PREVENTIVE NUTRITION

THIRD EDITION

NUTRITION � AND � HEALTH

Adrianne Bendich, Series Editor

Calcium in Human Health, edited by Connie M. Weaver and Robert P. Heaney, 2005Preventive Nutrition: The Comprehensive Guide for Health Professionals, Third

Edition, edited by Adrianne Bendich and Richard J. Deckelbaum, 2005Nutrients, Stress, and Medical Disorders, edited by Shlomo Yehuda and David I.

Mostofsky, 2005The Management of Eating Disorders and Obesity, Second Edition, edited by David J.

Goldstein, 2005Nutrition and Oral Medicine, edited by Riva Touger-Decker, David A. Sirois, and

Connie C. Mobley, 2005IGF and Nutrition in Health and Disease, edited by M. Sue Houston, Jeffrey M. P.

Holly, and Eva L. Feldman, 2005Epilepsy and the Ketogenic Diet, edited by Carl E. Stafstrom and Jong M. Rho, 2004Handbook of Drug–Nutrient Interactions, edited by Joseph I. Boullata and Vincent T.

Armenti, 2004Nutrition and Bone Health, edited by Michael F. Holick and Bess Dawson-Hughes,

2004Diet and Human Immune Function, edited by David A. Hughes, L. Gail Darlington,

and Adrianne Bendich, 2004Beverages in Nutrition and Health, edited by Ted Wilson and Norman J. Temple, 2004Handbook of Clinical Nutrition and Aging, edited by Connie Watkins Bales and

Christine Seel Ritchie, 2004Fatty Acids: Physiological and Behavioral Functions, edited by David I. Mostofsky,

Shlomo Yehuda, and Norman Salem, Jr., 2001Nutrition and Health in Developing Countries, edited by Richard D. Semba and

Martin W. Bloem, 2001Preventive Nutrition: The Comprehensive Guide for Health Professionals, Second

Edition, edited by Adrianne Bendich and Richard J. Deckelbaum, 2001Nutritional Health: Strategies for Disease Prevention, edited by Ted Wilson

and Norman J. Temple, 2001Clinical Nutrition of the Essential Trace Elements and Minerals: The Guide for

Health Professionals, edited by John D. Bogden and Leslie M. Klevey, 2000Primary and Secondary Preventive Nutrition, edited by Adrianne Bendich

and Richard J. Deckelbaum, 2000The Management of Eating Disorders and Obesity, edited by David J. Goldstein, 1999Vitamin D: Physiology, Molecular Biology, and Clinical Applications, edited by

Michael F. Holick, 1999Preventive Nutrition: The Comprehensive Guide for Health Professionals,

edited by Adrianne Bendich and Richard J. Deckelbaum, 1997

PREVENTIVE NUTRITIONTHE COMPREHENSIVE GUIDE FOR HEALTH PROFESSIONALS

THIRD EDITION

Edited by

ADRIANNE BENDICH, PhD, FACNGlaxoSmithKline, Parsippany, NJ

and

RICHARD J. DECKELBAUM, MD, FRCP(C)College of Physicians and Surgeons, Columbia University,New York, NY

Foreword by

ALFRED SOMMER, MD, MHSJohns Hopkins Bloomberg School of Public Health,Johns Hopkins University, Baltimore, MD

© 2005 Humana Press Inc.999 Riverview Drive, Suite 208Totowa, New Jersey 07512

www.humanapr.com

All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by anymeans, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher.

All papers, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of thepublisher.

Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information publishedand to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections anddosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, asnew research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactionsconstantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any changein dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is anew or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies forindividual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration statusof each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissionsor for any consequences from the application of the information presented in this book and make no warranty, express or implied, withrespect to the contents in this publication.

Cover design by Patricia F. ClearyProduction Editor: Robin B. Weisberg

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Library of Congress Cataloging-in-Publication Data

Preventive nutrition : the comprehensive guide for health professionals /edited by Adrianne Bendich and Richard J. Deckelbaum ; foreword by AlfredSommer.-- 3rd ed. p. ; cm. -- (Nutrition and health) Includes bibliographical references and index. ISBN 1-58829-445-5 (alk. paper) 1. Nutrition. 2. Medicine, Preventive. 3. Nutritionally induced diseases--Prevention.4. Diet therapy. [DNLM: 1. Nutrition. 2. Diet. 3. Nutrition Therapy. 4. NutritionalStatus. 5. Primary Prevention. QU 145 P944 2005] I. Bendich, Adrianne.II. Deckelbaum, Richard J. III. Series: Nutrition and health (Totowa, N.J.) RM216.P778 2005 615.8'54--dc22

2004021931

Dedication

v

AB dedicates this volume to her husband, David Kafkewitz, PhD,wth deepest gratitude for his unconditional support and understanding.

Richard J. Deckelbaum dedicates this volume to William and Katya,and the rest of our family and friends.

vii

Series Editor’s Introduction

The Nutrition and Health Series of books has had great success because each volumehas the consistent overriding mission of providing health professionals with texts that areessential since each includes (1) a synthesis of the state of the science; (2) timely, in-depthreviews by the leading researchers in their respective fields; (3) extensive, up-to-date,fully annotated reference lists; (4) a detailed index; (5) relevant tables and figures; (6)identification of paradigm shifts and their consequences; (7) virtually no overlap ofinformation between chapters, but targeted, interchapter referrals; (8) suggestions ofareas for future research; and (9) balanced, data-driven answers to patient as well ashealth professionals’ questions that are based on the totality of evidence rather than thefindings of any single study.

