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great thank you um for the introduction and thank you for inviting me
00:00:06
to speak at the symposium um the tasks that i was given
00:00:11
is to look at the history of fat and carbohydrate recommendations
00:00:17
and at first i thought a history you know but then i really enjoyed looking back
00:00:23
at uh where we yeah and um and asking the question of happy really changed
00:00:31
and when you are given the task like this the first challenge you face of courses time and
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um i decided not to do ancient history which could have been interesting
00:00:42
um but to really stay focused on the twentieth and the twenty first century
00:00:48
so then the next challenge is the nature of reports to its examined
00:00:53
and as you've heard from marion and adam many many recommendations addictive
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but ah focused on the authoritative reports from the united
00:01:04
states them from w. h. o. f. a. o.
00:01:07
obviously i'm most familiar with the uh the us
00:01:11
authoritative reports the national academy of science reports
00:01:15
but i i think taking an in depth look there gives us
00:01:19
a look at what's happening globally and that was reaffirmed
00:01:24
by including the reports from w. h. o. n. and f.
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a. o. which of course have a more global pockets
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so my question throughout looking at the of these reports was to really try to examine
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and to understand what has changed what is the nature of change that has happened
00:01:46
so i i this time line just to highlight
00:01:50
the key transition points that have impacted the nature of food nutrition recommendations
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um in the late eighteen hundreds and into the early nineteen hundreds
00:02:02
i'm certainly things that connected through the and and water was the germ theory of disease
00:02:08
the fact that something in your food could be well i'll cause of one of
00:02:13
the uh some of the major public health problems that occur during that time
00:02:18
and then in nineteen twelve that way of thinking was expanded or
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complimented like as mere found with the vitamin theory disease
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in which the absence of certain factors in the
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diet were associated with major public health problems
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and then in the nineteen sixties the concept
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that excess consumption and certain dietary factors
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was associated with non communicable disease cardiovascular disease heart disease
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began to emerge um primarily based on observation or epidemiological data
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and our understanding of the role of of student an attraction to health continues to the ball
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so my point is that all of these things exist at the same time but it's
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that transition in thinking that influences the way
00:03:10
we think of that carbohydrate recommendations
00:03:16
so then when you look at the nature recommendations the all this type of
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recommendations that included fat and carbohydrate were the suit guides food group
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so even before we knew all the essential nutrients and all these other factors
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food guides were put together as a way of saying here's a dietary
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pattern that's likely to be associated with health and well being
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in the nineteen forties and us beginning in nineteen forty one
00:03:48
the r. d. a. recommended dietary allowance process was established
00:03:53
so this then took on a more nutrient focus as we understood what
00:03:57
nutrients did in relation to certain types of disease particularly deficiency diseases
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it now make recommendation of how much nutrient needed to be in the the diet
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and that process as the ball into the dietary reference intake
00:04:14
and then the third phase or the food base
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dietary guidelines which began in the nineteen eighties
00:04:21
sort of in a way coming full circle recognising um
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while scientists love nutrients consumers eat fruits and how do we express nutrients
00:04:31
in terms of fruits so this evolution has been going on there
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yeah it's disappointing oh yes so i'm gonna focus on the
00:04:42
the r. d. a. process because that's really where
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the scientific evaluation has been focused so
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to think in terms of the authoritative reports of signs that his trip and the the recommendations
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so i i'm in this light i'm gonna put up a table with carbohydrate and fat
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and these are the recommendations that you see in the
00:05:05
national academy of sciences already a recommended dietary allowance
00:05:10
so what what how did the dimensions around fat and carbohydrate evolve
00:05:16
and um i i kind of want all agree nineteen sixty into it to one the
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first party a book i owned was nineteen sixty eight so that's that's my collection
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um but really if you look in those early reports that primary
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emphasis was on energy and really that carbohydrate and fat
00:05:35
we're as well as protein where the primary energy sources and
