Premature Death in the New Independent States (1997) / Chapter Skim
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Diet Modification and Food Policy Strategies: What Works?
Diet Modification and Food Policy Strategies: What Works?
Pages 355-374
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From page 355... ...
It includes not only fat and cholesterol, but also a diet characterized by excess calories, high protein, high sodium, low potassium or calcium, low fiber, heavy alcohol, deficient antioxidant vitamins, and a host of less well defined dietary constituents. While no dietary recommendation can totally ignore these additional macro- and micronutrients, the focus of this discussion is on reduction of total dietary fat, saturated fat, and cholesterol)
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From page 356... ...
Taken together, these comparisons provide a comprehensive picture of the potential ability to reduce cardiovascular disease rates through reductions in dietary saturated fat and cholesterol, acknowledging the simultaneous contributions of other factors in the overall disease trends. Additional information on the scientific rationale for the lowering of total dietary fat, saturated fat, and cholesterol is available in the literature (Carleton et al., 1991~.
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From page 357... ...
, thereby linking population-wide dietary change with declines in cardiovascular disease. Parenthetically, these improvements in serum cholesterol levels have been achieved despite a progressive rise in obesity in the United States, suggesting that the likely explanation for the population-wide changes in serum cholesterol is the TABLE 14-2 Estimates of Consumption of Total Fat, Saturated Fat, and Polyunsaturated Fat in the United States Between 1940 and 1985 % of Calories Total Saturated Polyunsaturated Polyunsaturated/ Year Fat Fat Fat Saturated 1940-1949 37.6 15.3 2.5 0.16 1950-1959 40.5 16.6 4.3 0.26 1960-1969 39.9 15.8 3.7 0.24 1970-1979 37.8 13.8 5.1 0.37 1980-1985 37.5 11.8 5.4 0.46 SOURCE: Popkin et al.
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From page 358... ...
As listed in Table 14-3, these constituencies include governmental bodies; the food industry; local institutions, such as worksites and schools; and health-related groups, including voluntary organizations, such as heart foundations and cancer societies, and health professionals. One important point to emphasize is that dietary change in many Western countries, certainly in the United States, cannot be attributed solely to any one organization or group.
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From page 359... ...
359 o o a' a' by o so o cq o O so o.
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From page 360... ...
The Role of Governmental Organizations Dietary Recommendations A logical starting point in designing strategies to achieve dietary change is to identify nutritional goals for the population, such as those recommended by several scientific and governmental bodies in the United States (National Research Council, 1989; U.S. Department of Agriculture and U.S.
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From page 361... ...
The price supports for dairy products and beef are especially high in the European Community and Nordic Europe, relative to supports for poultry, while the United States and Australia support dairy and beef prices and production to a lesser extent (Jones and Ralph, 1992~. In Hungary during the period 1960- 1985, prices of fats, meats, alcohol, and cigarettes were kept low, while prices of fruits and vegetables were less protected (Poulter, 1993~.
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From page 362... ...
At the same time, commercial efforts to market foods high in fat and cholesterol may serve as a barrier to health promotion. Particular concern has been expressed in the United States regarding the advertising of high-fat foods to children.
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From page 363... ...
At least 48 published reports have examined the health benefits and cost savings of a variety of health promotion/disease prevention interventions in the workplace, with generally positive results (Pelletier, 1991, 1993~. Worksites and the military provide opportunities for several nutritional interventions (American Dietetic Association, 1986~.
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From page 364... ...
Several well-designed studies have included worksite weight control programs that illustrate some potential strategies for altering employees' nutritional behavior. The Pennsylvania County Health Improvement Program, conducted among 12 small industries located in rural north-central Pennsylvania, established a county-wide risk factor reduction program (Brownell et al., 1984~.
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From page 365... ...
· The Heart Smart Program sought to change the entire school health environment in kindergarten through grade 6 with a health curriculum, a school lunch program, developmental programs for teachers and other school workers, and programs that could be taken home to adults (Downey et al., 1987; Butcher et al., 1988~. Changes in eating behaviors among both adults and children were observed.
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From page 366... ...
Dietary cholesterol was reduced 23 to 34 percent and saturated fat consumption 25 to 30 percent, both reductions being higher than in the control community (Fortmann et al., 1981~. Media campaigns in the NIS could serve an important role in increasing awareness that certain dietary behaviors are a major cause of heart disease, demonstrating the benefits of lowering dietary fat and cholesterol as a way to prevent heart disease, reinforcing positive attitudes and behaviors toward eating low-fat foods, and demonstrating skills in the purchase and preparation of these healthful alternatives (Bellicha and McGrath, 1990~.
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From page 367... ...
Many programs described in the literature, such as the Minnesota Heart Health Program, have used health professionals to endorse and support interventions (Farquhar et al., 1990~. The Minnesota Heart Health Program is a 13-year research project designed to reduce morbidity and mortality from coronary heart disease among whole communities in the upper midwestern United States.
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From page 368... ...
At the same time, recommending such screening to health care practitioners and the public for widespread implementation is also an effective means of enhancing awareness of these risk factors among the general public (Carleton et al., 1991~. In the Minnesota Heart Health Program, for example, a random sample of adults was offered a risk factor screening and education program that included a blood cholesterol screening (Murray et al., 1986~.
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From page 369... ...
CONCLUSIONS The populations of the NIS appear to consume saturated fat and cholesterol at levels similar to those previously prevalent in the United States, which has successfully reduced consumption of these macronutrients on a population-wide basis over the past 30 years or so. If there is no evidence of widespread undernutrition, the interventions available to governments, food producers, institutions, and health organizations may be similar to those tried singly or as a comprehensive program in the United States or other Western countries.
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From page 370... ...
1990 Effectiveness of community-wide education on cardiovascular disease risk factors: The Stanford Five-City Project. Journal of the American Medical Association 264:359-365.
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Schmid 1989 Worksite health promotion: Feasibility testing of repeated weight control and smoking cessation classes. American Journal of Health Promotion 3:11-16.
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From page 372... ...
1994 Community education for cardiovascular disease prevention: Risk factor change in the Minnesota Heart Health Program. American Journal of Public Health 84:1383-1393.
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Wynder 1988 Modification of risk factors for coronary heart disease. New England Journal of Medicine 318:1093-1100.
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From page 374... ...
. However, additional mechanisms have also been proposed, since dietary saturated fat and cholesterol correlate with coronary disease incidence even after adjustment for serum cholesterol levels (Shekelle et al., 1981)
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