Cent Of Total Calories Research Articles

The Dietary Treatment of Diabetes Mellitus

The most important dietary goal for individuals with type I diabetes mellitus is the establishment of a regular meal pattern with consistent day-to-day caloric and carbohydrate intake. Ideally, the diet should contain 55 to 60 per cent of total calories as carbohydrate, less than 30 per cent of calories as fat, less than 10 per cent of calories as saturated fat, and less than 300 mg of cholesterol per day. The best tool for helping type I individuals achieve these objectives is the Exchange Lists for Meal Planning. A second important dietary goal in type I diabetes is to avoid weight gain during intensive treatment programs. The most important dietary and therapeutic goal in obese persons with type II diabetes is weight loss. Unfortunately, no dietary method, whether initiated by self-help groups like TOPS, physicians, or other health care professionals, has been demonstrated to be effective in achieving and maintaining weight loss. Nevertheless, some individual patients will be successful, and it therefore is appropriate to attempt weight reduction with a balanced diet moderately restricted in calories. A reduction of 500 calories per day below the weight maintenance level is reasonable and can be expected to produce weight loss of about 1 lb per week. For those type II diabetic patients who are not able to lose weight and are at least twice their ideal body weight, gastric reduction surgery could be considered. The Glycemic Index of Foods is a new concept that has not been evaluated adequately. Recent evidence suggests that differences among foods are reduced when the foods are combined in a meal and thus raises questions about the utility of glycemic indexing. The longstanding restriction on the use of sucrose in the diabetic diet is without scientific basis. Recognizing this, the American Diabetes Association recently sanctioned consumption of modest amounts of sucrose in the diabetic diet. Although conclusive evidence is not yet available that high fiber diets improve glycemic control or reduce serum lipids in diabetic persons, it appears reasonable to encourage the consumption of natural foods high in soluble fiber. Vegetables (particularly legumes), oats, and many fruits are good sources. The American Diabetes Association recommends a goal of 40 g of soluble fiber intake per day. The dietary treatment of diabetes is likely to be more successful if physicians learn more about its essential features and pay it greater attention. The goals of dietary therapy are difficult to achieve and often require significant sacrifices.(ABSTRACT TRUNCATED AT 400 WORDS)

Carnitine supplementation vs. medium-chain triglycerides in postburn nutritional support

The effect of dietary supplementation of carnitine on protein metabolism was studied in a burned guinea-pig model. Animals bearing a 30 per cent total body surface area burn were enterally infused with three isocaloric and isonitrogenous diets via gastrostomy feeding tubes for 14 days. Two diets contained safflower oil (long-chain triglycerides, LCT) and another diet contained medium-chain triglycerides (MCT) as their lipid sources (30 per cent of total calories as lipid). l-Carnitine was added to one ofthe two diets containing safflower oil. There were no significant differences in nitrogen balance, urinary excretion, serum albumin or transferrin among the three groups. However, the use of MCT in place of LCT appeared to increase liver weight and liver nitrogen. In this model, carnitine supplementation did not enhance the nitrogen-sparing effect of fat following burn injury.

Ethanol-induced liver fibrosis in rats fed high fat diet.

Severe hepatic steatosis and focal necrosis of hepatocytes have previously been induced in rats by continuous intragastric infusion of ethanol and a diet containing only 5% fat as a per cent of total calories as reported by us previously. Since the ethanol diet fed ad libitum with such a low level of fat has previously failed to produce alcoholic fatty liver, continuously high blood alcohol levels achieved in this model appeared to be key in induction of the progressive pathologic lesions in the liver. In the current study, effects of increased fat intake on alcohol-induced liver injury were investigated. Seventeen pairs of male Wistar rats were implanted with gastrostomy cannulas and infused with a liquid diet containing 25% of total calories as fat plus ethanol or isocaloric dextrose. Ethanol intake was progressively increased from 32% up to 47% of total calories to maintain sustained intoxication for 30 to 120 days. Light and electron microscopic examination of the liver revealed moderate to severe fatty infiltration in all of the ethanol-fed rats, of which 14 had spotty or zonal necrosis in the centrilobular areas accompanied by polymorphonuclear and mononuclear cell infiltration. In addition, fibrosis was observed in association with the necrotic lesions or with large-droplet steatosis. Reticulin and trichrome stains clearly demonstrated fine fibrosis, including perivenular fibrosis as well as septum formation progressing to bridging fibrosis. Furthermore, increased numbers of Ito cells and myofibroblasts were observed in the perivenular fibrotic areas. These results demonstrate striking potentiation of alcohol-induced liver injury by the increased fat intake or by the concomitant decrease in carbohydrate intake.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of fat in human nutrition

Fat provides a major contribution to the palatability of food. It has a lubricating effect and improves the texture of many food products, and it also acts as a heat transfer medium in the frying of food. Fat is also a carrier of fat soluble flavour compounds which make some high fat products such as butter very attractive to consumers. As a consequence of these characteristics, fat in the diet has risen to 42.6% of calories according to the National Food Survey of 1980. The fat content of the diet in western countries shows a considerable increase during this century, and it also contrasts with developing countries where the fat intake is considerably less. A UN report estimates that fats provide about 14 per cent of total calories in developing countries. This has stimulated considerable research into the metabolism of fat and the relationship between the high intake of fat and diseases prevalent in western countries.

Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women.

We studied 10 vegetarian and 10 nonvegetarian premenopausal women on four occasions approximately four months apart. During each study period, the participants kept three-day dietary records, and estrogens were measured in plasma, urinary, and fecal samples. Vegetarians consumed less total fat than omnivores did (30 per cent of total calories, as compared with 40 per cent) and more dietary fiber (28 g per day, as compared with 12 g). There was a positive correlation between fecal weight and fecal excretion of estrogens in both groups (P less than 0.001), with vegetarians having higher fecal weight and increased fecal excretion of estrogens. Urinary excretion of estriol was lower in vegetarians (P less than 0.05), and their plasma levels of estrone and estradiol were negatively correlated with fecal excretion of estrogen (P = 0.005). Among the vegetarians the beta-glucuronidase activity of fecal bacteria was significantly reduced (P = 0.05). We conclude that vegetarian women have an increased fecal output, which leads to increased fecal excretion of estrogen and a decreased plasma concentration of estrogen.

The effect of dietary changes on high density lipoprotein cholesterol: The Oslo study

In some good responders to dietary treatment of hyperlipidemia followed for four years (the Oslo Study of men aged 40 to 49 years), a significantly increased high density lipoprotein (HDL) cholesterol concentration was found in the treated men as compared to an untreated control group, well matched for pretreatment values of HDL cholesterol, triglycerides and other relevant variables. In the treated group, diet analysis at four years revealed an isocaloric diet, with 27.9 per cent of total calories from fats, 8.2 per cent of total calories from saturated fatty acids and a polyunsaturated to saturated ratio (P:S ratio) of 1.01—as compared to 44.1, 18.3 and 0.39, respectively, in the control group. After four years of observation the mean total cholesterol in the treated group was 263 mg/dl versus 341 mg/dl in the control group, mean fasting triglycerides 129 mg/dl versus 200 mg/dl, whereas mean HDL cholesterol was approximately 20 per cent higher in the treated group than in the control group (50.09 mg/dl versus 42.22). The “HDL ratio” (HDL cholesterol × 100 to total cholesterol — HDL cholesterol) was 69 per cent higher in the treated group. HDL cholesterol was significantly and positively correlated with the P:S ratio in the diet. In this investigation only good diet responders have been studied. On the other hand, a clearly significant increased HDL cholesterol has been demonstrated in the dieters as compared to well matched control subjects. These results might be of interest in the view of HDL cholesterol as a well documented and independent “antirisk factor” for coronary heart disease.

Glucose and insulin responses to diet. Effect of variations in source and amount of carbohydrate.

The influence of variations in amount of carbohydrate in the diet (45 per cent or 65 per cent of total calories) and source (sucrose or corn syrup) on plasma insulin and glucose concentrations was evaluated in eight normal men. Four diets, which were alternated in a Latin square design, were consumed for 10 days. Plasma glucose and insulin concentrations were measured during an oral glucose tolerance test and over a 24-hour period while the test diets were consumed. The 24-hour study was completed with a portable, constant withdrawal pump, which allowed samples to be collected as a series of 48 consecutive, integrated, 30-minute samples. Thus, the 24-hour mean, or integrated, concentration as well as fluctuations during the day could be determined. The 24-hour integrated concentration of glucose did not vary significantly with the dietary changes tested. In contrast, two of the three methods used, to evaluate the glucose tolerance test results indicated that high carbohydrate diets improve glucose tolerance. Glucose fluctuations were significantly greater during ingestion of diets containing corn syrup than during those containing sucrose. The percentage of dietary energy supplied as carbohydrate did not influence glucose fluctuations significantly. Diets containing corn syrup were associated with significantly higher integrated concentrations of insulin than the sucrose diets. Insulin-integrated concentrations did not vary significantly with changes in the percentage of dietary carbohydrate. The insulin response to the glucose tolerance test did not vary with the source of carbohydrate and did not accurately reflect the 24-hour mean insulin concentrations. We concluded that (1) a change in the percentage of energy supplied as carbohydrate does not significantly influence the concentration of either glucose or insulin in normal subjects; (2) concentrations of glucose throughout the day are more stable when the dietary carbohydrate is sucrose than when it is corn syrup; (3) sucrose-containing diets require significantly lower insulin concentrations to maintain euglycemia than do corn syrup–containing diets; (4) glucose and insulin responses to an oral glucose tolerance test do not accurately reflect the 24-hour glucose and insulin concentrations obtained during ingestion of the test diets.

