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SMmSSUEPERIODICALS 332

BOOKS 347

SOFTWARE 349

RECEITLY RECIWED 349

PRACTITIONER'S BOOKSHELF 350

PBODICALSPeriodical reviews are contributed byMargene A. Wagstaff, MS, RD, India-napolis, Ind, and the Journal staff. Ar-ticles that have been abstracted are markedwith a darkened box ( ).

Names and addresses of all periodicalsabstracted in this section are publishedeach year in the December issue. Thecurrent list appears on page 1480 of theDecember 1993 issue. Requests for re-prints of articles abstracted here should besent directly to the authors of the originalarticles, whose addresses may be obtainedby consulting the publication in which thearticle appeared. Subscription orders forthe periodicals should be directed to therespective publishers.

THE AMBICAN JOURIALOF CIINCAL NUTRITION

Vol 58, October 1993* In vivo measurement of changes in bodycomposition: Description of methods andtheir validation against 12-day continuouswhole body calorimetry. S.A. Jebb, P.R.Murgatroyd, G.R. Goldberg, A.M. Prentice,and W.A. Coward. 455-462.* Sex differences in the relation of visceraladipose tissue accumulation to total bodyfatness. S. Lemieux, D. Prud'homme, C.Bouchard, A. Tremblay, and J-P. Despres.463-467.· Metabolic evidence that deficiencies of vi-tamin B-12 (cobalamin), folate, and vita-min B-6 occur commonly in elderly people.E. Joosten, A. van den Berg, R. Riezler, H.JNaurath, J Lindenbaum, S.P. Stabler, andR.H. Allen. 468-476.

Different postprandial metabolism of ol-ive oil and soybean oil: A possible mechanism of the high-density lipoprotein con-serving effect of olive oil. T WA. de Bruin,C.B. Brouwer, M. van Linde-Sibenius Trip,H Jansen, and D. W Erkelens. 477-483.

Lipoprotein metabolism in marasmic chil-dren ofNorthern Mauritania. F. Feillet, H -

J Parra, K. Kamian, J.-M. Bard, J-C.Fruchart, and M. Vidailhet. 484-488.

Relative and biomarker-based validity ofa food-frequency questionnaire estimatingintake offats and cholesterol. G.I. J Feunekes,WA. Van Staveren, JH.M. De Vries, JBurema, and J.G.A.J Hautvast. 489-496.

ISimple relationships exist between di-etary linoleate and the n-6 fatty acids ofhuman neutrophils andplasma. M.J James,R.A. Gibson, M. D'Angelo, M.A. Neumann,and L.G. Cleland. 497-500.

Depression of plasma cholesterol in menby consumption of baked products contain-ing soy protein. S.M. Potter, R.M. Bakhit,D.L. Essex-Sorlie, KE. Weingartner, KM.Chapman, R.A. Nelson, M. Prabhudesai, WD.Savage, A.I. Nelson, L. W Winter, and J WErdman, Jr. 501-506.

Acute effects of mycoprotein on subse-quent energy intake and appetite variables.WH. Turnbull, J Walton, and A.R. Leeds.507-512.

Long-term effects of guar gum in subjectswith non-insulin-dependent diabetesmellitus. P.-H. Groop, A. Aro, S. Stenman,and L. Groop. 513-518.* The correlation between two dietary as-sessments of carotenoid intake and plasmacarotenoid concentrations: Application of acarotenoidfood-composition database. MR.Forman, E. Lanza, L. -C. Yong, JM. Holden,B.I. Graubard, G.R. Beecher, M. Melitz, E.D.Brown, and JC. Smith. 519-524.*Antioxidant vitamins and low-density-lipoprotein oxidation. M. Abbey, P.J Nestel,and P.A. Baghurst. 525-532.* Influence of a meal and incremental dosesof zinc on changes in zinc absorption. L.Sian, KM. Hambidge, J.L. Wescott, L. V Miller,and P. VI Fennessey. 533-536.

I Intakes of calcium, phosphorus, and pro-tein, and physical-activity level are relatedto radial bone mass in young adult women.J.A. Metz, JJ.B. Anderson, and P.N.Gallagher; Jr. 537-542.

Cell mediated immune deficiency andmalnutrition are independent risk factorsfor persistent diarrhea in Bangladeshi chil-dren. A.H. Baqui, R.B. Sack, R.E. Black, H.R.Chowdhury, M. Yunus, and A. K Siddique.543-548.

Potential magnitude of the misclassi-fication of a population's trace element sta-tus due to infection: Example from a surveyof young Peruvian children. KH. Brown,CF. Lanata, ML. Yuen, J.M. Peerson, B.Butron, and B. Lnnerdal. 549-554.* Protein andfat effects onglucose responsesand insulin requirements in subjects withinsulin dependent diabetes mellitus. A.L.Peters and M.B. Davidson. 555-560.

Muscle hypertrophy with large-scaleweight loss and resistance training. JE.Donnelly, T Sharp, J. Houmard, M.G.Carlson, J.O. Hill, JE. Whatley, and R.G.Israel. 561-565.

Lymphocyte responsiveness of childrensupplemented with vitaminA and zinc. T.R.Kramer, E. Udomkesmalee, S. Dhanamitta,S. Sirisinha, S. Charoenkiatkul, S.Tuntipopipat, O. Banjong, N. Rojroongwasinkul, and J C. Simth, Jr. 566-570.

Accuracy of body composition mea-surements Researchers evaluated the ac-curacy of a variety of in vivo techniques formeasuring body composition: densitom-etry, total bodywater, skinfold thicknesses,whole-body impedance and resistance,body mass index, and two three-compart-ment models. Six subjects were confinedin a whole-body calorimeter; three wereoverfed and three were underfed for 12days to induce changes in body composi-tion, which were then measured using thevarious in vivo techniques. The body com-position measurements were cross-vali-dated using substrate balance estimatesderived from the continuous measurementof energy expenditure and substrate oxi-dation. Mean changes in weight were +2.90kg during overfeeding and -3.47 kg duringunderfeeding. The change in fat mass was37.1% during overfeeding and 59.3% dur-ing underfeeding. Use of the three-com-partment model yielded the least bias andgreatest precision of the in vivo methods.The smallest change in fat mass in anindividual subject that can be measuredusing this method is 1.54 kg. Of the predic-tion techniques evaluated, skinfold thick-nesses or the body mass index formulawere more precise than estimates basedon resistance or impedance.

Gender differences in body fatnessThis study indicates that men and womenhave different proportions of visceral adi-pose tissue. Researchers compared theamounts of abdominal adipose tissue andtotal body fat in 75 women and 89 men.After correction for gender differences inthe amount of total body fat, men hadsignificantly higher values of abdominalvisceral adipose tissue volume and totalvisceral adipose tissue volume than women.Results suggest that the greater healthhazards associated with excess fatness inmen than in women may be explained bythe fact that premenopausal women canaccumulate more body fat than men of thesame age before reaching the amounts ofvisceral adipose tissue found in men.

Vitamin B deficiencies in elderly per-sons Use of assay of serum metabolites forearly detection of vitamin B- 12, folate, andvitamin B-6 deficiencies in body tissuesseems justified in elderly persons so thatindividuals who might benefit from subse-quent vitamin therapy can be identifiedand treated. This recommendation comesfrom a study in which the serum concen-trations of these three vitamins and themetabolites homocysteine, cystathionine,methylmalonic acid, and 2-methylcitric acidwere measured in 99 healthy young people,64 healthy elderly persons, and 286 elderlyhospitalized patients. Low serum values of

332 / MARCH 1994 VOLUME 94 NUMBER 3

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all three vitamins were detected in bothgroups of elderly subjects. Low serum con-centrations of vitamin B-12 were found in6% of healthy elderly persons and in 5% ofelderly hospitalized patients; low serumfolate was found in 5% and 19%, respec-tively; and low serum vitamin B-6 wasfound in 9% and 51%, respectively. One ormore metabolites were elevated in 63%and 83% of healthy elderly subjects andelderly hospitalized patients, respectively.

Dietary and plasma carotenoid valuesA newly available food composition data-base that provides specific carotenoid val-ues for more than 2,300 foods allowedresearchers to compare values for dietaryintake of the five major carotenoids foundin human plasma (alpha carotene, betacarotene, beta cryptoxanthin, lutein, andlycopene) withrespectivevalues fromfoodsources. Three weeks of dietary intakedata were collected from 57 male non-smokers using both a food frequency ques-tionnaire and 7-day diet diaries; the di-etary intake data were then linked to thefood composition database. Adjustmentswere made for energy intake, percentageof energy from alcohol, and plasma lipidconcentrations. When data from the fooddiaries were used, dietary carotenoid in-takes were associated with plasma carote-noid concentrations for all the carotenoidsexcept beta carotene. Correlations betweendietary and plasma values for the provita-min A carotenoids were consistently sig-nificant when data from the food frequencyquestionnaire were used.

Antioxidants and LDL oxidation Di-etary supplementation with antioxidantvitamins protects low-density lipoprotein(LDL) from oxidation in vitro by increas-ing the lag time before onset of oxidation.The complementary modes of action ofvitamin C, a-tocopherol, and beta caro-tene may provide a rationale for their com-bined use. This 6-month study examinedthe rate of LDL oxidation in 22 adults aftera daily dose of 18 mg beta carotene, 900 mgvitamin C, and 200 mg a-tocopherol. After3 months of supplementation, plasma con-centrations of beta carotene, a-tocopherol,and vitamin C increased 500%, 55%, and27%, respectively. Lag time before theonset of oxidation was significantly length-ened after supplementation with the an-tioxidant vitamins (28% and 35% longerafter 3 and 6 months, respectively). Therewas a significant independent correlationbetween percent change in lag time andpercent change in plasma a-tocopherolconcentration.

Absorption of dietary zinc Results ofthis study support the hypothesis that ex-

ogenous dietary zinc competes for absorp-tion with endogenous zinc secreted intothe lumen of the gastrointestinal tract inresponse to a meal. Using three differentstable isotopes of zinc, researchers mea-sured fractional absorption of incrementalquantities of zinc in four healthy adults bymeasuring fecal excretion of unabsorbedisotope on 3 consecutive days. Isotopeswere administered first in the postab-sorptive state and then again with a stan-dard zinc-free breakfast. In the postab-sorptive state, fractional absorption wasnot affected by the quantity of zinc in-gested until zinc intake exceeded 5 mg.When the zinc was administered with ameal, however, fractional absorption afterintake of 3 and 5 mg zinc was less thanafter intake of 1 mg zinc.

Dietary protein and insulin dose Datasuggest that patients with diabetes whoinject insulin before their meals may needto increase their insulin dose when proteinis added to a meal. Glucose responses andinsulin requirements were measured usinga glucose-controlled insulin infusion sys-tem for 5 hours after 12 patients withinsulin-dependent diabetes mellitus con-sumed each of three meals: a 1,890 kJstandard meal, the standard meal plus 840kJ added protein, and the standard mealplus 840 kJ added fat. The glucose re-sponse was significantly greater to theprotein-added meal than to either the stan-dard or the fat-added meal because of anincrease in the late glucose response. Thelate insulin requirement was greater forthe protein-added meal and did not changeafter the fat-added meal.

AMBCAN JOURNALOF DISEASES OF CHILRBVol 147, October 1993* Effect of weight loss by obese children onlong-term growth. L.H. Epstein, A. Valoski,and J McCurley. 1076-1080.

Long-term growth in obese childrenafter weight loss Findings of this 10-yearfollow-up of 158 obese children aged 6 to12 years indicate that moderate energyrestriction in conjuction with dietary guid-ance does not negatively influence long-term growth. At entry to the study, theheight percentiles of the obese childrenwere significantly greater than those oftheir same-sex parent or than their par-ents' midparent height (an estimate ofparental contribution to height). After anaverage growth of 22.7 cm over the 10-year study, obese children were 2.2 cmtaller than their same-sex parent. Multiple

regression analysis showed that a child'sgender, age, baseline height, and percentoverweight; the midparent height; and achild's change in height from baseline to5 years accounted for 94% of the variancein growth. A child's change in percentoverweight did not help predict change inheight. Comparison of obese and normal-weight children at 10 years showed nodifferences in growth.

THE AMiICAN JOUIWAL OF MDINE

Vol 95, October 1993* Pheochromocytoma presenting as a pro-longed attack of Chinese restaurant syn-drome. CM. Heckemeyer. 446-447.

Pheochromocytoma symptomatic of"Chinese restaurant syndrome" TheChinese restaurant syndrome, first re-ported in 1968, has many symptoms sug-gestive of pheochromocytoma. This casereport tells of a previously healthy, 34-year-old woman who experienced severeheadache, nausea, diaphoresis, palpita-tions, and chest tightness after eating at aChinese restaurant. Symptoms were at-tributed to ingestion of monosodium gluta-mate (MSG). Physical examination led tosurgical removal of a tumor anterior to themidportion of the kidney; pathologicevaluation revealed a paraganglioma withfeatures consistent with extra-adrenalpheochromocytoma. Dietary supplemen-tation with pyridoxine reversed the sensi-tivity to MSG. Although pyridoxine defi-ciency has not been reported previouslywith pheochromocytoma, it is possiblethat an increased requirement for vitaminB-6 may exist. The patient's dietary intakeof this vitamin may have been inadequateto compensate for the increased require-ments caused by exaggerated catechol-amine production in the tumor.

AMEIUCAN JOURNAIL OF NURS1NG

Vol 93, October 1993* Orchestrating the care of mechanicallyventilated patients. T. Freichels. 26-32, 34-35.

Caring for mechanicallyventilated pa-tients Any patient who has been on me-chanical ventilation for as long as 72 hoursrequires a holistic treatment regimen thatincludes the patient's family and variousrehabilitative and ancillary therapists. Thisarticle presents a guide to patient care thatemphasizes collaboration among the careproviders during the recuperative phase of


mechanical ventilation. Four major factorsare emphasized: patient trust, nutritionalstatus, tissue oxygenation, and lung me-chanics. The dietitian's role is discussed.

