Annual Review of Nutrition - Volume 17, 1997

Additional energy needs for an exclusively breastfeeding woman are approximately 670 kcal/day. If one allows for gradual weight loss, the net increment needed is about 500 kcal/day. There is little evidence of energy-sparing adaptations in basal metabolic rate or dietary-induced thermogenesis during lactation, although physical activity may be reduced during the early postpartum period. In women with adequate fat reserves, moderately negative energy balance is not likely to affect lactation. The recommended increment in protein intake during lactation has been estimated to be about 15 g/day, based on a milk protein concentration of 11 g/liter. However, if one takes into account the protein cost of non-protein nitrogen in human milk, the recommended increment in protein is about 20 g/day. The latter value is consistent with data from nitrogen balance studies in lactating women. Low protein intakes are unlikely to affect milk volume but may alter certain fractions of milk nitrogen.

Cadmium, lead, mercury, and aluminum are toxic metals that may interact metabolically with nutritionally essential metals. Iron deficiency increases absorption of cadmium, lead, and aluminum. Lead interacts with calcium in the nervous system to impair cognitive development. Cadmium and aluminum interact with calcium in the skeletal system to produce osteodystrophies. Lead replaces zinc on heme enzymes and cadmium replaces zinc on metallothionein. Selenium protects from mercury and methylmercury toxicity. Aluminum interacts with calcium in bone and kidneys, resulting in aluminum osteodystrophy. Calcium deficiency along with low dietary magnesium may contribute to aluminum-induced degenerative nervous disease.

This article gives a brief history of military nutrition research in this century and reviews recent advances made through field testing. Although modern rations are nutritionally complete, ration developers are challenged to improve palatability to promote increased intakes in field training and combat settings. The principal goal for military nutritionists is to identify the optimal macronutrient mix and specific ration components that sustain a soldier's performance in the face of operational stressors such as sleep deprivation, intense physical activity, climatic extremes, and hypobaric hypoxia. Energy expenditures during typical field-training exercises average approximately 4000 kcal/day, whereas energy intakes are usually 3000 kcal/day or less when operational rations are consumed. One way to ameliorate the effects of this shortfall is to provide soldiers with a carbohydrate beverage supplement.

Long-chain fatty acids are involved in all aspects of cellular structure and function. For controlling amounts of fatty acids, cells are endowed with two acetyl-coenzyme A carboxylase (ACC) systems. ACC-α is the rate-limiting enzyme in the biogenesis of long-chain fatty acids, and ACC-β is believed to control mitochondrial fatty acid oxidation. These two isoforms of ACC control the amount of fatty acids in the cells. Phosphorylation and dephosphorylation of ACC-α cause enzyme inactivation and activation, respectively, and serve as the enzyme's short-term regulatory mechanism. Covalently modified enzymes become more sensitive toward cellular metabolites. In addition, many hormones and nutrients affect gene expression. The gene products formed are heterogeneous and tissue specific. The ACC-β gene is located on human chromosome 12; the cDNA for this gene has just been cloned. The gene for the α-isoform is located on human chromosome 17. The catalytic core of the β-isoform is homologous to that of the α-isoform, except for an additional peptide of about 150 amino acids at the N terminus. This extra peptide sequence makes the β-form about 10,000 daltons larger, and it is thought to be involved in the unique role that has been assigned to this enzyme. The detailed control mechanisms for the β-isoform are not known.

The central demographic reality of our times is the rapid aging of our society. Preventive nutritional and preventive health care of older people, therefore, are pressing issues that must be contended with. Several strategies for this are possible, including the broadcasting of general nutritional and health messages to the population, the inclusion of preventive nutrition and health as part of routine primary care, and nutrition screening: a process of self-identification by the older population in which they judge for themselves whether they are at nutritional risk and, if so, seek the care of professionals. This review focuses on some of the necessities for screening: sensitive, specific, and inexpensively applied screening devices; and explicit interventions that do not have major public health benefit for those who screen negative. Unfortunately, there is little evidence that screening is beneficial, nor have the benefits of this strategy been compared with its alternatives. Thus, the ethical imperative of screening has not been met: that because the activity is being promoted (it is not initiated by the public), its benefit must be conclusive.

In vitro studies of adipocytes taken from different body fat regions suggest substantial differences in lipolysis between intra-abdominal, lower-body subcutaneous, and abdominal subcutaneous regions. Gender and obesity appear to influence these regional differences. In situ measurements of glycerol release from adipose tissue provided further evidence that regional heterogeneity of lipolysis occurs in humans. In vivo studies of regional free fatty acid (FFA) release have confirmed that adipose tissue lipolysis varies between upper- and lower-body fat. Release of FFA from lower-body adipose tissue is less than that from upper-body adipose tissue in both obese and non-obese men and women. In non-obese men and women, meal ingestion suppresses FFA release from all adipose tissue regions, and adrenergic stimulation activated FFA release from different sites in a gender-specific fashion. Significant regional and gender differences in adipose tissue lipolysis occur in humans, and this could contribute to differences in the health effects of adipose tissue and could theoretically influence body fat distribution.

