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Diet and Nutrition in the Prevention and Treatment of Chronic Disease Status of Diet and Nutrition Research in the United States Diet and nutrition research goes on in almost every medical school, university, and pharmaceutical laboratory throughout the world. Thus, the knowledge of how to prevent illness and maintain health through nutrition grows every year. However, for such areas as reversing the effects of chronic disease through dietary or nutritional intervention or determining levels of nutrients required to achieve optimal metabolic or immune system functioning, there often is no critical mass of researchers or funds to follow up promising initial experimental results. In fact, the history of nutrition research is marked by examples where, for one reason or another, preliminary reports of a positive therapeutic effect of a certain vitamin, mineral, or nutritional manipulation appear but are often not followed up by the overwhelming majority of the medical community. In cases where such therapies eventually are proven to be safe and effective, it is sometimes not until years or even AUTHORS J. Daniel Kanofsky, .M.D., M.P.H. decades after the initial reports. The result is that many individuals may die or suffer needlessly, while effective interventions are available but not yet validated. For example, in the 1930s, Australian psychiatrist John Cade began a series of crude experiments on guinea pigs in which he injected them with the urine of psychiatric patients to test his hypothesis that mania-a mood disorder characterized by, among other things, periods of euphoria-might represent a state of intoxication resulting from an excess of some commonly occurring metabolite. Depress.ion, on the other hand, might represent the effects of abnormally low levels of the same metabolite (Johnson, 1984). Although all the urine samples proved toxic to the guinea pigs-Cade traced the toxicity to the urea component of the urine-the urine from the manic patients was far more toxic than urine from the schizophrenic or depressive patients. In his attempts to find out what was increasing the toxicity of the urea in the manic patients' urine, Cade happened upon the compound lithium citrate, which he eventually began injecting Helpful Definitions for Reading This Chapter: antioxidant: A compound that prevents oxidation of substances, particularly lipids, in food or in the body. Antioxidants are especially important in preventing the oxidation of polyunsaturated lipids in the membranes of cells. An antioxidant is able to donate electrons to electron-seeking compounds such as free radicals (see below). This in turn reduces electron capture and, thus, breakdown of unsaturated fatty acids and other cell components by oxidizing agents. atherosclerosis: A buildup of fat ty material in the arteries, including those in the heart. carbohydrate: A compound containing carbon, hydrogen, and oxygen atoms; most are known as sugars, starches, and dietary fiber. diet: All of the foods a person consumes either on a daily basis or on average over a period of time. enzyme: A compound, usually a protein, that speeds the rate of a chemical reaction but is not altered by the chemical reaction. epidemiology: The study of the occurrence, cause, and prevention of disease and death in human populations. fatty acid: A principal component of fats and oils. A fatty acid is composed of a chain of carbon and hydrogen atoms with an acid group at; one end. Examples include stearic acid (a saturated fatty acid), oleic acid (a) monounsaturated fatty acid), and linoleic acid (a polyunsaturated fatty acid). free radical: Short-lived form of compounds with an unpaired electron in the outer electron shell. Because free radicals have an electron-seeking nature, they can be very destructive to electron-dense areas of cells, such as DNA and cell membranes. lipid: A compound containing an abundance of carbon and hydrogen, little oxygen, and sometimes other atoms. Lipids include fats, oils, and cholesterol. lipoprotein: A compound found in the bloodstream containing a core of lipids with a shell of protein, phospholipid, and cholesterol. macronutrients: Compounds, such as fats, proteins, and carbohydrates, that must be broken down or metabolized by the body to obtain energy or basic building material. micronutrients: Mir erals and vitamins that are required for proper functioning of the body. These often act as cofactors or coer zymes in enzymatic processes. myocardial infarction: Death of part of the heart muscle due to a heart attack. nutrients: Chemical substances in food that nourish the body by providing energy, building materials, and factors to regula,te needed chemical reactions in the body. nutrition: The biological science of nutrition includes the processes by which the organism ingests, digests, absorbs, transports, metabolizes, and excretes food substances. Nutrition as a science and discipline also includes areas such as food policy, dietary behaviors, agricultural practices, cultural and anthropological aspects of food, etc. prospective: studies: Studies in which subjects are enrolled prior to their having developed the endpoint (i.e., condition or disease) of interest, and they are often followed until they develop such endpoints. Examples of prospective studies include clinical trials, in which some study subjects are given an investigator-imposed interventiori, and cohort or panel studies, which usually do not include investigator-imposed intervention. retrospective studies: Studies undertaken to determine whether those with and without a particular disease or condition differ according to past exposures. Examples of such studies include case-control studies and retrospective cohort studies. |