UNIVERSITY OF CALIFORNIA
COOPERATIVE EXTENSION

NUTRITION PERSPECTIVES

Volume 28, No. 5
September/October 2003

TABLE OF CONTENTS PAGE

Can Tea Extracts Lower Cholesterol?
The FAO and WHO Report On Diet and Chronic Disease
Low Cholesterol In Elders
Getting Doctors to Refer Patients to Dietitians
Homocysteine In Chronic Disease: An Update
Diet May be as Good as Statins In Reducing Cholesterol Count
A Smear of Peanut Butter for a Healthy Heart
Sweetened Drinks and Overweight Children
The Metabolic Syndrome
Diabetes Up 27 Percent, According to New CDC Report
New Organic Standards Are Here to Stay, But Don’t Show that Organic Foods Are Healthier
Iron Might Improve Fatigue In Women Without Anemia
State Health Department Issues Health Warning On Lead-Contaminated Chapulines (Grasshoppers)
Salmonella Outbreak Tied to Consumption of Raw Milk
2005 Dietary Guidelines Advisory Committee Selected
FDA, NCI Tune Up Fruits and Vegetables Message
Drinking Unpasteurized Juice May be Harmful to Your Health
Adolescents Become Ill after Ingesting Toxic Plant Seeds
California Food and Justice Coalition
AAP Continues Battle to Save Head Start
Low Maternal Vitamin C Intake Might be Linked with Preterm Delivery

Resources:
CMAB Releases Nutrition Education Material for Asian Americans

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

Sheri Zidenberg-Cherr, PhD, Nutrition Specialist, Cristy Hathaway, Nutrition Assistant, and staff prepare NUTRITION PERSPECTIVES. 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.

CAN TEA EXTRACTS LOWER CHOLESTEROL?

Epidemiologic studies have shown a link between tea consumption and lower risks for myocardial infarction (MI) and post-MI mortality (1,2). Still, the basis of the observed association between tea drinking and reduced cardiovascular risk is unclear, as is the potential benefit of specific polyphenols and flavonoids in teas.

In a recent multicenter Chinese study, researchers tested the cholesterol-lowering effect of tea extracts by randomizing 220 adults to receive either placebo or daily capsules that contained 75 mg of theaflavins (components of black tea), 10 mg of green tea catechins, and 150 mg of other tea polyphenols. At baseline, mean body mass index was 24, and mean levels of Total Cholesterol (TC), High Density Lipoprotein (HDL), and Low Density Lipoprotein (LDL) cholesterol were 241 mg/dL, 55 mg/dL, and 157 mg/dL, respectively. Participants derived 23 percent of calories from fat, and about half were regular tea drinkers (3).

At 12 weeks of follow-up, cholesterol levels had not changed significantly in the placebo group, but the treatment group showed significant mean reductions in total cholesterol (by 11.3 percent), LDL cholesterol (by 16.4 percent), and TC:HDL ratio (by 10.3 percent). No serious adverse events occurred in either group.

Evidence from animal models shows how polyphenols and green tea extracts might benefit patients with hypercholesterolemia, for example, by decreasing intestinal absorption of cholesterol, by increasing fecal excretion, or by upregulating hepatic LDL receptors. Whatever the mechanisms, the present results suggest that it would be worth pursuing larger clinical trials with clinical endpoints such as adverse cardiovascular events.

References:
1. Geleijnse JM, Launer LJ, van der Kuip DAM, Hofman A, and Witteman JCM. Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study. Am J Clin Nutr, May 2002; 75: 880-86.
2. Mukamal KJ, Maclure M, Muller JE, Sherwood JB, and Mittleman MA. Tea Consumption and Mortality After Acute Myocardial Infarction. Circulation; May 2002; 105: 2476-81.
3. Maron DJ, Lu GP, Cai NS, et al.Cholesterol-lowering effect of a theaflavins-enriched green tea extract: A randomized controlled trial. Arch Intern Med; June 23, 2003; 163:1448-53.
Source: Thomas L. Schwenk, MD. Journal Watch; 23(16); August 1, 2003; p. 126.

THE FAO AND WHO REPORT ON DIET AND CHRONIC DISEASE

A new Food and Agriculture Organization of the United Nations (FAO) and World Health Organization (WHO) report, entitled Diet, Nutrition and Prevention of Chronic Disease, was released in April 2003. The report outlines strategies for reducing the worldwide burden of chronic diseases.

Recommendations include:
· Limit fat to 15 percent to 30 percent of total daily energy and saturated fats to less than 10 percent.
· Carbohydrate should provide the bulk of energy requirements, with 55 percent to 75 percent of total calories.
· Daily intake of salt, preferably iodized, should be restricted to fewer than 5 g (approximately 1 teaspoon) a day.
· Fruit and vegetables intake should be at least 400 g (approximately 5 to 9 servings) a day.
· Recommended protein intake should be 10 percent to 15 percent of total calories.
· One hour per day of moderate intensity activity on most days of the week is needed to maintain a healthy body weight.

The complete report is available at http://www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf.
Adapted from: Nutrition Today; 38(5); September/October 2003; pp. 153.

LOW CHOLESTEROL IN ELDERS

The relation between serum cholesterol and mortality in elders is not straightforward. Two new studies add to the literature on this topic (1,2).

In a retrospective study of US Medicare beneficiaries (mean age, 76), researchers identified 4923 patients whose total-cholesterol (TC) levels had been measured during hospitalizations for myocardial infarction (usually within 1 day of admission) in 1992-1993. Patients were divided into 3 serum-TC subgroups: <200 mg/dL, 200-239 mg/dL, and ³240 mg/dL. Six-year all-cause mortality rates did not differ significantly among the groups, even after adjusting for other risk factors and comorbid conditions and after excluding the 6 percent of patients who had been discharged on lipid-lowering agents.

