Nutrition Perspectives Sept

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 530.752.3387; FAX, 530.752.8905.

FTC TO HOLD WEIGHT-LOSS ADVERTISING WORKSHOP IN NOVEMBER
The staff of the Federal Trade Commission (FTC) recently released a "Report on Weight-Loss Advertising: An Analysis of Current Trends." The report concludes that false or misleading claims, such as exaggerated weight loss without diet or exercise, are widespread in ads for weight-loss products, and appear to have increased over the last decade. The Commission also announced that they will hold a public workshop on November 19, 2002, to explore the impact that these ads have on public health and new approaches for fighting the proliferation of misleading claims for weight-loss products.

Many marketers, the report states, use false claims, misleading consumer testimonials, and deceptive before-and-after photos to market their products. According to the report, nearly 40 percent of the ads in the study, including ads that appeared in mainstream national publications, made at least one representation that is almost certainly false and 55 percent of the ads made at least one representation that is very likely to be false. Often ads promised weight-loss results beyond what is possible. Nearly half of the ads claimed that the users could lose weight without diet and exercise. In one ad, for example, the headline proclaimed: "LOSE UP TO TWO POUNDS DAILY WITHOUT DIET OR EXERCISE!" Other ads cited rapid, prolonged weight-loss claims, such as claims that consumers can lose 8 to 10 pounds per week over an extended period of time.
"We have known for some time now that there is a serious problem with weight-loss product advertising. This report demonstrates the extent of that problem," said FTC Chairman Timothy J. Muris. "Reputable marketers continue to take care to avoid false and misleading claims, but it appears that too many unscrupulous marketers are making false claims promising dramatic and effortless weight loss to sell their products. It is not fair to consumers; it is not fair to legitimate businesses, it is illegal, and it will not be tolerated."

The report, which examined 300 promotions that appeared in all major forms of media between February and May 2001, was prepared with the assistance of the Partnership for Healthy Weight Management (PHWM). The Partnership is a coalition of representatives from science, academia, the health care profession, government, commercial enterprises, and organizations whose mission is to promote sound guidance on achieving and maintaining a healthy weight.

"There is no such thing as a miracle pill for weight loss," Surgeon General Richard Carmona said. "The surest and safest way to weight loss and healthier living is by combining healthful eating and exercising. First eat healthfully, cut fats, eat at least five servings of fruit a day, and cut down on the amount of alcohol you drink. Next, get some physical activity in your day. Walking just 30 minutes a day, five days a week can reduce weight, and make you feel better."

According to the report, a comparison of current ads to ads that ran in 1992 suggests that there has been a dramatic increase in the number of weight-loss products and the amount of deceptive weight-loss advertising, during the last decade. The report noted two major trends: 1) a shift away from weight-loss products advertised as "low-calorie meal-replacements" in 1992 to pills and other products that commonly claimed to work without diet or exercise in 2001; and 2) that although ads from both 1992 and 2001 contain deceptive or false claims, the recent ads were much more likely to make specific misleading performance promises.

Since 1990, the Commission has filed 93 cases challenging false and misleading weight-loss claims involving over-the-counter drugs, dietary supplements, commercial weight-loss centers, weight-loss devices, and exercise equipment. Despite the unprecedented level of FTC enforcement over the last decade though, mislead-ing and deceptive ads continue to saturate the market.

According to health and nutrition experts, many of the weight-loss products and programs most heavily advertised are either unproven or unsafe, and frustrate efforts to promote healthy weight-loss efforts by promising unrealistic results.

"As health professionals, we are concerned about the epidemic of obesity and are equally concerned about false and misleading claims in advertising of weight-loss products and services," said George L. Blackburn, MD, PhD, chair in nutrition medicine at Harvard Medical School and a member of the PHWM. "Many promise immediate success without the need to reduce caloric intake or increase physical activity. The use of deceptive, false, or misleading claims in weight loss advertising is rampant and potentially dangerous. Many supplements, in particular, are of unproven value or have been linked to serious health risks."

Weight Loss Advertising Workshop
To address this growing problem of deceptive weight-loss advertising, the FTC is separately announcing a one-day workshop on November 19, 2002 to provide a public forum to explore the impact that these ads have on public health and new approaches for fighting the proliferation of misleading claims for weight-loss products.

Consumer Education
The weight-loss report, as well as resources for consumers, businesses, and the press, is available at www.ftc.gov/dietfit. The FTC has the following tips for consumers who are interested in weight-loss products or programs:

Consumers who wish advice on how to find a healthy weight loss plan should visit the PHWM web site at www.consumer.gov/weightloss.
Source: FTC Press Release; September 17, 2002.

CARDIOVASCULAR BENEFITS OF LONG-TERM FRUIT AND VEGETABLE CONSUMPTION
Eating at least three servings of fruits and vegetables each day over an extended period of time may help protect against stroke, heart disease, and other cardiovascular problems, a new study indicates (1). The study by Lydia A. Bazzano, PhD, and colleagues, of the Tulane University School of Public Health and Tropical Medicine, examined the relationship between fruit and vegetable consumption and the risks of cardiovascular disease (CVD) and stroke in a large group for an average of 19 years. They found that stroke incidence and mortality, as well as mortality from ischemic heart disease and CVD, were all significantly reduced in those who had eaten at least three servings of fruits and vegetables per day.

“Increase fruit and vegetable intakes have been recommended to prevent morbidity and mortality from cardiovascular disease,” the researchers conclude in their study. “Our findings provide additional evidence to support this recommendation.”
The study, part of the first National Health and Nutrition Examination Survey (NHANES I), involved prolonged follow-up of 9,608 adults ages 25 to 74 who were randomly distributed by sex, race and sociological group. All subjects were free of CVD at the study’s inception between 1971-1975. Follow-up data on dietary intake, disease and mortality were collected in 1982-1984, 1986, 1987, and 1992. In determining average daily servings of fruits and vegetables, the researchers used both a three-month food frequency questionnaire and a 24-hour dietary recall record. People who had eaten at least three servings per day of fruits and vegetables had a 27 percent lower incidence of stroke and a 42 percent lower stroke mortality rate, when all subjects were considered. In addition, the risk of death from ischemic heart disease and CVD was reduced by 24 percent and 37 percent, respectively. Men appeared to benefit more than women and whites more than nonwhites from frequent fruit and vegetable consumption with a few exceptions, such as a 53 percent reduction in stroke mortality for women versus a 23 percent reduction for men.
Reference:
1. Bazzano LA, He J, Ogden LG, et al. Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Am J Clin Nutr. 2002 July; 76(1); pp. 93-9.
Source: FDA Consumer; The Magazine of the US Food and Drug Administration; 36(5); September-October 2002; p. 9.

