Nutrition Perspectives May/June 2004

UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION

NUTRITION PERSPECTIVES

Volume 29, No. 3
May/June 2004

TABLE OF CONTENTS

Eliminate Childhood Lead Poisoning by 2010
New WHO Guidelines to Promote Proper Use of Alternative Medicines
Health Status of American Indians
Banning Suspect Supplements
Fluoride Supplements for Kids
Inside the Dietary Guidelines Advisory Committee Meeting
FDA Prohibits Ephedrine Alkaloids
Millions of Hispanics at Increased Rick for Type 2 Diabetes
Poor Diet and Lack of Exercise Are Catching Up With Smoking as Leading Cause of US Death
Child Nutrition and WIC Reauthorization Act
Health Canada Publishes Review of Caffeine Scientific Literature
Traveling the Road to Trans Fat Labeling
Folic Acid Underused by Women of Childbearing Age
The Role of Irradiation in Food Safety
Personalized Nutrition

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

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

Eliminate Childhood Lead Poisoning by 2010

The National Healthy People 2010 goal of eliminating elevated blood lead levels in children by 2010 is also the goal of the Childhood Lead Poisoning Prevention Branch.

Your creative help is needed in developing strategies to prevent elevated blood lead levels and to effectively manage those children who are lead poisoned. We invite you to contribute ideas by e-mailing jschilli@dhs.ca.gov, by calling (510) 622-4876, or by faxing (510) 622-5002.

Currently elevated blood lead levels are defined as blood lead levels at or greater than 10 micrograms per deciliter. Children with even higher lead levels, persisting at 15 micrograms per deciliter or greater, or one value of 20 micrograms per deciliter, receive special public health and environ-mental services. Hispanic children make up over 80 percent of those with these higher blood lead levels in California. In addition to contact with contaminated paint, dust, and soil in homes built before 1978, Hispanic children may also eat food prepared, served, or stored in pottery that contains lead.

Other potential sources of lead for Hispanic children include:

brightly colored ethnic remedies such as azarcon and greta;
several types of Mexican candy; and
grasshoppers, a traditional snack food in Oaxaca and other parts of Mexico.

You should assess your Hispanic child clients for these problem areas.

Poor nutrition is a frequent problem for lead-poisoned children, as they are frequently found to be anemic and in low-income minority families whose iron, calcium, and vitamin C intake are inadequate for healthy growth and development. Adequate intake of these three critical nutrients may protect against lead absorption. Nutrition counseling should help these children obtain a well-balanced and age-appropriate diet. Nutrition assessment should pay particular attention to dietary calcium, iron, and vitamin C.

Advice to caregivers may include one or two of the following, prioritized to the assessed need of the child:

participate in the WIC program if they are eligible
introduce pureed meat as soon as the child is developmentally ready
provide one serving of lean red meat per day to older children
provide iron supplements only when iron deficiency is documented, and only under the supervision of a physician or nutritionist
provide two servings of fruit or fruit juice per day
provide two servings of dairy products or other calcium-rich foods per day

Each child participating in a publicly funded program for low-income children is considered at risk for lead poisoning. Every health care provider is required by California regulation to test each child who receives services from a publicly funded program for low-income children such as Medi-Cal, CHDP, Healthy Families, or WIC for lead. Blood lead testing should be done when the child is 12 and 24 months of age, or anytime up to 72 months if the child has not previously been tested at the indicated times. A blood lead test may be done concurrently with a hemoglobin test. Keep the health care providers you work with aware of this requirement.

Children not in low-income programs should be evaluated to determine if they are at risk for exposure to lead-based paint, by asking if they have spent a lot of time in a place built before 1978 that has peeling or chipped paint or that has recently been renovated. If the family's answer is "yes" or "don't know," a blood lead test should be done. Medical providers should also be aware that recent immigrants may have been exposed to the cultural sources of lead (discussed earlier in this article) in their native country, as well as continuing use of products here, and may warrant a blood lead test.

Source: Jan Schilling, MPH, MS, RD, California Department of Health Services, Childhood Lead Poisoning Prevention Branch.

New WHO Guidelines to Promote Proper Use of Alternative Medicines

Since traditional, complementary, and alternative medicines remain largely unregulated, consumers worldwide need to be informed and given the tools to access appropriate, safe and effective treatment. To help address this issue, the World Health Organization (WHO) recently released a new set of guidelines for national health authorities to develop context specific and reliable information for consumer use of alternative medicines.

Up to 80% of developing country populations rely on traditional medicine for their primary health care, due to cultural tradition or lack of alternatives. In wealthy countries, many people seek out various types of natural remedies on the assumption that natural means safe.

However, as the use of traditional or alternative medicines increases so do reports of adverse reactions. In China, a country where traditional therapies and products are widely used in parallel with conventional medicine, there were 9,854 known reported cases of adverse drug reactions in 2002 alone, up from 4,000 between 1990 and 1999.

