Food Disappearance Data Research Articles

Descriptive analysis of changes in Ghana's food availability and food safety information between 2010 and 2020

Access to safe, nutritious, and sufficient food is essential to ensure food and nutrition security and healthy lives for all. Secure access to nutritious food ensures healthy eating habits, economic growth, and stability in an economy. However, food insecurity and malnutrition persist globally. In Ghana, more than half of food-insecure people reside in the Northern ecological zones of the country. Moreover, Ghana lacks a systematic food security monitoring system to track food insecurity among vulnerable populations. This study reviewed existing evidence on the current situation and changes related to food production, trade, safety, and consumption in Ghana, as part of the process to develop food-based dietary guidelines for the country. The literature review included peer-reviewed articles published from 2010 – 2020 in Ghana to document household-level food production, consumption, and safety issues. In addition, food disappearance data (from 2010 to 2018) from the Food and Agriculture Organization of the United Nations was analysed. Means and compound annual growth rates were calculated for each food item included. The results showed that per capita food production was higher than per capita consumption in all the food categories studied, except for vegetables, and fish and fishery products. Food consumption was centred on a few priority staple crops such as cassava, maize, rice, and yams, with less consideration given to underutilised foods such as akokono (palm weevil larvae). Food imports exceeded food exports in all food categories except 1) cocoa beans and products, 2) root crops and tubers, 3) oil-bearing crops and nuts, and 4) fruits and products. Fruit and vegetable consumption in Ghana has been declining since 2013. There was also a rise in the import and consumption of processed foods, especially tomato paste, sugars, and alcoholic and non-alcoholic beverages. Food safety issues included microbial contamination, aflatoxin contamination, polycyclic aromatic hydrocarbons in smoked fish, mercury in fish, pesticide and heavy metal residues in vegetables and fruits, and food adulteration. The evidence synthesized from this study will be useful to inform the development of food-based dietary guidelines for Ghana. Key words: Food, production, trade, consumption, food security, safety, Ghana

Global, Regional and National Consumption of Major Beverages in 2015: Systematic Analysis of Country-Specific Nutrition Surveys Worldwide (P10-038-19)

ObjectivesAssessing the impact of beverage intake on health has been limited by lack of reliable and standardized individual-level data on a global scale. We aimed to quantify global distributions of intakes of sugar-sweetened beverages (SSBs), fruit juices, milk, coffee, and tea by country (n = 188), super-region (n = 6), key population characteristics (all ages, sex, education, urban/rural location) and time (1990, 2015). MethodsPrimary national and subnational survey data on beverage intake in the Global Dietary Database (GDD) were identified through systematic searches of electronic databases and communications with data owners worldwide. This includes 1137 survey-years representing 6.78B people from 185 countries worldwide (97.5% of the world’s population). To address missing data and estimate distributions of intake for each diet factor and by country-, age-, sex-, education-, urban/rural- and year-specific stratum we developed a Bayesian hierarchical imputation model. The model combined primary intake data with time-varying country-level and survey-level covariates and further accounted for differences in intakes vs availability from FAO food disappearance data. ResultsIn 2015, global SSB intake in adults (20 + y) was 0.37 servings (8-oz)/day (Fig 1). The Latin-American region had the highest SSB intake (1.15 servings/day) and Asia the lowest (0.14 servings/day). For fruit juices, global intake across all ages was 0.19 servings (8-oz)/day; highest intakes were seen in Latin America (0.64 servings/day) and lowest in Asia (0.06 servings/day) (Fig 2). Global milk intake was 0.39 servings (8-oz)/day, ranging from 0.64 servings/day in the High-Income region to 0.20 servings/day in Asia (Fig 3). Intakes were generally similar by sex and higher at younger ages, urban areas, and higher education levels. Findings for coffee and tea, and over time, will be presented at the meeting. ConclusionsThese novel global dietary data highlight substantial variation in beverage intake worldwide, further informing global diet surveillance, priority setting and nutrition strategies. Funding SourcesBill & Melinda Gates Foundation. Supporting Tables, Images and/or Graphs▪▪▪

