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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...

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

The amount of snacking will probably be appropriate (Table 3). There is no consistent evidence that reduction of any particular energy source is more effective than any other in promoting fat loss, so 'balanced diets' conforming to the 'healthy diet' principles of WHO and many governments should be followed.

Importance of Weight Gain Prevention in Adults

There are a number of important reasons why it is preferable to focus on weight gain prevention as the key individual and population objective of obesity prevention initiatives in adults (Box 1). The association between elevated body mass index (BMI) and increased risk of ill health is clear and consistent. Box 1 Why focus on weight gain prevention Weight gain in adulthood carries an independent risk of ill health. Riskforchronic disease begins to increase from lowBMI levels and significant weight gain can occur within normal limits. Extended periods of weight gain are difficult to reverse. Weight gain in adulthood is mostly fat gain. The relationship between absolute BMI and health risk varies with age and ethnicity but no such variations occur in the relationship between weight gain and ill health. A focus on weight gain prevention avoids exacerbation of inappropriate dieting behaviors. It avoids reference to poorly understood terms such as 'healthy weight.' However, research has...

Key Elements of a Weight Gain Prevention Plan

Weight gain and obesity develop when the energy intake from food and drink exceeds energy expenditure from physical activity and other metabolic processes. It is often assumed that the prevention of weight gain should focus solely on attempting to alter these behaviors within individuals and communities. However, research has consistently shown that numerous and diverse factors, including environmental and social factors, influence the behaviors that lead to excessive weight gain. Addressing aspects of the obesogenic (obesity-promoting) environment, as well as individuals' eating and physical activity patterns, is considered to be critical to the success of any obesity prevention program. The 2003 WHO report on diet, nutrition, and the prevention of chronic disease undertook a detailed review of the literature and identified a range of key factors that either increase or decrease the risk of weight gain and the development of obesity (Table 2). These factors were rated on the quality...

Nutritionvitamins and weight gain

Nutritional recommendations for pregnant women are based upon the prepregnancy body mass index (BMI). A weight gain of 12.5 to 18 kg (28 to 40 lb) for underweight women (BMI< 19.8), 7 to 11.5 kg (15 to 25 lb) for overweight women (BMI 26), and 11.5 to 16 kg (25 to 35 lb) for women of average weight (BMI 19.8 to 26.0) is recommended.

Pattern of Weight Gain

Relatively little (1-2.5 kg) of the total weight gain during pregnancy occurs during the first trimester, whereas gain in the last two trimesters is relatively linear. Nevertheless, it is important to pay attention to the quality of pregnant women's diets during the first trimester and to ensure that they do not restrict their intake during this time, when there is the Maternal weight gain (kg) Maternal weight gain (kg) Figure 1 The relationship between maternal pregnancy weight gain and birth weight. (Reproduced with permission from the Institute of Medicine, Committee on Nutritional Status during Pregnancy and Lactation (1990) Nutrition during Pregnancy. Weight Gain. Nutrient Supplements. Food and Nutrition Board. Washington, DC National Academy Press.) strongest risk of nutrition-related birth defects and spontaneous abortions. In some studies, an association has been noted between low weight gain in the first trimester and increased risk of spontaneous preterm delivery.

Variability in Weight Gain

The BMI-specific target ranges for pregnancy weight gain are relatively narrow, but a very wide range of gain actually occurs. In a California study, for example, only 50 of the mothers who had an uncomplicated pregnancy with a normal birth-weight infant gained the recommended 12.5-18 kg, with the remainder gaining more or less. Since a substantial amount of the variation in weight gain is due to physiological variability and prepregnancy BMI, deviation from the recommended range may not necessarily be cause for concern. However, it is especially important to assess the dietary patterns and other behaviors of women whose weight gain is unexpectedly high or low. The IOM Implementation Guide for weight gain recommendations provides helpful information on the assessments that should be used.

Regulation of Prostaglandin and Leukotriene Synthesis by Dietary Fatty Acids

The diverse physiologic and pathologic functions mediated by eicosanoids highlight the importance of their fatty acid precursors in the diet. Unlike cellular proteins that are genetically predetermined, the PUFA composition of cell membranes is dynamic and is pivotally dependent on dietary intake. The typical Western diet is high in the n-6 family of PUFA (up to 25-fold more n-6 fats than n-3 fats are consumed). This predominance of n-6 fat is due to the abundance in the diet of the 'parent' 18-carbon PUFA linoleic acid (LA 18 2 n-6), which is present in high concentrations in corn, soy, safflower, and sunflower oils. Once ingested, LA can be converted to AA by a series of elongation and desaturation enzymes (Figure 6). Hence AA is the predominant PUFA of membrane

Dietary Protein Allowances and Implications of Adaptation

The Estimated Average Requirement (EAR) defines the notional mean requirement for the population group. The Recommended Nutrient Intake (RNI) is defined according to the range of interindividual variability and is two standard deviations above the EAR. The RNI (or Recommended Dietary Allowance) is thus an intake that will meet the requirement of most of the population assuming normal distribution of requirements and is therefore a 'safe allowance.' The Lower Nutrient Reference Intake, which is two standard deviations below the EAR, defines the lowest intake that will meet the requirement of some of the population. It follows from these definitions that in deriving dietary allowances from nitrogen balance studies, the variability in the reported values is very important since this is used to set the RNI. The currently agreed value is based on an EAR of 0.66 g kg and a SD 12 (i.e., 0.82 g kg). Such calculations try to assess true between-subject variation rather than measurement errors....

