Diet and health: what should we eat?

Enhancing effect of polysaccharides from an edible brown alga, Hijikia fusiforme (Hijiki), on release of tumor necrosis factor-alpha from macrophages of endotoxin-nonresponder C3H/HeJ mice

An enhancing activity for the release of tumor necrosis factor-alpha from macrophages of C3H/HeJ mice was detected in the hot water-soluble extract of an edible brown alga, Hijikia fusiforme (Hijiki in Japanese). This activity was divided into the polysaccharide and nonpolysaccharide fractions, with the former showing much higher activity than the latter. The active components in the polysaccharide fraction were further purified by ion-exchange column chromatography and gel permeation system of high-performance liquid chromatography; they were identified as polysaccharides with apparent molecular mass of about 2,000 and 70 kDa and were designated Hijiki-derived polysaccharides I and II (HPS-I and HPS-II), respectively. They also enhanced macrophage-dependent suppression against the growth of EL-4 tumor cells in an in vitro culture experiment, with HPS-I exhibiting much higher immunologic activity than HPS-II. Furthermore, other comparative experiments confirmed that the immunoenhancing activities of polysaccharides from H. fusiforme are associated with the functions of polysaccharides themselves, but not with the artificial activity induced by contaminated endotoxins. Some biochemical properties of immunoenhancing polysaccharides were partially characterized, and the significance of this finding is discussed from the viewpoint of the protective role of edible seaweeds against carcinogenesis.

Possible immunomodulating activities of carotenoids in in vitro cell culture experiments

Immunomodulating activities of beta-carotene and carotene-associated carotenoids such as canthaxanthin (beta, beta-carotene-4,4 dione) and astaxanthin (3,3'-dihydroxyl beta, beta-carotene 4,4-dione) were analyzed by in vitro cell culture experiments. (i) beta-Carotene, canthaxanthin and astaxanthin caused significant stimulatory effects on the cell proliferative response of spleen cells and thymocytes from BALB/c mice at the concentrations of 2 x 10(-8) to 10(-7) M, although they showed the activities different from each other. (ii) Astaxanthin exhibited the highest activity on the polyclonal antibody (immunoglobulin M and G) production of murine spleen cells at the concentrations of 2 x 10(-8) to 10(-7) M but beta-carotene did not cause a significant effect at a low concentration (2 x 10(-8) M) although stimulated at a high concentration (2 x 10(-7) M). Canthaxanthin expressed moderate activities at the same concentrations. (iii) All tested carotenoids significantly enhanced the release of interleukin-1 alpha and tumor necrosis factor-alpha from murine peritoneal adherent cells at the concentrations of 2 x 10(-8) to 10(-7) M and the ranks of cytokine-inducing activities were astaxanthin > canthaxanthin > beta-carotene. These results indicate that carotenoids such as beta-carotene, canthaxanthin and astaxanthin have possible immunomodulating activities to enhance the proliferation and functions of murine immunocompetent cells.

Effect of diet and moderate exercise on central obesity and associated disturbances, myocardial infarction and mortality in patients with and without coronary artery disease

OBJECTIVE

To test whether a fat modified and fruit and vegetable enriched diet in conjunction with moderate physical activity reduces the cardiac event rate in patients with coronary artery disease (CAD) and its risk factors in an urban setting in India.

SUBJECTS AND METHODS

480 patients either with CAD or with risk factors. Those with definite or possible CAD including angina pectoris (n = 210) based on World Health Organization criteria and patients with risk factors were assigned to diet A (n = 231) or diet B (n = 232) for a period of 3 years. Both groups were advised to follow a fat modified diet. Group A was also advised to consume at least 400 g/day of fruits, vegetables and legumes according to World Health Organization advice and include moderate physical activity.

RESULTS

Waist-hip ratios, fasting and post-prandial blood glucose, plasma insulin levels, blood pressure and weight fell significantly in patients in group A compared with those in group B. While triglycerides in group A showed a significant decrease, high density lipoprotein cholesterol showed a significant increase. Both groups showed a significant reduction in total and low density lipoprotein cholesterol, although the decrease was greater in group A than group B. Central obesity decreased by 6.2% in group A vs. 1.2% in group B, 95% confidence interval of difference 2.3 to 7.8. The incidence of cardiac events was significantly lower in group A than group B (29 vs. 43 patients, p < 0.01). All-cause mortality also significantly declined in group A compared with group B (16 vs. 24 died, p < 0.05). The group A patients with better adherence to exercise and diet showed greater reduction in central obesity and greater decline in cardiac event rates and total mortality compared to control group B.

