5th international conference on nutrition and fitness: the Centre for genetics, nutrition and health, Athens, 9-12 June 2004.

Every four years, coinciding with the Olympic Games, Artemis Simopolous and her spirited team invite leading researchers and policy makers to present on topics around the theme 'nutrition and fitness'. This year, over 250 delegates from 37 countries attended this four-day conference which was held at the scenic War Museum of Athens, Greece. This was particularly fitting given that the Olympic Games were to be held in the same country soon after.

Over the four days 50 invited speakers presented in one auditorium where we were treated to a very intense, high quality program. Half-day sessions were organised around the following themes: cardiovascular disease, optimising control of the ageing process, obesity, metabolic syndrome and diabetes, cancer, inactivity and chronic disease, defining the components of physical activity and healthy diet, and finally, the role of government in implementing a healthy diet and physically active lifestyle.

The opening presentation by Dr Maria Donati, from the Centre for High Technology Research and Education in Biomedical Science in Italy, outlined the IMMIDIET study, which aims to investigate the interactions between genetics and life habits in cardiovascular disease risk. This study builds on 15 years of experience in the study of gene polymorphism that has uncovered differing responses, for example, linking effects of physical activity to fibrinogen phenotype, or increases in triglyceride levels to the coagulation Factor VII genotype. At this session we were privileged to hear Professor Alexander Leaf, from the Massachusetts General Hospital and Harvard Medical School, Boston, present a review on the role of omega-3 fatty acids and ventricular arrhythmias. This was followed by a very interesting presentation by Dr Claudio Galli on the validity of a novel, rapid, relatively cheap fingertip blood test for the assessment of omega-3 polyunsaturated fatty acid status which has direct applications in epidemiological research.

The conference then moved from dietary assessment to the exciting area of 'nutrigenomics'. Dr Jose Ordovas from the Nutrition and Genomics Laboratory in Boston stressed that disease prevention was the most economical and successful approach to healthy ageing. To this end 'nutrigenetics' is emerging as a multidisciplinary field focusing on studying the interactions between nutrition, genetic factors, and health outcomes. Hence, using genetic and biochemical markers of disease, we can begin to characterise individuals who may respond better to one type of recommendation or another. The ultimate goal is to develop individual dietary intervention strategies aimed at achieving healthy ageing. Building on this field. Dr Harumi Okuyama from the Department of Preventive Nutraceutical Sciences at the Nagoya City University  in Japan reported on the importance of the balance between n-6 and n-3 polyunsaturated fatty acids in the diet. He argued that in Japan, major age-related diseases such as cancer, cardiovascular disease and pneumonia are linked to an increased inflammatory response caused by excessive intake of n-6 fatty acids. His research has shown that in rodents, oils with a low n-6:n-3 ratio show a suppression of the ageing process.

Arguably the number one public health issue in modern western societies is obesity and its related disorders. Dr Konstantinos Pavlou from the Hellenic Sports Research Institute in Athens provided a comprehensive overview of the worldwide epidemic of obesity and related disorders, and the various treatments for obesity including fad diets driving a billion dollar industry. Dr Len Storlien from AstraZeneca Research and Development in Sweden, and formerly from the University of Wollongong, reminded us of the relationships between obesity and the metabolic syndrome and hence the need for multiple approaches to the problem of obesity. Targeting lifestyle changes with pharmaceutical support and consideration of an individual's genetic composition, takes into account an individual's different susceptibility to obesity, their ability to comply and respond to change, as well as the benefits of common diet and exercise interventions. This point was reinforced by Dr Labadarios from the Department of Human Nutrition at the University of Stellenbosch and Tygerberg Academic Hospital in South Africa, who overviewed the clinical aspects of the metabolic syndrome, and the link with obesity and innate immune function to the inflammatory response. As previously suggested by Storlien, lifestyle modification together with pharmaceutical therapy may be the most appropriate approach, however, early intervention studies are needed to establish efficacy.

