4 questions | Applied Sciences homework help

1. Drink water instead of sugary drinks. Cut calories by drinking water or unsweetened beverages. Soda, en- ergy drinks, and sports drinks are a major source of added sugar, and calories, in American diets.

Part Three Nutrition and Fitness184 only partially breast-fed, the AAP recommends iron- fortified formulas. The Federal Food, Drug, and Cosmetic Act defines infant formula as “a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of human milk or its suitability as a complete or partial substitute for human milk.”15 Formulas include powders, concentrated liquids, or ready-to-use forms. Most formulas on the market are cow milk-based and some are free of the milk sugar lactose. Hydrolyzed formulas, which have smaller, more easily digestible protein molecules than other formulas, may be recommended for infants at risk of developing food allergies. So-called hypoallergenic formulas are recommended for babies who have food allergies, but who aren’t breast-fed. Soy-based and various formulas for infants with special needs are also available. The FDA specifies that infant formulas contain minimum amounts for 29 nutrients and maximum amounts for 9 of those nutrients. Parents should obtain advice from their child’s health-care provider regarding infant feeding. The AAP Web site (www.healthychildren.org) offers guidance on choosing a formula; preparing, sterilizing, and storing formula; the amount and schedule of feedings; switch- ing to solid foods; and other issues in infant and child nutrition. The most comprehensive nutrition guidelines16 for infants and toddlers were published in 2004 through a joint effort of the American Dietetic Association (ADA) and Gerber Products Company with help from outside consultants. The following suggestions are consistent with these guidelines. Children younger than 2 are not “little adults.” Un- like adults, they do not require variety to secure nutrition during the first 6 months or so of life. Except for fluoride and vitamin D (in the absence of sunlight), human milk alone provides the vitamins, minerals, carbohydrates, fats, and proteins needed for normal growth and develop- ment during early infancy. After 6 months, most infants need supplementary foods to meet current recommen- dations for energy, manganese, iron, fluoride, vitamin D, vitamin B6, niacin, zinc, vitamin E, magnesium, phosphorus, biotin, and thiamin. Single-grain cereal is often the first food added. Other single-ingredient foods can be added gradually until the baby is eating a variety of foods. New foods should be added one at a time, at intervals of a few days. This allows the baby to get used to the flavor of the food and can reveal whether a food might not agree with the baby. There is no evidence that introducing supplemental foods in any specific sequence or at any specific rate is beneficial. Repeated exposures are often necessary before a particular food is accepted. From 6 months to 3 years of age, children require fluoride supplementation only if the water supply is severely deficient in fluoride (less than 0.3 ppm). This should be discussed with the child’s doctor. Although healthy infants can vary considerably from one another in their caloric intake, appetite is likely to be the most efficient way to determine what an infant needs. Most infants instinctively know how much food they need and will not undereat or overeat unless pres- sured. Babies should be fed when hungry but should not be forced to finish the last few ounces of formula or food. Physicians routinely check whether growth and development are progressing normally. Although low-fat and low-cholesterol diets are widely recommended for adults, they are not appropri- ate for children younger than age 2. Infants require fat in their diet for normal growth and development. Bottles of milk or juice or a pacifier dipped in honey should not be used to put a baby to sleep because prolonged contact with their natural sugars can cause tooth decay usually referred to as “baby bottle decay.” Artificially sweetened foods should be avoided because they lack the calories that growing babies need. Infants are born with enough stored iron for 4 to 6 months. During this period, human milk or cow milk– based formulas usually supply sufficient amounts of zinc and calcium. After that, iron is more likely than any other nutrient to be lacking in the infant’s diet. For this reason, special efforts should be made to provide infants with iron during the first 2 years. In addition to breast milk, the best sources are meats and poultry, iron- fortified formula, and iron-fortified infant cereal. Dietary sources of zinc include oat cereals, meats and poultry, wheat germ, egg yolk, and cheddar cheese. Calcium is abundant in milk and other dairy products. Infants with a strong family history of food allergy should be breast-fed for as long as possible and should not receive complementary foods until 4 to 6 months of age. In 2008, the American Academy of Pediatrics17 concluded that there are insufficient data to conclude that further exclusion will prevent allergies from developing. vegetariaNisM Vegetarians are individuals who restrict or eliminate foods of animal origin (meat, poultry, fish, eggs, milk) from their diet. The main reasons people choose a Chapter Ten Basic Nutrition Concepts 185 vegetarian alternative are: (a) they think it is healthier, (b) they think it is more “natural,” (c) they think it is more “ecologic” because it takes less energy to produce vegetarian food than animal products, and (d) they are following religious or moral dictates. Vegetarians can be classified into categories based on which foods they exclude from their diet: Vegans or strict Vegetarians: Eat no animal products at all. lactoVegetarians: Consume milk and other dairy products in addition to plant foods. This form of vegetarianism is common among Seventh-day Adventists. lacto-oVo-Vegetarians: Eat no meat, poultry, or fish, but do eat eggs and milk products. Pesco-Vegetarians: Eat no meat but include fish, eggs, and milk products. semi-Vegetarians: Eat no red meat, but do include small amounts of poultry and/or fish in their diet. Possible Benefits of Vegetarianism Vegetarianism based on sound nutrition principles can be a healthful lifestyle choice, but neither vegetarians nor omnivores have a monopoly on healthful eating. Similar health benefits can be gained from well-selected diets of either type. The following are possible advantages of a vegetarian diet.

