Nutrition for Life’s Stages: The Evidence Base
Author:Ian B Puddey, MBBS,FRACP,MD
Keywords:
Abstract:
Asia Pac J Clin Nutr. 2002;11(10):S477-S479.doi:
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Nutrition: the new world map
Author:Geoffrey Cannon
Keywords:ecological nutrition, growth and health, nutrition, paradigm shifts in nutrition, population and planetary health
Abstract:The map of nutrition, evident in the structure of any course or textbook, derives from theses that framed a
science begun in the 1840s, developed until the 1940s, and consolidated until now. Nutritionists now are as
perplexed as the explorers of half a millennium ago, who continued to use maps that did not fit the wider world
they found. Until the 1600s, alternatives to Ptolemaic cosmology remained unthinkable despite its obvious
inadequacy, because it was of a universe with the earth, and man made in the divine image, at its centre.
Nutritionists now are inhibited for similar reasons. Two determining principles of nutrition science, the
identification of health with growth and the belief that animal food is superior to plant food, have a deep origin;
they derive from the materialist ideology that asserts a manifest destiny of humans to exploit and consume the
living and natural world. In response, a new nutrition is emerging, with a global perspective, whose ideology
places humans within nature, and whose theses make a wider frame, able to fit the world as we can discern it
now. The new nutrition gives equal value to personal, population and planetary health, with all that implies,
including the concept that the world is best perceived as a whole. The Copernican revolution changed the
meaning of movement on earth. The new nutrition can change the meaning of life on earth. Now is the time to
draw its map.
Asia Pac J Clin Nutr. 2002;11(10):S480-S497.doi:
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Nutrition: the new world disorder
Author:Geoffrey Cannon
Keywords:ecological nutrition, food systems, green revolution, liberalisation of food trade
Abstract:Scale up ‘we are what we eat’ and nutrition is revealed as an aspect of world governance. The quality and nature
of food systems has always tended to determine not only the health and welfare but also the fate of nations. The
independence of nations depends on their development of their own human and natural resources, including food
systems, which, if resilient, are indigenous, traditional, or evolved over time to climate, terrain and culture.
Rapid adoption of untested or foreign food systems is hazardous not only to health, but also to security and
sovereignty. Immediate gain may cause permanent loss. Dietary guidelines that recommend strange foods are
liable to disrupt previous established food cultures. Since the 1960s the ‘green revolution’ has increased crop
yield, and has also accelerated the exodus of hundreds of millions of farmers and their families from the land into
lives of misery in mega-cities. This is a root cause of increased global inequity, instability and violence. ‘Free
trade’ of food, in which value is determined by price, is imposed by dominant governments in alliance with
industry when they believe they can thereby control the markets. The World Trade Organization and other
agencies coordinate the work of transnational corporations that are the modern equivalents of the East India
companies. Scientists should consider the wider dimensions of their work, nutrition scientists not least, because
of the key place of food systems in all societies.
Asia Pac J Clin Nutr. 2002;11(10):S498-S509.doi:
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Discrepancies in nutritional recommendations: the need for evidence based nutrition
Author:Jim Mann, CNZM,PhD,DM,FRACP,FFPHM,FRSNZ
Keywords:Evidence-based medicine, level of evidence, randomised controlled trials, recommendations
Abstract:The widespread acceptance that ‘evidence-based medicine’ should determine all aspects of clinical practice
leads to a consideration as to whether ‘evidence-based nutrition’ should be based on similar principles.
Randomised controlled trials (RCT) are universally regarded as the gold standard by which to determine whether
a drug is appropriate in a particular clinical situation. The evidence for some nutritional recommendations is
indeed substantiated by RCT but in the case of some chronic diseases, notably cancers, where nutritional factors
may operate as promoters or protectors many years before the onset of clinical disease, RCT may not be
particularly appropriate. A range of experimental studies and descriptive epidemiological approaches may be
regarded as sufficient to justify nutritional recommendations or dietary guidelines. Recommendations for the
prevention and treatment of selected diseases will be considered in the context of their evidence-base.
Asia Pac J Clin Nutr. 2002;11(10):S510-S515.doi:
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Will feeding mothers prevent the Asian metabolic syndrome epidemic?
