Nutritional Considerations Reduction of Sodium Intake

Sodium reduction typically results in lower blood pressure in industrialized societies. Current guidelines in the United States suggest reducing the daily intake of sodium to approximately 100mmol, or approximately 2.4 g of sodium or less per day.

The DASH-Sodium trial demonstrated that reduction of sodium intake from 100 to 50mmolperday (approximately 1.5 g) significantly reduced blood pressure in individuals following either the common US diet or the DASH diet. In addition, TOHP2 (phase 2 of the Trials of Hypertension Prevention) and TONE (Trials of Nonpharmacologic Interventions in the Elderly) documented that reducing sodium can either prevent hypertension or facilitate hypertension control. It should also be noted that salt sensitivity increases with age, so those who demonstrate this sensitivity should maintain a reduced salt diet.

Consumers should either eliminate or limit salt added to foods in cooking and at the table as a means of reducing sodium intake. Nutrition facts labels require sodium content to be listed so that consumers can be more prudent about their diets. The amount of sodium in processed food, such as convenience foods (e.g., boxed products one would prepare at home), soups, and processed meats (e.g., sausage, ham, and other meat products), is often alarming. If there is not a nutrition label on a processed food product, one should assume sodium content is high. Canned products generally contain more sodium than fresh or frozen items, unless a product is specifically labeled as 'no salt added.' The consumption of fresh, unprocessed foods should be promoted.

Moderation of Alcohol Intake

The relationship between high consumption of alcohol (typically three or more drinks per day) and elevated blood pressure has been shown in numerous epidemiologic studies. A drink is defined as 12 oz. of beer, 5 oz. of wine, or 1.5 oz. of distilled spirits. Most evidence indicates that alcohol should be limited to two drinks per day for men and one drink per day for women. Ideally, daily alcohol consumption should be avoided. Whenever possible, alcohol, if consumed, should be done so with meals.

Consumption of a DASH Diet (Increasing Potassium, Magnesium, Calcium, and Fiber Intakes by Increasing Intakes of Fruits, Vegetables, and Low-Fat Dairy Foods)

The contribution of minerals, particularly potassium, magnesium, and calcium, and fiber was identified by contributions from fruits, vegetables, low-fat dairy products, whole grains, and nuts in the DASH eating plan. The DASH diet effectively used these components through an ideal dietary pattern to lower blood pressure.

Increased intakes of potassium have been associated with lower blood pressure. A meta-analy-sis of several trials suggested that 60-120 mmol per day of supplemental potassium reduces systolic and diastolic blood pressure by 4.4 and 2.5 mmHg, respectively, in hypertensive individuals. In normo-tensive individuals, systolic and diastolic blood pressure was reduced by 1.8 and 1.0 mmHg, respectively. Dietary intake of potassium can be easily achieved through consumption of various foods.

The DASH diet, while promoting dietary patterns, was developed very carefully with particular attention paid to the use of specific foods within categories that contribute more to the intakes of desired nutrients. As an example, consider the rank-ordered listing of potassium content of fruits and fruit juices presented in Tables 2 and 3. Dried fruits typically have the highest potassium content, followed by raw fruits and frozen fruits. Canned fruit products generally do not contain as high potassium content as other forms. There is less potassium contained in fruit juices and generally the

Table 2 Fruits, ranked by potassium content (mg/100g)