In an Italian population-based prospective cohort study, researchers divided 329 subjects (age range, 65-84) into quartiles of baseline serum TC levels: 78-189 mg/dL, 190-216 mg/dL, 217-275 mg/dL, and 276-417 mg/dL. In analyses adjusted for numerous potential confounders (including HDL cholesterol level, pre-existing chronic illness, and known coronary disease), 3-year all-cause mortality rates did not differ among the 3 highest quartiles; however, the mortality rate in the lowest quartile was roughly double any of the other 3. Excluding participants with cancer and liver disease, those who died in the first year, and those on lipid-lowering drugs did not change the findings.

For years, people have debated whether low cholesterol somehow predisposes elders to non-cardiac death, or whether low levels simply result from chronic diseases that are destined to be fatal (3). These studies won’t settle that debate, but their findings challenge the assumption that widespread drug treatment of older hypercholesterolemic patients would necessarily be beneficial.

References:
1. Foody JM, et al. Long-term prognostic importance of total cholesterol in elderly survivors of an acute myocardial infarction: The Cooperative Cardiovascular Pilot Project. J Am Geriatr Soc; July 2003; 51:930-6.
2. Brescianini S, et al. Low total cholesterol and increased risk of dying: Are low levels clinical warning signs in the elderly? Results from the Italian Longitudinal Study on Aging. J Am Geriatr Soc; July 2003; 51:991-6.
3. Schatz IJ, Masaki K, Yano K, et al. Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. Lancet; 2001; pp. 358-1.
Source: Allan S. Brett, MD. Journal Watch; 23(17); September 1, 2003; p. 134.

GETTING DOCTORS TO REFER PATIENTS TO DIETITIANS

A recent study in the American Journal of Clinical Nutrition looked at medical doctors’ (MDs) and registered dietitians’ (RDs) reasons for referring patients for nutrition counseling (1). It drew a convenience sample of general practitioners (GPs) and RDs and surveyed them on their referral patterns. “The primary influence on a GP’s decision to initiate nutrition management was the presentation of a patient who required nutrition advice.” From the GP’s perspective, barriers to providing nutrition counseling were time and knowledge, whereas RDs saw lack of patient interest as a significant issue. GPs referral patterns were dictated by the complexity of nutrition intervention needed, in contrast to RDs who see patient motivation as a key referral factor. Cost surfaced as the main barrier to RD referral for the GP, whereas RDs saw lack of GP understanding of where to refer as the main barrier to obtaining or referring more patients.

Reference:
1. Truswell AS, Hiddink GJ, Blom J. Nutrition guidance by family doctors in a changing world: problems, opportunities, and future possibilities. Am J Clin Nutr; 2003; 77(suppl): 1089S-1092S.
Source: Nutrition Today; 38(5); September/October 2003; pp. 154-5.

HOMOCYSTEINE IN CHRONIC DISEASE: AN UPDATE

Evidence continues to emerge suggesting that elevated homocysteine contributes to a number of chronic diseases associated with aging. The relation has been most extensively studied in heart disease and stroke, but new data implicate homocysteine in Alzheimer disease (AD) and other dementias, as well as age-related decline in physical function.

Cardiovascular Disease

A host of case-control studies have found a strong link between high homocysteine levels and increased risk of ischemic heart disease (IHD) and stroke. This relationship has been confirmed in some prospective studies, but other studies have not supported the connection (1). A recent meta-analysis including data from 12 prospective and 18 retrospective observational studies evaluated the risk of IHD or stroke associated with a 25 percent lower level of blood homocysteine.

The investigators found that across all studies, lower homocysteine was associated with an 11 percent lower relative risk of IHD and 19 percent lower risk of stroke. However, the correlation was strongest for retrospective studies in which blood was collected after the onset of disease; weaker associations were found in prospective studies in which subjects were healthy at baseline (2).

These findings suggest that lowering homocysteine may produce a modest reduction in the risk of cardiovascular disease. However, none of the studies analyzed adjusted for kidney dysfunction, which may elevate homocysteine levels and increase cardiovascular disease risk (3). Furthermore, the stronger retrospective vs. prospective associations may indicate that elevated homocysteine may be partly a result, and not necessarily a cause, of these cardiovascular pathologies.

Dementia

As with cardiovascular disease, several retrospective studies support a positive association between homocysteine levels and risk of AD and other dementias. These data recently were bolstered by findings from a prospective cohort analysis of Framingham Heart Study participants. Seshadri et al. analyzed data from over 1000 subjects who averaged 76 years of age and were free of dementia at baseline. Over a mean follow-up of eight years, and after controlling for age, sex, genetic and vascular risk factors, and plasma levels of folate and B vitamins, the investigators found that plasma homocysteine in the highest age-specific quartile doubled the risk of developing AD or other forms of dementia. Similar increases in risk were found in individuals who met the clinical criteria for homocysteinuria (homocysteine >14 mmol/L) (4).

These findings suggest that homocysteine is an independent risk factor for AD and other dementias. But establishing a causal relationship will require additional confirmation through prospective cohort studies and randomized controlled trials of homocysteine-lowering therapies.

Physical Decline

Using a cohort of participants in the MacArthur Studies of Successful Aging, Kado et al. prospectively studied 499 men and women aged 70 to 79 years who performed well on measures of gait, lower body strength and coordination, and manual dexterity at baseline. They measured homocysteine levels at baseline and then again at 28 months of follow-up. They also repeated the battery of tests to determine any changes in physical function (5).

