Section III: Nutritional Status / Lifecycle Issues

#P19

INFLUENCE OF CAROTENOID DEPLETION AND REPLETION ON SERUM CAROTENOID AND VITAMIN A CONCENTRATIONS. Betty Jane Burri, Anne L. Sowell,* Monica Wong. Western Human Nutrition Research Center, USDA/ARS/PWA, San Francisco, CA 94129; *Centers for Disease Control and Prevention, Atlanta, GA, USA.

Beta-carotene and other provitamin carotenoids are the major sources of vitamin A for most vegetarians. Carotenoids are also believed to be fat soluble antioxidants. Therefore, beta-carotene metabolism and its conversion to vitamin A are of importance to vegetarians. Carotenoid metabolism appears to be highly variable in healthy well-fed individuals. We hypothesized that vitamin A status, body fat stores, and oxygen consumption might influence serum carotenoid metabolism and concentrations. We measured serum carotenoid and vitamin A concentrations in 23 women participating in three metabolic research unit studies. Most of these women were fed low carotenoid diets supplemented with beta-carotene and mixed carotenoid capsules for over 100 days. Activities, exercise, diet and medications were controlled. We compared serum carotenoid concentrations to dietary intakes of carotenoids, vitamin A status (estimated by stable isotope dilution). body composition and oxygen consumption. Carotenoid concentrations appeared to decrease asymptotically In act women during carotenoid depletion, then increased in all women during carotenoid supplementation. However, carotenoid concentrations were highly variable. Serum vitamin A concentrations were unchanged. Carotenoid concentration changes were negatively correlated to vitamin A status (r ~ -0.7) in one study, but this influence appeared to be relatively small. Body composition and oxygen consumption had little or no influence on serum carotenoid concentrations. The major influence on carotenoid concentrations and metabolism remains unknown, but is probably genetic.

#P20

INFLUENCE OF PLASMA ,ß-CAROTENE CONCENTRATION ON BIOAVAILABILITY AND CONVERSION OF ,ß-CAROTENE-D8 STABLE ISOTOPE IN YOUNG HEALTHY WOMEN. Jin-Young K. Park, Betty Jane Burri, Tatyana Lukoyanova, and Stephen Dueker*. Western Human Nutrition Research Center, USDA/ARS/PWA, San Francisco, CA, USA., *Department of Nutrition, University of California, Davis, CA, USA.

Bioavailability and conversion of a stable isotope of ,ß-carotene (BC-d8) was determined in four young healthy women. They selected their own diets from a limited menu offered them during 21 days of metabolic research unit study. Their plasma ,ß-carotene (BC) concentrations were between 0.5 and 3 mg/1. After a 40 mg oral dose of BC-d8 in olive oil was given before breakfast, BC-d8 and retinol-d4 (VA-d4) concentrations in serial plasmas were measured using high performance liquid chromatography and gas chromatography-mass spectrometry, respectively. Area under the plasma concentration curve of BC-d8 or VA-d4 over 21 days was used as a index of % bioavailability or % conversion of BC-d8 to VA-d4, respectively. Plasma % bioavailability of BC-d8 in individuals was highly variable. Individual's % conversion of BC-d8 to VA-d4 was also variable. There was a positive association between % bioavailability of BC-d8 and its % conversion to VA-d4 (r^2=0.6). Plasma BC concentrations show a positive association with % conversion of BC-d8 to VA-d4 (r^2=0.7). Body weight (between 47 and 60kg) had a negative association with % conversion of BC-d8 to Vad4 (r^2=0.9). The results of our study suggest that there is a significant individual genetic variation of absorption and metabolism for ,B-carotene with a trend toward positive associations between absorption and metabolism. The people who absorb more ,ß-carotene may more efficiently metabolize the compound.

(Major funding for this project was provided by the U. S. Dept. of Agriculture.)

#P21

COBALAMIN (CBL) STUDIES ON TWO TOTAL VEGETARIAN (VEGAN) FAMILIES. Milton G. Crane 1,2, U.D. Register 3, and Richard Lukens 1. 1 Weimar Institute, Weimar, CA, 2 Department of Medicine and School of Public Health, Loma Linda University, Loma Linda, CA.

