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Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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DIET
AND
HEALTH

Implications for Reducing Chronic Disease Risk

Committee on Diet and Health
Food and Nutrition Board
Commission on Life Sciences
National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C. 1989

Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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NATIONAL ACADEMY PRESS · 2101 CONSTITUTION AVENUE, NW ·WASHINGTON, DC 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Frank Press is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Robert M. White is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Samuel O. Thier is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Frank Press and Dr. Robert M. White are chairman and vice chairman, respectively, of the National Research Council.

The study summarized in this publication was supported by funds from the National Research Council Fund, a pool of private, discretionary, nonfederal funds that is used to support a program of Academy-initiated studies of national issues in which science and technology figure significantly. The NRC Fund consists of contributions from a consortium of private foundations including Carnegie Corporation of New York, Charles E. Culpeper Foundation, William and Flora Hewlett Foundation, John D. and Catherine T. MacArthur Foundation, Andrew W. Mellon Foundation, Rockefeller Foundation, and Alfred P. Sloan Foundation; the Academy Industry Program, which seeks annual contributions from companies that are concerned with the health of U.S. science and technology and with public policy issues with technological content; and the National Academy of Sciences and National Academy of Engineering endowments. The study was also supported by W.K. Kellogg Foundation, The Henry J. Kaiser Family Foundation, Pew Charitable Trusts, Fannie E. Rippel Foundation, and Occidental Petroleum Corporation.

Library of Congress Cataloging-in-Publication Data

National Research Council (U.S.). Committee on Diet and Health.
Diet and health: implications for reducing chronic disease risk /          First Printing, July 1989
Committee on Diet and Health. Food and Nutrition Board, Commission      Second Printing, May 1990
on Life Sciences. National Research Council.                    Third Printing, May 1991
p. cm.                                                  Fourth Printing, July 1992
Includes bibliographies and index.                               Fifth Printing, March 1993
ISBN 0-309-03994-0
1. Chronic diseases—Nutritional aspects. I. Title.
[DNLM: 1. Chronic Disease. 2. Diet. 3. Health. 4. Risk Factors.
QU 145 N2761d]
RC108.N38 1989
613. 2—dc20
DNLM/DLC
for Library of Congress                                             89.3261
                                                            CIP

Copyright © 1989 by the National Academy of Sciences

No part of this book may be reproduced by any mechanical, photographic, or electronic process, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted, or otherwise copied for public or private use, without written permission from the publisher, except for the purposes of official use by the U.S. government.

Printed in the United States of America

Cover photographs:
Paul Robert Perry/UNIPHOTO (black-eyed peas); Peter Beck/UNIPHOTO (fish); Hanley and Savage/UNIPHOTO (milk); Peter Beck/UNIPHOTO (fruits; vegetables); Gordon E. Smith/UNIPHOTO (bread); Renee Comet/UNIPHOTO (basket).

Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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Page iii

Dedication

The Committee on Diet and Health dedicates this report to the late Lucille Hurley, a diligent and enthusiastic member of the committee who made an invaluable contribution to this study, and to the American people, whose demonstrated interest and concerns about how diet affects their health inspired us to undertake this effort. We hope that this detailed assessment of the data will facilitate an understanding of the complex interrelationship between diet, chronic diseases, and health, and enhance the potential for reducing the risk of chronic diseases.

Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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COMMITTEE ON DIET AND HEALTH

ARNO G. MOTULSKY (Chairman), Center for
Inherited Diseases, University of Washington,
Seattle, Washington

EDWIN L. BIERMAN (Vice Chairman), Division
of Metabolism, Endocrinology, and Nutrition,
University of Washington School of Medicine,
Seattle, Washington

DeWITT S. GOODMAN (Vice Chairman),
Institute of Human Nutrition, Columbia
University, New York, New York

DONALD B. McCORMICK (Vice Chairman),
Department of Biochemistry, Emory University
School of Medicine, Atlanta, Georgia

CLAUDE D. ARNAUD, JR., Endocrine Section,
University of California, San Francisco, and
Veterans Administration Medical Center, San
Francisco, California

JOHN C. BAILAR III, Department of
Epidemiology and Biostatistics, McGill
University School of Medicine, Montreal,
Quebec, Canada

HENRY BLACKBURN, Division of
Epidemiology, School of Public Health,
University of Minnesota, Minneapolis,
Minnesota