Dried

Apricots, dehydrated (low moisture) 1850

Bananas, dehydrated, or banana powder 1491

Peaches (low moisture) 1351

Apricots 1162

Litchis 1110

Prunes (low moisture) 1058

Peaches 996

Currants, zante 892

Persimmons, Japanese 802

Raisins 746-825

Plums (prunes) 732

Dates, medjool 696

Figs 680

Longans 658

Dates, deglet noor 656

Apples (low moisture) 640

Pears 533

Jujube 531

Apples 450 Raw

Tamarinds 628

Plantains 499

Breadfruit 490

Avocados 485

Durian, raw or frozen 436

Custardapple (bullock's heart) 382

Bananas 358

Passion-fruit, (granadilla), purple 348

Sapotes (marmalade plum) 344

Currants, European black 322

Kiwi fruit, (Chinese gooseberries) 312

Persimmons, native 310

Abiyuch 304

Jackfruit 303

Rhubarb 288

Guavas, common 284

Elderberries 280

Soursop 278

Currants, red and white 275

Cherimoya 269

Melons, cantaloupe 267

Longans 266

Loquats 266

Carissa (natal-plum) 260

Apricots 259

Pomegranates 259

Papayas 257

Jujube 250

Sugar apples (sweetsop) 247

Figs 232

Melons, honeydew 228

Cherries, sweet 222

Prickly pears 220

Pummelo 216

Roselle 208

Nectarines 201

Gooseberries 198

Quinces 197

Crabapples 194

Mulberries 194

Sapodilla 193

Grapes 191

Peaches 190

Kumquats 186

Melons, casaba 182

Cherries, sour, red 173

Litchis 171

Oranges 166-196

Carambola (starfruit) 163

Blackberries 162

Persimmons, Japanese 161

Plums 157

Tangerines (mandarin oranges) 157

Mangos 156

Feijoa 155

Strawberries 153

Raspberries 151

Acerola, (West Indian cherry) 146

Lemons 138-145

Rowal 131

Grapefruit 127-150

Rose apples 123

Pears, asian 121

Pears 119

Limes 117

Pineapple 115-125

Watermelon 112

Apples, with skin 107

Pitanga, (surinam cherry) 103

Apples, without skin 90

Cranberries 85

Java plum (jambolan) 79

Blueberries 77

Mammy apple (mamey) 47

Oheloberries 38

Fruits, frozen

Strawberries 148

Loganberries 145

Boysenberries 139

Cherries, sour, red 124

Raspberries, red 114

Rhubarb 108

From U.S. Department of Agriculture, Agricultural Research Service (2003) USDA National Nutrient Database for Standard Reference, Release 16. Available atwww.nal.usda.gov/fnic/foodcomp.

fresh forms of the juices have incrementally more than the processed forms. Fruits and juices in general contain some magnesium, another mineral of interest to the DASH investigators. Most fruits contain 2-30 mg of magnesium per 100 grams, but dried fruits contain much more (30-90 mg) and the amounts vary greatly. Fruit juices contain less than 20 mg of magnesium per 100 grams, with most containing less than 10 mg. Fiber content of fruit ranges from approximately 7 to 14 g of fiber for dried fruits on a per 100 gram basis and between 1 and 5g for other fruits per 100 grams. Generally, fruit juices contribute less than 1 g of dietary fiber per 100 grams, but high-pulp varieties of juices provide slightly more dietary fiber.

Table 3 Fruit juices, ranked by potassium content

(mg/100 g)

Fruit juice

K (mg)

Passion fruit juice, fresh

278

Prune juice, canned

276

Orange juice, fresh

200

Orange juice, from concentrate

190

Tangerine juice, fresh or canned

178

Orange juice, canned

175

Grapefruit juice, white or pink, fresh or canned

162

Pineapple juice, canned or from concentrate

134

Grape juice, canned or bottled, unsweetened

132

Apple juice, from frozen concentrate, unsweetened

126

Lemon juice, fresh

124

Apple juice, canned or bottled, unsweetened

119

Apricot nectar

114

Lime juice, fresh

109

Lemon juice, canned or bottled

102

Acerola juice, fresh

97

Cranberry juice, unsweetened

77

Lime juice, canned or bottled

75

Peach nectar

40

Papaya nectar

31

Grape juice, from frozen concentrate, sweetened

21

Pear nectar

13

From U.S. Department of Agriculture, Agricultural Research Service (2003) USDA National Nutrient Database for Standard Reference, Release 16. Available at www.nal.usda.gov/fnic/ foodcomp.

