Hearty diets for improved carciovascular health in the population

Hearty diets for improved cardiovascular health in the

populationBenecol seminar

München 27.8.2012

Pekka Puska, MD, PhD, MPolScDirector GeneralNational Institute for Health and Welfare (THL)Helsinki, FinlandVice President, Int. Association of National Public Health Institutes (IANPHI)Past President, World Heart Federation (WHF)

Pekka Puska, Director General

GLOBAL PUBLIC HEALTH IN TRANSITION

Chronic diseases – especially cardiovascular diseases

Leading health problem in industrialized countries

Main killers and rapidly growing problem in developing countries

04/13/23

0 1000 2000 3000 4000 5000 6000 7000 8000

Occupational risk factors for injury

Unsafe health care injections

Vitamin A deficiency

Zinc deficiency

Urban air pollution

Iron deficiency

Indoor smoke from solid fuels

Unsafe water, sanitation, and hygiene

Alcohol

Physical inactivity

High Body Mass Index

Fruit and vegetable intake

Unsafe sex

Underweight

Cholesterol

Tobacco

Blood pressure

WORLDWORLDDeaths in 2000 Attributable to Selected Deaths in 2000 Attributable to Selected Leading Risk Leading Risk

FactorsFactors

Number of deaths (000s)

Source: WHR 2002

Pekka Puska, Director General04/13/23

Seven of the Nine Top Determinants of Seven of the Nine Top Determinants of Mortality in the World Relate to How Mortality in the World Relate to How We Eat, Drink and MoveWe Eat, Drink and Move

Diet and physical activity, together Diet and physical activity, together with tobacco and alcohol, are key with tobacco and alcohol, are key determinants of contemporary determinants of contemporary public healthpublic health


Lipids and diet

• Serum lipids, and especially LDL cholesterol, are major causal factors in the atherosclerotic process

• Numerous studies show how diet influences strongly serum LDL cholesterol and other lipids (Keys, Hegstedt, Mensink & Katan)

• Numerous expert recommendations

04/13/23 Pekka Puska, Director General

WHO/FAO Expert ReportRecommendations• Limit saturated fat (<10 %) and replace by unsaturated

• Total fat intake: 15-30 %

• Limit salt (sodium) intake (<5 g)

• Limit sugar intake (<10 %)

• Increase fruit and vegetable intake (>400 g)

• Ensure physical activity: at least 30-60 min

• Ensure energy balance

RECOMMENDATIONS OF WHO/FAO EXPERT REPORT ON DIET, NUTRITION AND PREVENTION OF CHRONIC DISEASES (WHO/TRSNS. 16;2003)


General dietary recommendations for lipid control

• Reduce saturated fat and avoid trans fats

• Replace saturated fat with unsaturated (esp. polyunsaturated) fats

• Reduce dietary cholesterol

• Increase soluble fibers

• Maintain normal weight


Lipid control

Patients/individual:

Diet, drugs

Populations:

Health promotion and policies for healthy diet


Sound Combination of Population Strategy With High Risk Strategy

1. Population strategy:- Greatest public health gains- Cost effective- Results also in other health benefits

2. High risk strategy:

- Great benefits to the persons concerned

- Effective use of health services

Pioppi 25.9.2009


WHO Global Strategy on Diet, Physical Activity and Health

• Comprehensive roadmap for Member States and other stakeholders

• Based on strong evidence and broad consultations

• Emphasizes positive actions and collaboration

• Supports Member States

• Addresses global responses (WHA 2004)


Comprehensive action and partnership for national NCD prevention

• Governments (national, local)

• Health services

• Civil society (NGOs)

• Private sector

• Media

• International collaboration

Examples of intersectoral work 1.

Development of Finnish Rapeseed oil

Fen: y = -0.16x + 362

Gen: y = -0.16x + 358

41

42

42

43

43

44

44

45

45

1970 1975 1980 1985 1990 1995 2000 2005 2010

Year

g/kg

Fen

Gen

Change in fat content of Finnish cow milk

Change in fat content of Finnish cow milk

Examples of intersectoral work 2.

