UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION
NUTRITION PERSPECTIVES
Volume 24, No. 2
Mach/April 1999
TABLE OF CONTENTS
USDA Releases Food Guide Pyramid for Young Children
Phytonutrients in Apple Juice Have Antioxidant Properties That May
contribute to Heart Health
Child Obesity and Body Image
Pesticide Exposure and Children
Dietary Sources of Minerals and Vitamins Among US Children
Food Security Fact Sheet
USDA Ready to Move Forward with Irradiation
Diabetes Education
FDA Approves Orlistat (Xenical) for Obesity
Does L-Carnitine Burn Fat?
International Olympic Committee Considers Creatine a Food
News about Osteoporosis: Fruits and Vegetables Prevent Bone Decay
Female Athletes and Meatless Diets
Can Calcium Supplements Reduce the Recurrence of Colorectal Adenomas?
Maybe, Says a New Study
The FDA Proposes Rules on "Per Day" Dietary Supplement
Labeling and Soy Protein Heart Disease Health Claim
NHLBI Urges Americans to Take Control of Their Hypertension
Upcoming Conferences:
Women on the Move ll: Mind Over Moment-A New Fitness Seminar at UCLA
Extension
Diets, Supplements, and Current Issues in Sports Nutrition
Subscription for NUTRITION PERSPECTIVES
Sheri Zidenberg-Cherr, PhD, Editor
University of California
Department of Nutrition
One Shields Ave.
Davis, CA 95616
NUTRITION PERSPECTIVES is prepared by Sheri Zidenberg-Cherr, PhD, Nutrition Specialist,
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
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USDA RELEASES FOOD GUIDE PYRAMID FOR YOUNG CHILDREN
On Thursday, March 25 the USDA released the Food Guide Pyramid for Young
Children, an adaptation of the original Food Guide Pyramid (FGP). It was developed to
simplify the educational messages and focus on young children's food preferences and
nutritional requirements. The Food Guide Pyramid for Young Children employs the same
concepts as the original Food Guide Pyramid.
Questions & Answers about The Food Guide Pyramid for Young Children
Why did the USDA develop a pyramid for young children?
The Food Guide Pyramid for Young Children was developed to help improve the diets of young
children two-to-six years-old. An adaptation of the original Food Guide Pyramid was needed
because young children have unique food patterns and needs, and many young children are
not eating healthful diets. In addition, early food experiences are crucial to food
preferences and patterns throughout life. USDA receives numerous requests for information
about feeding young children and how to use the Food Guide Pyramid with young children,
particularly with respect to serving sizes.
How is the Food Guide Pyramid for Young Children different from the original Food Guide
Pyramid?
To make the graphic and messages easier to understand for this audience and their parents
and caregivers the Food Guide Pyramid for Young Children is different in several respects
from the original,. First, the Pyramid has been simplified by shortening food group names
and using single numbers rather than ranges for numbers of servings. Second, the Pyramid
graphic was designed to be more understandable and appealing to young children. Realistic
food items, in single serving portions when possible, were used in the graphic. The
abstract "sprinkles" that symbolized fat and added sugars in the original
Pyramid were eliminated, and in the tip of the Pyramid these symbols were replaced with
drawings of food items. Third, the educational message that physical activity is important
is stressed by showing young children engaged in active pursuits surrounding the Pyramid.
Is USDA changing its advice about what kids should eat?
No. The new illustration and materials were designed to be more appealing and appropriate
for young children, but the nutritional advice has not changed. The decision not to change
the nutritional advice was based on research about what children eat and their nutritional
needs. Nutritionists at the USDA identified what foods young children actually eat. Using
a nationwide food consumption survey, they compared these food choices, if eaten in
amounts recommended by the Food Guide Pyramid, to children's nutrient needs. This research
showed that young children's nutritional needs could be met by eating combinations of the
foods they normally eat, in Pyramid recommended amounts. Therefore, the recommendations in
the Food Guide Pyramid for Young Children were based on the original Pyramid. The food
groups are the same as those in the original, and the numbers of servings recommended for
young children fall at the lower end of the recommended ranges.
What are the main nutrition messages illustrated by the new graphic?
The main focus of the Food Guide Pyramid for Young Children is on eating a variety of
foods. Eating foods from each of the major Pyramid food groups every day is the best way
for children to grow well and be healthy. Children would also benefit from getting more
variety within certain food groups, choosing more whole grains and dark green vegetables,
for example. While focusing on the importance of variety, the Food Guide Pyramid for Young
Children de-emphasizes fat restriction, recognizing that some fats are necessary for early
growth and development. The Dietary Guidelines for Americans suggest that fat in
preschoolers' diets be gradually reduced from their current levels (34% of total calories)
to the level recommended for most people (no more than 30% of total calories) by about 5
years of age.
How do children's actual diets compare to the recommendations made in the Food Guide
Pyramid for Young Children?
Young children are not eating the recommended numbers of servings from most of the five
major food groups. The recommendations from the Food Guide Pyramid for Young Children are
compared to the actual amounts eaten by young children and by all individuals age 2 and
over. The actual intakes are from a USDA nationwide survey of food consumption.
What foods in the graphic are there because children eat them often, and what foods are
there because children need to eat more of them?
Most of the foods in the graphic are those foods commonly eaten by young children. For
example, fruit juices are more popular with young children than whole fruits. Potatoes and
tomatoes are the most frequently eaten vegetables. Some cooked vegetables, such as green
beans, are eaten more often than salad greens by young children. Breads, ready-to-eat
cereals, pasta, and tortillas are all common grain choices of young children. Dark-green,
leafy vegetables such as spinach are not eaten frequently by young children, but were
included in the illustration to encourage children to eat them more often. Of dark-green
vegetables, broccoli is eaten most often by this age group. Baked potato is not the most
commonly served form of potato but was illustrated to encourage serving children lower fat
versions of this popular vegetable. Whole-grain products also were shown to encourage
eating them more often.
