Major Dietary Changes Research Articles

Healthy Aspects of the Nordic Diet Are Related to Lower Total Mortality ,

AbstractHealth-promoting effects of the Mediterranean diet have been in focus for decades, whereas less interest has been given to existing healthy dietary habits within other Western cultures. The aim of the study was to develop a food index based on traditional Nordic food items with expected health-promoting effects and relate this to all-cause mortality in a cohort of Danes. Detailed information about diet, lifestyle, and anthropometry was provided by 57,053 Danes aged 50–64 y. During 12 y of follow-up, 4126 of the cohort participants died. A healthy Nordic food index, consisting of traditional Nordic food items with expected health-promoting effects (fish, cabbages, rye bread, oatmeal, apples and pears, and root vegetables), was extracted and associated with mortality by Cox proportional hazard models. Mortality rate ratios (MRR) with 95% CI were used to associate the index to mortality. In an adjusted model, a 1-point higher index score was associated with a significantly lower MRR for both men [0.96 (0.92–0.99)] and women [0.96 (0.92–1.00)] (P = 0.03). When the index components were evaluated separately, whole grain rye bread intake was the factor most consistently associated with lower mortality in men. In conclusion, an index based on traditional healthy Nordic foods was found to be related to lower mortality among middle-aged Danes, in particular among men. This study indicates that traditional, healthy food items should be considered before public recommendations for major dietary changes are made.

Lifetime Risk of Acute Myocardial Infarction in Japan

The incidence and mortality from coronary heart disease (CHD) in Japan are reported to be among the lowest of all industrialized countries,1,2 but, in the backdrop of major dietary changes and worsening cardiovascular risk factors,2 recent reports have shown an increasing trend of acute myocardial infarction (AMI) in the Japanese population.3,4 With the aging of the population and the presence of unfavorable cardiovascular risk factor scenario, AMI is likely to be an increasingly important health burden in Japan. Thus, prevention of AMI requires urgent attention. Lifetime risk (LTR) is an epidemiological measure that expresses the probability of disease in the remaining lifetime for an index age. Estimation of the LTR of AMI, which provides an absolute risk assessment, has not yet been reported for the Japanese population. In the present study, we estimated the short- and intermediate-term risks and LTR of AMI in a Japanese population. The Suita study,5 a cohort study for cardiovascular disease (CVD) established in 1989, randomly sampled Suita city residents ages 30 to 79 years and stratified the residents by sex and age class (10-year increments). From this sample, 6485 participated in the baseline survey between 1989 and 1994 (participation rate, 53.2%) at the National Cerebral and Cardiovascular Center, Osaka. After excluding participants with a history of CVD (n=208) and those lost to follow-up (n=779; predominantly because of moving out of Suita city after consenting to participate in the study, but before partaking in the baseline survey), data from the remaining 5498 participants (2571 men and 2927 women) were included in the analysis. The follow-up for the present study ended either at (1) AMI occurrence, (2) death, (3) date of leaving Suita city, or (4) at December 31, 2005, whichever came first. Identifying possible AMI events involved checking …

Micronutrient shortfalls in young children's diets: common, and owing to inadequate intakes both at home and at child care centers.

Numerous studies documented low intakes of iron, zinc, calcium, and other micronutrients in young children. A recent report suggests that intakes are low in both home food and food provided at day care centers. Most of the young children in that study could not have obtained adequate intakes of key micronutrients without major dietary changes. Is it time to recommend routine multivitamin/mineral supplementation for all young children?