The series volumes are not the outcome of a symposium. Rather, each editor has thepotential to examine a chosen area with a broad perspective, both in subject matter as wellas in the choice of chapter authors. The editors, whose trainings are both research- andpractice-oriented, have the opportunity to develop a primary objective for each book,define its scope and focus, and then invite the leading authorities to be part of theirinitiative. The authors are encouraged to provide an overview of the field, discuss theirown research and relate the research findings to potential human health consequences.Because each book is developed de novo, the chapters are coordinated so that the resultingvolume imparts greater knowledge than the sum of the information contained in theindividual chapters. Many of the books in the series come with a complementary copy ofthe book on a CD; recently published books are available as e-books and individualchapters of the e-books are also now available from Humana Press’ website,Humanapress.com

Preventive Nutrition: The Comprehensive Guide to Health Professionals, ThirdEdition, edited by me and Richard Deckelbaum remains the flagship volume of the seriesand continues to improve with each edition. The first edition, published in 1997, waswidely acclaimed for its emphasis on data-driven recommendations based on the totalityof the evidence that included the newest scientific discoveries and clinical applicationsin the key areas of preventive nutrition: cancer, cardiovascular disease, osteoporosis,age-related eye diseases, immune function, birth outcomes, and an international perspectiveon preventive nutrition strategies. The second edition, published in 2001, provided criticalupdates and also included new information on nutrition-related disease prevention strategies.In the same year, Richard and I also published a volume, Primary and SecondaryPreventive Nutrition, that reviewed several other clinical areas including obesity anddiabetes. In response to our readers and reviewers, we have combined the most relevantand timely chapters from these two volumes into the third edition of Preventive Nutrition.

Preventive Nutrition, Third Edition, which is now more than 900 pages of text,contains 37 chapters that help to define the areas where health professionals can improvehealth and reduce the risk of disease with dietary modifications. We have enhanced the

viii Series Editor’s Introduction

contents of the first two editions even further with the addition of 16 new chapters as wellas comprehensive updates of all of the chapters that are included in this edition. Chapterauthors are the most authoritative leaders in their various fields of expertise. The volumecontains cutting-edge chapters from 79 authors who provide a truly global perspective topreventive nutrition opportunities. In addition, Dr. Alfred Sommer, whose internationalresearch has been honored with the prestigious Lasker Award, has provided a thoughtfulForeword for our book. Thus, Richard and I have worked diligently to develop a thirdedition that is destined to be the benchmark in the field because of its extensive, in-depthchapters covering the most important aspects of preventive nutrition with emphasis onnormal human physiology and nutritional needs, analyses of epidemiological findings,in-depth and balanced discussions of clinical findings including the role of nutrients indisease treatment as well as primary and secondary disease prevention.

The book chapters are logically organized in nine sections to provide the reader witha basic understanding of the role of preventive nutrition strategies: I. Preventive NutritionOverview, II. Cancer Prevention, III. Cardiovascular Disease Prevention, IV. Diabetesand Obesity, V. Bone Diseases, VI. Prevention of Major Disabilities: Improvement inHealth Outcomes, VII. Optimal Pregnancy/Infancy Outcomes, VIII. Preventive Nutri-tion: Global Perspectives, and finally, IX. Critical Issues for the 21st Century. Thislogical sequence of chapters provides the latest information on the current standards ofpractice for clinicians, related health professionals including the dietitian, nurse, pharma-cist, physical therapist, behaviorist, psychologist, and others involved in the team effortrequired for successful treatments. This comprehensive volume also has great value foracademicians involved in the education of graduate students and postdoctoral fellows,medical students and allied health professionals who plan to interact with patients onquestions concerning the science behind the latest “study” presented on the evening newsbecause the chapters present a synthesis of the totality of the evidence, not a conclusionbased on a single study.

In-depth, balanced reviews of the current science behind questions related to topicssuch as soy; vitamin supplements; fat substitutes; DHA; trans-fatty acids; carotenoids,such as lycopene and lutein; and numerous other dietary components, provide health careprofessionals and students with excellent, well-referenced answers. Medically relatedprofessionals will certainly find the chapters dealing with obesity across the age span, andincluding the genetic components of related diseases, of particular importance to theirpractice. Additional chapters provide in-depth reviews of the functions of vitamins andminerals and other dietary factors in the endocrine, cardiovascular, respiratory,gastrointestinal, immune, skeletal, and ocular systems of the body. Obesity is a criticalconcern for virtually every health professional. The third edition has an expanded sectionon obesity and diabetes that includes important aspects of childhood obesity. There is aclear, data-driven message throughout the obesity section of the volume that obesity isa chronic disease. The volume is of particular importance because it includes understand-able chapters in highly technical areas written by the leading authorities who are actuallyworking in the areas of research discussed in their chapters.

Of added value to health care professionals who are interested in public health is theexceptional introductory chapter that places preventive nutrition in its historic perspec-tive and goes on to project the enormous potential for preventive strategies to reduce

human suffering. This chapter is balanced with the final book chapter that provides apractical approach to determining the economic value of adopting a number of the pre-ventive nutrition strategies discussed throughout the volume. An often-overlookeddietary component, alcohol, is critically examined in a separate chapter, as it can well bea double-edged sword and can impact diseases and conditions that would otherwise bebeneficially affected by implementing preventive nutrition strategies. Other unique chap-ters examine the national differences in the consumer messages that are permitted fordietary factors and the current status of nutrition education in medical schools. Of greatimportance, the authors have provided chapters that balance the most technical informa-tion with discussions of its importance for clients and patients as well as graduate andmedical students, health professionals, and academicians.

