UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION
NUTRITION PERSPECTIVES
Volume 25, No. 5
September/October 2000
TABLE OF CONTENTS
Judith Stern Elected to Committee of Experts
New Drug Treatment for Patients with Elevated Cholesterol
Weighing In On Diet Choices
NIH Announces Two Additional Centers for Dietary Supplement
Research
Resurgence of Rickets Prompts New Advice On Vitamin D
Diet Influences Homocysteine Levels
Lowering Blood Pressure In Diabetes
Does Fiber Help Prevent Cancer?
Keep Tabs on Female Athletes’ Menstrual Periods, Eating Habits
NHLBI Launches 10-Year Study On Early Detection of Heart Disease
Coffee and Cola—The Good News and the Bad News
Finger-Food Safety
Recognizing Dehydration In the Elderly
Resources:
Nutrition To Grow On
Job Announcements
Subscription for NUTRITION PERSPECTIVES
University of California
Department of Nutrition
One Shields Ave.
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, University of California, Department of
Nutrition, One Shields Ave., Davis, CA 95616-5270. Phone (530) 752-3387; Fax (530)
752-8905.
UC DAVIS NEWS:
Professor Judith Stern, Departments of Nutrition, was elected to the Bioavailability and Nutrient Absorption Expert Committee by the US Pharmacopoeia Council of Experts. She will serve for five years. The committee sets manufacturing standards for vitamins, minerals, and herbals.
Stern is a professor in the Department of Nutrition and Internal Medicine/Division of Clinical Nutrition and Metabolism, director of the UC Davis Food Intake Laboratory Group, and co-director of the Alternative Medicine Center for Research in Asthma, Allergy, and Immunology. She currently is studying the effects of obesity on longevity, lipids, and renal disease. Stern joined UC Davis in 1975.
Source: UC Davis News; Sept. 16, 2000.
NEW DRUG TREATMENT FOR PATIENTS WITH ELEVATED CHOLESTEROL
The FDA has approved colesevelam hydrochloride (Welchol; GelTex Pharmaceuticals, Inc., Waltham, Massachusetts), a non-absorbed polymer, to be administered alone or in combination with enzyme inhibitors (statins) as adjunctive treatment to diet and exercise for the reduction of elevated low-density lipoprotein cholesterol (LDL-C) in blood. Colesevelam is a nonabsorbent lipid-lowering agent that binds bile acids, resulting in the depletion of liver cholesterol stores. A compensatory increase in liver uptake of LDL-C reduces its levels in blood.
The drug was approved on the basis of eight clinical trials in which approximately 1,000 patients were treated with colesevelam for up to one year. With the exception of one long-term study, all studies were multicenter, randomized, double-blind, and placebo-controlled. A maximum therapeutic response to colesevelam was achieved within two weeks and was maintained during long-term therapy.
In one study, patients with LDL-C levels between 130 and 220 mg/dL, were given colesevelam for 24 weeks in divided doses with breakfast and dinner. The mean reductions of LDL-C were 15 percent and 18 percent for the 3.8-g and 4.5-g dose groups, respectively. High-density lipoprotein cholesterol increased by 3 percent in both groups.
Patients in another study, with LDL-C levels between 145 and 250 mg/dL, were given colesevelam (3.8 g) for six weeks as a single dose with breakfast, a single dose with dinner, or as divided doses with the two meals. The mean LDL-C reductions were 18 percent, 15 percent, and 18 percent for the three dosing regimens, respectively.
Co-administration of colesevelam (2.3 g or 3.8 g daily) with each of three statins (atorvastatin, lovastatin, or simvastatin) resulted in additional 8 percent to 16 percent reductions in the LDL-C level beyond that achieved by statin alone.
Colesevelam is not absorbed from the gastrointestinal tract and may cause adverse effects in some patients, including flatulence (12 percent), constipation (11 percent), infection (10 percent), and dyspepsia (8 percent).
Source: JAMA; 284(6); August 9, 2000; p. 685.
Losing weight can be pretty tough. It’s even harder to keep the pounds off once they’ve been shed. Many experts agree that the key to losing weight and maintaining a healthy weight is setting sensible goals and expectations. On its web site at: www.consumer.gov/weightloss/ , the Partnership for Healthy Weight Management has some good advice on starting a weight-loss program and sticking with it. The site promotes gradual weight loss, no more than two pounds a week, as opposed to a “crash” diet where much weight is taken off in a short period. A consumer guide available on the site, “Finding a Weight Loss Program that Works for You,” includes a checklist of various weight-loss plans that allows consumers to tailor their own program. The site also has helpful information on how to avoid weight-loss products advertised with extravagant, and often bogus, claims. The Federal Trade Commission manages the site as part of a coalition of scientific, academic, health-care, government, commercial, and public health members.
Source: FDA Consumer; 34(5); Sept/Oct 2000; p. 35.
NIH ANNOUNCES TWO ADDITIONAL
CENTERS FOR DIETARY SUPPLEMENT RESEARCH
The Office of Dietary Supplements (ODS), in collaboration with the National Center for Complementary and Alternative Medicine (NCCAM), two components of the National Institutes of Health (NIH), announced plans to establish two additional Centers for Dietary Supplement Research with an emphasis on botanicals.
The announcement of research awards to Purdue University in West Lafayette, Indiana, and the University of Arizona at Tucson, will bring the total to four NIH-supported Centers studying the health effects of botanicals. In 1999, ODS and NCCAM funded two dietary supplement research centers at the University of California at Los Angeles (UCLA) and the University of Illinois at Chicago (UIC).
“These competitive awards of approximately $1.5 million each per year for five years were made as a result of efforts by Congress to promote the scientific study of botanicals and to explore more fully the potential role of botanical dietary supplements,” said Paul Coates, PhD, Director of the ODS. He continued, “The Centers for Dietary Supplement Research also represent the realization of several scientific goals developed in the ODS Strategic Plan.”
According to national surveys, approximately one-third of Americans use complementary and alternative medicine (CAM), such as botanical dietary supplements. “The popularity of supplements such as soy isolates, green tea extract, garlic, echinacea, St. John's wort, and ginkgo has increased dramatically in the last decade; however, current standards regulating use of these supplements, coupled with sparse information concerning their safety or effectiveness, pose problems for health practitioners and consumers,” said Stephen Straus, MD, Director of NCCAM. “These centers will critically evaluate various botanicals presently in use, and provide valid information to aid the American public in making informed decisions,” Dr. Straus concluded. To address these issues, Congress appropriated funds for the ODS in fiscal year 1999 to develop a botanical research center initiative and expanded that support in 2000.
