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NUTRITION AND MEDICAL PRACTICE NUTRITION AND MEDICAL PRACTICE Editor, Lewis A. Harness, M.D. with Yank D. Coble, Jr., M.D. Donald I. Macdonald, M.D. George Christakis, M.D., M.P.H. MEMBERS OF THE FLORIDA MEDICAL ASSOCIATION ~ ry"I~ MTPPRES LI MIT D· A ' ER· GLA 0 inlernational Medical Publisher Published in the UK and Europe by MTP Press Limited Falcon House Lancaster, England Available elsewhere from THE A VI PUBLISHING COMPANY, INC. Westport, Connecticut, USA © Copyright 1981 by SOFTCOVER REPRINT OF THE HARDCOVER 1ST EDITION 1981 THE AVI PUBLISHING COMPANY, INC. All rights reserved. No part of this work covered by the copyright hereon may be reproduced or used in any form or by any means-graphic, electronic, or mechanical, including pho- tocopying, recording, taping, or information storage and re- trieval systems-without written permission of the publisher. Cover yhotograph from David Attie; frontispiece courtesy of Samue Frumkin, M.D., Internal Medicine Associates, West- port, CT. with patient. ISBN-I3: 978-94-011-6697-3 e-ISBN-13: 978-94-011-6695-9 DOl: 10.1007/978-94-011-6695-9 The Saybrook Press, Inc. Foreword All forms of life require food materials in certain minimum amounts to insure an active life and successful reproduction. Nutrition is concerned with what these materials are, how they function, what effects they have when absent and what happens to them when ingested. During the past two centuries such nutritional disorders as scurvy, beriberi, rickets and pellagra have been discovered, successfully treated and eradicated by physicians in developed countries. In this century, such noted researchers as Rose, Meyerhof and Krebs have contributed enormously to the field of nutrition. Currently, research is evolving new concepts and facts so rapidly that the average practitioner can hardly keep current, even in his own field of medicine. Bona fide research by universities and governmental agen- cies has produced voluminous information, much of which seems contra- dictory and therefore tends to confuse the general public, particularly in the area of potential carcinogens. This confusion has prompted consumer groups, politicians, and social welfarists to bring pressures and demands on medical schools and prac- titioners of medicine to increase their knowledge and concern in the field of nutrition. Taking advantage of and adding to this confusion are the health food faddists and cultists, some only for monetary gain and others with a real religious zeal. The above developments are partially responsible for the Florida Med- ical Association adopting Nutrition as its scientific theme for 1978- 1979. Part of this theme was exhibited in a special edition of the Journal of the Florida Medical Association, Inc., dedicated entirely to the subject of Nutrition. This issue of the Journal was so widely acclaimed across the nation that inspiration was generated to publish this in book form. The original articles published in the special issue have been updated and additional topics have been added. v vi NUTRITION & MEDICAL PRACTICE This publication is thought to be extraordinary and will contribute greatly to the education of physicians, medical students and the knowl- edgeable public alike. It should serve as a valid reference source for many years to come. Drs. Barness, Coble, Macdonald and Christakis have certainly selected their subject matter and contributors well and may be rightfully proud of this compendium of information. We all wish to make a special note of thanks to Dr. J. Lee Dockery, Uni- versity of Florida Medical School and Dr. Norman W. Desrosier, AVI Publishing Company, for their efforts in bringing this new book into being. o. William Davenport, M.D. January, 1981 Acknowledgement The Editors gratefully acknowledge the generosity of the following who helped make this publication on Nutrition possible: Mead Johnson & Company, Evansville, Indiana; Ross Laboratories, Columbus, Ohio; Uni- versity of Miami School of Medicine, Miami; University of South Florida College of Medicine, Tampa; University