Does USDA expect that children two to six years old will understand the messages in the
Pyramid graphic?
The Food Guide Pyramid for Young Children graphic was not designed to be a stand-alone
piece. It is an educational tool to be used by parents and caregivers with their children.
The design incorporates features that parents, during focus group testing, said would make
it "child-friendly" and easier to use in teaching their children. However they
recognized that they would need to help their children understand the meaning of the
Pyramid. The Pyramid provides a framework for fun and interactive family learning and an
opportunity for parents to model healthful food choices. The accompanying booklet provides
parents and caretakers with tips to help them select foods for their children, ways to
model healthful behaviors, and activities to teach children about the Pyramid, nutrition,
and health.
Is the original Pyramid still appropriate for educational efforts targeted to 2- to
6-year-olds?
The original Pyramid illustrates the Food Guide developed for the general population, with
ranges of servings from each food group suggested to meet the nutritional and calorie
needs of people of diverse ages, sizes, and activity levels. Either Pyramid could be used
in educational efforts for groups that include parents of young children, depending on the
specific objectives of the education. Both illustrate the same concepts, but the adapted
graphic is more visually appealing to young children.
What impact will the Year 2000 Dietary Guidelines have on the Food Guide Pyramid for young
Children? Why release the children's pyramid now?
The food groupings and recommended number of servings in each group depicted on the Food
Guide Pyramid for Young Children graphic are based on meeting nutrient requirements (RDAs)
using foods patterns commonly consumed by young children. These factors will not be
changed by revisions in the Dietary Guidelines. The USDA has had many requests for the
type of information contained in the Food Guide Pyramid for Young Children and, therefore,
we believe the public is best served by releasing it now. The USDA has used the best
available science in developing the adapted Pyramid, and there is sufficient scientific
evidence to go forward with its release at this time.
What type of information is included in the accompanying booklet?
The booklet Tips for Using the Food Guide Pyramid for Young Children 2-to-6-Years-Old was
developed to provide easy-to-read nutrition information to help parents and caregivers
play a major role in teaching their children how to develop healthful eating habits early
in life. The booklet topics include: tips to encourage healthy eating, child-size serving
information, hands-on food and kitchen activities for parents and caregivers to do with
children, and snack and meal planning ideas. The graphic and its supporting booklet may be
downloaded from the USDA Center for Nutrition Policy and Promotion home page at
www.usda.gov/cnpp Single copies of the booklet (Stock Number 001-000-04665-9) may also be
ordered from the Government Printing Office by calling (202)512-1800. Make checks payable
to Superintendent of Documents and mail to Superintendent of Documents, US Government
Printing Office, Washington, DC 20402.
PHYTONUTRIENTS IN APPLE JUICE HAVE ANTIOXIDANT PROPERTIES
THAT MAY CONTRIBUTE TO HEART HEALTH
Consumers of all ages have known for decades, if not centuries, that apples
are good for them. And because apple juice tastes so good and is 100% juice, many people
have made it their fruit juice of choice. But until recently, the scientific basis for the
health benefits associated with apple consumption has been unclear.
According to UC Davis researcher Dr. Eric Gershwin, "Many phytonutrients,
particularly those known as 'phenolic' compounds, can be found in fruits as well as their
juices. These phenolics may prevent damaging oxidation that occurs to the "bad"
cholesterol in the bloodstream, and could possibly help stop cholesterol from clogging the
arteries." He adds, "It has long been suspected, but not directly proven until
now, that many of these healthful components in apples pass through to apple juice and to
other apple products." One reason a group of UC Davis nutrition researchers undertook
research on apple juice and fresh apple components was to identify the phytonutrients in
these products and to determine if they might have any affect on risk factors for heart
disease. Gershwin states, "What we found was that both apple juice and apples possess
antioxidant activity that may have beneficial effects on human health."
Research Results: Apple Juice May Reduce Risk of Heart Disease
To investigate whether apple juice and apples contain those phytonutrients that have
antioxidant properties, a UC Davis research team (Drs. Debra Pearson, Christine Tan, Bruce
German, Paul Davis, and Eric Gershwin from the Departments of Internal Medicine, the Lipid
Laboratory, the Department of Nutrition and the Department of Food Science) recently
conducted in vitro research on apple juice and fresh apple components. They specifically
evaluated the phenolic content of apple juice from various processors around the country
and measured the relative antioxidant activity of these juices using a variety of
laboratory techniques. While the juices were the primary focus of the research, fresh
apple components, including the peel and the flesh, were also evaluated (1).
The laboratory analyses clearly identified and quantified several phenolic compounds that
were put into several classes (e.g., cinnamates, anthocyanins, flavan-3-ols, flavonols.)
Although the researchers note that the phytonutrient profiles of the tested products
varied, all apple juices and apple components exhibited significant antioxidant properties
that had the capability to stop the oxidation of low density lipoprotein (LDL or
"bad") cholesterol and, in fact, did inhibit LDL oxidation in vitro.
The research defined the phytonutrient compounds in both apple juice and apple components
and discussed how these compounds might reduce the risk of heart disease by preventing LDL
oxidation. As a result of the analysis done to date, it is clear to these researchers that
apple juice has the potential to become a significant aid on the prevention heart disease.
"We were pleasantly surprised at the results we saw," concludes Gershwin.
"Our research should go a long way to assuring parents who feed their children a
glass of apple juice or an apple every day that it just might keep the doctor away."
Other recent studies that have demonstrated apples' health benefits include two major
epidemiological studies from Finland. These studies found that the reduced risk of both
lung cancer and heart disease was specifically attributable to the phytonutrients-most
notable quercetin-found in apples (and in the study on heart disease, apples, and onions).