After controlling for age, sex, socioeconomic factors, smoking status, and medical conditions such as cardiovascular disease, diabetes, and cancer, the investigators found that each standard deviation increase in homocysteine levels produced a 1.5-fold increase in the risk of being in the worst quartile of decline in physical function. As with other areas of investigation, these findings require additional confirmation to determine their clinical significance.

Mechanisms and Treatment

Laboratory studies suggest that homocysteine has a direct toxic effect of vascular endothelial cells, enhances LDL oxidation, and alters platelet function. These activities have obvious negative implications for cardiovascular health and also may promote AD and dementia. Researchers further speculate that the oxidative stress resulting from elevated homocysteine may damage DNA and proteins. This could have negative impact on cellular regeneration, resulting in skeletal muscle atrophy and the general physical decline reported by Kado et al.

At least two randomized controlled trials report positive cardiovascular outcomes associated with homocysteine-lowering treatments. In one trial, supplementation with folate and B vitamins was associated with a reduced incidence of markers of subclinical atherosclerosis in siblings of patients with premature atherothrombotic disease (6). Another study found that in patients who underwent coronary angioplasty, vitamin supplementation reduced the need for target lesion revascularization (7).
Although these data are promising, they do not yet justify widespread testing for elevated homocysteine (8). Some experts recommend testing patients with a strong family history of cardiovascular disease or any unexplained premature cardiovascular symptoms. Although there is no firm basis for recommending specific therapeutic targets, several studies indicate that the risk of adverse outcomes appears to rise in the presence of homocysteine levels above 10 mmol/L. Therefore, a homocysteine level of less than 10 mmol/L may be a reasonable therapeutic goal in patients with a high risk of cardiovascular disease.

To achieve the potential benefits associated with reduced homocysteine levels, patients should consume a diet that meets RDAs for folic acid (400 mg), vitamin B6 (1.7 mg), and vitamin B12 (2.4 mg). In patients with confirmed elevation of homocysteine, supplementation with 1 mg/d folic acid, with or without vitamins B12 and B6, has been shown to reduce homocysteine levels in most cases.

References:
1. Krauss RM et al. AHA Dietary Guidelines Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association. Circulation; 2000; 102(18): 2284.
2. Homocysteine and Risk of Ischemic Heart Disease and Stroke: A Meta-analysis Homocysteine Studies Collaboration. JAMA; 2003; 288:2015-22.
3. Ray JG. ACP Journal Club; 2003; 138:78.
4. Seshadri S, Beiser A, Selhub J, et al. Plasma Homocysteine as a Risk Factor for Dementia and Alzheimer's. N Engl J Med; 2002; 346:476.
5. Kado DM, Bucur A, Selhub J, Rowe JW, Seeman T. Homocysteine levels and decline in physical function: McArthur studies of successful aging. Am J Med 2002; 113: 537-42.
6. Vermeulen EGJ, Stehouwer CDA, Twisk JWR, et al. Effect of homocysteine-lowering treatment with folic acid plus vitamin B6 on progression of subclinical atherosclerosis: A randomized, placebo-controlled trial. Lancet 2000; 35: 517-522.
7. Schnyder G, Roffi M, Flammer Y, Pin R, Hess OM. Effect of homocysteine-lowering therapy with folic acid, vitamin B12, and vitamin B6 on clinical outcome after percutaneous coronary intervention. JAMA 2002; 288:973-9.
8. Nutrition & the MD; 2001; 27(8):5.
Source: Nutrition & the MD; 29(7); July 2003; pp. 7-8.

DIET MAY BE AS GOOD AS STATINS IN REDUCING CHOLESTEROL COUNT

A 4-week study using 46 healthy adults with hyperlipidemia has found that a diet low in saturated fat and high in viscous fibers, plant sterols, soy, and nuts can reduce cholesterol levels on par with drug therapy. Participants in the study were randomized to receive 1 of 3 diets. The control diet was a diet very low in saturated fat, based on milled whole-wheat cereals and low-fat dairy foods, the second diet was the same low saturated fat diet as the control with the addition of a statin drug, and the dietary portfolio group ate a diet high in plant sterols (1.0 g/1000 kcal), soy protein (21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds (14 g/1000 kcal). Reduction in low-density lipoprotein cholesterol was 8 percent in the control group, 31 percent in the statin group, and 29 percent in the dietary portfolio group. Both the statin and dietary portfolio group had a statistically significant different response than the control group. There was no statistical difference between the statin and dietary portfolio group. Of course, the question is whether the dietary portfolio was tasty enough to be sustained long-term; that remains to be seen. Nevertheless, it does suggest that with the right motivation, lifestyle changes can have body-altering effects.

Reference:
1. James W. Anderson. Diet First, Then Medication for Hypercholesterolemia. JAMA; July 2003; 290(4); pp. 502-10, 531-33.
Adapted from: Nutrition Today; 38(5); September/October 2003; pp. 155.

A SMEAR OF PEANUT BUTTER FOR A HEALTHY HEART

Processes used for making commercial peanut butter do not negatively influence levels of healthful vitamin E in peanuts according to a new study, confirming that peanut butter can be as beneficial to the diet as nuts in protecting against coronary heart disease.
Institute of Food Technologists members, including researchers from the University of Georgia and Chungbuk National University in Korea, tested raw peanuts, roasted peanuts and peanut butter originating from crops harvested in two separate years. What they discovered was peanut butter is equivalent to raw peanuts in vitamin E content.