• Vegetarians, especially those who abstain from all animal foods, tend to eat less fat and have a lower body weight for their height than nonvegetarians do.
• Vegetarians have less constipation than meat-eaters. • Vegetarianism, as practiced by Seventh-day Adventists, has been associated with lower death rates from certain cancers (although abstention from tobacco and alcohol may be responsible for this).
• Vegetarianism may be associated with a lower incidence of atherosclerotic heart disease, high blood pressure, and diabetes. Lower body weight and/or nondietary factors may be contributory factors.

Possible Risks of Vegetarianism Vegetarians of all types can achieve recommended nutrient intakes through careful selection of foods. To avoid deficiencies, however, careful attention must be paid to food selection. Dr. William T. Jarvis has encoun- tered many tragedies in which cultlike adherence to a vegetarian ideology led people to starve themselves or their children to death or to substitute an ineffective “diet cure” for proven medical treatment.18 Foods of both animal and vegetable origin provide protein. However, proteins vary in nutritional quality because they differ in the kinds and amounts of amino acids they contain. Proteins from meat, fish, poultry, milk, and eggs rate the highest because they supply all of the essential amino acids in about the same propor- tions as those needed by the body. The proteins from some legumes (particularly soybeans and chickpeas) are close in nutritional quality to those from animal sources. Combining a small amount of animal protein with plant foods helps to improve the overall protein quality of the diet. High-quality protein can also be obtained by con- suming plant foods that are complementary; in other words, the essential amino acids insufficient in one food are provided by another food with an adequate amount. Succotash is an example of a high-quality mixture of complementary foods (corn and lima beans). Unless they choose a proper balance of foods, strict vegetarians are at risk for several deficiencies, especially vitamin B12. They also risk deficiencies of riboflavin, calcium, iron, and the essential amino acids lysine and methionine. Vegetarian children not exposed to sunlight are at risk for vitamin D deficiency. Zinc deficiency can occur in vegans because the phytic acid in whole grains binds zinc, and there is little zinc in fruits and vegetables. Since B12 is present only in animal foods and a limited number of specially fortified foods, vegans should prob- ably take B12 supplements prescribed by a physician. Strict vegetarianism is not desirable for children younger than 5 because it is difficult for vegans to meet children’s high requirements for protein and some other nutrients. Growing adolescents may have difficulty get- ting adequate caloric and nutrient intake from a vegan diet. Vegetarianism is not a good idea for pregnant or lactating women. The American Dietetic Association19 has published a detailed position statement on vegetarian diets. What Vegetarians Should Eat It is advisable for vegetarians to select a variety of items daily from each of the following groups: Protein grouP: Dried beans and peas, lentils, nuts, and eggs. grain anD cereal grouP: Whole grain and enriched breads, cereals, pasta, crackers, and other grain products. fruit anD Vegetable grouP: All fruits and vegetables, includ- ing a citrus fruit daily and a leafy green or bright yellow vegetable every other day. milK anD milK ProDucts grouP: Milk, yogurt, cheese, and other foods made with milk. This group is especially important for infants, children, and pregnant and nursing women because milk is the single best dietary source of calcium. Those who avoid milk products should give special attention to their intakes of protein, iron, and vitamin B12, as well as calcium and vitamin D. Part Three Nutrition and Fitness186 “Fast Food” The term “fast food” applies to the speed with which a food is prepared and served rather than the nature or composition of the food. Sometimes these foods are accused of being “junk foods” or of having “empty calories.” Many fast foods are very high in sodium, fats, and calories. Individuals who eat at fast food outlets can satisfy food group