• Low-Fat Diet Does Not Cut Health Risks, Study Finds
• Calcium plus Vitamin D Supplementation and the Risk of Fractures (PDF)
• Calcium plus Vitamin D3 for postmenopausal Women-Bone Appétit? (PDF)
• Editorial Calcium plus Vitamin D3 Supplementation and Colorectal Cancer in Women(PDF)
• How Sweet It Is: Sweeteners in Health and Disease
• CEO Digest July 2006-Volume 5-Issue 7
• Hurricane Preparedness
• New Weight Management Tool - Aim for a Healthy Weight(PDF)
• Aim for a Healthy Weight Web site.
• Standards of Medical Care in Diabetes–2006(PDF)
• Summary of Revisions for the 2006 Clinical Practice Recommendations(PDF)
• Trends in the Incidence of Type 2 Diabetes Mellitus From the 1970s to the 1990s(PDF)
• Diagnosis and Classification of Diabetes Mellitus(PDF)
• Introduction to Supplement(PDF)
• National Standards for Diabetes Self-Management Education(PDF)
• Prediction of Coronary Heart Disease in a Population With High Prevalence of Diabetes and Albuminuria(PDF)
• Preventing Cardiovascular Disease and Diabetes(PDF)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Low-Fat Diet Does Not Cut Health Risks, Study Finds
By GINA KOLATA
The largest study ever to ask whether a low-fat diet reduces the risk of getting cancer or heart disease has found that the diet has no effect.

The $415 million federal study involved nearly 49,000 women ages 50 to 79 who were followed for eight years. In the end, those assigned to a low-fat diet had the same rates of breast cancer, colon cancer, heart attacks and strokes as those who ate whatever they pleased, researchers are reporting today.

"These studies are revolutionary," said Dr. Jules Hirsch, physician in chief emeritus at Rockefeller University in New York City, who has spent a lifetime studying the effects of diets on weight and health. "They should put a stop to this era of thinking that we have all the information we need to change the whole national diet and make everybody healthy."

The study, published in today's issue of The Journal of the American Medical Association, was not just an ordinary study, said Dr. Michael Thun, who directs epidemiological research for the American Cancer Society. It was so large and so expensive, Dr. Thun said, that it was "the Rolls-Royce of studies." As such, he added, it is likely to be the final word.

"We usually have only one shot at a very large-scale trial on a particular issue," he said.

The results, the study investigators agreed, do not justify recommending low-fat diets to the public to reduce their heart disease and cancer risk. Given the lack of benefit found in the study, many medical researchers said that the best dietary advice, for now, was to follow federal guidelines for healthy eating, with less saturated and trans fats, more grains, and more fruits and vegetables.

Not everyone was convinced. Some, like Dr. Dean Ornish, a longtime promoter of low-fat diets and president of the Preventive Medicine Research Institute in Sausalito, Calif., said that the women did not reduce their fat to low enough levels or eat enough fruits and vegetables, and that the study, even at eight years, did not give the diets enough time.

Others said that diet could still make a difference, at least with heart disease, if people were to eat the so-called Mediterranean diet, low in saturated fats like butter and high in oils like olive oil. The women in the study reduced all kinds of fat.

The diets studied "had an antique patina," said Dr. Peter Libby, a cardiologist and professor at Harvard Medical School. These days, Dr. Libby said, most people have moved on from the idea of controlling total fat to the idea that people should eat different kinds of fat.

But the Mediterranean diet has not been subjected to a study of this scope, researchers said.

And Barbara V. Howard, an epidemiologist at MedStar Research Institute, a nonprofit hospital group, and a principle investigator in the study, said people should realize that diet alone was not enough to stay healthy.

"We are not going to reverse any of the chronic diseases in this country by changing the composition of the diet," Dr. Howard said. "People are always thinking it's what they ate. They are not looking at how much they ate or that they smoke or that they are sedentary."

Except for not smoking, the advice for a healthy lifestyle is based largely on indirect evidence, Dr. Howard said, but most medical researchers agree that it makes sense to eat well, control weight and get regular exercise.

That is also what the cancer society recommends. Dr. Thun, who described the study's results as "completely null over the eight-year follow-up for both cancers and heart disease," said his group had no plans to suggest that low-fat diets were going to protect against cancer.

