Page 711

Index

A

Absorption

arsenic, 391

calcium, 301, 312, 316, 317, 322, 349-351, 355, 359-360, 616, 667

cholesterol, 188-189, 201, 229, 657, 670

copper, 379

fats, 451

fiber's effect on, 6

food energy, 139

iron, 71, 77, 88, 92, 94, 301. 302, 368, 370, 517

phosphorus, 86

plant sterols, 201

trace element, 6, 368, 370

vitamin B12, 88

Acetaldehyde, 440, 441, 450

Acetylcholine, 217

Acne, 516

Acrylonitrile, 481-482, 662

Additives, food, see Food additives

Adenosine triphosphate (ADP), 143, 191, 419

Adipose tissue/adiposity

animals studies of, 148

blood flow and blood pressure in, 149

brown adipose tissue, 146-147, 436

carbohydrate intake and, 277

diabetes mellitus and, 123

distribution of, see Body fat distribution

energy intake and, 148

excess energy storage as, 139

fatty acids and, 28, 186, 193, 215

insulin resistance in, 149, 152

linoleic acid in, 203

lipoprotein lipase levels in, 143

norepinephrine and, 149

metabolism of, 147

obesity and, 147

osteoporosis and, 621

standards, 565-567

thermogenesis and, 152, 436

see also Obesity

Adrenal hyperfunction, 150

b-Adrenergic receptors, 152

Aflatoxins

carcinogenicity, 12, 264, 440, 490, 662, 665

liver cancer and, 119, 596-597, 601

protection against, 5, 478, 665

in trout, 490

see also Mycotoxins

Africa

cancer in, 117, 119, 120, 296, 334, 384, 386, 486-487

dental caries in, 127

diabetes in, 299, 333

gallstones in, 126, 301

serum cholesterol levels in, 166, 333

see also specific countries

Age

alcohol intake and, 61-62, 432, 451-452

atherosclerotic lesion characteristics and, 166

calcium intake and, 17, 69, 76, 264-265, 317, 347-351, 353, 354

body fat and, 139

bone mass and, 120-121, 264

breast cancer and, 119, 120, 207

CHD and, 101, 102, 165, 167, 445, 532

cholesterol intake and, 58, 161

dental caries and, 127, 128

diabetes mellitus and, 122, 123

eating patterns and, 75

energy expenditure and, 142, 146, 153

energy intake and, 52, 53, 59, 77-79, 89, 140-141, 146, 148, 153

fat intake and, 54-55, 161

fiber intake and, 294

gallbladder disease and gallstones and, 127, 218

hypertension and, 108, 109-110, 202, 416, 424, 660

intermittent claudication and, 107

lean body mass and, 147-148

liver cancer and, 119

lung cancer and, 119

mineral intake and, 69-74, 77-79, 81

obesity and overweight and, 90, 115

osteoporosis and, 69, 121-122, 316-318, 620

ovarian cancer and, 120

PAD and, 106, 107

plasma lipids and lipoproteins and, 224

prostate cancer and, 120

protein intake and, 16

renal function and, 265

serum cholesterol levels and, 163, 166

stomach cancer and, 117, 118

strokes and, 104

sugar intake and, 59

vitamin A status and, 51, 64, 312

vitamin D synthesis and, 312

vitamin intake and, 77-79, 81

Alabama, stroke rates in, 105

Alaska, arsenic contamination of well water in, 391

Alcohol and Health Practices Survey, 61

Alcohol consumption

age and, 61-52, 432, 451-452

animal studies of, 439-442

assessment of, 431, 436

atherosclerotic cardiovascular diseases and, 442-446

blood alcohol levels and, 431

(continued on next page)



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Page 711 Index A Absorption arsenic, 391 calcium, 301, 312, 316, 317, 322, 349-351, 355, 359-360, 616, 667 cholesterol, 188-189, 201, 229, 657, 670 copper, 379 fats, 451 fiber's effect on, 6 food energy, 139 iron, 71, 77, 88, 92, 94, 301. 302, 368, 370, 517 phosphorus, 86 plant sterols, 201 trace element, 6, 368, 370 vitamin B12, 88 Acetaldehyde, 440, 441, 450 Acetylcholine, 217 Acne, 516 Acrylonitrile, 481-482, 662 Additives, food, see Food additives Adenosine triphosphate (ADP), 143, 191, 419 Adipose tissue/adiposity animals studies of, 148 blood flow and blood pressure in, 149 brown adipose tissue, 146-147, 436 carbohydrate intake and, 277 diabetes mellitus and, 123 distribution of, see Body fat distribution energy intake and, 148 excess energy storage as, 139 fatty acids and, 28, 186, 193, 215 insulin resistance in, 149, 152 linoleic acid in, 203 lipoprotein lipase levels in, 143 norepinephrine and, 149 metabolism of, 147 obesity and, 147 osteoporosis and, 621 standards, 565-567 thermogenesis and, 152, 436 see also Obesity Adrenal hyperfunction, 150 b-Adrenergic receptors, 152 Aflatoxins carcinogenicity, 12, 264, 440, 490, 662, 665 liver cancer and, 119, 596-597, 601 protection against, 5, 478, 665 in trout, 490 see also Mycotoxins Africa cancer in, 117, 119, 120, 296, 334, 384, 386, 486-487 dental caries in, 127 diabetes in, 299, 333 gallstones in, 126, 301 serum cholesterol levels in, 166, 333 see also specific countries Age alcohol intake and, 61-62, 432, 451-452 atherosclerotic lesion characteristics and, 166 calcium intake and, 17, 69, 76, 264-265, 317, 347-351, 353, 354 body fat and, 139 bone mass and, 120-121, 264 breast cancer and, 119, 120, 207 CHD and, 101, 102, 165, 167, 445, 532 cholesterol intake and, 58, 161 dental caries and, 127, 128 diabetes mellitus and, 122, 123 eating patterns and, 75 energy expenditure and, 142, 146, 153 energy intake and, 52, 53, 59, 77-79, 89, 140-141, 146, 148, 153 fat intake and, 54-55, 161 fiber intake and, 294 gallbladder disease and gallstones and, 127, 218 hypertension and, 108, 109-110, 202, 416, 424, 660 intermittent claudication and, 107 lean body mass and, 147-148 liver cancer and, 119 lung cancer and, 119 mineral intake and, 69-74, 77-79, 81 obesity and overweight and, 90, 115 osteoporosis and, 69, 121-122, 316-318, 620 ovarian cancer and, 120 PAD and, 106, 107 plasma lipids and lipoproteins and, 224 prostate cancer and, 120 protein intake and, 16 renal function and, 265 serum cholesterol levels and, 163, 166 stomach cancer and, 117, 118 strokes and, 104 sugar intake and, 59 vitamin A status and, 51, 64, 312 vitamin D synthesis and, 312 vitamin intake and, 77-79, 81 Alabama, stroke rates in, 105 Alaska, arsenic contamination of well water in, 391 Alcohol and Health Practices Survey, 61 Alcohol consumption age and, 61-52, 432, 451-452 animal studies of, 439-442 assessment of, 431, 436 atherosclerotic cardiovascular diseases and, 442-446 blood alcohol levels and, 431 (continued on next page)

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Page 712 (continued from previous page) blood pressure and, 415, 420, 442-443, 452 body weight and, 432, 436 cancer and, 10, 16, 334, 437-442, 444, 452, 660, 673 CHD and, 16, 444-446, 533, 660, 673, 695 cigarette smoking and, 10, 444, 660 cirrhosis and, 10, 33, 92; see also Alcoholic cirrhosis clinical studies of, 436 coronary occlusion score and, 445 cultural aspects of, 433-435 data sources on, 47 diabetes mellitus and, 446 epidemiologic evidence on, 436, 437-439 ethnographic review of, 433-434 flushing of the skin and, 88, 93 gallbladder disease and. 127 glucose tolerance and, 446 historical perspective on, 433-435 hyperglycemia and, 446, 452 hyperlipidemia and, 443-444 hypertension and, 10, 16, 108, 415, 442-443, 660 hyperuricemia and, 447 hypoglycemia and, 446-447 insulin resistance and, 446 liver injury and, 10, 16, 33, 124-125, 447-449, 452, 673; see also Alcoholic cirrhosis for medicinal purposes, 434 metabolic disorders from, 446-449 neurological impairment and disorders and, 16, 431, 449-451, 452, 673 in nonliterate societies, 435 in non-Western literate societies, 435 nutritional disorders and, 10, 16, 434, 441-442, 448-449, 450-451, 634, 673 obesity and, 144, 436-437 osteoporosis and, 10, 619, 660 policy implications of, 451 during pregnancy, 10, 16, 452-453, 673, 681 recommended levels of, 16, 18, 451, 673, 675, 678-680, 682-683, 686-688 renal disease (chronic) and, 447, 452 reporting of, 25, 27, 60, 61, 81, 436, 442 safe levels of, 431, 432 sex differences in, 432-433, 452 stroke and, 105, 442-443, 452, 660 trace element intake from, 376 transcultural anthropological perspective on, 434 trends in, 60-61, 81, 431-433 vitamin deficiencies and, 335, 450-451, 452 in Western societies, 434-435 zinc and, 442, 450 see also Ethanol Alcohol dehydrogenase, 88, 93, 440, 448 Alcoholic beverages ale, 61 amount of ethanol in, 432 availability of, 47, 126 beer, 10, 16, 60, 61, 432-439, 441, 444, 445, 447, 451, 475, 660, 673 calories supplied by, 62, 140, 435-436 carbohydrate content of, 436 carcinogens in, 441, 452, 475, 480, 486 cognac, 436 80 proof, 432, 436, 438 86 proof, 443 gin, 434 monitoring status, 62, 81 rum, 434 sherry, 436, 441 vermouth, 441 vodka, 436 whiskey, 62, 393, 432, 434, 436, 437 wine, 16, 60, 61, 391, 392, 432-434, 436, 438, 439, 441, 444, 445, 673 see also Alcohol consumption: Ethanol: and specific alcoholic beverages Alcoholic cardiomyopathy, 446 Alcoholic cirrhosis age and, 125 animal studies of, 33 diagnosis of, 124 epidemiology of, 447-448 ethnic correlates of, 125 genetic and familial factors in, 92, 634 liver cancer and, 438-439 megaloblastic anemia and, 338 in migrants, 125 mortality rates, 125-126, 435, 447 nutritional factors in, 335, 336, 338, 448-449, 451, 634 population differences in frequency of, 125 prevalence of, 124, 447, 660 relation to alcoholism, 447-448, 660 sex differences in, 125, 447 socioeconomic status and, 125 time trends in morbidity and mortality, 125-126 see also Liver disease Alcoholic dementia, 449 Alcoholic peripheral neuropathy, 449 Alcoholic polyneuritis, 334 Alcoholism and alcohol abuse age and, 60-61, 432, 451-452 carcinogenic effects of dietary deficiencies associated with, 334, 441-442 defined, 431 electroencephalographic activity and, 93 family studies of, 92, 93 genetic and environmental factors in, 92-93, 433 liver damage from, 124-125, 334, 336, 338-340, 452, 660 male-limited susceptibility to, 93 markers of genetic susceptibility, 93 milieu-limited susceptibility to, 93 nutrient deficiencies from, 284, 334, 337-340, 357, 434, 450-452, 660 organ damage from, 92 prevalence of, 16, 433, 451, 673 racial and ethnic differences in, 443, 452 research needs on. 95, 453, 542, 556 symptoms of drunkenness, 431 twin studies of, 92, 93 Aldehyde dehydrogenase deficiency, 88, 93 Aldosterone, 418, 424 Alfalfa, 298, 490 Alginates, 74 Alkaline phosphatase, 302 Alkyl benzenes, 488 Allergic reactions, 478 Allyl isothiocyanate, 490 Aluminum Alzheimer's disease and, 387-388, 395 animal studies of, 387, 388 cancer and, 387 clinical studies of, 387-388 dietary sources of, 387 epidemiologic studies of, 387-388 intake trends, 387 short-term tests of, 387 Alzheimer's disease aluminum and, 387-388, 395 manganese and, 386 treatment of, 216 American Academy of Pediatric Dentistry, 17, 674 American Academy of Pediatrics, 17, 226, 674, 684-685 American Cancer Society, 676 American Dental Association, 17, 674 American Diabetes Association, 667, 676, 681 American Health Foundation, 685, 686 American Heart Association dietary recommendations, 226, 667, 676, 677, 685, 686 risk calculations for coronary disease events, 108-109 American Indians, see Native Americans, and specific tribes American Medical Association, 676 Ames test, see Mutagenicity tests Amino acids classification of, 259 data sources on availability of, 47 deficiencies, 262 glucogenesis from, 446 metabolism of, 337 requirement changes, 259 substitutions in apolipoproteins, 168 sulfur-containing, 423 supplements, 17, 448-449, 674 see also Essential amino acids; and specific amino acids Aminoazobenzene, 28, 478 4-Aminobiphenyl, 478 2-Aminofluorene, 264, 381, 384, 440 Aminoimidazoquinoline, 485 Aminomethylimidazoquinoline, 485 Aminopolysaccharides, 291 Ammonia, 86 Amyotrophic lateral sclerosis, 387 Anagyrine, 490 Analytical methods b-carotene, 313 dietary cholesterol, 199 fiber, 292-293 folacin in foods, 67 Anemia copper deficiency and, 381, 517 hemolytic, 88, 320, 490 iron deficiency, 77, 88, 369-370, 395 megaloblastic, 338 microcytic, 373 monitoring children and pregnant women for, 44, 51 pernicious, 88 Aneurysms, 105, 333

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Page 713 Angina pectoris, 100, 107, 320, 444, 514, 530; see also Coronary heart disease Angiography, 106, 169 Aniline, 478 Animal fat atherosclerotic cardiovascular diseases and, 15, 672 biologic marker of intake, 221 cancer and, 206, 209, 214, 229, 299 intake trends, 160, 179 cholesterol increases from, 179 SFAs in, 159 thrombotic brain infarction and, 194 Animal models atherosclerosis, 33, 171, 200, 227, 228, 295, 532 cancer, 315, 393-394 cholelithiasis, 219-220, 229 dental caries, 280 diabetes mellitus, 150, 152, 276-278, 299 hypercholesterolemia, 33, 171, 228 hyperlipidemia, 200 hypertension, 33, 149, 204-205, 262, 281, 390, 417, 423 obesity, 91, 143, 145, 146, 221, 222, 277, 278, 281 osteoporosis, 33-34, 375 pellagra, 33 scurvy, 33 sexually dimorphic, 276 strike, 262 see also Laboratory animals Animal protein atherosclerotic lesions and, 193, 265, 533 cancer and, 15, 207, 263, 659, 673 CHD and, 15-16, 265, 673 fat association with, 16, 260, 659 food sources of, see Meats gallstones and, 300 hypercholesterolemia and, 261, 265 intake trends, 9, 181, 259, 654 nutrients provided by, 16 recommended intakes of, 15-16, 17-18, 672-673, 675, 681, 682 serum cholesterol levels from, 9, 181, 261, 533 Animal studies alcohol intake, 92, 439-442 aluminum, 387, 388 Alzheimer's disease, 388 arsenic, 392 aspartame, 473-474 atherosclerosis, 112-113, 161, 169, 176, 189, 196, 200 atherosclerotic cardiovascular diseases, 148-149, 151-152, 195-196, 200-201, 333-334, 376-377, 381, 382 BHA, 476-477 BHT, 477 biotin, 340 cadmium, 389, 390 calcium, 354, 356, 357, 603 cancer, 7, 8, 150-151, 153, 213-215, 264, 282-283, 297-298, 314, 315-316, 319-320, 321, 332-333, 335-340, 357, 368-369, 371-372, 378, 381-382, 384-387, 389, 391-394, 439-442, 468-469, 472, 473-474, 476-477, 576, 600-604: see also specific cancer sites carbohydrates, 276-277, 280-283, 601-602 b-carotene and other carotenoids, 314 CHD, 261, 295-296, 532-533 chromium, 382-383 coffee and tea, 468-469, 470-471 criteria used to assess, 34-35 copper, 380, 381 cyclamate, 473 dental caries, 280-281, 374, 641-642 design problems in, 150, 260, 378 diabetes mellitus, 149-150, 152, 153, 276-278, 299-300, 385-386, 629-630 dietary cholesterol, 8, 171, 200-201 dietary fats containing no cholesterol, 196 dose sizes in, 260, 378 endocrine disorders, 582 energy balance and body weight, 145 energy expenditure and chronic disease, 151-152, 153 energy expenditure-storage relationship, 145-146 energy intake, 148-151, 153 extrapolation of findings to humans, 4, 35, 37, 278, 653 fats and lipids, 7, 148-149, 171, 189, 204-205, 213-215, 221-222, 600-601 trans fatty acids, 8, 196 fiber, 295-296, 297-298, 299-300, 602 fluoride, 374, 375 folacin, 338 food colors, 478-479 gallbladder disease and gallstones, 219-220 generalizability of results from, 280 human studies compared to, 35-36 hypercholesterolemia, 161 hyperlipidemia, 295-296 hypertension, 262, 340, 356, 359, 375, 390, 394, 417-418, 553, 574-575 IDDM, 277-278 interpretation of results from, 34 interspecies variability in responses, 4, 33-34, 35, 200, 476, 653 iodine, 384, 603 iron, 368-369, 370 iron-deficiency anemia, 370 lead, 393-394, 395 liver disease, 335-336, 338, 340 magnesium, 359 manganese, 385-386 mercury, 391 methodological issues, 200-201 molybdenum, 386-387 mycotoxins, 487 niacin, 336 NIDDM, 276-277 nitrites, nitrates, and N-nitroso compounds, 475-476 nonnutritive dietary components, 603-604 nutrient levels in, 150 of obesity, 7, 91, 143, 145, 146-147, 221-222, 281-282, 574-575, 576, 577, 582 osteoporosis and osteomalacia, 317, 354, 619-620 pair feeding in, 145, 149, 153 pantothenic acid, 340 peanut oil, 196 plasma lipids and lipoproteins from fat intake, 189 polybrominated biphenyls, 480 polychlorinated biphenyls, 480 polyvinyl chloride, 481 potassium, 423 protein, 261, 262-263, 264, 265, 601 PUFAs, 8, 159, 187, 188, 195-196 w-3 PUFAs, 8, 159 renal disease (chronic), 265, 395 reproductive effects of nonnutrients, 470-471 retinol and other retinoids, 315-316, 602 riboflavin, 335-336 role in nutrition research, 33, 34, 35-36 saccharin, 472 SFAs, 195-196 selenium, 376-377, 378, 602 sex-specific responses to caloric intake, 145 sodium, 417-418, 421, 603 strengths and weaknesses of, 4, 33-34, 35 stroke, 262-263 triglycerides, 171 vitamin A, 314, 315-316, 602 vitamin B6, 337, 338 vitamin B12, 339 vitamin C, 332-334, 602 vitamin D, 317 vitamin E, 319-320, 602 vitamin K, 321, 602 weight gain and loss cycles, 577 weighting of evidence from, 4, 35, 37-38, 653 zinc, 371-372, 602-603 see also Experimental evidence; Laboratory methods Anorexia nervosa, 358, 583-584 Antacids, 73, 355, 373, 388 Anthropomorphic measurements, 143, 450 Antibiotics, 322 Antocoagulants, 322 Antithrombotic agents, 191 a1,-Antitrypsin deficiency, 124 Apnea, prolonged, 88 Appalachia, CHD in, 102 Apolipoproteins alcohol intake and, 443 Apo A, 88, 163, 169, 188, 223, 276, 277, 294, 443 Apo B, 89, 169, 171, 187, 199, 277, 294 Apo C, 163, 169 Apo D, 163 Apo E. 89, 163, 168, 169 atherosclerosis and, 168-169 carbohydrate intake and, 277 CHD and, 88, 168-171, 534, 536 diabetes mellitus and, 276 dietary cholesterol intake and, 199, 223 dietary responsiveness and, 169 familial combined hyperlipidemia and, 89 familial dysbetalipoproteinemia and, 168 families of, 163 functions of, 163, 168-170 (continued on next page)

