UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION
NUTRITION PERSPECTIVES
Volume 29, No. 2
March/April 2004
TABLE OF CONTENTS PAGE
Dr. Barbara O. Schneeman Named To Lead FDA's Center for Food
Safety and Applied Nutrition’s Office of Nutritional Products, Labeling,
and Dietary Supplements
FDA Warning On Unapproved Performance Enhancer
Veneman Announces Expanded BSE Surveillance Program
Echinacea Does Not Improve Cold Symptoms
Green Onions Associated With Hepatitis A Outbreaks
Peanut Test Kits Approved
Even Moderate Amounts of Exercise Can Prevent Weight Gain
Improving Health Outcomes for Children with Diabetes
Antimicrobial Spray Safe for Fighting E. Coli
US Teens More Overweight Than Youth In 14 Other Countries
HHS Launches New Strategies Against Overweight Epidemic
Poor Fitness In Young Adults Associated with Later Cardiovascular
Problems
The FDA Forms Obesity Working Group
Joint Effort to Improve the Health of Older Hispanic Americans
Physical Activity Should be Promoted at Every Well-Child Visit
AAP Soft Drinks In Schools Policy Statement
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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.
DR. BARBARA O. SCHNEEMAN NAMED TO LEAD FDA'S CENTER FOR FOOD SAFETY AND APPLIED NUTRITION’S OFFICE OF NUTRITIONAL PRODUCTS, LABELING, AND DIETARY SUPPLEMENTSThe Food and Drug Administration (FDA) Acting Commissioner, Dr. Lester M. Crawford, today announced that Dr. Barbara O. Schneeman has been named to lead the Center for Food Safety and Applied Nutrition’s (CFSAN) Office of Nutritional Products, Labeling, and Dietary Supplements (ONPLDS).
"Barbara comes to us with an extensive background in nutrition science that lines up perfectly with her new position, as leader of the Office of Nutritional Products, Labeling and Dietary Supplements," said Commissioner Crawford. "I look forward to her bringing to the Center the leadership and standard of excellence for which she is very well known."
Dr. Schneeman comes from the University of California, Davis, where she has served as a member of the faculty since 1976. For the last three years, she served as the Associate Vice Provost for University Outreach, in addition to holding a professorial appointment in the Departments of Nutrition, Food Science and Technology and Internal Medicine in the School of Medicine. Prior to that, Dr. Schneeman completed an 18-month term as the Assistant Administrator for Nutrition in the Agricultural Research Service in the United States Department of Agriculture (1999-2000). She held many prestigious positions during her tenure at the University of California, Davis, including: Dean of the College of Agricultural and Environmental Sciences, and Director of Programs, Division of Agriculture and Natural Resources (1993-1999); Chairman, Department of Nutrition, (1988-1993); and Associate Dean, College of Agricultural and Environmental Sciences (1985-1988).
Dr. Schneeman received her B.S. degree from the University of California, Davis, in food science and technology, and her PhD in nutrition from the University of California, Berkeley. She has many professional activities and honors to her credit, which include membership on the 1990 and 1995 Dietary Guidelines for Americans Committee, Fellow of the American Association for the Advancement of Science and the FDA Commissioner’s Special Citation.
As the new ONPLDS director, Dr. Schneeman will oversee the development of policy and regulations for dietary supplements, nutrition labeling and food standards, infant formula and medical foods.
Dr. Schneeman replaces Dr. Christine Taylor, who accepted an assignment to head a special project on nutrition issues for the World Health Organization in November 2003. Dr. Schneeman will join the FDA on May 3, 2004.
Source: FDA Press Release; April 12, 2004.
FDA WARNING ON UNAPPROVED PERFORMANCE ENHANCER
Tetrahydrogestrinone (THG), a substance taken by athletes to improve their performance, is considered to be an unapproved drug by the FDA, and cannot be legally marketed.
The FDA is warning consumers that little is known about the safety of this substance, its structure, and relationship to better-known products. The agency says that its use may pose considerable risks to health. The FDA is concerned about the marketing and use of this unapproved product and is working with other federal law enforcement agencies to aggressively “engage, enforce, and prosecute” those firms or people who manufacture, distribute, or market THG.
While in some cases THG is being represented as a dietary supplement, the FDA says that in fact the substance does not meet the definition of a dietary supplement. Rather it is a purely synthetic “designer” steroid derived by simple chemical modifications from another anabolic steroid that is explicitly banned by the United States Anti-Doping Agency, an independent body that monitors and enforces drug use restrictions in athletic competitions. THG is closely and structurally related to two other synthetic anabolic steroids, gestrinone and trenbolone. Anabolic steroids, which build muscle mass, can have serious long-term health consequences in men, women, and children.
THG cannot be legally marketed without FDA approval under the agency’s rigorous approval standards, meant to ensure that drugs sold to American consumers are safe and effective.
Source: FDA Consumer; 38(1); January–February 2004; p. 4.
VENEMAN ANNOUNCES EXPANDED BSE SURVEILLANCE PROGRAM
Agriculture Secretary Ann M. Veneman recently announced details for an expanded surveillance effort for Bovine Spongiform Encephalopathy (BSE) in the United States.
“We are committed to ensuring that a robust US surveillance program continues in this country,” said Veneman. “This one-time extensive surveillance plan reflects the recommendation of the international scientific review panel.”
On December 30, Veneman announced that an international scientific review panel would review the US Department of Agriculture’s investigation into the BSE finding in Washington State and provide recommendations for future actions. In January, this panel, operating as a subcommittee of the Secretary’s Advisory Committee on Foreign Animal and Poultry Diseases, recommended a one-year enhanced surveillance program targeting cattle from the populations considered at highest risk for the disease, as well as a random sampling of animals from the aged cattle population.
