UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION
NUTRITION PERSPECTIVES
Volume 26, No. 1
January/February 2001
Glucosamine and Chondroitin Supplementation and
Osteoarthritis
New Dietary Reference Intake Report Released
Dietary Reference Intake Report Identifies Research Gaps
Fruits and Vegetables Yield Less Vitamin A Than Previously
Thought
Reducing Sodium Leads to Substantial Drop In Blood Pressure
NHLBI Study Shows Reduced Fat Intake to Lower Cholesterol Is Safe
and Beneficial for Children
Surgeon General Launches Effort to Develop Action Plan to Combat
Diabetes Rates Rise Another 6 Percent In 1999
Afternoon Blood Test May Miss Diabetes
Diabesity In America Conference
Most Popular Diets Flawed
Fats Down, Fruit and Veggies up In School Meals
Resources: One-Stop Shopping for Health Information on the Internet:
Medline “Plus”
Annual Bibliography of Dietary Supplement Research
Conferences: 34th Annual Conference of the Society for Nutrition
Education
Subscription for NUTRITION PERSPECTIVES
Sheri Zidenberg-Cherr, PhD, Editor Department of Nutrition University of California Davis, CA 95616
NUTRITION PERSPECTIVES is prepared by Sheri Zidenberg-Cherr, PhD, Nutrition Specialist, Cristy Hathaway, and staff. It is designed to provide research-based information on ongoing nutrition and food-related programs. It is published bimonthly (six times annually) as a service of the University of California Cooperative Extension and the United States Department of Agriculture. Subscription to NUTRITION PERSPECTIVES is available from UC Cooperative Extension, Department of Nutrition, University of California, Davis, California. Cost is ten dollars ($10.00) for a one-year subscription. Subscriptions and questions or comments on articles may be addressed to: NUTRITION PERSPECTIVES, Department of Nutrition, University of California, Davis, CA 95616-5270. Phone (916)752-3387; FAX, (916) 752-8905.
What
is osteoarthritis?
Osteoarthritis
is the most common form of arthritis. The areas most often affected include the
fingers, spine, feet, knees, and hips. It is caused by compression of bone and the
surrounding cartilage. As a result, the joints rub against each other causing pain
and stiffness (1).
How
prevalent is it?
Approximately
12 percent of the US population, ages 25 years and older, have their quality of life
affected by the physical disabilities osteoarthritis causes (2-4). Risk factors are age 45
years and older, female, genetic conditions or diseases affecting structure of cartilage
and joints, joint injuries caused by physical labor or sports, and obesity (1).
What are some of the current forms of traditional treatment and the risks associated with their long-term use?
The most common treatment is
the use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS). These include ibuprofen,
naproxen, and indomethacin. While NSAIDS are effective in relieving pain, their use
can cause gastrointestinal tract complications such as gastrointestinal bleeding,
perforation, and peptic ulcer disease, resulting in hospitalization and sometimes death (5).
There is a threefold risk for serious gastrointestinal side effects for those aged 60-69,
which increases to a sixfold risk when there is a history of peptic ulcer disease (6).
Pain
relievers such as acetaminophen and aspirin are also taken, but they have a tendency to
cause irritation to the stomach. Acetaminophen doesn’t reduce inflammation and
the amount of aspirin needed to reduce inflammation is 12 tablets per day (1).
Recently
approved drugs, rofecoxib (prescribed under the name Vioxx) and celecoxib (prescribed
under the name Celebrex) have been shown to have less gastrointestinal symptoms than
NSAIDS therapy. There is some concern that this classification of drug (COX-2 inhibitors)
is associated with increased risk of myocardial infarction due to blood clotting and an
increase tendency of bronchial constriction, which can result in asthmatic attacks.
However, there does not appear to be more of an increase in these types of episodes over
the comparable use of NSAIDS (7). These are only two of the drugs on the market used for
the treatment of osteoarthritis. For more information on additional drug treatments, go to
the the Medline plus website: http://www.nlm.nih.gov/medlineplus/druginfo/antiinflammatorydrugsnonsteroi202743.html
What
are popular alternative treatments?
Glucosamine
and chondroitin are compounds extracted from animal products that may be capable of
synthesizing cartilage found in the joints. These compounds are used separately and
in combination pills to reduce pain and inflammation (8). Glucosamine and chondroitin are
not fast acting. Benefits are not observed until at least 4 weeks after the initial
dose with continued use.
Is
there a relationship between osteoarthritis symptoms and glucosamine/chondroitin use?
While
many studies have been published on the efficacy of glucosamine and combined glucosamine
chondroitin supplements to decrease pain and improve function in osteoarthritis (9-11),
quality of the studies is questionable.
Are
there any current research studies investigating the efficacy of glucosamine and
chondroitin use?
The National Center for Complementary and Alternative Medicine (NCCAM) recently launched a glucosamine/chondroitin arthritis intervention trial. The study is a 24-week, placebo-controlled, double-blind study. The efficacy of glucosamine alone, chondroitin alone, and the combination of glucosamine and chondroitin will be compared to placebo in treating knee pain of osteoarthritis. This study is currently in progress, and no results have been published to date.
What
are the concerns associated with glucosamine/chondroitin supplementation?
Glucosamine
and chondroitin are not considered drugs and as such are not regulated as drugs by the
FDA. Manufacturers are not required to list potential side effects on the label nor
are products monitored by the FDA for purity.
Glucosamine
can cause gastrointestinal upset, drowsiness, skin reactions, and headache. Stomach upset
can also be caused by chondroitin (12). Studies on rats, mice and human cells from both
nondiabetic and type 2 diabetic subjects have shown that infusions of glucosamine induce
insulin resistance in a dose dependent manner, even after 48 hour exposure (13-14). The
significance of these and similar studies (15) is that they have shown a connection
between glucosamine and impaired insulin secretion, a combination of which can promote
hyperglycemia. Thus glucosamine can mimic some of the characteristics associated
with diabetes mellitus (16); however, there has been some argument that the quantities
used in these studies are much higher than can be achieved with oral doses ,such as the
doses used in glucosamine supplements.
ConsumerLab.com,
an independent organization that evaluates products for consumers and healthcare
professionals, purchased 25 brands of glucosamine, chondroitin and combined
glucosamine/chondroitin in December 1999 and January 2000. The levels of these
ingredients were tested and evaluated. Overall, nearly one third overstated the
quantity of the supplement. Among the combination supplements, almost half had lower
chondroitin levels than stated on the label (12).
What
else can you do to manage osteoarthritis?
To manage osteoarthritis, it is
recommended that individuals decrease high impact activities, which tend to increase
stress on joints and replace them with low impact activities, which increase flexibility
and strength. This can be achieved by using new household devices with thick rubber
handles, distributing the weight on objects carried by using both hands, and by using
larger joints such as your shoulder to open the door instead of your hands (1). These are
only a few suggestions on how to manage osteoarthritis, and for more information go to
Medline plus web page at: http://www.nih.gov/niams/healthinfo/osteoarthritis/textonly.htm
References:
2.
Felson D, Osteoarthritis. Rheum Dis Clin
North Am; Vol 16; pp. 499-512. 1990.