Table 4 contains a rank-ordered listing of vegetables (including beans) by content of potassium. Magnesium content is also shown. The data are presented for vegetables and beans in the raw form generally. It is important to remember that many fresh forms are concentrated in terms of weight when cooked, especially spinach and other greens, and it is thus possible to obtain a higher mineral content from cooked vegetables (especially in the case of potassium). The magnesium content differs less from the fresh to the cooked state for most vegetables and beans. Most vegetables contain approximately 1-3 g of dietary fiber per

Table 4 Potassium and magnesium content of vegetables (including beans), rank ordered by potassium content (mg/ 100 g; presented for raw vegetables unless otherwise specified)

Vegetable

K (mg)

Mg (mg)

Tomatoes, sun-dried

3427

194

Palm hearts

1806

10

Arrowhead

922

51

Yam

816

21

Beet greens

762

70

Lemon grass (citronella)

723

60

Butterbur (fuki)

655

14

Taro leaves

648

45

Epazote

633

121

Soybeans, green

620

65

Amaranth leaves

611

55

Cress, garden

606

38

Taro, tahitian

606

47

Yautia (tannier)

598

24

Taro

591

33

Winged bean tuber

586

24

Waterchestnuts, Chinese (matai)

584

22

Wasabi, root

568

69

Chrysanthemum, garland

567

32

Chrysanthemum leaves

567

32

Jute, potherb

559

64

Spinach

558

79

Lotus root

556

23

Parsley

554

50

Pigeonpeas, immature seeds

552

68

Bamboo shoots

533

3

Coriander (cilantro) leaves

521

26

Sweetpotato leaves

518

61

Mushroom, oyster

516

20

Vinespinach (basella)

510

65

Purslane

494

68

Fireweed, leaves

494

156

Mushrooms, portabella

484

11

Soybeans, mature seeds

484

72

Borage

470

52

Lima beans, immature seeds

467

58

Horseradish tree, pods

461

45

Corn salad

459

13

Squash, zucchini, baby

459

33

Cowpeas, leafy tips

455

43

Potatoes, red, flesh and skin

455

22

Arrowroot

454

25

Lambsquarters

452

34

Kale, scotch

450

88

Mustard spinach (tendergreen)

449

11

Mushrooms, brown, Italian or Crimini

448

9

Kale

447

34

Pumpkin leaves

436

38

Cowpeas (blackeyes), immature seeds

431

51

Jerusalem artichokes

429

17

Potato, flesh and skin

421

23

Chicory greens

420

30

Mountain yam, Hawaii

418

12

Potatoes, russet, flesh and skin

417

23

Ginger root, raw

415

43

Fennel, bulb, raw

414

17

Potatoes, skin

413

23

Potatoes, white, flesh and skin

407

21

Garlic

401

25

Cardoon

400

42

Dandelion greens

397

36

Dock

390

103

Brussels sprouts

389

23

Peas, mature seeds, sprouted

381

56

Mushrooms, enoki

381

16

Salsify (vegetable oyster)

380

23

Chard, Swiss

379

81

Parsnips

375

29

Artichokes (globe or French)

370

60

Fiddlehead ferns

370

34

Arugula

369

47

Seaweed, laver

356

2

Mustard greens

354

32

Squash, winter, butternut

352

34

Table 4 Continued

Vegetable

K(mg)

Mg

Kohlrabi

350

19

Squash, winter, all varieties

350

14

Pumpkin

340

12

Eppaw

340

32

Peppers, hot chili, green

340

25

Horseradish tree leafy tips

337

147

Rutabagas

337

23

Sweet potato

337

25

Shallots

334

21

Taro shoots

332

8

Beans, fava, in pod

332

33

Celtuce

330

28

Watercress

330

21

Beets

325

23

Broccoli, leaves

325

25

Broccoli, flower clusters

325

25

Broccoli, stalks

325

25

Lentils, sprouted

322

37

Peppers, hot chili, red

322

23

Carrots

320

12

Squash, winter, hubbard

320

19

Broccoli

316

21

Endive

314

15

Mushrooms

314

9

Swamp cabbage (skunk cabbage)

312

71

Burdock root

308

38

Beans, navy, mature seeds

307

101

Beans, pinto, mature seeds

307

53

Pepper, Serrano

305

22

Cauliflower

303

15

Okra

303

57

Radicchio

302

13

Celeriac

300

20

Cauliflower, green

300

20

Balsam pear (bitter gourd), pods

296

17

Chives

296

42

Turnip greens

296

31

Chicory roots

290

22

Radishes, white icicle

280

9

Onions, spring or scallions

276

20

Grape leaves

272

95

Cassava

271

21

Corn, sweet, yellow or white

270

37

Tomatillos

268

20

Squash, summer, all varieties

262

17

Celery

260

11

Tomatoes, yellow

258

12

Nopales

257

52

Pepper, banana

256

17

Cabbage, Chinese (pak-choi)

