UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION
NUTRITION PERSPECTIVES
Volume 28, No. 4
July/August 2003
TABLE OF CONTENTS PAGE
Nutrition and the General Practitioner
Physical Activity Promotion Through Primary Care
Counseling Patients on Physical Activity Makes a Difference
Obese Kids Have Poor Quality of Life
Lifestyle and Diet Changes Actually Do Lower Blood Pressure
Some Facts About Soy
The Hidden Health Costs of Meal Deals
The HHS Blueprint to Boost Breast-Feeding
The FDA and Breast-Feeding
More Mothers are Starting to Breast-Feed, But Many Give Up
The FTC Targets Coral Calcium
Resources:
Fortifying Food for the Poor
Breast-Feeding Resources
What’s New at IFC.ORG?
The Food Guide Pyramid: Basic Maintenance for Your Body
Prevent Childhood Choking: It’s Up to You
World Health Organization Report
Subscription for NUTRITION PERSPECTIVES
Sheri Zidenberg-Cherr, PhD, Editor
Department of Nutrition
University of California
Davis, CA 95616
Sheri Zidenberg-Cherr, PhD, Nutrition Specialist, Cristy Hathaway, Nutrition
Assistant, and staff prepare NUTRITION PERSPECTIVES. 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 (530) 752-3387;
FAX, (530) 752-8905.
NUTRITION AND THE GENERAL PRACTITIONER
The most recent supplement to the American Journal of Clinical Nutrition was entitled Nutrition Guidance of Family Doctors and covered the proceedings of the Third Heelsum International Workshop held in Heelsum, the Netherlands from December 10-12, 2001. Since 1995 the participants in the three Heelsum Workshops have developed into a multidisciplinary network of nutritionists, general practitioners (GPs), and behavioral scientists that are studying food, diet, and nutrition in the family practice setting. Areas of study include what individuals eat, how this influences their health status, how these habits can be changed, and the role of the GP in the process. Below are many of the topics discussed during the workshop and a list of general suggestions to help the GP bring nutrition consultation into his or her practice.
It is well known that many of today’s common diseases are either a result of, or can be modified by diet and lifestyle. Examples include, but are not limited to, obesity, heart disease, some cancers, diabetes, celiac disease, hypertension, and hypercholesterolemia. As many victims of these diseases and conditions rely on their GP for their primary care, it is imperative that the GP be armed with sound nutritional advice to give their patients. Yet here is where the issue gets tricky. Much of the nutritional data available to the GP was derived from population studies and may not be effective at the individual level (1). This is further complicated by the lack of randomized controlled nutritional intervention studies based on hard clinical endpoints. While these types of studies are common in drug research, they are rare in nutrition interventions because of the cultural, behavioral, and social influences on the diets of our heterogeneous population, and the huge expense attached to these types of trials (1).
Regardless of this, most people rely on their GP for nutritional advice even
though their physician may not be current on recent literature and recommendations.
In today’s information-based society, consumers are bombarded with nutritional
advice, be it correct or not, from the media, the Internet, and friends and
family, and they expect their GP to be as “up to date” as they are
when coming in for exams (2). Yet the typical GP is usually too busy to keep
up on current nutrition research, and it is easier and takes less time to prescribe
a medicine than to describe a healthy diet. The typical appointment with a GP
may only be 20 minutes or so, which is not even close to the time a thorough
nutritionist, such as a registered dietician (RD), spends with a client going
over diet history, offering a new food plan, suggesting new foods and products,
and explaining how to prepare them so that they appeal to the client (3). And
to make matters worse, many doctors report that they cannot refer their patients
to a RD because of a lack of reimbursement or insurance coverage. Because of
this, nurses often have to pick up the slack. But many nurses, like the GPs
may not have the necessary training and knowledge to provide sound nutritional
advice to patients (4).
With all the above factors in mind, Truswell and colleagues came up with the
following suggestions for the GP trying to answer the question: “What
should be the essential nutrition knowledge for a GP?” (3).
· Know and use available resources.
· Know where to research.
· Know a good RD.
· Know the principles of diet for coronary heart disease, diabetes, nutrition
for infants and the elderly and obesity.
· Do not forget to ask about supplement, herbal, and alcohol intake.
· Know about cultural aspects of diet (e.g. Ramadan).
· Measure weight routinely, derive the Body Mass Index (BMI), and inform
the patient what it means.
· Have the tools for assessing the patient’s present diet.
· Be able to translate dietary guidelines into foods.
· Have a copy of an up to date nutrition reference.
References:
1. Van Binsbergen, Jaap J, et al. Nutrition in primary care: Scope and relevance
of output form the Cochrane Collaboration. Am J Clin Nutr. 77(4S). April 2003.
2. Van Dillen, Sonja ME, et al. Understanding nutrition communication between
health professionals and consumers: development of a model for nutrition awareness
based on qualitative consumer research. Am J Clin Nutr. 77(4S). April 2003.
3. Truswell, A Stewart, et al. Nutrition guidance by family doctors in a changing
world: problems, opportunities, and future possibilities. Am J Clin Nutr. 77(4S).
April 2003.
4. Brotons, Carlos, et al. Dietary advice in clinical practice: the views of
general practitioners in Europe. Am J Clin Nutr. 77(4S). April 2003.
Source: Supplement to the American Journal of Clinical Nutrition. 77(4S). April
2003.
Stephanie Tarry, Masters Student, Nutrition Department, University of California,
Davis.
PHYSICAL ACTIVITY PROMOTION THROUGH PRIMARY CARE
A recent issue of the Journal of the American Medical Association (1) included an article written to help guide physicians in prescribing physical activity to their patients for improvement of health and quality of life. The major points of the article are summarized below.
Despite all the radio and TV advertisements for fitness centers, spas, and home gyms, the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey recently estimated that 27.6 percent of adults perform no activity, 46.2 percent perform some activity, and only 26.2 percent of US adults actually meet recommendations for physical activity. Similar numbers can be found among the nation’s youth. An estimated 14 percent of adolescents report no recent or regular physical activity and approximately 50 percent are not active enough to reap the benefits of regular physical activity. Given these statistics it is imperative that physical activity be increased among all age groups and thus has been designated a national health priority.
Because of the number of people of all age groups they see each year, physicians and other health professionals have the potential to become a major force in physical activity promotion. It is well known that physical activity helps promote good overall physical and psychological health during many phases of life, including childhood, pregnancy, adulthood and the senior years (2-8). Physical activity can help manage diseases such as diabetes, arthritis, and ease the discomfort of cancer treatments, as well as delaying the onset of first stroke, type 2 diabetes mellitus, and osteoporosis (9-12). Involvement in activities such as swimming, walking, and many sports have also been shown to reduce depression. When prescribing exercise, the physician should assess the patient’s needs, initial ability to perform physical activity, and interest level.
