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| Table 2: Initial Classification Based on Total Cholesterol and HDL-Cholesterol | ||
|---|---|---|
| Total Cholesterol | ||
| less than 200 mg/dl | Desirable Blood Cholesterol | |
| 200-239 mg/dL | Borderline-High Blood Cholesterol | |
| greater than 240 mg/dL | High Blood Cholesterol | |
| HDL-Cholesterol | ||
| less than 35 mg/dL | Low HDL-Cholesterol | |
Table 3 summarizes the levels for iniating dietary therapy and considering drug treatment in patients with and without CHD, and the LDL goals in these patients.
| Table 3(a): Treatment Decisions Based on LDL-Cholesterol: Dietary Therapy | ||
|---|---|---|
| Dietary Therapy | Initiation Level | LDL Goal |
| Without CHD and with fewer than 2 risk factors | greater than 160 mg/dL | less than 160/mg/dl |
| Without CHD and with 2 or more risk factors | greater than 130 mg/dL | less than 130 mg/dL |
| With CHD | greater than 100 mg/dL | less than 100 mg/dL |
| Table 3(b): Treatment Decisions Based on LDL-Cholesterol: Drug Treatment | ||
|---|---|---|
| Drug Treatment | Consideration Level | LDL Goal |
| Without CHD and with fewer than 2 risk factors | greater than 190 mg/dL* | less than 160 mg/dL |
| Without CHD and with 2 or more risk factors | greater than160 mg/dL | less than 130 mg/dL |
| With CHD | greater than 130 mg/dL** | less than 100 mg/dL |
* In men under 35 years
old and premenopausal women with LDL-cholesterol levels
190-219 mg/dL, drug therapy should be delayed except in
high-risk patients like those with diabetes.
** In CHD patients with LDL-cholesterol levels 100-129
mg/dL, the physician should exercise clinical judgement
in deciding whether to initiate drug treatment.
Dietary Therapy and Physical Activity
The general aim of dietary therapy is to reduce elevated serum cholesterol while maintaining a nutritionally adequate eating pattern. Dietary therapy should occur in two steps, the Step I and Step II Diets; (see table 4) these are designed to progressively reduce intakes of saturated fatty acids (saturated fat) and cholesterol and to promote weight loss in patients who are overweight by eliminating excess total calories and increasing physical activity.
| Table 4: AHA Step I and Step II Diet | ||
|---|---|---|
| Diet Component | Step 1 | Step 2 |
| Saturated fat | 8-10% of total calories | less than 7% of total calories |
| Fat calories | 30% or less of calories | 30% or less of total calories |
| Cholesterol | less than 300 mg/day | less than 200 mg/day |
Weight reduction in overweight patients and increased physical activity are extremely important elements of therapy for high blood cholesterol. Weight reduction enhances the LDL-cholesterol lowering that can be achieved by reducing intakes of saturated fats and cholesterol. Both weight reduction and exercise not only promote reduction of cholesterol levels but have other benefits, i.e., reducing triglycerides, raising HDL-cholesterol, reducing blood pressure, and decreasing the risk for diabetes mellitus. Thus they reduce risk for CHD in several ways beyond lowering LDL-cholesterol levels.
Patients with established CHD or other atherosclerotic disease should begin immediately on the Step II Diet.
In patients without CHD, after starting the therapeutic diet, the serum total cholesterol level should be measured and adherence to the diet assessed at 4-6 weeks and at 3 months. Although the goal of therapy is to lower LDL-cholesterol, most patients can be managed during dietary therapy on the basis of their total cholesterol levels. If the total cholesterol monitoring goal is met, then the LDL-cholesterol level should be measured to confirm that the LDL goal has been achieved. If this is the case, the patient enters a long-term monitoring program, and is seen quarterly for the first year and twice yearly thereafter. At these visits total cholesterol levels should be measured, and dietary and physical activity recommendations reinforced.
If the cholesterol goal has not been achieved with the Step I diet, the patient should progress to the Step II Diet. A minimum of 6 months of intensive dietary therapy and counseling generally should be carried out in primary prevention before initiating drug therapy; shorter periods can be considered in patients with severe elevations of LDL-cholesterol (> 220 mg/dL). Drug therapy should be added to dietary therapy, and not substituted for it. (JD)
Source: The Second Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults, Executive Summary, July 1993
Irradiated Poultry Now in Supermarkets
Your Kansas supermarket doesn't carry it yet, but irradiated poultry is now available in at least four supermarkets across the country. On Sept. 2, Carrot Top, a produce and grocery store in Northbrook, became the first retailer in the US to market irradiated raw poultry. Eighteen months earlier, Carrot Top was one of the first to sell irradiated strawberries. During the first 3 months of sales, irradiated strawberries sold at the ratio of 20:1 over conventional strawberries.
