Dietitians in breastfeeding management: an untapped resource in the hospital.

Maternity care nurses were surveyed to gather data on the state of breastfeeding in Utah hospitals. A questionnaire was distributed to labor and delivery, well-baby nursery, and postpartum nurses at 18 hospitals representing 86% of births in the state. The results indicated that of dietitians, physicians, and nurses, dietitians were the health care professionals least likely to provide breastfeeding information and assistance.

Integrity of small data bases in computer analysis of dietary data.

The integrity of data bases to support microcomputer-based dietary analysis programs has become increasingly important to developers and users of nutritional analysis software. This paper reviews critical issues in maintaining data integrity during development of small nutritional data bases. Because a limited number of large, source data bases provides the data for smaller, special-purpose data bases, this review initially focuses on factors that affect the quality and precision of methodologies used in establishing large data bases. Issues discussed are accuracy of source data as determined by analytical methodology and imputation procedures, and methods for insuring representativeness of data. The effect of data transfer procedures on small data base integrity are discussed, including use of multiple sources and standardization of naming and coding conventions. Also reviewed are procedures for selecting reduced numbers of foods and nutrients without sacrificing accuracy of analysis, and methods currently in use for validating small data bases.

Enzymes for liberation of pantothenic acid in blood: use of plasma pantetheinase.

Reported normal concentrations for human whole-blood total pantothenic acid vary from 1.1 to 12 mumol/L. This wide range may partly arise from the various enzymes used for liberation of pantothenic acid from coenzyme A, particularly the source of pantetheinase. A purified pantetheinase from pig kidney had greater than 100 times the specific activity and less than 0.01 times the pantothenate content of other commonly used extracts. Endogenous pantetheinase activity in human plasma was identified (11.2 +/- 2.0 mumol pantothenate .min-1.L-1, n = 29) and found comparable to the activity usually added from exogenous sources for liberation of pantothenate from whole blood (1-13 mumol.min-1.L-1). Alkaline phosphatase alone liberated as much pantothenate from hemolyzed whole blood as did alkaline phosphatase with pantetheinase. Previous reports of total blood pantothenate may be elevated by pantothenate in the pantetheinase extracts, an unnecessary source of error. Whole-blood total pantothenate concentrations less than 4.6 mumol/L are normal and do not indicate deficiency, as is often currently quoted.

Pantethine lipomodulation: evidence for cysteamine mediation in vitro and in vivo.

Recent human studies suggest rapid in vivo hydrolysis of the lipid-lowering drug, pantethine, to the vitamin pantothenic acid and the small aminothiol compound, cysteamine. To test whether the active agent is a hydrolysis product, we repeated three experimental models of pantethine's effect with pantothenate and cysteamine. In vitro experiments with human fetal fibroblasts showed equivalent modulation of cholesterol and methyl sterol synthesis by pantethine, cysteamine, or cystamine (the disulfide of cysteamine), but pantothenate had no effect. Similarly, in vivo experiments with 0.5% cholesterol-fed rabbits showed oral pantethine or equimolar cystamine significantly lowered plasma cholesterol, while pantothenate, cystine, and 2-hydroxyethyl disulfide did not. Lastly, diabetic male rats (40 mg/kg streptozotocin) fed 0.1% pantethine and lower plasma free fatty acids after 2 weeks than controls, an effect not seen with pantothenate and largely duplicated by cystamine. The efficacy of pantethine has previously been attributed to altered vitamin metabolism and increased coenzyme A concentration. Pantethine did increase CoA levels 45% in rat liver homogenates while equivalent amounts of cystamine or pantothenate did not. However, a causal relationship between CoA levels and pantethine's action as a hypolipemic agent has never been shown. At least in 3 independent experimental models, the lipomodulating effect of pantethine appears instead to be mediated by the hydrolysis product cysteamine.

Cluster analysis to improve food classification within commodity groups.

Mathematical clustering algorithms were used to classify foods within dairy, grain, and fat commodity groups on the basis of nutrients with limited availability in the food supply as well as those posing a possible health risk due to excess consumption. The procedure overcomes the problem that has made objective and accurate grouping, i.e., dealing simultaneously with 10 or more nutrients, difficult. The clustering routine classifies foods on the basis of similar nutrient content for any number of food attributes and assigns a degree of association to each food to indicate its compositional similarity to a prototype food for the cluster group. Foods within dairy, grain, and fat commodity groups were clustered on the basis of similar content of vitamin B-6, calcium, iron, magnesium, folacin, zinc, and added sugar, fat, cholesterol, and sodium. Whole milk and natural cheese clustered together on the basis of their moderate nutrient and relatively high fat and sodium content. Whole wheat breads, pumpernickel bread, and pancakes from mix constituted a grain subgroup with highest nutrient content, lowest cholesterol and sugar, lower fat, and higher sodium. Other subgroups based upon similarities in attributes were identified within food commodity categories. The result is an expansion of some food groups to incorporate concepts of both nutritional adequacy and moderation of food components of current nutritional concern.

Nutrition intervention: panacea or Pandora's box?

Past intervention efforts have not been effective in solving the nutrition problems in either industrialized or developing nations. While it may be intellectually stimulating, arguing over the subtleties of various strategies does not serve to improve the nutritional well-being of populations and may actually be detrimental. Whether we are concerned about an excess of calories or an inadequate supply of calories, the issue of calories is critical worldwide. A nutrient density approach provides a unified, scientifically justifiable, comprehensive approach to improving the nutritional status of populations in both developed and developing countries.

Alcohol consumption and nutrient density of diets in the Nationwide Food Consumption Survey.

Alcoholic beverage data from the U.S. Department of Agriculture's Nationwide Food Consumption Survey (NFCS), 1977-78, were compared with apparent consumption data from the U.S. Department of Health and Human Services (DHHS). NFCS data indicate that only one-fifth of the alcohol estimated to be consumed by DHHS is reported at the household level. For those individuals consuming alcoholic beverages, energy levels were higher than for non-drinkers. Average daily nutrient intake for most nutrients was similar for drinkers and non-drinkers. The nutrient density of diets of drinkers was significantly lower than that of non-drinkers with respect to protein, fat, carbohydrate, calcium, iron, phosphorus, vitamin A, and thiamin.

Consistency of nutrient consumption patterns in the United States.

With data from the U.S. Department of Agriculture's nutrient densities of diets of 7,810 individuals more than 4 years old were evaluated by use of the Index of Nutritional Quality (INQ) and standard dietary allowances per 1,000 kcal. With the exception of vitamins A and C, the nutritional quality of food consumed by various sex-age groups was remarkably consistent, despite wide variations in total calories consumed. The average concentrations of calcium, iron, magnesium, and vitamin B6 were not sufficient to meet recommended allowances. The reasonableness of recommended standards and the utility of the nutrient density concept for improving food habits of the population are discussed in view of these new data.