Mechanism of induction of hepatic drug-metabolizing enzymes by ethanol—I: Limited role of microsomal phospholipids

Two groups of female Sprague-Dawley rats were pair-fed nutritionally adequate liquid diets containing 36 per cent of total calories as ethanol or additional carbohydrate (controls). One group was fed a high fat diet (35 per cent of total calories as fat); the other group was fed a low fat diet (2 per cent of total calories as linoleate as the only source of fat). When given with the high fat diet, ethanol increased cytochrome P-450 and microsomal phospholipid content per g of liver. When given with a low fat diet, it increased cytochrome P-450 to a lesser extent and did not alter the microsomal phospholipid content when expressed per g of liver or per 100 g of body weight. Phosphatidylcholine accounted for the greater porportion of phospholipids and was increased by ethanol only with the high fat diet. L-Methionine-methyl[ 3H] and [ 14C]choline incorporation into phosphatidylcholine was unaltered by ethanol in either model. The fatty acid composition of phosphatidylcholine was altered by ethanol more significantly with the high fat diet. Since ethanol similarly enhances the activity of benzphetamine demethylation in both dietary models, quantitative and qualitative differences in microsomal phospholipids produced by ethanol are probably not responsible for the induction by ethanol of this drug-metabolizing enzyme activity. Further evidence to that effect was obtained from the measurement of benzphetamine demethylation in vitro by partially purified cytochrome P-450, reductase and lipid fractions of ethanol-fed and control rats fed a high fat diet. The stimulation of benzphetamine demethylation by the lipid fraction was identical whether using lipids from microsomes of ethanol-fed animals or control animals. Dietary fat plays a role in the induction by ethanol of cytochrome P-450 and NADPH-cytochrome P-450 reductase and on microsomal phospholipid content and composition. The effects of ethanol on microsomal phospholipids are probably not related to the induction of benzphetamine demethylation activity.

Menu planning in the Nutrition Program for the Elderly

A nutrient standard menu (NSM) planning method was developed for use in planning menus which provided one-third the Recommended Dietary Allowances for persons sixty years of age or older for nine indicator nutrients and calories, while restricting fat to less than 40 per cent of total calories. To eliminate manual calculations and make it easy for individuals untrained in dietetics or nutrition to use NSM planning, the nutrient composition of over a thousand commonly used menu items was listed in a menu planning manual in nutrient units which were one-tenth of the nutrient standard for the meal. Menus from third-party sources were monitored by selecting similar nutritionally analyzed menu items in the manual and adjusting the nutrient composition to conform to the portions actually served. Ten site managers of the Administration on Aging (AoA) evaluated the planning/monitoring method. The members of the group, on the average, were fifty-six years of age, had 1.6 years of education beyond high school, and had 4.6 years of foodservice experience. Approximately 83 per cent of the evaluators did not plan to monitor menus at their sites and had no formal training in dietetics or nutrition. Eighty-four per cent were able to plan menus satisfactorily after this brief introduction. The younger evaluators with more education grasped the concepts faster and were able to plan menus with greater accuracy. The data also indicated that previous experience in menu planning enhanced their ability to plan NSMs. Most felt the approach to be workable and applicable. Menu monitoring was more difficult for the evaluators. Seventy-five per cent were able to monitor menus satisfactorily, and all felt they could do so with more time. The data again showed that the younger individuals having more formal education were able to master the monitoring skills more easily.

Chapter VI: Nutritional Methods and Procedures

Chapter VI: Nutritional Methods and Procedures

Dietary Carbohydrate and Serum Cholesterol Levels in Man

Serum total cholesterol responses in two groups of institutionalized men fed modifications of a low fat dietary pattern allowing for the simultaneous variation of the type of carbohydrate and fat are reported. The results obtained with low sugar, high sugar and high sugar-lactose diets providing 45 per cent of total calories from carbohydrate and one of each of three test oils (safflower, olive and coconut) added to provide 38 per cent of the calories as fat were compared. Experimental periods were of four weeks’ duration. Serum cholesterol levels were slightly but significantly lower in those on the low sugar than in those on the high sugar diets. Since the size of this difference was about the same for each oil tested, no interaction between carbohydrate and fat was suggested. The partial substitution of lactose for sucrose in the high sugar diet did not further influence serum cholesterol except when coconut oil was the test fat; in this period a substantial elevation was noted. The carbohydrate effects on serum cholesterol are of a much smaller order of magnitude than the fat effects and manipulation of the source of dietary carbohydrate would appear to add little to the dietary regulation of blood cholesterol.

Calories do count

There have been statements in the medical and the lay literature to the effect that weight loss occurs more rapidly with diets high in fat and protein asc compared to equi-caloric diets containing large amounts of carbohydrate. In the present study, subjects have been maintained for many weeks on constant calorie intake. At intervals, the composition of the diet has been changed, the fat intake varying from 12 to 83 per cent, protein from 14 to 36 per cent, and carbohydrate from 3 to 64 per cent of total calories. In any given subject, the rate of weight loss was essentially constant throughout the entire study. It is therefore obvious that the significant factor responsible for weight loss is reduction of calories, irrespective of the composition of the diet.