Three Florida stores also sell irradiated poultry: Lawrenzo's Market and Italian Grocery, North Miami Beach; and two Wyndle's Foodland stores in Plant City.
Irradiated poultry carries the green international irradiation logo and the statement "Treated by irradiation to control salmonella and other foodborne bacteria."
All of the poultry was irradiated at the Vindicator, Inc. plant in Florida, the first and only operating US food irradiation facility. Since it opened in January 1992, Vindicator, Inc. has treated fresh produce, food packaging and a variety of agricultural products, including chicken.
The packages of chicken are placed on a conveyor which carries them into an irradiation chamber. The chicken receives a 1.5 to 3.0 kilogray dose of ionizing gamma radiation. Such a dose eliminates 99.5 to 99.9% of salmonella organisms on poultry and 100% of campylobacter. Like other poultry, irradiated chicken must be kept refrigerated. And, once the package is opened, the treated birds can be recontaminated by bacteria in the environment. (KP)
Source: Food Technology, Nov. 1993.
Modified Recipe: Blueberry Coffee Cake
Blueberry Coffee Cake
(Original)
1/4 cup butter
1/2 cup sugar
1 large egg
1/2 cup sour cream
2 cups flour
4 tsp baking powder
1/2 tsp salt
1/2 cup whole milk
1 1/2 cups fresh or frozen blueberries
1. Cream butter and sugar
together . Beat in egg and sour cream.
2. Sift together flour, baking powder and salt.
3. Stir in dry ingredients and milk alternately. Do not
overmix.
4. Fold in blueberries.
5. Pour batter into a greased 8" square pan.
Topping
3 Tbsp sugar
2 Tbsp finely chopped walnuts
1/4 tsp cinnamon
1. In small bowl, stir
together sugar, walnuts and cinnamon
2. Sprinkle over batter.
Bake at 4000 F for 20-25 minutes. Let cool in the pan 10
minutes. Serve warm. Serves 9.
Blueberry Coffee Cake
(Modified)
1 large egg
1/2 cup skim milk
1/2 cup plain yogurt
3 Tbsp vegetable oil
2 cups all-purpose white flour
1/2 cup sugar
4 tsp baking powder
1/2 tsp salt
1 1/2 cups fresh or frozen blueberries
1. Beat together egg,
milk, yogurt and oil.
2. Sift together flour, sugar, baking powder and salt.
3. Stir dry ingredients into the liquid mixture. Do not
overmix.
4. Fold in blueberries.
5. Pour batter into a greased 8" square pan.
Topping
3 Tbsp sugar
2 Tbsp finely chopped walnuts
1/4 tsp cinnamon
1. In small bowl, stir
together sugar, walnuts and cinnamon.
2. Sprinkle over batter.
Bake at 4000 F for 20-25 minutes. Let cool in the pan 10
minutes. Serve warm. Serves 9. (MP)
| Nutritional Comparison | ||
|---|---|---|
| Nutrition per serving: | Original | Modified |
| Calories | 275 | 242 |
| Fat | 10 g | 6.7 g |
| Cholesterol | 45.0 mg | 24.7 mg |
| Sodium | 329 mg | 289 mg |
| Percent of calories from fat | 33% | 25% |
Source: Eating Well, May/June 1993
1992 Pediatric Nutrition Surveillance System
The Pediatric Nutrition Surveillance System (PedNSS) monitors the health status of Kansas WIC children. Height, weight, hemoglobin, birthweight, and breast-feeding data is collected on children enrolled in both WIC and CSFP. In 1992, the records of 68,605 children were included in the survey.
The racial/ethnic makeup of the surveyed population was White (71%); African American (14.4%); Hispanic (11.7%) Asian (1.8%); and Native American (1.1%). This distribution differs from national statistics where people of color make up a larger percentage. It also shows that African Americans, Hispanics, and Asians make up a larger proportion of the WIC population than is seen in the overall population of Kansas.
Underweight children in Kansas was 3.6% compared to the national average (3.1%). The highest prevalence of underweight children was identified among African Americans and Asians.
In 1992, the incidence of overweight in WIC children nationally was 9.8% compared to 5.3% in the Kansas population. The largest prevalence of overweight was found among the Hispanic and Native American children at one year of age.