The panel also complimented the USDA on its investigative efforts as well as commented that the removal of specified risk materials from the food supply was the single most important action USDA took to protect public health. The USDA’s BSE surveillance program historically has been focused on the cattle populations where it is most likely to be found, including those condemned at slaughter because of signs of central nervous system disorders, non-ambulatory cattle and those that die on farms. In FY 2004, the USDA sampled 20,543 animals, a sample size designed to detect the disease if it occurred in one animal per million adult cattle with a 95 percent confidence level, which is 47 times the international standard for low-risk countries.
Veneman said that $70 million will be transferred from the USDA Commodity Credit Corporation to fund the enhanced program with the goal to test as many cattle as possible in the high-risk population as well as to test a sampling of the normal, aged cattle population over a 12 to 18 month time frame.
The enhanced surveillance plan incorporates recommendations from the international scientific review panel and the Harvard Center for Risk Analysis; both have reviewed and support the plan. In addition, the USDA is appreciative of the advice, assistance, and analyses provided by the House and Senate Agriculture Committees, House and Senate Appropriations Committees, and the House Government Reform Committees in developing this robust, aggressive surveillance plan.
The primary focus of the USDA’s enhanced surveillance effort will continue to be the highest risk populations for the disease, but the USDA will greatly increase the number of target animals surveyed and will include a random sampling of apparently normal, aged animals. The USDA will build on previous cooperative efforts with renderers and others to obtain samples from the targeted high-risk populations, which are banned from the human food supply.
Under the enhanced program, using statistically geographic modeling, sampling some 268,000 animals would allow for the detection of BSE at a rate of 1 positive in 10 million adult cattle with a 99 percent confidence level. In other words, the enhanced program could detect BSE even if there were only five positive animals in the entire country. Sampling some 201,000 animals would allow for the detection of BSE at the same rate as a 95 percent confidence level.
The sampling of apparently normal animals will come from the 40 US slaughter plants that handle 86 percent of the aged cattle processed for human consumption each year in the United States. The carcasses from these animals will be held and not allowed to enter the human food chain until test results show the samples are negative for BSE.
The USDA will begin immediately to prepare for the increased testing, with the anticipation that the program will be ready to be fully implemented June 1, 2004. In the meantime, BSE testing will continue at the current rate, which is based on a plan to test 40,000 animals in FY 2004. Testing will be conducted through the USDA’s National Veterinary Services Laboratory in Ames, Iowa, and a network of laboratories around the country.
The USDA is also working to approve rapid tests for use in the testing program. The USDA will help defray costs incurred by industries participating in the surveillance program for such items as transportation, disposal and storage, and carcasses being tested.
Source: USDA News Release; http://www.usda.gov/Newsroom/0105.04.html; March 15, 2004.
ECHINACEA DOES NOT IMPROVE COLD SYMPTOMS
Echinacea purpurea did not reduce the duration or the severity of upper respiratory tract infection (URI) symptoms in patients 2 to 11 years old, and its use was associated with increased risk of rash, according to a randomized, double-blind, placebo-controlled trial of 407 patients.
Nearly 40% of visits to pediatricians by children ages 1 to 5 years during the winter are due to URI symptoms. Children are frequently given decongestants, antihistamines and cough suppressants, but there is little evidence that these medications are effective in children younger than 12 years.
Echinacea has been used extensively to prevent and treat URI’s, but data are limited on the safety and efficacy in pediatric patients.
In this study, researchers compared echinacea with a placebo in the treatment of URI’s in children. Participants were enrolled for a four-month period. If they developed a URI, parents were asked to give their child the study medication, which was either echinacea or placebo, until symptoms resolved. Parents also filled out a logbook, documenting severity and duration of sneezing, coughing, nasal congestion and runny nose as well as the presence of fever and their assessment of cold severity.
Results showed that there were no significant differences between the two groups in duration of symptoms (median duration was nine days) severity of symptoms, number of days of fever (less than one day) or parent’s assessment of cold severity. In addition, use of childcare was not associated with any change in duration or severity of URI symptoms.
Researchers did find that rash occurred more often in the echinacea group (7.1% vs. 2.7%).
The results, they concluded, do not support the use of echinacea for treatment of URI’s in children 2 to 11 years old.
Source: AAP News; 24(3); March 2004; p. 108.
GREEN ONIONS ASSOCIATED WITH HEPATITIS A OUTBREAKS
The FDA says that raw or lightly cooked green onions (scallions) are associated
with an outbreak of hepatitis A, a liver disease, in Pennsylvania and three
other states. In an attempt to determine the source of the green onions and
how they became contaminated, the FDA has been working closely with the CDC
and these states so that the problem can be corrected.
Hepatitis A develops within six weeks of an exposure. It is usually mild and
characterized by jaundice (yellow skin), fatigue, abdominal pain, loss of appetite,
nausea, diarrhea, and fever. Hepatitis A can occasionally be severe, especially
in people with liver disease.
The first outbreak of hepatitis A associated with the onions occurred in September 2003 in Tennessee, North Carolina, and Georgia restaurants. Another outbreak of hepatitis A among patrons of a single restaurant in Pennsylvania occurred during late October and early November.
The FDA is advising consumers to:
• Cook green onions thoroughly. Cook in a casserole or sauté in
a skillet.
• Check food purchased at restaurants and delicatessens and ask whether
menu items contain raw or lightly cooked green onions. Request that raw or lightly
cooked green onions not be added to foods.
The FDA has alerted inspectors at the Mexican border to detain any raw green onions from a small number of implicated firms. Mexican officials have been vary responsive during the outbreak investigation and are investigating practices at these firms to determine what might have caused the contamination.
Regulations being developed under the Bioterrorism Act of 2002 give the agency new authority to help improve its ability to contain and prevent outbreaks of foodborne illness. These new regulations and increased presence at the border will help enhance the agency’s food safety and security measures.
Source: FDA Consumer; 38(1); January–February 2004; p. 5.
Several test kits to detect peanut proteins in breakfast cereal, cookies, ice cream, and milk chocolate have been designated as “performance tested methods” by the Association of Official Analytical Chemists International (AOAC), working in collaboration with the FDA. The AOAC validates and approves analytical methods used in foods and agriculture. The FDA relies on methods validated by the AOAC in its enforcement programs.