Trans‐Atlantic slavery: Isotopic evidence for forced migration to Barbados

The question of the ultimate origin of African slaves is one of the most perplexing in the history of trans-Atlantic slavery. Here we present the results of a small, preliminary isotopic study that was conducted in order to determine the geographical origin of 25 enslaved Africans who were buried at the Newton plantation, Barbados, sometime between the late 17th and early 19th century. In order to gain a more nuanced understanding of the slaves' origin, we used a combination of carbon, nitrogen, oxygen, and strontium isotope analyses. Carbon and nitrogen isotope ratios were determined in bone and dentinal collagen; oxygen and strontium isotopes were measured in tooth enamel. Results suggest that the majority of individuals were born on the island, if not the estate itself. Seven individuals, however, yielded enamel oxygen and strontium ratios that are inconsistent with a Barbadian origin, which strongly suggests that we are dealing with first-generation captives who were brought to the island with the slave trade. This idea is also supported by the fact that their carbon and nitrogen stable isotope values differ markedly between their teeth and bones. These intra-skeletal shifts reflect major dietary changes that probably coincided with their enslavement and forced migration to Barbados. While it is impossible to determine their exact origins, the results clearly demonstrate that the slaves did not all grow up in the same part of Africa. Instead, the data seem to suggest that they originated from at least three different areas, possibly including the Gold Coast and the Senegambia.

Ethical, legal, and social considerations in conducting the Human Microbiome Project

The early days of the genomic revolution—from the Asilomar Conference on Recombinant DNA in 1975 to the founding of the Human Genome Project in 1990—were marked by awareness among researchers, government officials, and policy makers that emerging scientific knowledge raised a host of ethical, legal, and social challenges. Scientists now undertaking research on the human microbiome—including those engaged in the National Institutes of Health’s (NIH) latest Roadmap initiative, the Human Microbiome Project (HMP)—confront a similarly uncharted ethical landscape. Not only does the conduct of human microbiome research raise important ethical considerations, but the long-term implications of the HMP also present the possibility of fundamental shifts in understandings of human life and health. The HMP is one of several international efforts to use metagenomic analysis to study human health. It is estimated that there are 10 times as many microbial cells than human cells in and on our bodies (Turnbaugh et al. 2007). We already know that human microbiota (i.e., all the microorganisms that inhabit the skin and mucous membranes) in certain sites of the body play an essential role in maintaining health and normal function (e.g., synthesis of vitamin K in the intestinal tract) (Lupp and Finlay 2005). The HMP aims to create a reference catalogue of microbial DNA that can be used as a resource to explore whether or not humans have a “core” microbiome (i.e., a microbiome that is common to all humans); whether there is stability in an individual’s microbiota through different periods in that individual’s life; whether there are similarities in microbiomes within families, communities, and different environments (Palmer et al. 2007); and ultimately, whether or not changes in the human microbiome can be correlated with changes in human health. A total of $8.2 million was awarded in 2007 to four institutions (Baylor College of Medicine, The Broad Institute, The J. Craig Venter Institute, and Washington University) to conduct the first phase of human sampling in the HMP. Samples are being collected from ∼250 healthy adults from five body sites: the oral cavity, skin, nasal cavity, gastrointestinal tract, and vagina, for a total of 18 subsites for women and 15 subsites for men. Peripheral blood is also being collected for human DNA sequencing and serum banking (to evaluate possible immune responses to the microbiome). Subjects will be screened using a general health questionnaire. Exclusion criteria for conditions that may influence the stability of the microbial environment, including taking specific medications (e.g., antibiotics, immunosuppressive agents), major dietary changes, history of cancer (exception of certain skin cancers) or chronic immune-mediated disorders (e.g., inflammatory bowel disease, psoriasis), history of chronic candidiasis (yeast infection), or active sexually transmitted diseases (e.g., gonorrhea) within the previous 2 mo for females. Children under the age of 18 and adults beyond the age of 40 will be excluded because of the need for a relatively uniform human population, especially considering the sample size and extent of potential variation within the human microbiome. Concerns about profound physiologic changes during adolescence and menopause in women also necessitate tighter boundaries to the age range. Each subject will provide at least one set of specimens within the first year, and at least 50% of these individuals are expected to participate in follow-up sampling within 12 mo of the initial sampling at all body sites. At least 10 subjects will be invited back for more extensive and invasive sampling at all body sites. All microbial DNA sequence data will be coded and released into publicly accessible databases. Clinical information that is collected will be coded and stored in a controlled-access database so that it can be correlated with analyzed data. Human DNA will be coded and stored for future analysis. Individual human DNA data will be released into controlled-access databases; aggregate data will be released into public databases. As the first phase of the HMP gets underway, it is important that the ethical, legal, and social implications of this research are carefully studied and responsibly managed. It is also essential that the research itself is conducted according to the highest ethical standards. Drawing on the significant body of scholarship that has amassed over the past two decades, and based on the involvement of two of the authors (A.L.M. and J.V.) with the first phase of the HMP, we identify five major ethical issues associated with conducting the HMP. This list is not exhaustive, and many of these issues are implicated in other areas of genetic research, but the complexity and exploratory nature of the HMP may, in some instances, necessitate modified resolutions.

