1 Food Matters Live 2014
Copyright © Global Stevia Institute 2014. All Rights Reserved.
Food Matters: Identifying the key consumer trends in weight management
Identifying key consumer trends- shape and natural
Dr. Margaret Ashwell OBE, Independent Scientific Consultant, Advisory Board Member,
Global Stevia Institute (GSI) 19th November, 2014
Trend #1 Focussing on Shape (waist-to-height ratio ) and not weight
Trend #2: Focussing on sweeteners of natural origin such as stevia
2 Food Matters Live 2014
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Trend #1 Focussing on Shape (waist-to-height) and not weight
2
One simple strategy to help the global obesity epidemic:
Focus prevention and treatment on those with central obesity- screened using WHtR
WHtR=0.5
“You should keep your waist circumference to less than half your height!”
BMI= BURY ME
IMMEDIATELY!
3 Food Matters Live 2014
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München, 11.3.2009
Danny de Vito
Ht=154 cm
85 kg
BMI 35
Waist =110
WHtR=0.71
Arnold Schwarzenegger
Ht=188 cm
120kg
BMI 34
Waist = 90cm
WHtR=0.47
Why Shape? Arnie and Danny have same BMI, but only Danny has WHtR well
The submarine (any
proxy for central body
fat) can see below the
surface
Increased insulin
Increased
pro-coagulant
activity
Increased
oxidised
LDL
Increased
triglycerides
Low HDL
Small, Dense LDL
Increased
platelet
aggregation
Increased
homocysteine
Glucose
Intolerance
BMI (Total obesity)
The Titanic can only see the tip of
the iceberg
Only sees
the
established
conditions
Prevent the
major
problems by
early detection
of risk factors
Insulin
resistance
Heart
disease
Why Shape? Many more risk
factors for CVD can be
detected earlier by measuring
central body fat rather than
BMI
Diabetes
Increased
blood pressure
Despres,1999 4
Release of
free fatty
acids(FFA) and
inflammatory
factors
5 Food Matters Live 2014
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Why Shape? Waist-to-height ratio is a better predictor of cardiometabolic risk facts than BMI
ASHWELL, M., GUNN, P. & GIBSON, S. 2012. Waist-to-
height ratio is a better screening tool than waist
circumference and BMI for adult cardiometabolic
risk factors: systematic review and meta-analysis.
Obes Rev, 13, 275-86.
For the first time, robust statistical evidence from 31 studies involving more than 300,000 adults in several ethnic groups, shows the superiority of
WHtR over WC and BMI for detecting cardiometabolic risk factors in both sexes.
6 Food Matters Live 2014
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BMI deciles
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
1 2 3 4 5 6 7 8 9 10
BMI deciles
mort
alit
y r
ate
%
male
female
Waist to height ratio
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
1 2 3 4 5 6 7 8 9 10
WHtR decilesm
ort
ality
ra
te %
male
female
There is a clearer correlation between WHtR and mortality rates than BMI and mortality rates(P<0.01).
Mo
rtal
ity
rate
(%
)
Ashwell M, Mayhew L, Richardson R, Rickayzen B (2014) Waist-to-height ratio is more predictive of years of life lost than body mass index. PLOS One 9, e103483
Why Shape? Stronger link between shape (WHtR) and mortality rates than between BMI and Mortality rates (using HALS 20 year follow-up data, 1985 to 2005)
7 Food Matters Live 2014
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7
Early edition Sunday Times 7/9/14 Later edition Sunday Times
Spot the Difference
8 Food Matters Live 2014
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0
4
8
12
16
20
24
< 0
.36
0.3
6
0.3
8
0.4
0.4
2
0.4
4
0.4
6
0.4
8
0.5
0.5
2
0.5
4
0.5
6
0.5
8
0.6
0.6
2
0.6
4
0.6
6
0.6
8
0.7
0.7
2
0.7
4
0.7
6
0.7
8
≥ 0
.8
Waist-to-height ratio (WHtR)
ye
ars
of lif
e lo
st (Y
LL
)
age 30
age 50
age 70
Minimum YLL at WHtR 0.4 to 0.5 ‘OK’
Take action WHtR>0.6
OK WHtR0.4-0.5
Consider action WHtR 0.5-0.6
Take care WHtR<0.4
Slightly Increased YLL at WHtR 0.5 to 0.6 ‘Consider action’
Much increased YLL at WHtR >0.6 ‘Take action’
Slight Increased YLL at WHtR <0.4 ‘Take Care’
Years of life lost (YLL) for men by waist-to-height ratio
Why Shape? Mortality data lends support to the boundary values of Ashwell ® Shape Chart
9 Food Matters Live 2014
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NDNS data (2008-2012) 1170 adults aged 19-64y
Ashwell and Gibson BMC Medicine (2014) 12,207
Why Shape? 28% of U.K. adults classified as “normal” by BMI have WHtR>0.5 They would be misclassified as ‘not at risk’ by BMI screening.
