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Dietary Intake Measurement

See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors. Zinc Physiology. See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Folic Acid Physiology, Dietary Sources, and Requirements. Iron Physiology, Dietary Sources, and Requirements. Obesity Definition, Aetiology, and Assessment. Osteoporosis Nutritional Factors Zinc Physiology. See also Adolescents Nutritional Requirements of Adolescents. Anemia Iron-Deficiency Anemia. Calcium Physiology. Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating. Follic Acid Physiology, Dietary Sources, and...

Impact of Lifestyle on Dietary Intakes

Slimming or weight control (whether justified or not) peer group pressure to consume certain foods or brands the development of personal ideology, such as the use of vegetarian diets following a specific diet to enhance sporting prowess or even convenience. Energy and nutrient intakes are influenced by specialized eating patterns, thus it is important to consider life-style choices when interpreting dietary survey data.

Other Factors that Impact on Dietary Intakes

Comparisons between boys and girls often reveal differences in dietary patterns, yet these are seldom consistent between surveys. On the whole, boys eat more meat and dairy products, while girls favor fruit, salad vegetables, and artificially sweetened drinks. The dietary practices of girls are more likely to be influenced by a desire to limit energy intakes. Lower intakes of dairy products, meat, and breakfast cereals seen in older adolescent girls explain their typically poor intakes of iron and calcium. children from lower socioeconomic backgrounds. Such a dietary pattern, characterized by lower than optimal levels of protective nutrients, combined with a higher prevalence of smoking, may partly explain the higher burden of chronic disease experienced by people from lower socioeconomic groups.

The Dietary Guidelines forAmericans

Research clearly shows that being overweight greatly increases your risk for many diseases, including heart disease, cancer, and diabetes. If you are overweight, combining a healthful eating plan with regular physical activity is the most effective way to lose weight and to sustain the loss (see sidebar Diet and Exercise The Perfect Pair, page 10). If you are at a healthy weight, your goal is to maintain that weight. Chapter 3 (page 47) provides further information on weight control.

The Power of the Food Guide Pyramid

The Food Guide Pyramid, the triangular symbol you see on many food packages, was developed by nutrition experts at the U.S. Department ofAgriculture (USDA) (see below). The Pyramid is an educational tool that translates nutrient requirements into the foods you need to eat and helps you put into action the advice offered by the Dietary Guidelines. In graphic form, the Pyramid displays the variety of food choices and the correct proportions needed to attain the recommended amounts of all the nutrients you need without consuming an excess of calories. The Pyramid divides all foods into six categories, based on the nutrients they contain.

The Food Guide Pyramid

The Food Guide Pyramid was developed by the U.S. Department ofAgriculture. The pyramid incorporates many principles that emphasize a plant-based diet that is low in fat, high in fiber, and rich in important vitamins, minerals, and other nutrients. All of these factors contribute to optimal health and help you to control your weight and to reduce the risk of heart disease and some types of cancer. The arrangement of the food groups in a pyramid shape calls attention to the kinds of foods to eat more of and those to eat in moderation.

Dietary Iron Absorption

The efficiency of iron absorption depends on both the bioavailability of dietary iron and iron status. Typically, 5-20 of the iron present in a mixed diet is absorbed. Dietary iron exists in two forms, heme and non-heme. Heme iron is derived from animal source food and is more bioavailable than non-heme iron, with approximately 20-30 of heme iron absorbed via endocytosis of the entire heme molecule. Iron is then released into the enterocyte by a heme oxidase.

Causes of Vitamin B12 Deficiency Dietary

Eggs (lacto ovo vegetarians) as part of their diet and thus a source of some, albeit reduced, dietary vitamin B12 still have reduced vitamin B12 status. Yet other communities who for religious or other reasons are strict vegetarians (vegans) have no source of vitamin B12 and are at high risk of deficiency. This risk can be reduced in some of these communities where fermented food is eaten, in which bacteria have introduced vitamin B12 also, it has been suggested that in some circumstances the food is contaminated by bacteria. However, vegans and in particular babies born to and weaned by strict vegan women are established to be at risk of vitamin B12 deficiency and such babies have been reported on several occasions to show the signs and symptoms of the neuropathy associated with such deficiency.

Dietary Recommendations for Increased Antioxidant Defense

Dietary recommendations that would result in increased antioxidant defense are not inconsistent with accepted recommendations for healthy eating. The recommendation to increase the consumption of plant-based foods and beverages is one that is widely perceived as health promoting, and the consistent and strong epidemiological links between high fruit and vegetable intake and the greater life expectancy seen in various groups worldwide whose diet is high in plant-based foods indicate that more emphasis should be given to this particular dietary recommendation. Vitamin C, vitamin E, various carotenoids, flavonoids, isoflavonoids, phenolic acids, organosul-fur compounds, folic acid, copper, zinc, and selenium are all important for antioxidant defense, and these are found in plant-based foods and beverages such as fruits, vegetables, nuts, seeds, teas, herbs, and wines. Dietary strategies for health promotion should be directed towards optimizing the consumption of these items. people in...

The Observational View of Dietary Antioxidants

Cancer and cardiovascular disease (CVD) are the two leading causes of death worldwide, diabetes mellitus is reaching epidemic proportions, and dementia and maculopathy are largely untreatable irreversible disorders that are increasingly common in our aging population. The prevalence and standardized mortality rates of these diseases vary considerably between and within populations. Mortality from CVD varies more than 10-fold amongst different populations, and incidences of specific cancers vary 20-fold or more across the globe. This enormous variation highlights the multiple factors at play in the etiology of chronic age-related diseases. These factors include smoking habit, socioeconomic status, exposure to infectious agents, cholesterol levels, certain genetic factors, and diet. Dietary factors have long been known to play an important role in determining disease risk. Indeed, 30-40 of overall cancer risk is reported to be diet-related, and there is a wealth of compelling...

Supplementation with Dietary Fatty Acids

Various dietary fatty acids have been shown to have numerous immunomodulatory effects. Arachidonic acid (AA, 20 4 n-6) is synthesized in mammalian tissues from the essential fatty acid linoleic acid (18 2 n-6), found in many plant products. The release of AA from cell membrane phospholipids via the action of phospholipase A2 results in the subsequent production of AA-derived eicosanoids, such as prostaglandin (PG) E2 and leukotriene (LT) B4, which have potent proinflammatory and chemo-tactic effects. Alternatively, when AA is replaced with an n-3 fatty acid in the diet, such as eicosapen-taenoic acid (EPA, 20 5 n-3) or docosahexaenoic acid (DHA, 22 6 n-3), there is competitive inhibition of the use of AA as a substrate, and eicosanoids with different biological activity (PGE3 and LTB5) are produced through the cyclooxygenase and 5-lipoxy-genase cellular metabolic pathways (Figure 1). More specifically, EPA-derived eicosanoids result in decreased platelet aggregation, reduced...

Breakfast Cereals and Dietary Recommendations

Dietary recommendations from the government and major health organizations suggest that the intake of dietary fat and cholesterol should decrease and the caloric intake from complex carbohydrates should increase (10). One way this can be accomplished is to increase the amount of cereals and grains in the diet. A RTE breakfast cereal is right in line with these dietary recommendations.

Dietary Supply Of Amino Acids

Bound protein in feedstuffs and pure forms of crystalline AA supply AAs in pig diets. Crystalline AAs are assumed to be completely absorbed from the gut and utilized by the animal. In contrast, animals are only able to utilize a portion of the AAs contained in bound protein for metabolic functions. Therefore, the total amount of AAs in a diet is not equal to the amount of AAs that are available to the animal for metabolic functions. As a consequence, estimates of bioavailability of dietary AAs are used in formulating swine diets to match the supply with requirements.

Fat Carbohydrate Fiber and Recommendations for Healthy Eating

The transition from the high-fat, milk-based diet of the young infant to the generally accepted adult recommendations for healthy eating should be gradual, beginning from the onset of weaning. There is little consensus as to when qualitative adult intakes should be achieved, although dietary modification is not recommended by any authority for children younger than the age of 2 years and most agree that an adult-type diet is appropriate from the age of 5 years. Some authorities recommend a gradual change between the ages of 3 and 5 years, whereas others suggest that for most children a low-fat, cereal vegetable predominant diet is suitable from age 2 years. If changes toward 'healthy eating' are made at too young an age, there is a danger that an inadequate energy and nutrient intake will result because infants and young children find it difficult to consume adequate quantities of such a bulky diet.

Dietary Cholesterol Intake Patterns

Dietary cholesterol intakes in the United States have been declining, from an average of 500 mg per day in men and 320 mg per day in women in 1972 to levels in 1990 of 360 mg per day in men and 240 mg per day in women. This decline is due in part to dietary recommendations to the US public to reduce total and saturated fat intake and to reduce dietary cholesterol daily intake to less than 300 mg and in part from the increased availability of products with reduced fat and cholesterol content. Major efforts in the early 1970s by public health agencies and advertising emphasized reducing dietary cholesterol as a means to lower plasma cholesterol levels, leading to a high degree of consumer concern regarding cholesterol-containing foods and demand for low-cholesterol products. Today, practically all foods sold in the United States are labeled for their cholesterol content and their percentage contribution to the daily value of 300 mg for cholesterol.

