Frontiers in the Nutrition Sciences Proceedings of a Symposium (1989) / Chapter Skim
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Nutrition and Public Health -- New Dimensions
Nutrition and Public Health -- New Dimensions
Pages 117-142
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From page 117... ...
This paper discusses various ways in which these changes will shape future public policy and practice related to nutrition. Those who watch the literature and who attend the numerous scientific symposia held annually around the country receive the more than $200 million a year the National Institutes of Health pours into nutrition-related research.
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From page 118... ...
FACTORS INFLUENCING NUTRITION POLICY The factors most likely to influence our nutrition policy agenda include the national disease profile, the development of scientific insights, the advent of new technologies, the U.S. demographic profile, economics, changing meal source patterns, and public and professional awareness.
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From page 119... ...
and unpublished data from the Division of Vital Statistics, National Center for Health Statistics (1988~. leading causes of death, 3 of which -- heart disease, stroke, and cancer -- account for more than 70% of all deaths in the United States (NCHS, 1987~.
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From page 120... ...
Table 2 illustrates the research areas identified as being of particular importance by the federal Interagency Committee on Human Nutrition Research. They include the following: Nutrient requirements throughout the life cycle, because of the importance of identifying how age-related metabolic changes have an impact on nutrient needs; 120
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in recognition of the substantial deficiencies in the ability of the United States to reliably assess the population's nutritional status; and 121
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From page 122... ...
TABLE 3 Nutrition-Related Technologies Gene characterization Genetic engineering Food and ingredient synthesis Food composition assays Body composition techniques Microicomputerized bioassays Automated personal diet profiles Automated analysis of food usage Gene Characterization. Mapping of the human genome has yielded the identification of the region of the DNA pathology responsible for sickle cell anemia, 122
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From page 123... ...
The food industry is currently pouring substantial sums of money into the development of new and reformulated food products -- more than 7,000 products were projected for 1986 alone (Albrecht, 1986~ -- that are targeted to a public apparently 123
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From page 124... ...
Food composition assays. Despite the fact that food composition analysis is the oldest of the food-related technologies, we still are relatively ignorant about the precise makeup of a sizable share of our food supply, particularly with respect to the various ways in which foods are prepared and served.
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Nonetheless, automation may well yield substantially enhanced capabilities for monitoring patterns for food usage. Automated analysis of food usage.
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From page 126... ...
. Sales of farm products USDA farm programs a USDA food programs Processed food industry Food and eating out Nutrition research 142.1 7.7 18.4 83.0 461.0 0.292 aDirect payments to farmers for farm-related activities.
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From page 127... ...
which make up two-thirds of total food service industry sales (National Restaurant Association, 1987) and which increased from $104.5 billion in 1984 to $128.6 billion in 1987 -- a 23% increase in just 3 years.
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From page 129... ...
The analysis also showed that women who obtained more than 20% of their food energy from these three types of food service establishments (high users) had lower densities of iron, calcium, vitamin C, carbohydrate, and fiber and higher densities of total fat and saturated fat, suggesting a slightly negative influence of the three types of food service establishments on nutritional quality (Guenther and Ricart, 1987~.
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From page 130... ...
and FDA national Cholesterol Awareness Surveys shows that in just a 3-year period, from 1983 to 1986, there were 8 to 10% increases in adult attitudes, beliefs, and action on lowering blood cholesterol to reduce the risk of heart disease (Schucker et al., 1987b)
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From page 131... ...
Professional Awareness One of the more curious aspects of health enhancement efforts is that if an effort is viewed as falling within the public domain -- if it is public health or health for the public -- then a large share of practicing health professionals somehow feel absolved of any responsibility, or expertise for that matter. Table 9, for example, which was also drawn from the Cholesterol Awareness Survey data (Schucker et al., 1987a,b)
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From page 132... ...
The percentage of the public and physicians responding that lowering of a high blood cholesterol level will have a large effect on coronary heart disease. In 1983, the total number surveyed was 4,007 members of the public and 1,610 physicians.
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From page 133... ...
Inevitably, the resulting insights influence the agenda by requiring a stratification of the goals and guidelines beneath the population level to accommodate group and individual variations. It is important for the society, however, to ensure that no single factor, whether it be economics, technology, public demand, or a quest for some undefinable standard of scientific purity, be allowed to overwhelm the process of crafting the U.S.
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From page 134... ...
Public demand provides the greatest impetus, but guidance from the nutrition community is needed. Reimbursement Policies Reimbursement for a service through an insurance mechanism, whether public or private, can be a major stimulus to any public health intervention.
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From page 135... ...
with the advent of the technologies discussed earlier: body composition techniques, microcomputer bioassays, and automated dietary profiles. Regardless of whether it is driven by technology, the science base, or public demand, it is not unreasonable to expect some sort of nutrition services ultimately to be provided as part of a reimbursable preventive services package.
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From page 136... ...
· Instead of general patterns of nutrient requirements throughout the life cycle, we should focus more definitively on individual variations in those requirements. Instead of undertaking assays of nutrient interactions and bioavailability, we will be titrating ways to use those phenomena to affect disease outcomes Our understanding of the relationships between nutrition and chronic diseases will begin to allow us to move more confidently in using diet as an intervention tool against those diseases, from approaches that are now oligodimensional in character to those of a more polydimensional nature -- in effect, to begin to deploy a kind of matrix management to the use of dietary tools in chronic disease control.
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From page 137... ...
day as a result of coronary heart disease; death rates from heart disease among blacks are about one-third higher than those among whites, and death rates from stroke are nearly double those among whites (NCHS, 1987~; and twice as many black babies as white babies die (NCHS, 1987~. While we do not have all the answers to these problems, we do have some answers and important hints about others.
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From page 138... ...
1986. The new National Cholesterol Education Program.
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From page 139... ...
Interagency Committee on Human Nutrition Research.
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Restaurants USA, December: 1-24. National Restaurant Association Research and Information Service Department.
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From page 141... ...
1986. Nationwide Food Consumption Survey, Continuing Survey of Food Intakes by Individuals: Men 19-50 Years, 1 Day.
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From page 142... ...
1987. Nationwide Food Consumption Survey, Continuing Survey of Food Intakes by Individuals: Women 19-50 Years and Their Children 1-5 Years, 4 Days.
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