3.
Guccione AA, Anderson JJ, et al. The
effects of specific medical conditions on the functional limitations of elders in the
Framingham Study. American Journal of Public Health; Vol 84; pp. 351-358; 1994.
4.
Lawrence RC, Arnett FC, et al. Estimates
of the prevalence of arthritis and selected musculoskeletal disorders in the United
States. Arthritis Rheum; Vol 41; pp. 778-799; 1998.
5.
Tamblyn R, Dauphinee D, Gayton D, et al.
Unnecessary Prescribing of NSAIDs and the Management of NSAID-Related Gastropathy in
Medical Practice. Annals of Internal Medicine; Vol 127; pp. 429-438; 1997.
6.
Rodriguez G LA, Risk of upper
gastrointestinal bleeding and perforation associated with individual non-steroidal
anti-inflammatory drugs. Lancet; Vol 343; pp. 769-772; 1994.
7.
Silverstein FE, Goldstein JL, Simon LS, et
al. Gastrointestinal Toxicity With Celecoxib vs Nonsteroidal Anti-inflammatory Drugs for
Osteoarthritis and Rheumatoid Arthritis. JAMA; 284(10); pp.1247-1255; 2000.
8.
McAlindon TE, LaValley MP, Gulin JP, and
Felson DT. Glucosamine and Chondroitin for Treatment of Osteoarthritis. JAMA; 283(11); pp.
1469-1475; 2000.
9.
Pujatle JM, LE, Ylescupidez FR.
Double-blind clinical evaluation of oral glucosamine sulphate in the basic treatment of
osteoarthritis. Curr Med Res Opin; Vol 7; pp. 110-114; 1980.
10.
Qiu GX GS, Giacovelli G, Rovati L, and Setnikar I.
Efficacy and safety of glucosamine sulfate versus ibuprofen in patients with knee
osteoarthritis. Arzneim Forsch; Vol 48; pp. 469-474; 1998.
11.
Reichelt A FK, Fischer M, Rovati L, and Setnikar I.
Efficacy and safety of intramuscular glucosamine sulfate in osteoarthritis of the knee: A
randomized, placebo-controlled, double-blind study. Arzneim Forsch. 44(75-80); 1994.
12.
ConsumerLab.com, Glucosamine and Chondroitin. 1999.
13.
Ciaraldi TP CL, Nikoulina S, Mudaliar S, et al.
Glucosamine regulation of glucose metabolism n cultured human skeletal muscle cells:
divergent effects on glucose transport/phosphorylation and glycogen synthase in
non-diabetic and type 2 diabetic subjects. Endocrinology; 140(9); pp. 3971-80; 1999.
14.
Rossetti L, HM, Chen W, Gindi J, and Birzalai N. In
vivo glucosamine infusion induces insulin resistance in normoglycemic but not
hyperglycemic conscious rats. Journal of Clinical Investigation; Vol 96; pp. 132-140;
1995.
15.
Virkamaki A, DM, Hamalainen S, Utrianinen T.
Activation of the hexosamine pathway by glucosamine:fructose-6-phosphate amidotransferase
in transgenic mice leads to insulin resistance. Journal of Clinical Investigation, Vol 98;
pp. 930-936; 1996.
16.
Monauni T, ZM, Cretti A, Daniels MC, et al.
Effects of glucosamine infusion on insulin secretion and insulin action in human.
Diabetes, 49(6); pp. 926-35; 2000.
Mindy
Dopler Nelson, MS
Doctoral Student
Nutrition Department
UC Davis
NEW DIETARY REFERENCE INTAKE REPORT RELEASED
The new DRI
report is the fifth in a series that updates and expands on the Recommended Dietary
Allowances (RDAs) in the United States and Recommended Nutrient Intakes in Canada. In
addition to vitamin A, the report examines the nutritional value of the micronutrients
vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel,
silicon, vanadium, and zinc. It sets a daily maximum level of intake for vitamin A as well
as for boron, copper, iodine, iron, manganese, molybdenum, nickel, vanadium, and zinc.
Specific recommended intakes are given for vitamins A and K, chromium, copper, iodine,
iron, manganese, molybdenum, and zinc. Although DRIs are designed for use in the United
States and Canada, they can provide guidance to researchers and policy-makers coping with
malnutrition elsewhere in the world. For example, while iron deficiency, especially among
pregnant women, is of concern in this country and Canada, it also is known to be
prevalent, along with vitamin A, zinc, and iodine deficiencies, in developing countries.
DRIs are
established using a new paradigm based on indicators of good health and the prevention of
chronic disease developed by US and Canadian scientists. They encompass not only
recommended daily intakes that are intended to help people maintain their health, but also
tolerable upper intake levels (ULs) that help them avoid harm from taking too much of a
nutrient. An adequate intake (AI), based on diets known to be nutritionally adequate for
the US and Canadian populations, is recommended when not enough evidence exists to set an
RDA. The reference intake values are designed to meet the needs of individuals in the
United States and in Canada who are healthy and free from specific diseases or conditions
that may alter their daily nutritional requirements.
Based on
national nutrition surveys, the report says that daily requirements for the nutrients it
examined can be met, in almost all instances, without taking supplements. One exception,
however, is that pregnant women usually need iron supplements to meet their increased
daily requirements. In fact, surveys in the United States show that only half of all
pregnant women who live here consume adequate amounts of iron in their diet. Below are
highlights of the report's recommendations. The full report contains dietary
recommendations, when the data allows, for all age groups, as well as for pregnant and
lactating women.
Specific Dietary Recommendations
Vitamin A:
Besides being important for normal vision, vitamin A plays a
vital role in gene expression, reproduction, embryonic development, growth, and immune
function. The most obvious symptom of inadequate vitamin A consumption is vision
impairment, especially night blindness, which occurs after the body's vitamin A stores
have been depleted. To ensure adequate stores of vitamin A in the body, men should consume
900 micrograms daily and women should consume 700 micrograms daily. The UL was set at 3
milligrams, or 3,000 micrograms, per day. Recent research shows that excess vitamin A
intake may increase the risk of physical birth defects, liver abnormalities in adults, and
bulging of the skull where bone has not yet formed in infants and young children.
Vitamin
K:
This nutrient plays an essential role in the coagulation of blood and is found in green leafy vegetables.
An AI of 120 micrograms for men and 90 micrograms for women was
determined based on the consumption level of healthy individuals. No adverse effects have
been reported for vitamin K, so a UL was not establish-ed. There have been reports that a
lack of the vitamin may be related to bone disease, including the development of
osteoporosis, but the panel concluded there is not sufficient evidence to firmly establish
a relationship.
Chromium:
A
number of studies have shown that chromium stimulates insulin action in the body. However,
the daily requirement for chromium could not be established because not enough information
exists to determine a relationship between a particular dose of the nutrient and insulin
response. Not all studies show that chromium supplementation has a positive effect on the
regulation of glucose levels, the report notes. Based on current estimated consumption by
the general population, an AI of 35 micrograms for men and 25 micrograms for women was
recommended. Chromium is widely distributed throughout the food supply. Few serious side
effects have been associated with excess intake of chromium from food, and little data are
available on adverse effects resulting from chronically high intake of the chromium
contained in supplements, so no UL was set. Some forms of chromium are known to be toxic,
but those are not present naturally in foods or contained in currently available dietary
supplements.