The Purdue Center for Dietary Supplement Research on Botanicals, directed by Connie Weaver, PhD, will study the health effects of polyphenols (a diverse group of chemical components widely distributed in plants), many of which are consumed both for their nutritive value and medicinal properties. Examples include soy, grapes, green tea, and several herbs. The speculated health-promoting effects of polyphenols are generally attributed to their antioxidant action, but other biological mechanisms may be involved and will be explored. Soy isoflavones, for example, function as phytoestrogens that may play a role in bone metabolism.
The proposed research agenda of the Purdue Center is clinically relevant to the two leading causes of death in the US, heart disease and cancer, and to two leading causes of diminished quality of life, osteoporosis and cognitive decline. The Purdue researchers will collaborate closely with investigators at the University of Alabama at Birmingham (UAB). The UAB research efforts will be directed by Stephen Barnes, PhD
The University of Arizona Center (UA), directed by Barbara Timmermann, PhD, will focus on three botanicals (ginger, turmeric, and boswellia) widely used in Ayurvedic medicine for the treatment of inflammatory diseases. Ayurveda, a medical system primarily practiced in India for 5,000 years, includes diet and herbal remedies, while emphasizing the body, mind, and spirit in disease prevention and treatment. The UA researchers propose to identify the active constituents of these three herbs and study their pharmacological activity. This research will lead to clinical studies of arthritis and other chronic inflammatory conditions, including respiratory diseases such as asthma. The UA group is recognized for their work in natural products chemistry research. It is anticipated that their future research efforts also will be important to the field of complementary and alternative medicine.
The Office of Dietary Supplements (ODS) strengthens knowledge and understanding of
dietary supplements by evaluating scientific information, stimulating and supporting
research, disseminating research results, and educating the public to foster an enhanced
quality of life and health for the US population. For additional information about ODS,
please visit their website at: http://dietarysupplements.information.nih.gov
.
The National Center for Complementary and Alternative Medicine (NCCAM) is dedicated
to exploring complementary and alternative healing practices in the context of rigorous
science; training CAM researchers; and disseminating authoritative information. For
additional information about NCCAM, please visit their website at: http://nccam.nih.gov .
Source: NIH Press Release; Sept. 20, 2000.
RESURGENCE OF RICKETS PROMPTS
NEW ADVICE ON VITAMIN D
As US pediatricians report a growing number of cases of nutritional rickets in infants and children, the US Centers for Disease Control and Prevention (CDC) is investigating the disease’s resurgence, and the American Academy of Pediatrics is suggesting vitamin D supplements for infants at risk for the condition.
Rickets was a common clinical problem in American cities until the fortification of milk with vitamin D in the 1930s. The condition most commonly is caused by vitamin D deficiency and is characterized by soft and deformed bones. By the 1960s, clinically recognized rickets nearly had disappeared. Rickets is not a reportable disease in the United States. During the last year, the CDC has received numerous reports of rickets cases, both inpatient and outpatient, from pediatricians across the United States. In 1999, Noman Carvalho, MD, FAAP, identified rickets in Georgia. This led pediatricians and epidemiologists at the CDC and the Georgia Department of Human Resources to investigate hospitalizations for rickets in the state of Georgia between 1997 and 1999 (1).
The investigation identified rickets in two pediatric age groups:
· infants who had been solely breastfed without adequate sunlight exposure or vitamin D supplementation, and
· toddlers receiving a milk alternative that did not contain vitamin D.
It is likely that these cases represent only a small proportion of Georgia’s rickets cases, because, while rickets generally is treated on an outpatient basis, these children had such significant disease that they required hospitalization.
In North Carolina, 30 cases of nutritional rickets occurred at two major medical centers between 1998 and June 1999 (2).
· All 30 cases were in African American infants
· All were breastfed without receiving supplemental vitamin D
· Subjects’ average age was 15.5 months
· Average duration of breastfeeding was 12.5 months
The signs and symptoms of rickets included:
· Failure to thrive
· Bone deformities
· Seizures due to hypocalcemia
The Role of Vitamin D
Vitamin D is a fat-soluble vitamin that functions with parathyroid hormone and calcitonin to maintain intracellular and extracellular calcium concentrations within a physiologically acceptable range. Vitamin D functions as a steroid hormone to facilitate intestinal absorption of calcium and phosphorus.
Vitamin D directly affects the deposition and reabsorption of bone. Rickets develops when inadequate calcium is absorbed intestinally and, as a result, calcium from the bone reservoir is used to maintain normal fluid and tissue levels. Vitamin D is available to humans through the photochemical action of sunlight or ultraviolet light on a precursor, 7-dehydrocholesterol, found in the epidermis. The photochemical reaction results in the formation of vitamin D3 (cholecalciferol). Exposure to sunlight provides most individuals with their vitamin D requirement. However, skin pigmentation and environmental conditions affect the amount of vitamin D synthesized in the skin.
Vitamin D is available in the diet through fortified milk and breakfast cereals, as well as some fish liver oils, the flesh of fatty fish, and egg yolks from hens fed vitamin D. The dietary reference intake (DRI) for vitamin D for infants and children is 200 IU per day. In the diet, vitamin D can be in the form of vitamin D2 or vitamin D3. Vitamin D2 (calciferol) is produced by ultraviolet irradiation of the plant steroid ergosterol; vitamin D3 is of animal origin. For humans, there is no practical difference between vitamins D2 and D3, and the general term vitamin D can be applied to both. Vitamin D also is available in vitamin supplements. Vitamin D is hydroxylated in the liver to 25-OH-cholecalciferol and further hydroxylated in the kidney to 1,25-dihydroxychole-calciferol, the functional form of the vitamin.
Recommendations for Vitamin D Intake During Infancy
Breastfeeding experts at the American Academy of Pediatrics are encouraged that more mothers are choosing to breastfeed their infants and are continuing breastfeeding for at least 6 months. The Academy recommends that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired. However, it should be recognized that breastmilk does not contain sufficient vitamin D to meet the requirement for infants.
Most infants’ vitamin D requirement easily can be met with direct sunshine. Infants with increased skin pigmentation require more sun exposure to meet their vitamin D requirement because melanin competes with 7-dehydrocholesterol, thus decreasing vitamin D synthesis. However, because sun exposure can increase the risk of developing certain skin cancers, most infants are shielded from the sun by either clothes or sunscreens.