Trend of Increase in the Incidence of Acute Myocardial Infarction in a Japanese Population: Takashima AMI Registry, 1990-2001

The incidence and mortality of acute myocardial infarction (AMI) remain low in Japan despite major dietary changes and worsening cardiovascular risk factors, a situation that should have resulted in a substantial increase in AMI rates (Japanese paradox). The current trend in the incidence of AMI was examined for the period 1990-2001 by use of data from the Takashima AMI Registry covering a stable population of approximately 55,000 in central Japan. AMI incidence rates (per 100,000 person-years) and 95% confidence intervals were calculated for 1990-1992, 1993-1995, 1996-1998, and 1999-2001. The incidence trend was determined by calculating the average annual change in percentage across the years. There were 352 (men: n = 224; women: n = 128) registered first-ever AMI cases during 1990-2001. The age-adjusted incidence rate of all AMI showed a gradual increase from 39.9 (95% confidence interval (CI): 29.8, 50.0) in 1990-1992 to 62.6 (95% CI: 51.5, 73.7) in 1999-2001. In men, the age-adjusted incidence rate increased from 66.5 (95% CI: 46.4, 86.6) in 1990-1992 to 100.7 (95% CI: 78.6, 122.7) in 1999-2001. In women, fluctuation was observed after an initial steep increase. The average annual incidence increased by 7.6% (95% CI: 3.5, 11.7) among men and by 8.3% (95% CI: 1.02, 15.6) among women. To the best of the authors' knowledge, this is the first study to report an increasing trend of AMI in a Japanese population.

The nutrition transition in high‐ and low‐income countries: what are the policy lessons?

AbstractThis article examines the speed of changes in diets, activity patterns, and body composition, summarizes major dietary changes, and provides some sense of the way the burden of obesity is shifting from the rich to the poor globally. The focus is on the lower‐ and middle‐income world with some examples from higher‐income countries. Then macro policy options are examined. A case study of edible oil pricing in China is presented. The challenge is for the agricultural economics profession to focus on this major global issue—one which challenges some of the earlier paradigms of food policy and agricultural development.

Less Subclinical Atherosclerosis in Japanese Men in Japan than in White Men in the United States in the Post-World War II Birth Cohort

Coronary heart disease incidence and mortality remain very low in Japan despite major dietary changes and increases in risk factors that should have resulted in a substantial increase in coronary heart disease rates (Japanese paradox). Primary genetic effects are unlikely, given the substantial increase in coronary heart disease in Japanese migrating to the United States. For men aged 40-49 years, levels of total cholesterol and blood pressure have been similar in Japan and the United States throughout their lifetimes. The authors tested the hypothesis that levels of subclinical atherosclerosis, coronary artery calcification, and intima-media thickness of the carotid artery in men aged 40-49 years are similar in Japan and the United States. They conducted a population-based study of 493 randomly selected men: 250 in Kusatsu City, Shiga, Japan, and 243 White men in Allegheny County, Pennsylvania, in 2002-2005. Compared with the Whites, the Japanese had a less favorable profile regarding many risk factors. The prevalence ratio for the presence of a coronary calcium score of > or =10 for the Japanese compared with the Whites was 0.52 (95% confidence interval: 0.35, 0.76). Mean intima-media thickness was significantly lower in the Japanese (0.616 mm (standard error, 0.005) vs. 0.672 (standard error, 0.005) mm, p < 0.01). Both associations remained significant after adjusting for risk factors. The findings warrant further investigations.