Vitamin E loss during roasting and milling was fully compensated by the addition of stabilizers and other ingredients ordinarily added to peanut butter during manufacturing.

"There was a lack of information in existing data on vitamin E content in peanut butter," said Ron Eitenmiller, PhD, professor at University of Georgia. "But we'd run so many studies on peanuts and peanut butters in the past, we had our suspicions that vitamin E content would remain high in the finished product," he said. Eitenmiller and his research team credits peanut butter's oil base and container as good barriers against oxygen, which reduces vitamin E content.

The researchers note studies linking nuts such as peanuts to beneficial effects on the heart, possibly by replacing harmful lipids with unsaturated lipids, and supplying healthful micronutrients like vitamin E to the blood. Data compiled by the US Department of Agriculture rank peanut butter among the top ten sources of vitamin E intake in the American diet.

Reference:
1. Chun J, et al. Effect of Peanut Butter Manufacture on Vitamin E. J Food Sci; 68(7): 2211–14.
Adapted from: Institute of Food Technologists Press Release; September 30, 2003.

SWEETENED DRINKS AND OVERWEIGHT CHILDREN

The past two decades have seen large increases in the number of overweight children and in children’s consumption of sweetened beverages (carbonated drinks, fruit-flavored drinks, tea, and powdered drinks). Researchers studied the beverage-consumption habits of 30 healthy children (age range, 6 to 13 years) for 4 to 8 weeks at a weekday summer camp and at home (1,2).

Overall, children drank significantly less milk on days of high sweetened-drink consumption (>16 oz daily) than on days of no sweetened-drink consumption. High sweetened-drink consumption was associated with reduced daily intake of protein, calcium, phosphorus, magnesium, zinc, and vitamin A. When children had a choice between milk and sweetened drinks, they almost always selected the latter.

Energy intake from solid food was roughly constant across levels of sweetened-drink consumption. Nevertheless, total daily energy intake was significantly higher when children drank sweetened beverages than when they did not. Furthermore, children who drank more than 16 oz of sweetened drinks daily gained more weight by the end of the study than did children who drank 6 oz to 16 oz daily.

These children were not good at regulating their overall calorie consumption to compensate for increased energy intake from sweetened drinks. This poor regulation resulted in excess calorie intake, weight gain, and overall poor nutrition.

References:
1. Mrdjenovic G and Levitsky DA. Nutritional and energetic consequences of sweetened drink consumption in 6- to 13-year-old children. J Pediatr; June 2003; 142:604-10.
2. Schwartz RP. Soft drinks taste good, but the calories count. J Pediatr; June 2003; 142:599-601.
Source: Robert A. Dershewitz, MD, MSc. Journal Watch; 23(15); August 1, 2003; p. 123.

THE METABOLIC SYNDROME

Individuals with a cluster of metabolically related health risks such as obesity (especially abdominal obesity), high blood pressure, high triglycerides, high cholesterol, and type 2 diabetes are said to have the metabolic syndrome. The syndrome affects an estimated 47 million Americans and puts them at a uniquely high risk of cardiovascular disease. It is identified as an important target for therapy by National Cholesterol Education Program guidelines, which define it clinically as the presence of three or more of the risk factors listed in Table 1.

Table 1. Risk Factors for Metabolic Syndrome (1).

Reference:
1. Adapted from the Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III), JAMA; 2001; 285:2486.
Source: Nutrition & the MD; 29(7); July 2003; p. 2.

DIABETES UP 27 PERCENT, ACCORDING TO NEW CDC REPORT

In general, Americans were healthier in 2002 than in 2001: Life expectancy was up, infant mortality was down, more pregnant women sought prenatal care for their babies, and more elderly people received flu shots in the winter. But even in this increasingly healthy environment, the number of Americans affected by diabetes and obesity continues to rise.

The Center for Disease Control’s (CDC) National Center for Health Statistics released these statistics in the new edition of its annual American checkup, Health, United States, 2003.

“While this report shows we’re continuing to make progress in improving Americans’ health, we know that we can do much more to reduce the impact of diabetes and other chronic, preventable diseases,” the Center for Heath and Human Services (HHS) Secretary Tommy G. Thompson said in a press release that announced the report. “There are simple steps we can all take, such as eating wisely and staying active, that can reduce the toll that diabetes, obesity, and heart disease take on our lives.”

Researchers uncovered the following statistics regarding obesity and diabetes:
· 6.5 percent of American adults (12 million) were diagnosed with diabetes in 2002, up from 5.1 percent in 1997; the CDC estimates that another 5 million adults have not yet been diagnosed
· The CDC estimates that 12 million adults have impaired fasting glucose tolerance, and many of them will develop diabetes unless they exercise and lose weight
· Obesity has risen from 15 percent of the population in 1980 to 31 percent in 2000
· Among high school students, 38 percent of girls and 24 percent of boys did not engage in the level of moderate or vigorous exercise recommended by the CDC

The CDC also offered the following data relevant to the anti-hunger community:
· The life expectancy gap between blacks and whites has narrowed to 5.5 years in 2002, compared to 7 years in 1990
· The teen birth rate is the lowest in 60 years at 45 births per 1,000 girls
· The vaccination rate of toddlers living in poor households was 72 percent; in households living at or above the poverty line, it was 79 percent
· In their first trimester of pregnancy, 83 percent of pregnant women received prenatal care, up from 76 percent in 1990

For more information, go to www.cdc.gov/nchs/.
Source: Nutrition Week; XXXIII(20); October 13, 2003; p. 7.