of Florida College of Medicine, Gainesville; Florida Pediatric Society and Florida Chapter, American Academy of Pediatrics. Lewis A. Barness, M.D. January, 1981 vii Dedication The editors and contributors of this book wish to dedicate their efforts on its behalf to the teaching and practice of good nutrition as a funda- mental of good health and a worthy endeavor in the field of medicine. ix Contributors BAKER, RUTH, R.D., M.P.H., Palm Beach County Health Depart- ment, West Palm Beach, Florida BARNESS, LEWIS A., M.D., Professor and Chairman, Department of Pediatrics, University of South Florida College of Medicine, Tampa BOYCE, H. WORTH JR., M.D., Director, Division of Gastroenterology, Department of Internal Medicine, University of South Florida College of Medicine, Tampa BRAY, GEORGE A., M.D., University of California at Los Angeles School of Medicine, Harbor-UCLA Medical Center, Torrance BRIN, MYRON, Ph.D., Department of Biochemical Nutrition, Roche Research Center, Hoffman-LaRoche Inc., Nutley, New Jersey BRUMBACK, C.L., M.D., M.P.H., Palm Beach County Health Depart- ment, West Palm Beach, Florida BURR, JANICE M., M.D., Co-Principal Investigator, Nutrition Divi- sion, Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, Florida CERDA, JAMES J., M.D., Professor of Medicine and Director of the Nutrition Laboratory, University of Florida College of Medicine, Gainesville CHRISTAKIS, GEORGE, M.D., M.P.H., Chief, Nutrition Division, Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, Florida COBLE, YANK D. JR., M.D., Specialist in Endocrinology and Nutrition, Jacksonville, Florida COPELAND, EDWARD M. III, M.D., Professor of Surgery, University of Texas Medical School, Houston DARBY, WILLIAM J., M.D., Ph.D., President, The Nutrition Foun- dation, New York and Washington, D.C. DAVIS, GEORGE K., Ph.D., Professor of Nutrition, I.F.A.S., University of Florida, Gainesville xi xii NUTRITION & MEDICAL PRACTICE DOLIN, BEN J., M.D., Private Practitioner; Associate Director of Nu- tritional Support Service, Methodist Hospital, Peoria, Illinois EASTON, PENELOPE S., Ph.D., R.D., Chairman, Dietetics and Nu- trition, Florida International University, Miami GERACE, TERENCE A., Ph.D., Director of Intervention and Co- Investigator, Nutrition Division, Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, Florida GROW, THOMAS E., Ph.D., Department of Basic Dental Sciences, University of Florida College of Dentistry, Gainesville GUILD, RALPH T., M.D., Instructor in Gastroenterology, University of Florida College of Medicine, Gainesville HARPER, ALFRED E., Ph.D., E.V. McCollum Professor of Nutritional Sciences, Departments of Nutritional Science and Biochemistry, Uni- versity of Wisconsin, Madison HERBERT, VICTOR, M.D., J.D., Professor and Vice Chairman of Medicine, State University of New York, Downstate Medical Center, New York KAFATOS, ANTHONY G., M.D., M.P.H., Associate Professor, Depart- ment of Epidemiology, University of Miami School of Medicine, Miami, Florida KAMINSKI, MITCHELL V. JR., M.D., Clinical Professor of Surgery, University of Health Sciences/Chicago Medical School, Chicago, Illinois LEAPLEY, PATRICIA M., R.D., Diabetes Center Dietician, University of South Florida College of Medicine, Tampa LIEBER, CHARLES S., M.D., Chief, Alcoholism Research and Treat- ment Center, Veterans Administration Medical Center, Bronx, New York MACDONALD, DONALD IAN, M.D., Pediatrician, Clearwater, Florida MAHAN, CHARLES S., M.D., Associate Professor, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville MALONE, JOHN I., M.D., Professor of Pediatrics and Co-Director of the Diabetes Center, University of South Florida College of Medicine, Tampa MAUER, ALVIN M., M.D., Director, St. Jude's Children's Research Hospital, Memphis, Tennessee MILLS, CHRISTOPHER B., M.D., Fellow, Metabolic Support Service, Ravenswood Hospital Medical Center, Chicago, Illinois PONDER, DEBRA L., M.S., R.D., Doctoral Student, Department of Food and Nutrition, Florida State University, Tallahassee RACKOW, JEANNE R., M.S., R.D., Professor of Nutrition, University of South Florida, Tampa