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Food Stely
confreence
MEETING FOR A WHITE HOUSE
CONFERENCE ON FOOD,
NUTRITION, AND HEALTH
December 3, 1998
PRESERVATION
PHOTOCOPY
Coronary Heart Disease Mortality Trends Among Whites and Blaclhttp://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00055774.hfm
MMWR
November 27, 1998 / 47(46);1005-8,1015
Weekly
Coronary Heart Disease Mortality Trends Among Whites and
Blacks Appalachia and United States, 1980-1993
Although heart disease-associated mortality has declined steadily since the 1960s, heart disease remains the leading cause of death for both
men and women of all races/ethnicities in the United States (1). This report compares temporal trends in coronary heart disease (CHD) death
rates for blacks and whites from 1980 to 1993 (the latest year for which data were available) in the Appalachian Region with trends for the
entire United States. The findings indicate that among whites aged greater than or equal to 35 years the burden of CHD is greater in
Appalachia than in the entire United States, with the disparity increasing over time, and among blacks, only slight differences in CHD rates
between Appalachia and the United States were observed.
From 1980 through 1993, annual age-adjusted CHD death rates for persons aged greater than or equal to 35 years were calculated using
mortality data compiled by CDC and population estimates from the Bureau of the Census. For both Appalachia and the United States, CHD
death rates were calculated separately for blacks and whites by sex and age group (i.e., ages 35-64 and greater than or equal to 65 years).
The 1980 U.S. population aged greater than or equal to 35 years was the standard for age adjustment. CHD deaths were defined as deaths
for which the underlying cause was listed on the death certificate as codes 410.0-414.0 and 429.2 of the International Classification of
Diseases, Ninth Revision (ICD-9). The cause of death is reported by attending physicians, medical examiners, and coroners on death
certificates and is subsequently coded according to the ICD-9. Linear regression models, with year as the independent variable and
log-transformed annual CHD death rate as the dependent variable, were estimated separately for each group. Beta coefficients from each
model were used to calculate the average annual percentage change in CHD mortality.
CHD mortality declined from 1980 through 1993 for each of the demographic groups for both Appalachia and the United States; however,
Appalachia and the United States differed in both the level of CHD mortality and the magnitude of decline for most demographic groups.
Among persons aged 35-64 years, CHD death rates for whites in Appalachia were consistently higher than those for the entire United States
(Figure 1). CHD death rates were 15% higher among white men aged 35-64 years in Appalachia than among white men in the United States
in 1980; in 1993, rates were 19% higher for white men in Appalachia. Similarly, CHD death rates were 15% higher among white women aged
35-64 years in Appalachia than among white women in the United States in 1980; in 1993, rates were 21% higher for white women in
Appalachia. In comparison, CHD death rates for blacks aged 35-64 years only differed slightly between Appalachia and the entire United
States (Figure 1).
For Appalachian residents aged 35-64 years, the average annual declines in CHD mortality from 1980 through 1993 were 2.3% for black
women, 3.1% for black men, 3.3% for white women, and 3.9% for white men. In the United States, average annual declines in the same age
group were 2.7% for black men, 2.8% for black women, 3.4% for white women, and 4.3% for white men.
Among persons aged greater than or equal to 65 years, whites in Appalachia had slightly higher CHD death rates than whites in the same
age group in the entire United States (6% higher in 1980 and 5% higher in 1993) (Figure 2). In comparison, blacks aged greater than or
equal to 65 years experienced slightly lower CHD death rates in Appalachia than blacks in the same age group in the entire United States
(Figure 2).
From 1980 through 1993, average annual declines in CHD mortality for Appalachian residents aged greater than or equal to 65 years were
1.8% for black men, 2.3% for black women, 3.2% for white men, and 3.3% for white women. In the United States, average annual declines for
persons in the same age group were 1.6% for black men, 1.7% for black women, 3.1% for white women, and 3.3% for white men.
Reported by: E Barnett, PhD, VE Braham, MA, JA Halverson, MA, Dept of Community Medicine; GA Elmes, PhD, Dept of Geology and
Geography, West Virginia Univ, Morgantown, West Virginia. Cardiovascular Health Br, Div of Adult and Community Health, National Center
for Chronic Disease Prevention and Health Promotion, CDC.
Editorial Note
Editorial Note: The findings of this report corroborate recent reports showing important geographic and race/ethnicity variability in both levels
and rates of decline in CHD mortality (3-7). The burden of CHD mortality observed among whites in Appalachia increased during 1980-1993.
In both Appalachia and the entire United States, CHD death rates for blacks remained higher than rates for whites; however, among blacks
there were only slight differences in CHD death rates between Appalachia and the entire United States.
The findings in this report are subject to at least two limitations. First, data used to calculate CHD death rates in this study include census
undercounts of black populations and variations in the accuracy of reporting underlying cause of death on death certificates. Second,
examination of CHD death rates for a large region such as Appalachia obscures important geographic variation in risk for heart disease within
the region. Rural and less affluent counties within Appalachia were at highest risk for CHD mortality and were least likely to have adequate
economic and medical-care resources (8).