Others cautioned against being too certain that a particular diet would markedly improve health, and said that whether someone developed a chronic disease might not be entirely under their control — genetics also plays a role.

David A. Freedman, a statistician at the University of California, Berkeley, who is not connected with the study but has written books on the design and analysis of clinical trials, said the results should be taken seriously.

"The studies were well designed," Dr. Freedman said, "and the investigators tried to confirm popular hypotheses about the protective effect of diet against three major diseases in women."

"But," he added, "the diet studied here turned out not to be protective after all."

The study was part of the Women's Health Initiative of the National Institutes of Health, the same program that showed that hormone therapy after menopause might have more risks than benefits.

In this case, the study addressed a tricky problem. For decades, many scientists have said, and many members of the public have believed, that what people eat — the composition of the diet — determines how likely they are to get a chronic disease. But that has been hard to prove. Studies of dietary fiber and colon cancer failed to find that fiber was protective, and studies of vitamins thought to protect against cancer failed to show an effect.

Many cancer researchers have questioned large parts of the diet-cancer hypothesis, but it has kept a hold on the public imagination. "Nothing fascinates the American public so much as the notion that what you eat rather than how much you eat affects your health," said Dr. Libby, the Harvard professor.

The study found that women who were randomly assigned to follow a low-fat diet ate significantly less fat over the next eight years. But they had just as much breast and colon cancer and just as much heart disease. The women were not trying to lose weight, and their weights remained fairly steady. But their experiences with the diets allowed researchers to question some popular notions about diet and obesity.

There is a common belief that Americans get fat because they eat too many carbohydrates. The idea is that a high-carbohydrate, low-fat diet leads to weight gain, higher insulin and blood glucose levels, and more diabetes, even if the calories are the same as in a higher-fat diet. That did not happen here.

Others have said the opposite: that low-fat diets enable people to lose weight naturally. But that belief was not supported by this study.

As for heart disease risk factors, the only one affected was LDL cholesterol, which increases heart disease risk. The levels were slightly higher in women eating the higher-fat diet, but not high enough to make a noticeable difference in their risk of heart disease.

Although all the study participants were women, the colon cancer and heart disease results should also apply to men, said Dr. Jacques Rossouw, the project officer for the Women's Health Initiative.

Dr. Rossouw said the observational studies that led to the hypothesis about colon cancer and dietary fat included men and women. With heart disease, he said, researchers have found that women and men respond in the same way to dietary fat.

The most recent study follows a smaller one, reported last year, on low-fat diets for women who had breast cancer. That study hinted that eating less fat might help prevent a recurrence. But the current study, asking if a low-fat diet could protect women from breast cancer in the first place, had findings that fell short of statistical significance, meaning they could have occurred by chance.

Dr. Rossouw said he was still intrigued by the breast cancer data, even though it was not statistically significant. The women on low-fat diets had a 9 percent lower rate of breast cancer; the incidence was 42 per thousand per year in women in the low-fat diet group, compared with 45 per thousand per year in women consuming their regular diet.

That could mean that fat in the diet may have a small effect, Dr. Rossouw said, perhaps in some subgroups of women or over a longer period of time. He added that the study investigators would continue to follow the women to see if the effect became more pronounced.

While cancer researchers said they were disappointed by the results, heart disease researchers said they were not surprised that simply reducing total fat had no effect, because they had moved on from that hypothesis.

Of course, Dr. Libby acknowledged, the latest advice, to follow a Mediterranean diet and get regular exercise, has never been tested in a large randomized clinical trial. "If they did a study like that and it was negative," he said, "then I'd have to give up my cherished hypotheses for data."

The low-fat diet was not easy to follow, said Dr. Rowan T. Chlebowski, a medical oncologist at Harbor-U.C.L.A. Medical Center and one of the study's principal investigators. Women were told to aim for a diet that had just 20 percent of its calories as fat, and most fell short.

The diet they were told to follow "is different than the way most people eat," Dr. Chlebowski said. It meant, for example, no butter on bread, no cream cheese on bagels, no oil in salad dressings.

"If a physician told a patient to eat less fat, that will do nothing," he said. "If you send someone to a dietitian one time, that will do next to nothing." The women in the study had 18 sessions in small groups with a trained nutritionist in the first year and four sessions a year after that.