Biscuit example:

• Leading Finnish biscuit manufacturer (LU Finland Ltd) has removed some 80.000 kg of SAFA by changing the fats used

• All trans fats removed and major transfer to rapeseed oil

Meat product example:

HK (Leading Finnish meat company)

since 2007 annually:

• 40.000 kg less salt

• 100.000 kg less saturated

fat in their products 1975 1980 1985 1990 1995

YEAR

1.6

1.8

2.0

2.2

2.4

Salt

co

ncen

tratio

n (

%)

Salt level in Finnish sausages




NGO’s• Finnish Heart Association, Finnish Diabetes Association• Many other NGOs (e.g. home economics, sports, …)

Private sector•Supermarket chains •Food industry: Product development and marketing

Legislation & Policy•MOH•Other ministries•Laws, taxation, subsidies

04/13/23

Finnish Nutrition Recommendations: Plate Model


www.sydanmerkki.fi

The Finnish Heart Symbol


RESULTSand

EXPERIENCES

04/13/23

Use of Butter on Bread Use of Butter on Bread (men age 30(men age 30––59)59)

%

0

20

40

60

80

100

1972 1977 1982 1987 1992 1997 2002

North Karelia

Kuopio province

Southwest Finland

Helsinki area

Oulu province

Lapland province


Butter consumption per capita in Finland

0

2

4

6

8

10

12

14

16

18

20

1955 1965 1975 1985 1995 2005

Co

nsu

mp

tio

n (

kg p

er c

apit

a)


Milk Consumption in Finland in 1970 and 2006 (kg per capita)

0

20

40

60

80

100

120

140kg

1960 1970 1980 1990 2000 2010

Whole milk

Whole form milk

Low fat milk

Skim milk


Use of Vegetable Oil for Cooking (men age 30–59)

0

10

20

30

40

50

60

70

1972 1977 1982 1987 1992 1997 2002 2007

North Karelia

Kuopio province

Southwest FinlandHelsinki area

Oulu province

Lapland province

%


Fat Intake as Percentage of Energy in Finland

0

10

20

30

40

1969-72

1982 1987 1992 1997 2002

Total fat (~ 30 EN%)

SFA (~10 EN%)

MUFA (10-15%)

PUFA (5-10%)En%

Year

Sources: Hasunen et al. 1976 Uusitalo et al. 1986 Kleemola et al. 1994 Findiet Study Group 1998 Männistö et al. 2003

Recommendations


Serum Cholesterol in Men Aged 30–59 Serum Cholesterol in Men Aged 30–59 YearsYears

FINRISK Studies 1997 & 2002

mmol/l

5

5,5

6

6,5

7

7,5

1972 1977 1982 1987 1992 1997 2002 2007

North Karelia

Kuopio

Turku/Loimaa

Helsinki/Vantaa

Oulu

Lapland


Change in age-adjusted mortality rates Finland, males aged 35–64 (per 100 000 population)

extension of the Project nationally

start of the North Karelia Project

North Karelia -85%

All Finland -80%

Rate per 100 000

1969-1971

2006 Change from 1969-1971 to 2006

All causes 1328 583 -56%

All cardiovascular

680 172 -75%

Coronary heart disease

489 103 -79%

All cancers 262 124 -53%

Coronary heart diseaseCoronary heart disease

Gain of some 10 healthy years in Finnish popupaltion

Gain of some 10 healthy years in Finnish popupaltion

Observed and Predicted Declines in Coronary Mortality in Eastern Finland, Men

-90

-80-70

-60

-50-40

-30

-20-10

0

1972 1977 1982 1987 1992 1997 2002 2007Year

%

ObservedPredictedCholesterolBlood pressureSmoking



IDENTIFYINGIDENTIFYING IMPLEMENTINGIMPLEMENTING

PRIORITIESPRIORITIES THEMTHEM

FROM PRIORITIES TO IMPLEMENTATION

04/13/23

Implementation gap

Finland Has Shown

• Prevention of cardiovascular diseases is possible and pays off

• Population based prevention is the most cost effective and sustainable public health approach to CVD control

• Prevention calls for simple changes in some lifestyles (individual, family, community, national and global level action)

• Influencing diet and especially quality of fat is a key issue

• Many results of prevention occur surprisingly quickly

(CVD, diabetes) and also at relatively late age

• Comprehensive action, broad collaboration with dedicated leadership and strong government policy support

13.04.23 Pekka Puska, Director General

Estimates of S-Chol changes in Estimates of S-Chol changes in 19821982––2002*2002*

Men

-0,6

-0,5

-0,4

-0,3

-0,2

-0,1

0

0,1

1982 1992 2002

mm

ol/l

PUFA

DietarycholesterolSFA

Keys

SFA+trans

Keys (trans) **

MeasuredS-Chol

* Based on calculated intakes of dietary fatty acids and cholesterol. Standardized to the 2001 Finnish population. Users of cholesterol lowering medication excluded in -92 and -02. ** Trans fatty acids included as SFA

(Source: KTL/Valsta, Tapanainen, Laatikainen, Männistö, Vartiainen, in preparation )04/13/23

8th Global WHO Conference on health promotion - “Health in all policies”

From Ottawa to Helsinki (June 2013)

13.04.23 Pekka Puska, Director General

04/13/23

Thanks


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Hearty diets for improved carciovascular health in the population

Health & Medicine