Global, Regional and National Consumption of Plant-Source Foods in 2015: Systematic Analysis of Country-Specific Nutrition Surveys Worldwide (OR21-01-19)

ObjectivesEstimating plant-source food (PSF) intake is crucial for evaluating associated health and environmental impacts; yet, worldwide consumption remains largely uncharacterized. Our aim was to quantify global distributions of daily intakes of fruits, vegetables (non-starchy, potatoes, other starchy), legumes, grains (refined, whole), and nuts/seeds by country (n = 188), super-region (n = 6), key population characteristics (all ages, sex, education, urban/rural location), and time (1990, 2015). MethodsThe primary data sources of PSF intake in the Global Dietary Database were from national and subnational surveys identified by systematic searches of electronic databases and communications with data owners from 1980 through 2015, including 1137 survey-years representing 185 countries (97.5% of the world’s population). To address missingness and estimate national and stratum-specific intake distributions worldwide, we used a Bayesian hierarchical imputation model. The model combined stratum-specific individual-level intakes with time-varying country- and survey-level covariates, and accounted for differences in intakes vs per capita availability from FAO food disappearance data. ResultsIn 2015, global fruit intake was 114 g/d (1.1 servings (100 g)/d), with highest intakes reported in Latin America (146 g/d) and lowest in the Middle East and North Africa (MENA) region (97 g/d) (Figure). Non-starchy vegetable global intake was 203 g/d (2 servings (100 g)/d); highest intakes were seen in Asia (269 g/d) and lowest in the Former Soviet Union (FSU) (135 g/d) and High-Income (136 g/d) regions. Global legume intake was 17 g/d (0.2 servings (100 g)/d), highest in Latin America (52 g/d) and lowest in FSU (3 g/d). For refined grains global average was 215 g/d (4.3 servings (50 g)/d), varying from 254 g/d in MENA to 117 g/d in Sub-Saharan Africa. Intakes were generally similar by sex and urban/rural location, and higher at older ages and higher education levels. Findings for potatoes, other starchy vegetables, whole grains and nuts/seeds, and over time, will be presented at the meeting. ConclusionsSuch global data, showing substantial variation in PSF consumption by nation and population worldwide, inform and highlight the need for country-specific priority setting and nutrition policies. Funding SourcesGates Foundation. Supporting Tables, Images and/or Graphs▪

Late effect of the food consumption on colorectal cancer rate

Studies have suggested that higher meat intake may increase colorectal cancer (CRC) risk while higher vegetable intake may reduce this risk. There is a substantial lag between the time of exposure to a risk factor (or protective factor) and incidence of cancer. For CRC, in particular, the time from formation of adenoma to occurrence of CRC takes from 10 to 15 years, or even more. This study correlates food disappearance data per capita for vegetable and meat with future age-adjusted CRC rates in USA. The lag weights, with a high confidence, showed that there is a positive correlation between the red meat availability and CRC age-adjusted incidence rates with a lag of at least 17 years and an Almon polynomial degree of 2. Conversely, there was a negative correlation between vegetables availability and future age-adjusted incidence rates of CRC.

Broad and Inconsistent Muscle Food Classification Is Problematic for Dietary Guidance in the U.S.

Dietary recommendations regarding consumption of muscle foods, such as red meat, processed meat, poultry or fish, largely rely on current dietary intake assessment methods. This narrative review summarizes how U.S. intake values for various types of muscle foods are grouped and estimated via methods that include: (1) food frequency questionnaires; (2) food disappearance data from the U.S. Department of Agriculture Economic Research Service; and (3) dietary recall information from the National Health and Nutrition Examination Survey data. These reported methods inconsistently classify muscle foods into groups, such as those previously listed, which creates discrepancies in estimated intakes. Researchers who classify muscle foods into these groups do not consistently considered nutrient content, in turn leading to implications of scientific conclusions and dietary recommendations. Consequentially, these factors demonstrate a need for a more universal muscle food classification system. Further specification to this system would improve accuracy and precision in which researchers can classify muscle foods in nutrition research. Future multidisciplinary collaboration is needed to develop a new classification system via systematic review protocol of current literature.

