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Friday, May 28, 2021, 10:25
Chronic diseases from the foods we consume?
By Wang Yuke
Friday, May 28, 2021, 10:25 By Wang Yuke




In Hong Kong, cancer, heart disease, cerebrovascular disease, and diabetes are among the 10 leading causes of death. Hypertension affected 27.7 percent of the local population, according to the Population Health Survey 2014-15, conducted by the Department of Health. High blood pressure often goes unnoticed until it triggers a heart attack, stroke, kidney failure, blindness and cognitive impairment, the report said. 

The prevalence of obesity-caused diabetes is a modern global epidemic. The term “diabesity” was coined to describe the coexistence of the two health conditions in one person. In Hong Kong 8.4 percent of people aged 15-84 are afflicted with diabesity, the same survey revealed.

Martin Wong Chi-sang, a professor at the Chinese University of Hong Kong, whose research interest includes non-communicable diseases control, said that the dietary patterns in Hong Kong were similar to Western populations. “Western diet, characterized by high consumption of red and processed meat, fried foods, high-fat dairy products, refined grains, sweets and desserts, is associated with increased risk of NCDs.” 

The 2011 Hong Kong Dietary Survey by the Chinese University of Hong Kong Department of Therapeutics and Medicine, on 1,010 adults aged 25-74 — followed up for nine to 14 years to track diabetes prevalence — the “relationship between dietary intake and the development of type 2 diabetes in a Chinese population” — concluded that more vegetables, fruits, and fish reduce the risk of diabetes, while consumption of more meat and milk products increases diabetes risk.

At a global level, 11 million deaths and 255 million DALYs (disability-adjusted life years) were attributable to dietary risk factors in the Global Burden of Disease 2017 report. The DALY index aggregates years lost to premature mortality, and the years of healthy life lost due to disability. Among the worst dietary factors for death and DALYs are the high intake of sodium, the low intake of whole grains, and the low intake of fruits. 

WHO Director-General Tedros Ghebreyesus urged governments to promote healthy diets in January. “Now is the time for governments to lead by example through ensuring that the food served or sold in public settings contributes to healthy diets and saves lives. No public funds should be spent on food contributing to unhealthy diets,” he said.

The major five diet-related chronic diseases are cardiovascular diseases, diabetes, hypertension, stroke and cancer. Among them, cardiovascular diseases, stroke and cancer are the primary causes of premature death. Hypertension and diabetes, from complications arising at the advanced stages, contribute to the risk of stroke and cardiovascular diseases. 

More than 62 percent of the burden of disease worldwide were from NCDs in 2017, compared to 43.2 percent in 1990, per the Global Burden of Disease Study. In high-income nations, this number could reach 80 percent. 

Increased COVID risk

Graham MacGregor, professor of cardiovascular medicine at the Wolfson Institute of Preventive Medicine, founded and currently chairs Consensus Action on Salt and Health, and World Action on Salt and Health. MacGregor said that the COVID-19 pandemic has alerted health authorities and society, to the link between diet, food sources, and chronic diseases.

Numerous studies have found that obesity increases the risk of coronavirus infection, and patients with an abnormal body mass index are more susceptible to severe stress and death. BMI is the weight divided by the square of an individual’s height, expressed as kilograms per square meter.

A US study on BMI and Risk for COVID 19-related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation and Death, concluded that there was a significant correlation between a high BMI and the risk of hospitalization, ICU admission, or death, among patients with coronavirus infection — particularly those patients older than 65. 

Lifestyle changes

We’ve undergone a “nutrition transition” from plant-based dietary patterns low in calories and nutrients, to calorie-dense diets lacking a balance of nutrients. Barry Popkin in 1993 invented the term to describe the shift in dietary consumption and energy expenditure that coincides with economic, demographic, and epidemiological changes in society. 

The high prevalence of infectious diseases linked to malnutrition, nutrition deficiency, periodic famine and environmental sanitation has given way to degenerative diseases of abundant, sumptuous, and wasteful lifestyles in urban societies. In Hong Kong, there’s a 30 percent of increase in average caloric consumption, from 2,592 kilocalories in 1961 to 3,358 kilocalories in 2017. 

“Obesity in Canada and the US, and likely in Hong Kong, is almost 100 percent due to excess calories in the diet,” said Norm Campbell, past chair of the Pan American Health Organization/WHO Expert and Technical Advisory Groups on Cardiovascular Disease Prevention, through Dietary Salt Reduction. Nutrition transition is reflected in the balance of natural and processed foods in daily meals, he added. 

“A steep decline of physical activity has been observed during the past few decades among the locals,” said Wong of CUHK. He lists rapid urbanization, the growing use of new technologies, changes in employment types, and convenient transportation, as contributing factors.

Diet is important in healthy aging, particularly in optimizing cognitive and physical function — with or without disease — said Jean Woo, director of the Centre for Nutritional Studies at CUHK. “This is little understood here,” she said, and pointed to growing frailty and dependency that accompany unhealthy aging. 

Globally, daily consumption of sugar-sweetened beverages was on average 49 grams, way over the optimal amount of 3 g. Daily intake of sodium was 6 g, while the optimal level was 3 g. 

More meat, less health

Consumption of processed meat per day in Hong Kong was 4 g, two times higher than the recommended 2 g. People eat an average of 27 g of red meat every day, 18 percent higher than the optimal amount. The average protein supply per capita per day has risen by 34.1 g from 98.3 g (2000-02) to 132.4 g (2015-17). 