AMALS OF HIWdA MEIC

Vol 119, October 1, 1993* Efficacy of psyllium in reducing serumcholesterol levels in hypercholesterolemicpatients on high- or low-fat diets. D.L.Sprecher, B.V. Harris, A.C. Goldberg, E.C.Anderson, L.M. Bayuk, B.S. Russell, D.S.Crone, C. Quinn, J Bateman, B.R. Kuzmak,and L.D. Allgood. 545-554.MA linoleate-enriched cheese product re-duces low-density lipoprotein in moderatelyhypercholesterolemic adults. P.A. Davis, J-F. Platon, ME. Gershwin, G.M. Halpern, C.L.Keen, D. DiPaolo, J. Alexander, and VA.Ziboh. 555-559.* Effect of garlic on total serum cholesterol:A meta-analysis. S. Warshafsky, R.S. Kamer,and S.L. Sivak. 599-605.. The questfora cholesterol-decreasing diet:

Should we subtract, substitute, or supple-ment? (Editorial.) T.A. Pearson and R.VPatel. 627-628.: Weight loss and mortality. (Editorial.) L.

Kuller and R. Wing. 630-632.Vol 119, October 15, 1993* Effect of caffeine on the recognition of andresponses to hypoglycemia in humans. D.Kerr, R.S. Sherwin, F. Pavalkis, P.B. Fayad,L. Sikorski, F. Rife, W V Tamborlane, andM.J. During. 799-804.

Psyllium reduces serum cholesterollevels Ingestion of psyllium results inmodest but significant improvements inserum levels of total and low-density li-poprotein cholesterol (LDL-C) in hyper-cholesterolemic persons who are follow-ing either a high-fat or a low-fat diet.Participants in this study were healthymen and women aged 21 to 70 years withprimary hypercholesterolemia (total se-rum cholesterol 5.7 mmol/L [220 mg/dL]). Over an 8-week treatment period, 37subjects followed a high-fat diet and 81followed a low-fat diet. Participants wererandomly assigned to receive either 5.1 gpsyllium (given in the form of Metamucil[Procter and Gamble Co, Cincinnati, Ohio],a nonsystemic, nonconstipating fibersupplement) twice daily or placebo. Se-rum levels of total cholesterol and LDL-Cdecreased 5.8% and 7.2%, respectively, inpsyllium recipients on high-fat diets and4.2% and 6.4%, respectively, in psylliumrecipients on low-fat diets.

Modified-fat cheese reduces serumlipid levels This study compared the ef-fect that eating either a linoleate-enriched(vegetable oil) or a part-skim-milk mozza-

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rella cheese product would have on plasmaconcentrations of lipids and apolipopro-tein in a sample of men and women withmoderate hypercholesterolemia. Partici-pants consumed their normal diets alongwith 100 g/day of one of the study cheesesfor 2 months; then subjects were crossedover to consume the other study cheese.Researchers noted no differences betweenthe diet periods in subjects' weight or inthe amount or type of kilocalories con-sumed. Consumption of mozzarella cheesehad no statistically significant effects onsubjects' lipid values. Eating the modified-fat cheese decreased levels of total andlow-density lipoprotein cholesterol com-pared with these lipid values at baselineand during consumption of the skim-milkmozzarella cheese. Levels of high-densitylipoprotein cholesterol, plasma triglycer-ide, and apolipoprotein A-I and B-100 wereunaltered. Responses were similar in menand women.

Garlic reduces hypercholesterolemiaThe best available evidence suggests thateating garlic, in an amount approximatingone half to one clove per day, decreaseslevels of total serum cholesterol about 9%.This observation comes from a meta-analy-sis of five randomized and placebo-con-

trolled studies of patients with total cho-lesterol levels greater than 5.17 mmol/L(200 mg/dL).

Caffeine and hypoglycemia Individualswho ingest moderate amounts of caffeinemay develop hypoglycemic symptoms ifplasma glucose levels fall into the "low-normal" range. Such a situation could oc-cur in the late postprandial period afteringestion of a large carbohydrate load. Thisfinding is from a study involving eighthealthy nonobese men aged 20 to 33 yearswho consumed either caffeine-free cola orcaffeine-free cola to which 400 mg caffeinehad been added. Because drug dosage isrelated to body size, a child who drinks onecan of cola ingests an amount of caffeinecomparable to that ingested by an adultwho drinks 4 cups of instant coffee.

AROIMES OF fJBOFMu ECVol 153, September 27, 1998* Increased mortality associated with vita-minA deficiency during human immunod-eficiency virus type 1 infection. R.D. Semba,NM.H. Graham, W T. Caiaffc J.B. Margolick,L. Clement, and D. Vlahov. 2149-2154.

JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / 335

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NEW REVIEW

Vol 153, October 11, 1993* The impact offemale hormone usage onthe lipid profile: TheFramingham OffspringStudy. S.M. Vaziri, J C. Evans, M.G. Larson,and P. WF. Wilson. 2200 2206.* Plasma lipoprotein levels as predictors ofcardiovascular death in women. KM. Bass,CJ. Newschaffer, MJ Klag, and TL. Bush.2209-2216.

Vitamin A deficiency and HIV mortal-ity A deficiency of vitamin A, an essentialmicronutrient for normal immune func-tion, seems to be an important risk factorfor disease progression during human im-nunodeficiency virus type 1 (HIV-1) in-fection. In this longitudinal study (meanfollow-up was 22.8 ± 1.1 months) involv-ing 179 intravenous drug users, more than15% of the HIV-1-seropositive individualshad plasma levels of vitamin A less than1.05 mol/L, a level consistent with vita-min A deficiency. The HIV-1-seropositiveindividuals also had significantly lowermean plasma levels of vitamin A than theHIV- 1-seronegative individuals. Vitamin Adeficiency was associated with lower lev-els of CD4 T cells. Use of vitamin A inpersons with HIV-1 infection or acquiredimmunodeficiency syndrome should beapproached with caution, however, untilfurther study shows that vitamin A supple-mentation does not increase HIV- 1 expres-sion in vivo. It must also be determinedwhether increasing vitamin A status im-proves clinical outcome in H1V infection.

Hormone use and serum lipids Data on1,930 women who participated in theFramingham Offspring Study show thatuse of oral contraceptives is associatedwith both favorable and unfavorable alter-ations in lipid concentrations with respectto atherogenic risk. In the premenopausalanalysis, pooled oral contraceptive use wassignificantly related to increased levels oftotal cholesterol, triglycerides, high-den-sity lipoprotein cholesterol (HDL-C), andapolipoprotein A-I. Increased estrogencontent was inversely associated with lev-els of low-density lipoprotein cholesterol(LDL-C) and apolipoprotein B, whereasincreased progestin content was inverselyrelated to levels of HDL-C and apolipopro-tein A-I. Among postmenopausal women,use of premarin only was significantly as-sociated with increased levels of HDL-Cand apolipoprotein A-I. Combined use ofpremarin and provera was significantlyassociated with increased levels of apo-lipoprotein A-I; less powerful but still sig-nificant associations were observed be-tween combined use of premarin andprovera and increased levels of HDL-C anddecreased levels of LDL-C. Thus, hormonereplacement therapy after menopause af-fects the lipid profile favorably.

Predictors of cardiovascular death inwomen Levels of high-density lipoprotein(HDL) and triglycerides are independentlipid predictors of cardiovascular disease(CVD) death. This conclusion was demon-strated in a study involving 1,405 womenaged 50 to 69 years who participated in theLipid Research Clinics' Follow-up Study.Age-adjusted CVD death rates and sum-mary relative risk estimates were calcu-lated during an average of 14 years offollow-up. After adjustment for other CVDrisk factors, HDL levels less than 1.30mmol/L (50 mg/dL) were strongly associ-ated with CVD mortality. Triglyceride lev-els were associated with increased CVDmortality at levels of 2.25 to 4.49 mmol/L(200 to 399 mg/dL) and 4.50 mmol/L (400mg/dL) or greater. At total cholesterol lev-els of 5.20 mmol/L (200 mg/dL) or greaterand at all levels of low-density lipoproteinand triglycerides, women with HDL levelsless than 1.30 mmol/L had higher CVDdeath rates than women with HDL levels1.30 mmol/L or greater.

ARTEIOSCLEROSI AN THROMBOSIS

Vol 13, October 1993I Obese men with type IIB hyperlipidemia

are insulin resistant. P. Karhapaa, E.Voutilainen, M. Malkki, andM Laakso. 14 69-1475.* Differential effects of body fatness andbody fat distribution on riskfactorsfor car-diovascular disease in women: impact ofweight loss. KE. Dennis and A.P. Goldberg.1487-1494.* Effects of canola, corn, and olive oils onfasting and postprandial plasma lipopro-teins in humans as part of a National Cho-lesterol Education Program step 2 diet. A.H.Lichtenstein, L.M. Ausman, W. Carrasco,JL. Jenner, L.J Gualtieri, B.R. Goldin, JM.Ordovas, and E.J Schaefer. 1533-1542.

CVD risk factors in women Results ofthis study affirm the deleterious effects ofan upper-body regional fat distribution inobese women, independent of the degreeof obesity, on lipoprotein ihpid risk factorsfor cardiovascular disease (CVD). Sub-jects were 50 obese women without diabe-tes; the women's mean body mass index(BMI)was31 ± 2andmeanagewas45 ± 10years. The women were grouped into anupper-body-obese or a lower-body-obesegroup on the basis of waist-to-hip ratio(WHR). At baseline, women in the upper-body-obese group had higher levels ofplasma triglycerides and lower levels ofhigh-densitylipoprotein cholesterol (HDL-C) than women in the lower-body-obesegroup, but both groups had similar levels oftotal and low-density lipoprotein choles-

terol and blood pressure. There were nosignificant differences in these CVD riskfactors at baseline when subjects werecompared by BMI. Although weight losslowered blood pressure and reduced levelsof triglycerides irrespective of WHR orBMI, only women in the upper-body groupincreased levels of HDL-C. In women witha WHR greater than 0.80, HDL-C levelsincreased 11%, and triglyceride levels de-creased 24%. The increase in levels ofHDL-C after weight loss was predicted in alinear model by the initial WHR, whereasthe reductions in levels of triglyceridesand blood pressure were predicted by thechange in body weight. Although weightloss improved CVD risk factors regardlessof BMI or WHR, the magnitude of theincrease in levels of plasma HDL-C and thedecrease in levels of triglycerides inwomen with an upper-body fat distribu-tion suggest that these women should bethe primary target for intervention be-cause they are likely to benefit the most inprevention of CVD.

Which fat is best in the NCEP diet?The dietary recommendations of the Na-tional Cholesterol Education Program(NCEP) step 2 diet are to limit total fatintake to less than 30% of energy intake,saturated fat intake to less than 7% ofenergy intake, and cholesterol intake toless than 200 mg/day. There is debate,however, concerning whether the remain-ing fat in this diet should be relatively highin monounsaturated or polyunsaturatedfatty acids. To examine this issue, research-ers studied the effects on plasma lipidvalues of three diets that met NCEP step 2guidelines but differed in their source offat. Two thirds of the fat content of eachdiet was given as either canola, corn, orolive oil in a randomized, double-blindedfashion for 32 days each. Plasma choles-terol concentrations decreased after con-sumption of all three test diets; however,the decreases were significantly greaterfor the diets enriched with canola oil orcorn oil than for the diet enriched witholive oil. Results indicate that middle-agedor elderly persons who follow the NCEPstep 2 diet can achieve a mean reduction inlow-density lipoprotein cholesterol of15 ± 2% and that oils rich in polyunsatu-rated or monounsaturated fatty acids canbe substituted for saturated fatty acids.

BRmI MEDICAL JOURNALVol 307, September 4, 1993* Iron and coronary heart disease. (Edito-rial.) M.J Burt, J W Halliday, and L.WPowell. 575-576.


* Influence of oral magnesium supplemen-tation on cardiac events among survivors ofan acute myocardial infarction. A.M. Gall0e,H.S. Rasmussen, L.N. Jrgensen, P. Aurup,S. Balslov, C. Cintin, N. Graudal, and P.McNair. 585-587.Vol 307, September 18, 19931 Serum albumin concentration, arm cir-

cumference, and oedema and subsequentrisk ofdying in children in centralAfrica. M.Dramaix, P. Hennart, D. Brasseur, P.Bahwere, O. Mudjene, R. Tonglet, Ph.Donnen, and R. Smets. 710-713.Vol 307, September 25, 19931 Chronic constipation in long stay elderly

patients: A comparison of lactulose and asenna-fibre combination. A.P. Passmore, KWilson-Davies, C. Stoker, and M.E. Scott.769-771.

Iron: Risk factor for heart disease?Studies that suggest a role for iron in heartdisease are cited. Researchers have hy-pothesized that the difference in rates ofheart disease between men and womenmight be explained by their different con-centrations of stored iron: iron stores risesteadily in men after adolescence but re-main low in women until age 45 years wheniron stores begin to rise. Other studies

have postulated that the low rates of heartdisease in developing countries may berelated to the high prevalence of iron defi-ciency in these populations. However, thelowiron stores in some populations may bedue' to a poor diet, and such diets may beless atherogenic because of factors otherthan iron content. If iron has a substantialrole in the pathogenesis of atherosclerosisand ischemic heart disease, persons whoare homozygous or heterozygous forhemochromatosis might be expected toexperience high rates of coronary heartdisease, but evidence of this is lacking. Thedebate raises questions about optimal bodyiron stores and optimal dietary require-ments. Until more is known about controlof the availability of iron in body tissuesand the toxicity of iron, no firm conclu-sions can be drawn. It seems prudent,therefore, to prescribe iron only for irondeficiency and during pregnancy.