The researchers from Finland's National Public Health institute in Helsinki did not
attribute their findings to fiber (an important component of fresh apples), but rather to
these phytonutrients that offer many benefits, not unlike the antioxidants consumers hear
so much about today.
Phytonutrients: On Health's Forefront
Natural compounds, such as phytonutrients, found in plant foods like fruits have been
shown to protect against cardiovascular disease, cancer, and general oxidative damage to
tissues. Thus, these phytonutrients act very similarly to better-known antioxidants like
vitamins C and E. The American Heart Association, in a scientific statement issued in
February (2), notes that considerable scientific evidence has shown that antioxidants
(like the phytonutrients found in fruits and vegetables) may contribute to disease
resistance and that epidemiological evidence indicates that greater antioxidant intake is
associated with lower disease risk. "That is why the American Heart association
continues to recommend that people increase their consumption of antioxidant-rich foods
such as vegetables, fruits, and whole grains," says the statement's author, Diane
Tribble, PhD, a member of he American Heart Association's volunteer nutrition committee
and staff scientist at the UC Berkeley Lawrence Berkeley National Laboratory. As a result
of the analysis done to date at UC Davis, it is clear to these researchers that apple
juice and apples have the potential to become a significant aid in the prevention of heart
disease.
Source: Pearson, DA; Tan, CH; German, JB; Davis, PA; Gershwin, ME. Apple juice inhibits
human low density lipoprotein oxidation. Life Sciences 64(N21):1913-1920, April 16, 1999.
CHILD OBESITY AND BODY IMAGE
In observance of National Nutrition Month, the American Academy of Pediatrics (AAP) News
asked William Dietz, MD, FAAP, and Loraine Stern, MD, FAAP, co-editors of the AAP's newest
book for parents, Guide to Your Child's Nutrition, to discuss key issues on children and
nutrition. Following are some questions and answers.
Q: How have these key nutritional issues changed over the last decade or so?
Dr. Dietz: The prevalence of obesity has doubled among children and adolescents between
1980 and 1994. The preoccupation with body weight is much more prominent among young girls
than it has been before. We have no data on feeding interactions, but my impression is
that these are common sources of disagreement within families.
Dr. Stern: Parents used to express concern that their young children were too skinny. Now,
for the past 10 years or so, I hear concerns that their child is too fat, even if the
child is normal. It seems many parents have distorted body images for their children as
well as themselves.
Q: What do you anticipate will be the emerging nutritional issues in the new millennium?
Dr. Dietz: I think we will see more of the same. In busy families, more care will be
provided at the discretion of people outside the home. Take-out food and the amount of
money that families spend on food outside the home will continue to increase. This means
that families will have to become increasingly aware of the fat and caloric content of
these foods, and recognize that they need to be better informed consumers. In addition,
the manufacturers of these products will continue to rely on the media to promote them to
children. Therefore, ongoing attention to media literacy will be essential.
Dr. Stern: We will have to address obesity as a family problem, which we do in the AAP
nutrition book. In addition, some consumers who have little if any basis for worry are
obsessed with children's exposure to chemicals, while nothing is being done about
firearms! Hopefully, supermarkets will have increasingly diverse selections for fresh
meals that can be purchased ready to sauté, steam, or microwave. I see parents and
children increasingly over-committed to activities and obligations so that shared meals
are abbreviated. If these meals can be prepared at home with wholesome food and without
the distraction and poor nutrition of the drive-through, we may improve habits.
Q: What can pediatricians do within the confines of well-child visits to address childhood
nutrition issues?
Dr. Stern: Just as we should have started to ask about television viewing and time spent
in front of the video screen, pediatricians should ask about family eating
habits-particularly the social aspects. We should encourage entertaining and
non-emotionally-charged conversations, allowing meals to be a time when parents and
children can listen to each other.
Dr. Dietz: I would add counseling about food and activity from early childhood, as well as
helping families understand and implement the rule that "Parents are in charge of
what children are offered and when, and children are in charge of whether they eat what is
offered and how much."
Q: What one piece of advice would you give the parents of your patients regarding their
child's nutritional health?
Dr. Stern: Serve food that is attractive and healthful and then back off. If your child
does not eat what you serve, he/she will not die of starvation, and it does not mean
he/she does not love you.
Guide to your Child's Nutrition is available from AAP Publications by calling (800)
433-9016 or by visiting the on-line AAP catalog at www.aap.org
. Quantity discounts are available for AAP members.
Source: AAP News 15(3): 30 March 1999.
PESTICIDE EXPOSURE AND CHILDREN
One of the first federal research center sites committed to studying
environmental health hazards to children will study the impact of pesticides on children.
Researchers at the University of California Berkeley School of Public Health will head a
five-year study measuring the effects of pesticide exposure on the children of California
farm workers. The study will examine if and how pesticides affect child growth,
development, and illnesses, such as respiratory complications. Children can be exposed to
pesticide residues in their food and from their everyday surroundings (1).
Reference: 1. California Agriculture 52(5): 5, September/October 1998.
Source: Nutrition Week 28(47): 7, December 11, 1998.
DIETARY SOURCES OF MINERALS AND VITAMINS AMONG US CHILDREN
What foods are making the biggest nutritional impact on the mineral and
vitamin intake of children in the US? The National Cancer Institute (NCI) and the US
Department of Agriculture (USDA) recently released the contribution of food groups among
children ages two to eighteen years from the 1989-91 Continuing Survey of Food Intake of
Individuals ll. From almost 2500 individual foods reported, 13 groups were created on the
basis of similar nutrient content and consumption. This is the first study to provide
estimates on the contribution of various foods to intakes of nutrients by children of all
ages using a nationally representative sample.
Minerals
For minerals, the results showed that milk supplied more than 50% of the calcium intake.
