American College of Nutrition 46th Annual Meeting

TWELVE-MONTH MICRONUTRIENT SUPPLEMENTATION TRIAL IN CAMBODIAN INFANTS 6 TO 18 MONTHS OF LIFE

M Giovannini, B Fiege, G Francescato, D Sala, G Radaelli, C AgostoniDepartment of Pediatrics, San Paolo Hospital, University of Milan, Italy

Aim: To assess the association of iron or iron plus micronutrient supplementation with growth, hematological profile, mortality and morbidity through 6-18 months of life. Study design: Double-blind, placebo-controlled comparative longitudianal trial conducted on 204 infants aged 6 months at recruitment living in Kompong Chhang Province, Cambodia. Allocation to treatment (Folic acid + Iron + multimineral and multvitiman [MMN], or Iron + Folic acid [FFA], or Placebo, given as Sprinkles) was performed at recruitment. Results: No significant differences among groups for any growth variable were found. At the end of the intervention trial hemoglobin plasma levels significantly increased in both MMN and FFA groups. NO significant difference increase in hemoglobin was observed between MMN and FFA. In infants without hemoglobinopathy, percentage increase of hemoglobin was higher in MMN group compared to FFA group. Conclusions: Starting at 6 months, and up to 18 months, a dietary supplementation with iron preparations helps in preventing the development of iron-deficiency anemia in Cambodian infants.

NIACIN-BOUND CHROMIUM SIGNIFICANTLY INCREASES LIFE SPAN IN RATS

H Preuss, B Echard, D. BagchiGeorgetown University, Washington DC & Creighton University, Omaha, NB

Avoiding insulin resistance may play a prominent role in extending life span of caloric restricted animals. We previously hypothesized that preventing insulin resistance by other means might prolong healthful lifespan despite no severe caloric limitations. Accordingly, we examined various effects of niacin-bound (vitamin B-3) chromium (NBC) alone (n=12) and in a formula (n=10) compared to control (n=10) over the lifespan of Zucker rates that have a proclivity toward developing "metabolic syndrome." In addition to NBC, the formula contained Allium sativum, Momordica charantia, Trigonella foenum-graecum and Gymnema sylvestre. The group NBC group received twice as much of a daily dose of chromium as the formula group. At six months, hematology and blood chemistries were analyzed. No abnormalities were noted in hematology. In the two treatment groups, circulating glucose levels were significantly lower. Of the other 16 chemistries, the only significant differences were elevated cholesterol and triglycerides in the formula group. Systolic blood pressures (SBP) were consistently lower in the NBC group after 10 weeks and in the formula group after 40 weeks. The first control rat died at 8 months followed by two more deaths at 9 and 10 months. The first deaths in the NBC and formula groups occurred in the tenth month. Whereas the death rate in the formula group eventually mimicked that in control, it was delayed in the NBC group. When all other rats had died, four in the NBC group continued to live at least a month beyond. The NBC group increased average life span by 19.1%, median life span by 12.2%, 30th percentile survival by 19.6% and maximum life span by 22%. We conclude that NBC can increase life span without caloric restriction and attribute the lack of effect in the formula group to either lower NBC dietary intake or the elevated cholesterol and triglycerides. There was no evidence of blood dyscracias or renal and liver perturbations from NBC over the life span of the Zucker rats. These studies suggest that caloric restriction works, at least in part, via effects on insulin sensitivity.

PLANT STEROL ABSORPTION RE OstlundWashington University School of Medicine, St. Louis, MO

Phytosterol (cholesterol-like compounds found in plants) in the natural diet and in supplements are likely to be as important as saturated fat and cholesterol in regulating serum cholesterol levels and represent a means to lower cholesterol levels in the general population.

