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~ 2. Nutrition
Nutrition plays a key role in the cause and prevention
of many health conditions. As a result, topics covered
by the 69 witnesses who concentrated on this area
were many and varied. A significant amount of atten-
tion was given to the role nutrition plays in two
physiological risk factors, hypertension and high serum
cholesterol, which contribute to chronic diseases such
as cancer, cardiovascular disease, diabetes, and others.
Also of major interest were several nutrition-centered
areas that are both risk factors for other diseases and
health problems in and of themselves-obesity, anorex-
ia and bulimia, and anemia.
Taking a somewhat different approach to the
problems of nutrition, a number of testifiers focused
on the basic problem of hunger, rather than on the
need for a balanced diet. Special mention was made
of hunger as it applies to the homeless and to mig-
rant workers. Still others discussed the need for an
overall balanced diet and the dietary needs of specific
population groups such as pregnant women, infants
and children, and hospitalized patients. The relation-
ship of good nutrition to birth outcome, mental
health, work performance, and the ability to recover
from illness also was noted. (~057J Witnesses
generally supported continuation and strengthening of
the 1990 Objectives concerning nutrition, and pointed
to the Surgeon Generals Report; on Nutrition and
Health t and the National Research Council's Diet and
Health2 as examples of consensus-building documents
that had contributed to progress toward the 1990
nutrition objectives.
The links between diet and health suggest clear
opportunities for reducing disease. Also, as witnesses
commented, history shows that given the opportunity,
information, and time, Americans will change their
eating habits. (~063; #462) However, they also em-
phasized that consumers must have the necessary
tools. The Society for Nutrition Education comments:
Dietary change is not easy, so that even though
a food may be better for one's health, it may
not be competitive in other factors of choice
such as taste, history, ease of preparation, etc.
Other strategies are needed to bring the public
to actually choose foods that are most
nutritious. (#462)
110 Healthy People 2000: Citizens Chart the Course
According to dietitian Marilyn Guthrie of the
Virginia Mason Clinic in Seattle, if improvements in
the nutritional and health status of Americans are to
occur, We need to do a better job at going beyond
making people aware of relationships between food
and health toward giving them the tools and skills to
make changes in eating behavior." (i¢077) Testifiers
also discussed strategies for surveillance and interven-
tion to change diets.
HUNGER
The feelings of many testifiers about the problem of
hunger in our country are best summed up by
Eleanor Young of the University of Texas Health
Science Center, San Antonio.
Identification of health objectives for the nation
relating to nutrition cannot possibly exclude the
serious concern of increased hunger in the
United States. In the 1960s and 1970s, iden-
tification of extensive hunger shocked the
American people. In response, development of
programs virtually eliminated this problem.
Now, during the 1980s, hunger in the U.S. has
returned. A fact that has now been well docu-
mented by some 20 studies conducted between
1982 and 1986 in major cities, including Boston,
Dallas, and Chicago. (#496)
The Society for Nutrition Education notes that
although the numbers may wax and wane, there al-
ways are hungry people in America. (#462) A 1987
report cited by Young estimated that 9 percent of the
population is hungry, including 12 million children
and 8 million adults. (~496) Several witnesses cited
local increases in the number of hungry people, as
indicated by a growth in the number of emergency
food sites, waiting lists for food services, and the
number of people seIved. (~057; #4623 In some
states, residency and citizenship requirements block
otherwise eligible migrant farm workers and unnatu-
ralized immigrants from receiving food benefits.
Similar requirements for a permanent domain within
the state bar the homeless from participating in public
assistance programs. (~462)
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Several objectives were proposed to reduce or
eliminate hunger. Dorothy Conway, representing the
California Conference of Local Health Department
Nutritionists, for instance, proposes that by the year
2000 no one in the United States will go without food
for more than 48 hours. (#043J
Jean Egan, representing the Michigan Dietetic
Association, addresses the importance of locating
surplus food and getting it to needy populations. She
says that national objectives relating to access to food
should be strengthened substantially in the Year 2000
Health Objectives. Witnesses underscored the impor-
tance of maintaining government and private sector
food programs, emphasizing the need for strong
outreach and easy access. (#043; #057J
The Society for Nutrition Education calls for
congregate facilities, such as school lunch rooms, to
be used for feeding homeless people. (#462J School
breakfast and lunch programs also can help to reduce
hunger and are discussed in the section on special
populations.