00:05:39
that carbohydrate and fat were essentially interchangeable as energy sources
00:05:44
the concept of crude fibre existed but not from the thinking of the
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dietary essential point of view it's that's rough region the diet
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so nineteen sixty a each we see that there was no already a established but there was
00:06:00
a recognition that you had to have some carbohydrate diet to thank you chose it
00:06:05
um there was some recognition that sure there might be associated with dental
00:06:10
care carriers and we began to see the term complex carbohydrate
00:06:15
um and in this case referring primarily the cellulose and having cellular says
00:06:20
um i've often thought that we might be better calling
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a complicated carbohydrate that complex was the term
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and really the nutrition significance was not really staying is known or understood it
00:06:31
seventy four fibre is ball was acknowledged but again
00:06:36
no demonstrated requirement for that in the diet
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so nineteen eighty we began to see a more specific direction of all
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that to decrease refined sugars increase complex carbohydrate
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in nineteen eighty nine is really a turning point um
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in terms of how we're thinking of recommendations
00:06:56
and that turning point comes back to the two reports that marion talked about
00:07:01
the diet and health report from the national research council implications for reducing chronic
00:07:07
disease risk and the surgeon general's report on die on diet and health
00:07:12
and so now the recommendations are more specific half the
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energy from carbohydrates complex carbohydrate rather than shoulders
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the recognition of the increase to the the need to increase
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fibre but with an emphasis on cyber containing fruits
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so we look at that you see a similar kind of evolution in
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the earliest thinking is primarily thought of as an energy source
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and in fact what some of the recommendations around energy source was
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recognise that for someone with the more strenuous work load
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perhaps they should have a higher fat diet because it was a more nutrient energy against diet
00:07:54
i'm certainly we also understood the essential fatty yes it needs
00:07:59
that some fat had to be in the diet to help with the absorption of fat soluble vitamins
00:08:04
and also recognition that thought that was often a carrier flavour
00:08:09
so in sixty eight we began to see that
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thinking evolving around fat and non communicable disease
00:08:17
but it was evidence warns only tentative decisions as to
00:08:21
desirable amounts of fat in patterns of fatty acids
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by seven before there was a reference to the american heart association
00:08:30
recommendations on total fat saturated fat and poly unsaturated fatty acid
00:08:36
but again these were viewed as for individuals at risk not for the general population
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and that was reiterated in nineteen eighty that recommendations um
00:08:49
would that were linked to high risk of cardiovascular disease were
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appropriate but for that population not for the general population
00:08:58
and now in nineteen eighty nine we again see the impact that those two seminal reports
00:09:04
specific recommendations for the total population for the general population
00:09:09
total fat should not exceed thirty percent of energy saturated fatty
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acid should be less than ten percent of energy
00:09:17
and six cooper should not exceed ten percent of energy
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less than three hundred milligrams of of cholesterol
00:09:23
during that time no already a was established for little lake or else a little manicure outside
00:09:29
but the what would constitute sufficient amounts were discussed
00:09:35
so the next iteration of the dietary guidelines the dietary reference intake
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it it is more of a key transition point because in nineteen ninety seven
00:09:46
and you process the whole process was updated to the dietary reference
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we still have the r. d. a. n. e. a. r. which is the way of looking
00:09:57
at the tree and adequacy making sure i'm nutrient intake is adequate to meet needs
00:10:03
but now new terminology is being introduced and that new terminology actually lens
00:10:09
the process more toward thinking about diet in non communicable disease
00:10:15
um the concept of an adequate intake which is the estimated intake
00:10:20
to sustain a to find nutritional stay the upper level
00:10:24
the level above which risk of an adverse effect
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um increases is introduced and probably what's
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most relevant to fat and carbohydrate
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is the a. m. d. r. the acceptable map macro
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nutrient distribution range or range of nutrient intake
00:10:45
that make sure that essential nutrient needs are met without increasing
00:10:50
risk of an c. d. done nine communicable disease it's
00:10:55
so now if we look at what the um the dietary reference intake start
00:11:02
for energy carbohydrate tribe fibre fat fatty acids cholesterol that's the
00:11:06
name of the report the two thousand and five report
00:11:10
and this now it's not only us support that for the d.