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Page 714 (continued from previous page) genetic polymorphisms, 168-169 hyperlipidemia and, 168 interaction with dietary fats, 168 LDL cholesterol and, 168 peripheral vascular disease and, 169 predictive power of, 169-170 research needs on, 89 plasma cholesterol and, 168 PUFAs and, 187, 188 in vegetarians, 294 b-VLDL cholesterol and, 168 Apples, 73 Arabinogalactans, 300 Arachidonic acid food sources of, 159 homeostatic actions of, 190 metabolism in humans, 177, 190, 191 structure of, 159 synthesis of, 159 see also w-6 Polyunsaturated fatty acids Arginine, 261 Arsenic absorption, retention, and excretion of, 391 animal studies of, 392 atherosclerotic cardiovascular diseases and, 391 biologic role of, 391 cancer and, 392, 395 dietary sources of, 391 epidemiologic studies of, 391, 392 occupational exposures to, 392 short-term tests of, 392 Arterial aneurysms, 105 Arteriosclerosis defined, 161 diabetes mellitus and, 124 obliterans, 105 plaque formation, 105 see also Atherosclerosis Arthritis gouty, 337, 447 hemochromatosis and, 92 see also Osteoarthritis Artificial sweeteners, taste of, 85; see also specific sweeteners b-Asarone, 488 Asbestos fibers, 441 Ascaris infection, 321 Ascorbic acid, see Vitamin C Ashkenazi Jews, 94 Asia alcoholic cirrhosis in, 447 cancer in, 117-120, 487 dental caries in, 127 diabetes mellitus in, 276 gallstones in, 126 serum cholesterol levels in, 166 see also specific countries Asian Americans alcohol intake by, 433 alcoholic cirrhosis in, 125 cancer incidence in, 118, 119 dental caries in, 128 diabetes mellitus in, 123 osteoporosis in, 122 Asian Indians, diabetes mellitus in, 123 Aspartame, 283, 471, 473-474; see also Food additives Aspirin, 190, 191 Association of Official Analytical Chemists, 293 Atherogenesis apolipoproteins as predictors of, 169-170 endothelial injury and, 177 in vitro studies of, 176-177 LDLs and, 198 peanut oil and, 187, 196 triglyceride structure and, 196 VLDLs and, 170 Atherosclerosis animal models and studies of, 33, 112-113, 161, 171, 176, 189, 200-201, 227, 228, 295, 333-334 apolipoproteins and, 168-169 autopsy data on, 165-166, 193 blood coagulation and, 190, 191 blood pressure and, 103 cerebral, 262 cholesterol intake and, 8, 161-162, 201, 657 childhood origin of, 222 cigarette smoking and, 103 in control subjects, 31 in diabetics, 275, 276 defined, 161 fat intake and, 162, 275, 655-656 trans fatty acids and, 193 fiber intake and, 295-296, 303 genetic factors in, 94, 668 HDL cholesterol and, 176 human studies of, 333 hydrogenated vegetable oils and, 195-196 hypercholesterolemia and, 176, 222 individual risk factors, 103, 167, 168 interventions for, 172, 191 LDL cholesterol and, 171, 172, 176 lesion characteristics in, 164, 529-530 lipoproteins and, 29, 168, 169 mortality rates, 103 myocardial infarction and, 161 pathogenesis of, 30, 33, 168, 175, 177, 529-530 platelet function and, 190 population differences in, 164 population risk of, 103 protective effects of nutrients for, 217, 303 w-3 PUFAs and, 191 sequelae, see Coronary heart disease; Peripheral vascular disease; Stroke serum cholesterol and, 29, 103, 161, 162, 165-166, 227, 333 SFA intake and, 7-8, 195-196, 228, 656 stroke and, 104 subclinical detection of, 29-30 thrombosis and, 161 triglycerides and, 175 VLDLs and, 175 vitamin C and, 333-334 see also Arteriosclerosis Atherosclerotic cardiovascular diseases alcohol and, 442-446 animal studies of, 148-149, 151-152, 376-377, 380, 382, 392 arsenic and, 391 blood pressure and, 112-113 body fat distribution and, 114, 117 carbohydrates and, 278-279 chromium and, 381-382 clinical studies of, 148, 151, 198-200, 370, 376, 380, 381-382, 571-572 copper and, 380 dietary cholesterol and, 7, 15, 161-162, 178, 197-198, 656, 666, 670 energy expenditure and, 151-152 energy intake and, 148-149, 380 epidemiologic studies of, 148, 151, 163-171, 192-194, 197-198, 370, 376, 381-382, 391, 569-571 fats and, 6, 7, 15, 33, 161-201, 227-228, 655-656 fatty acids and, 192-196 fiber and, 15 HDL levels and, 117 historical background on, 161-162 hypertension and, 107 intermittent claudication in, 107 lead intake and, 392 lipoprotein levels and, 117, 163-178, 571-572, 670 obesity and, 117, 221, 569-572, 676 plant sterols and, 201 plasma lipid levels and, 163-178 prediction formulas for, 167 prospective studies of, 570-571 protective dietary components for, 6, 672 protein and, 15 retrospective life insurance studies of, 569-570 risk factors for, 6, 52, 107 selenium intake and, 376-377 serum cholesterol levels and, 32, 196, 670 SFAs and, 7, 656, 666, 670 triglycerides and, 170, 171 vitamin E and, 320 zinc and, 370 see also Coronary heart disease; Peripheral vascular diseases; Stroke Atherosclerotic lesions age and, 166, 530 animal protein intake and, 193 in animals, 200 aortic, 166, 177 apolipoproteins in, 169 characteristics of, 161, 165-167, 193, 530-531 in children, 222, 223-224 fat intake and, 193 malondialdehyde-LDL in, 177 plasma lipids and liproproteins and, 169, 223-224 progression of fatty streaks to fibrous plaques, 222, 529-530 serum cholesterol and, 166, 167 vegetable protein and starch intake and, 193 see also Plaque Atherosclerotic occlusive disease, 333 Atherothrombotic disease, 175 Atractylosides, 467 Attention-deficit disorders, 283 Attributable risk, defined, 165 Australia cancer in, 207-209, 297, 332, 356, 438 CHD in, 100-101, 102 dietary recommendations in, 682, 686 gallstones in, 126 (continued on next page)

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Page 715 (continued from previous page) hypertension in, 108, 442 obesity and overweight in, 114-115 Austria, CHD in, 100-101 Autopsy data accuracy of, 29 on alcoholic cirrhosis, 447 on atherosclerosis, 164, 165-166, 193, 262 on CHD, 102, 445, 446 disease incidence and prevalence assessment through, 29, 127 on gallstones, 127, 195, 218 on PAD, 106 to study early stages of disease, 29-30 Avidin, 340 Azobenzene, 478 Azoxymethane, 297-298 B B vitamins, enrichment of foods with, 74; see also Biotin; Folacin; Niacin; Pantothenic acid; Riboflavin; Thiamin; Vitamin B6; Vitamin B12; Vitamins Bacon, 72, 80, 475 Bakery products carbohydrates supplied by, 15, 18, 60, 672 dough conditioners in, 74 enrichment of, 75 fats contributed by, 13, 15, 18, 56, 58, 670, 672 intake trends, 81 nitrites in, 475 recommended intakes of, 670, 675 see also specific bakery items Baking powder, 73, 387 Baking soda, 72 Bananas, 66, 73, 280 Bangladesh, Vitamin A deficiency in, 316 Barbiturates, 322 Beans, 57, 70 Beef, 56-58, 63, 80, 160, 207, 208, 370, 654 Beef fat, 186, 204, 213, 298; see also Animal fat Beets, 208, 297 Behavior alcohol intake and, 435, 446 carbohydrate intake and, 283 hypoglycemia and, 446 lead intake and, 395 Belgium cancer in, 208, 282, 332, 356 CHD in, 100-101 hypertension in, 108, 358 Benign prostatic hypertrophy, 371, 389 Benzanthracene, 481 Benzanthrene, 441 Benzidine, 478 Benzo[a]pyrene, 314, 321, 333, 369, 440, 476, 477, 481 Benzpyrene, 440 Beriberi, 334, 450 Beverages availability trends, 61 carbohydrates supplied by, 59, 60 carbonated, see Soft drinks dry mixes, 476 fortification of, 75 intake trends, 60 nutrient contribution of, 59, 74 see also Alcohol consumption; Alcoholic beverages; Coffee: Tea: and specific beverages BHA, see Butylated hydroxyanisole BHT, see Butylated hydroxytoluene Bias confounding and, 30 in diagnosis of disease, 30 in dietary surveys, 25, 44-45, 46, 55, 161, 181 in food composition data, 48 interviewer, 25 nonresponse, 25, 44-45, 52 recall, 27, 207 sample selection, 29, 44 in survey questions, 55 systematic, 46, 55, 161, 163 see also Errors; Methodological issues Bile acids, 125, 160, 162, 212-213, 215, 217-218, 219, 292, 296, 298, 301, 302, 320, 357, 440 Biliary tract lesions, 124 Binge eating, 25 Bioassays, see Laboratory methods Bioelectric impedance analysis, 144 Biologic markers accuracy of, 26, 28 alcoholism, 93 animal fat intake, 221 atherosclerosis, 29 carcinogen exposure, 51, 385 colorectal cancer, 212 energy intake, 28 fatty acids, 28 food intake, 26, 27 hemochromatosis, 92 hyperlipoproteinemia, 170 iron nutritional status, 50, 92 lead intake, 29 osteoporosis, 29 protein intake, 27, 28 selenium, 28 sodium or salt intake, 28, 414 value of, 28 validity checks against, 27, 28 see also Dietary data; Genetic markers Biotin animal studies of, 340 cancer and, 340 ESADD, 48 human studies of, 340 liver disease and, 340 safety index, 518 Blacks adherence to dietary guidelines, 80 alcohol intake by, 61, 433, 434 atherosclerosis in, 166 blood pressure in, 95, 111 cancer incidence in, 118, 119, 120, 209, 212, 339, 475 CHD in, 102, 333, 532 cholesterol intake trends among, 58, 161 diabetes mellitus in, 123, 333 fat intake by, 224 hypertension in, 11, 89, 95, 109, 111-112, 394, 416-417, 419, 420, 660 hypolactasia in, 88 nutrient intakes by, 69, 70-71, 73 obesity and overweight in, 90, 115-116 osteoporosis in, 122 red-cell sodium/lithium countertransport in, 89 sickle-cell disease among, 94 stroke deaths and incidence in, 15, 104, 672 see also Race or ethnicity Bladder cancer cholesterol intake and, 210 cigarette smoking and, 599 coffee and tea and, 467, 599, 603 epidemiologic studies of, 467, 599 fat intake and, 599 food additives and, 476, 477 nitrates and, 475 nonnutritive sweeteners and, 471, 473, 599, 603 population differences in, 120, 599 protective dietary components for, 9, 377, 599 schistosomiasis and, 120 sex differences in, 120 trace element intake and, 387 vitamin A and, 313-315, 599, 602, 658 vitamin C and, 333 vitamin E and, 319 Blindness, 124, 316 Blood pressure age and, 109-110, 416 amino acid deficiencies and, 262 alcohol intake and, 415, 420, 442-443, 452 arterial, 417 atherosclerotic cardiovascular diseases and, 103, 112-113, 148 body weight and, 10, 112, 117, 146, 148, 417, 420, 659 calcium intake and, 11, 17, 262-262, 355, 356, 515, 661 cerebral vascular accidents and, 113 CHD and, 103, 107, 112-113, 376, 382, 444, 535 classification of, 107, 549-550 congestive heart failure and, 113 energy intake and, 148 environmental factors in, 112 fat intake and, 202-205 genetic or familial factors in, 112, 418 hypertensive levels, 11, 107, 415; see also Hypertension intermittent claudication and, 107 kidney disease and, 107, 418 lead intake and, 394 linoleic acid intake and, 202, 204, 205 magnesium intake and, 358-359, 360 malnutrition and, 261 measurement of, 111 milk intake and, 262-262, 355 MUFA intake and, 204 myocardial infarction and, 148 normotension levels, 107, 414 obesity and, 112, 415, 420 population differences in, 108, 201-204, 550 potassium intake and, 11, 202, 203-204, 262-262, 355, 414, 416, 422, 424 protein intake and, 261, 262, 355 psychosocial stress and, 415, 417, 420 PUFA intake and, 204-205 (continued on next page)