HEADLINE: HHS, USDA TAKE NEXT STEP IN OBESITY FIGHT
The Human Health Services (HHS) Secretary Tommy G. Thompson and US Department of Agriculture (USDA) Secretary Ann M. Veneman recently met with officials from the National Restaurant Association and the National Council of Chain Restaurants to begin dialogue about how the food and beverage industries can help Americans combat obesity, which has reached epidemic proportions.

The meeting, the first in a series of talks with various representatives, came one week after HHS released new data indicating that nearly one-third of all adults in the United States now classify as obese, and that 15 percent of children and teens aged 6 to 19, close to 9 million children are overweight. It also follows up on a commitment by the Bush Administration, through its Healthier US Initiative, to examine new ways to educate Americans about balancing diets and physical activity to promote healthy lifestyles.

"I am calling on leaders from the food and beverage industry to aid us in our fight against obesity," Secretary Thompson said. "Overweight and obesity are at an all-time high in America and the public health consequences are enormous. At HHS, we aim to lead by example. We must act now, and act together, in order to improve the health of our country's adults and children."
"Bringing various industries together to promote balanced diets and healthier lifestyles is important as we look at more aggressive ways to fight obesity in America," Secretary Veneman said. "At USDA, our goal is to work together in partnership with all sectors to strengthen our ability to reach consumers about these important lifestyle decisions."

The meeting with industry leaders marks the beginning of a long-term collaboration seeking to deliver healthy food choices to the American public by providing easy-to-understand nutritional information, integrating healthiness into mass marketing strategies, and offering an increased variety of healthy meals.

In the near future, the two Secretaries will also be engaging other organizations to help combat the obesity epidemic, including fruit and vegetable growers, grocery manufacturers, public health groups, and state leaders through the National Governors Association and the National Conference of State Legislatures, as well as physical fitness groups and educators.

"Poor eating habits and lack of physical activity are associated with 300,000 deaths each year, and many more individuals experience lower quality of life," Secretary Thompson said. "Overweight and obesity also go hand in hand with diabetes. Type 2 diabetes, usually a disease of adults, is now appearing in children. We must arm Americans with the tools they need to eat responsibly and choose healthy behaviors."

To help fight the rising trend of overweight and obesity, HHS and USDA have launched several efforts during the past year. The HHS efforts include: "VERB: It's What You Do" Youth Media Campaign in July 2002, which encourages 9 to 13 year-olds to be physically active and engaged in their communities. Also, Secretary Thompson, in partnership with ABC Radio Networks, launched "Closing the Health Gap," a nationwide campaign targeted towards communities of color to help raise awareness about many health disparity areas, particularly diabetes, most often associated with overweight and obesity.

In addition, earlier this year, HHS and USDA launched a new, reinvigorated partnership with the "5-A-Day for Better Health Campaign," which emphasizes the importance of eating five to nine servings of fruits and vegetables daily. And in August, Secretaries Veneman and Thompson launched a "Walk For Better Health" initiative to promote more physical activity among the federal workforce and consumers.

Also, the USDA has spearheaded several initiatives aimed at combating the growing prevalence of overweight and obese children in America. Among current USDA initiatives are the "Eat Smart. Play Hard." campaign for schools; a 48-state nutrition education program for food stamp recipients; an action kit for community organizers titled "Changing the Scene: Improving the School Nutrition Environment," and a $6 million grant to 100 schools to provide fresh produce during the school day.

These disease prevention and health promotion campaigns underscore the administration's Healthier US Initiative, launched by President Bush in June 2002. The campaign focuses on improving overall health through regular physical activity, proper nutrition, preventive screenings, and healthy lifestyle choices.

Overall, the President's fiscal year 2003 budget for HHS provides more than $16 billion for disease prevention programs and research for children and adults. It also provides record-level funding for the USDA's Women, Infants, and Children (WIC) program, as well as increased funding for other child nutrition programs. Last year, the USDA provided more than $7 billion for activities to directly support consumption of fruits and vegetables by children and low-income families. For more information on the Healthier US Initiative, and for information on children's health, visit http://www.healthierus.gov and http://www.childrenshealth.gov. For details on the "VERB: It's What You Do" Youth Media campaign, go to http://www.verbnow.com. More information on USDA's nutrition programs can be found at http://www.gns.usda.gov.
*Note: The BMI is a single number that evaluates an individual's weight status in relation to height. BMI is generally used as the first indicator in assessing body fat and has been the most common method of tracking weight problems and obesity among adults. BMI is a mathematical formula in which a person's body weight in kilograms is divided by the square of his or her height in meters [i.e., wt/(ht)2]. The BMI is more highly correlated with body fat than any other indicator of height and weight. The criterion for obesity is the same for both men and women. Someone who is 5'7" is obese at 192 pounds and a person who is 5'11" is obese at 215 pounds. More on this at: http://www.cdc.gov/nccdphp/dnpa/bmi/index.htm.
Source: HHS Press Release; October 15, 2002.

NHLBI STUDY FINDS DRAMATIC DECLINE IN PHYSICAL ACTIVITY AMONG AFRICAN-AMERICAN AND WHITE GIRLS DURING ADOLESCENCE
Both African-American and white girls experience a dramatic decline in physical activity during adolescence with the greatest decline occurring in black girls, according to a study supported by the National Heart, Lung, and Blood Institute (NHLBI) (1).
Sue Kimm, MD, of the University of Pittsburgh School of Medicine, and colleagues found that by ages 16 or 17, 56 percent of black girls and 31 percent of white girls report they have no regular leisure-time physical activity.