Cheese ranked second as an important source of calcium. Of note is the fact that milk's
contribution to calcium intake decreased in the older children, while cheese's
contribution increased with age. Milk also contributed more to magnesium intake (23%) than
any other food group. For iron, enriched and fortified grain products were at the top of
the list. Ready-to-eat cereal was the highest contributor to iron intake among all
children (27%), amounting to more than three times the contribution of beef (98%) and
double that of yeast bread (13%). Beef was the top contributor of zinc (22%) among all
groups, followed by milk (16%) and ready-to-eat cereal (11%).
Vitamins
It was not a surprise to find that fruits and vegetables and their juices were the primary
sources of vitamin C, vitamin A, and carotene. In fact, orange/grapefruit juice
contributed more than 25% of children's vitamin C intake, and it increased to over 30% for
12- to 18-year-olds. Carrots contributed about 15% to all children's vitamin A and nearly
50% of their carotene intake. Folate-dense foods, such as orange/grapefruit juice and
dried beans/lentils, contributed at least 15% of folate intake, while spinach/greens and
oranges/tangerines ranked lower because of infrequent consumption. Fortified ready-to-eat
cereal was the top contributor by far to folate (23% to 33%), as well as the primary
source for vitamin A, and the third or fourth highest contributor for vitamin C. Fruit
drinks, although only partially made of juice, were the second biggest source of vitamin C
(14%) for all groups.
Fortified Cereals
One of the headlines resulting from publication of these intake data was that fortified
foods play a dominant role in micronutrient intakes of our children. Fortified
ready-to-eat cereals appear as the top sources for most vitamins and minerals, reflecting
the high level of fortification, as well as the frequency of consumption among all
children. A similarly important role for cereals as contributors to folate intake has been
observed in the elderly as well. However, this article cautions that although it may be
beneficial that fortified cereals increase the intake of certain nutrients such as folate
or iron, this may be problematic in terms of intake of other potentially beneficial
dietary constituents that are present in other less frequently consumed foods. An
additional benefit of ready-to-eat cereals is the pairing with milk, a key source of
calcium. Thus nutrition educators are advised to continue the encouragement of low-fat or
non-fat milk with cereal as well as the addition of fruits and vegetables to the diet of
children.
Source: Nutrition and the MD 25(3):7, March 1999.
FOOD SECURITY FACT SHEET
What does Food Security mean?
Access of all people at all times to enough food for an active, healthy life. Foods
security includes at a minimum: 1) the ready availability of nutritionally adequate and
safe foods, and 2) an assured ability to acquire acceptable foods in socially acceptable
ways (e.g. without resorting to emergency food supplies, scavenging, stealing, or other
coping strategies).
Why should we define food security and why should we measure it?
¨ Food security is an integral part of basic family and individual well-being, comparable
to health and housing.
¨ We now have the resources and technology to achieve food security for every person.
¨ The failure to do so should receive the full attention of governments and citizens at
every level. The antitheses of food security, food insecurity with or without hunger, is
unacceptable in its own right, and may lead to more serious health and developmental
problems for humans at all age levels.
¨ Monitoring food security is important to fully understand the nutritional and economic
status of individual Americans, and for identifying groups, subgroups, and geographic
locations with high-risk conditions.
¨ Accurate measures of food security are needed for program planners to design,
implement, and assess the efficacy of current programs and to improve their effectiveness
in meeting their objectives.
Has Food Security been measured in the US?
¨ In 1995, the US Bureau of Census conducted the first food security survey, as a
supplemented to its regular Current Population Survey.
¨ The food security survey was developed by the USDA to measure the extent and severity
of food insecurity and hunger in the US.
¨ Results of this first survey showed that:
¨ 88.1 percent of households were food secure
¨ 7.8 percent of households were food insecure without hunger
¨ 4.1 percent of households were food insecure with hunger
What does this mean?
This means that approximately 12 million households in the US are not food secure and
about 4 million of these households are considered to experience hunger.
Why is this happening?
¨ Poverty and low-paying jobs are the most significant inhibitors of food Security.
¨ Low-paying jobs have a major impact on hunger; of the 36.4 million people living in
poverty, 15 million (41%) are employed persons and 8 million (21%) are children.
¨ The Welfare Law will cut $54 billion from anti-poverty programs over the proposed
6-year period.
¨ Food Stamp benefits will decrease from 80 cents per meal to 66 cents per meal.
¨ The USDA estimates that every $40,000 annual loss to Food Stamps is equivalent to one
lost job in related food industries (farming, processing, wholesale, etc.)
¨ In 1996, requests for emergency food increased in the US by 11% from the previous year,
and numbers are continuing to rise.
¨ Approximately 62% of those needing emergency food assistance are families; and children
under 17 account for 41% of all clients. One third of emergency food clients have at least
one adult family member employed.
¨ less than 1/2 of emergency food clients receive food stamps
¨ more than 1/3 of emergency food clients have been rejected for food stamps
¨ Religious organizations and charities are expected to suffer a 36-46% decline in
contribution to emergency food programs by the year 2002 due to decreased government
assistance.
What is Food Insecurity?
¨ Limited or uncertain availability of nutritionally adequate and safe foods or limited
or uncertain ability to acquire acceptable foods in socially acceptable ways.
¨ Hunger is a severe form of food insecurity.
¨ Malnutrition is a potential consequence of hunger.
Why should we be concerned?
Maternal Nutrition Status
Fetal Growth and Development
¨ Food-insecure females are more likely to give birth to low-birth-weight infants than
food-secure females.
Fetal Mortality
¨ Infant mortality and morbidity risks are increased if females are food-insecure.
Child Nutritional Issues
Pediatric Growth and Development
¨ Food-insecure infants and children are at greater risk of stunted growth.
¨ Undernourished children have lower height-for-weight and height and weight-for-age
values than adequately nourished children.
Cognitive Growth and Development
¨ Inadequate nutrition is a major cause of impaired cognitive development in children.