Major Dietary Sources

The major sources of cholesterol in the diet are eggs, meat, and dairy products. A large egg contains approximately 215 mg of cholesterol and contributes approximately 30-35 of the total dietary cholesterol intake in the United States. Meat, poultry, and fish contribute 45-50 , dairy products 12-15 , and fats and oils 4-6 . In the United States, the range of dietary cholesterol intake is 300-400 mg per day for men and 200-250 mg per day for women thus, for much of the population the national goal of a dietary cholesterol intake of less than 300 mg per day has been met.

Dietary Fiber and the Colon

Nondigestable carbohydrates, traditionally defined as deriving from plant sources (but recently encompassing some non-plant-derived polysaccharides), that escape digestion and reach the colon nearly 100 intact compromise dietary fiber. The common short-chain fatty acids produced by fermentation include acetate, butyrate, and proprio-nate. The pattern of short-chain fatty acid production is dependent on several dynamic factors, including the type of fiber or oligosaccharide present in the diet, the transit time and exposure to bacteria, and the bacteria flora to which the substrate is being exposed. Short-chain fatty acids influence colonic physiology by stimulating colonic blood flow as well as fluid and electrolyte uptake. Butyrate in particular is thought to be preferred fuel for the colonocyte. This short-chain fatty acid is thought to have a role in maintaining the normal phenotype in these cells (i.e., in decreasing the risk of dyplasia by promoting differentiation and apoptosis...

Dietary Manipulation Of Fatty Acid Profile And Nutrient Content Of Animal Products

Dietary fat source Dietary fat source Table 2 Effect of dietary dosage and duration of supplemental vitamin E on tissue content of a tocopherol in cattlea Table 2 Effect of dietary dosage and duration of supplemental vitamin E on tissue content of a tocopherol in cattlea Fatty acids incorporated into body lipid can either be synthesized de novo by the animal (largely palmitic, C16 0 stearic, C18 0 and oleic acid, C18 1 n-9) or derived directly from dietary fat. Because animals preferentially use dietary fatty acids for the synthesis of body lipids, manipulation of the content and fatty acid composition of dietary fat represents a means to influence the fatty acid composition of body fat. 8 This applies in particular to monogastric animals. Microbes in the gastrointestinal tract of ruminant animals can alter the dietary fatty acid profile before it is absorbed. The high content of oleic (C18 1 n-9), linoleic (C18 2 n-6), and linolenic acid (C18 3 n-3) content in olive oil, sunflower...

Sources and Types of Dietary Fiber

The main sources of dietary fiber in most Western diets are well characterized, and high-quality data are available for both food composition and dietary intakes. This is not always true for diets in developing countries, however, and this problem bedevils attempts to investigate the importance of fiber by making international comparisons of diet and disease. Another problem is that different analytical approaches give slightly different values for the dietary fiber content of foods, and do not reflect the physical and chemical properties of the different polysaccharide components. The use of enzymic hydrolysis to determine the 'unavailable carbohydrate' content of foods was refined by Southgate, and his technique was used for the 4th edition of the UK standard food tables, The Composition of Foods published in 1978. The 6th edition, published in 2002, contains values for nonstarch polysacchar-ides, derived using the Englyst technique, but recommends use of AOAC methods for food...

Associations between Dietary Fiber and Disease Processes

Unknown among the latter, in contrast to white South Africans. Dietary fiber was known to resist digestion by human intestinal enzymes, which helped to explain the greater fecal bulk seen with higher fiber intakes. This was thought to lower colonic exposure to carcinogens through a simple dilution effect with fiber consumption. Subsequently, it was suggested that diabetes may be related to a deficiency of fiber in the diet whereas other epidemiological studies have shown associations between more dietary fiber consumption and lower risk of some of the hormone-dependent cancers (prostate and breast). Many of these observational population studies are limited by their reliance on reported food intakes which may be compromised in turn by food compositional data because the latter can be limited by the analytical methodology used. Multinational comparisons may be affected by the fact that food sources and processing vary between countries. There are other potential confounders. For...

Dietary Fiber Complex Carbohydrates and Health Outcomes A Need for Fiber Equivalents

Technology has proved to be a significant issue in human fiber research. Early studies were limited by the relatively simple analytical methods then current. These were designed to measure the fiber components of forage consumed by important ruminant farm animals. Forage foods are high in insoluble polysaccharides and contain lignin (which is not a carbohydrate but a complex polyphenolic ether) and look 'fibrous,' so dietary fiber was equated with roughage and was defined as ''those structural and exudative components of plants that were resistant to digestion by human gut enzymes.'' The methods used initially were quite severe and, with increasing sophistication of analytical methodology (notably chromatography), it became apparent that lignin was only a minor component of fiber compared with nonstarch polysaccharides (NSPs). Technological advances have revealed the importance of fractions such as soluble NSPs. As their name suggests, these dissolve in water but not necessarily under...

Dietary fat and serum cholesterol

The relationship between dietary saturated fat and serum cholesterol is shown by the data from Japan and Britain in Table 12.3. This comparison is a useful one because dietary saturated fat differs greatly, yet dietary polyunsaturated fat and cholesterol are similar in the two countries. As in other situations (salt and blood pressure, for example) the size of the association varies with age, yet there has been a tendency to generalize to older age groups the results of studies conducted in younger age groups. Many dietary trials, for example, have been conducted in people under 30. The few that have been conducted in people over 50 tend to support the above Japan-Britain comparison.6 In older people a reduction in dietary saturated fat equivalent to 10 of calories will lower serum cholesterol by about 1 mmol l, which in turn will reduce ischemic heart disease mortality in the long term by about 40 . Trans unsaturated fatty acids are also important randomized trials show that they...

Dietary Fiber and the Etiology of Hormone Dependent Cancers

Cancers of the breast, endometrium, ovary, and prostate fall into the hormone-dependent classification. An association between hormonal status and cancer risk arose from observations of oestrogen deprivation and breast cancer and testosterone deprivation and prostate cancer. Nutritional influences on breast cancer have been studied extensively and several (but not all) studies show diminished risk with greater intakes of dietary fiber. The situation for other cancers, especially prostate cancer, appears to be rather unclear, but given the commonality of the proposed protective mechanisms, it is reasonable to expect that some linkage may be found. Male vegetarians have been reported to have lower testosterone and oestradiol plasma concentrations compared to omnivores, and inverse correlations of testosterone and oestradiol with fiber intake have been reported. There are many published studies that have produced mixed and inconsistent results on the potential mechanisms involved....

Dietary Fiber Obesity and the Etiology of Diabetes

In 1975, Trowell suggested that the etiology of diabetes might be related to a dietary fiber deficiency. This is supported by several key pieces of evidence. Vegetarians who consume a high-fiber lacto-ovo vegetarian diet appear to have a lower risk of mortality from diabetes-related causes compared to nonvegetarians. Consumption of whole grain cereals is associated with a lower risk of diabetes. Importantly, the same dietary pattern appears to lower the risk of obesity, itself an independent risk factor in the etiology of type 2 diabetes. Obesity is emerging as a problem of epidemic proportions in affluent and developing countries. Consumption of whole grain cereal products lowers the risk of diabetes. A report showed that in 91249 women questioned about dietary habits in 1991, greater cereal fiber intake was significantly related to lowered risk of type 2 diabetes. In this study, glycemic index (but not glycemic load) was also a significant risk factor, and this interacted with a...

Dietary Intake Measurements

Table 1 describes the advantages and limitations of the main types of dietary methods, which are suitable for different purposes. Of the individual methods weighed records, estimated food records, 24-h recalls (24-h), and dietary histories are more intensive. The quantity of food consumed may be weighed directly or estimated using household measures such as cups and spoons, photographs, standard units, or average portions (see Table 2). For all methods the amount consumed can be measured or described either including or excluding wastage material usually discarded during food preparation, e.g., outer leaves and peel from vegetables or bones from cuts of meat. Some considerations when choosing a dietary method are shown in Table 3.

Individual Dietary Intake Methods

Many methods are available for estimating individual dietary intake measures and can be divided into two types retrospective measures of intake such 24-h recalls (24-HR), dietary history or food frequency questionnaires (FFQs), or current measures of intake such as weighed or estimated food records. Qualitative information is available from all methods but quantitative estimates for nutrient consumption are possible only if data for weighed or estimated portion weights are available. Most methods may be either self-completed or completed by a surrogate. The diet history consists either of an interview administered 24-HR or establishing usual eating pattern over a 1-week period, followed by a frequency questionnaire to provide additional information. The dietary history provides a representative pattern of usual intake and is interview administered only. For weighed food records (WRs) all food consumed over a period is weighed and recorded with details of food type and method of...

Reproducibility and Validity of Dietary Intake Measurements

In reality, 'the same circumstances' can never exist in relation to dietary measurements because diet (whether of individuals, households, or countries) varies over time, be it on a daily, weekly, seasonal, or annual basis. In epidemiological studies, the aim is usually to assess 'usual' intake. Part of the variation in any dietary measurement will thus relate to genuine variability of diet. The remaining variation will relate to biases associated with the method. Due consideration must be given to these time-related factors when evaluating the reproducibility and validity of dietary measures, and a well-designed validation study will separate the variability associated with reproducibility (the error in the method) from that associated with genuine biological variation over time. Validity is an expression of the degree to which a measurement is a true and accurate measure of what it purports to measure. Establishing validity requires an external reference measure against which the...