The incidence of low birthweight decreased from 9.1% in 1991 to 8.9% in 1992, and is below the national average of 9.4% for this population subgroup.
14.3% of the children screened had low hemoglobin values compared to 16.1% in 1990. This is the lowest rate of low hemoglobin recorded since 1982.
Increasing the incidence of breast-feeding and duration has been an emphasis in the Kansas WIC program for the past 3 years. 57.8% of WIC infants in 1992 were breast-fed at hospital discharge and at 6 months 28.9% were still being breast-fed. Data collected in 1993 indicated 61.5% of KS WIC infants were breast-fed in the hospital.
| The Kansas breast-feeding data compares favorably with national data: | ||
|---|---|---|
| Kansas | National | |
| Breast-fed within the first week of life | 57.0% | 34.5% |
| At one month | 48.0% | 26.7% |
| At three months | 37.1% | 21.0% |
| At six months | 29.3% | 16.9% |
(MP)
Source: Nutrition and WIC Update, October 1993
Mickey Leland Hunger Relief Act Passes
On August 5th, Congress passed the Mickey Leland Hunger Relief Act. FRAC called the Act "the single most important piece of anti-hunger legislation in more than 16 years".
Some of the provisions of the act related to eligibility for food stamps include:
- Removal of the cap on the shelter deduction. The new law increases and then removes the cap on the amount of shelter costs a household may deduct in determining eligibility for food stamps
- Exclusion of income earned by high school students.
- Earnings of high school students will be excluded through age 21.
- Exclusion of the Earned Income Tax Credit as a resource. The EITC is excluded as a resource in households receiving food stamps during the time of receipt of the EITC and participating continuously for the 12 month period.
The Leland Act removes certain barriers to food assistance. For example, it creates a deduction from income of child support payments made by a household member. It improves access to employment and training programs. It increases the value of a vehicle a household may own without losing benefits. It also allows households to accumulate resource for self-sufficiency purposes. (MP)
Source: Why, Summer 1993, No. 13
School Breakfast Program-Kansas is Improving
The number of schools in Kansas that participate in the School Breakfast Program increased by 68.5% in 1993 and the number of low income students that receive breakfast at school has increased by 70.5%. That is quite an accomplishment, in fact only one state in each category did better. This growth was achieved, in part, through: the implementation of a state law mandating that schools with 35 percent or more of students eligible for free or reduced-price meals participate in the School Breakfast Program; securing federal start-up funds in fiscal years 1990 through 1994; and by implementing "direct certification." "Direct certification" allows very low-income students who attend schools offering breakfast to receive free meals without filing an application. To qualify, they must be from households receiving food stamps or Aid to Families with Dependent Children.
But we still have a long way to go. Kansas is still scoring well below the national average for schools that offer lunch also offering breakfast (KS-36.7% vs US-58.4%). We rank 40th of the 50 states plus District of Columbia in this area. Kansas is also below the national average for low-income students participating in lunch who also participate in breakfast (KS-23% vs US-35.7%). In this area, we rank 35.
We know that not eating breakfast in the morning causes children to be lethargic and less ready to learn. Children who do not eat breakfast are more likely to miss school due to illness. A recently published study found that 16 percent of the children studied (24% of black girls) regularly missed breakfast. These children ate an average of 200 to 500 fewer calories per day than their friends who ate breakfast. They also fell short of the RDA's for vitamins A, E, D, and B-6 and calcium. And a 1987 study found that low-income elementary school children participating in the School Breakfast Program showed an improvement in standardized achievement test scores and a tendency toward improved attendance rates and reduced tardiness compared to similar students who did not eat breakfast at school.
Promoting school breakfast is definitely worth the effort. And it is good to know that Kansas is improving. (PP)
Sources: Food Research and Action Center. School Breakfast Score Card, 3rd Edition, 1992-1993.
CNI Nutrition Week, September 10, 1993.
Nicklas, T.A., Bao, W. Webber, L.S., and Berenson, G.S. Breakfast consumption affects adequacy of total daily intake in children, J Am Diet Assoc. 1993; 93: 886-891.