¨ Anemia remains a significant health problem among low income children; iron deficiency
has an adverse affect on a child's ability to learn by influencing attention span and
memory.
¨ Low-income children are at higher risk for lead poisoning, and lead poisoning can
result in neurodevelopmental disorders.
Behavioral and Emotional Problems
Compared to non-hungry children, hungry children are:
¨ four times more likely to suffer from fatigue
¨ three times more likely to suffer from irritability
¨ twelve times as likely to report dizziness
¨ three times as likely to suffer concentration problems
Illness and Infectious Diseases
¨ Food-insecure children report more frequent ear and respiratory infections, colds, and
diarrhea than food-secure children.
Elderly Nutritional Issues
Social Factors
¨ In 1993, an Urban Institute Study showed that between 2.5 to 4.9 million older
Americans were food-insecure.
¨ Social isolation and inadequate public transportation are barriers to elders in
receiving adequate health care, and living alone is a major risk factor for poverty.
Adequate diets may also be unavailable, unaffordable, or inaccessible.
Morbidity and Mortality
¨ A majority of the elderly are not consuming even 2/3 of the nutrients they need daily,
which may lead to weight loss, malnutrition, and dehydration.
¨ Hospital length of stay of malnourished elderly can be extended by almost 90% when
compared to hospital stays of healthy, older adults.
¨ Dehydration is a significant but preventable cause of hospitalization in the elderly
and is associated with an increased risk of mortality.
Health Care Costs
¨ During 1993 alone, an estimated $910 billion was spent on health care.
¨ On average, health care expenditures for the US are twice that of other developed
nations.
¨ With the advances of technology and the high incidence of low-birth-weight births, the
technical care of these infants cost more than $2 billion per year.
¨ Over a decade ago, health care, education, and child care for the 3.7 million children
born low-birth-weight cost $5.7 billion dollars, and accounted for 10% of all health care
costs for children.
¨ Poor, minority, and uninsured children suffer inadequate medical care twice as often as
other children.
¨ Medical care at the end of life consumes 10% to 20% of the total health care budget and
27% of the Medicare budget.
Source: Prepared by the Hunger and Malnutrition Dietetic Practice Group of The American
Dietetic Association, 1998.
USDA READY TO MOVE FORWARD WITH IRRADIATION
The USDA is taking the next step toward irradiation of red meat and is
expected to issue a proposed rule on the subject this summer. The proposed rule will
address standards for the use of meat irradiation, said Dan Englejohn of the USDA's Food
Safety and Inspection Service at a recent conference on irradiation in Washington, DC. The
Agriculture Department must consider several issues in the proposed rule. Englejohn said
one possibility is to use irradiation as a pathogen-reducing practice all along the
processing line, not just at the end. The rule will also address possible inconsistencies
between irradiation of chicken and red meat. For example, chicken must be irradiated in
its package with oxygen-permeable wrapping.
Labeling will be one of the more contentious issues addressed in the proposed rule, said
Englejohn. All irradiated products must carry the radura, the irradiation symbol, as well
as the statement, "treated with irradiation." But labeling carcass trimmings
that end up in other products such as soups and chili is another matter. It is up in the
air at this point whether or not these foods will be required to carry the radura symbols
as well, said Englejohn.
Also up in the air is consumer acceptance of irradiation. While the food industry is quick
to label the process a public health intervention, the public is still a little wary, said
Bob Hahn of Public Voice for Food and Health Policy. "Consumers want irradiated food
to be labeled clearly," said Hahn.
Source: Nutrition Week 28(14): 2, April 10, 1999.
DIABETES EDUCATION
A campaign alerting teachers and parents to early symptoms of diabetes in
children can increase the chances youngsters will be diagnosed before suffering from
diabetic ketoacidosis (DKA), a potentially life-threatening complication, according to
Italian researchers.
The authors put up more than 1,000 posters in 177 schools and 52 pediatricians' offices in
Parma, Italy. The posters included messages on symptoms of diabetes, including nighttime
bedwetting and excessive thirst. They also gave pediatricians devices to measure blood
glucose levels and glycosuria s well as patient cards with symptoms, guidelines for
diagnosis and a toll-free number to contact researchers. During the eight-year campaign,
investigators studied the incidence of DKA in newly diagnosed diabetic children ages 6 to
14 in Parma (group 1) and two nearby areas that did not participate in the prevention
program (group 2).
Twenty-four children in group 1 and 30 children in group 2 were diagnosed with
insulin-dependent diabetes mellitus (IDDM). DKA was present in 12.5 percent of the
children in group 1 and 83 percent in group 2. In addition, 57 percent of parents in group
1 said messages displayed on the posters led them to see a pediatrician. The authors
concluded that the $23,470 educational campaign led to the early diagnosis of IDDM and a
reduction of the incidence of DKA from 78 percent before the program was introduced to
12.5 percent afterward.
Source: AAP News 15(4): 3, April 1999.
FDA APPROVES ORLISTAT (XENICAL) FOR OBESITY
The Food and Drug Administration has approved orlistat, a new drug to treat obesity.
Orlistat is the first drug in a new class of non-systemically acting anti-obesity drugs
known as lipase inhibitors. Unlike other obesity drugs, orlistat prevents enzymes in the
gastrointestinal tract from breaking down dietary fats into smaller molecules that can be
absorbed by the body. Absorption of fat is decreased by about 30 percent. Because
undigested triglycerides are not absorbed, the reduced caloric intake may have a positive
effect on weight control.
The effects of orlistat on weight loss, weight maintenance, and weight regain and on a
number of obesity-related illnesses were assessed in seven long-term multicenter, clinical
trials. These studies included about 2,800 patients treated with orlistat and 1400
patients treated with placebo. A well-balanced, reduced-calorie diet was recommended for
all patients in the weight-loss and weight-maintenance study periods. The diet was
intended to decrease caloric intake by 20 percent and to provide 30 percent of calories
from fat. In addition, all patients were offered nutritional counseling. Of the patients
who completed one year of treatment, 57 percent of the patients treated with orlistat and
31 percent of the placebo-treated patients lost at least 5 percent of their baseline body
weight.