Magnesium not recommended for car-diac patients Long-term oral treatmentwith 15 mmol magnesium per day does notreduce the incidence of cardiac events insurvivors of an acute myocardial infarction;

indeed, magnesium supplementationseems to increase the risk of developing acardiac event. This observation comes froma study involving 468 men and women,aged 31 to 92 years, who had survived anacute myocardial infarction. Participantswere given either magnesium hydroxideor placebo daily for 1 year. There was nosignificant difference in the incidence ofeach ofthree cardiac events - reinfarction,sudden death, and coronary artery bypassgrafting - between the treatment and pla-cebo groups. However, when events werecombined and drop-outs were excludedfrom calculations, there was a significantlyhigher incidence of cardiac events in thetreatment group.

CERU CHIIIsTRY

Vol 70, September/October 1993[ Phytate content of some popular Kuwaitifoods. M.S. Mameesh and M. Tomar. 502-503.* Stability and nutrient contribution of P-carotene added to selected bakery products.

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A_ I ^^^ ^AA Ae

NEW I REVIEW

D.E. Rogers, R.. Maloaf; J. Langenteiet; JA.Gelroth, and G.S. Ranhotra. 558-561.

Nutrition value valu 'clr icken ad cor7l looroirkctures in jbtriulas fb i/lants with lac

those itoleraice. L. Cortejo, At Her7e(ddez,atd A. Sotelo. 572 575.

Bakery products with added caroteneBeta carotene is only a trace constituent inwheat and most other grains. Therefore,unless they contain butter, margarine, oreggs, bakery foods are an insignificantsource of dietary beta carotene. Syntheticbeta carotene can now be added to foods,including bakery goods, to provide colorstypical of butter, margarine, or eggs. In thisstudy, three bakery products-yellowcake, sugar cookies, and bagels- wereprepared with beta carotene added to theshortening formula. Prebaking processingsteps had no adverse effect on the stabilityor isomeric distribution of carotene. Caro-tene losses during baking ranged from ap-proximately 20% in bagels and cake toabout 30% in cookies. No significant addi-tional losses or isomeric transformationsoccurred during the typical shelf life of theproducts. A serving of each bakery prod-uct provided about 1 mg beta carotene.

CIRCULATION

Vol 88, October 1993· Lipids and lipoproteiass predicting coron-nary heart disease mortality altd nw rbidityin patients with non-it sultin-deperdet t di-betes. M. Laakso, S. Lehto, I. Peltil, and KPyirald. 1421-1430.*Abnoormalities of sodium handlin1g and ofcardioascularadaptatios during hIigh saltdiet in patients with mild heart failure. MVolpe, C. Tritto, N. DeLuca, S. RubattAE, MAE.Rao, F Lamenza, A. Mirante, I. Enea, VRendina, A.F Mele, B. Trimarco, and M.Condorelli. 1620-1627.

Serut cholesterol: Doing the right thing.(Editorial.) I. Stanle,; R. Stadle W VBrown, A.M. Gotto, P. Greenland, S. Grundy,M Hegsted, R. V Luepker, JD. Neaton, P.Steinberg, N Stone, L. Van Horz, and R. WWissler. 1954-1960.

CHD risk in diabetes This 7-year follow-up study provides evidence that low levelsof high-densitylipoprotein (HDL) and HDLcholesterol, high levels of very-low-densitylipoprotein (VLDL) cholesterol, and highlevels of total and VLDL triglycerides arepowerful risk indictors for coronary heartdisease (CHD) events inpatients with non-insulin-dependent diabetes mellitus(NIDDM). Among 313 patients withNIDDM, 56 died from CHD and 25 had anonfatal myocardial infarction during thefollow-up. The risk for CHI death was

fourfold and for all CHD events twofoldhigher among diabetic persons with lowlevels of HDL cholesterol than among dia-betic persons with HDL cholesterol levels

0.9 mmol/L. A high total triglyceride level(> 2.3 mrnol/L) was associated with a two-fold increase in the risk of CHI) events.

High-salt diet in mild heart failurePatients with asymptomatic to mildly symp-tomatic heart failure and no signs or symp-toms of congestion show a reduced abilityto excrete a sodium load and early abnor-malities of cardiac and hemodynamic ad-aptations to salt excess. This conclusion isfrom a balanced study of the effects of ahigh-salt diet (250 mEq/day for 6 days) onhemodynamics, salt-regulating hormones,and renal excretory response that involved12 patients with untreated idiopathic orischemic dilated cardiomyopathy and mildheart failure and 12 control subjects with-out heart failure (control subjects had beenmaintained previously on a 100-mEq/daysodium chloride diet). In control subjects,the high-salt diet was associated with sig-nificant increases of left ventricular end-diastolic volume, ejection fraction, andstroke volume and with a reduction of totalperipheral resistance. In control subjects,plasma atrial natriuretic factor levels in-creased, and plasma renin activity andaldosterone concentrations fell during thehigh-salt diet. In patients with heart fail-ure, left ventricular end-diastolic and end-systolic volumes increased in response tothe high-salt diet, whereas ejection frac-tion and stroke volume did not increase,and total peripheral resistance did notchange during the high-salt diet. In thepatient group, plasma atrialnatriuretic fac-tor levels did not rise after salt loading,whereas plasma renin activity and aldoste-rone concentrations were suppressed asmuch as in the control subjects. Althoughurinary sodium excretions were not sig-nificantly different in the two groups, therewas a small but systematic reduction indaily sodium excretion in patients withheart failure that resulted in a significantlyhigher cumulative sodium balance in pa-tients than in control subjects during thehigh-salt diet. Findings underscore a sus-ceptibility to retain sodium and waterearly in the development of heart failureand support the usefulness of sodium re-striction and early therapeutic interven-tions even in milder stages of the disease.

FOOD MANAGEMiEIT

Vol 28, October 1993Kitchen systems. Keeping pace at Dade

Countto Correctional ( ,lter P. Knia 2.

* 1.993 Ideas catalog. Transitionz intocyberspace & other phase changes into thejfutuie. FMStaff'uvith N Sherr; A. Friedland,and P. Hyse. 70-73.* 1993 Ideas cataloy. ell equipped. P. King.76-78.

T7(lrgetig the trends. Mlen us, n atrition &bran2dint I. DBoss and J White. 96-99, 102-104.· Menu attractions. Southwestern:El main-streott grade. I.C. Peterson. 108-10.9, 112-11'3.

tirhibition cooking. L.C. Peterson. 116.

Interactive computer networks Food-service operators can look forward to thedaywhen offices and facilities, even pocketcomputers, will be communications cen-ters linked to every part of an institution orcompany; to worldwide databases; and evento suppliers of produce, fish, and preparedfoods. Ordering will be done using interac-tive computer link-ups. Products will beinspected on screen and from any angle apurchaser chooses. Training will be con-duct ed in multiple locations using floor-to-ceiling wireless video screens. Operationswill be overseen by pocket computers. Thetelephone will incorporate video, computer,and voice recognition capabilities. Theportable computer will serve as fax ma-chine, newspaper, watch, appointmentbook and full-power computer. This earlyglimpse of future technologies also high-lights virtual reality, home shopping, andthe jargon of cyberspace.

New technology for foodservice equip-ment This preview of eight products thatexemplify the latest in foodservice tech-nology includes a dish machine that auto-matically loads and unloads trays and sil-verware, a vending machine that uses aconvection oven to cook specially devel-oped french fries in 35 seconds, a machinethat cooks pasta in less than 1 minutethrough a combination of temperature andpressure, and an oven that can bake a pizzain less than a minute. (The Flashbake Oven,which will also bake foods such as chickenor fish faster than conventional ovens, usesintense visible light and infrared energyfrom quartz lamps to heat foods using thelight absorption patterns of a food's indi-vidual ingredients.) Other items featuredare the next generation of rethermalizationcarts, which "pulse" heat to maintain serv-ing temperature without drying food, anda system for mass-producing pizza cruststhat uses a press with heated dies to bakecrusts as they are formed. Coming soon:robots that will take over the chores ofwashing floors and cleaning bathrooms!

Southwestern cuisine The foods ofMexico, California, and the SouthwesternI nited States are beconting national favor-

338 / MARCH 1994 V()LIME 94 NUMBER 3

v- -- I - - � I -1 __ . - ___ -1 -

ites. Already, salsa has supplanted ketchupas America's favorite condiment, accord-ing to the National Restaurant Association.A recent survey by the National Foodser-vice Panel found that 97% of noncommer-cial foodservice operations offer menuitems that are considered "Mexican," andmore than 70% expect to strengthen theirMexican menu profile. This article fea-tures several quantity recipes, includingPhoenix sunset chowder, green chili stew,beef taco filling, pollack tostadas, cheese-stuffed chilies in red sauce, Mexican lasa-gna, and lamb chili with jalapefio hominybread. A descriptive list of popular Mexi-can dishes now appearing on Americanmenus accompanies the article.

GR118TR10WOiOL GYVol 105, September 1993

Growthfailure in children with inflam-matory bowel disease: A prospective study.KJ Motil, R.J. Grand, L. Davis-Kraft, L.L.Ferlic, and E. O. Smith. 681-691.

* Intestinal lactase: What defines the de-cline? (Editorial.) G.M. Gray. 931-934.Vol 105, October 1993

Evaluation ofliquidyeast-derivedsucraseenzyme replacement in patients with su-crase-isomaltase deficiency. WR. Treem, NAhsan, B. Sullivan, T. Rossi, R. Holmes, JFitzgerald, R. Proujansky, and J Hyams.1061-1068.

Decline in intestinal lactase Typically,lactase activity declines exponentially atthe time of weaning to only a fraction(about 10%) oftheneonatalvalue. Even inindividuals in which lactase levels remainhigh in adulthood (eg, 75% to 85% of whiteadults of Western European heritage), thequantity of lactase is only about half thatof other saccharidases, such as sucrase,a-dextrinase, or glucoamylase, which aremaintained at optimal concentrationsthroughout life. The mechanism of lactasedecline that produces adult lactase defi-ciency, commonly known as hypolactasia,and the consequent syndrome of lactoseintolerance has been elusive. Multiplemechanisms may be responsible for theloss of lactase with maturation, and these

may vary depending on the mammalianspecies. This editorial highlights the workof Maiuri and colleagues at Auricchio'slaboratory in Naples, Italy; these research-ers have examined the immunoreactivityand enzymatic activity of lactase in thesmall intestine. Their insights concernlactase's topographic localization as theenterocyte migrates from the top of thecrypt to the villus apex for eventual dis-charge into the intestinal lumen. Theirdata can be correlated with other emerg-ing information to aid understanding oflactase maturational regulation and therelated hypolactasia.

GUT

Vol 34, September 1993N The effect of liquidfibre on gastric empty-ing in the rat and humans and the distribu-tion of small intestinal contents in the rat. JTomlin, N. Brown, A. Ellis, A. Carlsson, C.Bogentoft, and N. W. Read. 1177-1181.



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1994 ANNUAL MEETING ANDEXHIBITION

CALL FOR ABSTRACTSDEADLINE

The Department of Meetings reminds allmembers who wish to submit an abstract forpossible presentation at the 77th AnnualMeeting and Exhibition in Orlando, FloridaOctober 17 - 20, 1994: THE POSTMARKDEADLINE IS APRIL 2,1994.

For submission guidelines and an application,look to your December, January or Februaryissues of Journal of The American DieteticAssociation. For additional copies of the ab-stract application, call the ADA Departmentof Meetings at 800/877-1600, extension 4867.

TM

NEW H REVIEW

Initial response and subsequent course ofCrohn's disease treated with elemental dietorprednisolone. D.A. Gorard, J.B. Hunt, J. TPayne-James, KR. Palmer, R. G.P. Rees, M.L.Clark, M.J G. Farthing, J.J Misiewicz, andD.B.A. Silk. 1198-1201.

Effect of liquid fiber on gastric empty-ing Liquid fiber, a combination of the po-lysaccharide ethylhydroxyethylcelluloseand the surfactant sodiumdodecylsulphate,has the extraordinary physical property ofbeing liquid at room temperature but gel-ling firmly at 37° C. Liquid fiber may beuseful clinically in the management ofdumping syndrome in which symptomsare thought to be caused by an unnaturallyrapid delivery of the meal out of the stom-ach into the intestine. Liquid fiber may alsohelp control diabetes by delaying and slow-ing the rate of absorption of glucose. Stud-ies involving both rats and human beingsare reported. In the study involving humanbeings, 10 healthy men drank 250 mL liq-uid fiber or placebo on separate occasions.Liquid fiber delayed both the time at whichthe stomach first began to empty and therate at which it emptied. The time for halfthe stomach to empty significantly in-creased from 17.7 to 55.8 minutes. Thetime for 10% of the stomach to emptyincreased from 7.0 to 19.4 minutes. Aver-age emptying rate decreased from 4.49%per minute with placebo to 1.60% perminute with liquid fiber.

HOSPITALS & HEALTH NEWORKS

Vol 67, September 20, 1993N Baby boomers grow up. K Lumsdon. 24-34.

Baby boomers scrutinize the healthcare system As baby boomers age andincrease their contact with health careproviders, the number of "health-active"consumers will rise substantially, accord-ing to a forecast by the New York-basedHealth Strategy Group. By the year 2000, itis projected that health-active consumerswill constitute 40% to 50% of the con-sumer population. This generation's use ofhealth care services has barely been felt;until now, their use of health services hasbeen concentrated in areas such as obstet-rics and gynecology, pediatrics, orthope-dics, and elective surgery. What consumer-oriented baby boomers ultimately wantfromproviders is healthy aging. Their com-mon characteristics, according to KenDychtwald, PhD, an author and consultanton aging, are a desire for wellness, a de-mand for information to manage illnessesand avoid further risks, a stance of aggres-

sive consumerism, and a fear of infirmity.Patient education must shift from an acute-care focus to a more extensive interven-tionist approach, emphasizing smokingcessation, stress management, and weightand dietary programs. Providers need toback up their commitments to consumerinvolvement by rethinking the structure,content, and location of current educa-tional efforts. Caregivers, particularly pri-mary-care providers, must be willing tospend more time talking with patients. Acommunity outreach program organizedby St Mary's Hospital in Amsterdam, NY, iscited as one example of the kind of commu-nity education programs needed to servethis growing segment of health care con-sumers- the hospital opened an infor-mation kiosk at a local shopping mall staffedby volunteers and open every day.