Many traditional/alternative medicine products are sold over the counter. In a WHO survey of 142 countries, 99 responded that most of these products could be bought without prescription. In 39 countries, many traditional remedies were used for self-medication, bought or prepared by friends, acquaintances or the patient. These trends raise concerns over the quality of the products used, their therapeutic appropriateness for a given condition, and the lack of medical follow-up.

“The WHO supports traditional and alternative medicines when these have demonstrated benefits for the patient and minimal risks,” said Dr Lee Jong-Wook, Director-General of WHO. “But as more people use these medicines, governments should have the tools to ensure all stakeholders have the best information about their benefits and their risks."

Accessible, easy to understand information is key to guiding consumers in their choices. The guidelines provide simple, easy to follow tips on issues to look out for and a brief checklist of basic questions, which may be used to help facilitate proper use of traditional and alternative medicine.

Advice is provided to government authorities on preparing easy-to-access information and on working with the mass media to sensitize and educate the population. In addition, suggestions are given for several health system structures and processes needed to promote proper use of traditional and alternative medicines.

While the guidelines cannot compensate for poor products or inappropriate practices, they can help governments educate consumers on how to maximize the benefits and minimize the risks of traditional medicines.

Alternative therapies - documented benefits and risks

Empirical and scientific evidence exists to support the benefits of acupuncture, manual therapies and several medicinal plants for chronic or mild conditions. For instance, the effectiveness of acupuncture, a popular treatment for relieving pain, has been demonstrated both through numerous clinical trials and laboratory experiments. As a result, 90% of pain clinics in the United Kingdom and 70% in Germany include acupuncture as a form of treatment. Equally, some medicinal plants have shown efficacy for life-threatening conditions; medicine combinations containing the Chinese herb Artemisia annua are now considered amongst the most effective remedies against malaria.

However, there have been many cases of consumers unknowingly using suspect or counterfeit products; choosing inappropriate therapies in self-care; as well as several reports of unintentional overdose.

Similarly, there have been reports of consumers being injured by unqualified practitioners. For example, a study performed by the National Research Institute on Complementary and Alternative Medicine in Norway reported cases of pneumothorax caused by unqualified acupuncturists. In addition, there have been reports of paralysis caused by unqualified manual therapists.

Another potential risk is that patients do not inform their doctors about their use of traditional and complementary medicines. For instance, Ginkgo biloba is a commonly used herbal medicine worldwide whose main function is to prevent vascular disease and to increase blood circulation. The WHO Uppsala Monitoring Centre reported some cases of excess bleeding during a surgical operation. If the patient had informed the doctor about the use of the medicine this could have been avoided.

The development of the guidelines was carried out with the financial and technical support of the Regional Government of Lombardy, in collaboration with the State University of Milan. The guidelines are based on evidence and experiences collected from 102 countries representing all WHO regions.

Summary of highlights

Policies governments could put in place:

Make sure that sufficient information is provided to consumers on the efficacy and safety of products as well as on contraindications
Set up the right channels for consumers to report adverse drug reactions and make those channels known
Organize communication campaigns to equip consumers with the ability to discern the quality of the service they receive
Ensure that practitioners are appropriately qualified and registered
Encourage interaction between traditional and conventional practitioners
Provide insurance for non-conventional therapies and products whose evidence base is sound.
Health system structures and processes that would help promote better quality and safety:
Development of quality standards and treatment guidelines to ensure uniformity within a particular health system
Standardization of training and knowledge requirements for practitioners to promote the credibility of traditional or alternative practices and enhance consumer trust
Collaboration between conventional and traditional or complementary care providers to improve results of treatment but also promote health sector reform
Organization of traditional or alternative medicine practitioners to provide better structures for self-control mechanisms

Questions consumers should ask:

Is the therapy suitable for his/her disease or condition?
Does the therapy have the potential to prevent, alleviate and/or cure symptoms or in other ways contribute to improved health and well being for the consumer?
Is the therapy or herbal medicines provided by a qualified traditional medicine/ complementary and alternative medicine practitioner (TM/CAM) or health care practitioner with adequate training background, good skills and knowledge, preferably registered and certified?
Are the herbal medicinal products or materials of assured quality and what are the contraindications and precautions of the products or materials?
Are the therapies or herbal medicinal products available at a competitive price?

Source: WHO Press Release; June 22, 2004.

Health Status of American Indians

Do racial differences in health status continue to exist in the United States? Yes. Despite a national decline in deaths, American Indians are more likely to suffer from disease than any other ethnic minorities. In a recent telephone survey, American Indian men were more likely to be obese and smoke, and to have cardiovascular disease, hypertension, high cholesterol, and diabetes in comparison to black, Hispanic, and Asian men in similar communities. This survey also found rates of obesity, smoking, cardiovascular disease, and diabetes were highest in American Indian women in comparison to other minority women.

