Clinical Aspects of Functional Foods and Nutraceuticals

Clinical Aspects of

Functional Foods and Nutraceuticals

Edited by

Dilip Ghosh Debasis Bagchi Tetsuya Konishi

Clinical Aspects of

Functional Foods and Nutraceuticals

Clinical Aspects of

Functional Foods and Nutraceuticals Edited by

Dilip Ghosh Debasis Bagchi Tetsuya Konishi

Boca Raton London New York

CRC Press is an imprint of the Taylor & Francis Group, an informa business

CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2015 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20140716 International Standard Book Number-13: 978-1-4665-6916-4 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www.copyright.com (http:// www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com

Dedication To my beloved father, the late Mr. Tarak Chandra Bagchi, MSc, AIC.

Contents Preface...............................................................................................................................................xi Editors............................................................................................................................................... xv Contributors.....................................................................................................................................xix

Section I Introduction Chapter 1 Progress of Food-Based Dietary Guidelines around the Globe.................................... 3 Yasmine Probst, Rebecca Thorne, and Jane O’Shea Chapter 2 Clinical Perspective of Ayurceuticals: Challenges and Opportunities for Global Health and Wellness.................................................................................. 33 Namyata Pathak, Hiteshi A. Shah, and Ashok Vaidya Chapter 3 Functional Foods and Nutraceuticals: Potential Role in Human Health.................... 51 Chunling Wang and Song Li Chapter 4 Clinical Trial Barriers in Functional Foods and Nutrition......................................... 77 Rajshri Roy

Section II  Science Underpinning Health Benefits Chapter 5 Dual Function of Food Factors as Pharmacological Molecules.................................. 87 Tetsuya Konishi Chapter 6 Anti-Inflammatory and Chemopreventive Potentials of Citrus Auraptene................. 93 Akira Murakami Chapter 7 Food Functions Preventing Muscle Atrophy............................................................. 105 Junji Terao, Rie Mukai, Yui Yamashita, Arisa Ochi, Shohei Kohno, Katsuya Hirasaka, and Takeshi Nikawa Chapter 8 Effects of Nutraceuticals on Metabolic Syndromes.................................................. 115 Asim K. Duttaroy

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Chapter 9 Cardioprotective Food Function as Underpinning Strategy for Disease Prevention: Dietary Antioxidants in Diabetic Cardiac Complications..................... 127 Kenichi Watanabe, Somasundaram Arumugam, Rajarajan A. Thandavarayan, Kenji Suzuki, and Hirohito Sone Chapter 10 Clinical Application of Antiaging Food Factors in Functional Foods...................... 137 Akira Kubo and Fumi Nihei

Section III Problems and Challenges to Industries, Consumers, and Policy Makers Chapter 11 Maximizing the Survival of Probiotic Bacteria in Food to Improve Their Potential Health Benefit................................................................................... 147 Namrata Taneja, Derek Haisman, and Shantanu Das Chapter 12 Drug–Dietary Supplement Interactions.................................................................... 163 Noriaki Yohkoh Chapter 13 Journey from Pharmaceuticals to Food: Role of Evidence-Based Approach........... 173 R.B. Smarta Chapter 14 Heme Oxygenase-1 Induction Inhibits Intestinal Inflammation: Role of Food Factors................................................................................................. 185 Yuji Naito, Tomohisa Takagi, Akihito Harusato, Yasuki Higashimura, and Toshikazu Yoshikawa

Section IV Innovation versus Regulation Chapter 15 Regulatory Framework of Functional Foods in Southeast Asia............................... 197 Tee E. Siong Chapter 16 Health Claims Regulation and Scientific Substantiation of Functional Foods and the International Comparison............................................................................. 217 Toshio Shimizu Chapter 17 In Pursuit of Claims: What Works, What Does Not, and Why................................ 229 Josephine M. Balzac and George A. Burdock

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Chapter 18 Clinical Research—History of Regulations: A Global Perspective......................... 257 Kappillil Anilkumar and K.I. Anitha

Section V Farm to Clinic Approach/Functional Aspects of Food Factors Chapter 19 Role of Seed to Patient Model in Clinically Proven Natural Medicines.................. 279 Andrea Zangara and Dilip Ghosh Chapter 20 Innovation in the Food Industry: Industry–Academia Partnership.......................... 289 Amit Taneja, Anwesha Sarkar, and Shantanu Das Chapter 21 Curcumin for Prevention and Treatment of Chronic Diseases: An Overview of the Clinical Studies and Evidence-Based Support......................... 303 Myriam Hinojosa and Bharat B. Aggarwal Chapter 22 Human Clinical Trial for Nutraceuticals and Functional Foods............................... 325 Chin-Kun Wang Chapter 23 Clinical Outcomes, Safety, and Efficacy of Chinese Herbal Medicines.................. 337 Daniel Roytas