Use of Biological Markers to Validate Dietary Intake Measurements

Nutritional biomarkers are those elements or compounds in biological samples capable of reflecting relationships between diet, nutritional status, and disease processes. Not all biomarkers are suitable for use in dietary validation studies. One of the key features of a marker should be its ability to reflect intake over a wide range of intakes.

Selection of Dietary Assessment Measure

There are several alternative methods of dietary assessment that may be selected to assess intake. At the household level, a commonly used approach may be referred to as the food account method. A person in the household who is responsible for the acquisition and or use of food is selected to keep a daily record of all the food that enters the household for a specified period - often 1 week. This includes household food purchases, food production, and food received as gifts during that period. This provides a general picture of the food that passes through the household in a given week. There are several limitations to this approach, including the assumption of constant food stores, which may not be the case. For the purpose of better understanding the dietary intake within households, more elaborate methods are needed. One approach is to use a household diet record. In this case the household respondent is asked not only to report inflows of food, but also to record actual use and...

Dietary fat and coagulation

Dietary fat increases blood levels of coagulation factor VII and hence increases the risk of thrombosis, myocardial infarction and cerebral thrombosis.28,29 Saturated and unsat-urated fat increase factor VII equally, and the increase appears directly related to the extent of postprandial lipemia. The importance of this effect in increasing the risk of cardiovascular death is difficult to quantify. However, analyses of differences in serum cholesterol and ischemic heart disease mortality between different populations (so-called ecological comparisons), such as the Seven Countries Study, yield significantly larger estimates of the relationship than obtained from the cohort studies and trials discussed above, and differences between populations in serum cholesterol are largely attributable to differences in dietary fat, whereas genetic differences account for over half the variation in serum cholesterol between individuals in a cohort. At age 60, for example, the ecological estimate is a...

Body Weight Management

Body weight management comes into play at two critical periods during the life of a flock of laying hens, specifically the rearing and the molt periods. During the rearing period it is important to manage the nutrition, vaccination, beak trimming, house ventilation, and general management program so that the pullets meet the recommended body weight for the strain. 3 With the modern layer strains this process can be managementintensive, because it is not recommended to feed-restrict Body weight is generally controlled through changes in diet formulation, altering the duration of feeding phases during the pullet-rearing period, or modifications in the lighting program (intensity and day-length), thereby controlling the protein and energy intake. The third factor that affects growth rate is ambient temperature. Low temperatures will cause overeating, and high temperatures can cause reduced consumption of nutrients. Maintaining a thermal neutral temperature (55 75 F) after the initial...

Dietary Management

The aim of dietary management of bulimia nervosa is to break the binge-purge cycle previously described. The individual should be informed of the problems of maintaining this cycle through dieting and should be encouraged to stop dieting in an extreme way. They should also be educated about the damaging effects of vomiting and other purging behaviors. In some cases, this is enough to stop such behaviors. In others, this message should consistently be given to encourage them to work toward stopping these behaviors. An important part of breaking this cycle is to get the individual to monitor his or her intake through completing a food diary. In the example shown (Table 1), it can be seen how restricting intake earlier in the day can make the person more vulnerable to overeating later in the day. Food diaries are a powerful cognitive tool that enable the individual to understand his or her eating behavior more fully. Education is essential to ensure that people understand why they are...

Behavioral Weight Control

Because the majority of individuals with BED are also overweight and want to lose weight, and because obesity is associated with significant medical and psychosocial consequences, weight loss is a potentially important outcome in the treatment of BED. Numerous studies have documented that calorie restriction does not exacerbate binge eating in BED patients. Indeed, participation in behavioral weight control programs that focus on calorie restriction, provide education about sound nutritional principles, and promote physical activity may decrease binge eating and improve mood in BED patients. Therefore, concerns about the potentially deleterious effects of dieting should not deter obese patients who binge eat from attempting behavioral weight management. Weight lost through dieting is frequently regained, and sustained weight change involves a permanent modification of eating and exercise patterns. However, it is not necessary to achieve large weight losses to improve risk factors for...

Dietary toxins and contaminants

The adverse effects of excessive vitamin A in the cat's diet have been known for a long time, but occasional cases are still reported in those cats fed excessive amounts of raw liver, often as a result of the owners' ignorance. The clinical picture is characterised by lameness in long bones, painful or stiff necks, abnormal gingival mucosa and depression. Toxicity has been recorded both in young kittens and in adult cats. Diagnosis is based on dietary history and radiographic findings of bony exostoses of the spine, or abnormalities in the length of the long bones. While the bony abnormalities may persist, the progression of such lesions can normally be halted by dietary correction. Most toxicities that occur in domestic cats, even those that are dietary in nature, are relatively well recognised and occur on a repeat basis worldwide. However, our profession must always be open to the idea that a particular problem may arise for the first time, with no previous reports existing. Thus,...

Dietary Supplementation for Active Individuals

A wide variety of supplements are used with the aim of improving or maintaining general health and exercise performance. In particular, supplement use is often aimed at promoting tissue growth and repair, promoting fat loss, enhancing resistance to fatigue, and simulating immune function. Most of these supplements have not been well researched, and anyone seeking to improve health or performance would be better advised to ensure that they consume a sound diet that meets energy needs and contains a variety of foods. See also Anemia Iron-Deficiency Anemia. Appetite Physiological and Neurobiological Aspects. Bone. Carbohydrates Chemistry and Classification Regulation of Metabolism Requirements and Dietary Importance. Electrolytes Water-Electrolyte Balance. Energy Balance. Exercise Beneficial Effects. Fats and Oils. Osteoporosis. Protein Synthesis and Turnover Requirements and Role in Diet. Sports Nutrition. Supplementation Dietary Supplements Role of Micronutrient Supplementation...

Dietary Fats and Oils The Good Bad and Ugly

Dietary fats and oils are unique in modern times in that they have good, bad, and ugly connotations. The aspects of dietary fat that are classified as good include serving as a carrier of preformed fat-soluble vitamins, enhancing the bioavailability of fat-soluble micronutrients, providing essential substrate for the synthesis of metabolically active compounds, constituting critical structural components of cells membranes and lipoprotein particles, preventing carbohydrate-induced hypertriglyceridemia, and providing a concentrated form of metabolic fuel in times of scarcity. The aspects of dietary fat that can be classified as bad include serving as a reservoir for fat-soluble toxic compounds and contributing dietary saturated and trans fatty acids, and cholesterol. Aspects of dietary fat that can be classified as ugly include providing a concentrated form of metabolic fuel in times of excess and comprising the major component of atherosclerotic plaque, the

Dietary Fats and Oils and Cholesterol

Dietary fat serves critical functions in the human body. It provides a concentrated source of energy, slightly more than twice per gram than protein or carbohydrate. For this reason, the causes of energy imbalances are often attributed to this component of the diet. However, definitive data in this area are lacking. In addition to providing a source of metabolic energy, dietary fat provides a source of essential fatty acids, linoleic acid (18 2), and or other fatty acids that are derived from linoleic acid. Dietary fat is the major carrier of preformed fat-soluble vitamins (vitamins A, D, E, and K). The bioavailability of these fat-soluble vitamins is dependent on fat absorption. Dietary fatty acids are incorporated into compounds that serve as structural components of biological membranes and lipoproteins, and as such they serve as a reservoir for fatty acids having subsequent metabolic fates.

Fatty Acid Profile of Common Dietary Fats

Dietary fats and oils derive from both animal and plant sources, primarily in the form of triacylgly-cerol. The fatty acid profile of dietary fats commonly consumed by humans varies considerably (Figure 8). In general, fats of animal origin tend to be relatively high in saturated fatty acids, contain cholesterol, and are solid at room temperature. A strong positive association has been demonstrated in epidemiological, intervention, and animal data between cardiovascular disease risk and intakes of saturated fatty acids. The exception is stearic acid (18 0), a saturated fatty acid of which a large proportion is metabolized to oleic acid (18 1), a mono-unsaturated fatty acid. Fats and oils of plant origin tend to be relatively high in unsaturated fatty acids (both monounsaturated and polyunsaturated) and are liquid at room temperature. Notable exceptions include plant oils termed tropical oils (palm, palm kernel, and coconut oils) and hydrogenated fat. Tropical oils are high in...

Major Contributors of Dietary Saturated Monounsaturated and Polyunsaturated Fatty Acids and Cholesterol

The major types of dietary fats and oils are generally broken down on the basis of animal and plant sources. The relative balance of animal and plant foods is an important determinant of the fatty acid profile of the diet. However, with the increasing prominence of processed, reformulated, and genetically modified foods, it is becoming more difficult to predict the fatty acid profile of the diet on the basis of the animal verses plant distinction. According to the National Health and Nutrition Examination Survey (NHANES) recall data from 1999-2000, the 10 major dietary sources of saturated fatty acids in US diets are regular cheese (6.0 of the total grams of saturated fatty acids consumed), whole milk (4.6 ), regular ice cream (3.0 ), 2 low-fat milk (2.6 ), pizza with meat (2.5 ), French fries (2.5 ), Mexican dishes with meat (2.3 ), regular processed meat (2.2 ), chocolate candy (2.1 ), and mixed dishes with beef (2.1 ). Hence, the majority of saturated fatty acids are contributed by...