Pregnancy Weight Gain Recommendations

In 1970, the US National Academy of Sciences published guidelines for weight gain during pregnancy in the report, Maternal Nutrition and the Course of Pregnancy. The recommended pregnancy gain was 24 lb (10.9 kg), with a range of 10-25 lb (9.1-11.4 kg). The report advised health care providers and pregnant women not to restrict weight gain a practice that had been fairly widespread during the previous decade in order to reduce the perceived risks of labor complications, preeclampsia, and excess weight retention postpartum. In fact, many obstetricians had been recommending gains of only 15-20 lb (6.8-9.1 kg). Even with the more generous recommendations set in 1970, by the 1980s it had become clear that average gains of women in the United States far exceeded these guidelines. An analysis of data from the National Natality Survey in 1980 showed the average pregnancy weight gain to be 29 lb (13.2 kg), and by the time of the National Maternal Infant Health Survey in 1988 the average had...

Obesity and the Regulation of Body Mass

TIn the United States population, 30 of adults are obese and another 35 are overweight. (Obesity is defined in terms of body mass index (BMI) BMI weight in kg (height in m)2. A BMI below 25 is considered normal 25 to 30 is overweight, and greater than 30, obese.) Obesity is life-threatening. It significantly increases the chances of developing type II diabetes as well as heart attack, stroke, and cancers of the colon, breast, prostate, and endometrium. Consequently, there is great interest in understanding how body mass and the storage of fats in adipose tissue are regulated. To a first approximation, obesity is the result of taking in more calories in the diet than are expended by the body's energy-consuming activities. The body can deal with an excess of dietary calories in three ways (1) convert excess fuel to fat and store it in adipose tissue, (2) burn excess fuel by extra exercise, and (3) waste fuel by diverting it to heat production (ther-mogenesis) in uncoupled mitochondria....

Dietary Sources and High Intakes

Table 2 lists the riboflavin contents of some commonly consumed foods in Western countries. As is the case with most other B vitamins, the richest food sources comprise items such as offal and yeast extract, with meat and dairy products also providing quite generous amounts fruit and vegetables somewhat less, and the smallest amounts, in relation to their energy content, being present in ungerminated grains and seeds, such as nuts. There is an enormous difference in intakes and in status observed between most Western countries, where the dietary intake tends to be quite generous, and many developing countries, which depend on monotonous and ribo-flavin-poor staple foods such as polished rice. In developing countries, riboflavin deficiency tends to

Effects of Agroclimatic Seasonality on Food Availability and Dietary Intakes

As a result, both energy supply and dietary quality may be affected. The dietary changes observed in slack seasons may involve eating foods that are less preferred, but are more affordable, an option that is not biologically dramatic, but perceived by people as stressful. Households that are close to exhaustion of stocks of staple foods may use alternative food sources (root crops, gathered leaves and fruits, hunted small animals), may consume immature grains, or may reduce food intake by limiting portion size, reducing the number of meals, or skipping meals for an entire day. Dietary changes may also be due to reduced time available for food collection and preparation. Figure 1 Agro-climatic seasonality in different world regions. Seasonality is calculated taking into account soil characteristics and water balance and is an expression of the vegetative period of a food crop allowed by such conditions. From Ferro-Luzzi A, Branca F, and Pastore G (1994) Body mass index defines the risk...

Effect Of Dietary n3 Fatty Acids On Cognitive Function

Brain, and most other parameters remain approximately unchanged, these are not confounding factors and the effects of n-3 deficiency are generally assumed to be the result of the change in fatty acid composition of organs such as the brain. Table 2 lists oils commonly used in dietary depletion studies according to whether they are rich or poor sources of n-3 fatty acids.

Type of Dietary Carbohydrate and the Glycemic Index

Nondigestable complex carbohydrates are commonly known as dietary fiber the more correct terminology is nonstarch polysaccharides (NSPs). NSPs are either soluble or insoluble. Clinical studies have shown that diets rich in soluble fiber NSPs, such as guar gum, pectin, and sugar beet fibers, lower postprandial blood glucose and insulin levels. Guar gum, a 3-glactomannan from the Indian locust bean, also reduces postprandial lipemia. Nonsoluble NSPs have no effect on dietary glycemic index. Soluble NSPs, such as pulse vegetables, whole fruits, oats, and barley, form gelatinous gels within the stomach that delay gastric emptying and enzymic digestion, the latter by forming a physical barrier around the carbohydrate. Insoluble NSPs have little effect on gastric emptying and no effect on glucose absorption. High-fiber high-NSP diets are therefore not necessarily synonymous with low gly-cemic foods. Cellulose is the most widely used NSP in household cereals, whole meal bread, and brown...

Resistant Starch Oligosaccharides or Just Dietary Fiber

There has been much debate of the definition of dietary fiber and in particular whether it should include carbohydrates other than nonstarch poly-saccharides. Recently, the American Association of Cereal Chemists (AACC) proposed a new definition of dietary fiber, which would include both oligosaccharides and resistant starch as well as associated plant substances. This new definition would also require complete or partial fermentation and demonstration of physiological effects such as laxation, and reduction in blood glucose or blood cholesterol. A similar approach to include beneficial physiological effects is also proposed by the Food and Nutrition Board of the US Institute of Medicine. Thus, it is being increasingly recognized that oligosaccharides, resistant starch, and nonstarch polysaccharides are very similar especially in their effects on gut physiology and colonic fermentation. A comparison of their actions is summarized in Table 7. This inclusion of resistant starch and...