Cholesterol absorption is incomplete in normal subjects with only 56% of intestinal cholesterol being transported into body cholesterol pools. However, the range is wide with some individuals consistently having values as low as 11% or as high as 85%. Each day the intestine received approximately 1000 mg of endogenous biliary cholesterol and 150 mg of dietary cholesterol. Failure to completely absorb this load is the principal means by which cholesterol is eliminated from the body. Phytosterols reduce serum cholesterol levels by reducing intestinal cholesterol absorption by about 35%. However, phytosterols alone are inert and ineffective and need to be emulsified either naturally as in foods or by adding lecithin or be dissolved in food fats. Effective food formulations for phytosterols include margarines, salad dressings, beverages, and yogurt. Effective pharmaceutical formulations are also recently available. Phytosterols increase cholesterol elimination and work together with statin drugs that reduce cholesterol biosynthesis.

The average reduction in serum cholesterol with phytosterol treatemt is 10%. However, this may be an underestimation since natural dietary phytosterols may add to this and have not been studied very well. Natural dietary phytosterols such as those in vegetable oils and wheat germ are bioactive when presented in the original foods, reduce cholesterol absorption and should be considered as effectors in all diet studies.

FROM PLANTS TO BONESC WeaverDepartment of Foods and Nutrition, Purdue University, West Lafayette, IN

Isotopic tracer techniques are a useful approach to quantitate the uptake and transfer of minerals throughout the food chain and to understand the mechanisms for how lifestyle factors influence their metabolism. Bioavailability of minerals has been characterized using intrinsically labeled, hydroponically-grown plants, animal food sources, and supplements. For example, the role of endogenous phytate on mineral absorption was quantified. Exchangeable pools for calcium, zinc, and selenium have been characterized as was done previously for iron. Almost all the major sources of calcium have been evaluated for calcium bioavailability. Small complexes such as calcium oxalate can be absorbed intact in the lower gut. Because 99% of the body's calcium is in the bone, following the fate of calcium tracers elucidates bone turnover. Using calcium tracer kinetics and controlled feeding studies in pubertal children, calcium requirements and differences due to gender, race, and dietary salt have been determined during peak bone acquisition. Recently, a new calcium tracer 41Ca, is being used to determine treatment effects on reducing postmenopausal bone loss.

RESPONSE OF PLASMA GLUCOSE AND INSULIN AFTER LUNCH FOLLOWING A TOLERANCE CONTAINING DIFFERENT LEVELS OF b-GLUCANKM Behall, DJ Scholfield, JG HallfrischBHNRC, ARS, USDA, Beltsville, MD 20705

Consumption of foods containing soluble fiber has been reported to lower blood glucose and insulin levels after the meal. This study sought to determine if the reduced glycemic response continued after the next meal. After institutional review and approval, 10 control and 10 overweight men (average BMI 24 vs 29, 25-56 y) were fed the same controlled diet for 2 days before each tolerance meal containing 75 g available carbohydrate. On day three, fasting subjects consumed glucose or muffins containing 0.1, 2.4 or 3.8 g b-glucan per meal. Lunch was consumed 4 h after the morning meal. Overweight subjects had significantly higher mean glucose (6.0 vs 5.5 ± 0.2 mmol/L) and insulin (304 vs 181 ± 31 mmol/L) concentrations than controls. As anticipated, peak glucose and insulin responses and areas under the curve (AUC) were significantly lower after muffins containing 4.8 g b-glucan compared to glucose alone. After lunch, glucose and insulin concentrations at 1 and 2 hr and AUC were significantly lower after all muffins compared to glucose alone, with no statistically significant differences between thre three muffins. Compared to glucose alone, a morning meal containing complex carbohydrate had a greater impact on glycemic response after lunch than the presence of b-glucan in the meal.

