** High Priority **
This is information edited from On The Pulse per permission by the ADA
Legislative Office. I have selected items I think will be of interest
to the GN Practice Group members.
ADA POLICY INITIATIVES AND ADVOCACY REPORT
ON THE PULSE
Editor's Note: The Policy Initiatives and Advocacy group issues this
email
each week to inform members of the American Dietetic Association of
developments affecting food, nutrition and health. Topics reflect
ADA's
legislative and regulatory priorities in Washington and the states,
reimbursement issues, related matters and larger developments that
affect
the environment in which these topics are considered.
Information contained in On the Pulse includes sensitive material and
should
not be shared outside the American Dietetic Association. For
additional
information or to seek permission for reprinting, please contact ADA
Policy
Initiatives and Advocacy at 800/877-0877. Please send comments to
pulse@eatright.org.
Friday, April 25, 2003
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Conflicting reports from government agencies on salmonella in food
supply
USDA Undersecretary of Food Safety Elsa Murano announced a report
showing
the incidence of salmonella bacteria decreased last year, even while
sampling by USDA inspectors increased. "These data tell us that we
are
making steady and sustained progress in reducing the incidence of
salmonella
in raw meat and poultry products," she said. "This positive trend in
regulatory samples will hopefully translate into fewer cases of
salmonellosis due to meat and poultry." USDA tested over 58,000 samples
of
meat and poultry in 2002, of which 4.3 percent contained salmonella.
This
is an improvement from 2001 when 5 percent of 45,941 samples tested
positive. The only food product that showed an increase this year in
incidence of salmonella bacteria was ground chicken.
Concurrently, the Food Safety and Inspection Service (FSIS) announced
plans
to disclose test results to plants to assist them with process control.
"To
get real-time results is a good thing," said Karen Egbert, senior food
safety attorney for the Center for Science in the Public Interest
(CSPI).
"It will allow plants to identify if they have process failures earlier
and
then respond." CSPI, industry associations and the National Advisory
Committee on Microbiological Criteria for Foods had urged FSIS to
disclose
test results more quickly.
However, this week the Centers for Disease Control and Prevention (CDC)
also
released preliminary, but contradictory, FoodNet data for the incidence
of
foodborne illnesses from nine sites. CDC argues salmonella and E.
Coli
0157:H7 infections are not on the decline, and CDC data shows more
cases of
salmonellosis occurred than any other foodborne illness. When asked
about
this conflicting data, FSIS spokesman Steve Cohen said, "It's hard to
compare their data with our data." According to Cohen, CDC's data
includes
infections from all foods and all serotypes of salmonella.
Approximately 40,000 cases, 1000 resulting in death, of salmonella
infection, or salmonellosis, occur in the U.S. each year, and it is
usually
contracted by consumption of food products such as raw poultry, eggs,
and
beef, and unwashed fruit. Food prepared on surfaces that previously
contained raw meat or meat products can, in turn, become contaminated
with
the bacteria. ADA encourages consumers to cook foods thoroughly,
especially
eggs, poultry and meat; to keep foods clean; and to consume only
pasteurized
milk.
New WHO/FAO report released in Rome
The FAO/WHO this week released an expert report on diet, nutrition and
prevention of chronic diseases. The report is intended to serve as
the
basis for developing a global strategy to combat the growing burden of
chronic diseases. It contains the best currently available scientific
evidence on the relationship of diet, nutrition and physical activity
to
chronic diseases. The report examines cardiovascular diseases,
several
forms of cancer, diabetes, obesity, osteoporosis and dental disease
and
concludes that a diet low in saturated fats, sugars and salt, and high
in
vegetables and fruits, together with regular physical activity, will
have a
major impact on combating this high toll of death and disease.
The agencies stressed that solutions to the global surge in chronic
diseases
would require stronger linkages between those involved in health and
agriculture, at global, regional and national levels. The report is
based
on the collective judgment of a group of 30 independent experts with a
global perspective, who worked with their peers to review the best
currently
available evidence on diet, nutrition and its effects on chronic
diseases.
The recommendations on diet include limiting fat to between 15 and 30
percent of total daily energy intake, and saturated fats to less than
10
percent. The report suggests that carbohydrates should provide the
bulk of
energy requirements - between 55 and 75 percent of daily intake, but
that
free (i.e. added) sugars should remain beneath 10 percent. Daily
intake of
salt, which should be iodized, should be restricted to less than 5
grams a
day, while the intake of fruit and vegetables should be at least 400
grams.
The recommended protein intake is 10 to 15 percent.
The report also notes that physical activity is a key factor in
determining
the amount of energy spent each day and is fundamental to energy
balance and
weight control. One hour per day of moderate-intensity activity, such
as
walking, on most days of the week, is needed to maintain a healthy
body
weight. The two agencies note that creating an environment in which
the
healthy choice is the easy choice has significant implications for
consumer
information and labeling and for education and recreation. It also
has
important consequences for agricultural production and processing
methods as
well as trade. An electronic copy of the report is posted at
<ftp://ftp.fao.org/es/esn/nutrition/diet_prevention_disease.pdf>.
Obesity linked to cancer deaths
A study conducted by the American Cancer Society (ACS) shows obesity
is
associated with as many as 90,000 cancer deaths in the U.S. each year.
According to ACS, obesity is second only to smoking in its effect on
cancer
deaths -- 20 percent of all cancer deaths in women and 14 percent of
all
cancer deaths in men. "As a society, we have not really acknowledged
the
contribution of obesity to chronic disease in general and cancer in
particular," said lead researcher Eugenia Calle, ACS Director of
Analytic
Epidemiology. In 2002, only one percent of Americans surveyed by ACS
identified maintaining a healthy weight as a way to reduce cancer
risk.