In the first year, the women on the low-fat diets reduced the percentage of fat in their diet to 24 percent of daily calories, and by the end of the study their diets had 29 percent of their calories as fat. In the first year, the women in the control group were eating 35 percent of their calories as fat, and by the end of the study their dietary fat content was 37 percent. The two groups consumed about the same number of calories.

Some medical specialists emphasized that the study did not mean people should abandon low-fat diets.

"What we are saying is that a modest reduction of fat and a substitution with fruits and vegetables did not do anything for heart disease and stroke or breast cancer or colorectal cancer," said Dr. Nanette K. Wenger, a cardiologist and professor of medicine at Emory University School of Medicine in Atlanta. "It doesn't say that this diet is not beneficial."

But Dr. Freedman, the Berkeley statistician, said the overall lesson was clear.

"We, in the scientific community, often give strong advice based on flimsy evidence," he said. "That's why we have to do experiments."

Copyright 2006The New York Times Company

 

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Hurricane Preparedness

Hurricane season is just around the corner. Below please find some information that could be useful during this time. Remember to take advantage of “Tax –Free week to purchase most of these items…”

Discuss the type of hazards that could affect your family. Know your home's vulnerability to storm surge, flooding and wind.

• Locate a safe room or the safest areas in your home for each hurricane hazard. In certain circumstances the safest areas may not be your home but within your community.
• Determine escape routes from your home and places to meet. These should be measured in tens of miles rather than hundreds of miles.
• Have an out-of-state friend as a family contact, so all your family members have a single point of contact.
• Make a plan now for what to do with your pets if you need to evacuate.
• Post emergency telephone numbers by your phones and make sure your children know how and when to call 911.
• Check your insurance coverage - flood damage is not usually covered by homeowners insurance.
• Use a NOAA weather radio. Remember to replace its battery every 6 months, as you do with your smoke detectors.
• Take First Aid, CPR and disaster preparedness classes.
• Stock non-perishable emergency supplies and a Disaster Supply Kit (list below)
• Water - at least 1 gallon daily per person for 3 to 7 days
• Food - at least enough for 3 to 7 days
• Non-perishable packaged or canned food / juices
• Foods for infants or the elderly
• Snack foods
• Non-electric can opener
• Canned juices, shelf-stable milk (for powdered or concentrated, store extra water)
• Pre-packaged beverages (foil packets and foil-lined boxes that are tightly sealed)
• Instant oatmeal, granola bars, energy bars
• Ready-to-eat canned meat, vegetables, fruit, soup, stew
• Instant coffee and tea
• Peanut butter or other nut butters, jelly
• Trail mix, dried fruits, unsalted nuts, low-salt crackers
• Packets of sugar, salt, pepper, mustard, ketchup, mayonnaise and creamer
• Cooking
• Can opener
• Waterproof matches
• Heavy-duty aluminum foil
• Paper towels
• Paper plates, cups
• Plastic knives, forks, spoons
• Barbeque grill, camp stove, pots, pans
• Fuel for cooking (charcoal, propane, etc.)
• Dry ice packs.
• Sanitation
• Large plastic trash bags, trash cans
• Bar soap, liquid detergent
• Liquid sanitizer, anti-bacterial wet wipes (use to wipe off cans of food prior to opening)
• Household bleach
• Toilet paper
• Toothpaste, toothbrushes
• Shampoo
• Safety
• Essential medication (for yourself and your pets)
• Freshly stocked first-aid kit
• Flashlight, portable radio or TV, batteries
• Work-weight gloves, disposable rubber gloves, masks
• Sunscreen (at least 20 SPF), hats, bandanas
• Candles, waterproof matches
• Fire extinguisher
• Tent
• Sturdy shoes, heavy socks
• Extra pair of eyeglasses, goggles
• Air raft or self-inflatable mattress
• Razor blades, knife
• Garden hose (in case of fire)
• Shovel, broom, ax
• Hammer screwdriver, pliers
• Duct tape, rope
• Blankets / Pillows, etc.
• Clothing - seasonal / rain gear/ sturdy shoes
• First Aid Kit / Medicines / Prescription Drugs
• Special Items - for babies and the elderly
• Toiletries / Hygiene items / Moisture wipes
• Flashlight / Batteries
• Cash (with some small bills) - Banks and ATMs may not be open or available for extended periods.
• Keys
• Toys, Books and Games
• Important documents - in a waterproof container or watertight resealable plastic bag with insurance, medical records, bank account numbers, Social Security card, etc.
• Tools - keep a set with you during the storm
• Vehicle fuel tanks filled
• Pet care items

