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Nutrition more important than calories, say experts

Focus needed on nutrition to improve health

Adrian O'Dowd

Thursday, 27 August 2015

Clinicians and public health specialists should focus their patients’ attention on nutritional value of foods rather than calorie content to improve their health, conclude experts in an editorial* published today in the online journal Open Heart.

Experts argued that it would be far more beneficial to promote the nutritional value of foods to cut illness and death from cardiovascular disease and curb the rising tide of obesity.

Drawing on published evidence, Dr Aseem Malhotra of the Department of Cardiology at Frimley Park Hospital, Surrey, and consultant clinical associate to the Academy of Medical Royal Colleges, Dr James DiNicolantonio of Saint Luke’s Mid America Heart Institute, Missouri, USA, and Professor Simon Capewell, professor of clinical epidemiology at the University of Liverpool, argued that rather like stopping smoking, simple dietary changes could rapidly improve health outcomes at population level.

They gave an example of boosting omega 3 fatty acid (from fatty fish), olive oil, and nut intake as a way of reducing deaths from all causes and from cardiovascular disease within months.

Clinicians, however, had failed to act for too long, they said, and had focused too much on the calorific content of food by the food and weight loss industries, despite mounting evidence that it was the nutritional content that mattered.

Obesity cost the NHS more than £5 billion a year, while the costs of type 2 diabetes added up to more than £20 billion and were predicted to double over the next 20 years, they warned

Evidence showed that poor diet was consistently responsible for more disease and death than physical inactivity, smoking and alcohol put together.

Therefore, they called for:

  • sugary drinks to be taxed
  • government subsidies to make fruit, vegetables, and nuts more affordable
  • tighter controls on the marketing of junk food.

Daily consumption of a sugary drink (150 calories) was associated with a significantly increased risk of type 2 diabetes whereas daily consumption of a handful of nuts (30g of walnuts, 15g of almonds and 15g hazelnuts) or four tablespoons of extra virgin olive oil (around 500 calories) was associated with a significantly reduced risk of heart attack and stroke, they said.

“Shifting the focus away from calories and emphasising a dietary pattern that focuses on food quality rather than quantity will help to rapidly reduce obesity, related diseases, and cardiovascular risk,” they concluded.

“Primary and secondary care clinicians have a duty to their individual patients and also to their local populations. Our collective failure to act is an option we cannot afford.

“It is time to stop counting calories, and time to instead promote good nutrition and dietary changes that can rapidly and substantially reduce cardiovascular mortality. The evidence indeed supports the mantra that ‘food can be the most powerful form of medicine or the slowest form of poison’.”


* Aseem Malhotra, et al. It is time to stop counting calories, and time instead to promote dietary changes that substantially and rapidly reduce cardiovascular morbidity and mortality. Open Heart 2015;2:e000273. doi:10.1136/openhrt-2015-000273

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