Position of the American Dietetic Association: the role of nutrition in health promotion and disease prevention programs

Assessment of the Antioxidant/Hypolipidemic Relationship of Sideritis hyssopifolia in an Experimental Animal Model

Many publications have described the potential cardioprotective action of different medicinal plants, relating this effect with blood lipid levels. However, these publications do not justify the right amount of plant administered, which can vary greatly. Sideritis hyssopifolia is a little woody plant endemic to western and southwestern Europe. We have quantified its antioxidant activity, which can be used as an indicator of its cardioprotective action. This study evaluates the antioxidant capacity of Sideritis hyssopifolia to design a feed whose hypolipidemic effects are proven in cholesterol-fed New Zealand rabbits. Antioxidant action was assessed in infusions, which were prepared with 1 or 3 g of plant in 200 mL of water by using an ABTS assay and expressed as Ascorbic acid Equivalent Antioxidant Capacity (AEAC). Aqueous infusions with infusion times of 10 min and prepared with 3 g plant exhibited the strongest antioxidant activity. Sideritis hyssopifolia showed an intermediate antioxidant capacity for the concentrations and times of the infusion tested. According to our results, we suggest incorporating 2.36 g of S. hyssopifolia every 150 g of rabbit feeding stuff (15.73 g/kg). This chow decreased cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides levels in cholesterol-fed rabbits, as well as the atherogenic index. This reduction was similar to that obtained with simvastatin.

Combined Diet and Exercise Intervention in the Workplace

This study assessed the effectiveness of a 12-week pilot employee wellness program in reducing risk factors for coronary heart disease. Fifty university employees with at least one cardiovascular disease risk factor participated in the program. Interventions focused on diet, exercise, and monthly workshops. Pre- and post-intervention measurements included weight, body composition, blood pressure, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and blood sugar. Twenty-five employees had post-intervention measurements. A survey was administered to assess adherence. The correlation between adherence and improvement in cardiovascular disease risk factors was also tested. Significant differences were observed between pre- and post-intervention measurements of total cholesterol, LDL cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and weight. A significant correlation existed between self-reported level of participation in the diet aspect of the program and improvement in LDL levels. This multi-component, 12-week pilot employee wellness program was effective in reducing cardiovascular disease risk.

Eat Smart, Live Strong intervention increases fruit and vegetable consumption among low-income older adults

This study evaluated the impact of a four-session interactive nutrition education program-Eat Smart, Live Strong (ESLS)-on the consumption of fruit and vegetables by low-income older adults. A pre-post quasi-experimental design study was conducted with a longitudinal sample of 614 low-income Supplemental Nutrition Assistance Program (SNAP) participants and those eligible for SNAP, aged 60 to 80 years, in 17 intervention and 16 comparison senior centers in Michigan. The study compared participants' self-reports of their consumption of fruit and vegetables using a modified version of the University of California Cooperative Extension Food Behavior Checklist. ESLS increased participants' average daily consumption of fruit by 0.2 cups (P < 0.05) and vegetables by 0.31 cups (P < 0.01). ESLS, a four-session, cognitive-behavioral nutrition education program is an effective curriculum for helping low-income older adults eat more fruit and vegetables.

Microwave-assisted synthesis of some new pyrazolopyridines and their antioxidant, antitumor and antimicrobial activities

The chemical behavior of 4-(dimethylaminomethylene)-1-phenyl-3-(pyridin-3-yl)-1H-pyrazol-5(4H)-one (enaminone) (2) toward some active methylene reagents has been reported to give pyrazolopyridine derivatives. All the reactions were carried out by conventional heating and microwave irradiation technique. The antioxidant activity of the prepared compounds was studied using 1,1-phenyl-2-picrylhydrazyl (DPPH) assay. Compounds (4c) and (4d) showed the highest activity. The antitumor activity against liver and breast cell lines was tested. Compounds (6), (9) and (11) showed the highest activity for liver cell line while compounds (6) and (9) showed the highest activity for breast cell line. Compounds (4a-d) were screened for their antibacterial activity against Gram-positive, Gram-negative bacteria and antifungal activity.