Copper:
The new RDA for copper, a nutrient necessary for proper development of connective tissue, nerve coverings, and skin pigment, is 900 micrograms a day for both men and women. To protect against possible liver damage, the UL was set at 10 milligrams per day. Copper is widely distributed in foods such as organ meats, seafood, nuts, and seeds; some foods that are consumed in substantial amounts, such as milk, tea, chicken, and potatoes, also contain the nutrient, but at lower levels.
Iodine:
Iodine is an important component of thyroid hormones and is stored in the thyroid gland. A deficiency can cause mental retardation, hypothyroidism, goiter, and dwarfism. Based on research into how much iodine the thyroid needs to properly regulate enzyme and metabolic processes, an RDA of 150 micrograms a day was established for both men and women. Most food sources have little iodine, though some plants grown in iodine-rich soil and seafood have higher concentrations because they absorb the nutrient from their environ-ments. Iodized salt also is a dietary source. To avoid over-absorption of iodine by the thyroid, adults should not consume more than the UL of 1.1 milligrams daily.
Iron:
Iron is vital for transporting oxygen in the bloodstream and for the prevention of anemia. Even more of the nutrient is needed during periods of growth and for the fetus during pregnancy. Women during premenopause years also need more, since iron is lost through menstruation. The report sets the RDA for men and post-menopausal women at 8 milligrams per day, and at 18 milligrams for pre-menopausal women. Pregnant women should consume 27 milligrams a day, which usually requires taking a small supplement since it is difficult to get that much iron through diet alone. The RDA for women who breast-feed and are not menstruating is 9 milligrams a day; for adolescents who breast-feed, it is 10 milligrams daily. Human milk only provides enough iron for infants until they are 6 months old. The report recommends that older infants, those between the ages of 7 months and 12 months, who are breast-fed be given foods or formula containing additional iron; older infants receiving formula also should be given iron-fortified formula or foods. Oral contraceptives reduce menstrual blood losses, so women taking them need less daily iron. Post-menopausal women who are on hormone replacement therapy should consume more iron because the therapy often causes periodic uterine bleeding. Because the absorption of iron from plant foods is low compared to that from animal foods, vegetarians need to consume twice as much iron to meet their daily requirement.
The UL for iron is set at 45 milligrams a day for adults, above which gastrointestinal distress may occur, especially when consuming iron supplements on an empty stomach. Research has suggested a possible link between elevated iron stores and a higher incidence of heart disease and cancer. However, the report says that evidence for a relationship between dietary iron intake and increased risk of these diseases is inconclusive. In addition, individuals who inherit both genes for hereditary hemochromatosis, an iron absorption disorder, are at increased risk for accumulating harmful amounts of iron. The tolerable upper intake level was not set to protect these people since there is insufficient evidence to determine a specific maximum level that would provide significant protection against the development of the clinical symptoms of this disorder.
Manganese:
This nutrient is involved in bone formation and in protein, fat, and carbohydrate metabolism. Nuts, legumes, tea, and whole grains are rich sources of manganese. The report sets an adequate intake level for manganese at 2.3 milligrams per day for men and 1.8 milligrams per day for women. The UL is set at 11 milligrams for adults, based on a recent study showing that no adverse health effects occurred when this amount was consumed on a chronic basis. Neurological side effects, similar to symptoms caused by Parkinson's disease, were observed in an earlier study among participants who consumed 15 milligrams a day.
Molybdenum:
The new RDA for molybdenum is 45 micrograms per day for both men and women. Sources of this enzyme-enhancing nutrient include legumes, grain products, and nuts. The UL was set at 2 milligrams, based on studies showing impaired reproduction and growth in animals at high levels of chronic intake.
Zinc:
Zinc
is associated with more than 100 specific enzymes and is vital for protein function and
gene expression. Many breakfast cereals are fortified with zinc and it is naturally
abundant in red meats, certain seafoods, and whole grains. The RDA for zinc was set at 11
milligrams per day for men and 8 milligrams per day for women. Vegetarians may need up to
50 percent more, however, since a chemical in plants, called phytate, as well as calcium,
hinder zinc absorption in the body. As is the case with iron, human milk does not contain
enough zinc for older infants between the ages of 7 months and 12 months to meet their
RDA, so children this age should consume foods containing this nutrient if they consume
human milk or be given formula containing zinc. A UL of 40 milligrams for adults was set,
based on studies showing that zinc adversely affects copper absorption at high levels of
intake.
Arsenic,
Boron, Nickel, Silicon, and Vanadium:
Although there is some evidence suggesting a beneficial role for these elements in animal and human health, not enough data exist to define with certainty what their specific roles may be. Therefore, recom-mended intake levels were not established. However, based on adverse effects noted in animal studies, tolerable upper intake levels were set for boron at 20 milligrams per day; for vanadium at 1.8 milligrams per day; and for nickel at 1 milligram per day. Arsenic in chemical forms is a known toxic element, but not enough data exist on chronic intakes at lower levels from food and supplements to set a UL. Data also were lacking upon which to base a UL for silicon.
Adapted
from: National Academies, Institute of Medicine Press Release; January 9, 2001.
DIETARY REFERENCE INTAKE REPORT IDENTIFIES RESEARCH GAPS
The latest
Dietary Reference Intake report identifies several gaps in what is known about the
micronutrients it addressed. For example, there is a dearth of studies designed
specifically to estimate average nutrient requirements for healthy humans, especially
infants, children, adolescents, the elderly, and pregnant women. In addition, there has
been a lack of research aimed at studying the role of these micronutrients in reducing the
risk of chronic diseases or detecting side effects from chronic over-consumption. High
priority should be given to research that attempts to fill in this missing information,
including studies to further identify factors that impair or enhance the absorption and
metabolism of these nutrients and to further investigate the role of arsenic, boron,
nickel, silicon, and vanadium in human health.
The study
was sponsored by the US Department of Health and Human Services; the National Institutes
of Health; the Centers for Disease Control and Prevention; Health Canada; the Institute of
Medicine; the Dietary Reference Intakes Private Foundation Fund, including the Dannon
Institute and the International Life Sciences Institute; and the Dietary Reference Intakes
Corporate Donors' Fund, which includes contributions from Roche Vitamins Inc., Mead
Johnson Nutrition Group, Nabisco Foods Group, US Borax, Daiichi Fine Chemicals Inc., Kemin
Foods Inc., M&M/Mars, Weider Nutrition Group, and the Natural Source Vitamin E
Association.
The study
was undertaken by a group of more than 40 scientists from the United States and Canada
under the auspices of the Institute of Medicine's Food and Nutrition Board. The Institute
is a private, nonprofit organization that provides health policy advice under a
congressional charter granted to the National Academy of Sciences.
Copies of
Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper,
Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc will be available
later this year from the National Academy Press; tel. (202) 334-3313 or 1-800-624-6242.
Reporters may obtain a pre-publication copy from the Office of News and Public
Information.