The findings in this report suggest that the social and environmental conditions and resources that influence CHD mortality for whites aged
greater than or equal to 35 years may differ between Appalachia and the United States. The Appalachian region is characterized by low
levels of urbanization and lower standards of living than the nation (9). Life expectancy for both men and women is lower in Appalachian
counties than the United States (10). In addition to low levels of economic resources, many Appalachian counties lack medical-care facilities
(e.g., hospital coronary-care units and cardiac-rehabilitation units) for treatment of CHD (8). The population of Appalachia is predominantly
white; however, blacks comprise 6% of the population, with several rural counties of southern Appalachia having black populations that are
more than 20%. The similarity of CHD death rates for blacks in Appalachia with those in the nation overall suggests the need to examine the
similarities in socioenvironmental conditions and resources for blacks in Appalachia compared with the United States. Increasing inequalities
in CHD mortality trends for whites between Appalachia and the nation from 1980 through 1993 indicate the need for public health
interventions focused on this disadvantaged region.
In Appalachia, policies and programs should be instituted that enhance both primary and secondary prevention of heart disease mortality.
Secondary prevention of heart disease requires improved access to medical-care facilities and health-care professionals, especially for
residents of isolated rural counties. In addition, persons with heart disease require social support from their families and communities, and
access to facilities and programs for cardiac rehabilitation. Primary prevention of heart disease mortality requires communitywide
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improvements in the social environment, including full employment in healthy work environments, access to affordable healthy foods and
recreational facilities, and opportunities for social interaction and participation in civic life.
References
1. American Heart Association. 1998 heart and stroke statistical update. Dallas, Texas: American Heart Association, 1997.
2. Appalachian Regional Commission. Annual report, 1992. Washington, DC: Appalachian Regional Commission, 1992.
3. Sempos C, Cooper R, Kovar MG, McMillen M. Divergence of the recent trends in coronary mortality for the four major race-sex
groups in the United States. Am J Public Health 1988;78:1422-7
4. Wing S, Dargent-Molina P, Casper M, Riggan W, Hayes CG, Tyroler HA. Changing association between community occupational
structure and ischaemic heart disease mortality in the United States. Lancet 1987;2:1067-70.
5. Wing S, Casper M, Davis W, Hayes C, Riggan W, Tyroler HA. Trends in the geographic inequality of cardiovascular disease mortality
in the United States, 1962-1982. Soc Sci Med 1990;30:261-6.
6. Wing S, Barnett E, Casper M, Tyroler HA. Geographic and socioeconomic variation in the onset of decline of coronary heart disease
mortality in white women. Am J Public Health 1992;82:204-9.
7. Barnett E, Strogatz D, Armstrong D, Wing S. Urbanization and coronary heart disease mortality among African Americans in the
United States South. J Epidemiol Commun Health 1996; 50:252-7.
8. Barnett E, Elmes GA, Braham VE, Halverson JA, Lee JY, Loftus S. Heart disease in Appalachia: an atlas of county economic
conditions, 1998. mortality, and medical care resources. Morgantown, West Virginia: Prevention Research Center, West Virginia University,
9. Isserman AM. Appalachia then and now: an update of "The Realities of Deprivation" reported to the President in 1964. J Appalachian
Stud 1997;3:43-69.
10. Murray CJL, Michaud CM, McKenna MT, Marks JS. U.S. patterns of mortality by county and race: 1965-1994. Cambridge,
Massachusetts: Harvard University Center for Population and Development Studies, 1998.
Appalachia is comprised of 399 counties, including all of West Virginia and parts of Alabama, Georgia, Kentucky, Maryland, Mississippi, New
York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia (2).
Figure_1
FIGURE 1. Rates* of coronary heart disease mortality among persons aged
35-64 years, by year, race/ethnicity1, and sex - Appalachia and United States,
1980-1993
500
Black Men, Appalachia
Black Women, Appalachia
Black Men, U.S.
Black Women, U.S.
400
White Men, Appalachia
White Women, Appalachia
White Men, U.S.
White Women, U.S.
300
Rate
200
100
0
1980
1982
1984
1986
1988
1990
1992
Year
*Per 100,000 population.
Race-specific rates were limited to blacks and whites because numbers for other racial/ethnic
groups were too small for meaningful analysis.
Return to top.
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Figure_2
FIGURE 2. Rates* of coronary heart disease mortality among persons aged ≥65 years,
by year, race/ethnicity1, and sex - Appalachia and United States, 1980-1993
3000
2500
2000
Rate
1500
1000
White Men, Appalachia
White Women, Appalachia
White Men, U.S.
White Women, U.S.
500
Black Men, U.S.
Black Women, U.S.
Black Men, Appalachia
Black Women, Appalachia
0
1980
1982
1984
1986
1988
1990
1992
Year
* Per 100,000 population.
t Race-specific rates were limited to blacks and whites because numbers for other racial/ethnic
groups were too small for meaningful analysis.
Return to top.
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The role for Food Technology
While Americans are redefining what they want their foods to provide, it is
clear their actions are not following these definitions. They are looking for
nutrition to optimize health, prevent disease, enhance mental function and
improve athletic performance. A growing research base can identify beneficial
food components and optimal levels of these components that will be a primary
force driving product development. This will mean fortified, specially
formulated and biocngineered foods.
Thanks to food technology the market place can change dramatically.
The most recent example being food fortification of grain flours with folic acid
which has virtually eliminated the risk of heart disease from
hyperhomocystinemia. Other examples include fortification with calcium,
phosphorous, magnesium, vitamin D and fluoride at levels needed to reduce
the risk of chronic disease (osteoporosis) and to achieve optimal health and
well-being. These levels can only be met by fortification.