CONCLUSIONS

It is possible that moderate physical activity in conjunction with dietary changes in patients with CAD may cause substantial reductions in central obesity and associated disturbances corresponding to a significant decrease in cardiac events and mortality during the follow-up of 3 years.

Poor oral health and coronary heart disease

A few recent studies have shown associations between poor oral health and coronary heart disease (CHD). The objective of this study was to examine the incidence of CHD in relation to number of teeth present and periodontal disease, and to explore potential mediators of this association, in a prospective cohort study. This study is a part of the ongoing Health Professionals Follow-Up Study (HPFS). Participants included a US national sample of 44,119 male health professionals (58% of whom were dentists), from 40 to 75 years of age, who reported no diagnosed CHD, cancer, or diabetes at baseline. We recorded 757 incident cases of CHD, including fatal and non-fatal myocardial infarction and sudden death, in six years of follow-up. Among men who reported pre-existing periodontal disease, those with 10 or fewer teeth were at increased risk of CHD compared with men with 25 or more teeth (relative risk = 1.67; 95% confidence interval, 1.03 to 2.71), after adjustment for standard CHD risk factors. Among men without pre-existing periodontal disease, no relationship was found (relative risk = 1.11; 95% confidence interval, 0.74 to 1.68). The associations were only slightly attenuated after we controlled for dietary factors. No overall associations were found between periodontal disease and coronary heart disease. Tooth loss may be associated with increased risk of CHD, primarily among those with a positive periodontal disease history; diet was only a small mediator of this association.

Fruits and vegetables: protective or just fellow travelers?

Virtually all national and international dietary recommendations include advice to eat more fruits and vegetables. A recent study finds that people who do so are more likely to practice other healthful behaviors that can confound studies of lifestyle factors and chronic disease risk. This finding emphasizes the importance of following dietary recommendations as a whole and of developing more research on the health impact of overall dietary patterns.

Oxidative stress, nutrition and health. Experimental strategies for optimization of nutritional antioxidant intake in humans

Reactive oxygen species and reactive nitrogen species are formed in the human body. Endogenous antioxidant defences are inadequate to scavenge them completely, so that ongoing oxidative damage to DNA, lipids, proteins and other molecules can be demonstrated and may contribute to the development of cancer, cardiovascular disease and possibly neurodegenerative disease. Hence diet-derived antioxidants may be particularly important in protecting against these diseases. Some antioxidants (e.g. ascorbate, certain flavonoids) can exert pro-oxidant actions in vitro, often by interaction with transition metal ions. The physiological relevance of these effects is uncertain, as is the optimal intake of most diet-derived antioxidants. In principle, these questions could be addressed by examining the effects of dietary composition and/or antioxidant supplementation upon parameters of oxidative damage in vivo. The methods available for measuring steady-state damage (i.e. the balance between damage and repair or replacement of damaged molecules) and the actual rate of damage to DNA, proteins and lipids are reviewed, highlighting areas in which further methodological development is urgently required.

Suppressive effects of retinoids, carotenoids and antioxidant vitamins on heterocyclic amine-induced umu C gene expression in Salmonella typhimurium (TA 1535/pSK 1002)

Effects of retinoids, carotenoids and antioxidant vitamins were studied by mutagen-induced umu C gene expression system in Salmonella typhimurium (TA 1535/pSK 1002). Retinol (vitamin A), retinol acetate and retinoic acid showed remarkable inhibitory activities, whereas retinol palmitate exhibited significant but weak activity for umu C gene expression in tester bacteria induced by 3-amino-3,4-dimethyl-5H-pyrido[4.3-b]indol (Trp-P-1) in the presence of hepatic metabolizing enzymes (S9 mixture). Carotenoids having provitamin A activity (beta-carotene and canthaxanthin) exhibited moderate suppressive effects on the same experimental system. The ranks of suppressive activities were retinol > retinol acetate > retinoic acid > canthaxanthin > beta-carotene > retinol palmitate and their doses for inhibition by 50% (ID50) were estimated to be 1.2 x 10(-7), 3.0 x 10(-7), 5.4 x 10(-7), 1.5 x 10(-6), 4.0 x 10(-5) and 6.0 x 10(-5) M, respectively. However, they did not cause significant inhibition on umu C gene expression induced by direct-acting mutagen (adriamycin or mitomycin C) in the absence of S9 mixture. Inhibition of umu gene expression appears to be due to inhibition of P450-mediated metabolic activation of the heterocyclic amine Trp-P-1. Ascorbic acid (vitamin C) showed weak but significant suppressive activity at high-dose concentrations (3 x 10(-6) - 10(-4)M). However, alpha-tocopherol did not exhibit significant suppression at all dose concentrations. The significance of the experimental results is discussed from the viewpoint of the chemoprevention against genotoxicity associated with carcinogenesis.