Adapted
from: National Academies, Institute of Medicine, Press Release; January 9, 2001.
FRUITS AND VEGETABLES YIELD LESS VITAMIN A THAN PREVIOUSLY THOUGHT
Darkly
colored, carotene-rich fruits and vegetables, such as carrots, sweet potatoes, and
broccoli, provide the body with half as much vitamin A as previously thought, says the
latest report on Dietary Reference Intakes (DRIs) from the National Academies' Institute
of Medicine. This means people need to make sure they eat enough of these fruits and
vegetables to meet their daily requirement for vitamin A, especially if they do not eat
animal-derived foods, which serve as abundant sources of the nutrient for most people.
“Darkly
colored fruits and vegetables are still good sources of vitamin A,” said Robert
Russell, professor of medicine and nutrition, Tufts University School of Medicine, Boston,
and chair of the panel that wrote the report. “But new evidence shows that it takes
twice as much of them to yield the same amount of vitamin A in
the body as we previously
understood. People need to take this into consideration and make sure they select enough
carotene-rich fruits and vegetables to meet their daily vitamin A requirement. This is
especially true for those who don't eat meats, fish, eggs, or vitamin A-fortified milk or
cereal. They may need to significantly increase their consumption of such fruits and
vegetables.”
Three
carotenoids, alpha-carotene, beta-carotene, and beta-cryptoxanthin, are present in certain
orange, red, green, and dark-yellow fruits and vegetables. These carotenoids are referred
to as provitamin A because they can be converted to retinol, an active form of vitamin A,
in the body. Based on a comprehensive review of recent research, the panel found that the
amount of provitamin A carotenoids required to create a unit of retinol is twofold higher
than the amount believed needed in 1989 when the National Academy of Sciences last issued
recommendations for vitamin A.
Adapted
from: National Academies, Institute of Medicine Press Release; January 9, 2001.
REDUCING SODIUM LEADS TO SUBSTANTIAL DROP IN BLOOD PRESSURE
Recent Research Findings
Sodium
reduction combined with a typical US diet or the “DASH” diet, which is rich in
vegetables, fruit, and low-fat dairy products, and low in total and saturated fat,
substantially lowered blood pressure in persons with high blood pressure and persons with
higher than optimal blood pressure. These findings were from the results of a study
published in the “New England Journal of Medicine,” supported by the National
Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (1).
The
DASH-Sodium study found that the lowest blood pressure levels were in those eating sodium
levels much lower than the currently recommended maximum of 2,400 milligrams a day while
also eating the DASH (Dietary Approaches to Stop Hypertension) diet. In both the DASH diet
and a typical American diet, the lower the sodium, the lower the blood pressure. The
combination of following the DASH diet at the lower sodium level reduced blood pressure
more than either the DASH diet or lower sodium intake alone.
“The
DASH-Sodium study lays to rest the long-standing controversy over whether sodium reduction
lowers blood pressure in people who do not have hypertension, more commonly called high
blood pressure. The study also has important implications for the treatment of
hypertension, which affects almost 50 million people in this country,” says NHLBI
Director Dr. Claude Lenfant.
“These
results challenge Americans to eat the DASH diet and to reduce sodium consumption and the
food industry to reduce sodium levels in foods. Meeting this challenge, along with other
lifestyle changes, could prevent the rise of blood pressure with age and allow patients to
control their hypertension with fewer or even no drugs,” adds Dr. Lenfant.
In the
DASH-Sodium study, 412 people were randomly assigned to eat either a typical US diet (the
control diet) or the DASH diet, which is low in saturated fat, cholesterol, and total fat
and emphasizes fruits, vegetables and low-fat dairy foods (2). The DASH diet is also
reduced in red meat, sweets, and sugar-containing drinks. It is rich in potassium,
calcium, magnesium, fiber, and protein. The DASH diet was initially used in the first DASH
study, which examined the effect on blood pressure of whole dietary patterns rather than
of individual nutrients. The DASH diet was found to substantially reduce blood pressure
without decreasing salt intake.
In the
DASH-Sodium study, investigators sought to determine the effects on blood pressure of the
DASH diet at lower levels of sodium and were very interested in finding out whether sodium
intakes lower than the currently recommended maximum would be even better for reducing
blood pressure. The investigators also wanted to discover the combined effect of lower
dietary sodium with the DASH diet and the effects of sodium reduction in certain groups of
people, particularly those at increased risk but currently without high blood pressure.
The DASH
diet lowered blood pressure at each of the three levels of sodium intake. In addition,
lower sodium intake resulted in lower blood pressures for those on both the typical and
the DASH diets. This result applied to men, women, African Americans, whites, and those
with and without high blood pressure. Neither the DASH diet nor lower levels of sodium
caused undesirable effects. In fact, those on a lower sodium diet, whether control or
DASH, had fewer headaches. People with high blood pressure who ate the DASH diet at the
lowest sodium level had an average systolic pressure reading 11.5 mm Hg lower than
participants eating the control diet at the highest sodium level. The corresponding number
for participants who did not have high blood pressure was 7.1 mm Hg systolic pressure.
“The
combination of eating the DASH diet at a lower sodium level is a significant effect, equal
to or greater than the result you would expect from treatment with a single hypertension
medication,” says Dr. Frank Sacks, chair of the DASH-Sodium Steering Committee and
Associate Professor of Medicine at Brigham and Women's Hospital and Harvard Medical
School. “However, the long-term health benefits of the low sodium DASH diet will
depend on whether the American public is willing to make long-lasting dietary changes,
including choos-ing lower sodium foods, and whether the food industry makes available a
greater number of lower sodium food products,” adds Dr. Sacks.
“Following
the DASH diet at the 1,500 mg of sodium level may prevent the development of high blood
pressure and the increase in systolic blood pressure that typically occurs as people
age,” said Dr. Eva Obarzanek, the NHLBI Project Officer of the DASH-Sodium study.
Other longer-term studies suggest that the benefit on blood pressure is likely to persist
over the long term as long as people continue following the DASH diet and lower sodium
intake, she adds.
Dietary Recommendations
How does one
get to a daily level of 1500 mg of sodium (the equivalent of 4 grams or 2/3 teaspoon of
table salt)? According to Dr. Obarzanek, the best way for people to lower sodium in their
diets is to start out small with a few simple changes. “Buy unsalted varieties of
foods and condiments, take the salt away from the table, and don't use it in food
preparation,” she says.
A vitally
important guiding principle of low-sodium eating, according to Dr. Obarzanek, is to eat
fewer processed foods, a major source of sodium, or use lower sodium versions, if
available. This means cutting back on regular commercially prepared frozen dinners,
packaged mixes, and canned soup or broth.
To gauge the
sodium level of processed foods, read nutrition labels for sodium content and the percent
daily value. Dr. Obarzanek suggests choosing foods that are less than 5 percent of the
daily value for sodium. You can also select foods by milligrams of sodium per serving. For
example, a food with 140 mg of sodium or less per serving is considered “low
sodium,” one with 35 mg sodium or less per serving is “very low sodium,”
and a food that has 0.5 mg sodium or less per serving is “sodium free.” These
are the definitions used to label food products.
