Diet and Health Implications for Reducing Chronic Disease Risk (1989) / Chapter Skim
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1 Executive Summary
1 Executive Summary
Pages 3-22
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From page 3... ...
Several reports issued to date have addressed many issues of public health import tance. However, most have not been sufficiently comprehensive and have not crossed the boundary separating the simple assessment of dietary risk factors for single chronic diseases from the complex task of determining how these risk factors influence the entire spectrum of chronic diseases atherosclerotic cardiovascular diseases, cancer, diabetes, obesity, osteoporosis, dental caries, and chronic liver and kidney diseases.
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From page 4... ...
In this report, the committee reviews the evidence regarding all major chronic public health conditions that diet is believed to influence. it draws conclusions about the effects of nutrients, foods, and dietary patterns on health, proposes dietary recommendations that have the potential for diminishing risk, and estimates their public health impact.
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From page 5... ...
An essential step in developing dietary recommendations for overall health maintenance is the synthesis of recommendations pertaining to single diseases into a single coherent set of recommendations to reduce the overall risk of dietrelated chronic diseases. For example, recommendations tO enhance calcium intake for possible protection against osteoporosis might, in isolation, be viewed as conflicting with recommendations for coronary heart disease, because dairy prodUCtS-which contribute the most calcium to the U.S.
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From page 6... ...
For example, the advisability of consuming a diet low in saturated fatty acids, total fat, and cholesterol is supported by strong evidence of potential benefit in reducing the risk of cardiovascular diseases as well as comparatively weaker evidence that low-fat diets decrease the risk of certain kinds of cancers. Other Considerations The committee also considered whether tO base recommendations on individual nutrients, on single foods or food groups, or on overall pattern of dietary intake.
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From page 7... ...
A reduction in total fat consumption, however, facilitates reduction of saturated fatty acid intake; hence, in addition tO reducing the risk of certain cancers, and possibly obesity, it is a rational part of a program aimed at reducing the risk of coronary heart disease. Saturated Fatty Acids ~ Clinical, animal, and epidemiologic studies demonstrate that increased intakes of saturated fatty acids (12 tO 16 carbon atoms in length)
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From page 8... ...
Limited epidemiologic data suggest that consumption of one or two servings of hsh per week is associated with a lower coronary heart disease risk, but the evidence is not sufficient to ascertain whether the association is causal or related to the omega-3 polyunsaturated fatty acid content of fish. Monounsaturated Fatty Acids · Clinical studies indicate that substitution of monounsaturated for saturated fatty acids results in a Dietary Cholesterol · Clinical, animal, and epidemiologic studies indicate that dietary cholesterol raises serum total cholesterol and LDL cholesterol levels and increases the risk of atherosclerosis and coronary heart disease.
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From page 9... ...
· In intercountry correlation studies, diets high in meat a major source of animal protein have a strong positive association with increased atherosclerotic coronary artery disease and certain cancers, notably breast and colon cancer. Such diets are often characterized by a high content of saturated fatty acids and cholesterol, which probably accounts for a large part of the association with coronary heart disease, and by a high content of total fat, which is directly associated with the risk of these cancers.
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From page 10... ...
~ Studies in humans suggest that fat deposits in the abdominal region pose a higher risk of noninsutin-dependent diabetes mellitus, coronary heart disease, stroke, hypertension, and increased mortaiity than do fat deposits in the gluteal or femoral regions. · Experience in long-term management of obesity indicates that neither frequent fluctuations in body weight nor extreme restrictions of food intake are desirable.
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From page 11... ...
· A few data from epidemiologic and animal studies suggest that a high calcium intake may 11 protect against colon cancer, but the evidence is preliminary and inconclusive. ~ Unequivocal evidence from epidemiologic and clinical studies indicates that fluoridation of drinking water supplies at a level of ~ ppm protects against dental caries.
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From page 12... ...
would have to be higher or lower than the recommended intake for individuals, depending on the direction of the proposed dietary modification. For example, a recommendation that all individuals should reduce their fat intake to 30% or less of calories can be expected to lead to a population mean intake substantially below 30% of calories from fat.
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From page 13... ...
when substituted for saturated fatty acids, but they are more effective in lowering elevated serum triglyceride levels. Although consumption of hsh one or more times a week has been associated with a reduced risk of coronary heart disease, the committee does not _ ~
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From page 14... ...
Given the absence of human diets naturally very high in total polyunsaturated fatty acids and the lack of information about the long-term consequences of high polyunsaturated fatty acid intake (see Chapter 7) , it seems prudent to recommend that polyunsaturated fatty acid intake not be increased above the current average in the U.S.
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From page 15... ...
. Increased risks of certain cancers and coronary heart disease have been associated in some epidemiologic studies with diets high in meat and, as a
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From page 16... ...
Pregnant women and women who are attempting to conceive should avoid alcoholic beverages because there is a risk of damage to the fetus and no safe level of alcohol intake during pregnancy has been established. Although several studies show that moderate alcohol drinking is associated with a tower coronary heart disease risk, it WOULD be unwise to recommend moderate drinking for those who do not drink because, in the committee's judgment, a causal association has not been established and because even moderate drinking poses certain other risks, including the risk of alcohol addiction.
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From page 17... ...
In summary, the diet recommended by the committee should contain moderately low levels of fat, with special emphasis on restriction of saturated fatty acids and cholesterol; high levels of complex carbohydrates; only moderate levels of protein, especially animal protein; and only low levels of added sugars. Caloric intake and physical activity should be balanced to maintain appropriate body weight.
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From page 18... ...
For example, it examined the degree of concordance in death rates and mortality trends between the two leading diet-related causes of death-i.e., coronary heart disease and cancer to assess the degree to which common dietary risk and protective factors may be operating. It also analyzed the possible adverse consequences of reducing the intake of total fat, saturated fatty acids, and cholesterol, which would lead to a reduction in serum cholesterol levels and in the risk of atherosclerotic cardiovascular disease.
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From page 19... ...
In general, however, by using these approaches, the committee estimates that its recommendations for reducing intake of saturated fatty acids, dietary cholesterol, and total fat could lead to at least a 10% reduction in serum cholesterol levels and a 20% reduction in coronary heart disease risk in the United States beyond the 1987 levels. More stringent thetas modification provides the potential for even greater reduction in coronary disease risk in the fixture.
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From page 20... ...
Therefore, they only receive brief consideration below and in Chapter 28 of this report. it is apparent to the committee and the Food and Nutrition Board that if one of our national goals is to reduce the risk of chronic diseases and if dietary modification is likely tO assist in achieving that goal, then various sectors of society need tO collaborate in implementing dietary recommendations of the type proposed by the committee.
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From page 21... ...
Carefully designed intervention studies should be conducted to assess the public health impact of dietary modiEcat~on. Although many such studies have been conducted for heart disease, hypertension, dental caries, and obesity, and a few have focused on osteoporosis, no such long-term studies have yet been completed for cancer.
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From page 22... ...
DIET AND HEALTH The committee hopes that the findings contained in this report will be as widely disseminated as possible and urges that all those with an interest in and responsibility for public health participate in this effort. Recognizing the limitations of current knowledge, it strongly believes that periodic updates of its findings will be necessary as new data emerge to shed more light on associations between diet and chronic diseases.
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