The impact of edentulousness on food and nutrient intake

The authors collected dietary intake data about the food and nutrient intake of 49,501 male health professionals. Edentulous participants consumed fewer vegetables, less fiber and carotene, and more cholesterol, saturated fat and calories than participants with 25 or more teeth. These factors could increase the risks of cancer and cardiovascular disease. Mean differences in intake ranged from 2 to 13 percent, independent of age, smoking, exercise and profession. Longitudinal analyses suggest that tooth loss may lead to detrimental changes in diet.

High blood pressure, oxygen radicals and antioxidants: etiological relationships

This hypothesis proposes that high blood pressure is a pathological state associated with a loss of the balance between pro-oxidation and antioxidation, energy depletion, and accelerated aging in the target organs, such as heart, kidney and brain. Different nutritional, environmental, pharmacological factors and/or associated pathologies (diabetes, arteriosclerosis, cancer, alcoholism, etc.) and/or genetic components, can induce high blood pressure by breaking the redox equilibrium in the affected organs. Additional evidence, such as increase of oxidative damage, fibrogenesis, inhibition of the cardiocytic sodium-potassium pump, and heart hypertrophy, supports this hypothesis. These facts are analysed in the present paper, showing that they could contribute to the development of high blood pressure and associated pathologies by oxidative mechanisms.

Physical activity, nutrition, and chronic disease

Epidemiologic, animal, clinical, and metabolic studies demonstrate the independent roles of physical activity and nutrition in the prevention and treatment of several chronic diseases. Fewer data are available to describe the synergistic effects of exercise and diet, and questions remain as to whether and how these two lifestyle factors work together to promote health and prevent disease. This paper briefly reviews many of the known effects of physical activity and nutrition on the prevention and treatment of coronary heart disease, non-insulin-dependent diabetes mellitus, obesity, and osteoporosis as well as how exercise and diet may work together. A discussion of how to increase physical activity levels and how to improve dietary intake also is included. Finally, current exercise and dietary recommendations are summarized, as are directions for future research.

All-trans beta-carotene enhances mitogenic responses and ornithine decarboxylase activity of BALB/c 3T3 fibroblast cells induced by tumor promoter and fetal bovine serum but suppresses mutagen-dependent umu C gene expression in Salmonella typhimurium (TA 1535/pSK 1002)

Although previous epidemiological studies have indicated that beta-carotene is an important agent for the chemical prevention against carcinogenesis, a recent prospective study has strikingly suggested that supplementation with beta-carotene significantly increased the incidence of some types of cancer (The alpha-Tocopherol and beta-Carotene Cancer Prevention Study Group, New Engl. J. Med., 330 (1994) 1031-1035). To analyze the discrepancy of this problem, the authors analyze the effects of beta-carotene on biochemical and biological events associated with carcinogenesis by in vitro experiments. (1) All-trans beta-carotene enhanced the proliferation and DNA synthesis of BALB/c 3T3 cells induced by a tumor promoter, 12-O-tetradecanoyl-phorbol-13-acetate (TPA) and fetal bovine serum, although beta-carotene itself did not show mitogenic activity. (2) All-trans beta-carotene caused a remarkable stimulation for the early induction of ornithine decarboxylase (ODC) activity after the stimulation of TPA and fetal bovine serum. (3) All-trans beta-carotene exhibited significant antimutagenic activity which suppresses umu C gene expression in Salmonella typhimurium (TA 1535/pSK 1002) induced by a typical mutagen, 2-aminoanthracene (2-AA). These experimental results suggest that all-trans beta-carotene might cause beneficial and harmful effects on different phases of carcinogenesis.

Lactobacillus- and bifidobacterium-mediated antigenotoxicity in the colon of rats

