UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION

NUTRITION PERSPECTIVES

Volume 30, No. 2
March/April 2005

TABLE OF CONTENTS

Erythrocyte Folate and Its Response to Folic Acid Supplementation Is Assay Dependent in Women
Updating the Facts on Agricultural Biotechnology
Are Lower-Dose Supplements Better?
The EPA Strengthens Protections Against Lead in Water
The USDA Food Assistance Programs Spend Record Amount in FY04
California Looks to Terminate Junk Food from Schools
Infants of Pregnant Women with Eating Disorders Are At Risk
Complimentary and Alternative Medicine Use Among Midlife Women
HHS Launches African American Anti-Obesity Initiative
California Obesity Prevention Initiative (COPI)
Morbidly Obese Pay Nearly Twice as Much for Health Care
Parents Fail to Recognize Kids’ Weight Problems
Herbal Medicine Products May Contain Heavy Metals
Iron Deficiency In Children with ADHD

Resources:
Making It Happen! Tools for Healthier School Nutrition
COPI's TV Reduction Tool for Tweens

Book Review:
Nutritional Ergogenic Aids

Subscription for NUTRITION PERSPECTIVES

Sheri Zidenberg-Cherr, PhD, Editor Department of Nutrition University of California Davis, CA 95616

NUTRITION PERSPECTIVES is prepared by Sheri Zidenberg-Cherr, PhD, Nutrition Specialist, Cristy Hathaway, and staff. It is designed to provide research-based information on ongoing nutrition and food-related programs. It is published bimonthly (six times annually) as a service of the University of California Cooperative Extension and the United States Department of Agriculture. Subscription to NUTRITION PERSPECTIVES is available from UC Cooperative Extension, Department of Nutrition, University of California, Davis, California. Cost is ten dollars ($10.00) for a one-year subscription. Subscriptions and questions or comments on articles may be addressed to: NUTRITION PERSPECTIVES, Department of Nutrition, University of California, Davis, CA 95616-5270. Phone (916)752-3387; FAX, (916) 752-8905.

Erythrocyte Folate and Its Response to Folic Acid Supplementation Is Assay Dependent in Women

It has been well established that women of childbearing age must consume adequate levels of folic acid (the free form and most readily absorbable form of folate) to protect against the development of fetal neural tube defects, should they become pregnant. Low-income women, who often consume a diet high in fats and sweets rather than more nutritious alternatives, may be at risk for deficiency. Therefore, it is important for a physician to be able to accurately assess folate status in his or her patients.

There are several different methods for measuring folate status, including multiple biochemical assays, food frequency questionnaires, and short screeners. Although the biochemical measures of folate status are considered to be the most accurate methods, there is some controversy over their reliability and concern that they cannot be quickly administered.

In the current investigation, researchers aimed to test a new, more accurate red blood cell (RBC) folate assay against three others, and to assess the usefulness of a rapid screener for the identification of at-risk patients in a field setting.

Sixty-eight (29 pregnant and 39 nursing or non-pregnant) women were recruited from community clinics in the Sacramento area. At the initial visit, women were asked to complete a one-page folate screener and to have their blood drawn. Over the next 30 to 60 days, subjects were asked to take a daily vitamin supple-ment containing 800 ?g folate, 4 ?g vitamin B-12, 2.6 mg vitamin B-6, and 27 mg iron. At the end of this supplementation period, the folate screener was completed again, and blood was drawn for a second time.

As predicted, the new folate assay was found to be the most accurate. Of all four biochemical techniques, the new screener was the only one to correctly identify participants who were folate deficient. Additionally, the new folate screener was found to be a valid tool. It was significantly correlated with all four biochemical assays.

In summary, further comparisons among assay methods are warranted to identify the method that most accurately determines the actual RBC folate value. It is an important to appreciate that biochemical informa-tion cannot always be taken at face value. As with any medical information, it is important to have a qualified professional, who is up to date on current literature, interpret the results.

Adapted from: Clifford AJ, Noceti EM, Block-Joy A, Block T, and Block G. Erythrocyte Folate and Its Response to Folic Acid Supplementation Is Assay Dependent in Women. J Nutr; 2005 135: 137-143.

Karrie Heneman, PhD, Nutrition Department, University of California, Davis.

Updating the Facts on Agricultural Biotechnology

Myth: Modern biotechnology is inherently different from conventional breeding and poses greater risks.

Fact: Modern biotechnology is a refinement of techniques that have been used to improve plants for thousands of years. The main differences, compared to conventional breeding are that modern technology is a more precise process and there is a broader array of plant improvements that are possible.