To add
flavor to foods, try herbs, spices, lemon, lime, and vinegar rather than salt. Good snack
options include unsalted pretzels or nuts mixed with raisins, graham crackers, low-fat and
fat free yogurt, plain popcorn, and raw vegetables.
Dr.
Obarzanek has several suggestions for dining out. “Plan ahead and bank your
sodium,” she says. “If you know you're going to have a high sodium dinner at a
restaurant, have a lower sodium breakfast and lunch.” Other tips include
“downsizing,” ordering the “kiddie” meal, which will have less sodium
because it's a smaller portion; avoiding fried dishes since batter is salted; and ordering
sandwiches with lettuce and tomato instead of mayonnaise, sauces, and condiments.
Healthy
lower-sodium eating based on the DASH diet isn't just about restrictions, according to Dr.
Obarzanek. To follow this plan, people should eat 8 to 10 servings a day of fruits and
vegetables (fresh, frozen, dried or unsalted canned), 7 to 8 servings of grains and grain
products, and 2 to 3 daily servings of low-fat or fat-free dairy foods. The DASH diet also
calls for 2 or less daily servings of meats, poultry and fish and 4 to 5 servings a week
of nuts, seeds, and dry beans.
Just as with
sodium reduction, making small changes is the easiest way to begin following the DASH
diet. Start out by trying to have two servings of fruits and/or vegetables at each meal
and as snacks. Use fruits as dessert. To increase dairy foods, try to have one low-fat or
fat-free dairy serving at each meal. Treat meat as part of the whole meal, not the focus,
and instead emphasize vegetables, whole grains, and dry beans.
Additional
information on the DASH-Sodium Eating Plan, including a sample menu, recipes, and tips can
be found on the NHLBI Web site at www.nhlbi.nih.gov in the following document: DASHing
With Less Salt. You can also visit the DASH Web site at http://dash.bwh.harvard.edu.
References:
1. FM Sacks,
LP Svetkey, WM Vollmer, LJ Appel, et al. Effects on Blood Pressure of Reduced Dietary
Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. New Eng J Med; Vol.
344; No. 1; January 4, 2001.
2.
Nutrition Perspectives; DASH diet; Vol 24, No 2; Jul/Aug 1999; p. 9.
Adapted
from: NIH Press Release; January 3, 2001.
NHLBI STUDY SHOWS REDUCED FAT INTAKE TO LOWER CHOLESTEROL
Children with high blood cholesterol levels can benefit from reducing the amount of fat,
saturated fat, and cholesterol in their diets without adversely affecting their normal
development during puberty, according to new results from a long-term study funded by the
National Heart, Lung, and Blood Institute (NHLBI). The study appears in the February issue
of the journal “Pediatrics” (1).
In the Dietary Intervention Study in Children (DISC), children who adopted a recommended
low-fat, low-cholesterol diet decreased their intake of total fat, saturated fat, and
cholesterol within the first year of the study and maintained lower levels for several
more years. These dietary modifications did not alter the children's growth, nutritional
status, or sexual maturation throughout the seven-year study. Furthermore, the diet helped
the children significantly decrease their blood levels of low-density lipoprotein (LDL),
the “bad” cholesterol, for up to three years.
“This is the first study of this size to examine the long-term effects of reduced
dietary saturated fat and cholesterol intake among children,” said Dr. Claude
Lenfant, NHLBI director. “DISC confirms that dietary changes in children with high
levels of LDL cholesterol may thwart the development of atherosclerosis without adverse
effects.”
During the past decade, scientists have found increasing evidence that atherosclerosis
begins in childhood and that children and adolescents with high cholesterol levels are
more likely than those with normal or low levels to have high cholesterol levels as
adults.
In a 1991 report, the National Cholesterol Education Program's (NCEP) Expert Panel on
Blood Cholesterol Levels in Children and Adolescents recommended cholesterol screening for
children and adoles-cents with a family history of early heart disease or with a parent
who has high blood cholesterol. Children and adolescents from such high-risk families who
are found to have elevated blood cholesterol levels are advised to follow a diet low in
saturated fat and cholesterol. In addition, the panel suggested population-wide approaches
to lower the average blood cholesterol of all American children and adolescents by
reducing their consumption of saturated fat, total fat, and cholesterol. But some
scientists have questioned whether reducing fat in children's diets might cause problems
such as growth retardation, nutritional inadequacy, and adverse psychological effects
among pre-pubertal children.
“DISC addresses these concerns,” added Dr. Eva Obarzanek, NHLBI project
director. “Because this study examines children through several years during key
stages of development, we can measure the effects of dietary modifications in the context
of physiological changes during puberty.”
DISC was conducted at six medical centers and involved more than 650 children who began
the study at ages 8 through 10. Eligible participants had levels of LDL cholesterol that
were considered borderline to high (111.5 mg/dL or higher for boys and 117.5 mg/dL or
higher for girls).
Children were randomly assigned to either the intervention group or the “usual
care” group. Those in the intervention group participated in periodic sessions with
nutrition counselors to help them follow a regimen similar to the NCEP's therapeutic Step
Two Diet to lower LDL blood cholesterol levels: 28 percent of calories from total fat,
less than 8 percent from saturated fat, up to 9 percent from polyunsaturated fat, and
fewer than 150 mg of cholesterol per day. Participants in the usual care group received
information on general dietary recommenda-tions but did not attend any intervention
sessions.
Researchers observed no significant differences in height, weight, sexual maturation, or
levels of serum ferritin (iron status) between the intervention group and the usual care
group. In addition, participants in both groups consumed comparable quantities of key
vitamins (A, C and B-6), calcium, and zinc.
Blood tests to measure total cholesterol and LDL cholesterol levels were performed after
one, three, five, and seven years. Throughout the study, blood cholesterol levels in the
intervention group were lower than participants in the usual care group, with significant
differences between the groups found at one year and three years. At three years, LDL
cholesterol levels of DISC participants in the intervention group were on average 2.5
percent (3.3 mg/dL) lower than the levels of those in the usual care group. (Findings from
the study's first three years were published in the May 10, 1995, issue of the
“Journal of the American Medical Association”.) The differences between the
intervention and usual care groups in total blood cholesterol and LDL cholesterol levels
narrowed over time, however, and they were no longer statistically significant at five
years and seven years.
One contributing factor to this narrowing of differences was “a gradual improvement
in dietary habits in the usual care group, which helped to lower their blood cholesterol
levels,” according to Dr. Obarzanek. About five years from the start of the study,
participants in the usual care group began consuming dietary cholesterol in amounts
similar to those reported by the intervention group, making the differences in dietary
cholesterol intake between the groups no longer significant by the end of the study (year
7).
The amount of saturated fat and total fat intake among participants in the usual care
group also began approximating that of the intervention group at about the fifth year,
although the differences in dietary fat con-sumption between the two groups remained
significant throughout the study. At the seven-year assessment, the percent of saturated
fat intake dropped on average from 12.5 percent to 10.2 percent of calories in the
interven-tion group, and from 12.7 percent to 11.3 percent of calories in the usual care
group. In addition, total fat intake in the intervention group dropped on average from
33.4 percent to 28.5 percent of calories; in the usual care group, total fat dropped from
34.0 percent to 30.6 percent of calories.