Misconceptions about fructose-containing sugars and their role in the obesity epidemic

A causal role of fructose intake in the aetiology of the global obesity epidemic has been proposed in recent years. This proposition, however, rests on controversial interpretations of two distinct lines of research. On one hand, in mechanistic intervention studies, detrimental metabolic effects have been observed after excessive isolated fructose intakes in animals and human subjects. On the other hand, food disappearance data indicate that fructose consumption from added sugars has increased over the past decades and paralleled the increase in obesity. Both lines of research are presently insufficient to demonstrate a causal role of fructose in metabolic diseases, however. Most mechanistic intervention studies were performed on subjects fed large amounts of pure fructose, while fructose is ordinarily ingested together with glucose. The use of food disappearance data does not accurately reflect food consumption, and hence cannot be used as evidence of a causal link between fructose intake and obesity. Based on a thorough review of the literature, we demonstrate that fructose, as commonly consumed in mixed carbohydrate sources, does not exert specific metabolic effects that can account for an increase in body weight. Consequently, public health recommendations and policies aiming at reducing fructose consumption only, without additional diet and lifestyle targets, would be disputable and impractical. Although the available evidence indicates that the consumption of sugar-sweetened beverages is associated with body-weight gain, and it may be that fructose is among the main constituents of these beverages, energy overconsumption is much more important to consider in terms of the obesity epidemic.

Abstract P163: Global and Regional Consumption of Specific Dietary Fats and Dietary Cholesterol in 1990 and 2005: Systematic Analysis of Country-Specific Nutrition Surveys Worldwide

Background. Assessing the impact of diet on chronic diseases worldwide has been limited by availability only of food disappearance data rather than reliable and systematically assessed consumption data on dietary habits globally. Objective. To review and access published and unpublished national diet surveys worldwide in a systematic and consistent way to produce comprehensive intake data of specific dietary fats and their uncertainties by country, region, age, and sex in 1990 and 2005. Methods. We developed methods to identify, assess, and obtain exposure data (mean, SD) from nationally representative diet surveys worldwide on saturated, n-6, n-3 and trans fats, and dietary cholesterol. To address missing data and estimate mean intake, we developed and applied a multi-level hierarchical Bayesian model that accounted for country- and region-level data, measurement comparability, study representativeness, and diet assessment method. Time-varying country-level covariates were used to inform the estimates, including FAO food availability data, population, GDP, latitude, metabolic risks, and other diet covariates. Uncertainty of the estimates accounted for uncertainty from sampling and statistical modeling. Results. We obtained relevant data (85% by direct author contact) from 76 nationally representative and 15 large regional surveys from 49 countries in 15 regions, covering 75% of the world’s population. Several countries and regions lacked representative data. Data were most frequently available for saturated fat and dietary cholesterol (Figure). Results for other fats will be presented at the meeting. Conclusions. These new methods developed to systematically assess, compile and estimate the exposure distribution of specific dietary fats and cholesterol in a uniform fashion globally allow, for the first time, characterization of consumption habits and trends by country, region, age and sex. Such global assessment is imperative for estimating the impact of dietary fats on chronic diseases worldwide.