The US surgeon general, the CDC and the American College of Sports Medicine
developed the following recommendations for those beginning an exercise program:
1) Individuals of all ages should participate in 30 minutes of physical activity
of moderate intensity on most, if not all, days of the week.
2) Previously inactive individuals should begin with short amounts of moderate
intensity activity and gradually increase the duration or intensity until the
goal is reached.
3) Assess those with chronic diseases, men older than 40 years and women older
than 50 years before advising exercise.
4) Aerobic activity should be supplemented with strength-developing exercises
at least twice per week to improve musculoskeletal heath, maintain independence,
and decrease the risk of falling.
The biggest problem most people seem to have with being physically active is maintaining a program once it has been started. The physician can help patients stay motivated by helping them develop a personal action plan with goal setting strategies to overcome barriers, and monitoring of their progress. Physicians who prescribe exercise and then follow their patients’ progress with counseling (including problem solving and development of specific plans to ensure motivation and attain goals) have a much higher success rate with their patients than physicians who just prescribe activities and do not follow up. Physician initiated interventions should also incorporate community involvement such as suggesting starting a walking club, joining an aerobics class, and involvement in local health agency sponsored risk screening to help ensure long term success.
Estabrooks and colleagues developed the following “5 A’s Mnemonic”
to summarize the key steps and principles of prescribing a successful exercise
plan:
1) Assess the patient’s current level of physical activity and function.
2) Advise the patient by relating the patient’s recent laboratory results
and symptoms to physical inactivity, identify the personalized potential benefits
of physical activity, and provide guidance on the appropriate amount and type
of physical activity.
3) Agree with the patient if he or she is planning to develop a physical activity
goal at the present time, ask what barriers he or she anticipates for accomplishing
this goal, and ask what are the specific goals for the type, intensity, duration,
and frequency of physical activity.
4) Assist the patient in developing specific strategies to overcome his or her
identified barriers and specific graduated action plan.
5) Arrange for follow-up assessment, support, and problem solving.
References:
1. Artal R and O’Toole M. Guidelines of the American College of obstetricians
and Gynecologists for exercise during pregnancy and the postpartum period. Br
J Sports Med. 2003; 37; pp. 6-12.
2. Janz KF, Burns TL, and Torner JC, et al. Physical activity and bone measures
in young children: the Iowa Bone Development Study. Pediatrics. 2001;107: pp.
1387-1393.
3. American College of Sports Medicine Position Stand: the recommended quantity
and quality of exercise for developing and maintaining cardiorespiratory and
muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30:
pp. 975-991.
4. American College of Sports Medicine. Osteoporosis and exercise. Med Sci Sports
Exerc. 1995;27: pp. i-vii.
5. American College of Sports Medicine. Exercise for patients with coronary
artery disease. Med Sci Sports Exerc. 1994;26: pp.i-v.
6. Rejeski WJ and Mihalko SL. Physical activity and quality of life in older
adults. J Gerontol A Biol Sci Med Sci. 2001;56: pp. 23-35.
7. Spirduso WW and Cronin DL. Exercise dose-response effects on quality of life
and independent living in older adults. Med Sci Sports Exerc. 2001;33: pp. S598-S608.
8. Gorelick PB, Sacco RL, and Smith DB et al. Prevention of a first stroke:
a review of guidelines and a multidisciplinary consensus statement from the
National Stroke Association. JAMA. 1999;281: pp. 1112-1120.
9. Glasgow RE, Funnell MM, and Bonomi AE et al. Self-management aspects of the
improving chronic illness care breakthrough series: implementation with diabetes
and heart failure teams. Ann Behav Med. 2002;24: pp. 80-87.
10. Hootman JM, Macera CA, and Ainsworth BE, et al. Epidemiology of musculoskeletal
injuries among sedentary and physically active adults. Med Sci Sports Exerc.
2002;34: pp. 838-844.
11. Courneya KS. Exercise interventions during cancer treatment: biopsychosocial
outcomes. Exerc Sport Sci Rev. 2001;29: pp. 60-64.
Source: Estabrooks PA, Glasgow RE, and Dzewaltowski DA. Physical activity promotion
through primary care. JAMA; June 11, 2003;289(22): pp. 2913-2916.
Stephanie Tarry, Masters Student, Nutrition Department, University of California,
Davis.
COUNSELING PATIENTS ON PHYSICAL ACTIVITY MAKES A DIFFERENCE
It’s clear that physical activity is an important part of a healthy lifestyle. What is less clear is whether counseling by primary care physicians increases physical activity among their patients and whether such increased activity improves health. In this randomized controlled study, New Zealand researchers suggest that both outcomes can be achieved (1).
Forty-two general practices enrolled 878 adults (age range, 40-79); either nurses or physicians counseled intervention patients about physical activity goals. The counseling was followed by 3 phone contacts from exercise specialists during the next 3 months. At 1 year, the intervention group had increased their total energy expenditure significantly more than the control group had (by 9.8 kcal/kg/week vs. 0.4 kg/kcal/week), and significantly more intervention patients achieved 2.5 hours of moderate-to-vigorous exercise weekly than did control patients (14.6 percent vs. 4.9 percent). In addition, 4 items on a health questionnaire improved significantly only in the intervention group: general health, role physical, vitality, and bodily pain. There were no significant changes in body-mass index, blood pressure, coronary risk, or cholesterol levels in either group.
This intervention was simple, but it resulted in sustained improvements in exercise levels and in several measurements of well-being (at least for a year). Although this type of counseling might be reasonable in primary care practices, the initial counseling plus follow-up phone calls would be quite time-consuming when applied to a large number of patients.
Reference:
1. Elley, C. R., Kerse, N., Arroll, B., and Robinson, E.; Effectiveness of counseling
patients on physical activity in general practice: cluster randomized controlled
trial; British Medical Journal; April 12, 2003; 326; pp. 793-796.
Source: Keith I. Marton, MD; Journal Watch; June 1, 2003; 23(11); p. 88.
OBESE KIDS HAVE POOR QUALITY OF LIFE
The health-related quality of life reported by severely obese children and adolescents was significantly lower than their healthy peers and similar to young cancer patients, according to a survey of 106 children ages 5 to 8 years (1).