Kimm and colleagues studied 1,213 black girls and 1,166 white girls enrolled in the NHLBI Growth and Health Study from ages 9 or 10 to ages 18 or 19 years. A questionnaire measuring leisure-time physical activity was administered to the girls seven times during the study (years 1, 3, 5, and 7 to 10).

The scientists found an association between lower levels of parental education and activity decline in white girls of all ages and in older black girls (ages 13 to 17). Higher body mass index (a measure of body weight adjusted for height) predicted a decline in activity among both racial groups.

Pregnancy was associated with activity declines in black but not in white girls. According to Kimm, there may not have been an adequate number of pregnancies among white girls to detect a statistically significant effect on physical activity. Kimm noted that a similar situation may explain the race-specific results for smoking. Although cigarette smoking predicted a greater activity decline in white girls only, relatively few black girls smoked. Thus, there may not have been enough black smokers to detect an effect on physical activity.

Given the current epidemic of obesity, the researchers conclude that the "precipitous" drop in activity levels during adolescence "should sound an alarm" for action. They suggest that the risk factors identified in this study could help prioritize education resources and guide prevention efforts. Eva Obarzanek, PhD, research nutritionist, NHLBI, is available to comment on the study and the problem of obesity and low levels of physical activity in youth. Information about obesity, physical activity, and NHLBI's Hearts N' Parks program is available online at: www.nhlbi.nih.gov. Hearts N' Parks is a national community- based program focused on reducing obesity and the risk of heart disease by encouraging all Americans to aim for a healthy weight, follow a heart-healthy eating plan, and engage in regular physical activity.
Reference:
1. Kimm SY, Glynn NW, Kriska AM, et al. Decline in physical activity in black girls and white girls during adolescence. N Eng J Med; 347(10); September 5, 2002; pp. 709-15.
Source: NHLBI Press Release; September 17, 2002.

HHS TO STUDY EPHEDRA, STEP UP ENFORCEMENT AGAINST ILLEGAL MARKETING
Health and Human Services (HHS) Secretary Tommy G. Thompson has announced efforts to expand research on the safety of herbal ephedrine alkaloids, commonly referred to as ephedra. Marketed in the United States as weight loss, energy, and sports supplements, ephedrine alkaloids are active chemicals found naturally in a number of plants. They can also be produced synthetically.

Adverse event reports have raised questions about the safety of these products, and the Food and Drug Administration (FDA) has advised that further scientific research is needed. HHS recently funded the RAND Corporation to conduct a review of the existing science on ephedrine alkaloids, particularly in dietary supplements. The National Institutes of Health will use this information to guide an expanded research effort on the safety of ephedrine alkaloids.

Thompson also announced plans to aggressively pursue the illegal marketing of non-herbal synthetic ephedrine alkaloid products. In June, the FDA sent six warning letter to firms unlawfully selling these products over the Internet. The FDA also warned another company for illegally promoting its ephedrine product as an alternative to street drugs.

The firms that do not correct the violations described in the warning letters face further enforcement actions. This could include seizure of the illegal product and injunction from manufacturing and distributing the product, as well as prosecution of the companies and individuals. “These products are not for everyone,” says FDA Deputy Commissioner Lester M. Crawford, DVM, PhD. “Consumers should read the labels to ensure proper use.”

Consistent with industry standards and warnings that appear on many products, consumers under the age of 18 and women who are pregnant or nursing should not use these products. Consumers should consult a healthcare provider before using such products if they are using a prescription drug or if they have ever had high blood pressure, heart or thyroid disease, a seizure disorder, depression, diabetes, difficulty urinating, prostate enlargement, or glaucoma.

Anyone using a monoamine oxidase (MAO) inhibitor (a drug used in the treatment of selected atypical depression) or any allergy, asthma, or cold medication containing ephedrine, pseudoephedrine, or phenylpropanolamine should consult with a physician before using dietary supplements containing ephedrine alkaloids. Phenylpropanolamine may also be found in over-the-counter (OTC) weight-loss products. Because of safety concerns, the FDA recommended on November 2000, that consumers stop using products with phenylpropanolamine and has proposed that it be removed from the market. Consumers may still have products containing the ingredient in their medicine cabinets.

Consumers should discontinue use of ephedrine alkaloids if any of the following symptoms are experienced: rapid or irregular heart beat, chest pain, severe headache, shortness of breath, dizziness, loss of consciousness, sleeplessness, or nausea.
Source: FDA Consumer; The Magazine of the US Food and Drug Administration; 36(5); September-October 2002; p.3.

NEW RECOMMENDATIONS TO PREVENT HIGH BLOOD PRESSURE ISSUED
The National High Blood Pressure Education Program (NHBPEP) has updated its recommendations to prevent hypertension (high blood pressure). New recommendations include adequate intake of potassium and an eating pattern rich in fruits, vegetables, and low-fat dairy products. The advisory also reinforces earlier recommendations to limit consumption of sodium and alcohol, reduce excess body weight, and increase levels of physical activity.

Published in the October 16 issue of The Journal of the American Medical Association, the report also cautions that some widely publicized approaches have less proven or uncertain efficacy. Fish oil (omega-3 polyunsaturated fatty acids) and calcium supplements lower blood pressure only slightly in individuals with hypertension. In addition, the ability of herbal and botanical supplements to safely lower blood pressure is unproven, and these unregulated products can interact adversely with medications.
Developed by a distinguished panel of experts convened by the NHBPEP Coordinating Committee, the advisory reflects the latest scientific evidence and updates the first recommendations on preventing high blood pressure released nearly a decade ago. Like the 1993 advisory, the new report emphasizes two overall strategies to keep blood pressure from rising: a population-based strategy and an intensive strategy for high-risk individuals. High blood pressure (systolic blood pressure at or above 140 mmHg or diastolic blood pressure at or above 90 mmHg) is associated with an increased risk of death and disability from heart disease, stroke, congestive heart failure, and end-stage renal disease.

