Toward a nutrition-driven economy:Can dietary supplements aid productivity?
Adam Drewnowski, PhDDirector
Center for Public Health Nutrition UW Center for Obesity Research
Nutritional Sciences Program Professor of Epidemiology, University of Washington, Seattle, WA, USA
International Alliance of Dietary/Food Supplement Associations, IADSAAnnual Meeting, London, June 19, 2018
Nutrition, Sustainable Development Goals (SDGs), and workplace productivity
SDG 1: No poverty
• Poverty cannot be overcome without a healthy and well-nourished labor force.
• Workplace health promotion - healthy diets and healthier lives – can improve productivity.
• Investing in nutrition provides health and economic benefits.
SDG 2: Zero hunger
• If done right, global food systems should produce enough nutritious foods for all.
• But current agriculture produces cheap sugar, oil, and grain calories – and not enough nutrient-rich foods.
• Empty calories cost less; nutrient-rich foods cost more.
Making nutrient-rich diets more availableHow to provide optimal nutrition for all
5
Do all nutrients come from “real” foods?Nutrition experts still insist that all nutrients come from “real” foods, preferably unprocessed and home made. How realistic is that?
Tiger prawnsBlueberriesStrawberriesThree grain breadGreenhouse tomatoesKale
Food, health and incomes: UK 1935• That diet quality follows a
social gradient is not new.• Better diets were linked to
higher SES back in 1935• Fruit, vegetables, fish were
eaten by the rich.• Sugar, bread and lard were
eaten by the poor.• Not a lot has changed.
Food, health and incomes: Asia 2015
Nutrientdeficiencies
Calcium deficiency in Vietnam: NIN data
0 100 200 300 400 500 600 700 800 900 1000
NationalRed river delta
N midlandsN Central
Central HighlandsSoutheast
Mekong Delta
RuralUrban
PovertyNon poverty
Calcium intakes mg/d
Recommended: 1000 mg/d
Meat and fish; less dairy: Vietnam
0
100
200
300
400
500
600
700
800
900
1000
poverty non-poverty
consum
ption
seafoodfishmilk, freshmilk/cheesemeats/eggsfats/oilssaucessugarfruitsvegetablesnutstubers/beans/tofuOtherWheatRice
0
10
20
30
40
50
60
70
80
90
1981-5 1987-9 2000 2010
Inta
ke in
gra
m/d
ay
Nut/sesame
Milk/egg
Fats/oils
Fruits
Fish
Meat
The main public health question:
How to improve dietary nutrients-to-energy ratio?
Three important concepts • Energy density:
Defined as dietary energy per unit weight of food (kcal/100g or MJ/kg).
• Nutrient density:Defined in terms of nutrients per 100 kcal, 100g, or a serving of food.
• Energy and nutrient cost:Defined in terms of calories or nutrients per penny.
Energy-dense foods taste better • We like foods that are energy dense and/or sweet.• Dry starches, sugars, and fats are energy dense; kale is not.• Energy-dense refined grains, fats, and sweets are inexpensive.• Energy-dense foods can also be nutrient-poor.
Energy-dense foods are easy to overeatHigh energy density –Low volume (low water content)
Low energy density –High volume (water content) -- and higher cost
Energy-dense foods are cheaper• A city of 20 million needs 40,000 tons/d of food.
– Each person consumes 2,000 kcal/d of food.– Dietary energy density is 100 kcal/100g: – So each person needs 2kg/day
• But if dietary ED is 500 kcal/500g– Each person needs 400 g/day of food.
• A city of 20 million will need 8,000 tons/d of food.– The foods will be energy-dense grains, fats, and sweets– Economic cost will be less (food and transport)– Diet quality will be less (reduced nutrient to calorie ratio)
• This will impact health and productivity.