While one in seven US children is obese, little research has been done to assess their quality of life. In this study, investigators administered a 23-item pediatric quality of life inventory to youths referred to an academic children’s hospital for evaluation of obesity. Their parents also completed the questionnaire, which measured physical, emotional, social, and school functioning. Researchers then compared results to published quality of life data on healthy children and youths diagnosed with cancer who were receiving chemotherapy.
Study participants’ mean body mass index was 34.7, and 65.1 percent had
at least one obesity-related comorbid condition. The likelihood of obese youth
having impaired health-related quality of life was 5.5 times greater than their
healthy peers and was similar to those diagnosed with cancer. Parents’
quality of life assessments were even lower than their child’s in most
areas.
In addition, of all seven obesity-related comorbid conditions assessed, only
obstructive sleep apnea was related to lower health-related quality of life.
The authors noted that the similar quality of life scores of obese children and cancer patients were unexpected. While both groups may experience physical limitations and teasing from their peers, obese youths often aren’t exposed to the adverse effects of intense medical interventions that are common in pediatric cancer.
The authors concluded that physicians and parents should be aware of the risk of impaired quality of life in obese youths. They also suggested that interventions to treat obesity should target not only weight loss but also health-related quality of life.
Reference:
1. Schwimmer JB, Burwinkle TM, and Varni JW. Health-related quality of life
of severely obese children and adolescents. JAMA. 2003; 289: 1813-1819.
Source: AAP; 22(6); June 2003; p. 242.
LIFESTYLE AND DIET CHANGES ACTUALLY DO LOWER BLOOD PRESSURE
Although several lifestyle modifications (i.e., diet, exercise, and weight loss) are recommended as primary treatment for borderline and stage 1 hypertension, they have not been evaluated as a group. In addition, the DASH (Dietary Approaches to Stop Hypertension) diet, which often is recommended to hypertensive patients, has not been evaluated in community settings; the DASH diet emphasizes increased intake of fruits, vegetables, and low-fat dairy products, and decreased saturated and total fat consumption.
In a national multi-site study, 810 adults (mean age, 50) with elevated blood pressure (BP) (120-159 mmHg systolic, 80-95 mmHg diastolic, or both) who were not taking antihypertensive medications were randomized to a control group or to 1 of 2 behavioral interventions. The control group received a single BP advice session (1). Intervention programs included 18 sessions during 6 months: either on weight-loss promotion, sodium reduction, increased physical activity and limited alcohol intake or on all of these plus the DASH diet. At 6 months, mean systolic BP was reduced by about 4 mmHg, and mean diastolic was reduced by about 2 mmHg in both intervention group compared with the control group. Both intervention groups also achieved statistically significant changes in weight, physical activity, and diet.
These data confirm the expected benefit of lifestyle modification in lowering BP and give clinicians a sense of the expected magnitude of such benefit. However, implementing the behavioral interventions was quite labor-intensive. Moreover, the incremental benefit of the DASH diet (when added to the behavioral intervention) was small.
Reference:
1. Writing Group of the PREMIER Collaborative Research Group; Effects of comprehensive
lifestyle modification on blood pressure control: Main results of the PREMIER
clinical trial; JAMA; April 2003 23/30(289); pp. 2083-2093.
Source: Thomas L Schwenk, MD; Journal Watch; June 1, 2003; 23(11); p. 87.
What is soy?
Soy is a low cost source of protein that has been consumed in Asian nations
for many centuries. Regular intake of this food is thought to be partially responsible
for the lower rates of heart disease, stroke, and cancer observed in Eastern
populations. Due to recent concerns that have been raised about the use of hormone
replacement therapy, many researchers are looking to soy as a possible natural
alternative to prevent some of the symptoms associated with menopause (1).
What are the isoflavones?
The isoflavones genistein, daidzein, and glycitein are the flavonoid components
of soy protein. Also known as phytoestrogens, these compounds are structurally
similar to the hormone estrogen, and interact with estrogen receptors in the
body. Many researchers believe that the isoflavones may be the “active”
component of soy protein that is responsible for the beneficial effects observed
after soy consumption (1).
What are good sources of soy?
There are many soy products out on the market; however, most of these have undergone
such high levels of processing, that much of the nutritional benefit is lost.
Below is a list of high-quality sources.
· Edamame or Soy Beans- Soy beans are the least processed form of soy
protein. Available in most grocery stores, they can be purchased in fresh, frozen,
or roasted forms. These beans can be eaten alone, like peas, or added to salads
and stir-fries.
· Tofu- Tofu, or bean curd, is made by curdling soymilk with a coagulant.
Available in both soft and firm forms, tofu can be used in a variety of recipes
to partially replace either meat or dairy products. Due to the common use of
calcium sulfate as the curdling agent, tofu can also be a good source of calcium.
· Soymilk- soymilk is another high-quality source of soy protein that
is available in a variety of forms, including chocolate. It can be used to replace
milk added to coffee, tea, or cereal.
Why should people eat soy?
Epidemiological studies suggest that regular consumption of plant based protein
foods reduces one’s risk for chronic diseases such as cancer, heart disease,
and stroke (3,4,5). Plant-based foods, such as soy, can provide the body with
beneficial agents including vitamins, minerals, fiber, and flavonoids. Numerous
clinical trials have investigated the potential of soy to protect against risk
of chronic disease. Below is a list of some of these findings.
· Soy and Heart Disease- Consumption of soy protein has been associated
with decreasing the susceptibility of LDL cholesterol to oxidation, reducing
arterial stiffness, lowering total and LDL cholesterol, and increasing HDL cholesterol,
possibly reducing the risk of coronary artery disease (2).
· Soy and Cancer- Numerous studies have investigated the anti-carcinogenic
properties of soy. Regular consumption of soy protein has been associated with
a reduction in risk of both breast and prostate cancer. It has been suggested
that the isoflavones genistein and daidzein may decrease the amount and size
of cancer tumors (2).
· Soy and Osteoporosis- Due to the similarity in the structures of the
isoflavones and estrogen, several studies are investigating the ability of isoflavones
to reduce the rapid rate of bone loss that is associated with the onset of menopause.
Epidemiological evidence has shown that Asian women who consume the highest
levels of soy protein have elevated levels of bone mineral density (1).
· Soy and Diabetes- Regular consumption of soy protein may help to reduce
symptoms associated with Type 2 Diabetes. Soy has been shown to decrease postprandial
hyperglycemia, improve glucose tolerance, and decrease amounts of glycosylated
hemoglobin (6).