The approved test kits provide quick and reliable methods for the food industry
to more readily detect the presence of peanuts in food not labeled as containing
peanuts, and can more effectively prevent these products from reaching consumers.
Peanuts can cause severe and, in some cases, fatal allergic reactions in some
people.
The approved kits are: Biokits Peanut Assay, developed by Tepnel BioSystems Ltd. of Flintshire, UK; RIDASCREEN FAST Peanut, developed by R-Biopharm AG of Darmstadt, Germany; and Veratox for Peanut Allergen, developed by Neogen Corp. Lansing, Michigan.
The likely users of these kits are organizations that have laboratory facilities, such as research and industrial food operations and regulatory agencies. For example, use of these tests can assist organizations in rapidly determining whether their food processing operations are adequate to prevent the inclusion of peanut products in foods that do not declare peanuts as an ingredient. The tests also can determine whether food processing plant cleanup operations are sufficient to avoid cross-contamination.
Source: FDA Consumer; 38(1); January–February 2004; p. 6.
EVEN MODERATE AMOUNTS OF EXERCISE CAN PREVENT WEIGHT GAIN
Moderate amounts of exercise, such as walking 12 miles per week, may help prevent weight gain and can promote weight loss in non-dieting individuals, researchers say.
Results from the National Health and Nutrition Examination Survey 1999 indicate that an estimated 61 percent of US adults are either overweight or obese, defined as having a body mass index (BMI) of 25 or more, according to the Centers for Disease Control and Prevention.
Obesity is associated with a higher risk for several health problems, including heart disease and diabetes. It is widely believed that diet combined with physical activity plays an important role in weight management, but the amount of activity needed to prevent weight gain is unknown, according to Cris A. Slentz, PhD, of the Duke University Medical Center, Durham, NC, and colleagues.
The researcher investigated the effects of different amounts and intensities of exercise on weight (1). The results are published in the Jan.12, 2004, issues of Archives of Internal Medicine.
The randomized, controlled trial included 182 sedentary overweight men and women, ages 40-65 years, who were assigned to one of several groups: high amount/vigorous intensity exercise (equivalent to jogging about 20 miles per week at 65 to 80 percent peak oxygen consumption); low amount/ vigorous intensity exercise (equivalent to 12 miles of jogging per week at 65 to 80 percent peak oxygen consumption); or low amount/moderate intensity exercise (equivalent to 12 miles of walking per week at 40 to 55 percent peak oxygen consumption). A fourth group in the study, the control group did not exercise.
The study lasted eight months and the participants were asked not to change their diets during this time. Body weight and waist and hip circumference were measured. The researchers found that there was a clear relationship between the amount of physical activity and amount of weight loss, with the most weight loss seen in the high amount/vigorous intensity group, and the least in the low amount/moderate intensity group.
The control group gained weight over the study period. Compared with the control group, all exercise groups significantly decreased their weight and hip circumference measurements.
“These finding strongly suggest that, absent changes in diet, a higher amount of activity is necessary for weight maintenance and that the positive caloric imbalance observed in the overweight control was small and can be reversed by a modest amount of exercise. Most individuals can accomplish this by walking 30 minutes every day,” the authors wrote.
Source: FDA Consumer; 38(2); March–April 2004; p. 5.
IMPROVING HEALTH OUTCOMES FOR CHILDREN WITH DIABETES
Adolescents with diabetes achieve poorer glycemic control than adults do. To address the challenge of optimizing glycemic control in adolescents, investigators in Boston randomized 299 children (age range 7-16 years) with Type I diabetes to receive 1 of 3 interventions: standard care, care coordinated by a case manager (CM), or CM care plus educational modules (CM+). The primary task of the CM was to ensure clinic attendance. In the CM+ group, the CM also encouraged family discussion about 8 diabetes-related topics at the end of each visit and provided families with written materials to take home.
During the 2-year follow-up, the two CM groups had significantly more ambulatory visits than did the standard care group (mean 7.3 and 7.5 for CM and CM+, respectively, vs. 5.4 for controls). Children in the CM+ group had significantly fewer severe hypoglycemic events (45.4 events per 100 person-year vs. 56.1 and 64.8 in the CM and control groups, respectively) and fewer hospitalizations (8.9 per 100 person-year vs. 18.2 and 12.7, respectively) than did those in the other 2 groups. In an analysis restricted to children with HbA1c levels > 8.7 percent at study entry, those in the CM+ group had significantly lower levels at the conclusion of the study than did children in the other 2 groups combined (mean HbA1c level 9.34 percent vs. 9.93 percent).
Interventions that include a case manager plus educational materials for families might improve long-term health outcomes of children with diabetes. Such interventions also might improve the health status of children with other complex chronic diseases.
Reference:
1. Svoren BM, Butler D, Levine BS, Anderson BJ, Laffel LM. Reducing acute adverse
outcomes in youths with Type I diabetes: A randomized controlled trial. Pediatrics
112; October 2003; p. 914-922.
Source: Howard Bauchner, MD, Journal Watch; 23(22); November 15, 2003; p.178.
ANTIMICROBIAL SPRAY SAFE FOR FIGHTING E. COLI
The US Food and Drug Administration (FDA) has allowed a Utah company to market an antimicrobial spray that, when applied to uncooked beef carcasses, helps fight Escherichia coli (E. coli) O157:H7, an organism that can cause severe gastrointestinal disease or death in humans.
The company, aLF Ventures of Salt lake City, submitted a notice to the FDA providing scientific data supporting the firm’s conclusion that lactoferrin, an antimicrobial protein found in cow’s milk and beef, is not required to be approved by the FDA because use of the substance in foods is considered “generally recognized as safe” (GRAS). This means its safety has been established by available scientific data that has led qualified experts to conclude that the use of the ingredient is safe for its intended purpose.