Potential Benefits of Dietary Supplements

The 2000 Dietary Guidelines for Americans (new release due 2005) emphasizes choosing foods sensibly, maintaining a healthy weight, and exercising regularly. It acknowledges that some people may need a vitamin-mineral supplement to meet specific needs. Similarly, the Food and Nutrition Board and the American Dietetic Association also recognize that dietary supplements may be desirable for some nutrients and for some individuals. The following is a compilation of recommendations by these groups

Dietary Sources of Thiamin

Thiamin is present in most foods but cereal products provide most thiamin for most people in the world, although the source is fundamentally different in developing and more industrialized countries. In the developing world, unrefined cereal grains and or starchy roots and tubers provide 60-85 of dietary thiamin, whereas most dietary thiamin in industrialized countries is obtained from fortified cereal products. In the United Kingdom, for example, wheat flour is fortified with 2.4 mg thiamin per kilogram and many breakfast cereals contain 30 or more of the daily thiamin requirement per portion. Thiamin is present in greatest amounts in brewers yeast, the germ and aleuron layers of fresh wheat, egg yolk, and mammalian liver. It is also present in meat flesh, particularly pork, and vegetables, nuts, and legumes (Table 1). Milk from both humans (0.49-0.79 mmol l 0.23 mg 4.2MJ (1000 kcal)) and cows (1.18-1.48 mmol l) is a poor source of thiamin. Thiamin is actively secreted into milk by...

Dietary Fat and Weight Gain

Dietary restriction of cholesterol and saturated fatty acid can mitigate and in some cases prevent increases in LDL-cholesterol, VLDL-cholesterol, and hypertriglyceridemia during thiazide therapy. In addition, increases in body weight during long-term treatment with diuretics tends to increase plasma cholesterol, whereas weight loss is associated with improvement in plasma lipids. Whether the changes in weight reflect attendant alterations in insulin resistance or dietary effects on lipid synthesis is not known. However, the observations suggest that dietary fat and caloric intake are important in the pathogenesis of hyper-lipidemia during thiazide treatment.

Recommended Dietary Allowances and Tolerable Upper Intake Levels for Vitamin A

Recommended dietary allowances (RDA) for the US and Canada were recently revised by the Institute of Medicine (IOM). Owing to the serious, potentially irreversible, effects caused by an excess of vitamin A, guidelines were also established for a tolerable upper intake level (UL), defined as the highest intake of a nutrient that is likely to pose no risk of adverse health effects in nearly all healthy individuals. The 2001 RDA and UL for vitamin A for various life stages are listed in Table 2. Table 2 Recommended dietary allowances (RDA) for vitamin A in micrograms (mg), retinol activity equivalents (RAE) and international units (IU), and tolerable upper intake levels (UL, mg retinol day-1) for children and adults

Daily Recommended Dietary Allowance of Vitamin A

The Food and Nutrition Board of the Institute of Medicine revised the Recommended Dietary Allowance (RDA) of vitamin A in 2001 as 900 retinol activity equivalents (RAE) for men and 700 RAE for women. The RAE was introduced to avoid the ambiguity of international units (IU), which arises because 1IU of vitamin A (0.3 mg) and 1 IU of the vitamin A precursor (provitamin A) all-trans- 3-carotene (0.6 mg) do not have the same biological activity. Rather, 6 IU of -carotene and 12 IU of mixed carotenoids provide the biological activity of 1 IU of vitamin A. The RAE refers to the amounts necessary for the same degree of biological activity 1 mg atROH 12 mg -carotene 24 mg mixed carotenoids 1 RAE. Liver, dairy products, and saltwater fish, including herring, sardines, and tuna, serve as dietary sources of vitamin A and its esters. Cod and halibut liver oil provide especially rich sources of vitamin A, as does the liver of the polar bear, which benefits from occupying the top of the marine food...

Dietary Vitamin D Intakes and Low Vitamin D Status in the US

The other major determinant is poor skin exposure to sunlight, mainly to UV-B that is responsible for the conversion of 7-dehydrocholesterol to 25(OH)D3 in the dermis layer of the skin. In the US, inadequate exposure has become a major contributor over the last few decades because of concerns about skin cancer and because of increased indoor activities, including television and computers. (This poor dietary consumption and poor skin production of vitamin D seems to be paralleling the increase in overweight.) Because it is even more difficult to assess skin exposure for vitamin D synthesis, it has been extremely difficult to estimate with accuracy the additional need for dietary vitamin D. Seasonal variations yield wide swings or oscillations in skin production, depending on the position of the sun. For example, in the northern hemisphere, the highest skin production rates occur in the late spring, summer, and early autumn months (May to October), whereas in the southern hemisphere,...