and dietary guidelines by including salad selections and other low-fat items. NutrieNts oF special coNcerN Certain nutrients should be of special concern to con- sumers. Intakes of iron (Chapter 17), fluoride (Chapter 7), folic acid (folate), calcium, and vitamin D are insuf- ficient and should be increased in some segments of the population. Sodium is consumed in excessive amounts by many people. Folic Acid Studies have shown that women who have adequate folic acid intake during the months before and after conception have about half the incidence of neural tube defects (NTDs) among their offspring. These birth de- fects include spina bifida and other abnormalities caused by failure of the spinal column to close during the first month after conception, which leaves parts of the spinal cord exposed. To reduce the risk, the U.S. Preventive Services Task Force20 advises all women of childbearing age who are capable of becoming pregnant to consume 400 to 800 μg of folic acid per day. Dietary guidelines for pregnant women are discussed in Chapter 19. Folic acid is found in liver, green leafy vegetables, legumes, wheat germ, yeast, egg yolk, beets, whole wheat bread, fortified cereal, and citrus fruits and juices. It is also added to most enriched grain products. Al- though well-balanced diets provide adequate amounts of folic acid, some women still fall below the recommended amount. In 1993 the FDA approved health claims for supplement labels stating that women who consume enough folate may reduce the risk of having a child with an NTD. Calcium Calcium, along with fluoride and vitamin D, is essential for the proper formation and maintenance of bones and teeth. Osteoporosis (thinning of the bones) is a common disease in the aged, especially in women (see Chapter 19). Although hormonal problems may be more impor- tant than diet in the development of osteoporosis, the significance of dietary calcium, fluoride, vitamin D, and weight-bearing exercise should not be overlooked. A 1994 National Institutes of Health Consensus Statement warned that a large percentage of Americans were failing to meet recommended guidelines for optimal calcium intake.21 The currently recommended daily intakes are 700 mg from ages 1–3; 1000 mg from ages 4–8; 1300 mg from ages 9–18; 1000 mg from ages 19–50; 1000 mg for men and 1200 mg for women ages 51–70; and 1200 mg at age 71 and older.22 Milk is the most common source of calcium, but cheese, yogurt, and other foods made with milk also pro- vide significant amounts. Sardines and canned salmon, if eaten with the bones, are rich in calcium. Dark green leafy vegetables such as spinach and broccoli contain some calcium in absorbable form. It is difficult to in- gest adequate amounts of absorbable calcium if dairy products are eliminated from the diet. Women should discuss with their physicians how to ensure adequate intake of calcium through intake of dairy products and/ or supplementation. This is especially important for lactose-intolerant individuals who restrict their intake of milk to avoid the unpleasant symptoms of irregular lactose digestion. Vitamin D Vitamin D is essential for promoting calcium absorption in the gut and maintaining the blood calcium and phos- phate levels needed for bone growth and maintenance. Together with calcium, vitamin D helps protect older adults from osteoporosis. Vitamin D is naturally present in some foods, added to others, and available as a dietary supplement. It is also produced within the body when ultraviolet rays from sunlight strike the skin. Much recent attention has focused on vitamin D because studies suggest that it may play a major role in the prevention of cancer23 and several other diseases. There has also been widespread concern that Americans are not getting enough.24 However, in 2010, the IOM25 concluded:

• Aside from bone health, current evidence does not support other benefits for vitamin D or calcium intake.
• 600 IUs daily meets the needs of almost everyone in the United States and Canada, although people 71 and older may require as much as 800 IUs per day because of potential physical and behavioral changes related to aging.
• Higher levels have not been shown to confer greater benefits and have been linked to other health problems.
