Dietary Guidelines

– Poland 2017

Mirosław Jarosz, Katarzyna Stoś

Institute of Food and Nutrition
Warsaw, Poland

19 – 20 September 2017, Warsaw

 Other
The most important
Physical
activity
5-20% factors determining
10% health and life
expectancy
Medicine
10%

53%
Smoking
tobacco
11%

Genetics
15%
 Life expectancy GENES what does it depend on?
(interactions)
In pregnancy: bad diet, obesity, BMI 20–25 kg/m2
physical activity
physical activity
Excessive weight, obesity
Vegetables, fruit
monosaccharides
Fish (n-3 acids)
fats (animal!) Antioxidants (A, C, E, β-carotene)

salt Vit. D, calcium

red meat Microelements (Se, Zn)

Smoking tobacco Polyphenols

Drinking alcohol Fibre, nuts

Chronic inflammations Bacterial flora

Other Other
FOOD
PYRAMID
2016

Diagnosed
Medical condition
(number of people > 18 y/o)
Excessive weight and obesity 21 mln
Diabetes 3–4 mln
High cholesterol ~20 mln
Hypertension 10.5 mln
Coronary Artery Disease 3 mln
Precancerous lesions
12 mln
(polyps, atrophy)
Osteoporosis 3 mln
bulk data, 2015
FOOD
PYRAMID
2016 The evaluation of the prevalence of modifiable risk factors of hypertension
in patients pharmacologically treated due to hypertension
Jarosz M., Wolańska D., Stolińska H., Respondek W., Kłosiewicz-Latoszek L., 2016

97% of patients with hypertension

do not follow dietary
recommendations
Modifiable nutritional Lack of achieved desirable values (N=280)
and lifestyle factors Desirable values
of hypertension N %n
Nourishment
Sodium < 1500 mg 271 97
Potassium > 4700 mg 223 80
Calcium > 1000 mg 224 80
Magnesium > 320 mg/420 mg 133 47
Excessive weight and obesity BMI < 25 kg/m2 251 90
 Cancer – world, 2017

mortality 8.2

morbidity 14.1

prevalence 32.5
billions

II National Congress of Nutrition

Professor Aleksander Szczygieł Doctor of Medicine Food and nutrition in prevention and treatment – advances 2016
Institute of Food and Nutrition Warsaw, 27 January 2017
 Cancer – world, 2014

Premature deaths (<70 y/o)

- 4.3 mln

- 6.8 mln (↑ by 44%) in 2030

II National Congress of Nutrition

Professor Aleksander Szczygieł Doctor of Medicine Food and nutrition in prevention and treatment – advances 2016
Institute of Food and Nutrition Warsaw, 27 January 2017
  Obesity epidemic
Pomorskie
Province
19.0 Warmińsko-
Mazurskie
Zachodniopomorsie Kujawsko-Pomorskie
Province Podlaskie
Province Province
21.4 Province
23.9 20.3 20.5
Wielkopolskie
Mazowieckie

Year 2014 Lubuskie Province

Province
Province 19.8 32.0
N = 3266 students 23.0 Dolnośląskie Łódzkie
Province Province
Excessive weight and obesity 23.8 29.8 Lubelskie
Świętokrzyskie Province
in in Poland Opolskie
Province 24.6
Śląskie
among 10-15-y/o children Province
23.8 Province
18.0
16.5 Małopolskie
Podkarpackie
Province
KIK/34 Project Coordinator: Professor M. Jarosz Province

Researchers: J. Charzewska, K. Wolnicka, J. Jaczewska-Schuetz, A. Taraszewska

18.3 21.5
 Obesity is getting worse…
„[…] In the future, humanity may face not only
and alarming prevalence of obesity
but also increased severity of metabolic diseases
[diabetes, cardiovascular diseases and cancer]”

Y. Ding et al., Int J Obesity, 2014, 198-204

DNA hypomethylation of inflammation-associated genes…
Food and Nutrition Institute
FOOD
PYRAMID
2016 PYRAMID OF HEALTHY DIET
AND PHYSICAL ACTIVITY

WHAT IS THE PYRAMID OF HEALTHY DIET WHO IS THE PYRAMID FOR?

AND PHYSICAL ACTIVITY? The Pyramid is for healthy individuals,
It is the simplest and briefest general representation and it is designed to maintain good health.
of the comprehensive idea of human diet which gives a chance We have to remember, however, that in case
to live long and maintain high physical and intellectual of civilization disease co-morbidity (like
performance even in the old age. obesity, diabetes, ischaemic heart disease,
hypertension, osteoporosis) it may be necessary
to modify the recommendations in cooperation

HOW TO INTERPRET / with a doctor and with a dietician).