The National Weight Control Registry

Registry participants are recruited through newspaper and magazine articles and thus are a self-selected population. The registry members are primarily female (80 ) and Caucasian (97 ). Many have a strong genetic predisposition to obesity, with 73 having one or both parents with obesity and 46 having been overweight as a child. Participants in the registry are asked to indicate how they lost their weight in this successful effort. Approximately half say they lost the weight entirely on their own, whereas the other half reported receiving some type of assistance from a physician, dietician, or commercial program. The combination of diet plus exercise was used by 89 , with the most common dietary strategy being restricting intake of certain types of foods. The final characteristic of registry members is that they weigh themselves regularly. More than 44 weigh themselves daily and 31 weigh themselves at least once a week. Frequent monitoring of weight may allow these individuals to...

Dietary Recommendations

International dietary Guidelines recommend increased grain consumption. At present, the USA is the only nation to specify exact quantities of whole grain foods, and it is only within the last few years that whole grains have been considered seperately from total grain foods. The recommendations for grains have evolved over time to reflect changes in research and to simplify and clarify consumer messages. The latest American Dietary Guidelines (2005) now state a recommendation of 3 or more ounce-equivalent portions of whole-grain foods daily, with a further recommendation that at least half of grain consumption should be whole-grain. In the UK, the Food Standards Agency explicitly encourages consumers to select whole-grain varieties in their healthy eating advice, although no exact quantities are given. Many other European countries also tend to place emphasis on only cereals and fiber, without necessarily specifically highlighting whole grains. See also Cancer Epidemiology and...

Inadequate Dietary Intake of Zinc

In general, the risk of inadequate intake of dietary zinc within a population may be associated with the nature of the food supply, and its content and relative bioavailability of zinc. Animal source foods, in particular shellfish, small whole fish, beef, and organ meats such as liver and kidney, are rich sources of zinc. Furthermore, the zinc contained in animal source foods is more highly bioavailable than from plant source foods the presence of certain amino acids (e.g., histidine, methioinine), or perhaps other unidentified factors, may facilitate the intestinal absorption of zinc from animal flesh foods. Plant source foods, such as most fruits and vegetables including green leaves, and starchy roots and tubers, have relatively low zinc content. While whole grains and legumes have moderate to high zinc content, these foods also contain large quantities of phytate (phytic acid or myo-inositol hexaphos-phate), the most potent identified dietary inhibitor of zinc absorption. The zinc...

Biomedical Anthropology and Obesity The Primary Risk Factor for Type 2 Diabetes

More than 80 of new cases of type 2 diabetes are associated with obesity. This association has been demonstrated in many populations worldwide. Furthermore, risks correlate not only with the degree of adiposity but with the duration and distribution of body fat. A centripetal distribution of fat is a separate risk factor for both cardiovascular disease and diabetes and occurs more frequently in populations with high diabetes prevalence (Harris, 1991 Joos et al., 1984 Lieberman et al., 1999 Mueller et al., 1984). The risk occurs for both adults and Obesity and diabetes are linked to each other, and both are linked to dietary acculturation that involves the consumption of a surfeit of energy regardless of the food source (Kuhnlein & Receveur, 1996 Popkin, 2001 Teufel, 1996). Obesity has been extensively studied in populations with high diabetes prevalence. Overweight and obesity are in excess of 60 of the adults among Native Americans (ADA, 2002b Hall et al., 1992 Hanley et al., 2000...

Principles of Dietary Management of Diabetes

Developing the diabetes nutrition plan With the emphasis on individualization, the meal plan is driven by the diagnosis, pharmacologic treatment, lifestyle, and treatment goals. Important consideration is given to dietary preferences, socioeconomic factors, and the patient's ability to understand and implement instructions. Some patients will need instruction on fine points such as carbohydrate counting others will benefit from the crudest of prescriptions, such as advice to stop buying concentrated sweets or frequenting fast-food restaurants. Total energy intake The total energy requirement to maintain constant body weight may be calculated using the Harris-Benedict equation, taking into consideration the patient's activity level. The weight-maintaining requirement is then adjusted according to the therapeutic objective to accomplish weight loss, maintenance of weight, or weight gain. Examples of how to make these calculations are shown in Table 3. Specific conditions such as...

Dietary Transitions Lifestyle Factors and Diabetes

Anthropologists have explored cultural models of illness and the experience of being a person with diabetes. Cultural etiological models often include dietary elements, especially sugar and processed foods, that represent a departure from traditional, ethnically important diets (Kuhnlein & Receveur, 1996). Although many studies discuss the historical trends in type 2 diabetes as a result of modernization, Westernization, or even cokacolization and McDonaldization as creating obeseogenic and diabetogenic environments (Drewnowski & Popkin, 1997 Eaton, Eaton, & Konner, 1999 Popkin 1998, 2001 Wickelgren, 1998), only a few anthropological studies have explicitly documented these changes. Dietary acculturation takes many forms depending on (1) food availability including the influences of the environment, technology, and politics (2) food selection including the influences of cultural preference, afford-ability, and education and (3) biological needs, including the influences of...

Pregnancy Weight Gain and Postpartum Risk of Obesity

On average, well-nourished women retain relatively little weight approximately 1 year postpartum (approximately 0.5-1.5 kg). Delivery is followed by a rapid loss of weight in the subsequent 2 weeks due to fluid loss. This is followed by a slower rate of loss for the next 6 months, so a complete return to preconception weight should not be expected in less time than this. In general, weight still retained at 1 year postpartum is unlikely to be lost without lowering intake and or increasing physical activity. If weight retention is substantial, it can add to the risk of obesity in the longer term, and obesity is a major public health concern in many countries. The relatively low average weight retention postpar-tum obscures the fact that many women do retain an excessive amount of weight. Those who retain most are likely to have gained large amounts of weight during pregnancy. At 10-18 months postpartum, weight retention was 2.5 kg for women who gained more than the IOM recommendation...

