutrition 2012, 108, pp692-698

Micronutrient intake is a topic in Western countries

The consequences: inadequate micronutrient intake affects health and performance

Impaired functions, higher risk for non-communicable diseases

Long term health, wellness, vitality

Metabolic response

A balanced intake of all essential nutrients is required for long-term health, healthy aging and risk reduction of NCDs

Nutrient status

Desirable

Insufficient

Deficient Deficiencydisease

Adapted from B. Ames

Example of a deficiency disease – which is still an issue in major parts of the world

• The average life time costs (including quality of life and life expectancy) for a child with an NTD amounts to : € 242,948

• Food fortification with folic acid is a cost effective and humanitariancountermeasure(Jentik et al. (2008))

The impact and solution

Several hundreds of millions Euros of savings were estimated as cost benefit for folic acid fortification – next to the ethical aspects.

• 300,000 to 400,000 worldwide(Christianson A, et al., (2006))

• ~4,500 in Europe (J Behav Med 25:411–424)

• 100,000 in China (N Engl J Med 341:1509–1519)

Babies born annually with NTD

In the light of many countries experiences with folic acid fortification it is timely to advocate in countries with no fortification.

Many countries (in red) have mandatory fortification of food with folic acid in place

http://www.eurocat-network.eu/preventionandriskfactors/folicacid/folicacidmandatoryfortification

The following countries have mandatory fortification of food with folic acid.

Argentina Ghana Oman

Australia GrenadaPalestine, Occupied Territory

Bahrain Guadalupe ParaguayBarbados Guatemala Puerto RicoBelize Guyana QatarBolivia Haiti Saudi ArabiaBrazil Honduras South AfricaCanada Indonesia St VincentChile Iran SudanColombia Iraq TurkmenistanCosta Rica Jamaica UruguayCote d'Ivoire Jordan USACuba Kuwait YemenDominican Republic Mexico

Ecuador Morocco

El SalvadorNew Zealand

Fiji Nicaragua

However two third of the countries miss the opportunity of fortification

Vitamin A

-Carotene

Thiamine

Riboflavin

Niacin

Vitamin B5

Vitamin B6

Vitamin B12

Folate

Biotin

Vitam

in C

Vitam

in D

Vitamin E

Vitamin K

Dietary AO

Multivitam

in

PUFA

Aging Cancer

Dementia

Bone Health

Hypertension Diabetes

CVD

COPD

AMD

Insufficient intake of essential nutrientsincreases risk for non-communicable diseases

Source: internal data DSM

17

Example Vitamin D: the inadequate statusimpacts a number of body functions

Classical role of vitamin D: bone health

• Improves bone mineral density through calcium absorption and deposition

• Necessary to prevent rickets & osteomalacia

Emerging health benefits of vitamin D

• Muscle - Reduces risk of falling by improving muscle strength

• Immunity - Strengthens the immune system - Reduces risk of multiple sclerosis

and diabetes type • Cardiovascular - Lowers blood pressure• Cancer - Inhibits cell proliferation

osteoporotic

normal

18

Vitamin D comes from different sourcesSerum level is an indicator for individual status

25(OH)D serum level (nmol/L) is

a sensitive indicator of Vitamin D status(IOM 1997)

Four ranges are suggested to assess the individual status:

< 25 25 - 50 50 - 75 > 75

deficient insufficient (in)adequate desirable

(nmol/L)

Major cirulating form

SunFood Supplements

7-Dehydro-cholesterol

Vitamin D

Liver

25(OH)D

Kidney

1,25(OH)2D Active form

2

2

7

2 2

1

2

3

6

1

2

1

2

1

1 6

1

32

< 25

25-50

50-75

> 75

No info

Vitamin D levels in nmol/l

Deficient

Insufficient

(In)adequate

Desirable

Vitamin D status in Europe

Reference:E. M. Brouwer-Brolsma, H. A. Bischoff-Ferrari, R. Bouillon, E. J. M. Feskens, C. J. Gallagher, E. Hypponen, D. J. Llewellyn, E. Stoecklin, J. Dierkes, A. K. Kies, F. J. Kok, C. Lamberg-Allardt, U. Moser, S. Pilz, W. H. Saris, N. M. van Schoor, P. Weber, R. Witkamp, A. Zitterman, L. C. P. G. M. de Groot, Osteoporosis Int 2012

(boxes indicate studies in elderly)

A systematic review of vitamin D status in population worldwide

What are potential consequences oflow vitamin D status?

One in three women and one in five men over the age of 50 years will sustain an osteoporotic fracture

3.5 million new osteoporotic fractures occur each year in Europe

In women, the incidence of fractures is higher than the total incidence of cancer, heart infarction, stroke or diabetes

Osteoporotic fractures accounts for more days spent in hospital than many other diseases, including diabetes, myocardial infarction and breast cancer.