Dietary fats are essential for life and good health. Efficient absorption of dietary fats is dependent on the action of pancreatic triglyceride lipase. In the last few years, large advances have been made in describing the structure and lipolytic mechanism of human pancreatic triglyceride lipase and of colipase, another pancreatic protein that interacts with pancreatic triglyceride lipase and that is required for lipase activity in the duodenum. This review discusses the advances made in protein structure and in understanding the relationships of structure to function of pancreatic triglyceride lipase and colipase.

Triacylglycerols make up 98% of the lipid content of milk, ranging in different species from 0 to 50% of the total milk volume. The fatty aid composition of the triacylglycerols depends on the species, the dietary fatty acid composition, and the carbohydrate-to-lipid ratio of the diet. The rate of lipid synthesis in the lactating mammary gland depends on the stage of mammary development and is decreased by fasting and starvation in ruminants and rodents but not in species that fast during lactation, such as seals and hibernating bears. Regulatory agents include insulin, prolactin, and non-esterified fatty acids. Dietary trans fatty acids may depress milk lipid synthesis under certain conditions. Evidence is presented that fatty acids may play a major regulatory role in acute changes in de novo mammary fatty acid synthesis, acting primarily on the activity of acetyl coenzyme A carboxylase.

This review outlines the energy sources available to the horse, from its diet and from its body stores, at rest and while exercising. It looks at the current ways of describing the energy potential of diets fed to horses and discusses the relative advantages and disadvantages of the digestible energy and net energy systems. The more empirical net energy system for calculating the energy available for maintenance and work is compared with a more physiological partitioning system. Finally, the energy requirements for maintenance and exercise are discussed, together with how they may be practically determined and achieved through different diets.

Nutritional status in children is an indicator of health and well-being at both the individual and the population level. Screening for malnutrition should be an integral part of pediatric care universally. Nutritional intervention requires repeated measurement of nutritional status to assess severity and to track progress over time. Methodological issues in the assessment of nutritional status are reviewed with emphasis on anthropometric measurement, body composition, and energy expenditure of children at risk for malnutrition. Use of reference data, measurement error, maturational effects, and hereditary factors are among the issues reviewed and serve as guidelines in the interpretation of measurement of nutritional status.

Sensory responses to the taste, smell, and texture of foods help determine food preferences and eating habits. However, sensory responses alone do not predict food consumption. The view that a “sweet tooth” leads to obesity through excess sugar consumption is overly narrow. In reality, there are multiple links between taste perceptions, taste preferences, food preferences, and food choices and the amount of food consumed. Taste responses are influenced by a range of genetic, physiological, and metabolic variables. The impact of taste factors on food intake further depends on sex and age and is modulated by obesity, eating disorders, and other pathologies of eating behavior. Food preferences and food choices of populations are further linked to attitudinal, social, and—probably most important—economic variables such as income. Nutrition education and intervention strategies aimed at improving population diets ought to consider sensory pleasure response to foods, in addition to a wide range of demographic and sociocultural variables.

Many microorganisms previously unrecognized as food-borne or harmful are emerging as human pathogens transmitted by food. This is a result of recent acquisition of key virulence factors, detection by newly developed isolation procedures, or astute detective-like laboratory skills of microbiologists. Six microbial pathogens, including Shiga toxin-producing Escherichia coli, Listeria monocytogenes, Arcobacter butzleri, Helicobacter pylori, Cryptosporidium parvum, and Cyclospora, have become recognized as significant causes of human illness. Although the ecology and epidemiology of illness caused by some of these pathogens have not been fully elucidated, food has the potential of being an important vehicle in their dissemination. Existing technologies and new approaches such as irradiation and hazard analysis critical control point (HACCP) programs are useful tools in the control of food-borne hazards. However, because of ever-changing products, processes, food-handling practices, societal habits, and pathogens, emerging food-borne diseases will continue to be an important public health concern.