Scientists and nutrition experts view the improved dietary habits of the children in this
study as en-couraging, and reflective of positive trends in the general public. Population
surveys performed by the National Center for Health Statistics over the past few decades,
for example, have shown that adolescents are consuming less total fat, saturated fat, and
cholesterol.
“The results of these surveys, coupled with the new DISC findings, indicate that
pediatricians, parents, and children are getting the message that it is important to start
early to follow a low-saturated-fat and low-chole-sterol diet,” Dr. Lenfant added.
Another factor that may have contributed to the narrowing of the differences in blood
cholesterol levels between the two groups is lower adherence to the dietary
recommendations by intervention group participants in the later years of the study, when
they attended fewer intervention sessions. When investigators analyzed the blood
cholesterol levels among only those participants who were most actively engaged in the
study (those who attended all clinic visits), they found that the intervention group had
significantly lower blood levels of LDL-cholesterol than the usual care group for as long
as five years.
The DISC Collaborative Research Group concluded: “A combination of individual
counseling from pediatricians and other primary care providers, along with community-based
programs and public health campaigns may work together to promote cardiovascular health in
children.”
NHLBI press releases, resources for professionals and consumers, and other materials are
online at www.nhlbi.nih.gov.
Reference:
1. E
Obarzanek, SYS Kimm, BA Barton, et al. Long-Term Safety and Efficacy of a
Cholesterol-Lowering Diet in Children With Elevated Low-Density Lipoprotein Cholesterol:
Seven-Year Results of the Dietary Intervention Study in Children (DISC). Pediatrics; 2001;
107: 256-264.
Source:
NHLBI Press Release; February 05, 2001.
SURGEON GENERAL LAUNCHES EFFORT TO DEVELOP ACTION PLAN TO
COMBAT
Surgeon
General David Satcher recently announced a year long effort to develop a national action
plan for reducing the prevalence of overweight and obesity in the United States. Satcher
said the process would be inclusive and collaborative, and would include open public
comment periods, listening sessions, federal and non-federal dialogue, interactive
workshops, and the formation of working groups to implement strategies.
“The prevalence of overweight and obesity has nearly doubled among children and
adolescents since 1980,” Satcher told public health and industry leaders attending an
international nutrition conference. “It is also increasing in both genders and among
all population groups of adults. We want to establish strategies and set priorities so
that we can successfully implement obesity prevention efforts that focus on the family and
community, schools, work sites, the health care delivery system, and the media.”
The Surgeon General held a “listening session” on overweight and obesity at the
National Institutes of Health (NIH) in Bethesda, Maryland. At the meeting, entitled Toward
a National Action Plan on Overweight and Obesity: The Surgeon General’s Initiative,
five panels of experts presented their views on priorities for obesity prevention efforts.
Co-sponsors of the event included the NIH, the Centers for Disease Control and Prevention,
and the Office of Public Health and Science.
“The participants in this meeting brought fresh and exciting ideas to the
table”, said Deputy Assistant Secretary for Health, Randolph F. Wykoff.
“Overweight and obesity represent one of ten leading health indicators included in
Healthy People 2010, the nation’s health objectives for the next decade. With the
continuing input from these participants and the groups they represent, we stand to have a
real impact on an important public health problem.”
Several follow-up events will continue efforts to develop a national action plan. An
invitational, interactive workshop to further develop strategies and stimulate
collaboration is in the planning stages. A meeting of federal agencies will begin dialogue
to develop a coordinated federal approach. Further opportunity for public input in
development of the plan is envisioned during 2001. Overweight and obesity substantially
raise the risk of illness from high blood pressure, high cholesterol, type 2 diabetes,
heart disease and stroke, gallbladder disease, arthritis, sleep disturbances and problems
breathing, and certain types of cancers. On average, higher body weights are associated
with higher death rates.
The number of overweight children, adolescents, and adults has risen over the past four
decades. Total costs (medical cost and lost productivity) attributable to obesity alone
amounted to an estimated $99 billion in 1995. During 1988-94, 11 percent of children and
adolescents aged 6 to 19 years were overweight or obese. During the same years, 23 percent
of adults aged 20 years and older were considered obese. A webcast of the two-day December
listening session is accessible on the Internet at: http://videocast.nih.gov/.
Source:
HHS Press Release; January 8, 2001
DIABETES RATES RISE ANOTHER 6 PERCENT IN 1999
Diabetes rates rose a striking 6.0 percent among adults in 1999 according to researchers
at the Centers for Disease Control and Prevention (CDC). The new findings are reported in
the February issue of Diabetes Care, a journal of the American Diabetes Association, and
are further evidence that diabetes is a major public health threat of epidemic
proportions. Currently more than 16 million Americans have diabetes and about a third do
not know they have the disease.
This new report is a follow-up to a study CDC released in September showing that from 1990
to 1998 diagnosed diabetes, including gestational diabetes, rose 33 percent (4.9 percent
to 6.5 percent) among US adults (1). That study also linked the increase in diabetes with
the rising rates of obesity, a major risk factor for diabetes. The prevalence of obesity
increased significantly from 17.9 percent in 1998 to 18.9 percent in 1999, an increase of
5.6 percent in one year and 57 percent from 1991.
“This dramatic new evidence signals the unfolding of an epidemic in the United
States,” said Dr. Jeffrey Koplan, director of CDC. “With obesity on the rise, we
can expect diabetes rates to increase sharply as a result. If these dangerous trends
continue at the current rates, the impact on our nation's health and medical care costs in
future years will be overwhelming,” Koplan said. In 1997, an estimated $98 billion
was spent on health care associated with diabetes.
Both the September report and the follow-up data were derived from the Behavioral Risk
Factor Surveillance System (BRFSS), an ongoing data collection program conducted by state
health agencies in collaboration with CDC.
According to the 1999 survey, increases in diabetes were noted in every category examined
including sex, age, race, education, weight and smoking status. Prevalence increased among
both women (7.4 percent to 7.6 percent) and men (5.5 percent to 6.0 percent) and among all
ethnic groups including whites (5.9 percent to 6.2 percent), blacks (8.9 percent to 9.9
percent), Hispanics (7.7 percent to 8.0 percent), and all others (6.6 percent to 7.7
percent).
“Despite these dramatic increases, we are encouraged that maintaining healthy
behavior such as controlling weight through nutrition and physical activity can help ease
the burden of diabetes and may actually prevent its onset,” said Dr. Frank Vinicor,
director of CDC's diabetes program.
Approximately 800,000 new cases of diabetes are diagnosed each year. It is the seventh
leading cause of death in this country and a major contributor to serious health problems
such as heart disease, stroke, blindness, high blood pressure, kidney disease, and
amputations.
