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Nutrition

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Annex

Summary of the strength of evidence for obesity, type 2 diabetes, cardiovascular disease (CVD), cancer, dental disease and osteoporosisa


Obesity

Type 2 diabetes

CVD

Cancer Dental disease

Osteoporosis

Energy and fats






High intake of energy-dense foods

C↑





Saturated fatty acids


P↑

C↑b



Trans fatty acids



C↑



Dietary cholesterol



P↑



Myristic and palmitic acid



C↑



Linoleic acid



C↓



Fish and fish oils (EPA and DHA)



C↓



Plant sterols and stanols



P↓



α-Linolenic acid



P↓



Oleic acid



P↓



Stearic acid



P-NR



Nuts (unsalted)



P↓



Carbohydrate






High intake of NSP(dietary fibre)

C↓

P↓

P↓



Free sugars (frequency and amount)




C↑c


Sugar-free chewing gum




P↓c


Starchd




C-NR


Wholegrain cereals



P↓



Vitamins






Vitamin C deficiency




C↑e


Vitamin D




C↓f

C↓g

Vitamin E supplements



C-NR



Folate



P↓



Minerals






High sodium intake



C↑



Salt-preserved foods and salt




P↑h


Potassium



C↓



Calcium





C↓g

Fluoride, local




C↓c


Fluoride, systemic




C↓c

P-NRg

Fluoride, excess




C↑f


Hypocalcaemia




P↑f


Meat and fish






Preserved meat




P↑i


Chinese-style salted fish




C↑j


Fruits (including berries) and vegetables






Fruits (including berries) and vegetables

C↓k

P↓k

C↓

P↓l


Whole fresh fruits




P-NRc


Beverages, non-alcoholic






Sugars-sweetened soft drinks and fruit juices

P↑



P↑m


Very hot (thermally) drinks (and food)




P↑n


Unfiltered boiled coffee



P↑



Beverages, alcoholic






High alcohol intake



C↑o

C↑p

C↑g

Low to moderate alcohol intake



C↓q



Other food-borne






Aflatoxins




C↑r


Weight and physical activity






Abdominal obesity


C↑




Overweight and obesity


C↑

C↑

C↑s


Voluntary weight loss in overweight and obese people


C↓




Low body weight





C↑g

Physical activity, regular

C↓

C↓

C↓

C↓i

P↓t

C↓g

Physical inactivity/sedentary lifestyle

C↑

C↑




Other factors






Exclusive breastfeeding

P↓





Maternal diabetes


C↑




Intrauterine growth retardation


P↑




Good oral hygiene/absence of plaque




C↓e


Hard cheese




P↓c


Environmental variables






Home and school environments that support healthy food choices for children

P↓





Heavy marketing of energy-dense foods, and fast-food outlets

P↑





Adverse socioeconomic conditions

P↑





C↑: Convincing increasing risk; C↓: Convincing decreasing risk; C-NR: Convincing, no relationship; P↑: Probable increasing risk; P↓: Probable decreasing risk; P-NR: Probable, no relationship; EPA: eicosapentaenoic acid; DHA: docosahexaenoic acid; NSP: non-starch polysaccharides.

a Only convincing (C) and probable (P) evidence are included in this summary table.
b Evidence also summarized for selected specific fatty acids, see myristic and palmitic acid.
c For dental caries.
d Includes cooked and raw starch foods, such as rice, potatoes and bread. Excludes cakes, biscuits and snacks with added sugar.
e For periodontal disease.
f For enamel developmental defects.
g In populations with high fracture incidence only; applies to men and women more than 50-60 years old.
h For stomach cancer.
i For colorectal cancer.
j For nasopharyngeal cancer.
k Based on the contributions of fruits and vegetables to non-starch polysaccharides.
l For cancer of the oral cavity, oesophagus, stomach and colorectum.
m For dental erosion.
n For cancer of the oral cavity, pharynx and oesophagus.
o For stroke.
p For cancer of the oral cavity, pharynx, larynx, oesophagus, liver and breast.
q For coronary heart disease.
r For liver cancer.
s For cancer of the oesophagus, colorectum, breast (in postmenopausal women), endometrium and kidney.
t For breast cancer.