Many authoritative scientific bodies, including the National Academy of Sciences, have concluded that crops enhanced by using modern biotechnology are as safe as crops improved through classical breeding methods.

Because of advanced knowledge and greater scrutiny by regulatory agencies, biotech crops and foods may even be safer than their conventionally bred counterparts. Modern biotechnology allows the transfer of a single, well-characterized trait into the crop whereas hybridization allows the transfer of not only the desired trait, but also thousands of unwanted and sometimes poorly understood traits. Therefore, with biotechnology, scientists have a better understanding of the changes being made and are in a better position to assess the safety of the food products.

One example of improved safety is a biotech crop that may lower exposure to naturally occurring toxins. Research has shown that Bt corn helps prevent damage to corn stalks caused by the corn ear worm. That damage often leads to invasion by fungi that produce the toxin fumonisin, which may be linked to esophageal cancer in humans.

Myth: Biotech foods will introduce new allergens into the food supply, putting susceptible people at risk.

Fact: Usually protein is the component of food that provokes an allergic response, but only a very small number of proteins are allergens. Common sources of food allergens include such widely consumed foods as milk, eggs, wheat, fish, shellfish, tree nuts, peanuts, and soy.

Today, biotech companies avoid using genetic material from plant foods commonly associated with allergies. Furthermore, the US Food and Drug Administration (FDA) regulations would require that the use of genes from a known allergenic food would require allergenicity testing. In the mid 1990s, a biotech variety of soybean was developed with a gene from the Brazil nut, and testing sponsored by the company revealed the presence of an allergen. As a result, this soybean was never sold to consumers, demonstrating how rigorous testing can provide additional assurance of safety.

Researchers are also using biotechnology to remove allergens from foods, such as peanuts. The future of allergen-free foods may expand the choice of wholesome foods available to allergy sufferers.

Myth: Consumers want foods produced through biotechnology to be labeled.

Fact: The results of a nationally representative consumer survey (conducted by Cogent Research for the International Food Information Council, January 2004) show that when individuals are asked to identify information currently not on food labels that they would like to see added, three out of four say “nothing” and only 1 percent mention “genetically engineered” food. When the current FDA labeling policy is explained to consumers, 53 percent support the policy and 9 percent neither support not oppose the policy. Consumers who have heard “a lot” about biotechnology are significantly more likely than those who have heard less to support the FDA labeling policy, suggesting that providing consumers with increased information may go a long way to increasing understanding of the policy.

Unlike the results from the survey conducted by Cogent Research, however, the results of some polls suggesting that consumers want labeling do not represent the attitudes of the general public and often use manipulative terminology to bias responses.

Myth: Foods derived from biotechnology are not regulated.

Fact: Plants and foods derived through the use of biotechnology are regulated by as many as three agencies: the US Department of Agriculture (USDA), the US Environmental Protection Agency (EPA), and the FDA.

The USDA’s Animal and Plant Inspection Service regulates biotech crops to ensure that new varieties do not pose a threat to the environment while they are growing in the field.

The EPA regulates biotech crops with built-in protection from harmful pests. The EPA regulations ensure not only that the new plant is safe for the environment, but also that the protection produced by the plant is safe for consumers.

In 1992, the FDA issued a policy statement addressing the regulation of biotech foods and instituted a pre-market review process. Although this pre-market review process is voluntary, it is honored without exception by companies seeking to commercialize new biotech foods. Since 1992, the FDA has conducted more than 51 reviews of biotech foods, none of which raised safety concerns.

Myth: Agricultural biotechnology will not benefit developing countries.

Fact: It is estimated that about 840 million people do not currently have access to sufficient food supplies. Moreover, according to the US Census Bureau, the present world population is about 6 billion and is projected to grow to about 9 billion by 2050 (http://www.census.gov/ipc/www/worldpop.html). As the rapid increases in the levels of food production brought about in the last several decades begin to level off and the availability of arable land declines, increased demand for food and fiber, largely in the developing world, will need to be met, primarily through increased yields.

Low yields can contribute to a shortage of nutritious foods in developing countries. Biotechnology can help by developing plants to protect from insects and viral pests. For example, biotechnology was used to “immunize” papaya plants against the papaya ringspot virus, which had devastated papaya crops in Hawaii. This technique is now being applied to protect high-value papaya and cucurbit crops throughout Southeast Asia, India, the South Pacific, and Australia.

As former President Jimmy Carter noted, “Biotechnology is not the enemy. Hunger is.” Together with other forms of intervention, developments in biotechnology can contribute to enhancing the nutritional intakes of people throughout the world.