New micronutrients and macronutrients will be discovered and recommended.
These, together with the information we now have will form the basis for
dietary guidelines and food guides for consumer education. New foods will
need to be developed and current foods modified to provide optimal protective
factors at levels of dietary components higher than naturally occur. In some
cases the natural content of specific nutrients or other substances will need to
be lowered, such as fat.
Research is needed to improve our ability to define, measure, and manipulate
levels of protective constituents in foods through fortification, bioengineering
and selective plant breeding. The goal is to go beyond the traditional nutrients
and provide greater opportunity for tailored dietary recommendations to meet
an individual's nutrient requirement for optimal healthy and well being.
A coalition organized to discuss the implications of the new Dietary Reference
Intakes (DRIs) was co-sponsored by the American Society for Clinical
Nutrition and spearheaded by Lori Hoolihan, Ph.D., R.D. at the Dairy Council
Q
16% product
Assessment and Treatment of Obesity - A Development Edge
George L. Blackburn M.D., Ph.D.
7 early
Director, Center for the Study of Nutrition Medicine
Beth Israel Deaconess Medical Center/Harvard Medical School
We are at "the best of times and the worst of times" in terms of the assessment
and treatment of obesity. The World Health Organization (WHO) has
developed criteria for classification of obesity based on Body Mass Index (BMI
kg/m2) and the link between obesity and disease has gain "substantial scientific
evidence". The bad news is that obesity has increased at record levels with
over 58 million American adults and 22 percent of children are now
overweight.
This is not surprising when ones exams the source of calories using the
Continuing Survey of Food Intakes by Individuals (CSFII)¹
Food sources of energy intake are as follows:
Rank
Food
Percent
1.
bread
9.8
2.
beef
7.0
3.
milk
5.7
4.
cakes/cookies/
muffins/doughnuts
5.5
5.
soft drinks/sodas
4.1
12.
potatoes
2.6
6.
poultry
3.9
13. cereal(RTE) 2.6
7.
cheese
3.5
14. alcohol
2.5
8.
salad dressing/mayo
3.1
15.
rice/grains
2.2
9.
margarine
3.0
16.
potato chips
2.1
10.
sugars/jams
2.9
11.
pasta
2.6
Ready-to-eat (RTE)cereals, primarily because of fortification, were among the top 10 food
sources for 18 of 27 nutrients.
1 Food and nutrient intake by individuals in the United States (1989-91). Washington,D.C.
USDA, Agricultural Research Service 1995. NFS Report 91-2. and Subar, AF, Krebs-Smith, SM,
Cook A, Kahle, LL. Dietary sources of nutrients among US adults, 1989-1991. J Am Diet Assoc.
1998;98;537-547.
Coalition Members in Support of a White House Conference
on Food, Nutrition, And Health
December, 1998
1. American Academy of Pediatrics
2. American Association of Retired People
3. American Cancer Society
4. American College for Advancement in Medicine
5. American Council on Exercise
6. American Diabetes Association
7. American Dietetic Association
8. American Institute for Cancer Research
9. American Society for Clinical Nutrition
10. Association of Women's Health, Obstetrics and Neonatal Nurses
11. Banner Pharmacaps
12. Better Homes Fund
13. Bread for the World
14. Catholic Bishops' Conference
15. Center for Science in the Public Interest
16. Dietary Managers Association
17. Distilled Spirits Council of the United States
18. Dole Food Company, Inc.
19. Egg Nutrition Center
20. Feinstein International Famine Center
21. Food Marketing Institute
22. Food Research and Action Center
23. Grocery Manufactures of America, Inc.
24. Hoffmann-La Roche, Inc.
25. Institute of Food Technologists
26. International Food Information Council
27. Italian Food & Wine Institute
28. Kellogg Company
29. La Leche League International
30. Lutheran Office for Governmental Affairs, ELCA
31. Meals on Wheels Association of America
32. Minority Health Resource Center
33. National Association for Sports and Physical Education
34. National Association of Margarine Manufacturers
35. National Association of Pediatric Nurse Associates and Practitioners
36. National Black Child Development Institute, Inc.
37. National Confectioners Association/Chocolate Manufacturers Association
38. National Consumers League
39. National Fisheries Institute, Inc.
40. National Food Processors Association
41. National Food Service Management Institute
42. National Pasta Association
43. National Pork Producers Council
44. North American Society to Study Obesity
45. Ocean Spray Cranberries, Inc.
46. Pharmavite Corporation
47. President's Council on Physical Fitness & Sports
48. Procter & Gamble
49. Produce Marketing Association
50. Salt Institute
51. Shape Up America!
52. Slim Fast Food, Co.
53. Society for Nutrition Education
54. The Bush Center for Child Development and Social Policy
55. The David & Lucile Packard Foundation
2
56. The End Hunger Network
57. The Sugar Association
58. The Vegetarian Resource Group
59. U.S. Apple Association
60. U.S. National Committee for World Food Day
61. United Fresh Fruit and Vegetable Association
62. USA Rice Federation
63. Wine Institute
3
Steering Committee in Support of a
White House Conference on Food, Nutrition, and Health
- Statement of Purpose -
November, 1998
Food is fundamental to life and health. What and how we eat can affect profoundly how we
grow, develop, and age and our ability to enjoy life to its fullest. In America our food enterprise
is the largest of all our industries, contributing 16 percent of our gross domestic product.