Dieticians' intentions to recommend functional foods: The mediating role of consumption frequency of functional foods

This study explored the conceptual framework of dieticians' intentions to recommend functional food and the mediating role of consumption frequency. A web-based survey was designed using a self-administered questionnaire. A sample of Korean dieticians (N=233) responded to the questionnaire that included response efficacy, risk perception, consumption frequency, and recommendation intention for functional foods. A structural equation model was constructed to analyze the data. We found that response efficacy was positively related to frequency of consumption of functional foods and to recommendation intention. Consumption frequency also positively influenced recommendation intention. Risk perception had no direct influence on recommendation intention; however, the relationship was mediated completely by consumption frequency. Dieticians' consumption frequency and response efficacy were the crucial factors in recommending functional foods. Dieticians may perceive risks arising from the use of functional foods in general, but the perceived risks do not affect ratings describing dieticians' intentions to recommend them. The results also indicated that when dieticians more frequently consume functional foods, the expression of an intention to recommend functional foods may be controlled by the salience of past behaviors rather than by attitudes.

MyPyramid.gov: assessment of literacy, cultural and linguistic factors in the USDA food pyramid web site

MyPyramid.gov, a major national Web site about healthful eating and physical activity, was analyzed for literacy, cultural, and linguistic factors relevant to consumers. The assessment used 4 standardized readability tests, 1 navigational test, availability of non-English content, and new criteria for cultural factors. Readability scores averaged between grade levels 8.8 and 10.8, and half the navigation criteria were met. The Web site was available in Spanish, but it had little cultural tailoring for English speakers. It is recommended that MyPyramid's readability, navigation, and cultural tailoring be improved. References are provided to help educators learn more about assessing and using Internet communication with diverse audiences.

Linking active living and nutrition counselling: dietitians' perceptions

Healthy eating and active living have become key concepts in health promotion, and, increasingly, the two messages are being combined. Dietitians are in an ideal position to promote physical activity as an adjunct to nutrition counselling. Focus group interviews were used to identify dietitians' perceptions and needs related to incorporating active living messages into their practices. Six focus groups, involving 42 participants (40 registered dietitians and two dietetic interns), were conducted in cities throughout Alberta. Issues explored during the interviews included the dietitian's role in promoting active living, barriers to promoting physical activity, opportunities for collaboration between dietitians and exercise professionals, and dietitians' perceived needs for integrating active living messages into their practices effectively. Findings indicate strong support for incorporating active living messages into nutrition counselling. However, lack of knowledge was identified as a barrier to dietitians' proactive role, and concerns were raised about public and professional perceptions if dietitians counselled on this issue. Participants felt that they required additional knowledge and training in physical activity in order to promote it effectively. Development and implementation of programs designed to meet these needs would help dietitians integrate active living messages into their practices.

Position of the American Dietetic Association: Functional Foods

It is the position of the American Dietetic Association that functional foods, including whole foods and fortified, enriched, or enhanced foods, have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis, at effective levels. The Association supports research to define further the health benefits and risks of individual functional foods and their physiologically active components. Dietetics professionals will continue to work with the food industry, the government, the scientific community, and the media to ensure that the public has accurate information regarding this emerging area of food and nutrition science. Knowledge of the role of physiologically active food components, from both phytochemicals and zoochemicals, has changed the role of diet in health. Functional foods have evolved as food and nutrition science has advanced beyond the treatment of deficiency syndromes to reduction of disease risk. This position reviews the definition of functional foods, their regulation, and the scientific evidence supporting this emerging area of food and nutrition. Foods can no longer be evaluated only in terms of macronutrient and micronutrient content alone. Analyzing the content of other physiologically active components and evaluating their role in health promotion will be necessary. The availability of health-promoting functional foods in the US diet has the potential to help ensure a healthier population. However, each functional food should be evaluated on the basis of scientific evidence to ensure appropriate integration into a varied diet.

Food consumption patterns of rural older African American, Native American, and white adults in North Carolina

This paper describes the major food sources of selected nutrients for an ethnically diverse sample of older adults in rural North Carolina. A representative sample of 130 elders (> 70 years) completed semi-quantitative food frequency questionnaires. Percentages of foods most frequently consumed as the lead source of seven nutrients were calculated overall, by gender and ethnic group. Foods eaten at least one time per week were identified, and percentages of participants consuming that frequency were calculated. Major food sources included: salad oil/cooking oil for calories, total fat and saturated fat; miscellaneous vegetables for dietary fiber and folate; and orange/grapefruit juice for vitamin C. Heterogeneity in food sources was greatest for zinc and least for vitamin C. Variation across gender and ethnic groups was observed only in the degree to which specific food sources contributed to nutrient intake. These data provide greater insight into the dietary patterns of rural elders than examining nutrient intakes.