In addition, the information submitted to the FDA stated that the amount of added lactoferrin that remains on the beef after spraying is comparable to the amount that naturally occurs in the beef. The company also submitted data to the US Department of Agriculture (USDA). The USDA is responsible for addressing labeling issues with lactoferrin-treated beef.
Source: FDA Consumer; 37(6); November-December 2003; p. 7.
US TEENS MORE OVERWEIGHT THAN YOUTH IN 14 OTHER COUNTRIES
United States teens are more likely to be overweight than are teens from 14 other industrialized nations, according to survey information collected in 1997 and 1998 by two agencies of the Department of Health and Human Services (HHS) as well as institutions in 13 European countries and in Israel (1).
The HHS authors of the study were Mary Overpeck, DrPH, of the Health Resources and Services Administration and Mary Hediger, PhD, of the National Institute of Child Health and Human Development (NICHD), one of the National Institutes of Health (NIH).
“Overweight adolescents have an increased likelihood of being overweight
during adulthood, and adult overweight increases the risk for such health problems
as heart disease and diabetes,” said Duane Alexander, MD, director of
the NICHD.
The researchers relied on a measure known as body mass index (BMI) to gauge
obesity. In the study, the researchers calculated BMI by dividing the children's
weight in kilograms by the square of his or her height in meters. For children
and adolescents, a BMI at or above the 95th percentile for their age is considered
to be overweight. A BMI from the 85th to the 94th percentile for their age is
considered to be at risk for being overweight.
In the study, headed by Inge Lissau, PhD from Denmark, the researchers tabulated the BMIs of 29,242 children 13 and 15 years of age. The children were from Austria, the Czech Republic, Denmark, Flemish Belgium, Finland, France, Germany, Greece, Lithuania, Ireland, Israel, Portugal, Slovakia, Sweden, and the United States. The children's BMIs were based on self-reported heights and weights collected from surveys the children answered in school.
Children from the United States were the most likely to be overweight. Among 13-year-old boys in the US, 12.6 percent were overweight. Among 13-year-old girls, 10.8 percent were overweight. For US 15 year olds, 13.9 percent of boys were overweight, and 15.1 percent of girls were overweight.
Among the other countries taking part in the study, Greece had the next highest proportion of overweight 13-year-old boys, at 8.9 percent, followed by Ireland, at 7 percent. Portugal had the next highest proportion of overweight 13- year-old girls, at 8.3 percent, followed by Ireland, at 6.6 percent. After the US, Greece had the next highest proportion of overweight 15-year-old boys, at 10.8 percent, followed by Israel, at 6.8 percent. For 15-year-old girls, Portugal had the next highest proportion of overweight, at 6.7 percent, followed by Denmark, at 6.5 percent. Of all the countries that took part in the study, Lithuania had the lowest proportion of overweight, at 1.8 percent in 13-year-old boys, 2.6 percent in 13-year-old girls, .08 percent in 15-year-old boys, and 2.1 percent in 15-year-old girls.
“Since most obese adolescents remain obese as adults, this age group is a very important group to reach through preventive programs addressing issues of diet and sedentary lifestyles,” the study authors wrote.
The NICHD is part of the NIH, the biomedical research arm of the federal government. The NIH is an agency of the US Department of Health and Human Services. The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation.
Reference:
1. Lissau I; Overpeck MD, Ruan WJ, Due P, Holstein BE, and Hediger ML. Body
Mass Index and Overweight in Adolescents in 13 European Countries, Israel, and
the United States. Arch Pediatr Adolesc Med; 2004; 158:27-33.
Adapted from: NIH Press Release; January 5, 2004.
HHS LAUNCHES NEW STRATEGIES AGAINST OVERWEIGHT EPIDEMIC
With poor diet and physical inactivity poised to become the leading preventable cause of death in America, the Department of Health and Human Services (HHS) Secretary Tommy G. Thompson recently renewed efforts against obesity and overweight, announcing a new national education campaign and a new research strategy at HHS' National Institutes of Health (NIH).
A new study released by HHS' Centers for Disease Control and Prevention shows that deaths due to poor diet and physical inactivity rose by 33 percent over the past decade and may soon overtake tobacco as the leading preventable cause of death (1).
"Americans need to understand that overweight and obesity are literally killing us," Secretary Thompson said. "To know that poor eating habits and inactivity are on the verge of surpassing tobacco use as the leading cause of preventable death in America should motivate all Americans to take action to protect their health. We need to tackle America's weight issues as aggressively as we are addressing smoking and tobacco."
Secretary Thompson said the new HHS and Ad Council advertising campaign educates Americans that they can take small, achievable steps to improve their health and reverse the obesity epidemic. Consumers don't need to go to extremes, such as joining a gym or taking part in the latest diet plan, to make improvements in their health. But they do need to get active and eat healthier, he said.
"America needs to get healthier one small step at a time," Secretary Thompson said. "Each small step does make a difference, whether it's taking the stairs instead of an elevator or snacking on fruits and vegetables. The more small steps we can take, the further down the road we will be toward better health for ourselves and our families."
The HHS' release of its new education campaign with the Ad Council and the NIH research agenda coincided with publication of the CDC recent study in the Journal of the American Medical Association (2). The study, "Actual Causes of Death in the United States, 2000," finds that 400,000 deaths in the US in 2000 (17 percent of all deaths) were related to poor diet and physical inactivity. Only tobacco use caused more deaths (435,000). And while most of the major preventable causes of death showed declines or little change since 1990, deaths due to poor diet and physical inactivity increased 33 percent. "Poor diet and physical inactivity may soon overtake tobacco as the leading cause of death," the study concludes. The article is available at http://jama.ama-assn.org.
Secretary Thompson called on individuals to maintain a healthy weight and help to stem the rise in preventable death attributed to obesity and inactivity. He also called on corporations, communities, and others to join in a national cooperative effort to increase awareness of the problem and help individuals access healthy foods and opportunities for healthy physical activity.