What is being done to address this problem?

REACH 2010 is a community-based program taking place in 21 communities in 14 states across the country. Its objective is to decrease ethnic differences in health. To date, baseline information has been collected from 1,791 American Indians, 10,953 African Americans, 4,257 Hispanics, and 4,204 Asians. This information will be used to create targeted education campaigns for each of the participating communities.

Adapted from: MMWR, November 28, 2003.
Karrie Heneman, PhD. Nutrition Department, University of California, Davis.

Banning Suspect Supplements

The government should ban suspect dietary supplements even in the absence of direct evidence of harm to humans, concludes a study by the Institute of Medicine and National Research Council.

The study, commissioned by the US Food and Drug Administration (FDA), urged changes to the current supplements law (the Dietary Supplement Health and Education Act), which allows supplements to bypass the extensive safety and effective-ness tests required for pharmaceutical drugs. The report stated that manufacturers should be required to report information on consumer complaints about adverse effects experienced after taking supplements, and that animal tests and research on similar substances could be used to determine whether a supplement poses a “significant or unreasonable risk” to humans.

A decade ago, there were about 4,000 supplements on the market; today there are about 29,000, with 1,000 new products introduced each year.

The report, Dietary Supplements: A Framework for Evaluating Safety,” can be found at http://www.nap.edu/books/ 0309091101/html/.

Source: Hampton, Tracy, PhD; JAMA; 291(20); May 26, 2004; p. 2421.

Fluoride Supplements for Kids

A new recommendation from the US Preventive Services Task Force, sponsored by the Agency for Healthcare Research and Quality, is urging primary care physicians to prescribe oral fluoride supplements to infants older than 6 months and preschool children if their community water supply is deficient in fluoride (http://www.ahrq.gov/clinic/3rduspstf/dentalchild/dentchrs.htm.).

Fluoride can help prevent cavities, which affect up to 19% of children between
the ages of 2 and 5 years and more than half of children aged 5 to 9 years. Fluoride dosage recommendations are based on the fluoride level of a local community’s water supply and are available online at http://www.ada.org/public/topics/ fluoride/facts/tables.asp. The Task Force cautions physicians to ask local health departments about water fluoride levels to avoid over supplementation. Excess levels of fluoride can lead to fluorosis and cause mild discoloration of teeth.

Source: JAMA; 291(20); May 26, 2004; p. 2421.

Inside the Dietary Guidelines Advisory Committee Meeting

The Dietary Guidelines Advisory committees Department of Health and Human Services (HHS) and the US Department of Agriculture (USDA), met March 30-31 in Washington, DC, to develop recommendations for the 2005 guidelines. During their last meeting in January, the committee discussed the effect of nutrition on health.

The committee met once more in late May before submitting their recommendations to HHS and the USDA in June. The Sixth edition of the guidelines will be released in January 2005.

The guidelines, published jointly by HHS and the USDA every five years, advise people how to adopt good dietary habits to promote health and reduce risk for major chronic diseases. They also serve as the basis of federal food and nutrition education programs.

Janet King, PhD, RD, with the Children’s Hospital Oakland Research Institute in Oakland, CA and Professor in the Nutrition Department at the University of California, Davis, chairs the 13-member volunteer committee. Committee members are prominent researchers in their fields, but the committee also invites expert speakers to meetings to discuss areas outside of the committee’s specialties.

For example, experts Barbara Rolls, professor of Nutritional Sciences at Pennsylvania State University and Richard Mattes, professor of Foods and Nutrition at Purdue University, spoke about energy density and health. “The two speakers had divergent views on energy density, which helped the committee to sort out scientific questions,” said Kathryn McMurry, MS, senior nutrition advisor with the Office of Disease Prevention and Health Promotion for HHS.

The committee considers public comments in addition to expert testimony when making recommend-ations, said McMurry during an April 9 telephone interview. The committee is responsible for reviewing current scientific and medical knowledge. “They are not charged with assessing economic impact and implement-ability,” she said.

McMurry describes the guidelines as a reference point for comparing various publications and press stories. “They are the most reliable science-based recommend-ations for healthy eating,” she says.

During the January 28 meeting, the committee sought input from several experts on healthy amounts and sources of carbohydrates and fats, a topic that King feels will be the most challenging part of the guidelines recommendations report.

The next recommendations report may suggest different amounts of supplements to various populations. The previous report only recommended supplements for women of childbearing age, according to King.

As discussed during the March meeting, the new report may also provide recommendations on how to prevent excessive weight gain, or how to maintain weight loss, topics that have not previously been a major focus for the group. Subcommittees have conducted in-depth reviews of scientific literature related to carbohydrates, fatty acids, energy balance, fluids and electrolytes, nutrient adequacy, food safety, and ethanol.