All infant formulas contain 400 IU of vitamin D per liter, therefore infants fed formula are not at risk for developing rickets. Anecdotal and scientific information suggests that 400 IU is a safe and efficacious amount of vitamin D for infants on a daily basis, and therefore would not be excessive. Vitamin D supplements should be administered to all exclusively or predominantly breastfed infants to prevent rickets. The development of rickets in breastfed infants is not due to deficiency of vitamin D in breastmilk but to failure of the infant to receive adequate sunlight exposure. Because of concerns about sun exposure in young infants and lack of information about the dose of sunlight necessary to prevent rickets in infants with darkly pigmented skin, adequate sunlight exposure cannot be adequately defined (3,4).
Use of Milk Alternatives
Rickets has also been described in toddlers who had been fed a homemade or commercial beverage (unfortified rice or soy milk) as an alternative to cow’s milk. The alternative beverage was not nutritionally equivalent to vitamin D-fortified cow’s milk.
Vitamin D-deficiency rickets easily can be prevented in these children by providing them with vitamin D-fortified whole milk until age 2 years and then lower-fat vitamin D-fortified milk after age 2 years. Vitamin D-fortified milk is the only dairy product that contains vitamin D; products such as yogurt and cheese are not made with vitamin D-fortified milk. When a child cannot drink cow’s milk because of a medical problem, such as galactosemia or protein allergy, then a milk substitute that is nutritionally equivalent to vitamin D-fortified cow’s milk must be provided. Products such as unfortified soy, rice, almond, and oatmeal beverages may look like cow’s milk, but they do not contain vitamin D. Feeding such products to infants may lead to rickets.
Efforts are under way to assess the frequency with which this deficiency disease
occurs. Pediatricians who diagnose a case of
nutritional rickets associated with the use of a commercial or homemade alternative
beverage are urged to report it to the US Food and Drug Administration MedWatch program,
either through www.fda.gov/medwatch/how.htm or by use of the
direct interactive form at: www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm
.
References:
1. Nesby-O’Dell S, DVM, MPH, Tomashek K, MD, MPH, FAAP. 49th Annual Epidemic Intelligence Service (EIS) Conference in Atlanta.
2. Kreiter, SR; Schwartz, RP; Kirkman, HN Jr.; Charlton, PA; Calikoglu, AS; Davenport, ML. Nutritional rickets in African American breast-fed infants. Pediatrics, 2000 Aug, 137(2):153-7.
3. AAP Committee on Nutrition. Pediatric Nutrition Handbook, 4th Edition. 1998:14, 44.
4. AAP Committee on Environmental Health. Ultraviolet light: a hazard to children. Pediatrics. 1999; 104: 328-333.
Adapted from: AAP News; 17 (3); September 2000. p. 92.
DIET INFLUENCES HOMOCYSTEINE LEVELS
High homocysteine levels are an independent risk factor for atherosclerosis, and some data suggest that homocysteine may play a causative role. In turn, high dietary levels of folate and B vitamins may reduce homocysteine levels (1). A recent randomized trial was designed to test the effect of three diets on serum homocysteine levels: 1) a control diet; 2) a diet rich in fruits and vegetables but otherwise similar to the control diet; and 3) a combination diet rich in fruits, vegetables, and low-fat dairy products and low in saturated and total fat. The combination diet was that used in the Dietary Approaches to Stop Hypertension (DASH) trial and has been shown to help lower blood pressure. A total of 118 volunteers participated in the study (2,3).
During an 8-week intervention period, serum folate levels fell a mean 0.80 µg/L in the control group but rose 0.10 µg/L and 0.63 µg/L in the fruits-and-vegetables group and the combination group, respectively. Homo-cysteine levels rose a mean 0.46 µmol/L in the control group and 0.21 µmol/L in the fruits-and-vegetables group, but fell 0.34 µmol/L in the combination group (4).
These results do not prove that the DASH diet will prevent coronary events by lowering homocysteine levels, but the findings are consistent with that hypothesis. Recommending that patients eat a diet rich in fruits and vegetables and low in fat is clearly good advice.
References:
1. Top Stories of 1998; Journal Watch; 19(1); Jan 1, 1999; p. 6.
2. Blood pressure-lowering DASH diet also reduces homocysteine. Nutrition Perspectives; 25(4); Jul/Aug 2000; pp. 6-7.
3. The DASH diet. Nutrition Perspectives; 25(4); Jul/Aug 2000; pp. 6-7.
4. Appel LJ, Miller ER 3rd, Jee SH, Stolzenberg-Solomon R, Lin PH, Erlinger T, Nadeau MR, Selhub J. Effect of dietary patterns on serum homocysteine: Results of a randomized, controlled feeding study. Circulation; 102(8):852-7; Aug 22, 2000.
Adapted from: Journal Watch; 20(19); Oct 1, 2000; p. 152.
LOWERING BLOOD PRESSURE IN DIABETES
People with type 2 diabetes are more likely than the general population to have hypertension and to suffer complications from it. Lower blood pressure (BP) is known to be beneficial; because the required degree of blood pressure lowering still is unknown, this prospective study was undertaken.
Diabetic patients were recruited from 1977 through 1991 for a prospective trial of standard BP control versus tight BP control (i.e., use of beta-blockers and angiotensin-converting-enzyme inhibitors); all patients were assessed for a variety of vascular endpoints. A total of 3,642 patients were included in this analysis. Systolic BP was found to be significantly associated with almost all major endpoints, except for cataract extractions. Over a 10-year period, each 10-mm-Hg decrease in systolic BP was associated (after adjustment for several potential confounding variables) with a reduction in risk: 12 percent for any diabetes-related complication, 15 percent for diabetes-related deaths, 11 percent for myocardial infarctions, and 13 percent for microvascular complications. No BP threshold was seen for any endpoint risk.
References:
1. Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, Wright AD, Turner RC, Holman
RR. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): Prospective observational study. BMJ; 321; Aug 12, 2000; pp. 412-9.
2. Tuomilebto J. Controlling glucose and blood pressure in type 2 diabetes: Starting treatment earlier may reduce complications. BMJ; Aug 12, 2000; 321l394-5.
Adapted from: Journal Watch; 20 (19); Oct 1, 2000; p. 151.
Headlines recently announced that dietary fiber does not prevent colon cancer. The studies calling fiber into question, however, have been misrepresented by the media. Scientific evidence clearly shows that eating plenty of vegetables, fruits, whole grains, and beans, foods naturally high in fiber, is still an effective way to lower your risk for many types of cancer, including colon cancer.