Diet Quality Among Older Quebecers As Assessed By Simple Indicators

To determine whether older Quebecers are eating adequately and whether summary scores represent diet quality, a representative subset of participants aged 55 to 74 (weighted n=460, 47% male) was studied from the 1990 Enquête québécoise sur la nutrition dataset. Participants’ diet quality was scored from adjusted 24-hour recalls. Foods were coded into Canada's Food Guide to Healthy Eating food groups. Usual Dietary Adequacy Score (maximum=18) and Dietary Diversity Score (maximum=4) were calculated from adjusted food guide portions and validated internally in relation to achievement of nutrient recommendations using correlation analysis. Average usual Dietary Adequacy Score (mean ± standard error) was 14.96 ± 0.15 (men) and 13.72 ± 0.15 (women). Only 7% of men and 1% of women achieved the maximum usual score. Fortyfour percent of men and 45% of women scored a usual Dietary Diversity Score of 3, and 55% of men and 50% of women achieved 4. Thus, approximately half of older Quebecers showed inadequate dietary variety, and consumed fewer than the minimum recommended number of servings from certain food groups. Summary diet quality indicators are useful for tracking diet quality, and provide critical data for planning nutrition education programs targeting older persons.

Time for Assessment of Nutrition Services in Assisted Living Facilities

State regulations on the food and nutrition service components of care influence both care and service delivery of the elderly in assisted living facilities. Information on such regulations was abstracted from a survey of 50 states that had been carried out by the National Academy for State Health Policy. These data were supplemented by examining relevant state websites and by follow up phone calls. They were then evaluated using criteria recommended by expert groups. Forty-five states had some relevant food service and nutrition regulations, and five had no specific regulations. No state had regulations meeting all the criteria examined. The availability and completeness of food and nutrition regulations and standards in assisted living facilities may have life safety implications for older adults, and they deserve further evaluation.

Position of the American Dietetic Association: total diet approach to communicating food and nutrition information

It is the position of the American Dietetic Association that all foods can fit into a healthful eating style. The ADA strives to communicate healthful eating messages to the public that emphasize the total diet, or overall pattern of food eaten, rather than any one food or meal. If consumed in moderation with appropriate portion size and combined with regular physical activity, all foods can fit into a healthful diet. Public policies that support the total diet approach include Reference Dietary Intakes, Food Guide Pyramid, Dietary Guidelines for Americans, Nutrition Labeling and Healthy People 2010. The value of a food should be determined within the context of the total diet because classifying foods as "good" or "bad" may foster unhealthy eating behaviors. Eating practices are influenced by taste and food preferences, concerns about nutrition and weight control, physiology, lifestyle, environment, and food product safety. To increase the effectiveness of nutrition education in promoting sensible food choices, dietetics professionals plan communications and educational programs that utilize theories and models related to human behavior. Communication campaigns/programs should implement an active, behaviorally focused approach within the larger context of food choices. Nutrition confusion can be reduced by emphasizing moderation, appropriate portion size, balance and adequacy of the total diet over time, the importance of obtaining nutrients from foods, and physical activity.

The significance and possibility of functional food production

Abundant knowledge of the significance of food quality for all human living functions as well as growing human population and the occurrence of world "hidden hunger", directed food producers toward new production processes of and new product development that must satisfy the specific needs of different categories of consumers. The differences are reflected in sex age, religious affiliation, activity, health, social status etc. "Organic", "natural, minimal processing, functional (and often called "therapeutical") food nowadays represents the key interest of nutritionists, physicians and food producers. Such food should have a beneficial influence on human health, besides satisfying the nutritive and energetic necessities, by protective, prophylactic and healing performance. This paper discusses facts about the influence of food on human health, problems of malnutrition in developing and developed countries, presents states of food production in the world and in Yugoslavia, legislation and regulations on nourishment and food production, the disadvantages of former concepts of development of this production and possible directions of future trends with a particular review on functional food production.

Metropolitan and non-metropolitan trends in coronary heart disease mortality within Appalachia, 1980-1997

OBJECTIVES

In this article, we report on metropolitan and non-metropolitan trends in coronary heart disease (CHD) mortality within the Appalachian Region for the period 1980 to 1997. We hypothesized that trends in CHD mortality would be less favorable in non-metropolitan populations with diminished access to social, economic, and medical care resources at the community level.