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Page 716 (continued from previous page) racial or ethnic differences in, 95, 111, 417 salt/sodium intake and, 11, 16-17, 89, 202-205, 414-417, 422-424, 660, 674 sex differentials in, 110-111, 442 SFA intake and, 203-205 stroke and, 11, 105, 107, 202, 442, 443 sucrose intake and, 149 survey data on, 550 trace element intake and, 375, 382, 386 tracking phenomenon, 110 variation in, 549 of vegetarians, 201, 202, 300, 302 see also Hypertension Bloom's syndrome, 91 Body density measurement, 143 Body fat distribution abdominal, 10, 16, 105, 144, 565, 659, 673 atherosclerotic cardiovascular diseases and, 114, 117, 148 body weight and, 565 cancer and, 16, 673 CHD and, 10, 16, 144, 659, 673 diabetes mellitus and, 10, 16, 114, 117, 123, 144, 659, 673 endometrial cancer and, 144 energy intake and, 144, 148 femoral, 10, 659, 673 gallbladder disease and, 16, 673 gluteal, 10, 144, 565, 659, 673 heritability of, 90 hypertension and, 10, 16, 144, 659, 673 measurement of, 114, 144, 565-567 obesity and, 578 osteoarthritis and, 16, 673 during pregnancy and lactation, 145 prospective epidemiologic studies of, 578 stability of, 566-567 standards for, 565 stroke and, 10, 105, 117, 144, 659 waist-hip ratios, 16, 114, 117, 144, 148, 565-567, 578 Body fat/fatness age and, 139, 146 alcohol intake and, 450 blood pressure and, 112 body weight and, 139 carbohydrate and, 276 cardiovascular disease risk and, 148-149 energy balance and, 143-144, 153 energy intake and, 144-145, 281, 282 extreme leanness, 10, 659 heritability of, 117 measurement of, 114, 143-144 physical exercise and, 139, 144, 146, 151 stability of, 566-567 in twins, 90 see also Obesity; Triglycerides; Body fat distribution Body mass index atherosclerotic cardiovascular disease and, 148 carbohydrate intake and, 281 CHD and, 103 defined, 114 diabetes mellitus mortality and, 117 energy intake and, 144, 148, 221, 281 fat intake and, 221, 281 gallbladder mortality and, 117 mortality rates and, 569-570 obesity and, 90, 564-565, 566, 569-570 protein intake and, 281 skinfold measurements compared to, 114 trends, 16, 673 weight-height ratios and, 563-565, 673, 678 Body weight age and, 115 alcohol intake and, 432, 436, 450 animal studies of, 145, 577 blood pressure and, 10, 112, 117, 148, 417, 420, 659 body fat and, 139, 565, 577 body mass index and, 564-565 cancer and, 10, 16, 659, 673 carbohydrate intake and, 276, 277 CHD and, 10, 16, 103, 659, 673 clinical data on, 144-145 cycles of loss and gain, 577, 659, 676 determinants of, 7, 52, 53 diabetes mellitus and, 10, 16, 149, 659, 673 energy balance and, 139, 144-145, 153 energy expenditure and, 142, 153 energy intake and, 7, 14, 52-53, 139, 144-145, 153, 282, 673 epidemiologic data on, 144, 153, 576-577 fat intake and, 7, 144, 202, 222, 656, 671 fluctuations in, 576-577 gains, 576-577 gallbladder disease and, 10, 16, 659, 673 glucose tolerance and, 10, 148, 659 HDL cholesterol and, 146, 148 hypertension and, 10, 16, 108, 112, 419, 420, 659, 673 insulin levels and, 148 intermittent claudication and, 107 LDL cholesterol and, 146 losses, 577, 659 obesity and, 144, 576-577, 659 osteoarthritis and, 16, 673 osteoporosis and, 69 physical activity and, 53, 146, 152, 673 plasma or serum lipids and, 10, 148, 659 plasma triglycerides and, 148 recommendations, 676, 686-688 relative, defined, 114 standards of, 114, 563-565 stroke and, 105 trends in, 16, 52, 77, 221 of vegetarians, 77 see also Overweight Bone density losses alcoholism and, 451 calcium supplementation for, 515 detection of, 29, 120-121 estrogen therapy for, 515 incidence indicators, 29 osteoporosis and, 350, 515 phosphorus and, 358 see also Osteoporosis Bone fractures age and, 121 alcoholism and, 451 calcium intake and, 11, 17, 353, 515 fluoride and, 373, 375, 619 osteoporotic, 29, 121, 316-319, 350, 353, 621 sex and, 121 vitamin D and, 316-318 Bone mass age and, 120-121, 264 alcoholism and, 451 bone cell activities and, 349-350 calcium intake and, 349-353 estimation of, 351 hormonal status and, 121, 350 measurement of, 318 mineral balance and, 264, 349-350, 615 osteoporosis and, 350 sex and, 120 supplementation with calcium and, 352-353 vitamin D and, 316-318, 350, 353 Bosnia, CHD in, 164 Bowel, large, see Colon cancer Bowel cancer, see Colon cancer Bracken fern toxin, 489 Brain tumors, 211 Bran, 80, 278, 301; see also specific brans Brassicasterol, 201 Breads and rolls, 15, 18, 58, 62, 74, 76, 80, 81, 179, 279, 299, 302, 330, 672, 675 Breakfast cereals, 42, 64, 74, 75, 80, 279-280, 311, 330, 668 Breast cancer age and, 119, 120, 299 alcohol and, 10, 439, 598, 660 animal studies of, 150, 151, 213, 214 anthropomorphic measures and, 598 carbohydrates and, 282, 598 caloric intake and, 150, 151, 598 coffee and tea and, 468 dietary cholesterol and, 210, 439 early diagnosis of, 120 ecogenetic factors in, 91 endocrine-related, 204, 210 energy expenditure and, 152 epidemiologic studies of, 207-208, 210, 215, 229, 263, 299, 468, 598 fat intake and, 7, 14, 30, 31, 77, 205-208, 210, 214, 215, 229, 263, 282, 439, 598, 656, 671 fiber and, 77, 207, 263, 299, 302, 598, 659 folacin and, 338 genetic and familial factors in, 119-120, 439 genetic markers of, 120 incidence of, 593 hormonal status and, 117, 207, 214, 575, 598 mortality rates, 120, 439, 598, 655 nonnutritional risk factors, 439 obesity and, 117, 575, 598, 659 other cancers associated with, 118, 120 physical exercise and, 153 population differences in, 119, 206, 207 postmenopausal, 117 prevention of, 19 protective dietary components for, 9, 207, 213, 313, 332, 377 protein and, 9, 207, 263, 598 (continued on next page)

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Page 717 (continued from previous page) public information programs on, 77, 120 racial, ethnic, and migrant differences in, 119, 207, 208, 598 riboflavin and, 335 sex differential in, 119-120 SFAs and, 8, 206, 207, 210, 215, 439, 598, 656 socioeconomic status and, 119 trace elements and, 380, 383-384, 389 vitamin A and, 313, 315, 439, 658 vitamin B6 and, 337 vitamin B12and, 339, 341 vitamin E and, 318, 319, 322, 439 Breast milk, 222, 223 Brewer's yeast, 76, 381 Broca Index, 114 Broccoli, 69, 73, 81, 329, 488, 654; see also Cruciferous vegetables Brussels sprouts. 80, 81, 297. 488, see also Cruciferous vegetables Bulgaria, CHD death rates in, 100-101 Bulimia, 583, 584-585 Burke, Bertha, 24 Butter, 10, 57, 80, 160, 179, 186, 187, 207, 213, 220, 311, 312, 315, 480, 654 Butterfat, 159, 186, 189 n-Butyl-n-(4-hydroxybutyl)-nitrosamine, 333 Butylated hydroxyanisole (BHA), 476-477, 662 Butylated hydroxytoluene (BHT), 12, 441, 476, 477-478, 662 C Cabbage, 80, 81, 208, 297, 329, 433, 488, 657 Cadmium, 379, 388-390, 394 Caffeine cancer and, 468 hazards of, 5, 655 intake trends, 466 mutagenicity of, 469 sources of, 466 teratogenicity of, 470-471 Cafestol palmitate, 467 Cakes, 56, 58, 73, 81 Calcitonin, 355 Calcitriol, 355 Calcium absorption of, 301, 312, 316, 317, 322, 349-351, 355, 359-360, 616, 667 age and intake of, 17, 69, 76, 264-265, 317, 347-351, 353, 354, 616, 617 alcoholism and, 450-452 animal studies of, 354, 356, 357 availability trends, 53, 69 balance, 16, 264-265, 317, 349-350, 355, 616, 659 bone fracture and, 11, 17, 353, 616-617 bone mass and, 349-353, 517, 616-617 biologic role of, 17, 316, 347, 360, 661 blood pressure and, 11, 17, 261-262, 355, 356, 515, 553, 661 cancer and, 11, 356-357, 514, 661 CHD and, 515, 666 clinical studies of, 351-354, 355-356, 616-617 dental caries and, 281, 642 drug interaction with, 355 epidemiologic studies of, 351-352, 355, 356-357, 616-617, 654 estimation of intake, 351 estrogen status and, 354, 360, 617 fiber intake and, 301, 302, 354-355 food composition data availability on, 46-48 food sources of, 5, 17, 18, 69, 74, 92, 349, 666, 667, 674, 675 hyperparathyroidism and, 616, 619 hypertension and, 17, 355-356, 360, 415, 417 intake trends, 41, 69, 75, 77-79, 81, 348-349 magnesium and, 517 monitoring status, 69, 74, 81, 349 nutritional status, 69, 75, 81, 349 osteoporosis and, 5, 11, 17, 33, 264, 317, 318, 349-355, 359, 375, 515, 616-617, 619, 654, 659, 661, 666, 674 phosphorus and, 265, 354, 357-358, 360, 617-618 populations at risk of deficiencies in, 17, 76, 671, 674 protective effects of, 11, 261, 281, 357, 515 protein intake and, 354, 517, 659, 673 RDA, 48, 69, 348, 350, 360 recommended intake of, 17, 666, 674, 678, 680, 681 safety index, 518 serum cholesterol and, 261 standards for, 48 supplementation, 11, 17, 352-354, 356, 360, 514, 515, 517, 518, 553, 617, 661, 674, 680 from tap water, 25 toxicity, 517, 518 vitamin D and, 312, 316, 322, 353, 356, 616 California cancer in, 118, 119, 210, 297 CHD in, 102, 164, 445 hypertension in, 355 obesity and overweight in, 114-115 PAD in, 106 serum cholesterol levels in, 163 stroke in, 104-105 Calories alcoholic beverages, 436 fat, 14, 671 snack foods, 76 sources of, 15, 54, 56, 59, 62, 62, 80, 654, 672 see also Energy balance; Energy expenditure; Energy intake; Energy stores/storage; Food energy; Low-calorie diets Calorimetry, 141 Cameroon, dental caries in, 127 Campesterol, 201 Canada alcoholic cirrhosis in, 125 cancer in, 207, 282, 297, 299, 331, 388, 437, 467-468, 471-472, 475, 489, 699 CHD in, 100-101 dietary intake trends in, 224 dietary recommendations in, 682, 686-688 hypertension in, 442 obesity and overweight in, 114-115 Cancer acrylonitrile and, 481-482 aflatoxins and, 486-487 alcohol intake and, 16, 437-442, 673 aluminum and, 387 animal studies of, 8, 150-151, 153, 213-215, 282-283, 314, 315-316, 319-320, 321, 332-333, 335-340, 357, 368-369, 371-372, 378, 381-387, 389, 391, 392, 394-395, 468-469, 472, 473-474, 476-477, 483-484. 576, 600-604 arsenic and, 392 aspartame and, 473-474 BHA and, 12, 476-477, 662 BHT and, 12, 477-478, 662 biotin and, 340 cadmium and, 388-389 calcium and, 356-357, 514, 603 caloric intake and, 150-151 carbohydrates and, 282, 336, 601-602, 657-658 b-carotene/carotenoids and, 15, 313-314, 658 chromium and, 382-383 cigarette smoking and, 91 classification of, 117 clinical and metabolic studies of, 211-213, 282, 321, 368, 370-371, 380-381, 385, 576 coffee and tea consumption and, 12, 467-469, 662 copper and, 380-381 country differences in occurrence of, 117; see also specific countries cyclamate and, 472-473 defined, 117 detection of, 29 diagnosis of, 117 dietary cholesterol and, 210 dietary data for studies of, 24 dietary guidelines for prevention of, 676, 679, 688 dietary modification and, 699-701 dietary supplementation and, 514 diethylstilbestrol and, 482 DNA repair mechanisms and, 91 ecogenetic factors in, 91 energy expenditure and, 152-153 energy intake and, 150-151, 153 environmental factors in, 12, 19, 91 epidemiologic studies of, 150, 152-153, 206-210, 263-264, 282, 313, 315, 318-319, 331-332, 356-357, 368, 370-371, 374, 377-378, 382, 383-384, 386, 387, 389-391, 392, 394, 437-439, 467-468, 471-473, 483, 575-576, 594-600, 689 ethyl carbamate and, 486 fats and, 6-8, 13-14, 54, 153, 205-210, 225-226, 228-229, 600-601, 656, 666, 668, 670, 671 fiber and, 6, 15, 80, 296-299, 303, 602, 658 fluoride and, 11, 17, 374-375 folacin and, 338, 658 food colors and, 478-479 food storage and preparation and, 51 (continued on next page)

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Page 718 (continued from previous page) genetic and familial factors in, 91, 94, 211 human studies of, 334-340 in vitro assays, 314, 316 iodine and, 383-384, 603 iron and, 368-369, 603 latency periods, 12, 51, 662 lead and, 393-394 linoleic acid and, 208, 213, 227 manganese and, 385 mechanisms of action in, 441 mercury and, 390-391 metastasis, 213, 333, 372 molybdenum and, 386-387, 603 mortality rates, 6, 654, 700 naturally occurring toxicants and, 12, 486-490, 662 nitrates, nitrites, and N-nitroso compounds and, 474 nonnutritive dietary components and, 603-604, 662 niacin and, 336 obesity and, 117, 221, 575-576, 676 pantothenic acid and, 340 PBBs and, 480 PCBs and, 479-480 pesticides and, 12, 43, 483-484, 662 plant food intake and, 8 polycyclic aromatic hydrocarbons and, 481 polyvinyl chloride and, 480-481 protective effects of foods and nutrients for, 6, 8, 11, 15, 488, 657-658, 666, 672 prevention of, 19, 699-701 protein and, 15-16, 263-264, 601 public perceptions of risk factors for, 80 PUFAs and, 8, 14, 174, 194, 229, 657, 672 research objectives and priorities, 21, 51, 230, 284, 322-323, 341, 395-396, 492-493, 604-605 retinol and other retinoids and, 315-316, 658 riboflavin and, 334-335, 658 saccharin and, 12, 471-472, 662 salt and, 17, 603 selenium and, 11, 319, 377-378, 602, 661 serum cholesterol and, 14, 174, 210-211, 229, 671, 692-693, 689 short-term tests for, 369, 372, 374-375, 378, 383, 385, 387, 389, 391, 392, 394, 469, 472, 473-474, 477-478 thiamin and, 334 trace elements and, 6, 395, 602-603, 666; see also specific trace elements tryptophan and, 486 in United States, 117-120, 593-594 vitamin A and, 51, 313-314, 315-316, 514, 516, 602, 658 vitamin B6 and, 337 vitamin B12 and, 339, 658 vitamin C and, 331-333, 514, 602, 658 vitamin E and, 318-320, 602, 658 vitamin K and, 321, 602 zinc and, 370-372, 514, 602-603 see also specific cancer sites Canavanine, 490 Candies, 58, 74 Canola oil, 13, 671 Canthaxanthin, 314 Carbohydrates in alcoholic beverages, 436 animal studies of, 276-278, 280-283 apolipoprotein levels and, 276, 277 atherosclerotic cardiovascular diseases and, 278-279, 532-533, 672 attention-deficit disorders and, 283 availability trends, 53, 58-59, 80, 274, 654 blood pressure and, 203 body fat and, 282 body mass index and, 281 body weight and, 277, 282 calories from, 59, 80, 140, 654 cancer and, 282-283, 284, 336, 657, 658, 672, 695 categories of, 58 CHD and, 278-279, 284, 657 clinical studies of, 275-276, 277, 279-282 complex, defined, 273 criminality and, 283, 284 data sources on availability of, 47 dental caries and, 9, 127, 279-281, 284, 658, 672 energy expenditure for storage as fat, 140, 151, 221 energy intake from, 139-140 epidemiologic evidence on, 274-275, 279, 281, 282 food sources of, 14, 55, 59-60, 76, 273-274, 654, 671, 672, 675 gallstones and, 300 glucose tolerance and, 9, 274, 277, 284, 385, 657, 658 glycemic index, see Glucose tolerance glycosuria and, 277 HDL cholesterol and, 276, 278-279 hyperactivity and, 283, 284 hypercholesterolemia and, 275 hyperglycemia and, 275-277, 283, 284 hyperlipidemia and, 277 hypertriglyceridemia and, 275, 276, 278 IDDM and, 277-278 indigestible, see Fiber insulin levels and, 9, 149, 275, 277, 284, 385, 658 intake trends, 15, 54, 59, 76, 142, 273-274 interactions with other dietary constituents, 281, 330 lactose intolerance and, 283-284 LDL cholesterol and, 13, 276, 278, 671 metabolism of, 59 monitoring status, 81 NIDDM and, 9, 274-277, 284, 299, 658 obesity and, 9, 221, 277, 281-282, 284 protective effects of, 281 recommended intake of, 14, 15, 17, 18, 669-670, 671, 672, 675, 677-680, 682-683, 686 refined, 127 renal disease and, 277-278 retinopathy and, 277 serum cholesterol and, 261, 276-278 simple, defined, 273 triglyceride levels and, 275, 277, 278, 658 VLDL levels and, 275 see also Fiber; Sugars; and specific carbohydrates Carcinogenesis animal studies of, 33, 153, 213-215 caloric intake and, 150-151, 215 dietary fat and, 213-215 dose-response relationships in, 36 mechanisms of action in, 320, 335, 378-379, 477-478 nutritional deficiencies and, 441-442 short-term tests for, 34, 369, 372, 374-375, 378, 383, 385, 387, 389, 391, 392, 394 see also Cancer; Carcinogens Carcinogens biologic markers of exposure to, 51 epigenetic, 34 ethanol activation of, 440 metabolism of, 91 mutagenic action of, 91 produced in cooked foods, 481, 485-486 see also Cancer; Carcinogenesis; and specific carcinogens Cardiac function, obesity and, 578-579 Cardiac hypertrophy, 29 Cardiovascular diseases body weight and, 10, 659 in children, 222 dietary cholesterol and, 6, 196-201 magnesium intake and, 359 mortality rates from, 162 phospholipids and, 217 w-3 PUFAs and, 11-90 see also Atherosclerotic cardiovascular diseases Cardiovascular function, physical exercise and, 151-152 b-Carotenes and other carotenoids animal studies of, 314 antioxidant effects of, 314 cancer and, 9, 207, 313-314, 318, 322, 334, 341, 488, 658, 672, 695 data sources on availability of, 47-48 food sources of, 64, 311, 654 human studies of, 313-314 hypercarotenemia and, 314 in vitro studies of, 314 intake trends, 64, 82, 311, 312 mechanisms of action, 15, 314 protective effects of, 9, 15, 207, 302, 314, 322, 341, 488, 658, 672 see also Vitamin A Carotenodermia, 314 Carotenoids with no vitamin A activity cancer and, 314 inclusion in dietary surveys, 51 Carrageenan, 291 Carrots, 64, 73, 82, 279, 311, 654 Case-comparison studies cancer, 313, 315, 514 CHD, 444, 445 stroke, 443 Case-control studies alcohol intake, 437-439, 446 cancer, 153, 207-211, 263, 264, 282, 297-299, 302, 331-332, 356, 371, 377, 387-389, 437-439, 467, 471, 472, 488, 489, 514 cigarette smoking, 437 (continued on next page)