There is a hot debate going on about the ability of fiber to reduce risk of colon cancer. Exaggerated reports in the media about seemingly contradictory research results may keep that debate raging for some time. The argument gained steam last spring when the media reported on two new colon cancer studies. Headlines boldly announced that the two studies found no evidence of a link between dietary fiber and colon cancer prevention.
“The media like to report on research that contradicts expert advice. Journalists often focus on one sensational study without mentioning dozens of others that say the opposite. Scientists look for agreement among the greatest number of studies,” commented Dr. Ritva Butrum, American Institute for Cancer Research (AICR) vice president for research.
The AICR urges you not to abandon healthy dietary habits because of sensational media reports. The scientific evidence linking consumption of vegetables, fruit, whole grains, and beans, all of which are high in fiber, to cancer prevention is clear and convincing.
What’s Behind the Headlines?
Two studies published in The New England Journal of Medicine found that eating more fiber for several years did not prevent recurrence of colorectal polyps. These are the tiny growths that may precede colorectal cancer. One of the two studies, the Polyp Prevention Trial by Dr. Arthur Schatzkin and colleagues, tested a low-fat, high-fiber diet emphasizing vegetables and fruits. The other, by Dr. David Alberts and his colleagues that tested a wheat-bran fiber supplement (1,2).
There is some question about whether the subjects actually stuck to the test diets. In the first study, blood serum analysis suggest that vegetable and fruit consumption was considerably lower than it should have been. In regard to the second study, Dr. Alberts and his colleagues concede, “Compliance declined with each year of the study.”
How Fiber
Helps
Clearly, the results of these two studies alone do not support any change in your eating habits. Fiber should remain an important element in your diet. It has a strong, positive effect on the health of your colon.
· Fiber slows the absorption of food, which helps keep the levels of glucose and insulin steady.
· As fiber ferments in the colon, substances called short-chain fatty acids are produced. These substances regulate the growth rate of the cells lining the colon.
· By collecting and holding destructive bile acids, fiber protects the intestinal walls from damage.
· Finally, by increasing stool bulk and weight, fiber speeds the elimination of dietary carcinogens from the body.
Scientists are studying whether these processes offer protection against cancer. In the meantime, it still makes sense to choose fiber-rich foods. Nutrition experts suggest an intake between 20 and 35 grams per day. You can get all the fiber you need by eating five daily servings of vegetables and fruits, and seven servings of whole grains and beans. Because a serving of many of these foods is only a half-cup or a cup, that’s not hard to do.
References:
1. Schatzkin A, Lanza E, Corle D, Lance P, Iber F, Caan B, Shike M, Weissfeld J, Burt R, Cooper MR, Kikendall JW, Cahill J. Polyp Prevention Trial Study Group. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. N Engl J Med; 342 (16); 2000; p. 1149.
2. Alberts DS, Martínez ME, Roe DJ, Guillén-Rodríguez JM, Marshall JR, Van Leeuwen JB, Reid ME,
Ritenbaugh C, Vargas PA, Bhattacharyya AB, Earnest DL, Sampliner RE. Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. Phoenix Colon Cancer Prevention Physicians' Network. N Engl J Med; 343(10); Apr 20, 2000; p. 736.
Source: AIRC Newsletter; Issue 69; Fall 2000; pp. 1-3.
KEEP TABS ON FEMALE
ATHLETES’ MENSTRUAL PERIODS, EATING HABITS
Pediatricians need to question female athletes about their menstrual periods during preparticipation sports exams and regular check-ups, according to the new American Academy of Pediatrics (AAP) Policy Statement Medical Concerns in the Female Athlete (1).
If the athlete has regular menstrual periods, that’s a good indication she is consuming enough calories in her diet, said Mimi D. Johnson, MD, FAAP. If her periods are irregular or absent, however, it’s likely the athlete is not eating enough. It is important to realize that amenorrhea is not a normal response to sports, said Dr. Johnson, a member of the AAP Committee on Sports Medicine and Fitness and principal author of the statement. Although it’s important to rule out other causes of amenorrhea, like pregnancy and underlying pathological conditions, amenorrhea is usually a warning sign that your patient might have the female athlete triad. The triad consists of three conditions that often occur together: disordered eating, amenorrhea, and osteoporosis.
If left untreated, amenorrgic athletes may start losing bone density, putting themselves at increased risk for stress fractures and osteoporosis. Therefore, amenorrheic athletes should be counseled about their eating habits and encouraged to consume a diet higher in calories than their nonathletic peers.
“There’s a group of athletes that truly are naive that they need to increase their food intake when their training increases,” Dr. Johnson said. Parents, too, often do not recognize that their daughters need to eat more when they are active, she added. Anticipatory guidance from pediatricians can effectively prevent disordered eating habits in these athletes, Dr. Johnson said.
Athletes who are not eating appropriately do not perform at their optimal level, the policy states. Endurance, strength, reaction time, speed, and concentration are all impaired when nutrition is compromised. Pediatricians should advise their adolescent female athletes to eat enough to replenish the energy they use while training, thus allowing for a regular menstrual cycle, according to the policy.
Although athletes may not meet the criteria for anorexia or bulimia, some struggle with psychological issues that make it difficult for them to increase their food intakes, Dr. Johnson said. These athletes are said to have disordered eating habits. The statement recommends a team approach for working with these athletes. A physician, nutritionist, and mental health professional, in addition to coaches, parents, and teammates may need to be called on for help. Athletes with disordered eating or eating disorders may be struggling with issues of body image, not just athletic performance, Dr. Johnson said. They may be concerned that their nonathletic friends weigh less than they do.
“Teenagers are notorious for not recognizing that their friends might have different body builds,” she said. Nonathletes tend to weigh less because they have less muscle mass. These girls may also be dealing with issuesinvolvingself-esteem, assertiveness,andsexualabuse,Dr.Johnsonsaid. Eating habits can be a sensitive topictodiscuss with any female adolescent, and pediatricians need to be aware of this, Dr. Johnson said. “Speak with them in a way that’sn nonjudgmental,“ she advised. “Do not accuse them of not eating enough.”
Dr. Johnson said she hassuccessfully treated young athletes by focusing on the effect of diet on athleticperformance and bone density. “They don’twant to stop doing their sport because they have a stress fracture,” she said. Hormone replacement therapy may be considered for the mature female athlete who is struggling to increase her energy consumption but has been amenorrheic long enough for her bone mineral density to be compromised, Dr. Johnsonsaid.
