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Role of diet in Health & Disease

It is becoming increasingly clear that there is a strong relationship between the food we eat and our health Scientific knowledge of the beneficial role of various nutrients for the prevention and treatment of specific diseases is rapidly accumulating. Malnutrition is an impairment of health resulting from a deficiency, excess or imbalance of nutrients. It includes undernutrition, which refers to a deficiency of calories or one or more essential nutrients. Eg., Vitamin A deficiency, anaemia, B Vitamin deficiencies fluorosis etc.,

A good diet must fulfill the following criteria

It must furnish the appropriate levels of all nutrients to meet the physiologic and biochemical needs of the body at all stages of life cycle. It must avoid excesses of any nutrients that increase the risk of diet related diseases.
Primary prevention implies that the necessary steps are taken to ensure nutritional balance before any detrimental bio-chemical or physical changes can occur.

Functions of Food
First function Nutrition: supply of nutrients

Second function Organoleptic and/or Sociocultural properties


Third function Added value: health benefit

Let food be the medicine and medicine be the food

Hippocrates, 2500years ago

Recent knowledge, however, supports the hypothesis that, beyond meeting nutrition needs, diet may modulate various functions in the body and may play detrimental or beneficial roles in some diseases. In the western world, concepts in nutrition are expanding from the past emphasis on survival, hunger satisfaction, and preventing adverse effects to an emphasis on the use of foods to promote a state of well being and better health and to help reduce the risk of diseases.


400 B. C. Hippocrates used the word diet Nutritional deficiencies --1700-1940 Post WW II shift away from acute deficiencies Later Concerns toward dietary excess-including fat, cholesterol, sodium, sugar

Late 1900s:

Top Ten Causes Of Death In Developed Countries

Heart Disease Cancer Stroke Chronic Obstructive Pulmonary Disease Pneumonia and Influenza Unintentional Injuries AIDS and Infectious Disease Diabetes Mellitus Suicide Chronic Liver Disease

Percentage of Chronic Diseases Potentially Preventable by Lifestyle Modification


% Avoidable

90 80 70 60 50 40 30 20 10 0

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A functional food is any food that exerts health properties beyond the traditional nutrients it contains.

What are functional foods

Functional Foods ; Foods that, by virtue of their physiologically active components, provide health benefits which go beyond basic nutrition There are two categories of functional foods. 1. Foods that naturally contain biologically active, non-nutrient compounds that provide health benefits. These compounds are Phytochemicals which are also sometimes called Nutraceuticals. 2. Food products specifically formulated to have higher amounts of nutrients or phytochemicals than would naturally occur in that food. These are also called designer foods

Designer Foods
The term Designer Foods was coined by National Cancer Institute USA in 1989 to describe foods that naturally contain or are enriched with cancer-preventing substances such as phytochemicals. Subsequently, terms like Functional Foods, Nutraceuticals, Novel Foods came into existence Today, all these interchangeably terms are being used

Are products that have been isolated or purified from foods, demonstrated to have a physiological benefit or to provide protection against chronic disease Generally sold in medicinal forms not usually associated with food

Classically, a drug is any article intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease. National Academy of Science defines a functional food as one that encompasses potentially healthful products, including any modified food or food ingredient that may provide a health benefit beyond the traditional nutrients it contains. Food Nutrition Board modified the functional food as health food to resolve the drug-versus-nutrients concerns.

People with minor ailments

Foods for medical purposes

Health Foods
Healthy People


*(Foods for special dietary uses)

ill people

People concerned about their health

* Powdered milk for pregnant and lactating women * Powdered formula for infants

* Foods for the elderly

Consumer interest in the relationship between diet and health has increased the demand for information on functional foods. Rapid advances in science and technology, increasing healthcare costs, changes in food laws affecting label and product claims, an aging population, and rising interest in attaining wellness through diet are among the factors fueling U.S. interest in functional foods. Credible scientific research indicates many potential health benefits from food components. These benefits could expand the health claims now permitted to be identified by the Food and Drug Administration (FDA

Trends driving Designer Foods

Consumers Double Income, less time More health consciousness Natural self medication Health care professionals New Discoveries