The third edition of Preventive Nutrition continues to serve as a major resource oninternational nutrition because the volume includes important chapters about implemen-tation strategies from leading experts about national interventions in Europe, Asia, andAfrica. Prior editions were so well accepted by those interested in the impact of nutritionon world health, in part because of this unique section on global perspectives. In thecurrent edition, this section examines the successes and consequent public health impli-cations of national preventive nutrition strategies, not only in the United States andEurope, but also in “Westernizing” nations and developing countries. Updates fromNorway and Chile that were first provided in the 1997 edition are now included in thethird edition. Also updated is the chapter that examines the potential health benefits to theUnited States with adoption of preventive nutrition strategies. There are two insightfulchapters on the growing presence of obesity in Latin America and Japan and how theWesternization of eating habits has negatively impacted the health of these nations.

Hallmarks of all chapters include bulleted key points at the beginning of each chapteras well as a detailed table of contents; complete definitions of terms with the abbrevia-tions fully defined for the reader, and consistent use of terms between chapters. There arenumerous relevant tables, graphs, and figures as well as up-to-date references; all chap-ters include a conclusion section that provides the highlights of major findings. Eachchapter ends with a recommendations section that helps to guide the reader to data-driven, balanced advice for their students, clients, and/or patients. The volume containsa highly annotated index and within chapters, readers are referred to relevant informationin other chapters.

In conclusion, Preventive Nutrition: The Comprehensive Guide for Health Professionals,Third Edition provides health professionals in many areas of research and practice withthe most up-to-date, well-referenced and easy-to-comprehend volume on the importanceof understanding the current strategies for enhancing health and preventing diseasethrough the implementation of well-accepted and highly recommended preventive nutri-tion options. This volume will serve the reader as the benchmark in the nutrition field, asit stands as the most authoritative resource to date on prevention, and is a very welcomeaddition to the Nutrition and Health Series.

Adrianne Bendich, PhD, FACN

Series Editor

Series Editor’s Introduction ix

Foreword

xi

Why a third edition of Preventive Nutrition, and only a few years after the second?Because the public has developed an insatiable appetite for advice on what foods to eatand supplements to take, a phenomenon fed in large part by the sensationalist hype everynew “study” receives from the media. And the media are being fed with tantalizing newdata and claims at an accelerating rate.

Unfortunately, although people and policymakers want definitive recommendations,the vast outpouring of new data arrives in fragmentary (and often contradictory) bites, fartoo messy for the individual health professional to assimilate. By synthesizing these latestdata and integrating them into the broad body of existing information, Preventive Nutritiongoes a long way toward orienting health professionals to the field and guiding the advicethey give their patients and the public.

No one can seriously doubt the impact that nutrition has on health—well beyond theclassical deficiency syndromes described in the past (xerophthalmia, anemia, scurvy,pellagra). Recognition of the role of saturated fats in coronary artery disease led to adramatic change in America’s dietary habits and a halving of the incidence of fatal heartattacks. Public health interventions don’t get much better than that.

More recently, the surprising discovery that preconceptional folate supplements couldsignificantly reduce the incidence of neural tube defects resulted in the mandatoryfortification of cereal flour, which led to a significant reduction in the incidence of thisdevastating congenital defect. An outpouring of new studies suggest potential benefitsfrom a host of nutritional interventions for chronic diseases—critically important, givengreater longevity and aging of virtually all the world’s populations. Some, like the needfor increased calcium to reduce the soaring rates of osteoporosis, are well established,even if the ideal formulation (and concurrent use of drugs to the same end) is still beingstudied and the recommendations refined. Others, like zinc and antioxidant supplemen-tation to retard progression of macular degeneration, the leading cause of irreversibleblindness, now have the support of a rigorous randomized trial, which also, importantly,defined the small, specific group in which this proved beneficial.

But not all the “news” is necessarily true—at least not the way it is first perceived.Many of our most important and much-ballyhooed insights arise from observationalstudies: people who eat more salads and vegetables purportedly have lower risks ofcertain cancers; those consuming more fiber appear to have a lower risk of colon cancer.Although that might be so, randomized clinical trials have failed to demonstrate thatchanging the intake of these dietary factors actually altered the risk of disease. The “bestavailable evidence” is often less than we would prefer; and, as is often the case, recom-mendations and policies are made with less than adequate data.

Of course some “truths” don’t require randomized trials, but what we do about themdo. Today’s growing epidemic of obesity, already fueling a secondary epidemic of “adult”

xii Foreword

onset of diabetes among adolescents, is clearly fueled by increased intake of calorie-dense foods coupled with a sedentary lifestyle—and not just in the developed world.But instead of reducing the amount of food they consume and getting more exercise,inaccurately referred to as “simple lifestyle changes,” the small part of the public thatactually cares at all about its nutritional health and waistline has fixated instead onelaborate new dietary fetishes, whether “Atkins,” “South Beach,” or “The Zone.” Dothese really work? Are they safe? How should health professionals and policymakersrecommend intercepting our collective corpulence in ways that are proven safe andeffective for the populace as a whole?