Section VI  Future Trends Chapter 24 Traditional Foods and Their Values for Health and Wellness on Evidence- Based Approach........................................................................................ 361 V. Prakash, M.A. Alwar, and M.A. Lakshmithathachar Chapter 25 Impact of Personalized Nutrition on Public Health.................................................. 371 Lynnette Ferguson, Karen Bishop, and Nishi Karunsinghe Chapter 26 Effects of Ginger on Metabolic Syndrome: A Review of Evidence......................... 381 Srinivas Nammi, Yu-Ting Sun, and Dennis Chang Chapter 27 Local Food Futures and Healthy Communities: Role of Sustainable Practices....... 399 Sumita Ghosh

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Chapter 28 Oriental Traditional Philosophy and Food Function................................................. 413 Young Rok Seo and Yeo Jin Kim Chapter 29 Ayurnutrigenomics: Traditional Knowledge-Inspired Approach toward Personalized Nutrition............................................................................................... 423 Parikshit Debnath, Subhadip Banerjee, and Pratip Kumar Debnath

Preface In the past three decades, revolutionary achievements have taken place in the functional food and nutraceutical research, including the introduction of a number of cutting-edge dietary supplements backed by human trials and strong patents. Novel manufacturing technologies including unique extraction process and biodelivery such as nanotechnology and innovative packaging are very important steps for the successful positioning in marketplace. Growing clinical support is another tool for coping up with the stringent regulatory requirements, and finally consumer acceptance and appreciation around the world. The book covers vast areas of functional food and nutraceuticals from a clinical nutritional perspective. In addition to science underpinning, it also focuses on food innovation, global regulations, problems and challenges, and future direction. It provides an essential overview of the clinical aspects of functional foods and nutraceuticals for key stakeholders, drawing links between areas of knowledge that are often isolated from each other. This form of knowledge integration is essential for practice, especially for policy makers and administrators in government, private, or academic sector. This book includes six different sections that are explained in detail below.

INTRODUCTION This section demonstrates the basic understanding on the current scenario in the field of functional foods and nutraceuticals. Four chapters are included in this section. Dr. Yasmine Probst and collaborators from the Smart Foods Centre, University of Wollongong, NSW, Australia, highlighted the progress of food-based dietary guidelines around the globe in Chapter 1. Since “Ayurveda” is an integral and vital component of functional foods and nutraceuticals, Chapter 2 was designed by Dr. Ashok Vaidya and collaborators from Kasturba Health Society, Mumbai, India covering the clinical perspectives of Ayurceuticals and its challenges and opportunities for global health and wellness. Dr. Chunling Wang, a reputed nutrition scientist from COFCO Nutrition and Health Research Institute, Beijing, China, formalized Chapter 3 and Ms Rajshri Roy, accrediting practicing dietitian from the University of Sydney, emphasized about the clinical trials in Chapter 4.

SCIENCE UNDERPINNING HEALTH BENEFITS The health benefits of functional foods are extensively demonstrated from the pharmacological, toxicological, and clinical standpoints. Dr. Tetsuya Konishi, coeditor of this book and professor in Niigata University of Pharmacy and Applied Life Sciences (NUPALS), Niigata, Japan, discussed about the dual function of food factors in Chapter 5. Dr. Akira Murakami from Kyoto University, Kyoto, Japan, emphasized about the anti-inflammatory and chemopreventive potentials in Chapter 6. Dr. Junji Terao from Tokushima University exhibited the key food factors instrumental to ­prevent muscle atrophy, especially “sarcopenia,” in Chapter 7. Chapter 8 was designed by Dr. Asim K. Duttaroy, University of Oslo School of Medicine, Oslo, Norway on metabolic syndromes and associated concepts. Dr. Kennichi Watanabe from NUPALS, Niigata, Japan, outlined the novel cardioprotection by functional foods in Chapter  9. Chapter 10 was structured by Dr. Akira Kubo of Tokai University, Tokyo, Japan, which discusses about the various diets and their effects on aging.

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PROBLEMS AND CHALLENGES TO INDUSTRIES, CONSUMERS, AND POLICY MAKERS The continuing challenges to the industries, consumers, and policy makers are broadly discussed in this section. Dr. Namrata Taneja from Riddet Institute, New Zealand, designed Chapter 11, which elaborates about probiotics. Chapter 12 on food and drug interaction was highlighted by Dr. Noriaki Yoko, NUPALS, Niigata, Japan. Dr. R.B. Smarta from Interlink Marketing Consultancy, Mumbai, India, formalized Chapter 13, which discusses on the growth of both pharmaceutical and food industries; while Dr. Yuji Naito from Kyoto Prefectural University of Medicine structured Chapter 14 emphasizing on heme oxygenase and its functions.

INNOVATION VERSUS REGULATION In this section, the controversial issues of innovation versus regulation are discussed in four ­chapters. In Chapter 15, Dr. Tee E. Siong, the president of Nutrition Society of Malaysia, broadly discussed about functional foods and their effects in Southeast Asia. Dr. Toshio Shimizu, Nagoya Bunri University, Inazawa, Japan, extensively provided the comparative regulatory details in Chapter 16. In Chapter 17, Dr. George Burdock thoroughly discussed challenges associated with presumptive claim(s); while in Chapter 18, the effects of clinical research and clinical trial in health care was demonstrated by a renowned Advocate Kappillil Anilkumar.