00:11:14
r. i. process both canada and the us supported the process
00:11:19
so for carbohydrate we now have that are da of a hundred and thirty grams per day and that's based
00:11:25
on prevention of teaches so you could just a stylish
00:11:28
an r. d. a. based on a particular outcome
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the a. m. d. r. is then establishes forty five to sixty five percent of energy
00:11:38
with for sure there for total sure there was no upper
00:11:41
level established there was no adequate intake level establish
00:11:46
i'm sure there's word linked to dental carries and they
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did a calculation in the report regarding added sugars
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and suggested that no more than twenty five percent
00:11:58
of energy should be coming from added sugars
00:12:02
mainly because of concern about allusion of the nutrient quality of the diet
00:12:08
once added sugar exceeded that levels so it's more of a calculation to
00:12:13
come up with that and it was not considered to you well
00:12:16
dietary fibre was again viewed as not essential um but they could
00:12:21
establish an a ah an adequate intake for dietary fibre
00:12:25
and that was done based on decreasing rests for coronary heart disease
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the definition of fibre was expanded so we could include not
00:12:35
only fibre from food but isolated in synthetic fibres
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as long as they had been demonstrated to have a physiological
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benefit um that are of physiological effect that benefits hell
00:12:51
so in a sense it became consistent with the products definition
00:12:55
but of course in us we always do everything aroma is so
00:13:01
and the fat outside for total fat there's no yeah you are already a or a oh i
00:13:07
but the a. m. g. r. the acceptable macro nutrient distribution range is
00:13:12
as was established at twenty to thirty five percent of energy
00:13:16
for saturated that trans fatty acids thankless role
00:13:20
there is no e. a. r. r. d. a. a. i. are you well
00:13:24
in the recommendation is that intake needs to be as low as possible
00:13:29
looking at the whole in stature it's the little lake and yell full analytic else it
00:13:35
for those individual there could be in a high establish
00:13:40
an adequate intake established for the fatty acids
00:13:44
based on the essential fatty yes it need but then an a. m.
00:13:48
d. r. established if effect concept of what fits a healthy diet
00:13:53
that meets nutrient adequacy but does not increase risk for for chronic disease
00:13:59
for the and six who first the anti r. s. five to ten percent of energy
00:14:04
for the and three it's point six to one point two of percent of energy
00:14:10
and then a recognition that e. p. a. n. d. ha could be apart
00:14:14
of meeting that a. m. d. r. but nothing beyond that for e. p.
00:14:18
a. d. h. right and know you well was established for either one
00:14:23
so i think it's fair to ask the question why was there no e. a. r.
00:14:28
r. d. a. a. i. are you well for
00:14:31
saturated fatty acids trans fatty acids thankless role
00:14:35
and according to the report they're not essential nutrients so you don't
00:14:39
need an r. d. a. for something that's non essential nutrients
00:14:43
but beyond that when they looked at the evidence to
00:14:46
see that link between intake of these lip it's
00:14:51
and coronary heart disease the evidence suggests that there's a positive when
00:14:56
your relationship between intake and wrist for coronary heart disease
00:15:01
and when you look at those lines that were generated new can debate was this the right evidence
00:15:06
to look at but when you look at those there's no break anywhere it's a linear relationship
00:15:12
so there's not a point where risk increases in you should
00:15:15
set and you well not to exceed a certain level
00:15:19
and there's no break at the lower and so there's no minimum
00:15:22
it becomes intake needs to be as low as possible
00:15:27
now in contrast the dietary guidelines did
00:15:30
establish criteria for what's appropriate for
00:15:35
um saturated fat transfer yeah well transparent yes they still set as low as possible
00:15:41
um and why why is that why could the dietary guidelines for americans
00:15:46
make recommendations for fats where we couldn't for those body else it's
00:15:51
work that couldn't be done in the d. r. i. process
00:15:55
so with the dietary guidelines first of all they could reference the a. m. d. r.