Composition of Dietary Fats

Cholesterol in these fats is 33, 14, 0, and 12 mg table-spoon, respectively. Types of fat relatively high in monounsaturated fatty acids include canola oil (56 ), olive oil (73 ), and peanut oil (46 ). Types of fat relatively high in polyunsaturated fatty acids include soybean oil (51 ), corn oil (58 ), safflower oil (74 ), and sunflower oil (66 ). None of the vegetable oils high in monounsaturated or polyunsaturated fatty acids contain cholesterol. The fatty acid profile of diets varies widely among individuals and depends on such factors as availability, cultural and religious dietary patterns, price, and personal preferences.

Dietary Intake by Individuals

Information on food intakes by individuals is more precise than household food use data for the assessment of diet quality (13). For several reasons, household data were less than ideal for analyses of diet quality relative to the Recommended Dietary Allowances (RDA), which were the only standards available (25). Household food consumption data included food discard, resulting in overestimates of nutritional quality. To compare household intake levels with the RDAs, it was necessary to adjust for the consumption of food away from home, which was not surveyed, as well as to make various assumptions related to the apportionment of food among household members and their differing nutritional needs. Individual intake data represent foods as eaten, excluding food discard and including both food eaten at home and food away from home. Individual intakes can appropriately be compared with sex-and age-specific RDAs. The first USDA nationwide survey of food intakes by individual members of...

Effects of Dietary ALA Compared with Long Chain n3 Fatty Acid Derivatives on Physiologic Indexes

Several clinical and epidemiologic studies have been conducted to determine the effects of long-chain n-3 PUFAs on various physiologic indexes. Whereas the earlier studies were conducted with large doses of fish or fish oil concentrates, more recent studies have used lower doses. ALA, the precursor of n-3 fatty acids, can be converted to long-chain n-3 PUFAs and can therefore be substituted for fish oils. The minimum intake of long-chain n-3 PUFAs needed for beneficial effects depends on the intake of other fatty acids. Dietary amounts of LA as well as the ratio of LA to ALA appear to be important for the metabolism of ALA to long-chain n-3 PUFAs. While keeping the amount of dietary LA constant (3.7g) ALA appears to have biological effects similar to those of 0.3 g long-chain n-3 PUFAs with conversion of 11 g ALA to 1 g long-chain n-3 PUFAs. Thus, a ratio of 4 (15gLA 3.7 gALA) is appropriate for conversion. In human studies, the conversion of deuterated ALA to longer chain metabolites...

Dietary Modulation of Retinal Fatty Acid Composition and Function

Although retina and rod outer segment tenaciously retain 22 6n-3 during essential fatty acid deficiency (Connor et al., 1990, 1991 Wiegand et al., 1991), severe unbalanced n-6 n-3 diets or depleted n-3 fatty acid levels in membrane can cause abnormal change in biochemical and physiological membrane function. The level of 22 6n-3 in n-3 fatty acid-deficient chick brain and retina is restored by a diet containing 22 6n-3 (Anderson & Conner, 1994) and also after n-3 deficiency in the rhesus monkey (Neuringer et al., 1986 Neuringer & Connor, 1986). Functionally, n-3 fatty acid-deficient monkeys show delayed recovery of the dark adapted electroretinogram and impaired visual acuity at an early age (Neuringer et al., 1986), suggesting that n-6 fatty acids are not interchangeable with n-3 fatty acid in maintaining normal retinal function. After repletion with fatty acids from fish oil, the 22 6n-3 level increased rapidly after feeding, but no improvement in the electroretinogram...

Effect of Dietary Fat on Very Long Chain Fatty Acids and Rhodopsin Content

Retina membrane phospholipids, particularly phosphatidylethanolamine, contain a high level of 22 6n-3 (Birch et al., 1992 Suh et al., 1994). In the rod outer segment of the retina, significant amounts of 22 6n-3 in phosphatidylserine and phosphatidylcholine also occur (Suh et al., 1994). Increased dietary intake of n-3 fatty acids increases the n-3 Fig. 2. Developmental profiles and effect of dietary 20 4n-6 and 22 6n-3 on 20 4n-6 or 22 6n-3 in phosphatidylethanolamine of photoreceptors. Fig. 2. Developmental profiles and effect of dietary 20 4n-6 and 22 6n-3 on 20 4n-6 or 22 6n-3 in phosphatidylethanolamine of photoreceptors. Fig. 3. Developmental profiles and effect of dietary 20 4n-6 and 22 6n-3 on very long chain fatty acids in phosphatidylcholine of photoreceptors. Fig. 3. Developmental profiles and effect of dietary 20 4n-6 and 22 6n-3 on very long chain fatty acids in phosphatidylcholine of photoreceptors. fatty acid content of the rod outer segment (Suh et al., 1994, 1996 Lin...

Developmental Origins of Cardiovascular Disease Type 2 Diabetes and Obesity in Humans

Fetal Origins Adult Disease

Fetal growth restriction and low weight gain in infancy are associated with an increased risk of adult cardiovascular disease, type 2 diabetes and the Metabolic Syndrome. The fetal origins of adult disease hypothesis proposes that these associations reflect permanent changes in metabolism, body composition and tissue structure caused by undernutrition during critical periods of early development. An alternative hypothesis is that both small size at birth and later disease have a common genetic aetiology. These two hypotheses are not mutually exclusive. In addition to low birthweight, fetal 'overnutrition caused by maternal obesity and gestational diabetes leads to an increased risk of later obesity and type 2 diabetes. There is consistent evidence that accelerated BMI gain during childhood, and adult obesity, are additional risk factors for cardiovascular disease and diabetes. These effects are exaggerated in people of low birthweight. Poor fetal and infant growth combined with recent...

Management Dietary Elimination

The management of food allergy consists largely of elimination from the diet of the trigger food or foods. Elimination diets are used either for the diagnosis or the treatment of food intolerance, or for both. A diet may be associated with an improvement in symptoms because of intolerance to the food, a placebo effect, or the improvement may have been a coincidence. The degree of avoidance that is necessary to prevent symptoms is highly variable. Some patients are intolerant to minute traces of food, but others may be able to tolerate varying amounts. Strict avoidance and prevention of symptoms are the aims in certain instances, but in many cases it is unknown whether allowing small amounts of a food trigger could lead to either enhanced sensitivity or to the reverse, increasing tolerance. The duration required for dietary avoidance varies. For example, intolerance to food additives may last only a few years, whereas intolerance to peanuts is usually lifelong. Although food allergy is...

Compilations of Composition Data for Dietary Supplements

As the use of dietary supplements increases worldwide, there is an increasing need to quantify intakes of nutrients and botanical products from these sources. Compiling nutrient profiles of such products into tables can be very time-consuming because the number of products continues to grow and formulations of existing products often change over time. Furthermore, average analytic data are seldom available from the supplement manufacturers, and thus database compilers must rely on whatever information is available from the product label. In many countries, a label showing the amount of each nutrient in the product is required.

Dietary Contamination

Nickel and bismuth are not considered to be common dietary contaminants. Nickel is mainly inhaled as a dust by workers, whereas bismuth is mainly ingested in bismuth-containing medications such as Pepto-Bismol. Vegetables contain more nickel than other foods, and high levels of nickel can be found in legumes, spinach, lettuce, and nuts. Baking powder and cocoa powder may also contain excess nickel, possibly by leaching during the manufacturing process. Soft drinking water and acid-containing beverages can dissolve nickel from pipes and containers. Daily nickel ingestion can be as high as 1 mg (0.017mmol) but averages between 200 and 300 mg (3.4 and 5.1 mmol).

Fructose Consumption Body Weight and Obesity

With the increase in fructose intake, primarily as sugar-sweetened beverages, occurring coincidently with the increase in prevalence of overweight and obesity during the past two decades, it is important to examine the evidence that links fructose consumption and body weight gain. In epidemiological studies, consumption of larger amounts of soft drinks and sweetened beverages is associated with greater weight gain in women and increased energy intake and higher body mass index in children. In experimental studies, when fructose- or sucrose-sweetened beverages are added to the diet, subjects do not compensate for the additional energy provided by these beverages by reducing energy intake from other sources, and total energy intake increases. Possibly, this lack of compensation may be explained by the lack of a significant effect of fructose ingestion on the secretion of hormones involved in the long-term regulation of food intake. Data comparing the effects of ingesting fructose-and...

Obesity and Glycemic Index

Obesity contributes to the pathogenesis and morbidity of type 2 diabetes. Obesity is associated with changes in carbohydrate and fat metabolism that are central to the development of insulin resistance. Although low glycemic index diets enhance insulin sensitivity and improve metabolic cardiovascular risk factors, they will not reduce weight unless part of an energy-deficient diet. However, in obese subjects, when low glycemic carbohydrates are incorporated into a hypocaloric diet, there is a greater decrease in insulin resistance than can be accounted for by weight loss alone. Evidence from both animal and human studies demonstrates a change in body composition (decrease in fat but no change on overall weight) when exposed to a low glycemic index diet.