Lactic acid bacteria (LAB) are proposed to have several beneficial effects, including the inactivation of carcinogens. We have studied the potential of Lactobacillus acidophilus (from a commercially available yogurt), Lactobacillus gasseri (P79), Lactobacillus confusus (DSM20196), Streptococcus thermophilus (NCIM 50083), Bifidobacterium breve and Bifidobacterium longum (from human infant stool) to prevent the induction of DNA damage by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG, 7.5 mg/kg body wt) in colon cells of the rat. Using the new technique of single cell microgel electrophoresis, all investigated strains were antigenotoxic toward MNNG after a single dose of 10(10) viable cells/kg body wt p.o. eight hours before the carcinogen. One-half and one-tenth of this initial dose resulted in a loss of protective activity. High doses of heat-treated L. acidophilus strains were also not antigenotoxic. One mechanism of the preventive effect could be that bacterial metabolites or components are responsible. Accordingly, selected examples were investigated in vitro in colon cells of the rat. Metabolically active L. acidophilus cells, as well as an acetone extract of the culture, prevented MNNG-induced DNA damage. Different cell fractions from L. acidophilus (cytoplasm, cell wall skeleton, cell wall) were devoid of antigenotoxic activity, whereas the peptidoglycan fraction and whole freeze-dried cells were antigenotoxic. As a second carcinogen, 1,2-dimethylhydrazine (DMH) was used. A dose- and time-response study was first performed to assess the effects of DMH in several segments of the gastrointestinal (GI) tract. Exposure for 16 hours to 15 or 25 mg DMH/kg body wt p.o. induced DNA damage in cells of the distal colon of rats, whereas no cytotoxicity was seen. Pretreatment orally with LAB on four consecutive mornings before DMH gavage (8 hours after the last LAB application) revealed that L. acidophilus, L. confusus, L. gasseri, B. longum, and B. breve inhibited the genotoxic effect of DMH. One of four S. thermophilus and one of three Lactobacillus delbrueckeii ssp. bulgaricus strains were also protective. Heat-treated L. acidophilus did not inhibit DMH-induced genotoxicity. A few aliquots of the colon cells were processed immunohistochemically for the presence of the "proliferation cell nuclear antigen" (PCNA). DMH treatment did not increase PCNA, nor was there any modulation by LAB. The effect of L. acidophilus on foreign compound-metabolizing enzymes (Phase I and Phase II) in liver and colon cells of rats revealed only one parameter to be modulated, namely, a two- to three-fold increase in the levels of NADPH-cytochrome P-450 reductase. The meaning of this finding, in terms of possible chemoprevention by LAB, remains unclear. In conclusion, our studies show that most, but not all, LAB tested could strongly inhibit genotoxicity in the GI tract of the rat and that viable LAB organisms are required for the protective effect in vivo. The comet assay technique is a powerful tool to elucidate such in vivo antigenotoxic activities in tumor target tissues.

Food and nutrient intake and risk of cataract

The relationship between cataract extraction and diet was considered in a case-control study conducted in northern Italy. A total of 207 patients who had cataract extraction and 706 control subjects in a hospital for acute, nonneoplastic, nonoculistic, nondigestive tract diseases were interviewed during their hospital stay. Odds ratios (ORs) and their 95% confidence intervals (CIs), according to the intake of alcohol, coffee, tea, and cola, and frequency of intake of 34 food items and 8 micronutrients were derived from multiple logistic regression equations, including terms for age, sex, education, smoking status, body mass index, diabetes, and total calorie intake. Alcohol, coffee, decaffeinated coffee, tea, and cola intakes were not associated with cataract extraction. Among food items, reduced ORs for cataract extraction (highest tertile of intake compared to the lowest), with a significant inverse trend in risk, were found for intake of meat (OR 0.6, 95% CI 0.4 to 0.9), cheese (OR 0.7, 95% CI 0.5 to 1.0), cruciferae (OR 0.5, 95% CI 0.3 to 0.8), spinach (OR 0.6, 95% CI 0.4 to 0.9), tomatoes (OR 0.5, 95% CI 0.4 to 0.8), peppers (OR 0.7, 95% CI 0.4 to 1.1), citrus fruit (OR 0.5, 95% CI 0.2 to 1.3), and melon (OR 0.5, 95% CI 0.4 to 0.8). A significant increase in risk was found for the highest intake of butter (OR 2.8, 95% CI 1.2 to 6.4), total fat (OR 1.8, 95% CI 1.2 to 2.8), and salt (OR 2.4, 95% CI 1.4 to 4.0) compared to the lowest, and for consumption of oil other than olive oil (OR 1.6, 95% CI 1.1 to 2.2). Among micronutrients, lower ORs for cataract extraction (highest quintile of intake compared to the lowest) were found for intake of calcium (OR 0.5, 95% CI 0.3 to 0.8), folic acid (OR 0.4, 95% CI 0.2 to 0.7), and vitamin E (OR 0.5, 95% CI 0.3 to 1.0), while estimated intakes of methionine, retinol, beta-carotene, and vitamins A, C, and D were not associated. Thus, this study indicates that diet plays a considerable role in the risk of cataract extraction in this Italian population, with a protective action played by some vegetables, fruit, calcium, folic acid,and vitamin E, and an increased risk associated with elevated salt and fat intake.