• Whereas the average total intake of Americans is below the median requirement, national surveys show that average blood levels of vitamin D are above the 20 nanograms per milliliter needed for good bone health for practically all individuals.

Chapter Ten Basic Nutrition Concepts 187

• Except for institutionalized elderly and dark-skinned people, most Americans are getting enough vitamin D.
• The number of people with vitamin D deficiency in North America may be overestimated because many laboratories appear to be using standards that are much higher than the IOM committee considers appropriate.

Sodium The relationship of sodium intake to high blood pres- sure (hypertension) is of concern because hypertension is an important risk factor in coronary heart disease and stroke. However, sodium intake has not been proven to cause hypertension to develop.26 Approximately 80% of Americans are not genetically predisposed to hyperten- sion. One-third of the remaining 20% appear to be sensi- tive to sodium; they may be exposed to a higher risk if they consume excess amounts of sodium. Treatment of people with medically diagnosed hypertension will in- clude sodium restriction for those who are salt-sensitive. This subject is discussed in Chapter 15. The average American consumes approximately 10 to 12 g (2 to 2½ teaspoons) of salt per day, of which 3 g occur naturally in foods, 4 to 6 g come from salt or salt-containing ingredients added during food process- ing, and 3 to 4 g is discretionary intake (from the salt shaker). Since salt is about 40% sodium, this amounts to 4 to 5 g of sodium daily. Food labels (see below) list a Daily Value of 2.4 g per day for sodium, the amount contained in 6 g of salt. The National Research Council and various government agencies have concluded that reducing salt intake to 3 g per day (which would require eliminating the use of salt in cooking and at the table) would not be harmful and would improve the health of the population. However, most people are not harmed by higher levels, and habits, cultural preferences, and culinary customs are difficult to change. Significant amounts of sodium are contained in cured and processed meats, salted snacks, pickled and canned foods, and many frozen convenience foods. Even the small amounts of baking powder, flavor enhancers, and other additives in some foods contain sodium. Many manufacturers have reacted to recent health advice by producing more low-salt and no-salt products. Consum- ers who wish to limit their salt intake should check food labels. Sodium is also present in antacids, laxatives, and other drugstore items. When a household water-softening system replaces calcium (“hardness”) with sodium, having a kitchen faucet reserved for untreated water is another prudent strategy for sodium reduction. NutritioN laBeliNg The USDA regulates the labeling of meat and poultry products. The FDA regulates the labeling of nearly all other foods. Modern nutrition labeling began in 1974 when these agencies established voluntary rules requir- ing nutrition information on the labels of products that contained added nutrients or that carried nutrition claims. Since 1993 rules have been published to provide for consistent, scientifically based labeling for nearly all processed foods.27,28 The new rules, which took effect in 1994, provided a basic format for the nutrition panel, which must be titled “Nutrition Facts.” This panel must not only list the significant nutrients in the product, but also must Nutrient Daily Value Total fat* 65 g Saturated fat* 20 g Cholesterol* 300 mg Sodium* 2400 mg Potassium* 3500 mg Total carbohydrate* 300 g Fiber* 25 g Protein* 50 g Vitamin A 5000 IU Vitamin C 60 mg Calcium 1000 mg dailY values (dvs) For Food laBels27 Table 10-3 *Based on 2000 calories a day for adults and children older than 4. The values for total fat, saturated fat, and cholesterol are maximums. The FDA has also issued Daily Values for infants, children younger than 4, and pregnant and lactating women.29 Nutrient Daily Value Iron 18 mg Vitamin D 400 IU Vitamin E 30 IU Vitamin K 80 µg Thiamin 1.5 mg Riboflavin 1.7 mg Niacin 20 mg Vitamin B6 2 mg Folate 400 µg Vitamin B12 6 µg Biotin 300 µg Nutrient Daily Value Pantothenic acid 10 mg Phosphorus 1000 mg Iodine 150 µg Magnesium 400 mg Zinc 15 mg Selenium 70 µg Copper 2 mg Manganese 2 mg Chromium 120 µg Molybdenum 75 µg Chloride 3400 mg Part Three Nutrition and Fitness188 indicate how the amounts of certain ingredients are related to recommended levels. These relationships are expressed as “% Daily Values.” Daily Values (DVs) are derived from two sets of reference values: Reference Daily Intakes (RDIs) and Daily Reference Values (DRVs), neither of which ap- pears on the labels themselves. The RDIs cover 12 vitamins and 7 minerals. The DRVs, which are used for fat, carbohydrates, protein, fiber, sodium, and potassium, are based on a diet containing 60% carbohydrate, 10% protein, 30% fat (including 10% saturated fat), and 11.5 g of fiber per 1000 calories. DVs for cholesterol, sodium, and potassium are the same regardless of calorie level. For labeling purposes, Percent Daily Values are based on a diet of 2000 calories. This