The group is gradually working toward more food-based recommend-ations, says McMurry. For example, in addition to discussing healthy potassium levels, the committee may make recommendations about what fruits and vegetables will provide people with adequate intakes of it. The committee is also discussing the importance of fiber in the diet and may make recommendations about healthy sources of fiber, such as whole grains, fruits, and vegetables.
In the coming months, HHS will research how to better communi-cate with the public, educators, and intermediaries about what the guidelines mean, how to implement them, and how to use them for better nutrition. “We are looking to provide better, simple, easy-to-understand advice,” said McMurry.

After internal review of the committee’s recommendations, HHS and the USDA will write the 2005 guidelines. There will likely be an opportunity for public comment on the final recommendations. “We did that in 2000 and it was very helpful to get public reactions,” said McMurry.

The Federal Register announces all public meetings and posts meeting notices at: www. health.gov/dietaryguidelines; public comments, meeting materials and information sent to the committee are held at HHS in open files. Anyone can review it and make copies by calling (202) 690-7102 to make an appointment. Check the Federal Register for the dates of the final meeting when the committee will review and discuss a draft of its report. All public comments will be summarized without attribution in the appendix of the committee’s June report to HHS and the USDA.

Source: Nutrition Week; April 19,2004; XXXIV (8):3.

FDA Prohibits Ephedrine Alkaloids

As of April 12, 2004, dietary supplements containing ephedrine alkaloids are prohibited because they present an unreasonable risk of illness or injury, according to the US Food and Drug Administration’s (FDA) final rule published February 11 in the Federal Register. Use of these supplements has been linked to heart attacks and stroke, according to the FDA. “We will take appropriate enforcement actions if needed to stop manufacturers from illegally selling and distributing dietary supplements containing ephedra alkaloids,” said the Department of Health and Human Services (HHS) Secretary Tommy G. Thompson in an April 12 press release. “Any consumers who are still using them should stop immediately.”

On December 30, 2003, the FDA issued more than 60 letters to manufacturers notifying them of the agency’s intent to publish the rule as well as a consumer alert warning the public of the dangers of ephedra. The FDA will increase Internet surveill-ance to determine whether anyone, including the original targeted firms, continues to actively promote and sell these products. A majority of the manufacturers who received letters have stopped selling supplements containing ephedrine alkaloids. Go to: www.fda.gov/oc/initiatives/ ephedra/ february2004/ for more information.

Adapted from: Nutrition Week; April 19,2004; XXXIV(8): 6.

Millions of Hispanics at Increased Risk for Type 2 Diabetes

About 40 percent of US adults ages 40 to 74, millions of whom are Hispanic or Latino, currently have pre-diabetes, a condition that raises a person's risk of developing type 2 diabetes, heart disease, and stroke. To respond to this rapidly growing problem, experts from the US Department of Health and Human Services' National Diabetes Education Program (NDEP) and community-based organizations from around the country met at the National Council of La Raza's (NCLR) annual conference to discuss national and local efforts to stem the diabetes epidemic in the Hispanic community.

"Every minute of every day, another American develops type 2 diabetes," said Dr. Saul Malozowski, Senior Advisor for Clinical Trials and Diabetes Translation at the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health. "Without intervention, one in three children born in the year 2000 will develop diabetes in his or her lifetime. For some of us, the risk is even higher. If that child is Hispanic and female, she has a one in two chance of developing diabetes in her lifetime. We need to get the word out that type 2 diabetes prevention is proven, possible, and powerful."

While diabetes is a growing epidemic for Hispanics, a recent landmark study found that type 2 diabetes can be delayed or prevented in people at risk for the disease.

The National Diabetes Education Program (NDEP), a joint effort of the National Institutes of Health and the Centers for Disease Control and Prevention, developed a bilingual diabetes prevention campaign in response to the results of the Diabetes Prevention Program (DPP) clinical trial: "Prevengamos la diabetes tipo 2. Paso a Paso" (Let's Prevent Type 2 Diabetes: Step by Step). The campaign highlights the study's findings that by losing a small amount of weight, limiting fat and caloric intake, and exercising 30 minutes a day, 5 days a week, participants dramatically reduced their risk for diabetes by more than half. More than 500 Hispanics participated in the DPP.

"With 'Paso a Paso,' we are asking Hispanics to find out if they are at risk for diabetes, and we're showing them how to take action to prevent it," said Yanira Cruz, the chair of the NDEP's Hispanic/Latino Work Group, and a speaker at today's meeting. "The key is modest weight loss and regular physical activity. I want to encourage people to take this message of good health to their families and their communities, so we can put an end to the diabetes epidemic."