Proposed Mechanism by which Dietary Carbohydrates Glycemic Index Influence Insulin Resistance

Adipocyte metabolism is central to the pathogenesis of insulin resistance and dietary carbohydrates influence adipocyte function. The previous simplistic view that insulin resistance resulted from the down-regulation of the insulin receptors in response to hyperinsulinemia is being replaced by the hypothesis that high circulating NEFA levels both impair insulin action and reduce pancreatic fi cell secretion. It is plausible that low glycemic index carbohydrates

Recommended Dietary Allowances For Folate And Vitamin B12 Based On Genomic Stability

There is now increasing interest to redefine recommended dietary allowances (RDAs) of minerals and vitamins not only to prevent diseases of extreme deficiency but also to prevent developmental abnormalities and degenerative diseases of old age as well as optimizing cognition (75). Prevention of chromosome breakage and aneuploidy is an important parameter for the definition of new RDAs for micronutrients (9) such as folic acid and vitamin B12 because increased rates of DNA damage have been shown to be associated with increased cancer risk (76-78) and accelerated aging (79). Table 1 summarizes the information from in vitro and in vivo controlled experiments in human cells and human subjects with a view to defining, based on current knowledge, the optimal concentration and dietary intake of folic acid for minimizing genomic instability. The results from a variety of DNA damage biomarkers suggest that above RDA levels of folic acid intake are required to minimize DNA damage furthermore,...

Dietary Management Dietary Guidelines

Dietary recommendations are as for the general population until research proves otherwise. There are no specific dietary guidelines for the woman pregnant with a Down's syndrome child or for the pregnant Down's syndrome woman. There are indications that antioxidant and essential fatty acid intake may be particularly important, and folic acid supplements beneficial, but dietary advice is currently the same as for other pregnant women. The situation is similar for infant feeding. Brain lipids in the human infant are known to change with changing intakes of fatty acids. The needs of a newborn with Down's syndrome for the long-chain polyunsaturated fatty acids docosahexenoic acid and arachidonic acid have not been determined. Since breast milk contains the preformed dietary very long-chain fatty acids that seem to be essential for the development of the brain and the retina, it seems prudent to encourage breastfeeding. The antioxidant defence system has a particularly important role in...

Dietary Interventions

During infancy and early childhood, caloric intake should conform to the current guidelines from the Nutrition Committee of the American Academy of Pediatrics. During the first 6 months of life, breast milk or infant formulas are primary nutritional sources, followed by introduction of solids at 5 or 6 months of age. Solid textures are gradually advanced based on oromotor skills (jaw strength and tongue mobility). Due to the high likelihood for development of hyperphagia and obesity, the majority of parents avoid exposure of the PWS child to high-calorie solids, desserts, and juices. Via close nutritional follow-up during the first 2 years, oral intake can be appropriately adjusted to maintain weight for height between the 25th and 80th percentiles. Caloric restriction under the guidance of an experienced nutritionist is employed only if weight gain becomes excessive. Nutritional strategies beyond the toddler years focus on avoidance of obesity. A number of studies have evaluated the...

Hunger and Eating Behavior

Figure 3 Ratings of hunger made across the day by a group of obese women taking an appetite suppressant drug (dotted lines) or placebo (solid lines). Figure 3 Ratings of hunger made across the day by a group of obese women taking an appetite suppressant drug (dotted lines) or placebo (solid lines). In questioning the relationship between hunger and eating, we are also forced to place the action of hunger within a broader context of social and psychological variables that moderate food choice and eating behavior. Eating patterns are maintained by enduring habits, attitudes and opinions about the value and suitability of foods, and an overall liking for them. These factors, derived from the cultural ethos, largely determine the range of foods that will be consumed and sometimes the timing of consumption. The intensity of hunger experienced may also be determined, in part, by the culturally approved appropriateness of this feeling and by the host of preconceptions brought to the dining...

Dietary Lipid Approaches to the Prevention and Management of CVD

Level of Dietary Fat Dietary fat serves as a major energy source for humans. One gram of fat contributes 9 cal, a little more than twice that contributed by protein or carbohydrate (4calg 1) and somewhat more than that contributed by alcohol (7calg 1). When considering the importance of the level of dietary fat with respect to CVD prevention and management there are two major factors to consider the impact on plasma lipoprotein profiles and body weight. The potential relationship with body weight is important because of secondary effects on plasma lipids, blood pressure, dyslipidemia, and type 2 diabetes, all potential risk factors for CVD. With respect to the effect of the level of dietary fat on plasma lipoprotein profiles, the focus is usually on triglyceride and HDL cholesterol levels or total cholesterol to HDL cholesterol ratios. Evidence indicates that when body weight is maintained at a constant level, decreasing the total fat content of the diet, expressed as a per cent of...

Other Dietary Approaches for the Prevention and Management of CVD

When considering diets very low in fat and high in carbohydrates ('very low-fat' diets), it is important to separate the effects of the composition of the diet from confounding factors associated with intentional weight loss. For the purposes of this discussion, a very low-fat diet will be defined as less than 15 of energy as fat. Consumption of a very low-fat diet without a decrease in energy intake frequently decreases blood total, LDL, and HDL cholesterol levels and increases the total cholesterol HDL cholesterol ratio (less favorable) and triglyceride levels. A mitigating factor may be the type of carbohydrate providing the bulk of the dietary energy complex (whole grains, fruits, and vegetables) or simple (fat-free cookies and ice cream). The reason for this later observation has yet to be investigated. Notwithstanding these considerations, for this reason moderate fat intakes, ranging from < 30 to 25 to 35 of energy Dietary soluble fiber, primarily -glucan, has been reported...

Dietary Factors That Lower Blood Pressure

On average, as weight increases, so does blood pressure. The importance of this relationship is reinforced by the high and increasing prevalence of overweight and obesity throughout the world. With rare exception, clinical trials have documented that weight loss lowers blood pressure. Importantly, reductions in blood pressure occur before and without attainment of a desirable body weight. In one meta-analysis that aggregated results across 25 trials, mean systolic and diastolic blood pressure reductions from an average weight loss of 5.1 kg were 4.4 and 3.6 mmHg, respectively. Greater weight loss leads to greater blood pressure reduction. In aggregate, available evidence strongly supports weight reduction, ideally attainment of a body mass index less than 25 kg m2, as an effective approach to prevent and treat hypertension. Weight reduction can also prevent diabetes and control lipids. Hence, the beneficial effects of weight reduction in preventing cardiovascular-renal disease should...

Dietary Factors with Limited or Uncertain Effect on Blood Pressure

The body of evidence implicating magnesium as a major determinant of blood pressure is inconsistent. In observational studies, often cross-sectional in design, a common finding is an inverse association of dietary magnesium with blood pressure. However, in pooled analyses of clinical trials, there is no clear effect of magnesium intake on blood pressure. Hence, data are insufficient to recommend increased magnesium intake alone as a means to lower blood pressure. Numerous studies, including both observational studies and clinical trials, have examined the effects of fat intake on blood pressure. Overall, there is no apparent effect of saturated fat and n-6 polyunsatu-rated fat intake on blood pressure. Although a few trials suggest that an increased intake of monounsa-turated fat may lower blood pressure, evidence is insufficient to make recommendations. Likewise, few studies have examined the effect of dietary cholesterol intake on blood pressure. Hence, although modification of...

Dietary Reference Intakes for Infants

For infants, evaluation of evidence to establish the DRIs consistently revealed a paucity of appropriate studies on which to base an Estimated Average Requirement (EAR) or UL. A Recommended Dietary Allowance (RDA) could not be calculated if a value for the EAR was not established, in which case the recommended intake was based on an Adequate Intake (AI). The nutrient recommendations for infants from birth through 6 months of age for all nutrients except for energy and vitamin D were set as an AI, a value that represents ''the mean intake of a nutrient calculated based on the average concentration of the nutrient in human milk from 2 to 6 months of lactation using consensus values from several reported studies,'' multiplied by an average volume (0.780 l day) of human milk. The predicted daily volume of breast milk ingested by an infant was based on observational studies that used test weighing of full-term infants. For infants aged 7-12 months, the AI for many nutrients was based on...

Recommended Dietary Intakes

The US and Canadian recommended iron intakes are intended to meet the requirements of 97.5 of the healthy population, replacing excreted iron and maintaining essential iron functions with a minimal supply of body iron stores. They also assume a relatively high bioavailability of the dietary iron. The recommended 8mg daily for adult men and postmenopausal women can easily be met with varied Western-style diets. More careful food choices are needed to obtain the 18 mg recommended to meet requirements for 97.5 of adult menstruating women. This higher recommendation reflects the high menstrual iron losses of some women the median iron requirement is 8.1 mg for menstruating women. During pregnancy, dietary iron recommendations are increased to 27 mg daily, based on the iron content of the fetus and placenta (approximately 320 mg) as well as the expanded blood volume associated with a healthy pregnancy. Meeting this recommendation generally requires iron supplementation. Supplementation...

Cbt For Obesity The Past

Cognitive-behavioral therapy (CBT) constitutes the foundation of current lifestyle interventions for weight loss. Early behavioral theorists (e.g., Ferster, Nurnberger, & Levitt, 1962) invoked the principles of operant and classical conditioning to explain how learned patterns of overeating and sedentary behavior produce a positive energy balance and result in an excess accumulation of adipose tissue. From an operant conditioning perspective, overeating is viewed as a behavior largely controlled by immediate positive consequences. The taste of food serves as a powerful positive reinforcer, and the removal of the unpleasant sensation of hunger acts as a negative reinforcer. This combination of reinforcing properties strengthens the eating habit. In terms of classical conditioning, an association develops between the environmental circumstances that precede eating (e.g., mealtimes, the sight of food) and internal stimuli that are perceived as hunger (e.g., predigestive response of...

