- Email: [email protected]
SINU 2015 Congress Report
Nutrition, Metabolism & Cardiovascular Diseases (2016) 26, 268e270
Available online at www.sciencedirect.com
Nutrition, Metabolism & Cardiovascular Diseases journal homepage: www.elsevier.com/locate/nmcd
NEWS FROM THE ITALIAN SOCIETY OF HUMAN NUTRITION
SINU 2015 Congress Report* The 36th National Congress of the Italian Society of Human Nutrition was held in Florence on December 2e4 2015. The meeting was a success with regard to the degree of participation of the society members and other interested scientists and to its scientific and educational contents. A short report of the issues debated in the Congress lectures and in the scientific and educational sessions is offered in this issue of the Society official journal to the benefit of NMCD readers. The report, together with the full Congress program, can also be found on the SINU official website. The Congress opened with an International Workshop on Dietary Guidelines and Public Health, led by Prof. Furio Brighenti (University of Parma) and Dr. Laura Rossi (CREANUT, Rome). The workshop was the occasion for a face-toface comparison of the main contents and the structural approach between the latest Italian nutritional guidelines and similar experiences from USA, China, and New Zealand. It was agreed that periodic reformulation of guidelines is prompted by the continuous evolution of science but also by the ever changing dietary habits and lifestyles of a society where growing attention to nutrition-related health issues paradoxically coexists with an objective increased rate of medical conditions attributable to overeating and dietary imbalances. Two aspects were common to all countries: i) the attention to the excessive economic cost of healthy eating for large sectors of the population at a time of worldwide economic crisis; ii) the problem of sustainability of food production due to its growing impact on the environment. The Mediterranean dietary model is envisaged as one that may provide positive solutions to both questions. A common objective of the North American, Chinese, New Zealand and Italian guidelines is the fight against obesity, with special regard to childhood obesity, for the prevention of chronic non-communicable diseases. A few country-specific features of the process of guideline preparation and of the guideline presentation *
Prepared by the SINU board members: P. Strazzullo (President), G. Cairella (Vice-President), A. Pinto (Secretary), A. Bordoni (Treasurer), C. Agnoli, D. Erba, N. Pellegrini, L. Rossi, G.L. Russo, F. Sofi, E. Verduci http://dx.doi.org/10.1016/j.numecd.2016.02.014
format by the countries represented at the meeting were also discussed. The plenary lecture by Prof. Gianfranco Gensini (University of Florence), introduced by Prof. Pasquale Strazzullo (Federico II University of Naples), dealt with EBM and its role in cardiovascular disease prevention. Gensini focused on the merits gained by the EBM methodology in over 20 years of practice synthesized in the famous EBM pyramid. However, he also referred to the need for an EBM renaissance, intended as an evolution of classical EBM, from which it differs for being more person-oriented and tailored on specific individual features (Precision Medicine). An attempt to conform to this evolutionary trend is being made with the ongoing revision of the ISO-SPREAD Guidelines on the Prevention, Diagnosis and Treatment of Stroke, which includes substantial nutritional recommendations about dietary prevention of stroke as well as recommendations for the nutritional care in the acute and the rehabilitation phase. In the Round Table on Nutritional Prevention of Stroke chaired by Prof. Strazzullo, the ad hoc SINU Working Group reported on the recent revision of the ISO-SPREAD Guidelines with regard to Nutrition and Stroke. The SINU/ISO-SPREAD Working Group effected a systematic review of the literature available with respect to nutrition and prevention of stroke as well as to nutritional care in the acute phase and during rehabilitation from stroke. Position statements were delivered concerning the role of specific nutrients and food groups and, accordingly, recommendations were made for stroke prevention. In particular, a strong recommendation was released in favor of the adhesion to a Mediterranean-like diet, rich in fruits, vegetables, unrefined cereals, with moderate consumption of low fat milk products, extra virgin olive oil as main condiment, regular consumption of nuts and high fat fish, small amounts of red or processed meats, and moderate drinking of wine with meals. The parallel session on Nutrition and Gastrointestinal Cancer, chaired by Prof. Alessandro Casini (University of Florence) and Prof. Alessandro Pinto (La Sapienza University of Rome), dealt, among other factors, with the
News from the Italian Society of Human Nutrition