GEORGE A. BRAY, Section of Diabetes and
Clinical Nutrition, University of Southern
California, Los Angeles, California

KENNETH K. CARROLL, Biochemistry
Department, University of Western Ontario,
London, Ontario, Canada

GEOFFREY R. HOWE, National Cancer Institute
of Canada Epidemiology Unit, Faculty of
Medicine, University of Toronto, Toronto,
Ontario, Canada

LUCILLE S. HURLEY (deceased), Department of
Nutrition, University of California, Davis,
California

LAURENCE N. KOLONEL, Cancer Research
Center of Hawaii, University of Hawaii,
Honolulu, Hawaii

HENRY C. McGILL, JR., Southwest Foundation
for Biomedical Research, University of Texas
Health Science Center, San Antonio, Texas

ANTHONY B. MILLER, Department of
Preventive Medicine and Biostatistics,
University of Toronto, Toronto, Ontario,
Canada

LOT B. PAGE, National Institute on Aging,
Bethesda, Maryland

RICHARD M. SCHIEKEN, Division of Pediatric
Cardiology, Medical College of Virginia East
Hospital, Richmond, Virginia

RICHARD B. SHEKELLE, School of Public
Health, University of Texas Health Science
Center at Houston, Houston, Texas

LOUIS TOBIAN, JR, Hypertension Section,
University of Minnesota Hospital School of
Medicine, Minneapolis, Minnesota

ELEANOR R. WILLIAMS, Department of
Human Nutrition and Food Systems,
University of Maryland, College Park,
Maryland

Adviser

PAUL D. STOLLEY, University of Pennsylvania,
Department of Medicine, Philadelphia,
Pennsylvania

Food and Nutrition Board Liaison

WILLIAM E. CONNOR, Department of
Medicine, Oregon Health Sciences University,
Portland, Oregon

M.R.C. GREENWOOD, Department of Biology,
Vassar College, Poughkeepsie, New York

Food and Nutrition Board Staff

SUSHMA PALMER, Director

FRANCES M. PETER, Deputy Director and Editor

CHRISTOPHER P. HOWSON, Project Director

FARID E. AHMED, Project Coordinator

SUSAN E. BERKOW, Program Officer

ALDON GRIFFIS, Research Assistant

MARIAN F. MILLSTONE, Research Assistant

AVIS I. HARRIS, Senior Secretary

DOROTHY R. MAJEWSKI, Senior Secretary (until October 1988)

MICHELLE E. SMITH, Senior Secretary (from November 1988)

ELSIE C. STURGIS, Senior Secretary

Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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FOOD AND NUTRITION BOARD

RICHARD J. HAVEL (Chairman),
Cardiovascular Research Institute, University
of California School of Medicine, San
Francisco, California

HAMISH N. MUNRO (Vice Chairman), U.S.
Department of Agriculture Human Nutrition
Research Center on Aging, Tufts University,
Boston, Massachusetts

EDWARD J. CALABRESE, Environmental
Health Program, Division of Public Health,
University of Massachusetts, Amherst,
Massachusetts

DORIS H. CALLOWAY, Department of
Nutritional Sciences, University of California,
Berkeley, California

WILLIAM E. CONNOR, Department of
Medicine, Oregon Health Sciences University,
Portland, Oregon

DeWITT S. GOODMAN, Institute of Human
Nutrition, Columbia University, New York,
New York

M.R.C. GREENWOOD, Department of Biology,
Vassar College, Poughkeepsie, New York

JOAN D. GUSSOW, Department of Nutrition
Education, Teachers College, Columbia
University, New York, New York

JOHN E. KINSELLA, Institute of Food Science,
Cornell University, Ithaca, New York

LAURENCE N. KOLONEL, Cancer Research
Center of Hawaii, University of Hawaii,
Honolulu, Hawaii

BERNARD J. LISKA, Department of Food
Science, Purdue University, West Lafayette,
Indiana

REYNALDO MARTORELL, Food Research
Institute, Stanford University, Stanford,
California

DONALD B. McCORMICK, Department of
Biochemistry, Emory University School of
Medicine, Atlanta, Georgia

J. MICHAEL McGINNIS (Ex Officio), Office of
Disease Prevention and Health Promotion,
Department of Health and Human Services,
Washington, D.C.