00:16:00
for total fat infer part ways just pulled that into the the dietary guidelines
00:16:06
and then they use a technique called food pattern model wait so from pattern
00:16:10
model in allows you to calculate calories for added sugars installer fat
00:16:16
that notion you figure out what you need to eat me your essential nutrient needs
00:16:21
how many calories are left over at the end of that process that can
00:16:25
be added sugars in solid facts so the the the food uh the
00:16:31
dietary guideline process also recognises the relationship between saturated fat in
00:16:37
total fat if you have some fat in your diet
00:16:40
it's like we're gonna have some saturated fat in the diet and that
00:16:44
also saturated fat and cholesterol or part of certain food groups
00:16:48
so if those fruit groups are in the diet there's going
00:16:51
to be a certain amount of saturated fat and cholesterol
00:16:55
so it's not based on an adverse effect it's based on a calculation
00:17:00
of what's a reasonable amount to get you to that as low as
00:17:03
possible or that came from the the d. r. ah process
00:17:10
so there is a a new report and patrick stover it's
00:17:15
the i think the expert here on this report
00:17:18
um i'm not gonna talk about the report but there's a new report from the national academy
00:17:23
and developing dietary reference intake space on chronic disease
00:17:28
where it's recognising that the d. r. i. you establish for chronic disease
00:17:32
differs from the kind of d. r. i. you would use to look at nutrient requirements
00:17:38
and that it's a concept that applies to nutrients as well
00:17:41
as other food substances meaning other non nutrient food substances
00:17:47
and i've i've are allergic to the report because i think it
00:17:51
will influence the way we think about fat and carbohydrate recommendations
00:17:56
as on this process is move forward to establish these
00:18:00
types of of the are the are on it
00:18:04
so what is changing than when we look at recommendations
00:18:09
if you look just at the numbers the numbers aren't
00:18:12
changing that much of anything but been remarkably consistent
00:18:17
but what is changing is first of all and
00:18:21
identifies occasion of components within carbohydrate and fat
00:18:25
we're now looking at the different components and recognising
00:18:30
that those components have differential a fact
00:18:34
and so we need to think about recommendations in terms of
00:18:37
the effects of those different components within carbohydrate and fat
00:18:42
i'm certainly then the role of non
00:18:44
communicable diseases in um influencing recommendations
00:18:48
we really thought that when when recommendations finally get
00:18:52
modified um it's because we're now thinking about
00:18:56
non communicable diseases and how do we lowered the
00:19:00
rest for those diseases in the population
00:19:03
and then this last point on evaluation of evidence i'm gonna come back to that
00:19:08
um but for someone of what quickly at a w. h. o. f. a. o. process
00:19:13
and i'm gonna do it briefly because really we're seen
00:19:16
a similar kind of evolution and m. process
00:19:20
but thinking more on a global level in global perspective
00:19:25
so again if you look at the older reports um
00:19:28
there been expert meetings for since the nineteen fifties
00:19:33
and may tend to focus on the status signs for various
00:19:36
nutrients and provided guidance on requirements and recommended in takes
00:19:42
i'm beginning in the late nineteen seventies we
00:19:45
now see several expert consultations on carbohydrate
00:19:49
there's a expert consultations on fat and boils and these
00:19:53
then began to pick up a different flavour
00:19:56
so against focusing on the terminology the components within
00:20:00
carbohydrates the components within fats and oils
00:20:04
what are the different types and what level is so appropriate how do you quantify the
00:20:09
recommendations regarding those different components within carbohydrates and
00:20:14
within the fat and while category
00:20:16
recognising technical issues in production and processing
00:20:20
particularly on the fats and oils and how that might influence the the types of fats and oils
00:20:27
and of course that impact on non communicable diseases and
00:20:32
i i think equivalent to the surgeon general report in the n. r. c. report
00:20:37
w. a. chose two thousand and three um t. r.
00:20:40
nine one sect the expert consultation on diet
00:20:44
nutrition and prevention of chronic disease is also one of those salmon all turning point reports
00:20:50
where it was the recognition that on a global basis we need to look
00:20:56
beyond just nutrient adequacy questions and also
00:21:00
think in terms of increasing risk
00:21:03
for non communicable diseases on a global basis and home
00:21:09
including recommendations setting population targets for components that could
00:21:14
be a associated with it in c. d.'s
00:21:18
what's in progress right now is the w. h.