Germany: Health care cost impact of low vitamin D status

Net socio-economic benefit ranges from* : 585 mio €Including medical and therapeutic costs for prevention, treatment and supplementation costs vitamin Dup to 778 mio €Including societal perspective, e.g. family care, reha costs

24 Hip and vertebral fractures have the most „cost-intense“ medical implications• Number osteoporosis patients: 8-10 mio (2010)*• Number of hip and vertebral fractures p.a.: 150.000*

Optimized vitamin-D status reduces number of fractures by 20 %• Reduction of 5.478 hip fractures and 18.420 less vertebral fractures

(in osteoporosis-diagnosed population)

Source: * Sproll 2011

Costs of vit D supplementation for women > 55 with low vit D status: 180 -200 mio EUR

25

Magnitude of vitamin D considering additional health benefits

Bone fractures

20 %

Cardio Vascular Diseases

20 %

Multiple Sclerosis

50%

Diabetes

25%

Cancer and others

25 %

Source: Grant et al 2009

Risk reduction by optimal vitamin status:

26

Large health care cost savings could be achievedwith adequate vitamin D status

Source: vitamin D and socioeconomic costs, T. Sproll

Adequate levels can be achieved with voluntary food fortificationand/or supplementation for risk groups with costs of only20-30 EUR/person per year

Zittermann 2010 Germany: € 37,5 bn/y overall perspective,including direct and indirect costs and implications

Grant et al 2009 17 countries in Europe: € 187 bn/y direct and indirect cost savings (= 16,7 % of total health care costs)

Example omegas: required over the life cycle

Slide 27

Brain & Eye Health

• Reduced cognitive decline

• Lower risk of dementia

• Lower risk of age-related macular degeneration

Seniors

Heart Health

• Lowers triglycerides

• Increases HDL

• Improves blood vessel function

• Normal cardiac function

Adults

Brain/eye development

• Improves visual acuity

• Promotes cognitive development

• Reduces risk of overweight and obesity

Infants & Toddlers

Maternal health

• Promotes maternal DHA status

• Increases DHA content of breast milk

• Supports normal gestation period

• Promotes fetal brain and eye development

Pregnancy

Omegas play a vital role over the full life cycle

DHA is important during pregnancy and thefirst two years

DHA

So, are pregnant women consuming therecommended intakes of DHA?

Recommended DHA intake for pregnant andlactating women =

at least 200 mg DHA per day

Koletzko et al, Br J Nutr 2007; 98:873-877.

However only median intake of 75 mg DHA/day reported!

Cosatto et al, Nutrients 2010; 2(2): 198-213

Achieving the recommended intake of 200 mg DHA is a challenge

30

So using fortified foodsor taking a supplementwith DHA may be a wisechoice!

• High-dosage supplementation of long-chain polyunsaturated fatty acids (particularly DHA) in mothers, started at mid-pregnancy, has been associated with long-term positive effects on intelligence quotient scores of neurodevelopment. (Early Human Development 86 (2010) S3–S6)

• Five-year-old children whose mothers received modest DHA supplementation versus placebo for the first 4 months of breastfeeding performed better on a test of sustained attention.

• This, suggests that DHA intake during early infancy confers long-term benefits on specific aspects of neurodevelopment. (J Pediatr 2010)

3rd month 6th month

9th month at birth

Youngson (1995) Encyclopedia of family health

Cognitive health benefits of DHA supplementation during pregnancy & lactation

LC-PUFAs support growth and development

DHA and AA are important for fetal development

• DHA is essential for development of fetalbrain and retina.

• AA is important for normal development of organs and cells.

• PUFAs are not synthesized by the fetus, but taken from maternal blood supply and accumulated in the fetus during gestation.

Cunningham and McDermott, 2008

Long-chain polyunsaturated fatty acids (LC-PUFA), Docosahexaenoic acid (DHA)Arachidonic acid (AA), Prostaglandin E2 (PGE2)

LC-PUFAs are needed for growth of the placenta. Further demands are made on the mother's fatty acid supply as the placenta and the fetus grows.

• Education in healthynutrition

• Incentive programs

• Food fortification

• Biofortication

• Supplementation

Not one solution will eliminate deficiencies and inadeqate intake - it is about the right ratio between the approaches, depending on the country, nutrition status and other factors

Solutions are available ....

Roadmap for a nutritious diet for all

Nutrition for a healthy life

Current status

1. Assess micronutrient intake & status in different regions/population groups

2. Explore impact on health and risk for nutrition-related diseases

3. Assess impact on health care and economic development

4. Develop, advocate and facilitate adequate fortification and supplementation tailored to countries and populations

Thank you!manfred.eggersdorfer@dsm.com

Who has health has hope,who has hope has everything

Please visitwww.vitaminsinmotion.com