  — proper identification / immunization records / medications
  — ample supply of food and water
  — a carrier or cage
  — muzzle and leash

“While no one wants to think about a disaster happening to them, being prepared for one can be your best defense”

 

 

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CEO DIGEST

FROM RONALD S. MOEN, CEO, AMERICAN DIETETIC ASSOCIATION

 

 

Food & Nutrition Conference & Expo Offers Unparalleled Educational and Networking Opportunities … Visit www.eatright.org/fnce and read all about FNCE in Hawaii. The Association will build on the islands’ sense of community and bring together experts from a variety of areas to dialogue about the newest science and technology important to the dietetics profession. The Expo will showcase the products your clients are asking about on a daily basis and products that will enhance your institution’s food operation. Don't forget to register; the early-bird deadline is July 19. Contact ADA’s Travel Store at www.fareweasel.com/Default.aspx?cdt=632846684928654716 or 800/947-0167 to get the lowest available fares. Log on to www.eatright.org/cps/rde/xchg/ada/hs.xsl/events_1800_ENU_HTML.htm and make your housing and airline reservations today! Here is just some of what is in store for you at FNCE:
Develop your Professional Portfolio and Enhance Your Expertise in Honolulu … FNCE 2006 is the one event to learn about cutting-edge information, research and your special area of practice. Attend and learn at the one meeting designed in broad content areas to enhance your skills and knowledge. Educational sessions are offered in all major Learning Need Codes and multiple codes may apply to one session.
Experience Ohana … In Hawaii, celebrations are built around the community or Ohana, the family. To bring these traditions to ADA’s first annual conference in Hawaii, join the Opening Night celebration for attendees. Savor the delicacies of Hawaii, enjoy local entertainment and catch the Aloha spirit at a special ticketed event following the Saturday Opening Session Ross Keynote Address by Gregory Stock, PhD, MBA.
Extend Your Polynesian Adventure … with a post-FNCE Island Excursion. Each Island Excursion also offers informative professional workshops that you won’t want to miss. Packages are available from September 20-23. For more information, visit www.mcahawaii.com/adahi2006/pp.html.
Wanted at FNCE: Students and Hosts … If you will be a full-time student as well as a student ADA member in September, you are eligible to be a FNCE Student Host. Selected randomly from applicants from eligible states (this year’s states are Arizona, California, Hawaii, Idaho, Montana, Nevada, Oregon, Utah and Washington), Student Hosts work a minimum of seven to nine hours at FNCE and in return receive automatic complimentary student member registration (a $164 value).
Applicants who are not chosen as Student Hosts receive a letter entitling them to FNCE’s early-bird registration rate when they register on-site in Honolulu. Student Host applications have been sent to all program faculty directors and are available at www.eatright.org/l.cfm?A=education_8336. An active student ADA member number and faculty signature are required on the application. The deadline to apply is July 19. For questions or more information, contact Andrea Patterson at 312/899-4867 or apatterson@eatright.org.
Attention All ADA Student Members: Special programming for students is planned throughout FNCE, including networking events and educational sessions in all areas of your potential future practice. And the Expo Hall will host more than 300 exhibitors including many prospective employers.
Visit www.eatright.org/fnce2006 for all the information you’ll need on the sessions, special events, post-FNCE island excursions and workshops and other programs.

Have Fun and Support Your Foundation at FNCE … Proceeds from all ADAF events directly benefit the Foundation. For more information — including registration, times, sponsors, CPE credits and (if applicable) fees and ticket prices — see the FNCE Program Preview or visit www.eatright.org/fnce2006 and click on ADA Foundation Events on the left side of the screen.