The recommended dose of orlistat is one capsule with each main meal that includes fat.
During treatment, the patient should be on a nutritionally balanced, reduced-calorie diet
that contains no more than 30 percent of calories from fat. Orlistat is indicated for
obese patients with a body mass index (BMI, a measure of weight in relation to height), of
30 or more, or for patients with a BMI of 27 or more who also have high blood pressure,
high cholesterol, or diabetes. A person who is 5'5" in height and weighs 180 pounds
would have a BMI of 30. Because orlistat reduces the absorption of some fat-soluble
vitamins and beta carotene, patients should take a supple-ment that contains fat-soluble
(A, D, E, and K) vitamins and betacarotene. The most common side effects of orlistat are
oily spotting, gas with discharge, fecal urgency, fatty/oily stools, and frequent bowel
movements. Orlistat is manufactured by Roche Laboratories Inc. under the trade name
Xenical.
Source:
DOES L-CARNITINE BURN FAT?
L-Carnitine is not present in adipose tissue. Therefore, it cannot influence the breakdown
of fats (triglycerides). It functions in the muscle cells and organs is to bind long-chain
fatty acids derived from triglycerides within the cells or to form albumin-bound fatty
acids in the blood, and transport these into mitochondria. However, the rate of fatty acid
oxidation in mitochondria is determined by the availability of fatty acids in the cytosol
(cell fluid) rather than by the availability of carnitine.
Supplemented L-carnitine does not activate enzymes involved in fatty acid oxidation.
Activation of enzymes involved in fatty acid transport by carnitine is not probable
either, since carnitine functions as a biocatalyst (carrier) and not as a substrate. Last,
but not least, it has been shown in vivo, that after L-carnitine-supplementation no
"extra" carnitine was taken up by skeletal muscle (1,2). The intramuscular
concentration of carnitine remained constant, while the excretion of free and esterified
carnitine (acetylcarnitine) in urine increased dramatically.
In conclusion, L Carnitine is no a "fat burner". It does not accelerate either
the breakdown of fat or the loss of body weight. Body weight/fat can only be reduced if
the energy supplied by food is lower than the energy requirement for basal body functions
and physical activity.
Reference: 1. Soop et al. Applied Physiology 64(6): 2394-99, 1988.
2. Wagenmakers AJM, Carnitine Supplementation Effects on Exercise Metabolism and
Performance. Insider 1, 1998.
Source: Insider 6(2):1, September 1998.
INTERNATIONAL OLYMPIC COMMITTEE CONSIDERS CREATINE A FOOD
The International Olympic Committee (IOC) has decided that creatine will not
be added to its banned-substance list. The head of the IOC medical commission, Prince
Alexandre de Merode, said that creatine is considered a food and could not be compared to
testosterone or anabolic steroids, so it should not be prohibited. Many National Olympic
Committees had been trying to get creatine added to the IOC's banned substance list
because of short-term problems such as muscle cramping and dehydration associated with its
use.
Source: Nutrition Forum 16(2):1, March/April 1999.
NEWS ABOUT OSTEOPOROSIS: FRUITS AND VEGETABLES PREVENT BONE
DECAY
While we hear a great deal about the importance of milk and other calcium-containing foods
for bone health, a new study published in the American Journal of Clinical Nutrition shows
that fruits and vegetables are also important in the prevention of osteoporosis. The
authors evaluated participants from the Framington Heart Study and found that lifelong
dietary intakes of potassium, magnesium, and fruit and vegetables were determinants of
bone mineral density in elderly men and women.
Katherine L. Tucher, PhD, associate professor of nutrition at Tufts University and lead
investigator of the study says, "This suggests that a good quality diet in adulthood
is important to bone health beyond the better known contributions of calcium and vitamin
D, and provides yet another reason to emphasize the intake of fruits and vegetables."
According to Dr. Douglas Kiel, assistant professor of medicine at Harvard Medical School
and associate director of Medical Research at Hebrew Rehabilitation Center for Aged,
"Normal digestion produces increased acidity. In this environment, bone acts as a
buffer vase. Minerals are drawn out of the bone to neutralize the acid, thereby reducing
the strength of the bone. Fruits and vegetables help to prevent this loss of bone mineral
density because they create a more alkaline environment in the body-they neutralize the
acid without depending on the buffering effects of the bone minerals. It is also possible
that potassium and magnesium have direct effects on bone cells."
People who consume a lot of highly processed foods often lack adequate amounts of
potassium and magnesium. Good sources of potassium include fruits and vegetables such as
bananas, oranges, tomatoes, potatoes, broccoli, and melon. Good sources of magnesium
include a variety of whole foods including fruits and vegetables, milk, fish, and whole
grains.
Osteoporosis affects roughly 25 million Americans, often leading to bone fractures. Bone
is living tissue and its density is constantly affected by diet and exercise. Although the
body builds and stores bone more efficiently during the younger years, it is never too
late to start healthy bone-building habits. Eating fruits and vegetables can help!
Reference:
1. Tucker KL; Hannan MT; Chen HL; Cupples LA; Wilson PWF; Kiel DP. Potassium, magnesium,
and fruit and vegetable intakes are associated with greater bone mineral density in
elderly men and women. AJCN 69(4):727-36 April 1999.
Source: Public Information Committee (PIC) ASCN/ASNS Press Release March 30, 1999.
FEMALE ATHLETES AND MEATLESS DIETS
A meatless diet in young female athletes should be a red flag to physicians
because it may indicate inadequate intake of protein, iron, and zinc, as well as
amenorrhea and serious eating disorders.