In a captivating presentation Dr Antonio Tataranni from the Clinical Diabetes and Nutrition Section of NIDDK, Arizona, reported on the observational work with Pima Indians of south western Arizona. He pointed out that although Pima Indians have one of the highest reported prevalence rates of obesity and type 2 diabetes mellitus, they enjoy a relatively low prevalence of hypertension and cardiovascular disease, and that this may be due to differences in physiological responses to increased adiposity and insulinemia observed in Caucasians. Tataranni suggested that the abnormalities associated with the Metabolic Syndrome are the result of independent physiological processes and that clinical treatment and prevention strategies might be better aimed at the individual components. (This point was further explored with Tataranni when we sailed on the Aegean Sea at the official conference dinner.)

This conference was a good opportunity for dietitians to listen to a range of presentations from within the discipline of exercise science and vice versa. Dr Frank Booth from the USA gave a very entertaining overview of the consequences of physical inactivity, namely chronic disease. He highlighted the fruits of human achievement--machines to perform work and the 'McDonaldisation' of society--as contributing largely to inactivity. In turn he argued, inactivity affects the functions/structures of most organ systems. In fact, the World Health Organization has issued a press release stating that 'a sedentary lifestyle could very well be among the ten leading causes of death and disability in the world' (1). Following on from Dr Booth's overview, Dr Bengt Saltin of Denmark offered hope, suggesting that regular exercise, even at low levels and short duration, does improve metabolic fitness and thus, overall health.

Having set the scene in the preceding three days, the presenters on the final day (which went from 9.00am to 9.00pm) were charged with defining the components for physical activity and a healthy diet in addition to outlining the role of government in promoting a healthy diet and physically active lifestyle. After an informative overview from Professor Mark Wahlqvist a number of exercise interventions studies were presented. These included descriptions of a program for Lebanese schoolchildren, a population program for nutrition and physical activity in Serbia and a muscle test that improved functional status in patients with chronic heart failure.

Interest in the Mediterranean diet derives directly from Ancel Key's work in the Seven Country study back in the late 1950s (2). Dr Simopolous presented earlier work which outlined the traditional Greek diet which consisted of a high intake of fruits and vegetables, bread rather than pasta, olives and olive oil, less milk but more cheese, more fish, less meat and moderate amounts of wine. Most importantly this diet provided a proportion of omega-6:omega-3 ratio of around 1-2:1, which is contrasted with a modern western diet >10:1. A number of studies support this style of eating including a landmark intervention trial, the Lyon Heart Study. We were treated to a detailed presentation of this study by Professor Michel de Lorgeril, from Lyon, France with the key finding that a Mediterranean type of diet decreases the risk of cardiac death by 30% and sudden cardiac death by 45%. Professor de Lorgeril made the point that in the context of a diet rich in oleic acid and poor in saturated and omega-6 fatty acids, even small doses of omega-3 (1 g/day) might be protective. The final session of the conference challenged us to look forward to ways of promoting a healthy diet and physical activity. Mr Amalia Waxman from the World Health Organization, Switzerland outlined a global strategy on diet, physical activity and health. The guiding principle is that the reduction of non-communicable diseases (NCDs) requires a multi-sectorial, multi-stakeholder approach. Professor Linda Tapsell followed on from this point and overviewed the recently established and internationally unique, National Centre of Excellence in Functional Foods. This is a part of the Australian government initiative, the National Food Industry Strategy. Professor Tapsell outlined research initiatives undertaken by the centre that have potential to be taken up by industry to support healthy ageing, weight control, healthy lifestyle and child health.

Having spent plenty of time walking around, up and down the Acropolis (a Greek word meaning 'high city') and sampling the wonderful Mediterranean cuisine on offer we felt we were living Aristotle's so-called authentic life. In essence this conference reinforced that we are really rediscovering what Hippocrates wrote about over 2000 years ago: 'if there is any deficiency in food or exercise the body will fall sick'. However, the strategies to overcome the obesity pandemic while encouraging, largely appear elusive.

References

1. World Health Organization. Sedentary Lifestyle: a global public health problem, http://www.who.int/hpr/physactiv/sedentary.lifestyle2.shtml Accessed 22 october 2004.

2. Keys A, Anderson JT, Grande F. Prediction of serum cholesterol responses of man to changes in fat in the diet. Lancet 1857:273:959-66.

Craig S Patch MBA APD 

Lynda Gillen APD

ARC Key Centre for Smart Foods

University of Wollongong