Monitoring Foods and Nutrients Sold and Consumed in the United States: Dynamics and Challenges

The food products available, purchased, and consumed in the United States are changing rapidly (1), yet there is little understanding among nutrition professionals of the nature of these changes and what they mean for nutritional health. In 2010, we identified over 85,000 uniquely formulated products in the US food system (2), while there were around 7,600 foods with unique nutrient compositions in the US Department of Agriculture (USDA) food composition tables (FCT)(3). In addition, the USDA updates the nutrient composition of foods in the FCTs periodically, while the food industry claims to be making key product reformulations (on calories, sodium, sugar, trans-fat, and other saturated fat) as part of major commitments (4, 5), along with shifts in industry norms and government regulations. The evolution of the US food system reflects innovations in food production, delivery, preservation and preparation, changing economic conditions, social norms and expectations regarding food availability, safety, variety, and knowledge. Government policy and food industry actions affect the food supply, consumer behavior (demand), and ultimately the diet and health of the US population. The Institute of Medicine, National Cancer Institute (NCI), Centers for Disease Control and Prevention (CDC), Economic Research Service of the USDA, recent conferences, workshops, and publications have highlighted the urgency for finding ways to improve diets by addressing these structural changes (6–8). Historically, national aggregate data sources exist that provide macro-level and per-capita measures of food purchase, availability, and nutritional quality— the USDA food balance data (since 1909) and food disappearance data (since 1970) (9), and the Bureau of Labor Statistics’ Consumer Expenditure Survey (since 1980) (10). However, none of these surveys provides detail data regarding specific food products, their nutritional composition, and who consumed them. In the 1990s, the National Nutrition Monitoring and Related Research Program (NNMRRP) laid the groundwork for improvements in nutrition monitoring efforts across various agencies and included over 50 surveillance activities that monitor and evaluate the US population’s health and nutritional status (11). Unfortunately, the NNMRRP could not provide continuous support for these agencies to keep up with the rapidly changing landscape of the food supply. By 2005, an expert panel reported that there was not a single data source that provided all of the needed information to address research on food and nutrition policies (6). Rather, researchers rely on numerous public and commercial data sources designed independently with varying purposes, not as parts of a unifying system for monitoring food and nutrient intakes. , These data sources vary in sample size, representativeness, breadth and depth of measures, and costs. Clearly, there is a need to enhance the monitoring of our food and nutrition environment in order to create effective programs and policies across the areas of public health, agriculture, economic development, and welfare. Data sources that monitor the foods sold, purchased, or consumed in the United States are summarized in Supplementary Table 1. These sources include:

Contents of mineral elements in Swedish market basket diets

The aim of this study was to estimate the average dietary exposure to toxic and essential mineral elements in the Swedish population (Cd, Pb, Zn, Cu, Ni, Cr, Fe, Mn, Co, Se, Ca, K, Mg, Na, I). Market baskets were purchased during March–May 1999 in four cities representing the major geographical regions and population centres in Sweden. The market baskets were based on food disappearance data representing more than 90% of annual supply, and were divided into 12 food groups. Large variations between food groups were seen for the average concentrations of most essential elements. Differences between the four cities were relatively small (CoV < 10–20%), exceptions being e.g. Se in cereals and I in meat. Pb concentration varied considerably among food groups ranging from <0.001 mg/kg in soft drinks to 0.027 mg/kg in wine. Cd concentration varied from <0.001 mg/kg in soft drinks and dairy products to 0.024 mg/kg in cereal products. Average contents of the elements were (per/person/day) 1110 mg Ca, 2580 mg Na, 3320 mg K, 285 mg Mg, 11.3 mg Zn, 9.2 mg Fe, 3.5 mg Mn, 1.15 mg Cu, 0.20 mg I, 0.052 mg Se, 0.09 mg Ni, 0.025 mg Cr, 0.011 mg Co, 0.007 mg Pb and 0.010 mg Cd. Compared to a previous study in 1987 no or minor changes in the supply of Ca, Mg, Zn, Mn, Cu and Cd have occurred. The content of Fe was about 40% lower in the present study, mainly due to cessation of flour fortification. The content of Se was about 30% higher. The content of Pb was about 50% lower, probably due to the elimination of Pb from petrol and other measures taken to reduce Pb emissions in Sweden. The average content of essential mineral elements in the Swedish diet was close to or above daily recommended intakes for adults, except for Mg and Fe. The average Pb and Cd content corresponds to 3% and 17% of the JECFA PTWI, respectively. The content of Cd corresponds to 47% of the new TWI established by EFSA in 2009.