SPECIFIC NUTRITIONAL RISK FACTORS
Many nutrition goals are related to risk factors
associated with specific diseases or disorders such as
heart disease, stroke, cancer, diabetes, osteoporosis,
and others. 1NNO of these risk factors-high blood
pressure (hypertension) and high serum choles-
terol~re central nutrition goals, but they are the
focus of Chapter 24 and therefore are discussed brief-
ly here. Obesity, anorexia and bulimia, and anemia
are directly related to food consumption; they are
problems in themselves, as well as causes of other
conditions. Food-borne diseases, foods that might
cause dental cavities, and calcium intake as a factor
in osteoporosis prevention also are nutritional issues;
they are discussed in Chapters 18, 26, and 27, respec-
tively.
Hypertension
Individuals with high blood pressure are at increased
risk for cardiovascular disease. Much of the testimony
on nutrition and hypertension focused on the role of
sodium, and there was disagreement among the
testifiers. The 1990 Objectives call for reductions in
the average daily sodium intake to 3-6 grams and
seek increases in the percentage of food that is
labeled for sodium content. The American Heart
Association (AMA) and other witnesses want to
continue to target sodium intake, perhaps with
quantitative changes; the AHA suggests that an adult's
daily intake of sodium not exceed 3 grams. (#636)
However, other witnesses, including the Salt Institute,
say that recent research argues for eliminating sodium
reduction goals for the general population. Only
about one-third of the population is salt-sensitive, and
for another third of the population, salt reduction
may be harmful, it says. (#053; #082J Chapter 24
continues this discussion in greater length.
Cholesterol
An elevated blood cholesterol level is one major risk
factor for cardiovascular disease. The testimony on
nutrition as a way of reducing serum cholesterol levels
focused on food labeling; public education; and
reduction in the fat, saturated fat, and cholesterol
content of manufactured food. Several witnesses favor
adding cholesterol content to the objective dealing
with food labeling; the 1990 objectives on food
labeling included only sodium and caloric values.
Other testimony calls for the food industry's coopera-
tion in reducing the fat and cholesterol content of
foods. One proposal, for example, says that by the
year 2000, the saturated fat content (specifically
coconut and palm oils) in processed and convenience
foods should be reduced 50 percent from present
levels. (~178J
Several witnesses suggested incorporating the
AMA's dietary guidelines for reducing these risk
factors into the Year 2000 Health Objectives. These
guidelines call for an average daily consumption of
cholesterol of 300 milligrams or less per day; the
percentage of calories from fat should be less than 30
percent; the percentage of calories from saturated and
polyunsaturated fat should each be less than 10
percent. f#627; #636J
A primary consideration in changing the public's
consumption of fats and other substances must be
education, according to Jennifer Anderson of
Colorado State University.
I would like us to think that as we translate the
nutrition information, we also must think of
practical messages, telling people how you eat to
reduce the risk of chronic disease. I would like
us to fly and encourage people to think about
how they decrease fat; how they can increase
fiber; and how they, therefore, apply the dietary
guidelines developed from the U.S. Department
of Health and Human SeIvices and the U.S.D.N
(~739)
Nutrition 111
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Obesity
Obesity is an important risk factor for hypertension as
well as for diabetes, cancer, and cardiovascular dis-
ease. Young describes it as the single most prevalent
nutrition problem in the United States. According to
the latest National Health and Nutrition Examination
Survey (NHANES) study cited in her testimony, 34
million adults in the United States are overweight,
which is defined as at least 20 percent above their
desirable weight, and 13 million of them are severely
overweight, or 40 percent over their desired weight.4
(~496)
lithe 1990 Objectives include targets for reducing
the proportion of the population that is overweight,
and witnesses favored continued efforts in this area.
One specific objective recommended for the year 2000
calls for reducing the prevalence of obesity in men by
20 percent and in women by 25 percent. Strategies to
achieve these reductions include education, research
into causes and interventions, and physicians' npre-
scribing~weight reduction. (#496J Another objective
proposed is that pilot weight loss programs in which
weight loss is rewarded be established for federal and
state health workers. (#052)
George Bray of the University of Southern
California reported that three European and two U.S.