José Cortez took this message to his family and community after learning about the success of diabetes prevention efforts by other Latinos. Cortez, who works for Chicanos Por La Causa, a statewide community development corporation in Phoenix, now hikes regularly with his family, and even coordinates an annual hike for his organization.

Cortez shared his successes, both personally and professionally, to spread the message of diabetes prevention today at the NCLR workshop.

"Chicanos Por La Causa creates opportunities for leaders in the community," said Cortez. "But strong leaders need to be healthy. For me, that means hiking regularly, but for others that may mean taking a walk during lunch or substituting fruits and vegetables for less healthy foods. But taking the first step is always the most important."
To help Hispanics take their first step, the NDEP is offering a new music CD free of charge to help Hispanics get more physical activity to prevent type 2 diabetes. Performed by a diverse group of Hispanic recording artists, MOVIMIENTO, Por Su Vida (Movement, For Your Life) is a collection of six original songs with a Latin dance beat and lyrics that celebrate life in an effort to promote physical activity as a way to stay healthy and help prevent diabetes.

The CD's appeal transcends age and language boundaries combining cross-cultural lyrics with key messages and words repeated in Spanish and English. Strong, positive health messages are promoted via energetic, sizzling songs that make you want to get up and move. The CD comes with an insert that includes tips on how to incorporate the music into day-to-day activities as well as into special events such as community cultural gatherings, health promotion programs or even aerobics classes.

"Everything counts, taking the stairs, walking the dog, dancing to music, mowing the lawn, small changes can be easily incorporated," said Cruz. "Physical activity just needs to occur every day. Make it fun and take it step by step!"

The campaign also includes:

National radio public service messages that will air on Spanish-language radio stations across the country
Print public service announcements that encourage Hispanics to prevent diabetes
A recipe and meal planner booklet featuring healthier twists on traditional Latino recipes
New education materials on diabetes prevention
The Department of Health and Human Service's NDEP is a federally funded program co-sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention and is a leading source for information about diabetes care and prevention. NDEP has more than 200 partner organizations that form a network to reach the health care community and those affected by diabetes at the federal, state, and local levels.

For more information or to obtain a free copy of MOVIMIENTO or any of the campaign materials, call 1-800-438-5383 (bilingual information specialists are available), or visit the NDEP website at www.ndep.nih.gov.

Source: NDEP Press Release; June 29, 2004.

Poor Diet and Lack of Exercise Are Catching Up With Smoking as Leading Cause of US Death

Although smoking still leads the way as the top cause of death, contributing to 18% of all deaths in 2000, a new Centers for Disease Control (CDC) report shows that a poor diet and lack of physical activity are a close second, causing 17% of the deaths in the US population. According to the researchers, approximately half of the 2.4 million deaths in 2000 could be attributed to behavioral risk factors.

The CDC estimates that poor diet and reduced physical activity will soon overtake tobacco as the leading cause of death. The CDC estimates that 64% of all Americans are overweight, including more than 30% who are considered obese. Approximately 15% of children and adolescents aged 6 to 19 are overweight, almost double the rate of 2 decades ago.

Reference:
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004; 291:1238-1245.

Source: Nutrition Today; 39(3); May/June 2004; p. 98.

Child Nutrition and WIC Reauthorization Act

The federal government invests more than $16 billion annually in child nutrition programs under the Child Nutrition Act, Richard B. Russell National School Lunch Act, and related programs. On June 24, 2004, the House overwhelmingly approved the Child Nutrition and WIC Reauthorization Act, a House-Senate consensus forged to strengthen these programs and improve their effectiveness for America’s most vulnerable children.

With childhood obesity reaching an epidemic proportion among America’s youth, it is clear that Congress must act to increase the focus on comprehensive solutions that incorporate healthy habits, nutritional education, and increased physical activity with ongoing efforts to combat hunger and food insecurity. The Child Nutrition and WIC Reauthorization Act strikes the appropriate balance between encouraging healthy environments that will address the childhood obesity epidemic while preserving local control for states, communities, and schools.

The Child Nutrition and WIC Reauthorization Act (S. 2507) is a bipartisan, bicameral consensus that will strengthen nutritional service programs, promote healthy choices among children, and address growing concerns that the federal school lunch program does not do enough to ensure free and reduced-price lunch benefits go to children who qualify. The bill includes major provisions of H.R. 3873, the Child Nutrition Improvement & Integrity Act, legislation introduced by the Education Reform Subcommittee Chairman Mike Castle (R-DE) earlier this year to strengthen and enhance federal child nutrition programs and services.