· Soy and Obesity- In studies comparing low energy diets containing soy
protein with those containing milk protein, soy protein reduced cholesterol
and triacylglycerol in addition to the decrease in body weight that was observed
in the milk protein group (6).
How much soy is recommended?
According to the American Heart Association and the FDA, daily consumption ³25
grams of soy protein with isoflavones can help to lower cholesterol levels in
individuals at high risk for heart disease (7). An average serving of soy foods
provides 6.25 grams of soy protein, so an individual who is trying to lower
his or her cholesterol should aim for eating four servings of high-quality soy
foods a day. If a breast cancer patient, or person who is at high risk for this
disease, enjoys eating soy, occasional consumption does not appear to pose any
risk (8).
What are some ways to increase soy intake?
Below is a list of suggestions to help you and your clients achieve the American
Heart Association and the FDA’s recommended four servings of soy a day:
Replace some or all of the meat in your favorite recipes with tofu
or texturized vegetable protein (TVP)
· In spaghetti sauce, replace half of your ground beef with TVP.
· In stir-fry or fajitas, replace the usual chicken or beef with cubed
firm tofu.
· In chili, replace half of your ground beef with TVP.
· Make tacos with TVP.
· Add some TVP to meatloaf.
Use silken tofu to replace sour cream, yogurt, or cheese in recipes
· Make a dip for vegetables with half silken tofu and sour cream. Add
one package of dried onion soup mix, combine in a blender, and serve.
· Make a morning smoothie with silken tofu instead of the usual yogurt.
· Replace half of the ricotta cheese with pureed firm tofu in lasagna.
· Use silken tofu to replace the heavy cream in your favorite soup recipe.
· Make a half sour cream, half silken tofu mixture to use as a low fat
topping on baked potatoes.
Try some of the new soy products available at the super market
· Replace your morning breakfast sausage with soy sausage.
· Try some of the numerous types of garden or soy burgers.
· Use soymilk instead of creamer in your morning coffee or tea or on
your breakfast cereal.
· Use soy nuts as a salad topper or eat them alone as a snack.
· Try soynut butter and jelly for your next brown bag lunch.
Should people take isoflavone supplements?
Although many researchers have attempted to isolate the active component of
soy to create an effective soy supplement, there appears to be some additional
benefit provided by consuming the intact protein particularly for lowering cholesterol.
Furthermore, the actual isoflavone content of any supplement cannot be guaranteed.
For these reasons, it is recommended that people wishing to lower their cholesterol
attempt to incorporate high-quality sources of soy protein into their diet rather
than resorting to supplements.
Can too much soy be harmful?
Numerous clinical studies have found that daily consumption of up to 50 g of
soy protein is not only safe, but may also be effective in improving risk factors
for chronic disease such as cancer, diabetes, and cardiovascular disease (7).
For individuals with, or at high risk for breast cancer, there appears to be
no adverse effects of occasional eating soy (8); especially if it is enjoyed
as part of a low-fat, high-fiber diet.
Listed below are some common foods and their soy protein content.
Food Serving Soy Protein (g) Isoflavone Content (mg)* Kcal
Soy Burger 1 patty 8 7 100
Soy Nuts 1 oz. 12 38 150
Soy Milk 1 cup 8 24 100
Texturized Vegetable Protein (TVP) ¼ cup 14 27 50
Tofu 3 oz. 9 33 45
Soy Protein Bar 1 bar 6 10-15** 180
Soy Breakfast Pattie 2 patties 16 4 160
Soy Flour ¼ cup 12 33 90
Soy Beans, Boiled ½ cup 7 47 190
Tempeh ½ cup 18 36 200
Soy Nut Butter 2 Tbs. 8 0 160
* Isoflavone content obtained from the USDA-Iowa state university database
on the isoflavone content of food.
**Estimated from nutrition label information.
References:
1. Messina, MJ. Soy Foods and Soybean Isoflavones and Menopausal Health. Nutr
Clin Care; 5; 2002; 272-282.
2. Kris-Etherton, PM, Hecker, KD, Bonanome, A, Coval, SM, Binkoski, AE, Hilbert,
KF, Griel, AE, and Etherton, TD. Bioactive Compounds in Foods: Their Role in
Prevention of Cardiovascular Disease and Cancer. Am J Med; 113(9B); 2002; 71S-88S.
3. Goodman-Gruen D, Kritz-Silverstein D. Usual Dietary Isoflavone Intake is
Associated with Cardiovascular Disease Risk Factors in Postmenopausal Women.
Journal of Nutrition; 131; 2001;1202-1206.
4. Kleijn MJJd, Schouw YTvd, Wilson PWF, Grobbee DE, Jacques PF. Dietary Intake
of Phytoestrogens IsAssociated with a Favorable Metabolic Cardiovascular Risk
Profile in Postmenopausal U.S. Women: The Framingham Study. Journal of Nutrition;
132;2001;276-282.
5. Nagata C. Ecological Study of the Association Between Soy Product Intakes
and Mortality From Cancer and Heart Disease in Japan. International Journal
of Epidemiology;29; 2000; 832-836.
6. Bhathena SJ, Velasquez MT. Beneficial role of dietary phytoestrogens in obesity
and diabetes. Am J Clin Nutr. 76; 2002; 1191-1201.
7. Erdman, JW. Soy Protein and Cardiovascular Disease. Circulation.102; 2000;
2555-2559.
8. Messina MJ, Loprinzi, CL. Soy for Breast Cancer Survivors: A critical review
of the literature. J. Nutr. 131. 2001. a. 3095S-3108S.
Karrie Cesario, Doctoral Candidate, Nutrition Department, University of California,
Davis.
THE HIDDEN HEALTH COSTS OF MEAL DEALS
Much food for only a little more money, that’s the “deal” that American eateries and food retailers are offering us, but overweight, obesity and chronic disease are the real price we pay for these food bargains.
Just before lunch, Katie Weigle went into a fast food restaurant in Washington, D.C., and ordered a cheeseburger. “For just $1.40 more you can get a meal package, cheeseburger, fries and a Coke,” the server said. “Sounds too good to be true,” Katie replied. The server responded, “As a matter of fact, for just 58 cents more, you can super size that meal….”
So Katie walked out the door with a bag containing a 4-ounce hamburger, a large order of French fried potatoes and a large Coke. It was a bargain. The trouble was, her lunch now contained 1,380 calories, or about 700 more calories than a woman her size requires at lunch.
That’s how “value marketing” works. Restaurants and food retailers offer you a lot more food for just a little more money. Since food, as opposed to labor, rent or utilities, is their smallest cost, they make money on such deals. Customers are happy, too. They pay a little less per unit and get an enormous portion of food.