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Page 719 (continued from previous page) dietary intake assessment methods in, 24-25, 27, 208 dietary supplements, 514 hypertension, 358 methodological considerations in, 31, 193, 470, 653 myocardial infarction, 162 PAD, 175 reliability of, 31 strengths and weaknesses of, 31, 193, 208 weight of evidence for causation, 4. 35, 37, 653 see also Epidemiologic evidence, studies, and cohorts Casein, 261, 281, 295 Catechol, 490 Catecholamines, 142 Cauliflower, 80, 81, 297, 654 Celery, 489 Celiac disease, 321 Cell cultures barking deer fibroblasts, 478 Chinese hamster cells, 385, 391, 394, 461, 477, 478, 480, 485 cholesterol autooxidation products and, 201 hamster embryo, 374-375, 383, 385, 482, 485 HeLa cells, 482 human fetal lung fibroblasts, 476 human lymphocytes, 389, 480 mouse lymphoma cells, 383, 482 Novikoff ascite hepatoma cells, 383 rat alveolar macrophages, 387 Syrian hamster cells, 389, 392, 394, 482 trace element carcinogenicity, 374-375, 383, 387 see also In vitro studies and methods; Mutagenicity tests; Short-term tests and studies Cellulose, 291-293, 295, 298-302 Centers for Disease Control, nutrition monitoring by, 44 Central America, alcohol intake in, 433 Central nervous system genetic variation in, 88 hypertension and, 418 nutrient roles in functions of, 159 Cereal grains and cereal grain products BHA and BHT in, 476 enrichment of, 66, 74, 75, 368 intake trends, 41, 59-60, 76, 80, 260, 293, 654 malted, 273 in meat mixtures, 75 nitrites in, 475 nutrient contribution of, 43, 62, 66, 259, 260, 273, 293, 312, 349, 370, 373, 385 nutrient losses during refining, 70 protective effects of, 8, 295, 296, 302, 666 recommended intake of, 13-15, 18, 670, 671, 672, 675 see also Breakfast cereals; Grains and grain products; Whole grains and whole-grain products Cerebral hemorrhage, 103, 104, 105, 176, 194, 442, 531; see also Stroke Cerebral infarction, 103, 104, 105, 113, 423, 442, 443, 530-531: see also Stroke Cerebral thrombosis, 176, 442 Cerebral vascular accidents, 113 Cerebrovascular disease diabetes mellitus and, 124 intermittent claudication and, 175 w-3 PUFAs and, 192 see also Stroke Cervical cancer, 313, 338, 377, 380, 575 Cervical dysplasia, 332, 338 Chaconine, 489 CHD, see Coronary heart disease Cheese, 18, 56, 57, 66, 69, 71, 72, 160, 179, 194, 207, 209, 280, 281, 370, 387, 654, 675 Cheeseburgers, 56 Chicken, 73; see also Poultry Children, see Infants and children Chile alcohol-related deficiencies in, 451 cancer in, 421, 475 peripheral vascular disease in, 391 China arteriosclerosis in, 162 atherosclerotic cardiovascular diseases in, 376 cancer in, 118, 313, 315, 334, 341, 371, 386, 475, 487 gallbladder disease and gallstones in, 126 hyperlipidemia in, 443 hypertension in, 108, 415 vitamin deficiencies in, 334, 341 Chinese hamster ovary, see Cell cultures: Mutagenicity tests Chloride, 48, 423-424 Chlorogenic acid, 467 Chlorophyll, 70 Chocolate, 280, 466 Cholcalciferol, see Vitamin D Cholecystitis, 125 Cholelithiasis bile composition and, 219, 220 cholecystitis and, 125 clinical/metabolic studies of, 218-219 ecogenetic factors in, 219 incidence of, 29, 127 nutritional factors in, 124, 195, 218, 220, 229 see also Gallbladder disease and gallstones Cholestane triol, 201 Cholesterol, see Dietary cholesterol; HDL cholesterol; LDL cholesterol; Serum or plasma cholesterol Cholesteryl esters, 162, 169, 176-177 Cholestyramine, 167 Choline, 160, 216-217, 338, 339, 448, 449 Chromium animal studies of, 382-383 atherosclerotic cardiovascular diseases and, 381-382 biologic role of, 381 cancer and, 382, 395 CHD and, 515 clinical studies of, 381-382, 383 data sources on availability in food supply, 47 diabetes and, 383 epidemiologic studies of, 381-382 ESADDI, 48 food sources of, 381 glucose metabolism and, 381, 382, 515 intake trends, 381 protective of, 277 serum cholesterol and, 515 short-term tests of, 383 supplementation, 382, 515 Chrysene, 441 Chylomicrons, 162-163, 177, 296, 443 Cigarette smoking alcohol consumption and, 10, 437, 444, 445 cancer and, 10, 91, 210, 322, 368, 389, 437-438, 467, 660 cerebral infarction and, 105 CHD and, 101, 103, 151, 195, 444, 445, 531, 535 gallbladder disease and, 127 intermittent claudication and, 106, 107 myocardial infarction and, 148 osteoporosis and, 621 PAD and, 106, 107, 531 stroke and, 105, 443 trace element intake from, 376, 389, 390, 392 vitamin C deficiencies and, 68 Cirrhosis of the liver alcohol intake and, 633-634; see also Alcoholic cirrhosis biliary, 320 causes of, 124, 320, 321, 633 childhood, 381 classification of, 124 definition, 124 diagnosis of, 124 essential features of, 124, 633 incidence indicators, 29 morbidity and mortality, 125, 633 niacin and, 336 vitamin B6 and, 337-338 vitamin B12 and, 339 vitamin K and, 321 Citric acid cycle, 448 Citrus fruits, 9, 15, 18, 60, 61, 67, 293, 298, 329, 331, 654, 657, 672, 675 Clinical studies and trials alcohol intake and chronic disease, 448 aluminum intake and chronic disease, 387-388 Alzheimer's disease, 387-388 angiographic end points, 171-172 atherosclerotic cardiovascular diseases, 148, 151, 198-200, 376, 380, 381-382, 571-572 body weight fluctuations, 577 , calcium intake and chronic disease, 351-352, 355-357, 654 calcium supplementation, 352-354 cancer, 211-213, 282, 321, 356-357, 368, 370-371, 380-381, 385, 576 carbohydrates, 275-276, 277-278, 279-280, 281, 282, 638-640 CHD, 171-175, 193, 194-195, 260-261, 295, 534-535 cholelithiasis, 219 chromium intake and chronic disease, 381-382, 383 copper intake and chronic disease, 380-381 (continued on next page)

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Page 720 (continued from previous page) crossover, 203 dental caries, 279-280, 638-641 design of, 32-33 diabetes mellitus, 149, 152, 153, 299, 372, 383, 385, 573-574, 628-629 dietary cholesterol and chronic disease, 198-199, 218 diverticulosis, 300 double-blind, 32-33, 173, 203, 216, 320 endocrine disorders, 581-582 energy balance and body weight, 144-145 energy expenditure and chronic disease, 151, 152 energy expenditure-storage relationship, 145-146 energy intake and chronic disease, 148, 149, 153, 219 exposure duration in, 32 fat or lipid intake, 7, 201-204, 218-219, 221 trans fatty acids and, 193 fiber intake and chronic disease, 295, 299, 300, 301 fluoride intake and chronic disease, 375, 640-641 gallbladder disease and gallstones, 218-219, 301, 575 hematologic responses to chronic disease, 579-580 hyperlipidemia, 295 hypertension, 202-204, 262, 300, 355-356, 394, 417 IDDM, 277 immunologic responses to chronic disease, 579-580 iron intake and chronic disease, 368 large-scale preventive trials, 172-175 lead intake and chronic disease, 394-395 liver disease, 448 manganese intake and chronic disease, 385 metabolic studies, 33, 35, 140-141, 143, 182-189, 193, 198, 211-213, 275, 277, 448 MUFA intake and chronic disease, 184 NIDDM, 273-274 Nurses' Health Study, 221 obesity, 7, 221, 281, 573-574, 575, 576, 577, 579-580, 581-582 osteoarthritis, 580 osteoporosis and osteomalacia, 264-265, 316-317, 351-352, 372, 375, 654 physical activity and chronic disease, 153 protein intake and chronic disease, 260-261, 262, 264-265 PUFA intake and chronic disease, 184-186, 218-219 randomized, 194-195, 203, 261, 320 renal disease (chronic), 265, 394-395 response to serum cholesterol, 198 selenium intake and chronic disease, 376 SFA intake and chronic disease, 182-184 small-scale, 171-172, 653 sodium intake and chronic disease, 417-418 strengths and weaknesses of, 4, 32-33, 653 uses, 32 vitamin D intake and chronic disease, 316-317 vitamin E intake and chronic disease, 320 vitamin K intake and chronic disease, 321 weight of evidence for causation, 35 zinc intake and chronic disease, 370-371, 372-373 see also Intervention trials; Randomized clinical studies Cobalamin, see Vitamin B12 Cocarcinogens, activation of, 440; see also Ethanol Cocoa, 281 Cocoa butter, 183 Coconut oil, 13, 159, 182, 183, 184, 186, 187, 189, 196, 204, 205, 213, 220, 223, 670 Cod liver oil, 191 Coenzyme Q, 320 Coffee and tea animal studies of, 468-469, 470-471 availability trends, 60, 61 cancer and, 12, 467-469, 662 CHD and. 11-12, 192, 469-470, 662 decaffeinated coffee, 60, 466, 469 epidemiologic studies of, 11-12, 467-468, 469-470 fluoride in tea, 74 intake patterns, 60, 76, 466-467 reproductive effects of, 470-471 serum cholesterol and, 11, 469, 533, 662 short-term tests of, 469 see also Caffeine Cognitive development and function, 395, 449 Cohort studies, see Epidemiologic evidence, studies, and cohorts; Longitudinal (cohort) studies Collagen, 191 Collard greens, 69, 349 Colles' fracture, 121 Colombia, cancer in, 384, 475 Colon cancer adenomatous polyps and, 211 animal studies of, 151, 213, 297-298, 600 biologic markers of, 212 calcium and. 11, 356, 514, 661 caloric intake and. 151, 263, 595-596 carbohydrates and, 282 b-carotene and, 314 cholesterol intake and, 174, 210 clinical studies of, 212 coffee and tea and, 467-468 Dukes' A and B, 211 ecogenetic factors in, 91 epidemiologic studies of, 153, 211, 263, 296-297, 467-468 familial polyposis and, 91 fat intake and, 14, 205, 209, 282, 357, 600-601, 656, 671, 693 trans fatty acids and, 213, 600-601 fiber and, 6, 9, 210, 212, 296-298, 302, 303, 357, 602, 658, 666 folacin and, 338 food additives and, 476-477 genetic and familial factors in, 91, 118 mortality rates, 690-691 MUFAs and, 601 obesity and, 575 pantothenic acid and, 340 physical activity and, 153 population differences in, 212, 296 prevention of, 6, 19 protective dietary components for, 8, 11, 15, 303, 315, 322, 341, 377, 488, 672 protein and, 9, 263, 659 PUFAs and, 213, 600 serum cholesterol and, 14, 206, 210, 211, 671. 692-693 sex differences in, 118 SFAs and, 8, 174, 215, 656, 692-693 trace elements and, 368, 377, 380, 385, 393 vitamin B12 and, 339, 341 vitamin C and, 332, 333, 341 vitamin E and, 319, 322 Colorectal cancer alcohol intake and, 438, 596 calcium and, 356, 357, 360, 596 carbohydrates and, 208 dietary cholesterol and, 210, 596 endocrine-related, 210 epidemiologic studies of, 152-153, 208-209, 282, 284, 438, 595-596, 654, 657 fat intake and, 7, 77, 206, 208-209, 215, 595 fiber and, 77, 208, 296, 297, 302, 488, 596 incidence and mortality from, 118-119 linoleic acid and, 208 other cancers associated with, 118, 120, 595 meats and, 208, 596 MUFAs and, 596 physical activity and, 152-153 protective dietary components for, 208, 314, 596 protein and, 208, 598-599 public information programs on, 77 racial, ethnic, and migrant differences in, 118 sex differences in, 118, 119, 208 SFAs and, 208, 692-693 U.S. rates of, 118, 593 vitamin A and, 314, 658, 596 vitamin C and, 332, 514, 596 Coloring dyes, 74 Community trials Busselton Community Study, 210 hypertension, 202, 693 Computed tomography, 104, 144, 175, 351-353 Condiment sauces, 72 Conference of Health Effects of Blood Liproproteins, 164 Confounding/confounders in case-comparison studies, 443 in CHD studies, 284 in cross-sectional comparisons, 24, 204, 228 defined, 30 in dietary intake data, 185, 194, 197. 274, 284 (continued on next page)

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Page 721 (continued from previous page) in obesity studies, 114 in temporal relationships, 30-31 Congeners, 441 Congenital malformations, 124 Congestive heart failure, 29, 113, 124, 175 Connecticut cancer in, 467 CHD in, 102 Constipation, 302, 354 Contaminants, environmental carcinogenicity of, 12, 662 naturally occurring, 12, 486-490 survey data on, 51 see also Aflatoxins; Pesticides; and other specific contaminants Continuing Surveys of Food Intakes of Individuals (CSFII) bias in, 55, 161 corrections to data base, 46 dietary intake data reported by, 53-55, 62-67, 69, 70-73, 160-161, 274, 293, 312, 329-331, 348, 368, 466, 509, 511 methods in, 42, 45-46 nutrients and food constituents reported in, 47, 62-74, 312 populations represented by, 44-45, 49 Cookies, 18, 58, 81, 675 Coordinated State Surveillance System, 44 Copper absorption, 379 anemia and, 381 animal studies of, 380, 381 atherosclerotic cardiovascular diseases and, 370, 380, 395 biologic role of, 379 cancer and, 380-381 cirrhosis and, 381 clinical studies of, 380-381 in contraceptive devices, 381 coronary arrhythmias and, 380 data sources on availability of, 47-48, 51 environmental sources of, 381 epidemiologic studies of, 380-381 ESADDI, 48, 72, 379 excess intake of, 381 fiber and, 301 food sources of, 72 hypertension and, 390 intake trends, 72, 379 interaction with other trace elements, 370, 373, 379, 380, 386, 390, 395, 517 metabolic disorders from, 124 safety index, 518 supplementation, 380 Corn bran, 299 Corn oil, 64, 159, 183, 184, 186, 187, 189, 204, 205, 213, 214, 220, 223, 261, 277, 671 Corn products, 57 Corn sweeteners, 58, 60 Corn syrups, 273, 274, 281, 654 Cornstarch, 277, 278, 281 Coronary artery disease, 190, 192, 278, 333, 376, 659; see also Coronary heart disease; Peripheral arterial disease; Stroke Coronary heart disease (CHD) age and, 101, 102, 167, 445, 532 alcohol intake and, 16, 444-446, 533, 660, 673, 695 animal studies of, 261, 295-296, 532-533 apolipoproteins and, 88, 168-171, 534, 536 blood pressure and, 103, 107, 112-113, 376, 382, 535 body fat distribution and, 16, 144, 659 body mass index and, 103 body weight and, 16, 103, 673 calcium and, 515, 666 carbohydrates and, 8, 278-279, 284, 533, 657-658 case fatalities, 102 in children, 222, 225 cholesterol intake and, 8, 14, 31, 33, 58, 77, 80, 103, 161, 197-198, 228, 534-536, 657, 668, 670, 694 cigarette smoking and, 101, 151, 195, 444, 445, 534, 535, 571 clinical trials of, 11-12, 171-175, 194-195, 218, 260-261, 295, 534-535 coffee and tea and, 11-12, 469-470, 533, 534, 662 commonality of risk and protective factors for, 693 coronary-prone behavior and personality and, 103, 537 country differences in incidence of, 31, 100-101, 104 diabetes mellitus and, 103, 124, 171 diet trial feasibility for, 32 eating patterns and, 103 end points, 172-175 energy intake and, 148, 534, 536-537 epidemiologic evidence on, 102, 163-171, 197-198, 260, 294-295, 369, 469-470, 533-534 ethnic, racial, and migrant differences in, 102, 149, 178 fat intake and, 5, 7, 31, 33, 54, 77, 80, 93, 102, 161, 278, 656 fiber and, 9, 294-296, 302, 303, 533, 534, 658 fish consumption and, 8, 13, 185, 192, 193, 657, 671 foods correlated with, 192 gallbladder disease and, 127 genetic and familial factors in, 86, 88-89, 93, 103, 171, 224, 536 HDL cholesterol and, 151, 166-168, 171, 376, 533-536 HDLs and, 88, 444 hypercholesterolemia and, 86, 88, 171, 172, 534, 536 hyperlipidemia and, 6, 171, 533 hypertension and, 101, 107, 535 individual risk of, 164-165, 166-168, 170 LDL cholesterol and, 166-168, 171, 178, 227, 228, 532-533, 536 LDLs and, 86, 88, 168, 444 lipids and, 88-89, 93, 177 manganese and, 386 morbidity, 100 mortality rates, 6, 89, 100-102, 151, 164-165, 167, 197, 445, 531-532, 572, 655, 690-691 MUFAs and, 54 nephrotic syndrome and, 171 obesity and, 376, 535, 569-570, 659 observational studies of, 533-534 occupational factors and, 102-103, 537 pathogenesis of, 99-100, 168, 175, 530 peripheral vascular disease and, 175 physical activity and, 16, 103, 151, 153, 534, 536-537 population differences in rates, 100-101, 113, 164, 168, 170, 177, 227, 532 population risk of, 103, 166 premature, 171, 227, 536 prevention of, 113, 167, 172-175, 185, 192, 193, 194-195, 227, 679, 686-687 protective dietary components for, 8, 227, 295, 533, 534, 657-658 protein and, 9, 15-16, 260-261 psychosocial factors in, 103, 537 public information programs on, 77 public perceptions of risk for, 80 PUFAs and, 54, 193, 227-228, 533-534, 657 renal disease and, 171 risk factors for, 77, 88, 101, 102-103, 113, 171, 532-537 serum cholesterol and, 6, 86, 88, 93, 101, 102, 103, 161-164, 167, 172-175, 177-178, 195, 222, 225, 227, 228, 376, 445-446, 532, 533-534, 668, 671, 692, 697-699, 700-701 sex differences in, 100, 102, 167, 369, 536 SFAs and, 7-8, 14, 54, 77, 102, 103, 193, 228, 532-535, 656, 666, 668, 671, 694 socioeconomic factors and, 101, 102-103, 275, 532 stroke and, 105 supplement use and, 514-515 time trends in, 101-102, 196 trace elements and, 369, 370, 376, 380, 515, 382 triglycerides and, 170-171 in the United States, 101, 531-532 in vegetarians, 278-279 vitamin C and, 33, 515 vitamin E and, 514-515 VLDL cholesterol and, 170-171 Corpus uteri, see Uterine cancer Correlation analysis studies, 275, 332, 352 Cottonseed oil, 64, 184, 186, 490 Coumarin, 322, 490 Crab meat, 72 Crackers, 58 Cream, 203, 207 Creatinine, 28 Creatinuria, 320 Criminality, and carbohydrate intake, 283, 284 Croatia, CHD in, 164 Cross-sectional studies blood pressure, 202, 204, 415, 442 confounding in, 24, 204, 228 dental caries, 279 energy intakes by elderly people, 147-147 glucose tolerance, 274 hyperlipidemia, 443 (continued on next page)