evidence about the relationship between dietary factors and gastrointestinal cancers mainly based on data collected by the American Institute for Cancer Research and the Continuous Update Project at Imperial College of London. These projects highlighted the causal contributions of body fatness, high intake of red and processed meats and alcohol to the risk of colorectal cancers, but also of esophageal and liver cancers, and by contrast pointed out the protective effects of dietary fiber intake and physical activity. Dr. Sabina Sieri (Italian National Cancer Institute) gave a plenary lecture introduced by Prof. Brighenti to present an official SINU document on vegetarian diets delivering recommendations on how to maximize the benefits and minimize the risks of followers of vegetarian diets. The authors conducted a systematic review of the literature on the bioavailability of such nutrients as proteins, vitamin B12, iron, zinc, calcium, vitamin D and omega-3 fatty acids in vegetarian diets and on the coverage of the respective physiological needs in the various age groups. The authors shared the view that vegetarians should increase the intake of proteins by 5e10% with respect to LARN recommendations, and the intake of vitamin B12 through either food or bacterial derived supplements, should prefer foods that are good sources of calcium and alpha-linolenic acid, and increase their intake of iron, zinc and cadmium to match LARN recommendations. The session on “Pasta: Innovating the Tradition”, led by Prof. Gabriele Riccardi (Federico II University of Naples) and Prof. Nicoletta Pellegrini (University of Parma), addressed the issue of the nutritional value of pasta, an excellence of the Italian tradition. Based on the analysis of the MOLI-SANI and the INHES cohorts, higher consumption of pasta was reportedly associated with greater adherence to a Mediterranean dietary model and inversely associated with BMI and other indicators of adiposity. The central role of pasta in a healthy diet was highlighted in the EXPO 2015 World Pasta Forum Consensus document, which pointed out the pasta satiating power, its lowglycemic, low environmental impact, and the fact that pasta consumption is associated with preference for plant foods such as vegetables and legumes. It was also reported that both condiments (e.g. pesto) and technological innovation play a role in determining the low-glycemic impact of the pasta compared to other foods, such as bread and semolina, obtained with the same raw materials. New data show that, while Italy remains the world’s leading consumer of pasta, pasta is consolidating its position worldwide in the framework of a Mediterraneanlike diet. The parallel session on “Supplementations”, chaired by Prof. Ciappellano (University of Milan) and prof. Luca Scalfi (Federico II University of Naples), debated the potential benefits and possible risks of supplementing folic acid and vit. B12, calcium and vit. D, and omega3 fatty acids in various settings and medical conditions. Particular attention in this regard was given to the role of functional foods
269
versus natural foods and supplements as such. Increased intake of folic acid in the peri-conceptional period is an example of rational nutrition strategy. As to vitamin B12, consideration is given to the factors contributing to its reduced bioavailability and to possible ways this deficit may be corrected. As to the health effects of calcium and/ or vitamin D supplementation, the best policy is to quote a nutritional intervention in at-risk groups such as the elderly. With regard to n-3 PUFA, different forms of food fortification were described deserving particular attention to the differences in food matrix. The plenary lecture in honor of Dr. Gianni Barba, beloved former SINU secretary, was held this year by Dr. Silvia Valtueña Martínez, introduced by Dr. Alfonso Siani (National Research Council Institute of Food Science). It dealt with “Traditional foods, food innovation and new approaches to risk assessment in the area of nutrition”. Dr. Valtueña emphasized the role of “regulatory” science and the scientific and technical foundations upon which food regulations are based. In this context, she dealt with the often misused concept of “traditional foods”, that must be intended as foods derived from primary production, with a history of safe use in a third country. From “tradition” she stepped up to “innovation” and risk assessment, highlighting the concept that before introducing novel foods or food technologies, health benefit for humans needs to be firmly established. Within the session on “Gluten Sensitivity” led by Prof. Francesco Sofi (University of Florence) and Prof. Elvira Verduci (University of Milan), Prof. Nicoletta Pellegrini emphasized the difficulty in drawing any sound conclusion about the nutritional adequacy of gluten-free diets, as ad hoc studies have yielded conflicting results, but also on gluten-free foods as such. In these foods, the need to create a structure similar to gluten influences the food nutritional quality. The food industry must be encouraged to innovate these foods to achieve a nutritional quality comparable to that of the foods they replace. The session: “Food lipids: can