Two families (four adults and five children) ranging in age from 10-53 years volunteered for evaluation of cobalamin (vitamin B 12) status. All were total vegetarians for 2 to 6 yrs., except for a little milk less than once/month. All were "healthy," free from recognizable symptoms of cobalamin deficiency. After evaluation, urine and fasting blood samples were drawn before and again after 60 days on CBL 500 mcg/day (chewed). Results were as follows: Initial red cell count ranged from 3.94 to 4.92, and hematocrit ranged from 36.8 to 43.2. Six of 9 were slightly below normal. Their MCV, MCH, and serum iron were all in midnormal range. Serum folate ranged from 7.3 to 17 (N=>2.7). Serum SCBL was <200 pg/ml in 8 of 9 (one was (331 pg/ml) and all increased to be 356-728 pg/ml on CBL (p<0.005). Serum Methymalonic acid (nmol/L) (SMMA) was elevated in 5 of 8, and the values of all but one decreased to within normal limits on CBL (Ave. -67.9%; p<0.005). Urine methylmalonic acid (µmol/nmol creatinine) (UMMA) values were elevated in 7 of 8; all decreased to within normal limits on CBL (p<0.005). Serum total homocysteine (µmol/L) (STHcys) and Serum Total 2-methylcitric acid (µmol/L) (ST2-Mca) were within normal in all 8 initially; both decreased significantly (P<0.005) on CBL by -31% and -28.2% respectively. Serum cystathionine (nmol/L) levels were below normal and remained low in 3 of 8 subjects, indicating an adquate B6 intake.

These studies indicate that all total vegetarians should assure themselves of a reliable source of vitamin B12, and verify their ability to absorb it. If we combine the data of the SCBL and UMMA, all nine of the subjects had evidenced of CBL deficiency. Of interest was that the initial values for STHcys and ST2-Mca were within normal limits yet decreased consistently by an average of -31% and -28.2% (p<0.005) on CBL therapy.

Funded by Donald and Barbara Cox and a fund of the LLUSPH.

#P22

PLASMA AMINO ACIDS DISCRIMINATE BETWEEN TOTAL VEGETARIANS AND NON-VEGETARIANS. Alfredo Mejia, Merritt C. Horning and Albert Sanchez. Nutrition Department, Loma Linda University, Loma Linda, CA, USA; Lassen Foundation, Chico, CA, USA; and Pacific Health Education Center, Bakersfield, CA, USA.

Subjects consuming total vegetarian diets have very low risk of coronary heart disease (CHD) compared to the general population. They also have a unique plasma amino acid profile, including higher levels of arginine (Arg) and glycine (Gly); and lower levels of lysine (Lys) and valine (Val) when compared with subjects who eat regular omnivore diets. We performed discriminant analysis to determine whether the plasma levels of Arg, Gly, Lys, and Val are predictive of the type of diet ingested. The sample population consisted of 38 healthy total vegetarians (20 men, 18 women) and 53 omnivores (20 men, 33 women). Plasma levels of Arg, Gly, Lys, and Val are predictive of the type of diet 94% of the times in all subjects, and when the data was analyzed by sex, 95% for male and 98% for female. Plasma levels of Arg, Gly, Lys, and Val can be used as metabolic markers to discriminate between subjects eating omnivore and total plant food diets with >93% certainty. Those amino acids should be included simultaneously in the discriminant analysis equation; because if they are used individually, their predictive value is weaker (Val, 65%; Lys, 71%; Gly, 72%; and Arg, 81%). Discriminant analysis based on Arg, Gly, Lys, and Val is highly predictive to discriminate among subjects eating total vegetarian diet or omnivore diet. Thus, these plasma amino acids could be used to assess the compliance of subjects participating in clinical trials based on total vegetarian diets and omnivore diets. In addition, we hypothesize that the unique plasma amino acid profile of total vegetarians may be a protective factor against CHD.

#P23

EFFECT OF THE TYPE OF LACTATION ON THE PSYCHOMOTOR DEVELOPMENT IN MEXICAN INFANTS. O. Angulo-G, N. Cruz-Cansino, MD Callejas-Flores, C. Rivas-Valerio, ML Suarez-Quiroz and I Rivas. Instituto Tecnologico de Veracruz, Dpto. Ing. Quimicay Bioquimica Veracruz, 91880, Ver. Mexico.