The statement also recommends that pediatricians encourage athletes and coaches to emphasize body composition rather than weight. If necessary, arange of values for desired weight and body fat amounts can be given rather than a specific value. There are some women whoseweight can vary tremendously around their menstrual cycles, Dr. Johnson said.
“Weight doesn’t tell you what the body is made of,” Dr. Johnson said. “Athletesare particularly perfectionist and if youtell them that theirweightneeds tobe at a certain number, they will strive to be there.”
Reference:
1. American Academy of Pediatrics. Committee on Sports Medicine and Fitness. Medical concerns in the female athlete. Pediatrics; 106(3); Sept, 2000; pp. 610-3. Adapted from: AAP News; 17(3); September 2000. p. 109.
NHLBI LAUNCHES 10-YEAR STUDY
ON EARLY DETECTION OF HEART DISEASE
The National Heart, Lung, and Blood Institute (NHLBI) has launched a 10-year, multicenter study to find new ways of detecting heart disease early, before it produces symptoms.
The $68 million Multi-Ethnic Study of Atherosclerosis (MESA) will involve six centers, and will recruit 6,500 participants aged 45 to 84. Half of the participants will be men and half women. About 40 percent of the participants will be white, 30 percent African American, 20 percent Hispanic, and 10 percent Asian, mostly of Chinese ancestry. None of the participants will have known heart disease at the time of their enrollment in the study.
The six centers are: Columbia University in New York City, the Johns Hopkins University in Baltimore, Maryland, Northwestern University in Chicago, Illinois, the University of Minnesota in Minneapolis-St. Paul, the University of California at Los Angeles, and Wake Forest University in Winston-Salem, North Carolina. The study's coordinating center is the University of Washington in Seattle.
“The earlier the risk of heart disease can be detected, the sooner steps can be taken to prevent its development,” said NHLBI Director Dr. Claude Lenfant. “Most of this prevention effort has focused on the standard risk factors for heart disease. This study may give us new and better indicators of heart disease risk.”
The study also could yield more specific predictors of heart disease: It will try to determine which factors best predict heart disease in men and women, and in each of the ethnic groups.
“The progression of heart disease from subclinical, or without signs or symptoms, to clinical has not really been studied before in some groups, such as Asians,” said Dr. Robin Boineau, NHLBI deputy project officer for MESA. “All of the participants will be undergoing the same tests and it will be possible to see differences in how the disease develops.”
Standard risk factors for heart disease are high blood pressure, high blood cholesterol, cigarette smoking, diabetes, overweight, physical inactivity, age (45 or older for men; 55 or older for women), and family history of early heart disease (a father or brother diagnosed with heart disease before age 55, or a mother or sister diagnosed before age 65).
The study will collect information on those risk factors, as well as other sociodemographic, lifestyle, and psychosocial factors. It also will examine a variety of newly emerging factors, such as calcium deposits in the coronary artery. These deposits have been correlated with an increased risk of coronary artery disease. However it is not known if such deposits can pinpoint who will actually develop the disease.
“This study will use computed tomography, which gives cross-sectional images of the heart. The images will be checked for the amount of calcium in the coronary arteries to see if that predicts who goes on to develop coronary artery disease,” said Boineau.
Other tests to be undertaken include: cardiac magnetic resonance imaging (MRI), a noninvasive device that gives images of the heart, including its mass; ultrasound, a noninvasive device that measures the thickness and flexibility of the carotid artery wall; ankle-brachial blood pressure index, which assesses the blood flow in the lower extremities; electrocardiogram; blood samples to measure new risk factors such as indicators of inflamma-tion and genetic markers; and a device that measures pulse waves at the radial artery.
“Some of these tests could be easily done in the doctor's office, if they prove to be effective predictors of heart disease. For example, the device that measures the pulse waves at the radial artery of the wrist could be used during a routine checkup,” explained Boineau.
Participants will undergo four examinations over the course of the study. Besides coronary artery disease, they will be followed to see if certain factors can predict the development of stroke and congestive heart failure. NHLBI press releases and other materials are online at: http://www.nhlbi.nih.gov .
Source: NIH Press Release; September 14, 2000.
COFFEE AND COLA—THE GOOD NEWS AND THE BAD NEWS
Caffeine May Protect Against Parkinson’s Disease
Caffeine drinks such as cola, coffee, and tea may lower the risk of developing Parkinson’s disease (PD) (1). Researchers at the Veterans Administration Medical Center in Honolulu can’t explain how beverages that make people jittery can help prevent a disease that results in tremors. Nevertheless, they found that men who drank coffee were less likely to get PD. And the more coffee they drank, the better. Noncoffee-drinking men were two to three times more likely to get PD than those who drank from 4 ounces to 28 ounces a day. But, they were five times more likely to develop PD than those who drank 28 ounces or more a day, or about 4-1/2 six ounce cups.
Caffeine was identified as the protective ingredient in coffee after niacin and eight other nutrients were determined to be unrelated to PD. The addition of milk of sugar to coffee did not make any difference in the findings.
Lead researcher G. Webster Ross, MD, suggests several theories to explain the findings. Men who have a propensity to develop PD may have an intolerance to caffeine. Another possibility is that caffeine may protect against the nerve cell destruction that causes PD. The findings were based on data from the Honolulu Heart Program, an ongoing study of 8,004 Japanese-Americans, which began in 1965. As the study considered only men with this ethnic background, the researchers said it is unclear whether the same results would be found in women and other ethnic groups. “It is too early to recommend coffee drinking to prevent Parkinson’s disease,” says Ross.
Sodas May Boost Bone Breakage
Carbonated beverages and physical activity may not mix, according to a study by the Harvard School of Public Health and Harvard Medical School (2). The study concluded that active girls who drink carbonated beverages, especially cola, are five times more likely to have bone fractures than those who don’t drink these beverages. The study was done on 460 ninth and tenth-grade girls who reported their activity levels, carbonated beverage drinking habits, and history of bone fractures. The greatest increases in likelihood of bone fractures were for those who drank carbonated beverages and engaged in high-level or vigorous physical activity. In previous studies, the researchers also found a similarly strong relationship between carbonated beverage consumption and bone fractures in active postmenopausal women and teenagers.
The researchers don’t know why this occurs, but allow for the possibility that cola and other carbonated drinks contain phosphoric acid, which affects calcium metabolism and bone mass. Another theory is that more young people replace milk in their diets with soda, giving bodies less calcium with which to build strong bones.