Federal Child Nutrition Programs and Services

The Child Nutrition and WIC Reauthorization Act would:

Promote nutrition education and physical activity at the state and local level to prevent childhood obesity, as originally proposed by Rep. Castle in H.R. 2227, the Childhood Obesity Prevention Act;
Require local wellness policies designed and implemented at the local level, and authorize the Department of Agriculture to provide technical assistance, if requested by the school or school district, in implementing healthy school environments. The content of local wellness policies would be decided by local parents, teachers, administrators, school food service, school boards, and the public. The Child Nutrition and WIC Reauthorization Act would not permit the federal government to dictate to local school districts the content of wellness policies to encourage nutrition and physical activity;
Continue current policy encouraging all children to consume cow’s milk, yet give schools the option to offer a nutritionally equivalent non-dairy substitute to children who cannot drink cow’s milk for medical or other special dietary reasons;
Authorize the continuation and expansion of the Fruit and Vegetable Pilot Program, which provides free fresh and dried fruits and fresh vegetables, to 8 states and 3 Indian reservations;
Ensure food safety by maintaining and strengthening quality and safety standards and improving meal quality; and
Strengthen partnerships between local farms, school gardens, and child nutrition programs to ensure fresh, local produce can go from the farms to schools, an initiative proposed by Reps. Fred Upton (R-MI) and Ron Kind (D-WI).

Improving Access to Child Nutrition Programs for Military Families & Other Eligible Children

The Child Nutrition and WIC Reauthorization Act would:

Allow children whose parents are in the Armed Forces and living in privatized military housing to continue receiving free- or reduced-price meals at school if they meet eligibility requirements;
Permanently authorize for-profit child care centers to participate in the Child and Adult Care Food Program (CACFP) if at least 25 percent of the children meet the income eligibility criteria for free- or reduced-price meals; and
Continue the authority for schools, churches, community organizations, and private non-profit groups to operate Summer Food Service Program sites, and continues operation of special pilot programs (Lugar pilots) that reduce paperwork requirements and thereby increase the number of low-income children who receive free meals and snacks during the summer months.

Ensuring Integrity, Efficiency, and Quality in the School Lunch Program

The Child Nutrition and WIC Reauthorization Act would:

Help parents by allowing them to submit a single application for multiple children;
Reduce paperwork by allowing school lunch certifications to be valid for one full year, preventing situations in which schools are forced to repeatedly certify children within a single school year;
Improve accuracy and reduce costs for schools by allowing parents to electronically file school lunch applications (through the use of an e-signature) and automate the certification process;
Improve accountability by clarifying that school districts, not school food personnel or school food authorities, are responsible for the certification process;
Increase enrollment of eligible children by requiring direct certification of school lunch eligibility (i.e. students who receive food stamps are automatically eligible for program benefits);
Authorize a demonstration program in 5 states or parts of states to evaluate the impact of expanding free school meal eligibility to children in households with incomes at 185 percent of poverty or below (i.e. eliminate the reduced-price meal category);
Help to reduce the stigma among children receiving free and reduced-price lunches by helping schools make technological improvements, such as automated "meal card" systems that keep students' financial status confidential, to increase the efficiency of program operations, as proposed by Rep. Ric Keller (R-FL);
Provide incentives for school districts to reduce administrative error in school lunch processing; and
Require training and more frequent administrative reviews and oversight by federal and state authorities.

Strengthening Program Integrity, Improving Nutrition, and Enhancing Infant Formula Benefits

The Child Nutrition and WIC Reauthorization Act would:

Authorize funds for the WIC program, which includes grants to states, nutrition services and administration funds, and a farmers' market nutrition program;
Ensure the supplemental foods available through WIC are consistent with current nutrition science;
Require participating vendors to purchase infant formula from a list of state-licensed wholesalers and distributors approved to distribute infant formula;
Require vendors to be notified of an initial violation in writing prior to documentation of another violation, unless the state agency determines that notifying the vendor would compromise an investigation;
Improve fairness and integrity of the infant formula rebate process;
Limit the size of state alliances developed for purposes of soliciting competitive bids for infant formula to a maximum of 100,000 infants. Current alliances of greater size may continue. States serving fewer than 5,000 infants, and tribal organizations may request to join any alliance; and
Enact strong cost containment measures to ensure that WIC food costs and voucher payments are consistent with competitive retail prices for supplemental foods, ensuring efficient use of taxpayer dollars and the ability to serve the greatest number of eligible women, infants, and children.

[Online Source]: http://edworkforce.house.gov/issues/108th/ education/childnutrition/billsummaryfinal.htm.

Health Canada Publishes Review of Caffeine Scientific Literature

For centuries, many cultures have enjoyed caffeine-containing foods and beverages. In fact, as long ago as 2,700 BC, the Chinese Emperor Shen Nung sipped hot brewed tea. In 575 AD coffee beans were used as currency and were consumed as food in Africa.

Today, caffeine is widely consumed around the world and is one of the most extensively studied ingredients in terms of its potential effects on health.