"The United States has made substantial gains over the past several decades in preventing high blood pressure and in detecting and controlling high blood pressure when it does develop," said Dr. Claude Lenfant, director of the National Heart, Lung, and Blood Institute (NHLBI), which coordinates the NHBPEP. "However, Americans continue to be at high risk for hypertension and related complications. These revised recommendations can help us do better."

Fifty million adults in the United States, including more than one of every two adults over the age of 60, have high blood pressure, according to the National Center for Health Statistics. Furthermore, data from NHLBI's landmark Framingham Heart Study suggest that middle-aged and elderly individuals face a 90 percent risk of developing hypertension during their remaining years.

Framingham research has also shown that the risk of cardiovascular disease associated with high blood pressure increases gradually, even before hypertension occurs. The approximately 23 million adults in the US with high-normal blood pressure levels (systolic pressure of 130-139 mmHg and/or a diastolic pressure of 85-89 mmHg) are 1.5 to 2.5 times more likely to have a cardiovascular event or to die within 10 years, compared to those with optimal blood pressure (systolic pressure of less than 120 mmHg and diastolic pressure of less than 80 mmHg). Normal blood pressure levels are 120-129 mmHg systolic and 80-84 mmHg diastolic.

"Epidemiological data suggest that if we could lower the average systolic blood pressure among Americans by 5 mmHg, we'd see a 14 percent drop in deaths from stroke, a 9 percent drop in heart disease deaths, and a 7 percent drop in overall mortality," said Dr. Paul Whelton, senior vice president for health sciences for Tulane University Health Sciences Center and co-chair of the NHBPEP working group that developed the latest recommendations. "A reduction as small as 2 mmHg in the average American's systolic blood pressure could save more than 70,000 lives per year."

Proven behavioral changes can lower one's blood pressure and reduce the risk of a cardiovascular event. The report cites one study, for example, that found that people with normal blood pressure levels who increased the amount of regular physical activity lowered their systolic blood pressure by more than 4 mmHg. In another study, overweight participants with normal blood pressure levels significantly lowered their systolic blood pressure by losing weight (fewer than 8 lbs); in addition, the percentage of participants in this group who had high blood pressure seven years later was less than half of the percentage of the control group which remained overweight.

The clinical trial known as Dietary Approaches to Stop Hypertension, or DASH, has demonstrated the critical role of nutrition in controlling blood pressure. Based on the results of DASH, the NHBPEP now recommends an eating plan that is rich in fruits, vegetables, and low-fat dairy products and that has limited saturated and total fat.

Furthermore, limiting daily dietary sodium intake to less than 2,400 mg of sodium (about 1 teaspoon of salt) per day helps lower or control blood pressure. In one study, older patients with hypertension significantly lowered their systolic blood pressure and decreased their need for medications by moderately reducing how much sodium they consumed. The advisory highlights that although limiting the amount of salt added during cooking and at the table is important, three-fourths of the average individual's total intake of salt and sodium comes from sodium added during processing and manufacturing. Therefore, NHBPEP urges food manufacturers to lower the amount of sodium in the food supply, and to offer these products at equitable prices.

Other behavioral changes for people with blood pressure above optimal levels include consuming more than 3,500 mg of dietary potassium per day, an approach especially important for individuals with high sodium intake, and limiting alcohol consumption to no more than 1 ounce of ethanol (e.g., 24 oz beer, 10 oz wine, or 2 oz 100-proof whiskey) per day in most men and to no more than 0.5 ounce per day in women.

These lifestyle factors are essential for seniors and others who are more likely to develop high blood pressure, such as those with high-normal blood pressure or a family history of hypertension; those who are African American, overweight or obese, or inactive; and those who consume more than the recommended amounts of dietary sodium or alcohol, or insufficient amounts of potassium.

The report advises, however, that efforts to prevent blood pressure from rising in children are also important. School administrators can help by offering heart healthy foods in their cafeterias and health education programs in their classrooms.
"Our society needs to better support individuals who are trying to make healthy lifestyle changes," said Dr. Jiang He, who co-chaired the NHBPEP working group with his Tulane colleague. For instance, reimbursement of counseling services for hypertension prevention could help consumers adopt healthy behaviors.

"Consumers need to be better informed about portion sizes, food content and labeling," added NHBPEP Coordinator Dr. Edward Roccella. "Training programs for health care providers also need to focus more on nutrition and other lifestyle issues related to blood pressure."
Source: NHLBI Press Release; October 15, 2002.

HEALTH BENEFITS OF MUSHROOMS
For centuries, people have enjoyed mushrooms for their flavor. But nutritious? Until recently mushrooms, perhaps because of their neutral color, were assumed to have few, if any, nutrients. The fact is that the unassuming mushroom provides generous amounts of three B-complex vitamins, several minerals and may have disease-fighting powers. All this with virtually no fat or sodium and few calories, making mushrooms an ideal food for those on weight control, diabetic and hypertensive diets and everyone who loves good, healthy food.

Here are highlights of on-going research that is shedding light on mushrooms’ remarkable cancer-fighting potential.

Mushrooms and breast cancer research
The American Cancer Society warns that one in eight American women will be diagnosed with breast cancer in her lifetime. Studies underway at the Beckman Research Institute of the City of Hope in Duarte, California, suggest that fresh white mushrooms (Agaricus bisporus) contain substances that appear to inhibit activity of aromatase, an enzyme used in the production of estrogen, believed to have breast cancer-promoting effects in post-menopausal women (1).

Initially, extracts from seven vegetables, green onion, celery, carrot, bell pepper, broccoli, spinach and mushrooms, were tested for aromatase-inhibiting activity. The most effective aromatase inhibitor was found in white mushrooms. The study’s second phase tested only mushrooms to learn whether other varieties contain the aromatase inhibitor. It included portabella, shiitake, crimini (brown), oyster, enoki, woodear, chanterelle, and small and large white (stuffing) mushrooms. The large white mushrooms emerged as the most potent inhibitor of aromatase activity. The other members of the Agaricus family, portabella, crimini, and small white mushrooms, also demonstrated significant anti-aromatase effects.