More than 900,000 men and women were tracked over sixteen years to
determine
the role of weight in cancer deaths. The results supported previously
established links between obesity and uterine, renal, esophageal,
gallbladder, colorectal and breast cancers. Other types linked,
surprisingly, to obesity were hepatic, pancreatic, prostate, cervical,
ovarian and gastric cancers. "Overweight and obesity has a very broad
impact on cancer across most cancer sites," said Calle. The study was
published in the New England Journal of Medicine this week.
NHLBI study finds all-in-one lifestyle changes effectively lower blood
pressure
Lifestyle changes to prevent or control high blood pressure need not be
made
one at a time. According to a study supported by the National Heart,
Lung,
and Blood Institute (NHLBI), with special counseling, Americans can
make all
the needed changes at the same time. The best results were achieved
when
the lifestyle changes included adoption of the DASH diet, which is rich
in
fruits, vegetables, and lowfat dairy products.
"This is the first time a host of behavioral steps to prevent or
control
high blood pressure has been put together in one intervention," said
NHLBI
Director Dr. Claude Lenfant. "Past studies looked at one or two
changes at
a time, and it was thought that doing more would prove too hard. But
PREMIER shows that an all-in-one approach works and can help Americans
reduce their blood pressure, lowering their risk for heart disease and
stroke."
The government-funded study included over 800 adults (average age: 50
years), who were not on blood pressure medication, led sedentary lives,
were
overweight, and had mild, stage 1 hypertension. Participants were
randomly
assigned to one of three groups: Advice-Only, Established, and
Established
Plus DASH. All three groups received printed materials about blood
pressure
and lifestyle. In addition, those in the Advice-Only group received a
30-minute individual session with a nutritionist, which did not
include
counseling on how to make behavior changes. Those in the Established
group
had 18 counseling sessions in 6 months -- 14 group meetings and 4
individual
sessions. They kept track of their diet, including calorie and sodium
consumption, and their physical activity. Those in the Established Plus
DASH
group had the same intervention schedule as those in the Established
group,
but also were taught to follow the DASH diet and to record their daily
servings of fruits, vegetables, dairy products, and fat.
After 6 months, blood pressure levels had declined in all three groups
but
the reduction was significantly more in the two intervention groups and
most
in the Established Plus DASH group. The percent of those with
hypertension
dropped after 6 months from 37 to 12 in the Established Plus DASH
group,
from 37 to 17 in the Established group, and from 38 to 26 in the
Advice-Only
group.
Other key results include:
* Optimal blood pressure was best achieved in the
Established
Plus DASH group
* Fewer of those in the two intervention groups who
started
the trial without high blood pressure went on to develop hypertension
* Consumption of fruits, vegetables, and dairy products
significantly increased in the Established Plus DASH group, compared to
the
other two groups.
* Significant weight loss occurred in all groups, but was
greatest in the Established Plus DASH group.
One of the key findings in the study is that people can not only follow
the
DASH diet on their own but also can lose weight on it, even though it
calls
for many more servings of fruits and vegetables a day than Americans
typically consume. The new findings suggest that it's feasible for
Americans to use the eating plan, lose weight if they're overweight,
and
protect themselves against the risks of high blood pressure. "Our
study
shows that people can simultaneously make multiple lifestyle changes
that
lower blood pressure and improve their health," said study chair Dr.
Lawrence Appel, professor of medicine at Johns Hopkins University.
This
study is unique because it is the first one to look at the combination
of
diet and exercise on blood pressure, not diet or exercise alone. Based
on
the study results, one could recommend three hours of moderately
intense
exercise per week, a reduced-fat, reduced-sodium diet high in fruits
in
vegetables, weight loss of at least fifteen pounds and limiting
alcoholic
beverages to one per day for women, or two per day for men. Results of
the
study, called PREMIER, appear in the April 23 issue of The Journal of
the
American Medical Association.
Nutrient content claims on multi-serve, meal-type meat and poultry
products
FSIS is proposing to amend its nutrition labeling regulations to change
the
definition of "meal-type" products to allow for nutrient content claims
on
multiple-serve food containers, to adopt the definition of "main dish"
used
by the Food and Drug Administration (FDA). The proposal will also
define
how meal-type products and main dishes should be nutritionally labeled.
The
change in the definition of meal-type products would allow nutrient
content
claims to be based on 100 grams of product rather than on the serving
size,
which is based on the Reference Amounts Customarily Consumed for the
food
components. These actions are being proposed in response to a
petition
filed by ConAgra, Inc. The proposed changes will help to ensure that
FSIS'
nutrition labeling regulations are parallel, to the maximum extent
possible,
to the nutrition labeling regulations of FDA, which were promulgated
under
the Nutrition Labeling and Education Act (NLEA) of 1990.
ADA national conferences provide RDs with tools to successfully provide
MNT
Practitioners cannot afford to miss this conference where presenters
reveal
tools and best practices, and highlight critical skills RDs need to
successfully provide MNT. Attendees are presented with step-by-step
training on MNT protocols, a requirement for Medicare Part B and for
health
plans. In addition, practitioners will learn how best to increase
efficiencies to provide cost-effective, quality care.
Register today to attend this one-day ADA conference, "Using Medical
Nutrition Therapy (MNT) for Reimbursement and New Business
Opportunities."
To obtain a registration from and conference brochure, visit ADA Web
site
<http://www.eatright.com/mntworkshpfall02.html>. Share this message
with
your co-workers and colleagues who may also be interested in attending.
For
additional questions, e-mail to: mntconf@eatright.org.
Upcoming dates and locations include:
Oakbrook, Illinois May 2
Nashville, Tennessee May 23
Boston, Massachusetts June 13
Dallas, Texas June 20
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