Author:W Philip T James, MD,DSc,FRCP,RSE
Keywords:Fetal programming, low birth weight, maternal nutrition, metabolic syndrome
Abstract:Evolutionary pressures have probably amplified the mechanisms for minimizing the impact of environmental
factors through compensatory maternal mechanisms. Nevertheless, experimentally there are clear long-term
programming effects of manipulations to the maternal diet on the likelihood of neural-tube defects associated
with folate deficiency The fat/lean ratios of the newborn, and subsequent development, seem to be linked to
amino acid or folate supply. An altered balance in the hypothalamic–pituitary–adrenal axis, which experimentally has profound effects on brain development, is induced by low-protein maternal diets. Such diets are linked
to a reduced pancreatic capacity for insulin production and to an altered hepatic architecture, with a change in
the control of glucose metabolism. Human studies suggest that what happens in pregnancy is modified by the
child’s diet in the first months of life. Low birthweight is linked to early stunting, and predisposes to abdominal
obesity and metabolic syndrome in later life. Metabolic syndrome amplifies the risks of diabetes, hypertension,
coronary heart disease and probably some cancers. Mothers with gestational diabetes are themselves prone to
early type 2 diabetes and produce heavier babies prone to childhood obesity and adolescent type 2 diabetes.
There is increasing evidence of an intergenerational effect, with big babies being prone to excess weight gain,
which then, in girls, predisposes them to diabetes in pregnancy, which, in turn, promotes an accelerating cycle
of early diabetes in subsequent generations. Essential fatty acids and fat soluble vitamins are important, but we
need early interventions and monitoring systems to justify coherent policies.
Asia Pac J Clin Nutr. 2002;11(10):S516-S523.doi:
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Child and adolescent obesity in the 21st century: an Australian perspective
Author:Louise A Baur BSc(Med), MBBS, PhD, FRACP
Keywords:Australia, body mass index, complications, management, obesity, overweight, prevalence, prevention
Abstract:The early 21st century has seen the development of a global epidemic of obesity in both developed and
developing countries. In Australia at least one in five children and adolescents are overweight or obese, with
rapid rises in prevalence apparently continuing. Similar trends are seen in other countries. Child and adolescent
obesity is associated with both immediate and long-term medical and psychosocial problems, including a
clustering of risk factors for the development of cardiovascular disease and diabetes. Thus, obesity poses a major
health problem for the paediatric population. Major environmental and societal changes have led to a decrease
in physical activity, a rise in sedentary behaviour and the consumption of high fat and high-energy foods, all in
turn influencing the development of obesity. Effective management involves a multimodal approach with a
developmentally aware approach, involvement of the family, a focus on healthy food choices, incorporation of
physical activity and a decrease in sedentary behaviour all being important. Ultimately, however, the obesity
epidemic requires a major focus on primary prevention. Australia has a national strategy for the prevention of
overweight and obesity that depends upon intersectoral and intergovernmental cooperation, supported by
adequate resourcing and significant community ownership.
Asia Pac J Clin Nutr. 2002;11(10):S524-S528.doi:
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Nutrition before birth, programming and the perpetuation of social inequalities in health
Author:Vivienne Moore BSc(Hons), MPH, PhD and Michael Dav
Keywords:
Abstract:The need to explain social inequalities in health has led to the theory that chronic disease is due, in part, to a
legacy of adverse experiences in early life. Epidemiological studies show consistently that individuals who are
small at birth have an increased risk of cardiovascular disease in adulthood. There is growing consensus that this
association reflects a causal relationship and is not simply the product of bias or confounding. The concept of
programming is invoked as the biological mechanism; birth size is thus a proxy for fetal programming. Recent
findings suggest that fetal programming interacts with the post-birth environment. The adverse exposures that
are thought to underlie and potentiate programming cluster in socially patterned ways, thus creating substantial
inequalities in health. Experiments in animals demonstrate that nutritional interventions before or during
pregnancy can produce programming phenomena in the offspring, sometimes without an impact on birth size.
However, the extent to which maternal nutrition contributes to programming in contemporary developed
countries is uncertain.