FARM TO CLINIC APPROACH/FUNCTIONAL ASPECTS OF FOOD FACTORS Chapter 19 designed by Drs. Andrea Zangara and Dilip Ghosh, Australia, discusses about herbal medicines. Dr. Shantanu Das of Riddet Institute, New Zealand, highlighted about the innovations in the food industry in Chapter 20, and Chapter 21 was extensively demonstrated by Dr. Bharat B. Aggarwal and his esteemed team from MD Anderson Cancer Center, Texas, extensively demonstrated the properties of Curcumin and its compounds. Chapter 22 formalized by Dr. Chin-Kun Wang, Chung San Medical University, Taiwan, discusses about functional foods use in human trials. Dr. Daniel Roytas from Southern School of Natural Therapies, Fitzroy, VIC, Australia, formalized Chapter 23, which elaborates about pertinent issues related to the safety and quality of Chinese herbal medicine.

FUTURE TRENDS This section describes where we are and where to go. Dr. V. Prakash, an eminent scientist and the president of Nutrition Society of India, Hyderabad, India, demonstrated the concept of traditional foods and their values for health and wellness in Chapter 24, which was followed by Chapter 25 by Dr. Lynnette Ferguson, the University of Auckland, Auckland, New Zealand, dealing with the concept of food and its supplements of public health. Chapter 26 was formalized by Dr. Dennis Chang, University of Western Sydney, NSW, Australia, which elaborates about ginger and its effects on metabolic syndrome. Dr. Sumita Ghosh, University Technology of Sydney, NSW, Australia, highlighted the importance of local food and its impact on health in Chapter 27 and discussed about the pros and cons of the future of controversial food supplements and its wide acceptance in the community. Chapter 28 demonstrated by Dr. Young Rok Seo, Dongguk University, Seoul, Republic of Korea, deals with differing food preparations and consumptions. Chapter 29 emphasized by Dr. Parikshit Debnath and his esteemed colleagues, SDM College of Ayurveda and Hospital, Hassan, India, discusses about Ayurnutrigenomics. Health, marketing, and business professionals are continuously struggling to establish the inarticulated needs in conjunction with regulatory hurdles and customer requirements for appropriate nutrition, optimal health, and disease prevention. Although clinical support of any health benefits from foods and nutraceuticals is essential to commercialize the products, an in-depth understanding

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of the traditional use and benefits is important while accepting such functional foods with m ­ edicinal ­properties. In the organizational context, commitment to clinical research and assimilation of novel technologies is the only way to boost efficiency, productivity, and finally the well-being of humankind. We, the editors, performed our best to design and implement the best concepts from both Oriental and modern Western world on functional foods and nutraceuticals for our esteemed readers. Dilip Ghosh Nutriconnect Debasis Bagchi University of Houston Tetsuya Konishi Niigata University of Pharmacy and Applied Life Sciences (NUPALS)

Editors Dilip Ghosh, PhD, FACN, has received his PhD in ­biomedical science from the University of Calcutta, Kolkata, India. Previously, he held positions in Organon (India) Ltd., a division of Organon International BV and Akzo Nobel, the Netherlands; HortResearch, New Zealand; the US Department of Agriculture (USDA)-Agricultural Research Service (ARS), Human Nutrition Research Center on Aging (HNRCA) at Tufts University, Boston, Massachusetts; the Smart Foods Centre, University of Wollongong, NSW, Australia; and Neptune Bio-Innovation Pty Ltd., NSW, Australia. Dr. Ghosh is a most sought-after international speaker, facilitator, and author. He has been involved for a long time in drug development (both synthetic and natural) and functional food research and development in both academic and industrial domains. He is a fellow of the American College of Nutrition, Clearwater, Florida, and also a member in the editorial board of several journals. Currently, he is the director at Nutriconnect, NSW, Australia; professionally involved with Soho Flordis International, University of Western Sydney, NSW, Australia; and honorary ambassador at Global Harmonization Initiative (GHI), NSW, Australia. Dr. Ghosh has published more than 60 papers in peer-reviewed journals and numerous articles on food and nutrition in magazines and books. His two recent books, Biotechnology in Functional Foods and Nutraceuticals and Innovation in Healthy and Functional Foods, have created a strong impact in functional food and nutraceutical domains. He was an associate editor and member of Toxicology Mechanisms and Methods (2006–2007) and is a review editor for Frontiers in Nutrigenomics (2011 to present), American Journal of Advanced Food Science and Technology (2012 to present), Journal of Obesity and Metabolic Research (2013 to present), and Journal of Bioethics (2013 to present). He can be reached at [email protected] and [email protected]. Debasis Bagchi, PhD, MACN, CNS, MAIChE, received his PhD in medicinal chemistry in 1982. He is a professor in the department of pharmacological and pharmaceutical sciences at the University of Houston, College of Pharmacy, Houston, Texas. Dr. Bagchi is also the chief scientific officer of Cepham Inc., Piscataway, New Jersey. He served as the senior vice president of Research & Development of InterHealth Nutraceuticals Inc., Benicia, California, from 1998 till February 2011, and then as the director of Innovation and Clinical Affairs at Iovate Health Sciences Research Inc., Oakville, Ontario, from February 2011 to June 2013. He received the Master of American College of Nutrition Award in early October 2010. He is currently the chairman of the International Society for Nutraceuticals and Functional Foods (ISNFF), USA, immediate past president of American College of Nutrition, Clearwater, Florida, and past chair of the Nutraceuticals and Functional Foods division of the Institute of Food Technologists (IFT), Chicago, Illinois. He is serving as a distinguished advisor on the Japanese Institute for Health Food Standards, Tokyo, Japan. He is a member of the Study Section and Peer Review Committee of the National Institutes of Health (NIH), Bethesda, Maryland. He has published 299 papers in peer-reviewed journals, 24  books, and numerous patents. He has delivered xv

