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Unformatted text preview: Nutrition and Fitness: Cultural, Genetic and Metabolic Aspects Acknowledgement The publication of these proceedings is made possible by a grant from the Stavros S. Niarchos Foundation World Review of Nutrition and Dietetics Vol. 98 Series Editor Artemis P. Simopoulos The Center for Genetics, Nutrition and Health, Washington, D.C., USA Advisory Board Regina C. Casper USA Uri Goldbourt Israel C. Gopalan India Tomohito Hamazaki Japan Federico Leighton Chile Michel de Lorgeril France Edwin C.M. Mariman The Netherlands Victor A. Rogozkin Russia Marjanne Senekal South Africa Leonard Storlien Sweden Changhao Sun China Antonio Velazquez Mexico Mark L. Wahlqvist Australia Paul Walter Switzerland Bruce A. Watkins USA Selected Proceedings of the International Congress and Exhibition on Nutrition, Fitness and Health Shanghai, November 30 to December 2, 2006 Nutrition and Fitness: Cultural, Genetic and Metabolic Aspects Volume Editor Artemis P. Simopoulos The Center for Genetics, Nutrition and Health, Washington, D.C., USA 48 figures, 12 in color, and 34 tables, 2008 Basel · Freiburg · Paris · London · New York · Bangalore · Bangkok · Shanghai · Singapore · Tokyo · Sydney Artemis P. Simopoulos The Center for Genetics, Nutrition and Health Washington, D.C., USA Library of Congress Cataloging-in-Publication Data International Congress and Exhibition on Nutrition, Fitness, and Health (2006 : Shanghai, China) Nutrition and fitness : cultural, genetic, and metabolic aspects / volume editor, Artemis P. Simopoulos. p. ; cm. – (World review of nutrition and dietetics, ISSN 0084-2230 ; v. 98) “Selected Proceedings of the International Congress and Exhibition on Nutrition, Fitness, and Health, Shanghai, November 30 to December 2, 2006.” Includes bibliographical references and indexes. ISBN 978-3-8055-8530-9 (hard cover : alk. paper) 1. Nutrition–Congresses. 2. Physical fitness–Congresses. I. Simopoulos, Artemis P., 1933– II. Title. III. Series. [DNLM: 1. Nutrition Physiology–Congresses. 2. Physical Fitness–Congresses. 3. Health Promotion–Congresses. 4. Metabolism–physiology–Congresses. 5. Nutrigenomics–Congresses. W1 WO898 v.98 2008 / QU 145 I6018 2008] QP141.A1I57 2006 612.3–dc22 2008009241 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents® and Index Medicus. Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. © Copyright 2008 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland) Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel ISSN 0084–2230 ISBN 978–3–8055–8530–9 Dedication The proceedings of the conference are dedicated to the concept of positive health as enunciated by the Hippocratic physicians (5th century BC). Positive health requires a knowledge of man’s primary constitution (which today we call genetics) and of the powers of various foods, both those natural to them and those resulting from human skill (today’s processed food). But eating alone is not enough for health. There must also be exercise, of which the effects must likewise be known. The combination of these two things makes regimen, when proper attention is given to the season of the year, the changes of the winds, the age of the individual and the situation of his home. If there is any deficiency in food or exercise the body will fall sick. Olympian Shanghai Ode Olympians and Taoists both philosophize, look inward and discover higher states of mind. When ancient days were new, both cultures had a clue: control diet and exercise! In two thousand and six the first conference was fixed for fitness and food in Shanghai. China welcomes Greece and their Concept of Positive Health, applauding the relation to the way the Chinese felt. In two thousand and eight the Olympians create a reason for China to celebrate. The way Greece plays her part in sports, science and art has won deep respect from the Chinese heart. Lee Pinkerson, 2007 Contents IX Preface 1 Nutrition and Fitness from the First Olympiad in 776 BC to the 21st Century and the Concept of Positive Health Simopoulos, A.P. (Washington, D.C.) 23 Omega–3 Fatty Acids, Exercise, Physical Activity and Athletics Simopoulos, A.P. (Washington, D.C.) 51 Omega–6 Fatty Acids and Excessive Adipose Tissue Development Ailhaud, G. (Nice) 62 Non-Conventional Genetic Risk Factors for Cardiovascular Disease Allayee, H. (Los Angeles, Calif.) 