Assessment of estimated daily intake of nitrite by average consumption of processed foods in Korea

This study has been performed to estimate the average daily intake of nitrite used in Korea as a color fixative. The crude estimation of daily intake was calculated based on maximum permitted levels (MPL) and national food disappearance data in 1998. In order to refine estimated daily intake (EDI), daily food consumption nationwide National Health and Nutrition Survey in 1998 and the concentration of nitrite in their permitted foods were applied. The crude EDI of nitrite was 17.85 μg/kg bw/day, representing 25.5% of acceptable daily intake (ADI) assigned by JECFA. The refined average EDI for nitrite was 0.87 μg/kg bw/day, representing 1.25% of ADI. For average consumers of age–sex groups ranged from 0.2 to 4.8 μg/kg bw/day, representing 0.3%–6.9% of the ADI.

Sugar and cardiovascular disease: A statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association.

The purpose of this report is to review the effects of dietary sugar on health, with an emphasis on cardiovascular disease (CVD) and its risk factors. Although there are no dietary trials linking sugar consumption and CVD, there are several reasons why sugar consumption should be limited. There are many, sometimes confusing, terms used in the literature. Simple carbohydrate (sugar) refers to mono- and disaccharides; complex carbohydrate refers to polysaccharides such as starch. Common disaccharides are sucrose (glucose+fructose), found in sugar cane, sugar beets, honey, and corn syrup; lactose (glucose+galactose), found in milk products; and maltose (glucose+glucose), from malt. The most common naturally occurring monosaccharide is fructose (found in fruits and vegetables). The term dextrose is used to refer to glucose. Intrinsic or naturally occurring sugar refers to the sugar that is an integral constituent of whole fruit, vegetable, and milk products; extrinsic or added sugar refers to sucrose or other refined sugars in soft drinks and incorporated into food, fruit drinks, and other beverages. Added sugar was not a significant component of the human diet until the advent of modern food-processing methods. Since then, the intake of sugar has risen steadily. The average US sugar utilization per capita on the basis of food disappearance data was 55 kg (120 lb) per year in 1970, and it reached 68 kg (150 lb) per year in 1995 (almost 0.5 lb per day).1 Sugar (simple carbohydrate) intake averages 25% of total energy intake. Data from the 1989 to 1991 Continuing Survey of Food Intake by Individuals indicate that soft drinks and sugars added at the table (eg, sugar/syrups and jams) are 2 of the top 4 carbohydrate sources for US adults.2 Yudkin and colleagues in the 1960s3 and 1970s4 found that a higher intake of sugar was associated …

Polyunsaturated fatty acids in the food chain in the United States

In the United States, intake of n-3 fatty acids is approximately 1.6 g/d ( approximately 0.7% of energy), of which 1.4 g is alpha-linolenic acid (ALA; 18:3) and 0.1-0.2 g is eicosapentaenoic acid (EPA; 20:5) and docosahexaenoic acid (DHA; 22:6). The primary sources of ALA are vegetable oils, principally soybean and canola. The predominant sources of EPA and DHA are fish and fish oils. Intake data indicate that the ratio of n-6 to n-3 fatty acids is approximately 9.8:1. Food disappearance data between 1985 and 1994 indicate that the ratio of n-6 to n-3 fatty acids has decreased from 12.4:1 to 10.6:1. This reflects a change in the profile of vegetable oils consumed and, in particular, an approximate 5.5-fold increase in canola oil use. The ratio of n-6 to n-3 fatty acids is still much higher than that recommended (ie, 2.3:1). Lower ratios increase endogenous conversion of ALA to EPA and DHA. Attaining the proposed recommended combined EPA and DHA intake of 0.65 g/d will require an approximately 4-fold increase in fish consumption in the United States. Alternative strategies, such as food enrichment and the use of biotechnology to manipulate the EPA and DHA as well as ALA contents of the food supply, will become increasingly important in increasing n-3 fatty acid intake in the US population.