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invited lectures in various national and international scientific conferences, organized workshops, and group discussion sessions. Dr. Bagchi is also a member of the Society of Toxicology, a member of the New York Academy of Sciences, a fellow of the Nutrition Research Academy, and a member of the TCE stakeholder Committee of the Wright Patterson Air Force Base, Fairborn, Ohio. He is the associate editor of the Journal of Functional Foods and the Journal of the American College of Nutrition, and also serving as an editorial board member of numerous peer-reviewed journals, including Antioxidants & Redox Signaling, Cancer Letters, Toxicology Mechanisms and Methods, and The Original Internist. Dr. Bagchi received funding from various institutions and agencies including the US Air Force Office of Scientific Research, Arlington, Virginia; Nebraska Department of Health & Human Services, Lincoln, Nebraska; Biomedical Research Support Grant from the NIH, Bethesda, Maryland; National Cancer Institute (NCI), Bethesda, Maryland; Health Future Foundation Inc., Quezon City, Philippines; Procter & Gamble Co., Cincinnati, Ohio; and Abbott Laboratories, Abbott Park, Illinois. Tetsuya Konishi, PhD, was born in 1944 at Shanghai in China and grew up in Akita, mostly in Tokyo, Japan. He graduated from Tokyo College of Pharmacy in 1966 and completed his graduate study in radiopharmacy in 1968. After that, he engaged in research and education as an assistant professor in the physical and analytical chemistry department of Tokyo College of Pharmacy and carried out metabolic studies on lipophilic vitamins using radioisotope tracers. After finishing his PhD in pharmaceutical sciences, he worked with Dr. Lester Packer as a postdoctoral research fellow at the University of California– Berkeley, Berkeley, California, and was also appointed as a research biochemist at the Energy and Environment division of Lawrence Berkeley National Laboratory, Berkeley, California, from 1975 to 1978, where his interest was focused on membrane bioenergetics studies, mainly on bacteriorhodopin, a phototransduction protein in halobacteria. He had his laboratory in the department of biophysics and radiochemistry in Niigata University of Pharmacy and Applied Life Sciences (NUPALS), Niigata, Japan, in 1978 to start his biophysical studies on molecular adaptation of halobacteria to an extreme environment as an associate professor and later as a full professor until 2000. During this period, his works were mainly focused on energy transduction by Na/H antiporter and also on radiation protection in halobacteria. The Na/H antiporter is the first protein found by him in that bacteria, which works as an essential device for energy transduction. Radical biology was an approach for the latter subject. In 2001, he established a functional and analytical food sciences department in the Faculty of Applied Life Sciences and has developed broad spectra of researches on the health beneficial functions of antioxidant natural products and traditional herbal medicines, which include such studies as metabolism and functions of anthocyanins, antioxidant herbal prescriptions in protecting cerebral oxidative damage and aging, and DNA damage checkpoint modulation by food factors. Since 2012 he is a professor emeritus of functional and analytical food sciences and a specific project professor for “The Basic Research on Developing Functional Food for Next Generation” in NUPALS, Niigata, Japan. His special interest is focused on complementary application of food functions in modern medicine treatment, that is, adjuvant use. He published more than 160 original research papers and reviews in peer-reviewed journals. He has engaged in social activities such as a board member of several academic committees including Niigata International Food Award, Japanese Society of Food Factors, Japanese Society of Flavonoid Research, World Federation of Traditional Chinese Medicine, and so on, and is now the head of Organization for Food and Bio-Research promotion in Niigata. He has also engaged in the editorial board of several science

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journals such as Journal of Pharmacological Research, Molecular Nutrition & Food Research, Cancer Chemotherapy, Journal of Biological & Pharmacological Research, and Medicine as well as reviewer of many international journals. He has worked as an examiner of PhD theses at several abroad universities such as India, Hong Kong, and Germany, and as a grant evaluator of Austrian Science Academy. He founded and organized the International Niigata Symposium on Diet and Health (INSDH) in 2008, which is held at Niigata city every year. The INSDH is collaborated with the world-famous Oxygen Club of California (OCC) congress and Linus Pauling Institute (LPI) conference on optimum health and diet, in which he engaged as a board member. He also founded and directed NUPALS Liaison R/D Center from 2007 to 2010. He is directing a five-year consortium project titled “The Basic Research on Development of Functional Foods for Next Generation” at NUPALS supported by the Ministry of Science and Education started from 2010. He is now serving as a visiting professor of Changchun University of Chinese Medicine to develop the international collaborative research on functional food. He can be reached at [email protected] or [email protected].