Especially noteworthy is the promise of the biological and genetic revolutions in biomedicine
and agriculture. With disease prevention becoming more important in this time of health care
reform, advances in the nutrition and food science provide great opportunities to improve the
lives of millions of Americans. The United States' preeminent role as a feeder to the world is a
stunning example of how advances in science and technology have led to improved food
production and processing. As a result, citizens in this country and in many other countries have
available adequate amounts of nutritious and safe foods at reasonable cost.
The time is now to reevaluate how the nutrition agenda should be refined to provide a vision for
programs, interventions, and research that lead us into the next century. In December of 1997,
near the 30th anniversary of the 1969 White House Conference on Food, Nutrition and Health, a
Steering Committee was formed to encourage another White House Conference to focus that
vision.
The Steering Committee represents a broad group of public and private scientific and policy
interests. More than 200 groups have expressed their support for a Conference to date, including
presidents of professional associations, leaders of food industry, heads of advocacy groups, and
others such as key government decision-makers.
Accomplishments of the 1969 White House Conference
President Nixon called the 1969 White House Conference on Food, Nutrition and Health to both
reaffirm the United States commitment to a full and healthful diet for all Americans and to
explore what we yet need to know and do to achieve that goal. The Conference successfully
transformed the United States nutrition agenda and safety net and marked a turning-point in the
history of food policy in the United States.
A series of direct actions can be linked to the 1969 Conference. The Food Stamp Program was
expanded to become a nationwide household food security program and the WIC Program was
started to provide supplemented food and nutrition education for at risk pregnant women, infants,
and children. The School Lunch Program was expanded and the School Breakfast Program
created.
Beginning in the mid-1970's, more research has focused on a better appreciation of the links
between diet and chronic disease. During this period, a series of dietary recommendations
emerged, including the Senate Select Committee on Nutrition's Dietary Goals, closely followed
by the 1980 Dietary Guidelines for Americans, which has been continuously updated every
five years.
The Nutrition Facts Label and the Food Guide Pyramid are examples of two successful
government sponsored activities that have occurred in the last decade to help Americans better
understand and move towards a more healthful diet.
The Need for Another White House Conference
There has never been a greater body of knowledge which links food, nutrition, and diet to health
and disease and never before a greater need to apply this knowledge to promote the health and
well-being of the American population. We need to strengthen the links between basic research
in human nutrition and the application of this knowledge to achieve improvements in the
delivery of health services and cost-savings from disease prevention.
The aim of the next Conference will be to review the programs and policies which have been
implemented since the first Conference, to examine their efforts, and to consider how we might
now achieve the national goal of a good diet for every citizen.
The United States has a long rich history of public investment in nutrition. Much good has
occurred as a result of the first Conference, and many positive independent efforts prevail, but
much still needs to be done. There are no fast or easy answers to the nutritional problems facing
America today, or to the unforeseen problems of the future.
Persistent hunger continues to plague segments of the U.S. and the developing world. Current
estimates of future demand worldwide for food indicate that this need will be met only through
continued investment in agricultural research - albeit at a level already reduced from the late
1970's and early 1980's. Yet this occurs at a time where dollars in agricultural research are
declining. Federal nutrition support for human nutrition research has stagnated in real dollars
since the early 1980's. The challenge is to meet the food and nutritional need in a taut budgetary
environment.
But as we continue to strive to provide an adequate and healthful diet for those with too little
food, the consequences of too much food have become one of the most urgent public health
concerns in America today. More than half of all U.S. adults - 97 million people - are
overweight or obese. Even more trying, the number of our children overweight or obese has
doubled in the last 20 years, beginning at an earlier age than ever. The costs of obesity-
associated diseases is estimated at $100 billion annually and contributes to 300,000 deaths each
year. Clearly, the public health consequences of obesity are staggering and imminent.
We are in the tide of a revolution in agriculture, biotechnology, food production, and the capacity
to improve the quality of our food supply, not only with respect to traditional nutrition and safety
factors, but also in regard to special health promoting qualities of food and diet. The coalescence
of American world leadership in agriculture science and nutrition science, projects an entirely
new era of health promotion and well-being relating to food, diet and agriculture. The
2
opportunities provided by the robust activities in agriculture and nutritional sciences and genetics
also present challenges to our systems of marketing, consumer education, and international trade
which deserve attention at the highest levels of our political system.
Death, disease, and disability resulting from food-borne hazards continue to impose a large
national burden and are largely preventable. The Centers for Disease Control and Prevention
estimates that as many as 6.5 million cases of food-borne illness occur annually in this country,
contributing to as many as 9,000 deaths, with an overall toll on society of $5 billion to $13
billion in medical costs and productivity loses. In addition, potential new threats to ensuring the
safety and quality of America's food supply include microbial contaminants, pesticide and drug
residues, and naturally occurring toxic or anti-nutrient food constituents.
These are just some of the challenges we face today and in the coming years. Although many of
these and other concerns are being addressed at the public and/or private level, no program or
group can overcome these complex challenges alone. The only way we can truly succeed at
ensuring a healthful diet for all Americans is to come together to strengthen our national
nutrition policies.