252

19

Hyacinth beans, immature seeds

252

40

Broadbeans, immature seeds

250

38

Broccoli, frozen

250

16

Lettuce, cos or romaine

247

14

Cabbage

246

15

Peas, green

244

33

Cabbage, red

243

16

Pokeberry shoots (poke)

242

18

Yardlong bean

240

44

Cabbage, Chinese (pe-tsai)

238

13

Lettuce, butterhead

238

13

Tomatoes, red, ripe

237

11

Carrots, baby

237

10

Radishes

233

10

Cabbage, savoy

230

28

Eggplant

230

14

Radishes, oriental

227

16

Seaweed, agar

226

67

Winged beans, immature seeds

223

34

Cowpeas, young pods with seeds

215

58

Peppers, jalapeno

215

19

Onions, welsh

212

23

Squash, summer

212

21

Tomatoes, orange

212

8

Peppers, sweet, yellow

212

12

Chicory, witloof

211

10

Peppers, sweet, red

211

12

Beans, snap, green

209

25

Beans, snap, yellow

209

25

Tomatoes, green

204

10

Asparagus

202

14

Peppers, Hungarian

202

16

Peas, edible, podded

200

24

Broccoli raab

196

22

Turnips

191

11

Beans, kidney, mature seeds

187

21

Lettuce, red leaf

187

12

Sesbania flower

184

12

Poi

183

24

Squash, summer, scallop

182

23

Leeks (bulb and lower leaf portion)

180

28

Winged bean leaves

176

8

Peppers, sweet, green

175

10

Pumpkin flowers

173

24

Lettuce, iceberg

152

8

Gourd, white flowered (calabash)

150

11

Yambean (jicama)

150

12

Mung beans, mature seeds

149

21

Cucumber, with peel

147

13

Onions

144

10

Gourd, dishcloth (towelgourd)

139

14

Cucumber, peeled

136

12

New Zealand spinach

130

39

Seaweed, spirulina

127

19

Chayote, fruit

125

12

Onions, sweet

119

9

Squash, winter, spaghetti

108

12

Seaweed, kelp, raw

89

121

Radish seeds, sprouted, raw

86

44

Alfalfa seeds, sprouted, raw

79

27

Seaweed, irishmoss, raw

63

144

Seaweed, wakame, raw

50

107

Jew's ear (pepeao), raw

43

25

Data source: U.S. Department of Agriculture, Agricultural Research Service. 2003. USDA National Nutrient Database for Standard Reference, Release 16. Nutrient Data Laboratory Home Page, http://www.nal.usda.gov/fnic/foodcomp.

100 grams; beans and legumes offer approximately 5 g of dietary fiber, and some dried vegetables offer more than double this amount.

Nuts were also an important part of the DASH diet, contributing potassium, magnesium, fiber, and protein. They contain fat, mostly monounsaturated, and thereby contribute energy to the diet. Table 5

Table 5 Potassium, magnesium, and fiber content of nuts and seeds per 100 grams, ranked by potassium content

Description

K (mg)

Mg (mg)

Fiber (g)

Nuts

Pistachio nuts, dry roasted

1042

120

10.3

Pistachio nuts, raw

1025

121

10.3

Ginkgo nuts, dried

998

53

9.3

Chestnuts, European, dried,

986

74

11.7

unpeeled

Almonds, dry roasted

746

286

11.8

Almonds

728

275

11.8

Almonds, oil roasted

699

274

10.5

Almonds, blanched

687

275

10.4

Hazelnuts or filberts

680

163

9.7

Cashew nuts, raw

660

292

3.3

Brazil nuts, dried,

659

376

7.5

unblanched

Hazelnuts or filberts, blanched

658

160

11.0

Cashew nuts, oil roasted

632

273

3.3

Pine nuts, pinyon, dried

628

234

10.7

Pine nuts, pignolia, dried

597

251

3.7

Chestnuts, European, roasted

592

33

5.1

Cashew nuts, dry roasted

565

260

3.0

Walnuts, black, dried

523

201

6.8

Chestnuts, European, raw,

518

32

8.1

unpeeled

Ginkgo nuts, raw

510

27

9.3

Walnuts, English

441

158

6.7

Hickorynuts, dried

436

173

6.4

Pecans, dry roasted

424

132

9.4

Butternuts, dried

421

237

4.7

Pecans

410

121

9.6

Pecans, oil roasted

392

121

9.5

Macadamia nuts, raw

368

130

8.6

Macadamia nuts,

363

118

8.0

dry roasted

Ginkgo nuts, canned

180

16

9.3

Seeds

Breadnuttree seeds, dried

2011

115

14.9

Cottonseed kernels, roasted

1350

440

5.5

(glandless)