Rapid development of designer foods

Government Regulatory framework for claims

Marketing Companies Search for growth opportunities

Major Health Concerns

Weight Loss
Diabetes (glucose management) Bowel/gut health

Heart/circulatory health
Sodium levels Nutrition/diet

Examples of Functional Components

Carotenoids Beta-carotene : carrots, various fruits neutralizes free radicals which may damage cells; Lutein, Zeaxanthin: kale, collards, spinach, corn, eggs, citrus may contribute to maintenance of healthy vision Lycopene : tomatoes and processed tomato products may contribute to maintenance of prostate health

Dietary (functional and total ) Fiber

Insoluble fiber : may contribute to maintenance of a healthy digestive tract Beta glucan :oat bran, rolled oats, oat flour may reduce risk of coronary heart disease (CHD) Soluble fiber: psyllium seed husk may reduce risk of CHD Whole grains,cereal grains may reduce risk of CHD and cancer; may contribute to maintenance of healthy blood glucose levels

Fatty Acids
Monounsaturated fatty acids (MUFAs) :tree nuts may reduce risk of CHD Polyunsaturated fatty acids (PUFAs) - Omega-3 fatty acids-: walnuts, flax may contribute to maintenance of mental and visual function PUFAs - Omega-3 fatty acidsDHA/EPA :salmon, tuna, marine and other fish oils may reduce risk of CHD; may contribute to maintenance of mental and visual function PUFAs - Conjugated linoleic acid (CLA) :beef and lamb; some cheese may contribute to maintenance of desirable body composition and healthy immune function

Anthocyanidins :berries, cherries, red grapes bolster cellular antioxidant defenses; may contribute to maintenance of brain function FlavanolsCatechins, Epicatechins, Procyanidins :tea, cocoa, chocolate, apples, grapes may contribute to maintenance of heart health Flavanones :citrus foods:neutralize free radicals which may damage cells; bolster cellular antioxidant defenses Flavonols::onions, apples, tea, broccoli : neutralize free radicals which may damage cells; bolster cellular antioxidant defenses Proanthocyanidins:cranberries, cocoa, apples, strawberries, grapes, wine, peanuts, cinnamon: may contribute to maintenance of urinary tract health and heart health Isothiocyanates \Sulforaphane cauliflower, broccoli, broccoli sprouts, cabbage, kale, horseradish may enhance detoxification of undesirable compounds and bolster cellular antioxidant defenses

Inulin, Fructo-oligosaccharides (FOS), Polydextrose whole grains, onions, some fruits, garlic, honey, leeks, fortified foods and beverages may improve gastrointestinal health; may improve calcium absorption Lactobacilli, Bifidobacteria yogurt, other dairy and non-dairy applications may improve gastrointestinal health and systemic immunity

IsoflavonesDaidzein, Genistein soybeans and soy-based foods may contribute to maintenance of bone health, healthy brain and immune function; for women, maintenance of menopausal health Lignans :flax, rye, some vegetables may contribute to maintenance of heart health and healthy immune function

Soy Protein
Soy Protein: soybeans and soybased foods may reduce risk of CHD

Diallyl sulfide, Allyl methyl trisulfide garlic, onions, leeks, scallions may enhance detoxification of undesirable compounds; may contribute to maintenance of heart health and healthy immune function Dithiolthiones cruciferous vegetables contribute to maintenance of healthy immune function

History of functional Foods

Japan is by far and away the most developed market for functional foods, although the Asia-Pacific region generally is an important market for these products.
Consumers have a long held awareness of the role of food in health and functional foods have been regarded as an integral part of the culture for many years

Japan- Research on functional foods began early 1980s when 86 specified research programme on Systematic analysis & Development of food functions Funded by Ministry of Education. Later 1980s & early 1990s. The Ministry again sponsored. Analysis of functional foods and molecular design 1991, The Japanese Ministry of Health & Welfare established labeling regulations for Foods for Specified Health Use (FOSHU) These foods are included as 1 of 4 categories described in Japans Nutrition Improvement law as Foods for dietary uses

Conditions that define FOSHU

It is a food, not in the form of a capsule or powder and should derived from naturally occurring ingredients. It can and should be consumed as part of the daily diet. It has a particular health function when ingested.

> 100 Japanese Companies evolved in development & marketing F.F.