Dietary cancer and prevention using antimutagens.

Many of the cancers common in the Western world, including colon, prostate and breast cancers, are thought to relate to dietary habits. Of the known risk factors, many will act through increasing the probability of mutation. Recognised dietary mutagens include cooked meat compounds, N-nitroso compounds and fungal toxins, while high meat and saturated fat consumption, increasing rates of obesity, and regular consumption of alcohol and tobacco are all dietary trends that could indirectly enhance the probability of mutation. However, there are significant difficulties in implementing and sustaining major dietary changes necessary to reduce the population's intake of dietary mutagens. Dietary antimutagens may provide a means of slowing progression toward cancer, and be more acceptable to the population. Consideration of genetic mechanisms in cancer development suggest several distinct targets for intervention. Strategies that reduce mutagen uptake may be the most simple intervention, and the one least likely to result in undesirable side effects. Certain (but not all) types of dietary fibres appear to reduce mutation through this mechanism, as may certain probiotics and large planar molecules such as chlorophyllin. Antioxidants have been suggested to scavenge free radicals, and prevent their interactions with cellular DNA. Small molecule dietary antioxidants include ascorbic acid, Vitamin E, glutathione, various polyphenols and carotenoids. We found a statistically significant relationship between colon cancer incidence and soil selenium status across different regions of New Zealand. Additionally, a study of middle-aged men suggested that blood selenium levels lower than 100 ng/ml were inadequate for repair or surveillance of oxidative (and other) DNA damage. We suggest that selenium will be an important antimutagen, at least in New Zealand, possibly through antioxidant effects associated with selenium's role in enzymes associated with endogenous repair of DNA damage. Modulation of xenobiotic metabolizing enzymes is well recognised as cancer-protective, and is a property of various flavonoids and a number of sulfur-containing compounds. Many fruits and vegetables contain compounds that will protect against mutation and cancer by several mechanisms. For example, kiwifruit has antioxidant effects and may also affect DNA repair enzymes. Dietary folate may be a key factor in maintenance of methylation status, while enhanced overall levels of vitamins and minerals may retard the development of genomic instability. The combination of each of these factors could provide a sustainable intervention that might usefully delay the development of cancer in New Zealand and other populations. Although there are a range of potentially antimutagenic fruits, vegetables and cereals available to these populations, current intake is generally below the level necessary to protect from dietary or endogenous mutagens. Dietary supplementation may provide an alternative approach.

Implementation of a 4-y, high-fiber, high-fruit-and-vegetable, low-fat dietary intervention: results of dietary changes in the Polyp Prevention Trial