METHODS

Our study population consisted of adults aged 35 years and older who resided within the 399 counties of the Appalachian Region between 1980 and 1997. We examined mortality trends for sixteen geo-demographic groups, defined by gender, age, race, and metropolitan status of county of residence. For each geo-demographic group, we calculated annual age-adjusted CHD mortality rates. Line graphs of these temporal trends were created, and log-linear regression models provided estimates of the average annual percent change in CHD mortality from 1980 to 1997. Data on social, economic, and medical care resources for metropolitan vs. non-metropolitan counties were also analyzed.

RESULTS

Rates of CHD mortality were consistently higher in non-metropolitan areas compared with metropolitan areas for blacks of all ages and for younger whites. CHD mortality declined among almost all geo-demographic groups, but rates of decline were slower among non-metropolitan vs. metropolitan residents, blacks vs. whites, women vs. men, and older vs. younger adults. Non-metropolitan areas had fewer socioeconomic and medical care resources than metropolitan areas in 1990.

CONCLUSIONS

Appalachia, particularly non-metropolitan Appalachia, needs policies and programs that will enhance both primary and secondary prevention of CHD, and help diminish racial inequalities in CHD mortality trends.

Position of the American Dietetic Association: nutrition, aging, and the continuum of care

Scientific evidence increasingly supports that good nutrition is essential to the health, self-sufficiency, and quality of life of older adults. With the population of the United States living longer than ever before, the older adult population will be more diverse and heterogeneous in the 21st century. The oldest-old and minority populations will grow more quickly than the young-old and non-Hispanic white populations, respectively. For the current 34 million adults 65 years of age and older living in the United States, there are about 12 million caregivers who provide formal or informal care. A broad array of culturally appropriate food and nutrition services, physical activities, and health and supportive care customized to accommodate the variations within this expanding population of older adults is needed. With changes and lack of coordination in health care and social-support systems, dietetics professionals need to be proactive and collaborate with aging-services and other health care professionals to improve policies, interventions, and programs that service older adults throughout the continuum of care to ensure nutritional well-being and quality of life. The American Dietetic Association supports both the provision of comprehensive food and nutrition services and the continuation and expansion of research to identify the most effective food and nutrition interventions for older adults over the continuum of care.

Position of the American Dietetic Association: functional foods

It is the position of The American Dietetic Association that functional foods, including whole foods and fortified, enriched, or enhanced foods, have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis, at effective levels. The Association supports research to further define the health benefits and risks of individual functional foods and their physiologically active components. Dietetics professionals will continue to work with the food industry, government, the scientific community, and the media to ensure that the public has accurate information regarding this emerging area of food and nutrition science. Knowledge of the role of physiologically active food components, both from phytochemicals and zoochemicals, has changed the role of diet in health. Functional foods have evolved as food and nutrition science has advanced beyond the treatment of deficiency syndromes to reduction of disease risk. This position reviews the definition of functional foods, their regulation, and the scientific evidence supporting this emerging area of food and nutrition. Foods can no longer be evaluated only in terms of macronurtrient and micronutrient intake. Analyzing the content, of other physiologically active components will be necessary. The availability of health-promoting functional foods in the US diet has the potential to help ensure a healthier population. However, each functional food should be evaluated on the basis of scientific evidence to ensure appropriate integration into a varied diet.

Position of the American Dietetic Association and Dietitians of Canada: women's health and nutrition

Within the past 10 years women's health has evolved to a much broader paradigm, beyond reproductive issues. From a physiological perspective, women's health now refers to the prevention, diagnosis, and management of conditions or diseases that may be unique to women, be more prevalent in women, or manifest differently in women than men. Women's health encompasses emotional, social, cultural, spiritual, and physical well-being. It is determined by the social, political, and economic context of women's lives. Nutrition is involved in the etiology or treatment of half of the 10 leading causes of death in women. The incidence of osteoporosis and extremes in body weight are approaching epidemic proportions in women. This position reviews the following health problems: cardiovascular disease, cancer, osteoporosis, weight, and diabetes mellitus. Dietetics professionals are in the perfect position to understand the issues surrounding women's health in order to deliver a message to women that will allow them to make wise decisions regarding their health. Nutrition is a critical component of risk reduction and treatment, and must be included in clinical and preventive services for women. Dietetics professionals must work to increase their knowledge about women's health issues, to promote health and education programs, to influence policy makers, to deliver the highest-quality medical nutrition therapy, and to be proactive in documenting the effectiveness of outcomes-based research.