Study of diet, biomarkers and cancer risk in the United States, China and Costa Rica.

One striking paradox in epidemiologic research is the strong association between diet and cancer in ecologic studies compared with the weaker associations reported in many within-country case-control and cohort studies. However, most ecologic studies have relied on indirect measures of dietary intake, such as food disappearance data. The objectives of our study were to assess the feasibility of collecting dietary and biomarker data from individuals living in countries having markedly different dietary patterns and cultures and to examine the magnitude of the between-country variation in their measurement. Adults surveyed in Shanghai (China), Costa Rica and King County (Washington, USA) completed a 24-hr dietary recall, a cancer risk factor survey, and provided a blood sample. We analyzed a subset of the blood specimens for vitamins C, E, carotenoids and phospholipid fatty acids. We observed substantial differences in nutrient intakes and in mean plasma concentrations of dietary biomarkers across the study populations. For example, King County participants had the highest daily intake of vitamin C (mean 78.3 +/- 12.2 mg compared with 42.6 +/- 38.3 mg in Shanghai and 34.8 +/- 43.8 mg in Costa Rica). The mean plasma vitamin C level in King County was also the highest of the 3 study sites: 927.9 +/- 43.9 microg/dl in King County, 585.7 +/- 35.9 microg/dl in Shanghai and 461.1 +/- 33.1 microg/dl in Costa Rica. Plasma trans fatty acids (a biomarker of a diet high in hydrogenated fats) were highest in King County and lowest in Shanghai.

Study of diet, biomarkers and cancer risk in the United States, China and Costa Rica

One striking paradox in epidemiologic research is the strong association between diet and cancer in ecologic studies compared with the weaker associations reported in many within-country case-control and cohort studies. However, most ecologic studies have relied on indirect measures of dietary intake, such as food disappearance data. The objectives of our study were to assess the feasibility of collecting dietary and biomarker data from individuals living in countries having markedly different dietary patterns and cultures and to examine the magnitude of the between-country variation in their measurement. Adults surveyed in Shanghai (China), Costa Rica and King County (Washington, USA) completed a 24-hr dietary recall, a cancer risk factor survey, and provided a blood sample. We analyzed a subset of the blood specimens for vitamins C, E, carotenoids and phospholipid fatty acids. We observed substantial differences in nutrient intakes and in mean plasma concentrations of dietary biomarkers across the study populations. For example, King County participants had the highest daily intake of vitamin C (mean 78.3 ± 12.2 mg compared with 42.6 ± 38.3 mg in Shanghai and 34.8 ⅔ 43.8 mg in Costa Rica). The mean plasma vitamin C level in King County was also the highest of the 3 study sites: 927.9 ± 43.9 μg/dl in King County, 585.7 ± 35.9 μg/dl in Shanghai and 461.1 ± 33.1 μg/dl in Costa Rica. Plasma trans fatty acids (a biomarker of a diet high in hydrogenated fats) were highest in King County and lowest in Shanghai. Int. J. Cancer 82:28–32, 1999. © 1999 Wiley-Liss, Inc.

Dietary changes and disease transition in China.