CDC works in collaboration with the National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) in sponsoring the National Diabetes Education Program (NDEP), an
initiative involving both public and private partners to improve diabetes treatment,
promote early diagnosis, and maintain quality of life for people who have diabetes. For
more information on diabetes, visit CDC's Web site: http://www.cdc.gov/diabeteswww.cdc.gov/diabetes
or call toll free: 877-CDC-DIAB (877-232-3422). For information about nutrition and
physical activity, call toll free at 888-CDC-4NRG (888-232-4674) or visit the web site at
www.cdc.gov/nccdphp/dnpa. The CDC protects people's health and safety by preventing and
controlling diseases and injuries; enhances health decisions by providing credible
information on critical health issues; and promotes healthy living through strong
partnerships with local, national and international organizations.
Source:
CDC Press Release; January 26, 2001.
AFTERNOON BLOOD TEST MAY MISS DIABETES
Doctors who
give their afternoon patients the fasting plasma glucose test are likely to miss half of
the diabetes cases in this group, according to research published in “The Journal of
the American Medical Association” (JAMA) on December 27. The American Diabetes
Association currently recommends the fasting plasma glucose test for detecting type 2
diabetes. The test is diagnostic for diabetes if a person has a blood glucose level of 126
milligrams per deciliter (mg/dl) or higher, and a second test on another day confirms the
same high level of blood glucose.
The
recommendation is based on studies of plasma glucose measured in the morning after an
8-hour fast. However, many patients are seen in the afternoon after variable periods of
fasting. In the “JAMA” study, researchers from the National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK) and Social and Scientific Systems,
Inc., analyzed fasting plasma glucose levels taken at different times of the day from
adults participating in the Third National Health and Nutrition Examination Survey (NHANES
III) conducted from 1988 to 1994. The researchers compared the plasma glucose levels of
6,483 people tested in the morning after a median fasting time of 13.5 hours to the
glucose levels of 6,399 people tested in the afternoon after a median fasting time of 7
hours. Participants in both groups were otherwise similar in age, sex, race, weight,
physical activity, waist-to-hip ratio, family history of diabetes, and other factors that
may affect blood glucose levels.
The
researchers found that fasting plasma glucose levels were consistently higher in the
morning group compared to the afternoon, with an overall mean difference of 5 mg/dl.
Moreover, the afternoon patients had blood glucose levels suggestive of diabetes at half
the rate of the morning group. “If the current recommended criteria for diagnosing
diabetes were applied to the afternoon patients, about half the cases of diabetes would be
missed,” says NIDDK's Dr. Maureen Harris. To accurately detect diabetes in afternoon
patients, the researchers suggest that the diagnostic standard of glucose levels for this
group should be lower, 114 mg/dl or greater instead of the current standard of 126 mg/dl
or greater. In any case, the researchers advise physicians to confirm the diagnosis by
repeat testing on a different day, preferably in the morning.
About 16
million people in the United States have diabetes, the most common cause of blindness,
kidney failure, and amputations in adults. Type 2 diabetes accounts for about 90 percent
of diabetes cases in the United States, and a third of these cases are undiagnosed. Type 2
diabetes is most common in people who are overweight, inactive, age 40 and older, and have
a family history of diabetes. The disease is also more common in minorities: African
Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and
Pacific Islanders are at particularly high risk for type 2 diabetes. Many people can
control their blood glucose by following a careful diet and exercise program, losing
excess weight, and taking oral medication. However, the longer a person has type 2
diabetes, the more likely he or she will need insulin injections, either alone or combined
with oral drugs. About 10 percent, or 1.6 million of people with diabetes, have type 1,
formerly known as juvenile onset diabetes or insulin-dependent diabetes. This form of
diabetes, which usually occurs in children and adults under age 30, develops when the
body's immune system attacks the insulin-producing cells of the pancreas.
Adapted
from: NIH Press Release; December 26, 2000.
DIABESITY IN AMERICA CONFERENCE
United
States government data shows that obesity afflicts 22 percent of adult Americans
nationwide, but an even higher proportion of African American and Hispanic populations
suffer from the negative effects of obesity. What is most alarming, children and teens are
developing Type 2 diabetes as a consequence of the growing prevalence of obesity in these
age groups. The occurrence of this disease is being documented in children for the first
time in our nation’s history. There are 16 million people with diabetes in America,
most of them have Type 2 diabetes as a consequence of a combination of poor diet and
inactivity. In fact, most people with Type 2 diabetes are overweight or obese. The Shape
Up America! Diabesity public health initiative is a direct response to data from the
Centers for Disease Control (CDC) documenting the increased prevalence of type 2 diabetes
in America.
Shape Up
America! is launching the first phase of its new Diabesity Initiative in March 2001. They
plan to hold a weekend conference in Washington, DC to address the growing prevalence of
diabesity or obesity induced diabetes, in all age groups, but especially in children. As
part of this initiative, they are planning to gather the latest scientific thinking on the
link between obesity and Type 2 diabetes. They will assemble an outstanding panel of
scientific speakers to address the relative contribution of both activity and diet in the
etiology, prevention, and treatment of diabesity. We will also do a qualitative assessment
of health care professionals who treat pediatric type 2 diabetes and plan to interview
groups of physicians who treat the afflicted children and to report the findings at the
conference. They will be focusing on minority populations, especially African Americans
and Hispanics.
At the
conference, their goal is to gather science-based recommendations for action. Thus, a
primary outcome of the conference will be the development of communication action plans
for media, parents and educators, health care professionals, researchers and policymakers.
For this purpose, they are partnering with the Washington, DC office of Hill and Knowlton
in the planning and implementation of this conference. Hosted by Shape Up America http://www.shapeup.org/diabesity/diabesity.htm
Source:
Shape Up America; January 22, 2001.
Most
popular diets help people drop pounds initially, but only traditional moderate-fat,
high-carbohydrate regimens seem to keep dieters slim, according to the first major review
of popular diets by the federal govern-ment. The Agriculture Department study found that
any diet that limits food to about 1,500 calories per day produces short-term weight loss,
The Washington Post reported. Those diets do little to help the dieter lower cholesterol
and blood pressure levels. The study was released publicly January 11, 2001, the Post
said. USDA spokesman Andy Solomon declined to comment. “This basically tells you that
you can lose weight on any of the diets, if you keep your calories down,” Agriculture
Secretary Dan Glickman told the Post. “The trick is how you maintain that weight
loss. “The report, the first in an ongoing review of popular diets, casts doubt on
newer, unorthodox approaches. Those programs that have put more demands on dieters, like
those recommended by groups such as the American Heart Association and Weight Watchers,
have the best scientific evidence to back up their success rates and health claims.
The American
Heart Association and Weight Watchers recommends consuming no more than 30 percent of
calories as fat, limiting protein to about 20 percent of the diet and consuming more
fruits, vegetables and complex carbohydrates to help satisfy hunger with fewer calories.
They are the most nutritionally adequate and showed some of the best improvements in blood
levels of the most dangerous cholesterol and blood fats and in blood sugar control, the
study found. “Based on the scientific knowledge we have, this seems to be the most
efficacious way to go and it is most likely the safest,” the Post quoted Xavier
Pi-Sunyer, director of the obesity research center at St. Luke's-Roosevelt Hospital in New
York and editor of Obesity research, which will publish the full USDA study in
March-April.
Source:
USDA Associated Press Release; January 10, 2001.