00:21:22
o. is updating the recommendations um i'll
00:21:26
talk a little bit more about the sure your recommendation that that marion referred to
00:21:31
um and they have a but that also includes review on dietary fats as
00:21:36
welles carbohydrates and some of those updates are are not published yet
00:21:43
so to look briefly at w. h. o. f. a. or not gonna
00:21:47
go through the whole background but if we start with um
00:21:54
t. r. nine ones the acts the two thousand and three report
00:21:58
you see as you go down total fat fifteen to thirty percent of
00:22:02
energy saturated fat less than ten percent holly six to ten percent
00:22:07
um trans fatty acids they make a recommendation of less than one percent
00:22:12
models by difference cholesterol less than three hundred milligrams sounds familiar in terms of
00:22:18
what we've been hearing for um recommendations on fat and carbohydrate um
00:22:24
the there is a fat and while expert
00:22:28
consultation that was published in twenty ten
00:22:31
i'm not gonna read through all the numbers from that consultation in twenty ten
00:22:37
i think what's important to understand about it came out
00:22:40
of the f. a. o. w. h. o. consultation
00:22:44
is the process then is shifting terminology it's looking at acceptable
00:22:50
macro nutrient distribution range so it's using that concept of
00:22:55
what's the range that allows you to meet nutrient needs
00:22:59
well not increasing the risk of and c. d.
00:23:02
um they actually use terminology such as a lower in d. r. you shouldn't go blow
00:23:07
certain levels aren't up or a. m. d. r. you shouldn't go above certain levels
00:23:12
um and then the other part that is real shift in the fats and oils report
00:23:18
it's now looking at the strain of the evidence that supports these recommendations
00:23:23
so it's moving beyond just an expert opinion into more
00:23:27
of an evaluation of of strength up yeah buttons
00:23:31
looking at the carbohydrate reports at the the bottom here
00:23:35
um again total carbohydrate fifty five to seventy five percent of energy
00:23:41
three sure there's less than ten percent and i think it's important to recognise that
00:23:46
the less than ten percent of free sugar started in two thousand and
00:23:49
three and was reaffirmed in the the update out but i'll talk more about
00:23:54
that total fibre from foods non starch probably sack rides from fruits
00:23:59
there was a another expert consultation and um and in two thousand
00:24:04
and eighty basically into worse the the nine one six recommendations
00:24:11
so i i i i had this fear that marion was gonna give you all the exciting stuff and i'm
00:24:16
gonna bore you with faxes sorry we keep coming back to the same numbers over and over again
00:24:22
but i'm gonna come back to this slide um because i've been focusing on
00:24:29
b. r. d. a. process and i i think hopefully
00:24:33
you see that as we've learned more about
00:24:37
the role that food nutrition plays we change the nature of the r. d. a. is
00:24:43
and we're looking at a process that allows us to
00:24:46
incorporate a more information with respect to well uh
00:24:51
um risk of nine communicable disease but at the end of the day it's a very nutrient
00:24:57
oriented process looking at the science that helps us
00:25:00
understand what we recommend for for nutrient
00:25:04
and so i wanna also then think about how these other two types of guidelines fit
00:25:11
the food guide and the um the dietary guidelines
00:25:15
so from a historical point of view which was my
00:25:19
task that the guys came first um that's that's
00:25:24
where we were and i i actually just make sure you like i included in old food guide
00:25:30
from the us that uh sort of preceded uh a lot of where we are today
00:25:35
in terms of of thinking about home recommendation time on fat and carbohydrate and fart
00:25:43
you can read that point three and i think it's actually get better recommendation because
00:25:48
that was how many people got their vitamin a was what's from butter
00:25:54
so then in the forties we started this process which is much more
00:25:59
nutrients focus quantitative l. evidence uh uh
00:26:03
s. men's of nutrient requirements
00:26:06
and then in the um nineteen eighties we recognise
00:26:10
that for consumers we had to figure out
00:26:13
how do you express the principles of which may be trash and in terms of food
00:26:19
and to do it the way that then becomes useful for policy decisions and um
00:26:27
one of the key reports that had he mel was again and f. a.