10 Food Matters Live 2014
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Trend #2 Focussing on sweeteners of natural origin such as stevia
Stevia is anew type of sweet
Sugar “Artificial”
Sweeteners
Stevia Naturally Sourced,
Low Calorie Sweetener (LCS)
11 Food Matters Live 2014
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Mauro Fisberg, MD PhD Pediatric Physician, Nutrition Scientist, and Professor, Federal University of
Sao Paulo, Brazil
Bernadene Magnuson, PhD Food toxicologist specializing in ingredient and sweetener safety and regulation,
Professor, University of Toronto, Canada
Margaret Ashwell OBE, PhD Independent Scientist, specializing in
nutrition & obesity, UK
Board of Scientific Advisors from around the world
Keith Ayoob, EdD, RDN Internationally-known nutritionist, author, and Professor of Pediatrics, Albert Einstein School of Medicine,
USA Ursula Wölwer-Rieck, PhD Institut Prof. Dr. Georg Kurz GmbH,
Bonn University, Cologne, Germany
Juana Morillas-Ruiz, PhD Faculty of Health Sciences, San Antonio Catholic University
of Murcia, Spain
For more information on the science of stevia, visit www.GlobalSteviaInstitute.com
Rachel Cheatham, PhD Executive Director of the GSI PhD Nutritional Biochemist, Communications Professional and Professor of Food Marketing at Tufts university in Boston Chicago, USA
12 Food Matters Live 2014
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Stevia is available in foods and beverages throughout Europe
13 Food Matters Live 2014
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The science of stevia
What is stevia? –Origin
–Extraction
–Definitions
–Chemistry and physiology
–Benefits
–Safety
Stevia and weight/waist management
Conclusions
14 Food Matters Live 2014
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Stevia is a plant native to South America
Grows as a perennial small shrub
Used as a sweet herb for hundreds of years
Dr. Bertoni discovered stevia in Paraguay in 1887
First used as a commercial sweetener 40 years ago in Japan
Now grown in 5 continents as a sustainable and profitable crop
China leads the world in stevia production
15 Food Matters Live 2014
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Stevia extraction process: From farm to ingredient Dry Stevia Leaves
Water Extraction (steep in water)
Filtration (remove small leafy particles)
Activated Carbon Treatment (remove organic residues)
Ion Exchange Treatment (remove minerals)
Absorption/Desorption Resin (Concentrate Glycosides)
Spray Drying
Stevia Extract
16 Food Matters Live 2014
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Stevia: Generic term used to refer to different forms of the sweetener, including:
the whole plant Stevia (Rebaudiana Bertoni); the leaves where the sweet compounds are found;
Stevia extract: A generic name for a preparation made by steeping the leaves of the Stevia plant to extract the sweet compounds from the leaf material.
Purified Stevia Leaf Extract: High purity stevia leaf extract contains 95% or greater steviol glycosides. Only high purity stevia extracts meeting this specification are approved by major regulatory agencies, including JECFA and CODEX for use in foods and beverages.
The term "stevia" as used in this presentation refers to high purity stevia leaf extract
Stevia Definitions
17 Food Matters Live 2014
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Stevia’s sweet components are called steviol glycosides
Natural compounds in the stevia leaf
Have a common steviol backbone (a terpene)
Number of sugars and their arrangement on sites of
steviol backbone vary (R1, R2) in the different
glycosides
Each steviol glycoside has unique taste and sweetness
profile
18 Food Matters Live 2014
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Sweetening power of 11 main glycosides in the stevia plant
The sweetness of about three stevia leaves can replace the sweetness of sugar in a 330ml can of sugar-reduced (25%) carbonated soft drink.