we improve them?”, chaired by Prof. Ciappellano (University of Milan) and Dr. Alessandra Fabbri (Food Hygiene and Nutrition Service, R. Emilia), first dealt with alterations of fats in the processes of transformation and with the efforts by the industry aiming at the stabilization of the products for safe conservation, with particular reference to heat treatment, which reduces the microbiological and enzymatic modifications, but accelerates decomposition reactions, synthesis and oxidation, making the addition of antioxidants useful. The focus then moved onto milk and dairy products with special attention to the process of homogenization of milk to make fat-soluble active principles more available for absorption. The industrial fortification of milk with omega3 fatty acids proved to be able to increase the blood levels of EPA and DHA in consumers. The potential benefits were highlighted of trans fatty acids derived from the rumen and those of the conjugated isomers of linoleic acid (CLA) occurring in milk-derived products. As to baked foods, the industry faces two problems. The first one is given by the paradox whereby the consumer,
270
while increasingly oriented in favor of “healthy choices”, most often actually prefers the “butter taste”, so that the “quality” of fat used becomes crucial. The second problem is that the demand for fats and oils for domestic and industrial consumption is currently higher than the primary production of these substances, hence the increasing need to take into account the “sustainability” of productions and their environmental impact. Eventually, the attention switched on meat, a major source of nutrients and micronutrients less available in plant products. Although its nutritional value is mainly in relation to the protein content, the quantity and quality of the fat content characterizes the different meats. The selection of species, the methods of farming and the quality of animal feed has led to a progressive reduction and to a marked improvement in the quality of the fat content of meat, which can also be enriched in omega-3 and vitamins with reduction of the cholesterol content. The educational session on the “Measurement of Dietary Intakes in Epidemiological Studies”, chaired by Dr. Sabina Sieri and by Dr. Ersilia Troiano (ANDID, Rome), discussed one of the main challenges faced by nutritional epidemiology, the difficulties arising both from inaccuracies on the side of participants in reporting their intakes and from the relatively small inter-individual variation in food intake due to the homogenization of dietary habits in the population. These problems explain the difficulty to detect possibly true biological associations between specific dietary habits and any given medical condition. The choice of the instrument to be used for the investigation of the dietary intakes in a given study is eventually function of the objectives of the study and of the financial resources available. The “Gianni Barba Awards for the best original communication presented at the Meeting by young investigators went to Dr. Federica Prinelli (University of
News from the Italian Society of Human Nutrition
Milan) for a study on the association of degree of adherence to Mediterranean diet and all-cause mortality in the 20-year follow-up of an Italian cohort. Recognitions for the best abstracts submitted to the meeting went to Dr. Francesca De Pascale (Federico II University of Naples) for a clinical study of the effects of dietary salt intake restriction on risk factors for kidney stone disease and to Dr. Luigi Barrea (Federico II University of Naples) for a study on the association between severity of psoriatic disease and adhesion to a vegetarian diet. In addition to these papers, a number of excellent original communications were delivered at the meeting, certifying the intensity and the quality of epidemiological, clinical and experimental research activity going on in Italy in the nutritional area despite the financial crisis and the budget limitations for the research and the academic institution. Following the election of the new components of the Scientific Council of the Society, Prof. Pasquale Strazzullo was nominated SINU President for 2016e2019: he will be supported by Dr. Giulia Cairella, Vice-president, Prof. Alessandro Pinto, Secretary, Prof. Alessandra Bordoni, Treasurer, Prof. Elvira Verduci, Nicoletta Pellegrini, Francesco Sofi and Dr. Claudia Agnoli, Daniela Erba, Gian Luigi Russo, Sabina Sieri, as board members. The new board acknowledged the fruitful work carried out by Prof. Furio Brighenti and all the members of the past scientific council in the interest of the Society and of the scientific community and their many successful endeavors among which the revision of the RDIs (LARN), the ongoing preparation of the revised Nutritional Guidelines and the SINU collaboration to the ISO-SPREAD guidelines for the prevention and therapy of stroke, to be release shortly this year. The next national meeting of the society will be held in Bologna, November 2016.