WALTER MERTZ, Human Nutrition Research
Center, Agricultural Research Service, U.S.
Department of Agriculture, Beltsville,
Maryland

ARNO G. MOTULSKY (Ex Officio), Center for
Inherited Diseases, University of Washington,
Seattle, Washington

MALDEN C. NESHEIM, Office of the Vice
Provost, Cornell University, Ithaca, New York

Food and Nutrition Board Staff

SUSHMA PALMER, Director
FRANCES M. PETER, Deputy Director
LUCIANA FROST, Administrative Associate
UTE S. HAYMAN, Administrative Assistant

Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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COMMISSION ON LIFE SCIENCES

BRUCE M. ALBERTS (Chairman), Department
of Biochemistry and Biophysics, University of
California, San Francisco, California

PERRY L. ADKISSON, Office of the Chancellor,
The Texas A&M University System, College
Station, Texas

FRANCISCO J. AYALA, Department of Ecology
and Evolutionary Biology, University of
California, Irvine, California

J. MICHAEL BISHOP, The G.W. Hooper
Research Foundation, University of California
Medical Center, San Francisco, California

FREEMAN J. DYSON, School of Natural
Sciences, The Institute for Advanced Study,
Princeton, New Jersey

NINA V. FEDOROFF, Department of Embryology,
Carnegie Institution of Washington, Baltimore,
Maryland

RALPH W.F. HARDY, Office of the President,
Boyce Thompson Institute for Plant Research,
Ithaca, New York

RICHARD J. HAVEL, Cardiovascular Research
Institute, University of California School of
Medicine, San Francisco, California

LEROY E. HOOD, Division of Biology,
California Institute of Technology, Pasadena,
California

DONALD F. HORNIG, Interdisciplinary
Programs in Health, Harvard School of Public
Health, Boston, Massachusetts

ERNEST G. JAWORSKI, Biological Sciences,
Monsanto Company, St. Louis, Missouri

SIMON A. LEVIN, Ecosystems Research Center,
Cornell University, Ithaca, New York

HAROLD A. MOONEY, Department of
Biological Sciences, Stanford University,
Stanford, California

STEVEN P. PAKES, Division of Comparative
Medicine, Southwestern Medical School,
University of Texas, Dallas, Texas

JOSEPH E. RALL, National Institutes of Health,
Bethesda, Maryland

RICHARD D. REMINGTON, University of Iowa,
Iowa City, Iowa

PAUL G. RISSER, Office of the Vice President,
University of New Mexico, Albuquerque, New
Mexico

RICHARD B. SETLOW, Biology Department,
Brookhaven National Laboratory, Upton, New
York

TORSTEN N. WIESEL, Laboratory of
Neurobiology, Rockefeller University, New
York, New York

Commission on Life Sciences Staff

JOHN E. BURRIS, Executive Director

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Preface

In the first half of the twentieth century, research in human nutrition was concerned primarily with the role of essential nutrients, particularly vitamins, in human deficiency diseases. It was not until the end of World War II that nutrition research in human populations in the United States focused on the role of diet in chronic diseases, such as coronary heart disease and cancer. The link forged by these later epidemiologic studies was strengthened by complementary evidence from laboratory studies. In the last decade, the wealth of information provided by these studies has been used by U.S. government agencies and other expert groups to propose dietary guidelines aimed at reducing the risk of one or more chronic diseases among North Americans.

Although there has been increasing consensus among various groups on many of the dietary guidelines, there remains a lack of agreement on several specific points. Our incomplete knowledge about the multiple environmental and genetic factors that determine chronic disease risk, specifically dietary and nutritional risk factors, the imprecision in methods for assessing nutrient and dietary status, and the differences among target groups and the objectives of recommendations proposed by many expert groups have all contributed to the variability in dietary guidelines. Furthermore, there has been insufficient documentation of the scientific bases underlying the conclusions and recommendations and the criteria used to derive them.

In recent years, the public has-been confronted with a plethora of information on diet and its association with chronic diseases without guidance on how to separate fact from fallacy. The National Research Council's Food and Nutrition Board in the Commission on Life Sciences recognized this dilemma and the need to address the important issue of the role of diet in the etiology and prevention of the major causes of morbidity and mortality in the United States. In 1984, the Board established the Committee on Diet and Health to undertake a comprehensive analysis of the scientific literature on diet and the spectrum of major chronic diseases and to evaluate the criteria used to assess the strength of the evidence on associations of diet with health. This report is the result of this critical and detailed analysis and is the first of a systematic series of reports to be issued in a pattern similar to the Board's Recommended Dietary Allowances (RDAs)—a periodic review that provides guidelines on the desirable amounts of essential nutrients in the diet.