JE1NIR OF THE AM MCANCOLEGE OF MITRiIW

Vol 12, October 1993Amino acidfortification ofprotein foods.

(Editorial.)N.S. Scrimshaw and VR. Young.481-483.I Lysine supplementation of cerealfoods: A

retrospective. N. W Flodin. 486-500.] Reducing atherogenic risk in hyper-lipemic humans withflax seed supplemen-tation: A preliminary report. ML. Bier-enbaum, R. Reichstein, and T.R. Watkins.501-504.* Body image and eating behavior in adolescents. D.C. Moore. 505-510.

Thermnogenic response tofood: Intra-indi-vidual variability and measurement reli-ability. M. Houde-Nadeau, L. DeJonge, andD.R. Garretl. 511 516.

1 Dietary habits offirst-year medical stu-dents as determined by computer softwareanalysis ofthree-dayfood records. S.R. Glore,C. Walker, and A. Chandler. 517-520.

Recent epidemiologic studies on nutri-tion and cataract in India, Italy, and theUnited States. E.R. Schoenfeld, M. C. Leske,and S.-Y Wu. 521-526.* Does a vegetarian diet control Wilson'sdisease?G.J Brewer, V Yuzbasiyan Gurkan,R. Dick, Y Wang, and V Johnson. 527-530* Iron status and iron supplementation inchildren with classical phenylketonuria.B.D. O. Miranda da Cruz, H. Seidler, and KWidhalm. 531-536.I Renal excretion of ascorbic acid: Effect of

age and sex. D.G. Oreopoulos, R.D. Lin-deman, D.J VanderJagt, A.H. Tzamaloukas,H.N. Bhagavan, and P.J Garry. 537-542.* Bloodglucose risefollowingprenatal vita-mins in gestational diabetes. S. P. Sparks, L.Jovanovic-Peterson, and C.M. Peterson. 543-546.L 1 Colostrum composition in adolescentmothers. MR. Vitolo, A.L. Dias Brasil, F.Ancona Lopez, and FJ de N6brega. 547550.

Body image and eating behavior Areview of the literature indicates that ap-proximately two thirds of adolescent girlsat any age are dissatisfied with their weight;dissatisfaction increases proportionatelywith increasing actual weight. Slightly morethan half of all girls are dissatisfied with theshape of their bodies, and this attitude ispositively correlated with actual bodyweight. Girls are most likely to be dis-tressed about excess size of their thighs,hips, waist, and buttocks and inadequatesize of their breasts. Girls who are dissatis-fied with their bodies are more likely toengage in potentially harmful weight con-trol behaviors, such as dieting; fasting; self-induced vomiting; and use of diuretics,laxatives, and diet pills. Those who diet aremore likely to begin this practice in earlyadolescence, to be white rather than black,to be of higher socioeconomic status, toengage in other eating-related practices(eg, binge eating), and to have a poor bodyimage and low self-esteem. Underweightboys are most likely to be dissatisfied withtheir weight, and many boys with normalweight wish to weigh more. Approximatelyone third of boys are dissatisfied with theirbody shape, desiring larger upper armsand shoulders and a bigger chest. Boys aremore likely to choose exercise than dietingor purging as a method of weight control.Dieting among boys is more likely to beassociated with increased body weight andparticular sports, such as wrestling.

Vegetarian diet for treating Wilson'sdisease The literature indicates that cop-per is less bioavailable from a vegetariandiet than from a mixed diet. Researchershave noted that the typical American dietprovides a marginal average copper intake.Patients with Wilson's disease who follow atypical American diet ingest only about25% more copper than is required. Thissuggests that a vegetarian diet, if it re-duces copper bioavailability by about 25%,would be an adequate maintenancetherapy for Wilson's disease. This article,which reports the cases of two patientswho were almost totally noncompliant withanti-copper therapy but who followedlactovegetarian diets by choice, providessupport for use of a vegetarian diet fortreatment of Wilson's disease. Findingsalso emphasize the marginal copper intakein American diets and suggest that someseemingly healthy people, particularlyvegetarians, may be at risk for mild copperdeficiency.

Iron status of children with PKU Ironstatus and iron supplementation were de-termined in children with phenylketonuria(PKU) through assessment of dietary in-take and measurement of ferritin. hemat-

340/ MARCH 1994 VOLUME 94 NUMBER 3

i

ocrit, hemoglobin, mean cellular hemoglo-bin, mean cellular volume, serum iron,total iron-binding capacity, unboundediron-binding capacity, transferrin satura-tion, and transferrin. These values werecompared with reference values and withdata from age-matched control subjects.The prescribed phenylalanine-restricteddiet supplied all the recommended nutri-ents for the children with PKU. Dietaryiron was present in the diets, but itsbioavailability is questionable as severallaboratory results were not within acceptedreference values. Aferrous sulphate supple-ment (5 mg elemental iron per kg bodyweight) was given daily for 120 days to agroup of children with PKU who had lowiron parameters. Values for serum ferritin,transferrin saturation, and serum iron in-creased after treatment. The authors pointto the need for improved diagnosis of ironstatus and determination of whether chil-dren with PKU can benefit from therapeu-tic iron treatment.

Gestational diabetes linked to prena-tal vitamins Ingestion of prenatal vita-mins commonly prescribed during preg-nancy increases blood glucose levels ofwomen with gestational diabetes mellitus;the increase in blood glucose caused by thevitamins is greater than the effect on glu-cose after ingestion of a sucrose capsuleproviding carbohydrate content equiva-lent to that provided by the prenatal vita-mins. Although the exact cause of theincrease in blood glucose is not clear, itappears prudent to prescribe prenatal vi-tamins with a low relative glycemic indexand to instruct women with gestationaldiabetes mellitus to ingest these prepara-tions separately from snacks or meals.These conclusions are based on a studyinvolving nine women with gestationaldiabetes. Each subject ingested one of sixprenatal vitamin and mineral prepara-tions, a placebo, or a sucrose capsule, inrandom order. The sucrose capsule con-tained 1 g sucrose (equivalent to the high-est glucose-carbohydrate content of anyprenatal vitamin). The placebo contained1 g table salt given in a capsule of thesame color as the sucrose and vitamincapsules. Relative glycemic index was sig-nificantly elevated for all vitamins.

JOI AL OF THE AIMWCANMATUCS SOCETY

Vol 41, October 1993· Calcium homneostasis of an elderly popu-lation upon admission to a nursing home. L.Komar, J Nieves, F. Cosman, A. Rubin, VIShen, and R. Lindsay. 1057-1065.

[-I Serum fructosamine as a screening testfor diabetes in the elderly:A pilot study. W. TCafalu, WH Ettinger, A.D. Bell-Farrow, andJ T. Rushing. 1090-1094.

Calcium homeostasis in elderly pa-tients Vitamin D malnutrition is prevalentamong elderly patients admitted to long-term-care facilities. Low to low-normal cir-culating levels of 25-hydroxyvitamin D[25(OH)D] were recorded among 109 eld-erly patients upon their admission to afacility in Paramus, NJ; 86% had circulat-ing levels of 25(OH)D less than 50 nmol/L,and 41% had levels less than 25 nmol/L.Sixteen percent of patients had franklyelevated levels of parathyroid hormone.Alkaline phosphatase and osteocalcin lev-els were elevated in 23% and 13% of pa-tients, respectively. Eighty-five percent ofpatients had bone mineral measurementsin the osteoporotic range. There was anegative association between 25(OH)Dlevels and a history of fracture.

JOUNIM OF THE AMERIUCANOIL CHUISTS' SOC IE

Vol 70, October 1993: Antioxidant effects of d-tocopherols at dif-

ferent concentrations in oils during micro-wave heating. H. Yoshida, G. Kajimoto, andS. Emura. 989-995.· A study on cashew nut oil composition.T G. Toschi, M.F. Caboni, G. Penazzi, G.Lercker, andP. Capella. 1017-1020.

Cashew nut oil Cashew nut oil is particu-larly rich in y-tocopherol, which is veryactive among tocopherols as an antioxi-dant. This, along with a high oleic acidcontent, confirms that cashew nut oil iswell suited to cooking and frying of foods.Eight samples of cashew nut oil were as-sayed, and the component triacylglycerols,fatty acids, and severalunsaponifiable com-pounds were analyzed by gas chromatog-raphy and high-performance liquid chro-matography. Values for total lipid amount,unsaponifiable percentage, fatty acids, ste-rols, triterpene alcohols, and tocopherolsare reported.

JOU IA OF THE CANADIANDETE11C ASSOCIATIONVol 54, Fall 1993* Consumer awareness of nutrition infor-mation onfood package labels. D.J Reid andS. Hendricks. 127-131.* Factors affecting fat consumption of uni-versity students: Testing a model to predict

eating behaviour change. J.A. DeWolfe andB.M. Shannon. 132-137.* Weight preoccupation in NorthAmericanculture. G.D.M. Marchessault. 138-142.* Standards of care: An innovative ap-proach. E.J Corner and B.J Rodey. 143-146.I Auditing the nutrition content of patient

charts: One hospital's perspective. S.Skopelianos. 147-150.* The nutrient intake, growth, and eatingpattern of preschool children with single,employed mothers. M.L. Campbell. 151-156.

Consumer awareness of nutrition la-bels In-home interviews were conductedin five cities across Canada with 820 menand women identified as the "principalgrocery shopper" for their household(sample was 80% women and 20% men).Seventy percent of respondents consid-ered nutrition to be "very" or "extremely"important in their food choices; 64%claimed to read food package labels fornutrition information, and 71% did sowhen choosing between products. Com-plexity was the greatest barrier to use ofa product's ingredient list and panel;credibility was the main barrier to use ofnutrition or health claims. French-speak-ing respondents reported greater impor-tance, use, and understanding of the ingre-dient list, panel, and nutrition claims thandid English-speaking respondents. Fifty-nine percent of respondents did not wantadditional nutrition information on foodlabels. About half of the consumers sur-veyed indicated that they would find nu-trition information useful for meat, eggs,and fresh fruits and vegetables.

Social-cognitive model for predictingbehavior change At the core of social-cognitive theory is the idea that behavior ismolded and changed through the interac-tion of a person's cognitive processes andenvironmental influences. In this study ofthe social-cognitive model for behaviorchange, "self-efficacy" was identified asthe key "cognitive" variable and "friendsupport" was identified as the key "envi-ronmental" variable. In a test of the modelthat involved dietary change among uni-versity students, the outcome measurewas change in dietary fat after completionof a nutrition course and 3 months later.Researchers expected that a supportiveenvironment of friends would strengthenself-efficacy and encourage a change tolow-fat eating habits. Students' fat intakedecreased during the nutrition course andremained lower at the 3-month follow-up;however, overall, the change was not sta-tistically significant. Immediately after thecourse, women reported greater supportfrom friends than did men, and this sup-port had a favorable impact on dietary fat


NEW HREVIEW

intake. At the 3-month follow-up, self-effi-cacy was an important predictor of changefor all students, whereas the influence offriend support was different for men andwomen. Men reported a more positive ef-fect of friend support at 3 months than atthe end of the course and this support hada positive influence on dietary change.Women reported a small but negative im-pact on their self-efficacy at follow-up.

Weight preoccupation in North Ameri-can culture This commentary argues thathistorical traditions have produced apresent-day cultural context conducive toweight preoccupation. According to theauthor, preoccupation with weight affectswomen in particular because of their sub-ordinate position in North American soci-ety. This vulnerability has been exploitedand extended by a mass consumer culture.Compounding the problem, the advice ofthe medical community is consistent withthe culture's fashion ideals. The authorurges more discussion of the potential ben-efits of being moderately heavy, the haz-ardous effects of our compulsion withweight, and the dismal success rates ofweight loss programs.

Developing standards of care This ar-ticle reports one hospital's approach todeveloping standards of care that focus onevaluating the goals, intensity, and out-come of care. The standards operate underthe premise that the process and intensityof care are determined by the goals of care.The standards devised by the HendersonGeneral Division of Hamilton Civic Hospi-tals, Ontario, Canada, are based on popu-lations defined by the level of nutritioncare required and can be applied to pa-tients with multiple medical and nutritionconcerns. A flow chart depicts the stan-dards of care.

Diets of children with employed moth-ers This study assessed the nutrient in-take, growth, and eating patterns of 1602- to 4-year-old children of mothers whoare single parents and employed outsidethe home. Dietary intake was assessed by3-day records kept by the mothers andnonparent caregivers. The mean intake ofmost children met recommendations forenergy and nutrients. Nevertheless, 63%of children took supplements. Fat contrib-uted 33% of energy intake. The children'sgrowth, in general, was acceptable. Foodeaten at home was the major source ofenergy and nutrients at breakfast, eveningmeal, and evening snack. Food eaten withnonparent caregivers was the major sourceof energy and nutrients at lunch and day-time snacks and a secondary source atbreakfast. Results highlight the important

role that nonparent caregivers have inmeeting the nutrient needs of preschoolerswith single, employed mothers.

JOURNAL OF CONSUMER RESEARCH

Vol 20, September 1993· A model of consumers' preventive healthbehaviors: The role of health motivation andhealth ability. C. Moorman and E. Matulich.208-228.· The influence of positive affect on varietyseekingamongsafe, enjoyableproducts. B.E.Kahn and A.M. Isen. 257-270.

Consumers' preventive health behav-iors This article draws on research acrossdisciplines to develop a model that in-cludes a comprehensive set of consumerand behavior characteristics related to theacquisition of health information (eg, us-ing media and other sources) and mainte-nance of health (eg, improving dietary in-take). The model was tested in a survey of404 consumers. Results indicate that theinteraction of health ability and healthmotivation affects consumers' health be-haviors. However, mixed results suggestthat high levels of ability and motivationare not always critical precursors of healthbehaviors. Instead, the impact of thesecharacteristics depends on the particularhealth behavior and the specific healthability. Implications for theory and prac-tice are discussed. For example, this re-search indicates that health informationprograms for older consumers should dis-seminate information through health pro-fessionals (an information source that isnot negatively related to age) and shouldreinforce older consumers' current highlevel of health maintenance behaviorsthrough provider channels or other non-information-based channels. Other resultsindicate that motivated but unhealthy con-sumers perform more healthful behaviorsthan do motivated and healthy consumers.One way to interpret this surprising find-ing is that motivated consumers who areunhealthy use their lack of health to justifythe need for action. If this is true, currenthealth could be viewed as a health liabilityrather than a health ability because cur-rent health may create an illusion of well-being that reduces healthful behaviors.