Cbt For Obesity The Present

More than 150 studies have evaluated the effectiveness of CBT for obesity. Reviews of randomized trials show that comprehensive interventions, typically delivered in 15 to 24 weekly group sessions, produce average weight losses of approximately 8.5 kg (Wadden, Brownell, & Foster, 2002). This amount of weight loss commonly produces clinically significant improvements in selected risk factors for disease (e.g., blood pressure, blood glucose, blood lipids) and beneficial changes in mood and psychological well-being. Indeed, a recent large-scale, randomized controlled trial in overweight persons at risk for diabetes demonstrated that an The clinical significance of weight reductions achieved in CBT is determined by whether or not the weight loss is maintained over the long run. In most studies, treatment is ended by 4-6 months, and participants are commonly followed for an additional 6 to 12 months. By 18 months following study entry, participants maintain only about 50 of their...

Definition of obesity

Definitions of overweight and obesity in adults have varied over time.7 Ideally, a health-oriented definition of obesity would be based on the amount of excess body fat that determines the presence of weight-responsive health risk in an individual.8 Body mass index (BMI), defined as weight in kilograms divided by height in meters squared (kg m2), is an easily obtained measure that is now widely used, as it has a high correlation with excess body fat or adiposity. However, BMI is not a measure of body fat and does not convey information on regional fat distribution. The latter is important, as it is now well established that central or visceral fat deposition is a major independent determinant of the metabolic and cardiovascular risk associated with an increase in fat mass.9-11 Recent evidence-based guidelines therefore recommend the use of both BMI and waist circumference in the assessment of overweight or obese patients.1 Table 19.1 summarizes the current classification of overweight...

Effects of Dietary Fats and Cholesterol on Lipoprotein Metabolism

The cholesterolemic effects of dietary fatty acids have been extensively studied. The saturated fatty acids Ci2 o, C14.0, and Ci6 0 have a hypercholester-olemic effect, whereas Cig 0 has been shown to have a neutral effect. Monounsaturated and polyunsatu-rated fatty acids in their most common cis configuration are hypocholesterolemic in comparison with saturated fatty acids. The effects of trans fatty acids on lipid levels are under active investigation. Our current knowledge shows that their effect is intermediate between saturated and unsaturated fats. The effect of dietary cholesterol on lipoprotein levels is highly controversial. This may be due in part to the dramatic interindividual variation in response to this dietary component. Specific effects of dietary fats and cholesterol on each lipoprotein fraction are the focus of other articles and they are only briefly summarized below and in Table 3.

Programming of Obesity Experimental Evidence

Obesity and related metabolic disorders are prevalent health issues in modern society and are commonly attributed to lifestyle and dietary factors. However, the mechanisms by which environmental factors modulate the physiological systems that control weight regulation and the aetiology of metabolic disorders, which manifest in adult life, may have their roots before birth. The 'fetal origins' or 'fetal programming' paradigm is based on observations that environmental changes can reset the developmental path during intrauterine development leading to obesity and cardiovascular and metabolic disorders later in life. The mechanisms underlying the relationship between prenatal influences and postnatal obesity and related disorders are relatively unknown and remain speculative, as are the interactions between genetic and environmental factors. While many endocrine systems can be affected by fetal programming recent experimental studies suggest that leptin and insulin resistance are...

Sleep apnea and obesity hypoventilation syndrome

Obesity is the most common precipitating factor for obstructive sleep apnea and is a requirement for the obesity hypoventilation syndrome, both of which are associated with substantial morbidity and increased mortality.78 Numerous case reports and non-controlled trials document substantial improvement in sleep apnea and the obesity hypoventilation syndrome, particularly with surgically induced weight loss. In a recent Cochrane review of lifestyle modification for obstructive sleep apnea, the reviewers concluded that there were currently no randomized trial data available for analysis.79 Thus, there are currently no data regarding the magnitude of weight loss necessary to produce a clinically significant improvement in obesity related obstructive sleep apnea, nor regarding which group of patients is most likely to benefit from this intervention.

Experimental Evidence for Programming of Obesity

Several animal models of early growth restriction have been developed in an attempt to elucidate its relationship with adult onset disease and provide a framework for investigating the underlying mechanisms. Animal studies have clearly shown that prenatal undernutrition programs not only postnatal cardiovascular dysfunction but also obesity, elevated plasma leptin concentrations, glucose intolerance, and even activity levels and dietary preferences. In rats hypertension, insulin resistance and obesity have been induced in offspring by maternal undernutrition,46 a low protein diet,7 maternal uterine artery ligation,8 maternal dexamethasone (DEX) treatment9 or prenatal exposure to the cytokines interleukin (IL)-6 and tumour necrosis factor (TNF)-alpha.10 There are also increasing experimental data in other species. In guinea pigs, IUGR caused by uterine artery ligation or maternal undernutrition results in reduced glucose tolerance, increased sensitivity to cholesterol loading11 and...

Pharmacotherapy of obesity

Strong evidence indicates that the use of appropriate weight loss drugs can augment diet, physical activity and behavior therapy in weight loss.5,15 Orlistat is gastrointestinal lipase inhibitor that reduces enteral fat absorption by around 30 .81 Sibutramine is a centrally active serotonin and norepinephrine uptake inhibitor that reduces hunger, increases satiety, and which may have a small thermogenic effect.82 Both compounds have been approved by licensing authorities in most countries for the pharmacologic treatment of obesity and the management of overweight patients with related comorbidities. They can be used as an adjunct to diet and physical activity for patients with a BMI of 30 or greater with no concomitant obesity risk factors or diseases, as well as patients with a BMI of 27 or greater with concomitant obesity related risk factors (hypertension, dyslipidemia, type 2 diabetes), when these patients have failed to reduce and maintain weight loss by lifestyle interventions...

Dietary Mg Deficiency

Severe Mg deficiency is very rare, whereas marginal Mg deficiency is common in industrialized countries. Low dietary Mg intake may result from a low energy intake (reduction of energy output necessary for physical activity and thermoregulation, and thus of energy input) and or from low Mg density of the diet (i.e., refined and or processed foods). Moreover, in industrialized countries, diets are rich in animal source foods and low in vegetable foods. This leads to a dietary net acid load and thus a negative effect on Mg balance. In fact, animal source foods provide predominantly acid precursors (sulphur-containing amino acids), whereas fruits and vegetables have substantial amounts of base precursor (organic acids plus potassium salts). Acidosis increases Mg urinary excretion by decreasing Mg reabsorption in the loop of Henle and the distal tubule, and potassium depletion impairs Mg reabsorption. Mg deficiency treatment simply requires oral nutritional physiological Mg supplementation.

Dietary and Nutritional Management of Secondary Undernutrition

The syllogism for dietary and nutritional management is to get enough nutrients into the body to restore nutritional adequacy and balance, taking any chronic barriers to uptake and retention into consideration. The blend of nutrients must be tailored to the specific absorptive or utilization problems, e.g., compensatory fat-soluble vitamins in water-miscible forms with severe fat malabsorption, and extra doses of highly available iron with chronic blood loss. These can be delivered within a dietary context with supplements and fortified vehicles in nonacute conditions. Even nondietary routes have been devised as in the treatment of vitamin D deficiency due to Crohn's disease with tanning bed ultraviolet B radiation.

Shifts in Dietary and Activity Patterns and Body Composition Seem to Be Occurring More Rapidly

The pace of the rapid nutrition transition shifts in diet and activity patterns from the period termed the receding famine pattern to one dominated by NR-NCDs seems to be accelerating in the lower and middle-income transitional countries. We use the word 'nutrition' rather than 'diet' so that the term NR-NCDs incorporates the effects of diet, physical activity, and body composition rather than solely focusing on dietary patterns and their effects. This is based partially on incomplete information that seems to indicate that the prevalence of obesity and a number of NR-NCDs is increasing more rapidly in the lower and middle-income world than it has in the West. Another element is that the rapid changes in urban populations are much greater than those experienced a century ago or less in the West yet To truly measure and examine these issues, we would need to compare changes in the 1980-2000 period for countries that are low and middle income to changes that occurred a half century...

Dietary Counselling and Fortification

Dietary counselling, usually provided by a dietitian, is an integral part of oral nutritional support. It includes advice on dietary fortification, which is often the first-line treatment of malnutrition in the home and other care settings. Counselling may involve advice on eating patterns (e.g., eating certain types of snacks at particular times of day) or addition of energy- and protein-rich food ingredients (e.g., cream, milk, oil, butter, sugar, and skimmed milk powder) to meals. Commercial energy- and protein-containing supplements can also be used to improve intake without substantially altering the taste of food and drink. The use of nutritionally fortified food snacks as part of the diet may improve both the intake and the status of micronutrients. However, the success of these dietary strategies is limited in patients with severe anorexia, those living in poverty and due to other social factors, and in those with inadequate motivation. Thus, patients may find it difficult to...

Individual Nutritional Status and Dietary Intake Data

Information on the dietary intake and nutritional status of individuals in a population is essential for monitoring trends in these indicators over time and in response to political and environmental changes, as a means of identifying groups for intervention, and to assess the impact of interventions on nutritional status of the population. Although dietary intake and simple anthropometric measurements, such as weight and height, have often been the focus of health and nutrition surveys, it is essential that other indicators of nutritional status such as micronutrient deficiencies also be documented because they continue to be important public health problems in most developing countries. Furthermore, as discussed previously, information on factors that are direct (e.g., the prevalence of infections) and indirect (e.g., maternal education and family socioeconomic status) causes of nutritional problems increases the usefulness of nutritional surveillance information for policymakers....