The three major objectives of this study were:

· to develop criteria for systematically evaluating the scientific evidence relating dietary components, foods, food groups, and dietary patterns to the maintenance of health and to the reduction of risk of chronic disease;

Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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· to use these criteria to assess the scientific evidence relating these same factors (dietary components, foods, food groups, and dietary patterns) to health and to the reduction of chronic disease risk; and

· on the basis of this assessment, to propose dietary guidelines for maintaining health and reducing chronic disease risk, to suggest directions for future research, and to provide the basis for periodic updates of the literature and guidelines as new information on diet and health is acquired. The 19-member interdisciplinary committee appointed to conduct the study was assisted by one adviser and two Food and Nutrition Board liaison members. Collectively, the Committee on Diet and Health included expertise in such disciplines as biochemistry, biostatistics, clinical medicine, epidemiology, foods and food consumption patterns, human genetics, metabolism, various aspects of nutrition, public health, and toxicology. During the course of the study, the committee examined data on the association between diet, health, and chronic disease, focusing on coronary heart disease, peripheral arterial disease, stroke, hypertension, cancer, obesity, osteoporosis, diabetes mellitus, hepatobiliary disease, and dental caries. Whenever possible, the committee looked directly at primary sources of data contained in the literature. Works of other evaluative bodies, for example, the Surgeon General's Report on Nutrition and Health published in 1988 and Dietary Guidelines for Americans published in 1985 by the Departments of Agriculture and Health and Human Services, were important secondary sources of information. By drawing from the vast and diverse epidemiologic and laboratory data base, the committee has attempted to ensure a comprehensive and critical review. Thus, the conclusions and recommendations throughout this report are supported by a detailed discussion of the basis underlying them.

The committee held 13 meetings during which it evaluated the literature and prepared its general review and summary. A public meeting convened at the outset of the study served as a forum for open discussion and presentation of views and information by the public and by representatives of the food industry, consumer groups, and scientists.

In the early stages of the study, the committee conducted five workshops during which it interacted with and shared the expertise and research findings of a larger community of scientists. These workshops provided committee members an opportunity to consider new or controversial data and all valid scientific points of view and to identify gaps in knowledge. The subjects considered in the workshops included the role of vitamins, minerals, and trace elements in chronic disease risk; the importance of genetic factors in selected diet-related chronic diseases; the association of energy, fiber, and carbohydrates with chronic disease; pediatric diet and the risk of adult chronic disease; and criteria for formulating dietary guidelines.

The committee's report is presented in four parts. Part I (Introduction, Definitions, and Methodology) offers four introductory chapters in addition  to the Executive Summary (Chapter 1). These chapters highlight the methods and criteria used by the committee as well as the major conclusions and dietary recommendations, their bases, and their implications. Chapter 2 presents the criteria for evaluating the evidence linking diet and chronic disease. The strengths and weaknesses of methodologies for assessing dietary intake as well as those of specific kinds of studies (both human and animal) designed to assess diet-health relationships are reviewed. Trends in, and assessment of, food consumption patterns and the nutritional status of the U.S. population are discussed in Chapter 3. In Chapter 4, the committee discusses the role of genetics in nutrition and how genetic and environmental factors interact to influence diet-associated risks of chronic disease. Chapter 5 presents the rationale for selecting the major diet-related chronic diseases addressed in this report and provides an overview of the extent and distribution of those diseases in the United States. In Part II of this report (Evidence on Dietary Components and Chronic Diseases), the criteria described in Chapter 2 provide the basis of a review of the evidence by nutrients. The 13 chapters in that section (6 through 18) summarize the epidemiologic, clinical, and laboratory data pertaining to each nutrient or dietary factor and the chronic diseases identified by the committee. Nutrient interactions and mechanisms of action are discussed where applicable. Part III (Impact of Dietary Patterns on Chronic Diseases) briefly reassembles the evidence relating nutrients to specific chronic diseases or conditions and comments on the importance of diet relative to nondietary risk factors in the etiology of those diseases. Part IV (Overall Assessment, Conclusions, and Recommendations) contains two chapters. Chapter 27 presents the committee's conclusions, along with a summary of the process, criteria, and scientific bases underlying them. Chapter 28 presents the

Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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committee's dietary recommendations and the rationales for each, as well as a detailed discussion of how the recommendations compare to those issued in the past by other expert groups and the bases for similarities and dissimilarities among these. Also contained in this section is an in-depth discussion of the potential risks and public health benefits of the committee's dietary recommendations.