Source: Food Insight; March/April 2004; pp. 4-6.

Are Lower-Dose Supplements Better?

While high-dose vitamin supplements have had a run of bad press lately, not all of the news coming from supplementation studies is negative. Recently reported findings from a randomized, controlled primary-prevention trial in France show that a daily supplement containing 120 mg of vitamin C, 30 mg of vitamin E, 6 mg of beta carotene, 100 ?g of selenium, and 20 mg of zinc reduced incidence of cancer and all-cause mortality in men but not in women (1).

In contrast to many previous prevention trials, which have tested “pharmacologic” doses of micro-nutrients, this study tried doses that correspond more closely to intakes achievable through an ordinary balanced diet.

The study, dubbed SU.VI. MAX (Supplementation en Vitamines et Minéraux Antioxidants), involved a general population of over 13,000 men and women who were free from major chronic diseases at baseline. The authors followed the participants for a mean of 7.5 years, assessing primary endpoints of major fatal and non-fatal cardiovascular events and cancer.

In the study population as a whole, the authors found no significant differences between the supplement and placebo groups for any of the endpoints. In the sex-stratified analysis, however, the authors observed a 31% lower incidence of cancer and a 37% lower rate of death from all causes in the men taking supplements compared with men who took the placebo.

The authors attribute the sex-specific effect to the lower baseline status of several antioxidants, particularly beta-carotene, in the men. “The efficiency of supplementation in reducing cancer incidence may be related to the ability to correct antioxidant status with an adequate dose of antioxidant nutrients in individuals with a sub-optimal antioxidant status (as the men in our study),” they note.

This interpretation is broadly supported by findings of the Linxian trial, a study that tested nutritional doses of several micronutrients in a poorly nourished population of Chinese men and women (2). As the SU.VI.MAX authors observe, this is the only other trial that has reported a beneficial effect of supplementation on cancer incidence and total mortality.

Reference:
Hercberg S, Galan P, Preziosi P, et al. A Randomized, Placebo-Controlled Trial of the Health Effects of Antioxidant Vitamins and Minerals. Arch Intern Med; 2004; 164:2335.
Blot WJ, Li JY, Taylor PR, et al. Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst; 1993; 85:1483-91.
Source: Nutrition & the MD; January 2005; 31(1):6.

The EPA Strengthens Protections Against Lead in Water

The EPA said on March 7 it is initiating the Drinking Water Lead Reduction Plan to strengthen, update, and clarify existing requirements for water utilities and states to test for and reduce lead in drinking water.

This action, the agency said, will tighten monitoring, treatment, lead service line management, and customer awareness. The plan also addresses lead in tap water in schools and childcare facilities to further protect vulnerable populations.

To read more about the EPA’s Actions, go to http//yosemite.epa.gov/ opa/admpress.nsf/blab9f485b098972852562e7004dc686/e8e0702362bb3df6875256fbd005aaf0b!OpenDocument.

Source: Nutrition Week; March 14, 2005; XXXV(6); 6.

The USDA Food Assistance Programs Spend Record Amount in FY04

The US Department of Agriculture (USDA) released its Food Assistance Landscape report in March, which shows that record-high amounts of money were spent through the agency’s 15 food assistance programs in fiscal year (FY) 2004.

Expenditures totaled $46 billion, the second year in a row that they exceeded the previous record high. Expenditures were also 10% higher than in FY03, making assistance costs increased. The federal fiscal year runs from October 1 to September 30.

Five programs, the Food Stamp Program, the National School Lunch Program, WIC, the School Breakfast Program, and the Child and Adult Care Food Program, accounted for 94% of the USDA’s total expenditures for food assistance, according to the report. Seventy-six percent of the increase between FY03 and FY04 was due to the rise in food stamp spending.

Spending for the Food Stamp Program totaled $27 billion, breaking the previous record of $24.6 billion in FY95. FY04 expenditures rose 13% over FY03. The report noted that the rise in food stamp expenditures contrasts the rising economic tide in the US in FY04.

“The number of food stamp recipients typically rises during recessionary periods when the number of unemployed and poor persons increases, and falls during periods of growth as the number of unemployed and poor persons decreases. The unemployment rate was 5.5% in 2004, down from 6% the previous year. This marked the first decrease in the unemployment rate in the last four years,” the report said. “Despite the decrease in unem-ployment, food stamp participation continued to increase in FY04. Efforts to increase awareness of and improve access to the Food Stamp Program help explain at least some of the increase,” according to the report.

