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Food for thought: How functional
ingredients can help tackle (age-related) cardiometabolic disorders
Sumanto Haldar
Clinical Nutrition Research Centre, Singapore
Presentation Overview
• Prevalence of ageing and the associated increase in
cardiometabolic disease risk in Asia
• Foods and Food Components believed to contribute to
or alleviate risk of cardiometabolic diseases
• Some recent research at the Clinical Nutrition Research
Centre (CNRC) Singapore
World population aged > 60 years
World Population Ageing 2013, United Nations
World population pyramids
Harper S, Science (2014) 346: 587-591
Years lived with disability 1990-2016
Years lived with
disability has not
improved since the
1990s despite
improvements in life
expectancy
Lancet (2017) 390:
1211-1259
Age associated chronic “disorders”
• Obesity
• Diabetes
• Heart disease
• Cancer
• Cognitive decline
• Poor mobility
Epidemic of obesity in Singapore
HPB-MOH Clinical Practice
Guidelines 1/2016
Moderate-risk – 23-27.4 kg/m2
High-risk – ≥ 27.5 kg/m2
> 50% Singaporeans
have a moderate to high
risk BMI
Age-related increase in obesity
• Despite reductions in
energy intake and/appetite
with increasing age
• Lower total energy
expenditure (TEE)
Phys Rev 2006 86: 661-667
BMC Public Health 2012 12: 658
Asians have different body fat composition and
distribution
Adv Food Nutr Res 2015, 75: 97-154
Type 2 diabetes occurs at a lower BMI in
Asians
RCW Ma et al, Ann N Y Acad Sci (2013); 128: 64-91
Study in Asian adolescents
Elsamadony A et al, Obesity (2017), 25: 1974-1979
427 Asian and 306 non-
Asian 14-19 years old
Asians had:
- WC, BMI
- TG
Asians had higher
insulin resitance for a
given excess weight
WC change between 1990s and 2010s at BMI 25 Kg/m2
Albrecht SS et al, Eur J Clin Nutr (2015), 69: 1312
So simply fixing energy imbalance will
NOT solve the problem
• While short-term weight loss can be achieved
through calorie restriction, the biological relevance
may be limited
• Obesity and associated cardiometabolic
diseases have a multifactorial and multicomponent
aetiology (beyond energy balance)
– 1 nutrient 1 disease or condition
Dietary pattern vs single nutrients
Zheng Y et al, Nat. Rev. Endo. 2018; 14: 88-98
Mozaffarian D, Circulation 2016; 133: 187-225
Calorie content of two meals
1575 kcal 1575 kcalProf. Barbara Rolls, Pennsylvania State University
Dietary energy density and obesity
Higher the dietary
energy density (kcal/g)
the greater the
propensity for adiposity
Eur J Nutr (2015) 54:
59-65
Refined grain intake and metabolic
syndrome risk – CURES study
> 2000 individuals
Higher refined grain
intake associated with:
- WC
- BP
- FBG
- TG, LDL-C
- HOMA-IR
Metab Clin Exp (2009)
58: 675-681
Adding legumes to rice decreases its GR
Crossover RCT in T2D
patients (n=17, 35-70 yrs)
Served 50 g available CHO
Rice +/- legumes
- in PPG from 90 min
onwards with all bean
types
Nut J (2012) 11: 23
Non-soy legumes and lipid profile
Meta-analysis of 10 RCTs ≥ 3
wks duration (n=268)
- Total Cholesterol
- LDL-Cholesterol
- TG (marginal p)
Nut Metab Cardiov Dis (2011)
21: 94-103
Carob extract juice vs sucrose beverage
HbA1C
Mean glucose
after main
meals
Fasting
glucose
Oxidative
stress in PBLs
12 week double-blind RCTs in 38 T2Ds
Focus needs to be on ‘beneficial’ dietary
pattern based on improved food quality• Reduce
– Rapidly digested, (refined) carbohydrates
– Processed meats
– Sodium and trans fat
– Added sugar
• Increase
– Fruits and non-starchy vegetables
– Legumes and nuts
– Whole grains
– Fish
• Choose foods that are less calorie dense but more nutrient
dense
Foods and dietary patterns more relevant
than single nutrients
• Importance of food based guidelines – individual relates to foods
better than nutrients
• More effective to make concerted but small changes in several
dietary factors rather than a big change in one factor
• Consideration needs to be made on food matrix, food processing
and food preparation
• “Diet quality independent of energy imbalance can influence
metabolic risk and propensity towards abdominal adiposity”
- Mozaffarian D, Circulation 2016; 133: 187-225
Clinical Nutrition Research Centre
(CNRC)
Our Vision:To develop an integrated program that understands how
food, food components and processing may be used to
minimize risk of obesity, diabetes, CVD and promote
healthy aging, within the Asian dietary context, in Asians
https://www.a-star.edu.sg/cnrc
CNRC Facilities
Facilities
CALORIMETERS
SPECIALIZED LABORATORIES
& EQUIPMENT
OTHER MONITORING
CAPABILITIES
BODY COMPOSITION
• Blood Biochemistry and
Analytical Labs
• Food Chemistry Analysis
Labs
• In vitro Digestion System
• Product Development
Kitchen
• Sensory Analysis Booths
• Computer-based Cognitive
Testing Booths
• Treadmill and Ergometer
Room
• Clinical Suites
• Continuous Glucose Monitoring
Systems (CGMS)
• Hyperinsulinemic Euglycemic
Clamp
• Ambulatory Blood Pressure
Monitoring (ABPM)
• Peripheral artery tonometry
(EndoPAT)
• Electromyography Measurements
• Muscle Biopsy
• Infra-red (IR) Camera Imaging
• Micro Oxygen Sensors
• Whole-body
Calorimeters
• Indirect Calorimeter
(Basal Metabolic Rate
measurement)
• COSMED BodPod® and
PeaPod® Scanning
(Air Displacement
Plethysmography)
• Dual-energy X-ray
Absorptiometry (DEXA)
Scanning
Ambulatory
blood pressure
monitoring
Triaxial
accelerometer
EndoPAT
Continuous
Glucose Monitor
Sucrose (Table sugar) Isomaltulose
α1, 2-glycosidic bondGlycemic Index: 65Energy: 4 kcal/gFood source: Sugar cane
α1, 6-glycosidic bondGlycemic Index: 32Energy: 4 kcal/gFood source: Honey
65 32
Effect of inclusion of isomaltulose in beverages along with
low-GI meals on 24h GR in Chinese males
-0.5
0.0
0.5
1.0
1.5
2.0
2.50
60
12
0
18
0
24
0
30
0
36
0
42
0
48
0
54
0
60
0
66
0
72
0
78
0
84
0
90
0
96
0
10
20
10
80
11
40
12
00
12
60
13
20
13
80
14
4024
h in
crem
enta
l ch
ange
in g
luco
se
(mm
ol/
L)
time (min)
low GI high GI
10h inside whole body calorimeter
Dinner
Breakfast
Lunch
Snack
Inclusion Isomaltulose or sucrose
during the test meals:
30g with dinner in fruit drink
30g with breakfast added to tea
20g with lunch in fruit drink
20g with snack added to tean = 20
age: 21-29
BMI:18-29
Henry CJ et al. Nutrients. 2017 ; 9(5): E473.