Everything would be hunky dory, if they didn’t eat all those extra calories.
Seventy percent of respondents to a recent American Institute for Cancer Research
(AICR) survey, however, said they eat everything they are served in a restaurant
all or most of the time. So a decade or two of “value marketing”
may help explain why 64 percent of Americans are now overweight or obese.
Survey Counts the Health Cost
Of course, Katie didn’t eat that 1,380-calorie lunch. She brought it back to AICR along with her sales slip. Her purchase was part of a study conducted by health organizations nationwide. They were attempting to quantify just how much damage “value marketing” does.
Here are some of their results:
· At Cinnabon, when one Minibon (300 calories) was ordered, the clerk
said, “It’s only 48 cents more for a classic Cinnabon (670 calories).”
So researchers paid 24 percent more for 123 percent more calories.
· At 7-Eleven, researchers asked for a “Gulp” of Coke (150
calories) and left the store with a “Double Gulp” (600 calories)
for only 37 cent more. That’s a 42 percent increase in price for 400 percent
more calories.
· At the movie theaters, researchers asked for medium popcorn without
butter (900 calories) and were told you can get a large (1,160 calories) for
only 60 cents more. That’s 23 percent more money for 260 more calories.
· Researchers found a whopping big “deal” at McDonald’s.
There they paid 8 cents less to buy the large value meal (Quarter Pounder with
cheese, large fries and a large Coke at 1,380 calories) than to buy the Quarter
Pounder, small fries and a small Coke (890 calories). That is, they spent 8
cents less to purchase 490 calories more.
The list goes on, but the pattern is the same: customers are manipulated into paying a little bit more for many more calories than they can afford to eat.
How to Fight Back
Say ‘small’, say ‘half’ and share. When ordering,
always insist on the smallest size. At times that is difficult. “Small”
has grown so large in our eateries that it often has names like “tall”
or “supreme.” Just say, “Which is the smallest size? That
is the one I want.”
At table service restaurants, order the half size, if it is available. If not,
cut the meal in two and tell the server to put half in a doggie bag. If you
can set half aside before it is served, you’ll be spared any temptation.
When all other strategies fail, order one meal and share it. Even if the restaurant makes you pay for the extra set up, you’ll save money and leave feeling comfortably full. In an age when candy bars are 3.7 ounces instead of 2, bagels are 4.5 ounces instead of 1.5, and sodas are 62 ounces instead of 8, the best way to ensure your health may be to share every food item you buy with a friend or loved one.
Cancer and Obesity
Research links being overweight with increased risk of cancer. Overweight and
inactivity account for one-quarter to one-third of all breast, colon, endometrial,
kidney, and esophageal cancers. If you are concerned about your weight, eat
a little less and exercising a little more. For guidance in reducing your portion
size, call 1-800-843-8114, and ask for a free copy of the New American Plate
brochure. For help with making healthy choices when dining out, order AICR’s
“Healthy Eating Away Form Home” pamphlet by visiting the AICR website
at www.aicr.org or write AICR, 1759 R Street, NW, P.O. Box 97167, Washington
D.C. 20090-7167
Source: American Institute for Cancer Research Newsletter. Summer 2003; 80:pp.1,3.
THE HHS BLUEPRINT TO BOOST BREAST-FEEDING
Two decades of scientific research, and years of proactive measures by health experts and others, are beginning to pay off. Attitudes and behaviors toward breast-feeding in the United States are changing.
During the last 15 years, the importance of breast-feeding has been recognized as one of the most valuable medical contributors to infant health. In 1990, the United States signed a formal declaration on the protection, promotion, and support of breast-feeding adopted by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). At the same time, the Department of Health and Human Services (HHS), through a national health promotion and disease prevention initiative called Healthy People 2000, and subsequently Healthy People 2010, established breast-feeding objectives for the first year of an infant’s life.
Recognition of the benefits of breast-feeding has already spread to many health and professional organizations, such as the American Academy of Family Physicians, the American Dietetic Association, and the American College of Obstetricians and Gynecologists. Moreover, the American Academy of Pediatrics (AAP) considers breast-feeding to be “the ideal method of feeding and nurturing infants.”
A Blueprint for breast-feeding
To further these efforts, the HHS Office of Women’s Health (OWH), in the cooperation with the other federal agencies and health care professional organizations, developed a comprehensive national breast-feeding policy, called the HHS Blueprint for Action on Breastfeeding.
The OWH has been given further funds to translate the recommendations of the
Blueprint into the National Breastfeeding Awareness Campaign to promote breast-feeding
among first-time parents. The overall goal of both the Blueprint and the campaign
is to increase the number of mothers who breast-feed their babies in the early
period following their birth (postpartum) to 75 percent and to raise to 50 percent
those who are breast-feeding at 6 months postpartum by the year 2010.
The Blueprint introduces an action plan for breast-feeding that reaffirms its
superiority for most newborns. The plan is based on education, training, awareness,
support, and science, and includes key recommendations of the HHS Subcommittee
on Breastfeeding.
“The Blueprint has been widely circulated and the number of requests for the document has been unprecedented,” says Suzanne G. Haynes, Ph.D., chairwoman of the HHS Subcommittee on Breastfeeding and senior science advisor at the OWH. “It is being used in teaching settings, in hospitals, and in communities,” she adds, noting that the US Department of Agriculture is using the document to promote breast-feeding in nine state projects.
As part of the National Breastfeeding Campaign, a comprehensive three-year media campaign will be launched in the summer of 2003. The campaign will be marketed in partnership with selected organizations and will get the message out through public service announcements, bus-stop posters, billboards, articles in community newspapers, parenting and women’s magazines, Web sites, and educational pamphlets.
In addition, 18 community-based demonstration projects throughout the United States will work with the OWH and the Advertising Council to Implement the Advertising Campaign on a local level. The projects will attempt to educate women about the benefits of breast-feeding, encourage them to choose to breast-feed, and create awareness that breast-feeding is normal, desirable, and achievable.
Legislative support of breast-feeding is growing. As of 1999, 33 states had
enacted laws relating to a wide range of issues involving various aspects of
breast-feeding, such as redefining indecent exposure rules, allowing breast-feeding
in public places, jury duty postponement due to breast-feeding, and promotion
of breast-feeding programs. Hawaii, for example, prohibits employers from discriminating
against a mother who breast-feeds or expresses milk with a pump at the workplace.
