A heretical view of the American Heart Association's nutritional dogma [abstract]

The dogma is as follows: no more than 33 percent of the calories in the diet should come from fat, and of those no more than 33 percent should come from saturated fat. Because of the saturated fats in eggs and butter, both of these foods are unsuitable. Diets that do not conform to these standards raise serum cholesterol levels and thereby promote coronary heart disease (CHD). However, serum cholesterol is not correlated with dietary cholestorol. diet or drug regimes that reduce serum cholesterol do not reduce mortality. Blood lipoprotein a, the best single predictor of CHD, correlates not at all with fat in the diet but inversely with ascorbic acid. Low-fat diets do not protect against CHD type 2. In practice, they are almost always high-carbohydrate, and often high-sucrose diets. Such diets promote obesity, Type-2 diabetes mellitus, and the production of advanced glycosylation end-products, which in turn promote hypertension and CHD. Because of the need for essential fatty acids, all diets should include unsaturated fatty acids. However, as quantities rise above optimum the unsaturated acids promote greater free radical damage and require increasing amounts of oil-soluble anti-oxidants to counteract this effect. Eggs are excellent food, containing, in addition to protein, carbohydrate, fat and all the vitamins, minerals and essential fatty acids needed to produce a chicken. They do not promot CHD. Nutritionally, butter is much better than margarine which contains large amounts of trans fatty acids, that interfere with the metabolism of essential fatty acids, raise low density lipoprotein and triglycerides and lower high density lipoprotein. The best is a low-carbohydrate diet with little sucrose and adequate levels of vitamins, minerals and essential fatty acids. (AU)

Evaluation of hospital dietic services in seven Caribbean countries

OBJECTIVE: To improve the delivery of dietic services in hospitals in the Caribbean, an assessment was carried out of the extent to which nutrition intervention was included in the medical management of patients. METHODS: The documentation of the nutritional intervention at secondary care facilities was the focus of a medical record audit of hospitalised patients. Medical records from 491 patients in 88 wards from 15 hospitals in Monsterrat, Jamaica, Guyana, British Virgin Islands, Grenada, Dominica and St. Vincent were audited. In each hospital at least 20 percent of the medical records of inpatients were audited. The medical records were randomly selected from each ward and were audited for selected anthropometric data, height and weight measurements, laboratory and clinical data, diagnosis, diet prescription and documentation of a "nutrition note" by dietetic personnel as well as nutrition-specific information in the "progress notes" and "nurses notes". RESULTS: The provision of nutrition intervention was relatively low or not adequately documented by any category of the relevant health care staff (medical, nursing and dietetic) in any of the countries. Except for anthropometric data, there was adequate baseline information (diagnosis, laboratory and clinical data) to initiate nutrition intervention. The absence of a diet prescription by the physician in more than 50 percent of the records in most countries indicated that insufficient attention is being paid to the contribution of nutrition in the delivery of medical care. Of the 15 hospitals assessed, 8 were operating without a professional dietitian or nutritionist. CONCLUSIONS: While primary prevention remains a main focus, we must provide adequate care and rehabilitation for those already afflicted. The study shows that there is a clear need to strengthen the nutritional care offered to hospitalized clients in the Caribbean so as to facilitate their early rehabilitation and quick return to productivity in society. At the forefront of realizing this goal is the availability of adequate resources in nutrition, specifically, human resources. (AU)

Determination of the nutritional status of high-risk antenatal women in St. Elizabeth, Jamaica

