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Recommendations on Diet, Chronic Diseases, and Health
Pages 665-710

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From page 665...
... The committee concluded that the overall evidence regarding a relationship between certain dietary patterns (e.g., a diet high in saturated fat and total fat) and chronic diseases (e.g., cardiovascular diseases or certain cancers)
From page 666...
... diet are also major sources of saturated fatty acids (SFAs) , which are known to increase plasma cholesterol levels and CHD risk.
From page 667...
... Overall, the committee found the arguments for quantification compelling. Reconlmendations for Individuals as Opposed to Populations There are two approaches to reducing dietary risk factors for chronic diseases: the first is the individual-based approach aimed at identifying and treating individuals at high risk and the second a more global population-based or public health approach aimed at the general population (Blackbum and Jacobs, 1984; Goldbourt, 1987; Olson, 1986~.
From page 668...
... For example, the majority of CHD deaths occurs not among those at high risk because of high serum cholesterol levels, but in people who have only moderate elevations in serum cholesterol (i.e., <240 mug/; National Cholesterol Education Program, 1988~. Thus, any reduction in the intake of saturated fatty acids, DIET AND HEALTH total fat, and cholesterol in this segment of the noDulation could result in a large absolute decrease in CHD deaths.
From page 669...
... Feasibility of Implementation Should the feasibility of implementation affect dietary recommendations7 For example, if an em pert committee concludes that the population would be healthier if fat consumption were reduced from an average of 40% to no more than 10% of total calories, should it consider not only the feasibility of designing nutritionally balanced diets with only 10% of calories from fat but also the 669 \h-_ 100 mg/dl 150 mgJdl 200 mg,~dl FIGURE 2~2 Hypothetical distribution of serum total cholesterol levels (mean + 2 SD) in a population associ' ated with a public health goal that all individuals lower their serum total cholesterol to 200 mg/dl or less.
From page 670...
... High-fat diets are also linked to a high incidence of some types of cancer and, probably, obesity. Thus, reducing total fat and saturated fatty acid intake is likely to lower the rates of these chronic diseases.
From page 671...
... The evidence linking high-fat diets to increased cancer risk is less persuasive than that associating saturated fatty acids and dietary cholesterol to CHD, but the weight of evidence indicates that high-fat diets are associated with a higher risk of several cancers, especially of the colon, prostate, and breast. Most evidence from studies in humans suggests that total fat or saturated fatty acids adversely affect cancer risk.
From page 672...
... are generally also high in fat. Studies in various parts of the world indicate that people who habitually consume a diet high in plant foods have low risks of atherosclerotic cardiovascular diseases, probably largely because such diets are usually low in animal fat and cholesterol, both of which are established risk factors for atherosclerotic cardiovascular diseases.
From page 673...
... These trends as well as 673 the association of moderate, regular physical activity with reduced risks of heart disease lead to the committee's recommendation that the U.S. population increase itS physical activity level and that all healthy people maintain physical activity at a moderately active level, improve physical fitness, and moderate their food intake to maintain appropriate body weight.
From page 674...
... signiflcant~y reduces the risk of dental caries in people of all ages, especially in children during the years of primary and secondary tooth formation and growth. There is no evidence that such fluoride concentrations have any adverse effects on health, including cancer risk.
From page 675...
... COMPARISON OF TEIE COMMITTEE'S RECOMMENDATIONS WITH THOSE BY OTHER EXPERT GROUPS Recommendations to the General Population In the recent history of dietary recommendations for overall health, an expert group from Sweden, Norway, and Finland was among the first to propose in 1968 that the general population should avoid excessive caloric intake, reduce fat intake from 40 to 25-30% of calories, reduce saturated fatty acid intake while increasing dietary polyunsaturated fatty acids, reduce consumption of sugar and sugar-containing foods, and increase the consumption of vegetables, potatoes, skim milk, fish, lean meat, and cereal products (Anonymous, 1968~. The next two decades were characterized by a proliferation of dietary recommendations by authoritative groups in the United States, Canada, many western European countries, Japan, Australia, and New Zealand.