Intracellular lipid-binding proteins are a family of low-molecular-weight single-chain polypeptides that form 1:1 complexes with fatty acids, retinoids, or other hydrophobic ligands. These proteins are products of a large multigene family of unlinked loci distributed throughout the genome. Each lipid-binding protein exhibits a distinctive pattern of tissue distribution. Transcriptional control, regulated by a combination of peroxisome proliferator activated receptors and CCAAT/enhancer-binding proteins, allows for a variety of both cell and tissue-specific expression patterns. In some cells, fatty acids increase the expression of the lipid-binding protein genes. Fatty acids, or their metabolites, are activators of the peroxisome proliferator–activated receptor family of transcription factors. Therefore, as the concentration of lipid in the diet increases, the expression of lipid-binding proteins coordinately increases. As revealed by X-ray crystallography, the lipid-binding proteins fold into β-barrels, forming a large internal water-filled cavity. Fatty acid ligands are bound within the cavity, occupying only about one-third of the accessible volume. The bound fatty acid is stabilized via a combination of enthalpic and entropic forces that govern ligand affinity and selectivity. Cytoplasmic lipid-binding proteins are the intracellular receptors for hydrophobic ligands, delivering them to the appropriate site for use as metabolic fuels and regulatory agents.

Some coffee brewing techniques raise the serum concentration of total and low-density-lipoprotein cholesterol in humans, whereas others do not. The responsible factors are the diterpene lipids cafestol and kahweol, which make up about 1% (wt:wt) of coffee beans. Diterpenes are extracted by hot water but are retained by a paper filter. This explains why filtered coffee does not affect cholesterol, whereas Scandinavian “boiled,” cafetiere, and Turkish coffees do. We describe the identification of the cholesterol-raising factors, their effects on blood levels of lipids and liver function enzymes, and their impact on public health, based on papers published up to December 1996.

Regulation of gene expression by nutrients is an important mechanism in the adaptation of mammals to their nutritional environment. This is especially true for enzymes involved in the storage of energy, such as the lipogenic and glycolytic enzymes in liver and adipose tissue. Transcription of the genes for lipogenic and glycolytic enzymes is stimulated by glucose in adipose tissue, liver, and pancreatic β-cells. Several lines of evidence suggest that glucose must be metabolized to glucose-6-phosphate to stimulate gene transcription. In adipose tissue, insulin increases the expression of lipogenic enzymes indirectly by stimulating glucose uptake. In the liver, insulin also acts indirectly by stimulating the expression of glucokinase and, hence, by increasing glucose metabolism. Glucose response elements have been characterized for the l-pyruvate kinase and S14 genes. They have in common the presence of a sequence 5′-CACGTG-3′, which binds a transcription factor called USF (upstream stimulatory factor). Another glucose response element, which uses a transcription factor named Sp1, has been characterized in the gene for the acetyl-coenzyme A carboxylase. The mechanisms linking glucose-6-phosphate to the glucose-responsive transcription complex are largely unknown.

Broadly defined, phytoestrogens include isoflavones, coumestans, and lignans. A number of these compounds have been identified in fruits, vegetables, and whole grains commonly consumed by humans. Soybeans, clover and alfalfa sprouts, and oilseeds (such as flaxseed) are the most significant dietary sources of isoflavones, coumestans, and lignans, respectively. Studies in humans, animals, and cell culture systems suggest that dietary phytoestrogens play an important role in prevention of menopausal symptoms, osteoporosis, cancer, and heart disease. Proposed mechanisms include estrogenic and antiestrogenic effects, induction of cancer cell differentiation, inhibition of tyrosine kinase and DNA topoisomerase activities, suppression of angiogenesis, and antioxidant effects. Although there currently are no dietary recommendations for individual phytoestrogens, there may be great benefit in increased consumption of plant foods.

Obesity has become an epidemic in the United States and in many other countries of the world. Obesity is a chronic disease, not a failure of willpower. Diet, exercise, and behavioral modification of lifestyle are rarely successful over the long term. Medications have been used sparingly, because of concerns about addiction and ineffectiveness, but used chronically, obesity drugs are effective. The two main categories of obesity drugs are centrally active adrenergic and serotonergic agents. These drugs reduce appetite, enhance satiety, and increase energy expenditure. Use of single agents produces modest weight loss and use of combinations increases loss, but few patients reach their goal weight. Co-morbidities associated with obesity resolve or are reduced in severity with weight loss. Adverse events of major concern are changes in brain biochemistry and primary pulmonary hypertension. Published guidelines for use of obesity medications recommend they be used only for medically significant obesity.

Diets high in simple carbohydrates and low in fats lead in the mammalian liver to induction of a set of enzymes involved in lipogenesis. This induction occurs, in part, through transcriptional mechanisms that lead to elevated levels of the mRNA for these enzymes. For most of the lipogenic enzymes, an increase in glucose metabolism is required to trigger the transcriptional response. The intracellular mediator of this signaling pathway is unknown, although evidence suggests either glucose-6-phosphate or xylulose-5-phosphate. Studies to map the regulatory sequences of lipogenic enzyme genes involved in the transcriptional response have been performed for the l-type pyruvate kinase, S14, and acetyl-coenzyme A carboxylase genes. These studies have identified the DNA sequences necessary to link the signal generated by carbohydrate metabolism to specific nuclear transcription factors.