In addition, several health plans are working to make women aware of the many
health benefits breast- feeding hold for their newborns and for themselves.
“We have support of the leading policy groups for health plans,”
says Haynes. According to the American Association of Health Plans (AAHP), health
plans have a vital role to play in increasing the number of women who successfully
breast-feed their babies.
Health plans can influence both families and health care providers through targeted educational interventions promoting breast-feeding, and breast-feeding support services, provided before, during, and after birth. Additionally, health plans can support breast-feeding mothers during the critical first days and weeks postpartum by offering all mothers access to special services provided by trained physicians, nurses, lactation specialists (breast-feeding coaches), and peer counselors or other trained health care providers.
Benefits of Breast-feeding
Science has proved that breast-fed babies have a healthier start in life. Human milk contains a balance of nutrients that closely matches infant requirements for brain development, growth, and a healthy immune system. Human milk also contains immunologic agents and other compounds that act against viruses, bacteria, and parasites. Since an infant’s immune system is not fully developed until age 2, human milk provides a distinct advantage over formula.
Because breast milk provides protection against germs that a baby or mother may carry, studies in infant feeding have found lower rates of several chronic childhood diseases, including respiratory infections and ear infections, as well as symptoms such as diarrhea, among children who were breast-fed.
Research also suggests that breast-fed infants gain less weight and tend to be leaner at 1 year of age than formulated infants. This early indicator may influence later growth patterns, resulting in fewer overweight and obese children.
But infants aren’t the only ones who benefit from breast-feeding. Mothers, too, are the recipients of many positive hormonal and physical effects. Breast-feeding releases a hormone in a woman’s body that causes her uterus to return to its normal size and shape more quickly and reduces blood loss after delivery. In addition, according to the Blueprint, studies have shown that breast-feeding for longer periods of time (up to 2 years) and among younger mothers may reduce the risk of premenopausal and possibly postmenopausal breast cancer. Also, the risk of ovarian cancer may be lower among women who have breast-fed their children.
Haynes says intriguing new developments indicate that breast milk may even have another role in the battle against cancer. In particular, breast-feeding may reduce the risk of childhood cancer.
Researchers have identified a protein in human milk, human alpha-lactalbumin made lethal to tumors (HAMLET), that induces apoptosis, or programmed cell death, in which cells, responding to environmental signals, self-destruct. Apoptosis, a relatively new study in biology, is the natural mechanism the body uses to recycle material that is not needed for functioning. When apoptosis is initiated, the cell’s genetic material becomes shredded so that the cell cannot replicate itself. With cancer cells, apoptosis is inhibited, allowing rapid growth of dysfunctional cells. Haynes says that the isolation of HAMLET as a trigger for apoptosis in cancer cells could give further weight to evidence lining breast milk to reduced incidences of some cancers.
From a budget standpoint, breast-feeding can save a family hundreds of dollars a year, even with the added cost of breast pumps, devices regulated by the Food and Drug Administration that allow mothers to express milk when they are away from their babies, or when they want to save extra milk to be given to the baby at other times. According to the Blueprint, breast-feeding also saves money for insurers and employers by cutting down on doctor visits and sick days.
Overcoming Obstacles
Why, then, with all these benefits, don’t more mothers breast-feed? Breast-feeding requires a substantial commitment from a mother. Some mothers feel tied down by the constant demands of a nursing newborn. Others feel embarrassed or concerned about breast-feeding, especially in public places.
“That’s just the type of image we’re trying to change,” says Haynes. “We’re trying to normalize breast-feeding so that people won’t blink an eye when they see it.” Haynes says removing these kinds of barriers is a major challenge of the campaign. But she also emphasizes that breast-feeding is not the end of a woman’s indepen-dence. Women can use pumps to express milk when they are going to be away from their babies so that others can bottle feed them, allowing mothers to keep up their milk supply. She adds that women can return to full-time work with careful planning and a discussion with employers about a private and sanitary area to express milk.
Cautions About Breast-feeding
Despite the benefits, not every mother is able to breast-feed or chooses to do so. In rare cases, a mother’s health may prevent her from breast-feeding. Women who test positive for HIV and AIDS or who have human T-cell leukemia virus type 1 (HTLV-1) should not breast-feed or provide their breast milk for the nutrition of their own or other infants because of the risk of transmission to the child.
Under certain conditions, a case-by-case assessment should be made about whether or not breast-feeding is advisable or should be temporarily stopped.
According to the Blueprint, some of these conditions include:
· Exposures to environmental chemicals, such as DDT, dioxin, and methyl
mercury Hepatitis C
· Illicit drug use, such as amphetamines, cocaine, heroin, and marijuana
· Implants and breast surgery
· Metabolic disorders such as galactosemia, a condition in which the
infant cannot metabolize lactose, a sugar found in all mammalian milk
· Tobacco and alcohol use, since alcohol and nicotine are present in
breast milk. However, for women who cannot or will not stop smoking, breast-feeding
is still advised, since the benefits of breast milk outweigh the risks from
nicotine exposure
· Use of drugs such as cyclosporine, doxorubicin, ergotamine, methotrexate,
and radioactive isotopes, as well as anti-anxiety, anti-depressant, and antipsychotic
agents. For most prescribed and over-the-counter medications taken by women,
the risk to the nursing infant is unknown
Mothers should always ask their physicians before continuing or taking new medications while nursing. The American Academy of Pediatrics (AAP) first issued a statement on the transfer of drugs and chemicals into human milk in 1983, revising its list in 1989 and 1994. Information continues to become available. The current statement, which can be found on the AAP’s Web site (www.aap.org/policy/0063/html), is intended to assist physicians in counseling a nursing mother regarding breast-feeding when the mother has a condition for which a drug is medically indicated.
Susan F. Wood, Ph.D., director of the FDA’s Office of Women’s Health (OWH) says, “The FDA’s Center for Drug Evaluation and Research and the OWH are working to improve the current label on products so that it is more helpful to both mothers and prescribing physicians. However, more research is needed in order for good information to show up in the label, and the FDA is also working to encourage such research.”
Increasing Rates
As of 2001, the year for which the most recent statistics are available, almost 70 percent of all mothers breast-fed in the early postpartum period, and about 32 percent of all mothers breast-fed at 6 months postpartum. Comparing rates in 2001 to 1996, increases in initiating breast-feeding and continued breast-feeding to 6 months were greater among groups that have been historically less likely to breast-feed: black women, women younger than 20 years old, no more than high school educated, working women and others. However, racial and ethnic disparities in breast-feeding rates remain significant and, according to the HHS, black women breast-feed at alarmingly low rates.