F.F have launched in the following areas Soft drinks Ready meals Breakfast cereals Biscuits Confectionary Milk products Ice creams Salad dressings.

Foods that are used to improve peoples health and for which claims for specific health effects are allowed
Foods that improve intestinal conditions. Foods for those with high cholesterol. Foods for those with blood pressure. Foods related to mineral absorption. Non-Carcinogenic foods. Foods for lowering blood sugar level.

> 70 % of Functional Foods Development in Japan are liquid form i.e.

1988 Otsuka Fibe Mini dietary fibre supplement Coco cola Co. Fibi A Fibre rich soft drink contains high fructose corn syrup, fibre (guargum) caramel colour, flavour, citric acid & Vitamin C. Yakult A Fermented Milk & Bifiel L. A. bacteria sold in 50 ml bottles by Yakult Aunties. Targeted for young women, claims that prevents aging and maintains skin elasticity. (contains Ca, vitamins and oligosaccharides)

Functional Water for Good Skin

Stay slim & Fit & improve skin from inside Contrex, France
Ligne et beaut- Stay slim, improve skin from the inside with fruit Juice, Wheat germ, vitamins C, E, B9, beta carotene & calcium Ligne et Tonus Stay slim & fit with fruit juice, tea & plant extracts, vitamin C, ginseng, calcium & fucus

Hydrates skin, repels free radicals, helps prevent tissue breakdown

Purified Water & activated oxygen. SkinCola, Spain

Energy drinks
Most Popular Category

Functional Sports Water

Orange & Lemon, Citrus

Orange,Lemon Energising mineral water

No Additives/Preservatives Vitamin/Mineral Fortified. Vittel, Germany, UK

Active O2 Sports Waters. High Oxygen content, rich in magnesium & vitamins Adelholzener Alpenquellen, Germany

Functional Water with Isoflavones & Vitamins

Flavors include Blueberry Grape, Lemon Green Tea, Peach Mango, and Strawberry Guava. Apple & Vitamin health drink

Fruit Flavoured water with soy isoflavones.

linked to many health benefits" including: lowering cholesterol, reducing the risk of heart disease, protecting against some cancers, preventing bone loss, treating osteoporosis, and easing menopausal symptoms

Strengthens nails, hair & immune system. Aids digestion, stimulates bone growth. Frankenmarkter, Austria

Soy2O, Leading Brands, USA

Other Functional Beverages

Functional Foods US Perspective

Reasons for increased interest Increased health care costs 14 % of GNP Recent legislation Scientific discoveries Dietary factors CHD & Cancers Consumer interest in Functional Upswing in interest in Foods , physical fitness and overall well being

The Functional Foods in USA evolved differently than Europe

- Diets & life styles

- Consumer marketing forces - Lack of an established & main stream of homeopathic medicine market Gatorade Ist therapeutic isotonic sport beverage.

In 1993, NIH Bionutrition Initiative Connection bet nut. status and human health & disease. Functional Foods industry developed based on the research by Bionutrition Initiative, inclusion of fibre (Oatbran) in products. Next inclusion of other brans Omega fatty acids, antioxidants

Benecol margarine

Stanol esters, which are extracted from pine tree pulp.

Benecol lowers cholesterol.

Brain gum Phosphatidyl serine (PS), a fat like substance extracted from soya beans that is also found naturally in cells, where it help the flow of nerve impulses. Calcium fortified orange juices helps build bone. Folate enriched flour
clinical depression. Echinacea prevents birth defects.

Celestial seasonings St. Johns Wort Tea Mood mender, helps to mild to moderate Fresh Samanthas super juice with Echinacea is a defender of health. promote relaxation.

Kava kava corn chips

Ginkgo biloba is strengthen the mind Alzeimers patients who took ginkgo for three to six month showed a small improvement in mental function.

Three US legislative acts of the 1990s have likely had a significant effect on the promotion of the concept of functional foods. Nutrition Labeling and Education Act (1990) Mandated that FDA establish regulations requiring most foods to have uniform nutrition label and claims about the disease prevention could be made about nutrients in foods. Dietary supplement Health and Education Act (1994) defined dietary supplements as any product that contains one or more dietary ingredients such as vitamins, minerals, herbs or other ingredients used to supplement in the diet. FDA Modernization Act (1997) amended the Federal food drug and cosmetic Act by allowing health claims other than FDA such as National Academy of Sciences or National Institute of Health.