Lead researcher Shiuan Chen, PhD, says that several compounds in the mushroom are probably responsible for the effect. Dr. Chen explains that, while his research looks promising, it’s too early to tell whether the results can be replicated in humans or even animals. His colleagues begin tests with mice later this year.

Mushrooms and prostate cancer
Ongoing research suggest that selenium, working with its partner Vitamin E to scavenge cell-damaging free radicals, may help prevent prostate cancer in men, the second most common cancer in men after skin cancer. Last year, at least 31,000 deaths were attributed to the disease.

When it comes to selenium content, mushrooms surpass all other items in the produce category. A serving of crimini, in fact, provides almost one-third the Daily Value for selenium, according to the USDA. Portabella and white mushrooms are also good selenium sources. With their significant dose of selenium in every serving, mushrooms may turn out to be important ingredients in a cancer-fighting diet.

Selenium came to the forefront of prostate cancer research when in 1996; skin cancer patients were given selenium to learn whether it would prevent recurrence. It had no effect on skin cancer, but researchers noticed that it did decrease prostate cancer by more than 60 percent, which prompted further study (2).

Findings from the Baltimore Longitudinal Study on Aging found that men with the lowest blood selenium levels were four to five times more likely to have prostate cancer than those with the highest selenium levels. Furthermore, blood selenium levels appear to decrease with age, suggesting that older men should add more selenium to their diets (3).

The National Cancer Institute and the Southwest Oncology group launched a 12-year study last year. Dubbed SELECT, the Selenium and Vitamin E Cancer Prevention Trial, the study will follow 32,000 men at 400 sites across North America to learn how selenium and Vitamin E work to protect against prostate cancer (4).

WhiteAgaricus bisporus

CriminiAgaricus bisporus (Also called brown)

PortabellaAgaricus bisporus (Also called Portobello)

Shiitake Lentinus edodes

White mushrooms can have closed veils (caps that fit closely to the stem) with white caps and delicate flavor or open veils with darker caps and richer taste. Represent 90 percent of the mushrooms consumed in the US

Similar in appearance to white mushrooms, but with a light tan to rich brown cap and a firmer texture. Deeper, earthier flavor than white mushrooms.

Large relative of white and crimini mushrooms; caps measure up to 6 inches in diameter. Portabellas have a longer growing cycle, resulting in a deep, meat-like texture and flavor.

Tan to dark brown with broad, umbrella-shaped caps, wide-open veils and tan gills. Rich and woodsy with a meaty texture.

Trading Meat for Mushrooms
Over the past several decades, Americans in growing numbers are exploring and enjoying meatless meals both at home and at restaurants. A survey by the vegetarian resource Group found that 57 percent of Americans order a vegetarian item “sometimes, often or always” when dining out (5). The health benefits of moving to a plant-based diet are many, including reducing the risk for obesity, coronary artery disease, hypertension, diabetes, and some types of cancer.
Mushrooms go with just about anything, imparting their own flavor as well as taking on flavors of other ingredients, so they’re ideal for meatless recipes, from soups and appetizers to main course and sandwiches their flavor intensifies during cooking and their unique texture holds up to a variety of cooking methods, including sautéing, grilling, and stir-frying. Mushrooms are also an appealing addition to vegetable-based casseroles, stews or chilies.
For more information, visit www.mushroomcouncil.or.
Reference:
1. Grube BJ, Eng ET, Kao YC, Kwon A, Chen S. White button mushroom phytochemicals inhibit aromatase activity and breast cancer cell proliferation. J Nutr. 131:3288-3293,2001.
2. Combs GF Jr, Clark LC, Turnbull BW. Reduction of cancer risk with an oral supplement of selenium. Biomed Environ Sci; 10:227-324,1997.
3. Brooks JD, Metter EJ, Chan DW, et al. Plasma selenium level before diagnosis and risk of prostate cancer development. J of Urology, 166:2034-2038, 2001.
4. Wood M. Selenium’s secrets probed in new study. USDA-ARS. March 2002. http://www.ars.usda.gov/is/AR/archive/mar02/selen0302.htm.
5. Restaurants USA, June 2002.
Adapted from: The Mushroom Council; Summer 2002.

FOOD BORN DISEASE OUTBREAKS IN US SCHOOLS
Food-borne disease outbreaks in US schools resulted in nearly 50,000 illnesses, 1,514 hospitalizations and one death from 1973-1997, according to an analysis of data collected by the US Centers for Disease Control and Prevention (1). Researchers reviewed the number and size of food-borne disease outbreaks in primary and secondary schools, colleges’ and universities. They also examined etiologic agents, food vehicles of transmission, site of food preparation and other contributing factors.
Over the 25-year surveillance period, 604 outbreaks were reported. The three most commonly identified etiologic agents were Salmonella (36 percent of outbreaks), Staphylococcus aureus (25 percent) and Clostridium perfringes (11 percent). However, 60 percent of outbreaks had no known cause.

Specific food vehicles of transmission were identified in 55 percent of the outbreaks. The most commonly implicated vehicles were foods containing poultry (18.6 percent), while salads, Mexican-style foods and beef each were responsible for about 6 percent of the outbreaks. Over the surveillance period, data also showed a three-fold increase in the percentage of outbreak linked to salad and an eightfold increase in outbreaks due to turkey.

The most commonly reported food preparation practices that contributed to school-related outbreaks were improper food storage and holding temperature, and food contaminated by a food handler.

Researchers suggested several measures that could reduce the number of food-borne outbreaks in schools, including:

Reference:
1. Daniels NA, MacKinnon L, Rowe SM, Bean NH, Griffin PM, Mead PS. Foodborne disease outbreaks in United States schools. Pediatr Infect Dis J. 2002; 21:623-628.
Source: AAP NEWS; 21(4); October 2002; p.158.