77 ApoE Genotype: Impact on Health, Fitness and Nutrition Angelopoulos, T.J.; Lowndes, J. (Orlando, Fla.) 94 Nutrition in the Prevention of Chronic Diseases Tapsell, L.C.; Probst, Y.C. (Wollongong, N.S.W.) 106 Exercise and Obesity: Lifestyle Modification as a Means in Prevention and Treatment Pavlou, K.N. (Athens) VII 131 Nutritional Risk Factors for Gastrointestinal Cancers: The Multiethnic Cohort Study Kolonel, L.N. (Honolulu, Hawaii) 150 Mediterranean Food and Diets, Global Resource for the Control of Metabolic Syndrome and Chronic Diseases Urquiaga, I.; Echeverría, G.; Polic, G.; Castillo, O.; Liberona, Y.; Rozowski, J.; Perez, D.; Martinez, C.; Vasquez, L.; Strobel, P.; Mezzano, D.; Leighton, F. (Santiago) 174 The Role of Government in Nutrition and Fitness Bourne, P.G. (Oxford/Grenada) 179 Balancing the Scales: A Common-Sense Look at Global Nutrition Problems and What Can Be Done about Them Clay, W.D. (Rome) Appendix I 198 Historical Perspective: The Antiquity of Exercise, Exercise Physiology and the Exercise Prescription for Health Tipton, C.M. (Tucson, Ariz.) Appendix II 247 Declaration of Olympia on Nutrition and Fitness Ancient Olympia, Greece, May 28–29, 1996 (in various languages) 254 Author Index 255 Subject Index Contents VIII Preface The papers in this volume of World Review of Nutrition and Dietetics consist of selected papers presented at the Nutrition and Fitness Conference in Shanghai, China, in November 2006. The conference was under the auspices of the World Council on Nutrition, Fitness and Health (WCNFH). Since 1988, the International Conferences on Nutrition and Fitness (ICNF) have been held every 4 years in Greece, prior to the Olympic Summer Games, either at Ancient Olympia or in Athens. The ICNF are dedicated to the concept of ‘Positive Health’ as stated by Hippocrates in the 5th century BC. The first conference took place at Ancient Olympia in 1988. At that time, the concept of combining ‘Nutrition’ and ‘Fitness’ in a scientific conference was a ‘new’ one. These two disciplines or fields have moved closer since then and today the ‘Nutrition and Fitness’ concept has been incorporated in the World Health Organization (WHO) program under the title ‘Global Strategy on Diet, Physical Activity and Health’ (May 2004). Similarly, the concept of Positive Health, based on the triad of Genetics, Nutrition and Physical Activity, is attracting many scientists in the areas of Nutrigenetics and Nutrigenomics. The establishment of the new International Society of Nutrigenetics/Nutrigenomics (ISNN – ) and the very successful 1st Congress of ISNN bear evidence to the fact that ‘old concepts’ are now not only being accepted but their importance is recognized worldwide and rapid progress is taking place. Because of the rapid advances in Genetics, Nutrition and Fitness, it was felt that the meetings should be held every 2 years instead of only every 4 years only prior to the Olympic Summer Games. It was thus agreed by the WCNFH that the ICNF will be held every 2 years as follows. IX The country that is holding the Olympic Summer Games will hold a Nutrition and Fitness conference 2 years prior to the games and in the Olympic year, the ICNF will always be held at Ancient Olympia or in Athens. This volume begins with the keynote presentation ‘Nutrition and Fitness from the First Olympiad in 776 BC to the 21st Century and the Concept of Positive Health’ by Artemis P. Simopoulos. The paper is a rather extensive overview of the concepts of Olympism, which are unique to Greek thought and the Concept of Positive Health. In fact, the first evidence of the importance of food and exercise in health appears in the Hippocratic corpus in the 5th century BC. Diet did not refer simply to food, but to the whole lifestyle, including nutrition and exercise. Among the Greeks, the concept of Positive Health was important and occupied much of their thinking. Those who had the means and leisure applied themselves to maintaining positive health. Today the need for proper diet and exercise for health and well-being is well recognized and major recommendations to that effect have been made by many national and international organizations. The traditional diet of Greece as exemplified by the diet of Crete was shown by the Seven Countries Study to be the healthiest. In the paper, Dr. Simopoulos gives a detailed description of the components of the traditional diet of Greece and shows that the Greek diet is very similar to the Paleolithic diet on which humans evolved. A major characteristic of such a diet is that it is balanced in the ␻–6 and ␻–3 essential fatty acids, which is unique to the diet of Greece and not to the other Mediterranean diets. In fact, in the paper which follows, ‘Omega–3 Fatty Acids, Exercise, Physical Activity and Athletics’, Dr. Simopoulos provides evidence for the metabolic and physiologic aspects of the ␻–6/␻–3 