Congratulations … to the following individuals who will be honored at FNCE for their outstanding contributions to the dietetics profession:
Marjorie Hulsizer Copher Award: Polly A. Fitz, MA, RD, CDN
Lenna Frances Cooper Lecture: Marion Taylor Baer, PhD, RD
Honorary Membership
George A. Bray, MD
Samuel Klein, MD
Medallion Awards:
Christina K. Biesemeier, MS, RD, LDN, FADA
Anne E. Daly, MS, RD, BC-ADM, CDE
Marion J. Franz, MS, RD, LD, CDE
Charlette Gallagher-Allred, PhD, RD
Edith H. Hogan, RD, LD
Jane E. Libby, MS, RD, LDN
Carlene Russell, MS, RD, LD, FADA
Margaret J. Tate, MS, RD
Media Excellence Award: Anne M. Fletcher, MS, RD, LD
Excellence in Practice Awards
Clinical Nutrition: Susan L. Brantley, MS, RD, CNSD, LDN
Community Dietetics: Betty L. Lucas, MPH, RD, CD
Consultation & Business Practice: Barbara A. Wakeen, MA, RD, LD
Dietetics Education: Mary E. Hise, PhD, RD, CNSD
Dietetics Research: Judith Wylie-Rosett, EdD, RD
Dietetics Technology: Peggy R. Turner, MS, RD, LD
Management Practice: Kristen W. Schroeder, RD, CD
Mary Abbott Hess Award for Recognition of an Innovative Food/Culinary Effort: Maryann Meade, MS, RD, CDN
Anita Owen Recognition Award for Innovative Nutrition Education Programs for the Public: Ann Marie Krautheim, MA, RD, LD
Judy Ford Stokes Award for Innovation in Administrative Dietetics or Foodservice Facility Design: Teresa A. Nece, MS, RD, LD, SFNS
The Dietetics Education Task Force … has completed its task after 2-1/2 years. I want to thank the Task Force members for their hard work and dedication to the profession and the Association. The final report was released to the House of Delegates on June 30. On July 10, the final report will be posted to ADA’s member-only Web site at www.eatright.org/cps/rde/xchg/ada/hs.xsl/governance_787_ENU_HTML.htm. This final report will be forwarded to the Phase 2 Task Force as part of its charge to determine next steps. Further dialogue on this issue will occur during the Spring 2007 House of Delegates meeting when the Phase 2 Task Force presents its recommendations.

The Gold Standard of Practice Available at Your Fingertips … ADA unveils the Disorders of Lipid Metabolism Toolkit, a set of resources for the practicing RD, which supports the application of the Disorders of Lipid Metabolism Evidence-Based Guideline. Available via download for $20, the toolkit includes the MNT protocol, documentation forms, client education resources, outcomes monitoring forms and more. As the gold standard of practice, the toolkit will provide you with confidence as you provide scientifically based care. Benefits include:
Improved patient care
Cutting-edge approach to care
Easy-to-use technology
Framework for training new staff and performance evaluations
Decreased risk of liability
Implementation of the Nutrition Care Process and evidence-based practice

New Adult Weight Management Evidence-Based Nutrition Practice Guideline … This free member benefit contains systematically developed recommendations, based on scientific evidence, designed to assist practitioners on appropriate nutritional care for adults who are overweight and obese. For further information on each of these new resources, visit www.adaevidencelibrary.com/.
Seeking RDs in Outpatient Settings to Complete Coding Survey … ADA is working with other professional health-care organizations who participate in the American Medical Association’s coding and payment committees to develop revised codes for patient-care team conferences. ADA actively participated in the code development to make sure RDs were represented and acknowledged as a key professional involved in multidisciplinary patient care conferences. As a next step in the code process, ADA’s Coding and Coverage Committee needs input from RDs in outpatient settings who participate in team conferences. In early July, ADA will distribute the AMA coding survey to RDs to determine their time and effort involved in participating in team conferences. RDs who complete the survey will provide critical information to help ADA shape the code value and payment rates for these revised codes that may be used among private insurance payers. Watch for details on member electronic list groups and at www.eatright.org/advocacy/mnt.

Sports Nutrition Tool Kit … ADA and the Gatorade Sports Science Institute have teamed up to create the Performance Challenge Program, designed to help you break into sports nutrition with high school-age athletes. The tool kit features a CD-ROM containing interactive tools, tips and handouts. More than 3,000 ADA members have already requested this free CD. More details are available at www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition_5977_ENU_HTML.htm.