studies have now shown that fat distribution is a
greater risk factor than total body fat, and that
sufficient data exist to add maldistribution of fat to
the objectives. Bray proposes that by the year 2000,
the prevalence of individuals with waist-hip measure-
ments above the tenth percentile for age, as defined
by recent epidemiologic data from North America,
should be reduced by 10 percent for both males and
females, regardless of initial body mass index. (~238)
A number of witnesses note that pediatric obesity
is a growing problem that should be included in the
Year 2000 Health Objectives. (~228; #462J Accord-
ing to Nancy Wooldridge, representing the Alabama
Dietetic Association, many overweight children remain
overweight as adults. (~228) Physical activity is de-
creasing among youth while dietary intake remains
high, according to testimony. Dodds proposed an ob-
jective for the year 2000 calling for the prevalence of
obesity among children age 6-11 and girls age 12-17
to be reduced by 10 percent. (#462)
Anorexia and Bulimia
Some witnesses recommended that targets relating to
eating disorders such as anorexia and bulimia be
112 Healthy People 2000: Citizens Chart the Course
included in the Year 2000 Health Objectives. A
survey of 300 middle- and upper-class shoppers in
Boston found that 10 percent of them had a bulimic
history.5 (#216) Another study at a large, Eastern
university found that only 1 percent of the women
had bulimia. Part of the difficulty in determining the
prevalence of this disorder, according to the authors
of this latter study, is the definition of bulimiac
Whether there is an epidemic of bulimia on the
college campus or not depends on the definition
of bulimia. If bulimia is defined as self-reported
overeating in combination with occasional
purging, then the answer is an emphatic "yes.
If, however, the term bulimia is restricted to the
diagnosis of a clinically significant disorder, the
answer is "no." Its prevalence rate did not ex-
ceed 1.3 percent in a sample of university wo-
men, those presumed to be at highest risk.6
The incidence of anorexia is steadily increasing,
-with nearly 1 percent of women now affected, accord-
ing to the Utah Nutrition Council. A proposed goal
for the year 2000 is to prevent and reduce the
incidence of eating disorders. The strategies recom-
mended to achieve this include media campaigns,
outpatient clinics, and a hotline to prevent relapse.
(#216)
Anemia
Conway notes that the use of iron-fortified infant
formulas is declining and suggests that this could
result in an increase in infant and child iron
deficiency anemia. Education and iron supplementa-
tion are required to prevent the condition. Conway
proposes that the year 2000 objectives on anemia
target all age groups. (#043) Sharon Hoerr of Mi-
chigan State University echoes Conway's point by cal-
ling for the identification of Additional population
subgroups at risk for impaired iron status. Specifi-
cally she states that "the prevalence of impaired iron
status as defined by low iron stores in children aged
one to two years, in males aged 11 to 14, and in
females aged 15 to 44 years, should be reduced to at
least 50 percent of those levels estimated for these
groups in NHANES II." (~100)
SPECIAL TARGET GROUPS
In addition to identifying objectives for several mltri-
tion-related conditions, testimony produced recom
OCR for page 113
mendations for targeting populations with special
nutritional needs. Pregnant women, infants and chil-
dren, and hospitalized patients received special atten-
tion in the testimony. Others suggested that this list
be expanded to include the elderly and some sub-
groups within the minority population.
Pregnant Women
For pregnant women, nutrition counseling was seen as
a critical part of prenatal care. The Michigan Die-
tetic Association recommended that objectives relating
to access to comprehensive prenatal care specifically
mention nutritional services. f#O57J The federal
Special Supplemental Food Program for Women, In-
fants, and Children (WIC) was hailed as an important
way to improve the nutritional status of pregnant
women. (~057; #063) According to the Grocery
Manufacturers of America:
'rhe WIC program is a vivid example of how
health objectives can be achieved through
cooperation with government, the food industry,
the banking industry, local communities, and
health professionals. This program has now
developed into a food assistance program remar-
kable both in its degree of personal nutrition
services, as well as its ability to produce
measurable improvements in the nutritional
status of its clients, and has had an economic
impact that is continuing to be viable. (~063J
However, several witnesses pointed to the lack of
adequate resources as a real obstacle to the potential
impact of WIC. The March of Dimes Birth Defects
Foundation states, "There is no state in the country
that services all of its WIC-eligible women and
children. In 42 states, fewer than 50 percent of those
eligible are sensed." (#203J The Society for Nutri-
tion Education adds that "high volume WIC programs
are seldom able to consistently provide individual
attention." (#462)
Several states are attempting to supplement the
WIC program. A study by the Michigan Food and
Nutrition Advisory Commission looked at admissions
between 1978 and 1982 to a Flint hospital in which
children, age two or less, failed to thrive. Shirley
Powell, who represents the group, reports that even
though these children were in the WIC caseload, their
results were poor.