Body Composition in Childhood and Definition of Childhood Obesity

However, the percentage of body weight that is fat varies normally throughout childhood (Table 1). The infant is born with modest amounts of fat. More than 50 of the energy in breast milk comes from fat, and young infants lay down fat very rapidly so that in the 4 or

Risk Factors for Childhood Obesity

There is no clear evidence that obese individuals eat more or exercise less than their nonobese peers. Methods of measuring energy intakes and outputs are not precise when used over time and in community settings. The range of normal requirements and normal basal metabolic rates is large and obscures the energy imbalances of individuals. However, for the individual, obesity occurs when energy intake (food) exceeds the energy expenditure (basal metabolism, physical activity, growth, counteracting infection, maintaining body temperature, and ther-modynamic action of food).

Diet and Dietary Change

Studies from several countries suggest that the childhood obesity epidemic has developed despite secular trends toward lower energy intakes by children. These estimates may have failed to account for recent increases in food eaten outside the home in the United Kingdom and other countries. The eating habits of most families in industrialized countries have changed during the past 30 years in ways that seem likely to make it easy for individuals to overeat. Foods are readily available and children have money to buy them. Much advertizing of snack foods is aimed at children. Manufactured foods

Obesity Associated with Recognized Medical Condition

There are conditions in which obesity is part of a recognized genetic defect, clinical syndrome, or acquired pathological condition (Table 2). Together, these conditions account for only a very small Table 2 Specific conditions associated with obesity in childhood Congenital obesity Inherited syndromes associated with childhood obesity proportion of obese children. With the exception of very rare single gene defects in leptin metabolism, obesity is a secondary feature in these conditions and presentation is usually for some other aspect of the condition. Single gene defects affecting leptin are associated with progressive gross obesity from early life and may respond with dramatic fat loss with leptin treatment. Where obesity is only a part of a spectrum of abnormalities, common associated features are short stature, developmental delay, and craniofacial and other bony abnormalities. Chromosomal abnormalities are more frequent causes of a predisposition to obesity. Prader-Willi...

Prevention of Obesity in Childhood

The prevention of obesity involves creating lifestyle changes at the family, school, community, and national level. Initiatives need to be affordable and sustainable so that those most at risk of obesity are reached and feel ownership of community programmes. Table 5 suggests changes needed to reduce the obesogenic factors in the current Westernized environment. If the obesity epidemic is to be halted, governments and international industries have to work with communities to bring about effective change. Table 5 Possible national and community measures to reduce epidemic of childhood obesity in Western societies See also Adolescents Nutritional Problems. Appetite Psychobiological and Behavioral Aspects. Breast Feeding. Children Nutritional Requirements Nutritional Problems. Diabetes Mellitus Etiology and Epidemiology. Exercise Beneficial Effects. Food Choice, Influencing Factors. Nutritional Assessment Anthropometry Clinical Examination. Obesity Definition, Etiology and Assessment Fat...

Natural Dietary Habits

When observed for a sufficient period, omnivory is clearly a combination of carnivory and herbivory. The proportions of animal and plant foods consumed by omnivorous mammals are dependent both upon species' preferences and foods available in the environment. Omnivorous species are found in taxonomic orders that include bats, marsupials, pigs, primates, rodents, and Carnivora. 1,2 However, grouping these species in an omnivorous category tends to obscure the diversity of their dietary habits. All are presumed to consume animal tissues of various types, but food selections from the plant kingdom are sometimes used to identify particular specializations. For example, bats that consume insects incidental to (or as supplements to) their principal food nectar may be called nectarivores. Primates feeding on insects and small vertebrates but predominantly on plant exudates may be known as gummivores. Rodents feeding on invertebrates and small vertebrates but mainly on seeds may be known as...

Rational for Obesity Prevention

There are a number of reasons why prevention is likely to be the only effective way of tackling the problem of overweight and obesity. First, obesity develops over time, and once it has done so, it is very difficult to treat. A number of analyses have identified the limited success of obesity treatments (with the possible exception of surgical interventions) to achieve long-term weight loss. Second, the health consequences associated with obesity result from the cumulative metabolic and physical stress of excess weight over a long period of time and may not be fully reversible by weight loss. Third, the proportion of the population that is either overweight or obese in many countries is now so large that there are no longer sufficient health care resources to offer treatment to all. It can be argued, therefore, that the prevention of weight gain (or the reversal of small gains) and the maintenance of a healthy weight would be easier, less expensive, and potentially more effective than...

Objectives of Obesity Prevention

There remains a great deal of confusion regarding the appropriate objectives of an obesity prevention program. It is often assumed that to be effective, any intervention to address the problem of excess weight in the community should result in a reduction in the prevalence of overweight and obesity. However, such an objective is unrealistic and may be counterproductive. Most communities are experiencing significant increases in the average weight of the population as a result of a sizeable energy surplus resulting from reduced energy expenditure combined with an increased energy intake. This is leading to rapidly escalating rates of overweight and obesity. To reverse this trend will require not only the removal of this energy surplus but also the creation of a negative energy balance that will need to be maintained by the whole population for a significant period of time. Few (if any) interventions are capable of reducing energy intake, or increasing energy expenditure sufficiently,...

Who Should Obesity Prevention Strategies Target

Deciding where to invest limited time and resources in obesity prevention is a difficult task but finite health resources make this a necessity. WHO has identified three distinct but equally valid and complementary levels of obesity prevention (Figure 1). The specific 'targeted' approach directed at very high-risk individuals with existing weight problems is represented by the core of the figure, the 'selective' approach directed at individuals and groups with above average risk is represented by the middle layer, and the broader universal or populationwide prevention approach is represented by the outer layer. This replaces the more traditional classification of disease prevention (primary, secondary, and tertiary), which can be confusing when applied to a complex multifactorial condition such as obesity. Figure 1 Levels of obesity prevention intervention. (Adapted from Gill TP (1997) Key issues in the prevention of obesity. British Medical Bulletin 53(2) 359-388.)

Obesity Prevention Programs

A number of systematic reviews have assessed the current scientific literature on programs addressing the prevention of obesity in both children and adults and have identified only a limited number of evaluated programs. The reviews concluded that there was simply too small a body of research conducted in a limited number of settings to provide firm guidance on consistently effective interventions. However, reviews of childhood obesity prevention initiatives indicated that certain approaches appear to be associated with greater success. Intensive intervention in small groups was a successful management strategy in children, as was involving the entire There was general agreement that efforts should be heavily oriented toward preventing obesity in children because of the greater likelihood of success at a younger age. More effort needs to be directed at creating environmental and policy changes that will support the adoption of behaviors conducive to weight control rather than simply...

Health Risks due to Overweight Obesity

Increasing body fatness is accompanied by profound changes in physiological function. These changes are, to a certain extent, dependent on the regional distribution of adipose tissue. Generalized obesity results in alterations in total blood volume and cardiac function while the distribution of fat around the thoracic cage and abdomen restricts respiratory excursion and alters respiratory function. The intra-abdominal visceral deposition of adipose tissue, which characterizes upper body obesity, is a major contributor to the development of hypertension, elevated plasma insulin concentrations and insulin resistance, hyperglycemia, and hyperlipidemia. The alterations in metabolic and physiological function that follow an increase in adipose tissue mass are predictable when considered in the context of normal homeostasis. Table 1 Obesity-associated diseases and conditions

Types of Dietary Treatment

There are several dietary strategies available both in a clinical and commercial setting. These diets vary greatly in the degree of caloric restriction, relative amounts of macronutrients (protein, carbohydrate, fat), medical supervision, scientific basis, and cost. These diets can be broadly divided into Traditionally, low-calorie diets that incorporate various methods for restricting food intake have been recommended for weight management. Such treatment requires a period of supervision for at least 6 months. A review of 48 randomized control trials (RCTs) shows strong and consistent evidence that an average weight loss of 8 of the initial body weight can be obtained over 3-12 months with a low-calorie diet (LCD) and this weight loss causes a decrease in abdominal fat, the adipose tissue deposition that is associated with the highest disease risk. Very low-calorie diets (VLCD) have been shown to reduce weight at a greater rate in the first 2-3 months compared to low-calorie diets...

Drug Treatment of Obesity Rationale

Diet restriction even when combined with behavioral therapy and increased exercise is often unsuccessful in achieving weight loss and maintenance in obese subjects. Obesity is not a single disorder but a heterogeneous group of conditions with multiple causes. Although genetic differences are of undoubted importance, the marked rise in the prevalence of obesity is best explained by behavioral and environmental changes that have resulted from technological advances. In such circumstances, it is appropriate to consider pharmacological treatment as an adjunct to the other treatment modalities. In broad terms a pharmacological agent can cause weight loss by reducing energy intake or absorption and by increasing energy expenditure. Current drug treatment of obesity is directed at reducing energy food intake either by an action on the gastrointestinal system or via an action through the central nervous system control of appetite and feeding.

Prescribing guidelines for antiobesity drugs

Anti-obesity drugs should be prescribed in an appropriate clinical setting that includes systems for monitoring and follow-up of progress. The choice of anti-obesity drug is largely dependent on the experience of the prescriber in using one or another agent (see Table 5). For the two agents currently recommended for use there are no good clinical studies that have directly compared them or have explored which particular patient will benefit more from one than the other. A drug should not be considered ineffective because weight loss has stopped, provided the lowered weight is maintained.