References:
1. Ross GW, Abbott RD, Petrovitch H, Morens DM, Grandinetti A, Tung KH, Tanner CM, Masaki KH, Blsnchette PL, Curb JD, Popper JS, and White LR. Association of coffee and caffeine intake with the risk of Parkinson’s disease. J Am Med Assoc; May 24/31, 2000. pp. 2674-2679.
2. Neville H. Golden, MD. Osteoporosis prevention: A pediatric challenge. Arch Ped Adolesc Med; Vol:154; June 2000. p. 542.
Source: FDA Consumer; 34(5); Sept/Oct 2000; p. 5.
Toddlers delight in feeding themselves. However, caution is advised to help prevent food from lodging in small airways. At the Children’s Nutrition Research Center (CNRC) in Houston, TX, nutritionists provide the following advice on finger foods for children younger than 3 years of age:
· Check baked goods for nuts, which are the number one food-related choking hazard for young children.
· Avoid giving hard or difficult-to-chew foods like raw carrots or other crunchy vegetables, hard candy, jelly beans, nuts, and lollipops. Spread thick and sticky peanut butter very thinly.
· Modify the shape and texture of firm and round foods. Cook carrots, potatoes, and other hard vegetables until soft, then cut into small pieces. Cut grapes into quarters and cut hot dogs into fine lengthwise sticks. Dice meats. Chop apples and firm fruits into very small pieces.
· Keep an eye on small children when they are eating. They might eat in a hurry, stuff too much food in their mouths, or chew their food inadequately.
· Feed small children in a relaxed atmosphere and only when they are seated. Do not allow children to run or play with food while chewing.
· Train toddlers to chew food thoroughly before swallowing or trying to speak.
The CNRC experts also advise that child caretakers receive appropriate emergency training, including how to perform the Heimlich maneuver on children and cardiopulmonary resuscitation (CPR) techniques.
Source: Nutrition and Your Child; No 2, 2000; p.3.
RECOGNIZING DEHYDRATION IN THE ELDERLY
Dehydration is a very important and often unrecognized cause of hospitalization, morbidity, and mortality in elders (See table). It has been estimated that 189,000 patients over 65 years of age are discharged annually from short-stay hospitals in the US with dehydration as a primary diagnosis; the true incidence may be higher (1).
Table: Consequences of Untreated Dehydration in the
Elderly
·
Associated
infection, with high mortality rate ·
Renal failure ·
Decreased skin
turgor with skin breakdown ·
Confusion and
lethargy ·
Increased falls and
related injury ·
Constipation with
impaction Source: Geriatrics, 1991; 46:35. |
Why the Elderly Are at Risk
Dehydration is the most common fluid or electrolyte disturbance in the elderly. There are a host of physio-logic factors that place this population at risk. One of the most important of these is that elderly persons often have a reduced sensation of thirst. Other age-related changes that may make the elderly prone to dehydration include:
· reduced total body water;
· decreased renal concentrating ability;
· decreased renin activity and aldosterone secretion; and
· a decrease in the effectiveness of plasma vasopressin.
In addition, decreased access to water due to immobility, poor vision, and altered mental status must be considered. Moreover, older adults may drink less due to fear of urinary incontinence; this practice probably is counterproductive, however, because it is linked to infection and decreased bladder distensibility (2).
Dehydration often is difficult to recognize. There is no absolute definition of dehydration, but a useful indicator is a rapid weight loss of greater than 3 percent of body weight (1). In addition, laboratory tests can help identify patients requiring intervention. These lab results include serum sodium levels of 148 mmol/L or higher and a serum urea nitrogen-to-creatinine ratio of 25 or more. However, it should be noted that a variety of factors, (e.g. renal vascular disease, gastrointestinal bleeding, or steroid-induced catabolism) may increase this ratio in elderly persons, even when dehydration is not present. Dehydration also may present with a normal serum sodium.
Warning Signs and Symptoms
It is important to be able to recognize the warning signs, symptoms, and risk factors of dehydration. Gross and colleagues evaluated 55 patients aged 60 or older who presented to the emergency department with suspected dehydration (3). According to the authors, examination of the mouth is critical in assessing possible dehydration.
“Of all physical signs evaluated, tongue furrows, tongue dryness, and dry mucous membranes of the mouth and nose were among the strongest correlates of dehydration,” they reported. “Small or absent saliva pool and tongue coating were also correlates of dehydration.” On the other hand, they caution that dry mouth can also be a result of mouth breathing or SjÖgren’s syndrome, and can be produced by medication or anxiety.
Additional corroborating evidence is required to establish the diagnosis of dehydration. Such proof might come in the form of new overt upper body muscle weakness, speech difficulty, confusion, or sunken eyes, all of which have moderately strong correlations with dehydration. Self-reported sensations of thirst and dryness were among the least reliable indicators of dehydration severity.
· Patients with recurrent urinary tract infections or pneumonia, or any patient with infection where there is doubt as to the adequacy of oral intake.
· Patients who have inadequate food intake.
· Patients with cognitive impairment.
· Patients with physical impairment.
Prevention
As for what constitutes a fluid intake level sufficient to prevent dehydration, the application and compari-son of four different recommended standards in 121 residents of a long-term care facility provide the following observations:
· 30 ml/kg of actual body weight, with a minimum of 1500 ml per day, appears to be an adequate and practical standard for preventing dehydration in elderly persons who do not have acute illness.
· 30 ml/kg of actual body weight (with no minimum) appears to be adequate, but should be used cautiously in elderly persons who are extremely under or overweight.
· The standard of 100 ml/kg for the first 10 kg body weight, 50 ml/kg for the next 10 kg, and 15 ml/kg for additional weight may overestimate needs, especially in overweight patients.
· The standard of 1 ml/kcal energy consumed is problematic in residents who routinely consume inadequate energy (5).
Attaining fluid intake goals may require the repeated encouragement and intervention of staff, family, and other caregivers. When severe cognitive impairment is not the issue, patients who refuse to drink may benefit from psychiatric evaluation for depression. If patient refusal persists or if the patient is unable to swallow due to physical or central nervous system dysfunction, a feeding tube may have to be considered. In all cases the caregiver should take care not to induce fluid overload. Patients who show signs of fluid overload such as orthopnea, shortness of breath, altered sleep patterns, or confusion may require diuretics to restore water balance.
References:
1. Weinberg AD, Minaker, KL. Dehydration. Evaluation and management in older adults. Council on Scientific Affairs; JAMA; 274(19); Nov 15, 1995; pp. 1552-6.