Breadfruit seeds, roasted

1082

62

6.0

Breadfruit seeds, raw

941

54

5.2

Sunflower seed kernels, dry

850

129

9.0

roasted

Pumpkin and squash seed

807

535

3.9

kernels, dried

Pumpkin and squash seed

806

534

3.9

kernels, roasted

Sunflower seed kernels, dried

689

354

10.5

Flaxseed

681

362

27.9

Sunflower seed kernels

491

129

11.5

Sunflower seed kernels, oil

483

127

6.8

roasted

Sesame seeds, whole, dried

468

351

11.8

Sesame seed kernels, dried

407

347

12.7

(decorticated)

Sesame seed kernels,

406

346

16.9

toasted

includes the potassium, magnesium, and fiber content of some common nuts and seeds. Although this is presented based on a rank-ordered content of potassium, it is easy to see that some nuts and seeds are a significant source of magnesium and dietary fiber and their consumption was therefore encouraged in the DASH diet.

Low-fat dairy products were also an important part of the DASH diets. These were used primarily to increase the calcium content of the diets from a low content of approximately 450 mg on the control and fruit and vegetable diets to approximately 1250 mg on the DASH diet at the 2000 kcal (8368 kJ) level. Calcium has frequently been reported to have an inverse relationship with blood pressure, but studies utilizing supplemental calcium have been inconsistent. With supplements, effects on blood pressure reduction have been negligible. Nonetheless, the blood pressure lowering effect of the DASH diet has been suggested to be in part related to the calcium content of the diet. It should be noted that the DASH diet also was lower in fat and higher in protein, and therefore it is not easily attributable to one factor alone but rather a combination of several factors, as depicted in Figure 1.

The final point regarding composition of the DASH diet is that it included specific food choices. The diet contained whole grains, poultry, and fish (in addition to the fruits, vegetables, low-fat dairy, and nuts previously mentioned). Although it was reduced in total and saturated fat, it was also reduced in meats, sweets, and sugar-containing beverages. Food was consumed as an overall pattern in which it is quite possible that the interaction between food items is as important as the specific foods in reducing blood pressure. Thus, the DASH diet contained dietary patterns promoted by the National Institutes of Health, National Heart, Lung, and Blood Institute. The dietary patterns of DASH are presented at three energy levels in Table 6.

From U.S. Department of Agriculture, Agricultural Research Service (2003) USDA National Nutrient Database for Standard Reference, Release 16. Available at www.nal.usda.gov/fnic/ foodcomp.

T Fruits T Vegetables I Sodium I Fat T Protein T Dairy products ? Other nutrients _ ? Nutrient interactions

Figure 1 Assessing the effects of the DASH-Sodium diet on blood pressure. The figure depicts the fact that there is some certainty associated with the increases in fruits and vegetables and reduction in sodium. The gray areas represent the other components of the diet and the possible contribution of each, alone or in combination with other factors.

Table 6 Food group servings for the DASH diet at three energy levels

Food group Daily servings (except as noted)

1600 kcal or 2000kcal or 3100 kcal or

Table 6 Food group servings for the DASH diet at three energy levels

Food group Daily servings (except as noted)

1600 kcal or 2000kcal or 3100 kcal or

6694 kJ

8368kJ

12970 kJ

Grains and grain

6

7-8

12-13

products

Vegetables

3-4

4-5

6

Fruits

4

4-5

6

Low-fat or fat-free

2-3

2-3

3-4

dairy foods

Meats, poultry,

1-2

2 or less

2-3

fish

Nuts, seeds, dry

3perweek

4-5

1

beans

per week

Fats and oils

2

2-3

4

Sweets

0

5 per week

2

Dietary Protein Consumption

Results of meta-analyses from several investigators indicate an inverse association between dietary protein and blood pressure levels. However, data have not been conclusive. The DASH diet contained approximately 18% of energy from protein compared to 15% of energy from protein in the other diets tested. Because of the addition of low-fat dairy foods and the reduced emphasis on high-fat meats, it can be assumed that this elevation in protein was brought about by foods that contributed protein from perceived beneficial sources. This is an area of dietary intake that requires more research.