New Online Community …Using new technology that offers an enriched networking experience, ADA’s new Dietetics Community helps members get and stay connected to each other. Join now for the opportunity to exchange ideas, discuss issues, solve common problems, develop skills and share knowledge and best practice. More than over 800 Dietetics-L subscribers have transitioned to the online Dietetics Community. For more information, including instructions on how to join, visit www.eatright.org/cps/rde/xchg/ada/hs.xsl/home_8924_ENU_HTML.htm.

Call for 2007 Nominations … Identifying potential volunteer leaders for ADA, the Commission on Dietetic Registration and the House of Delegates is vital to the future of the Association and the dietetics profession. I’m sure you know at least one ADA colleague who would fill the leadership bill. Submit nominations for ADA’s 2007 national ballot. Nominations for President-elect and Speaker-elect are due by August 1 and all other nominations are due by November 1. Visit www.eatright.org/nominations for information, forms and qualifications criteria or call 800/877-1600, ext. 5000. Nominations may also be e-mailed to nominations@eatright.org.

Journal Debuts New Benefit … Beginning with the July issue, the Journal of the American Dietetic Association now offers Microsoft PowerPoint slides of selected tables and figures from research articles. These slides offer educators, students, public speakers and others a valuable tool in illustrating the research on which dietetics practice is based. The slides can also offer practicing RDs an easy way to show clients the science behind the nutrition counseling they provide. The first slide to be made available accompanies the article “Nutrigenetics, Plasma Lipids and Cardiovascular Risk.” In the future, multiples slides may be available for a single article and more than one article per month may offer slides. All slides are downloadable from www.adajournal.org/ at no cost to members.

First RD Joins CMS Medicare Committee … Congratulations to Ronni Chernoff, PhD, RD, on her appointment to a two-year term on the Center for Medicare & Medicaid Services’ Medicare Coverage Advisory Committee, beginning January 2007. She is the first registered dietitian to serve as a voting member of the committee, which advises CMS on whether medical items and services are reasonable and necessary under Medicare law. Appointment to this committee is highly competitive, with members selected on the basis of their expertise, education and background in a wide variety of scientific, clinical and related fields. For more information, visit www.cms.hhs.gov/FACA/02_MCAC.asp.

And Congratulations to…
William Proulx, PhD, RD, chair of the department of human ecology and associate professor of nutrition and dietetics at the State University of New York College at Oneonta. The Joint Commission on Accreditation of Healthcare Organizations and the National Pharmaceutical Council Inc. are collaborating on a project that will result in a monograph related to “Measuring and Improving Care for Osteoporosis: A Proposal to Identify and Disseminate Performance Measures.” Mr. Proulx was selected to serve on a panel that will guide the selection of performance measures to be included in the monograph.
Kathleen C. Niedert, MBA, RD, NHA, director of clinical nutrition and dining services at Western Home Communities, Cedar Falls, Iowa; and Caroline Breeding, RD, LD, FADA, president and owner of Dietary Consultants Inc., Richmond, Ky. They have been selected as ADA’s representative and alternate representative, respectively, for JCAHO’s Long Term Care Professional and Technical Advisory Committee.
Sandy Robbins, RD, CSP, LD, neonatal nutrition specialist at Inova Fairfax Hospital for Children, Falls Church, Va. She served as a reviewer for the Recommended Standards for Newborn ICU Design (6th ed) as they pertain to breast milk and infant formula preparation.
Malena Perdomo, RD, CDE, outpatient clinical dietitian at Kaiser Permanente Colorado, in Denver, and ADA’s Latino nutrition media spokesperson. She appears on-air and works as a behind-the-scenes adviser to the host/producer of “Los Secretos de Maya,” a Spanish-language cooking and health show airing Saturday mornings on Denver’s KGHB-TV.

Mark your calendar …
FNCE future dates:
2006 - Honolulu, Hawaii, September 16-19
2007 - Philadelphia, Pa., September 29-October 2
2008 - Chicago, Ill., October 25-28
2009 - Denver, Colo., October 17-20
2010 - Boston, Mass., November 6-9

Enjoy your summer!

 

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