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Page 739 (continued from previous page) CHD and, 376, 535, 569-571, 578, 659 childhood adiposity and, 566, 685 clinical studies of, 7, 221, 281, 571-572, 573-574, 575, 576, 577, 579-580, 581-582 country differences in, 114-115 defined, 114, 563 diabetes mellitus and, 9, 10, 117, 276, 571, 573-574, 655, 659, 676 dietary management of, 474, 673, 676 endocrine disorders and, 581-582 energy balance and, 153, 567-568, 655, 659 energy expenditure and, 142-143, 567-568, 659 energy intake and, 9, 10, 16, 149, 220, 281, 284, 567-568, 577 energy transfer efficiency and, 143 environmental factors in, 90, 568 epidemiologic studies of, 90, 144, 220-221, 281, 569-571, 573, 575-577, 578, 579, 581 fat cell size and number and, 583 fat intake and, 7, 13, 14, 54, 144, 220-222, 229, 567, 655, 656, 670, 671 fiber and, 300 gallbladder disease and gallstones and, 7, 10, 117, 127, 218, 219, 229, 575, 656, 659, 676 genetic and familial factors in, 10, 16, 86, 87, 90-91, 94, 116-117, 415, 568-569, 659, 668 HDL cholesterol levels, 117, 146, 571 hematologic and immunologic consequences of, 579-580 hypercellular and hypertrophic, 566 hyperphagia and, 145, 568, 583 hypertension and, 10, 108, 117, 149, 415, 572-573, 659, 676 hypertrophic, 146 hypoglycemia and, 447 lipid metabolism and, 571-572, 676 measurement of, 114 metabolic efficiency and, 10, 568, 577, 659 misconceptions about, 582-583 myocardial infarction and, 148 PAD and, 107 physical activity and, 10, 140-141, 142, 144, 146, 281, 659 population differences in frequency, 114-114 pregnancy and, 580-581 prevention of, 16, 93 prospective studies of, 569-570, 578 psychosocial factors in, 116 pulmonary function and, 579 racial, ethnic, and migrant differences in, 88, 90, 114-115, 116, 149 research needs on, 95 retrospective life insurance studies of, 569-570 as a risk factor for chronic diseases, 117 risk factors for, 115-117 sex differences in, 115-116, 144 SFA intake and, 144, 567 socioeconomic status and, 116 stroke and, 578 subclinical detection of, 30 thermogenesis and, 143, 146 time trends in frequency of, 115 in the United States, 114 see also Adipose tissue/adiposity; Body fat/fatness; Body weight; Overweight Observational studies blood pressure, 201-202 cancer, 210 of children, 225 CHD, 533-534 compared to experimental studies, 36 criteria for evaluating, 28-29 disease incidence and prevalence assessment in, 29-30 misclassification in, 29, 30 problems common to, 29-32 serum or plasma lipids/lipoproteins, 188, 210, 225, 533-534 weight given to, 36 see also Case-control studies; Dietary intake; Longitudinal (cohort) studies Obstructive atherothrombotic disease, 106 Occupational factors and exposures in cancer, 12, 368, 371, 380-381, 382, 389, 391-393, 479-480, 483-484 in CHD, 102-103 environmental contaminants, 479-480 ethanol, 437 in hypertension, 112, 394 pesticides, 483-484 trace element toxicity and, 385, 388, 389, 390 trans-Octadecanoic acid, 58 Oils availability trends, 57, 80 cholesterol intake from, 58 nutrient contributions of, 64, 159, 160 hydrogenation of, 57, 58, 160 recommended intake of, 13, 18, 670 vitamin composition of, 64 see also Salad and cooking oils; Vegetables fats and oils; and specific oils Oklahoma, CHD in, 102 Oleic acid availability trends, 54, 654 cancer and, 207, 209, 213 data sources on availability of, 47 food sources of, 55, 184, 213 hydrogenation of oils rich in, 186 intake trends, 56 serum cholesterol-lowering poperties, 184, 228 structure of, 159 Olive oil, 13, 179, 182, 184, 213, 214, 671 Olives, 72 Onions, 297 Oranges, 73 Oregon, arsenic contamination of well water in, 391 Orientals, skin reaction to alcohol, 88, 93; see also Asian Americans; Asian Indians Organ culture, hamster tracheal system, 316 Organ meats, 13, 388, 671 Ornithine transcarbamylase deficiency, 86 Oropharyngeal cancer, 10, 313, 319, 334, 377, 441, 437, 660 Osteoarthritis, 16, 373, 580, 659, 673 Osteoporosis and osteomalacia age and, 121-122, 316-318, 616, 620 alcohol intake and, 10, 619, 660 animal studies of, 317, 354, 375, 619-620 biologic marker, 29 bone loss and, 350, 515. 619 bone mass and, 349-350 cadmium intake and, 17, 390 calcium and, 5, 11, 33, 317, 318, 349-355, 359, 375, 515, 616-617, 619, 654, 659, 661, 666, 674 characteristics of, 349, 615 cigarette smoking and, 621 clinical studies of, 264-265, 316-317, 351-352, 372-373, 375 diabetes and, 621 diagnosis of, 121 dietary modifications to prevent, 676, 680 drug intake and, 355 epidemiologic studies of, 264-265, 316-317, 351-352, 372-373, 375, 616-619 estrogen status and, 354, 515, 617, 620, 621 fiber intake and, 354-355, 618-619 fluoride intake and, 375, 619 genetic and familial factors in, 122, 620 hormonal status and, 69, 264, 316-317, 350, 354, 617, 620 mechanisms of action and interactions in, 317-318 medical conditions aggravating, 621-622 obesity and, 621 pathophysiological relationships in, 349-351 phosphorus and, 354, 375, 617-618, 619 previous fractures and, 621 population differences in frequency, 121, 615 protein intake and, 9, 264-265, 354, 618, 659 racial/ethnic differences in, 95, 122, 615, 620 reproductive history and, 621 research needs on, 95 risk factors for, 69, 121-122 sex and, 121-122, 615, 620 socioeconomic status and, 122 subclinical detection of, 29-30 supplementation with calcium and, 352-354, 515 syndromes, 121-122 time trends in frequency of, 121 U.S. incidence of, 121, 655 vitamin D and, 316-318, 616, 618 zinc intake and, 372-373 see also Bone density losses Ovarian cancer age and, 120 carbohydrates and, 282 characteristics of, 120 coffee and tea and, 468, 599 contraceptive use and, 599 defining, 120 endocrine-related, 210 epidemiologic studies of, 209, 299, 468, 599 fat intake and, 209, 210, 599 (continued on next page)

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Page 740 (continued from previous page) fiber intake and, 299, 302 incidence of, 599 genetic or familial factors in, 120 obesity and, 117, 575 other cancers associated with, 118, 120, 599 population differences in, 120, 599 protein and, 264 socioeconomic status and, 120, 599 trace elements and, 377, 380 vitamin B12 and, 339 Overweight atherosclerotic cardiovascular diseases, 117 body fat and, 146 among children, 44 clinical studies of, 152 cross-sectional studies of, 144 defined, 114 food intake and, 144 glucose tolerance and, 152 other cancers associated with, 120 physical exercise and, 16, 146, 152 prevalence of, 114, 655 sex differences in, 144 see also Obesity Oxyphenbutazone, 322 Oysters, 71, 370 P Pacific Islanders cancer in, 119 CHD in, 102 diabetes in, 299 neurological disorders in, 387 obesity in, 90 PAD, see Peripheral arterial disease Palatibility, 159, 186 Palm oils, 13, 159, 184, 205, 670 Palmitic acid, 13, 183, 184, 186, 189, 227, 670 Pancreatic cancer alcohol intake and, 10, 438, 597, 660 carbohydrates and, 282 cigarette smoking and, 597 coffee and tea and, 468, 597 diagnosis of, 119 epidemiologic studies of, 263-264, 438, 468 fat intake and, 213, 229, 600 incidence, 597 meat consumption and, 597 niacin and, 336 population differences in, 119 protective dietary components for, 9, 215, 315, 322, 377 protein intake and, 263-264 race differences in, 119 sex differences in, 119 socioeconomic status and, 119 trace elements and, 368, 380 U.S. incidence of, 119 vitamin A and, 315, 322, 658 vitamin B12 and, 339 Pancreatitis, 170 Pantothenic acid animal studies of, 340 cancer and, 340 data sources on availability of, 47 ESADDI, 48 human studies of, 340 hypertension and, 340 liver disease and, 340 safety index, 518 Parathyroid hormone, 316, 318, 350-351, 353, 355, 356, 360 Parkinsonian dementia, 387 Parsley, 489 Parsnips, 489 Pasta, 60, 72, 179 Pastries, 18, 56, 675 Peaches, 73, 293 Peanut oil, 187, 196 Peanuts, 67 Pears, 73, 280, 293 Peas, 57 Pectin, 62, 291, 292, 295, 298-302, 658 Pediatric population, nutrition monitoring of, 44; see also Infants and children Pellagra, 33 Peripheral arterial disease (PAD) age and, 106 angina pectoris and, 107 atherosclerotic cardiovascular diseases and, 107 blood pressure and, 107, 538 body weight and, 107, 538 CHD and, 103, 107, 170 cigarette smoking and, 106, 107, 538 clinical syndromes, 105, 537-538 data scarcity on, 106 diabetes and, 106, 107, 538 diagnosis of, 105-106, 538 familial associations in, 106 glucose tolerance and, 106, 107, 538 hypertension and, 107, 113, 538 large-vessel, 107 lipoprotein levels and, 107, 538 obesity and, 107, 538 pathogenesis of, 175, 531 physical activity and, 107 risk factors for, 106-107, 538-539 serum cholesterol and, 107, 538 sex and, 105 small-vessel, 107 stroke and, 103, 105, 113 triglycerides and, 107, 175, 538-539 in the United States, 537-538 see also Intermittent claudication Peripheral vascular diseases in animals, 200 arsenic and, 391 blood lipids and lipoproteins and, 175 diabetes mellitus and, 124 rates of, 194 Pesticides carcinogenicity of, 12, 43, 381, 392, 482-483, 662, 695 on fruits and vegetables, 18, 675 limitations of laboratory methods for, 43 nervous system damage from, 43 occurrence of and exposure to, 18, 392, 482, 695 public beliefs about exposures to, 43 regulation of, 43 reproductive effects in laboratory animals, 484-485 residue in foods, 391 survey of exposures to, 43 teratogenicity of, 43 testing of, 43 Phenanthrene, 441 Pharmacogenetics, 88 Phenobarbital, 440 Phenolic antioxidants, see Butylated Hydroxyanisole: Butylated hydroxytoluene Phenylalanine, 259, 474 Phenylketonuria, 86, 474 Phenylthiocarbamide, 85 Philippines cancer in, 487, 489 energy expenditure during preganancy in, 147 vitamin A deficiency in, 316 Phorbol ester, 215, 316 Phosphate, 70, 281, 301 Phosphatidylcholine, 191, 216-217 Phosphatidylethanolamine, 191 Phosphatidylglycerol, 160 Phosphatidylinositol, 160, 191 Phosphatidylserine, 191 Phosphoenolpyruvate carboxykinase, 386 Phosphoinositides, 217 Phospholipids, 125, 160, 216-217 Phosphorus alcoholism and, 451 availability trends, 53, 70 biologic role of, 347, 349, 357, 661 calcium balance and, 265, 354, 357-358, 617-618 data sources on availability of, 47-48 excesses of, 357-358 fiber intake and, 301 food sources of, 70, 74, 349 hypophosphatemia and, 357 impaired absorption of, 86 intake trends, 70, 77-79, 81, 349 monitoring status, 81 nutritional status, 70, 349 osteoporosis and, 354, 617-618 RDA, 48, 70 safety index, 518 vitamin D and, 312, 316 Photosensitivity, 314 Physical activity/exercise aerobic, 151 body fat and, 139, 144, 146, 151 body weight and, 146, 151, 152, 436, 673 bursts of, 151 cancer and, 152-153 cardiovascular function and, 151-152 CHD risk and, 16, 103, 151, 153, 536-537 diaries of, 141 energy intake and, 146, 675 food intake and, 140-141, 673 gallbladder disease and, 127 glucose tolerance and, 146, 151, 152, 153 HDL levels and, 443 hypertension and, 108, 112, 555 insulin metabolism and, 146, 151, 152 intermittent claudication and, 107 myocardial infarction and, 148 NIDDM and, 152 obesity and, 140-141, 142, 144, 281, 659 osteoporosis and, 69, 375, 621 (continued on next page)

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Page 741 (continued from previous page) recommendations for, 16-18, 675, 678-680, 682-683, 696 resting metabolic rate and, 146 trace element levels and, 381 vitamin requirements and, 330 see also Energy expenditure Phytates, 291, 368, 370 Phytoene, 314 Phytosterolemia, 201 Pickles, 72, 387, 421 Pies, 18, 56, 675 Pima Indians gallstones in, 126, 219 diabetes mellitus in, 123 energy expenditures by, 143 obesity in, 88 Pituitary hypofunction, 150 Plains Indians, 274 Plant constituents and metabolites. toxic, 488-490 Plant foods intake trends, 41 protective effects of, 9-10, 672 see also specific vegetables and fruits Plant protein, 18, 259, 260-261, 262: see also Soy protein Plant sterols, 160, 201 Plaque, atherosclerotic aortic, 106 creation of, 529 intermittent claudication and, 172 progression of fatty streaks to, 222, 529-530 qualitative changes with age, 530 thrombosis and, 530-531 see also Atherosclerotic lesions Plaque, dental, 279, 280 Plasma cholesterol, see Serum or plasma cholesterol Plasma lipids and lipoproteins, see Serum or plasma lipids and lipoproteins Platelet function atherosclerosis and, 190 docosahexaenoic acid and, 191 eicosahexaenoic acid and, 191 endothelial injury and, 177 hyperreactivity, 190 w-3 PUFA role in, 190-191 w-6 PUFA role in, 190 Plummer-Vinson disease, 334, 368, 441 Poland cancer in, 118 CHD in, 100-101 Polybrominated biphenyls (PBBs), 480 Polychlorinated biphenyls (PCBs), 12, 43, 479-480, 662 Polycose, 281 Polycyclic aromatic hydrocarbons (PAHs), 12, 36, 368, 387, 421, 441, 481, 485, 662 Polycythemia vera, 339 Polynesians, pancreatic cancer in, 119 Polyneuropathy, 450 Polysaccharides, 58, 273, 291, 292, 295; see also Fiber; Starches Polyunsaturated fats and fatty acids (PUFAs) animal studies of, 8, 189, 195-196, 204, 213 atherosclerosis and, 195-196 availability trends, 80, 654 cancer and, 8, 14, 174, 205, 213-214, 229, 672, 694 CHD and, 8, 54, 192 clinical and metabolic studies of, 8, 184-188, 218-219 data sources on availability of, 47 food sources of, 159, 223, 261, 672 gallbladder disease and gallstones and, 218-219 HDL cholesterol levels and, 8, 188 hydrogenated, 186 hypertension and, 204, 415 hypocholesterolemia and, 182 intake trends, 41, 55, 161, 180, 181 LDL cholesterol levels and, 8, 183, 189 lipoprotein levels from, 184-188 mechanisms of action, 187-188 obesity and, 221 plasma lipids and lipoproteins and, 189 recommended intakes of, 14-15, 185, 671-672, 675, 677-680, 682-683, 685-687 serum cholesterol and, 8, 162, 177-178, 179, 183-189, 225, 261 structure of, 159 triglycerides and, 8, 188 see also Arachidonic acid; Linoleic acid; w-3 Polyunsaturated fatty acids: w-6 Polyunsaturated fatty acids; w-9 Polyunsaturated fatty acids w-3 Polyunsaturated fatty acids (w-3 PUFAs) biologic role of, 159 blood pressure and, 205 cancer and, 8, 206, 213-215, 229, 657 clinical and metabolic studies of, 185-185 eicosanoid metabolism and, 190 food sources of, 8, 13, 15, 159, 192, 205, 206, 213, 227-228, 671 homeostasis and, 8, 190 lipoprotein levels and, 185-186 serum or plasma cholesterol and, 185-186, 671 serum or plasma triglycerides and, 8, 13, 657, 671 platelet function and, 191 protective effects of, 192, 206, 213, 214, 227-228, 229, 657, 671 see also Docosahexaenoic acid; Eicosapentaenoic acid w-6 Polyunsaturated fatty acids (w-6 PUFAs) animal studies of, 8, 205 blood pressure and, 205 cancer and, 8, 206, 213-215, 229 clinical and metabolic studies of, 184-185 food sources of, 13, 205, 213, 671 HDL cholesterol and, 8, 189, 657 LDL cholesterol and, 8, 13, 189, 657, 671 liproprotein levels and, 184-186 serum or plasma cholesterol and, 8, 184-186, 227, 657 recommended intake of, 14-15, 672 structure, 159 see also Arachidonic acid: Linoleic acid w-9 Polyunsaturated fatty acids. see Oleic acid Polyvinyl chloride (PVC), 480-481, 662 Population differences alcoholic cirrhosis, 125 atherosclerosis, 164 blood pressure, 108 cancer occurrence, 117-120, 207, 209, 212 cardiovascular disease, 192-193, 197 CHD rates and risk, 100-101, 113, 164, 166, 168, 170 among/within countries, see specific countries dental caries, 127 diabetes mellitus, 274-275, 276 dietary cholesterol intake, 197 fat intake and chronic disease, 192-193 gallbladder disease and gallstones, 126 genetic traits, 87-88 HDL cholesterol, 166 hypertension, 108 LDL cholesterol, 166 obesity, 114-115 osteoporosis, 121 plasma lipid and lipoprotein levels from fat intake, 178-181 serum cholesterol, 163-164 stroke frequency, 103-104 triglycerides, 170 VLDL cholesterol, 170 see also Epidemiologic evidence. studies, cohorts: Race or ethnicity: and specific countries Pork, 56, 57, 63, 65, 160 Portal cirrhosis, see Alcoholic cirrhosis Portugal alcoholic cirrhosis in, 125 cancer in, 384, 421 Potassium animal studies, 423 biologic role of, 421 blood pressure and, 202, 261, 355, 415, 418-419, 422-423, 424 CHD and, 422-423 data sources on availability in food supply, 47-48 epidemiologic studies, 422-423 ESADDI, 48, 73 food sources of, 15, 73, 672 hypertension and, 202, 415, 418-419, 422-423, 424 intake trends, 73, 421-422 magnesium deficiency and, 358 nutritional status, 73 protective effects of, 422, 424 recommended intakes of, 681 stroke and, 11, 15, 422-242, 660-661, 672 Potatoes availability trends, 81 cancer and, 282, 296 fresh, 57 fried, 56 intake trends, 56, 57, 58, 293, 654 nutrient contribution of, 62, 67, 73, 259, 273 recommended intakes of, 675 processed, 57, 73, 476 starch in, 261 sweet, 82, 654 (continued on next page)