Fish Oil Supplementation

Studies suggest that an intake of fish oil at a level of approximately 4 g per day reduces systolic blood pressure by approximately 1.7-2.1 mmHg and diastolic blood pressure by 1.5-1.6 mmHg. These effects tend to be larger in individuals older than 45 years of age and in populations with blood pressure readings greater than 140/90 mmHg. Generally, there have been differences associated with fish oil capsules compared to naturally occurring sources of EPA and DHA from fatty fish, again indicating dietary pattern rather than consumption of individual items may be crucial. The DASH diet had a relatively high fish content (compared to animal meats) and this may be yet one more factor contributing to the lowering of blood pressure in individuals on the DASH diet.

The American Heart Association recommends eating two servings of fish per week and emphasizes that the choice should be a fatty fish (such as salmon, herring, or mackerel). Not all fish have the same content of omega-3 fatty acids. Table 7 provides a listing of amounts of combined EPA/ DHA in fish and other seafood sources and the amount of consumption (in ounces of product) necessary to provide a 4-g intake. Descriptors include common raw and canned products, but the intakes given are rough estimates due to potential variability in oil content within species, season, and diet. Cooking methods and other preparation techniques may affect the final concentrations in raw fish.

Other Fatty Acid Effects

Monounsaturated fatty acids, particularly olive oil, may help lower blood pressure. Olive oil has typically been associated with the popularized Mediterranean diet, which has been promoted as a treatment for cardiovascular disease. Other oils (e.g., canola and peanut oil) have a high monounsa-turated fat content. Nuts, which are part of the DASH diet, contain significant amounts of monounsaturated fats and fit well in the Mediterranean diet.

Caffeine

Although a link between caffeine consumption (particularly coffee) and hypertension may exist, effects of coffee drinking on blood pressure appear to be dependent on the time of consumption and subsequent determination of blood pressure values. Generally, a role for caffeine intake and development of hypertension is not believed to be significant.

Weight Reduction

Obesity and overweight are considered independent risk factors for cardiovascular disease and are closely associated with hypertension. This linkage was demonstrated in the 1960s by the Framingham Heart Study investigators in the United States. Obesity in the industrialized world has been increasing at epidemic proportions. The relationship between increasing body weight and increasing blood pressure has been termed obesity hypertension, and treatment requires consideration of physiologic changes related to this disorder. Although efforts have been under way in the United States to reduce overweight and obesity, it is estimated that the age-adjusted prevalence of overweight and obesity (body mass index (BMI) >25.0) among adults aged 20 or older is 64%; for those considered obese (BMI >30.0) it is 30%. During a 25-year period in the United States, this reflects approximately a 36% increase in the combined levels of overweight and obesity and essentially a doubling of obesity rates.

Table 7 Eicosapentaenoic (EPA, 20:5 n-3) and docosahexaenoic (DHA, 22:6 n-3) acid in fish/seafood (per 100 grams) and the amount of consumption (in ounces) required to provide ~4g of EPA + DHAperday (ranked in order of content)

Fish/seafood

EPA (g)

DHA (g)

EPA + DHA (g)

