Three recent major statements on the prevention or treatment of food-related chronic diseases, two from the USA and one from Europe, should give us pause, for one reason or another.
Waist is best to assess cardio-metabolic risk
A position statement from the American Society for NutritionReference Klein, Allison, Heymsfield, Kelley, Leibel and Nonas1–Reference Klein, Allison, Heymsfield, Kelley, Leibel and Nonas3 supports those of us who have always been slightly sceptical about BMI as the best test of body fatness. Doing anthropometric measurements on athletes does that to you! The statement prefers waist circumference for monitoring patients at risk and their response to weight-loss programmes, or when taking decisions on which patients should be evaluated for hyperlipidaemia or hyperglycaemia.
The statement also recommends the development of new cut-off levels for waist circumference for use in clinical practice, because the previously suggested levels4 have been seen to be of limited value. A number of factors are suggested as necessary to take into account when establishing a more useful waist circumference cut-off level than the present; i.e. gender, age, BMI, race and ethnicity.
This consensus statement should be especially useful in training programmes and in the design of new studies. It provides a nice overview of the measurement technique, the anatomical relationships, the biological mechanisms, and – in particular – the power of waist circumference to predict cardio-metabolic outcomes.
Less energy-dense food – less heavy body
Reduction in dietary energy density causes weight loss. This is shown once again by results from an American trialReference Ledikwe, Rolls, Smiciklas-Wright, Mitchell, Ard and Champagne5. The study investigated the effects of energy density in the diet on health measures, including anthropometry, in three different interventions.
The trick when working on energy density seems to be to exclude the fluid (drinks) content from the calculations, as has been reported earlierReference Ledikwe, Blanck, Khan, Serdula, Seymour and Tohill6. The authors conclude that achievement of considerable weight loss was causally related to reductions in energy density of diets, and that even modest reductions in energy density were associated with reduced body weight.
White paper – should try harder
A white paper on a strategy for Europe on nutrition and on overweight- and obesity-related health issues7 was launched by the European Commission recently, as a follow-up of the 2005 green paper, Promoting Healthy Diets and Physical Activity 8.
The white paper emphasises the importance of collaborating with industry, and also suggests the set up of a ‘high level group’ focused on nutrition- and physical activity-related health issues. This group will assess national and regional actions together with the Commission, and disseminate information regarding best practice. The importance of monitoring and surveillance is also very much highlighted.
However, in common with many other national and international policy documents, training of professionals as well as research is more or less forgotten. Higher education and research in public health nutrition should be priorities at European as well as national level. Who otherwise will be working in the monitoring and surveillance systems, if training of high-quality staff is not included? And who will do the quality assurance as well as ensure the evidence base of the best practice, if higher education and research is completely out of the picture?