NEW ORGANIC STANDARDS ARE HERE TO STAY, BUT DON’T SHOW THAT ORGANIC FOODS ARE HEALTHIER

It has been a year since the new National Organic Standards (NOS), which developed consistent standards for all food sold as organic, became law. The following labeling guidelines tell consumers how the product was grown:
· 100 percent organic: All of a product’s ingredients or contents are organic. The United States Department of Agriculture (USDA) Organic Seal can be displayed on these products.
· Organic: The product must consist of at least 95 percent organically produced ingredients. The USDA Organic Seal can be displayed on these products.
· Made with Organic Ingredients: The product must contain at least 70 percent organic ingredients and can display the phrase “Made with Organic” followed by a listing of up to 3 specific ingredients.
To be “organic,” a food must be grown and processed without using most conventional pesticides, without fertilizers made with synthetic ingredients or sewage sludge, without pesticides; only that approved pesticides are used. Organic foods are usually more expensive, but whether they are better is in the eye of the beholder. There are no scientific studies that prove that organic foods contain any more nutrients than conventional-grown foods today.

Reference:
1. USDA Launches Organic Standards: New Rules Welcomed, But Are Organics Better? Food Insight; May/June 2003.
Source: Nutrition Today; 38(5); September/October 2003; pp. 155.

IRON MIGHT IMPROVE FATIGUE IN WOMEN WITHOUT ANEMIA

Fatigue is known to be a symptom of iron deficiency anemia, but whether iron deficiency, in the absence of anemia, can cause fatigue is unclear. After data from a large study showed that many iron-deficient women do not have anemia, investigators from Switzerland examined the effects of iron supplementation in 144 non-anemic women (age range, 18-55) with unexplained fatigue (1).

Participants were assigned randomly to receive either placebo or oral ferrous sulfate (80 mg) daily. At baseline, mean serum ferritin was 30 mg /L; 85 percent had serum ferritin levels of less than or equal to 50 mg/L. A 10-point visual analog scale was used at baseline and 4 weeks later to measure the patients’ perception of fatigue. At 4 weeks, mean scores had decreased by 29 percent (from 6.4 to 4.5) in the iron-treated group and by 13 percent (from 6.5 to 5.6) in the placebo group. Significant responses occurred only in women with baseline ferritin levels of less than or equal to 50 mg/L. Adherence and dropout rates were similar in the two groups.

Results of this double-blind study strongly suggest that in women of childbearing age, iron deficiency can contribute to fatigue, even in the absence of anemia. This is one of the first studies to suggest this association, and these findings indicate that supplemental iron might benefit non-anemic women with unexplained fatigue, although perhaps only those with serum ferritin levels of less than or equal to 50 mg/L.

References:
1. Verdon F, Burnand B, Stubi CL, et al. Iron supplementation for unexplained fatigue in non-anemic women. BMJ; May 24, 2003; 326:1124-6.
Source: Keith I. Marton, MD. Journal Watch; 23(15); August 1, 2003; p. 123.

STATE HEALTH DEPARTMENT ISSUES HEALTH WARNING ON LEAD-CONTAMINATED CHAPULINES (GRASSHOPPERS)

Consumers, particularly pregnant women and children, should avoid eating chapulines (grasshoppers) from Oaxaca, Mexico, because they may contain excessively high levels of lead that could cause serious health problems, State Health Director Diana M. Bontá, R.N., Dr.P.H., warned today.

"Lead is toxic to humans, especially infants, young children and developing fetuses, in both short- and long-term exposures," said Bontá. "Lead can cause damage to the central nervous system, resulting in learning disabilities and behavioral disorders that could last a lifetime."

Residents from some regions of Mexico eat chapulines (chap-oo-lean-ès) as a traditional snack food. Chapulines are usually prepared with ingredients such as garlic, salt, lime juice or a red chili powder coating. They are not widely available in commercial distribution and usually brought into the United States by individuals who have recently visited Oaxaca or other parts of Mexico.

The product, often a dull red color, is sold in small, unlabeled bags at Hispanic retail food stores, in restaurants and at flea markets. The public and sellers of chapulines are encouraged to contact the California Department of Health Services (CDHS) at (916) 445-2264 to provide information that can assist public health investigators in learning more about the potential threat that the product poses to children.

Recent analysis of chapulines from Oaxaca, Mexico, showed that they may contain as much as 2,300 micrograms of lead per gram of product. The US Food and Drug Administration (FDA) has recommended that children under age 6 should consume on average no more than 6.0 micrograms of lead each day from all food sources. A young child eating one of these highly contaminated chapulines could ingest nearly 60 times his or her tolerable daily intake for lead. While some of the chapulines analyzed contained no detectable lead, consumers have no practical way of determining if the product is contaminated with lead. The source of lead in the chapulines from Oaxaca is under investigation.

CDHS began investigating the product after it was referred to the department by the Monterey County Health Department. County investigations of several lead poisoning cases involving children determined that the children were eating chapulines. CDHS investigators are working with FDA and local health departments to ensure that the wholesale and retail food industries are aware of the potential hazards associated with lead in foods.

Parents of children who may have consumed chapulines should consult with their physician or health care provider to determine if further testing is warranted. For more information about lead poisoning, parents may contact their local childhood lead poisoning prevention program or local public health department.

Additional information and a list of local lead prevention programs are also available at DHS' Web site at: http://www.dhs.cahwnet.gov/childlead/ or by calling the California Childhood Lead Poisoning Prevention Branch in Oakland at (510) 622-5000.
Source: CDH Press Release; November 13, 2003.