00:26:33
o. w. h. o. consultation on preparation use the three base dietary guidelines
00:26:38
looking at my two colleagues down here route then michael who were very involved in in that report
00:26:44
um and have a. o. has subsequently use that report to help many countries
00:26:50
develop toothpaste dietary guidelines so it's moving toward but the food profit
00:26:57
and i'm sure do the slide earlier um that the us dietary
00:27:02
guidelines have been published every five years since nineteen eighty
00:27:07
now keep in mind they do that because they're mandated by
00:27:09
the law to publish dietary guidelines every five years
00:27:14
but if a am showed you in a very nice table
00:27:18
hell you know the the covers change some of what's highlighted on the cover changes that
00:27:25
the basic recommendations have been pretty consistent over
00:27:30
the history of the the dietary guidelines
00:27:33
and if you look at uh what i regard as some of the the consistent messages
00:27:39
on the cautionary side since the very beginning there's always
00:27:43
been a cautionary message on saturated that yeah so
00:27:48
um i think in nineteen ninety we started
00:27:50
introducing cautionary messages on trends that yes
00:27:54
it's it's been there ever since cholesterol it's been there from the the beginning
00:27:59
i'm looking uh energy bounce that at balancing energy from total energy from far out
00:28:05
added sugar consumption of refine those are all very consisting house very metal
00:28:10
metal messages that had been in the dietary guidelines from the beginning
00:28:15
likewise on the encourage side um sources of unsaturated
00:28:20
fatty acids have been encouraged from the beginning
00:28:24
and the kind of eating patterns that um meet nutrient requirements reduce and c. d. risk
00:28:31
so they're fibre containing fruit their complex carbohydrates
00:28:36
limiting the be added sugars those
00:28:38
of all the and part of the messages from the get go
00:28:42
so again not that much is changed and if i come back to
00:28:47
this slide i've already talked a little bit about the first three
00:28:51
but now i want to look at that issue of the evaluation of evidence to specify recommendations
00:28:57
because that's an area where we see quite a bit of
00:29:00
change and i think worse continuing to see evolution
00:29:06
so i'm gonna use as an example from the us the
00:29:08
evaluation of evidence from the dietary guidelines for americans
00:29:13
so and again it's every five years so you can look at how the process has changed
00:29:19
and if you look at from basically nineteen eighty to two thousand
00:29:24
the method for reviewing the evidence was based on the
00:29:27
collective knowledge and expertise of an advisory committee
00:29:31
very good experts but still that was the basis for reviewing the evidence
00:29:38
in two thousand and five the advisory committee the committee that advice is the government
00:29:43
um had more of a task to search and review the scientific literature
00:29:48
and then in twenty ten twenty fifteen a
00:29:51
systematic review of scientific literature was introduced
00:29:55
as the basis on which the dietary guidelines advisory committee was going to operate
00:30:02
so since two thousand and five the focus has been on the production
00:30:07
by an advisory committee at the technical report that's evaluating scientific evidence
00:30:13
that goes to the government that then develops the dietary
00:30:17
guidelines for americans based on those scientific conclusions
00:30:22
and if you look at what the twenty fifteen dietary guidelines committee you used to they developed
00:30:30
their scientific report which then informs the development of the the dietary guidelines
00:30:35
they did they had systematic reviews that were commissioned
00:30:39
based on questions raised by the advisory committee
00:30:43
they used existing systematic reports that were relevant to use met
00:30:47
analysis that existed or other types of authoritative reports
00:30:52
they had data analysis primarily based on e. n. haynes survey in you have to
00:30:57
look at the american population what they're eating what a disease patterns work
00:31:02
and then the food pattern model in which i i mentioned so was the way of
00:31:06
seeing what kind of food patterns could beat the recommendations
00:31:14
w. h. o. has also implemented and evidence based process
00:31:19
and there's the guidelines for at the for um i
00:31:22
handbook for guideline development that's available from their website
00:31:27
'kay have used a process referred to as the grade process
00:31:32
and if you ask me out remember what grades stands for but
00:31:35
it's basically a systematic review process to look at the literature
00:31:40
how one add value weights epidemiological data randomised controlled
00:31:45
trials what criteria used to develop um
00:31:49
a a rubric to understand the strength of the the evidence
00:31:58
so just to remind you that still the basic recommendations are anti r. nine one six
00:32:04
and what had uh what debbie way joe has published in terms of their up day or guidelines on
00:32:10
sodium potassium and i'm free sugars sodium and potassium aren't carbohydrates are fat so i'm in a
00:32:18
look a little bit more at the um at the shelter guideline so the sure guideline
00:32:24
there to key systematic reviews that underline the sugar guideline from w. h. o.
