The Importance of Healthy Diets

Healthcare providers have many reasons to stress a healthy diet to their patients, but making that advice stick can be another matter. Now, three new studies provide further evidence to help convince your patients about the importance of healthy eating.

The first study,¹ published in June 2015, looked at 2010 national burdens of disease related to sugar-sweetened beverage (SSB) consumption. A multinational team of researchers pooled information from national dietary surveys conducted between 1980 and 2010, and looked at SSB consumption for over 600,000 people living in 51 countries. The researchers also analyzed data about BMI, diabetes, cardiovascular disease (CVD), and cancer (esophageal, colon, pancreatic, breast, uterine, kidney, and gall bladder) from meta-analyses and large prospective cohort pooling studies. Finally, they used the Global Burden of Disease, Injuries and Risk Factors 2010 Study to identify data about disease-specific mortality and morbidity for 187 countries between 1990 and 2010.

Key results:

• 184,000 deaths/year worldwide were due to SSB consumption, with 72.3% (133,000) from diabetes, 24.2% (45,000) from CVD, and 3.5% (6,450) from cancers.  

• Most of the deaths due to SSBs occurred in middle income countries (70.9%), compared to lower (5.0%) and higher income countries (24.1%).

• Adults aged 20-44 years had the highest burden of mortality from SSBs; 14% of all diabetes and obesity-related deaths in this age group were due to SSBs.

• About 1 in 20 diabetes-related disability-adjusted life years in adults <44 years are due to SSBs.

• Latin America and the Caribbean had the highest SSB consumption and the highest absolute mortality due to SSB consumption.

♦ Of the 20 most populous countries, Mexico had the largest proportion of deaths due to SSBs (12.1%), followed by the US, Indonesia, and Brazil.

Because consumption of SSBs represents a modifiable behavior with the potential to prevent death and disability, with repercussions on future earnings and productivity, the authors stressed an “urgent need for strong global prevention programs.”

The second study looked at the possible link between trans fat consumption and cognitive dysfunction.² In the study, researchers at the University of San Diego in La Jolla, CA found that people who eat higher levels of trans fats may have more difficulty with word recall than people with lower levels of trans fat consumption. Trans fats, mainly manufactured industrially, have been linked to abnormal lipids, insulin resistance, inflammation, and adverse cardiac effects. Past studies have linked trans fat consumption to mood and behavioral problems. The FDA recently declared that trans fats are “no longer considered generally safe,” and is requiring manufacturers to phase out partially hydrogenated oils over the next three years.³

In the study, researchers conducted a cross-sectional analysis of data from the UCSD Statin study conducted from 1999-2005. The primary analysis focused on men (n=694, age 20-85 years). Because participants had been screened as part of a drug trial, younger women of reproductive potential were excluded, leaving insufficient numbers of young women for the analysis. Researchers assessed dietary trans fats using a self-reported food questionnaire and tested word memory by showing participants 82 cards with words on them, and asking them to identify recurrent words.

Key Results:

• Younger men ate more trans fats than women and older men (P=0.001).

• Only adults <45 years showed adverse effects on memory related to eating trans fats.

• Participants recalled 0.76 fewer words for each gram/day of trans fats consumed  (P=0.006).

Because adjusting for systolic blood pressure, waist circumference, and BMI weakened the relationship between decreased word recall and increased trans fat consumption, the authors suggested that mechanisms by which trans fats affect BMI, such as oxidative stress, could impact memory. 

The third study may provide hope for change.⁴ The study took place at the University of Exeter, UK, where researchers looked at whether online inhibition training could decrease high calorie food consumption and weight in 83 overweight or obese adults. Participants were randomized to four 10-minute sessions of computerized response inhibition training (active group) or a control group. In the active group, pictures of high-calorie snack foods (chips, chocolate, cookies, and cake) were linked to inhibition signals which required users to pause before continuing with the activity. Weight, calorie intake, daily snacking frequency, and subjective food evaluations were self-reported.

Key Results:

• 82% of participants completed all four training sessions.

• The active group had significant weight loss over 2 weeks (average 0.67 kg, P=0.02) and 6 months (P=0.008), reduced daily calorie intake (P=0.01), and reduced preference for high calorie foods (P=0.02).

• Both groups reported significantly less snacking at 1 and 6 months (P<0.001 and P=0.002, respectively).

• About 63% of the active group guessed that inhibition signals were paired with high calorie foods, though additional analyses suggested that being aware of their category did not affect weight, daily calorie intake, high calorie food preference, and snacking frequency.

“[T]his study suggests that food response inhibition training modifies real-world eating behavior, reducing calorie intake and facilitating weight loss in a sample of predominantly middle-aged, overweight adults,” the authors wrote. “High rates of adherence and positive feedback suggest the intervention is highly acceptable, and as it could be made freely available online it has the potential to help reduce the burden of overweight and obesity in an accessible and cost-effective manner.”

Take Home Points

• Sugar sweetened beverages may cause 184,000 deaths/year worldwide, with the burden of mortality highest among middle income countries, adults aged 20-44 years, and people living in Latin American and the Caribbean.

• Trans fats may cause problems with word recall memory, especially among younger men who eat more trans fats.

• Online food response inhibition training may reduce calorie intake and improve weight loss, and may have the potential to decrease the burden of overweight and obesity.

References:

1. Singh GM, et al. Estimated global, regional, and national disease burdens related to sugar-sweetened beverage consumption in 2010. Circulation. 2015 Jun 29. [Epub ahead of print]

2. Lawrence NS, et al. Training response inhibition to food is associated with weight loss and reduced energy intake. Appetite. 2015 Jun 29;95:17-28.

3. Food and Drug Administration. The FDA takes step to remove artificial trans fats in processed foods. June 16, 2015. Accessed August 18 2015 at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm451237.htm.

4. Golomb BA, Bui AK. A fat to forget: trans fat consumption and memory. PLoS One. 2015 Jun 17;10(6):e0128129.