BNF Nutrition Bulletin Vol 2 I, September I996

associations between fruit and vegetable intakes and disease. Consistency and sim- plicity of messages on fruit and vegetables was likely t o be more effective for public health education.

Studies with small numbers of subjects receiving detailed and extensive informa- tion and motivational counselling have indicated that significant increases in fruit and vegetable intakes can be achieved. However; longer term data, and the effi- cacy ofthe mass communication o f health messages on increasing fruit and vegeta- ble intakes, are lacking. Barriers to greater consumption o f fruit and vegetables are consistently reported as higher costs, wastage, inconvenience during meal preparation, and a lack o f availability at points offood choice eg canteens ortake- away restaurants. To what degree perceived barriers are factors that justify rather than influence food choice behav- iour is unclear.

Research is needed t o describe and untangle consumer trade-offs between possible improvements in health versus certain culinary convenience and cultural norms, before any health-education led changes in food choice are likely t o re- sult in increased fruit and vegetable consumption.

Ursula Arens British Nutrition Foundation

Summer Meeting I996 Nutrition Society Coleraine, 24-29 June I996

The conference this year offered the usual mixture o f high quality symposia and oral communications, together with a large number of poster presentations.

A special symposium Diabetes towards the year 2000, jointly organised by the Irish Section, Macronutrient Metabolism Group, Biochemical Society and British

Dietetic Association, covered a wide va- riety o f topics, ranging from Dietary and lifestyle factors contributing t o insulin resistance, t o Pancreatic 8-cell dysfunc- tion and glucose toxicity in diabetes.

Professor Home reported that despite the major conclusion o f the Diabetes Control and ComplicationsTrial (DCCT) -that improved control reduces inci- dence of complications-there was little difference in the incidence o f retinopathy until control was very poor (glycosylated haemoglobin H b A I c>8). H e also pointed out that although improved con- trol was generally associated with an increased frequency o f hypoglycaemic episodes this was not observed in all trial centres, suggesting that it is a problem which can be overcome. Indeed Profes- sor Ian Macdonald showed that with intensive education, frequent blood glu- cose monitoring and multiple insulin injections, better control can be achieved without more episodes of hypoglycaemia. Professor Home suggested that the chal- lenge for diabetic clinics was t o improve organisation, patient access, education and monitoring and also t o look at pa- t ient empowerment as a means o f improving the quality o f care for diabetic patients.

Can we prevent diabetes in the f i rs t place? Professor Gale outlined ENDIT- a five year randomised placebo control- led study which is investigating the effectiveness o f nicotinamide in the pre- vention of the condition in first degree relatives o f diabetics. A study in New Zealand has already shown a reduced rate o f progression of diabetes in people given nicotinamide.

In terms of other dietary factors in- volved in the development of diabetes it seems we are still in the dark, although Professor Green demonstrated a link between in utero exposure t o nitrosamines and the seasonality o f insu- lin dependant diabetes mellitus (IDDM)

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BNF Nutrition Bulletin Vol 2 I , September I996

onset in men and suggested that consump- tion of foods rich in these compounds may increase the risk of developing IDDM by a factor of I .5 to 4.0. In addition there also appears to be a suggestion of a link between milk consumption and IDDM risk. Professor Hales reported that lighter birthweight and poor early nutrition may lead to an increased incidence of non- insulin dependant diabetes mellitus (NIDDM) or impaired glucose tolerance later in life, particularly if the individual becomes overweight during adulthood.

The subject of obesity and diabetes is always under debate and Professor Mike Lean encouraged the medical profession to adopt new attitudes to the manage- ment of weight loss. Concentrating on NIDDM he questioned whether the cur- rent recommendations are sufficient and suggested that perhaps there should be more emphasis on quality of life and risk factor management. A moderate weight loss can improve insulin sensitivity, glu- cose tolerance, lipid levels and blood pressure, and maintenance of weight loss is of primary importance in these patients.

The plenary symposium Nutn'tional Is- sues for Women was entirely chaired and presented by women. The stimulating presentations covered Cardiovascular risk factors for women, Fear of fatness in ado- lescent girls, and Gender and nurture in industrial societies.

Dr Ann Prentice posed the question Is nutrition an important factor in osteoporosis? In terms of calcium intake and bone density the link proved to be weak. For some countries the associa- tion between these factors is often negative. The bone mineral content of British compared to Gambian women is apparently similar, despite the latter hav- ing significantly lower intakes of dietary calcium.

It was suggested that the body may be able to adapt to variations in calcium in- take by varying calcium absorption. In a

study o f Norwegian prisoners who switched from their usual diet t o one lower in calcium, although there was an initial net loss of calcium, absorption in- creased after a period of six t o nine months. It is possible that a low intake primes the body to metabolise calcium more efficiently thus preventing loss of bone density.

Controversies surrounding diet and breast cancer were discussed by Profes- sor Leonore Kohlmeier: She concluded that we are no further forward in untan- gling the relationships of total energy intake and fat intake to breast cancer: Willett et a/. found no link between either total en- ergy, total fat or saturated fat intake and the development of breast cancer: In ad- dition, data from the Euramic Study suggest that there appears to be no association between breast cancer and O-carotene lev- els in adipose tissue samples-a finding which casts a shadow over the link be- tween antioxidant status and cancer development. It was suggested that the ratio of n-3 to n-6 fatty acids may be im- portant as it has been shown that a higher intake of n-3 is associated with a reduced incidence of the disease. Also pre-pubes- cent nutrition is possibly more important than diet in adulthood as delayed menarchy has been shown to reduce the risk of breast cancer in later life.

The theme of women and nutrition was evident in other areas of the conference, with sessions on pregnancy, lactation and weaning evoking lively discussion. The topic of pre-menstrual syndrome was also tack- led, with two oral presentations demonstrating an effect of magnesium sup- plementation on relief of symptoms such as anxiety and craving (Coelho de sousa).

Overall,the conference was ofthe qual- ity and standard we have come to expect from the Nutrition Society, and thanks and congratulations are due to the organisers.

Helen Lloyd British Nutrition Foundation

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