SALMONELLA OUTBREAK TIED TO CONSUMPTION OF RAW MILK

Sixty-two people in four states were infected with Salmonella enterica serotype typhimurium, and the source was determined to be raw, unpasteurized milk from an Ohio dairy farm, according to the Centers for Disease Control and Prevention.

The initial investigation of two hospitalized children infected with S. typhimurium implicated consumption of raw milk purchased at a dairy-restaurant. A subsequent epidemiologic investigation in December 2002 identified 62 cases of S. typhimurium isolated from a person with an epidemiologic link to the dairy. Case patients included 40 dairy customers, six household contacts, and 16 workers. Their symptoms included diarrhea, cramps, fever, chills, body aches, bloody diarrhea, nausea, vomiting, and headache.
A case-control study verified that of the potential risk factors, including eating other food at the dairy and visiting the petting zoo, only consumption of raw milk was significantly associated with illness.

While raw milk products no longer are sold in Ohio, the authors noted that the intrastate sale of raw milk for human consumption is still legal in 27 states. Therefore, consumers need to be educated about the hazards of consuming raw milk products, and regulations should be strengthened to protect the public.
Resource: CDC; MMWR; 2003; 2:613-61.
Source: AAP News; 23(3); September 2003; p. 94.

2005 DIETARY GUIDELINES ADVISORY COMMITTEE SELECTED

The Department of Health and Human Services (HHS) Secretary Tommy G. Thompson and Agriculture Secretary Ann M. Veneman designated 13 professionals to serve on the Dietary Guidelines for Americans report, published every 5 years. A broad-based nutrition policy guide, the Dietary Guidelines document uses the latest scientific and medical knowledge to advise the general public on ways to improve overall health through proper nutrition.

Committee members include:
Lawrence J. Appel, MD, MPH, Professor of Medicine, John Hopkins University School of Medicine, Baltimore, MD.
Yvonne Bronner, ScD, RD, LD, Professor and Director of MPH/DrPH Program, Morgan State University, Baltimore, MD.
Benjamin Caballero, PhD, MD, Director and Professor of the Center for Human Nutrition and Division of Human Nutrition, Department of International Health, John Hopkins Bloomberg School of Public Health, Baltimore, MD.
Carlos Arturo Camargo, Jr, MD, DrPH, Assistant Professor of Epidemiology, Harvard Medical School, and Assistant Professor of Epidemiology, Harvard School of Public Health, Boston, MA.
Fergus M. Clydesdale, PhD, Professor of Food Science and Dean of the College of Natural Resources and Environment, University of Massachusetts, Amherst, MA.
Vay Liang W. “Bill” Go, MD, Professor of Medicine, University of California at Los Angeles (UCLA) School of Medicine.
Janet C. King, PhD, RD, Senior Scientist, Children’s Hospital Oakland Research Institute, Oakland, CA; Professor Emerita, Department of Nutritional Sciences and Toxicology, University of California at Berkeley, CA; Adjunct Professor, Department of Nutrition and the Department of Internal Medicine; University of California at Davis, CA.
Penny M. Kris-Etherton, PhD, RD, Distinguished Professor of Nutrition, Pennsylvania State University, University Park, PA.
Joanne R. Lupton, PhD, Professor of Animal Science, of Food Science and Technology, of Nutritional Sciences, and of Veterinary Anatomy and Public Health, Texas A&M University, College Station, TX.
Theresa A. Nicklas, DrPH, MPH, LN, Professor of Pediatrics, Department of Pediatrics, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX.
Russel R. Pate, PhD, Associate Dean for Research, School of Public Health, and Professor, Department of Exercise Science, University of South Carolina, Columbia.
F. Xavier Pi-Sunyer, MD, MPH, Director, Obesity Research Center, Professor of Medicine, Columbia University College of Physicians and Surgeons, and Chief, Division of Endocrinology, Diabetes and Nutrition, St. Luke’s-Roosevelt Hospital, NY.
Connie M. Weaver, PhD, Head and Distinguished Professor, Department of Foods and Nutrition, Purdue University, West Lafayette, IN.

The Department of Health and Human Services, which is the secretariat for this year’s guidelines committee is also adding expertise to assist in the effort.

New Dietary Guidelines staff members include:
Kim Stitzel, RD, formerly on staff at the ADA Washington office and the Food and Nutrition Board, and Jennifer Webber, RD, of Chapman Associates. They join Kathryn McMurray, MPH, a veteran of the last Dietary Guidelines secretariat; Carol Thomas, MD; and Woody Kessell, MD, at the Department of Health and Human Services.
Source: Nutrition Today; 38(5); September/October 2003; pp. 152-3.

FDA, NCI TUNE UP FRUITS AND VEGETABLES MESSAGE

The public-private partnership, led by the National Cancer Institute (NCI), running the “5 A Day” program has supersized it’s recommended serving of fruits and vegetables to “5 to 9 A Day” for men.

All fruits and vegetables that do not exceed fat and sodium content limits, currently, that means everything but avocadoes and some nuts, are considered “healthy” and can bear the “5 to 9 A Day” logo. The Food and Drug Association (FDA) is considering lowering the maximum allowable amount of sodium in a serving of what it considers “healthy” foods from 480 mg to 360 mg, which might limit the number of packaged fruits and vegetables that can make that claim.

In a separate move, the FDA reinforced the NCI’s campaign by approving a “dietary guidance message” that can be put on fruits and vegetable foods that qualify for the “5 to 9 A Day” program. The guidance states, “Diets rich in fruits and vegetables may reduce the risk of some types of cancer and other chronic diseases.”