00:32:30
the one looks that dietary sugars and body weight and the
00:32:34
other looks at home free sugars and dental care it's
00:32:38
those two systematic reviews of the literature are what informs
00:32:43
the development of the the w. h. o. guideline
00:32:46
so just to remind you of the specific they're actually three recommendations
00:32:51
wanna general recommendation to reduce intake uh free sugars
00:32:56
and then um one that recommends reducing intake uh free shudders to less than ten percent of
00:33:02
total energy a strong recommendation and then asked for the rent reduction to less than
00:33:08
five percent of the total energy intake which is the conditional recommendation
00:33:13
now for me to really understand the w. h. o. recommendations you have to look at the remarks
00:33:20
and i don't have i haven't summarised all the remarks
00:33:23
that i i tell these three points work he
00:33:26
to understanding the recommendations and how that we we chose operate
00:33:32
so the first recommendation is looking at the totality of evidence
00:33:37
that um w. h. o. had on the relationship or free sugars to body weight
00:33:42
and the relationship to dental carries so it's a general recommendation
00:33:47
recommendation to that ten percent of total energy less than ten percent of total energy
00:33:53
is based on the mater quality evidence from observation all studies and dental
00:33:58
carries so the numerical recommendation comes from the dental carries work
00:34:04
and the recommendation three the thought um conditional recommendation it's conditional
00:34:09
because it's based on very low quality yeah buttons
00:34:12
but it's evidence that w. h. o. felt should not be ignored
00:34:21
now i i can't say i'm anything more about carbohydrate
00:34:25
and fat with respect to w. h. o.
00:34:28
this poem details slide here is the agenda from the alignment meeting
00:34:34
of the nutrition guidance expert advisory group it met in croatia
00:34:38
in july of this year and you can see from the agenda and if
00:34:42
you look at the edge and uh for the meetings preceding us
00:34:46
clearly w. h. o. is working toward updating
00:34:49
its recommendations on fat and carbohydrate
00:34:53
um there are some systematic reviews that happen publish
00:34:58
so there's one looking at reducing total fat intake on body weight
00:35:02
there's one on trans fatty acid intake and let let
00:35:06
that unlike for proteins and unsaturated fatty acid
00:35:09
on sermon but but sunlight approaching so the fact that w. h.