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Page 742 (continued from previous page) teratogens in, 489 white, 57 Poultry availability trends, 57, 80, 160 fat intake from, 56, 161 fortification of, 75 intake trends, 80, 63, 161 nutrients provided by, 62, 65, 71, 160, 370 recommended intake of, 13, 18, 670, 675, 681 skin, 13, 18, 160, 670, 675 Praziquantel, 477 Pregnancy and lactation alcohol intake during, 10, 16, 449-450, 451, 660, 673, 381 body fat distribution during, 145 carbohydrate intake during, 276 coffee intake during, 470 diabetes mellitus during, 134 energy balance during, 139, 141, 147 energy expenditure during, 142, 147 food intake during, 145 gallbladder disease and, 127 metabolic efficiency during, 145 nutrient requirements during, 81 nutrition monitoring during, 44 obesity and, 580-581 osteoporosis and, 621 RDAs for, 64-73 vitamin A toxicity during, 516 vitamin requirements for, 330 Premature coronary arteriosclerosis, 86 Premenstrual syndrome, 516 Prepared foods, nutrient labeling survey of, 43 Prevalence of disease alcoholism and alcohol abuse, 431 anorexia nervosa, 584 atherosclerotic cardiovascular diseases and, 178 bulimia, 584-585 CHD, 102 dental caries, 279 diabetes mellitus, 123 fetal alcohol syndrome, 449-450 gallbladder disease and gallstones, 126-127 hypertension, 108 iron-deficiency anemia, 369 measures of, 29-30 monitoring of, 44 obesity, 114-116 problems in assessment of, 29-30 stroke, 103-104 see also specific countries and U.S. states Prevention CHD, 172-175, 194-195 cholesterol absorption, 201, 229 dental caries, 280-281 large-scale trials, 172-175, 194-195 public health approach to, 6, 19, 229, 701-702 see also Dietary guidelines and recommendations; Protective effects Prevention paradox, 93, 94 Probucol, 177 Processed foods, intake trends, 76 Prolactin, 214 Propylgallate, 441 Prospective cohort studies cancer, 263, 313, 315, 368 CHD incidence and mortality, 164, 279, 570-571 diseases with long latency, 30 hypertension, 442 lead exposure, 395 obesity, 570-571 weight of evidence for causation, 4, 37, 653 Prostacyclin, 190 Prostaglandins, 190, 205, 214, 215 Prostate cancer age and, 120 calcium supplementation and, 353 carbohydrates and, 282 coffee and tea and, 468 early detection of, 120 endocrine-related, 210 epidemiologic studies of, 7, 152, 153, 209, 229, 264, 468, 599-600 fat intake and, 7, 14, 206, 209, 210, 215, 600, 656, 671 hormonal status and, 600 incidence of, 593, 599-600 mortality rates, 120 obesity and, 117, 575, 600 oleic acid and, 209 other cancers associated with, 118, 600 physical activity and, 152 population differences in, 120, 600 protein intake and, 209, 264 racial or ethnic differences in, 120, 599-600 SFAs and, 8, 209, 210, 215, 229, 656 trace elements and, 371, 380, 388, 389, 514, 600 vitamin A and, 313-314, 315, 318, 600 vitamin B12 and, 339 vitamin C and, 332 vitamin E and, 318 Protective effects BHA, 477 BHT, 441 calcium, 281, 356-357 b-carotenes and carotenoids, 15, 207, 314, 322, 332, 341, 488 cereals, 295 chromium, 277 cocoa, 281 dairy products, 207, 280, 281 fiber, 208, 295-297, 299, 302, 202, 331 fruits, 341, 488 linoleic acid, 208, 227-228 lycasin, 281 phosphate, 281 plant sterols, 201 protein, 281 w-3 PUFAs, 206, 213, 214, 215, 227-228, 229 retinoids, 315 saccharin, 281 selenium, 11, 277, 371-372, 377, 661 vegetables, 15, 207, 208, 297, 298, 341, 488 vitamin A, 488 vitamin C, 331, 341, 658 vitamin E, 332, 341, 441 xylitol, 281 Protein age and, 16 alcohol intake and, 448, 450 animal studies of, 33, 261, 262, 264, 265 atherosclerosis and, 261, 262, 265, 658-659, 672 availability trends, 53, 80, 259-260, 654 biologic marker of, 27, 28 biologic role of, 259 blood pressure and, 261-262, 355 body mass index and, 281 calcium balance and, 9, 16, 264-265, 354, 659, 673 cancer and, 9, 108, 109, 263-264, 299, 336, 659, 673 CHD and, 9, 15-16, 260-261, 673 clinical studies of, 260-261, 262, 264-265, 618 composition of, 15, 259, 672 correlation with fat intake, 260, 263, 673 data sources on availability of, 27-28, 46-48, 51, 81, 259-260 dental caries and, 281 energy expenditure for storage as fat, 140, 151 energy intake from, 139-140 epidemiologic studies of, 260, 261-262, 263-265, 618 food sources of, 9, 18, 41, 55, 62-63, 76, 92, 259-260, 672, 675, 696 gallbladder disease and, 127 glucose tolerance and, 274 hormonal status and, 264 hypercholesterolemia and, 261, 265 hypertension and, 261-262, 659 intake trends, 15, 41, 54, 62-63, 76-79, 81, 142, 259-260, 673, 696 lipoprotein levels and, 260-261 malnutrition, 450 monitoring status, 81 nutritional value of, 259 osteoporosis and, 9, 264-265, 354, 618, 659 protective effects of, 281 RDA, 15, 62 recommended intakes of, 15-16, 17-18, 672-673, 675, 679, 680 renal disease (chronic), and 265 renal toxicity of, 264 serum cholesterol and, 260-261, 265, 659 sex differences in, 16, 62-63 stroke and, 262 vegetarian intakes of, 260, 262, 265 see also Animal protein; Plant protein Protein kinase C, 215 Proteinuria, 276 Prunes, 73 Pseudocholinesterase variation, 88 Psoralens, 489 Psychosocial factors CHD and, 101, 103, 537 dietary intake and, 80, 81 hypertension and, 112, 415, 420, 554-555 obesity and overweight and, 116 see also Stress Public information programs breast cancer, 120 dietary fat, fiber, and cancer, 77 dietary fat/saturated fat, cholesterol, and heart disease, 77 (continued on next page)

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Page 743 (continued from previous page) effectiveness of, 5, 80 sodium and hypertension, 77, 80 Public opinion surveys on diet and health, 80 Puddings, 58 Puerto Rico alcohol intake and, 437 cancer in, 297, 437 CHD in, 164, 279 hypertension in, 355 PUFAs, see Polyunsaturated fatty acids Pulmonary function, obesity and, 579 Purine, 331 Pyridoxamine, see Vitamin B6 Pyridoxine, see Vitamin B6 Pyrrolizidine alkaloids, 488-489 Q Quercetin, 469, 488, 489 Quetelet Index, 114, 204, 209 Quinones, 489-490 R Race or ethnicity adherence to dietary guidelines, 80 alcohol intake and, 61, 434-435 alcoholic cirrhosis and, 125 cancer and, 118, 119, 206 CHD and, 102 cholesterol intake and, 161 dental caries and, 128 fetal alcohol syndrome and, 449-450 gallstones and, 218 genetic predisposition to disease, 87, 88, 94, 95 hypertension and, 11, 89, 95, 105, 109, 111-112, 149, 394, 419, 420, 554 nutrient intakes by, 70-71 obesity and overweight and, 88, 90, 115-116 osteoporosis and, 620 policy implications of, 88, 93 population studies of, 87-88 strokes and, 104 see also Asians; Blacks; Hispanics; Orientals Radionuclides, survey of exposures to, 43 Randomized clinical studies blood pressure in vegetarians, 262 strengths of, 30-31 weight of evidence for causation, 35 see also Clinical studies and trials; Intervention studies and trials RDA, see Recommended Dietary Allowances Receptor action for LDL removal, 86, 88-89, 103 model for, 86 Recommended Dietary Allowances adequacy of intakes below, 73, 81, 348 calcium, 48, 69, 348, 350, 360 cutoff points, 49 defined, 49 energy, 148 folacin, 48, 67, 331 iodine, 48 iron, 48, 70-71, 367 magnesium, 48, 70, 349 niacin, 48, 66, 330 phosphorus, 48, 70, 357 protein, 15, 62 riboflavin, 48. 65, 330 thiamin, 48, 65, 330 use in national surveys, 48-49, 81 vitamin A, 48, 64, 311 vitamin B6, 48, 66, 330, 331 vitamin B12, 48, 67, 331 vitamin C, 67-68, 329 vitamin D, 48, 64, 312 vitamin E, 48, 64-65, 312 zinc, 48, 370 Recommended Energy Intakes, 52 Rectal cancer alcohol intake and, 10, 438, 440, 660 carbohydrates and, 282 epidemiologic studies of, 152 fat intake and, 282 physical activity and, 152 sex differences in rates of, 118 vitamin C and, 332, 341 vitamin E and, 319 see also Colorectal cancer Red meats, 70, 80, 160, 370, 678 Reliability, of case-control studies, 31 Religious groups, see specific groups Renal cancer, 206, 264, 282, 333, 336, 388-389, 391, 393-394 Renal disease (chronic) alcohol intake and, 447 animal studies of, 265 cadmium and, 390 choline deficiency and, 216 clinical studies of, 265, 394-395 diabetes mellitus and, 124 epidemiologic studies of, 265, 394-395 glomerular sclerosis, 265, 277-278 high blood pressure and, 107, 418 lead and, 394-395 protein intake and, 265 triglycerides and, 171 vitamin D and, 318 Renin-angiotensin system, 205, 447 Reproductive effects coffee and tea, 470-471 cyclamate, 473 pesticides, 484-485 see also Pregnancy and lactation Research needs alcohol and alcoholism, 95, 447, 453, 542, 556, 704, 705, 706 alcoholic cirrhosis, 635 amino acids, 266, 705 animal studies, 303, 541 apolipoproteins, 89 atherosclerosis, 541-542, 703, 705 atherosclerotic cardiovascular disease, 229-230, 303, 360, 395, 541-542, 705 B vitamins, 341, 705 biologic markers of exposure, 21, 704-705, 706 blood pressure, 95, 360, 424-425, 556, 704 body mass determinants, 154, 703 BHA and BHT, 492 breast cancer, 703, 705, 706 calcium, 360, 556, 622, 704, 705 cancer, 21, 230, 284, 322-323, 341, 395-396, 492-493, 604-605, 703, 704, 705, 706 carbohydrates, 154, 284, 303, 542, 630, 644, 703, 704, 705 carcinogens, 492-493, 704, 705 b-carotene and carotenoids, 322-323, 704, 706 CHD, 284, 541-542, 630, 703, 705 children, 425 chloride, 425, 704, 705 clinical and metabolic studies, 21, 303, 322-323, 360, 541-542 coffee, 492, 704 colon cancer, 303, 705, 706 colorectal cancer, 284 competing risks, 21, 705 cooking/processing effects on foods, 493, 704 copper, 72, 396, 705 dental caries, 284, 644, 704, 705 diabetes, 284, 395, 630, 703, 705 dietary cholesterol, 541, 630 dietary fat, 154, 541-542, 703, 705, 706 dietary surveys, 21, 492, 704 dose-response relationships, 21, 705 ecogenetics, 95, 703, 704 elderly people, 154, 303 energy balance, 154, 542, 703 environmental factors in nutrition and disease, 425, 630, 703, 704, 706 epidemiologic studies, 303, 341, 360, 493, 704 fetal energy needs, 154 fiber, 81, 303, 360, 622, 630, 703, 705 fluoride, 284, 644, 704 folacin, 67, 81 food additives, 492, 706 gallstones, 220, 230-231, 635, 703, 705 genetic factors in disease and nutrition, 95, 154, 424-425, 453, 556, 605, 630, 644, 703, 705 genetic markers, 425, 453, 556, 705 HDL cholesterol, 154, 541, 703 hemochromatosis, 95 hypertension, 95, 420, 425, 556, 703, 704, 705 immune system, 396 interactions among nutrients, 21, 341, 395, 425, 705, 706 intervention studies, 21, 303, 425, 604-605, 706 lactose malabsorption, 92 lipids, 95, 541-542, 556, 703 lipoproteins, 284, 541-542, 703 liver disease, 341, 705 magnesium, 70, 74, 81, 360 metabolic disorders, 87, 95, 153, 284 methodologies, 21, 396, 604, 704 molecular and cellular nutrition, 21-22, 706 MUFAs, 541, 703 mutagens, 492-493, 704, 705 NIDDM, 95, 303, 630, 703, 705 nitrosamines, 492, 704 nonnutritive dietary constituents, 492-493, 704 nutritional requirements, 396, 705-706 obesity, 95, 230, 425, 630, 703, 705, 706 osteoporosis, 95, 360, 622, 704 PAD, 541 pancreatic cancer, 303, 705 pediatric antecedents of disease, 556 potassium, 425, 704, 706 (continued on next page)