The committee hopes this report will be a useful resource document for scientists in academia and industry, for the general public, and for policymakers. Furthermore, it believes that the nine dietary recommendations presented in Chapter 28 and in the Executive Summary (Chapter 1) can be implemented within the framework of the current U.S. lifestyle. Collaboration among government agencies, the food industry, health professionals (physicians, nutritionists, dietitians, and public health personnel), educational institutions, leaders in mass media, and the general public is encouraged to attain this goal.

The committee greatly appreciates the hard work and organization provided by the Food and Nutrition Board staff headed by Dr. Sushma Palmer and consisting of Drs. Christopher Howson, Farid Ahmed, and Susan Berkow, Mrs. Frances Peter, Mr. Aldon Griffis, Ms. Marian Millstone, Ms. Dorothy Majewski, Ms. Avis Harris, Ms. Michelle Smith, and Mrs. Elsie Sturgis.

The committee is also greatly indebted to Dr. Charles Lieber of the Bronx Veterans Administration Medical Center for his major contribution to the chapter on alcohol and to the many people who served as consultants, as advisers, and in other resource capacities. Many of these people drafted manuscripts for consideration by the committee, presented their views at the public meeting, or upon request, commented on drafts, presented data, or engaged in discussions during committee meetings, conferences, or workshops. Specifically, the committee expresses its thanks to Dr. Norman Bell, Veterans Administration Medical Center, Charleston; Dr. Peter Bennett, National Institutes of Health; Dr. Gerald Berenson, Louisiana State University Medical School; Dr. Jan Breslow, Rockefeller University; Dr. Raymond Burk, University of Texas Health Sciences Center; Dr. Ritva Butrum, National Institutes of Health; Dr. Tim Byers, State University of New York; Dr. T. Colin Campbell, Cornell University; Dr. James Carlos, National Institute of Dental Research; Dr. Marie Cassidy, George Washington  University; Dr. George Christakis, University of Miami School of Medicine; Dr. Charles Davidson, Massachusetts Institute of Technology; Dr. William Dietz, New England Medical Center; Dr. Jean Durlach, Hospital Cochin; Dr. Johanna Dwyer, Francis Stem Nutrition Center; Dr. S. Boyd Eaton, Emory University; Dr. R. Curtis Ellison, University of Massachusetts Medical Center; Dr. Gail Eyssen, University of Toronto; Dr. L. Jack Filer, Jr., Executive Director of the International Life Sciences Institute-Nutrition Foundation; Dr. Michael Goldblatt, McDonald's Corporation; Dr. Clifford Grobstein, University of California, San Diego; Dr. Scott Grundy, University of Texas Health Sciences Center; Dr. Suzanne Harris, Deputy Assistant Secretary for Food and Consumer Services; Dr. Robert Heaney, Creighton University; Dr. Dwight Heath, Brown University; Dr. D. Mark Hegsted, Harvard University; Dr. Richard Hillman, Washington University Medical School; Dr. Paul Hochstein, University of California; Dr. Michael Holick, Tufts Human Nutrition Research Center; Dr. Paul Hopper, General Foods Corporation; Dr. Edward Horton, University of Vermont; Dr. Thomas Hostetter, University of Minnesota; Dr. Michael Jacobson, Center for Science in the Public Interest; Dr. Norman Kaplan, University of Texas; Dr. Carl Keen, University of California, Davis; Dr. Ahmed Kissebah, University of Wisconsin; Dr. Leslie Klevay, USDA-Human Nutrition Research Center; Dr. David Klurfeld, Wistar Institute; Dr. William Knowler, National Institutes of Health; Dr. Stephen Krane, Harvard University Medical School; Dr. Peter Kwiterovich, Johns Hopkins University; Dr. Orville Levander, USDA-Human Nutrition Research Center; Dr. A. Harold Lubin, American Medical Association; Dr. Lawrence Machlin, Hoffman-LaRoche, Inc.; Dr. Aaron Marcus, New York Veterans Administration Medical Center; Dr. Alvin Mauer, University of Tennessee; Dr. Paul McCay, Oklahoma Medical Research Foundation; Dr. Janet McDonald, Food and Drug Administration; Dr. J. Michael McGinnis, Department of Health and Human Services; Dr. Donald McNamara, University of Arizona; Dr. Judy Miller, Indiana University School of Medicine; Dr. John Milner, University of Illinois; Dr. William Mitch, Emory University School of Medicine; Dr. Curtis Morris, University of California, San Francisco; Dr. Janice Neville, Case Western Reserve University; Dr. Ralph Paffenberger, Stanford University; Mr. Richard Peto, University of Oxford; Dr. Ernesto Pollitt, University of California, Davis; Dr. Gerry Reaven, Stanford University; Dr. Floyd Rector, University of California, San Francisco; Dr.

Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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Lawrence Resnick, New York Hospital-Cornell Medical Center; Dr. Irwin Rosenberg, Tufts University; Dr. Paul Saltman, University of California, San Diego; Dr. Raymond Schucker, Food and Drug Administration; Dr. William Schull, University of Texas; Dr. Noel Solomons, Institute of Nutrition of Central America and Panama; Dr. Charles Sing, University of Michigan Medical School; Dr. Michael Stem, University of Texas Health Science Center; Dr. Ira Tabas, Columbia University; Dr. Paul R. Thomas, Institute of Medicine; Dr. Michael Tuck, University of California, Los Angeles; Dr. Myron Weinberger, Indiana University; Dr. Sidney Weinhouse, Temple University School of Medicine; Ms. Clair Wilson, Council for Research Planning in Biological Sciences and the Vegetarian Society of D.C.; Dr. Richard Wurtman, Massachusetts Institute of Technology; and Dr. Catherine Woteki, National Center for Health Statistics.

Finally, the committee would like to thank the staff of the library of the National Academy of Sciences for their invaluable assistance in preparing this report and the staff of the National Academy Press, especially Chief Manuscript Editor Richard Morris, who herded this volume through production. Special acknowledgment is due to Dr. Richard J. Havel, Chairman of the Food and Nutrition Board, and other board members for their expert advice, oversight, and constant encouragement over the course of this 3.5-year study.

ARNO G. MOTULSKY
CHAIRMAN
COMMITTEE ON DIET AND HEALTH

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Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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Contents

Part I: Introduction, Definitions, and Methodology

1 Executive Summary

3

2 Methodological Considerations In Evaluating The Evidence

23

3 Dietary Intake And Nutritional Status: Trends And Assessment

41

4 Genetics And Nutrition

85

5 Extent And Distribution Of Chronic Disease: An Overview

99

Part II: Evidence on Dietary Components and Chronic Diseases

6 Calories: Total Macronutrient Intake, Energy Expenditure, And Net Energy Stores

139

7 Fats And Other Lipids

159

8 Protein

259

9 Carbohydrates

273

10 Dietary Fiber

291

11 Fat-Soluble Vitamins

311

12 Water-Soluble Vitamins

329

13 Minerals

347

Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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14 Trace Elements

367

15 Electrolytes

413

16 Alcohol

431

17 Coffee, Tea, And Other Nonnutritive Dietary Components.

465

18 Dietary Supplements

509

Part III: Impact of Dietary Patterns on Chronic Diseases

19 Atherosclerotic Cardiovascular Diseases

529

20 Hypertension

549

21 Obesity And Eating Disorders

563

22 Cancer

593

23 Osteoporosis

615

24 Diabetes Mellitus

627

25 Hepatobiliary Disease

633

26 Dental Caries

637

Part IV: Overall Assessment, Conclusions, and Recommendations

27 Overall Assessment And Major Conclusions

651

28 Recommendations On Diet, Chronic Diseases, And Health

665

Index

711

Suggested Citation:"Front Matter." National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. doi: 10.17226/1222.
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Next: Part I: Introduction, Definitions, and Methodology »
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Diet and Health examines the many complex issues concerning diet and its role in increasing or decreasing the risk of chronic disease. It proposes dietary recommendations for reducing the risk of the major diseases and causes of death today: atherosclerotic cardiovascular diseases (including heart attack and stroke), cancer, high blood pressure, obesity, osteoporosis, diabetes mellitus, liver disease, and dental caries.

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