Asia Pac J Clin Nutr. 2002;11(10):S529-S536.doi:
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Nutrition and the early origins of adult disease
Author:John P Newnham 1MD FRACOG CMFM, Timothy JM Moss Ph
Keywords:Cardiovascular disease, diabetes mellitus, fetus, nutrition, pregnancy
Abstract:There is now overwhelming evidence that much of our predisposition to adult illness is determined by the time
of birth. These diseases appear to result from interactions between our genes, our intrauterine environment and
our postnatal lifestyle. Those at greatest risk are individuals in communities making a rapid transition from lives
of ‘thrift’ to a lives of ‘plenty’. From a global perspective, such origins of diabetes, coronary heart disease and
stroke, should render research in these fields as one of the highest priorities in human health care. Prevention will
be enhanced by elucidation of the mechanisms by which the fetus is programmed by the mother for the life she
expects it to live. At the present time, there is evidence that fetal nutrition and premature exposure to cortisol are
effective intrauterine triggers, but a multitude of alternative pathways require investigation. It is also likely that
programming extends across generations, and may involve the embryo and perhaps the oocyte. An oocyte that
becomes an adult human develops in the uterus of its grandmother, so further research is required to describe the
role of environments of grandmothers and mothers in predisposing offspring to health or illness in adult life.
Asia Pac J Clin Nutr. 2002;11(10):S537-S542.doi:
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Risk of suboptimal iron and zinc nutriture among adolescent girls in Australia and New Zealand: causes, consequences, and solutions
Author:R S Gibson PhD, A-L M Heath PhDand E L Ferguson Ph
Keywords:adolescent, anaemia, Australia, bioavailability, diet, girls, iron, New Zealand, zinc
Abstract:Surveys in Australia, New Zealand and other industrialised countries report that many adolescent girls have
dietary intakes of iron and zinc that fail to meet their high physiological requirements for growing body tissues,
expanding red cell mass, and onset of menarche. Such dietary inadequacies can be attributed to poor food
selection patterns, and low energy intakes. Additional exacerbating non-dietary factors may include high
menstrual losses, strenuous exercise, pregnancy, low socioeconomic status and ethnicity. These findings are
cause for concern because iron and zinc play essential roles in numerous metabolic functions and are required
for optimal growth, immune and cognitive function, work capacity, sexual maturation, and bone mineralization.
Moreover, if adolescents enter pregnancy with a compromised iron and zinc status, and continue to receive
intakes of iron and zinc that do not meet their increased needs, their poor iron and zinc status could adversely
affect the pregnancy outcome. Clearly, intervention strategies may be needed to improve the iron and zinc status
of high risk adolescent subgroups in Australia and New Zealand. The recommended treatment for iron
deficiency anaemia and moderate zinc deficiency is supplementation. Although dietary intervention is often
recommended for treating non-anaemic iron deficiency and mild zinc deficiency, it is probably more effective
and appropriate for prevention than for the treatment of suboptimal iron and zinc status. Many of the strategies
for enhancing the content and bioavailability of dietary iron are also appropriate for zinc.
Asia Pac J Clin Nutr. 2002;11(10):S543-S552.doi:
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Family food environments of 5–6-year-old-children: Does socioeconomic status make a difference?
