The Healthy Core Metabolism: A New Paradigm for Primary Preventive Nutrition Anthony Fardet, Edmond Rock To cite this version: Anthony Fardet, Edmond Rock. The Healthy Core Metabolism: A New Paradigm for Primary Pre- ventive Nutrition. Journal of Nutrition, Health and Aging, Springer Verlag (Germany), 2016, 20 (3), pp.239-247. 10.1007/s12603-015-0560-6. hal-01458429 HAL Id: hal-01458429 https://hal.archives-ouvertes.fr/hal-01458429 Submitted on 6 Feb 2017 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. J Nutr Health Aging Volume 20, Number 3, 2016 THE HEALTHY CORE METABOLISM: A NEW PARADIGM FOR PRIMARY PREVENTIVE NUTRITION A. FARDET, E. ROCK 1INRA, Human Nutrition Department, JRU 1019, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand & Clermont Université, Université d’Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000 Clermont-Ferrand, France. Corresponding author: Dr. Edmond Rock, INRA, Human Nutrition Department, JRU 1019, UNH, CRNH Auvergne, F-63000 Clermont- Ferrand & Clermont Université, Université d’Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000 Clermont-Ferrand, France, +33 (0)4 73 62 41 69, fax +33 (0)4 73 62 46 38, E-mail: [email protected] Abstract: Research in preventive nutrition aims at elucidating mechanism by which our diet helps us to remain in good health through optimal physiological functions. However, despite decades of accumulated data in human nutrition and regular subsequent nutritional recommendations, obesity and type 2 diabetes epidemics continue to progress worldwide each year leading to a regular decrease of the Healthy Life Years, notably in Western countries. Such a paradox may be explained by the Nutrition Transition, the extreme application of the reductionist paradigm in nutrition research, the lack of nutritional education and a too strong focus on curative nutrition in at risk/ill subjects. In this position paper, we hypothesized that researchers should focus more on healthy subjects, from birth until maturity. Rather than exploring what differentiates healthy and at risk/ ill subjects, we propose to thoroughly study what characterizes a healthy state and its underlying metabolism. We define it as the Healthy Core Metabolism which remains stable whatever energy inputs (diets) and outputs (exercise), genetic background and external/internal stress, e.g., temporary illnesses. As a basis for Healthy Core Metabolism investigation, we observed that main physiological and ubiquitous functions of human organism, i.e., the neuro-vasculo-sarco-osteoporotic system, tend to follow a concave curve with common phases of growth, optimum, and decline. Finally, we hypothesized that true primary preventive nutrition should focus on the growth phase to reach the maximum capital of a given physiological function so that - whatever the further decline -, Healthy Life Years may approach or coincide with theoretical Life Expectancy. Key words: Healthy core metabolism, preventive nutrition, metabolic optimum, healthy metabolic range. Introduction to achieve optimal health and to live a long life in good health, idealistically to align the Healthy Life Years with Life The World Health Organization has proposed to cluster Expectancy. Therefore, the target of this primary prevention prevention in 3 categories: 1) Primary prevention includes is clearly the healthy large public. Preventive nutrition is all actions intended to reduce the incidence of a disease in a then ensured by public health policies via different mode of population, thereby reducing the risk of occurrence of new communication such as food pyramids, nutritional education, cases. It uses measures of individual (personal hygiene, diet, national nutrition programs such as the French Programme physical activity and sport, vaccinations ...) and collective National Nutrition Santé (PNNS, http://www.mangerbouger.fr/ (drinking water, waste disposal, food safety, immunization, pnns). hygiene and habitat workplace) prevention. This traditional Yet, diet-related chronic diseases prevalence increases concept of prevention inevitably leads to a vast improvement each year, notably for type 2 diabetes, obesity, cancers and in the quality of life and social institutions reform program; cardiovascular diseases. It then appears that preventive 2) Secondary prevention includes «all acts intended to reduce nutrition did not succeed in stopping such epidemics despite the prevalence of a disease in a population, thereby reducing several decades of research and the huge amount of nutritional the duration of disease progression». It takes into account data collected (1). Several reasons may be proposed for this the early detection and treatment of first symptoms; 3) situation: first, the well-known nutrition transition from Tertiary prevention includes all actions intended to reduce the traditional, unrefined, nutrient-dense and minimally-processed prevalence of chronic disability or recurrence in a population, foods to ultra-processed and energy-dense foods and the so as to minimize the functional consequences of disability parallel reduction of physical activities together with increased from the disease; it extends the prevention to the field of sedentarity (2), second, the application of the reductionist rehabilitation by seeking to promote professional and social paradigm associating one nutrient with one physiological reintegration. effects and reducing food health potential to only a few In theory, research in preventive nutrition aims at elucidating compounds and that have led to fractionation-recombination the mechanism by which our diet help us to remain in good of foods and to consider preventive nutrition according to a health, through optimal physiological functions. Today, pharmacological approach on the one hand and food bioactives preventive nutrition also associates physical activities, and similar to drugs on the other hand (1), and third the generally more generally gaining a sense of lifestyle choices and their low level of nutritional education leaving most populations effects upon one’s health. The final objective is therefore powerless in front of marketing pressure (e.g., advertisements Received January 19, 2015 Accepted for publication March 3, 2015 239 J Nutr Health Aging Volume 20, Number 3, 2016 HEALTHY CORE METABOLISM AND PREVENTIVE NUTRITION and labeling, risky health claims, etc.) by agro-food industry related chronic diseases like obesity (9), type 2 diabetes (10), and related stakeholders for ultra-processed and/or recombined cardiovascular diseases (11) and cancers (12). But to the best foods with high monetary added value. of our knowledge, the healthy state remains to be defined As a result, the Healthy Life Years progressively decrease or characterized via metabolomics. Indeed, most human each year leaving an always longer duration of life with studies were interested by what differentiate ill versus healthy disabilities, notably due to diet-related chronic diseases. The populations, not with what is common to them. duration with disabilities is today above 20 years in France for Today, it is clear that preventive nutrition is rarely applied both women (between 64, Healthy Life Years, and 85 years, very early in human life, but most of the time in the second half Life Expectancy) and men, which is more and more humanly of life where the individuals are already at risk if not affected and economically unbearable (1). Yet, in 1980, Fries et al. by degenerative diseases. The development of functional foods introduced the Compression of Morbidity hypothesis, « positing and supplements (i.e., nutraceuticals) for the latter population that the age of onset of chronic illness may be postponed more are more for curing an already unbalanced diet than for than the age at death and squeezing most of the morbidity avoiding illness (1). And if nutraceuticals fail to restore a in life into a shorter period with less lifetime disability » healthy state, this leaves place for pharmacological industry (3). Preventive nutrition and healthy diets may therefore be and medicine. It seems that a real primary nutrition-based expected to significantly extend the Healthy Life Years nearer prevention should be applied very early, at least during the to the age at death (4). Yet, until today, preventive nutrition first half of life, and idealistically starting by the mother before has been mainly focusing on secondary and tertiary prevention child conception. Yet, today, researchers in nutrition seem more that is preventing at risk people or curing ill subjects from focused on the health state of elderly than that of infants, young developing chronic diseases. In addition, research in preventive children, adolescent and young adults (i.e., before midlife); the nutrition has primarily investigated differences between at elderly having a higher purchasing power than the youngest! risk/ill and healthy subjects to unravel potential differences Therefore, from a scientific perspective there is an in physiological states (5). Paradoxically, the healthy