The n-6 and n-3 long chain polyunsaturated fatty acids LCPUFA (Arachidonic; AA and docosahexaenoic acids, DHA) are important components of the central nervous system. AA and DHA are normally derived by desaturation and elongation of linoleic and linolenic acids. However, newborn babies seem to present reduced desaturation and elongation enzyme activities making necessary to supply LCPUFA by dietary means. The purpose of this study was first of all, to determine the fatty acid composition of human milk as well as infant formulas commercialized in Veracruz, Mexico. Secondly, to determine the effect of lactation: breast feeding vs formula feeding on the psychomotor development during the first four months of life. Thirty samples of milk were obtained from lactating women in Veracruz and twenty infant formulas were analyzed for their fatty acid profile. The psychomotor development was evaluated according to a modified methodology derived from the Gessel Scale in 30 breast fed and 30 formula fed babies during four months. Body weight, length and head circumference was registered monthly. Results showed that human milk contains indeed LCPUFA whereas infant formulas contain linoleic acid and linolenic acid as the longest fatty acids. Small differences were registered for MUFA and SCFA. The anthropometric measurements were not statistically different between the two groups evaluated. Breast fed infants, on the contrary, manifested higher psychomotor scores than did formula fed infants. In summary, human milk provides for LCPUFA necessary for better psychomotor development in full-term infants. Careful consideration should be given to inform pregnant mothers as to these benefits that lactation offers to the infant she carries.

#P24

DIETARY AND SUPPLEMENT INTAKE OF VEGETARIANS DURING PREGNANCY. Rana Drake1, Sheela Reddy 2, G. Jill Davies 1. South Bank University, London, UK. 2 Leatherhead Food RA, Surrey, U.K.

Little is known about the nutrient intake of vegetarians during pregnancy. Studies of non-pregnant vegetarians have highlighted potential problems but dietary intakes are known to change during pregnancy due to a variety of factors.

Caucasion primiparous women from different dietary groups were recruited by placing adverts in magazines, posters in cafes and shops, and with the assistance of midwives. Volunteers answered questions about dietary changes they had made during pregnancy and completed a 3 day estimated record of their diet.

Dietary records were analyzed from 31 lacto-ovo-vegetarians, 14 pesco-vegetarians, and 69 non-vegetarians. Energy and fat intakes were similar in each group while the two vegetarian groups were found to derive significantly lower vitamin B 12 intakes than the other two groups. Many women reported making dietary changes during pregnancy due to cravings, aversions, and other influences. Many also started to take nutrient supplements. The dietary changes made by women in all three groups were similar and were in line with general antenatal advice. Sources of dietary advice were investigated and significantly more vegetarians than non-vegetarians reporting finding the dietary advice available to them to be inadequate.

It is concluded that some vegetarian women would benefit from specifically targeted dietary advice for pregnancy.

Financial assistance from Cow and Gate Nutricia is gratefully acknowledged.

#P25

HEALTH OF VEGETARIANS DURING PREGNANCY AND PREGNANCY OUTCOME. Rana Drake', Sheela Reddy 2, G. Jill Davies l. 'South Bank University, London, UK. 2 Leatherhead Food RA, Surrey, UK.

The quality of a woman's diet influences her health during pregnancy and the well being of her infant. The implications of an increasing number of young women eating a vegetarian type diet is therefore of interest. Whilst slightly lower birth weights have been reported among Indian vegetarian groups, Caucasian vegetarians in the UK have received little attention. Caucasian primiparous women from different dietary groups were recruited by placing adverts in magazines, posters in cafes and shops and with the assistance of midwives. Questionnaires concerning diet, life style and health were completed by 132 women during pregnancy including 34 lacto-ovo-vegetarians, 17 pesco-vegetarians and 81 non-vegetarians. Volunteers were sent a second questionnaire soon after their expected date of delivery to collect information about pregnancy outcome, these were returned by 126 women. The incidence of nausea and constipation was similar in all three groups. More lacto-ovo-vegetarians (26%) reported suffering from anaemia than non-vegetarians (1 1 %) and pesco-vegetarians (6%). When pregnancy outcomes were compared between the groups no significant differences were found in length of gestation, infant birth weights or in the incidence of complications or health problems. In conclusion lacto-ovo-vegetarians more frequently reported anaemia during pregnancy, but this was not associated with any adverse pregnancy outcomes. Financial assistance from Cow and Gate Nutricia is gratefully acknowledged.