2. Kositzke, JA. A question of balance—Dehydration in the elderly; J Gerontol Nurs; 16(5); May 1990; pp. 4-11.
3. Gross CR, Lindquist RD, et al. Clinical indicators of dehydration severity in elderly patients. J Emerg Med; 10(3); May-Jun, 1992; pp. 267-74.
4. Hoffman, NB. Dehydration in the elderly: Insidious and manageable. Geriatrics, 46(6); Jun 1991; pp. 35-8.
5. Holben DH, Hassell JT, et al. Fluid intake compared with established standards and symptoms of dehydra-tion among elderly residents of a long-term-care facility. J Am Diet Assoc, 99(11); Nov 1999; pp. 1447-50.
Source: Nutrition and the MD; 26(7); July 2000; pp. 6-7.
PIG EARS, COW HOOVES, OTHER DRIED PET TREATS CAN MAKE YOU ILL
Dogs love them. They’re blissfully chewy and delightfully smelly to your pet, but treats made from the leftover parts of food-producing animals can make you and your family very sick.
Pet treats made from the dried ears, hooves, lungs, and bones of pigs and cows have been implicated in Salmonella poisoning in humans. In late 1999, Canadian health officials alerted the Food and Drug Administration to more than 35 human cases of Salmonella poisoning that occurred in Canada over the past year and were link-ed to contact with pig ears produced in that country. Some of these illnesses required children to be hospitalized.
“It’s alarming to find that number of serious illnesses,” says Gloria Dunnavan, the director of the Division of Compliance in the FDA’s Center for Veterinary Medicine. “We want to make sure there is no Salmonella in dried animal parts being sold as pet treats in the United States.”
Earlier this year, the FDA alerted US distributors of both the suspect Canadian products and US-manufactured dried animal parts. After the US retail store Costco tested and found Salmonella in samples of Medalist brand pig ears produced in this country, manufacturer Treat Makers LLC recalled the products in May. The recall covers treats sold at Costco stores in 11 states: Washington, Oregon, California, Arizona, New Mexico, Nevada, Utah, Colorado, Idaho, Montana, and Hawaii. The products are packaged in 25-count bags and stamped with lot numbers 07600EXU3 or 08300EX01 on a white sticker on the back of the bag.
In June, another US manufacturer, Products Carousel, Inc., recalled its Pets Carousel 100% Choo-Hooves Pressed Sticks, Item #90010-S, because of possible contamination with Salmonella. The Pets Carousel products were sold by Petsmart in Ohio and Arizona.
Although no illnesses from these products have been reported in the United States,
consumers should handle dried animal parts like they would handle raw meat, according to
Dunnavan. In other words, wash your hands with soap and hot water after handling, avoid
putting the treats on food contact surfaces (such as kitchen countertops), and don’t
allow children to touch their mouths after handling until they’ve washed their hands.
Dunnavan also advises consumers not to purchase unpackaged dried treats, which are more
likely to be contam-inated by Salmonella.
While healthy pets rarely become ill from the bacteria, they can become carriers of Salmonella and infect humans or other animals. This means that you could become infected if Fido licks your face after chewing a contaminated product.
Salmonella can cause vomiting, diarrhea, fever, and stomach cramps in otherwise healthy individuals and can be fatal in young children, the elderly, or people with weakened immune systems.
Consumers may return the recalled Medalist and Pets Carousel products to the store where they purchased them for a full refund. Customers with questions about the recall should call Treat Makers at 1-888-250-7369 or Products Carousel at 1-800-231-3572. The FDA continues to work with pet treat manufacturers to investigate the cause of the problem and to find ways to prevent it in the future.
Source:
FDA Consumer; 34(5); Sept/Oct 2000; p. 7.
RESOURCES:
Nutrition to Grow On: A Garden-Enhanced Nutrition Education Curriculum for Children in Elementary Schools links nutrition instruction and gardening activities in nine lesson plans. Its primary goal is to help children and their caregivers gain 1) the knowledge and skills needed to make healthy food choices; and 2) a greater appreciation of the land that provides the food. Intended for use with children in the upper elementary grades in California, it can also be used at different grade levels and in other regions of the United States.
This curriculum is based on sound theoretical principles. It has been designed to be:
· Enjoyable. In this curriculum the student is continually stimulated in an interactive environment.
· Simple. The curriculum minimizes preparation time. Few materials have to be gathered or prepared prior to each activity, and detailed background information is provided.
· Integrative. Each lesson is integrated with the published state content standards.
· Adaptive. Teachers are encouraged to adapt the curriculum to their own classroom setting.
Raise Your Nutritional Knowledge IQ!
The titles of the nine lessons are as follows:
1. Introduction to Nutrition and Gardening. Covers the origin of food, the requirements of living things, and plant parts.
2. Nutrients We Need. Covers the definition and classes of nutrients, and why the human body needs them.
3. The Food Guide Pyramid. Presents the six food groups and the nutrients they contribute to the human body.
4. Serving Sizes. Identifies the serving sizes recommended by the Food Guide Pyramid and the visual cues students can use to estimate portions of food.
5. Food Labels. Explains the various items on the Nutrition Facts label so that students can analyze and compare the nutritional value of foods.
6. Get Physically Active. Covers the importance of physical activity to the heart and the relationship between the food children eat and their health and well-being.
7. Goal Setting. Shows children how to incorporate some dietary guidelines into daily activities and how to set goals for healthy dietary habits.
8. Consumerism. Identifies the techniques used by companies to sell food products, helping children become aware of how advertisements influence food choices.
9. Making Healthful Snacks. Shows children how to make low-fat healthful snacks.
The appendices provide written quizzes, web sites, and a list of companies and organizations that promote nutrition education. Nutrition to Grow On is notable for its extensive developmental testing process. Drafts of the lessons were first presented to a variety of students in grades three through six to determine clarity and effectiveness. After receiving comments on the curriculum from teachers and students, the authors revised the lessons and tested them on different groups until both content and delivery were considered satisfactory. At this stage, the lessons were reviewed for accuracy by professionals in nutrition and gardening.
The final lessons were then formally evaluated in nine separate classrooms of fourth graders. On examination of the results, the authors found that the students participating in the Nutrition to Grow On curriculum significantly improved their knowledge of nutrition and preference for vegetables. That finding is encouraging because preferences for vegetables are a known predictor of healthful dietary habits that may last a lifetime.
Nutrition to Grow On was developed by Jennifer Morris, PhD, and Sheri Zidenberg-Cherr, PhD, Department of Nutrition, University of California, Davis. They worked in collaboration with Mary Shaw, Solano County Master Gardener, University of California Cooperative Extension. This publication is still in development. Call the California Department of Education Press, Sales Office (1-800-995-4099), after February 1, 2001 for information on availability.