Contributors Bharat B. Aggarwal Department of Experimental Therapeutics The University of Texas: MD Anderson Cancer Center Houston, Texas M.A. Alwar Samskriti Foundation Mysore, India Kappillil Anilkumar The Lawyers’ Syndicate High Court of Kerala Ernakulam, India K.I. Anitha Health & Research Centre Thiruvananthapuram, India Somasundaram Arumugam Department of Clinical Pharmacology Niigata University of Pharmacy and Applied Life Sciences Niigata, Japan Josephine M. Balzac Burdock Group Consultants Orlando, Florida Subhadip Banerjee Department of Ayurveda Pharmacology Bengal Institute of Pharmaceutical Sciences Kalyani, India Karen Bishop Faculty of Medical & Health Sciences The University of Auckland Auckland, New Zealand George A. Burdock Burdock Group Consultants Orlando, Florida

Dennis Chang School of Science and Health University of Western Sydney Sydney, Australia Shantanu Das Goodman Fielder Ltd. Auckland, New Zealand Parikshit Debnath Department of Swasthavritta (Preventive Medicine) SDM College of Ayurveda and Hospital Hassan, India Pratip Kumar Debnath Department of Philosophy to Science Research Gananath Sen Institute of Ayurveda and Research Kolkata, India Asim K. Duttaroy Department of Nutrition University of Oslo Oslo, Norway Lynnette Ferguson Faculty of Medical & Health Sciences The University of Auckland Auckland, New Zealand Dilip Ghosh Nutriconnect Sydney, Australia Sumita Ghosh School of Built Environment University of Technology Sydney, Australia

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Derek Haisman Riddet Institute Massey University Palmerston North, New Zealand

Akira Kubo School of Medicine Tokai University Tokyo, Japan

Akihito Harusato Molecular Gastroenterology and Hepatology Kyoto Prefectural University of Medicine Kyoto, Japan

M.A. Lakshmithathachar Samskriti Foundation Mysore, India

Yasuki Higashimura Molecular Gastroenterology and Hepatology Kyoto Prefectural University of Medicine Kyoto, Japan Myriam Hinojosa Department of Experimental Therapeutics The University of Texas: MD Anderson Cancer Center Houston, Texas Katsuya Hirasaka Department of Nutritional Physiology University of Tokushima Graduate School Tokushima, Japan Nishi Karunsinghe Faculty of Medical & Health Sciences The University of Auckland Auckland, New Zealand Yeo Jin Kim Department of Life Science Dongguk University Seoul, Republic of Korea Shohei Kohno Department of Nutritional Physiology University of Tokushima Graduate School Tokushima, Japan Tetsuya Konishi HALD Food Function Research and NUPALS Liaison R/D Promotion Center Niigata University of Pharmacy and Applied Life Sciences Niigata, Japan

Song Li COFCO Nutrition and Health Research Institute Chao Yang District Beijing, People’s Republic of China Rie Mukai Department of Food Science University of Tokushima Graduate School Tokushima, Japan Akira Murakami Division of Food Science and Biotechnology Kyoto University Kyoto, Japan Yuji Naito Molecular Gastroenterology and Hepatology Kyoto Prefectural University of Medicine Kyoto, Japan Srinivas Nammi School of Science and Health University of Western Sydney Sydney, Australia Fumi Nihei Dr. Akira Kubo’s Office, Co., Ltd Chuo-ku, Tokyo Takeshi Nikawa Department of Nutritional Physiology University of Tokushima Graduate School Tokushima, Japan Arisa Ochi Department of Nutritional Physiology University of Tokushima Graduate School Tokushima, Japan

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Jane O’Shea School of Medicine University of Wollongong Wollongong, Australia Namyata Pathak ICMR Advanced Centre of Reverse Pharmacology in Traditional Medicine Kasturba Health Society Mumbai, India V. Prakash Nutrition Society of India Indian Council of Medical Research Hyderabad, India and Innovation and Development at JSSMVP JSS Technical Institutions Campus Mysore, India Yasmine Probst School of Medicine University of Wollongong Wollongong, Australia

Hiteshi A. Shah ICMR Advanced Centre of Reverse Pharmacology in Traditional Medicine Kasturba Health Society Mumbai, India Toshio Shimizu Department of Health and Human Life Nagoya Bunri Universty Nagoya, Japan Tee E. Siong TES NutriHealth Strategic Consultancy Selangor DE, Malaysia R.B. Smarta Interlink Marketing Consultancy Pvt. Ltd. Mumbai, India Hirohito Sone Department of Internal Medicine Division of Hematology, Endocrinology and Metabolism Niigata University Graduate School of Medical and Dental Sciences Niigata, Japan

Rajshri Roy Clinical Nutrition & Dietetics, School of Public Health University of Sydney Sydney, Australia

Yu-Ting Sun School of Science and Health University of Western Sydney Sydney, Australia