Positive feelings induce consumerchoices Research has shown that positivefeelings induced by everyday positiveevents - such as receiving a free productsample - can influence social interactionsand thought processes. This "positive af-fect" on cognitive processes may give riseto more creative and flexible processing of

information. In the current study, research-ers sought to determine whether the influ-ence of positive affect could be extendedto consumer choices regarding a variety offood product lines. Subjects were asked tomake 25 successive choices about itemswithin food categories. A significant inter-action was found regarding the influenceof positive affect, induced by the gift of asmall bag of candy or sugarless gum, andsubjects' tendency to seek variety in theirproduct choices. In three food categories(crackers, soup, and snack foods), a posi-tive-affect manipulation increased vari-ety-seeking behavior when circumstancesdid not involve unpleasant or negative fea-tures. However, when a negative feature,such as the possibility that a product wouldtaste bad, was introduced, there was nodifference in variety-seeking behavior be-tween subjects who received the small giftand control subjects. Positive affect alsoincreased subjects' tendency to categorizenontypical items as belonging to a pre-defined product category and increasedsubjects' belief that a product designed toreduce negative health effects would besuccessful.

JOUI'dAL OF FOOD PROTECTION

Vol 56, October 1993· Extending shelf life of poultry and redmeat by irradiationprocessing. D. W. Thayer.831-833, 846.* Growth inhibition ofPenicillium expansumby several commonly usedfood ingredients.D. Ryu and D.L. Holt. 862-867.* Sensitivity of Listeria monocytogenes toselected spices. YA. Hefnawy, S.I. Moustafa,and E.H Marth. 876-878.

International regulatory status and har-monization offood irradiation. D.D. Derr.882-886

Irradiation for poultry and red meatThe shelf life of poultry, pork, and beef issignificantly extended by treatment withionizing radiation. This study provides evi-dence that foodborne pathogens can becontrolled by doses of ionizing radiationbelow 10 kGy (kilogray). Treatments thatcombine ionizing radiation with vacuumpackaging or modified atmosphere pack-aging have produced better than predictedresults. Additional research on the com-bined processes is needed.

Controlling mold on fresh fruit Be-cause Alar (daminozide) and other syn-thetic pesticides and fungicides have been,or soon may be, taken off the market,alternative methods are needed to preventthe growth of mold and mycotoxins instored fruit. Researchers examined the


antifungal activity of several compoundsnot generally used to control mold growthon fresh apples and in apple juice: cinna-mon oil; clove oil; their principal compo-nents cinnamaldehyde and eugenol, re-spectively; and potassium sorbate. Theeffectiveness of the inhibitor was depen-dent on the apple cultivar treated. Both0.1% cinnamon oil and 0.5% potassiumsorbate decreased spoilage. Patulin wasnot detected in applejuice containing 0.3%cinnamon oil or 0.5% sorbate after incuba-tion with Penicillium expansum for 7days at 25 ° C. These findings can be ap-plied to fresh apple cider, a product oftensold at farmers' markets and through simi-lar distribution systems.

Antibacterial action of spices Listeriamonocytogernes may be inhibited by somespices, particularly sage and allspice. Theresponse of L monocytogenes to variousconcentrations of 10 different spices wasstudied. Mace and nutmeg also exhibitedantibacterial action, whereas black pep-per, cumin, garlic powder, paprika, redpepper, and white pepper either had noeffect or enhanced microbial growth. How-ever, an increase in concentration of spicestended to delay onset of bacterial growth.

JOURNAL OF THE NATIONALCANCER INSTITUTE

Vol 85, October 6, 1993Is dietary .fat a risk factor for prostate

cancer? (Editorial.) J. Pienta and P.S.Esper. 1538-1540.* A prospective study of dietary fat and riskof prostate cancer. E Giovannucci, E.B.Rimm, G.A. Colditz, M.J Stampfer, A.Ascherio, C.C. Chute, and W C. Willett. 15711579.

Dietary fat and prostate cancer Datafrom the Health Professionals Follow-upStudy support the hypothesis that intakeof animal-source fat, especially fat fromred meat, is associated with elevated riskof advanced prostate cancer. In 1988 and1990, follow-up questionnaires were sentto the cohort of men aged 40 through 75years who had completed a validated foodfrequency questionnaire in 1986. As ofJanuary 31, 1990, 300 new cases of pros-tate cancer, including 126 advanced cases,were documented in 47,855 participantswho had been free of diagnosed cancer in1986. Fat intake from dairy products (withthe exception of butter) or fish was unre-lated to risk. Intake of saturated fat,monounsaturated fat, and ca-linolenic acid,but not linoleic acid, was associated withrisk of advanced prostate cancer; only the

association with a-linolenic acid persistedwhen saturated fat, monounsaturated fat,linoleic acid, and a-linolenic acid weremodeled simultaneously.

THE JOURNAL OF PEDIATWCS

Vol 123, October 1993Effect of human immunodeficien cy virus

infection on the growth of young children.R.E. McKinney, Jr, JWR. Robertson, andtheDukePediatricAIDS Clinical Trials Unit.579-582.* Infant feeding and idiopathic intussus-ception. A. Pisacane, G. Caracciolo, i. deLuca, G. Grillo, C. Simeone, N Impagliazzo,and G. Mozzarella. 5.93-595.lMolybdenum cofactor deficiency. G.L.Arnold, C.L. Greene, JP Stout, and S..Goodman. 595-598.

Nitrogen balance in extremely low birthweight infants with nonoliguric hyperkal-emia. JL. Stefano and ME. Norman. 632-635.

Intussusception and infant feeding Ithas been suggested that this kind of intes-tinal obstruction may have a dietary cause,probably because most cases of intussus-ception occur at weaning. This report of acase-control study shows that breast-fedinfants had a relative risk of intussuscep-tion of 6.0 when breast-feeding was exclu-sive and of 2.3 when breast-feeding waspartial compared with infants who werenever fed human milk. Exclusive breast-feeding may be a risk factor for idiopathicintussusception in infancy.

Molybdenum cofactor deficiency Thisreport describes a new case of thisunderrecognized inborn error of metabo-lism, which results in neonatal seizuresand neurologic abnormalities. Character-istic biochemical defects in affected indi-viduals include hypouricemia, elevatedurine sulfate (detectable by dipstick), andelevated S-sulfocysteine (detectable byanion exchange chromatography). Notreatment, including diets lowin protein orin sulfur-containing amino acids, sulfite, ormolybdenum supplementation or use of asulfite binder (penicillamine), has success-fully reversed the neurologic deteriora-tion. The cofactor is not stable enough foradministration.

JOURNAL OF NUTRMIlON EBUCATIONVol 25, September/October 1993* Nutrition claims in advertising: A studyoffour worn n's nmgazines. B. W Hickman,G. E Gates, and R.P Dowdy. 227 235

Impact of a worksite cancer preventionprogram on eating patterns of workers. M. KHunt, JR. tiebert, G. Sorensen, D.R. Harris,J Hsieh, D.H. Morris, and A.M. Stoddard.236-244.

Attitudes and behaviors about pesticideresidues, susceptibility to cancer, and con-sumption ofrlits and 'r(egetables. KL. Dittus,VN Hillers, and KA. Beerman. 245-250.· Importance of nutritional issues amongfamilyphysicians. A. Lasswell, B.R. Deforge,and J. Sobal. 251-257.* Nutrition education research in weightmanagement among adults. E.S. Parham.2,58-268.

Views of theory, research, and practice: Asurey ofouztrition education and consumerbehaviorprofessionals. K GlanzandJ Rudd.269-273.

Using expert review panels to score nutri-tion case studies. G.E. Gates. 274 277.* More resources Jor nutrition education:Strengthening the case. A. Berg. 278-282.

Pyramid picks: Introducing the FoodGuide Pyramid in the elementary school.J T Malyn. 291-2939.· Gems: Lessonplansfor WIChomeless. MB.Siegler, G.K. Franklin, and M.A. Lynch.294A. Clusterivng: Creating neaningfulfoodopportunities for children. N.L. McCrea.294B. Choleslerol education for seniors. A.Dowdy, J Burgess, J Cox, J. Ellis, L. John-ston, and S. McNutt. 294C. Food interview-ing activity. A.A. Hertzler, G.A. Veazey, andM.P. Ward. 294D.

Nutrition claims in advertisementsThere has been a progressive increase inthe use of nutrition claims by food andbeverage advertisers. Issues of 1990 maga-zines contain more nutrition claims thanissues from 1982; those from 1982 containmore than those from 1975. Nutrition claimsreflecting one or more of the topics ad-dressed in dietary recommendations forgeneral health also increased over thisperiod, especially nutrition claims refer-ring to the absence of specific dietary sub-stances (eg, fat) from food or beverageproducts. These findings are from a surveyof 1,309 food and beverage advertisementsthat appeared in four women's magazines:BetterHomes and Gardens, Good House-keeping, Ladies' Home Journal, andMcCall's. Appeals to consumer concerns,such as taste, convenience, and quality,were used in almost all advertisements.

Importance of nutrition among familyphysicians A survey of 142 graduates of afamily medicine residency illustrates theimportance of including nutrition in post-graduate education for primary care physi-cians. Almost all physicians counseled pa-tients about nutrition and made referralsfor patients with nutrition problems. About63%, primarily those in metropolitan ar-eas, referred patients to registered dieti-tians in private practice. These physicians


r r - r v

NEW REVIEW

believed that most nutrition issues wereimportant in medical practice, especiallynutrition in diabetes management, weightcontrol, and cardiovascular disease. Nutri-tion issues affecting the life cycle wereranked, as a group, as being more impor-tant than nutrition issues related tochronic disease or prevention. Physicianswho were younger (ie, 40 years old oryounger), female, or nonwhite gave nutri-tion a higher importance ranking relatedto the practice of medicine.

Research on weight management Thisreview identifies three areas of research:descriptions and characterizations of obe-sity; the search for theoretical bases forhuman behavior in weight managementsituations; and experimental, quasi-experi-mental, and evaluation studies of nutritioneducation interventions. The idea that asingle program can solve the problem mustbe abandoned and replaced by a process ofdevelopment over time. As part of thisprocess, persons would choose from amongseveral options the programs and resourcesthat meet their individual needs. Thesemight include a clinic-based program forinitial orientation, a worksite program forreinforcement, a low-fat cooking class fordiversification, reading from a recom-mended list for flexibility, and a self-helpgroup for long-term support.

"Teaching" behavioral change AlanBerg, senior nutrition adviser for the WorldBank, draws on his experience to illustratethe importance of nutrition education inencouraging behavioral change. For ex-ample, after 5 years of breast-feeding pro-motion, researchers have attributed a 12%reduction in infant mortality in Brazil toimproved breast-feeding practices. In Jor-dan, nutrition education is credited withincreasing from 42% to 68% the initiationof breast-feeding within 6 hours after birth.The costs of such efforts are low comparedwith other forms of nutrition intervention(eg, weighing and screening for malnutri-tion and feeding programs). The argumentfor investing in behavioral change in devel-oping countries is supported by researchconducted by the International Food PolicyResearch Institute that shows that malnu-trition often persists when incomes of poorfamilies rise, even when more food entersthe household and the amount of availablefood is greater than a family's require-ments. Bergdiscusses resource constraints;a major problem is the fact that healthdepartments assign nutrition a low priorityin government budgets. There seems to belittle confidence that nutrition education,as normally practiced, works. The poten-tial of behavioral change needs to be ac-knowledged. and Deonle must be trained in

the skills of "social marketing," a strategycombining research, conmmununications, andevaluation to solve social problems.

Innovative education strategies Four"gems" are highlighted. The first describesthree lesson plans for homeless partici-pants in the Special Supplemental FoodProgram for Women, Infants, and Childrenin New Jersey. Topics are storing foodssafely, preparing meals with little or noequipment, and choosingnutritious snacks.A second project describes the use of thebrainstorming approach "clustering" tohelp adults recall and identify childhoodmemories of foods in association with cur-rent-dayfood and meal needs. The processhas helped in such areas as outlining foodideas for child care meals and identifyingsocial, familial, and economic influenceson children's food choices and eating pat-terns. The third "gem" highlights a pilotcholesterol education program, CRISP(Cholesterol Reduction in Seniors Pro-gram), sponsored by the National Insti-tutes of Health. The teaching format andresources used during the 1-year multi-center study are described. Dietitians in-volved in the study cited such advantagesas problem solving and goal setting amongparticipants, feelings of socialization andloyalty to the project, and time-savings forthe instructor because of the format (groupinstruction followed by individual counsel-ing). The fourth project, a food interview-ing activity, helps college students increasetheir proficiency in retrieving names, de-scriptions, and amounts offooditems eaten;local concepts and cultural expressionsare incorporated into the exercise. Therole of client and interviewer and how toscore the interview are described. Theproject has students compare the nutri-tional value of a food reported as collectedby the student interviewer with the actualintake of the client to point out the dangerof creating an inadequate nutrient profile.

THE LANCET

Vol 342, September 25, 1993* Comparative efficacy of rice-based andglucose-based oral rehydration salts plusearly reintroduction offood. I.M. Fayad, M.Hashem, C. Duggan, M. Refat, M. Bakir, 0.Fontaine, and M. Santosham. 772-775.

I Hypertriglyceridaemniaandvascularrisk.Report of a meeting of physicians and scien-tists, University College, London MedicalSchool. 781-787.