GRAY DAVIS SIGNED ASSEMBLY BILL 1793: STATE DEPARTMENT OF EDUCATION TO DEVELOP MODEL CONTENT STANDARDS FOR PHYSICAL EDUCATION
Great news for the health of California children: Governor Davis signed physical education (PE) bills AB 1793 and SB 1868! The bills, AB 1793 (Migden) and SB 1868 (Torlakson) can build on the success of SB 19 and the Los Angles Unified School District (LAUSD) resolution banning the sale of unhealthy beverages to improve the school environment. These bills are important steps towards ensuring all kids have access to quality PE. Creating a healthy school environment that promotes physical activity, along with good nutrition, is essential in addressing the childhood obesity epidemic in California.

NHLBI FUNDS NEW HEART-HEALTH EDUCATION PROJECTS IN HIGH-RISK COMMUNITIES
The National Heart, Lung, and Blood Institute (NHLBI) recently announced the funding of six new community-based education projects, which will focus on improving the cardiovascular health of those at increased risk for heart disease and stroke.
The new awards extend to 12, the NHLBI's nationwide network of community-based organizations known as Enhanced Dissemination and Utilization Centers (EDUCs). The EDUC program was launched in 2001 to implement focused heart- health education strategies in high-risk communities.

"These projects take what we have learned about the prevention, identification, and treatment of cardiovascular disease and apply that knowledge where it is most needed, in communities with the highest heart disease and stroke death rates," said NHLBI Director Claude Lenfant, MD.

Heart disease and stroke remain the first and third leading causes of death in the U.S. However, certain geographic areas and racial/ethnic groups are disproportionately affected. The Federal Government's Healthy People 2010 initiative seeks to eliminate those disparities and improve health care for all.

"The EDUC program is a key part of the NHLBI's agenda to achieve the goals of Healthy People 2010. All of the EDUCs are in health service areas (HSAs) where the death rate for coronary heart disease and/or stroke is in the top 15 percent of HSAs nationally," said Robinson Fulwood, PhD, Senior Manager, Public Health Program Development in NHLBI's Office of Prevention, Education, and Control.

The new projects target high-risk communities in urban and rural areas in Maryland, Nebraska, Colorado, Ohio, and North Carolina. The EDUCs emphasize the forging of community health partnerships to meet individual project goals. Objectives are achieved through a variety of creative approaches including training peer health educators; conducting awareness-raising town-hall meetings, community-based screening and referral programs, and nutrition and physical activity programs; and working with physicians to improve the implementation of clinical practice guidelines.

In keeping with the "network" aspect of the program, the six existing EDUCs, now in their second year of activity, will share lessons learned and examples of success with the new programs through regular discussion forums. Tracking of progress is helped by a series of built-in evaluation measures.
Source: NHLBI Press Release; October 8, 2002.

NEW SUGAR SUBSTITUTE APPROVED
The Food and Drug Administration (FDA) has approved Neotame for use as a general-purpose sweetener in a variety of food products. Depending on its food application, Neotame is 7,000 to 13,000 times sweeter than sugar. The NutraSweet Company of Mount Prospect, Ill makes the non-nutritive, high-intensity sweetener.

Examples of uses for which Neotame has been approved include baked goods, non-alcoholic beverages, chewing gum, confections and frostings, frozen desserts, gelatins and puddings, jams and jellies, processed fruits and fruit juices, toppings, and syrups. Neotame has not been approved for use in meat or poultry. Any proposed uses of food additives in meat, poultry, or eggs must also be evaluated by the US Department of Agriculture. The FDA reviewed data from more than 113 animal and human studies to determine the safety of Neotame.
Source: FDA Consumer; The Magazine of the US Food and Drug Administration; 36(5); September-October 2002; pp.8.

FDA WARNING ON CHINESE DIET PILLS CONTAINING FENFLURAMINE
The Food and Drug Administration (FDA) is alerting the public about Chinese weight-loss products, Chaso (Jiabfei) Diet Capsules and Chaso Genpi, because they pose a potential health risk.
The agency is alerting the public to this health risk because several people in Japan have become ill, and some have died, after consuming these diet products.

“FDA is taking this action as a precautionary measure to help assure that people are not exposed to this potentially dangerous product,” says FDA Deputy Commissioner Lester M. Crawford, DVM, PhD.

Products of this type are often sold in small urban markets as alternatives to Western medicine. In 2001, the FDA issued a nationwide alert on the recall of 13 “Treasure of the East” herbal products because of a dangerous ingredient, aristolochic acid, which is toxic to the kidney. The deaths in Japan linked to these Chinese weight-loss products may have resulted from the presence of such active drug ingredients as fenfluramine in the capsules.

Fenfluramine and another diet drug, phentermine, were used in combination for weight loss until it was determined that the combination of drugs was linked to valvulopathy, a serious and sometimes fatal heart disease. Fenfluramine and a chemically similar drug, dexfenfluramine, were removed from the market in 1997. Phentermine, when used alone, has not been associated with valvulopathy and remains on the market.

The FDA has advised its import operations personnel to be on the alert for Chaso Diet Capsules and Chaso Genpi. The agency is urging consumers not to take these diet pills and to notify their local FDA office if the products are found in their area.
Source: FDA Consumer; The Magazine of the US Food and Drug Administration; 36(5); September-October 2002; p.7.

FDA STEPS UP SEAFOOD SAMPLING
The Food and Drug Administration (FDA) is increasing its sampling of imported shrimp and crayfish (also known as crawfish) to check for the presence of the antibiotic chloramphenicol. The agency is taking this action because low levels of the drug in imported shrimp and crayfish have been detected by some states and other countries.
Chloramphenicol is a potent, broad-spectrum antibiotic used to treat infections in people. Federal regulations prohibit its use in food-producing animals and animal-feed products because it has not been possible to identify a safe level of human exposure to chloramphenicol.