Daniel Roytas Department of Nutritional Medicine Southern School of Natural Therapies Fitzroy, Australia

Kenji Suzuki Department of Internal Medicine Division of Gastroenterology and Hepatology Niigata University Graduate School of Medical and Dental Sciences Niigata, Japan

Anwesha Sarkar Riddet Institute Massey University Palmerston North, New Zealand Young Rok Seo Department of Life Science Dongguk University Seoul, Republic of Korea

Tomohisa Takagi Molecular Gastroenterology and Hepatology Kyoto Prefectural University of Medicine Kyoto, Japan

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Amit Taneja Riddet Institute Massey University Palmerston North, New Zealand Namrata Taneja Riddet Institute Massey University Palmerston North, New Zealand Junji Terao Department of Food Science University of Tokushima Graduate School Tokushima, Japan Rajarajan A. Thandavarayan Department of Clinical Pharmacology Niigata University of Pharmacy and Applied Life Sciences Niigata, Japan Rebecca Thorne School of Medicine University of Wollongong Wollongong, Australia Ashok Vaidya ICMR Advanced Centre of Reverse Pharmacology in Traditional Medicine Kasturba Health Society Mumbai, India Chin-Kun Wang School of Nutrition Chung Shan Medical University Taichung, Taiwan

Contributors

Chunling Wang COFCO Nutrition and Health Research Institute Chao Yang District Beijing, People’s Republic of China Kenichi Watanabe Department of Clinical Pharmacology Niigata University of Pharmacy and Applied Life Sciences Niigata, Japan Yui Yamashita Department of Nutritional Physiology University of Tokushima Graduate School Tokushima, Japan Noriaki Yohkoh Department of Clinical Pharmacy Niigata University of Pharmacy and Applied Life Sciences Niigata, Japan Toshikazu Yoshikawa Molecular Gastroenterology and Hepatology Kyoto Prefectural University of Medicine Kyoto, Japan Andrea Zangara Ginsana SA SFI Group Bioggio, Switzerland

Section I Introduction

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Progress of Food-Based Dietary Guidelines around the Globe Yasmine Probst, Rebecca Thorne, and Jane O’Shea

CONTENTS 1.1 Overview....................................................................................................................................3 1.2 Development of Dietary Guidelines.......................................................................................... 4 1.3 Dietary Guidelines of the Oceania Region................................................................................4 1.4 Dietary Guidelines of North America.......................................................................................7 1.5 Dietary Guidelines of South America..................................................................................... 13 1.6 Dietary Guidelines of Europe.................................................................................................. 14 1.7 Dietary Guidelines of the Asian Region..................................................................................20 1.8 Dietary Guidelines of Africa...................................................................................................26 References......................................................................................................................................... 30

1.1 OVERVIEW Dietary guidelines have been developed worldwide in an effort to assist populations with healthy food choices. The guidelines may be food or nutrient based and are commonly focused on particular health concerns of the country such as overweight and obesity. There is a large degree of variability in the development of dietary guidelines around the world; some countries have opted for one guideline for all, whereas other countries have developed multiple subsets of guidelines related to particular population groups. The provision of dietary guidelines of a country is not regulated though they are a recommended approach that has been suggested by the World Health Organization (WHO) as one of the two international organizations supporting such activities. The WHO, alongside the Food and Agriculture Organization of the United Nations (FAO), acknowledge that it has long been known that particular nutrients are needed to sustain human health and well-being, and work to disseminate nutrient information to countries in an effort to encourage the development of national dietary allowances for these nutrients. Such nutrient allowances may directly form dietary guidelines of a nutrientfocused nature; though stemming from such developments, countries may also work toward practical approaches of how to translate the nutrient information into everyday practice, an approach often seeing the development of food-based dietary guidelines. This chapter provides an overview to some of the existing dietary guidelines available around the globe. Where a country regularly updates its dietary guidelines, a comparison of the most recent sets of guidelines will also be addressed. The focus of the dietary guidelines also varies between countries with some developed directly for the general public and others specifically targeted at health professionals to assist with consistency of education messages utilized within the country. The guidelines reviewed will be those available as the most recent guidelines published in the English language. The guidelines currently undergoing an update have not been included. 3