FATS DOWN, FRUIT AND VEGGIES UP IN SCHOOL MEALS
Agriculture Secretary Dan Glickman announced that school meals include more low or reduced
fat foods, greater menu variety, and more fruits and vegetables, according to two new
United States Department of Agriculture (USDA) studies.
“School meals reach nearly 27 million children each day, sometimes providing
the most nutritious meal a child receives,” said Glickman. “Fortunately, more
than ever before, these meals are hitting the mark in providing good nutrition and healthy
selections.”
The School Nutrition
Dietary Assessment–II, finds:
·
More schools today offer students food choices low in fat. From 1992 to
1999, schools offering students lunches which followed nutrition guidelines for total fat
improved from 34 to 82 percent in elementary schools and 71 to 91 percent in secondary
schools. The improvements in fat and saturated fat content were achieved without
compromising the overall nutrient contribution of school meals.
·
There has been a significant decrease of total fat levels in school
meals. From 1992 to 1999, fat levels in school breakfasts were reduced from 31 percent to
26 percent of total calories. During the same period, fat levels in school lunches were
reduced from 38 percent to 34 percent of total calories. The nutrition goal for school
meals is no more than 30 percent of total meal calories from fat.
·
Schools have also reduced the levels of saturated fat in meals. From
1992 to 1999 saturated fat in school lunches dropped from 15 percent to 12 percent of
total calories. During the same period, saturated fat in school breakfasts dropped from 14
percent to 9.8 percent. The nutrition goal for school meals is less than 10 percent of
total meal calories from saturated fat.
·
A majority of school districts increased the number of fruit,
vegetable, and grain/bread choices offered in school lunches. Roughly two-thirds of all
school lunch menus offered more than two fruit and vegetable choices, while more than
one-quarter of all menus included five or more fruit and vegetable choices.
·
More schools are meeting national standards for lower fat in lunches.
In 1992, only one percent of all schools lunches met the standard for total fat and none
met the standard for saturated fat. In 1999, 18 percent of elementary schools and 22
percent of secondary schools met the standard for total fat and 15 percent of elementary
schools and 17 percent of secondary schools met the standard for saturated fat in all
school lunches offered.
·
National nutrition standards continue to be met for other guidelines.
Meals offered and selected exceeded the RDA standards for key nutrients. Lunches in
secondary schools and breakfasts in both elementary and secondary schools contained fewer
calories than the standard. Students did not always take every type of food offered.
Shirley R. Watkins, USDA under Secretary for Food, Nutrition and Consumer Services said,
“We are encouraged by the improvements shown in both studies; however, we must
continue to work with our partners to ensure that these improvements continue. We must
provide training and technical assistance as well as nutrition education and we must
encourage school administrators, boards of education, and parents to ensure that school
environments support healthy choices. Children need sufficient time to eat their meals in
an environment that models good nutrition and encourages the development of healthy eating
patterns. It takes more than menus to change students’ food choices, and it will take
all of us working together to bring about the change our children need,” she added.
Additional information is available on the web at: www.fns.usda.gov.
Source:
USDA Press Release; January 10, 2001.
ONE-STOP SHOPPING FOR HEALTH INFORMATION ON THE INTERNET: MEDLINE
“PLUS”
“So many sites and so little time,” is the plaint of many faced with searching
the web for health information. Finding up-to-date health information just became a bit
easier with the addition of a daily health news feed from the major US print media to the
National Library of Medicine's MEDLINE “plus” consumer-friendly site.
Every weekday morning the home page of “medlineplus.gov” (that's the complete
address) will be updated with health- related articles selected from the Associated Press,
New York Times Syndicate, and United Press International. The Library has made special
arrangements with the publishers to make the articles available, and more sources will be
added in the future. They will not only be listed on the home page, but each will be
linked to one or more of the 430 “health topics” within MEDLINE
“plus”. Thus, for example, someone interested in diabetes will find a section
called “Latest News” at the top of the diabetes page.
In addition to highlighting important news items on the MEDLINE “plus” home
page, a complete list of news items from the last 30 days is also available, a feature
that may prove especially useful to librarians.
“We realize how important it is for people who search for information on the web, for
their personal health and that of their families, to be able to go to a site they trust.
This latest news feature from authoritative press sources is a new and welcome addition to
our service,” said Donald A.B. Lindberg, MD, director of the National Library of
Medicine. MEDLINE “plus” draws on the extensive resources of the National
Institutes of Health and other reliable, non-commercial sites. No registration is ever
required for MEDLINE “plus” users.
MEDLINE “plus”, which was introduced in October 1998, receives a remarkable 5
million page hits each month. Usage has doubled in just the past 6 months. In addition to
the “health topics” on individual diseases and medical conditions, the site has
an extensive medical encyclopedia with thousands of illustrations, detailed information
about more than 9,000 brand name and generic prescription and over the counter drugs, a
medical dictionary, directories of doctors and hospitals, and links to Clinicaltrials.gov,
the NIH web site listing more than 5,000 clinical studies. There are even links to the
scientific database, MEDLINE, so that the user can have access to the latest published
research.
The National Library of Medicine, which is the world's largest library of the health
sciences, is a part of the National Institutes of Health in Bethesda, Maryland. The
Library has an extensive Web site at www.nlm.nih.gov that provides a great variety of
information for the general public and for health professional
Source:
NIH Press Release; January 26, 2001.
ANNUAL BIBLIOGRAPHY OF DIETARY SUPPLEMENTS RESEARCH
The NIH
Office of Dietary Supplements (ODS) announced the availability of the first issue of the
“Annual Bibliography of Significant Advances in Dietary Supplement Research.”
HHS notes that the bibliography was developed as a joint effort of ODS and the Consumer
Healthcare Products Association (CHPA). Editors of peer-reviewed journals were asked to
nominate original research papers from their respective journals in 1999 to develop the
bibliography. In response to this request, over 200 nominations were received and then
forwarded to scientific experts to review and identify the top 25. This publication
highlights scientifically sound research on
dietary supplements and their
role in health maintenance. Officials at ODS hope, “this bibliography will serve as a
useful reference source for nutrition and health professionals, educators, and health
communicators, as well as the scientists who conduct the research.” Copies of the
document are posted at the following www site: http://ods.od.nih.gov/publications/publications.html
A paper copy is available from ODS at 301-435-2920; e-mail: ods@nih.gov - Information about ODS is posted at the
following www site: http://dietary-supplements.info.nih.gov
.
Source:
ASNS Legislative Supplement; January 2001.
Full Circle: Agriculture, Nutrition, and Health
July 20-24,
2001
Oakland
Marriott City Center
Oakland,
California
Don’t
miss this opportunity to enjoy the company and benefit from the experiences of other
nutrition education professionals. The “Full Circle” theme will highlight
relationships among agriculture, nutrition, and health policies and practices.
You’ll hear about and learn how to influence nutrition policies at the local, state
and national level; develop skills to improve teaching and communication abilities; and
meet and speak with leaders in nutrition education, science and policy. For more
information on the SNE conference, visit SNE’s website at: www.sne.org www.sne.org www.sne.orgor
contact the SNE office at 202-452-8534.
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NUTRITION PERSPECTIVES
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