NUTRITION INTERVENTION IN IBDA. KeshavrzianDepartment of Medicine, Rush University Medical Center, Chicago, IL

Many patients with Inflammatory Bowel Disease (IBD) are dissatisfied with conventional IBD therapy and have turned to the use of nutritional therapy including botanical dietary supplements (BSD) and "IBD diets" in the hope of finding greater efficacy and lower toxicity. The notion that current conventional therapy of these chronic disabling diseases is not satisfactory is also widely accepted by health care professionals. First, there is no cure for IBD, and the most successful current therapeutic strategy (steroids and immunomodulators) provide only a partial response and then in only 80% of patients. Second, these patients must always remain on medications, and current medications have major adverse effects. One possible explanation for the les-than-satisfactory results from current IBD therapy is that these therapies are not using an optimal strategy. Conventional therapies are primarily focused on attenuating the mucosal immune response to luminal antigens. While logical, it has not proved ideal. An alternative therapeutic approach is preventing activation of the mucosal immune response. Thus, therapy focusing on either changing luminal antigen loador protecting mucosal barrier integrity " which would prevent activation of the mucosal immune system by limiting exposure of the mucosa to luminal antigens " could in principle be a more effective therapeutic strategy. The nutritional intervention, at least in theory, has a potential to e such a strategy. Dietary supplements like BDS can protect gut barrier and prevent loss of gut barrier integrity and even repair disrupted barrier via their antioxidant and anti-inflammatory properties and specific diets can change microflora from a pro-inflammatory to anti-inflammatory milieu (prebiotics).

THE IMPACT OF PHOSPHORUS ON INTESTINAL ABSORPTION OF CALCIUM, MAGNESIUM, IRON AND ZINCK Stark, K FairbanksDepartment of Nutrition, Dietetics and Food Science, Brigham Young Univeristy, Provo, UT

The effect of dietary phosphorus (P) on the intestinal absorption of divalent cations has been controversial. This study collected human data from papers which reported dietary and fecal P and dietary and fecal phosphorus for at least one of the cations calcium (Ca), magnesium (Mg), iron (Fe) or zinc (Zn). For two studies, individual data for subjects consuming self-selected diets was obtained. From these studies, the apparent intestinal absorption of P and the respective cations were calculated and compared. Generally, a decreased P absorption was associated with a decreased cation absorption, but not always. As fecal P increased, cation absorption decreased. The total P in the diet appeared to be important as it determined the fecal P. Low fecal P, about 300 mg/day, was generally associated with the highest cation absorption. The relationship between dietary and fecal cations and P were determined using ratios of mmol (Ca, Mg) or mmol (Fe, Zn) per mmol of P. the correlation of the dietary ratios with the fecal ratios for each cation were significant (p < 0.0001). Dietary ratios determined the fecal ratios. The consistency of the ratios suggested that P forms complexes or binds the cations in set ratios that are determined by the amount of unabsorbed P in the lumen of the intestine. This has implications in human diets because it affects the absorption of these cations.

NUTRITION EDUCATION AT U.S. MEDICAL SCHOOLS " A NATIONAL SURVEYMS Edwards, C Pratt, PE McBrideUniversity of Texas Medical School, Houston, TX; National Heart, Lung, and Blood Institute (NHLBI), Bethesda, MD; and the university of Wisconsin, Madison, WI

This survey determined the extent to which nutrition is taught by U.S. medical schools and the interest of non-Nutrition Academic Award (NAA) medical schools in working with NAA schools. A 32-item survey was mailed to curriculum deans at 125 U.S. medical schools during 2003-2004. A total of 93 schools responded to the survey representing a 74% response rate. Nutrition is included in the curriculum at 98% of the schools but only 24% of schools reported having a required nutrition course. A majority of schools (85%) described their nutrition curriculum as an integrated curriculum. Forty-one percent of schools reported having a Problem-Based Learning curriculum in which nutrition is taught. Most schools (86.4%) have multiple instructors who teach nutrition with both M.D. and Ph.D., R.D. faculty. Nutrition electives are available throughout the four years of undergraduate training at 64% of medical schools. Evaluation of students is done by focused nutrition exams at 32% of schools whereas over 70% of schools responding to the survey reported using integrated basic science exams. Eighty-eight percent of schools indicated an interest in sharing nutrition resources developed by the NAA Program. U.S. medical schools are making efforts to include nutrition education as an integral part of the medical school curriculum. However, more medial schools need to consider nutrition as a required course in medical education.

This work was supported by the National Heart, Lung, and Blood Institute grant #1 K07 HL04326-01.