To investigate the findings from research on caffeine and health, scientists at Health Canada conducted a comprehensive literature search of more than 250 research studies focusing on caffeine and health. (Health Canada is the federal department responsible for helping Canadians maintain and improve their health.) Among the many health issues investigated were cardiovascular effects, effects on calcium balance and bone status, behavioral effects in adults and children, carcinogenic potential, and reproductive effects. The findings of the 2003 report, Effects of Caffeine on Human Health (1), provided answers to some frequently asked questions about caffeine and, on the basis of the data reviewed, concluded that there is “ample evidence indicating that for the general population of healthy adults, moderate caffeine intake… is not associated with adverse effects.”

Reference:
Nawrot P, Jordan S, Eastwood J, et al. Effects of Caffeine on Human Health. Food Additives and Contaminants; 2003, 20(1): 1-30.

Source: Food Insight; November/December 2003; p. 7.

Traveling the Road to Trans Fat Labeling

One hundred years ago a newly patented process for hardening liquid fats by partial or full hydrogenation revolutionized food technology. Animal fats that people used for cooking and baking tended to spoil and produce off-flavors. Hydrogenation allowed the development of shelf-stable vegetable-based fats with neutral flavor. Vegetable shortenings and margarines eventually became household items because of wartime rationing of scarce animal fats. The versatility of the hydrogenation process promoted the industrial development of fats to achieve specific physical and chemical characteristics in processed foods.

Hydrogenated fats received another boost when scientific evidence related saturated fatty acid (saturated fat) intake to elevated low-density lipoprotein (LDL) cholesterol levels and risk for coronary heart disease. Health professionals advised people to reduce their intake of animal fats and choose products made with vegetable fats. With the realization that coconut, palm kernel, and palm oils contain a relatively high amount of saturated fat compared to other vegetable oils, dietary advice specified avoiding products containing these “tropical oils.” In response, manufacturers replaced tropical oils with partially hydrogenated oils to maintain desirable freshness and texture in products such as French fries and baked goods. Although products made with partially hydrogenated oils are lower in saturated fat they also contain trans fatty acids (trans fat). Trans fats are produced during hydrogenation, with the amount depending on the degree of hydrogenation. Although trans fats are chemically unsaturated, they have functional properties similar to those of saturated fats.

Hydrogenated fats came into question when research during the 1990’s indicated that increasing trans fat intake raises LDL cholesterol levels and possibly reduces high-density lipoprotein (HDL) cholesterol levels, thereby increasing the total cholesterol to HDL-cholesterol levels, thereby increasing the total cholesterol to HDL-cholesterol ratio. To address this public health concern, the Food and Drug Administration (FDA) proposed mandatory labeling of trans fat contents in 1999 and published a final rule in July 2003. Manufacturers have until January 1, 2006 to list the trans fat content on food labels. However, the trans fat-phobia that has developed during recent years has already prompted many manufacturers to disclose whether their products contain no declarable amount of trans fat (< 0.5 grams per serving) and others to reformulate products to eliminate or lower the trans fat content. Expect more food labels to declare the trans fat content well before 2006.

One unresolved issue is the lack of a Daily Value (DV) for trans fat. The DV is used to calculate a percent DV. Establishing a percent DV would help put a product’s trans fat content in perspective on the food label by indicating to consumers how much trans fat is present compared with a daily amount. While the Food and Nutrition Board’s Committee on Use of Dietary Reference Intakes In Nutrition Labeling recommended that saturated and trans fat content of foods use a combined
DV, no scientific entity has recommended an amount of trans fat that the FDA could use to establish a DV. A DV also would provide the FDA with a basis for developing criteria and disclosure or disqualifying levels for nutrient content and health claims. Generally a 5 percent DV or less is “low” and a 20 percent DV or more is “high.”

The 2002 Institute of Medicine (IOM) Dietary Reference Intakes Macronutrient Report did not provide quantitative dietary guidance for trans fat, saturated fat or cholesterol. Instead, the IOM recommended that the intake of trans fat, saturated fat and cholesterol be as low as possible while consuming a nutritionally adequate diet.

The IOM recommendation has raised several questions. Can the available scientific evidence relating trans fat intakes and LDL cholesterol levels be re-evaluated in order to establish a DV? Should the current DV’s for saturated fat (20 g) and cholesterol (300 mg) be reconsidered or revoked to provide a consistent labeling rationale? If there is no DV, what is the best way to put the trans fat (or saturated fat or cholesterol) content of a food into perspective?

In the absence of trans fat quantification on the food label, health professionals and media have been instructing consumers to consult the ingredient list of each food product for “hydrogenated or partially hydrogenated” oils to detect the presence of trans fat. This practice is tricky at best and does not serve as a foolproof way to determine the presence or amount of trans fat in a particular product. When trans fat content is labeled, the FDA and health organizations are advising consumers to select products that have a lower amount of trans fat and saturated fat combined, a concept that may be difficult to communicate to consumers. It is apparent that we have not reached the end of the road to trans fat labeling.