Available online at www.sciencedirect.com
Nutrition, Metabolism & Cardiovascular Diseases journal homepage: www.elsevier.com/locate/nmcd
NEWS FROM THE ITALIAN SOCIETY OF HUMAN NUTRITION
SINU 2015 Congress Report* The 36th National Congress of the Italian Society of Human Nutrition was held in Florence on December 2e4 2015. The meeting was a success with regard to the degree of participation of the society members and other interested scientists and to its scientific and educational contents. A short report of the issues debated in the Congress lectures and in the scientific and educational sessions is offered in this issue of the Society official journal to the benefit of NMCD readers. The report, together with the full Congress program, can also be found on the SINU official website. The Congress opened with an International Workshop on Dietary Guidelines and Public Health, led by Prof. Furio Brighenti (University of Parma) and Dr. Laura Rossi (CREANUT, Rome). The workshop was the occasion for a face-toface comparison of the main contents and the structural approach between the latest Italian nutritional guidelines and similar experiences from USA, China, and New Zealand. It was agreed that periodic reformulation of guidelines is prompted by the continuous evolution of science but also by the ever changing dietary habits and lifestyles of a society where growing attention to nutrition-related health issues paradoxically coexists with an objective increased rate of medical conditions attributable to overeating and dietary imbalances. Two aspects were common to all countries: i) the attention to the excessive economic cost of healthy eating for large sectors of the population at a time of worldwide economic crisis; ii) the problem of sustainability of food production due to its growing impact on the environment. The Mediterranean dietary model is envisaged as one that may provide positive solutions to both questions. A common objective of the North American, Chinese, New Zealand and Italian guidelines is the fight against obesity, with special regard to childhood obesity, for the prevention of chronic non-communicable diseases. A few country-specific features of the process of guideline preparation and of the guideline presentation *
Prepared by the SINU board members: P. Strazzullo (President), G. Cairella (Vice-President), A. Pinto (Secretary), A. Bordoni (Treasurer), C. Agnoli, D. Erba, N. Pellegrini, L. Rossi, G.L. Russo, F. Sofi, E. Verduci http://dx.doi.org/10.1016/j.numecd.2016.02.014
format by the countries represented at the meeting were also discussed. The plenary lecture by Prof. Gianfranco Gensini (University of Florence), introduced by Prof. Pasquale Strazzullo (Federico II University of Naples), dealt with EBM and its role in cardiovascular disease prevention. Gensini focused on the merits gained by the EBM methodology in over 20 years of practice synthesized in the famous EBM pyramid. However, he also referred to the need for an EBM renaissance, intended as an evolution of classical EBM, from which it differs for being more person-oriented and tailored on specific individual features (Precision Medicine). An attempt to conform to this evolutionary trend is being made with the ongoing revision of the ISO-SPREAD Guidelines on the Prevention, Diagnosis and Treatment of Stroke, which includes substantial nutritional recommendations about dietary prevention of stroke as well as recommendations for the nutritional care in the acute and the rehabilitation phase. In the Round Table on Nutritional Prevention of Stroke chaired by Prof. Strazzullo, the ad hoc SINU Working Group reported on the recent revision of the ISO-SPREAD Guidelines with regard to Nutrition and Stroke. The SINU/ISO-SPREAD Working Group effected a systematic review of the literature available with respect to nutrition and prevention of stroke as well as to nutritional care in the acute phase and during rehabilitation from stroke. Position statements were delivered concerning the role of specific nutrients and food groups and, accordingly, recommendations were made for stroke prevention. In particular, a strong recommendation was released in favor of the adhesion to a Mediterranean-like diet, rich in fruits, vegetables, unrefined cereals, with moderate consumption of low fat milk products, extra virgin olive oil as main condiment, regular consumption of nuts and high fat fish, small amounts of red or processed meats, and moderate drinking of wine with meals. The parallel session on Nutrition and Gastrointestinal Cancer, chaired by Prof. Alessandro Casini (University of Florence) and Prof. Alessandro Pinto (La Sapienza University of Rome), dealt, among other factors, with the
News from the Italian Society of Human Nutrition