NUTRITION, FAMILY, AND CONSUMER SCIENCES ADVISOR IN SHASTA AND TRINITY COUNTIES, CA (ANCM-00-07)
The University of California Cooperative Extension is seeking a career-track academic candidate to con-duct extension, educational, and research programs in nutrition, family, and consumer sciences for all ethnic and socioeconomic groups and individuals, plus community agencies, educators, and social service groups. This position will conduct educational programs, supervise staff and budgets for federally funded programs, and implement applied research in areas of human nutrition, food preservation and safety, family relations, childcare, and family self-sufficiency in life skills and money management. The incumbent will provide programmatic leader-ship, direction, and support to 4-H Youth Development Program Representative(s). This position is headquartered in Redding, CA.
Requirements:
A minimum of a Master’s Degree in food and nutrition, family development, consumer science, or closely related field. Food and nutrition knowledge preferred. A background check and criminal history check including fingerprinting will be required for the successful applicant. Salary will be in the Cooperative Extension Assistant Advisor rank ($38,200 to $42,400), commensurate with experience and professional qualifications.
Applications must be postmarked by 5pm November 15, 2000, for consideration. Refer
to Position No.: ANCM-00-07. AA/EO Employer.
For complete Position Vacancy Announcement (PVA) and Application form contact: Sydni
Gillette, Academic Recruitment Office, DANR: North Coast and Mountain Region, University
of California, Cooperative Extension, One Shields Ave. (1 Hopkins Rd if using FEDEX),
Davis, CA 95616-8575. Phone message: 530-754-8587; FAX: 530-754-8540. Email:
skgillette@ucdavis.edu; or, Division
Website: http://danr.ucop.edu
NUTRITION, FAMILY AND CONSUMER SCIENCE ADVISOR IN SAN DIEGO COUNTY, CA. (#ACCSO-00-02).
The University of California is seeking a career track academic candidate to address the Cooperative Extension research and educational program priorities of consumers/families in San Diego County. This position will improve specific practices related to their nutrition, health, and food safety practices, develop and disseminate information useful to consumers, agencies and organizations, and develop programs in the utilization of community resources, consumer and family resource management, economic stability and security, and under-standing of the consumer agriculture connection. Responsibilities of the position include the Expansion of the Food and Nutrition Education Program for youth and adults, and the Food Stamp Nutrition Education Program. The position will provide local leadership and knowledge in nutrition, food safety and consumer issues. The position will also enlist skills of county-based advisors, campus specialists and faculty at the local/national level, and provide information to all clientele. Maintain close liaison with local, state, and federal agencies and organizations dealing with program issues.
Requirements:
Minimum of a Master’s Degree in nutrition, food safety, or home economics with coursework in nutrition. Ability to work independently and as a team member; ability to relate research-based information to the public and conduct issue-focused research, and to teach effectively. Interpersonalskills toestablish andmaintainpositiveworkingrelationships with clientele, public agencies, and academic colleagues. Experience in communityassessment andprogram design is desirable. Computer skills required.
Apply by January 12, 2001 to: Cheryl Gneckow, DANR, Central Coast and South Region, #213, Univ. of California, Riverside 92521 (909) 787-3604; (cheryl.gneckow@ucr.edu ).
NUTRITION, FAMILY, AND
CONSUMER SCIENCES ADVISOR
CALAVERAS, AMADOR, and TUOLUMNE COUNTIES, CA (ANCM-00-06)
The University of California Cooperative Extension is seeking a career-track academic candidate to
conduct extension, educational and research programs in Nutrition, Family, and Consumer Sciences for all ethnic and socioeconomic groups and individuals, plus community agencies, educators, and social service groups. This position will conduct educational programs, supervise staff and budgets for federally funded programs, and implement applied research in areas of human nutrition, food preservation and safety, family relations, childcare, and family self-sufficiency in life skills and money management. This position’s headquarters is in Calaveras County, San Andreas, CA.
Requirements:
A minimum of a Master’s Degree in food and nutrition, family development, consumer
science or closely related field. Food and nutrition knowledge preferred. A background check and criminal history check including fingerprinting will be required for the successful applicant. Salary will be in the Cooperative Extension Assistant Advisor rank ($38,200 to $42,400), commensurate with experience and professional qualifications.
Applications must be postmarked by 5pm November
15, 2000, for consideration. Refer to Position No.: ANCM-00-06. AA/EO Employer. For complete Position Vacancy
Announcement (PVA) and Application form contact: Sydni Gillette, Academic Recruitment
Office, DANR: North Coast and Mountain Region, University of California, Cooperative
Extension, One Shields Ave. (1 Hopkins Rd if using FEDEX), Davis, CA 95616-8575. Phone
Message: 530-754-8587; FAX: 530-754-8540. Email: skgillette@ucdavis.edu
; or, Division Website: http://danr.ucop.edu
NOTE: The top line of the mailing label shows the expiration date for your
subscription.
Please renew before that date to avoid a break in service.
o Renew my subscription o Start a new subscription
Enclosed is a payment of $10.00 for a one year subscription (6 issues). Checks should be payable to the Regents of the University of California.
PLEASE PRINT INFORMATION TO ENSURE ACCURACY
Name_______________________________________________________________________________________
Address_____________________________________________________________________________________
City____________________________State_____________Zip____________County_______________________
Professional Affiliation (optional)__________________________________________________________________
o The above is a change of address
Mail this form and payment to: NUTRITION PERSPECTIVES
Department of Nutrition, University of California
One Shields Ave.
Davis, California, 95616-8669.
The University of California, in compliance with the Civil Rights Act of 1964, Title IX
of the Education Amendments of 1972, and the Rehabilitation Act of 1973, does not
discriminate on the basis of race, creed, religion, color, national origin, sex, or mental
or physical handicap in any of its programs or activities, or with respect to any of its
employment policies, practices, or procedures. The University of California does not
discriminate on the basis of age, ancestry, sexual orientation, marital status,
citizenship, medical condition (as defined in section 12926 of the California Government
Code), nor because individuals are disabled or Vietnam era veterans. Inquiries regarding
this policy may be directed to the Director, Office of Affirmative Action, Division of
Agriculture and Natural Resources, 300 Lakeside Drive, Oakland, CA 94612-3550, (510)
987-0097.
NUTRITION PERSPECTIVES
University of California
Department of Nutrition
One Shields Ave.
Davis, CA 95616-5270