The protein from animal meat has consistently accounted for a big chunk of the overall protein supply. Eaten sparingly and frugally before, meat is now an everyday staple with a huge surplus thrown out. Eating too much red meat is health-damaging. 

A 2012 study by the Harvard School of Public Health found that one daily serving of unprocessed red meat (the size of a deck of cards) and one daily serving of processed red meat (one hot dog, or two slices of bacon) increased the risk of death from cardiovascular disease, or from cancer, by 13 percent and 20 percent respectively. This also adds up excess calories, which translates to surplus fat stored in the body.

For-profit foods

“Commercially, adding sugar, saturated fat and sodium makes low-quality cheap food taste better with a long shelf life,” Campbell said. “Hence the emergence of high-profit but low-quality food.” This highly commercial food also becomes an acquired taste so that foods without such a strong flavor profile don’t satisfy, “unless people re-accustom to natural foods over time,” Campbell said. He added also that “Sugar has addictive properties as well.”

Salt is another silent killer. The average salt intake among people aged 15-84 in Hong Kong was 8.8 g per day, according to the 2014-15 Population Health Survey, well above the WHO recommended daily limit of 5 g. Salt is routinely coated on chips, or dissolved in gravy, sauce, and soup, for better flavor. 

However, this powerful flavor-enhancer raises our blood pressure, and narrows, weakens, and blocks our blood vessels. The result is ischemic stroke. Half of ischemic strokes are attributable to hypertension, according to the World Heart Federation. “Hypertension kills 10 million people a year, compared to the COVID-19 statistic of a million a year,” MacGregor said. “We have ‘normalized’ hypertension.”

“The sensors on our taste buds and in our noses tell us that sweet is fuel, salty is sodium, umami is protein,” said Bruce German, director of the Foods for Health Institute at the University of California, Davis. Taste is simple and universal, he added. Profit-hungry food brands take advantage of our intrinsic fondness of sweet, salty and umami, spiking generously more into the foods they peddle, he said. 

“If I’m a multinational company selling food, and want the majority of people in the world to love it, I’ll definitely make it tastier by tossing in more sugar, salt and fat, and process out bitter and sour,” German said. 

Food branding is a genius business model that has wrecked human health, argued German. Branded food corporations hype their products as the most healthy and tasty, but these are mostly false claims, he contended, because “no one food is the best, and no single food is a diet. Diet is a complex assortment of different foods, each consumed in moderation.” 

“We (as consumers) don’t bother to measure the essential nutrients in food,” resulting in the imbalanced diet that makes us ill, German said. 

Industrial agriculture grip

Industrial agriculture, which generates US$2.4 trillion annually for mass production and global supply, is responsible for the bulk of food-borne illness. It is dominated by a handful of giant corporations that nuclear physicist and natural-agriculture champion Vandana Shiva of India, called the “poison cartel.” 

In 2020, the top 10 global corporations employed over 1 billion people worldwide. US-based Cargill is the biggest revenue generator at US$114.7 billion in 2020. US-based ADM and German company Bayer round out the top three. This incredible cartel power over essential food supply, and influence over governments, cannot be underestimated. 

Veterinary drugs and agrochemicals, including growth hormones, antibiotics, pesticides, fertilizers, fungicides and herbicides, are exploited in livestock farming as growth-promoters, to optimize the production, asserts Wong. 

They pose health risks to humans, in high concentration, or in low doses but over an extended period. For example, nitrogen applied as a fertilizer to crops can affect hemoglobin iron in the blood, leading to hypoxemia and death; consumption of pesticides can cause physical deformity, skin allergy and congenital abnormality; exposure to synthetic hormones can contribute to early puberty and cancer. 

A growing body of studies confirm that industry-farmed foods have less nutritional value than those grown in an extensive, natural environment, but chemical food contamination as a health risk has not been studied in Hong Kong, Woo said. 

What to do?

Every individual should be responsible for his or her own health — switching part of the red meat diets to plant-based alternatives, and replacing the inactive lifestyle with routine physical activity. “The best method of encouraging physical activity is to build exercise communities,” Campbell said. 

He acknowledged that Hong Kong is blessed in this regard “with great hiking tracks and cycling routes.” The sight of people walking and jogging on the streets is already a good motivation, he said.

The WHO’s diet and nutrition recommendations for chronic disease prevention place a high premium on foods of plant origins, which feature variation, and nutrient-dense but non-caloric foods, such as legumes, vegetables, fruits, minimally processed grains, and other staples. 

Campbell feels governments can introduce import requirements (levels of sodium) and regulations (taxation, labeling, warnings) to upgrade the quality of imported foods. “Importers can be encouraged by civil society to import healthier foods as well.” These require civic support and political will to enforce.

Food labeling was a major step by the special administrative region government, which however “encountered opposition from trade bodies, even though it was already a common practice in many countries to promote healthy eating,” Woo said. There is a belief that chronic diseases have declined due to anti-smoking legislation, she noted. By implication, trade bodies feel no further regulations are required.

The “Salt/Sugar Label Scheme for Prepackaged Food Products” was introduced jointly by the Centre for Food Safety, and the Food and Health Bureau in 2017. But it remains a “voluntary” program. In commerce, voluntary programs seldom work. If it is important enough, it deserves to be legislated.

Technology can help us, German said. “By making our phone smarter, we can use mobile apps to calculate the essential ingredients in the food we’re eating, and assess the calories we’re burning. Everybody will be his own dietician.”

Contact the writer at jenny@chinadailyhk.com


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