A dietary guidance message differs from a health claim in that it covers a category of food and not a single substance, and it does not require FDA review and authorization, but still must be “truthful” and “not misleading,” according to the FDA.

“We’re absolutely thrilled with this new guidance message,” said Christine E. Filardo, MS, RD, communications director for the Produce for Better Health Foundation. The foundation represents produce farmers in the “5 A Day” partnership, and generates advertisements and retail circulars to promote the campaign in grocery stores. “It does what we work very hard to do…help people better understand the connection between increased fruit and vegetable consumption and health promotion. We see it as a wonderful tool.”

One reason the slogan “5 A Day” changed to “5 to 9 A Day” earlier this year was because the NCI wanted to underscore the cancer-fighting benefit of fruits and vegetables for men in general, black men in particular, said Filardo.

The Centers for Disease Control and Prevention (CDC) and the US Department of Agriculture (USDA) data show that black men suffer from diet-related cancers, heart disease, and high blood pressure disproportionately to other ethnic groups, and only eat an average of 3.1 servings of fruits and vegetables per day.

In order to promote the message, the NCI signed retired National Basketball Association star Clyde “The Glide” Drexler to represent the campaign and record public-service announcements. It also enlisted the help of the American Cancer Society, the National Association for the Advancement of Colored People, the National Association of Black Journalists, and Black Entertainment Television.

“This campaign to reach African-American men is a major priority for NCI,” said Lorelei DiSogra, EdD, RD, director of the National 5 A Day for Better Health Program. “We are committed to driving a national, multi-year, multi-faceted communications and education campaign to get the ‘9 A Day’ message to African-American men.”
Source: Nutrition Week; XXXIII(17); August 25, 2003; p. 1.

DRINKING UNPASTEURIZED JUICE MAY BE HARMFUL TO YOUR HEALTH

Most people think of juice as a good alternative to soda, but drinking un-pasteurized juice can cause illness, especially in the young, the elderly, and those with compromised immune systems. When fruits and vegetables are made into juice, bacteria can remain and grow. For the past 5 years, un-pasteurized juices have been required to be labeled with a warning.
For further information about juice, call 888-SAFEFOOD (FDA, July 25, 2003).
Source: Nutrition Today; 38(5); September/October 2003; pp. 197.

ADOLESCENTS BECOME ILL AFTER INGESTING TOXIC PLANT SEEDS

Reports of 14 Ohio adolescents becoming ill after intentionally ingesting “moonflower” seeds highlights the need for awareness of the potential toxicity from recreational plant use, according to the Centers for Disease Control and Prevention (CDC).

The Cincinnati Drug and Poison Information Center (DPIC) was notified in the fall of 2002 when adolescents in the Akron/Cleveland area became ill shortly after eating the seeds or drinking tea brewed using plant seeds (1).

The patients ranged in age from 12 to 19 years, and 12 (86 percent) were male. All 14 patients reported to the emergency department with anticholinergic signs and symptoms, including dilated pupils, tachycardia, hallucinations, and urinary retention. Signs and symptoms typically lasted 24 to 48 hours, and the illness resolved with supportive care and benzodiazepine administration. All patients recovered fully after treatment. Use of the common name moonflower initially led to confusion over which of the several moonflower plants was involved in these exposures. Based on clinical presentations and a photograph taken by a parent, DPIC later identified the plant as Datura inoxia. The plant has large white flowers that bloom at dusk and pods containing up to 200 seeds.

Moonflower is not on the US Drug Enforcement Agency’s list of controlled substances, but the sale of seedpods for illicit use is prohibited in the Akron/Cleveland area.

This report underscores four important points, according to the CDC.
First,
· adolescents and parents should be aware of the potential toxicity from recreational use of a plant and the need for medical attention if an exposure occurs.
Second,
· gardening practices in a community might provide opportunities for experimentation with intoxicating substances. Because D. inoxia is used as an ornamental plant in the Akron/Cleveland area, local garden suppliers should discuss the plant’s potential toxicity with the purchaser.
Third,
· because toxicity differs for various plants of this type, use of the common name moonflower can be misleading clinically and might complicate identification of some species.
Finally,
· poison control centers can detect trends in drug abuse or poisonings and provide information that local and state health departments can use to inform the public.

Reference:
1. CDC; Suspected moonflower intoxication--Ohio, 2002. MMWR; August 22, 2003; 52:788-91.
Source: AAP News; 23(4); October 2003; p. 168.

CALIFORNIA FOOD AND JUSTICE COALITION

Mission Statement:
The California Food and Justice Coalition (CFJC) is a statewide membership coalition committed to the basic human right to healthy food while advancing social, agricultural, and environmental justice. We are partners of the National Community Food Security Coalition, and collaborate with community-based efforts in California working to create a socially just, ecologically, and economically sustainable food supply.

We envision a California food system in which all activities, from farm to table, are equitable, healthful, sustainable, and community-driven.