READ THE PYRAMID?

It is a graphic description of
proper balance between various
categories of food necessary in
daily diet. The higher the level,
the smaller the amount of food and
frequency of meals consisting of
the products of that category.

EATING THE PRODUCTS RECOMMENDED IN THE PYRAMID

IN PROPER QUANTITIES AND RATIOS, AS WELL AS DAILY
PHYSICAL ACTIVITY, ARE CRUCIAL FOR HEALTH AND WELLBEING
 FOOD

PYRAMID
2016
 FOOD

PYRAMID
2016

Fruit and vegetables

Meat
Sugar, sweets
Salt
Liquids (water, coffee, tea)
FOOD
PYRAMID
2016

Fruit and vegetables

at the base of the Pyramid

 Fruit and vegetables at the base of the Pyramid.

Eaten with no limitation*

– the more and more often, the better

* At least 400 g, in 5 portions – 1 portion may be 1 glass of juice

Fruit and vegetables
vs. the risk
of premature death
(cancer, heart attack, stroke)
FOOD
PYRAMID
2016

decrease in %

0–1 1–3 3–5 5–7 7+

Number of portions a day
Oyebode O, et al. JECH, 2014
 FOOD
PYRAMID
2016

Fruit and vegetables intake vs.

life expectancy (1950-2012)
150 85
vegetables
fruit
125 80
trwanie
M życia - mężczyźni

Average life expectancy (years)

Intake per person (kg/year)

trwanie
F życia - kobiety 75
100
70
75
Vegetables 1950–2012 65
50 M: r=0.62
F: r=0.77 60

25 Fruit 1950–2012
M: r=0.82 55
G: r=0.88 years
0 50

Jarosz M., Rychlik E., Sekuła W.,

Ann. Nutr. Metab., 2015, 67, suppl. 1, 134-135
FOOD
PYRAMID
2016

Fruits and Vegetables Get a Golden Halo Once Again

A.H. Lichtenstein
Circulation, 2015
Human Nutrition Research Center on Aging

Vegetables, fruit 7–9 x/day vs. 2–4 x/day

Age 25
Observation time 20 years
Arteriosclerosis (45 lat) 26%
 Impact of fruit and vegetables on human brain
FOOD
PYRAMID
2016

fibre, polyphenols
↑ SCFA interaction
brain – digestive tract
immunomodulation (hormones, neural pathways, cell junctions
/ synapses)

↓ inflammatory ↑ neurotrophic transcription

cytokines factor in frontal cortex
(IL1ß, TNFα)

improved cognitive functions and memory

Khan NA. et al., J. Nutr., 2015
FOOD Akry-
acry-
PYRAMID Karci-
carci-
2016 Cukier
sugar loamid
lamide
nogeny
nogens
Palenie
smoking Sól
salt
tytoniu
tobacco Fruk-
fruc-
Izomery
trans tose
toza
trans
fats

OCHRONA
PROTECTION
Blood vessels heart attack, stroke

DNA cancer

Tissues inflammation

Nerve cells Alzheimer’s, DEPRESSION,

and synapse Parkinson’s
telomeres Ageing of cells and tissues
 Fruit and vegetable
intake vs. cancer

II National Congress of Nutrition

Professor Aleksander Szczygieł Doctor of Medicine Food and nutrition in prevention and treatment – advances 2016
Institute of Food and Nutrition Warsaw, 27 January 2017
Stomach Fruit intake and stomach cancer morbidity
cancer (1960-2014)

2.4 x
fruit by 15%
M

incidence rate (per 100 000)

F
Intake per person (kg/year)

3x

3x

years
Jarosz M. et al, Gastroenterol. Res. Pract. 2012; Jarosz M. Rychlik E et al., 2016
Colorectal Fruit intake and colorectal cancer morbidity (1960-2014)
cancer

2.4 x
Fruit by 15%
Intake per person (kg/year)

Morbidity rate (per 100 000)

F

years

Jarosz M. et al, Gastroenterol. Res. Pract. 2012; Jarosz M. Rychlik E et al., 2016
 Fruit intake and colorectal cancer (1960-2014)
Colorectal
cancer

by 50%
fruit by 19%
Intake per person (kg/year)

incidence rate (per 100 000)

F

years

Jarosz M. et al, Gastroenterol. Res. Pract. 2012; Jarosz M. Rychlik E et al., 2016
 Stomach cancer morbidity (1960–2012)
H. pylori infection ~80% of population
40
(na 100 000)

35 morbidity
wsp. rate - M
zachorowalności - mężczyźni

30 wsp. zachorowalności
morbidity rate - F - kobiety
(per 100 000)
zachorowalności

25

20 Intake:
↑ 2.5x fruit
Współczynnikrate

15
Incidence

10
↑ 41% vegetables
5
↓ 26% salt years
lata
0
1960 1964 1968 1972 1976 1980 1984 1988 1992 1996 2000 2004 2008 2012

Jarosz M., Sekuła W., Rychlik E., Figurska K., World Journal of Gastroenterol., 2011, 17, 1, 89-97 and data from 2014 r.
 FOOD

PYRAMID
2016

Fruit and vegetables

Meat
Sugar, sweets
Salt
Liquids (water, coffee, tea)
FOOD

Meat
PYRAMID
2016

 Limit meat intake

(especially red meat
and processed meat products to 0.5 kg/week).