The Polyp Prevention Trial (PPT) was a multicenter randomized clinical trial designed to determine the effects of a high-fiber (4.30 g/MJ), high-fruit-and-vegetable (0.84 servings/MJ), low-fat (20% of energy from fat) diet on the recurrence of adenomatous polyps in the large bowel. Our goal was to determine whether the PPT intervention plan could effect change in 3 dietary goals and to examine the intervention's effect on the intake of other food groups and nutrients. Participants with large-bowel adenomatous polyps diagnosed in the past 6 mo were randomly assigned to either the intervention (n = 1037) or the control (n = 1042) group and remained in the trial for 4 y. Three dietary assessment instruments were used to measure dietary change: food-frequency questionnaires (in 100% of the sample), 4-d food records (in a 20% random cohort), and 24-h dietary recalls (in a 10% random sample). Intervention participants made and sustained significant changes in all PPT goals as measured by the dietary assessment instruments; the control participants' intakes remained essentially the same throughout the trial. The absolute differences between the intervention and control groups over the 4-y period were 9.7% of energy from fat (95% CI: 9.0%, 10.3%), 1.65 g dietary fiber/MJ (95% CI: 1.53, 1.74), and 0.27 servings of fruit and vegetables/MJ (95% CI: 0.25, 0.29). Intervention participants also reported significant changes in the intake of other nutrients and food groups. The intervention group also had significantly higher serum carotenoid concentrations and lower body weights than did the control group. Motivated, free-living individuals, given appropriate support, can make and sustain major dietary changes over a 4-y period.

Results from two repeated 5 day dietary records with a 1 y interval among patients with colorectal polyps

Dietary factors are known to be associated with initiation and development of colorectal cancer (CRC), and also with CRC's major precursor, the colorectal polyp. In long-term intervention studies on colorectal polyps, dietary changes may therefore affect potential effects of the study intervention. To examine potential dietary changes among polyp-patients randomly selected from a 3 y intervention study after 1 y. Of 116 polyp-bearing out-patients (50% men), aged 50-76 y, who participated in the double-blind 3 y placebo-controlled endoscopic follow-up and intervention study against growth and recurrence of polyps, 30 patients were randomised (strata: sex, age and polyp size) to perform a repeated 5 day dietary record by weighing after 1 y. The patients received a daily mixture of vitamin C (150 mg), alpha-tocopherol (75 mg), beta-carotene (15 mg), selenium (101 microg) and calcium (1.6 g) or placebo (lactose) for a period of 3 y with annual colonoscopic examinations and polyps size measurements to test if the mixture was able to reduce polyp growth and recurrence. Polyps of >9 mm were removed, whereas the remainders and new discoveries of polyps <9 mm were left in situ until the end of the study. Twenty-nine patients agreed to perform the repeated 5 day dietary record, and 86% performed the second record within 48-58 weeks after the first record. The results showed that, with the exception of vitamin D, milk and milk products, no significant differences were found between the two records. The median value of the Spearman's correlation coefficient for energy and energy-yielding nutrients was 0.66, for vitamins and minerals 0.58, and for foods 0.58. Individual differences between the records were found for most variables, but most of these were negligible. After 1 y, no major dietary changes were found which could be associated with a changed susceptibly for malignancy, and thereby affect potential effects of the study intervention. We may thus suggest that a potential changed susceptibility towards growth and recurrence of polyps, is due to the specific intervention, and not due to other major dietary changes.

The nutrition transition in South Korea

An accelerating shift from infectious to noncommunicable diseases and concurrent shifts in diet, activity, and body composition are universal trends but are especially apparent in middle- and lower-income countries. A unique nutrition transition has occurred in South Korea, a country that modernized earlier than most Asian countries did. The purpose of this analysis was to describe the South Korean nutrition transition, focusing on specific features that other countries might follow to retain the healthful elements of their traditional diets. We used secondary data on economics, dietary intake, anthropometry, and causes of death, including a series of comparable nationally representative dietary surveys (the National Nutrition Survey). The structure of South Korea's economy, along with the country's dietary and disease patterns, began an accelerated shift in the 1970s. Major dietary changes included a large increase in the consumption of animal food products and a fall in total cereal intake. Uniquely, the amount and rate of increase in fat intake have remained low in South Korea. South Korea also has a relatively low prevalence of obesity compared with other Asian countries with similar or much lower incomes. The nutrition transition in South Korea is unique. National efforts to retain elements of the traditional diet are thought to have shaped this transition in South Korea in the midst of rapid economic growth and the introduction of Western culture.

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-

Can the risk of colon cancer be lessened?