Effects of repeated boluses of sucrose on proliferation and on AOM-induced aberrant crypt foci in rat colon

Colonic mucosal proliferation, aberrant crypt foci (ACF) induction, and fecal bile acids, parameters connected to the risk of colon cancer development, were studied in female F344 rats treated with starch or sucrose boluses or with a sucrose diet. Cell proliferation was higher in animals treated with a single sucrose bolus than in those given a starch bolus (15 g/kg body wt), with 4.3 +/- 0.64 and 2.17 +/- 0.57 (SE) mitotic figures (MF) per crypt in the sucrose and starch bolus groups, respectively (p < 0.01). When azoxymethane (AOM, 20 mg/kg) was administered 24 hours after a single sucrose or starch bolus, the number of ACF per colon after 30 days was higher in the sucrose bolus group [107.5 +/- 9.5 (SE)] than in the starch bolus group (67.8 +/- 0.9, p < 0.01). In additional experiments, colon cell proliferation (MF/crypt) was higher in rats given boluses of sucrose three times per week for 40 days after AOM (20 mg/kg) [5.9 +/- 0.7 (SE)] than in rats given starch boluses (2.96 +/- 0.4) or fed sucrose continuously (3.6 +/- 0.5). On the contrary, after 40 days of dietary treatment, the number, dimension, and percentage of ACF secreting sulfomucins and sialomucins were not varied among these three groups. However, the percentage of "large ACF" (ACF with > or = 4 crypts) secreting sialomucins or predominantly sialomucins was higher (p < 0.05) in the sucrose bolus group than in the starch group. The concentration of fecal bile acids and long-chain fatty acids was the same in the sucrose and starch groups, but the concentrations of deoxycholic and oleic acid were significantly higher in the sucrose bolus group. In conclusion, the administration of sucrose as a bolus had a stronger effect than continuous sucrose feeding on some parameters related to colon carcinogenesis and might be considered a risk factor in colon carcinogenesis.

Basis and consequences of primary and secondary prevention of gastrointestinal tumors

Carcinomas of the gastrointestinal tract (GI) are among the most common malignancies with regard to their incidence and mortality. Nutritional factors play an important role in the tumor development. The strength of their influence varies with the localization in the GI tract. Epidemiological studies focusing on GI cancer incidence or mortality as an endpoint necessitate large numbers of subjects to achieve significant results. Generally, a low energy and fat intake and a high intake of antioxidative vitamins (vitamin C, E, beta-carotene) and secondary plant metabolites (especially polyphenols) appear to be protective in GI carcinogenesis. Moderate drinking of alcohol and increased consumption of whole grain products, as opposed to highly refined carbohydrates, may help to reduce the risk of colon cancer. The recommended type of diet is low in fat, especially in saturated fatty acids, includes monounsaturated fatty acids, and includes moderate amounts of polyunsaturated fatty acids (no more than 10% of calories). Moderate consumption of salt and of highly salted, smoked, and barbecued foods should be encouraged. Obesity should be avoided by trying to match energy intake with expenditure while increasing physical activity levels. The mechanisms by which nutritional factors act especially on molecular events still remain to be examined. The use of molecular biomarkers will help us better understand cancer development as well as the role and significance of nutritional factors in this process.

Dietary sucrose, glucose, fructose, and starches affect colonic functions in rats

To study the effect of dietary sugars and starches on parameters linked to colon carcinogenesis, female Sprague-Dawley rats were fed for one month five different diets containing sucrose, glucose, fructose, cornstarch, or Hylon 7, a starch with a high amylose content. After this period, colon proliferation, assessed by [3H] thymidine incorporation in vitro, was higher (p < 0.05) in rats fed sucrose than in rats fed glucose, fructose, or cornstarch [labeling index was 7.17 +/- 0.75, 5.03 +/- 0.07, 4.55 +/- 0.72, 4.00 +/- 0.70, and 5.89 +/- 1.05 (SE) in sucrose, glucose, fructose, cornstarch, and Hylon 7 diets, respectively]. Cecal pH was lower in rats fed cornstarch and Hylon 7 than in rats fed sucrose, glucose, or fructose. Content of short-chain fatty acids (SCFAs) in the cecum was higher in rats fed Hylon 7 than in those fed glucose and fructose. In conclusion, glucose and fructose, compared with sucrose, decrease mucosal proliferation and may be considered protective factors in colon carcinogenesis, although they do not affect SCFA production and cecal pH. On the contrary, Hylon 7 does not change mucosal proliferation but increases SCFAs and lowers cecal pH, two conditions associated with a lower risk of colon cancer.

Diet and overall survival in elderly people

OBJECTIVE

To assess the influence of a specific dietary pattern on overall survival.

DESIGN

Cohort study.

SETTING

Three rural Greek villages, the data from which were collected as part of an international cross cultural study of food habits in later life.

SUBJECTS

182 elderly residents of the three villages.