approximates the maintenance level for many postmenopausal women, the group most often targeted for weight reduction. Where space permits, the label must include DVs for both 2000- and 2500-calorie diets, and manufacturers are permitted to indicate DVs for other calorie levels. Table 10-3 lists the DVs for adults and children older than 4. Figure 10-2 illustrates the “Nutrition Facts” panel required on most food labels. Other provisions include customary serving sizes and definitions for descriptive terms such as “light,” “low fat,” and “high fiber.” Table 10-4 defines the conditions under which terms such as “light” or “low-fat” are legally permitted. The FDA estimates that about 90% of processed food should carry nutrition information. In addition, uniform point-of-purchase nutrition information should accompany many fresh foods, such as fruits, vegetables, % Daily Value shows how a food fits into the over- all daily diet. Some daily values are maximums, as with fat, whereas others are minimums, as with carbohydrates. The Daily Values are based on daily diets of 2000 and 2500 calories. Individuals should adjust these values to fit their own calorie intake. (Moderately active people consume about 15 calories per day for each pound of body weight.) The nutrients required on the nutrition panel are those considered most important to the health of today’s consumers, most of whom need to be concerned about getting too much of certain items (such as saturated and trans fat) rather than too few (as was the case years ago with certain vitamins). Serving sizes, stated in both household and metric measures, reflect the amounts that people actu- ally eat. Calories from fat are shown to help consumers meet dietary guidelines, which recommend that people get no more than 30% of their calories from fat, with satu- rated and trans-fats kept as low as possible. Figure 10-2. Sample food label. Fats, carbohydrates, and proteins provide energy (calories). Nutrition Facts Serving Size 1 cup (228g) Servings Per Container 2 Amount Per Serving Calories 250 Calories from Fat 110 % Daily Value* Total Fat 12g Saturated Fat 3g Trans Fat 3g Cholesterol 30 mg Sodium 470mg Total Carbohydrate 31g Dietary Fiber 0g Sugars 5g Protein 5g Vitamin A Vitamin C Calcium Iron * Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs. Calories: 2,000 2,500 Total Fat Less than 65g 80g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Sodium Less than 2,400mg 2,400mg Total Carbohydrate 300g 357g Dietary Fiber 25g 30g 18% 15% 10% 20% 10% 0% 4% 2% 20% 4% Chapter Ten Basic Nutrition Concepts 189 free or without: An amount that is nutritionally trivial and unlikely to have a physiological consequence. calorie free: Fewer than 5 calories per serving. sugar free: Less than 0.5 g per serving of monosaccharides and/or disaccharides. soDium free or salt free: Less than 5 mg per serving. A claim made for a food normally free of or low in a nutrient must indicate that the situation exists for all similar foods. For example: “spinach: a low-sodium food.” Labels of foods containing insignificant amounts of ingredients (such as baking soda or sodium ascorbate) commonly understood to contain sodium must use an asterisk to refer to a note below the ingredient list that the amount of added sodium is trivial. low or little: Low enough to allow frequent consumption without exceeding the dietary guidelines. Generally less than 2% of the Daily Value for the nutrient. A claim of “very low” can be made only about sodium. low calorie: Fewer than 40 calories per serving and per 100 g of food. May be used for meal-type products with 120 calories per 100 g of food. light (or lite): Contains one-third fewer calories than the ref- erenced food. Products deriving more than half their calo- ries from fat must have their fat content reduced by 50% or more with a minimum reduction of more than 3 g per serving. The percentage of reduction of calories and/or fat must be specified immediately proximal to the claim. May not be used for foods or nutrients meeting the requirements for a “low” claim. The term “light” can be used for a salt substitute if it contains at least 50% less sodium than ordi- nary table salt. Other use of “light” must specify whether it refers to look, taste, or odor, unless the meaning of the term is obvious and fundamental to the product’s identity. (Thus, light brown sugar would require no explanation). less (or fewer), lower, or reDuceD: Contains at least 25% less of a nutrient (or calories) than the referenced food. May not be used for foods or nutrients meeting the requirements for a “low” claim. more: Contains at least 10% more of a desirable nutrient than does a comparable food. The terms “fortified,” “en- riched,” or “added” may be used instead under appropriate circumstances. Use limited to vitamins, minerals, protein, dietary fiber, and potassium. high, rich in, or excellent source: Contains 20% or more of the DRV per serving. gooD source: Contains 10% to 19% of the DRV. Can also be described as “contains” or “provides.” fat free: Less than 0.5 g of fat per reference amount and serving size, and no added ingredient that is a fat or oil. The term “fat free” may not