The plethora of information emanating from molecular biology on the one hand andepidemiological and clinical studies on the other have provided, and will ultimatelyprovide, the basis for rational, evidence-based nutritional “prescriptions” for better health.People seek (and deserve) the best advice available from their health professionals. Giventhe growing numbers of chronic diseases and the direct and indirect costs associated withthem, relatively inexpensive nutritional interventions need to be discovered, promul-gated, and actually employed. This latest edition of Preventive Nutrition provides acomprehensive integration of the best available data on the role of nutrition in health. Itis an excellent place to discover what still needs scientific inquiry and what healthprofessionals might reasonably advise their patients and the public.

Alfred Sommer, MD, MHS

Johns Hopkins Bloomberg School of Public HealthJohns Hopkins University, Baltimore, MD

Preface

xiii

Preventive Nutrition was first published in 1997; the second edition appeared in 2001.Also in 2001, we edited a volume entitled Primary and Secondary Preventive Nutrition.Both texts were very well accepted as critical resources for medical school libraries andhealth care professionals including physicians, nutritionists, dietitians, nurses, and phar-macists. The volumes were also used by many academic researchers as the basis fordeveloping graduate courses in preventive nutrition; Preventive Nutrition has beenadopted as a text in many of the most highly rated graduate nutrition programs in theUnited States, Europe, South America, and Asia. The overall goal of the third edition ofPreventive Nutrition is to combine and update chapters of excellence that were includedin the first and second editions of Preventive Nutrition, as well as critical chapters fromPrimary and Secondary Preventive Nutrition and to add new chapters that emphasize thecritical role of nutrition in a growing number of health arenas.

In the third edition we provide health professionals with up-to-date, comprehensivereviews that evaluate the dietary practices and interventions that have been shown toreduce disease risk and/or to improve health outcomes. Evidence-based nutritional inter-ventions are a critical component of preventive medicine approaches to prevent anincreasing number of diseases and diminish their consequences. Within the past decade,many studies have demonstrated the potential for optimizing macro- and micronutrientintakes to improve not only individual outcomes throughout the life cycle, from fetaldevelopment to the aging process, but also to reduce individual and national health carecosts.

This third edition is more comprehensive that the previous volumes. The averagenumber of chapters for each of the three previous volumes was 25; this edition contains37 chapters. Several chapters that first appeared in Primary and Secondary PreventiveNutrition have been revised and are therefore new subject areas for Preventive Nutrition,Third Edition. The volume is divided into the following nine sections: I. PreventiveNutrition Overview; II. Cancer Prevention; III. Cardiovascular Disease Prevention; IV.Diabetes and Obesity; V. Bone Diseases; VI. Prevention of Major Disabilities: Improve-ment in Health Outcomes; VII. Optimal Pregnancy/Infancy outcomes; VIII. PreventiveNutrition: Global Perspectives, and finally, IX. Critical Issues for the 21st Century. Thenumbers of chapters in each section are well balanced, contain numerous comprehensivetables and clearly labeled figures, and reflect the major areas of recent research importantto health professionals. Also new to this edition is the inclusion of Key Points at thebeginning of each chapter that define the chapter’s critical learning points for the reader.The third edition of Preventive Nutrition continues to include a comprehensive index aswell as helpful listings of relevant books, journals, and websites.

There is a new introductory chapter that provides an historic perspective as well asinsight into the future economic consequences of adopting a preventive nutrition strategyto improve health. In the section on cancer, there is a comprehensive updating of the

xiv Preface

components in the diet that affect cancer risk, including an overview on informationrelating to cancers of the esophagus and stomach. There are new chapters on tomatoes,lycopene and prostate cancer, soy and cancer prevention, and dietary supplement use andtheir effects on cancer risk. The “new” research on dietary components that are notconsidered to have traditional “essential nutritional value” but have been shown to haveimportant health consequences, such as fiber, specific long-chain fatty acids, non-provitaminA carotenoids, and other phytochemicals, are placed in perspective with regard to theavailable knowledge to date by expert authors who are the leaders in their fields.

In the cardiovascular disease section, there are comprehensive revisions to the chap-ters on iron, homocysteine, and the long-chain omega-3 fatty acids. Within the pastdecade, there have been several critical intervention studies that examined the potentialfor antioxidants from supplements to reduce cardiovascular disease risks as well asmyocardial infarction, vascular pathology, and ultimately mortality. A new chapterreviews the totality of the evidence on the effects of antioxidant supplements on cardio-vascular outcomes.

Diabetes and obesity are major health concerns that are significantly impacted by dietand dietary components. We have included this key section from the Primary andSecondary Preventive Nutrition volume as well as five distinctive chapters by leadingclinical authorities in obesity and diabetes research. There is a comprehensive chapter ontrans fats; another that addresses the current epidemic of childhood and adolescentobesity and insulin resistance followed by two provocative chapters on prevention ofchildhood obesity—one that examines clinical programs, the other with a more publichealth perspective. Lastly, there is a chapter on the impact of weight reduction on decreas-ing chronic disease-related risk factors.

Bone diseases affect millions of adults and not only seniors. We include separatechapters on osteoarthritis (a new chapter) and osteoporosis, and another new chapter onanti-osteoporosis medications . The latter stresses the requirements for calcium, vitaminD, and other nutrients to achieve the full efficacy of these drugs.

In the section on the prevention of major disabilities, there is a new chapter on cataractprevention and the role of antioxidants. There are updated chapters on the importance ofantioxidant nutrients in the prevention of diseases resulting from oxidative stress, anotherthat includes recent studies on the importance of micronutrients in maintaining theimmune function of healthy older adults, and an updated chapter on the impact of vitaminA on the immune function of the very young, stressing the developing countries. A newchapter reports on recent studies that explored the potential for a century-old interven-tion, cod liver oil, to reduce the risk of respiratory infections in urban children from theUnited States.