"The fact that more than a third of deaths in America each year are related to smoking, poor eating habits, and physical inactivity is both tragic and unacceptable, because these are largely preventable behaviors," said CDC Director Julie Gerberding, MD. "Investments in programs to increase physical activity, improve diet, and increase smoking cessation are more important than ever before and must continue to be high priorities."
An estimated 129.6 million Americans, or 64 percent, are overweight or obese. Obesity and overweight have been shown to increase the risk for developing type 2 diabetes, heart disease, some forms of cancer, and other disabling medical conditions. The total direct and indirect costs, including medical costs and lost productivity, were estimated at $117 billion nationally for 2000, according to the 2001 Surgeon General's Call to Action on Prevent and Decrease Overweight and Obesity.
Secretary Thompson unveiled an innovative public awareness and education campaign, entitled Healthy Lifestyles & Disease Prevention that encourages American families to take small, manageable steps within their current lifestyle, versus drastic changes, to ensure effective, long-term weight control.
The Healthy Lifestyles & Disease Prevention initiative, which includes
multi-media public service advertisements (PSAs) and a new interactive Web site,
file://www.smallstep.gov, encourages Americans to make small activity and dietary
changes, such as using stairs instead of an elevator, or taking a walk instead
of watching television.
The PSAs were developed for the HHS in cooperation with the Ad Council. Designed
for all media. They provide tongue-in-cheek examples of the power of small steps
for long-term, sustained weight control and good health. The PSAs, created pro
bono by New York agency McCann Erickson through the Ad Council, show typical
Americans finding "love handles," double chins, and other unwanted
body parts in public places, apparently "lost" as their neighbors
used the stairs instead of the escalator, got active at the beach or walked
to the office. The PSAs, available at http://www.adcouncil.org/campaigns/healthy_lifestyles,
will run and air in advertising time and space that is donated by the media.
"Our research has shown that many Americans believe that they need to make drastic changes in their lifestyles to get healthy," according to Peggy Conlon, president and CEO of the Ad Council. "This innovative, clever advertising shows how small steps can go a long way."
The companion Web site, by communications firm Carton Donofrio Partners Inc., will provide information for Americans to incorporate the small steps into their routines.
"We know that gloom and doom messages warning against weight gain don't work," Secretary Thompson said. "These messages are provocative and attention-getting, but they are also empowering and achievable."
Secretary Thompson also announced that the NIH is developing a Strategic Plan for NIH Obesity Research. The strategy will intensify research to better understand, prevent and treat obesity through:
• Behavioral and environmental approaches to modifying lifestyle;
• Pharmacologic, surgical and other medical approaches; and
• Breaking the link between obesity and diseases such as type 2 diabetes,
heart disease, and some forms of cancer.
The draft strategic plan, available at http://obesityresearch.nih.gov, was open for public comment until April 2. It was developed by a task force established by NIH Director Elias A. Zerhouni, MD, in the spring of 2003.
"The NIH Task Force on Obesity Research has developed a dynamic strategy that coordinates the stimulus for funding obesity research across 25 institutes, centers and offices at NIH," Dr. Zerhouni said. "There is no single cause of all human obesity, so we must explore prevention and treatment approaches that encompass many aspects, such as behavioral, sociocultural, socioeconomic, environmental, physiologic, and genetic factors. The NIH can greatly expand scientific knowledge of this complex and multi-faceted disorder."
Current year NIH funding for obesity research is $400.1 million, up from $378.6 million in fiscal year 2003. The budget request for fiscal year 2005 is $440.3 million, a 10 percent increase from the current year.
The HHS has long spearheaded initiatives to motivate Americans of all ages to become more active and learn more about healthy living. The Healthy Lifestyles & Disease Prevention campaign will now coalesce health organizations, media, athletic organizations and others to join in promoting healthier lifestyles. Already partnering with the HHS in the public education campaign are such varied organizations as Lifetime Television, Sesame Workshop and the United Fresh Fruit & Vegetable Association. Additional partners will be added as the campaign continues.
All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news
References:
1. [Online source]: http://www.cdc.gov/nccdphp/factsheets/death_causes2000.htm
2. Mokdad AH, Marks JS, Stroup DF, and Gerberding JL. Actual Causes of Death
in the United States, 2000. JAMA; 2004; 291:1238-1245.
Source: HHS Press Release. March 9, 2004.
POOR FITNESS IN YOUNG ADULTS ASSOCIATED WITH LATER CARDIOVASCULAR PROBLEMS
A new study indicates that poor fitness in young adults is associated with the development of cardiovascular disease risk factors later in life.
Mercedes R. Carnethon, PhD, of Northwestern University’s Feinberg School
of Medicine in Chicago, and colleagues investigated whether low fitness, estimated
by short duration on an exercise treadmill test, was associated with the development
of risk factors for cardiovascular diseases (CVDs) and whether improving fitness
was associated with risk reduction.
Cardiovascular diseases account for a large proportion of deaths in people over
the age of 45. “Numerous risk factors for CVD, including hypertension,
diabetes, and hypercholesterolemia [high cholesterol], are suspected to be influenced
by fitness, and these factors may mediate the association between low fitness
and mortality [death],” the authors said in the study, published in the
December 17, 2003, issue of the Journal of the American Medical Association.
The participants, men and women 18 to 30 years of age, were enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. The CARDIA study recruited 5,115 participants from four geographic areas (Birmingham, Ala, Chicago, Minneapolis, and Oakland, Calif.). Participants who completed the treadmill examination at baseline were followed up from 1985-1986 to 2000-2001. A subset of participants (2,478) repeated the exercise test in 1992-1993.
“After adjustment for age, race, sex, smoking, and family history of diabetes, hypertension or premature myocardial infarction [heart attack], participants with low fitness (less than 20th percentile) were 3- to 6- fold more likely to develop diabetes, hypertension, and the metabolic syndrome than participants with high fitness (at or above 60th percentile),” the authors write. “Improved fitness over seven years was associated with a reduced risk of developing diabetes and the metabolic syndrome, but the strength and significance was reduced after accounting for changes in weight.”
