Diet and Health examines the many complex issues concerning diet and its role in increasing or decreasing the risk of chronic disease. It proposes dietary recommendations for reducing the risk of the major diseases and causes of death today: atherosclerotic cardiovascular diseases (including heart attack and stroke), cancer, high blood pressure, obesity, osteoporosis, diabetes mellitus, liver disease, and dental caries.

Contents

• Dedication
• COMMITTEE ON DIET AND HEALTH
• FOOD AND NUTRITION BOARD
• COMMISSION ON LIFE SCIENCES
• Preface
• PART I. INTRODUCTION, DEFINITIONS, AND METHODOLOGY
  • 1. Executive Summary
    • Purpose, Approach, and Scope of the Study
    • Criteria for Assessment
    • Criteria and Process for Formulating Dietary Recommendations
    • Major Conclusions and their Bases
    • The Committee's Dietary Recommendations
    • Implications of Recommendations for Food Choices
    • Impact on Public Health: Benefits and Risks of Dietary Modification
    • Implementation of Dietary Recommendations
    • Research Directions
  • 2. Methodological Considerations in Evaluating the Evidence
    • Assessment of Dietary Intake of Humans
    • Evaluating Single Studies for Quality and Relevance
    • Evaluating the Evidence as a Whole
    • Summary
    • References
  • 3. Dietary Intake and Nutritional Status: Trends and Assessment
    • National Surveys of Dietary Intake and Nutritional Status
    • Trends in the Food Supply and Dietary Intakes
    • Changes in Eating Patterns
    • Do Food Choices in the United States Reflect a Concern about Health?
    • Public Opinion Surveys about Diet and Health
    • Summary
    • References
  • 4. Genetics and Nutrition
    • Applicability to Nutrition
    • Inborn Errors of Metabolism as a Model
    • Research Methods in Medical Genetics
    • Gene-Environment Interaction
    • Other Genetic Factors that Affect Nutrition
    • Genetic Factors in Some Chronic Diseases
    • Policy Implications of Genetic Variations
    • Summary
    • Directions for Research
    • References
  • 5. Extent and Distribution of Chronic Disease: An Overview
    • Atherosclerotic Cardiovascular Diseases
    • Hypertension and Hypertension-Related Diseases
    • Obesity and Related Diseases
    • Cancers
    • Osteoporosis
    • Diabetes Mellitus
    • Hepatobiliary Disease
    • Dental Caries
    • References
• PART II. Evidence on Dietary Components and Chronic Diseases
  • 6. Calories: Total Macronutrient Intake, Energy Expenditure, and Net Energy Stores
    • Energy Intake
    • Energy Expenditure
    • Energy Balance
    • Evidence Associating Total Energy Intake with Chronic Diseases
    • Evidence Associating Energy Expenditure with Health and Chronic Diseases
    • Summary
    • Directions for Research
    • References
  • 7. Fats and Other Lipids
    • Trends in the Food Supply
    • Lipid Intake: National Surveys
    • Evidence Associating Dietary Fats and Other Lipids with Chronic Diseases
    • Effects of Dietary Fats and Other Lipids on Health and Disease in Children
    • Overall Summary
    • Directions for Research
    • References
  • 8. Protein
    • Patterns of Intake in the U.S. Diet
    • Evidence Associating Protein with Chronic Diseases
    • Summary
    • Directions for Research
    • References
  • 9. Carbohydrates
    • Dietary Intake of Carbohydrates
    • Evidence Associating Carbohydrate Intake with Chronic Diseases
    • Summary
    • Directions for Research
    • References
  • 10. Dietary Fiber
    • Physiological Effects of Dietary Fiber
    • Sources of Dietary Fiber
    • Patterns of Fiber Intake in the United States
    • Methodological Problems in Assessing Fiber-Disease Interrelationships
    • Evidence Associating Dietary Fiber with Chronic Diseases
    • Other Chronic Diseases
    • Potential Undesirable Effects of Dietary Fiber
    • Other Potential Effects
    • Summary
    • Directions for Research
    • References
  • 11. Fat-Soluble Vitamins
    • Dietary Sources, Patterns of Intake, and Levels of Fat-Soluble Vitamins
    • Evidence Associating Fat-Soluble Vitamins with Chronic Diseases
    • Summary
    • Directions for Research
    • References
  • 12. Water-Soluble Vitamins
    • Dietary Sources, Patterns of Intake, and Levels of Water-Soluble Vitamins
    • Evidence Associating Water-Soluble Vitamins with Chronic Diseases
    • Summary
    • Directions for Research
    • References
  • 13. Minerals
    • Evidence Associating Minerals with Chronic Diseases
    • Summary
    • Directions for Research
    • References
  • 14. Trace Elements
    • Evidence Associating Trace Elements with Chronic Diseases
    • Summary
    • Directions for Research
    • References
  • 15. Electrolytes
    • Evidence Associating Electrolytes with Chronic Diseases
    • Summary
    • Directions for Research
    • References
  • 16. Alcohol
    • Patterns of Alcohol Consumption in the United States
    • Genetics and Alcoholism
    • Cultural Aspects of Alcohol Use
    • Evidence Associating Alcohol Consumption with Chronic Diseases