Author:Karen Campbell RD MPH, David Crawford PhD, Michell
Keywords:
Abstract:
Asia Pac J Clin Nutr. 2002;11(10):S553-S561.doi:
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Asian migration to Australia: food and health consequences
Author:Mark L Wahlqvist AO, BmedSc, MD, BS, MD (Uppsala),
Keywords:acculturation, Asia, Australia, eco-disease, eco-nutrition, food variety, health, indigenous, migrant
Abstract:Australia’s food and health patterns are inextricably and increasingly linked with Asia. Indigenous Australians
arrived in the continent via Asia and have linguistic connections with people who settled in south India; there
was interaction and food trade between both South-East Asia and China and northern indigenous Australians
over thousands of years. After European settlement in 1788, there have been several and increasing (apart from
the period of the infamous White Australian Policy following the Colonial period and Independence, with
Federation, in 1901) waves of Asian migration, notably during the gold rush (Chinese), the building of the
overland Telegraph (Afghans), the Colombo Plan and Asian student education in Australia from the 1950s
onwards (South-Eeast Asians), and with refugees (Vietnamese and mainland Chinese), and business (late
twentieth century) and progressive family reunion. Each wave has injected additional food cultural elements and
caused a measure of health change for migrants and host citizens. Of principal advantage to Australia has been
the progressive diversification of the food supply and associated health protection. This has increased food
security and sustainability. The process of Australian eating patterns becoming Asianized is evident through
market garden development (and the introduction of new foods), fresh food markets and groceries, restaurants
and the development of household cooking skills (often taught by student boarders). Most of the diversification
has been with grain (rice), legumes (soy), greens, root vegetables, and various ‘exotic fruits’. Food acculturation
with migration is generally bi-directional. Thus, for Asians in Australia, there has been a decrease in energy
expenditure (and a lower plane of energy throughput), an increase in food energy density (through increased fat
and sugary drink intakes), and a decrease in certain health protective foods (lentils, soy, greens) and beverages
(tea). This sets the stage for ‘eco-diseases’. In a population probably genetically programmed (but modifiably)
in uteroto abdominal obesity, diabetes (type II and gestational) and cardiovascular disease, these conditions may
be rapidly acquired on migration, along with certain cancers (breast, colo-rectal and prostate). Thus, whilst Asian
migration to Australia has provided health opportunities for host citizens, there have been threats to migrant
citizens in regard to nutrition-related health.
Asia Pac J Clin Nutr. 2002;11(10):S562-S568.doi:
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Morbidity mortality paradox of 1st generation Greek Australians
Author:Antigone Kouris-Blazos PhD, APD
Keywords:Anglo-Celtic Australians, Australian Bureau of Statistics, cardiovascular disease, food habits in later life, Greek-born Australians, morbidity mortality paradox, traditional Greek food pattern
Abstract:There is evidence in Australia that 1st generation Greek Australians (GA), despite their high prevalence of
cardiovascular disease (CVD) risk factors (e.g. obesity, diabetes, hyperlipidaemia, smoking, hypertension,
sedentary lifestyles) continue to display more than 35% lower mortality from CVD and overall mortality
compared with the Australian-born after at least 30 years in Australia. This has been called a ‘morbidity
mortality paradox’ or ‘Greek-migrant paradox’. Retrospective data from elderly Greek migrants participating in
the International Union of Nutrition Sciences Food Habits in Later Life (FHILL) study suggests that diets
changed on migration due to the: (i) lack of familiar foods in the new environment; (ii) abundant and cheap
animal foods (iii) memories of hunger before migration; and (iv) status ascribed to energy dense foods (animal
foods, white bread and sweets) and ‘plumpness’ as a sign of affluence and plant foods (legumes, vegetable
dishes, grainy bread) and ‘thinness’ as a sign of poverty. This apparently resulted in traditional foods (e.g. olive
oil) being replaced with ‘new’ foods (e.g. butter), ‘traditional’ plant dishes being made more energy dense, larger
serves of animal foods, sweets and fats being consumed, and increased frequency of celebratory feasts. This shift
in food pattern contributed to significant weight gain in GA. Despite these potentially adverse changes, data
from Greece in the 1960s (seven countries study) and from Australia in the 1990s (FHILL study) has shown that
Greek migrants have continued to eat large serves of putatively protective foods (leafy vegetables, onions, garlic,
tomatoes, capsicum, lemon juice, herbs, legumes, fish) prepared according to Greek cuisine (e.g. vegetables
stewed in oil). Furthermore, GA were found to return to the traditional Greek food pattern with advancing years.
We suspect that these factors may explain why GA have recently been found to have over double the circulating
concentrations of antioxidant carotenoids, especially lutein, compared with Australians of Anglo-Celtic ancestry.
This in turn may have helped to make the CVD risk factors ‘benign’ and reduce the risk of death. This raises the
question whether specific dietary guidelines need to be developed for recent migrants to Australia, encouraging
them to retain the best of their traditional cultures and include the best of the mainstream culture.