The Development of Food Based Dietary Guidelines

The population rather than in terms of specific nutrients or food components. Scientifically, these guidelines are based on the association between dietary patterns and the risk of diet-related diseases and incorporate recommendations that address major diet-related public health issues. In addition to communicating scientific knowledge about the association between food, dietary patterns, and health, development of FBDG provides an opportunity to strengthen consensus among various government and non-government organizations on important nutrition recommendations to be incorporated into educational programs. In addition, by expressing scientific principles in terms of food, FBDG recognize the consumer awareness of food rather than nutrients and emphasize to consumers the importance of meeting nutrient needs with foods. Thus, both the content of the FBDG and the process of development are important. Health statistics will indicate the major causes of morbidity and mortality in a...

Types of Obesity Surgery

At least 30 surgical techniques have been developed for the treatment of obesity. Superficial cosmetic removal of adipose tissue (liposuction) will not be considered because it has no lasting benefit and it is not regarded as a treatment for obesity. Jaw wiring (intermandibular fixation) can restrict intake of food but it is no longer recommended for surgical treatment of obesity due to a lack of long-term efficacy. The operative procedures currently used for the surgical treatment of obesity are outlined below. Able to lose weight prior to surgery Have no evidence of psychiatric disease or maladaptive eating behaviors Absence of endocrine disorders that can cause morbid obesity Gastric banding involves the external 'pinching off' of the upper part of the stomach with a band usually made of Dacron. A modification of the gastric banding is an inflatable circumgastric band attached to a subcutaneous reservoir that allows access by a hypodermic syringe to inject or withdraw fluid thereby...

The Dietary Reference Intakes DRIs

We all need the same nutrients, but the amounts we need depend on our age, sex, and a few other factors. For example, women who are pregnant or breastfeeding need more of most nutrients. The Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences, a group of nutritional scientists from the United States and Canada, has established the Dietary Reference Intakes (DRIs), a set of recommendations for nutrient intake. The DRIs are age- and sex-specific. With the exception of fats and carbohydrates (whose requirements depend only on our calorie needs), a separate DRI is set for each of the known nutrients for each of10 different age groups. From the age of 9 years, males and females have separate DRIs, and additional DRIs are set for women who are pregnant or breastfeeding. How did the nutrient recommendations originate Concerned with the need to provide proper nutrition for newly drafted World War II soldiers, many of whom were undernourished, the Department of...

Precursors For Bulimia Nervosa Chronic Caloric Restriction and Dieting

Food deprivation in healthy individuals, which is experienced as a stress by the organism, has been known to increase the risk of binge eating. As described by Keys et al. 50 , if normal individuals, after having undergone chronic food restriction, regain access to food, they experience food cravings and uncomfortable overeating to the point of eating ''immense'' meals. Such overeating occasionally leads to compensatory behaviours such as vomiting to relieve the discomfort. Dieting exposure has been identified as a risk factor for BN by Fairburn et al. 51 .

Dietary Management of Secondary Overnutrition

The dietary management of secondary overnutrition would logically be to restrict the intake of the nutrients accruing in excess. This is not always facile or feasible, however, due to the intrinsic complexity of foods and beverages, where most are sources of multiple essential micronutrients. Marked reduction in total energy intake can jeopardize the intake of proteins and essential fats. For the metal-storage afflictions such as Wilson's disease and hemochromatosis, removing copper and iron from the diet, respectively, are the fundamental elements of management. Some additional benefits can be gained by blocking the metals' absorption, as with high doses of zinc in Wilson's disease or with strong black tea (tannins) in hemochromatosis. Fundamentally, however, the management of metal-storage diseases requires some interventions to selectively remove the overload by

Dietary Cholesterol and Plasma Cholesterol

The effect of dietary cholesterol on plasma cholesterol levels has been an area of considerable debate. In 1972, the American Heart Association recommended that dietary cholesterol intake should average less than 300mgperday as part of a 'heart-healthy,' plasma cholesterol-lowering diet. Since that initial recommendation, a number of other public health dietary recommendations in the United States have endorsed the 300 mg daily limit. Interestingly, few dietary recommendations from other countries contain a dietary cholesterol limitation. The evidence for a relationship between dietary cholesterol and plasma cholesterol indicates that the effect is relatively small, and that on average a change of 100 mg per day in dietary cholesterol intake results in a 0.057 mmoll-1 (2.2mgdl-1) change in plasma cholesterol concentrations. Studies have also shown that the majority of individuals are resistant to the plasma cholesterol-raising effects of dietary cholesterol 'nonresponders' and have...

Muslim Dietary Laws Food Processing And Marketing

Muslim dietary laws are a set of rules and requirements governing the lives of Muslims, or followers of the Islam religion. The food industry, like any industry, responds to the needs and requirements of consumers. Today's consumers are not only concerned with health and nutrition, they are also conscious of what goes into their bodies as food. Some of these restrictions by consumers are self-imposed philosophical or nutritional choices, whereas others are mandated by their religious beliefs. Muslim dietary laws are based on the Muslim scriptures, the Quran and the Hadith.

