Fruit

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Fruit Vegetables and the prevention of
diseases the evidence

• Stephen Atkin
• Professor of Endocrinology and Metabolism
• Stephen.atkin_at_hyms.ac.uk

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A balanced diet is very important
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• Five a a day
• Change 4 life   

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The facts

• Vitamins, minerals
• Trace elements
• Obesity
• Cancer

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Vitamins water soluble or fat soluble

• Example of water soluble vitamin Vitamin C
• Citrus and soft fruits, green leafy vegetables.
• Essential for collagen formation, enzyme
  co-factor, anti-oxidant prevention of damaging
  effects of free radicals. Also role in iron
  absorption.
• deficiency scurvy, more mild gum disease,
  loosening of teeth, easy bruising and poor wound
  healing.
• infants (6-12 months).
• Elderly.
• Low income families.

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• Example of fat soluble vitamin ?-carotene
• Yellow, orange and green fruit and vegetables
• Provitamin of Vit A. Vit A essential to processes
  of vision, reproduction, growth and cellular
  differentiati
• Deficiency - Longterm inadequate intakes
  associated with night blindness, susceptibility
  to infection
• Not seen in developed world as multiple sources
  of vit A
• Fortification of margarines

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Minerals
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Magnesium

• green leafy vegetables
• cofactor for many enzymes, required for protein
  synthesis and for both anaerobic and aerobic
  energy synthesis
• Deficiency linked to cardiovascular, skeletal, GI
  and CNS disorders

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Potassium

• Almost all fruit and vegetables
• essential for the maintenance of normal osmotic
  pressure within cells, enzyme cofactor, required
  for secretion of insulin
• Deficiency can cause rapid/irregular heart
  rhythm, muscle weakness

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Trace elements
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• Cobalt
• green leafy vegetables
• essential trace element, integral part of vit
  B12, which is essential for folate and fatty acid
  metabolism,
• molybdenum
• legumes, green leafy veg, cauliflower
• metalloenzyme function

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• manganese
• green veg and tea
• essential component of number of enzymes
• boron
• almost all fruit and veg
• involved in metabolism of various elements
  (including calcium copper and magnesium) glucose,
  triglycerides, oestrogen

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Who needs fruit and veg when you have got it all
in a tablet?
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The biggest threat to the developed world?
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Economic impact of obesity in England

• The estimated annual cost of obesity to the
  economy is
• 3.5 billion for the UK economy
• 18 million sick days
• 40,000 lost years of working life

National Audit Office Report. Tackling Obesity in
England. London, 2001.
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Consequences of obesity in adults

• Associated with increased morbidity and mortality
• Risk factor for range of chronic diseases
• Cardiovascular disease (2-3 fold? risk)
• Type 2 diabetes, hypertension (gt3 fold? risk)
• Some cancers e.g. colorectal, oesophageal, breast
  and endometrial
• Increased likelihood of gallstones,
  osteoarthritis and high blood pressure (in turn
  increasing risk of stroke)
• Increased complications during childbirth

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Childhood obesity parents will live longer than
their children
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Eat well plate
Bread, cereals and potatoes
Fruits and vegetables
Meat, fish and protein alternatives
Milk and dairy products
Foods rich in sugars and fat
Reproduced with kind permission of the Food
Standards Agency
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Plate model (the one you actually eat off)
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Relative risk of health problems associated with
obesity
Disease
Women
Men
Type 2 diabetes Hypertension Myocardial
infarction Colon cancer Angina Gall bladder
disease Ovarian Cancer Osteoarthritis Stroke
12.7 4.2 3.2 2.7 1.8 1.8 1.7 1.4 1.3
5.2 2.6 1.5 3.0 1.8 1.8 - 1.9 1.3
National Audit Office Report. Tackling Obesity in
England. London, 2001.
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Cancer

• Antioxidant effects of vitamins
• Antioxidants such as vitamins C, E and A (in the
  form of carotenes) protect cells from toxic by
  products formed in the body
• Free radicals
• oxidation

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FSA review of antioxidants in foods

• Disease prevention of antioxidants lower heart
  disease and cancer deaths
• Do not get these effects from supps need the
  complex of substances in fruit/veg

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Heart disease

• Free radicals
• oxidation of cholesterol
• LDL
• Atherosclerosis heart disease

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Stroke

• Meta analysis of 8 studies including 257 551
  individuals
• Compared with individuals who had less than three
  servings of fruit and vegetables per day, showed
  that fruit and vegetables had a significant
  protective effect on both ischaemic and
  haemorrhagic stroke

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The evidence

• Large well designed studies investigating effects
  of supplements no evidence of benefit in cancer
  or heart disease
• 7 studies vitamin E supplementation
• 8 studies Beta carotene

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• dietary sources linked to lower rate of heart
  disease, for example the tomato
• vitamin C
• vitamins A and B,
• potassium, iron and phosphorus.
• Lycopene

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The humble apple Vitamin A 67.5 IU Vitamin
C 5.7mg Vitamin E (Alpha Tocopherol) 0.2mg Vitam
in K 2.8mcg Niacin 0.1mg Vitamin
B6 0.1mg Folic acid 3.8mcg Pantothenic
Acid 0.1mg Choline 4.2mg Minerals Amounts
Per Serving Calcium 7.5mg Iron 0.1mg Magnesi
um 6.3mg Phosphorus 13.8mg Potassium 134mg S
odium 1.3mg Fluoride 4.1mcg  
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Fibre

• Fibre populations with high fibre intake tend
  to have low risk of colon cancer (UKs third most
  common cancer, claiming 18,000 lives in the UK
  each year)
• Eating plenty fresh fruit and veg thought to
  prevent against this.
• Insoluble fibre fruit and veg contain this,
  keeps bowels healthy and stop constipation

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Fibre

• Breast cancer
• Foods rich in this are more bulky so help make us
  feel full, which means we are less likely to eat
  too much.

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Fibre content of fruit/veg (standard portion or
one piece) g RDA Carrot 4.0 14 Broccoli
2.0 9 Peas 4.0 14 Spinach 2.0 7 Apple 3
.0 12 Orange 4.0 14 Banana 6.0 23 Peach
3.0 12 Strawberries 3.0 12 White bread
1.0 4 Wholemeal bread 2.0 8 Pasta 2.5 10
Rice 1.0 4 (bread per slice approx)
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Conclusion

• Robust evidence that fruit and vegetables have
  added benefits globally for health that you
  cannot get by replacing them with pills and
  tablets