Effect of response to a low-fat diet among adolescent males on their adult blood cholesterol levels.

BACKGROUND: While primary prevention of adult cardiovascular diseases should begin early, there are problems in identifying children at increased risk of future disease. METHODS: We did a follow-up study in 1991-1992 of 100 male former students at a boarding high school who had blood cholesterol measured in 1970-1971 both prior to and following a school-wide, reduced-fat dietary intervention. We compared adult cholesterol levels of the 50 subjects whose cholesterol decreased > or = 16.5% (the median decrease) following the 1970-1971 intervention (Diet-Sensitive) with the 50 whose response was < 16.5% (Non-Diet-Sensitive). RESULTS: Blood cholesterol of adults who were Diet-Sensitive in 1970-1971 was 4.2 mg/dl lower than their baseline values in adolescence, while adults classified as Non-Diet-Sensitive as adolescents showed a 15.9 mg/ dl increase in cholesterol over 21 years. Adjusting for baseline adolescent values, Non-Diet-Sensitive subjects were 4.8 (95% CI 1.4, 15.9) times as likely as Diet-Sensitive subjects to have adult cholesterol > or = 200 mg/ dl. Also, Diet-Sensitive adults on a low-fat diet had adult blood cholesterol levels > 20 mg/dl lower than Non-Diet-Sensitive adults on a similar diet (180.1 vs 202.1 mg/dl, respectively). CONCLUSIONS: Degree of response to a low-fat, low-cholesterol diet during adolescence may identify male subjects who will have differing patterns of cholesterol change over time.

National Dairy Council Award for Excellence in Medical/Dental Nutrition Education Lecture, 1993: some early beginnings and what now?

In 1942 the Department of Nutrition was established at Harvard University jointly in the schools of public health and medicine. It continues to stimulate and expand the teaching of nutrition in these schools, as well as in the school of dental medicine and similar schools in other universities. Nutrition is so broadly involved in health and disease that it should be woven, in an organized fashion, into many of the standard courses in these and other health professional schools. A separate, more detailed course in nutrition may be made available for those who wish to learn more about nutrition. Exposing nutrition quackery and other types of nutrition misinformation should be part of any program in nutrition education, particularly in schools of medicine, public health, and dentistry. Stimulating the teaching of nutrition in schools for health professionals requires the enthusiastic support of the dean and faculty as well as adequate financial support.

Unproven diet therapies in the treatment of the chronic fatigue syndrome.

This report is a review of the unproven diet therapies recommended for individuals with chronic fatigue syndrome (CFS). Diet therapies promoted for the relief of CFS symptoms by the authors of five CSF self-help books were evaluated on the basis of nutritional adequacy and scientific rationale. Unproven diet therapies for patients with CFS include megavitamin/mineral supplements; royal jelly and other dietary supplements; and elimination, avoidance, and rotation diets. Claims that these therapies relieve CFS symptoms and promote recovery are anecdotal and have not been substantiated by clinical research. The yeast-avoidance and sugar-free diets, both promoted to combat Candida albicans overgrowth, are of questionable value in treating patients with CFS. The rotation diet is not balanced and does not meet the current recommended dietary intake levels. Diet strategies that call for the avoidance of food additives, preservatives, sweeteners, and other ingredients are not supported by available evidence and are not practical for patients with CFS. A diet plan for patients with CFS should be based on sound nutritional principles and common sense. Until the results of studies demonstrating the benefits of particular diet therapies in the management of CFS are available, patients with CFS are advised to eat a varied diet selected from among and within the basic food groups to ensure an adequate nutrient intake and to reach and maintain a reasonable body weight.

Use of fat-modified food products to change dietary fat intake of young people.

Food purchasing and preparation practices were modified in two boarding high schools to increase the polyunsaturated-to-saturated fat ratio (P/S) of the diet of students by changing food products rather than attempting to change eating behaviors. During years when fat-modified products were served, the P/S of males increased by 75 percent, versus a decrease of 6 percent during control years. For females, P/S increased by 53 percent during intervention years, versus an increase of 6 percent during control years.

Effects on blood pressure of a decrease in sodium use in institutional food preparation: the Exeter-Andover Project.

To judge the effect on blood pressure, sodium intake of students at two boarding high schools was reduced by 15-20% through changes in food purchasing and in preparation practices in the schools' kitchens. Students were not asked to change their usual eating habits. Each school served alternately as the control or intervention school for one school year. Blood pressure was monitored among 341 subjects during control years and 309 subjects during intervention years. Analysis of blood pressure differences between early in the school year and near the end of the school year, with adjustment for sex and initial blood pressure, showed the effect of the dietary intervention to be -1.7 mmHg for systolic (95% CI = -0.6, -2.9, p = 0.003) and -1.5 mmHg for diastolic pressure (95% CI = -0.6, -2.5, p = 0.002). Such modest and easily attainable changes in sodium intake, if maintained, could have a significant effect on the future risk of essential hypertension among young people.

The environmental component: changing school food service to promote cardiovascular health.

An environmental program directed at the food service departments of two boarding high schools has been tested in a concurrently controlled longitudinal investigation in which the intervention was applied to each school in alternate years. It has been demonstrated that changes in food purchasing and preparation practices can markedly decrease sodium and modify the fat composition of foods, and that such practices result in significant changes in the nutrient intake of students. Even without an educational component for students, who maintained their usual dietary practices, the changes by food service workers led to 15-20% less sodium intake, 20% less saturated fat intake, and an increase in the P/S ratio from 0.46 to 0.84 among students. The change in sodium intake over a school year resulted in lower blood pressure among students receiving the intervention. Adjusting for sex and baseline blood pressure, the estimated effect of the intervention on systolic pressure was -1.7 mmHg (95% C.I. -0.6, -2.9; p = 0.003); for diastolic pressure, it was -1.5 mmHg (95% C.I. -0.6, -2.5; p = 0.002). Such modifications by school food service workers are well accepted and produce very palatable foods. The widespread dissemination of such practices could favorably affect cardiovascular risk factors of students everywhere.