A cross-sectional study was done of forty-eight women attending the High Risk Antenatal Clinic at the Black River Hospital in the Parish of St. Elizabeth during the three month period of September to November, 1999 to determine their nutritional status. The data collection instrument included a twenty-four diet recall as well as food frequency questionnaire. The study group included teenagers (41.7 percent), women twenty years and older (20 percent) and women thirty to forty-four years old (38.3 percent). Twenty-seven women were pregnant for the first time while 18 women were multiparous and 3 women were grand multiparous. There was more than 50 percent unemployment and over 50 percent of the study group included students, housewives and unskilled women. Of note, there were no tertiary graduates or any member of the Technical, Professional or Managerial occupational groups. All forty-eight women completed primary (56 percent) or secondary (44 percent) schooling. Fifteen women had confirmed medical conditions or diseases including anemia, astma, congenital heart disease, gout, hypertension, Rhesus negative blood group and sickle cell disease. Thirty-eight women experienced side effects of pregnancy, with high prevalences of heartburn and vomiting at 54 percent and 45.8 percent respectively. Thirty-eight women consumed pica agents such as dirt, cake soap and ashes, marl with ice showing the highest prevalence of 58.3 percent. For the first and second trimester periods of 0-28 weeks weight gain was in excess of the range while weight gain for the third trimester (29-40) weeks was within the range for the period. The nutrient intakes used to determine nutritional status were the Recommended Daily Allowance for the age group which included calories, protein and fat. Deficiencies expressed as a perecntage of the RDA were vitamin C and D, calcium and iron. Adequate nutrient sources were demonstrated from the responses to the food frequency questionnaire. The prevalence of anaemia was 23.8 percent and close to one half of the group (47.9 percent) took iron supplements. The study group was already at risk due to their low socio-economic status and were deemed equally at a nutritional risk due to the notable excesses and deficiencies in their nutrient intake (AU)

National survey of children's health in Trinidad and Tobago: methods and results for height

OBJECTIVE: To measure height as an indicator of nutritional status in a representative sample of primary school children in Trinidad and Tobago. DESIGN AND METHODS: A cross-sectional survey was carried out. After stratifying for county, schools were sampled with probability proportional size. In each school all children were sampled from the admission class (mean age 5.8 years) and the `rising nines' (mean age 8.6 years). Measurements were made of children's heights. In order to standardize for age, standard deviation scores (SIDS or z scores) were calculated using age and sex specific British growth reference curves for 1990 as standard. In the reference population the mean (SD) SDS is 0.0 (1.0). Results were presented by sex and ethnic group. RESULTS: Measurements were made for 6,731 children in 66 schools. After excluding missing values data were analysed for 6,343 children (3065 boys and 3278 girls). In boys the mean height SIDS in those of African descent was 0.47 (1.04), in those of Indian descent 0.24 (1.08) and in those of mixed ethnicity 0.19 (1.07). The equivalent figures for girls were 0.53 (1.10), 0.19 (1.04) and 0.29 (1.12). Height SDS were higher for children aged 5-6 years than those aged 8-9 years. CONCLUSIONS: The distribution of children's heights in Trinidad and Tobago is similar to that observed in African Caribbean and Indian origin children in Britain. Overall the results suggest that nutritional conditions are as adequate as in the reference population.(Au)

Perception of a healthy diet (PHD): a survey among fourth form secondary school students in Trinidad

OBJECTIVES: To determine the percentage of students with the correct perception of a healthy diet and to ascertain determinants of students' perceptions. DESIGN AND METHODS: A cross-sectional survey of 795 randomly chosen secondary schools throughout Trinidad was conducted over two weeks. Students who completed all six sections of a self-administered, anonymous questionnaire with at least 50 percent correct response in each section were deemed to have the correct perception of a healthy diet. RESULTS: 165 (21.1 percent) students had the correct perception of a healthy diet. More females (102,23.9 percent) than males (63, 17.79 percent; p=0.036) gave correct responses. A significantly higher proportion of students from Government schools (30.8 percent vs 19.6 percent, p=0.008). Concerning "Healthy Choices", 87.3 percent of students passed whereas the "Dietary Beliefs" section had the lowest pass rate of 30.8 percent. Of the 676 students who reported being exposed to nutritional information, 153 (22.64 percent) had the correct perception. However, 11.3 percent of the students who reported no previous exposure to such information passed (p=0.008). Religion, ethnicity and family history of chronic disease had no significant influence on students' perception. CONCLUSION: The majority of students sampled had an incorrect perception of a healthy diet. Perception varied with gender, exposure to nutritional information, type and geographic location of school attended.(Au)