Stevioside and Rebaudioside A together make up 14-18% of leaf content
19 Food Matters Live 2014
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What happens to steviol glycosides in the body? Why zero caloric impact?
O glucoseO
glucose
glucose
O
glucose
H
H
CH3CH2
O
CH3
O
Upper GI tract •steviol glycosides are not digested •pass straight into into colon
Colon glucose removed from
side chains of glycosides
fermented by bacteria (insignificant calories produced)
steviol backbone remains
and is modified by liver to
steviol glucuronides excreted in urine
H O
H
H
C H 3 C H 2
O
C H 3
O H
No accumulation of stevia (or any component or by-product of stevia) in the body
20 Food Matters Live 2014
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Summary of Stevia Benefits
• Sweet ingredient in foods and beverages
• Natural origin, plant-based • Zero calories • Appropriate for diabetics • Suitable for whole family, including
children and pregnant women • Tooth friendly • Suitable for cooking, ideal for a range
of food and beverages • pH, heat, and shelf stable
21 Food Matters Live 2014
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Stevia safety
All major global markets have approved the use of high purity stevia leaf extract in foods and beverages for use by the general population,
which includes children and pregnant women.
Over 200 studies have been reviewed to gain approval
22 Food Matters Live 2014
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Steviol glycoside worldwide regulatory approval
Regulatory Authorities/Organization Key Outcome/Observations
Joint (FAO & WHO) Expert Committee on Food Additives (JECFA)
Reviewed safety and established Acceptable Daily Intake (ADI) for stevia (>95% steviol glycosides)
Food Standards Authority of Australia and New Zealand (FSANZ)
Steviol glycosides approved as food additive in Australia and New Zealand; “unlikely to have adverse effects on blood pressure, blood glucose”
United States Food and Drug Administration (FDA)
No Objections to Generally Recognized as Safe (GRAS) status (Issued in 26 separate notices)
French food safety agency (AFSSA) Approved stevia ( ≥97% Reb A) in food and beverages
European Food Safety Authority (EFSA) Pan-European Approval “Steviol glycosides…..are not carcinogenic, genotoxic or associated with any reproductive/developmental toxicity.”
Health Canada (HC) “….evaluation of available data support the safety and efficacy of steviol glycosides”
23 Food Matters Live 2014
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In Europe, EFSA gave safety report in 2010; EC gave approval for use in products in 2011
24 Food Matters Live 2014
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High purity stevia extract is safe for the whole family
25 Food Matters Live 2014
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The science of stevia
What is stevia? –Origin
–Extraction
–Definitions
–Chemistry and physiology
–Benefits
–Safety
Stevia and weight/shape management
Conclusions
26 Food Matters Live 2014
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Many studies on stevia have produced results confirming
its safety, and one study showed stevia had no effect on
satiety ( Anton et al, 2010). But there are no long term
trials which look at the effectiveness of stevia in weight
control.
We have no reason to believe that the effectiveness of
stevia replacing sugar in drinks and foods would lead to
different conclusions from those obtained with other low
calorie sweeteners (LCS).
More research in humans will be important to clarify the
role of stevia in long-term energy reduction.
In the meantime, let’s look at studies with other LCS
Does replacement of caloric sweeteners with stevia facilitate weight/waist loss or weight maintenance by helping reduce energy intake?
27 Food Matters Live 2014
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In RCTs , use of LCS is associated with loss of BMI, fat mass and waist circumference (Miller and Perez, 2014)
28 Food Matters Live 2014
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Summary: Identifying key consumer trends - shape and natural Trend #1 Focussing on Shape (waist-to-height ratio ) and
not weight
Waist-to-height ratio is a better predictor of morbidity and mortality than BMI
“Keep your waist to less than half your height” is a simple Shape message for all
Trend #2: Focussing on sweeteners of natural origin such as stevia
Stevia is a new zero calorie sweetener of natural origin with any benefits
Stevia has safety approved worldwide for all target groups
Effectiveness results similar to other LCS likely to be obtained with foods/drinks sweetened with stevia