evidence about the relationship between dietary factors and gastrointestinal cancers mainly based on data collected by the American Institute for Cancer Research and the Continuous Update Project at Imperial College of London. These projects highlighted the causal contributions of body fatness, high intake of red and processed meats and alcohol to the risk of colorectal cancers, but also of esophageal and liver cancers, and by contrast pointed out the protective effects of dietary fiber intake and physical activity. Dr. Sabina Sieri (Italian National Cancer Institute) gave a plenary lecture introduced by Prof. Brighenti to present an official SINU document on vegetarian diets delivering recommendations on how to maximize the benefits and minimize the risks of followers of vegetarian diets. The authors conducted a systematic review of the literature on the bioavailability of such nutrients as proteins, vitamin B12, iron, zinc, calcium, vitamin D and omega-3 fatty acids in vegetarian diets and on the coverage of the respective physiological needs in the various age groups. The authors shared the view that vegetarians should increase the intake of proteins by 5e10% with respect to LARN recommendations, and the intake of vitamin B12 through either food or bacterial derived supplements, should prefer foods that are good sources of calcium and alpha-linolenic acid, and increase their intake of iron, zinc and cadmium to match LARN recommendations. The session on “Pasta: Innovating the Tradition”, led by Prof. Gabriele Riccardi (Federico II University of Naples) and Prof. Nicoletta Pellegrini (University of Parma), addressed the issue of the nutritional value of pasta, an excellence of the Italian tradition. Based on the analysis of the MOLI-SANI and the INHES cohorts, higher consumption of pasta was reportedly associated with greater adherence to a Mediterranean dietary model and inversely associated with BMI and other indicators of adiposity. The central role of pasta in a healthy diet was highlighted in the EXPO 2015 World Pasta Forum Consensus document, which pointed out the pasta satiating power, its lowglycemic, low environmental impact, and the fact that pasta consumption is associated with preference for plant foods such as vegetables and legumes. It was also reported that both condiments (e.g. pesto) and technological innovation play a role in determining the low-glycemic impact of the pasta compared to other foods, such as bread and semolina, obtained with the same raw materials. New data show that, while Italy remains the world’s leading consumer of pasta, pasta is consolidating its position worldwide in the framework of a Mediterraneanlike diet. The parallel session on “Supplementations”, chaired by Prof. Ciappellano (University of Milan) and prof. Luca Scalfi (Federico II University of Naples), debated the potential benefits and possible risks of supplementing folic acid and vit. B12, calcium and vit. D, and omega3 fatty acids in various settings and medical conditions. Particular attention in this regard was given to the role of functional foods
269
versus natural foods and supplements as such. Increased intake of folic acid in the peri-conceptional period is an example of rational nutrition strategy. As to vitamin B12, consideration is given to the factors contributing to its reduced bioavailability and to possible ways this deficit may be corrected. As to the health effects of calcium and/ or vitamin D supplementation, the best policy is to quote a nutritional intervention in at-risk groups such as the elderly. With regard to n-3 PUFA, different forms of food fortification were described deserving particular attention to the differences in food matrix. The plenary lecture in honor of Dr. Gianni Barba, beloved former SINU secretary, was held this year by Dr. Silvia Valtueña Martínez, introduced by Dr. Alfonso Siani (National Research Council Institute of Food Science). It dealt with “Traditional foods, food innovation and new approaches to risk assessment in the area of nutrition”. Dr. Valtueña emphasized the role of “regulatory” science and the scientific and technical foundations upon which food regulations are based. In this context, she dealt with the often misused concept of “traditional foods”, that must be intended as foods derived from primary production, with a history of safe use in a third country. From “tradition” she stepped up to “innovation” and risk assessment, highlighting the concept that before introducing novel foods or food technologies, health benefit for humans needs to be firmly established. Within the session on “Gluten Sensitivity” led by Prof. Francesco Sofi (University of Florence) and Prof. Elvira Verduci (University of Milan), Prof. Nicoletta Pellegrini emphasized the difficulty in drawing any sound conclusion about the nutritional adequacy of gluten-free diets, as ad hoc studies have yielded conflicting results, but also on gluten-free foods as such. In these foods, the need to create a structure similar to gluten influences the food nutritional quality. The food industry must be encouraged to innovate these foods to achieve a nutritional quality comparable to that of the foods they replace. The session: “Food lipids: can we improve them?”, chaired by