The increase was also attributed in part to an increase in the average per person benefit, the report said.

Go to www.ers.usda.gov/publications/fanrr28-6/ to read the whole report.

Source: Nutrition Week; March 14, 2005; XXXV(6); 7.

California Looks to Terminate Junk Food from Schools

California Governor Arnold Schwarzenegger said on March 7 that he supported a Democrat-sponsored bill to ban soft drinks in schools. His chief of staff told the Associated Press (AP) that Schwarzenegger’s administration was planning to develop a legislative package that would address snack foods in school, too.

“First of all, we in California this year are introducing legislation that would ban the sale of all junk food in the schools,” Schwarzenegger said during a question-and-answer session with fans on the final day of the Arnold Classic, the annual bodybuilding contest that bears his name, the AP reported. The governor said junk food would be pulled from school vending machines in favor of healthier foods, including fruits and vegetables.

California is one of many states eyeing similar moves for their school systems this year.
Go to httm://thestar.com.my/news/story.asp?file=/2005/3/8/latest/21855Schwarzene&sec=latest to read the article.

Source: Nutrition Week; March 14, 2005; XXXV(6); 6.

Infants of Pregnant Women with Eating Disorders Are At Risk

Little is known about pregnancy and neonatal outcomes in women with past or current eating disorders. Investigators in Stockholm prospectively compared 49 nulliparous non-smoking women who had previously diagnosed eating disorders (24 anorexia nervosa, 20 bulimia nervosa, 5 unspecified; mean duration of disorder, 9 years) with 68 controls; both groups were enrolled during early pregnancy (1).

In 11 patients (22%), relapse of eating disorders during pregnancy led to contact with a psychiatrist or psychologist. The anorexia subgroup had a significantly lower mean body-mass index than did bulimics and controls. Compared with controls, women with eating disorders were significantly more likely to experience anemia and hyperemisis, to deliver infants with significantly lower mean birth weight and smaller mean head circumference, and to deliver infants who had micro-cephaly, the condition of having a small head or having reduced space for the brain in the skull (0 vs. 12).

It’s not surprising that women with eating disorders are at increased risk for delivering infants who are small for gestational age. It is surprising to find such an increased incidence of microcephaly: the importance of microcephaly to infant development is unknown at this time.

Reference:
Kouba S , Hallstrom T, Lindholm C, et al. Pregnancy and neonatal outcomes in women with eating disorders. Obstet Gynecol; February 2005: 105:255-60.
Source: Robert W. Rebar MD. Journal Watch; March 15, 2005, 25(6): 50.

Complimentary and Alternative Medicine Use Among Midlife Women

To assess the use of complementary and alternative medicine (CAM) among women in midlife, investigators examined the longitudinal association between CAM and use of conventional health care in a prospective sample of midlife women in the US. The sample represented white, black, Hispanic, Japanese, and Chinese women at seven clinical sites nationwide.

Among the 2565 participants, only 23% did not use CAM during the 2-year study (starting in 1996-1997). Fully 43% used CAM continuously, and 33% were sporadic users. Continuous CAM users were more likely to be white or Japanese, English-speaking, in the highest tertile of income, and to have a college education. The CAM use did not differ by menopausal status, but users of hormone therapy were more likely to report continuous CAM use.

Individuals who reported poorer health status and those with the highest body-mass index (BMI) were those most likely to be continuous CAM users. CAM use, higher BMI, poorer health, and hormone therapy use were all associated with increased conventional health care use. Japanese women reported less conventional health care use than did white women.

These data have important implications for health care providers, because they indicate that midlife women commonly are users of CAM. Those using CAM are among the most frequent users of conventional health care as well. Use of CAM for menopause management might be expected to increase as questions about hormone therapy continue to arise in the aftermath of the Women’s Health Initiative.

Source: Robert W. Rebar MD. Journal Watch; March 1, 2005, 25(5): 39-40.

HHS Launches African American Anti-Obesity Initiative

The Department of Health and Human Services (HHS) Secretary Mike Leavitt recently announced the award of $1.2 million to improve efforts to reduce obesity among African Americans through a new partnership with national African American organizations.

"The obesity epidemic is one of the major health challenges facing our nation, and African American communities are highly affected by this disease and its health consequences," Secretary Leavitt said. "The initiative we are announcing today will mobilize three of the nation's premier academic and civic organizations to join us in a new partnership to mount critical prevention efforts in the African American community."

