Behind the scenes of doctors' nutritional advice: the infrastructure of nutrition information that is used in practice.

Though this sixth Heelsum meeting has concentrated on over- and under-nutrition, GPs in their work look after patients with a wide range of diseases that may be helped by different dietary managements (van Weel C. Morbidity in family medicine: the potential for individual nutritional counselling, an analysis from the Nijmegen Continuous Morbidity Registration. Am J Clin Nutr 1997; 65 (suppl 6): 1928s-32s). Much attention is paid to evidence from randomized controlled trials (RCTs). However, most of the nutrition advice by physicians has to be based on accumulated evidence from different sources other than Cochrane reviews and RCTs (Truswell AS. Levels and kinds of evidence for public-health nutrition. Lancet 2001; 357: 1061-2; Truswell AS. Some problems with Cochrane reviews of diet and chronic disease. Eur J Clin Nutr 2005; 59 (suppl 1): s150-4). This paper will briefly review the informational infrastructure of human nutrition, being regularly updated, that is in the background of doctors' advice on diets to their patients. The main parts of this nutrition information include: (i) recommended nutrient intakes/dietary reference intakes, (ii) dietary goals and guidelines, (iii) textbooks of human nutrition, (iv) chapters on nutrition in medical textbooks, (v) ABC of Nutrition, written for GPs and (vi) lastly, a new book about the research on diet and coronary heart disease (CHD) in the 20th century contains the main pieces of evidence that underlie today's nutrition guidance both to people at risk of CHD and for the general community.

Cerebrovascular disease in 48 countries: secular trends in mortality 1950-2005.

BACKGROUND: Cerebrovascular disease (stroke) is the second most common cause of death and among the top five causes of morbidity in many developed and developing countries. The aim of this study was to investigate patterns of increase and decrease in stroke mortality in 48 different countries. METHODS: The mortality curves of stroke for 48 countries that had reliable data and met other selection criteria were examined using age standardised death rates for 35-74 years from the WHO. Annual mortality rates for individual countries from 1950 to 2005 were plotted and a table and graph were used to classify countries by magnitude, pattern and timing of stroke mortality. Male and female trends were plotted separately. RESULTS: The secular trend of stroke mortality varied markedly among countries. Different stroke patterns were distinguishable, including 'declining', 'rise and fall', 'rising' and 'flat'. Furthermore, epidemic peaks per 10(5) (M/F) were higher in Asia, in particular in Japan (433/304), Russian Federation (388/221) and Bulgaria (301/214), and were lowest in Canada and Australia (29/18). There were considerable differences among some continental and regional geographic areas. For example, Japan, Belgium, Portugal and Eastern Europe exhibited a rise and fall pattern while other countries fell into the other three categories. CONCLUSIONS: In many countries, stroke mortality has decreased, between 1950 and 2005, often very considerably. The different dates of mortality downturn likely are consistent with the implementation of various prevention strategies. This could be translated to policy interventions for stroke control in countries with a rising trend of the disease.

Dietary approaches that delay age-related diseases.

Reducing food intake in lower animals such as the rat decreases body weight, retards many aging processes, delays the onset of most diseases of old age, and prolongs life. A number of clinical trials of food restriction in healthy adult human subjects running over 2-15 years show significant reductions in body weight, blood cholesterol, blood glucose, and blood pressure, which are risk factors for the development of cardiovascular disease and diabetes. Lifestyle interventions that lower energy balance by reducing body weight such as physical exercise can also delay the development of diabetes and cardiovascular disease. In general, clinical trials are suggesting that diets high in calories or fat along with overweight are associated with increased risk for cardiovascular disease, type 2 diabetes, some cancers, and dementia. There is a growing literature indicating that specific dietary constituents are able to influence the development of age-related diseases, including certain fats (trans fatty acids, saturated, and polyunsaturated fats) and cholesterol for cardiovascular disease, glycemic index and fiber for diabetes, fruits and vegetables for cardiovascular disease, and calcium and vitamin D for osteoporosis and bone fracture. In addition, there are dietary compounds from different functional foods, herbs, and neutraceuticals such as ginseng, nuts, grains, and polyphenols that may affect the development of age-related diseases. Long-term prospective clinical trials will be needed to confirm these diet-disease relationships. On the basis of current research, the best diet to delay age-related disease onset is one low in calories and saturated fat and high in wholegrain cereals, legumes, fruits and vegetables, and which maintains a lean body weight. Such a diet should become a key component of healthy aging, delaying age-related diseases and perhaps intervening in the aging process itself. Furthermore, there are studies suggesting that nutrition in childhood and even in the fetus may influence the later development of aging diseases and lifespan.

Search for the most complete multivitamin.

The group descriptor "multivitamin" doesn't guarantee that all vitamins are included in the product or that they are present in proportion to nutritional requirements. In fact the great majority of multivitamin preparations do not contain all the 13 established vitamins. We have reviewed the stated composition of all vitamin products registered with the Australian Therapeutic Goods Administration. All containing fewer than five vitamins were excluded and so were those containing non-culinary herbs or amino acids, or intended only for export, or designed for children and pregnancy or in the form of powder and injections. 163 multivitamins were left for scoring. One point was awarded for each vitamin but a point was deducted if the amount was below or clearly above the Recommended Dietary Intake (RDI). We found two multivitamin preparations containing 13 vitamins at levels close to the RDIs: Centrum Complete (our score 11) and Centrum Select 50+ (score 10); five multivitamins containing 12 vitamins: the best Avon Women's Complete (score 12) and Pluravit (score 10). Others contain fewer vitamins (or scored less than 10). Centrum and Pluravit are available at major outlets and their cost is moderate. We recommend that these most complete multivitamins should be clearly listed in MIMS and dispensed in public hospitals when " Rx multivitamins" is prescribed. People who take a multivitamin supplement to insure that they obtain their vitamin requirements would be best to ask for a multivitamin that contains all (or nearly all) the 13 true vitamins.

Nutrition guidance by family doctors in a changing world: problems, opportunities, and future possibilities.

During the Third Heelsum International Workshop, Nutrition Guidance of Family Doctors Towards Best Practice, December 10-12, 2001, Heelsum, the Netherlands, 17 papers were presented. Each paper was discussed by all the participants at the workshop. These discussions were tape-recorded, transcribed, rearranged into topics, and summarized here. There are situations that call for nutrition advice to be given by general practitioners (GPs). GPs are trusted, they are not selling any particular food, and patients accept that their GPs may talk to them about diet. Compared with dietitians, GPs have much less time to advise about diet, so they must condense information. It is easier for a GP to give dietary advice if the patient is registered on the practice's list and if the GP can be paid for preventive work. Six topics seemed to be particularly new and challenging in our changing world: (1) Use of dietary supplements, herbal preparations, and functional foods; (2) patients as partners; (3) computers in practices; (4) evidence-based medicine; (5) the Internet; and (6) the obesity epidemic. These topics were reported as problems and then discussed as opportunities. The aim of the Heelsum Collaboration on General Practice Nutrition was to facilitate the nutrition work of GPs in their practices by researching the problems and barriers and by testing solutions. In line with this aim, some suggestions for research are provided.