Guidelines for young child feeding in the Caribbean - Part I

The guidelines for young child feeding have been developed and prepared as a supportive-tool primarily for health personnel involved in the care of infants and children in Caribbean countries. The recommendations address some practical aspects of nutrition before, during and after pregnancy. These are: The benefits of breastfeeding and strategies for its promotion, protection and support; review of infant feeding options for mothers with HIV and other infections; nutrition of the newborn; feeding of low birth weight infants and those with special requirements; replacement feeding for infants who are not breastfed; complementary feeding with emphasis on the continuation of breastfeeding for two years and beyond; guidelines on vitamin and mineral supplementation; management of feeding-related problems in early childhood; policy issues and nutrition education in relation to the promotion of adequate nutrition in early childhood.(Au)

Blood pressure is related to placental volume and birth weight

The objective of this study was to determine whether maternal nutrition and fetal and placental size program blood pressure. A longitudinal study linking the maternal anthropometric measurements of the first antenatal visit, ultrasound data of placental and fetal size, anthropometry at birth, and childhood growth and blood pressure was performed. The subjects were 428 women who attended the antenatal clinic at the University Hospital of the West Indies, Kingston, Jamaica, and their children, who were subsequently followed up. Systolic blood pressure at ages 1, 2, 2.5, 3, and 3.5 years was the main outcome measure. Pooling the data across ages, systolic blood pressure fell by 1.4 mm Hg for every 1-kg increase in birth weight (95 percent CI 0.2 to 2.7, P=0.02) and by 1.2 mm Hg for every 100 mL increase in placental volume at 20 weeks of gestation (95 percent CI 0.4 to 2.0, P=0.004). Blood pressure was also negatively associated with placental volume at 17 weeks and fetal abdominal circumference at 20 weeks. Measures of maternal nutritional status were strongly related to birth weight and placental volume but not directly to childhood blood pressure at these young ages. In conclusion, blood pressure is associated with fetal size in this population, as previously described among Europeans. We found associations between placental volume and abdominal circumference in the second trimester and childhood blood pressure, suggesting that the initiating events of blood pressure programming occur early in pregnancy. Measures of maternal nutritional status were not directly related to childhood blood pressure at these young ages but were strong predictors of both birth weight and placental volume, suggesting an indirect relation.(Au)

Nutrient content of five commonly consumed Jamaican foods

There is a dearth of food composition data for the foods and dishes most frequently consumed in Jamaica. Samples of five foods in their forms most commonly consumed by the Jamaican population (brown stewed chicken, rice and peas, boiled and roasted breadfruit, and steamed callaloo) were collected and analysed for proximates, dietary fiber, and minerals. Also determined were the cholesterol level of brown stewed chicken and the carotenoid content of steamed callaloo. National samples of mixed dishes were collected from 10 representative households while samples of single foods were purchased from 10 Jamaican markets and roadside vendors nationwide. Primary samples of each food were pooled to form composites from which analytical samples were drawn. Analytical results of brown stewed chicken and rice and peas revealed substantive amounts of protein, total fat, and several of the minerals. Steamed callaloo and boiled and roasted breadfruit were most noted for their potential contribution to dietary fiber and the minerals calcium, potassium, magnesium, and phosphorus. This is the first report on nutrient composition data for commonly consumed Jamaican foods.(Au)

Promoting national school feeding programmes in the Caribbean

School feeding programmes are of critical importance in the development of children today. Scientific research in the Caribbean and elsewhere provides evidence of the cognitive and nutritional benefits of adequately fed school children. Foods available to students through the various programmes have a clear role in realizing these positive effects. Based on this evidence, the Caribbean Food and Nutrition Institute advocates an appropriately administered school feeding programme that can contribute significantly to the achievement of adequate nutritional requirements of students. This is also seen as an effective strategy to develop students to achieve maximum academic and developmental capacities. The withdrawal of several external agencies that once supported these programmes has placed greater responsibility on Caribbean Governments to provide guidance and resources in the establishment of school feeding programmes. The effort should encourage schools to be actively and positively involved in creating an environment that supports the attainment and maintenance of optimal nutritional status with specific attention to dietary intake. School feeding programmes should be viewed as one of the strategies for instilling and promoting positive health habits in students (this should include physical activity). The success of these programmes will depend on the will of decision-makers at both the governmental and the school levels to meet the nutritional needs of their students. In addition, the school programme may need supportive public policy (probably including legislation), community participation and promotional activities.(Au)

Assessing your food intake

This issue of Nyam News seeks to help readers to understand why and how their health professionals require and extract information on their eating behaviour. A clear understanding of these issues will enable you to help your health worker to serve you better.