Physically active adolescents may believe red meat is fattening and therefore will
eliminate it from their diet so they can reach or maintain a low body weight. The authors
point out that girls may try to legitimize their eating behavior by calling themselves
vegetarians. Young athletes may not be aware they are putting themselves at risk for
adverse effects on health, training, and performance. Since meat contains more easily
absorbed forms of iron and zinc than plant foods, those who do not eat meat may not get
enough of the two key minerals. Low dietary iron intake can contribute to iron deficiency,
which is associated with changes in immune function, cognitive development, temperature
regulation, energy metabolism, and work performance. Zinc deficiency is associated with
anemia, short stature, and impaired wound healing.
In addition, non-meat-eating athletes may be deficient in protein, especially if they do
not consume enough calories. More protein is needed to maintain nitrogen balance when
energy intake is low. Meatless diets also have been linked to menstrual abnormalities and
eating disorders. Amenorrhea is associated with premature osteoporosis and increased risk
of scoliosis and stress fractures. Anorexia nervosa and bulimia can cause serious health
problems and death.
The authors suggested that physicians ask about weight, nutrition, menstrual function, and
performance goals during a pre-participation exam and educate athletes about eating a
balanced diet that includes alternative sources of protein, iron, and zinc.
Reference: Loosli, AR and Ruud, JS. The Physicain and Sports Medicine. 26(11):45-8 1998.
Source: AAP News 15(2): 2, February 1999
CAN CALCIUM SUPPLEMENTS REDUCE THE RECURRENCE OF COLORECTAL
ADENOMAS?
MAYBE, SAYS A NEW STUDY
The results of a clinical study published in The New England Journal of
Medicine indicate that supplementation with calcium may reduce the risk of recurrence of
colorectal adenomas (also referred to as polyps). Principal investigator John A. Baron,
MD, MS, MSc, of Dartmouth Medical School led the Calcium/Polyp Prevention Study, a
multicenter study funded by the National Institutes of Health. Dartmouth Medical School
was the coordinating center for this clinical trial that was designed to assess the
benefits of calcium supplementation on colorectal adenoma recurrence in patients with a
history of colorectal adenomas.
Why Adenomas/Polyps are Important
"Adenomas may develop into colorectal cancer. Less than a year into the study, we saw
positive results due to calcium-fewer adenomas and so less potential for cancer,"
said Baron.
The study used calcium carbonate supplements (1200 mg of elemental calcium provided by
Caltrate calcium supplements) and was conducted over a four-year period. Eight hundred and
thirty-two patients were randomized into two groups: calcuim-supplemented and placebo The
average age of the patients in the study was 61 years, and 72% were men. Patients
underwent two colonoscopies to assess the effects of calcium. Medical complaints and
complications were not associated with the use of calcium supplementation.
Within a year, the positive effects of calcium were noted. Over the full four-year course
of the study, the results showed that subjects who received the calcium supplements had a
19% decrease in the risk of recurrence of any adenoma and a 24% decrease in the number of
adenomas, which are known precursors of colorectal cancer.
Clinical Significance
According to the American Cancer Society (ACS), colon and rectal cancers (often referred
to together as colorectal cancer) were responsible for approximately 28,600 deaths in
women and 27,900 deaths in men in the US in 1998. In addition, the ACS estimated that
there were new cases of colorectal cancer in 67,000 women and 64,600 men in the US in
1998. Overall, colorectal cancer accounted for about 11% of new cases of cancer reported
in 1998 and was responsible for about 10% of all cancer deaths in the US. Colorectal
cancer is the third most common cancer in women and men . The results of the Calcium/Polyp
Prevention Study suggest new preventive measures to combat recurrence of colorectal
adenomas.
This study provides the most compelling evidence to date about the beneficial effects of
calcium in reducing the recurrence of colorectal adenomas. Earlier studies in humans and
animals indicated positive effects, but the Calcium/Polyp Prevention Study provides new
statistically significant results in human subjects in a multicenter placebo-controlled
trial. Baron notes "Epidemiological data regarding the association between dietary
calcium and the risk of colorectal cancer have varied considerably, but in aggregate are
consistent with the effect we observed."
Reference: New England Journal of Medicine 340(2):101 1999.
Source: Nutrition and the MD 25(3):5, March 1999.
THE FDA PROPOSES RULES ON "PER DAY" DIETARY SUPPLEMENT
LABELING AND SOY PROTEIN HEART DISEASE HEALTH CLAIM
In the November 10, 1998 Federal Register, the FDA proposed a health claim
for foods that link soy protein consumption (in conjunction with a diet low in saturated
fat and cholesterol) with a reduced risk of coronary heart disease (CHD). Studies show
that 25 grams of soy protein a day have a cholesterol-lowering effect. The FDA has
concluded that a soy product could qualify for the health claim only if it contained at
least 6.25 grams of soy protein a serving because soy protein occurs in or can be added to
a variety of foods and beverages, making it possible to eat as many as four servings of
soy-protein-containing products a day. If each serving contained at least 6.25 grams of
soy protein, four servings a day would provide the requisite 25 grams of soy protein.
In the January 12, 1999 Federal Register, the FDA proposed to amend its nutrition labeling
regulations for dietary supplements to provide that the quantitative amount and the
percent of Daily Value (DV) of a dietary ingredient may be voluntarily declared on a
"per day" basis in addition to the required "per serving" basis, if a
recommendation is made on the label that the supplement be consumed more than once a day.
The Federal Register may be accessed on-line at www.access.gpo.gov/nara/index.html
Source: FDA Consumer 33(2): 2, March/April 1999.
NHLBI URGES AMERICANS TO TAKE CONTROL OF THEIR HYPERTENSION
May is National High Blood Pressure Education Month and this year's theme highlights the
threat of uncontrolled hypertension. The National Heart, Lung, and Blood Institute (NHLBI)
urges Americans: "If Your Blood Pressure Is Not Lower Than 140/90, Ask Your Doctor
Why." NHLBI sponsors the hypertension month effort with the National High Blood
Pressure Education Program (NHBPEP), which it coordinates.