Socioeconomic Consequences in Overweight Adolescents and Young Adults
Gortmaker and colleagues published new evidence that documents severe social and economic consequences of overweight during adolescence. This study examined the relationship between being overweight (BMI greater than 95th percentile for age and sex) at age 16 to 24 years and social and economic characteristics and self esteem seven years later in a cohort of over 10,000 young people. The authors also compared the results in the obese group to a sample of young people with other chronic conditions and disabilities. They found that overweight during adolescence has important social and economic consequences that are greater than those associated with other chronic physical health conditions. The consequences are more severe for women than for men. Overweight women married less often, had lower incomes and completed fewer years of school. No significant differences in self-esteem were found. Gortmaker et al conclude that the negative impact of overweight on socioeconomic status may be due to discrimination and consideration should be given to extend the Americans with Disabilities Act to include overweight individuals. As educators we can work to prevent obesity by encouraging a healthy lifestyle. We also need to examine our own preconceptions of the obese so we do not inadvertently contribute to their discrimination. (PP)
Source: Gortmaker, S.L., et al. Social and economic consequences of overweight in adolescence and young adulthood.
NEJM 329:1008-1012, 1993 as reported in October 1993 Foods and Nutrition Specialist Newsletter, University of Wisconsin-Extension.
Many people give up on an exercise program even before they begin. Part of the reason may be that they have been lead to believe that if they can not or will not commit to an exercise program of 30 minutes straight every other day, they need not bother. But that is not true.
The latest from a panel of experts from the Centers for Disease Control and Prevention as well as the American College of Sports Medicine suggests that health benefits are seen by people who simply accumulate 30 minutes of moderate-intensity physical activity over the course of the day. Such things as using the stairs instead of the elevator, gardening, raking leaves, and walking part of the way to work would qualify as moderate intensity.
This panel points to increasing evidence that adding short periods of activity (5 or 10 minutes) here and there reduces the risk for heart disease, high blood pressure, osteoporosis, and breast and colon cancer. These little spurts of activity throughout the day also help alleviate depression, anxiety, and stress.
According to one of the experts, Dr. Steven Blair, former vice-president of the American College of Sports Medicine, for people who are extremely sedentary, a little extra activity can reduce the risk of disease as much as quitting smoking. Of course, avid exercisers who work out for 20 to 30 minutes several times a week don't need to cut back. This kind of work out not only keeps you healthy, but also helps you look good. But for those who are not interested in becoming athletes, just a little activity can help prevent chronic diseases. (PP)
Source: Tufts University Diet and Nutrition Letter, October 1993.
Teenage Birthrate Still Going Up
The teenage birthrate has gone up in this country for the fifth straight year, according to the Center for Disease Control in an October 1993 report. This report was based on 1991 data, the most recent year available. For every 1000 girls between ages 15-19, there were 62.1 births reported in 1991, up from 59.9 in 1990. (PP)
Source: CNI Nutrition Week, October 15, 1993
Cooking with Reduced-Fat Cheeses
The new lower-fat cheeses like "light" American, Cheddar, Swiss and mozzarella often contain 33 to 50% less fat than regular cheeses. Instead of fat, they may be made with added milk solids, natural gums or fat substitutes. Since there is less fat, the texture is more firm. Also, the flavor may be milder since reduced-fat cheeses do not age as well as higher-fat cheese.
To get the highest quality product when cooking with these reduced-fat cheeses:
Add grated, diced or slivered cheese to sauces at the end of cooking. Remove from heat and stir until melted. Use mustard, salsa, or spices for a more intense flavor.
In casseroles, layer the cheese for smooth melting. When low-fat cheese is used as a topping for baked dishes, add it near the end of baking and heat only until it's melted. Serve at once.
For broiled cheese sandwiches, place the slices as far away from the heat as possible or choose a temperature below "broil."
Use a mixture of half reduced-fat and half full-fat cheese to lower saturated fat content without affecting flavor or texture.
Since reduced-fat cheese have a shorter shelf life, it's important to keep them well wrapped and refrigerated and use them as soon as possible. Don't try to use nonfat American and Cheddar cheeses in cooking. They're better served at room temperature in sandwiches, as a snack or in salads. Nonfat cream cheese also is not intended for baking, but you can toss it with hot pasta for a creamy sauce. (JD)
Sources: "Facts & pointers about reduced-fat cheeses," National Dairy Promotion and Research Board; Colorado CES, June 1993
You may have read or heard about antioxidant nutrients-vitamin A and beta-carotene, vitamins C and E, and selenium-possibly being important in preventing cancer or coronary heart disease. Now comes evidence that some of the antioxidants are important for eye health.
In the US and other developed countries, age-related macular degeneration (AMD) is the leading cause of permanent blindness in Caucasians over age 65. The impact of this disease will likely increase as more Americans live longer. Little is known about its causes or how to prevent it.
