YANA Notes for September, 1999
Summary of a Scientific Conference on Preventative Nutrition:
Pediatrics to Geriatrics

The note below summarizes the recent article reporting a consensus on preventative nutrition by the American Heart Association, American Cancer Society, American Dietetic Association, American Academic of Pediatrics, the National Institutes of Health, and the American Society for Clinical Nutrition.  This has been referred to as the Universal Dietary Guidelines.  The citation is:  Deckelbaum, et al., Circulation, 100:4 (27 July 1999), 450-456.  The complete article is also online at the American Heart Association's web site.

The common links between specific nutritional factors and risks for chronic diseases are shown in the table below.

                                                                                                                                  Disease Risk

Dietary intake	Cancer	Atherosclerosis	Obesity	Diabetes
High calories	X	X	X	X
High total and/or saturated fat	X	X	X	X
High salt	X	X	...	X
Low fiber and complex carbohydrates	X	X	...	X
Low antioxidants	X	X	...	X

X indicates increased risk; … indicates no known association with the disease

                                                                                                                         Disease Risk

Disease mechanism	Cancer	Atherosclerosis	Obesity	Diabetes
Insulin resistance	-	+	+	+
Cell proliferation	+	+	-	+
Inflammation	+	+	-	+
Apoptosis	+	+	-	+
Changes in signal transduction/          gene expression	+	+	+	+
DNA modifications/mutations	+	+	+	+

+ indicates that there is an association between the disease risk and the disease mechanism;
- indicates that there is no association presently known between the two factors

One of the most important activities of the panel was to review the evidence from a wide body of literature on the relationship between nutrition and disease.  While there are still specific diseases that are related to certain dietary factors, such as high intake of saturated fat and colon cancer, the overall objective was to arrive at the consensus.  The recommendation is that the diet should be used by everybody over the age of 2.  Part of the report gives suggestions for specific needs of "special" populations.  Children should be phased into the diet between the ages of 2 and 5.  Children older than 5 should particularly pay attention to dietary fat intake.  Other special populations are the elderly, women, and minorities.  Specific research recommendations are made for these populations.

The consensus recommendations from the different organizations are:

•  Saturated fats:  less than 10 percent of calories
•  Total fat:  less than 30 percent of total calories
•  Polyunsaturated fat:  less than or equal to 10 percent of total calories
•  Monounsaturated fat:  less than or equal to 15 percent of total calories
•  Cholesterol: less than or equal to 300 milligrams per day
•  Total calories: to achieve and maintain desirable weight
•  Salt intake: limited to less than 6 grams per day

•  Eating a variety of foods
•  Balancing food with physical activity to maintain or improve your weight
•  Choosing a diet with plenty of grain products, vegetables, and fruits
•  Choosing a diet low in fat, saturated fat, and cholesterol
•  Choosing a diet moderate in sugars
•  Choosing a diet moderate in salt and sodium
•  If you drink alcoholic beverages, do so in moderation.

Older women who are breast cancer survivors are willing to take hormone (estrogen) replacement therapy when the risk of breast cancer recurrence is small and severe symptoms of menopause are present. Implication:  Physicians are starting to take a look at hormone replacement therapy as a genuine alternative for women with a history of breast cancer. Ganz et al., Cancer, 86:5 (1 September 1999), 814-820.

No survival advantage was found for a low fat diet after a diagnosis of breast cancer; however, increased survival was found for women eating more protein, but not red meat.  Implication:  More studies need to examine the protein finding to determine whether this advantage is more widespread.  Holmes, et al., Cancer, 86:5 (1 September 1999), 826-835.

The effectiveness of breast self-examination can be improved by followup training; this study reports that a slight advantage to using a vertical rather than a radial pattern for self-examination; using breast models results in better self-examination; reminders improve compliance, but the effect is over when the reminders cease.  Clarke and Savage, Cancer Nursing, 22:4, 320-326.

Patients with four or more involved lymph nodes have a significantly worse outcome after relapse than node-negative patients; in this study, the authors conclude that these also represent a marker of an aggressive phenotype of breast cancer.  Implication:  Patients with four or more involved lymph nodes should be considered to have an aggressive form of breast cancer.  Jatoi et al., J. Clin Onc, 17:8 (August, 1999), 2334-2340.