MAIN OUTCOME MEASURE

Overall mortality.

RESULTS

Diet was assessed with a validated extensive semiquantitative questionnaire on food intake. A one unit increase in diet score, devised a priori on the basis of eight component characteristics of the traditional common diet in the Mediterranean region, was associated with a significant 17% reduction in overall mortality (95% confidence interval 1% to 31%).

CONCLUSION

A diet meeting currently understood health criteria does predict survival among people.

European School of Oncology Advisory report to the European Commission for the "Europe Against Cancer Programme" European Code Against Cancer

A European School of Oncology Advisory Group has reviewed the European Code Against Cancer after its initial use over a 6-year period. With minor modifications, the original ten recommendations were found to be adequate, although it was agreed that an Annex was necessary to explain the scientific evidence supporting each point, and is presented herewith. Tobacco smoking clearly remains the most important cause of cancer, and now it can be quantified better than ever before. It is also clear that it is never too late to stop smoking: stopping even in middle age, prior to the onset of serious illness has a beneficial effect on life expectancy. Alcohol drinking is an important cause of cancer, and yet modest consumption levels protect against cardiovascular disease mortality. The optimal strategy seems to be a consumption not exceeding 2-3 drinks per day, although this limit may be lower for women. Increased consumption of fruits and vegetables, reduction in consumption of fatty foods, reduction of obesity and increased physical activity can all be recommended to reduce cancer risk. Exposure to excessive sunlight remains a problem which should be limited. Control of occupational cancer is a three-way partnership: legislation identifies and limits exposure to known carcinogens, employers enact the legislation and workers should respect the measures introduced. There are a number of signs and symptoms which may lead to cancer being diagnosed earlier, and patients with these should be referred to a doctor. For women, participation in organised programmes of cervical cancer and breast cancer (after 50 years of age) should lead to a reduction in mortality from these forms of cancer. The key element is organised programmes, where quality control and quality assurance are in force. These revised recommendations are the result of an agreement following advice, review and dialogue with cancer experts throughout Europe. They were approved by the European Community Cancer Experts at their meeting in Bonn on 28-29 November 1994. Their implementation by the European population should greatly reduce cancer incidence and mortality.

Vegetable and fruit consumption: some past, present and future practices

In Western populations, historically, from early times until the 19th century, diets were composed largely of plant foods-cereals, beans, vegetables and fruit. The huge majority of populations were very poor with restricted food choices. The same situation prevails with most present-day Third World populations, although principally with rural dwellers. In Western populations, in recent times, stemming largely from urbanization and rise in prosperity, and accompanying increased partiality to animal foods, there have been falls in the intake of some plant foods yet rises in others. Potato intake has halved, whereas vegetable consumption has increased only slightly, although that of fruit more so. National consumptions of these foodstuffs vary widely, those in the United Kingdom and United States of American being only about half of those in Mediterranean countries, Spain, Portugal and Greece. In the former countries, present dietary guidelines urge that vegetable consumption be doubled, with fruit up by a half. In southern Africa, consumption of vegetables and fruit by the white population appears similar to those in The USA and UK. Yet in African cities, intake is low due to their cost. In view of the protective role of high vegetable and fruit intake in the combating of coronary heart disease and many forms of cancer, the relatively low consumption of these foodstuffs, especially in the poorer populations, is disappointing, and alas, appears unlikely to rise in the near future.

Chemo- and dietary prevention of colorectal cancer

Because of the substantial morbidity and mortality associated with colorectal cancer, and the limitations and costs of treating this disease, prevention remains a desirable (if elusive) goal. In this paper, we discuss both chemo- and dietary prevention strategies for colorectal cancer, recognising the overlap and cross-fertilisation between these two approaches. Chemopreventive compounds are drugs and are developed for clinical use like other pharmaceuticals. A formal sequential multi-phase programme for development of chemopreventive agents has been instituted by the National Cancer Institute, U.S.A. This involves both preclinical efficacy and clinical studies. Such studies increasingly employ preneoplastic intermediate markers (such as proliferation measures) as well as neoplastic adenomas as endpoints. Promising chemopreventive agents include calcium, aspirin and other non-steroidal anti-inflammatory drugs, vitamins (such as vitamin E and folate), 2-dimethylfluorornithine (DFMO), oltipraz and ursodeoxycholic acid. Several lines of evidence implicate diet in colorectal carcinogenesis. Key hypotheses in diet and colorectal cancer (which are amenable to prevention, research and action), in addition to those pertaining to the micronutrient chemopreventives, include dietary fat and fibre, food mutagens, red meat, and overall low-fat, high-fibre, high fruit and vegetable dietary patterns and cuisines. Several adenomatous polyp recurrence studies with fibre supplement, macronutrient or dietary pattern interventions have been undertaken internationally. We review early findings from this new generation of studies, and anticipate the future results from these investigations and the ambitious Women's Health initiative in the U.S.A. Results from these studies may convert the promise of colorectal cancer prevention into reality.