Impact Of Dietary Essential Fatty Acids On Neuronal Cell Composition And Function

Brain membranes were generally viewed as resistant to structural change by both endogenous and exogenous factors. Data have shown that brain membranes are much more sensitive to changes in composition induced by dietary fat than previously thought (Bourre et al., 1989a Foot et al., 1982 Jope & Jenden, 1979 Lee, 1985 Wurtman et al., 1981). Moreover, the extent of the changes in brain membrane composition by dietary fat varies among brain regions, cell types, and organelles (reviewed by Clandinin et al., 1997 Clandinin et al., 1991 Hargreaves & Clandinin, 1990). Earlier studies examining the role of dietary fat on brain membrane composition have used rodents that were fed 18 2n-6-deficient diets for several weeks to a few generations. Results from these studies demonstrate qualitative changes in brain membrane fatty acid composition associated with essential fatty acid deficiency (i.e., increase in 20 3n-9 and decrease in 20 4n-6 Koblin et al., 1980 Paoletti & Galli, 1972 Sun...

Very Low Calorie Diets and Meal Planning

Weight control programs have used low calorie diets (LCD), which usually consist of approximately 1200 to 1500 kcal day. Thomas A. Wadden and Albert J. Stunkard's initial study, which was conducted in 1986, and studies that followed, consistently found that a VLCD combined with behavior therapy was more successful than a LCD combined with behavior therapy, in producing more initial weight loss (in the short term) however, this initial weight loss did not improve long-term outcome. Williamson and Perrin reported on the results of several studies, which used VLCDs in addition to behavior therapy. They noted that the addition of behavior therapy to a VLCD, in the active treatment phase, did not yield weight loss above that usually associated with VLCDs alone however, the addition of behavior therapy did seem to slow the rate of weight regain. In addition to VLCDs, diets that are more structured have also been emphasized. According to Rena Wing, food provision (actually providing the...

Dietary n3 Deficiency in the Mouse 721 Mouse Visual Acuity and n3 Deficiency

Effect of Dietary DHA During n-3 Sufficiency on Behavior in the Mouse Recently, Carrie and colleagues (Carrie, et al., 2000) studied the effect of addition of sardine oil (a source of long-chain n-3 fatty acids) to a diet containing adequate n-3 and n-6 fatty acids. The control was a diet with equivalent amounts of palm oil. Both diets contained 14 fat of which 31 and 2.0 , respectively, were n-3. The sardine oil diet contained 0.94 g DHA and 1.6 g of EPA per 100 g of feed. Groups of 12 female OF1 mice from each dietary treatment were tested in the open-field, Morris water maze, and avoidance tests as young adults, mature, and old. To avoid memory effects, mice were not subjected to the same test twice. The effect of the n-3 diet on young mice was a significant increase in exploration and locomotor activity. In older mice, exploration, as measured

Dietary Selenium Absorption and Mechanisms of Incorporation of Selenium into Selenoproteins

Figure 1 summarizes the main pathways of interconversion of selenium in mammalian tissues. Selenium appears not to be an essential element for plants, but it is normally taken up readily into their tissues and is substituted in place of sulfur, forming the seleno-amino acids selenomethionine and selenocysteine, which are then incorporated at random in place of the corresponding sulfur amino acids into plant proteins. All branches of the animal kingdom handle selenium in essentially similar ways. When ingested, plant selenium-containing proteins liberate free seleno-methionine and selenocysteine, either for incorporation at random into animal proteins or for metabolic turnover, to liberate inorganic selenide, which is the precursor of active selenium to be inserted at the active site(s) of the selenoproteins. Selenide is also supplied by the reduction of selenite and selenate that enters the diet from nonorganic sources (i.e., from the environment) or from dietary supplements of...

Methods for Estimating Dietary Intake at the Household Level Household Budget Surveys

A record is made by a respondent of details of all quantities of food entering the household (purchased, home grown, or received over a period), usually over a period of 7 days. Changes in larder stocks are not estimated as on average some households will gain and some will use up stocks. Estimates of losses and wastage during preparation are made. This method is used for the UK Expenditure and Food Survey (until 2001 the National Food Survey), and has included consumption of food, confectionery, soft drinks, and alcohol outside the home since 1992. As consumption outside the home now accounts for a substantial proportion of dietary intake in the UK the method was modified in 2001 to include the use of till receipts and individual 2-week diaries for each household member aged 7 years or older. This method can be used to measure seasonal variation in intake over 1 year.

Dietary Sources High Intakes and Antimetabolites

As can be seen from Table 1, different types of foods differ considerably, not only in their total contribution to nicotinic acid equivalents, but also in the ratio of the contribution from preformed niacin and from tryptophan. In a typical Western diet, it has been calculated that if the 60 mg tryptophan 1 mg niacin formula is applied, then preformed niacin provides about 50 of the niacin supply in the diet. In practice it seems possible for all of the niacin requirement to be provided by dietary tryptophan in Western diets. As is the case for the other B vitamins, meat, poultry, and fish are excellent sources of niacin equivalents, followed by dairy and grain products, but as noted above, certain grains such as maize, and whole highly polished rice, can be very poor sources and may be associated with clinical deficiency if the diets are otherwise poor and monotonous.

