EFAD: Athens conference report

ursula arens writer; nutrition & dietetics

Ursula has spent most of her career in industry as a company nutritionist for a food retailer and a pharmaceutical company. she was also a nutrition scientist at the British Nutrition Foundation for seven years. Ursula helps guide the NHD features agenda as well as contributing features and reviews.

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Delegates attending the efaD athens Conference number eight, ate lots of local delights. Plates were mountain-high with souvlaki, salads and spanakopita. aside from eating together, there were lots of opportunities to compare and contrast the science and practice of dietetics in a melody of european accents, the unfair constant being that the official language of the event (=english) was not the mother tongue of the vast majority of those attending.

The European Federation of the Associations of Dietitians (EFAD) was established in 1978 to encourage both the better nutrition status of the population of the member countries of Europe, and to support the scientific and professional development of dietetics, with a view to entwining these two public and professional strands. Membership of EFAD is open to all National Associations of Dietitians from member states of the European Union, and there are currently 33 member associations (of which the BDA is one), representing over 30,000 dietitians. In addition to funding from member associations, EFAD receives funding from the Executive Agency for Health and Consumers, under the framework for the Health Programme of the European Union.

The EFAD Athens conference held in October 2014, offered a rich diversity of themes to consider and, at all times, there were three to five parallel events to choose from. Over the threeday conference, there were 16 lectures, 10 workshops and 21 roundtables and, as always with a large conference, some preparation time is needed to blend learning the most with rushing around the least.

There were many star speakers. French sociologist Claude Fischler offered dazzling insights into the many ways that we think about food and how this influences food choices. Questions on foods show particular polarity between American versus French respondents, and Professor Fischler has researched these differences in depth. Prompted with pictures of chocolate cake, Americans think “guilt - calories”, whereas French think “celebration - pleasure”. A picture of a jug of cream makes Americans think “unhealthy”, whereas French think “whipped”. Professor Fischler observed that when looking at the many risk factors there were for obesity, the one that consistently scored highest was being an English-speaker. Americans valued quantity, variety and comfort, whereas the French selected quality and pleasure-giving to explain their food choices. For a sociologist to observe that people are muddled and inconsistent in their views is not stopthe-press news, but Claude Fischler also gave some historical examples of strident pronouncements of the healthiness of foods that would today elicit opposite opinions. The obvious thought is which of our current dietary guidelines will amuse future nutrition professionals? Today his main area of research is commensality - eating together and sharing food - and possible effects on public health; eating a lunchtime sandwich al desko is unlikely to score well, but can the who-you-eat-with really out-trump the what you eat in relation to health?

Another internationally acclaimed speaker was James Hill, best known for the establishment of the National Weight Control Registry (NWCR) in the US. This project is an inversion of the normal research project; rather than ex-

perts giving advice on weight control, it involves recruiting those who have been successful at losing significant amounts of weight (at least 35kg), and maintained this loss for at least a year, and then collecting information on habits and beliefs associated with success (positive deviance). Typical NWCR members are female, aged 45-50. Nearly half of the subjects have lost weight on their own, whereas the others had the support of a health professional or some weight loss organisation. Overall, common patterns for successful weight loss maintenance were breakfast eating, the use of low-calorie sweeteners, regular self-weighing and doing some vigorous physical activity for an hour daily. Changes to lifestyle required dedication and determination and Professor Hill contrasted tales of success with some examples of the social costs of weight loss, such as no longer meeting the friends who gathered weekly over beer and pizza.

There has been a levelling off of obesity trends in the US population and Professor Hill discussed commentary on this. Was there a saturation of those within the population who were genetically susceptible to weight gain in a foodrich environment? Was it an increased availability of products that supported small changes to lifestyle choices, such a replacement of energycontaining drinks with low calorie alternatives? “Any (energy-deficit) diet works,” concludes America’s most authoritative weight loss expert, but the urgent issue is now to better understand and support weight maintenance. Nutrition professionals needed to improve matching weight loss therapies to the specific needs of dieters, and more effort was needed to screen out ‘not ready for weight loss’ patients from programmes in order to reduce disappointment on both sides of the consulting table.

A star-of-the-future is Aimilia Papakonstantinou, a dietitian who lectures at the Agricultural University of Athens. She spoke about the use of low calorie sweeteners for people with obesity or diabetes mellitus. Low calorie sweeteners are assessed for safety by both European experts (EFSA) and experts supported by the United Nations and the World Health Organisation (JECFA). Regulatory agencies use data to then define ‘Acceptable Daily Intakes’ levels, the amount of an approved sweetener that can be consumed daily over a lifetime, without any anticipated health problems. Of course, all sweeteners in use have been approved by expert agencies as safe, but there were often public concerns over concepts of natural versus artificial ingredients in foods. Dr Papakonstantinou referred to the importance of evidence-based data as the basis for dietetic advice and, from this, the use of approved sweeteners could be supported. But did the use of sweeteners support health in those who were overweight and in those with diabetes? One study showed that the inclusion of non-nutritive sweetened drinks was at least as effective as drinking water, during a 12-week weight loss programme (Peters JC et al, Obesity, 2014). Another review showed that the inclusion of low-calorie sweeteners, in place of regularcalorie choices, supported modest weight loss (Miller PE, AJCN, 2014). Some observational studies reporting positive associations between obesity and the use of low-calories sweeteners may represent ‘reverse causality’ whereby being obese increases the chance of seeking products containing sweeteners.

The session on hydration brought in a local theme: fluid balance in the citizens of Athens. Maria Kapsokefalou of the Agricultural University of Athens has researched the effects of seasonality on water balance. The significant differences in summer and winter temperatures in Greece resulted in strong differences in typical intakes of fluids of one litre per person daily. Mean intakes of total water intakes in a sample of Athenians was 2,892ml per day in the winter, rising to 3,875ml per day in the heat of summer. Professor Kapsokefalou observed that generally water balance was tightly maintained so that measured intakes matched measured outputs; however, there were more subjects with aberrant water balances in summer, indicating that it was more difficult to remain hydrated during periods of heat.

During discussions on hydration status, there may be some differences in concept between the public and scientific use of terminology. Public understanding of the term ‘water’ may only include the clear fluids consumed from a glass or a bottle and not the 20 to 30 percent of water intakes also provided by solid and formed foods, so advice on water intakes may cause confused

and exaggerated public perceptions of requirements. Some consistency of the terms ‘waterfluid-liquid’ would be useful in public health messages, otherwise correct science information outputs may be lost-in-translation. But this is what dietetics is all about anyway.

Professor Ron Maughan from Loughborough University presented interesting views on the question of why drink? No debate is needed to support the view that more people should be more active more often, but of interest is the data showing that subjective perceptions of the general effort of running-around are increased during states of greater dehydration. Studies of identical exercise tasks showed increases in the self-assessments of effort needed, when intakes to hydration are restricted. When there are so many items on the public list of “why I can’t be bothered to exercise”, impairment of the easiest one to rectify, hydration status, should always be considered during advice on fitness. Peak performance is not usually the concern of recreational exercise, and health and wellness benefits more strongly drive participation. However, one valid reason to moderate effort during exercise is heat, and Professor Maughan described data showing the adverse effects of greater leakage across the blood-brain barrier as environmental temperatures increased.

The website ‘efad.org’ will be the site to check for future events and conferences. Attending an EFAD conference is a wonderful opportunity for a science and practice update on dietetics. And a wonderful opportunity to visit a European city: Amsterdam is next on the list.

Declaration Ursula’s attendance at the 8th EFAD conference held in Athens on 9-12 October 2014, was kindly funded by The Coca Cola Company