Growth failure had nearly doubled [1978-1982]
and the increases closely paralleled rising
unemployment and deepening recession. The
doctor continues to see serious problems, and
she is involved in piloting an intervention in
which close counseling on infant care and
feeding is provided, in addition to WIC's food
supplementation. f#390J
The Massachusetts Department of Public Health
also has tried to go beyond WIC, according to its
Commissioner Deborah Prothrow-Stith, but it is still
not enough.
We are one of the states that significantly
supplements our WIC funding, and we do that
not only in the monetary reward, but also in
looking at foods and agriculture. We have made
an alliance with our Department of Food and
Agriculture, and women are eligible to receive
fruits and fresh vegetables. But even with those
initiatives, we have an infant mortality rate that
concerns us. (#735J
Among the suggested objectives aimed at improv-
ing nutrition for pregnant women is one from the
Utah Nutrition Council supportive of "goals and
objectives that would improve the quality and quantity
of sound nutrition education programs, including
those targeting pregnant teen girls delivering low-
birth-weight infants, who "increasingly need nutritional
help and guidance." (~216J
Infants and Children
Many witnesses emphasized the nutritional benefits of
breast-feeding for infants; Chapter 22 provides more
detail. Testifiers in this area called for maintaining or
increasing the 1990 targets for the percentage of
mothers that breast-feed.
Many testifiers emphasized the importance of
school meal programs for preschoolers and school-
age children. According to Carol Neill of the Califor-
nia School Food Services Association, school children
who are hungry or malnourished suffer a range of
effects from permanent necrologic defects to behavior
problems, inability to concentrate, and other learning
problems. (#161)
lithe National School Breakfast Program serves
about 4 million children, 89 percent of them at no
Nutrition 113
OCR for page 114
charge or at a reduced price.7 In addition, ap-
pro~mately 24 million children receive a school lunch
each school day, many of them free or at a reduced
price.8 Food assistance programs are directly related
to improvements in dietary habits and nutritional
status of children, according to testimony. (#161)
Witnesses supported maintaining and extending these
programs. Specifically, according to Jacqueline
Frederick of the New Jersey Department of Educa-
tion:
The National School Lunch Program should
have guidelines for feeding special populations.
In essence, the school lunch program must
consider the nutrition requirements of the
pregnant teen, the problems of refugee children
with marginal nutritional status, and children
with various physical and mental handicaps.
Nutritious, well-balanced meals should not only
be available to each student, but should be
tailored to meet their specific nutritional needs.
(#618J
Witnesses also feel that dietary guidelines are
needed for preschoolers and school-age children.
They say that adult guidelines sometimes are used to
determine appropriate levels for children, but this is
not the best approach. (#161; #590) For example,
Egan points out that "the progress of the USDA/
DHHS Dietary Guidelines promotion in school lun-
ches has been greatly hampered by the lack of ava~la-
bility of the revised school lunch recipes that have
been adapted to comply with the Dietary Guidelines.
(~057J
In an attempt to get dietary guidelines designed for
children, Neill requests that Congress require a study
on "how to apply the USDA/DHHS Dietary
Guidelines to children, including, in particular, sodi-
um, fat, and sugar recommendations." The group
asks that all food companies that supply the school
lunch programs review their specifications to ma~-
mize compliance with the guidelines. (~161)
The Nutrition Education and Training Program
(NET), designed to teach children the value of a
nutritionally balanced diet through positive daily
lunchroom experiences and appropriate classroom
reinforcement, also drew support. Carol Philipps of
the Midwest Region NET Program Coordinators
praises NET not only for contributing to the improve-
ment in nutrition topic areas of the objectives, but
also for helping in the related areas of dental caries,
periodontal disease, obesity and overweight, eating
114 Healthy People 2000: Citizens Chart the Course
disorders, and intervention against certain chronic
diseases. (#590) In addition to its role in training
teachers and school food service personnel, Ann
Butler of the Texas Department of Human Services
sees the NET network as having the potential to
"conduct school food service research, develop
workshops and training materials, and provide techni-
cal training," in order to offer "an educational
framework that would ultimately improve children's
nutritional status. (~606)
HospRaIized Patients
A number of testifiers suggested that malnutntion is
a serious problem among hospital patients, even those
in general hospitals. Estimates vary according to the
criteria used, but they agreed that about half of all
patients suffer from malnutrition, and longer-stay
patients are more likely to be malnourished than
shorter-stay patients.9 Also, according to Joel Kopple
of the Harbor-UCLA Medical Center, poor nutritional
status is associated with increased morbidity and mor-
tality. (~681) Testifiers suggested as objectives that
the prevalence of hospital malnutrition be reduced by
25 to 50 percent. (#23S, #496) To reduce hospital
malnutrition, Kopple called for an increase in the
number of hospital personnel who can assess the nu-