People are said to have “metabolic syndrome” when they have several disorders of the body’s metabolism at the same time, such as obesity, high blood pressure, and high cholesterol, according to the American Diabetes Association. The conditions that make up metabolic syndrome, also called “insulin resistance syndrome” or “syndrome X,” can lead to hardening of the arteries and an increased risk for cardiovascular and kidney disease.
“Our findings demonstrate the importance of low cardiorespiratory fitness in young adulthood as a risk factor for developing cardiovascular comorbidities [related illnesses] in middle age,” the authors say in the study. “Previous work has demonstrated that engaging in a regular exercise program can improve fitness.”
Given the current obesity epidemic and observations of decline in daily energy expenditure in the population. The study’s authors conclude that improving cardio-respiratory fitness in young men and women and developing pubic health policies that encourage physical activity should be important health policy goals,.
Adapted from: FDA Consumer; 38(1); January–February 2004; p. 7.
THE FDA FORMS OBESITY WORKING GROUP
Obesity rates have skyrocketed over the last 20 years and the situation keeps getting worse. More than 60 percent of adults in the United States are overweight or obese, according to the Centers for Disease Control and Prevention (CDC). About 15 percent of children and adolescents are overweight and the list of related health problems is long. People who are overweight or obese are at increased risk for high blood pressure, high cholesterol, diabetes, heart disease, certain cancers such as breast and colon, depression, and other illnesses.
The FDA Commissioner Mark B McClellan, MD, PhD, says the current policies and advice to the public on obesity haven’t been effective enough. He is calling on researchers, the food industry, consumer groups, and the medical community to work with the FDA to tackle this epidemic.
“Helping more Americans achieve a healthy weight is a major priority,” McClellan said at an FDA public meeting held on October 23, 2003, at the National Institutes of Health in Bethessda, Md. “We want people to have good, clear information about the nutritional value of foods, and we want to protect them from false and misleading claims.” McClellan noted that too many people are looking to dietary supplements as a quick fix for being overweight or obese. “Dietary supplements may help you lose weight, but they also pose health risks,” he said.
The public meeting was sponsored by the FDA’s Obesity Working Group, which McClellan formed in August 2003 to develop strategies to help consumers lead healthier lives through better nutrition. The group is led by the FDA’s Deputy Commissioner Lester Crawford, DVM, PhD.
The public meeting, which included FDA presentations and a public participation session, encouraged discussion on six main questions:
• What is the available evidence on the effectiveness of education campaigns
to reduce obesity?
• What are the top priorities for nutrition research to reduce obesity
in children?
• What is the available evidence that the FDA can use to guide effective
efforts to prevent and treat obesity by behavioral and medical interventions?
• What changes to food labeling could result in the food industry developing
healthier foods and in consumers selecting healthier foods?
• What research opportunities exist that might best support the development
of healthier foods?
• What are the most important things that the FDA could do to make a significant
difference in addressing overweight and obesity, based on the scientific evidence
available?
The FDA’s Obesity Working Group completed a report on February 11, 2004
that includes an action plan. The action plan set out specific means for developing
and implementing new and innovative ways to help consumers make healthier choices.
The working group was charged with developing a message and outlining an obesity
education program to deliver the message.
The working group may craft approaches that propose improvements to the food
label, increase collaboration with the restaurant industry to better inform
consumers, facilitate development of more medical products to treat obesity,
and identify research needs for producing healthier foods, as well as research
to get a better understanding of consumer behavior and motivation.
Several organizations presented comments to the FDA at a meeting, including the American Obesity Association, who would like to see more focus on the treatment of obesity and stressed the importance of enforcement for fraudulent weight-loss products.
The Center for Science in the Public Interest suggested the use of a “healthy food symbol” that could make it easier for consumers to spot nutritious foods. The National Food Processors Association suggested the need for all stakeholders to refocus Americans’ understanding of the role of diet and exercise to achieve and maintain healthy weight.
Other participants included the International Food Information Council, the
Girl Scouts of American, the Physicians Committee for Responsible Medicine,
Shape Up America, and the Center for Consumer Freedom.
Source: Michelle Meadows; FDA Consumer; 38(1); January–February
2004; p. 29.
JOINT EFFORT TO IMPROVE THE HEALTH OF OLDER HISPANIC AMERICANS
Reducing heath disparities among older Hispanic Americans is the focus of a new collaboration between the Food and Drug Administration and the Administration of Aging (AoA), two agencies within the US Department of Health and Human Services (HHS).
“This new effort represents another step toward our goal of closing the health gap affecting racial and ethnic minorities,” says HHS Secretary Tommy G. Thompson. By focusing the efforts and resources of these two important agencies, we will strengthen our efforts to reach older Hispanic Americans with health messages that can help them stay healthier and live longer.”
As part of the effort, the FDA and the AoA will identify issues that affect the health of older Hispanic Americans and will develop culturally sensitive messages for them. The agencies will also cultivate and expand partnerships with national Hispanic organizations, electronic and print media, and other private organizations to support education and outreach to Hispanic communities.
“We are committed to helping protect and advance the health of all Americans,” says FDA Commissioner Mark B. McClellan, MD. PhD. “Older Hispanic Americans and their families need to have the best health information available and in a language and format they can best understand and use.”
The agencies will work with community partners to develop educational materials and caregiver tool kits on the safe use of medicines, nutrition and healthy eating, drug interactions, reporting side effects, antibiotic overuse, dietary supplements, and health fraud.
To kick off this effort, the agencies hosted a panel on reducing heath disparities at a National Hispanic Leadership Roundtable in Washington D.C., in October 2003. The roundtable was the first of several forums planned by the FDA and the AoA. The two agencies will continue to meet with Hispanic leaders to discuss areas of concern affecting senior Hispanics in America and to share perspectives on approaches for reaching this audience.