The patterns of food consumption in China have changed substantially over the past two decades, along with the continuous development of the national economy. From 1978 to 1987, the national food disappearance data showed a 2-fold increase in meat consumption, a 2.8-fold increase in egg consumption, and a 2.9-fold increase in fat and oil consumption.1 The same trend was clearly seen from the national nutrition survey data. Between 1982 and 1992, the national consumption of cereals and tubers decreased by 12 and 47% respectively, whereas meat, egg, and fat/ oil consumption increased by 38, 60, and 61%, respectively.2 The contribution of fat to the total dietary energy reached 28.4% in 1992, and in big cities like Beijing, Shanghai, and others, energy from fat has exceeded 30% of the total energy intake.2 The major dietary changes in China are the rapid increase of animal product and fat/oil consumption and, at the same time, the slight decrease of cereal and tuber consumption, although the average dietary pattern in China still consists mainly of a plant-food-based diet. On the other hand, China is also undergoing a rapid epidemiologic transition, that is a shift from a disease pattern dominated by infectious and deficiency diseases to an epidemic of non-communicable chronic diseases which will eventually dominate. Although nutritional deficiency diseases and infectious diseases have not been eradicated, these conditions are now largely confined to certain economic and age groups, and particular regions. At the same time, however, death from cancer, cardiovascular and cerebrovascular disease, and morbidity from diabetes, osteoporosis, and so on are increasing rapidly. By 1996, 66% of the total deaths in China were caused by chronic diseases, and in urban areas this figure was 76%.3 The main causes of death now in urban China are cancer, cardiovascular and cerebrovascular disease, and respiratory disease. The health implications of these dietary changes could be further illustrated by some results from a collaborative ecologic study on diet, lifestyle, and disease mortality.4 The study was carried out in 130 villages in 65 counties of rural China. A wide variety of dietary, lifestyle, and biochemical characteristics were recorded for a total of 6500 subjects, ages 35–64 y. Several relevant examples of study results will be presented here. Example 1: Based on the correlation of mortality between specific diseases, the diseases were geographically clustered into two groups, i.e., one associated with poor economic development—diseases of poverty (e.g., infectious diseases), and the other associated with the emergence of more wealth— diseases of affluence (e.g., most chronic diseases).5 It was found that the chief correlate of the latter disease group was plasma cholesterol (r 5 0.48, P , 0.01), even though the average county mean was only 127 mg/dL, ranged from 86 to 181 mg/ dL.4 Further analysis of the same data showed that the plasma cholesterol level was positively correlated with the consumption of meat (r 5 0.26, P , 0.05) and total fat (r 5 0.27, P , 0.05), and inversely correlated with the consumption of certain dietary fiber fractions, such as total neutral detergent fiber (r 5 20.34, P , 0.01).5 Example 2: Plasma Apo B was directly associated with mortality from coronary heart disease (r 5 0.39, P , 0.01); in turn, Apo B was significantly positively associated with animal protein intake (r 5 0.25, P , 0.05) and frequency of meat intake (r 5 0.32, P , 0.01), but significantly inversely associated with plant protein intake (r 5 20.37, P , 0.01) and selected carbohydrate intake, such as starch (r 5 20.40, P , 0.01) and pectin (r 5 20.26, P , 0.05).5 A repeat survey in the same 65 counties in 1989 showed that within 6 y the average contribution of dietary fat intake to the total dietary energy increased from 15 to 20%. At the same time, the average plasma total cholesterol level in males increased from 127 to 142 mg/dL, and in females from 127 to 143 mg/dL. It is quite obvious that this rapid epidemic transition is mainly caused by life-

Dietary factors in the fall in coronary heart disease mortality

The role of dietary change in the fall in heart disease mortality has been hotly debated. Three countries, Australia, USA and UK with equal ‘care’ and sophistication of surgical techniques have shown different timing in the beginning of the decline of this ‘epidemic’; around the mid 1960s in the first two countries, but not until the late 1970s for the UK. The cause of this difference may be the changing food habits of their populations. Using food disappearance data, apparent consumption of butter and margarine show opposite trends (butter down and margarine up) predating the decline in mortality in both the USA and Australia by at least 7 years and also in the UK, but at a later time, (about 1970). Changes in adipose tissue linoleate, a marker for polyunsaturated fat intake, support this indirect evidence, with depot levels rising in the USA from the 1960s and 10 years later in the UK. Other evidence supports the view of decreasing saturated fat intake and increasing polyunsaturated intake prior to 1960 in the USA. Although many factors must contribute to the decline in mortality from CHD, change in dietary P S ratio would seem to be the major dietary contributor.