Asia Pac J Clin Nutr. 2002;11(10):S569-S575.doi:
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Acculturation: Aboriginal and Torres Strait Islander nutrition
Author:Cindy Shannon
Keywords:Health policy, indigenous, nutrition, risk factors, traditional diet
Abstract:The health status of Australia’s indigenous people remains the worst of any subgroup within the population, and
there is little evidence of any significant improvement over the past two decades, a situation unprecedented on a
world scale. Compared with non-indigenous Australians, adult life expectancy is reduced by 15–20 years, with
twice the rates of mortality from heart disease, 17 times the death rate from diabetes and 10 times the deaths
from pneumonia. Despite improvements in perinatal mortality, they continue to represent a major cause of death,
with infant deaths up to 2.5 times higher than the general population. The problems of educational disadvantage
and unemployment are reflected in twice the rates of smoking and high obesity levels. Seven percent of
indigenous families are homeless, with many more in inadequate and overcrowded housing, sometimes lacking
water or sewerage. Economic disadvantage is real: 23% worry about going without food. Nutritional deficiencies
in children have resulted in failure to thrive, contributing greatly to the problems of pneumonia and infectious
diseases. The remoteness and isolation of many Aboriginal communities limit education and employment
opportunities. It is important to consider the historical context of Aboriginal and Torres Strait Islander people, in
order to gain an understanding of current health problems. The impact of past policies and practices and the
‘introduced diet’ are reflected in the poor health outcomes described above. This session will explore some of
the underlying historical, cultural, structural and political factors that can be linked to the current problems.
Asia Pac J Clin Nutr. 2002;11(10):S576-S578.doi:
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Nutrition knowledge and food consumption: can nutrition knowledge change food behaviour?
Author:Anthony Worsley BSc (Hons),PhD
Keywords:Behaviour change, food behaviour, nutrition knowledge
Abstract:The status and explanatory role of nutrition knowledge is uncertain in public health nutrition. Much of the
uncertainty about this area has been generated by conceptual confusion about the nature of knowledge and
behaviours, and, nutrition knowledge and food behaviours in particular. So the paper describes several key
concepts in some detail. The main argument is that ‘nutrition knowledge’ is a necessary but not sufficient factor
for changes in consumers’ food behaviours. Several classes of food behaviours and their causation are discussed.
They are influenced by a number of environmental and intra-individual factors, including motivations. The
interplay between motivational factors and information processing is important for nutrition promoters as is the
distinction between declarative and procedural knowledge. Consideration of the domains of nutrition knowledge
shows that their utility is likely to be related to consumers’ and nutritionists’ particular goals and viewpoints.
A brief survey of the recent literature shows that the evidence for the influence of nutrition knowledge on food
behaviours is mixed. Nevertheless, recent work suggests that nutrition knowledge may play a small but pivotal
role in the adoption of healthier food habits. The implications of this overview for public health nutrition are:
(i) We need to pay greater attention to the development of children’s and adults’ knowledge frameworks
(schema building); (ii) There is a need for a renewed proactive role for the education sector; (iii) We need to take
account of consumers’ personal food goals and their acquisition of procedural knowledge which will enable
them to attain their goals; (iv) Finally, much more research into the ways people learn and use food-related
knowledge is required in the form of experimental interventions and longitudinal studies.
Asia Pac J Clin Nutr. 2002;11(10):S579-S585.doi:
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An innovative program for changing health behaviours
Author:Valerie Burke MD,FRACP, Trevor A Mori PhD, Nella G
Keywords: Blood pressure, cholesterol, diet, weight control
Abstract:Health-related behaviours affecting diet, weight control and physical activity are important for long-term
cardiovascular health but behaviour change is difficult to initiate and even more difficult to maintain. We have
developed a health promotion program, in which social support has a key role, to encourage a prudent diet,
weight control and physical activity. Behaviour change is based on evaluating initial behaviour, weighing up
costs and benefits, assessing barriers to change and goal-setting. We first evaluated the program in couples
beginning to live together, a group chosen because of the risk of weight gain and decreased physical activity
after marriage, readiness to change behaviour at that time in the life course and the opportunity to use partner’s
support in achieving behaviour change. In an initial short-term study with 39 couples, intake of fat and takeaway foods decreased and consumption of fruit, vegetables and reduced fat foods increased. Physical activity
increased and there was a 6% fall in blood cholesterol. Further evaluation in 137 couples included assessment
after 12 months. A decrease in fat intake and increase in physical activity and fitness seen at the end of the
program persisted 1 year later. Lower cholesterol and a trend to lower weight gain and lower blood pressure
were also maintained after 12 months. We have modified the program aiming for weight loss, improved dietary
habits and increased physical activity in overweight treated hypertensives, supported by their partners.