Another major objective of this volume is to examine key research linking nutritionalstatus with the prevention of birth defects and optimization of birth outcomes. This areais gaining in importance as birth weight and size are being linked to risk of chronicdiseases in adulthood. One of the critical nutrient-based discoveries of the last century isthe ability to prevent neural tube birth defects by folic acid supplementation. The updatedchapter contains the latest data that confirm and strengthen the original findings thatpericonceptional supplementation with a folic acid-containing prenatal supplementsignificantly reduced the risk of first time neural tube birth defects as well as cardiovascular

and other serious birth defects. There is a revised chapter on the significant associationbetween micronutrient status and risk of preterm delivery and low birth-weightoutcomes. This chapter is complemented by the new chapter on the relevance of measuresof maternal thinness for predicting economic crisis in a nation. The final chapter in thissection deals with an update of another of the major nutritional advances of the last fewdecades, the essentiality of long-chain omega-3 fatty acids for the optimal developmentof the brain and the retina of the fetus and the vision and intellectual capacity of thenewborn.

Preventive Nutrition has been so well accepted by those interested in the impact ofnutrition on world health in part because of the unique section on global perspectives.This section examined the successes and consequent public health implications ofnational preventive nutrition strategies, not only in the United States and Europe, but alsoin “Westernizing” nations and developing countries. A number of these chapters did notappear in the second edition. We have gone back to the authors of these valuable chapters.We are very pleased to include updates of data from Norway and Chile that were firstprovided in the 1997 edition, and are now included in the third edition. Also updated isthe chapter that examines the potential health benefits to the United States with adoptionof preventive nutrition strategies. There are two insightful chapters on the growing pres-ence of obesity in Latin America and Japan and how westernization of eating habits hasnegatively impacted the health of these nations.

The final section of this comprehensive volume is also new to Preventive Nutrition andexamines critical nutritionally related issues for the 21st century. There is an in-depthlook at the role of alcohol consumption and whether the benefits outweigh the risks.Another important addition to the volume is the comprehensive chapter that examines theeffects of drug–nutrient interactions from many different perspectives. These interac-tions become increasingly important as our society ages and uses many drugs daily, allof which have some impact on nutritional status. The last three chapters serve as veryuseful resources to many of our readers. In the United States, the government regulationof foods and dietary supplements is complex and evolving; thus we include a chapter onthe current status of the regulations and the health claims that have emerged in the lastdecade. Many of our readers are involved in the development of curricula for graduateand medical schools, and there is a chapter on the current level of nutrition educationprovided in the US medical schools. Finally, we include a chapter that examines the linkthroughout the life cycle between health and economic value of preventive nutritionstrategies in individuals, communities, and/or nations. This last chapter completes thecircle and brings us back to the very first chapter that described the historic perspectiveon nutrition strategies that prevent chronic diseases and improve human health.

The third edition provides access to practicing health professionals, includingphysicians, nutritionists, dentists, pharmacists, dietitians, health educators, policymakers,and research investigators to the considerable recent research demonstrating that theonset of major diseases can be prevented, or at least delayed, with simple nutritionalapproaches. Many health professionals are frequently asked about recent findings onvitamins or other nutrients presented in their local newspaper or on the evening news.Patients demand counseling from their health care providers on �-carotene, lycopene,antioxidants, soy, fiber, folate, calcium, and the myriad of bioactive phytochemicals,such as those found in garlic and other foods.

Preface xv

As the demographics of US and European populations change and become moremulticultural, it is increasingly important for health professionals to understand thenutritional backgrounds and diversities of their patients and clients. As important, theremay be significant national dietary initiatives that provide roadmaps for effective imple-mentation of preventive nutrition within an overall strategy of health improvement,especially for vulnerable members of the population, such as the poor. As editors, wehave endeavored to include the most compelling areas of nutritional research that canhave immediate impact on the health and education of our readers. We anticipate that thethird edition of Preventive Nutrition will be a valued resource to health professionals andstudents who are interested in reducing disease risk and enhancing health by implement-ing the well-documented preventive nutrition strategies outlined in this volume.

We thank Paul Dolgert and the staff at Humana Press for their confidence in our visionand their assistance in bringing this volume to fruition. We also thank Nicole Ticknor atGSK and Randy Weiss at Columbia University for their administrative support. Weremain grateful to our authors for their insightful chapters and to Dr. Alfred Sommer forhis eloquent Foreword.

Adrianne Bendich, PhD, FACN

Richard J. Deckelbaum, MD, FRCP(C)

xvi Preface

Contents

Series Editor’s Introduction ........................................................................................ vii

Foreword ....................................................................................................................... xi

Preface ........................................................................................................................ xiii

Contributors ................................................................................................................. xxi

Value-Added eBook/PDA ......................................................................................... xxv

I Preventive Nutrition Overview1 Preventive Nutrition: A Historic Perspective

and Future Economic Outlook ..................................................... 3Nancy D. Ernst and J. Michael McGinnis

II Cancer Prevention2 Prevention of Cancers of the Esophagus and Stomach ................. 25

Elizabeth T. H. Fontham and L. Joseph Su

3 Non-Nutritive Components in Foods as Modifiersof the Cancer Process ................................................................. 55

Keith W. Singletary, Steven J. T. Jackson,and John A. Milner

4 Dietary Supplements and Cancer Risk: EpidemiologicalResearch and Recommendations ................................................ 89

Marian L. Neuhouser, Ruth E. Patterson, Alan R. Kristal,and Emily White

5 Soy Consumption and Cancer Prevention:A Critical Review ...................................................................... 123

Jin-Rong Zhou and John W. Erdman, Jr.