“Working together with Hispanic leaders, we hope that we’ll be
able to increase the quality and years of healthy life and eliminate health
disparities faced by older Hispanics,” says Assistant Secretary for Aging
Josefina G. Carbonell.
The older Hispanic population is at high risk for chronic diseases such as heart
disease, cancer, HIV infection, stroke, pneumonia, diabetes, and influenza.
“Many of these conditions are preventable,” Carbonell said at the
roundtable. “For example we know that immunizations effectively prevent
influenza.” In 2003, almost one-third of Hispanic seniors did not receive
a flu shot. “We need to work on these issues,” said Carbonell.
The Hispanic population over the age of 65 was 2 million in 2002 and is projected to grow to more than 13 million by 2050. Hispanics made up 5.5 percent of the entire older US population in 2002; by 2050, Hispanics are expected to account for 16 percent of the older US population.
Part of the FDA’s mission is to help the public get the accurate, science-based information it needs to use medicines and foods to improve health.
The AoA’s mission is to promote the dignity and independence of older people, and to help society prepare for an aging population.
For more information go to the Food and Drug Administration website, www.fda.gov or go to the website for the Administration on Aging, www.aoa.go.
Source: FDA Consumer; 38(1); January–February 2004; p. 9.
PHYSICAL ACTIVITY SHOULD BE PROMOTED AT EVERY WELL-CHILD VISIT
Physical inactivity is recognized as a major risk factor in the development of heart disease and increases the risk of strokes and other major cardiovascular disease. Even though heart attacks and strokes are rare in children and adolescents, evidence shows the process leading to these conditions begins in early childhood.
Being physically fit is important throughout life. Maintaining a good level of physical fitness allows an individual to develop and maintain functional capability to meet the demands of living and promote optimal health. Today, children’s physical fitness levels are determined by physical activity patterns.
While no one questions the need for improving the healthy behaviors of our youth, it is clear that reliance on school and community-based programs is insufficient to address this complex and growing problem on inactivity. Pediatricians are one of the few groups in the medical care system that youngsters routinely see for preventive and health maintenance examinations. Therefore, promoting appropriate physical activity that can be maintained throughout life should be a priority at every well-child visit.
Pediatricians can help promote physical activity among their patients by:
• discussing the importance of physical activity as part of daily life;
• assessing and recording the level of physical activity at all well-child
visits;
• emphasizing that physical activity should be fun, developmentally appropriate
and maintained throughout life;
• collaborating with each patient to create an activity plan or “activity
prescription.” An activity prescription could be modeled after the “FITT
Method” (frequency, intensity, time and type);
• encouraging parents to be role models for active lifestyles and to promote
opportunities for increased physical activity for their children at all stages
of development;
• working with schools, and communities to provide a range of extracurricular
programs that enable safe participation; and
• counseling all children, even those with special needs, to be physically
active.
US children are significantly less active than they were a generation ago. Nearly
half of American youths ages 12 to 21 years are not vigorously active on a regular
basis. About 14% of young people report no recent physical activity. Participation
in all forms of physical activity declines strikingly as age or grade in school
increases. Inactivity is greatest among female, minority, and special needs
youths at all ages. Unfortunately, inactive children are more likely to become
inactive adults.
The American Heart Association recommends that:
• All children ages 2 and older should participate in at least 30 minutes
of enjoyable, moderate intensity activities (i.e. walking or bicycling) every
day.
• All children should perform at least 30 minutes of vigorous physical
activities (sweating and hard breathing) at least three to four days each week.
• If children are unable to have a full 30-minute activity period, frequent
10 - or 15 - minute periods should be provided for engaging in vigorous activities.
• Physical activities should be appropriate for age, gender, and stage
of physical and emotional development.
Health care professionals can visit the Centers for Disease Control and Prevention’s (CDC’s) Web site at www.cdc.gov/nccdphp /dash/physicalactivity/brochures/index.htm to download brochures about physical activity for their patients. They also can order the American Academy of Pediatrics (AAP) brochures titled, Encouraging Your Child to be Physically Active and Better Health and Fitness through Physical Activity by visiting the AAP Bookstore at www.aap.org/bookstore or calling (866) THE-AAP! (866-843-2271).
In addition, the Academy supports a new CDC campaign called “VERB,” which aims to get youths more active and offer parents support to help children discover the joys of physical activities. VERB is a multicultural campaign designed to show children between the ages of 9 and 13 years (tweens) how physical activity can be fun, healthy and enjoyable.
Adapted from: Feinstein, Ronald A. M.D., FAAP; AAP News; 24(3); March 2004; p. 120.
AAP SOFT DRINKS IN SCHOOLS POLICY STATEMENT
ABSTRACT.
This statement is intended to inform pediatricians and other health care professionals, parents, superintendents, and school board members about nutritional concerns regarding soft drink consumption in schools. Potential health problems associated with high intake of sweetened drinks are 1) overweight or obesity attributable to additional calories in the diet; 2) displacement of milk consumption, resulting in calcium deficiency with an attendant risk of osteoporosis and fractures; and 3) dental caries and potential enamel erosion. Contracts with school districts for exclusive soft drink rights encourage consumption directly and indirectly. School officials and parents need to become well informed about the health implications of vended drinks in school before making a decision about student access to them. A clearly defined, district-wide policy that restricts the sale of soft drinks will safeguard against health problems as a result of over-consumption.
BACKGROUND AND INFORMATION
Overweight
Overweight is now the most common medical condition of childhood, with the prevalence having doubled over the past 20 years. Nearly 1 of every 3 children is at risk of overweight (defined as body mass index [BMI] between the 85th and 95th percentiles for age and sex), and 1 of every 6 is overweight (defined as BMI at or above the 95th percentile). Complications of the obesity epidemic include high cholesterol, high blood pressure, type 2 diabetes mellitus, coronary plaque formation, and serious psychosocial implications. Annually, obesity-related diseases in adults and children account for more than 300 000 deaths and more than $100 billion per year in treatment costs.