Decreased intake of energy, total and saturated fat, and weight loss seen at the end of the 16 week program was
significantly greater in the intervention group than with usual care. Blood pressure fell in the program group at
the end of intervention and, in men, withdrawal of antihypertensive drugs was significantly associated with the
intervention. Weight loss and a decrease in waist circumference were maintained in the program group up to
16 months after entering the study. This program has the potential for wider application in other at-risk groups.
Asia Pac J Clin Nutr. 2002;11(10):S586-S597.doi:
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Sustaining dietary changes for preventing obesity and diabetes: lessons learned from the successes of other epidemic control programs
Author:Boyd Swinburn MB, ChB, MD, FRACP
Keywords:Diabetes, epidemics, obesity, prevention
Abstract:A degree of success has been achieved in controlling several epidemics of infectious and non-infectious causes
of death in countries, such as, Australia and New Zealand. Using the epidemiological triad (host, vector,
environment) as a model, the key components of the control of these epidemics have been identified and
compared to the current status of interventions to prevent obesity and its main disease consequence, type 2
diabetes. Reductions in mortality from tobacco, cardiovascular diseases, road crashes, cervical cancer and
sudden infant death syndrome have been achieved by addressing all corners of the triad. Similarly, prevention
programs have minimized the mortality from HIV AIDS and melanoma mortality rates are no longer rising. The
main lessons learned from these prevention programs that could be applied to the obesity/diabetes epidemic are:
taking a more comprehensive approach by increasing the environmental (mainly policy-based) initiatives;
increasing the ‘dose’ of interventions through greater investment in programs; exploring opportunities to further
influence the energy density of manufactured foods (one of the main vectors for increased energy intake);
developing and communicating specific, action messages; and developing a stronger advocacy voice so that
there is greater professional, public and political support for action. Successes in the other epidemics have been
achieved in the face of substantial barriers within individuals, society, the private sector and government. The
barriers for preventing obesity/diabetes are no less formidable, but the strategies for surmounting them have
been well tested in other epidemics.
Asia Pac J Clin Nutr. 2002;11(10):S598-S606.doi:
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Eating well: ageing gracefully!
Author:Karen E Charlton MSc,MPhil(Epidemiol),SRD
Keywords:ageing, chronic diseases, cognitive function, micronutrient status, sarcopenia
Abstract:The potential impact of dietary manipulation on the maintenance of physical and cognitive function between
middle and old age has profound consequences for optimization of health, independence and well-being for the
latter years. This review article considers four key areas: the role of diet and longevity; potential dietary
measures to prevent sarcopenia; diet and cognitive function; and dietary interventions with regard to primary or
secondary prevention of age-related chronic disorders. Caloric restriction has been shown to slow ageing and
maintain health status in both primates and rats. The evidence has limited applicability to humans, since it is
unlikely that 30% reduced diets could be maintained long-term. The causes of sarcopenia, which manifests as
loss of strength, disability and reduced quality of life, are multifactorial. However, resistance with ageing to
regulatory amino acids known to modulate translation and initiation, particularly leucine, raise possibilities with
regard to dietary intervention. The pattern of protein intake appears to be important in whole-body protein
retention in older adults. A body of evidence is emerging that associates various dietary factors with a reduction
in cognitive decline with age, or a delay in the progression of Alzheimer’s disease, particularly with regard to
intake of vitamin E and C-containing foods, as well as fish intake. Epidemiological evidence demonstrates a role
for dietary intervention in the primary prevention of chronic diseases, even in old age. However, the potentially
harmful effects of micronutrient supplementation in the secondary prevention of coronary heart disease raise
concern regarding appropriate dietary messages for the elderly. The role of the antioxidants, lycopene, lutein and
zeaxanthin, in the prevention of cataracts and age-related macular degeneration support the almost universal
dietary guideline ‘eat more fruit and vegetables’. In future dietary guidelines for the elderly need to be evidencebased and take into account protective food patterns, rather than target specific foods.