The National Association for Equal Opportunity in Higher Education (NAFEO), Silver Spring, Md., will work with the National Urban League, New York, N.Y., and the National Council of Negro Women, Washington, D.C. Initiatives planned by these organizations include prevention, education, public awareness, and outreach activities intended to bring about a greater understanding of the impact of obesity on other conditions.

An estimated 129.6 million Americans, or 64 percent, are overweight or obese. Obesity and overweight have been shown to increase the risk of developing serious and often disabling medical conditions. Adult African American women had age-adjusted obesity rates of 48.8 percent, compared to 30.7 percent for adult white women, according to data from the Centers for Disease Control and Prevention (CDC) for the period 1999-2002. African American girls and boys also had higher rates of overweight than white children in the same age groups.

"Obesity is a risk factor for many diseases which disproportion-ately impact minority populations, including heart disease, some cancers, diabetes, and stroke," said Dr. Garth Graham, HHS deputy assistant secretary for minority health. "Because these problems affect multiple groups, we will also be announcing a second phase of the initiative in the near future, which will focus on reducing obesity among Hispanic populations."

In implementing the new projects targeting African Americans, NAFEO will work with five of its member institutions to improve health habits among college-age youth: Talladega (Ala.) University; Alcorn (Miss.) State University; Lincoln (Pa.) University; South Carolina State University, Orangeburg; and Wiley (Texas) College.

The National Council of Negro Women will conduct a research-based public education campaign to educate young and mid-life women (ages 35-59) about healthy aging and ways to improve their overall health. The Council will conduct focus groups among women in Los Angeles, Calif.; Washington, D.C.; Chicago, Ill.; New Orleans, La.; and Houston, Texas, as it develops new consumer education materials.

The National Urban League will pilot-test an Urban Health and Fitness Campaign focused on physical activity, nutrition and prevention of diseases such as diabetes. Working through selected local affiliates, the project aims to develop comprehensive community action plans, influence school-based curricula and health/fitness activities, and provide technical assistance to meet community needs.

Source: HHS Press Release; April 7, 2005.

California Obesity Prevention Initiative (COPI)

The California Obesity Prevention Initiative (COPI) and its partners work to create environ-ments and policies that support physical activity and healthy eating for all Californians.

The mission of the COPI is to reduce the prevalence of obesity and its associated health risks in Californians through promotion of physical activity and healthy eating as well as address the societal, technological, and environmental influences on obesity.

Goals

Long-term goals:

• Reduce the life long risk of obesity and overweight and their associated health risks by intervening with children and youth who are high risk;
• Address the disparities in obesity prevalence and treatment for underserved and vulnerable populations in California, especially for children and youth;
• Create environments that support healthy eating and physical activity for all Californians, especially for children and youth.

Objectives:

COPI is taking action by:

• Establishing a state infrastructure: COPI works with the State Planning Group consisting of DHS' nutrition and physical activity programs with an interest in obesity prevention.
• Identifying and involving internal and external partners: COPI works closely with many internal and external partners, including the California Obesity Prevention Advisory Group consisting of representatives from over 50 organizations and agencies who provide guidance and recommendations on addressing the obesity issue in California.
• Identifying and improving relevant data and surveillance sources: The State Planning Group and collaborating partners formed the Surveillance Workgroup comprised of select professionals with experience in data collection, management, analysis, epidemiology, surveillance, and evaluation. The initial charge of the committee was to scrutinize existing data sources to ensure that they comprehensively monitor the burden of obesity in California. A summary of surveillance systems relevant to monitoring the burden of obesity and related behaviors has been developed and is entitled California Obesity Prevention Initiative Surveillance Review. If you would like a copy of this summary, go online at: http://www.dhs.ca.gov/ ps/cdic/copi/.
• Conducting strategic planning activities to develop a comprehensive state physical activity and nutrition plan to prevent obesity: The California Obesity Prevention Advisory Group assisted COPI and the State Planning Group in the creation of a comprehensive state physical activity and nutrition plan, Reversing the Obesity Epidemic: California's Strategies for Action (CSA), to prevent obesity and other chronic diseases. To better address the needs of ethnic specific groups, several focus groups with leaders and residents from African American and Hispanic communities were also completed. Information from these focus groups was integrated into California's Plan for Action.
• Implementing a comprehensive state physical activity and nutrition plan to prevent obesity: COPI, the State Planning Group and the California Obesity Prevention Advisory Group completed California's Plan for Action that describes promising strategies to address the societal, technological, and environmental influences on obesity. The plan was developed with the input of over 90 key obesity prevention leaders and experts from public and private organizations and agencies.