Oral rehydration salts This study ofyoung children with acute diarrhea sup-ports the continued recommendation ofglucose-based solutions of oralrehydration

salts as standard therapy; findings alsoemphasize the importance of resumingfeeding once dehydration is corrected. Fortreatment, 460 boys aged 3 to 18 monthswere randomly assigned to receive either arice-based or a glucose-based oralrehydration salt solution. After fullrehydration (4 to 12 hours), a weaningfood consisting of rice and mixed veg-etables was given until diarrhea stopped.Continuing fluid losses through liquid stooland vomitus were replaced with the as-signed oral rehydration salt solution. Dur-ing the rehydration phase, there were nodifferences in volume of stool, volume ofsolution taken, duration of rehydrationphase, or weight gain between the groups.However, after initiation of feeding, thegroup receiving the glucose-based solu-tion had significantly lower stool volumes,required a smaller amount of solution, andhad a shorter duration of diarrhea than thegroup receiving the rice-based solution.

MECIE & SCIMHCE H SPORTS & EXIClISE

Vol 25, October 1993* Validity of near infrared body composi-tion analysis in children and adolescents.S.L. Cassady, D.H. Nielsen, KF Janz, Y-TWu, JS. Cook, and JR. Hansen. 1185-1191.

Near infrared analysis of body compo-sition This study evaluated the validityand reliability of near infrared analysis forthe assessment of body composition inchildren and adolescents. Forty-eight boysand girls with a mean age of 12.7 ± 2.7years underwent three methods of bodycomposition testing: near infrared spec-trophotometer, densitometry by hydro-static weighing, and skinfold anthro-pometry. Percent body fat and fat-freemass derived from the Lohman's age-ad-justed Siri equation served as the refer-ence criteria. Inviewofthe excellentwithin-and between-session reliability, near infra-red analysis offers the potential of obtain-ing longitudinal data in growth and devel-opment studies. However, the significantmean differences, moderate correlationswith reference criteria, and inflated stan-dard errors of estimate and total predic-tion errors indicate that refinement of pre-diction equations is needed to establishmeasurement validity.

METABOISM: CIICAL AND EWTAL

Vol 42, September 1993· Insulin resistance, glucose intolerance,and hyperinsulinemia in patients with mi-


crovascularangina. M.M-T. Fuh, C.-Y Jeng,MM-S. Young, WH-H Sheu, Y-D.I. Chen,and G.M. Reaven. 1090-1092.- Differential effects of estrogen on low-den-sity lipoprotein subclasses in healthy post-menopausal women. H. Campos, F.M. Sacks,B. W Walsh, I Schiff, M.A. O'Hanesian, andR.M. Krauss. 1153-1158.i Insulin sensitivity, insulin secretion, and

glucose effectiveness in anorexia nervosa: Aminimal model analysis. M. Fukushima, YNakai, A. Taniguchi, H. Imura, I. Nagata,and K Tokuyama. 1164-1168.1 Resting energy expenditure and weightloss in human immunodeficiency virus-infected patients. U. Suttmann, J Ockenga,L. Hoogestraat, O. Selberg, I. Schedel, H.Deicher, and MJ Miller. 1173-1179.I1 Energy metabolism in response tooverfeeding in young adult men. S. Kleinand M. Goran. 1201-1205.Vol 42, September 1993, Supplement 1· The National Heart, Lung, and Blood In-stitute Workshop on Biobehavioral Mecha-nisms in Lipid Metabolism and Atheroscle-rosis. Bethesda, Md, January 24-26, 1993.S.S. Knox and B.S. McCann, guest eds. 1-56.Vol 42, October 1993* Protein and glucosefuel kinetics and hor-monal changes in elderly trauma patients.M. Jeevanandam, S.R. Petersen, and R.F.Shamos. 1255-1262.* Indices of thyroid function and weightloss in human immunodeficiency virus in-fection and the acquired immunodeficiencysyndrome. C. Grunfeld, M. Pang, W Doerrler,P. Jensen, L. Shimizu, KR. Feingold, andR.R. Cavalieri. 1270-1276.

1 Alteration oflipoprotein(a) concentrationwith glycemic control in non-insulin-de-pendent diabetic subjects without diabeticcomplications. H. Nakata, K Horita, and M.Eto. 1323-1326.I Calcium and sodium handling during

volume expansion in essential hyperten-sion. P. Coruzzi, A. Biggi, L. Musiari, R.Ceriati, G.L. Mossini, A. Guerra, and A.Novarini. 1331-1335.

Microvascular angina Plasma glucoseand insulin responses to oral glucose andinsulin-mediated glucose disposalwere de-terminedin 20 patients with microvascularangina and 20 healthy volunteers matchedfor age, gender, and degree of obesity.Plasma glucose and insulin responses to a75-g oral glucose challenge were signifi-cantly higher in patients with microvascu-lar angina than in control subjects; steady-state plasma glucose concentrations werealso higher in patients after a 180-minuteinfusion of somatostatin, glucose, and in-sulin. Because steady-state plasma insulinlevels were similar in the two groups, thesedata indicate that patients with microvas-cular angina are insulin resistant, glucoseintolerant, and hyperinsulinemic.

Heart, Lung, and Blood Institute workshopon lipid metabolism and atherosclerosis,multidisciplinary teams of biomedical andbehavioral scientists were assigned to re-view and discuss findings from laboratory,clinical, and epidemiologic research on theinteractions between lipid metabolism andbehavior. This supplement reports the con-clusions of the workshop's five workinggroups. Three of the reports address theimpact of various hormones on lipid me-tabolism and atherogenesis. The first,"Stress and lipid metabolism: Modulatorsand mechanisms," evaluates evidence thatpsychological stress affects lipid concen-trations, principally through the actions ofepinephrine, norepinephrine, and cortisol.The second report, "Sex steroids,psychosocial factors, and lipid metabolism,"considers the role of reproductive hor-mones in mediating the relationship be-tween stress and lipid metabolism. Thethird report, "Insulin, health behaviors,and lipid metabolism," describes the pos-sible role of insulin metabolism in mediat-ing the relationship between health behav-iors and lipid metabolism. The remainingtwo reports consider the extent to whichvery low cholesterol concentrations maybe associated with deleterious health con-sequences. "Lipids, growth, and develop-ment," reviews the debate concerningwhether dietary guidelines for low fat in-take should be extended to children. Thefifth report, "Low or lowered cholesteroland risk of death from suicide and trauma,"summarizes evidence concerning a pos-sible link between lowered cholesterolconcentrations and violent deaths; the re-port distinguishes between studies of pa-tients with low, as opposed to lowered,cholesterol concentrations.

Protein and carbohydrate metabolismduring trauma The responsiveness ofwhole-body protein and glucose kineticsto severe trauma and the role of regulatoryhormones in the early catabolic "flowphase"of injury were investigated in two groupsof trauma patients ("young," aged 18 to 59years and "geriatric," aged 60 to 85 years).The geriatric group lost 25% to 40% lessnitrogen than the young group, mainlybecause of a significantly decreased rateof breakdown of whole-body protein. Ad-vancing age had a significant positive cor-relation with plasma glucose levels andnegative correlations with levels of circu-lating growth hormone, loss of urinary ni-trogen, and protein turnover. Total energyintake of 1.1 times resting energy expendi-ture and daily nitrogen intake of 200 mg/kgbody weight are recommended for elderlytrauma patients; this nitrogen intake is65% of the suggested infusion for a generaltrauma population.

Thyroid hormones and wasting in AIDSThyroid indexes were analyzed in a cohortof patients with acquired immunodefi-ciency syndrome (AIDS). Results showthat asymptomatic patients with humanimmunodeficiency virus infection who havestable weight and normal caloric intakemaintain normal serum levels of circulat-ing 3,3', 5'-triiodothyronine (T3). Levels ofT3 and free T3 begin to decrease in AIDS,whereas patients with secondary infec-tion, anorexia, and weight loss show de-creases in T3 levels consistent with the"euthyroid-sick syndrome."

THE NEW E6IGLAND JOUWIAL OF MBCE

Vol 329, September 30, 1993The effect of intensive treatment of diabe-

tes on the development and progression oflong-term complications in insulin-depen-dent diabetes mellitus. The Diabetes Controland Complications Trial Research Group.977-986.

Social and economic consequences of over-weight in adolescence and young adult-hood. S.L. Gortmaker, A. Must, JM. Perrin,A.M Sobol, and WH. Dietz. 1008-1012.Vol 329, October 7, 1993· Alteration in glucose metabolism by cry-ing in children. (Letter.) J. Aono, W Ueda,and M Manabe. 1129.

Glucose metabolism in crying chil-dren The metabolic changes that occur incrying and struggling children may besimilar to those that occur in adults underemotional or physical stress. This conclu-sion comes from a study involving 28 boysaged 1 to 3 years who underwent circum-cision. The boys were assigned to one oftwo groups depending on their attitudebefore anesthesia: a calm group or a cryinggroup. The boys had not been allowed toeat solid food after midnight but had beenencouraged to drink fluids until 2 hoursbefore anesthesia was induced. Blood glu-cose and plasma lactic acid concentra-tions were significantly higher in the cry-ing group.

MNUTRON N CLNCL PRACTICE

Vol 8, October 1993* Pediatric nutrition support. M. Marian.199-209.* Nutrition support for the elderly. JM.Karkeck. 211-219.

I Team treatment of eating disorders. D.Landau-West, D. Kohl, and P Pasulka. 220-225.[ ] Nutrient needs of the preterm infant. J.Rose, K Gibbons, S.E. Carlson, and W. WKKoo. 226-232.


Biobehavioral mechanisms in lipid me-tabolism In conjunction with a National

NEW REVIEW

Drug use evaluation approach to moni-toring use of total parenteral nutrition: Areview of criteriafor use in cancerpatients.T W Mattox. 233-237.

Pediatric nutrition support When thegastrointestinal tract can be used, enteralnutrition is the preferred method of nutri-tion support for pediatric patients. Indica-tions and contraindications, feedingroutes,selection of formulas, types of infusions,administration of formulas, and monitor-ing are discussed. Discussion of parenteralnutrition covers nutrient requirements,energy substrates (carbohydrate, protein,and fat), potential complications, require-ments for vitamin and trace elements,monitoring, and complications.

Geriatric nutrition support Recent ad-vances in understanding of the nutritionsupport needs of elderly and oldest-elderlypatients are summarized. Decisions regard-ing use of enteral or parenteral support aremore difficult with older patients becauseoutcomes may not be positive over the longterm. It is crucial that the patient and his orher family be included in the decision-making process and that the entire sup-port team be involved in monitoring thesuccess of feeding. Collecting and inter-preting data about the nutritional status ofelders have been organized into a mean-ingful process by the Nutrition ScreeningInitiative, a joint project of The AmericanDietetic Association, the American Acad-emy of Family Physicians, and the NationalCouncil on the Aging. The Level I and LevelII screening forms developed by the Nutri-tion Screening Inititiative are depicted.

PBNATRICS

Vol 92, October 1993* Is there a relationship between dietary fatand stature or growth in children three tofive years of age? S. Shea, C.E. Basch, A.D.Stein, I.R. Contento, M. Irigoyen, and P.Zybert. 579-586.

Dietary fat and growth in preschoolersAssessment of a predominately Hispanicgroup of 215 children aged 3 to 4 years atbaseline supports the safety of moderatereduction of fat in the diets of young chil-dren. Four 24-hourrecalls and three Willettsemiquantitative food frequency question-naires were administered to the children'smothers over a 1-year baseline period;mean follow-up was 25 months. Mean in-take of total fat provided 27.1% of energyintake in the lowest quintile of fat intakeand 38.4% of energy intake in the highestquintile of fat intake. There were no differ-

ences in stature or growth across quintilesdefined by consumption of total fat, satu-rated fat, or cholesterol. Children who con-sumed a smaller percentage of total energyfrom fat also consumed significantly lesstotal energy, saturated fat, cholesterol,calcium, and phosphorus and more carbo-hydrate, iron, thiamin, niacin, vitamin A,and vitamin C. Maintenance of calcium andphosphorus intake should be part of anyprogram of dietary fat reduction. The au-thors recommend substitution of low-fatmilk for whole milk, rather than elimina-tion of whole milk, as one such strategy.

PULIC HEALTH REPORTS

Vol 108, September/October 1993* Health promotion and disease preventionstrategies. M. Aguirre-Molina, A. Ramirez,and M. Ramirez. 559-564.Vol 108, Supplement 1, 1993* Overview of the Youth Risk Behavior Sur-veillance System. L.J Kolbe, L. Kann, andJ.L. Collins. 2-10.* Measuring dietary behaviors among ado-lescents. F. Trowbridge and B. Collins. 37-41.* Results from the national school-based1991 Youth Risk Behavior Survey andprogress toward achieving related healthobjectivesfor the nation. L. Kann, W War-ren, J.L. Collins, J Ross, B. Collins, L.JKolbe. 47-55.

Appendix II. Youth Risk Behavior Sur-veillance System questionnaire. 60-66.

Health promotion for Latinos This ar-ticle is one of six devoted to reports fromthe Surgeon General's national workshop"Implementation Strategies for ImprovingHispanic-Latino Health." The rapid growthand relative youth of the Latino populationin the United States, soon to become thelargest ethnic-racial group in the country,present special challenges to health pro-viders. This article summarizes problemsencountered by Latinos in obtaining healthpromotionand disease prevention services,previous recommendations for addressingthese problems, and new strategies forimplementing more effective health ser-vices. Examples of innovative public healthprograms are offered. HealthStart, a Med-icaid-funded program in New Jersey, at-tempts to improve accessibility and pro-vide comprehensive services for pregnantMedicaid recipients and children youngerthan 2 years. Another community-basedprogram, A Su Salud (To Your Health),aims to improve screening of behaviorsrelated to nutrition and cancer risk amongLatinos in southern Texas. Mass mediamessages support a community networkof volunteers who promote positive role

models while offering one-on-one encour-agement for improving health activities.