It is imperative that all groups (academia, health scientists, the food industry and food
manufacturers, consumer organizations, representatives of poverty groups, local and national
legislators and public administrators) unite at a forum to discuss the food and nutrition agenda
for the next century.
It is our intent that the deliberations of the Conference will be thoughtful, constructive, and non-
partisan, based upon the existing scientific evidence, with a clear vision both of competing
national needs and of American's potential for achievement. We hope that this Conference, like
the 1969 White House Conference, will be a catalyst for change in the structure, focus and
direction of programs, and in the definition of national nutrition policies that lead us into the 21st
century, and beyond.
3
Meeting for a White House Conference
on Food, Nutrition, and Health
December 2, 1998
-Attendees -
Dr. George L. Blackburn
Dr. William Harlan
Dr. Irwin Rosenberg
Past-President,
Deputy Director, NIH
Director, USDA Human
Am. Society Clinical Nutrition
Bldg. 1, Rm. 260
Nutrition Research Center on
Assoc. Director, Div. of Nutrition
9000 Rockville Pike
Aging at Tufts Univ.
Harvard Medical School
Bethesda, MD 20892
711 Washington Street
Boston, MA 02215
Phone: (301) 496-1508
Boston, MA 02111
Phone: (617) 632 8543
Fax: (301) 402-2517
Phone: (617) 556-3330
Fax: (617) 632-0235
Fax: (617) 556-3295
Mr. Chris Jennings
Mr. John Cady
Assistant to the President for
Ms. Melanne Verveer
President and CEO
Domestic Policy
Assistant to the President and
National Food Processors
Office of Domestic Policy
Chief of Staff to the First Lady
Association
The White House
Office of the First Lady
1350 I Street, NW, Suite 300
Washington, DC 20502
OEOB, Room 100
Washington, DC, 20005-3305
Phone: (202) 456-5584
Washington, DC 20500
Phone: (202) 639-5900
Fax: (202) 456-2878
Phone: (202) 456-6266
Fax: (202) 639-5932
Fax: (202) 456-6244
Dr. Eileen Kennedy
Ms. Maria Echaveste
Deputy Under Secretary for
Ms. Barbara Wooley
Assistant to the President and
Research, Educ., and Economics
Public Liaison office in the
Director for Public Liaison
USDA, Room 217-W
White House
Office of Public Liaison
1400 Independence Ave., SW
Office of Public Liaison
OEOB, Room 122
Washington, DC 20250
OEOB, Room 122
The White House
Phone: (202) 720-8885
The White House
Washington, DC 20500
Fax: (202) 690-2842
Washington, DC 20502
Phone: (202) 456-2930
Phone: (202) 456-2930
Fax: (202) 456-6218
Dr. Bernadette M. Marriott
Fax: (202) 456-6218
Office of Dietary Supplements
Ms. Sara Ehrman
NIH, Bldg. 31, Rm. 1B25
Dr. Catherine Woteki
Center for Middle East Peace
9000 Rockville, Pike
Under Secretary for Food Safety,
& Economic Cooperation
Bethesda, MD 20892
USDA, Room 225-E
633 Pennsylvania Ave., NW
Phone: (301) 435-2920
1400 Independence Avenue, SW
Fifth Floor
Fax: (301) 480-1845
Washington, DC 20250
Washington, DC
Phone: (202) 720-0350
Phone: (202) 624-0850
Ms. Lynn Parker
Fax: (202) 690-0820
Fax: (202) 624-0855
Director of Child Nutrition
Programs and Nutr. Policy
Dr. Ann Marie Gebhart
Food Research and Action
Executive Director
Center (FRAC)
American Society for Clinical
President-Elect, Society for
Nutrition
Nutrition Education
9650 Rockville Pike
1234 N Vermont Street
Bethesda, MD 20814
Arlington, VA 22201-4826
Phone: (301) 530-7110
Phone: (202) 986-2200 x3012
Fax: (301) 530-7110
Fax: (202) 986-2525
50
Sciena-
Potential topic areas for a White House Conference on Food,
Nutrition, and Health and Satellite Conferences, December, 1998
food betw then ton
1) The state of nutrition of the American people
Federal and State monitoring systems of dietary and nutritional evaluation
quality
Demographic and trends data
Matching data on nutritional state with knowledge on diet and disease (e.g.,
child & maternal nutrition, heart disease, cancer, obesity, and diabetes)
Setting standards for dietary and nutrition evaluation
Projected nutrient needs into the 21st century
2) Reaching Americas' health goals through national food and nutrition policy with
attention to vulnerable groups and special problems
Gumt
Poor and low income
Pregnant and nursing women and infants
Children and adolescents
Degenerative conditions in middle age
Success
The aging and elderly
hungs
The sick and disabled
grant
3) Meeting our countries future food and nutritional needs
The productivity of American agriculture (agriculture and the environment, organic farming,
sustainable agriculture, biotechnology)
Responding to changes in U.S. demographics in ethnic and minority populations
Dealing with new science, new technologies, and new foods
Dietary supplements
Food fortification
Safety and efficacy of ingredients/foods/supplements with purported health benefits
The current and future role of healthcare professionals in providing nutrition services (cost
effectiveness, access barriers, third party reimbursement, training and certification of
professionals)
4) Evolving our food systems to meet the demands of the coming century
Dilin
Food delivery and distribution
Advertising and marketing
Packaging and labeling
Ensuring food safety
Recognizing long-term trends
Show lot in
I'
International issues in a global Colours economy
just
can't
5) Strengthening the design and effectiveness of our food assistance programs
Establishing our needs today and tomorrow