Surgical Treatment for Obesity

Surgical treatment is an appropriate intervention for the management of morbid obesity. Criteria for selection of patients suitable for surgery are listed in Table 6. Enhancing effect on thermogenesis Adjunct to diet in obese patients with BMI > 30kgm 2 without comorbidities or BMI > 27 kg m 2 with comorbidities Those with uncontrollable appetite Frequent snackers Nocturnal eaters Dietary fat malabsorption Adjunct to diet in obese patients with BMI > 30kgm 2 without comorbidities or BMI > 28kgm 2 with comorbidities Those who have lost at least 2.5 kg through diet and lifestyle modification Patients requiring longer term behavioral changes whose dietary assessment suggests high-fat intake Patients with impaired glucose tolerance Those with elevated LDL cholesterol Chronic malabsorption Cholestasis

Efficacy of Surgical Treatment for Obesity

Surgery is usually successful in inducing substantial weight loss in the majority of obese patients. This is achieved primarily by a necessary reduction in calorie intake. In a review of RCT comparing different treatment strategies of obesity, surgery resulted in greater weight loss (23-28 kg more weight loss at 2 years) with improvement in quality of life and comorbidities. The Swedish Obese Subjects (SOS) study demonstrated long-term beneficial effects on cardiovascular risk factors. The development of type 2 diabetes mellitus is most favorably influenced with a 14-fold risk reduction in those obese patients undergoing surgical treatment.

Multidisciplinary Approach to the Management of Overweight and Obesity

Published evidence confirms that patients do better whatever the treatment when seen more frequently and for a greater length of time. Moreover, strategies that involve expertise incorporating dietetic, behavioral, and exercise experts as well as physicians and surgeons are also more successful in sustaining weight loss. This underlines the importance of a multidisciplinary approach. Treatment programs should include a system for regular audit and the provision for change as a result of the findings. Any center that claims to specifically provide expertise in weight management should incorporate the essential elements outlined in Table 7.

Dietary Guidelines for Health Function and Disease Prevention

Concomitant to recommendations for daily nutrient intake based on requirements, guidance and orientation for the pattern of selection of nutrient sources among the food groups have emerged as so-called 'dietary guidelines.' They are often accompanied by an icon or emblem, such as a pyramid in the US, a rainbow in Canada, and a Hindu temple in India, each of which expresses the general tenets of the dietary guidelines in a visual manner. A quantitative prescription, or some notion of balance among foods and food groups, is the basis of dietary guidelines there is also often a proscription for foods considered to be harmful or noxious. The additional susceptibility of older persons to chronic degenerative diseases makes adherence to these healthful dietary patterns, throughout the periods in the life span preceding the older years, more relevant. Recent epidemiological research has shown that compliance or behavior concordant with healthy eating guidelines are associated with lower...

Barriers to Meeting Recommended Nutrient Intakes and Healthful Dietary Intake Patterns by Older Persons

The late Professor Doris Calloway, in the early 1970s, commented ''People eat food, not nutrients.'' This highlights the paradoxes in considering and enumerating the objectives of dietary intake at the level of the Elderly persons face a number of challenges in meeting their recommended nutrient intakes. In the first instance, they are likely to be those with the least sophisticated or available knowledge of the nutrients required and the food sources to provide them. The social, economic, and physiological changes imposing on the lives of persons surviving to advanced age pose logistical problems for their selecting and purchasing a diet. Economic dependency and the limited incomes of older persons may restrict their access to high-quality foods. Social isolation, depression, and impaired mobility, as well as chewing difficulties may limit the variety of items included in the diet with advancing age. In some circumstances, it may be that free-living and independent elders are...

Absorption Transport And Metabolism Of Dietary Folates

If one takes into account all folyl oligo-y-glutamyl forms of the various one-carbon and unsubstituted oxidation states of the vitamin, folate metabolism becomes complex. However, it is generally agreed that food folate exists largely in 5CH3-H4folate and formyltetrahydrofolate (formyl-H4folate) forms (27). (Figure 1 gives the structure of all reduced folate derivatives.) The predominant natural dietary folate is 5CH3-H4folate (28,29), which is readily oxidized to 5-methyl-5,6-dihydrofolate (5CH3-5,6-H2folate) (27). In this oxidized form, it may add up to 50 of the total food folate (30). relatively stable. Fortunately, ascorbate secreted into the stomach lumen can salvage acid-labile 5CH3-5,6-H2folate by reducing it back to acid-stable 5CH3-H4folate and, thus, may be critical for optimizing the bioavailability of food folate (31). It has recently been shown that dietary formyl-H4folates may also utilize the natural pH of the gastrointestinal tract to isomerize and yield biologically...

Dietary Sources and Interconversions

Common dietary sources of the various polyunsaturated fatty acids are shown in Table 1. Vertebrate animals can synthesize saturated and monounsaturated fatty acids from dietary carbohydrate but are unable to synthesize 18 2o6 or 18 3o3. These polyunsaturates must, therefore, be provided in the diet and are referred to as essential fatty acids. Animals can, however, convert 18 2o6 to 20 4o6 via the action of desaturase and elongase enzymes. 1 The same enzymes are involved in the conversion of 18 3o3 to 20 5o3 and 22 6o3. This ability to synthesize C20 and C22 polyunsaturates from their C18 precursors varies greatly among animal species. Vertebrate animals are unable to perform interconversions between the o6 and o3 series. 1

Dietary Sources of Phosphorus

A conservative estimate is that most adults in the United States consume an extra 200-350 mg of phosphorus each day from these sources and cola beverages. Therefore, the total phosphorus intakes for men and women are increased accordingly. Because the typical daily calcium intake of males is 600-800 mg and that of females is 500-650 mg, the Ca P ratios decrease from approximately 0.5-0.6 to less than 0.5 when the additive phosphates are included. As shown later, a chronically low Ca P dietary ratio may contribute to a modest nutritional secondary hyperparathyroidism, which is considered less important in humans than in cats. Table 1 provides representative values of calcium and phosphorus in selected foods and the calculated Ca P ratios. Only dairy foods (except eggs), a few fruits, and a few vegetables have Ca P ratios that exceed 1.0.

Recommended Potassium Intake Current Intake and Dietary Sources

On the basis of available data, an Institute of Medicine committee set an Adequate Intake for potassium at 4.7g day (120 mmol day) for adults. This level of dietary intake should maintain lower blood pressure levels, reduce the adverse effects of salt on blood pressure, reduce the risk of kidney stones, and possibly decrease bone loss. Current dietary intake of potassium is considerably lower than this level. Dietary intake surveys typically do not include estimates from salt substitutes and supplements. However, less than 10 of those surveyed in NHANES-III reported using salt substitutes or a reduced-sodium salt. Because a high dietary intake of potassium can be achieved through diet rather than pills and because potassium derived from foods also comes with bicarbonate precursors, as well as a variety of other nutrients, the preferred strategy to achieve the recommended potassium intake is to consume foods rather than supplements. Dietary sources of potassium, as well as bicarbonate...

Dietary Determinants Of Efficacy

At least four dietary factors can modulate phytase efficacy. First, high levels of dietary calcium or calcium phosphorus ratios reduce the effectiveness of phytase. In phytase-supplemented diets, the recommended calcium phosphorus ratio is 1.2 1, not 2 1 as used in diets with adequate inorganic phosphorus added. Second, moderate to high levels of inorganic phosphorus may inhibit the full function of phytase. Third, supplemental organic acids such as citric acid or lactic acid enhance phytase efficacy. Those acids may reduce the pH of stomach digesta, thus providing a better environment for phytase to function, and or to enhance the solubility of digesta phosphorus and modify the transit time of digesta in the small intestine. In addition' organic acids may release cations chelated by phytate reducing the amount of insoluble phytate cation complexes that are resistant to phytase action thereby increasing the efficacy of endogenous or supplemented phytase. Last inclusion of hydroxylated...

Dietary Guidelines for Pregnancy

In general, pregnant women should follow the dietary advice provided by reputable national or professional organizations for all members of the public. For example, the Dietary Guidelines of the US Department of Agriculture include advice to eat a variety of foods maintain or improve your weight and choose a diet low in fat, saturated fat, and cholesterol and moderate in sugars, salt, and sodium. However, advice to control or maintain body weight, or to consume alcohol in moderation if it is consumed, is inappropriate in pregnancy. Specific guidelines for pregnant women are available and provide more specific information on recommended nutrient intakes, weight gain, the need for vitamin mineral supplements, activity, and the use of alcohol and other substances. Examples include a position paper by the American Dietetic Association and guidelines from the March of Dimes. Most of the increased requirements for nutrients during pregnancy can be met primarily by an adequate dietary...

PMS and Dietary Factors

Modern Western diets high in refined cereals lack magnesium. Many dietary surveys, including those sponsored by governments throughout the Western world, have shown that the mean intake of magnesium for women is below recommended dietary standards, with subgroups having exceptionally low intakes. Decreased intake or absorption or increased renal excretion may lead to a reduced intracellular magnesium. Indeed, perhaps the most consistent physiological abnormality yet found for PMS subjects has been the reduced magnesium level in red blood cells compared with controls. High doses of vitamin B6 have been found to be effective in treating most of the most common symptoms of PMS in several double-blind, placebo-controlled trials. For this reason administration of dietary supplements is a popular therapy for PMS used by many medical practitioners. However, as large doses have been associated with dependency and sensory neuropathy, doses higher than 50 mg per day should be avoided. See also...

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