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1.2  DEVELOPMENT OF DIETARY GUIDELINES Establishing dietary guidelines has significant clinical and public health impact for a country as recommendations may be set to address the issues related to different age group- and gender-related over- or undernutrition problems. The guidelines are generally developed from the evidence supporting particular selected statements or phrases for the country’s dietary guidelines. This evidence may be in the form of consumer consultation, previous food intake surveys, or reviews of the scientific literature. Updates to the guidelines are likely to take place in 10–15 years as new evidence is accumulated or the WHO and the FAO update their position in relation to the nutrients included. Some countries, however, choose to update their guidelines more regularly. The last established report of such recommendations is from the joint FAO and WHO consultation of 1999, leaving many countries to follow the processes outlined by others to ensure that their guidelines remain relevant. Considerations that must be undertaken by a country before an update of the dietary guidelines occurs within a country include a range of factors such as the following (Beaton 2003): • Evidence that the guidelines, if followed, would result in dietary patterns with inadequate nutrient requirements • Evidence that the guides developed from the guidelines require an update or redesign • Evidence that a time has been reached in which it cannot be concluded whether a single food guide or a collection of food guides is developed to suit distinct groups • The need to align with emerging or updated dietary reference intake values • The need to reflect new foods in the marketplace or the new fortification practices • Transborder health promotion campaigns that may impact on food selection practices • Emerging international nutrition standards and trade regulations that impact on the existing food supply • Ineffective current guidelines • Expectations for a revision by health professionals Time has also changed the previous approach to dietary guidelines foci of avoidance of nutrient inadequacy and rather has now in many instances been teamed with the need to also avoid nutrient excess. This shift is being demonstrated by a need for revisions of recommended dietary intake levels of nutrients for particular countries. These intake levels commonly have an upper limit set as a form of risk management (Beaton 2003). Such risk management also sees many countries creating models of exemplar dietary patterns that may result from various combinations of intake that may result from consumer interpretation of the advice given. Such dietary pattern models are generally created based on the existing national food consumption survey data. Therefore, dietary guidelines are not only developed based on the food supply and eating habits within given countries but also underpinned by cultural practice and beliefs within the population or population groups being targeted. Subsections 1.3 through 1.8 provide an overview of selected dietary guidelines across the globe with a focus on those most recently updated.

1.3  DIETARY GUIDELINES OF THE OCEANIA REGION The dietary guidelines of Australians have recently undergone a 10-year revision, resulting in a significant shift in the detail included within the guidelines though the overall content has remained largely the same (National Health and Medical Research Council 2003, 2013a, 2013b). Endorsed by the National Health and Medical Research Council, the guidelines are developed to target not only the general population but also health professionals and policy makers. The guidelines are updated through an iterative process of expert review and consultation. The focus on variety of food sources remains a standing characteristic while the range of food sources recommended has increased.

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The underlying nutrient focus appears via the messages to limit and select specific types of foods from within the food groups. Having safe food practices as well as encouragement of water as the primary beverage of choice remain consistent. The message to support breastfeeding and the need to remain physically active have been maintained, while messages for specific population groups have been added in the latest revision (Table 1.1). TABLE 1.1 Dietary Guidelines for Australians 2003

Enjoy a wide variety of nutritious foods: • Eat plenty of vegetables, legumes, and fruits • Eat plenty of cereals (including breads, rice, pasta, and noodles), preferably whole grains • Include lean meat, fish, poultry, and/or their alternatives • Include milk, yogurt, cheeses, and/or their alternatives. Reduced-fat varieties should be chosen, where possible • Drink plenty of water Take care to • Limit saturated fat and moderate total fat intake. • Choose foods low in salt. • Limit your alcohol intake if you choose to drink. • Consume only moderate amounts of sugars and foods containing added sugars.

2013

Eat a wide variety of nutritious foods from the following five groups every day: • Plenty of vegetables, including different types and colors, and legumes/beans • Fruits • Grain (cereal) foods, mostly whole grains, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa, and barley • Lean meat and poultry, fish, eggs, nuts and seeds, and legumes/beans • Milk, yogurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under the age of two years) Drink water. Limit intake of foods and drinks containing saturated and trans fats: • Include small amounts of foods that contain unsaturated fats. • Low-fat diets are not suitable for infants. (Continued)

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Clinical Aspects of Functional Foods and Nutraceuticals

TABLE 1.1 (Continued) Dietary Guidelines for Australians 2003 Prevent weight gain: Be physically active and eat according to your energy needs. Care for your food: Prepare and store it safely. Encourage and support breast-feeding.

2013 Limit intake of foods and drinks containing added salt: • Read labels to choose lower sodium options among similar foods. • Do not add salt to foods. Limit intake of foods and drinks containing added sugars. In particular, limit sugar-sweetened drinks. If you choose to drink alcohol, limit intake. To achieve and maintain a healthy weight you should be physically active and choose amounts of nutritious foods and drinks to meet your energy needs. Children and adolescents should eat sufficient nutritious foods to grow and develop normally. They should be physically active every day and their growth should be checked regularly. Older people should eat nutritious foods and keep themselves physically active to help maintain muscle strength and a healthy weight. Encourage and support breastfeeding. Care for your food; prepare and store it safely.

Source: National Health and Medical Research Council, 2003, http://www.nhmrc.gov.au/_files_nhmrc/publications/­ attachments/n33.pdf; National Health and Medical Research Council, 2013a, http://www.nhmrc.gov.au/_files_ nhmrc/publications/attachments/n55a_australian_dietary_guidelines_summary_book_0.pdf; National Health and Medical Research Council, 2013b, http://www.nhmrc.gov.au/_files_nhmrc/publications/­ attachments​ /​ n31.­pdf.