#P26

NUTRIENT INTAKE AND NUTRITIONAL STATUS OF VEGETARIANS AND LOW-MEAT EATERS CONSUMING A DIET MEETING PREVENTATIVE RECOMMENDATIONS. Ingrid Hoffmann, Maike J. Groeneveld, Claus Leitzmann. Institute of Nutritional Science, Justus Liebig-University Giessen, Germany.

The dietary recommendations for the prevention of nutrition-related diseases are based on a high consumption of vegetables (including potatoes), fruits, wholegrain products and dairy products and on a reduction of meat and meat products.

In a cross sectional study a group of 243 healthy women (25 to 65 years of age) who practiced such a wholesome diet for at least 5 years, were studied on the consequences of their intake and nutritional status of nutrients: essential, protective and unfavorable ones. One subgroup (111 vegetarians, VEG) completely omitted meat and fish from their diet, the other subgroup (132 non-vegetarians, NVEG) included small amounts of meat (about 30 g/d on average). They were compared to a corresponding group of 175 women eating a normal mixed diet containing about 130 g meat/d (control group).

The VEG clearly showed the highest intake of protective nutrients (e.g. complex carbohydrates, antioxidants, dietary fiber) and the best nutrient ratio. The VEG had the lowest intake of substances known to be unfavorable (e.g. total fat, saturated fatty acids, cholesterol, alcohol). For essential nutrients a high intake could be observed for those vitamins that are dominant in plant foods like vitamin B1, B6, folic acid, vitamin C and E. The intake of vitamins mainly provided by animal foods (especially vitamin B2, B12, and D) was lower than for the NVEG and the control group. Only for vitamin By were critical plasma values detected - specifically for those VEG who consumed less than 380 g dairy products/day. The high iron intake of the VEG is mainly based on plant foods causing lower ferritin levels than for the NVEG and the control group without differences in the serum iron concentrations.

This study shows that strict adherence to the preventative recommendations (vegetarian version) in a daily diet needs careful planning and that a diet meeting the preventative recommendations containing small amounts of meat retains the advantages of a vegetarian diet but avoids its possible disadvantages.

#P27

INVESTIGATION OF THE EFFECTS OF A VEGETARIAN DIET ON THE GROWTH, BODY COMPOSITION, METABOLISM, AND ENERGY-NUTRITIONAL INTAKES OF YOUNG CHILDREN. Riccardo Trespidi, Public Health Service, Verona, Italy; Leonardo Pinelli, Pediatria Preventiva e Sociale, Universita di Verona, Verona, Italy; Claudio Maffeis, Diabetologia Pediatrica, Universita di Verona, Verona, Italy

Growth, body composition, metabolism, and energy and nutritional intakes were compared in ovo-lacto- and facto-vegetarian and nonvegetarian Italian children between 8-9 years old at the start of the two-year study. The omnivore control group followed a standard Mediterranean diet. Nutritional intakes were broken down into animal and vegetable protein, saturated and nonsaturated lipids, cholesterol, simple and complex carbohydrates, fiber, and iron. Results show no significant difference between meatless and meat-based diets with respect to growth, body composition, and metabolism, although the vegetarian children were, on the whole, slimmer. In the ovo-lacto and facto vegetarians, the energy intake was significantly higher, the intake of protein, saturated fatty acids, and cholesterol was lower, and the intake of mono- and polysaturated lipids and vitamin B12 was comparable. In addition, the fiber intake was more than double that of the nonvegetarians and the iron intake was also significantly higher. Lastly, comparison of the vegetarians' blood chemical parameters revealed no significant differences with respect to standard values.

#P28

CHANGES IN BODY COMPOSITION AFTER 6 MONTHS ON A SELF-SELECTED VEGETARIAN DIET. Frances Robinson, Allan Hackett, David Billington, Gareth Stratton. School of Education & Community Studies, Liverpool John Moores University, Liverpool, UK.

It is known that Caucasian vegetarians tend to be closer to desirable levels of body weight and leaner than do their non-vegetarian counterparts. Evidence from several previous studies which investigated some of the changes apparent after switching to a vegetarian diet has shown that body weight is reduced but these studies provided guidelines on what the diet should include.

This paper examines some of the anthropometric changes which occurred as a result of changing to a self-selected UK vegetarian diet.

36 volunteers, recruited as they changed to a vegetarian diet completed the study. Measurements of weight, height, mid-arm circumference, triceps and biceps skinfolds (from which per cent body fat was calculated), waist and hip circumference were taken. After six months on their self-selected vegetarian diet volunteers were invited back and measurements were repeated.