be used for a food that is inher- ently free of fat unless there is an accompanying statement that all foods of this type are inherently fat free. Labels of foods containing insignificant amounts of ingredients (such as nuts) commonly understood to contain fats are permitted to note that the amount of added fat is trivial. (Percent) fat free: Permissible only for foods that meet the FDA definition of low fat. (Note that the fat percentage is determined by weight, not calories.) legal deFiNitioNs oF descriptive terMs For Food laBels28 Table 10-4 low fat: Contains 3 g or less of fat per reference amount, per serving size, and per 100 g of product. May not be used for foods inherently low in fat unless accompanied by a disclaimer that all foods of this type are inherently low in fat. May be applied to meal-type products if the meals also derive 30% or fewer of their calories from fat. reDuceD or less fat: Reduced fat content by 25% or more, with at least 3 g less per reference amount and per serving size. saturateD fat free: May be used for all products that are fat free. Labels of products that are not fat free but contain less than 0.5 g of saturated fat per reference amount must disclose the amount of total fat. low in saturateD fat: 1 g or less per serving, with not more than 15% of calories from saturated fat and 1% or less of total fat as trans-fatty acids. Labels of foods containing insignificant amounts of ingredients commonly understood to contain saturated fats must state that the amount of satu- rated fat is trivial. Meal-type products must also derive less than 10% of their calories from saturated fat. reDuceD or less saturateD fat: At least 25% less saturated fat per serving than the reference food. When these terms are used the label must indicate the percent reduction and the amount of saturated fat in the reference food. The reduction must be at least 1 g. cholesterol free: Less than 2 mg of cholesterol and 2 g or less of saturated fat per serving. Labels of foods containing insignificant amounts of ingredients commonly understood to contain cholesterol must state that the amount of choles- terol is trivial. low in cholesterol: 20 mg or less per serving and per 100 g of food, and 2 g or less of saturated fat per serving. reDuceD or less cholesterol: At least 25% less cholesterol per serving than its comparison food. The label of a food containing more than 13 g of total fat per serving or per 100 g of the food must disclose that fact. low soDium: Less than 140 mg per serving and per 100 g of food (a little less than half a cup). Very low soDium: Less than 35 mg per serving and per 100 g of food. light in soDium: Contains at least 50% less sodium than an appropriate comparison food. fresh: Can only be linked to raw food, food that has not been frozen, heated, processed, or preserved. (Low-level irradia- tion is permissible.) freshly: Can be used with a verb such as “prepared,” “baked,” or “roasted” if the food is recently made and has not been heat-processed or preserved. “Freshly frozen” may be used for foods that are quickly frozen while fresh. lean: Meat or poultry product with less than 10 g of fat, less than 4.5 g of saturated fat, and less than 95 mg of choles- terol per 100 g. extra lean: Meat or poultry product with less than 5 g of fat, less than 2 g of saturated fat, and less than 95 mg of choles- terol per 100 g. antioxiDant claims: Nutrient must have established RDI and scientific evidence of antioxidant activity. Level must meet definition of “high,” “good source,” or “more.” © 2011, Stephen Barrett, M.D. Part Three Nutrition and Fitness190 fruits anD Vegetables anD cancer Low-fat diets rich in fruits and vegetables (foods that are low in fat and may contain dietary fiber, vitamin A, and vitamin C) may reduce the risk of some types of cancer, a disease associated with many factors. Broccoli is high in vitamins A and C and is a good source of dietary fiber. fiber-containing grain ProDucts, fruits, anD Vegetables anD cancer Low-fat diets rich in fiber-containing grain products, fruits, and vegetables may reduce the risk of some types of cancer, a disease associated with many factors. Dietary fat anD cancer Development of cancer depends on many factors. A diet low in total fat may reduce the risk of some cancers. calcium anD osteoPorosis Regular exercise and a healthy diet with enough calcium help teen and young adult white and Asian women maintain good bone health and may reduce their risk of osteoporosis later in life. Dietary sugar alcohol anD Dental caries Full claim: Frequent between-meal consumption of foods high in sugars and starches promotes tooth decay. The sugar alcohols in [name of food] do not promote tooth decay. Shortened claim (on small packages only): Does not promote tooth decay. Dietary saturateD fat anD cholesterol anD risK of coronary heart Disease While many factors affect heart disease, diets low in saturated fat and cholesterol may reduce the risk of this disease. fruits, Vegetables, anD grain ProDucts that contain fiber, Particularly soluble fiber, anD risK of coronary heart Disease Diets low in saturated fat and cholesterol and rich in fruits, vegetables, and grain products