Selenium in human milk and dietary selenium intake by Greeks

Fluorimetric determination of selenium in colostrum, transitional and mature human milk gave the following concentrations (mean and standard deviation): 41 ± 16, 23 ± 6 and 17 ± 3 ng Se ml −1, respectively. The ranges for each kind of milk, especially for mature milk, were narrow. For all cases studied, the Se concentration in milk decreased with lactation time, reaching a plateau, at 17 ng Se ml −1, after 20 days. It is estimated that breast-fed-only babies in Greece receive ∼ 5–11 μm Se day −1 up to 6 month of age. From consumed food data it was estimated that adult Greeks receive 100 ± 6 μg Se day −1, in close agreement with our previously determined value of 110 μg Se day −1 estimated from food disappearance data.

Estimation of the amount of dietary starch available to different populations

The daily per capita availability of dietary starch was estimated for 38 selected countries using food disappearance data from the FAO provisional food balance sheets (1972-1974 average); starch availability was also estimated for Canada from 1960 to 1987 using Agriculture Canada disappearance data. Total starch availability varies fourfold among the difference countries; the availability of different sources of starch vary up to 80-fold. Wheat and roots-tubers were the major sources of starch in countries with low total starch availability. Either corn and pulses, rice and pulses, or wheat and potatoes were the major sources of starch in those countries with high total starch availability. Starch availability in Canada, both total and by source, has been relatively constant over the 27 years examined. Slight increases in total starch and starch from cereals and pulses in 1987 will need to be followed to determine whether these represent the beginning of a real change in per capita starch availability.

Isomeric trans fatty acids in the U.S. diet.

Since actual consumption data for trans fatty acid (FA) intakes for the U.S. population do not exist, estimates of trans fatty acids (FAs) available in the U.S. food supply have been calculated from U.S. Department of Agriculture-Economic Research Service (USDA-ERS) fats and oils production figures and food disappearance data for fats and oils. Based on weighted averages for the trans levels in each fats and oils category, these estimates of trans FAs available in the U.S. food supply range from 12.5 to 15.2 g/person/day (average 13.3 +/- 1.1 g/person/day). Estimates of trans FA consumption have been calculated; these estimates predict a wide range from 1.6 to 38.7 g/person/day. These calculations are based on published estimates of trans FAs available in the total fat of 5-15%, and the total fat intake (range 31-258 g/person/day) of a representative sample of adults (ages 20-59) as determined by the Lipid Research Clinics (LRC). Using an equation based on a relationship between trans FAs in adipose tissue and dietary fat, an intake range of 0.7-28.7 g/person/day trans FAs for the same LRC fat consumption data can be predicted. Adipose tissue isomer profiles that indicate 90-95% of the trans FAs in the tissues comes from partially hydrogenated vegetable fats and oils allow us to predict a dietary intake range from 11.1 to 27.6 g/person/day trans FAs. The significance of these estimates to nutrition policy is discussed.

Trends in coronary heart disease mortality and food consumption in the United States between 1909 and 1980

This study is an ecological comparison of coronary heart disease (CHD) mortality trends and trends in food consumption in the United States population between 1909 and 1980. CHD mortality data were obtained from published vital statistics. National food disappearance data, compiled regularly by the US Department of Agriculture (USDA), were the primary source of dietary information used. Food balance sheets and USDA household survey data were used for corroborative purposes. Dietary data were analyzed to observe trends in the per capita consumption of calories and fat; to determine the contribution of major food groups to both calories and fat; and to determine the effect of substitutions within those food groups on consumption of calories and fat. Dietary substitutions towards less-saturated fatty acids support the hypothesized relationship between dietary fat and CHD. These changes preceded CHD mortality changes by 10-20 y.