Colon cancer was rare or uncommon in the past, and still is in traditionally-living third world populations. It now affects 3-5% of western populations. Epidemiological, case control, experimental and other studies suggest that proneness to colon cancer can be lessened by major dietary changes, principally decreasing fat intake by a third, and doubling the intake of fiber-containing foods, especially vegetables and fruit--recommendations similarly advocated for the avoidance of coronary heart disease and other degenerative diseases. Among nondietary factors, evidence indicates familiality, obesity and atmospheric pollution to be contributory, while parity, physical activity, solar radiation, high social class, estrogen use, and aspirin use, appear protective. Despite insufficiencies of knowledge of prevention, avoiding action should certainly be taken by those familially prone. For the rest, conceivably a prudent life-style could benefit a proportion avoiding colon cancer.

Risk factors for coronary heart disease: Synthesis of a new hypothesis through adaptation

A risk factor is a characteristic which is associated with a greater than average probability of developing coronary disease. Raised serum cholesterol and hypertension are two such factors. Intervention studies conducted to confirm the risk factor hypothesis have shown that reduction of serum cholesterol and essential hypertension may be associated with a small decreased CHD incidence, however there were almost as many deaths due to coronary disease in the intervention groups as in the control groups. These findings suggest that our approach to risk factor intervention may be a misguided attempt which needs modification. It is possible that the major risk factors develop in an attempt of our body to adapt to environmental factors such as increaed intake of salt, saturated fat and cholesterol, physical inactivity, increased intake of calories and obesity and stress. Smoking may be the result of social changes. Since the body has to modify its metabolic mechanism depending upon the factor to which it adapts, development of hyperlipidemia and hypertension may be protective mechanisms of the body which it has developed while fighting against environmental factors. Reduction of major risk factors by drug therapy may mean that we are trying to prevent the body, fighting environmental factors. Thus our approach to control of the major risk factors should be to treat the causative environmental factors or alter the lifestyle. There is evidence that diet, physical inactivity and obesity are most important in the pathogenesis of major risk factors and dietary changes, weight loss and increased physical activity may be independently associated with substantial reduction in hypertension and hyperlipidemia leading to decreased CHD and total mortality and retardation in atherosclerosis. More evidence is necessary to confirm the role of these methods in the management of risk factors and prevention of CHD and to confirm the present hypothesis.

Does a reduced fat diet cause retardation in child growth?

Background. A diet low in saturated fat and cholesterol is strongly recommended by the American Heart Association and the National Cholesterol Education Program as a way to prevent coronary heart disease. In addition, the National Cancer Institute has suggested that dietary fat restriction may also prevent the development of some cancers. However, the American Academy of Pediatrics reviewed the same evidence in relation to children and concluded that the major dietary changes recommended for adults should not be prescribed for children. Methods. In this article, we review the evidence for the detrimental consequences associated with dietary fat restriction for children. Evidence from studies on secular trends, migration, and vegetarian communities suggests minor effects of dietary fat restriction upon growth. In addition, there is some evidence indicating that children who are placed on severe dietary restriction during growth periods may experience growth stunting. Virtually all of the published studies have serious methodological limitations. Conclusion. We conclude that dietary fat restriction may have some small, but measurable, effects upon growth.

Improvement in glucose tolerance after one year of follow-up in a Hindu community in Africa