Metabolism of Dietary Nucleic Acids in Humans

The metabolism of these exogenous nucleic acids follows a similar pattern to the intra-cellular process described previously, but the bacterial flora of the intestine are the first point of attack. This digestion is rapid. Studies in pigs (confirmed by later studies in humans) demonstrated that up to 50 of radiolabeled dietary purine was degraded and lost as carbon dioxide gas within 30 min, with the remaining 43 being recovered in the urine and 5 in the feces (Figure 3). It has been shown that dietary pyrimidine nucleotides, but not purines, are incorporated into RNA. Humans thus have no apparent requirement for purines from the diet, and the intestinal mucosa provides an effective barrier to their uptake through a battery of enzymes that rapidly degrade purine nucleotides, nucleosides, and bases to the metabolic waste product, uric acid. This phenomenon may represent an important evolutionary development to protect the integrity of the cellular DNA or to ensure that...

The Mediterranean diet

The traditional Mediterranean diet has been described to have eight components (i) high monounsaturated-to-saturated fat ratio (ii) moderate ethanol consumption (iii) high consumption of legumes (iv) high consumption of cereals (including bread) (v) high consumption of fruit (vi) high consumption of vegetables (vii) low consumption of meat and meat products and (viii) moderate consumption of milk and dairy products.130 Most of these are found in many diets. The characteristic component is olive oil, and many equate a Mediterranean diet with consumption of olive oil. Based on ecological comparisons, Keys etal131 hypothesized that traditional Mediterranean diet conferred protection against CVD and several other disorders, principally because of a low saturated fat content. Three prospective population studies in Greece, Denmark, and Australia provided supportive evidence of protective effects on overall mortality.132 However, this traditional form of Mediterranean diet has not been...

Short Term Eating Behavior Is Set by Ghrelin and PYY336

Dropping sharply just after the meal (Fig. 23-39). Injection of ghrelin into humans produces immediate sensations of intense hunger. Individuals with Prader-Willi syndrome, whose blood levels of ghrelin are exceptionally high, have an uncontrollable appetite, leading to extreme obesity that often results in death before the age of 30. This interlocking system of neuroendocrine controls of food intake and metabolism presumably evolved to protect against starvation and to eliminate counterproductive accumulation of fat (extreme obesity). The difficulty most people face in trying to lose weight testifies to the remarkable effectiveness of these controls.

Dietary Lna And Dha As Substrates For Brain And Retina Dha Compositional Studies

In nontracer experiments, relative contribution of dietary LNA and DHA to CNS DHA accretion have been examined in various species, including chicks, rat pups, newborn piglets, and guinea pigs. Anderson and colleagues studied the relative efficacy of LNA and DHA in restoring neural DHA levels in newly hatched chicks, as presented in Fig. 1 (Anderson, Connor, & Corliss, 1990). Laying hens were fed a n-3-deficient diet for 2 mo, and their hatched chicks were then fed a control diet or n-3-deficient diets supplemented with LNA (+LNA) or DHA (+DHA) at 3.6 wt (0.44 kcal) for 3 wk. After 3 wk, the DHA group showed brain DHA levels similar to that of controls (12.3 vs 8.3 ), whereas dietary LNA alone brought the level to only 25 of the controls. Similar results were observed for retinal DHA accretion. It was concluded that dietary DHA exerts a fourfold greater potency compared to LNA as a substrates for brain and retina DHA accretion. group. It was thus concluded that dietary LNA is 24 as...

Issues Associated with Measurement of Dietary Intake

There is potential for the occurrence of measurement error with the measurement of any exposure such as when using dietary methods to measure nutritional intake. Errors may arise as a result of flaws in the design of the measurement instrument or during data collection or processing. Measurement error may also occur as a result of individual characteristics of participants in studies. Measurement error can be defined as the difference between the measured exposure (or measure of dietary intake) and the true exposure. All measurement of dietary exposures is subject to some degree of measurement error making it difficult to achieve measurements of true intake. Efforts to reduce measurement error during data collection and processing should be introduced into the protocol of all studies, however, even if preven-tative measures are taken it is impossible to eliminate it altogether. It is difficult to identify the type and structure of measurement error associated with dietary intake....

What Is a Dietary Supplement How Are They Regulated in Different Countries

Each country has developed regulatory definitions and systems that place dietary supplements, particularly botanicals, into categories of drugs, traditional medicines, or foods. However, in the late 1980s, many countries launched major changes in regulations that may or may not have been approved at the time of this writing. Many regulations are still in draft form. The US Congress defined the term 'dietary supplement' in the Dietary Supplement Health and Education Act (DSHEA) of 1994. A dietary supplement is a product, taken orally, that contains a 'dietary ingredient' that is intended to supplement the diet. The dietary ingredient includes vitamins, minerals, herbs or other botanicals, amino acids, a dietary substance for use by man to supplement the diet by increasing the total dietary intake (e.g., enzymes or tissues from organs or glands), or a concentrate, metabolite, constituent, or extract. Dietary supplements may be found in many forms, such as tablets, capsules, softgels,...