    • Policy Implications
    • Summary
    • Directions for Research
    • References
  • 17. Coffee, Tea, and Other Nonnutritive Dietary Components
    • Food Safety Laws
    • Coffee and Tea
    • Nonnutritive Sweeteners
    • Preservatives, Antioxidants, Food Colors, and Other Intentionally Added Substances
    • Indirect Additives, Contaminants, and By-Products of Food Processing
    • Naturally Occurring Toxicants in Foods
    • Summary
    • Directions for Research
    • References
  • 18. Dietary Supplements
    • Use of Dietary Supplements
    • Nutrient Adequacy and Supplement Use
    • Evidence Associating Dietary Supplements with Chronic Diseases
    • Nutrient Toxicities
    • Additional Concerns
    • Legal Status
    • Committee Conclusions
    • Directions for Research
    • References
• PART III. Impact of Dietary Patterns on Chronic Diseases
  • 19. Atherosclerotic Cardiovascular Diseases
    • Coronary Heart Disease
    • Peripheral Arterial Disease
    • Stroke
    • Overall Summary
    • Directions for Research
    • References
  • 20. Hypertension
    • Evidence Associating Dietary Factors with Hypertension
    • Evidence Associating Nondietary Factors with Hypertension
    • Pediatric Diet and Adult Hypertension
    • Summary
    • Directions for Research
    • References
  • 21. Obesity and Eating Disorders
    • Weight Standards
    • Adiposity Standards
    • Causes of Obesity: Increased Energy Intake or Decreased Energy Expenditure?
    • Genetic Factors in Obesity
    • Evidence Associating Overweight or Obesity with Chronic Diseases and Physiologic Function
    • Misconceptions
    • Eating Disorders
    • Summary
    • Directions for Research
    • References
  • 22. Cancer
    • Trends in Cancer Incidence in the United States and the Role of Diet
    • Evidence Associating Dietary Factors with Cancer at Specific Sites
    • Summary
    • Directions for Research
    • References
  • 23. Osteoporosis
    • Bone and Mineral Metabolism
    • Evidence Associating Dietary Factors with Osteoporosis
    • Evidence Associating Nondietary Factors with Osteoporosis
    • Summary
    • Directions for Research
    • References
  • 24. Diabetes Mellitus
    • Evidence Associating Dietary Factors with Diabetes Mellitus
    • Summary
    • Directions for Research
    • References
  • 25. Hepatobiliary Disease
    • Cirrhosis of the Liver
    • Gallstones
    • Summary
    • Directions for Research
    • References
  • 26. Dental Caries
    • Evidence Associating Dietary Factors with Dental Caries
    • Evidence Associating Nondietary Factors with Dental Caries
    • Summary
    • Directions for Research
    • References
• PART IV. Overall Assessment, Conclusions, and Recommendations
  • 27. Overall Assessment and Major Conclusions
    • Special Characteristics of the Study
    • Criteria and Process for Interpreting and Integrating Evidence
    • Major Conclusions and their Bases
    • References
  • 28. Recommendations on Diet, Chronic Diseases, and Health
    • Criteria and Process for Formulating Dietary Recommendations
    • The Committee's Dietary Recommendations
    • Implications of Recommendations for Food Choices
    • Comparison of the Committee's Recommendations with those by Other Expert Groups
    • Potential Adverse Consequences of Dietary Recommendations
    • Dietary Fat Intake, Serum Cholesterol Levels, and Mortality from Cardiovascular Diseases and Cancer
    • Public Health Impact (Potential Benefits) of Dietary Recommendations
    • Implementation of Dietary Recommendations
    • Research Directions
    • References

The study summarized in this publication was supported by funds from the National Research Council Fund, a pool of private, discretionary, nonfederal funds that is used to support a program of Academy-initiated studies of national issues in which science and technology figure significantly. The NRC Fund consists of contributions from a consortium of private foundations including Carnegie Corporation of New York, Charles E. Culpeper Foundation, William and Flora Hewlett Foundation, John D. and Catherine T. MacArthur Foundation, Andrew W. Mellon Foundation, Rockefeller Foundation, and Alfred P. Sloan Foundation; the Academy Industry Program, which seeks annual contributions from companies that are concerned with the health of U.S. science and technology and with public policy issues with technological content; and the National Academy of Sciences and National Academy of Engineering endowments. The study was also supported by W.K. Kellogg Foundation, The Henry J. Kaiser Family Foundation, Pew Charitable Trusts, Fannie E. Rippel Foundation, and Occidental Petroleum Corporation.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Frank Press is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Robert M. White is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Samuel O. Thier is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Frank Press and Dr. Robert M. White are chairman and vice chairman, respectively, of the National Research Council.