What to know about trans fat in foods

Some products have already listed the amount of trans fat on the Nutrition Facts Panel. All others will do so before January 1, 2006. Since the presence of “hydrogenated” oils does not serve as the best determinant of the trans fat content in foods, here are some facts to consider:

Some margarines contain some partially hydrogenated oils, but the combined amounts of trans and saturated fats are often less than the amount of saturated fat in butter.
Spreads with plant stanol or sterol esters also contain partially hydrogenated oils. The plant stanol/sterol esters provide a LDL-cholesterol labeling benefit and trans fat content is a negligible 0.5-1.0 gram per tablespoon.
Peanut butters, which are rich in mostly beneficial unsaturated fat, may contain 1 to 2 percent partially hydrogenated oil to prevent oil separation. The resulting amount of trans fat is not detectable in a 2-tablespoon serving.

Source: Food Insight; November/December 2003; pp. 4-5.

Folic Acid Underused by Women of Childbearing Age

Women who start taking daily folic acid supplements (0.4 mg) at least 3 months before conceiving can reduce risk for neural tube defects by as much as 70%. Investigators at four clinics in Arkansas asked 322 women (age range, 18-45; 51% black) at routine gynecologic visits about supplement use.

Although 62% of women were aware that folic acid supplementation prevents birth defects, only 27% of these women and 23% of all women were taking daily folic acid supplements or multivitamins. Only 40% of the cohort reported weekly use. Only 8% of young black women (age range, 18-24) reported daily use of folic acid supplements. Daily use was associated significantly with being married, with an annual household income ?US$30,000, with awareness of folic acid’s benefits, and especially with a reported tendency to follow physician advice. Higher educational level and pregnancy planning also were associated with daily folic acid use.

These data confirm previous findings in that they document a substantial gap between patients’ knowledge about the benefits of folic acid supplementation and those patients’ actions. To try to limit neural tube defects, health care providers should emphasize the benefits of folic acid use to women of childbearing age at routine visits, and clinicians and public health officials should collaborate in devising ways to increase folic acid intake among such women.

Source: Robert W. Rebar, MD. Journal Watch; May 15, 2004; 24(10): 82.

The Role of Irradiation in Food Safety

What is food irradiation?

This form of food processing uses high-energy radiation to eliminate harmful microbes in red meat, poultry, pork, fruits and vegetables, aromatic spices, seeds, herbs, seasoning, enzyme preparations, eggs, and wheat.

Why should foods be irradiated?

It is estimated that 76 million cases of food borne illness occur in the United States annually. Food irradiation, a process that is supported globally by medical, scientific, and public health professionals, has the potential to greatly reduce this number. Irradiation may also help to reduce the amount of toxic and environmentally damaging chemicals used by farmers to fight pests.

What are the limitations of food irradiation?

Food irradiation does not destroy toxins or prions (responsible for mad cow disease) and fails to prevent cross-contamination of food during preparation. Although it does not significantly affect the nutrient content of a food, irradiation may slightly alter the taste, color, and/or odor. It is hoped that recent improvements in the technique will solve this problem.

Is food irradiation safe?

Although some groups feel that consumption of irradiated foods is harmful, scientific review has found these claims to be untrue. The Center for Disease Control estimates that if 50 percent of the meat and poultry eaten in the United States were irradiated, 900,000 fewer cases of food borne illness would occur annually.

Source: Robert W. Rebar, MD. Journal Watch; May 15, 2004; 24(10): 82.
Karrie Heneman, PhD. Nutrition Department, University of California, Davis.

Personalized Nutrition

What is personalized nutrition?

Personalized nutrition involves the establishment of dietary recommendations for individuals based on their genetic makeup and their individual chronic disease risk. It is also referred to as “nutrigenomics”, “nutrigenetics”, “individualized nutrition”, and “nutritional genomics.”

Is personalized nutrition advice an advantage over recommendations to follow the current USDA Dietary Guidelines for Americans?

It is known that adherence to the USDA Dietary Guidelines for Americans is beneficial for a majority of the population; however, genetic factors may limit the benefits that an individual receives.

Personalized nutrition would allow users to consume a diet that would provide them with an optimal level of nutrients.

Can the public currently receive accurate personalized nutrition advice?

Although many experts agree that personalized nutrition will be the way of the future, this is still a very new area of research. Much more work must be completed before consumers will have access to personalized dietary recommendations.

Adapted from: Food Insight; November/December 2003; pp. 1, 5.
Karrie Heneman, PhD. Nutrition Department, University of California, Davis.

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