Asia Pac J Clin Nutr. 2002;11(10):S607-S617.doi:
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Preventing cancer: dietary lifestyle or clinical intervention?
Author:Graeme P Young, MB BS, MD, FRACP, Richard K Le Leu
Keywords:Breast cancer, cancer prevention, chemoprevention, colorectal cancer, dietary lifestyle, screening
Abstract:In Australia, colorectal, prostate and breast cancers are the most frequently occurring cancers in our society, a
pattern that is quite different from that of underdeveloped countries. While diet is largely responsible for these
differences, technological advances mean that the solutions can be viewed as systematic, financial, lifestyle or
technological. They range from those that require self-discipline and care for personal well-being through to those
that are seemingly a quick technological fix that will work in spite of an unhealthy lifestyle. There are three main
approaches available for prevention of these cancers: dietary lifestyle, chemoprevention and screening. It has been
estimated that the potential for prevention by a healthy dietary lifestyle is excellent and might reduce the burden of
breast, prostate and colorectal cancer by 33–55%, 10–20% and 66–75%, respectively. This should be safe and
inexpensive and have collateral benefit such as reduced cardiovascular disease and osteoporosis. But, population
compliance with more plant-based, less calorie dense foods is uncertain, the most healthy are likely to be the most
compliant and evidence for effectiveness when interventional programs are undertaken is disappointing. It is not
clear how dependable the dietary approach would be where inherited genetic factors determine risk for one of these
cancers. Chemoprevention, the administration of natural or synthetic agents that delay, slow down or inhibit the
process of tumorigenesis, are still under development and study. Hormone receptor modulators for breast and
derivatives of non-steroidal anti-inflammatory drugs for colorectal cancers seem to have most promise and may
reduce tumour incidence or death by as much as 50%. These agents are simpler to comply with than changing
dietary lifestyle and they are more potent, hence they may be of particular value in high-risk settings. But they are
likely to be more costly and run the risk of adverse effects with few collateral benefits. Screening, or the testing of
an individual for a disease when that individual does not have any symptoms or signs suggesting that the disease is
present, aims to prevent or delay the development of the cancer. Screening impacts on mortality more so than on
incidence, reducing colorectal cancer mortality in the range 15–60% and breast cancer mortality by 23–37%.
Screening has the advantage of being effective in high-risk as well as average-risk groups and is an ‘easy’ solution
for the person who elects not to follow a healthy dietary lifestyle. Nonetheless, it is expensive, demanding on
resources, provides no collateral benefits and does not have the same potential to reduce incidence of disease as
does the dietary approach. With these Western cancers, we are fortunate that there are options for prevention. At
least choices are available and some will suite certain circumstances and personalities more than others.
Asia Pac J Clin Nutr. 2002;11(10):S618-S631.doi:
>>Abstract
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Importance of preventing weight gain in adulthood
Author:Tim Gill BSc,PhD,RPHNutr
Keywords: Body composition, obesity, prevention, risk factors, weight gain
Abstract:In the last 20 years, there has been a dramatic upsurge in the average weight of Australian adults. In this period,
on average, Australian women have gained 4.8 kg, whilst Australian men have gained 3.6 kg. Consequently, the
prevalence of obesity in men has increased from 8% to 19% and in women from 7% to 21%. This threatens to
wipe away many recent health gains, as obesity has been associated with a wide range of chronic and debilitating
illnesses, such as diabetes, heart disease, some cancers, sleep apnoea and osteoarthritis. Any weight gain in
adulthood is usually as a result of an increase in fat stores, and the risk of ill-health from increasing weight
actually begins at quite low BMI. Unfortunately, weight gain can be difficult or slow to reverse in the middle
years because of physiological and behavioural changes that occur at this time of life. Adults should focus on
preventing or minimizing weight gain over time by retaining physical activity within their daily living and by
sensible dietary changes. Even if weight gain does occur with age, a regimen of regular exercise and a diet rich
in fruit and vegetables and low in fat will provide some protection against a rapid decline in health.
Asia Pac J Clin Nutr. 2002;11(10):S632-S636.doi:
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Can food variety add years to your life?