Traditional Europe diet Low in SFAs Low in Sodium & High Dietary fibre Recent years Processed foods Convenience & improved nut Americanization Increased popularity of fast foods

Nutrition Experts Calling for a return to more traditional diet

Development of Functional Food industry in Europe. Europe High level of consumer acceptances & demand for Homeopathic, herbal or botanical medicines Functional Foods. Recently Increased interest in orthomolecular medicine Herbal & botanical extracts

Eg. Garlic, Omega FAs, Oligosaccharides & - carotene

Benecol plant sterol decreases cholesterol. Less Salt 1970s Heikki Karppani Mineral Salt, Low sodium + P & Mg as Pan Salt Exported to 15 Countries. Multi Bean product contains a mix of plant sterols + Minerals. decreasing high blood pressure & Genetic Obesity.

- Omecol cholesterol lowering F. Acids.

- Multifactor grains Rhy bread with fibre. (Ryemax) - Low lactose products

Advantages of functional foods

Some functional foods make it easier to meet requirements for nutrients that are often deficient in American diets. The addition of Calcium to orange juice and the B-vitamin folate to enriched flour are two examples. Some functional foods make it possible to achieve higher intakes of nutrients or phyto chemicals than would be realistic with natural food sources of these compounds

Possible disadvantages of functional foods

Functional foods that contain added nutrients or phytochemicals may send confusing messages about how to plan healthful diets. Calcium-fortified orange juice is an improvement on a food that is already healthful. Calcium-fortified candy or fiber-enriched white bread, on the other hand, involve addition of beneficial substances to foods that are otherwise devoid of healthful properties

Manufactured functional foods cannot duplicate all of the benefits of whole plant foods, some of which are not yet known. For example, plant foods like leafy green vegetables, which are naturally rich in calcium, also provide Vitamin-K and VitaminC, both of which are needed for healthy bones, as well as numerous nutrients and phytochemicals that protect against chronic disease.
A diet based on whole plant foods is likely to be more healthful than one based on functional foods.

Scientific research
The scientific evidence for functional foods and their physiologically active components can be categorized into four distinct areas: (a) clinical trials, (b) animal studies, (c) experimental in vitro laboratory studies, and (d) epidemiological studies. Regardless of the research design, a hypothesis-driven approach to the development of and evaluation of the efficacy of functional foods is paramount to advancing science in this area

Much of the current evidence for functional foods lacks well-designed clinical trials; However, the foundational evidence provided through the other types of scientific investigation is substantial for several of the functional foods and their health-promoting components

Levels of intake

Safe levels of intake must be considered when evaluating functional foods in the context of a healthy diet. For the majority of research studies, the optimal levels of nutrients and other physiologically active components in functional foods have yet to be determined in humans. Animal research has provided some indication of desired intake; however, these data are difficult to extrapolate to human dietary requirements

Many functional foods or food components will require continued in vivo and in vitro research, as well as pharmacokinetic studies, before specific levels can be determined for clinical trial investigations. Once clinical trials have been completed, more specific recommendations can be formulated.

Expanding roles for dietetics professionals Dietetics professionals have a unique opportunity to play a vital and central role in the evaluation and implementation of research studies that are focused on functional foods and their physiologically active components. Research findings will need to be translated into practical information for consumers by knowledgeable dietetics professionals.

Scientific Criteria
Many academic, scientific, and regulatory organizations are considering ways to establish the scientific basis to support claims for functional components or the foods containing them. FDA regulates food products according to their intended use and the nature of claims made on the package.

The future functional food product development will focus in

Infant formula that more closely mimics breast milk. Prescriptive food products for immuno compromised patients. Food products that offer enhanced physiological benefits in inhibiting tumor formation.

credible scientific research is needed to confirm the benefits of any particular food or component. For functional foods to deliver their potential public health benefits, consumers must have a clear understanding of, and a strong confidence level in, the scientific criteria that are used to document health effects and claims.
The scientific community continues to increase its understanding of the potential for functional foods and their role in health.