Helping special groups (infants and mothers, school children, elders, and disadvantaged)
Looking at how we design intervention strategies and the role of research in developing those
strategies
Food recovery and gleaning
6) Improving public health through education and communication
Educah
In public institutions (schools, military, hospitals, long-term care facilities, prisons)
With food assistance programs
Professional training
Community nutrition and extension
Physical activity
Benefits and obstacles to life-long behavior change
Public-private partnerships
Nutrition promotion
Electronic channels of communication (Internet and www)
Funding of health education programs
7) Expanding and translating the science-base for human nutrition and health
The Federal role in nutrition research, support, and training
The role of State and private universities and research institutes
The role of industry research and development
The special challenge of applied and translational research for implementation in populations
Application of science to improved quality of life (e.g., healthier pregnancy and child
development, the prevention of degenerative conditions of aging)
UIIO
Council for Responsible Nutrition
1300 19th Street, N.W., Suite 310
Washington, DC 20036-1609
(202) 872-1488
Teletax (202) 872-9594
October 27, 1998
Contact:
Lisa Meyer
(202) 872-1488
CONGRESS SUPPORTS WHITE HOUSE CONFERENCE ON
FOOD, NUTRITION AND HEALTH
The 105th Congress' spending package expressed strong support for a
White House Conference on Food, Nutrition and Health. The Senate report
accompanying the 1999 fiscal year's Labor/Health and Human Services
spending bill included this language:
"The Committee also notes that 1999 marks the 30th anniversary of
the landmark White House Conference on Food, Nutrition and Health which
lead to many major advancements in nutrition and health policy. The
Committee encourages the Institute (National Institutes of Health) to plan
and convene a conference to develop human nutrition policy
recommendations for the next century. This conference should be developed
in cooperation with the Agriculture Department and ensure full and
appropriate private sector involvement."
"This is a significant step in the effort to convene a White House
Conference," said John B. Cordaro, CRN's president and chief executive
officer. "Now we must work with the next Congress, the administration and
--more--
An Association of the Nutritional Supplements, ingredients, and other Nutritional Products Industry
Congress Supports White House Conference
2-2-2-2
all interested groups to ensure that the conference becomes the catalyst for
enhancing U.S. food, health and nutrition policies and programs to benefit all
Americans," he added.
At a March 1997 symposium before the U.S. Department of
Agriculture advisory board, Cordaro had urged a conference to celebrate the
30-year anniversary of President Nixon's 1969 Conference on Food,
Nutrition, and Health.
Since then, CRN has worked with the Tufts University School of
Nutrition Science and Policy, members of Congress, executive agency officials
and industry professionals to garner support for a conference in the year
2000. A steering committee formed in December 1997 has helped guide the
concept and to date, numerous groups - including professional associations,
the food industry, advocacy groups and government decision-makers - have
expressed interest in and support for a conference.
Irwin Rosenberg, M.D., dean for nutrition sciences at Tufts, said,
"We're enthusiastic about the opportunity to work with the new Congress,
the administration and their various agencies to gain consensus on the
application of advances in human nutrition research and better serve
Americans' health needs into the 21st century."
CRN, founded in 1973, is a trade association representing
approximately 100 companies in the dietary supplement industry. The
Council and its members are dedicated to enhancing the health of the
American public through responsible nutrition, including the appropriate use
of dietary supplements.
####
Meeting for a White House Conference on
Food, Nutrition, and Health
December 2, 1998
4:00 pm
Old Executive Office Building
- Agenda -
Welcome and Introductions
Dr. George Blackburn
Harvard Medical School
Background and Purpose
Dr. Irwin Rosenberg
Tufts University
Potential Topic Areas
Dr. George Blackburn
Harvard Medical School
Timeline
Dr. Catherine Woteki
Under Secretary for Food Safety, USDA
Summary and Next Steps
Dr. George Blackburn
Harvard Medical School
D6
NE
TUESDAY, DECEMBER 1, 1998
Health
Fitness
The New York Times
The Cancer-Diet Link
Dietary Do's
Dr. Arnot IS not wrong in suggesting that
The cancers most directly linked to diet
diet plays an important role in reducing
are those that arise in lining tissues
the risk of cancer, including breast cancer.
throughout the body, especially cancers of
The American Cancer Society estimates
the colon and rectum, lung, bladder, stom-
that diet is a primary factor in a third of
ach and, to a lesser extent, the breast, uter-
cancer deaths. That estimate is derived
us and prostate. The following dietary sug-
from thousands of studies of people world-
gestions are based on the strongest associ-
wide and is supported by findings in lab-
ations established in studies:
oratory cell cultures and animal experi-
FRUITS AND VEGETABLES Evidence in
ments.