The guidelines are not developed in isolation but rather have a closely related food guide that incorporates the key messages. This guide utilizes food portion size and number of servings to translate the guidelines messages into practice-based approaches for the general public/health education. The dietary guidelines of New Zealand are endorsed by the Ministry of Health with separate guidelines available for specific population groups (Ministry of Health 2009a). Utilizing the same nutrient reference values as Australia, similarities may be seen between the two countries’ dietary guidelines as well. The guidelines of New Zealand are fewer in number though also addressing the message of variety, avoidance of particular risk nutrients, suggestions for beverages to avoid and encourage, and the underpinning message of physical activity. Contrary to the Australian guidelines, the New Zealand message for physical activity provides more detail about the level of activity. Similarly, the message relating to the use of salt provides an alternate approach of using iodized salt for consumers. This message has only recently been promoted to the Australian consumers as a result of research into the nutrients’ importance in brain development (Table 1.2). While the guidelines for the general population are now 10 years old, the guidelines for the subgroups of infants and toddlers (Ministry of Health 2008a), children (Ministry of Health 2009b), adolescents, pregnant and breast-feeding women (Ministry of Health 2008b), and older people (Ministry of Health 2010) have more recently been updated.

Progress of Food-Based Dietary Guidelines around the Globe

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TABLE 1.2 New Zealand’s Food and Nutrition Guidelines for Healthy Adults Maintain a healthy body weight by eating well and engaging in daily physical activity.a Eat well by including a variety of nutritious foods from each of the following four major food groups each day: • Eat plenty of vegetables and fruits. • Eat plenty of breads and cereals, preferably whole grains. • Have milk and milk products in your diet, preferably reduced or low-fat options. • Include lean meat, poultry, seafood, eggs, or alternatives. Prepare foods or choose pre-prepared foods, drinks, and snacks • With minimal added fat, especially saturated fat. • That are low in salt; if using salt, choose iodized salt. • With little added sugar; limit your intake of high-sugar foods. Drink plenty of liquids each day, especially water. If you choose to drink alcohol, limit your intake. Purchase, prepare, cook, and store food to ensure food safety. Source: Ministry of Health, 2009a, http://www.health.govt.nz/publication/clinical​-guidelines​-weight​-management​-new​-​ zealand​-adults. a At least 30 minutes of moderate-intensity physical activity on most if not all days of the week, and if possible, do some vigorous exercises for extra health and fitness.

1.4  DIETARY GUIDELINES OF NORTH AMERICA The dietary guidelines of the United States are updated on a five-yearly basis by a process of scientific consultation. The last two updates of these guidelines are shown in Table 1.3 with the committee already working toward the 2015 update. Between 2005 and 2010, the main difference that is notable is the decreased length in the later set of guidelines (Health.gov 2008; US Department of Agriculture 2012). Although both are published online with supporting detail for each guideline, the 2005 guidelines also coincided with the release of the MyPyramid interactive tool for consumers to build healthy food habits. MyPyramid was developed from extensive consumer consultation in the form of focus groups and Web–TV-based questionnaires to determine the aesthetics of the tool as well as the concepts to be included (Haven et al. 2006). The consumer work ran as a number of phases beginning initially in 2002 and repeated again in 2004 (Britten et al. 2006). Most notably, this research showed that the image of the pyramid was well understood while the detail behind the recommendations was lacking. The guidelines themselves, however, are broken down into sections. Management of weight was maintained across the two standards of 2005 and 2010, with the section of physical activity from 2005 also being incorporated into this section. The concept of foods to increase were also maintained through the additional nutrients mentioned in the later edition allowed for the incorporation of nutrient sections that were previously separated out on their own. The alcohol, sodium, and potassium sections, and parts of the fat and carbohydrate sections were condensed and formed a new section of food and food components to be reduced, creating a shorter and more direct message overall. The Canadian guidelines (Health Canada 2007, 2011) are not updated as regularly as those of the United States but did undergo a significant revision in 2007 seeing an expansion of many of the existing guideline messages. The message of variety was incorporated into a collection of messages for each food group that was addressed. These food groups were previously all grouped together as one message. The messages relating to physical activity, alcohol, and caffeine have been removed, while more positive messages encouraging consumption of water for thirst have been used. The wording of the newer guidelines appears to be more positive in its choice of wording.

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Clinical Aspects of Functional Foods and Nutraceuticals

TABLE 1.3 Dietary Guidelines for Americans 2005a

Weight management • To maintain body weight in a healthy range, expend balance calories from foods and beverages with calories. • To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity. • To lose weight, aim for a slow, steady weight loss by decreasing calorie intake while maintaining an adequate nutrient intake and increasing physical activity. • For overweight children: Reduce the rate of body weight gain while allowing growth and development. Consult a health-care provider before placing a child on a weight reduction diet. • For pregnant women: Ensure appropriate weight gain as specified by a health-care provider. • For breast-feeding women: Moderate weight reduction is safe and does not compromise weight gain of the nursing infant. • For overweight adults and overweight children with chronic diseases and/or on medication: Consult a health-care provider about weight loss strategies prior to starting a weight reduction program to ensure appropriate management of other health conditions. Physical activity • Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and healthy body weight.

2010

Balancing calories to manage weight • Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors. • Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages. • Increase physical activity and reduce time spent in sedentary behaviors. • Maintain appropriate calorie balance during each stage of life—childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age. Foods and food components to reduce • Reduce daily sodium intake to