Knowing your health/nutritional status

"What you do not know cannot hurt you", is a popular saying but often, far from true when the issues concern health and nutrition. Many persons are likely to have a nutrition-related disorder without knowing. Over time, without corrective action they may develop health problems which could have been prevented or delayed had they paid more attention to their nutritional profile.

Culture-specific strategies for capturing local dietary intake patterns

To capture cultural reality and apply it to nutrition research, ethnographic research should be integrated with nutrition research and community-based nutrition research designs should be dictated by the local culture. Choosing the most appropriate dietary assessment for a study population requires attention to culture-specific technology for food acquisition, storage, exchange, processing, and preparation, as well as consideration of cultural rules pertaining to food distribution and consumption at the household level. Nutrition researchers should work with ethnographers to determine whether the assessment method used in a specific culture should capture the food intake of the household as a unit or of the individuals in each household.(AU)

Medical nutritional therapy in special diabetes situations

Diabetes management throughout the lifespan involves dealing with several situations where medical nutrition therapy can greatly influence the outcome using nutrition assessment techniques and selection as well as blood glucose records to guide intervention and evaluation. Special situations requiring nutritional intervention are: - Hyperglycemia - this needs nutrition assessment and intervention with goals for children, adults, the elderly and treatment options using carbohydrates and protein. - Exercise - this requires assessment of the influence of exercise on daily blood glucose fluctuations with apropriate nutritional recomendations. - Gestational diabetes - nutrition assessment and intervention regarding; carbohydrate and fat content, weight control and selecting the appropriate meal planning option or strategy. Medical nutritional therapy for complications such as: - Gastroparesis requires assessment of medical nutrition intervention, evaluation using blood glucose testing and intervention by selecting meal planning strategy. Renal disease requires assessment of medical nutrition intervention relating to protein and calories whilst selecting the meal planning strategy. - Cardiovascular disease requires assessment, nutrient modifications and intervention for the role of fat, hyperglycemia and alcohol as well as selecting a meal planning strategy. (AU)

Nutrition in early life - "long term effects" - Keynote Address

Most estimates indicate that during the next 20 years most of the morbidity and mortality in the world will be related to chronic diseases, such as cardiovascular disease, diabetes mellitus, some cancers and mental health. The aetiology of each condition is complex and multifactorial, but recent evidence shows that nutritional exposure during early life might be critical in determining individual susceptibility to a range of other environmental factors in the generation of chronic disease in adulthood. It is proposed that the underlying susceptibility originates through "programming" during fetal and early infant life. Thus, in response to a limited availability of nutrients the fetus adapts and this adaption results in a permanent change in organ structure and metabolic function, giving rise to the hypothesis of "Fetal Origins of Adult Disease". Across Britain there is a two-fold variation in cardiovascular disease which cannot be adequately explained by variations in lifestyle. Early studies suggested they may be explained by differences in the physique and growth of young women, the growth of their babies in utero and during infancy, and the consequent lifelong differences in the physiology and metabolism of the offspring. Novel epidemiological studies by Barker and colleagues in Southampton allowed exploration of these ideas using detailed maternity and health visitors records which have been kept from the early years of this century. Babies born fifty years ago were traced and their size at birth and one year of age related to the occurrence of cardiovascular disease in later life. Amongst 10,000 men in Hertfordshire who had lower birthweight and remained lighter than average at one year of age the risk of death from heart disease was three times that of men at the upper end of normal. Small size at birth is also associated with high blood pressure and diabetes, high serum cholesterol and disordered blood coagulation. The lightest babies at birth were ten times more likely to develop the metabolic syndrome of hypertension, impaired glucose tolerance and raised blood lipid levels than those who were heaviest at birth. Stroke is also increased in those with a lower birth weight. These relationships are even more evident in babies in whom growth is disproportionate, thus thinner babies are more likely to develop non-insulin diabetes mellitus as adults.(Au) [truncated at 2500 characters]