ratio and its beneficial effects in many conditions. Of great interest is the evidence that endurance exercise increases the eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content of muscle cell membrane phospholipids, which may account for the beneficial effects of ␻–3 fatty acids in increasing sensitivity to insulin and lead to decreased risk in the development of metabolic syndrome. Obesity is a major risk factor for cardiovascular disease (CVD), hypertension, diabetes, arthritis, and some forms of cancer. Research on the prevention of obesity, its management, the role of diet and exercise has contributed enormously to our understanding in the development of obesity. Dr. Gérard Aihaud and his group have contributed the most on the obesogenic aspects of ␻–6 fatty acids. In his paper, ‘Omega–6 Fatty Acids and Excessive Adipose Tissue Development’, Dr. Ailhaud presents evidence showing that excess of adipose tissue at an early age is associated with subsequent overweight and obesity in adulthood. Polyunsaturated fatty acids (PUFAs) of the ␻–6 and ␻–3 series have been shown in rodents not to be equipotent in promoting adipogenesis in vitro and adipose tissue development in vivo (␻–6 PUFAs ⬎⬎ ␻–3 PUFAs) with ␻–3 PUFAs counteracting the adipogenic effects of ␻–6 PUFAs. The biochemical Preface X mechanisms underlying ␻–6 PUFA effects have been demonstrated. Since the 1960s, the increasing prevalence of overweight and obesity in humans has been associated with a positive energy balance. In the meantime, however, and consistent with animal data, consumption of ␻–6 linoleic acid (LA) and arachidonic acid (AA) has increased dramatically and is accompanied by a major increase of the ␻–6/␻–3 ratio in breast milk, formula milk and most consumed foods. Dr. Ailhaud concludes that, ‘Whether prevention appears as the key issue, owing to the continuous presence of adipose precursor cells throughout life and to the slow turnover of fat cells once formed, the status of lipids from the very beginning of the food chain deserves a re-evaluation.’ Despite numerous advances made in identifying the genes for rare, mendelian forms of CVD, relatively little is known about the common, complex forms at the genetic level. Moreover, most genes that have been associated with CVD, whether they are single gene forms or more common forms of the disease, have primarily been involved in biochemical pathways related to what are considered ‘conventional’ risk factors. However, recent genetic studies have begun to identify genes and pathways associated with CVD that would not be considered to underlie conventional risk factors. Dr. Hooman Allayee, in his paper ‘Non-Conventional Genetic Risk Factors for Cardiovascular Disease’, presents the evidence for this latter notion based on genetic studies in humans. The author presents evidence of how a combination of mouse and human genetics led to identification of the 5-lipoxygenase pathway for CVD with potentially important implications for its treatment and diagnosis. Increased dietary AA significantly enhanced the apparent atherogenic effect of genotype, whereas increased dietary intake of ␻–3 fatty acids EPA and DHA blunted this effect. Lastly, the prospects for identifying CVD genes in the future and for potentially developing more effective therapeutic strategies are discussed. The genetics of apolipoprotein E (ApoE) polymorphism is one of the most extensively studied over the past 30 years. There are three common allelic variants (␧2, ␧3 ␧4) producing three protein polymorphisms: E2, E3, E4. ApoE3 is the most common or ‘wild type’. Drs. Angelopoulos and Lowndes, in their paper on ‘ApoE Genotype: Impact on Health, Fitness and Nutrition’, provide an extensive review and conclude that ApoE genotype is associated with plasma lipids and inflammation. ApoE2 isoform is usually associated with lower total cholesterol and low-density lipoprotein (LDL) cholesterol, whereas ApoE4 isoform has higher levels of both. Therefore, the ApoE4 isoform has an overall disease-promoting effect on cardiac health. The effect of regular physical activity on serum total cholesterol, LDL cholesterol, the LDL/high-density lipoprotein (HDL) ratio and LDL particle size may vary with ApoE genotype. ApoE2 and ApoE3 individuals are more responsive and show more favorable lipid changes following exercise interventions. Preface XI The importance of nutrition has been extensively studied and accepted worldwide as an essential factor in health maintenance and in the prevention and management of chronic disease. In developing countries, the problem is sometimes referred to as double