Measuring health behaviors of ado-lescents This article, the first of 13 articlesfocusing on adolescent health, describesthe development and rationale of the YouthRisk Behavior Surveillance System. Devel-oped by the Centers for Disease Controland Prevention, the surveillance systemwas designed to identify specific behaviorsamong youth that cause the most impor-tant health problems; to assess whetherthese behaviors are increasing, decreas-ing, or unchanged; and to provide data thatare comparable among national, state, andlocal samples of youth. This overview out-lines the components and characteristicsof the surveillance system and describeshow the system is being used to improvehealth and education policies and pro-grams for young people.

Measuring dietary behaviors of ado-lescents This article describes how ques-tions designed to obtain dietary informa-tion were developed for the Youth RiskBehavior Surveillance System question-naire. First, major short- and long-termhealth outcomes associated with dietarybehaviors were identified. National healthobjectives from Healthy People 2000 pro-vided guidance. Questions were written toobtain information on weight loss prac-tices, body weight perception, and dietarychoices. Questions focused on intake of"marker foods" to determine intake of fruit,fruit juices, green salad, cooked vegetables,and fatty foods. "Yesterday" was selectedas the recall period. The 75-item question-naire is depicted in appendix II.

Dietary behaviors of adolescents Thisarticle reports results from one compo-nent of the Youth Risk Behavior Surveil-lance System, the school-based 1991 YouthRisk Behavior Survey. The sampling frameconsisted of students in grades 9 through12 in public, parochial, and other privateschools in the 50 states and the District ofColumbia; a sample size of about 18,000students was chosen. Responses to surveyquestions on dietary behaviors revealedthat 12.9% of all students had eaten five ormore servings of fruits and vegetables dur-ing the day preceding the survey. Malestudents, white students, and 10th-gradestudents were significantly more likely tohave eaten five or more servings of fruitsand vegetables than were female students,black or Hispanic students, and 12th-gradestudents, respectively. Among all students,64.9% ate no more than two servings ofhigh-fat foods (eg, from three "high-fatcategories": hamburger, hot dogs, or sau-sage; french fries or potato chips; and


cookies, doughnuts, pie, or cake). Girlsand Hispanic students were significantlymore likely to have eaten two or fewerservings of high-fat foods than were boysand white or black students, respectively.There was no variation in intake of high-fatfoods by grade level.

RESTAURANTS USAVol 13, September 1993* Seniors: Who they are and how they spend.R. Iwamuro. 37-41.* Thefoodservice industry: 1991 In review.43.

Senior market This fourth article in aseries based on revised US Census Bureauprojections focuses on consumers aged 65years and older. During the next 20 years,the senior population is expected to in-crease at a slower rate than in previousdecades. A modest 1.2% annual growthrate is projected for 1991 to 2010 com-pared with the 2.4% average annualgrowthin this segment between 1950 and 1990.The oldest segment of the population (ie,persons aged 85 years and older) is ex-pected to be the fastest-growing groupand to double in size from 1991 to 2020.The population aged 100 and older is ex-pected to increase 50% between 1990 and1995. Five farming states had the highestproportion of the oldest old in 1990: Iowa,South Dakota, Nebraska, North Dakota,and Kansas. According to CREST (Con-sumer Reports on Eating Share Trends),older adults are more likely to patronizerestaurants for breakfast and lunch andless likely to do so for dinner than personsunder age 65. Side dishes (eg, salads, hotvegetables, and varieties of potatoes) areamong the most frequently ordered items.Seniors are twice as likely as younger con-sumers to order fish, seafood, and beefentrees and less likely to order hamburg-ers, cheeseburgers, pizza, or Mexican food.

Foodservice trends This article providesan overview of National Restaurant Asso-ciation data on the size and scope of thefoodservice industry, including sales, pur-chases, and major market segments. Dataon institutional foodservice indicate that1991 sales increased 3.1% to $27.4 billion.Institutional sales, which grew 1.3% in realterms, outpaced other major sectors. Ofthe major institutional groups (employee,educational, transportation, and hospitalfoodservice), transportation posted thelargest gain, up 8.2%. Healthy sales in-creases were also recorded by communitycenters and public and private collegesand universities.

TRY= I DEVIOPUNT

Vol 47, October 1993* Three secrets ofgood user documentation.G. Irving. 17-18.* Ten tipsforfabulousflips. S.L. Doyle. 18-20.* Casestudies:Let'sget real. R. J. Inguagiato.20-23.

Guidelines for writing guidelinesUser documentation is the written infor-mation that explains how to operate a newcomputer system or piece of equipment.Clarity is essential, and a clearly writtendocument requires three elements: under-standing of what a user needs to know(ie, provide concise information on how tomake the product work); good organiza-tion (ie, identify major points, group infor-mation logically, and separate items forease of comprehension); and good writing(ie, connect related ideas and use termi-nology consistently).

Flashy flipcharts Here are tips for get-ting your message noticed through the useof flipcharts. Color is the most overlookedoption on flipcharts: use bright, "hot" col-ors, such as magenta, turquoise, and aquabut never use more than three colors on asingle chart. Ifalimited number offlipchartsare available, frame them in clear plasticand use a grease pencil to check off majorpoints. After the session, wipe off the pen-cil marks and reuse the charts. Use en-larged clip art, color photographs, com-putergraphics, templates, stick-onlettering(text should be at least 1-inch tall), fabrics,glitter, and other media. Strengthenflipcharts with foamcore (foam with paperlaminate on both sides, available at artsupply stores).

Writing behavioral case studies Awell-written case study can create a virtualreality for the reader. The approach pre-sented in this article involves five steps.Identify a case goal (eg, to resolve a prob-lem, negotiate an agreement, or enlist sup-port). Establish a case objective (ie, iden-tifythe sectors of the organization depictedby the case, describe the people in the casestudy, and explain why these people areinvolved in the situation described). Col-lect background information on each per-son. Characterize case study members.Depict the organizational culture.

BOOKS

PEIATRIC SWALLOMWHY AND F1G:ASESSNMT AND MANAGeBmITEdited by Joan C. Arvedson, PhD, andLinda Brodsky, MD. San Diego, Calif:Singular Publishing Group; 1993.Softcover. Pp 472. Price $49.95.ISBN 1-56593-069-X

This book uses an interdisciplinary focusto provide a comprehensive review of oral-motor and feeding problems of infants andchildren. It offers evaluation and interven-tion strategies related to feeding, position-ing, nutrition, and medical interventions.

The text is technical and includes manytables, illustrations, and photographs tocomplement the material. Case studies il-lustrate the treatment modalities. Thisvariety of visuals and content creates aninteresting and educational text.

The chapter on nutrition provides anoverview of pediatric assessment and man-agement techniques. Unfortunately, thesection on energy requirements of the terminfant had a few discrepancies. Althoughenergy ranges from the 1980 Recom-mended Dietary Allowances (RDAs) arediscussed in the text, the table of nutrientsand energy values uses the more current1989 RDA values. Also confusing is theinformation on the quantities of carbohy-drate, fat, and protein needed as energysources for the infant. On the other hand,strengths of this chapter are the thoroughreview of pediatric growth assessment andthe easy-to-follow discussion and table onformula selection. This chapter should bea review for the pediatric nutritionist, butwill provide an informative reference forother members of the interdisciplinaryteam.

One unique chapter discusses drooling(sialorrhea), a disorder rarely addressed innutrition textbooks. A review of theanatomy, physiology, and pathophysiol-ogy of drooling is provided, plus a variety ofassessment and management techniquesand case studies.

In addition to the informative content,the importance of interdisciplinary care isstressed throughout the book. Beginningwith a rationale for team approach, thephilosophy is reinforced in subsequentchapters and case studies that are writtenby experts from many disciplines. Oneaspect of the team approach that is notwell-developed is the behavioral compo-nent of feeding disorders. Behavioral mis-management affects more than 21% ofcases of feeding problems in disabled chil-dren, yet behavioral interventions are onlymentioned in a few sections.


Few child care centers have or followstandard guidelines for foodservice.Read ADA's position paper onfoodservice standards for child carecenters (page 323) and research byBriley and colleagues on child caremenus (page 276).

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In summary, this is a worthwhile refer-ence for pediatric nutritionists and otherhealth care professionals, particularlythoseserving children with developmental dis-abilities. The book offers a broad range ofstrategies for evaluation and treatmentand reinforces the value of the team ap-proach for the management of this multi-faceted pediatric problem. -JANET WHORSLEY, MPH, RD, Division of Child-ren's Specialty Services, Virginia De-partment of Health, Richmond.

NUTRITION IN PREGNANCY AND LACTATION5th ed. By Bonnie S. Worthington-Roberts, PhD, RD, and Sue RodwellWilliams, PhD, MPH, RD. St Louis, Mo:Mosby-YearBook; 1993. Softcover. Pp525. Price $27.95. ISBN 0-8016-6569-8

This standard reference has been updatedand revised to make it a must for thepractitioner's and student's bookshelf. Theauthors incorporate recent research, con-sensus data, summary inserts, and chartsin this edition. Case studies, nutrition edu-cation guidance, and frequent use of ex-amples add to the readability and the use-fulness of this text.

Although written at a college and pro-fessional level, selected information will beuseful to support staff in community-basedprograms such as the Special Supplemen-tal Food Program for Women, Infants, andChildren. In particular, many of the casestudies illustrate common and unique prob-lems encountered in these stages of the lifecycle. The case studies can serve as entrypoints for discussions with students andhealth care staff on the subject of clientinteraction.

The many inserts and charts not onlyprovide capsules of basic information butalso address current issues and debates. Ofspecial interest to dietitians are the sum-maries of Institute of Medicine documents;information on applications for weight gain;and recommendations on supplementa-tion.

The chapters on lactation, nutritionalconsiderations regarding human milk, andpromotion and support of breast-feedingreflect the depth of current research andthe sensitivity of the human element. An-other issue addressed with sensitivity isthat of nutritional considerations in fertil-ity and family planning. Although this topicis a minor component of the total content,the tone is objective and the informationprovides a reasonable overview.

Considerations appropriate for counsel-ing obese patients, adolescents, and thosewith special health or dependency needsare other highlights of this book. Thesetopics are addressed independently and

appear throughout the book.Finally, the authors made each chapter

a learning tool. Chapters begin with objec-tives and end with review questions, alearning activity, and a list of key terms.Next to the terms are page notations toallow readers to self-check their answers.

The authors have managed to present areadable and practical text. Nutrition inPregnancy and Lactation serves as areview and a resource for dietetics practi-tioners, and offers information that can beshared with others in various health caresettings. - JUDITH L. DODD, MS, RD,Allison Park, Pa.

NUTRITIONAL NEEDS OF THE PRETEIMINFANT: SCIWIIFIC BASIS ANDPRACTICAL GUIDEUNESEdited by Reginald C. Tsang, AlanLucas, Ricardo Uauy, and StanleyZlotkin. Baltimore, Md: Williams &Wilkins; 1993. Hardcover. Pp 321.Price $50. ISBN 0-683-08425-9

This book provides the most current andcomprehensive discussion among investi-gators worldwide in the field of neonatalnutrition and is an essential reference foranyone who manages nutrient needs of thepreterm infant. It is a sequel to the bookVitamin and Mineral Requirements inPretermInfants (Tsang RC, ed. NewYork,NY: Marcel Dekker; 1985). Once again,investigators throughout the world wererecruited to address the major advances inunderstanding the optimal nutrition man-agement of low birthweight infants. Theeditorial committee sponsored by the In-ternational Union of Nutrition Sciencesincluded Reginald C. Tsang (United States),Stanley Zlotkin (Canada), Alan Lucas (Eu-rope), and Ricardo Uauy (Central and SouthAmerica). Their mission was to determinea worldwide common approach to nutri-tion recommendations for the neonatalperiod.

Experts in relevant fields reviewed andreferenced nutrients such as water, en-ergy, protein, carbohydrate, fat, vitamins,and minerals. Each chapter covers therequirements for individual nutrients forthe extremely low-birth-weight infant(< 1,000 g); the 1,000 g to 1,750 g preterminfant; and for infants after discharge fromthe hospital. The editors review the litera-ture and state the specific goal of optimalnutrition for each nutrient, the toxicity anddeficiency limits for intake, interactionswith other nutrients, and metabolism inspecific clinical conditions. Case studiesthat illustrate practical issues in relation tomanagement of select nutrient disordersin neonates are also included.

Additional chapters include information

on enteral nutrition, parenteral nutrition,conditions requiring special nutrition man-agement, and regulatory and public policyaspects regarding infant feeding.

An appendix provides reference tablesthat are not available elsewhere. Nutritionneeds of stable and growing preterm in-fants and preterm infants in the transi-tional stage are given in both mass unitsand Systeme International units. The en-teral intake recommendations for stableand growing preterm infants that are theconsensus of the editors of this book arecompared to the recommendations of theAmerican Academy of Pediatrics and theEuropean Society of Paediatric Gastroen-terology and Nutrition. Additional tableslist the 1992 nutrient compositions per 100kcal of both US and international commer-cial formulas and human milk supplementsdesigned for preterm infants. - JUDITHA. ERNST, DMSc, RD, Indiana Univer-sity School of Medicine, Indianapolis.

NUTRITION AND FTNESS H HEALT ANDDISEASE. VOL 71Edited by Artemis P. SimopoulosBasel, Switzerland: Karger; 1993.Hardcover. Pp 244. Price $280.ISBN 3-8055-5706-XNUTRITION AND RTNESS FOR ATHLETES.VOL 72Edited by Artemis P Simopoulosand Konstantinos N. Pavlou. Basel,Switzerland: Karger; 1993. Hardcover.Pp 199. Price $237.ISBN 3-8055-5707-8

To ensure better nutrition for all people,reduce of hunger and malnutrition in vul-nerable groups, eliminate of micronutrientmalnutrition, and prevent of diet-relatedchronic and degenerative diseases are thedreams of many health professionals. Thesetwo volumes are the proceedings of the2nd International Conference on Nutritionand Fitness and offer a host of ideas andcurrent thinking related to research find-ings, training, and programs to help profes-sionals move toward these dreams. Thisconference was conducted under the pa-tronage of the International Olympic Com-mittee and the World Health Organizationin May 1992.