Blood lipids in Greek adolescents and their relation to diet, obesity, and socioeconomic factors

A study of blood lipid levels in adolescent students in rural and urban areas of Greece was undertaken. Blood samples were drawn from 307 adolescents aged 12 to 18 years attending two rural and two urban high schools of different socioeconomic level (urban/lower, urban/higher). Obesity among adolescents had statistically significant detrimental effects on the lipids profile, being associated with higher total and low-density-lipoprotein (LDL) cholesterol and lower high-density-lipoprotein (HDL) cholesterol levels. Adolescents living in urban areas had substantially and significantly higher levels of total and LDL cholesterol, but among urban residents, higher socioeconomic status was associated with lower levels of total and LDL cholesterol. There was no clear evidence that total, LDL, and HDL cholesterol levels were substantially affected by qualitative aspects of diet as evaluated through a food frequency questionnaire. The results of this study indicate that the traditional Mediterranean pattern of living and eating in the rural areas of Greece is associated with a favorable lipid profile in adolescents, which may explain the very low incidence of coronary heart disease (CHD) in these areas. In urban areas lipid profiles are satisfactory in children of high socioeconomic status but unfavorable in children of low- to middle-class families, which are known to be at higher risk for CHD.

Chemoprevention of digestive organs carcinogenesis by natural product protocatechuic acid

The worldwide increase in cancer mortality demands a practical and effective chemopreventive approach to this problem. Using animal bioassay, the authors demonstrated protocatechuic acid (PCA, 3,4-dihydroxybenzoic acid), a simple and antioxidative phenolic acid present in fruits, vegetables, and nuts, to be an efficacious agent in reducing the carcinogenic action of 4-nitroquinoline 1-oxide in oral cavity, N-methyl-N-nitrosourea in glandular stomach, azoxymethane in colon, and diethylnitrosamine in liver. PCA exerts its chemopreventive action partly through inhibition of cell proliferation induced by carcinogens in the target organs. The prospect of this agent as chemopreventive against human cancer warrants a thorough investigation, such as dose-dependent efficacy and its potential toxicity at an effective dose level in other species of animals. Considering its promising anticarcinogenic potency, proliferation biomarkers, including tissue and blood polyamine levels, might eventually be useful in assessing the possible role of PCA intake in high risk populations for cancers of these organs.

Haemorrhagic toxicity of a large dose of alpha-, beta-, gamma- and delta-tocopherols, ubiquinone, beta-carotene, retinol acetate and L-ascorbic acid in the rat

Antioxidants occasionally have become prooxidants when a large amount was ingested. The haemorrhagic toxicity of butylated hydroxytoluene, a synthetic antioxidant, may involve such a mechanism. This study investigated whether haemorrhage is induced by overdoses of tocopherols, beta-carotene, ubiquinone or L-ascorbic acid, which are representative biological antioxidants. Male Jcl:SD rats (six rats/group) were fed d-alpha, d-beta, d-gamma or d-delta-tocopherols, ubiquinone Q-10, beta-carotene or retinol acetate at a level of 0.5%, or L-ascorbic acid at 5% in the diet for 7 days. Only two rats given retinol acetate died with lung haemorrhages. Haemorrhages were observed in five or six, six, one, one, one or one of six surviving rats given d-alpha, d-beta or d-gamma-tocopherols, ubiquinone Q-10, beta-carotene or retinol acetate, respectively (except for a retinol group in which four rats survived). Major haemorrhages were noted in the epididymis. In the alpha-, beta- and gamma-tocopherol, ubiquinone Q-10, beta-carotene or retinol acetate-treated groups, prothrombin and kaoline-activated partial thromboplastin time indices were 26-28, 37, 59, 42, 63 and 65% or 27-28, 35, 65, 38, 59 and 28%, respectively, of the control values. Only the prothrombin index was significantly decreased to 67% in delta-tocopherol-administered rates, whereas controls and those receiving L-ascorbic acid showed no signs of bleeding or coagulation defect. The same tendency was also seen in the decreasing effect on vitamin K-dependent blood coagulation factors. These results suggest that the four naturally occurring tocopherols have a tendency to cause haemorrhage in the order of alpha > beta > gamma > delta, and ubiquinone Q-10 and beta-carotene als0o have relatively strong and weak haemorrhagic effects, respectively, with regard to prothrombin and partial thromboplastin time indices.