people has accumulated rapidly in recent
These studies suggest that a reorienta-
years to support the protective role of
tion of American eating habits - to em-
plant foods against most cancers. The av-
phasize fruits, vegetables and whole
erage American eats only about three or
grains while minimizing red meats, total
four servings a day of vegetables and
fat and especially saturated fats and alco-
fruits, while five servings, and preferably
hol - can significantly reduce the likeli-
nine, are recommended. Especially help-
hood of developing most of the common
ful are yellow, dark-green and orange veg-
cancers like those of the colon and rectum,
etables rich in carotenoids; fruits like cit-
lung, bladder, stomach, esophagus, mouth,
rus, tomatoes and strawberries that are
throat and breast.
rich in vitamin C, and all the cabbage fam-
:-What cannot be said is that adopting a
ily vegetables like broccoli, brussels
particular diet can assure that you won't
sprouts, cauliflower, collards, kale, bok
get cancer or that, if you do, the diet will
choy and mustard and turnip greens. Such
prevent the cancer from recurring.
foods are linked to lower risks of lung,
"Last year the American Institute for
stomach, colon and rectum, oral cavity,
Nancy Doniger
Cancer Research and the World Cancer
esophagus and, to a lesser degree, breast,
PERSONAL HEALTH
Research Fund released an analysis of
bladder, pancreas and larynx cancers.
more than 4,500 studies that examined the
Garlic, onions and leeks contain allium
Diet Is Not a Panacea,
relationship between cancer, diet and ex-
compounds that help ward off cancer, es-
ercise. The conclusion, as summarized in
pecially breast cancer. To reduce loss of
the protective chemicals, these vegetables
should be cut up and let stand for 10 min-
But It Cuts Risk of Cancer
utes before they are cooked. Other recent
Good bets for good
findings suggest that the risk of prostate
health: fruits, vegetables
cancer can be reduced by eating lots of
cooked tomato products, including ketch-
and exercise.
up, that are rich in a carotenoid called ly-
By JANE E. BRODY
copene and foods rich in the mineral sele-
Eating to Reduce
nium, like meats, fish, grains and seeds.
When words like "cure" and "preven-
Cancer Risk
SOY AND OTHER DRIED BEANS These con-
tion" appear in the title of a book about a
No food can prevent cancer,
the current issue of Nutrition Action
tain plant estrogens that may be beneficial
chronic, disabling or life-threatening dis-
but a diet that emphasizes fruits
Health Letter: "While there are no guar-
in reducing the risk of hormone-related
ease, they often enrich authors and pub-
antees, there is plenty you can do to cut
vegetables and whole grains
cancers, including breast, uterine and pos-
lishers at the public's expense. Such is like-
your risk." Simply eating more fruits and
sibly ovarian cancer. A soy-rich diet may
ly the case with a best seller, "The Breast
lowers the risk. Experts
vegetables, for example, can eliminate
in part explain why Asian women have a
recommend these foods:
Cancer Prevention Diet" by Dr. Bob Ar-
about 20 percent of cancers, the analysis
low risk of these cancers. Dried beans may
not, the medical correspondent for NBC.
Dried beans
suggests.
also help against colon cancer. But experts
The book's premise - that adopting a
Perhaps most important is that the rec-
say that beans are most likely to be protec-
diet rich in soy. flaxseed and fish oils can
Tomatoes
ommended anti-cancer diet is the very
tive when used in place of meats and when
prevent breast cancer - has been soundly
Broccoli
same diet that studies have shown can
the rest of the diet is low in fat.
denounced by breast cancer researchers
help to counter heart disease, high blood
WHOLE GRAINS Wheat bran in whole-
and patient advocates alike as promising
Cabbage
pressure, diabetes and obesity.
grain cereals and breads is strongly linked
something it cannot possibly deliver.
Milk
In other words, anyone who is interested
to reducing the risk of developing colon
As Fran Visco, president of the National
Breast Cancer Coalition put it. "There is
Salmon
in maximizing the chances of staying
and rectal cancers, probably because they
no breast cancer prevention diet," and the
healthy would be wise to consider adopting
speed the passage of wastes and limit ex-
Carrots
basis for Dr. Arnot's assertion is too flim-
a diet rich in whole grains, fruits and vege-
posure of the lower gut to cancer-causing
tables that are loaded with fiber, vitamins
substances.
sy to warrant a radical dietary shift based
Green tea
and minerals and other cancer-fighting
OTHER HELPFUL FOODS The list of possi-
on a "bet," as he put it, that it will deliver
All dark green leafy vegetables
chemicals that occur naturally in plant
ble dietary cancer weapons keeps grow-
the goods.
foods. A protective diet would also be mod-
ing. Among recent additions are green tea,
Faced with an onslaught of criticism,
Garlic and onions
erate in animal protein - especially red
olive oil (linked to a lower risk of breast
Dr. Arnot now says he should have used
Whole grains
meats - and low in fat, saturated fat, sim-
cancer when used in place of other fats)
the words "risk reduction" instead of
ple sugars and alcohol.
and milk and other foods rich in calcium
"prevention" in his book title. Critics say
All-bran cereal
the book overextends laboratory findings
In contrast to the low-carbohydrate
and vitamin D (linked to a reduced risk of
that have yet to be confirmed in women,
All fruits, especially apples.
scheme advocated by Dr. Arnot, such a
breast and colon cancer). Though the evi-
suggests dietary changes that have not
oranges, strawberries and grapes
diet is rich in carbohydrates - not sugars,
dence that flaxseed and fish oils can re-
been tested for long-term safety and inti-
Red peppers
of course, but the complex carbohydrates,
duce the risk of developing breast or any
mates that, counter to all rules of sound
or starchy foods, particularly in their natu-
other cancer is still highly preliminary,
medical science, it is foolhardy to wait for
Olive Oil
ral, unrefined, fiber-rich state. This IS also
there are many other health benefits asso-
definitive proof of the effectiveness and
a diet that can help fight obesity. which is
ciated with eating more fish
safety of the diet.
strongly linked to an increased risk of
The New York Times
breast, uterine and other cancers
DO NOT FORGET THE NEEDIEST!
