Human Nutrition: A Continuing Debate

252 Pages·1992·23.046 MB·English

by  Dr Martin Eastwood, Dr Christine Edwards, Professor Doreen Parry (auth.)

Human Nutrition
Human Nutrition
A continuing debate
An Account of a Symposium
Nutrition in the Nineties
which formed part of the Edinburgh Science Festival
The Symposium was organized by the Pfizer Symposium
Committee of the University of Edinburgh
Post-Graduate Board for Medicine
MARTIN EASTWOOD
Gastrointestinal Unit, Department ofM edicine, University ofE dinburgh, Western General
Hospital, Edinburgh
CHRISTINE EDWARDS
Department ofH uman Nutrition, University ofG lasgow
DOREEN PARRY
Department ofN utrition, Queen Margaret College, Edinburgh
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Contents
Contributors xi
Foreword xiii
R. Passmore
Introduction xv
M. Eastwood, G. Edwards and D. Parry
1 National food policies 1
w.P. T. James and A. Ralph
1.1 Introduction 1
1.2 World War II 2
1.3 Post-war developments 3
1.4 Britain today 4
References 12
Discussion 14
2 Infant origins of common diseases 17
D.}.P. Barker
2.1 Introduction 17
2.2 Geographical distribution of infant mortality 17
2.3 Cardiovascular disease and infant death 19
2.4 Hertfordshire infant follow-up study 20
2.5 Preston infant follow-up study 23
2.6 Unequal death rates in three Lancashire towns 24
2.7 Conclusion 26
References 27
Discussion 28
PART ONE Cholesterol and Fat 31
3 Atherosclerosis in perspective: the pathophysiology of
human cholesterol metabolism 33
}. Shepherd and G.}. Packard
3.1 Introduction 33
vi Contents
3.2 Cholesterol in the plasma 35
3.3 Cholesterol and atherosclerosis 38
3.4 Low-density lipoprotein and atherosclerosis 39
3.5 High-density lipoprotein and atherosclerosis 41
3.6 Diet and plasma cholesterol metabolism 43
3.7 Drugs and plasma cholesterol metabolism 46
Acknowledgements 48
References 48
4 Unobserved publications 51
D. Kritchevsky
4.1 Introduction 51
4.2 Blood cholesterol 51
4.3 Variability 52
4.4 Diet 53
4.5 Blood cholesterol reduction and outcome 55
4.6 Low blood cholesterol and outcome 57
4.7 Conclusions 57
Acknowledgement 58
References 58
Discussion 61
PART lWO Sugar 67
5 Sugars in human disease: a review of the evidence 69
KW. Heaton
5.1 Introduction 69
5.2 Physical facts and physiology 71
5.3 Sugars and spontaneous calorie intake 72
5.4 Health consequences of overnutrition 74
5.5 Metabolic effects of dietary sugars 76
5.6 Sugars and Crohn's disease 79
5.7 Summary and conclusions 79
References 79
6 Sugars not for burning 82
A.A. Jackson
6.1 Introduction 82
6.2 Principles of nutrition 83
6.3 Requirements for dietary sugars 86
6.4 Metabolic demand: synthesis 90
Contents vii
6.5 Dietary carbohydrate 97
6.6 Conclusion 97
References 99
Discussion 100
PART THREE Fibre 105
7 Towards a recommended intake of dietary fibre 107
J.H. Cummings and S.A. Bingham
7.1 Introduction 107
7.2 The case for dietary fibre (non-starch polysaccharides) in the
diet 108
7.3 Bowel habit and bowel disease risk 112
7.4 Diet and bowel habit 116
7.5 A recommended intake of dietary NSP 117
References 118
8 Dietary fibre: the facts? 121
I. Macdonald
8.1 Introduction 121
8.2 Association or cause and effect 121
8.3 Dietary intake 122
8.4 Dietary fibre and the colon 123
8.5 Gall stones 123
8.6 Obesity 124
8.7 Conclusion 125
References 125
Discussion 126
PART FOUR Salt 131
9 Salt and hypertension: the controversy continues 133
D.C. Beevers
9.1 Introduction 133
9.2 Ancient times 133
9.3 Early clinical data 133
9.4 Laboratory evidence 134
9.5 Epidemiology 134
9.6 The INTERSAL T project 134
9.7 Migration studies 136
viii Contents
9.8 Salt depletion studies 137
9.9 Sodium restriction in populations 139
9.10 Conclusions 140
References 140
10 Electrolytes and blood pressure 142
D.A. McCa"on and M.E. Reusser
10.1 Introduction 142
10.2 Hypertension and diet 142
10.3 Salt 144
lOA Calcium 145
10.5 Potassium 146
10.6 Magnesium 147
10.7 Other electrolytes 147
10.8 Hormonal mechanisms 148
10.9 Conclusions 148
Acknowledgements 149
References 149
Discussion 153
PART FIVE Food Additives and Food Manufacture 157
11 Food additives: an overstated problem? 159
A.E. Bender
11.1 Introduction 159
11.2 Use offood additives 159
11.3 Types offood additives 159
11.4 Safety testing 160
11.5 The acceptable daily intake of an additive (ADI) 162
11.6 Consumer pressures, press and other media demands 162
11.7 Generally regarded as safe (GRAS) 162
11.8 Problems 163
11.9 Food intolerance 163
11.1 0 Safety 165
11.11 Public perception 166
11.12 Publicists 166
11.13 Industry's response 166
11.14 Conclusions 167
References 167
12 The food manufacturers' role and problems 168
K C. Anderson
12.1 Introduction 168
Contents ix
12.2 The manufacturers' role 169
12.3 Industry's role in providing information 170
12.4 Manufacturers' problems 172
12.5 The future 175
12.6 Conclusions 176
References 176
Discussion 178
PART SIX Nutritional Recommendations 183
13 Nutritional policy for children 185
B.A. Wharton
13.1 Introduction 185
13.2 Successes 185
13.3 Problems and uncertainties 189
13.4 Personal practice and recommendations 194
References 200
14 Advice for the middle-aged 202
J,s. Garrow
14.1 Introduction 202
14.2 Demography and mortality in the coming decade 202
14.3 The increasing prevalence of obesity 203
14.4 Do the NACNE (1983) guidelines still apply? 204
14.5 Recent concerns not covered by NACNE proposals 206
14.6 Priority for the problem of obesity 206
References 207
15 Nutritional requirements of the elderly 209
IH. Rosenberg
15.1 Introduction 209
15.2 Body composition 210
15.3 Physical activity 210
15.4 Magnesium 211
15.5 Vitamin 0 211
15.6 Pyridoxine 212
15.7 Immune function 212
15.8 Antioxidant vitamins 213
15.9 Digestive function 213
15.1 0 Homocysteine 214
15.11 Cataract 214
15.12 Summary 215
References 215
x Contents
16 Nutrition in the nineties: an overall view 217
J. Hautvast
16.1 Introduction 217
16.2 Nutritional goals for Europe in the nineties 217
16.3 Nutritional research in Europe 219
16.4 Food and nutritional policy in Europe 221
16.5 Recommended dietary allowances (RDAs) for Europe 222
16.6 Assumptions to achieve dietary guidelines in the nineties 223
16.7 Nutrition professional organizational structure in Europe 225
16.8 Final remarks 225
References 226
Discussion 227
Appendix: Participants 232
Index 240