Eat fish (min. 2x/week),

pulses
and eggs (up to 6/week)
FOOD
PYRAMID
2016
Limitation of intake:
meat preparations (gr. A1 carcin.)
and red meat (gr. A2 carcin.)

2015 „wrong”
2007 epidemiology
IARC
A1 Smoked
meat
A2 Red meat
Colorectal cancer
Pancreatic cancer
Prostate cancer
FOOD
PYRAMID
2016
Limitation of intake:
meat preparations (gr. A1 carcin.)
and red meat (gr. A2 carcin.)

Type of meat Mechanism

processed, smoked transformation
(nitrates and nitrites) Into nitrosamines

Polycyclic aromatic hydrocarbons;

heat processed heterocyclic aromatic amines

red DNA damage

(heme iron)

IARC, 2015
 FOOD
PYRAMID
2016
Limitation of intake:
meat preparations (gr. A1 carcin.)
explanation (cont.) and red meat (gr. A2 carcin.)

Meat and colorectal cancer risk

Intake
Increase in risk
(daily)

50 g processed meat by 18%

100 g red meat by 17%

IARC, 2015
 FOOD

PYRAMID
2016

Fruit and vegetables

Meat
Sugar, sweets
Salt
Liquids (water, coffee, tea)
 Don’t add sugar, avoid sweets
FOOD
PYRAMID
2016

 Avoid sugar, sweets, and

carbonated drinks
(sucrose, glucose, fructose).
Replace them with fruit and nuts.
 Don’t add sugar, avoid sweets
FOOD
PYRAMID
2016

 very caloric
obesity (diabetes, hypertension, cancer)
 include saturated fatty acids
and trans fats
arteriosclerosis (heart attack, stroke, IHD), dementia
 good conditions for bacteria growth
tooth decay (90% of Poles)
 FOOD

PYRAMID
2016

Fruit and vegetables

Meat
Sugar, sweets
Salt
Liquids (water, coffee, tea)
 FOOD
PYRAMID
Don’t add salt
2016

 Don’t add salt, buy product with low salt

intake.

 Use herbs and spices*

– they include valuable components,
improve taste, and have anti-inflammatory
properties.
* Don’t use flavouring mixtures.
FOOD
PYRAMID
Don’t add salt
2016

Blood pressure and sodium intake

from snacks in adolescents
V. Ponzo et al., Eur. J. Clin. Nutr.,
2015, 69, 681-686

snacks 50% of daily intake (> 2g/day)

hypertension:

6 years = 3.5%
18 years = 12.8%
 FOOD

PYRAMID
2016

Fruit and vegetables

Meat
Sugar, sweets
Salt
Liquids (water, coffee, tea)
FOOD
PYRAMID
2016

Remember to drink water,

at least 1.5 l a day*

Important in preventing
some medical conditions,
tea and coffee can also be
a source of water
* With water from drinks and food, the
income should be 2–2.5 l/day.
FOOD

RULES OF HEALTHY DIET

PYRAMID
2016

connected with the Pyramid of Healthy Diet and Physical Activity

1. Have meals regularly (4-5 meals every 3-4 hours).

2. Eat fruit and vegetables as often as you can and in eat as much of them as you can,
at least half of the total amount of your total intake. Remember about a proper
balance: 3/4 – vegetables i 1/4 – fruit.
3. Eat cereal products, especially wholemeal.
4. Every day drink at least 2 big glasses of milk. You can replace them with yoghurt,
kefir, and – to some degree – with cheese.
5. Limit your meat intake (especially red and processed meat to 0.5kg/week).
Eat fish, pulses and eggs.
6. Limit your animal fat intake. Replace them with plant oils.
7. Limit sugar and sweets (replace them with fruit and nuts).
8. Don’t add extra salt to your meals and buy products with a low salt content.
Use herbs – they contain valuable ingredients and improve taste.
9. Remember to drink water, at least 1.5 l a day.
10. Don’t drink alcohol.
THANK YOU
FOR YOUR ATTENTION