6 Tomato, Lycopene, and Prostate Cancer ..................................... 157Jessica K. Campbell and John W. Erdman, Jr.

III Cardiovascular Disease Prevention7 Iron and Heart Disease: A Review of the Epidemiological

Data........................................................................................... 173Christopher T. Sempos, Richard F. Gillum,

and Anne C. Looker

8 Homocysteine, Folic Acid, and Cardiovascular Disease Risk .... 191Shirley A. A. Beresford and Arno G. Motulsky

9 n-3 Fatty Acids from Fish and Plants: Primary and SecondaryPrevention of Cardiovascular Disease .................................... 221

William E. Connor and Sonja L. Connor

xvii

xviii Contents

10 Antioxidant Vitamin Supplementationand Cardiovascular Disease ..................................................... 245

Howard N. Hodis, Wendy J. Mack, and Alex Sevanian

11 Health Effects of Trans Fatty Acids ............................................. 279Ronald P. Mensink and Susanne H. F. Vermunt

IV Diabetes and Obesity12 Obesity and Insulin Resistance in Childhood

and Adolescence ....................................................................... 293Erik Bergström and Olle Hernell

13 Prevention of Pediatric Obesity: Examining the Issuesand Forecasting Research Directions...................................... 321

Myles S. Faith, Christina J. Calamaro, Angelo Pietrobelli,Meredith S. Dolan, David B. Allison,and Steven B. Heymsfield

14 Can Childhood Obesity Be Prevented?: Preschool Nutritionand Obesity ............................................................................... 345

Christine L. Williams15 Obesity and Chronic Disease: Impact of Weight Reduction........ 383

Henry I. Frier and Harry L. Greene

V Bone Diseases16 Osteoarthritis: Role of Nutrition and Dietary Supplement

Interventions ............................................................................. 405Timothy E. McAlindon

17 Calcium Requirements During Treatment of Osteoporosisin Women .................................................................................. 425

Richard Eastell

18 Osteoporosis: Protein, Minerals, Vitamins,and Other Micronutrients ......................................................... 433

Robert P. Heaney

VI Prevention of Major Disabilities: Improvementin Health Outcomes19 Antioxidant Status and Risk for Cataract .................................... 463

Mark Siegal, Chung-Jung Chiu, and Allen Taylor

20 Antioxidant Nutrients and Preventionof Oxidant-Mediated Diseases ................................................. 505

Ronald Anderson

21 Nutritional Supplements and Upper Respiratory TractIllnesses in Young Children in the United States .................... 521

Linda A. Linday

22 Micronutrients and Immunity in Older People ............................ 551John D. Bogden and Donald B. Louria

23 Vitamin A and the Prevention of Morbidity, Mortality,and Blindness ............................................................................ 573

Richard D. Semba

VII Optimal Pregnancy/Infancy Outcomes24 Folic Acid-Containing Multivitamins and Primary Prevention

of Birth Defects ........................................................................ 603Andrew E. Czeizel

25 Maternal Nutrition and Preterm Delivery .................................... 629Theresa O. Scholl

26 Dietary Polyunsaturated Fatty Acids for OptimalNeurodevelopment: Recommendations for PerinatalNutrition .................................................................................... 665

Ricardo Uauy, Patricia Mena, Adolfo Llanos,and Patricio Peirano

27 Micronutrient Deficiencies and Maternal Thinness:First Chain in the Sequence of Nutritional and HealthEvents in Economic Crises ....................................................... 689

Martin W. Bloem, Saskia de Pee, and Ian Darnton-Hill

VIII Preventive Nutrition: Global Perspectives28 Potential Benefits of Preventive Nutrition Strategies:

Lessons for the United States ................................................... 713Walter C. Willett

29 Nutrition and Food Policy in Norway: Effects on Reductionof Coronary Heart Disease ...................................................... 735

Kaare R. Norum, Gunn-Elin A. Bjørneboe, Arne Oshaug,Grete Botten, and Lars Johansson

30 Prevention of Malnutrition in Chile ............................................. 753Fernando Mönckeberg Barros

31 Effect of Westernization of Nutritional Habitson Obesity Prevalence in Latin America: Analysisand Recommendations .............................................................. 771

Jaime Rozowski, Oscar Castillo, and Manuel Moreno

32 Effects of Western Diet on Risk Factors of ChronicDiseases in Asia ........................................................................ 791

Kaichi Kida, Koji Takemoto, Sei Won Yang,and Supawadee Likitmaskul

IX. Critical Issues for the 21st Century33 Alcohol: The Balancing Act ......................................................... 807

William E. M. Lands34 Influence of Medication on Nutritional Status ............................ 833

Joseph I. Boullata

Contents xix

xx Contents

35 Health Claims for Foods and Dietary Supplements:Current and Emerging Policies ............................................... 869

Annette Dickinson

36 Teaching Preventive Nutrition in Medical Schools ..................... 889Martin Kohlmeier and Steven H. Zeisel

37 Preventive Nutrition Throughout the Life Cycle:A Cost-Effective Approach to Improved Health ...................... 901

