Nutrition and Wellbeing

Week 1: The Makings of a Healthy Diet

Step 1.6: Energy for life

Additional Reading (Optional)

If you are interested in learning more these resources provide excellent additional
reading (optional):

1. Diogenes GI Database
http://www.mrc-hnr.cam.ac.uk/research/research-sections/nutrition-
health-interventions/gi-database/

This information on Glycaemic Index is on the Medical Research Council weblink

for the Diogenes intervention study. Diogenes is a pan-European Programme to
tackle obesity from a dietary perspective: seeking new insights and new routes to
prevention.

2. Prentice AM & Jebb SA. 2001. Beyond body mass index. Obes Rev. 2(3):
141-7.
http://www.ncbi.nlm.nih.gov/pubmed/12120099

Body mass index (BMI) is the cornerstone of the current classification system for
obesity and its advantages are widely exploited across disciplines ranging from
international surveillance to individual patient assessment. However, like all
anthropometric measurements, it is only a surrogate measure of body fatness.
Obesity is defined as an excess accumulation of body fat, and it is the amount of
this excess fat that correlates with ill-health. We propose therefore that much
greater attention should be paid to the development of databases and standards
based on the direct measurement of body fat in populations, rather than on
surrogate measures. In support of this argument we illustrate a wide range of
conditions in which surrogate anthropometric measures (especially BMI) provide
misleading information about body fat content. These include: infancy and
childhood; ageing; racial differences; athletes; military and civil forces personnel;
weight loss with and without exercise; physical training; and special clinical

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circumstances. We argue that BMI continues to serve well for many purposes, but
that the time is now right to initiate a gradual evolution beyond BMI towards
standards based on actual measurements of body fat mass.

3. Fogelholm M. 2010. Physical activity, fitness and fatness: relations to

mortality, morbidity and disease risk factors. A systematic review. Obes
Rev. 11(3): 202-21.
http://www.ncbi.nlm.nih.gov/pubmed/19744231

The purpose of this systematic review was to study the relative health risks of
poor cardio-respiratory fitness (or physical inactivity) in normal-weight people vs.
obesity in individuals with good cardio-respiratory fitness (or high physical
activity). The core inclusion criteria were: publication year 1990 or later; adult
participants; design prospective follow-up, case-control or cross-sectional; data
on cardio-respiratory fitness and/or physical activity; data on BMI (body mass
index), waist circumference or body composition; outcome data on all-cause
mortality, cardiovascular disease mortality, cardiovascular disease incidence, type
2 diabetes or cardiovascular and type 2 diabetes risk factors. Thirty-six
publications filled the criteria for inclusion. The data indicate that the risk for all-
cause and cardiovascular mortality was lower in individuals with high BMI and
good aerobic fitness, compared with individuals with normal BMI and poor fitness.
In contrast, having high BMI even with high physical activity was a greater risk for
the incidence of type 2 diabetes and the prevalence of cardiovascular and
diabetes risk factors, compared with normal BMI with low physical activity. The
conclusions of the present review may not be applicable to individuals with BMI >
35.

4. Pi-Sunyer FX. 2000. Obesity: criteria and classification. Proc Nutr Soc. 59(4):
505-9.
http://www.ncbi.nlm.nih.gov/pubmed/11115784

Obesity is defined as an excess accumulation of body fat. To measure fat in the

body accurately is difficult, and no method is easily available for routine clinical
use. Traditionally, overweight and obesity have been evaluated by anthropometric
measurement of weight-for-height. More recently, BMI has been used. The normal
range is 19-24.9 kg/m2, overweight is 25-29.9 kg/m2, and obesity >/= 30 kg/m2.
Not only is the total amount of fat an individual carries important, but also where
the fat is distributed in the body. Fat in a central or upper body (android)
distribution is most related to health risk. The most accurate way to measure
central obesity is by magnetic resonance imaging or computer-assisted

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tomography scanning, but this approach is too expensive for routine use. Simple
anthropometric measurements can be used, such as waist circumference. A waist
circumference of greater than 1020 mm in men and 880 mm in women is a risk
factor for insulin resistance, diabetes mellitus and cardiovascular disease. There is
a clear genetic predisposition for obesity. The genetic contribution to obesity is
between 25 and 40 % of the individual differences in BMI. For the overwhelming
majority of individuals, the genetic predisposition will not be defined by one gene,
but by multiple genes. Eventually, classification of obesity may be done by
genetic means, but this approach will require more knowledge.

5. Chowdhury R, Warnakula S, Kunutsor S, et al. 2014. Association of dietary,

circulating, and supplement fatty acids with coronary risk. Ann Intern Med
160(6): 398-406.
http://www.ncbi.nlm.nih.gov/pubmed/24723079

BACKGROUND: Guidelines advocate changes in fatty acid consumption to

promote cardiovascular health.
PURPOSE: To summarize evidence about associations between fatty acids and
coronary disease.
DATA SOURCES: MEDLINE, Science Citation Index, and Cochrane Central Register
of Controlled Trials through July 2013.
STUDY SELECTION: Prospective, observational studies and randomized, controlled
trials.
DATA EXTRACTION: Investigators extracted data about study characteristics and
assessed study biases.
DATA SYNTHESIS: There were 32 observational studies (530,525 participants) of
fatty acids from dietary intake; 17 observational studies (25,721 participants) of
fatty acid biomarkers; and 27 randomized, controlled trials (103,052 participants)
of fatty acid supplementation. In observational studies, relative risks for coronary
disease were 1.02 (95% CI, 0.97 to 1.07) for saturated, 0.99 (CI, 0.89 to 1.09) for
monounsaturated, 0.93 (CI, 0.84 to 1.02) for long-chain -3 polyunsaturated, 1.01
(CI, 0.96 to 1.07) for -6 polyunsaturated, and 1.16 (CI, 1.06 to 1.27) for trans
fatty acids when the top and bottom thirds of baseline dietary fatty acid intake
were compared. Corresponding estimates for circulating fatty acids were 1.06 (CI,
0.86 to 1.30), 1.06 (CI, 0.97 to 1.17), 0.84 (CI, 0.63 to 1.11), 0.94 (CI, 0.84 to 1.06),
and 1.05 (CI, 0.76 to 1.44), respectively. There was heterogeneity of the
associations among individual circulating fatty acids and coronary disease. In
randomized, controlled trials, relative risks for coronary disease were 0.97 (CI,
0.69 to 1.36) for -linolenic, 0.94 (CI, 0.86 to 1.03) for long-chain -3

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polyunsaturated, and 0.89 (CI, 0.71 to 1.12) for -6 polyunsaturated fatty acid
supplementations.
LIMITATION: Potential biases from preferential publication and selective
reporting.
CONCLUSION: Current evidence does not clearly support cardiovascular
guidelines that encourage high consumption of polyunsaturated fatty acids and
low consumption of total saturated fats.

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