Beta-glucan
OatsBarley
• Soluble fiber obtained from:
Barley and oats
• EFSA approved ingredient
• 4 g/30 g dry weight portion
Food applications:
Yellow noodles Beta-glucan powder
Beta-glucan yellow noodles
Glycemic response and glycemic index of various noodles
-1.0
1.0
3.0
5.0
0 15 30 45 60 75 90 105 120Ch
an
ge in
b
loo
d g
luc
os
e
(mm
ol/L
)
Time (mins)
Glucose reference
Noodles
Beta-glucan noodles
Addition of plant protein isolates in sugar
sweetened milkshake
Beverage Energy
(kJ)
Available
Carbohydrate
(g)
Protein
(g)
Fat
(g)
Fibre
(g)
Weight
(g)
Control 1252 50 3 10 4 400
Oats 1672 50 27 10 5 400
Pea 1680 50 27 10 4 400
Rice 1672 50 27 10 5 400
Ingredients:
• Water
• Sucrose
• Hershey chocolate powder
• Thick cream
• Protein powder (to ↑ 24g protein)
Effect of addition of plant protein isolates on
glucose homeostasis
Tan SY et al. Eur. J. Nutr. 2017 DOI 10.1007/s00394-017-1547-3
Dietary bioactives as functional foods to improve
cardiometabolic health
Polyphenol intake and CMD risk
PolySPice (PSP) Study
• Whether consuming polyphenol rich mixed spices and base vegetables used as curry ingredients can improve postprandial glucose control in healthy volunteers?
• Specific outcome measures included: – Total polyphenol content (TPC) and urinary polyphenol excretion
– 24 h glucose (using CGM) and postprandial insulin, TG responses
– Gut hormone (e.g., GLP-1, ghrelin) and subjective appetite responses
Total Polyphenol Content (TPC) of test meals using
Folin-Ciocalteu assay
D0C – Dose 0 Control (0 g spices)
D1C – Dose 1 Curry (6 g spices)
D2C – Dose 2 Curry (12 g spices)
Values represent mean ± SD (n=6).
****P ≤ 0.0001
Haldar et al Eur J Nutr 2017
Mean incremental Glucose concentration
p for linear trend < 0.05
Haldar et al Eur J Nutr 2017
Postprandial GLP-1 and Insulin concentrations
As compared with D0C
Mean iAUCPB D1C = -6%
Mean iAUCPB D2C = -15%
p for trend = 0.089
As compared with D0C
Mean iAUCPB D1C = +28%
Mean iAUCPB D2C = +45%
p for linear trend <0.05
Haldar et al Eur J Nutr 2017
Haldar et al Eur J Clin Nutr 2018; 72: 297-300
Cocoa flavanol and CVD risk
Adding mangosteen pericarp waste to enhance
functional properties of dark chocolate
• Increase in total polyphenol contents (TPC) of both
regular and compound chocolates
• Without compromising sensory aspects
Phytochemical Rich Ingredients as Functional
Foods (PRIFF) Study
300,000 known
plant species100,000 used by
humankind
30000
Edible
7000 used as food
at local level120 Important at national
scale
30 provide 90% of plant
calories
3 provide
60% calories
(rice wheat
maize)
Need to better explore biodiversity to alleviate the risk of
age-associated chronic diseases?
Summary
• Ageing is associated with metabolic dysfunction
• Healthy metabolism is more than just calorie balance
• Functional ingredients can play important roles in reducing obesity and
age associated cardiometabolic disease risk
• Adherence to dietary patterns that are more nutrient dense (e.g.,
phytochemical rich) rather than energy dense should be encouraged
• Given the biodiversity of edible plants and plant products within Asia, the
opportunity to intervene to favorably modulate CMD risk is promising!
CNRC Team
Thank you!
https://www.a-star.edu.sg/cnrc
“I am grateful to old age because it has
increased my desire for good
conversation and decreased my desire
for good food.”
—Cicero, DeSenectute, 43 B.C.
“I am grateful to old age because it has
increased my desire for good
conversation AND INCREASED my
desire for good food in order to
enhance healthy ageing”
—Unknown, 2018 A.D.