Adrianne Bendich and Richard J. Deckelbaum

Appendix A: Related Readings ................................................................................. 923

Appendix B: Web Sites of Interest ............................................................................ 927

Index ........................................................................................................................... 931

Contributors

DAVID B. ALLISON, PhD • Section on Statistical Genetics, Department of Biostatistics,and Clinical Nutrition Research Center, Department of Nutrition Sciences,University of Alabama at Birmingham, Birmingham, AL

RONALD ANDERSON, PhD • Medical Research Council Unit for Inflammationand Immunity Department of Immunology, Faculty of Health Sciences, Universityof Pretoria, South Africa

FERNANDO MÖNCKEBERG BARROS, MD • Faculty of Health Science, Diego Portales University,Santiago, Chile

ADRIANNE BENDICH, PhD, FACN • Medical Affairs Department, GlaxoSmithKline,Parsippany, NJ

SHIRLEY A. A. BERESFORD, PhD • Department of Epidemiology, University of Washington,Seattle, WA

ERIK BERGSTRÖM, MD • Department of Clinical Sciences, Pediatrics, Umeå University,Umeå, Sweden

GUNN-ELIN A. BJØRNEBOE, PhD, MD • Directorate for Health and Social Affairs, Oslo,Norway

MARTIN W. BLOEM, PhD • Helen Keller International Regional Office Asia Pacific,Singapore

JOHN D. BOGDEN, PhD • Department of Preventive Medicine and Community Health,UMDNJ-New Jersey Medical School, Newark, NJ

GRETE BOTTEN, PhD, MD • Center for Health Administration, University of Oslo,Norway

JOSEPH I. BOULLATA, PharmD, BCNSP • School of Pharmacy, Temple University, Philadelphia,PA

CHRISTINA J. CALAMARO, RN • University of Pennsylvania School of Medicine, Philadelphia,PA

JESSICA K. CAMPBELL, PhD • Department of Food Science and Human Nutrition,University of Illinois at Urbana-Champaign, Urbana, IL

OSCAR CASTILLO, MSc • Department of Nutrition, Pontifical Catholic University ofChile, Santiago, Chile

CHUNG-JUNG CHIU, DDS, PhD • Laboratory for Nutrition and Vision research, USDAHuman Nutrition Research Center on Aging, Tufts University, Boston, MA

SONJA L. CONNOR, MS, RD, LD • Department of Endocrinology, Diabetes and ClinicalNutrition, Oregon Health & Science University, Portland, OR

WILLIAM E. CONNOR, MD • Department of Endocrinology, Diabetes and ClinicalNutrition, Oregon Health & Science University, Portland, OR

ANDREW E. CZEIZEL, MD • Foundation for the Community Control of HeredityDiseases, Budapest, Hungary

IAN DARNTON-HILL, PhD • Nutrition Department, UNICEF New York, New York, NY

xxi

RICHARD J. DECKELBAUM, MD, FRCP(C) • Institute of Nutrition, College of Physiciansand Surgeons, Columbia University, New York, NY

SASKIA DE PEE, MD • Helen Keller International Regional Office Asia Pacific,Singapore

ANNETTE DICKINSON, PhD • Council for Responsible Nutrition, Washington, DCMEREDITH S. DOLAN, MS, RD • Weight and Eating Disorders Program, University of

Pennsylvania School of Medicine, Philadelphia, PARICHARD EASTELL, MD, FRCP, FRCPath, FMedSci • Academic Unit of Bone Metabolism,

Division of Clinical Sciences, University of Sheffield, Sheffield, EnglandJOHN W. ERDMAN, JR., PhD • Department of Food Science and Human Nutrition,

University of Illinois at Urbana-Champaign, Urbana, ILNANCY D. ERNST, PhD • Ernst Nutrition Consulting, White Stone, VAMYLES S. FAITH, PhD • Weight and Eating Disorders Program, University of Pennsylvania

School of Medicine, Philadelphia, PAELIZABETH T. H. FONTHAM, DrPH • School of Public Health, Louisiana State University

Health Science Center, New Orleans, LAHENRY I. FRIER, PhD • Slim Fast Foods Company, West Palm Beach, FLRICHARD F. GILLUM, MD • National Center for Health Statistics, Centers for Disease

Control and Prevention, Hyattsville, MDHARRY L. GREENE, MD • Division of Endocrine and Metabolism, Department

of Internal Medicine, University of Kentucky, Lexington, KYROBERT P. HEANEY, MD • John H. Creighton University Professor, Creighton

University Medical Center, Omaha, NEOLLE HERNELL, MD • Department of Clinical Sciences, Pediatrics, Umeå University,

Umeå, SwedenSTEVEN B. HEYMSFIELD, MD • St. Luke’s Roosevelt Hospital Center, Columbia University

College of Physicians & Surgeons, New York, NYHOWARD N. HODIS, MD • Atherosclerosis Research Unit, Departments of Medicine,

Preventive Medicine, and Molecular Pharmacology and Toxicology, Keck Schoolof Medicine and School of Pharmacy, University of Southern California, LosAngeles, CA

STEVEN J. T. JACKSON, PhD • Department of Food Science and Human Nutrition,University of Illinois, Urbana, IL

LARS JOHANSSON, PhD • Directorate for Health and Social Affairs, Oslo, NorwayKAICHI KIDA, MD, PhD • Department of Pediatrics, Ehime University School

of Medicine, Shigenobu, JapanMARTIN KOHLMEIER, PhD • Department of Nutrition, School of Public Health and