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
Nutrition Societies Presidents' Forum: Future challenges
and opportunities for nutrition societies in the 21st
century¹⁻⁴
George L Blackburn, John A Milner, Barbara C Hansen, Steven B Heymsfield, April C Mason, and
Gerald E Gaull
ABSTRACT
The Chair introduced "Pasteur's Quadrant" as a
long, healthy, enjoyable life. How wonderful it is that we have
potentially useful paradigm for modern science. Developed by
so much good to accomplish in the coming years.
Princeton's Donald E Stokes, the quadrant is two-by-two matrix
Indeed, in Pursuing Happiness, Wesleyan University econ-
that classifies knowledge as fundamental and/or applied. The Chair
omist Stanley Lebergoot writes that people want diversified,
also noted the effect of competitive pressures, and the necessity for
worthwhile experiences-experiences that provide beauty and
cooperation among nutrition societies. The Presidents of The
amusement, that hold their attention, that deliver learning,
American Society for Nutritional Sciences (ASNS), The American
pleasure, and spiritual fulfillment (1). He notes that consumer
Society for Clinical Nutrition (ASCN), The American Society for
goods can be a means to that end by extending life or making
Parenteral and Enteral Nutrition (ASPEN), and the Chair of the
it more pleasant or interesting. We need only look at adver-
Institute of Food Technologist's (IFT) Nutrition Division pre-
tisements to see the role of food in meeting this end.
sented their views on how societies can prepare to meet their
No longer burdened by the need to tackle the negative
members' upcoming needs. The Director of the Center for Food
aspects of nutritional science-deficiency, toxicity, and essen-
and Nutrition Policy discussed the future role of nutrition societies
tiality-we can focus on the "positive" challenges: the oppor-
and how they might interact with various interest groups. The
tunities for using nutrition to prevent and treat disease, to
Forum, which included an opportunity for audience participation,
extend and improve life quality, and to pursue happiness. Here,
took place soon after the February 1996 release of "Meeting the
we can surely find common ground, despite our diverse meth-
Challenge: A Research Agenda for America's Health, Safety, and
ods for reaching it.
Food." Published by the Executive Office of the President's Office
As illustrated by Stokes' Pasteur's Quadrant (2), work in
of Science and Technology Policy, the report highlights the im-
both applied and fundamental science will produce results that
portance of nutrition to our nation's health.
Am J Clin Nutr
bring tremendous benefit to society, even without "useful
1996;64:813-22.
knowledge" in the strictest sense.
The concept of science policy began under President Roos-
KEY WORDS
Nutrition research, science policy, nutrition
evelt, with Vannevar Bush charged to organize the scientific
societies, public policy, parenteral nutrition, enteral nutrition
community. His theme was "Science, the endless frontier."
Now comes the Pasteur's Quadrant thesis (Figure 1) from
Stokes, professor of politics and public affairs at Princeton's
Woodrow Wilson School.
INTRODUCTION
George L Blackburn, Forum Chair and President-elect of
The American Society for Clinical Nutrition
I From the Nutrition Support Service, Beth Israel Deaconess Medical
Center/Harvard Medical School, Boston; the Department of Nutrition, The
I hope you all had the opportunity a few weeks ago to look
Pennsylvania State University, State College; the Department of Physiol-
into the heavens and watch Comet Hyakytake moving across
ogy, University of Maryland Medical School, Baltimore; the Obesity
the night sky. As rare and beautiful as the event was to us, just
Research Center, St Luke's-Roosevelt Hospital, Columbia University,
imagine the terror and wonder this spectacle would have
College of Physicians and Surgeons, New York; the Department of Foods
caused in centuries past, when people used the stars as a sure
and Nutrition, Purdue University, West Lafayette, IN; and The Center for
and stable tool for navigating and for monitoring the change in
Food and Nutrition Policy and The CeresR Forum, Georgetown University,
seasons. We, of course, knew what to expect and could look up
Washington, DC.
2 Supported in part by NIH NIDDK grants 1P30 DK 6200 and DK
into the night with pleasurable anticipation.
46574, and NCI grants CA45504 and CA56422.
So too can we look ahead to the next century with the same
3 Presented at the 36th Annual Meeting of the American Society for
sense of promise and anticipation. Nutritional science has
Clinical Nutrition, April 14, 1996, in Washington, DC.
moved beyond the stage of identifying what is minimally
4 Reprints not available. Address correspondence to GL Blackburn, Beth
needed to prevent deficiency and to sustain life into an exciting
Israel Deaconess Medical Center, One Deaconess Road, Boston, MA
range of opportunities for realizing what is optimal to ensure a
02215.
Am J Clin Nutr 1996;64:813-22. Printed in USA. © 1996 American Society for Clinical Nutrition
813
The American Society for Clinical Nutrition Inc. does not endorse any commercial enterprise.