Prof. Ciappellano (University of Milan) and Dr. Alessandra Fabbri (Food Hygiene and Nutrition Service, R. Emilia), first dealt with alterations of fats in the processes of transformation and with the efforts by the industry aiming at the stabilization of the products for safe conservation, with particular reference to heat treatment, which reduces the microbiological and enzymatic modifications, but accelerates decomposition reactions, synthesis and oxidation, making the addition of antioxidants useful. The focus then moved onto milk and dairy products with special attention to the process of homogenization of milk to make fat-soluble active principles more available for absorption. The industrial fortification of milk with omega3 fatty acids proved to be able to increase the blood levels of EPA and DHA in consumers. The potential benefits were highlighted of trans fatty acids derived from the rumen and those of the conjugated isomers of linoleic acid (CLA) occurring in milk-derived products. As to baked foods, the industry faces two problems. The first one is given by the paradox whereby the consumer,
270
while increasingly oriented in favor of “healthy choices”, most often actually prefers the “butter taste”, so that the “quality” of fat used becomes crucial. The second problem is that the demand for fats and oils for domestic and industrial consumption is currently higher than the primary production of these substances, hence the increasing need to take into account the “sustainability” of productions and their environmental impact. Eventually, the attention switched on meat, a major source of nutrients and micronutrients less available in plant products. Although its nutritional value is mainly in relation to the protein content, the quantity and quality of the fat content characterizes the different meats. The selection of species, the methods of farming and the quality of animal feed has led to a progressive reduction and to a marked improvement in the quality of the fat content of meat, which can also be enriched in omega-3 and vitamins with reduction of the cholesterol content. The educational session on the “Measurement of Dietary Intakes in Epidemiological Studies”, chaired by Dr. Sabina Sieri and by Dr. Ersilia Troiano (ANDID, Rome), discussed one of the main challenges faced by nutritional epidemiology, the difficulties arising both from inaccuracies on the side of participants in reporting their intakes and from the relatively small inter-individual variation in food intake due to the homogenization of dietary habits in the population. These problems explain the difficulty to detect possibly true biological associations between specific dietary habits and any given medical condition. The choice of the instrument to be used for the investigation of the dietary intakes in a given study is eventually function of the objectives of the study and of the financial resources available. The “Gianni Barba Awards for the best original communication presented at the Meeting by young investigators went to Dr. Federica Prinelli (University of
News from the Italian Society of Human Nutrition
Milan) for a study on the association of degree of adherence to Mediterranean diet and all-cause mortality in the 20-year follow-up of an Italian cohort. Recognitions for the best abstracts submitted to the meeting went to Dr. Francesca De Pascale (Federico II University of Naples) for a clinical study of the effects of dietary salt intake restriction on risk factors for kidney stone disease and to Dr. Luigi Barrea (Federico II University of Naples) for a study on the association between severity of psoriatic disease and adhesion to a vegetarian diet. In addition to these papers, a number of excellent original communications were delivered at the meeting, certifying the intensity and the quality of epidemiological, clinical and experimental research activity going on in Italy in the nutritional area despite the financial crisis and the budget limitations for the research and the academic institution. Following the election of the new components of the Scientific Council of the Society, Prof. Pasquale Strazzullo was nominated SINU President for 2016e2019: he will be supported by Dr. Giulia Cairella, Vice-president, Prof. Alessandro Pinto, Secretary, Prof. Alessandra Bordoni, Treasurer, Prof. Elvira Verduci, Nicoletta Pellegrini, Francesco Sofi and Dr. Claudia Agnoli, Daniela Erba, Gian Luigi Russo, Sabina Sieri, as board members. The new board acknowledged the fruitful work carried out by Prof. Furio Brighenti and all the members of the past scientific council in the interest of the Society and of the scientific community and their many successful endeavors among which the revision of the RDIs (LARN), the ongoing preparation of the revised Nutritional Guidelines and the SINU collaboration to the ISO-SPREAD guidelines for the prevention and therapy of stroke, to be release shortly this year. The next national meeting of the society will be held in Bologna, November 2016.