From page 676...
... The Inter-Society Commission for Heart Disease Resources (1970, 1984) has also periodically proposed dietary recommendations to lower the risk of heart disease in the United States.
From page 677...
... adults. The committee's quantitative limits on the intake of total fat, saturated fatty acids, and cholestero!
From page 678...
... 678 o ._ CJ o o of Ct ~ _ o o o C)
From page 679...
... 679 - Cal ° .~- .
From page 680...
... 680 1 oo m Q)
From page 681...
... This recommendation stems from concern about the risk of chronic liver disease, hypertension, some forms of cancer, and cardiovascular diseases. The committee's overall recommendation on alcoholic beverages is in agreement with others (e.g., ACS, 1984; DHHS, 1988; NACNE, 1983; NCI, 1984a,b, 1987; NRC, 1982; Swedish National Food Administration, 198 1; USDA/DHHS, 1985~.
From page 684...
... Furthermore, there is often a difference of opinion about the importance of diet in comparison to other environmental and genetic risk factors for specific chronic diseases and, consequently, about the potential impact of dietary modification on these risk factors. The Committee on Diet and Health recognizes the importance of genetic variation for dietary recommendations.
From page 685...
... children had higher plasma cholesterol levels than did children in other countries and that they might thus be at higher risk of CHD in adulthood. In 1983, the American Heart Associ' ation recommended that all children over 2 years of age reduce total fat intake to 30% or less of calories, with 10% or less from saturated fatty acids and not more than 10% from polyunsaturated fatty acids and that they should reduce cholesterol intake tO LOO mg/1,000 kcal (AMA, 1983~.
From page 686...
... 686 Cal Ct C, Ct CO ._ 5 ._ en :, LO C)
From page 688...
... 688 Ct c Cal Cal Ct Cry A} ._ ~ C)
From page 689...
... 689 ~ 1 ._ Ct ~3 so C)
From page 690...
... that promotes one disease might inhibit another and, for example, that dietary contributors to certain cancers and cardiovascular diseases are not the same. Similarly, concordance of diet with diet-related risk factors or disease precursors (e.g., between a diet low in total fat and saturated fat and low serum cholesterol levels or reduced prevalence of colonic polyps, or among energy intake, relative body weight, and blood pressure)
From page 691...
... DIETARY PAT INTAKI:, SERUM CHOLESTEROL 1LEVELS, AND MORTALITY PROM CARDIOVASCU LAR DISEASES AND CANCER A major goal of the committee's recommendation to reduce the intake of total fat, SFAs, and dietary cholesterol is to lower the population mean and distribution of serum total and low-density
From page 692...
... and Potter, 1984; Sidney and Farquhar, 1983~. The evidence reviewed in Chapter 7 does not support a causal relationship between low serum cholesterol levels and colon cancer.
From page 693...
... Moreover, ecological studies in 20 countries show that per capita intake of total fat and saturated fatty acids is directly correlated with mortality from colon cancer and all cancer sites (Sidney and Farquhar, 1983~. Despite their limitations, data from such studies provide no support for a causal relationship between a lowest diet, low serum cholesterol, and cancer.
From page 694...
... Moreover, it would be possible to identify high risk people by their combined high blood pressure and low serum cholesterol values and tO reduce their risk by controlling their hypertension. in contrast, the estimated reduction in throw boric stroke and coronary disease risk in the pop ulation from reducing serum cholesterol levels would vastly counterbalance any small (and thus far entirely hypothetical)
From page 695...
... In the committee's judgment, any hypothetical increase In gastric cancer risk from high complex carbohydrate intake would be substantially less than the overall reduction in risk likely to occur with decreases in fat and nitrite intake and increases in vegetable and vitamin C consumption. The net effect of the committee's recommendations is likely to be a reduction in gastric and colon cancer rates.
From page 696...
... The committee's recommendation to balance physical activity and food intake in such a way as to maintain appropriate body weight should not result in nutrient deficiencies, which might occur if caloric intakes were substantially reduced. In fact, increased activity and caloric intake should improve the nutrient quality of the dice, if DIET AND HEALTH calories are provided by a variety of nutrientdense foods.