burden of disease, where malnutrition exists in the company of growing rates of lifestyle-related diseases such as obesity, diabetes and CVD. The frontiers of science have brought forth new understanding of the links between early undernutrition and the later development of chronic lifestyle-related disease, challenging the nutrition scientist and practitioner to evaluate practice to better support health throughout the life course. Dr. Linda Tapsell, in her paper on ‘Nutrition in the Prevention of Chronic Disease’, emphasizes the impact of birth size on later nutritional challenges and the importance of maternal nutrition, not only in pregnancy but perhaps also in the pre-pregnancy period, and the significance of subsequent nutritional practices at critical times in growth and development. Underpinning this understanding is the role of genetic background on nutritional requirements (nutrigenetics) and the effect of nutrients and food bioactives on genetic expression (nutrigenomics). This whole new enterprise has significant implications for the development of the food supply and of dietary advice to support health. An appreciation of the biological significance of whole foods also becomes a necessary parallel activity to that of consuming food in a way that matches and supports human health. Epigenetics suggest that maternal health, and especially nutrition prior to pregnancy and during fetal life, influence the development of chronic diseases in the offspring. This thinking questions many of the true relationships between diet and health in epidemiologic studies that have not considered the factors that may operate prior to conception and fetal life. Dr. Konstantinos Pavlou, in his paper ‘Exercise and Obesity: Lifestyle Modification as a Means in Prevention and Treatment’, presents a thorough review of the evidence that diet by itself is not adequate to maintain weight loss. Physical activity is essential for weight loss maintenance. Dr. Pavlou discusses the physiologic and metabolic changes that occur by the addition of physical activity, especially in ‘driving up’ the metabolic rate, preserving lean muscle tissue, increasing oxygen uptake, reducing calorie absorption, and suppressing appetite. Dr. Pavlou discusses the evidence that exercise is effective in decreasing the symptoms of depression and anxiety in overweight and obese individuals as well as in hospitalized, manic-depressive patients and in non-hospitalized college students. The author makes the point that ‘Fitness’ needs to be more precisely defined. There is a need to promote diet and fitness and not focus on diet and fatness. It is better to be fit and lean. However, if one cannot be lean, then it is preferable and safer to be ‘fit and fat’ rather than unfit and fat. Although several lines of investigation, including studies of migrant populations, indicate that diet is a major contributor to the etiology of cancer, establishing Preface XII specific nutritional relationships has proven to be elusive. The Multiethnic Cohort Study was established in 1993–1996 to further research on diet, other lifestyle factors, and cancer, and to explore the interactions between environmental exposures and genetic susceptibility in determining cancer risk. Dr. Laurence Kolonel in his paper ‘Nutritional Risk Factors for Gastrointestinal Cancers: The Multiethnic Cohort Study’ describes the study. The cohort consists of 215,000 participants, all of whom completed a self-administered baseline questionnaire that included an extensive quantitative food frequency questionnaire. Recent findings related to gastrointestinal cancers are discussed, including strong inverse associations between colorectal cancer and intake of dietary fiber in men, and intake of total calcium in both men and women. An interaction between intake of folate and alcohol and the C677T polymorphism in the methylenetetrahydrofolate reductase gene is also discussed in the context of diet-gene interactions. Recent results related to pancreatic cancer show a positive association with red meat intake and an inverse association with dark green vegetable intake among smokers. Contrasting findings regarding the effect of obesity (BMI ⱖ30) on pancreatic cancer in men and women are discussed in relation to chronic inflammation and insulin resistance as possible mechanisms. These analyses demonstrate the value of such an ethnically diverse cohort for research on diet, nutrition and cancer. Dr. Federico Leighton et al. in their paper ‘Mediterranean Diets, Global Resource for the Control of Metabolic Syndrome an...
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