Tackling Chronic Diseases: the Tackling Chronic Diseases: the Potential of Preventive Potential of Preventive

Medicine through Medicine through Improvements to DietImprovements to Diet

Cathie Martin, MA, PhD, ProfessorDepartment of Metabolic BiologyJohn Innes CentreNorwich Research Park,United Kingdom Niels Bohr Professor,Department of Plant Biology and BiotechnologyCopenhagen University,Denmark

May 2009

Other chronic disease 9%

Injuries 9% Respiratory 7%Diabetes 2%

Communicable diseasesmaternal and perinatal

nutritional deficiencies 30%

Cardiovascular disease 30%

Cancer 13%

Source: World Health Organisation

Leading causes of death worldwide, 2005

2005

Facts:Facts:

• The total number of people dying from chronic diseases is twice the number of people dying from infectious diseases including HIV/AIDS.

• 80% of mortality from chronic disease occurs in low and middle income countries

• The poor are more vulnerable to chronic disease because of increased exposure to risks and decreased access to health care

• Chronic diseases cause poverty• Without action deaths from chronic diseases will

increase by 17% between 2005 and 2015 (WHO report 2005)

Cardiovascular disease (CVD) Diabetes Obesity Cancers Respiratory diseases

Chronic Conditions:Chronic Conditions:

Chronic conditions, including cardiovascular diseases (CVD), diabetes, obesity, cancers and respiratory diseases, account

for 59% of the 57 million deaths annually and 46% of the global burden of disease.

Of those with chronic conditions 60% are between the ages of 18 and 64. 90% of seniors have at least onechronic disease and 77% have two or more chronic

diseases.

Globally, chronic disease is projected to cause 388 million

deaths in the next 10 years

Socio-Behavioural Risk Factors for Chronic Disease

OBESITY

Obesity is a major emerging disease, particularly

afflicting the poor.

Obesity has a strong correlation with the incidence of

several degenerative diseases, such as type II diabetes,

glucose intolerance, cardiovascular disease, and cancer.

Obesity is reaching epidemic proportions

Even in Italy obesity is becoming a problem particularly in the young

What can plant science do to combat chronic disease?

Emphasise the good things in food

Objectives: To generate defined dietary material (model foods) to test the impact of specific flavonoids on cardiovascular and age-related degenerative diseases in a whole food context using animal model systems.

EU: FP6

To find out what foods are good for you

Special dietsIntroduction of 20% of corn seeds powder in a standard pellet formula

Effects on ex vivo

myocardial infarction

Effects on vascular reactivity

8-week treatment(~15 mg/kg/day)

Control line (r1)Control line (r1)Genotype: Genotype: p1r1c1A1p1r1c1A1

Flavo-enriched line Flavo-enriched line (ACR)(ACR)

Genotype: p1R1C1A1Genotype: p1R1C1A1

Example of TTC staining for infarct size Example of TTC staining for infarct size determinationdetermination

Risk Zone+ =

Group r1

Group ACR

Infarcted zone(white)

Ischemic viable zone

(red)

Non-ischemic Zone (blue)

Marie-Claire Toufektsian, Michel de Lorgeril

Infarct SizeInfarct Size

Marie-Claire Toufektsian, Michel de Lorgeril

AnthocyaninsAnthocyanins offer offer cardioprotection against cardioprotection against

ischaemia/reperfusion injuryischaemia/reperfusion injury

National Cancer Institute and National Cancer Institute and National Research Council in the USNational Research Council in the US

recommend:recommend:

5 servings of fruit and/or vegetables5 servings of fruit and/or vegetables per dayper day

(www.5aday.org)(www.5aday.org)

Out of 15,000 surveyed only 23%Out of 15,000 surveyed only 23% Americans achieved this intakeAmericans achieved this intake

More worryingly the numbers attaining 5-a-day have decreased over the

past 10 years

Using genetic engineering Using genetic engineering techniques we can develop techniques we can develop

healthier foods, rapidlyhealthier foods, rapidly

del/rosdel/ros (line N)(line N)

del/rosdel/ros (line C)(line C)

WTWT

del/rosdel/ros (line N)(line N)

Antioxidant capacity of purple compared to red tomatoes

Eugenio Butelli, Cathie Martin

p53-/p53- knockout mice

Red tomato – supplementedpellets

Purple tomato –supplementedpellets

Life span, pathology

Diet Number of mice

AverageLifespan (days)

Std Error

MaximumLifespan(days)

Standard diet 24 142.0 8.7 211

Diet supplemented with 10% red tomato powder

15 145.9 12.6 213

Diet supplemented with 10% purple tomato powder

20 182.2 8.6 260

Lucilla Titta, Marco Giorgio

So what can society do about chronic disease?

Grand challenges in chronic non-communicable diseases: The top 20 policy and research priorities for conditions such as diabetes, stroke and heart disease.

Nature, 450, 494-496 22 November 2007

Sponsored by the Oxford Health Alliance

Many chronic conditions could be prevented:

• 36 Million of the projected deaths from chronic disease could be avoided by 2015

• 50% of avoided deaths would be in people <70 years old

• Economic impact would be enormous: calculated loss in national income to chronic disease in UK is: $33Billion

Commentary posted by Rachel Nugent

Alas, this Grand Challenge has no money, no Foundation, no benefactor. Indeed, it is a kind of reverse Grand Challenge, as it consists of scientists telling us what needs to be done to address chronic NCDs and hoping that someone will pony up the money

to do it.

Increase the availability and Increase the availability and consumption of healthy foodconsumption of healthy food

We need to start by ensuring that children eat well

Jamie Oliver

…….we need second generation GMOs

to help combat chronic disease

One important feature of the tomato study One important feature of the tomato study was that it showed that genetic modification was that it showed that genetic modification is not just a generic technology that is either is not just a generic technology that is either good or bad, but that very different things good or bad, but that very different things can be done with genetic modification of can be done with genetic modification of plants—including the development of plants—including the development of products that have very real advantages for products that have very real advantages for consumers.consumers.

This displaces the debate from ‘it is alright This displaces the debate from ‘it is alright for them’.for them’.

• Research on functional foods is best Research on functional foods is best undertaken by publicly-funded undertaken by publicly-funded organisations:organisations:

To promote consumer confidence in To promote consumer confidence in the resultsthe results

To access and assess the entire range To access and assess the entire range of health-promoting phytonutrients not of health-promoting phytonutrients not just those of commercial interestjust those of commercial interest

• But the regulatory burden is too costly for ‘not-for-But the regulatory burden is too costly for ‘not-for-profit’ organisations to bring improved GMO profit’ organisations to bring improved GMO products to the consumerproducts to the consumer

• The social burden is also very heavy in undertaking The social burden is also very heavy in undertaking this research:this research:

One really has to wonder exactly who this tomato One really has to wonder exactly who this tomato will benefitwill benefit, asked VAS's biosecurity representative, , asked VAS's biosecurity representative, Simona Capogna. Simona Capogna. It will undoubtedly help those who It will undoubtedly help those who hold the patent, those firms that sell it (at an inflated hold the patent, those firms that sell it (at an inflated price) and those researchers who use it as a career price) and those researchers who use it as a career move or who buy shares in biotech firms……move or who buy shares in biotech firms……

Detractors do not believe it is possible to use GM Detractors do not believe it is possible to use GM technology for the ‘common good’.technology for the ‘common good’.

The Future?The Future?