Cbt For Obesity The Future

Does the CBT model of obesity require reformulation Cooper and Fairburn (2002) have agued for the need to reformulate the theory, aims, and procedures used in CBT for obesity. These authors maintain that the problem of poor long-term outcome following CBT for obesity may be attributed to two factors (a) inattention to the cognitive factors that contribute to weight regain and (b) ambiguity over treatment goals in long-term interventions. They note that long-term failure may be directly related to unrealistic expectations about weight loss and its benefits. Indeed, while CBT commonly produces body weight reductions of 8-10 , obese persons typically enter treatment expecting weight losses of 25-32 (Foster, Wadden, Vogt, & Brewer, 1997). Furthermore, Cooper and Fairburn observe that obese persons also have personal goals that they hope weight loss will produce for them, such as dramatically improving physical appearance, enhancing social acceptability, and increasing self-confidence...

Natural Dietary Habits

Carnivores derive most or all of their energy and nutrient needs from consumption of animal tissues, either by predation or scavenging. 1 We are most likely to associate carnivory with predators such as lions, tigers, and leopards, which feed primarily on terrestrial animals. However, carnivores that are specialized to feed on aquatic vertebrates (fish) and invertebrates (squid), such as dolphins, have been called piscivores. 2 Those that feed on aquatic invertebrates of limited mobility (crustaceans and clams), such as walruses, have been called crustacivores. 2 Carnivores that feed primarily on colonial insects (ants and termites), such as anteaters or pangolins, might be called myrmecivores. Those that feed on noncolonial insects or arachnids, such as tarsiers and shrews, have been called insectivores. 2 Those that feed on zooplankton, such as baleen whales, have been called plaktoni-vores. 2 Bats in the family Phyllostomatidae are adapted for feeding on the blood of warm-blooded...

Genetic And Dietary Factors Which Influence N3 Fatty Acid Metabolism

Because of the inability to synthesize n-3 fatty acids de novo, all animals require these fatty acids in their diet to meet their demand for maintaining a high concentration of DHA in the brain. Although little direct evidence exists in any species concerning the quantitative conversion of n-3 fatty acid precursors to DHA, it has been estimated based on rodent studies that an n-3 fatty acid intake of 0.5 of energy as a-linolenic acid (LNA) is needed in order to maintain an adequate level of DHA in the brain (Bourre et al., 1989). However, it must be recognized that the ability to biosynthesize DHA from LNA or other n-3 fatty acids varies among different animal species (Rivers et al., 1975 Hassam et al., 1977 Sinclair et al., 1979 Clandinin et al., 1985 Scott & Bazan, 1989 Salem & Pawlosky, 1994 Pawlosky et al., 1994 Fu & Sinclair, 2000). Moreover, the composition of fat in the diet has a significant influence on the liver production of long-chain PUFAs (Salem & Pawlosky,...

Classification of Eating Disorders Obesity

Obesity can be classified as an eating disorder since, primarily or secondarily, obese patients eat These abnormalities are seen in individuals who can no longer control their weight by dieting and exercising and have to resort to abnormal subterfuges, such as the following 1. An intrusive body image delusion makes the patients see themselves as being overweight when they are actually severely undernourished. This leads to a pathological fear of fatness (dys-morphophobia), a chronic voluntary starvation, and resistance to any external pressures to gain weight. Anorexic patients hide and dispose of food in the most ingenious ways to avoid eating.

Dietary Exposure To Nnitroso Compounds

The dietary exposure to NDMA (the most commonly occurring VNA in the diet) has been calculated in a number of food surveys and is summarized in Table 1. It should be taken into consideration that exposure estimates of this kind suffer from uncertainties in food consumption trends averaged over a population. Over the last decade, reductions in the use of nitrates and nitrites used for curing meats to the minimum amount required to inhibit bacterial growth, and modification of malting techniques in the brewing industry have resulted in significant reductions in the levels of NDMA. In most dietary surveys, cured meats and beer have been implicated as the major dietary sources of NDMA. As a direct consequence, NDMA exposure over the last decade has probably decreased from about 1 jug d to ca 0.3 fig d NDMA in most Western countries. An exposure estimate of between 10-100 fig d for currently identified NVNA would not seem unreasonable. In developing countries, particularly China and other...

High Fat Diets and Obesity Possible Influence of n3 PUFAs

Obesity is one of the major health risks for a number of diseases, particularly heart disease and diabetes. It is well known that ingestion of a diet high in saturated fats is one of the major causes of obesity. There are two explanations for this observation. First, diets high in saturated fats do not seem to be as satiating as either high-carbohydrate or highprotein diets (Doucet et al., 1998), even when the high-fat diet is less palatable (Warwick, 1996). Second, whereas increased intake of either carbohydrate or protein causes a concomitant increase in energy expenditure (e.g., nonshivering thermogenesis), increased intake of saturated fat does not cause a similar increase in energy expenditure. Individuals maintained for 1 wk on a high-carbohydrate or high-protein diet have, whereas individuals maintained on a diet high in saturated fat did not have, increased body temperature and ingested fat was mostly sequestered to adipose tissue that is, increased intake of saturated fat...

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...

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...

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...

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...

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 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...

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...

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.

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...

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

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...

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...

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.

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...

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.

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...

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 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

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...

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...

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.

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...

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 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...

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...

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.

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...

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 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 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.

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

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.

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

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.

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...

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 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...

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...

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.)

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...

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.

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...

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...

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...

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

Very Long Chain Fatty Acids

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...

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