“The FDA is concerned about any detection of chloramphenicol in shrimp and crayfish,” says FDA Deputy Commissioner Lester M. Crawford, DVM, PhD. “The agency will take whatever action is necessary to protect the public health.”
The FDA actions include issuing an import alert and directing inspectors to test seafood and refuse US entry to any product identified and confirmed as containing more than 1 part per billion (ppb) of chloramphenicol, the lowest level currently detectable by FDA analysis methods. The agency is modifying its methods to detect 0.3 ppb, which will place US methodologies in line with those used by Canada and the European Union.

The FDA is also working cooperatively with the states and other countries to share methods for determining levels of chloramphenicol in shrimp and honey, says Arnold Borsetti, PhD, a chemist and associate director for operations in the FDA’s Center for Food Safety and Applied Nutrition. In July, the FDA held a conference call with officials in all 50 states. “We want to assure that information available to FDA, to include sampling and testing methodologies, is shared with all the states,” says Borsetti. “Since there are many ports of entry for imported food products across the US, this information-sharing is very important to aid in the coordination and consistency of effort at both the federal and state level.”

Because some states detected chloramphenicol in shrimp and crayfish imported from China and other Southeast Asian countries, FDA and Chinese officials met in June to discuss these drug residues and exchange information on testing methods. Chinese officials informed the FDA that China has banned the use of chloramphenicol in animals and animal feeds. They are also testing shrimp, crayfish, and other animal-derived foods intended for export to ensure the absence of chloramphenicol and other drug residues.

The FDA will continue to work with other governments and state agencies to ensure the safety of the US food supply.
Source: FDA Consumer; The Magazine of the US Food and Drug Administration; 36(5); September-October 2002; p. 4.

NIH RELEASES ANNUAL BIBLIOGRAPHY OF SIGNIFICANT ADVANCES IN DIETARY SUPPLEMENT RESEARCH
The Office of Dietary Supplements (ODS) at the National Institutes of Health (NIH) recently announced the release of the third issue of the Annual Bibliography of Significant Advances in Dietary Supplement Research. Developed as a joint effort of ODS and the Consumer Healthcare Products Association (CHPA), this publication presents significant research in the dietary supplement field for the year 2001.

"ODS is pleased to release the 2001 Bibliography. The response to the 1999 and 2000 Bibliographies has been so positive that we are continuing the series with a third edition. Interest and use of dietary supplements continues to be prevalent in the United States population, which heightens the importance of sound scientific research in this field," said Paul M. Coates, PhD, Director of ODS.

"This bibliography provides an excellent opportunity to give well-deserved recognition to those scientists conducting dietary supplement research."

For the 2001 issue of the Annual Bibliography, ODS and CHPA received over 250 original research article nominations from 34 peer-reviewed journals. An international team of expert reviewers in the fields of nutrition and botanical sciences and public health reviewed and ranked the articles. The top 25 articles were selected for publication.

The articles for the 2001 bibliography included research in the following areas:

New this year, in the Bibliography, are the two lists of citations of papers from the 1999 and 2000 Annual Bibliographies. The lists will allow the reader to see trends in dietary supplement research over the last three years and to follow up in areas of interest.

"The ODS is delighted to partner again with CHPA on this publication that highlights significant research on dietary supplements and their role in health maintenance. We are also greatly indebted to our team of scientific PhD, reviewers who assisted us in the compilation of this year's Bibliography," said Rebecca B. Costello, PhD, Deputy Director of ODS. "We envision that this bibliography will serve as a useful reference source for students, nutrition and health professionals, educators, and health communicators, as well as the scientists who conduct the research."

Copies of the third Annual Bibliography of Significant Advances in Dietary Supplement Research may be downloaded from the ODS website at
http://ods.od.nih.gov/publications/publications.html.Single copies may also be requested from ODS by phone (301-435-2920) or email (ods@nih.gov).
Source: NIH Press Release; October 16, 2002.

RESOURCES:
NEW REPORT: LA SODA BAN/HEALTHY SCHOOL FOOD CAMPAIGN
The Center for Food and Justice recently released its report, "Challenging the Soda Companies: The Los Angeles Unified School District Soda Ban," available at http://departments.oxy.edu/uepi/cfj/resources/SodaBan .html. They welcome feedback, and would like to know about similar campaigns or prospective campaigns and whether there would be interest in linking healthy school food initiatives (for example, farm to school programs) with campaigns to get junk food and sodas out of schools. Contact the Center for Food and Justice at: cfj@oxy.edu.
Source: CFJ Press Release; September 13, 2002.

UPDATED NUTRIENT DATABASE FOR STANDARD REFERENCE IN FOODS
The Agricultural Research Service (ARS) recently launched an updated version of its flagship database that reports nutrients in 6,220 food items. Named the "Nutrient Database for Standard Reference, Release 15," or SR15 for short, it is the major authoritative source of food composition in the United States.

From cheese crackers to chicken patties, salsa to salmon, chances are you'll find it in SR15. Both generic and brand name food items are included. Information is derived from United States Department of Agriculture (USDA) research, qualified food industry sources, USDA-sponsored contracts and rigorously evaluated scientific literature. A single food item's complete profile boasts 117 nutrient categories, which appear in columnar format. Newly developed algorithms are used to evaluate data for scientific accuracy, and quality control programs maximize data reliability.

Meat product categories in particular have been beefed up. Ground beef data were revamped to reflect new market trends and the demand for lower fat products. Nutritive profiles were added for a variety of emu, ostrich, deer, bison, and elk products as well as for eight new beef cuts. Many brand name, ready-to-eat breakfast cereals and candies were updated to reflect current names and nutrient values.

The method of reporting vitamin A equivalents changed from micrograms (mcg) of retinol equivalents to retinol activity equivalents (RAEs). This change was made to adopt the same standard used by the National Academy of Sciences in the new Dietary Reference Intakes (DRIs) for vitamin A. By reporting RAEs, consumers and health care providers who want to compare their vitamin A intakes to the new DRIs will find those values in SR15.