tritional status of patients and for training medical
students and other health care providers to be more
sensitive to nutritional disorders. f#681)
EDUCATION AND OTHER PREVENTIVE
STRATEGIES
Educating both the public and health professionals
about the role of nutrition in disease prevention Is
an important part of the effort to achieve nutrition
objectives. However, witnesses also emphasized the
need to go beyond merely informing consumers about
good nutrition; they also must have the ability and
the will to change their dietary habits. (~007; #077)
Nutrition education can come from a varietr of
sources: schools, health providers, mass media, com-
munity organizations, professional and trade associ-
ations, and health professionals. Powell suggests that
by the year 2000, every state should have a broad-
based, interdisciplinary commission to provide advice,
advocacy, and networking on health-related food and
nutrition issues for consumers. (#390)
Making nutrition counseling a part of school meal
programs, the WIC program, or elderly meal programs
is very effective, according to the Society for Nutrition
OCR for page 115
Education, which reported findings that when WIC
clients were counseled about nutrition, the birth
weight of their babies increased by 15 to 60 grams.~°
(~462) Several witnesses called for the inclusion of
nutrition education in the school health curriculum;
this is discussed more fully in Chapter 9.
Education also must be targeted toward health pro-
fessionals. Young pointed out that a 1985 National
Academy of Sciences report found nutrition education
in medical schools inadequate. She says that not
even one-third of medical schools have a required full
course in nutrition and suggested, along with other
witnesses, that the objectives be expanded to include
nutrition education for health professionals. (~496)
According to the Grocery Manufacturers' Association,
the 1990 objective that virtually all contacts with
health professionals include a nutritional component
is unrealistic. Instead, efforts should begin with the
education of health professionals and then address
their contacts with high-risk patients or those with a
disorder in which nutrition plays a role. (#063)
Once consumers are aware of good nutritional
habits, food labels can help them make dietary
changes. The importance of dear labeling of fat
(saturated and unsaturated), calories, cholesterol, and
sodium content was mentioned repeatedly. Health
claims permitted on labels should be worded so they
do not confuse consumers, and efforts should be made
to eliminate health fraud. Kathy Duffy of Harborview
Medical Center in Seattle noted that with a large
fraction of the population unable to read English,
nutrition information should be presented with
pictures, signs, colors, or logos. `~0s2~ Restaurant
menus and fast-food outlets could also provide
information on nutritional content. (~462)
Other testifiers said that nutrition education and
counseling should be part of general fitness programs;
these should include the availability of healthy foods,
especially in the workplace where exercise programs
are sometimes offered and where cafeteria or vending
machine food is available. f#l00; #736J
IMPLEMENTATION
The goal-setting process must take into account some
fundamental issues critical to progress in preventing
nutrition-related problems. According to witnesses,
these include funding, data needs, adequate staffing
with nutritional specialists, and involvement of a
variety of players.
Many witnesses spoke of an urgent need for a
national system to monitor progress toward the nutri-
tion objectives. According to Conway, a data system
should be integrated at the federal, state, and local
levels including, perhaps, a tie-in between local sys-
tems and NHANES. (~043) Such a system should
have a core set of commonly Identified data items,
says the Society for Nutrition Education. (#462)
Hoerr notes, as an example, the current use of dif-
ferent definitions of obesity and ways to measure it.
`#1009
In addition to surveillance objectives, several types
of research were proposed. Examples include studies
of the cost and benefits of dietary changes (#0774;
research into food-borne disease and individual
susceptibility (#7334; exploration of food processing
techniques that do not require harmful additives
(#2284; and general nutrition research, especially by
the federal government. (#733)
Testimony involved discussion of the roles of many
different types of organizations in improving nutrition-
al status. These include the federal government
through the National Institutes of Health, the Food
and Drug Administration, and the Department of
Agriculture; the Institute of Medicine's Food and
Nutrition Board; state and local health departments;
professional associations of dietitians and other health
providers; community and social service groups;
schools; employers; and the food industry. Represen-
tatives of many of these groups testified about their
involvement in preventing nutrition-related health
problems. Dietitians, for example, emphasized the
role they can play in education and counseling. The
National Daily Council, in particular, emphasized its
public education efforts. f*S71'
The American Dietetic Association noted that 33
state health agencies have established dietary recom-
mendations but that barriers to implementation, such
as inadequate funding, personnel, and administrative
structure, interfere with progress in meeting objec-
tives. (#007) Others made clear that meeting nutri-
tional objectives will require putting in place the
resources upon which effective strategies can be built.