California's Plan for Action focuses on six goals:

• Improving access to healthy foods, particularly in schools and low income communities, to increase consumption of fruits and vegetables, decrease consumption of high calorie, low nutrient foods, and decrease food insecurity and hunger;
• Increasing access to physical activity options, including family centered ones, to increase rates of physical activity and decrease rates of physical inactivity;
• Improving access to culturally and linguistically appropriate nutrition and physical activity information to promote life-long skills;
• Developing community-based obesity prevention strategies, particularly within diverse communities;
• Implementing research projects and surveillance systems that identify effective obesity prevention strategies; and
• Improving the ability of healthcare systems and providers to implement obesity related primary prevention, early intervention and treatment strategies, particularly in a culturally and linguistically appropriate manner.
• Developing and implementing a pilot intervention: COPI partnered with the Sports, Play, and Active Recreation for Kids (SPARK) program to train physical education specialists and teachers at 40 low-resource schools to increase the quantity and quality of physical education content and instruction. Along with SPARK, four schools are participating in the Peaceful Playgrounds Program that is designed to increase activity before school, during recess/lunch, and after school. Peaceful Playgrounds also teaches social skills and conflict resolution. An evaluation is being conducted in a sampling of schools.
• Providing training and technical assistance: COPI provides technical assistance to internal and external partners on issues related to obesity, nutrition, and physical activity. COPI disseminates key training opportunities, reports, research findings and other pertinent obesity-related information to state and local partners.

This website is supported by the Preventive Health and Health Services Block Grant from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

[Online Source]: http://www.dhs.ca.gov/ps/cdic/copi/.

Morbidly Obese Pay Nearly Twice as Much for Health Care

University of Cincinnati researchers found that $56 billion in University of Cincinnati heath-care expenditures in 2000 were linked to excess body weight, a 12% increase from 1998 (1). Health-care costs for morbidly obese adults are nearly twice those of people considered to be of normal weight, says a study led by University of Cincinnati researchers.

The study found that medical expenditures for morbidly obese adults in the year 2000 were 81% more than for normal-weight adults, 65% more than overweight adults, and 47% more than obese adults.

The excess costs among morbidly obese adults resulted from greater spending on visits to the doctor, outpatient hospital care, inpatient care and prescription drugs, the researchers say.

“The economic burden of morbid obesity among US adults is substantial,” says David Arterburn, MD, assistant professor of internal medicine and researcher at the Institute for the Study of Health at University of Cincinnati’s Academic Health Center.

The study, led by Dr. Arterburn, appears in the Feb. 14, 2005 issue of the International Journal of Obesity.

In 2000, nearly 5 million US adults were considered morbidly obese, bringing health-care spending associated with excess body weight to more than $11 billion that year.

Morbid obesity (defined as being 100 pounds or more over ideal body weight or having a body mass index (BMI) of 40 or higher), is rising twice as fast as obesity (BMI greater than 30) in the US. Between 1990 and 2000, the prevalence of morbid obesity increased from 0.78% to 2.2%, representing a total of over 4.8 million morbidly obese US adults in the year 2000.

The authors found that $56 billion in US heath-care expenditures in 2000 were linked to excess body weight, a 12% increase from 1998.

“If the number of morbidly obese Americans continues to increase over the next decade, total US health-care expenditures will likely continue to rise,” says Dr. Arterburn.

Morbid obesity is associated with a substantially increased risk of sickness and death from chronic health conditions such as diabetes, hyperten-sion, cardiovascular disease, and cancer.

The authors state that further research is needed into specific interventions that will reduce the incidence and prevalence of morbid obesity and improve the health and economic outcomes of morbidly obese individuals.

Coauthors include Matthew L. Maciejewski, PhD, of the University of Washington, and Joel Tsevat, MD, professor of internal medicine and researcher at UC’s Institute for the Study of Health. The research was supported by a grant from the Department of Veterans Affairs.

Reference:
Arterburn DE, Maciejewski ML, and Tsevat J. Impact of morbid obesity on medical expenditures in adults. Intern J Obesity; February 14, 2005; 29, 334?339.
[Online source:] Dama Kimmon. University of Cincinnati; February 13, 2005; http://www.uc.edu/news/NR.asp?id=2426.

Parents Fail to Recognize Kids’ Weight Problems

Parents of overweight and obese kids often did not realize that their children were carrying excess pounds, according to a survey of 277 British parents (1).

Parents completed a question-naire asking them to estimate their own and their child’s weight on a five-point scale ranging from “very under-weight” to very overweight.” Parents also were asked to describe how concerned they were about their child’s weight on a scale from “very worried about underweight” to “very worried about overweight.” Research-ers then weighed study participants.