Who is affected by high blood pressure?
High blood pressure affects about 50 million--or one in four--American adults. Of those
with hypertension, about 68 percent are aware of their condition--but only 27 percent have
it under control. The reasons for this include not taking drugs as prescribed and/or not
taking a medication that sufficiently lowers blood pressure.
What are the potential health consequences of high blood pressure?
Hypertension can lead to stroke, heart failure, or kidney damage. To help prevent that,
blood pressure must be lowered to less than 140/90 mm Hg.
How can high blood pressure be controlled?
Normal blood pressure <130/< 85 mm Hg. "We advise Americans to talk about their
blood pressure with their doctor," said NHLBI Director Dr. Claude Lenfant. "They
should have their blood pressure checked and, if it's high, ask about adjusting their
medication and whether they've made the necessary lifestyle changes to bring it to below
140/90. The lifestyle changes to control high blood pressure are:
¨ if overweight, lose weight;
¨ become physically active;
¨ choose foods lower in salt and sodium; and
¨ limit alcohol intake.
What resources are currently available?
The NHLBI and the NHBPEP have set up a special web site, which can be accessed through the
NHLBI home page at http://www.nhlbi.nih.gov
The NHLBI and the NHBPEP also have written materials available:
¨ Facts about the DASH diet-DASH is an eating plan rich in fruits, vegetables, and low
fat dairy foods and lower in saturated fat, total fat, and cholesterol. It has been shown
to reduce high blood pressure. The fact sheet gives an overview of the plan and a week of
DASH menus.
¨ Heart healthy recipes from the NHLBI Stay Young At Heart Program
¨ Latino and African American recipe books.
¨ Controlling High Blood Pressure: A Woman's Guide, A guide in Spanish* also is
available.
¨ Facts About How to Prevent High Blood Pressure-This fact sheet gives an overview of
hypertension.
¨ Special booklets series for African Americans and Latinos-how to prevent and control
cardiovascular risk factors. The Latino series is in Spanish and English."
¨ I.Q. Quizzes-about the Healthy Heart and Physical Activity.
These materials can be ordered from the NHLBI Information Center, PO Box 30105, Bethesda,
MD 20824-0105. Single copies are either free or have a small charge. All are available
free at the special hypertension control web site.
Also, check out NHLBI's new Achieve Your Healthy Weight website. It can be accessed
through the NHLBI home page or the high blood pressure education month site. The site
offers practical information on weight loss, including heart healthy recipes, and tips on
how to make behavior changes, choose a weight loss program, and shop for low calorie
foods. Finally, for recorded messages about high blood pressure prevention and control,
call toll-free 1-800-575-WELL. "May is an opportunity to make a new start on a
healthier heart," said Dr. Edward Roccella, NHBPEP Coordinator. "The same
lifestyle steps that control high blood pressure also may prevent it. So everyone in the
family can take action together.
UPCOMING CONFERENCES:
WOMEN ON THE MOVE ll: MIND OVER MOVEMENT-A NEW FITNESS SEMINAR AT UCLA
EXTENSION THIS SPRING
Scientific research clearly supports the specific benefits of exercise for
disease prevention and health promotion for women. Concurrently, the competing
responsibilities of modern life-relationships, parenting, care-taking, and career-make it
difficult for most women to exercise daily.
In Women on the Move, experts will update participants on the latest health and fitness
research, focusing on women ages 35-65, and provide practical tips and skill applications
to help them add fitness and fun to their daily activities.
The seminar meets Saturday, 9:00 am to 3:30 pm, May 22, at the UCLA 3400 Boelter Hall. The
fee is $70 (noncredit) and $125 (credit).
For complete details, call (310) 825-7093 or write: UCLA Extension Sciences, 10995 Le
Conte Ave. Ste. 714, Los Angeles, CA 90024. To register for courses, call (310) 825-9971
or (818) 784-7006.
DIETS, SUPPLEMENTS, AND CURRENT ISSUES IN SPORTS NUTRITION
The American Society for Clinical Nutrition and The American College of Sports
Medicine is sponsoring a program on June 1, 1999 at the Sheraton Seattle, in Seattle
Washington. Each presentation will be 40 minutes long, consisting of a 30 minutes talk and
10 minutes of questions and answers.
Educational Benefits:
Physical activity and fitness with optimal nutrition are key strategies for promoting the
health of the nation. The American College of Sports Medicine (ACSM) and The American
Society for Clinical Nutrition (ASCN) are active members of the Healthy People 2000
Consortium on National Health Promotion and Disease Prevention Objectives. This
educational activity is sponsored by the two societies and is designed to provide
physicians, dietitians, exercise scientists, and other health professionals with the
rationale and practical knowledge of the role of nutrition in exercise and sports. Experts
in the fields of clinical nutrition, epidemiology, psychology, and sports medicine will
present the latest research findings and will discuss their implications for competitive
and recreational athletes.
Continuing Education Credits:
The ASCN designates this educational activity for up to 7.5 hours in category 1 credit
towards the American Medical Association Physician's Recognition Award. The ACSM's
Professional Education Committee certifies that this continuing education offering meets
the criteria for 7.5 hours of ACSM Continuing Education Credit. The Commissions of
Dietetic Registration will be requested to approve the program for continuing education
credits for registered dietitians. CME hours will be awarded at the time the certificate
of attendance form is completed and returned.
Tuition
The enrollment fees are a follows: MDs, $150; PhDs, RDs, and others, $100; Students, $60.
Target Audience
ASCN and ACSM members, MDs, PhDs, RDs, and other health-care professionals in the field of
nutrition, sports medicine, or both. For more information or to register over the phone
please call (301)571.1863.
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NUTRITION PERSPECTIVES
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