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Page 744 (continued from previous page) phosphorus, 360, 622 physical activity, 154, 706 protein, 265-266, 360, 542, 556, 622, 630, 703, 705 public health program design, 21, 706 w-3 PUFAs (fish oils), 542, 703, 705 w-6 PUFAs, 541, 703 quantitative relationships, 605, 705-706 racial/ethnic differences in disease frequency, 95, 556, 706 renal disease, 266, 447, 630, 705 responsiveness to nutrients, 95, 705 resting metabolic rate, 154 risk-altering dietary constituents, 20-21, 703-704 salt sensitivity, 95, 420, 425 SFAs, 541, 630 selenium, 323, 396, 705 serum cholesterol, 492 social and behavioral, 21, 703, 706 sodium, 424-425, 556, 704, 705, 706 stomach cancer, 303, 704, 705, 706 supplementation, 360, 520, 706 sweeteners, 81, 704 taste and olfaction, 95 thermogenesis, 146 a-tocopherol, 323, 704 trace elements, 395-396, 705 vitamin B6, 63, 66, 81, 331 vitamin C, 341, 704, 705 vitamin D, 704 vitamin E, 323, 704, 705 zinc, 72, 74, 81, 396, 705 Respiratory tract cancer. see Lung cancer; and other specific cancers Resting metabolic rate, 141, 142, 146, 153; see also Energy expenditure; Energy intake Retinol and other retinoids alcohol intake and, 441, 451 animal studies of, 315-316 cancer and, 9, 315-316, 319, 322, 334, 377, 441, 658 deficiency diseases, 316 human studies of, 315 in vitro assays, 316 mechanisms of action, 316 protective effects of, 9 toxicity, 516 see also Vitamin A Retinopathy, 277 Retrolental fibroplasia, 320 Retrospective life insurance studies, 569-570 Rhubarb, 489-490 Riboflavin alcohol intake and, 335, 441, 450 animal studies of, 335-336 availability trends, 53, 65, 75 biologic roles of, 330 cancer and, 334, 335, 336, 341, 371, 441, 658 data sources on availability of, 47-48 deficiency, 334, 336 food sources of, 65, 92, 330 fortification of foods with, 75 human studies of, 334-335 intake trends, 65, 77-79, 81, 330 liver disease and, 335-336 mechanisms of action in disease, 335 monitoring status, 63, 65, 81, 331 RDA, 48, 65, 330 safety index, 518 Rice, 76, 279, 300, 420 Rickets, 86, 302 Risk CHD, 103, 165, 166-168, 170, 697-699 of excess nutrient intake, 51 of heterozygotes for nutritional disorders, 86-87, 92 of inadequate nutrient intake, 51 inferences of causality, 36 relative, defined, 36, 165 stroke, 105 Risk assessment for body fat distribution, 144 from dietary lipid profiles, 698 for formulating dietary recommendations, 5-6, 666-667 interchangeability of methods, 26 population-attributable fraction in, 109, 697 from short-term tests, 34 Risk reduction calculation of, 19, 109 for cancer, 699-700 for CHD, 19, 697-699 from cholesterol lowering, 19, 89, 697-699 defined, 4 for hypertension, 89, 109 population versus individuals, 6-7, 93, 652 from salt restriction, 89 Roughage, 80 Roumania, CHD in, 100-101 Rural populations cancer in, 117, 212 CHD in, 445 hypertension in, 108, 203 serum cholesterol in, 445 S Saccharin, 12, 281, 283, 471-472 Safflower oil, 159, 182, 184, 186, 187, 202, 203, 205, 223, 671 Safrole, 488, 489 Salad and cooking oils, 18, 55, 57, 58, 64, 160, 186, 654, 675 Salad dressings, 18, 56, 58, 675 Salami, 421 Salt appetite centers, 413 atrophic gastritis and, 11 blood pressure and, 10, 16-17, 89, 202-205, 415-417, 422, 424, 660, 674 conversion to mg sodium, 72 depletion, 414 discretionary addition of, 414 estimation of intake of, 415, 421 excretion, 414 historical uses of, 413 hypertension and, 10-11, 16, 33, 77, 80, 89, 95, 108, 202, 203, 417-418, 420, 660, 668, 674, 681 iodized, 74, 384 preservation of foods with, 18, 421, 413 public information programs on, 77, 80 recommended intake of, 16-17, 18, 660-661, 673-674, 678-681, 686-688, 696 restricted intake, and blood pressure, 89 sensitivity, 415, 674; see also Hypertension stomach cancer and, 11, 17, 420-421, 674, 675, 681, 682-683 stroke and, 421 substitutes, 424 supplements, 423-424 Salt-cured (salt-pickled) foods, 11, 16, 17, 72, 421, 424, 475, 660-661, 673, 674, 675, 681, 695 San Francisco Bay Area, cancer in, 118 Satiation, 88, 159, 292 Saturated fats and fatty acids (SFAs) animal studies of, 288 atherosclerosis and, 7, 23, 103, 195-196, 228, 656 atherosclerotic cardiovascular diseases and, 7, 13, 196, 656, 666, 670 animal studies of, 189, 195-196 availability trends, 54, 80, 564 blood pressure and, 201, 203-205 body mass index and, 221 body weight and, 144 cancer and, 5, 7, 8, 14, 174, 206-210, 215, 229, 263, 656, 671 CHD and, 5, 6, 7-8, 14, 54, 77, 93, 102, 192, 228, 656, 666, 668, 671, 694, 698-699 data sources on availability of, 47 dietary cholesterol and, 200 food sources of, 13, 16, 18, 56, 159, 204. 205. 222, 223, 670, 675 intake trends, 41, 55, 56, 81, 160, 161, 180 LDL cholesterol and, 7-8, 13, 227, 228, 656, 670 lipoproteins and, 182-184 mechanisms of action, 187-188 monitoring status, 81 nutrient densities of, 208 plasma lipids and lipoproteins and, 7, 189 recommended intakes of, 13, 14, 17-18, 226, 229, 666, 669, 670, 671, 675, 677-680, 682-683, 685-688, 692-693 serum or plasma cholesterol and, 7-8, 13, 162, 178-180, 182-189, 195, 225, 227, 228, 656, 666, 669, 670 structure of, 159 see also specific fatty acids Saudi Arabia, alcohol intake in, 435 Sausage, 72, 421, 475 Schistosomiasis, 120 Scotland cancer in, 384 CHD in, 100-101 energy expenditure during preganancy in, 147 hypertension in, 391 Scurvy, 33, 329, 434 Seafood, 74, 388, 391, 392 Second National Health and Nutrition Examination Survey, see National Health and Nutrition Examination Surveys

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Page 745 Seeds intake trends, 54, 76 nutrients in, 62, 66, 70, 72, 292, 312, 349 Segregation analysis, 87 Selenium alcohol consumption and, 376 animal studies of, 376-377, 378 atherosclerotic cardiovascular diseases and, 376-377 biologic marker of intake, 28 biologic role of, 375-376 cancer and, 11, 318-319, 322, 335, 371-372, 377-379, 602, 661, 667 cigarette smoking and, 376 clinical studies of, 376 data sources on availability in food supply, 47 epidemiologic studies of, 376, 377-378 ESADDI, 48, 74, 375 fiber intake and, 301 hypertension and, 390 intake trends, 74 interactions with other elements, 376, 390 mechanisms of action in cancer, 378-379 mutagenicity of, 378 protective effects of, 11, 277, 371-372, 378-379, 395, 661, 667 safety index for, 518 short-term tests of, 378 toxicity of, 11, 518, 661 Selenodiglutathione, 379 Serbia, CHD in, 164 Serine, 331 Serum or plasma cholesterol absorption, synthesis, and excretion of, 188-189 action of dietary components that raise, 171, 187, 195 age and, 163, 164, 177, 224 alcohol intake and, 443 apo E and, 168 atherosclerosis and, 23, 103 biologic role of, 162 body weight and, 10, 659 cancer and, 14, 18, 174, 206, 210-211, 229, 671, 692-693 carbohydrates and, 276-278 carriers of, 160 cerebral hemorrhage and, 194 CHD risk and, 6, 7, 13, 14, 19, 32, 86, 88-89, 93, 101, 102, 103, 107, 163-165, 167, 170, 172, 174, 175, 178, 195, 224, 225, 227, 228, 376, 444, 533-534, 671, 697-699, 700-701 clinical and metabolic studies of, 174, 182-189 coffee intake and, 11, 469, 662 dietary cholesterol intake and, 8, 13, 178, 189, 195, 197, 198-199, 201, 228, 357, 670 extrinsic factors in, 181-182 familial hypercholesterolemia and, 103, 171 fat intake and, 7, 178-188 trans fatty acids and, 187 fiber intake and, 9, 292, 294, 295-296, 302, 659 food intake and, 148 gallbladder disease and, 127, 217-218 hydrogenated vegetable oils and, 186, 189 intermittent claudication and, 107, 175 interventions for lowering, 172-174, 178, 182; see also Clinical studies/trials LDL cholesterol and, 179, 181-183, 197, 199, 201 low-fat diets and, 32 lowering effects of nutrients and foods, 8, 162, 182, 184-186, 194, 195, 217, 227, 260-261, 265 measurement of, 188 in migrants, 163, 178-181 MUFA intake and, 8, 184, 189, 229, 357 myocardial infarction and, 148, 162, 165 observational studies of, 533-534 peanut oil and, 187 population differences in, 163-164, 178-181, 195, 445 predictive equations for, 180, 182, 184, 198-199, 533 protein intake and, 260, 261, 265 PUFA intake and, 18, 184-186, 194, 195 SFA intake and, 7-8, 13, 162, 178-179, 182-187, 195, 225, 227, 228, 656, 666, 670 stroke and, 18, 175, 693-694 trace elements and, 370, 382, 515 transport of, 162 vegetarianism and, 8, 264, 294 vitamin C and, 333, 515 see also Dietary cholesterol; HDL cholesterol; LDL cholesterol Serum or plasma lipids and lipoproteins age and, 224 animal studies of, 189 apolipoproteins and, 168 atherosclerotic cardiovascular diseases and, 163-178, 223-224 body weight and, 148 cell receptors for, 103 childhood arterial lesions and, 223-224 in children, 223-225 dietary cholesterol and, 197 dietary intakes and, 224, 225; see also specific foods and nutrients dietary phospholipids and transport of, 217 ecological associations, 224 familial associations, 224 fat intake and, 93, 178-192 fish oils and, 185 functions and transport mechanisms, 160, 162-163, 217 lowering of, 172 macrophage interaction with, 176 observational studies of diet and, 225 peripheral vascular diseases and, 175 sex and, 224 stroke and, 175-176 trace element intake and, 515 tracking of, 224-225 Sesquiterpene lactone, 490 Seventh-Day Adventists cancer in, 209, 210, 212, 263, 437, 467, 445, 446, 693, 695 CHD in, 193, 445, 446 stroke in, 194 Sex differentials in adherence to dietary guidelines, 80 alcoholic cirrhosis, 125, 447 alcohol intake, 61, 432-433 bladder cancer, 120 blood pressure, 110-111, 442 body weight, 52 breast cancer, 119-120 carbohydrate intake, 59 CHD, 100, 102, 167, 369 cholesterol intake, 161 colorectal cancer, 118, 119, 208, 297, 438 dental caries, 127, 128 eating patterns, 75 energy expenditures, 142, 153 energy intake, 53, 59, 77-79, 81, 140, 148, 153 esophageal cancer, 118 fat intake, 54, 161 fiber intake, 62, 293-294 gallbladder disease and gallstones and, 127, 218 hemochromatosis, 92 hypertension, 110-111, 442 liver cancer, 119 lung cancer, 119 mineral intakes, 69-74, 77-79, 81 obesity and overweight, 90, 114, 115-116 osteoporosis, 121-122, 620 PAD, 106, 107 pancreatic cancer, 119 plasma lipids and lipoproteins, 224 prostate cancer, 120 protein intake, 16, 62-63, 77-79 RDAs, 64-73 stomach cancer, 118 strokes, 104 sugar intake, 59 vitamin intakes, 64-68, 77-79, 81 SFA, see Saturated fats and fatty acids Shellfish, 13, 18, 71, 73, 370, 671, 675, see also Seafood; and specific shellfish Short-bowel syndrome, 321 Short-term tests and studies advantages and disadvantages in nutrition research, 34 arsenic, 392 aspartame, 473-474 BHA, 477 BHT, 477-478 cadmium, 389 carbohydrates, 278 chromium, 383 coffee and tea, 469 cyclamate, 473 eicosanoid effect on platelet function, 191 fluoride, 374-375 food colors, 478-479 iron, 369 lead, 394 manganese, 385 mercury, 391 molybdenum, 387 mycotoxins, 487 need for, 51 (continued on next page)

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Page 746 (continued from previous page) nitrites, nitrates, and N-nitroso compounds, 476 pesticides, 483-484 polybrominated biphenyls, 480 polychlorinated biphenyls, 480 polyvinyl chloride, 481 saccharin, 472 salt, 421 selenium, 378 uses, 34, 51 zinc, 372 see also Cell cultures; In vitro tests and studies: Mutagenicity tests: and specific tests Shortening, 55, 57, 160, 186, 476 Sickle-cell disease, 94 Silicon, 291 Singapore, cancer in, 438 Sitosterol, 160 Skin cancer, 9, 150, 314, 315, 318, 319, 320, 332, 378, 380, 392, 395, 441, 469, 658 Skinfold measurements, 114, 143, 180, 450 Snack foods carbohydrates in, 76 dental caries and, 280 fats in, 76 fortification of, 74 intake trends, 76 introduction of, 42 protein in, 76 sodium in, 73 Socioeconomic status alcohol intake and, 62 alcoholic cirrhosis and, 125 cancer and, 118-120 carbohydrate intake and, 59, 274, 275 cholesterol intake and, 58, 161 CHD and, 101, 102-103 dental caries and, 128 diabetes mellitus and, 123, 275 dietary intake and, 41, 80, 81, 180-181 endometrial cancer and, 120 fetal alcohol syndrome and, 449 hypertension and, 112, 555 LDL cholesterol and, 224 meat intake and, 63 mineral intake and, 70-71 obesity and, 90, 116 osteoporosis and, 122 serum cholesterol levels and, 179, 180-181 vitamin intake and, 64-69, 312, 331 Sodium alcohol intake and, 447 animal studies on, 417-418, 421 availability trends, 72 biologic markers of intake, 28 biologic role of, 413 cancer and, 333, 420-421 conversion to mg of salt, 72 data sources on availability in food supply, 47-48 ESADDI, 48, 72 food sources of, 72-73 hereditary factors interacting with, 418 human studies of, 415-417, 420-421 hypertension and, 77, 80, 89, 112, 414-420 intake trends, 41, 72-73, 413 monitoring status, 73, 74, 81 physiologic requirements for, 414 public information programs on, 77, 80 sensitivity in humans, 420 transport mechanisms, 418-419 see also Salt Sodium bicarbonate, 414 Sodium chloride, see Salt Sodium citrate, 414, 423 Sodium glutamate, 414 Sodium a-methylpanthothenate, 340 Soft drinks, 58, 60, 61, 74, 76, 81, 274, 466, 468, 470, 471 Solanine, 489 Soups, 72 Sour cream, 315 South Africa cancer in, 212, 339 dental caries in, 127 diverticulitis in, 300 hypertension in, 442 plasma lipid/lipoproteins and fat intake levels in, 179 South African Bantu, 121, 164 South America alcohol consumption in, 433 alcoholic cirrhosis in, 447 Southeast Asians, thalassemia among, 93 Soviet Union cancer in, 118 CHD in, 167 gout in, 386 Soy protein, 260, 261, 22-65 Soy sauce, 392, 421 Soybean oil, 13, 64, 159, 184, 186, 223, 319, 671 Soybeans, 42, 57, 299, 300 Special Supplemental Food Program for Women, Infants, and Children, 224 Spinach, 208, 297, 329, 667 Spinocerebellar degeneration, 217 Sprue, 321 Squash, winter, 82 Starches availability trends, 58, 274 cancer and, 282 CHD and, 279 dental caries and, 279 food sources of, 60, 261, 273 linoleic acid from, 202 resistant, 291 wheat, 281 Starvation, alcohol-related, 447 Stearic acid, 184 Steroid hormones, 160, 162 Stigmasterol, 201 Stomach cancer age and, 117, 118 alcohol intake and, 437-438, 595 animal studies of, 420-421 carbohydrates and, 282, 595, 657 copper and, 380 ecogenetic factors in, 91 epidemiologic studies of, 264, 298-299, 420-421, 438, 594-595 fat intake and, 595 fiber and, 298-299, 595 incidence and mortality rates of, 118, 593, 594, 655 iron and, 368 lead and, 393 mechanisms of action in, 421 in migrants, 118, 594 nitrates, nitrites, and N-nitroso compounds and, 475, 595 prevention of, 19 protective dietary components for, 8, 9, 15, 488, 595, 672 protein intake and, 264 regional differences in, 118 salt or sodium and, 11, 17, 420-421, 424, 475, 594-595, 603, 674, 681 selenium and, 377 sex differences in, 118 socioeconomic status and, 118 vitamin A and, 313, 314 vitamin B12, and, 339, 341 vitamin C and, 9, 332, 341, 488, 595, 658 vitamin E and, 319 Strawberries, 293, 329 Stress (psychosocial), 381, 415, 417, 451 Stroke age and, 15, 104, 105, 540, 672 alcohol intake and, 10, 105, 442-443, 660 animal studies of, 262-263 blood lipids and lipoproteins and, 175-176 body fat distribution and, 105, 117, 144, 540, 659 body weight and, 105 causes, 103, 104, 539 CHD and, 105 cigarette smoking and, 105, 443 clinical syndromes, 539 country differences in, 103-104 diabetes and, 105 diagnosis of, 104 environmental factors in, 104-105, 540 epidemiologic studies of, 202, 262, 422-423 fat intake and, 202, 540 frequency in U.S., 104, 539 genetic and familial differences in, 105 habitual diet and, 105 HDL cholesterol and, 539-540 hemorrhagic, 202, 442, 443, 539 hypertension and, 10, 104, 105, 107, 113, 539, 540, 693-694 mortality rates, 103, 104, 125, 655 PAD and, 103, 105 pathogenesis, 103, 530-531 population differences in frequency, 103-104, 539 potassium and, 11, 15, 422-423, 660-661, 672 protein intake and, 9, 262-263, 659 racial, ethnic, and migrant differences in, 5, 104-105, 540, 672 residual damage from, 104 risk factors for, 29, 104-105, 194, 202, 539-540, 693-694 serum cholesterol and, 18, 104, 105, 539, 693-694 sex differences in, 104, 442-443 SFAs and, 540 sodium and, 11 thromboembolic, 202, 442, 443, 539 time trends in mortality and morbidity, 104 see also Cardiovascular diseases; Transient ischemic attacks