Results showed that 19% of children (mean age 7.4 years), 52% of mothers, and 72% of fathers were overweight or obese. Among overweight parents, 40% of mothers and 45% of fathers judged their own weight to be “about right.”

In addition, parents were less likely to recognize overweight in sons than daughters.

Study findings also revealed that the prevalence of overweight did not differ among socioeconomic groups.

The authors noted that parents might not recognize overweight in their children due to denial, reluctance to admit the problem or desensitization to excess weight because it has become the norm. They concluded that the fight against the obesity epidemic will be hampered until parents become aware of and concerned about overweight in their children.

Reference:
Jeffery AN, Voss LD, Metcalf BS, Alba S, and Wilkin TJ. Parents' awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21). BMJ, Jan 2005; 330: 23 - 24.
Source: AAP News; March 2005; 26(3): 2.

Herbal Medicine Products May Contain Heavy Metals

Twenty percent of Ayurvedic herbal medicine products (HMPs) available in Boston-area grocery stores contained potentially harmful levels of heavy metals, according to an analysis of 70 products.

Ayurvedic medicine originated in India more than 2,000 years ago, and relies on HMPs. Ayurveda has been increasing in popularity in the US, and remedies are available from South Asian markets, Ayurveda practitioners, health food stores and the Internet.

Since 1978, at least 55 cases of heavy metal intoxication associated with Ayurvedic HMPs have been reported in adults and children in the US and abroad.

In this study, researchers bought 70 different HMPs at 30 Boston-area stores, and sent them to the New England Regional Environmental Protection agency laboratory for analysis. The HMPs were manufactured by 27 companies in India and Pakistan, and cost an average of $2.99 per package. The products had a variety of indications, most commonly gastrointestinal (71%). Seven specifically recommended pediatric use.

Results of product analyses showed that 14 (20%) contained lead, mercury, and/or arsenic. Those who took the products as recommended could be at risk for heavy metal intake above US Pharmacopoeia standards.

The authors recommended mandatory testing of all imported Ayurvedic HMPs for toxic levels of heavy metals as well as advisories to users, encouraging them to consult their physicians about heavy metal screening. In addition, physicians should consider Ayurvedic HMP intake in the differential diagnosis of unexplained heavy metal toxicity.

Source: AAP News; April 2005; 26(4): 2.

Iron Deficiency In Children with ADHD

Low iron stores may contribute to attention-deficit/hyperactivity disorder (ADHD), and children with the disorder may benefit from iron supplementation, according to a study of 53 children with ADHD and 27 controls (1).

It has been suggested that dopamine dysfunction may cause ADHD symptoms. Iron is a co-enzyme of dopamine synthesis, and iron deficiency alters dopamine receptor density and activity in animals. Therefore, brain iron stores may influence dopamine-dependent functions. In the brain, iron is bound to ferritin, the levels of which are decreased by iron deficiency and increased by iron supplementation.

Low ferritin levels already have been shown to cause mental retardation and behavioral disorders in children. In this study, researchers investigated whether iron deficiency contributes to ADHD symptoms.

Fifty-three children, ages 4 to 14 years, who met the criteria for ADHD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were compared with 27 age- and sex-matched control children without ADHD. The severity of ADHD was evaluated using the Conners’ Parent Rating Scale, including the hyperactivity, cognitive and oppositional subscales.

Investigators also measured subjects’ serum ferritin, blood hemoglobin, hematocrit, and iron levels.

Results showed that serum ferritin levels were abnormally low in 84% of children with ADHD compared with 18% of controls. In addition, 32% of the children with ADHD had extremely low serum ferritin levels compared with only 3% of controls.

Results also showed that low serum ferritin levels were correlated with more severe general ADHD symptoms and greater cognitive deficits.

Serum iron, hemoglobin, and hematocrit levels were normal in both groups.

The authors noted that this is the first clinical study to their knowledge showing abnormally low serum ferritin levels in children with ADHD. Low ferritin levels should be considered a specific and primary abnormality since anemia had been ruled out. They suggested that iron supplementation might improve central dopaminergic activity in children with ADHD, decreasing the need for psychostimulants.

Reference:
Konofal E, Lecendreux M, Arnulf I, and Mouren MC. Iron Deficiency in Children With Attention-Deficit/Hyperactivity Disorder. Arch Pediatr Adolesc Med; 2004; 158:1113-1115.
Source: AAP News; February 2005; 26(2): 2.