Nutrition 115
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REFERENCES
1. U.S. Department of Health and Human Services: Surgeon General's Report on Nutrition and Health (DHHS
Publication No. [PHS] 88-50210), 1988
2. National Research Council, Committee on Diet and Health: Diet and Health. Washington, D.C.: National
Academy Press, 1989
3. Brown, JL: Hunger in the U.S. Sci Am 256~2~:37-41, 1987
4. Najjar MF: Anthropometric reference data and prevalence of overweight, United States, 1976-1980. Vital
and Health Statistics Series 11, No. 238 (DHHS Publication No. [PHS] 87-1688), 1987
5. Pope HG, Hudson JI, Yurgelun-Todd D: Anorexia nervosa and bulimia among 300 suburban women
shoppers. Am J PsychiatIy 141~2~:292-294, 1984
6. Schotte DE, Stunkard AJ: Bulimia vs. bulimic behaviors on a college campus. J Am Med Assoc
258~9~:1213-1215, 1987
7. Radzikowski J. Gale S.: The national evaluation of school nutrition programs: Conclusions. Am J Clin Nutr
40~2~(suppl.~:454-461, 1984
8. Radzikowski J. Gale S: Requirement for the national evaluation of school nutrition programs. Am J Clin
Nuer 40~2~(suppl.~:365-367, 1984
9. Roubenoff R. Roubenoff RA, Preto J. et al.: Malnutrition among hospitalized patients: A problem of
physician awareness. Arch Intern Med 147~8~:1462-1465, 1987
10. Rush D (Principal Investigator): Evaluation of the Special Supplemental Food Program for Women, Infants
and Children (WIC), voL 1: Summa~y. Research Triangle Institute, New York State Research Foundation for
Mental Hygiene, 1987
11. Comm~ttee on Nutrition in Medical Education: Nutrition Education in U.S. Medical Schools. Washington,
D.C.: National Academy Press, 1985
TESTIFIERS CITED IN CHAPTER 12
007 Lechowich, Karen, et al.; The American Dietetic Association
043 Conway, Dorothy; California Conference of Local Health Department Nutrition~sts
052 Duf~, Kathy; Harborview Medical Center and Wilkins, Jennifer; Pullman, Washington
053 McCarron, David et al.; The Oregon Health Sciences University
057 Egan, M. Jean; Michigan Dietetic Association
063 Fletcher, Carol; Groce~y Manufacturers of America
077 Guthrie, Marilyn; Virginia Mason Clinic (Seattle)
082 Hanneman, Richard; Salt Institute
100 Hoerr, Sharon; Michigan State Universitr
161 Neill, Carol; Alum Rock Union Elementary School District (California)
178 Reid, Elaine; Sacred Heart Medical Center (Spokane, Washington)
203 Smith, Richard; Hen~y Ford Hospital (Detroit)
216 Utah Nutrition Council
228 Wooldridge, Nangy; Alabama D~etetic Association
238 Bray, George; University of Southern California
116 Healthy People 2000: Citizens Chart the Course
OCR for page 117
390 Powell, Shirley; Southeastern Michigan Food Coalition
462 Dodds, Janice; Society for Nutrition Education
496 Young, Eleanor; University of Texas Health Science Center at San Antonio
571 Speckmann, Elwood; National Dairy Council
590 Philipps, Carol; Wisconsin Department of Public Instruction
606 Butler, Ann; Texas Department of Human Services
618 Frederick, Jacqueline; New Jersey Department of Education
627 Stokes, III, Joseph; Boston University
636 Ballin, Scott; American Heart Association
681 Kopple, Joel; University of California, Los Angeles
733 Morse, Roy; Institute of Food Technologists
735 Prothrow-Stith, Deborah; Massachusetts Department of Public Health
736 Wood, Lonng; NYNEX Corporation
739 Anderson, Jennifer; Colorado State University
Nutrition 117
Representative terms from entire chapter:
nutritional status