00:35:12
o. has commissioned those studies tells you what they're looking at
00:35:18
transparent in that regard so this graph um is i took this
00:35:24
graph from a report that f. a. o. has recently published
00:35:29
and which the report the report is actually aimed at looking
00:35:32
at sustainability issues and how they affect dietary guideline messages
00:35:37
but this is a summary of what they saw was the most common messages in guidelines and
00:35:42
they rang countries by income level and so you see i i put an arrow
00:35:48
for the countries without recommendations in countries with uh i'm sure recommendations
00:35:56
pretty much all countries have recommendations in in this regard
00:36:01
and if you look within the report um at least
00:36:05
ninety percent of countries redo across all income levels
00:36:09
recommend reduce fact consumption are changing in type of fat
00:36:15
particularly as it relates to non communicable disease virtually
00:36:20
all countries also talk about reducing sugar consumption
00:36:24
i'm particularly free sugars or added sugars don't have slightly different meanings
00:36:30
and then there's several additional things that relate to carbohydrates and fat
00:36:35
um foods that provide fibre cooking your preparation method they all relate to
00:36:41
um but the type any amount of fat in the diet
00:36:45
so i i come back then to my opening
00:36:48
question fat and carbohydrate recommendations have they changed
00:36:52
i'm certainly are traditional thinking of carbohydrate and fat as
00:36:57
energy sources and for fat as essential fatty acids
00:37:01
um but those have not changed we do still recognise those roles
00:37:06
i think we've kind of mood pass crude fibre at this point i'm in part because
00:37:12
we now think in terms of dietary fibre non start how in fact right
00:37:17
on as well as then looking at shelters the nature of digestible carbohydrates
00:37:22
what impact they have on t. i. physiology quite scenic effect
00:37:26
um within fats we're looking again at those components so
00:37:32
again if you focus on the numbers the numbers haven't really changed
00:37:38
sometimes we say thirty percent energy from fat sometimes we say thirty five percent
00:37:43
energy from fat what has changed is that recognition of the components
00:37:48
and i think more work is still needed to really
00:37:51
understand the various components within carbohydrate in within fat
00:37:56
quantification of the recommendations we are now looking at
00:37:59
how much makes a reasonable dietary pattern
00:38:03
and certainly the role nine communicable diseases has been key in determining recommendations
00:38:09
and the evidence that we're using to specify or recommendations so
00:38:15
thinking about what has changed in what has not changed
00:38:19
i think it also identifies some future challenges
00:38:23
um and just some of the things that occurred to me in terms of future challenges
00:38:29
i'm often frustrated by the mix meanings for terminology
00:38:33
um my talk example is what is meant by low fat in what is meant by high fat
00:38:39
i know that in nineteen ninety when i'm thirty percent energy from fat was
00:38:44
put in the dietary guidelines that was viewed as a low fat diet
00:38:49
in two thousand and that was declared as a moderate fat diet
00:38:54
um and some white recorded now as high fat diets so
00:38:59
these terms get bandied about that without the specificity of what we mean by low
00:39:04
fat what we mean by high fat i'm likewise what is meant by sweets
00:39:09
um i often see in the public literature the terms sweets used to imply sure
00:39:15
that when the foods that are talked about in i think variance point is right on
00:39:21
when we talk about the suits those students often or sources of fat
00:39:27
brief other types of refined carbohydrates as well the shippers so we need
00:39:31
to start talking about those foods not just the the components
00:39:36
um i think another important areas the emerging focus on dietary patterns
00:39:41
that address boat nutrient adequacy as well as reducing the risks
00:39:45
for for and in c. d.'s not communicable diseases
00:39:50
and i think the dietary powdered approach gives us the opportunity to integrate across recommendations
00:39:56
um if anything looking across the timeline i would say that
00:40:01
a single nutrient approach is so twentieth century it over
00:40:08
twenty first century says we really now need to think more in terms
00:40:12
of dietary patterns systems approaches how to integrate across our recommendation
00:40:19
um the evidence based approaches are becoming increasingly
00:40:23
important and how we set our recommendations
00:40:27
and that requires a true investment in how we develop the
00:40:31
evidence space that will be needed for those recommendations
00:40:35
it's not a trivial issue to actually invest in research
00:40:40
that leads us to hard outcomes not just surrogate
00:40:43
outcomes if we're going to be successful
00:40:46
in this area and of course i think it's only fair add
00:40:51
something sponsored by mental nestle to also raises the question of
00:40:55
what is the role of the food industry in helping consumers me recommendations
00:41:01
um the food industry is the master of taste cost inconvenience
00:41:05
and often times it's used as a waiter criticising
00:41:09
industry and criticising what is being doing beat
00:41:13
it has been done in terms of the public in some of our public health challenges
00:41:19
but taste cost inconvenience can also be a way
00:41:22
to help consumers make better choices and
00:41:25
i hope that that's the direction will be going in the future thank you how

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