The HHS believes that the nation needs to address these low rates as a public health challenge and put in place national, culturally appropriate strategies to promote breast-feeding. There are many reasons for the low breast-feeding rates in the black community, but they are reversible. For one thing, breast-feeding is thought to be painful. Most people do not realize that, although there can be some initial discomfort, if done properly, breast-feeding should not cause pain.
Another reason is that the attitude toward breast-feeding in the black community has not been positive. Experts say the message that breast-feeding is superior to formula feeding has not been heard. Black women also say it is difficult for them to receive information and education about breast-feeding, to have breast-feeding initiated in the hospital, to continue breast-feeding in the early days in the home setting, and to continue breast-feeding for an extended period.
The Baltimore-based African-American Breastfeeding Alliance, Inc. (AABA) seeks to make breast-feeding a family affair, since black communities often are based on kinship. The decision to breast-feed is frequently directed related to influence from peers, husbands, boyfriends, and other family members. In other words, a woman is more likely to breast-feed if members of her family, primarily spouses, support it.
“It is often taken for granted that African-American women will not breast-feed so they generally don’t receive good breast-feeding education and support, “says Katherine Barber, founder and Executive Director of AABA. According to AABA education should be an essential component during prenatal care. Increasing the rates of breast-feeding is a compelling public health goal, particularly among the racial and ethnic groups who are less likely to initiate and sustain breast-feeding throughout the infant’s first year. According to the Blueprint, this goal can only be met when breast-feeding is supported in the family, community, workplace, health care sector, and society.
Overall, the HHS Blueprint for Action on Breastfeeding speaks to federal state, and local governments, families, and the medical community, especially hospitals, where staff can be re-educated, consultants hired, and peer counselors made available to promote breast-feeding. Recognizing that breast-feeding rates are influenced by various factors, the document suggests an approach in which all interested people and organizations come together to forge a partnership to promote and encourage breast-feeding in the United States.
Adapted from: FDA Consumer; 37(3); May-June 2003; pp.12-17.
Two of the Food and Drug Administration’s (FDA’s) regulatory centers
have a responsible role with regard to breast-feeding.
The FDA’s Center for Devices and Radiological Health (CDRH) is responsible
for ensuring that devices such as breast pumps are safe and effective for nursing
moms. Breast pumps are classified as either powered or non-powered devices.
All powered breast pumps are subject to pre-market review and clearance prior
to marketing in the United States. Non-powered breast pumps do not require any
pre-market review unless the manufacturer makes a fundamental change in the
technology of the device. Both types of breast pumps are, however, subject to
other regulatory controls, such as good manufacturing practices and record keeping.
To report an adverse experience by telephone, or to register a complaint about breast pumps, contact the FDA’s Office of Emergency Operations at 1-888-463-6332.
The FDA’s Center for Food Safety and Applied Nutrition (CFSAN) is responsible for the safety and nutritional adequacy of commercially prepared infant formulas.
In the rare circumstances when breast-feeding is not possible or recommended, or for various reasons a mother may choose not to breast-feed, commercially prepared infant formula can be used as an alternative form of feeding. Infant formulas are high in liquids or reconstituted powders fed to infants and young children. They have a special role to play, because often they are the only source of nutrients for infants during a very vulnerable period of rapid growth and development.
Current laws require that infant formula manufacturers must provide the FDA
assurance of the nutritional quality of each formulation before marketing. The
FDA has provisions that include requirements for certain labeling, nutrient
content and manufacturer’s quality control procedures (to assure the nutrient
content), as well as for company records and reports. For more information on
commercially prepared infant formulas, visit CFSAN’s Web site at: www.cfsan.fda.gov/~dms/inf-toc.html.
Adapted from: FDA Consumer; 37(3); May-June 2003; p.15.
MORE MOTHERS ARE STARTING TO BREAST-FEED, BUT MANY GIVE UP
Because of its health advantages for children, breast-feeding has been encouraged by US initiatives such as the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Are such initiatives succeeding?
These researchers synthesized 1993-1998 data that were gathered in 10 states to ensure that study subjects accurately represented women in each of those states (1). The data were gathered from 96,204 recent mothers who started breast-feeding after delivery and from 56,739 who continued to breast-feed at 10 weeks postpartum.
Overall, breast-feeding initiation increased from 57.0 percent in 1993 to 67.5
percent in 1998; the average annual gain of 8 percent varied by state. Increases
were most notable among women with any one of these characteristics: black race,
age younger than 20, less than high school education, breast-feeding discussions
during prenatal care, unmarried status, 3 or more children, Medicaid participation,
vaginal delivery, and infant in the neonatal intensive care unit. Smaller increases
occurred among mothers who were white, older, better educated, and more affluent
and who had cesarean deliveries. Unfortunately, the percentage of initiators
at 10 weeks postpartum did not increase (from 58.5 percent in 1993 to 57.9 percent
in 1998).
Efforts to increase breast-feeding initiation appear to be working, although
greater improvements are desirable. We also must figure out how to encourage
mothers to continue to nurse. Active promotion by clinicians and by community
and workplace support systems appears to offer the most promise.
Reference:
1. Ahluwalia, I. B., Morrow, B., Hsia, J., Grummer-Strawn, L. M.; Who is breast-feeding?
Recent trends form the pregnancy risk assessment and monitoring system; Journal
of Pediatrics; May 2003; 142; pp. 486-91.
Source: Robert A. Dershewitz, MD, MSc; Journal Watch; 23(14); July 15, 2003;
p.115.
There’s no question calcium can be good for you, as it promotes bone
growth. Just don’t start saying it can cure cancer, multiple sclerosis,
and heart disease, or you might end up in the same situation as Shop America,
a Chicago company that was challenged by the Federal Trade Commission (FTC)
in federal court. The agency’s complaint asks the court to freeze the
company’s assets and return money to consumers, many of whom bought its
Coral Calcium Supreme supplement after watching a widely televised infomercial
on cable channels such as Women’s Entertainment, Comedy Central, the Discovery
Channel, and Bravo. The FTC also sent out warning letters to several other retailers
of coral calcium, made from deadly marine coral, about the consequences of making
health claims that go “far beyond any scientific evidence” of the
health benefits of the mineral.
“The Commission has voiced strong concerns about deceptive claims for
dietary supplements,” said Howard Beales, director of the FTC’s
Bureau of Consumer Protection. “These cases demonstrate that the FTC will
take aggressive enforcement action, particularly when, as alleged in this case,
the products are marketed as cures for serious diseases like cancer and heart
disease. Marketers who step over the line will find themselves between a rock
and a hard place.”