School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NCALAN R. KRISTAL, DrPH • Cancer Prevention Program, Fred Hutchinson Cancer

Research Center, Seattle, WAWILLIAM E. M. LANDS, MD • National Institute on Alcohol Abuse and Alcoholism—

Retired, Bethesda, MDSUPAWADEE LIKITMASKUL, MD • Department of Pediatrics, Siriraji Hospital

Bangkok, Thailand

xxii Contributors

LINDA A. LINDAY, MD • Department of Pediatrics, The St. Luke’s-Roosevelt HospitalCenter and The College of Physicians and Surgeons, Columbia University, NewYork; Department of Otolaryngology, The New York Eye and Ear Infirmary, NewYork, and New York Medical College, Valhalla, NY

ADOLFO LLANOS, MD, MPH • Institute of Nutrition and Food Technology, University ofChile, Santiago, Chile

ANNE C. LOOKER, PhD • National Center for Health Statistics, Centers for DiseaseControl and Prevention, Hyattsville, MD

DONALD B. LOURIA, MD • Department of Preventive Medicine and Community Health,UMDNJ-New Jersey Medical School, Newark, NJ

WENDY J. MACK • Atherosclerosis Research Unit, Department of Preventive Medicine,Keck School of Medicine, University of Southern California, Los Angeles, CA

TIMOTHY E. MCALINDON, MD, MPH • Department of Rheumatology, Tufts-New EnglandMedical Center, Boston, MA

J. MICHAEL MCGINNIS, MD, MPP • Robert Wood Johnson Foundation, Princeton, NJPATRICIA MENA, MD • Institute of Nutrition and Food Technology, University of Chile,

Santiago, ChileRONALD P. MENSINK, PhD, MSC • Department of Human Biology, Maastricht University,

Maastricht, The NetherlandsJOHN A. MILNER, PhD • Nutritional Science Research Group, National Cancer Institute,

Bethesda, MDMANUEL MORENO, MD • Department of Nutrition, Pontifical Catholic University

of Chile, Santiago, ChileARNO G. MOTULKSY, MD, SCD • Departments of Medicine and Genome Science, University

of Washington, Seattle, WAMARIAN L. NEUHOUSER, PhD, RD • Cancer Prevention Program, Fred Hutchinson

Cancer Research Center, Seattle, WAKAARE R. NORUM, PhD, MD • Institute for Nutrition Research, University of Oslo,

NorwayARNE OSHAUG, PhD • Akershus University College, NorwayRUTH E. PATTERSON, PhD, RD • Fred Hutchinson Cancer Research Center, Seattle, WAPATRICIO PEIRANO, MD, PhD • Institute of Nutrition and Food Technology, University

of Chile, Santiago, ChileANGELO PIETROBELLI, MD • University of Pennsylvania School of Medicine, Philadelphia,

PAJAIME ROZOWSKI, PhD • Department of Nutrition, Pontifical Catholic University

of Chile, Santiago, ChileTHERESA O. SCHOLL, MPH, PhD, • Department of Obstetrics and Gynecology, UMDNJ

School of Medicine, Stratford, NJRICHARD D. SEMBA, MD, MPH • Department of Ophthalmology, Johns Hopkins School

of Medicine, Baltimore, MDCHRISTOPHER T. SEMPOS, PhD • Health of the Population (HOP) Integrated Review

Group, Center for Scientific Review, National Institutes of Health, Bethesda, MD

Contributors xxiii

ALEX SEVANIAN, PhD • Atherosclerosis Research Unit, Department of Molecular Pharmacologyand Toxicology, School of Pharmacy, University of Southern California, LosAngeles, CA

MARK SIEGAL, BS • Laboratory for Nutrition and Vision Research, USDA Human Nu-trition Research Center on Aging, Tufts University, Boston, MA

KEITH W. SINGLETARY, PhD • Department of Food Science and Human Nutrition,University of Illinois, Urbana, IL

ALFRED SOMMER, MD, MHS • School of Hygiene and Public Health, Johns HopkinsUniversity, Baltimore, MD

L. JOSEPH SU, PhD • School of Public Health, Louisiana State University HealthScience Center, , New Orleans, LA

ALLEN TAYLOR, PhD • Laboratory for Nutrition and Vision Research, USDA HumanNutrition Research Center on Aging, Tufts University, Boston, MA

KOJI TAKEMOTO, MD • Department of Pediatrics, Ehime University School of Medicine,Shigenobu, Japan

RICARDO UAUY, MD, PhD • Institute of Nutrition and Food Technology, Universityof Chile, Santiago, Chile

SUSANNE H. F. VERMUNT, PhD • Unilever Health Institute, Vlaardingen, The NetherlandsEMILY WHITE, PhD • Cancer Prevention Program, Fred Hutchinson Cancer Research

Center, Seattle, WAWALTER C. WILLETT, MD • Department of Nutrition, Harvard School of Public Health,

Boston, MACHRISTINE L. WILLIAMS, MD, MPH, FAAP • Department of Pediatrics & Institute

of Human Nutrition, College of Physicians and Surgeons, Columbia University,New York, NY

SEI WON YANG, PhD • Department of Pediatrics, Seoul University Children’s Hospital,Seoul, Korea

STEVEN H. ZEISEL, MD, PhD • Department of Nutrition, School of Public Health andSchool of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC

JIN-RONG ZHOU, PhD • Beth Israel Deaconess Medical Center, Harvard MedicalSchool, Boston, MA

xxiv Contributors

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