One theory is that unwanted oxidation can occur in sensitive eye tissue that leads to AMD. Research evidence comes from both experimental and clinical studies in which animals short of antioxidant nutrients and exposed to bright light were more likely to show harmful eye changes. Studies involving vitamins and minerals including zinc are underway to enroll 5,000 patients throughout the US to examine this theory.
Antioxidants, especially vitamins C, E, and the carotenoids (precursors of vitamin A found in plant foods), may also play a role in preventing some kinds of cataracts. Several researchers have been comparing dietary and supplemental antioxidant intakes by cataract patients with those free of the condition. In general, their findings suggest that these nutrients are beneficial.
Should you take high potency vitamins and minerals to ward off eye problems? Not yet, unless your physician suggests otherwise. The evidence is not strong enough and the dangers not well-tested. For example, some individuals consuming high levels of supplementary zinc have developed an anemia related to copper deficiency. The zinc blocked copper absorption. It takes the body a long time to recover from the anemia for it must rid itself of too much zinc even if extra copper is supplied to bring zinc and copper back into balance.
Supplements with 100 percent of the recommended amounts of vitamins and minerals are safe. It's the high potency supplements that can be dangerous. The safest bet is to eat more fruits and vegetables. The Food Guide Pyramid suggests at least two servings of fruits including a good source of vitamin C (citrus fruits and tomatoes are high in ascorbic acid) and three servings of vegetables including a dark green or deep yellow one daily for the carotenoids. Fruits and vegetables have other virtue also: low fat, low calories, high fiber plus other vitamins and minerals. If you must choose between supplements and more nutritious foods, reach for the food. It will cost less, be safe and offer better protection overall. (MC)
Sources: Nutrition and Macular Degeneration, Role of Antioxidants in Heart Disease, and Do Antioxidants Play a Role in Preventing Cataracts?, Nutrition & the M.D., 18:5, pp 1-3, May 1992.
Have you ever wanted a picture book of food ingredients? Here it is, Cook's Ingredients, published by the Reader's Digest, contributing editor, Adrian Bailey.
Most ingredients are pictured plus a short description and how used. Foods included are: vegetables; dried peas, beans, and lentils; mushrooms and truffles; herbs, spices, and seeds; flavorings; seasonings and extracts; pickles, chutneys, and pastes,... nuts; grains,... sugars, syrups, and honey... cheeses and more, 233 pages.
To order a copy call Customer Service at Reader's Digest 1-800-234-9000 or write Reader's Digest, Customer Service, Pleasantville, N.Y. 10572. The cost is $23.97 plus $3.65 delivery. (JD)
(Thanks to Diane Nielson for this resource)
Three books have been brought to my attention as resources for family time ideas. Here's a brief description of each.
The Quality Time Almanac (1986) is by S. Adams Sullivan. It is a source book of ideas and activities for parents and kids. Some of the activities involve mealtime and food. There's a napkin folding activity that looks fun. Some of the activities I didn't like and some of the recipes need to be modified to lower fat. I found this book at the library but not at a bookstore.
I Can Make a Rainbow (1976) by Marjorie Frank is almost 300 pages of ideas to do with children. Things to do with pencil, pen, crayon and chalk; paper; paint; cloth, yarn and string; food. Even things to do when there's nothing to do. Each page has a different activity. Many of the food activities are sweets so go easy on them. The cost of the book is $16.95.
Prime Time Together...with Kids (1989) by Donna Erickson is a book of 100 creative ideas; activities, games and projects. There are 10 food related activities. I liked the sherbet watermelon dessert, apple wreath, and the cookie cutter munchies for Valentine's Day. This book sells for $12.99. Of the three books, I liked this one best. (JD)
The American Egg Board has come out with another integrated curriculum. This one is for Grades K-3 and is titled Adventures with Mighty Egg. It is designed to encourage students to want to know more about eggs and other subjects as they develop math, science, language arts, creativity and other skills. There are 8 lessons and activity sheets. A reading list is also included.
Free copies are available from the Kansas Poultry Association, 1816 Alabama, Manhattan, Ks 66502, (913) 539-5441. (JD)
How to Read the New Food Label
The area extension offices now have this videotape available to support county programming on the new food labels. The tape is about 15 minutes in length and outlines the basic changes. It was produced by National Health Video, Inc. (KP)
K-State Research and Extension is a short name for the Kansas State University Agricultural Experiment Station and Cooperative Extension Service, a program designed to generate and distribute useful knowledge for the well-being of Kansans. Supported by county, state, federal and private funds, the program has county Extension offices, experiment fields, area Extension offices and regional research centers statewide. Its headquarters is on the K-State campus, Manhattan.