that contain some types of dietary fiber, particularly soluble fiber, may re- duce the risk of heart disease, a disease associated with many factors. soluble fiber from certain fooDs anD risK of coronary heart Disease Soluble fiber from foods such as [name of soluble fiber source, and, if desired, name of food product], as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. A serving of [name of food product] supplies __ grams of the [necessary daily dietary intake for the benefit] soluble fiber from [name of soluble fiber source] necessary per day to have this effect. soy Proteins anD heart Disease (1) 25 grams of soy protein a day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. A serving of [name of food] supplies __ grams of soy protein. (2) Diets low in saturated fat and cholesterol that include 25 grams of soy protein a day may reduce the risk of heart disease. One serving of [name of food] provides __ grams of soy protein. Plant sterol anD stanol esters anD coronary heart Disease (1) Foods containing at least 0.65 gram per of vegetable oil sterol esters, eaten twice a day with meals for a daily total intake of least 1.3 grams, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. A serving of [name of food] supplies __ grams of vegetable oil sterol esters. (2) Diets low in saturated fat and cholesterol that include two servings of foods that provide a daily total of at least 3.4 grams of plant stanol esters in two meals may reduce the risk of heart disease. A serving of [name of food] supplies __ grams of plant stanol esters. soDium anD hyPertension Diets low in sodium may reduce the risk of high blood pressure, a disease associated with many factors. folate anD neural tube Defects Healthful diets with adequate folate may reduce a woman’s risk of having a child with a brain or spinal cord defect. uNqualiFied health claiMs perMissiBle iN Food laBeliNg Table 10-5 Manufacturers who want to use wording that differs from the FDA’s model claims can petition for FDA approval. Although preapproval is not required, claims that are not preapproved can trigger regulatory action if the FDA considers them misleading. raw fish, meat, and poultry. Although this is voluntary, it will be mandated if fewer than 60% of retailers fail to comply voluntarily. Similar labeling rules may be proposed for restaurant, delicatessen, and institutional foods. Approved Health Claims A “health claim” is defined as any type of communi- cation in labeling that is intended to suggest “a direct beneficial relationship between the presence or level of any substance in the food and a health or disease-related Chapter Ten Basic Nutrition Concepts 191 condition.” If the FDA approves a claim, it issues model claims that sellers are free to modify as long as the mean- ing does not change. Health claims are permissible only if (a) a food substance is associated with a disease- or health-related condition for which the general U.S. population or an identified subgroup is at risk, (b) the claim is made in the context of the product’s relationship to overall diet, and (c) the claim is supported by publicly available sci- entific evidence (including well-designed and properly conducted experiments). In addition, the claims must be “complete, truthful, and not misleading.” Any claim that a single food (as opposed to overall dietary composition) or food component (such as a vitamin, mineral, or other entity portrayed as a dietary supplement) can prevent, cure, mitigate, or treat a disease or symptom would render the product subject to regulation as a drug and would not be appropriate for labeling of a food. Three types of food-related health claims are permitted: unqualifieD claims must be based on “significant agreement” among qualified experts that the claims are supported by solid evidence.30 Table 10-5 lists these claims. qualifieD claims can be based on less scientific support, as long as the labeling provides an appropriate perspective. The labeling can state that there is evidence of benefit but must add that the evidence is limited or not conclusive and, in some cases, it must mention that the FDA does not endorse the claim. Qualified claims are permissible for selenium and cancer; antioxidant vitamins and cancer; nuts and heart disease; walnuts and heart disease; omega-3 fatty acids and coronary heart disease; olive oil and coronary heart disease; unsaturated fats from canola oil and coronary heart disease; green tea and cancer; chromium picolinate and diabetes; B vitamins and vascular disease; calcium and colon/rectal cancer and recurrent colon/rectal polyps; calcium and phos- phatidylserine and cognitive function and dementia; corn oil products and heart disease; and 0.8 mg of folic acid and neural tube birth defects.31 fDama claims. The Food and Drug Administration Moderniza- tion Act of 1997 permits manufacturers to seek approval for claims that are based on authoritative statements by federal scientific bodies. The four health claims that have been approved so far must be worded exactly as follows: • “Diets containing foods that are a good source of potas- sium and that are low in sodium may reduce the risk of high blood pressure and stroke.”