Author:Gayle S Savige Dip Teach, BSc, GradDip Diet, PhD
Keywords:Dietary habits, fish, food variety, legumes, nuts
Abstract:The traditional food habits of Greeks and Japanese differ widely, yet both populations have the longest life
expectancies in the world. Food variety is one feature common to both food cultures. By eating a wide variety
of foods, numerous chemicals that give rise to the diverse range of colours, tastes, textures and smells of
different foods are consumed. Many of these naturally occurring chemicals are likely to play a role in health.
Within the broad scope of foods available, foods for thought include fish, legumes and nuts. These foods are also
likely to protect older adults against some of the diseases more prevalent with ageing such as coronary heart
disease and cancer.
Asia Pac J Clin Nutr. 2002;11(10):S637-S641.doi:
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Benefits of exercise and dietary measures to optimize shifts in body composition with age
Author:Maria A Fiatarone Singh, MD, FRACP
Keywords:Ageing, obesity, osteopenia, physical activity
Abstract:Ageing is associated with changes in body composition, including an increase and redistribution of adipose
tissue and a decrease in muscle and bone mass, beginning as early as the fourth decade of life. These changes
have significant implications for the health and functioning of the individual because of their associations with
chronic disease expression and severity, as well as geriatric syndromes such as mobility impairment, falls, frailty
and functional decline. Therefore, understanding the preventive and therapeutic options for optimizing body
composition in old age is central to the care of patients in mid-life and beyond. Pharmacological interventions
are currently available for maintaining or improving bone mass, and much current interest is focused on anabolic
agents that will preserve or restore muscle mass, as well as those that can potentially limit adipose tissue
deposition. However, in this brief review, non-pharmacological modulation of body composition through
appropriate dietary intake and physical activity patterns, will be discussed. There is sufficient evidence currently
to suggest that a substantial portion of what have been considered ‘age-related’ changes in muscle, fat and bone
are in fact related either to excess energy consumption, decreased energy expenditure in physical activity, or
both factors in combination. In addition, selective underconsumption of certain macro- or micronutrients
contributes to losses of muscle and bone mass. Each of the three compartments will be considered in turn, with
recommendations for optimizing the size of these body tissue stores in early adulthood, and minimizing
undesirable changes typically seen in middle and old age.
Asia Pac J Clin Nutr. 2002;11(10):S642-S652.doi:
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Ethical consequences for professionals from the globalization of food, nutrition and health
Author:Noel W Solomons MD
Keywords:Chronic disease, diet, ethics, globalisation, nutrition
Abstract:Globalization is the process of increasing interconnections and linkages, within societies and across geography,
due to improved communication and expanded world trade. It limits the differentiation wrought by human
cultural evolution, and homogenizes health practices, diet and lifestyle. There are both beneficial and adverse
consequences of the globalization process. Globalization also presents a challenge to the development of ethics
for practice and advocacy by food and nutrition professionals. Among the related terms, ‘morals’, ‘values’ and
‘ethics’, the latter connotes the basic rules of conduct for interactions within society and with the inanimate
environment; rules based on recognized principles (ethical principles). The application of these principles is to
resolve ethical dilemmas that arise when more than one interest is at play. Recognized ethical principles include
autonomy, beneficence, non-maleficence, justice, utility and stewardship. These can be framed in the context of
issues that arise during advocacy for material and behavioural changes to improve the nutritional health of
populations. Clearly, at the global level, codes of good conduct and the construction of good food governance
can be useful in institutionalizing ethical principles in matters of human diets and eating practices. Ethical
dilemmas arise in the context of innate diversity among populations (some individuals benefit, whereas others
suffer from the same exposures), and due to the polarity of human physiology and metabolism (practices that
prevent some diseases will provoke other maladies). Moreover, the autonomy of one individual to exercise
independent will in addressing personal health or treatment of the environment may compromise the health of
the individual’s neighbours. The challenges for the professional in pursuit of ethical advocacy in a globalized era
are to learn the fundamentals of ethical principles; to bear in mind a respect for difference and differentiation that
continues to exist, and which should exist, among individuals and societies; and to avoid a total homogenization
of agriculture and food supplies.
Asia Pac J Clin Nutr. 2002;11(10):S653-S665.doi:
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