Day 1 :
Azienda Sanitaria Universitaria Integrata di Trieste, Italy
Giulio Barocco has a Master of Science in Prevention and Complex Actions, a Graduate Degree in Health Professions of Prevention Sciences and a Bachelor’s Degree as Food Merceology and Prevention Technician. Since 2007 he has held an Expert position for the integration and joint management of food safety and nutrition quality at the Public Health Agency of Trieste (ASUITS). He acts as an Advisor for the development of food and nutrition projects and policies in the framework of the “Gaining Health” program (Regional Health System of the Region Friuli Venezia Giulia). He has developed several integrated programs on nutrition, food security and food safety for public institutions at local and regional level.
Multidimensional Survey of catering in elderly care homes in Friuli Venezia Giulia Region, Italy (2016) coordinated by Local Health Agency (LHA) of Trieste has shown some critical aspects in the quantity–quality profile of food administered in the segment of welfare catering. The formulation of meals can be characterized by the excessive use of processed raw materials and incorrect preparation practices which, although meeting the caloric and macronutrient needs, do not always guarantee a sufficient protection from oxidative stress. At some nursing homes, losses of up to 70% of antiradical power of several vegetable dishes have been observed such as demonstrated by University of Trieste. This is a serious problem for institutionalized elders as, according to literature, the prevalence of denutrition and the risk of malnutrition exceed 20% and 50% respectively of the guests. In view of these findings, the LHA has adopted Nutrient Analysis Critical Control Points (NACCP) process as a working tool for the integration of hygiene best practices and measures to prevent the damage of some nutrient fractions during the various steps of all production processes (food supply, storage, preparation and cooking methods). To maximize the intake of bioactive compounds by consuming protective meals new criteria have been introduced into public procurement contracts. Criteria establish more raw materials, such as fresh fish, lower exposure of food to degradation agents by redefining the timing of the production flows, workloads, technological systems used. Accurate declination of the process under examination has allowed to serve meals that can guarantee a sufficient protection from oxidative stress to elderly. Integrating the NACCP process and good nutritional practice with the criteria of green public procurement and sustainable development goals falls within the broad framework of actions aimed at implementing principles of Health in All Policies ratified by the WHO.
Mukorgawa Women’s University, Japan
Yukio Yamori MD, Ph.D. is a Former WHO Expert Committee Member on Cardiovascular Diseases, Professor Emeritus of Kyoto University, and currently Director of Mukogawa Women’s University Institute for World Health Development and President, Hyogo Prefecture Health Promotion Association. He is an honorary member for numerous organizations such as Stroke Council of American Heart Association and High Blood Pressure Research Council of Australia. He won CIBA Award for Hypertension Research from American Heart Association (1982), Beltz Award for Nutritional Factors-related to CVD (1993), the Order of Purple Ribbon from Japanese Government (1998) and Special Award from Japanese Society of Hypertension (2008) and Orders of the Sacred Treasure from Japanese Government (2012). He has contributed to research on the pathogenesis of hypertension, stroke and atherosclerosis, gene analyses of cardiovascular diseases, development of models for cardiovascular diseases (SHR, SHRSP) and cardiovascular and nutritional epidemiology.
Background and Aim: WHO-coordinated CARDIAC (Cardiovascular Disease and Alimentary Comparison) Study covering over 60 populations in the world revealed sodium(Na) intakes and Na/potasium(K) ratio checked by 24-hour urine (24U) samples were associated positively with the age–adjusted mortality rates of strokes, and therefore, Na and Na/K ratios of 24U were proven to be useful predictors of strokes.1.2 Since CARDIAC study also proved significant inverse association of 24U biomarkers of fish and soy intakes, taurine (T) and isoflavones (I) with the age-adjusted mortality rates of coronary heart diseases (CHD),2.3 we investigated the association of these biomarkers with the risks of CHD.
Methodology: About 100 males and 100 females aged 48-56, from each study site, 50 in total in the world, were invited to health examination for anthropological examination and automated blood pressure measurement as well as fasting blood sampling and 24U collection by using “aliquot cups” for collecting easily 1/40th of voided urine each time. The quintiles of 24UT(T1-5) and 24UI(I1-5) were analyzed in relation to cardiovascular risks.4
Findings: The group who excreted both lowest 24UT and 24UI, T1-I1, showed significantly (p<0.001) higher BMI and serum cholesterol after age and sex adjustment than the group who excreted both highest 24UT and 24UI, T5-I5. The Odds ratios of obesity and hypercholesterolemia in the lowest T1-I1 were 8.6 and 7.7, significantly (p<0.01, 0.001) higher than in the highest T5-I5, but Odds ratio of hypertension was 1.4, not significant.
Conclusion: 24UT and 24UI were strongly associated with obesity and hypercholesterolemia, 2 major risks of CHD. Therefore, 24UT and 24UI are the predictors for CHD. When these are combined with 24UNa and 24UK, these 24U biomarkers obtained noninvasively are useful for objective estimation of individual nutritional situation and risk assessment of CHD and stroke, thus can be predictors for 2 major cardiovascular diseases.
University of Copenhagen, Denmark
Dr. Jens Byskov graduated from the University of Copenhagen, Denmark as a Medical Doctor with later specialty in Public Health, and from London School of Tropical Medicine as MSc in Community Health in Developing Countries. He has worked with research and capacity development for health systems within the Danish Institute for Health Research and Development and has been residing in African countries over 10 years. He has coordinated multicountry health systems studies. Being Emeritus from the University of Copenhagen he works as a research and health systems technical advisor in the School of Public Health of the University of Zambia.
The ever-increasing evidence and technical developments supporting population health has not yet reached the goal of health for all. The decision making for population health has not led to optimally accountable, fair and sustainable solutions. Technical experts, politicians, managers, service providers, community members, and beneficiaries each have their own values, expertise and preferences, to be considered for necessary buy-in and sustainability. Some of these are well recognized and partly addressed, but those not addressed or hidden constitute vested interests that may be the main constraint for achieving population health. We present and test a hypothesis that health for all and sustainable population health are indeed synonymous. We next search for explicit or implicit concurrence with the hypothesis in the implicit or explicit practice of health systems and associated research. For a start this will be done by reviews of available systems plans, reports and published research. It will be discussed whether results are associated with the existing degree of national or subnational level democratic practice. If the hypothesis holds a greater democratization in health systems practice will be suggested as an ethical imperative.