Nutrition and carcinogenesis: historical highlights and future prospects

Historical reviews were presented of several selected nutritional factors that are determinants of cancer incidence in laboratory experiments utilizing animals. An all-inclusive review of nutrition as it impacts cancer incidence was not done. Rather, the selection of subjects was based on a combination of several factors. (1) The efficacy of the factor as an inhibitor. (2) Current interest in the factor. (3) The extent to which the mechanisms of the inhibition is known and that knowledge may facilitate future studies. (4) The relevance to the human problem. The future of research on cancer prevention is bright. There are now mechanism-based rapid assays to detect food stuffs that prevent cancer and to assay for the active compounds therein. The list of inhibitors shown in Table 8 will continue to grow. The challenge is to achieve universal application to the human population of appropriate dietary practices that include foods that provide the protective factors shown in Table 8.

Accumulation of beta-carotene in normal colorectal mucosa and colonic neoplastic lesions in humans

The quantity of beta-carotene (BC) accumulated in colonic polyps and colonic cancerous tissue in humans in situ was determined relative to the quantity accumulated in normal colon and rectal tissue. Serum concentration of BC, retinol, and alpha-tocopherol and tissue BC concentration were determined by high-performance liquid chromatography in samples obtained before and after oral supplementation with BC (30 mg/day). The serum BC and retinol concentrations significantly increased in response to supplementation in control, polyp, and cancer patients, but there was no change in serum alpha-tocopherol concentration. The BC concentration in tissue (colon, rectum, and tumor) of cancer patients was significantly less than that in tissue samples from control and polyp patients. Relative to baseline values, BC accumulated to a significant extent in tissues from all patients, including polyp and tumor tissue, during supplementation. The results indicate that BC does accumulate in colonic neoplastic tissue in humans and may potentially be utilized to augment cytotoxicity of chemotherapeutics or to prevent malignant transformation of cells.

[Changes in the diet pattern of the Brazilian urban population (1962-1988)]

Contemporary changes in food consumption patterns in urban areas of Brazil are described. The main data sources are two national food expenditure surveys undertaken in the early 60's and late 80's (1961-62 and 1987-88) and one national food intake survey undertaken in the mid-70's (1974-75). The analysis is restricted to the seven metropolitan areas represented in the three surveys. Food patterns are described on the basis of the relative consumption of different food groups, proportion of energy from carbohydrates, protein and lipids, proportion of animal and vegetable protein and fats, proportion of complex and simple carbohydrates, ratio between polyunsaturated and saturated fatty acids and relative consumption of cholesterol. Main food changes were similar in the Northeastern and Southeastern cities and involved: 1) reduction in the relative consumption of cereals, beans, roots and tubercles; 2) replacement of lard, bacon and butter by vegetable oils and margarine: and 3) increase in the relative consumption of eggs, milk and dairy products. As a net result of these changes there was, simultaneously, a decrease in the carbohydrate content of the Brazilian diet and an increase in its fat content. Total protein content of the diet remained at around 12% in the three surveys but animal protein increased. Changes in the fat content of the diet involved an increased proportion of vegetable fat, an increased ratio of poly-unsaturated/saturated fatty acids and a reduction in cholesterol intake. Health implications of dietary changes are discussed based on the World Health Organization's dietary guidelines.

Role of chemopreventers in human diet

Recent research has confirmed that many common foods contain nonnutritive components that may provide protection against chronic disease including some forms of cancer. These naturally occurring compounds, which possess anticarcinogenic and other beneficial properties, are referred to as chemopreventers. The predominant mechanism of their protective action is due to their antioxidant activity and the capacity to scavenge free radicals. Among the most investigated chemopreventers are some vitamins, plant polyphenols, flavonoids, catechins, and some components in spices. The majority of chemopreventers are available in and consumed from vegetables, fruits, grains, and tea. Various naturally occurring chemicals in garlic, soybeans, tea, and red wine appear to be responsible for the beneficial effect of these commodities on several chronic diseases. This article will review some recent studies in the search for the beneficial effects of dietary chemopreventers on human health.

Nutrition and health aspects of free radicals and antioxidants

Although the role of free radicals has continued to capture the imagination of scientists, the interest in nutritional aspects of free radicals is relatively recent. Oxidative stress, which often arises as a result of the imbalance in the human antioxidant status, has been implicated in ageing and in a number of human diseases such as cancer, atherosclerosis, malaria and in rheumatoid arthritis. This review discusses the current status of free radicals in nutrition and dietary antioxidants and considers the possibility that use of a range of antioxidants, which have been carefully evaluated, combined with methods for measuring oxidant generation, would help to delineate the contribution of nutrients to the modulation of the consequences of free radicals in the human body.