Soft Drinks and Fruit Drinks
In the United States, children's daily food selections are excessively high in discretionary, or added, fat and sugar. This category of fats and sugars accounts for 40% of children's daily energy intake. Soft drink consumers have a higher daily energy intake than non-consumers at all ages. Sweetened drinks (fruitades, fruit drinks, soft drinks, etc) constitute the primary source of added sugar in the daily diet of children. High-fructose corn syrup, the principle nutrient in sweetened drinks, is not a problem food when consumed in smaller amounts, but each 12-oz serving of a carbonated, sweetened soft drink contains the equivalent of 10 teaspoons of sugar and 150 kcal. Soft drink consumption increased by 300% in 20 years, and serving sizes have increased from 6.5 oz in the 1950s to 12 oz in the 1960s and 20 oz by the late 1990s. Between 56% and 85% of children in school consume at least 1 soft drink daily, with the highest amounts ingested by adolescent males. Of this group, 20% consume 4 or more servings daily.
Each 12-oz sugared soft drink consumed daily has been associated with a 0.18-point increase in a child's BMI and a 60% increase in risk of obesity, associations not found with "diet" (sugar-free) soft drinks. Sugar-free soft drinks constitute only 14% of the adolescent soft drink market. Sweetened drinks are associated with obesity, probably because over-consumption is a particular problem when energy is ingested in liquid form and because these drinks represent energy added to, not displacing, other dietary intake. In addition to the caloric load, soft drinks pose a risk of dental caries because of their high sugar content and enamel erosion because of their acidity.
Calcium
Milk consumption decreases as soft drinks become a favorite choice for children,
a transition that occurs between the third and eighth grades. Milk is the principle
source of calcium in the typical American diet. Dairy products contain substantial
amounts of several nutrients, including 72% of calcium, 32% of phosphorus, 26%
of riboflavin, 22% of vitamin B 12 , 19% of protein, and 15% of vitamin A in
the US food supply. The percent daily value for milk is considered either "good"
or "excellent" for 9 essential nutrients depending on age and gender.
Intake of protein and micronutrients is decreased in diets low in dairy products.
The resulting diminished calcium intake jeopardizes the accrual of maximal peak
bone mass at a critical time in life, adolescence.
Nearly 100% of the calcium in the body resides in bone. Nearly 40% of peak bone
mass is accumulated during adolescence. Studies suggest that a 5% to 10% deficit
in peak bone mass may result in a 50% greater lifetime prevalence of hip fracture,
a problem certain to worsen if steps are not taken to improve calcium intake
among adolescents.
STATEMENT OF PROBLEM
Soft drinks and fruit drinks are sold in vending machines, in school stores,
at school sporting events, and at school fund drives. "Exclusive pouring
rights" contracts, in which the school agrees to promote one brand exclusively
in exchange for money, are being signed in an increasing number of school districts
across the country, often with bonus incentives tied to sales. Although they
are a new phenomenon, such contracts already have provided schools with more
than $200 million in unrestricted revenue.
Some superintendents, school board members, and principals claim that the financial
gain from soft drink contracts is an unquestioned "win" for students,
schools, communities, and taxpayers. Parents and school authorities generally
are uninformed about the potential risk to the health of their children that
may be associated with the unrestricted consumption of soft drinks. The decision
regarding which foods will be sold in schools more often is made by school district
business officers alone rather than with input from local health care professionals.
Subsidized school lunch programs are associated with a high intake of dietary protein, complex carbohydrates, dairy products, fruits, and vegetables. The US Department of Agriculture, which oversees the National School Lunch Program, is concerned that foods with high sugar content (especially foods of minimal nutritional value, such as soft drinks) are displacing nutrients within the school lunch program, and there is evidence to support this.
There are precedents for using optimal nutrition standards to create a model district-wide school nutrition policy, but this is not yet a routine practice in most states. The discussion engendered by the creation of such a policy would be an important first step in establishing an ideal nutritional environment for students.
RECOMMENDATIONS
• Pediatricians should work to eliminate sweetened drinks in schools.
This entails educating school authorities, patients, and patients' parents about
the health ramifications of soft drink consumption. Offerings such as real fruit
and vegetable juices, water, and low-fat white or flavored milk provide students
at all grade levels with healthful alternatives.
• Pediatricians should emphasize the notion that every school in every
district shares a responsibility for the nutritional health of its student body.
• Pediatricians should advocate for the creation of a school nutrition
advisory council comprising parents, community and school officials, food service
representatives, physicians, school nurses, dietitians, dentists, and other
health care professionals. This group could be one component of a school district's
health advisory council.
• Pediatricians should ensure that the health and nutritional interests
of students form the foundation of nutritional policies in schools.
• School districts should invite public discussion before making any decision
to create a vended food or drink contract.
• If a school district already has a soft drink contract in place, it
should be tempered such that it does not promote over-consumption by students.
• Soft drinks should not be sold as part of or in competition with the
school lunch program, as stated in regulations of the US Department of Agriculture.
• Vending machines should not be placed within the cafeteria space where
lunch is sold. Their location in the school should be chosen by the school district,
not the vending company.
• Vending machines with foods of minimal nutritional value, including
soft drinks, should be turned off during lunch hours and ideally during school
hours.
• Vended soft drinks and fruit-flavored drinks should be eliminated in
all elementary schools.
• Incentives based on the amount of soft drinks sold per student should
not be included as part of exclusive contracts.
• Within the contract, the number of machines vending sweetened drinks
should be limited. Schools should insist that the alternative beverages listed
in recommendation 1 be provided in preference over sweetened drinks in school
vending machines.
• Schools should preferentially vend drinks that are sugar-free or low
in sugar to lessen the risk of overweight.
• Consumption or advertising of sweetened soft drinks within the classroom
should be eliminated.
Source: AAP Policy Statement; 113(1); January 2004, pp. 152-154
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