• “Drinking fluoridated water may reduce the risk of [dental caries or tooth decay].”
• “Diets rich in whole grain foods and other plant foods and low in total fat, saturated fat, and cholesterol may reduce the risk of heart disease and some cancers.”
• “Diets low in saturated fat and cholesterol, and as low as possible in trans fat, may reduce the risk of heart disease.”

Most people who follow the Dietary Guidelines for Americans will get adequate amounts of the nutrients for which claims are permissible. Thus the principal (if any) value of the health claims may be to remind consumers that since many substances may promote health, eating a wide variety of foods is a good idea. trustworthY iNForMatioN sources The dissemination of nutrition advice is poorly regulated by law. For this reason, consumers seeking nutrition advice should be very careful in selecting their advisers. Trustworthy information can be obtained from nutrition or medical professionals, professional organizations, and publications identified in the remainder of this chapter and in the Appendix. Untrustworthy sources are identi- fied in. Your primary care provider is probably the most convenient person from whom to obtain advice on nutrition. Medical doctors are often criticized for not knowing enough about nutrition. The American Council on Science and Health disagrees32: Not all physicians are nutrition experts, just as not all are specialists in cardiology or community medicine. However, the practicing physician has sufficient knowledge of the bio- chemical and physiological principles of nutrition, and has access to many resources which can aid in answering patients’ questions. Most people who read about a “new nutritional discovery” don’t have enough knowledge to figure out whether it’s a real scientific development or a piece of quack nonsense. Physicians do have the expertise to make this kind of judgment √ Consumer Tip Many organizations evaluate and publish accurate in- formation about nutrition. Some communicate primarily with health and nutrition professionals, whereas others primarily serve the public. The following organizations are generally trustworthy: Academy of Nutrition and Dietetics American Council on Science and Health American Medical Association American Society for Nutrition Council on Agricultural Science and Technology International Food Information Council Institute of Food Technologists International Life Sciences Institute National Center for Nutrition and Dietetics Quackwatch USDA Food and Nutrition Information Center U.S. Food and Drug Administration Part Three Nutrition and Fitness192 and to evaluate the technical research on which popular reports are based. If you have a question that your doctor can’t answer, he or she can refer you to someone who can. Nutrition Professionals Many accredited colleges and universities offer nutri- tion courses based on scientific principles and taught by qualified instructors. A bachelor’s degree requires 4 years of full-time study that qualify a graduate for entry-level positions in dietetics or foodservice, often in a hospital. A master’s degree in nutrition requires 2 more years of full- time study beyond the undergraduate level. People who wish to become nutrition researchers usually pursue a Ph.D. in biochemistry. This requires at least 2 more years of study plus a dissertation based on original laboratory research. Those wishing to concentrate on teaching or educational research usually seek a degree of Ph.D. or Ed.D. in nutrition education. With few exceptions, a nutrition-related degree from an accredited university signifies a broad background in nutrition science and a thorough grasp of nutritional concepts. In addition to an academic degree, most serious

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