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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

Cb



Trans fatty acids



C



Dietary cholesterol



P



Myristic and palmitic acid



C



Linoleic acid





Fish and fish oils (EPA and DHA)





Plant sterols and stanols





a-Linolenic acid





Oleic acid





Stearic acid



P-NR



Nuts (unsalted)





Carbohydrate






High intake of NSP(dietary fibre)



Free sugars (frequency and amount)




Cc


Sugar-free chewing gum




c


Starchd




C-NR


Wholegrain cereals





Vitamins






Vitamin C deficiency




Ce


Vitamin D




f

g

Vitamin E supplements



C-NR



Folate





Minerals






High sodium intake



C



Salt-preserved foods and salt




Ph


Potassium





Calcium





g

Fluoride, local




c


Fluoride, systemic




c

P-NRg

Fluoride, excess




Cf


Hypocalcaemia




Pf


Meat and fish






Preserved meat




Pi


Chinese-style salted fish




Cj


Fruits (including berries) and vegetables






Fruits (including berries) and vegetables

k

k

l


Whole fresh fruits




P-NRc


Beverages, non-alcoholic






Sugars-sweetened soft drinks and fruit juices

P



Pm


Very hot (thermally) drinks (and food)




Pn


Unfiltered boiled coffee



P



Beverages, alcoholic






High alcohol intake



Co

Cp

Cg

Low to moderate alcohol intake



q



Other food-borne






Aflatoxins




Cr


Weight and physical activity






Abdominal obesity


C




Overweight and obesity


C

C

Cs


Voluntary weight loss in overweight and obese people





Low body weight





Cg

Physical activity, regular

i

t

g

Physical inactivity/sedentary lifestyle

C

C




Other factors






Exclusive breastfeeding





Maternal diabetes


C




Intrauterine growth retardation


P




Good oral hygiene/absence of plaque




e


Hard cheese




c


Environmental variables






Home and school environments that support healthy food choices for children





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.


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