Go to www.ftc.gov/os/2003/06/coralcalciumcmp.pdf
to download a copy of the complaint.
Source: Nutrition Week; June 16, 2003; 33(12); p. 7.
A new alliance of public and private sector partners, the Global Alliance for Improved Nutrition (GAIN), was launched last month to help developing countries implement locally developed food fortification programs to eliminate micronutrient deficiencies (http:/www.gainhealth.org/). Such deficiencies, especially in vitamin A, iron, folic acid, and iodine are associated with such problems as birth defects, impaired physical development, blindness, and increased susceptibility to infections
GAIN began with a $50 million grant from the Bill and Melinda Gates Foundation,
followed by contributions from the Canadian, United States, and Dutch governments.
China, Morocco, South Africa, and Vietnam will be the first countries to receive
fortification grants form the Alliance.
Source: Joan Stephenson, PhD; JAMA; July 9, 2003; 290(2); p.184.
BREAST-FEEDING RESOURCES
· US Food and Drug Administration
Center for Food Safety and Applied Nutrition (HFS-555)
5100 Paint Branch Parkway
College Park, MD 20740-3835
www.cfsan.fda.gov
· Office of Women’s Health
Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857
www.fda.gov/womens/
· Office on Women’s Health
Department of Health and Human Services
8550 Arlington Blvd., Suite 300
Fairfax, VA 22031
1-800-994-WOMAN (1-800-994-9662)
TDD: 1-800-220-5446
www.4women.gov
· La Leche League International
1400 N. Meacham Road
Schaumburg, IL 60173-4808
1-800-525-3243 (for information and local chapter numbers)
www.lalecheleague.org
Source: FDA Consumer; 37(3); May-June 2003; p.17.
Do you need to know the definition of a specific food-related term? If so,
go to http://ific.org/glossary/ and look it up. You’ll find comprehensive
definitions for almost 300 food-related terms at the click of your mouse.
Source: IFIC Foundation Food Insights; March/April 2003; p. 7.
THE FOOD GUIDE PYRAMID: BASIC MAINTENANCE FOR YOUR BODY
A unique approach to communicate how the US Department of Agriculture’s Food Guide Pyramid can be used by everyone! This brochure provides nutrition messages and tips that support the Food Guide Pyramid and Dietary Guidelines for Americans in order to help individuals achieve a healthful lifestyle. To create greater consumer understanding, Pyramid servings are compared with foods and portions that typical individuals may consume in “real life.” Features include: portion distortion, tips for “carrying out,” a sample Food Guide Pyramid-friendly menu, and ways to be realistic, adventurous, flexible, and active as a part of a healthy lifestyle. This brochure was focus group tested with general consumers and developed in partnership with the Food Marketing Institute and the US Department of Agriculture.
To order a single, free copy, send a self-addressed, stamped envelop to Food
Guide Pyramid, PO Box 65708, Washington, DC 20035 or access it on the web at
http://ific.org/pdf/FoodGuidePyramid.pdf.
Source: IFIC Foundation Food Insights; March/April 2003; p. 5
PREVENT CHILDHOOD CHOKING: IT’S UP TO YOU
A new poster, developed in partnership with the National SAFE KIDS Campaign, provides guidelines and tips to help caregivers, parents, and others take the steps necessary to prevent the incidence of airway obstruction or choking in young children. Suitable for display in the home, a health care provider’s office, or day-care center, the four-color poster is printed in English on one side and Spanish on the other.
To receive the poster, write to:
Choking Prevention Poster
International Food Information Council Foundation
1100 Connecticut Ave., NW, Suite 430
Washington, DC 20036
Requests for multiple copies must be accompanied by a check made out to the
International Food Information Council Foundation (single copies are free; additional
copies are $1.50 each).
Source: IFIC Foundation Food Insights; March/April 2003; p. 5.
WORLD HEALTH ORGANIZATION REPORT
On April 23, 2003, the Word Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO) released an independent report entitled Diet, Nutrition, and the Prevention of Chronic Diseases. The report identifies new recommendations for the governments on diet and physical activity that can be used to combat chronic conditions (i.e., cardiovascular diseases, diabetes, obesity, and various cancers) by decreasing the incidence of risk factors (i.e., hypertension, hypercholesterolemia, overweight, and sedentary lifestyles).
The report outlines approaches to altering nutritional intake while increasing energy expenditure.
These include:
· Performing moderate-intensity physical activity for at least an hour
per day;
· Increasing the dietary intake of fruits and vegetables; and
· Reducing the intake of sodium, as well as foods with elevated saturated
fat and/or sugar levels.
As next steps, WHO is preparing the Global Strategy on Diet, Physical Activity,
and Health, while the FAO is working to monitor diets, identify information
needs, and explore the impact of the recommendations on policy and practice.
The independent report on diet and chronic disease can be downloaded at: http://www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf.
Source: IFIC Foundation Food Insights; March/April 2003; p. 7.
SUBSCRIPTION FOR NUTRITION PERSPECTIVES NEWSLETTER
NOTE: The top line of the mailing label shows the expiration date for your
subscription.
Please renew before that date to avoid a break in service.
__Renew my subscription __Start a new subscription
Enclosed is a payment of $10.00 for a one-year subscription (6 issues). Checks should be payable to the Regents of the University of California.
PLEASE PRINT INFORMATION TO ENSURE ACCURACY
Name_______________________________________________________________________________________
Address_____________________________________________________________________________________
City____________________________State_____________Zip____________County_______________________
Professional Affiliation (optional)__________________________________________________________________
__The above is a change of address
Mail this form and payment to: NUTRITION PERSPECTIVES, Department of Nutrition,
University of California, Davis, California, 95616-8669.
The University of California, in compliance with the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, and the Rehabilitation Act of 1973, does not discriminate on the basis of race, creed, religion, color, national origin, sex, or mental or physical handicap in any of its programs or activities, or with respect to any of its employment policies, practices, or procedures. The University of California does not discriminate on the basis of age, ancestry, sexual orientation, marital status, citizenship, medical condition (as defined in section 12926 of the California Government Code), nor because individuals are disabled or Vietnam era veterans. Inquiries regarding this policy may be directed to the Director, Office of Affirmative Action, Division of Agriculture and Natural Resources, 300 Lakeside Drive, Oakland, CA 94612-3550, (510) 987-0097.
NUTRITION PERSPCTIVES
Department of Nutrition
University of California
Davis, CA 95616-5270