Resources:

Making It Happen! Tools for Healthier School Nutrition

Making it Happen! School Nutrition Success Stories recently released at George I. Sanchez Elementary School, describes successful approaches by schools to improve student nutrition. Making It Happen!, a joint publication of US Departments of Agriculture (USDA), Food Nutrition and Consumer Services and Health and Human Services' Centers for Disease Control and Prevention (CDC) with the support of the Department of Education celebrates the bold steps that many schools and school districts have taken to increase the availability of healthy foods outside of school meal programs.

"We urge schools throughout the United States to take action to fight the increasing prevalence of overweight among our children and to encourage physical activity and healthier school nutrition," said Dr. Ed Thompson, Chief, Public Health Practice, CDC. "CDC is delighted to see Sanchez Elementary School, and other schools in Austin and throughout Texas, take this important first step."

Making It Happen! includes thirty-two case studies demonstrating that schools and their communities can work together to create healthier nutrition environments for our children. The publication, which supports the President’s HealthierUS initiative, provides concrete examples of how schools and school districts across the US are helping to implement changes where food is available that make healthy food and beverage choices the norm.

"Nearly one-third of America’s children are overweight or at risk of becoming overweight. Schools recognize that obesity is a serious problem facing children," said Eric M. Bost, USDA Under Secretary for Food, Nutrition and Consumer Services. "Making It Happen! shows that schools are not only very concerned about the health of their students but are willing to take action to improve it."

Making It Happen! describes six different approaches that schools and school districts can use to successfully improve the nutritional content of foods served to students such as marketing the healthy food choices and using fundraising activities and rewards that support student health. The release of Making It Happen! is well-timed to help local education agencies develop wellness policies for schools that are now required by law under the Child Nutrition and WIC Reauthorization Act of 2004.

"Making It Happen! shows the positive steps that can be taken when local communities and their schools work creatively to provide healthier alternatives to our children," said Deborah A. Price, Deputy Undersecretary of the US Department of Education’s Office of Safe and Drug-Free Schools.

The Making It Happen! success stories are available through the Food and Nutrition Services' Team Nutrition website at www.fns.usda.gov/tn and on CDC’s Division of Adolescent and School Health Web site at www.cdc.gov/healthyyouth.

For more information on CDC’s programs, please visit the CDC website at http://www.cdc.gov.

[Online source]: CDC Press Release. March 23, 2005. http://www.cdc.gov/healthyyouth/nutrition/Making-It-Happen/press-release.htm.

COPI's TV Reduction Tool for Tweens

The California Obesity Prevention Initiative's (COPI’s) Do More, Watch Less! TV reduction tool is targeted towards 10 to 14-year-olds in after school programs and other youth-serving organizations. The sessions aim to help youth incorporate more screen-free activities into their day while reducing the time they spend on screen-based activities such as watching TV, surfing the Internet, and playing video games.

This website is supported by the Preventive Health and Health Services Block Grant from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.
[Online Source]: http://www.dhs.ca.gov/ps/cdic/copi/.

This website is supported by the Preventive Health and Health Services Block Grant from the Centers for Disease Control and Prevention. Its contents are solely the responsibi-lity of the authors and do not necessarily represent the official views of CDC. To get a copy of this TV reduction tool, go to http://www.dhs .ca.gov/ps/cdic/copi/.

[Online Source]: http://www.dhs.ca.gov/ps/cdic/copi/.

Book Review:

Nutritional Ergogenic Aids

Athletes continually seek ways to gain a competitive advantage and often turn to nutritional ergogenic aids to build muscle, enhance energy, and improve physical performance. Unfortunately, limited research supports their efficacy or safety, leaving us to rely on hype and hearsay rather than hard science.

Nutritional Ergogenic Aids provides an up-to-date review of what is hypothetical and what is known about nutritional ergogenic aids. Among the 23 aids discussed are branched-chain amino acids, carnitine, creatine, glucosamine, chrondroitin sulfate, turine, biocarbonates, and ginseng. Experts from the fields of nutrition and exercise/sports science analyze data available from human studies, offer guidelines on safe use, and present current scientific evidence regarding the benefits, shortcomings, and usefulness of nutritional ergogenic aids.

This authoritative resource distinguishes the science from the speculation about this growing area of sports nutrition. It is an important reference for nutritionists, dietitians, exercise scientists, sports physicians, strength and conditioning specialists, and trainers who dispense advice about these products on a regular basis.

Source: CRC Press. Catalog no. 1626, June 2004, 552 pp. ISBN: 0-8493-1626-X, $99.95/ £60.99.

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