Organizational Platform:
We believe:
· That access to healthy food is a basic human right and must not be compromised
· That communities are enriched by the cultivation and celebration of diverse food traditions and experience
· That the production, distribution, and preparation of food must be healthy and humane for all humans, animals, and ecosystems
· That agricultural land and biological diversity must be protected for future generations
· That all food commerce must be just, democratic, and economically fair
We support:
· Food systems that are responsive to and reflective of each unique region, and are supported at the state and federal level
· Ecological farming practices and efforts to minimize the number of miles food travels from field to table
· Decent and just living and working conditions for all workers from farm to table, and democratic participation in their workplaces
· The provision of adequate publicly funded safety nets while working to minimize the need for them
· Community-based, culturally appropriate nutrition education
· A restoration of the connection between people and the sources of their food, and the revitalization of agrarian cultures
· Increased awareness of indigenous food and agricultural histories
We work to:
· Assess, research and address the root causes of food insecurity to create a just food and farming system
· Increase knowledge and awareness of food security from the grassroots to decision-makers
· Advocate for policies and funding that build community food security
· Increase communication and collaborations among community members, agencies, and organizations to strengthen food security

To find out more about CFJC, you can contact Heather Fenney, California Organizer, CFJC, at: phone: 310-822-5410, or e-mail: heather@foodsecurity.org, or visit www.fodsecurity.org/california.html.
Source: CFJC News Release; July 28, 2003.

AAP CONTINUES BATTLE TO SAVE HEAD START

The American Academy of Pediatrics (AAP) is working to protect the Head Start program from reform proposals put forward by the Bush administration and Congress that could dismantle the federal program. In late July, the program faced its first setback with the passage of US House legislation that included such reforms. However, the battle continues in the US Senate.
By the closest of margins, 217-216, the House approved the School Readiness Act (HR 2210), which would allow some states to block grant the program. However, thanks to AAP members’ advocacy efforts, the final House bill was an improvement over the initial proposals.

As passed by the House, the School Readiness Act would:
· retain the Department of Health and Human Services’ (HHS’) authority over the program;
· limit block grant options to only eight pilot states;
· require pilot applicants to demonstrate their standards are comparable to federal Head Start standards prior to receiving funds;
· provide additional funding for Head Start; and
· require that the eight pilot states guarantee funding for all Head Start centers for at least five years.

While the House legislation is less extreme, the Academy believes there are still significant improvements that can be made before it can be supported in the Senate, including maintaining the current federal funding structure and all existing federal performance standards.

“The Senate must do what’s right for kids and preserve and expand the Head Start program so that every child starts off heading for success,” said AAP President E. Stephen Edwards, MD, FAAP.

The Academy is asking members to contact their senators and urge them to save the Head Start program. For more information, contact Katy Grossman, AAP Department of Federal Affairs, (800) 336-47, ext. 3006, or kgrossman@aap.org.
Source: AAP News; 23(3); September 2003; p. 94.

LOW MATERNAL VITAMIN C INTAKE MIGHT BE LINKED WITH PRETERM DELIVERY

Premature membrane rupture occurs in 30 to 40 percent of all preterm births. Evidence that vitamin C helps to maintain membrane strength prompted investigators in North Carolina to analyze data from 1944 low-to-moderate-income participants (51 percent white, 42 percent black) in a prospective cohort study of risk factors for preterm birth.

Upon recruitment (at 24-29 weeks’ gestation), each woman filed out a self-administered food-intake questionnaire; frequency of preconception vitamin C intake was assessed with an abbreviated version. Median preconception vitamin C intake was estimated at 94 mg daily from diet and at 124 mg from all sources (including supplements); median second-trimester estimates were 182 mg and 251 mg, respectively. Rates of preterm delivery, preterm labor, and preterm premature membrane rupture were 11 percent, 4 percent, and 2 percent respectively.

Overall, vitamin C intake was not linked with preterm delivery status. However, women with low vitamin C intake (<10th percentile) both before conception and during the second trimester had quadruple the risk for preterm premature membrane rupture than did women with intake at or above that percentile during both periods.

These intriguing observational data suggest that low vitamin C intake before conception and during the second trimester is linked with risk for preterm premature rupture of membranes. If this finding is substantiated, there would be an opportunity for randomized controlled trials for an inexpensive, safe method of limiting preterm deliveries.

Reference:
1. Siega-Riz AM, Promislow JH, Savitz DA, Thorp JM Jr, McDonald T. Vitamin C and the risk of preterm delivery. Am J Obstet Gynecol; 189(2); August 2003; pp. 519-25.
Source: Robert W. Rebar, MD. Journal Watch; 23(20); October 15, 2003; pp. 161-2.

RESOURCE:

CMAB RELEASES NUTRITION EDUCATION MATERIAL FOR ASIAN AMERICANS

The California Milk Advisory Board’s (CMAB) nutrition education materials for Asian Americans are now available online on the Real California Cheese web site.

Currently there are five different pamphlets available for download by healthcare professionals:
· The Shape of Good Eating, based on the USDA’s food guide pyramid;
· New Home-New Foods, an introduction to dairy products;
· Understanding Lactose Intolerance, a guide for recognizing and dealing with the malady;
· Better Health with Calcium, a basic guide to the benefits of dietary calcium; and,
· Cheese—Good Tasting, Good For You, which was developed with WIC and addresses the three most popular commodity cheeses, Cheddar, Mozzarella and Monterey Jack.

Dietitians who visit http://www.realcaliforniacheese.com/CalifDairy/-nutrition.html can download copies of the five pamphlets and the Eat Well to Be Well teaching guide as well as previewing the video, A New World of Delicious Foods. All materials were developed with dietitians for recent Asian immigrants.

Pamphlets are available in Chinese, Korean, Tagalog, and Vietnamese. Better Health with Calcium also is available in Spanish. Each was created with assistance from a registered dietitian who speaks and reads the language. Most were written with lower literacy levels in mind.

For more information about these materials and how you can use them in your programs, contact Jennifer Giambroni at (415) 277-4910 or jennifer@allisonpr.com.
Adapted from: California Milk Advisory Board letter; September 12, 2003.

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