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Megacities are future obesity hotspotsEnergy-dense foods that are nutrient-poor will impact productivity
Nutrition Reviews, Volume 66, Issue 1, 1 January 2008, Pages 23–39, https://doi.org/10.1111/j.1753-4887.2007.00003.x
Nutrient density of foods: NRF9.3
https://doi.org/10.1111/j.1753-4887.2007.00003.x
0
100
200
300
400
500
600
700
800
900
-200 -100 0 100 200 300NRF9.3 per 100 kcal
Ener
gy d
ensi
ty (k
cal/1
00g)
Dairy Meat Eggs Beans Grains Fruits Vegetables Fats Sugars
Low-cost sweets, fats can be nutrient-poor
Nutrient poor
0
100
200
300
400
500
600
700
800
900
0.1 1 10 100Energy cost ($/1000 kcal)
Ener
gy d
ensi
ty (k
cal/1
00g)
Dairy Meat Grains Fruits Vegetables Fats Sugars
Sweets, fats cost less: nutrients cost more
Expensive
Cheaper
-150
-100
-50
0
50
100
150
200
250
300
350
400
450
0.1 1 10 100
Energy cost ($/1000 kcal)
Nut
rient
den
sity
(NR
9.3
per 1
00 k
cal)
Dairy Meat Eggs Beans Grains Fruit Vegetables Fats Sugars
Nutrient-rich foods cost more
Nutrient rich and expensive
What is nutrient rich and cheap?
What are the links between workplace nutrition and productivity?
How is productivity defined• Absenteeism (days off, sick leave)• Presenteeism (lower performance)• Days of work lost• Employee health cost• Early retirement• Turnover• Short- and long-term disability
Mental Health
Musculoskeletal disorders
Communicable diseases
Noncommunicable diseases
Diets and lifestyle
D epression, stress, anxiety, m igraine, insom nia,
substance abuse, narcolepsy,
Rheum atoid arthritisColitis, C rohn/s, IB SG out, chronic pain
InfluenzaH epatitis C
H erpes zoster, H IV
O besity, T2D , H ypertension,
CV D , Cancer
D iet, nutrition,Physical activ ity, Sm oking,
A lcohol
Chief obstacles to workplace productivity
Stress reduction, meditationAmazon, Salesforce:
Private transportation fleets:Microsoft, Google
Free nutrient-rich foodGoogle, Microsoft:
Diet quality can depend on where you live and work
This is where spatial epidemiology science crosses into public policy –
and urban planning
• Spatial analyses of measuredheights and weights for 59,767 insured adults.
• Data from health insurance.• King Co. is one of the healthiest
counties in WA State - but localdisparities by census tract (CT) exist.
• Crude obesity rates ranged from 5% to 30% depending on where people lived.
• Similar spatial data obtained for type II diabetes and for metabolic syndrome.
• Drewnowski, Rehm, Arterburn Int J Obesity Sept 2013
Seattle obesity patterns by census tract
Tax assessor data become SmartMaps of wealth
30
What you eat depends on where you liveSoda (SSB) and salad consumption (servings per week) by Seattle census block
HEI 2010
We can map obesity in Seattle by census blockMicrosoft
Amazon
Obesity, NCDs and
workplace productivity are inversely linked
This is where spatial epidemiology crosses into public policy –
and economics
Which city will Amazon pick for HQ2?
What is the leading indicator of?Worker nutrition status and health
Labor force productivity
0
10
20
30
40
T or o
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Mon
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ery…
Denv
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Bosto
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Rale
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N. V
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New
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Los A
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Wa s
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Austi
n
Miam
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P hila
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Atlan
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Nash
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Newa
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Colum
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P itts
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Chic a
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napo
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Dalla
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Amazon will pick least obese
• NCDs are the largest cause of death in the world, affecting economic growth, productivity, social welfare, education and quality of life.
• Health of the labor force can have profound economic consequences for the region.
• There are links between dietary nutrient density, body weight, and economic outcomes.
Prevent NCDs, increase productivity
Thank you
The two forms of malnutrition are linked to nutrients-to-calorie ratio
• Too many calories; not enough nutrients– Overweight – Obesity– Vitamin/mineral deficiencies– Overfeeding/Undernutrition
• Not enough calories or nutrients– Wasting – Stunting– Vitamin/mineral deficiencies– Undernutrition
Energy-dense foods are cheaperAre poverty and obesity linked by easy access to palatable, cheap energy-dense foods?
Drewnowski & Specter, Am J Clin Nutr 2004;79:6-16