The ARS Nutrient Data Laboratory in Beltsville, MD, provides electronic access to SR15 for free from its web site and for purchase on CD-ROM. To access SR15, go to: http://www.nal.usda.gov/fnic/foodcomp/Data/ SR15/sr15.html. ARS is USDA's chief scientific research agency.
Source: ARS News Service; Agricultural Research Service, USDA, August 15, 2002.

CHILDREN AND WEIGHT: WHAT COMMUNITIES CAN DO
Children and Weight: What Schools and Communities Can Do is the most recent project in a series of materials on childhood overweight developed through Cooperative Extension at the University of California. The Children and Weight series includes informative publications for parents as well as health care professionals on this high profile public health concern.
The Children and Weight: What Schools and Communities Can Do Resource Kit will serve as a “how-to” guide offering technical assistance to community leaders who wish to launch a local task force dedicated to reducing childhood overweight.

A final version of the kit was released on October 1, 2002. The price is $100. Order from the publications division web site at: http://anrcatalog.ucdavis.edu/
Source: Press Release; September17, 2002.

NEW WEBSITE OFFERS SELF-DIRECTED AND INTERACTIVE TRAINING MODULES FOR THE CDC 2000 GROWTH CHARTS AT NO COST
Recognizing the need for training for use and interpretation of the 2000 CDC Growth Charts, the Health Resources Services Administration/Maternal and Child Health Bureau (MCHB) has collaborated with the Centers for Disease Control and Prevention to develop a new training website. This website provides self-directed and interactive training modules for clinical and public health professionals who use growth charts to assess physical growth in infants, children, and adolescents. MCHB-developed training modules include: Accurate Weighing and Measuring; Using the CDC Growth Charts for Children with Special Health Care Needs; Adolescent Physical Development: Uses and Limitations of Growth Charts; Children with Poor Growth; and Head Circumference. The Centers for Disease Control and Prevention (CDC) have developed related modules, including: Overview of the CDC Growth Charts, Using the BMI-for-age Growth Charts, and Overweight Children and Adolescents: Recommendations to Screen, Assess and Manage. Each module contains learning objectives, text, examples to complete, and a glossary of new terms. Users complete modules at their own pace and may choose to listen to audio clips and complete self-tests to gauge their understanding.

The MCHB training modules, and a link to the CDC-developed modules, can be accessed at: http://depts.washington.edu/growth/
Source: CDC Growth Chart Training Modules Press Release; September 16, 2002.

HEALTHY FARMS, HEALTHY KIDS: EVALUATING THE BARRIERS AND OPPORTUNITIES FOR FARM-TO-SCHOOL PROGRAMS
Healthy Farms, Healthy Kids (64 pp), a publication of the Community Food Security Coalition, describes in detail seven farm-to-school projects from around the country, providing plenty of information to start a project in your community. It examines the barriers and opportunities surrounding farm-to-school programs, including childhood obesity, the struggles of family farmers, and the changing school food environment with the rise of fast food and soft drinks in the school lunchroom. The report also includes an analysis of federal policies related to nutrition and local food systems and makes a series of policy recommendations.

To order, send a check in the amount of $12 each copy, plus shipping and handling of $4 for up to 2 copies and $1 for each additional copy of 3 or more copies to: CFSC, PO Box 209, Venice CA 90294, or e-mail your credit card information (Visa/MC only) with expiration date to asfisher@aol.com, fax 310-822-1440, or call 310-822-5410. Please include your name, organization, address, city, state, zip, phone number, and email address with your check, fax, or email.

Hosted by the California Department of Health Services Primary Care and Family Health
Division and The Center for Weight and Health, University of California, Berkeley

The California Department of Health Services (DHS), Primary Care and Family Health Division, in collaboration with the UC Berkeley Center for Weight and Health, is pleased to announce its second Childhood Obesity Conference: “Making an Impact Now: Environmental, Family and Clinical Approaches,” January 6-8, 2003, at the Marriott Hotel and Marina in San Diego.
Childhood obesity is a modern epidemic of considerable consequence. This public health issue now affects every ethnic group and class in America. Childhood obesity increases the risk of obesity-related medical conditions such as diabetes and cardiovascular and respiratory diseases. Increased pediatric obesity in the United States is taking a distressing medical toll and causing unprecedented annual expenditures for treatment. Prevention, education, and treatment in communities and primary care settings are fundamental components of efforts to control the burden of pediatric obesity.

On March 19-20, 2001, DHS and the UC Berkeley Center for Weight and Health held the first California Childhood Obesity conference addressing issues, strategies and programs related to pediatric obesity. The response from attendees far exceeded our expectations. This year’s conference will expand on the 2001 conference by exploring how environment, family, and clinical approaches can address the childhood obesity epidemic in the community. We are also happy to announce that we have moved to a larger facility to accommodate a greater number of attendees.

As in 2001, this conference is designed for all persons interested in research, prevention, education, and treatment of pediatric obesity. Keynote speakers include U.S. Surgeon General Dr. Richard Carmona, New York University Professor Dr. Marion Nestle, American Diabetes Association President Dr. Francine Ratner Kaufman, and U.S. Department of Agriculture Under Secretary Eric M. Bost. In addition, a variety of concurrent sessions will provide the most up-to-date information on pediatric obesity interventions from state and national leaders.

We encourage you to attend the upcoming conference in San Diego and look forward to continuing to partner with you in tackling the challenging issues around childhood obesity.

Registration
To register, please call (800) 858-7743, or visit www.rce.csus.edu and click on "Conference Services".

To request a Poster Session application, please call (800) 858-7743. Notification of Poster Session acceptance will be made no later than November 18, 2002.

Hotel Information
For overnight accommodations, please call the Marriott directly at (800) 228-9290. The group rate is $110 plus tax. Please mention that you are attending the Childhood Obesity Conference to receive the group rate. The room reservation cut-off date is December 4, 2002. After December 4, overnight accommodations are based on availability at the prevailing rate.
Questions? Please call CSUS RCE Conference and Training Services at (800) 858-7743. Watch the website www.rce.csus.edu for program updates.

Funding is made possible by the US Department of Agriculture, Food Stamp Program through the California Nutrition Network for Healthy, Active Families.

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

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