Paired t-tests showed that statistically significant changes (P < 0.05) were found in hip and waist circumferences, waist to height ratio, biceps and triceps skinfold thickness and per cent body fat; all of which had decreased compared to baseline.

These results would suggest that these volunteers changing to a self-selected vegetarian diet experienced considerable changes in body composition.

(Research supported by Liverpool John Moores University).

#P29

DOES A VEGETARIAN DIET REDUCE THE VARIETY OF FOODS CONSUMED? Frances Robinson, Allan Hackett. School of Education & Community Studies, Liverpool John Moores University, Liverpool, UK.

Omitting meat from the diet could lead to the assumption that one has a less varied diet. Work in Japan (Okuda 1991) found that consuming more foods was associated with more people achieving recommended nutrient intakes.

In this study, volunteers kept dietary records from the time that they switched to a self selected vegetarian diet. This paper describes the change in the number of different foods eaten over 3 days, as recorded in dietary diaries whilst eating meat (baseline) and then after 3 and 6 months on the vegetarian diet had elapsed. Two control groups of meat eaters and long-standing vegetarians were also included in the study and the number of different foods eaten over the 3 days by each group was compared to baseline and after 3 and 6 months. The number of foods eaten on each occasion was compared using a

Wilcoxon matched-pairs test.

Number of foods consumed at baseline, 3 months and 6 months by study volunteers was 32, 31 and 31, by vegetarians: 31, 30 and 30 and by omnivores: 32, 29 and 31 respectively. No significant differences were found.

These results show that all groups were eating similar numbers of foods. It does not seem, therefore, that changing to a vegetarian diet causes any significant reduction in the number of foods eaten.

(Research supported by Liverpool John Moores University)

#P30

DOES SWITCHING TO A SELF-SELECTED VEGETARIAN DIET ALTER MACRONUTRIENT INTAKE? Frances Robinson. Allan Hackett, David Billington, Gareth Stratton. School of Education & Community Studies, Liverpool John Moores University, Liverpool, UK.

Despite many studies of the diets of vegetarians compared to omnivores, the effects of changing from an omnivorous diet to a non-prescribed vegetarian diet has received little attention. In the present study, 43 adults, 32 female and 11 male, (mean age 31 years) who were embarking on a vegetarian diet of their choice kept a record of food intake for 3 days whilst still consuming a mixed diet. Subsequent 3 day food intake records were kept at 3, 6, 9 and 12 months after subjects had changed to their vegetarian diet. Differences in intakes of macronutrient composition of the diet from each record were examined by paired t-test.

The results showed that after 3 months on a vegetarian diet, marked differences were observed in the macronutrient intakes of the female subjects. Percentage of energy from carbohydrate increased significantly (P<0.05) and percentages of energy from protein and total fat decreased. Both male and female subjects experienced reductions in energy intake (P<0.05) from 6 months onwards.

It may be concluded that although energy intake of both male and female subjects dropped after changing to a vegetarian diet, more marked effects on macronutrient intake were experienced by female subjects.

(Research supported by Liverpool John Moores University)

#P31

A STUDY OF THE USE OF NUTRITIONAL SUPPLEMENTS BY A GROUP OF VEGETARIANS IN SOUTH WALES. Marv Barasi, Frances Robinson. Faculty of Community Health Sciences, University of Wales Institute Cardiff, Cardiff, Wales.

Commercially manufactured nutritional supplements are widely available over the counter. As a result, many people may be taking unnecessary supplements leading to potentially more harm than good. This study aimed to investigate supplement usage by vegetarians in an urban area of South Wales. 78 volunteers completed the questionnaire which asked about supplement use and included a dietary assessment from which a diet score was derived, a higher score meant a potentially greater need for supplements. 38 of the respondents claimed to be regular supplement users and a startling number took more than 2 supplements daily. When asked their reason for taking supplements, more than half of those who claimed to take supplements regularly said they did not know. From the dietary assessment, it appeared that non-users of supplements had higher diet scores than users. In conclusion, it appears that a large proportion of this group of vegetarians were taking nutritional supplements whether or not they are needed. People should be made more aware of their nutritional needs before prescribing supplements to themselves and advice should be made easily available on the use and misuse of nutritional supplements especially to new vegetarians who may believe that supplements are needed.

(Research supported by University of Wales Institute Cardiff).

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