From page 697...
... These observations indicate that there is a potential for substantial reduction of atherosclerotic CHD and stroke in the entire population and for a continued favorable downward trend in the United States. The reduction in all-cause mortality and CHD mortality can be roughly estimated by applying the committee's dietary recommendations for reduced intake of total fat, saturated fatty acids, and cho
From page 698...
... These would be underestimates of the effects of overall dietary modification because they do not consider the independent effects of reducing di' etary cholesterol on CHD risk or the effects of reduced salt intake and reduced body weight on hypertension. Similarly, the proportionate reduction in CHD incidence that would result from a reduction in serum cholesterol can be estimated from the graded risk observed in very-Iong-term cohort studies, i.e., an approximately 3% reduction in incidence for each {% difference in the average serum cholestero!
From page 699...
... estimated that 27% of the breast cancer risk for these women might be attributable to total dietary fat intake. The second study showed a moderately increased risk for colorectal cancer associated with a high saturated fatty acid intake in both men and women.
From page 700...
... It also analyzed the possible consequences of reducing the intake of total fat, SFAs, and chores' terol- actions that would reduce serum cholesterol an] CHD risk but that in some studies are also associated with increased risk of colon cancer mortality.
From page 701...
... Such data are most extensive for serum cholesterol levels and the risk of CHD and much less extensive for dietary factors and CHD, cancer, and other major causes of death. Estimates for the reduction in CHD risk were derived by extrapolating the effects of a downward shift in average serum cholesterol levels, by comparing CHD risk in populations with substantially different diets and mean serum cholesterol levels, and by examining the results of cholesterol-Iow' Bring trials on cardiovascular disease incidence.
From page 702...
... The challenge to the private sector now is to undertake more scientifically based advertising, to develop suitable educational materials, and to make more nutritionally desirable and affordable foods more widely available in grocery stores, restaurants, hospitals, and other public eating facilities. Food marketing research suggests that the public is now better informed and more intensely interested in matters pertaining to diet, chronic diseases, and health and that it actively seeks nutrition guidance (Iones and Weimer, 198li Louis Harris & Associates, Inc., 1978, 1979; Mark Clements Research, Inc., 1980~.
From page 703...
... · The mechanism for regional fat accumulation, the feedback signals for regulation of fat stores, the means tO modify body fat distribution, and the relative risks associated with regional fat deposits. ~ The role of postprandial lipoproteins and their remnants in atherogenesis and in the risk of coronary heart disease and their relationship to dietary fat intakes.
From page 704...
... · The relative role of different types of coffee and constituents of coffee and tea in altering cancer risk and in affecting serum cholesterol levels and heart disease risk. · Further identification of nutritive and nonnu' .
From page 705...
... ~ The potential beneficial or adverse effects of mild to moderate alcohol consumption on coronary heart disease risk. · The optimal range of intake of water-soluble vitamins for prevention of chronic diseases, especially cancer and liver disease at all stages of the life cycle.
From page 706...
... Inten~ention trials should be undertaken only when a substantial body of data indicates a high likelihood of benefit without discemible risk. A few such trials (e.g., fat-reduction for breast cancer risk; a trial tO examine multiple risk factors to test multiple disease end points; a trial with sodium restriction, potassium supplementation, and weight control for hypertension; ,B-carotene supplements for the risk of cancers of the lung, gastrointestinal tract, and cervix; increased dietary fiber for the risk of colon cancer; and especially trials that can simultaneously measure the impact of dietary mollification on multiple disease end points)
From page 707...
... 1980. Total serum cholesterol and cancer mortality in a middle~aged male population.
From page 708...
... 1981. An apparent inverse relationship between serum cholesterol and cancer mortality in Puerto Rico.
From page 709...
... 1979. Diet and coronary heart disease: a review.
From page 710...
... 1986. Lipids, and lipoproteins as predictors of coronary heart disease, stroke, and cancer in the Honolulu Heart Program.


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