Oral glucose tolerance was studied following a 75 g glucose load in 108 (82.4%) of 131 male and 110 (79.1%) of 139 female members of a Hindu subcommunity aged 15 years and over in Dar es Salaam. One year later, the glucose tolerance tests were repeated in 93 (86.1%) and 93 (84.5%) of the 108 male, and 110 of the female subjects, respectively. In the first survey, 25 (26.9%) of the 93 male and 24 (25.8%) of the 93 female subjects had impaired glucose tolerance (IGT), 6 (6.4%) and 15 (16.1%), respectively, had diabetes mellitus; and 62 (66.7%) and 54 (58.1%), respectively, had normal glucose tolerance. In the repeat survey, of the 93 male and 93 female subjects, 8 (8.6%) and 7 (7.5%) had IGT, 4 (4.3%) and 10 (10.8%) had diabetes; and 81 (87.1%) and 76 (81.7%) were normal, respectively. Of the 21 subjects diagnosed as having diabetes in the first survey, 13 (61.9%) continued to show diabetic glucose tolerance; 4 (19%) IGT and 4 (19%) had normal glucose tolerance with no gender difference. One (1.6%) of the 62 male subjects and none of the 54 females with normal glucose tolerance in the first survey progressed to IGT, while the remainder retained normal glucose tolerance. Diabetes and IGT rates in both surveys were higher for the older than the younger persons. A significant fall in mean fasting and post-75 g blood glucose levels, and in mean systolic and diastolic pressure levels was observed between the first and second surveys in both genders. There was, however, no significant difference in body mass index (BMI), serum total cholesterol and triglyceride levels between surveys, suggesting that major dietary changes had not taken place. Male subjects who showed persistent IGT had significantly lower mean level of body mass index (kg/m 2) than subjects who reverted to normal, whilst for the whole group those who had persistent IGT were older. It is tempting to speculate that these changes were due to community action. However, in view of the lack of change in weight and lipids and similar results in other communities in Tanzania when retested at 1 week, further studies are needed to establish the significance of the findings.

Student dietitians’ experiences with dietary compliance

The majority of students (91%; no. = 10) thought that following a modified diet was a very valuable experience. The student who did not think the assignment was valuable had been following a diet similar to that assigned, although she did not report this on the pre-test diet evaluation form. Overall, students thought they were better able to identify what it was like to make major dietary changes, especially when those changes are imposed by someone else. They had an increased awareness of the feelings of deprivation that patients might experience when foods become restricted. The students also believed that they would be more understanding when counseling patients and make more diligent efforts to individualize the diet as much as possible. Some thought they had a better understanding of noncompliance and would now be more empathic toward their patients. Assessing the changes required and the degree of difficulty experienced helped the students bring what had been learned conceptually to a conscious awareness.

Major dietary changes in nineteenth-century Europe.

While there is still a great deal of research to be done eating patterns in the past, from the evidence accumulated so far is safe to say that most Europeans entered the nineteenth century as primarily grain eaters. Virtually every other food available, would seem, fell into the category of luxury items. Luxury foods like meat, fish, cheese, eggs, vegetables, and fruits were readily available to the upper reaches of society, but the great majority of Europeans ate them a very, very limited basis [I]. We still do not know for sure to what extent vegetables were consumed before 1800. But one thing is definitely clear—most artisans and peasants in European society up to 1800 had to consume breadstuffs morning, noon, and night. This overdependence a single staple item by the many is becoming a well-documented fact. In his social history of Paris under Louis XIV, Leon Bernard tells us that the city's artisans subsisted black bread and and that the working class largely lived on the edge of starvation [2]. One hundred years later, at the time of the French Revolution, the artisans of Paris were still obviously meatless. According to Jeffrey Kaplow, their diet was now primarily soup and bread, along with water [3]. Rural elements were likewise poorly off, most of them rarely consuming meat or other sources of protein. Speaking of the Irish peasantry in the 1690s, Sir William Petty commented, As for flesh, they seldom eat it [4]. Other observers of the time, including the famous English student of dietetics, Dr. William Stark, knew that the masses were grain eaters and starved for other foods. Writing in 1788, Stark remarked, I learned that many of the poor people near Inverness [Scotland] never took any kind of animal food, not even eggs, cheese, butter or milk [5]. When the grain crop failed, as did in the late 1780s in France, the results, in the words of

Dietary dangers.

Patients receiving anticoagulants should seek medical advice before making major dietary changes, according to doctors in Salford.