Volume 71 includes papers regardingvarious nutrition and fitness topics relatedto athletes and 46 abstracts from the postersession at the conference. Volume 72 con-sists of papers related to the role of nutri-tion and fitness in health and disease and ingrowth and development throughout thelife cycle. The papers and abstracts werecontributed by groups representing coun-tries throughout the world. Most of theauthors cover their topics extremely well


although some papers are less well pre-sented.

Topics addressed in Volume 71 includethe contributions of macronutrients to peakperformance of the elite athlete and con-cerns for specific high-risk athletic groupsin relation to nutrition and fitness. Thesegroups were ballet dancers, gymnasts,wrestlers, and jockeys. It also includespapers that focus on special topics includ-ing exercise and mood, vitamin E require-ments for increased physical activity, andthe principles of nutrition in the RussianFederation. The section containing theabstracts offers a cursory look at a range oftopics including nutrient intakes of variousathletic groups, effects of nutritionalsupplements on work capacity, the benefi-cial effect of a kind of Chinese tonic onmice, and the universal language of food.

Volume 72 addresses a range of topicsincluding diet and exercise in cardiovascu-lar disease; obesity; osteoporosis; new con-cepts on nutrition, fitness, and the Recom-mended Dietary Allowances; and updateson policies and programs related to nutri-tion and physical fitness in Central andSouth America, Greece, Kenya, China, andthe United States.

These two volumes are excellent refer-ences for dietitians, nutrition educators,exercise physiologists, physicians, researchscientists, and policy makers interested inthe roles of nutrition and exercise in sportsperformance, health promotion, and dis-ease prevention. Together these volumespresent a unique, internationally basedoverview of a variety of important issuesthat influence the promotion of positivehealth throughout the world. -LINDA B.HOUTKOOPER, PhD, RD, NutritionalSciences Department, University ofAri-zona, Tucson.

Wum

MOBEL 1 M6H POCKET COMPUTER1988. Department of Dietetics,Massachusetts General Hospital, FruitSt, Boston, MA 02114; 617/726-2545.Price $245. Includes a hand-heldcomputer in a plastic case loaded withprograms, programming worksheets,code cards, and two user's manuals -a 293-page operations manual and a96-page functions manual.

Equipment Required The MGH PocketComputer Model 1 operates on a SharpPC- 1262 Pocket Computer with 10K RAM.It includes built-in calculator functions.Major Function The Model 1 is designedto facilitate the most frequently used nutri-

tion assessment, support, and care calcu-lations in the clinical setting.Target Audience The Model 1 is suitedfor clinical dietitians and dietetic techni-cians who are involved with comprehen-sive nutrition assessment and support cal-culations of hospitalized patients atdifferent stages of the life cycle.Capabilities The Model 1 performs avariety of nutrition assessment functionsincluding basal energy expenditure; injuryand activity factors; ideal body weight;basal metabolic rate for children; Recom-mended Dietary Allowances for childrenunder 10 years of age for energy, protein,calcium, and iron; creatinine height index;body mass index; total lymphocyte count;net protein utilization; nitrogen balance;and desired ratio of energy to nitrogen.

Nutrient intake and support functionsinclude the simple calculation of energygiven the grams of carbohydrate, proteins,and fats. Another capability includes cal-culating nutrient intake from supplements,infant formulas, parenteral and intrave-nous solutions, and enteral nutrition solu-tions. A program that estimates intakesbased on meal exchanges is provided.

Nutrition care planning functions in-clude methods for estimating energy needsusing fever and activity factors, and anexchange-based diet builder.

Optional enhancements that can be pro-grammed into the computer to fit specificneeds include amilligramto milliequivalentconverter, a pound to kilogram converter,a function to add sodium and potassium tothe product profiles included in the data-base, a method to calculate carbohydratesfrom peritoneal dialysate. Additional as-sessment tools include serum transferrin,bodyweight change percentage, andmeancorpuscular volume.Limitations The functions must be memo-rized to figure out the programmed com-puterized nutrition assessment and sup-port capabilities. Notwithstanding, anyonecan eventually master those functions withrepeated use.

Most hand-held computers designed forclinical dietetians include a standard for-mulary database of enteralproducts, whichmay be edited and modified. However, theModel 1 requires users to customize theirown formulas by programming into thecomputer's memory the names, nutrients,and energy compositions of those prod-ucts the user intends to use. The program-ming time may vary with the user's compe-tence and the program's complexity.Comments The Model 1 is highly por-table and attractive and has a screen. Func-tions are easyto leamand master. It doublesas a calculator. The user's manual explainsstep-by-step how to use the pocket com-puter and features a troubleshooting guide

and reference citations. Telephone cus-tomer support is available free, but it re-quires a toll call. The program will retainvalues for the latest patient assessed evenif the computer is turned off. Thecomputer's useful battery-saving featurewill cause the screen to fade out if no keysare pressed after 11 minutes.

Before deciding on a hand-held com-puter for nutrition assessment and sup-port, it may be wise to outline desiredcapabilities and compare them with whatis on the market. Two other recent re-views of pocket computers appeared inthe Journal (JAm Diet Assoc. 1993; 93:500-501, and 1993;93:1478-1479). -JOHN ORTA, EdD, RD, CoordinatedDietetics Program, CaliforniaState Uni-versity, Los Angeles.

RECaHITY HECOBED

AMNIICA'S FOODS: HEALTH MESSAGESANM CLAIMSEdited by James E. Tillotson. BocaRaton, Fla: CRC Press, Inc; 1993.Hardcover. Pp 287. Price $89.95.ISBN 0-8493-8001-4

APPLIED NUTRITION AMDIET THERAPY FOR NURSES2nd ed. By Judi Davis and KimSherer. Philadelphia, Pa: W B.Saunders; 1994. Hardcover. Pp 1,176.Price $55. ISBN 0-7216-6785-6

THE UPI HYPOTHESIS OF ATHIWOGEISBy William E. Stehbens. Austin, Tex:R. G. Landes Company; 1993.Hardcover. Pp 196. Price $89.95.ISBN 1-879702-79-7

NUTRITON: SCIBCE AND APPLCATIONSBy Lori A. Smolin and Mary B.Grosvenor. Philadelphia, Pa:Saunders College Publishing; 1994.Softcover. Pp 576 (plus appendix andglossary). Price $46.75. ISBN 0-03-072811-8.

NUTRITIONAL BOCHEMSTRYBy Tom Brody. San Diego, Calif:Academic Press, Inc; 1994. Hard-cover. Pp 658. Price $75. ISBN 0-12-134835-0

NUTRITIONAL CARE FOR HIGH-RISKNEWBOR SRevised ed. Edited by Sharon Groh-Wargo, MS, RD; Melody Thompson,MS, RD; and Janice Hovasi Cox, MS,RD. Chicago, Ill: Precept Press; 1994.Hardcover Pp 450. Price $59.95.ISBN 0-944496-39-3.


NEW H REVIEW

OPPORTUNITIES THE NUTRITIONAND FOOD SCIECESEdited by Paul R. Thomas, MS, EdD,RD;and Robert Earl, MPH, RD.Washington, DC: National AcademyPress; 1994. Softcover. Pp 310. Price$36.95 ($44.50 for outside US,Canada, and Mexico). ISBN 0-309-04884-2

REVIEW OF DIETETICS: REGISTEREDDIETITIANS' EXAMINATION STUDY MANUAL3rd ed. By Mary Abbott Hess and AnneElise Hunt. Gaithersburg, Md: AspenPublishers; 1993. Loose-leaf Pp 496.Price $159. ISBN 0-8342-0395-2

STRONG MEDICIlEBy George C. Halvorson. New York,NY Random House; 1993. Hardcover.Pp 251. Price $19. ISBN 0-679-42980-8

WEST'S AND WOOD'S INTRODUCTIONTO FOODSERVICE7th ed. Edited by June Payne-Palacio,PhD, RD; Virginia Harger, MS, RD;Grace Shugart, MS; and Monica Theis,MS, RD. New York, NY: MacmillanPublishing; 1994. Hardcover. Pp 664.Price $41.25. ISBN 0-02-390390-2

PRACTnmlOBS BOOKSHB.F

Cholesterol guide The Only Choles-terol Guide You'll Ever Need (New York,NY: Ballantine Books; 1994. Softcover. Pp190. Price $4.99. ISBN 0-345-38133-5) byJoel M. Berns, DMD, Kenneth L. Cohen,MD, FACP, and Betsy A. Taylor, MS, RD,offers a simple way to lower blood choles-terol level, reduce risk for heart disease,and achieve a desirable body weightthrough the cholesterol-saturated fat in-dex. This index number, which combinesboth the saturated fat and cholesterol of afood, reflects the ability of a food to raisethe blood cholesterol level. The introduc-tion offers advice on how to start reducingcholesterol intake, develop goals, and un-derstand the tableof foods. The table offoods provides the cholesterol-saturatedfat index number, the total energy, and thetotal fat grams for many food items, whichare listed in alphabetical order. There arenotes, appendixes, and lists of samplemeals.

International cooking InternationalLight Cuisine (St Petersburg, Fla:GemServ, Inc; 1993. Hardcover. Pp 188.Price $24.95 [add $3.95 for shipping/han-dling] ISBN 0-9633070-2-9) by Chris Borgesprovides lighter recipes of popular food

dishes from around the world. Each recipewas analyzed by Bonnie Hechtkopf, MS,RD. Each recipe lists energy, fat, sodium,protein, carbohydrate, and cholesterol con-tents per serving. The book offers guide-lines on portion sizes, seasonings and gar-nishes, and measurement equivalents.There is also a glossary of terms, substitu-tion ideas, and a list of culinary equipmentthat will be needed. Recipes from France,Greece, Italy, Spain, and the United Statesare included. For more information, con-tact: GemServ, Inc, 10460 Roosevelt Rd,Suite 248, St Petersburg, FL 33716-3818;800/274-8585; fax, 813/573-0308.

Free food chart Pyramid Plus: A Star-Studded Guide to Food Choices for Bet-ter Health is an educational resource con-sisting of an instructor's guide and lessonplans aimed at teenagers and adults. Six45-minute lesson plans cover topics suchas general nutrition, weight management,eating for performance, and eating for con-venience and includes support materialsand worksheets. The basic tool for all les-sons is the Pyramid Plus food chart basedon the US Department of Agriculture'sFood Guide Pyramid. Pyramid Plus in-cludes typical serving sizes and a samplemeal pattern. Charts can be ordered indi-vidually or as part of the education kit. Formore information, contact: Nutrition Edu-cation Services/Oregon Dairy Council,10505 SWBarbur Blvd, Portland, OR 97219;503/229-5033.

FDA video Nutrition educators can useFood Labels, a 6-minute video preparedby the US Food and Drug Administration,to help teach the public how to read anduse the new food label. The video explainshow the daily value allowances of key nu-trients will be displayed on the label, and itprovides consumers with guidelines forunderstanding the meanings behind manu-facturers' claims about foods. The video isavailable for $12.90 (includes shipping andhandling). For more information, contact:GIG Marketing, 1730 N Lynn St, Suite A-28, Arlington, VA 22209; 703/522-5655.

Meal planning stickers and videoMag-netic Piece Meal Planner assists withnutrition counseling for persons with dia-betes. Topics covered include weight loss,pregnancy, and lactation. The magneticboard and stickers display portion sizes,and food illustrations and are color-codedto correspond with The American DieteticAssociation/American Diabetes AssociationExchange Lists for Meal Planning. Themeal planner is available for $69.95. Thevideo, which explains the meal plannerand the exchange lists, is available for$24.95. Worksheets ($24.95) are available

for clients to take home to reinforce themessage. For more information, contact:ARA Healthcare Nutrition Services, 1101Market St, 20th Floor, Philadelphia, PA19107; 800/999-8989; fax, 215/238-3543.

Healthful eating cookbooks A revisedbooklet, You Can Control Your Choles-terol, and its companion titles, Low-FatEating and Weight Control, all combinebasic diet concepts with practical tips in aneasy-to-understand format with illustra-tions. Ann M. Del Tredici, MS, RD, StaceySilberzweig, MS, RD, and Nancy Clark, MS,RD, contributed to the content. The cost ofeach booklet is $1.35 ($25 minimum or-der); quantity discounts are available. Formore information, contact: Krames Com-munications, Order Department, 1100Grundy Lane, San Bruno, CA 94066-9821;800/333-3032; fax, 415/742-9265.

Soybean kit A comprehensive kit of in-formative and educational materials is avail-able to dietitians from the American Soy-bean Association. The six components ofthe kit cover everything about this sourceof protein and fiber including a week-longsoybean menu planner with recipes. Thecost of the kit is $10. A brochure entitledSoybeans: Unlocking the Secret to GoodNutrition, which details recent researchabout the health benefits of soybeans isalso available. A brochure entitled Soy-bean Oil Gives You the One Thing OilsCan't is also available. For more informa-tion, contact: Evans Groups, 190 QueenAnne N, Seattle, WA 98109; 206/285-5522.

Comprehensive resource Food andNutrition Encyclopedia Volumes 1 and2 (2nd ed. Boca Raton, Fla: CRC Press;1994. Pp 3,700. Price $295. ISBN 0-8493-8980-1) is edited by Audrey Ensminger,MS, RD, M. E. Ensminger, MS, James E.Konlande, PhD, and John R. K. Robson,MD. Their goal is to provide an easy-to-read, objective, comprehensive, diverse,and illustrative resource in the areas offood, nutrition, and health. There are 1,600illustrations and figures including a foodcomposition chart. The food compositionchart is divided into subjects such as babyfoods, bakery products, cereals and flours,desserts, fish, nuts, and vegetables. Eachentry is analyzed by energy, protein, fat,carbohydrate, fiber, calcium, phosphorus,sodium, mineral, and vitamin content.

In the Recently Received section of theFebruary 1994 issue of the Journal (page221), the title of the book Nutrition inExercise and Sport was listed incorrectly.The Journal regrets the error.


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