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Page 747 Subarachnoid hemorrhage, 103, 104 Sucrose availability trends, 58, 274 blood pressure and, 149 cancer and, 282 cariogenicity, 9, 279, 281, 284 diabetes mellitus and, 275, 277 food sources of, 273 hyperglycemia and, 277 hypoglycemia and, 283 intake trends, 59, 60, 654 intolerance, 284 obesity and, 277, 281 renal disease and, 278 triglyceride levels and, 278 see also Sugars Sucrose polyester, 221, 479 Sugars added during food processing, 273 availability trends, 57, 58, 80, 274, 654 cancer and, 282 CHD and, 192, 278, 279 data sources on availability of, 47 dental caries and, 15, 280, 284, 672, 685 form of, 279, 280 fortification of, 74 intake trends, 58-60, 76, 80, 274 invert, 280 recommended intake of, 15, 17, 18, 672, 675, 677-680, 682-683, 686-687 refined, 76 see also Fructose; Nonnutrititive sweeteners; Sucrose Sunflower seed oil, 64, 204, 205, 261, 671 Supplements, see Dietary supplements/supplementation Surveys, see Dietary surveys Sweden cancer in, 118, 480, 483 CHD in, 100-101 dietary guidelines in, 682, 686 Swedish Cancer Registry, 211 Swedish Twin Registry, 90 Sweeteners availability trends, 80-81 research needs on, 81 artificial, see Aspartame; Cyclamates; Saccharin see also Sugars; and other specific sweeteners Sweets intake trends, 54 mineral contribution of, 74 Switzerland alcoholic cirrhosis in, 125 cancer in, 319, 384 CHD in, 100-101 dental caries in, 127 Sympathetic nervous system caloric intake effects on, 149 cardiovascular function, 152 fat intake effects on, 149 Syrups, 57, 58 T Taiwan cancer in, 368 peripheral vascular disease in, 391 Tannins and tannic acid, 468-469, 490 Tarahumara Indians, cholesterol levels in, 166 Tardive dyskinesia, 216 Taste and olfaction food choices and, 85, 88 obesity and, 281 research needs on, 95 Tay-Sachs disease, 94 Tea, see Coffee and tea Temperature (ambient) energy intake and, 153 obesity and response to, 146 Tendon xanthomas, 171 Tennessee. CHD in, 102 Ten-State Nutrition Survey, 42-43, 90, 264, 351 Teratogenicity pesticides, 43 vitamin A, 516 Testicular cancer, 206, 282, 593, 603 Thailand cancer in, 487 energy expenditure during preganancy in, 147 hypertension in, 416 Thalassemia, 94 Thermogenesis (diet-induced) adaptive, 141-142 adiposity and, 152 alcohol intake and, 436 of carbohydrates, fats, and protein, 141, 143 defined, 141 food intake and, 146 metabolic efficiency and, 152 NIDDM and, 152 Thiamin alcoholism and, 334, 449, 450 availability trends, 53, 65, 75 biologic role of, 329-330 cancer and, 334 data sources on availability of, 47-48 deficiency, 334, 449 food sources of, 65, 330 fortification of foods with, 75 human studies of, 334 intake trends, 65, 77-79, 81, 330 monitoring status, 63, 65, 81, 331 RDA, 48, 65, 330 safety index, 518 supplementation, 449 Third World countries, dental caries in, 127 Threonine, 259 Thrombosis, 104, 105, 161, 190 Thromboxane, 190, 214, 376 Thymidine, 337 Thymidylate, 331 Thyroid cancer, 380, 383-384, 477 Thyroxin, 142, 384 Tissue histocompatability antigen (HLA), 85, 89, 122 a-Tocopherol, see Vitamin E Tocotrienols, 296, 312 Tomatoes, 57, 67, 73, 297, 329 Total Diet Study description of, 43 nutrients and food constituents reported in, 47, 63, 71, 72, 74, 348 Toxic substances naturally occurring, 486-490 plant constituents and metabolites, 488-490 survey of exposures to, 43, 51 see also specific substances Toxicity from blocked catabolic pathway of essential amino acid, 86 of cholesterol derivatives, 201 iron, 92, see Hemochromatosis nutrient, and supplementation, 11, 515-517 see also specific dietary constituents Trace elements, 6. 51; see also specific elements Trace minerals, food composition data on, 28; see also specific minerals Tracheal cancer, 333 Transient ischemic attacks, defined, 103 Triglycerides alcohol intake and, 443, 448 body weight and, 148, 221 carbohydrate intake and, 275, 277, 278 characteristics of, 162-163 CHD and, 170-171, 224 energy expenditure of storing dietary fats as, 140 fat intake and, 148, 221, 448 fiber intake and. 295, 300 fish oils and, 185 food intake and, 148 individual differences in, 170 myocardial infarction and, 148 PAD and, 107 population differences in, 170 PUFA intake and, 8, 13, 227, 657, 671 transport of, 162-163 VLDLs and, 185, 443 vitamin E and, 320 1, 3, 7-Trimethylxanthine, 466 Tryptophan, 66, 259, 262, 330, 337, 440, 486 Tuberous xanthomas, 171 Tumorigenesis/tumors caloric intake and, 150-151, 153 fiber intake and, 9 protein intake and, 264 PUFA intake and, 205, 213 see also Cancer; Carcinogenesis; and specific nutrient or nonnutritive component Tungsten, 386-387 Turkey, 73 Turnip greens, 69, 329, 349 Tyrosine, 262 U Ulcerative colitis, 321 Ultrasound, 106, 144 Ultraviolet light cancer and, 91, 314, 320, 332, 378 mutagenicity of, 385 Vitamin D from, 64, 312 Uganda, cancer in, 212 Underweight, among children, 44 trans-Unsaturated octadecanoic acid, 186-187 Urine, 28, see also Excretion United Kingdom alcoholic cirrhosis in, 125 cancer in, 313, 319, 389, 439, 467 (continued on next page)

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Page 748 (continued from previous page) CHD in, 100-101, 102, 103, 693 dental caries in, 127 dietary recommendations in, 683, 686-687 hypertension, 389, 442 ischemic heart disease in, 197 obesity and overweight in, 114-115 osteoporosis in, 121, 317 stroke in, 103 United States alcohol intake patterns in, 431-433, 451-452 alcoholic cirrhosis in, 125, 447 bone fracture in, 121 cancer in, 117-120, 212, 313, 377, 384, 386, 388, 437, 439, 467, 468, 593-594 CHD in, 100-101, 102, 103, 164, 445, 469-470, 531-532 dental caries in, 127 diabetes mellitus in, 122 diverticulosis in, 300 fetal alcohol syndrome in, 449 gallbladder disease and gallstones in, 126, 218 hyperlipidemia in, 443 hypertension in, 105, 108, 394, 414, 442 malnutrition related to alcoholism in, 450 nitrosamines intake in, 475 salt intake in, 414 obesity and overweight in, 114-115 osteoporosis in, 121 PAD in, 537-538 protein intake patterns in, 259-260 serum cholesterol levels in, 163 stroke in, 104, 539 temporal trends in CHD in, 101-102 see also specific states Urethane, 476, 477, 486 Urinary tract infections, 475 U.S. Department of Agriculture (USDA) Beltsville Human Nutrition Research Center, 53 dietary recommendations, 676 food supply monitoring, 24, 259-260 fortification standards, 75 Human Nutrition Information Service, 42 joint nutrition monitoring activities with DHHS, 44, 676 Nutrient Data Bank, 46, 311 national surveys of dietary intake and nutritional status. 42; see also Historical Food Supply; Nationwide Food Consumption Surveys Primary Data Set, 48 U.S. Department of Health and Human Services dietary recommendations, 676 joint nutrition monitoring activities with USDA, 44, 676 Office of Disease Prevention and Health Promotion, 99 surveys of food intake and nutritional status, 24, 42-43, 61; see also Hispanic Health and Nutrition Examination Survey; National Health and Nutrition Examination Surveys; Total Diet Study U.S. Surgeon General, 434, 667, 676, 681 Utah, cancer in, 296 Uterine cancer, 206, 282 V Valine, 259 Veal, 63 Vegans, 76; see also Vegetarians and vegetarianism Vegetable fats and oils cancer and, 8, 206, 214, 229 food sources of, 160 hydrogenated, 57, 186 intake trends, 160 nutrient contribution of, 312 SFAs in, 13, 159 see also Polyunsaturated fats and fatty acids; Salad and cooking oils; and specific fats and oils Vegetables availability trends, 57, 80 cancer and, 6, 15, 80, 207, 296, 297, 303, 332, 488, 666 canned, 73 contaminants in, 391, 675; see also Pesticides dark green leafy, 17, 67, 69, 71, 311, 312, 329, 330, 674 fresh, 57 frozen with sauces, 73 green and yellow, 15, 18, 57, 64, 65, 70, 313, 488, 657-658, 672, 675 intake trends, 54, 76, 81, 260, 654 nitrates in, 475 nutrient contribution of, 15, 18, 48, 60, 62, 64-66, 72-74, 260, 293, 301, 311, 331, 349, 672 protective effects of, 8, 9, 15, 203, 207, 208, 296, 297, 303, 313, 332, 488, 657-658, 666, 672 processed, 57 raw, 488 recommended intakes of, 13-15, 18, 226, 670-672, 675, 679 vitamin content, 66 see also specific vegetables Vegetarians and vegetarianism alcohol intake and, 443 blood pressure and, 201, 262, 300, 302 cancer and, 210, 212 CHD and, 278-279, 295 defined, 76 historical trends, 76 lacto-ovo, 8-9, 76, 210, 212, 260, 262, 263, 294, 658 mineral status, 301 nutrient intakes, 8-9, 76-77, 78, 201, 260, 260, 278, 294, 295, 658 osteoporosis and, 264, 317 supplement use by, 515 total, 76, 260 serum cholesterol and triglyceride levels in, 8-9, 265, 294, 302, 658 Very-low-density lipoproteins (VLDLs) carbohydrate intake and, 275, 278 composition of, 162-163 dietary cholesterol intake and, 199, 200 fatty acid effects on, 188 function of, 163 PAD and, 107 see also VLDL cholesterol Vinyl chloride, 440 Vitamin A alcohol intake and, 441, 450-451, 452 availability trends, 53, 64, 75, 311, 654 biologic role of, 311, 315 cancer and, 9, 51, 313-314, 315-316, 322, 331, 334, 371, 441, 488, 514, 516, 658 data sources on availability of, 47-48, 51, 81 fortification of foods with, 74, 75, 311 food records of intake of, 26 food sources of, 64, 311, 654 hypercarotenemia and, 314 intake trends, 64, 76-79, 80, 81, 311-312 international units, 47, 311 monitoring status, 63, 64, 81 nutritional status, 64, 76 populations at risk of deficiencies in, 76 protective effects of, 488 RDA, 48, 64, 311 retinol equivalents, 47, 64, 68, 311 safety index, 518 supplements use, 315, 514, 516 toxicity, 11, 516 see also b-Carotenes and other carotenoids; Retinol and other retinoids Vitamin B1, see Thiamin Vitamin B2,see Riboflavin Vitamin B6, alcohol intake and, 441, 450 animal studies of, 337, 338 availability trends, 53, 66 biologic role of, 330, 337, 441 cancer and, 337, 441 data sources on availability of, 47-48 food sources of, 66, 331 human studies of, 337-338 intake trends, 66, 76-79, 81, 330-331 liver disease and, 337 nutritional status, 76, 331 populations at risk of deficiencies in, 76, 331 RDA, 48, 66, 330 research needs on, 63, 66, 81 safety index, 518 toxicity, 516, 518 Vitamin B12 availability trends, 53, 67 biologic role of, 216, 331 cancer and, 338, 341, 358 data sources on availability of, 47-48 defective absorption of, 88 deficiencies, 216 food sources of, 67, 331 intake trends, 67, 77-79, 81, 331 monitoring status, 81 nutritional status, 67 RDA, 48, 67 Vitamin C (ascorbic acid) alcoholism and, 332, 450 animal studies of, 332-334 atherosclerosis and, 333-334 availability trends, 53, 67, 75, 654 biologic role of, 329 cancer and, 9, 331-333, 338, 341, 488, 514, 658 CHD and, 333-334, 515 colds and, 517 (continued on next page)

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Page 749 (continued from previous page) data sources on availability of, 47-48, 51, 81 food sources of, 9, 67-68, 329, 341, 654, 658 fortification of foods with, 67, 75, 329, 654 human studies of, 331-332, 333 intake trends, 41, 67-68, 76-79, 81, 329 iron absorption and, 71, 77, 367, 368, 517 monitoring status, 63, 68, 81, 329, 331 nitrosamines and, 475, 476 nutritional status, 68, 76, 81, 329 populations at risk of deficiencies in, 68, 76 protective effects of, 9, 331-332, 341, 476, 488, 514, 515, 658 RDA, 67-68, 329 safety index, 518 scurvy, 33, 329 serum cholesterol and, 515 supplements, 514, 515, 518 Vitamin D aging and, 312, 318, 322 alcoholism and, 451 animal studies of, 33, 317 availability trends, 312 biologic role of, 312, 316 cancer and, 356 D2 (ergocalciferol), 312, 317 D3 (cholcalciferol), 312, 317 data availability on intakes, 64 1, 25-dihydroxycholcalciferol, 312, 316, 317, 318, 356, 390 fiber intake and, 302 food sources of, 64, 312 fortification of foods with, 74, 312 human studies of, 316-317 hydroxycholecalciferols, 317, 318 intake trends, 312 mechanisms of action and interactions, 317-318, 357-358, 360 osteoporosis/osteomalacia and, 316-318, 322, 350, 353, 618 RDA, 48, 64, 312 recommended intakes of, 680 renal disease and, 318 safety index, 518 skin synthesis of, 160 supplementation, 353 Vitamin E alcohol intake and, 441, 451 animal studies of, 319-320 atherosclerotic cardiovascular disease and, 320, 376 availability trends, 53, 64, 312, 654 biologic role of, 312, 320 cancer and, 318-320, 377, 379, 443, 658 CHD and, 514-515 data sources on availability of, 47-48 deficiency diseases, 320-321 food sources of, 64, 312, human studies of, 318-319 interaction with vitamin K, 321 intake trends, 65, 81, 312 mechanisms of action, 320 protective effects of, 441, 476 RDA, 48, 64-65, 312 safety index, 518 sucrose polyester and, 479 a-tocopherol, 68, 476 toxicity of, 321, 516-517, 518 Vitamin K animal studies of, 321 availability trends, 312 biologic role of, 312 cancer and, 321 deficiency, 321-322 ESADDI, 48, 312 food sources of, 312 human studies of, 321 interaction of vitamin E with, 322 K1 (phylloquinone), 312, 321, 322 K2 (menoquinone), 312, 322 K3 (menadione), 321, 322 liver disease and, 321-322 malabsorption of, 321-322 toxicity, 321 Vitamins, food sources of, 28, 63; see also specific vitamins VLDL, see Very-low-density lipoproteins VLDL cholesterol apolipoproteins and, 168 carbohydrate intake and, 278 CHD and, 170-171 individual differences in, 170 lecithin and, 217 population differences in, 170 W Waffles, 73 Warfarin, 321, 322 Washington cancer in, 483 CHD in, 102 Water, softened, 73; see also Drinking water Water-soluble vitamins, see Biotin; Folacin; Niacin; Pantothenic acid; Riboflavin; Thiamin; Vitamin B6; Vitamin B12; Vitamin C Weight, see Body weight Weight-reduction dieting age-sex trends in, 76 prevalence of, 82 Wernicke-Korsakoff's syndrome, 92, 334, 449, 450 Wheat bran, 278, 292, 298, 299, 301, 302 Wheat germ, 67 Wheat gluten, 42 Wheat products, 57, 301, 302 Wheat starch, 280 Wheat straw, 295 Whole grains and whole-grain products, 8, 14, 18, 62, 64-67, 70, 71, 76, 80, 293, 301, 302, 312, 370, 381, 671, 675, 679; see also Cereal grains and cereal grain products Wilms's tumor, 393 Wilson's disease, 124 Women CHD in, 445 dietary recommendations for, 671 fat intake trends, 54-55 nutrient deficiencies from alcoholism, 450 see also Sex differentials World Health Organization definitions of health and disease prevention, 99 dietary recommendations, 686 hypertension classifications, 107, 550 cirrhosis definition, 124 Global Oral Epidemiology Bank, 127 X Xanthomas, 171, 201 Xeroderma pigmentosum, 91 Xerophthalmia, 316, 451 Xylitol, 279 Y Yanomami Indians, 414, 415 Yeast, 476 Yemenite Jews diabetes mellitus in, 123 plasma lipids/lipoproteins and fat intake by, 180-181 Yogurt, 18, 69, 76, 207, 370, 675 Yugoslavia bone fracture in, 351-352 cancer in, 421 CHD in, 100-101 serum cholesterol levels in, 163 Yusho disease, 479 Z Zambia, dental caries in, 127 Zinc alcohol intake and, 442, 450, 451 animal studies, 371-372 atherosclerotic cardiovascular diseases and, 370 availability trends, 53, 71 bioavailability of, 71-72, 301, 301, 370 biologic role of, 370 cancer and, 334-336, 370-372, 380, 442, 514 CHD and, 370, 380, 515 clinical studies, 370-371 data sources on availability, 47-48, 51 deficiency, 336, 450 diabetes mellitus and, 372 epidemiologic studies, 370-371 food sources of, 71-72, 370 HDL cholesterol and, 370 hypertension and, 370, 390, 394 immunocompetence and, 372, 395, 517 intake trends, 71-72, 81 interaction with other trace elements, 370, 371, 373, 379, 380, 390, 515 mutagenicity, 372 nutritional status, 72, 370 occupational exposures, 371 osteoarthritis and, 373 osteoporosis and, 372-373 RDA, 48, 71, 370 safety index, 518 serum cholesterol and, 261, 370, 515 short-term tests of, 372 supplements, 370, 373, 514, 515 toxicity, 517, 518 Zucchini, 297