Oz. to

F

sh, caviar, black and red, granular

2.74

3.80

6.54

2.2

F

sh, mackerel, salted

1.62

2.97

4.58

3.1

F

sh, roe, mixed species, cooked

1.26

1.75

3.01

4.7

F

sh, shad, American, raw

1.09

1.32

2.41

5.9

F

sh, roe, mixed species, raw

0.98

1.36

2.35

6.0

F

sh, mackerel, Atlantic, raw

0.90

1.40

2.30

6.1

F

sh, anchovy, European, canned in oil

0.76

1.29

2.06

6.9

F

sh, salmon, chinook, raw

1.01

0.94

1.95

7.2

F

sh, salmon, Atlantic, farmed, raw

0.62

1.29

1.91

7.4

F

sh, herring, Pacific, raw

0.97

0.69

1.66

8.5

F

sh, salmon, pink, canned

0.85

0.81

1.65

8.5

F

sh, herring, Atlantic, raw

0.71

0.86

1.57

9.0

F

sh, anchovy, European, raw

0.54

0.91

1.45

9.7

F

sh, mackerel, Pacific and jack, raw

0.51

0.93

1.44

9.8

F

sh, salmon, Atlantic, wild, raw

0.32

1.12

1.44

9.8

F

sh, sablefish, raw

0.68

0.72

1.40

10.1

F

sh, mackerel, spanish, raw

0.33

1.01

1.34

10.5

F

sh, whitefish, mixed species, raw

0.32

0.94

1.26

11.2

F

sh, salmon, coho, farmed, raw

0.39

0.82

1.21

11.7

F

sh, salmon, chum, canned

0.47

0.70

1.18

12.0

F

sh, tuna, fresh, bluefin, raw

0.28

0.89

1.17

12.0

F

sh, salmon, sockeye, raw

0.52

0.65

1.17

12.0

F

sh, salmon, sockeye, canned

0.49

0.66

1.16

12.2

F

sh, salmon, coho, wild, raw

0.43

0.66

1.09

13.0

F

sh, salmon, pink, raw

0.42

0.59

1.01

14.0

F

sh, sardine, Atlantic, canned in oil

0.47

0.51

0.98

14.4

F

sh, trout, rainbow, farmed, raw

0.26

0.67

0.93

15.2

F

sh, halibut, Greenland, raw

0.53

0.39

0.92

15.4

F

sh, tuna, white, canned in water

0.23

0.63

0.86

16.4

F

sh, shark, mixed species, raw

0.32

0.53

0.84

16.7

F

sh, bluefish, raw

0.25

0.52

0.77

18.3

F

sh, bass, striped, raw

0.17

0.59

0.75

18.7

F

sh, trout, mixed species, raw

0.20

0.53

0.73

19.3

F

sh, smelt, rainbow, raw

0.28

0.42

0.69

20.4

Mollusks, oyster, Pacific, raw

0.44

0.25

0.69

20.5

Fish, swordfish, raw

0.11

0.53

0.64

22.1

Fish, spot, raw

0.22

0.41

0.63

22.4

Fish, salmon, chum, raw

0.23

0.39

0.63

22.5

Fish, wolffish, Atlantic, raw

0.31

0.32

0.62

22.6

Fish, bass, freshwater, mixed species, raw

0.24

0.36

0.60

23.7

Fish, sea bass, mixed species, raw

0.16

0.43

0.60

23.7

Fish, trout, rainbow, wild, raw

0.17

0.42

0.59

24.0

Fish, pompano, florida, raw

0.18

0.39

0.57

24.8

Mollusks, oyster, eastern, wild, raw

0.27

0.29

0.56

25.2

Fish, drum, freshwater, raw

0.23

0.29

0.52

27.3

Mollusks, squid, mixed species, raw

0.15

0.34

0.49

28.9

Crustaceans, shrimp, mixed species, raw

0.26

0.22

0.48

29.4

Fish, sucker, white, raw

0.19

0.29

0.48

29.5

Mollusks, mussel, blue, raw

0.19

0.25

0.44

32.0

Fish, tilefish, raw

0.09

0.35

0.43

32.8

Fish, pollock, Atlantic, raw

0.07

0.35

0.42

33.5

Mollusks, oyster, eastern, farmed, raw

0.19

0.20

0.39

36.1

Fish, pollock, walleye, raw

0.15

0.22

0.37

37.9

Fish, seatrout, mixed species, raw

0.17

0.21

0.37

37.9

Crustaceans, crab, queen, raw

0.26

0.11

0.37

37.9

Fish, catfish, channel, wild, raw

0.13

0.23

0.36

38.8

Fish, halibut, Atlantic and Pacific, raw

0.07

0.29

0.36

38.9

Crustaceans, crab, blue, canned

0.19

0.17

0.36

38.9

Fish, carp, raw

0.24

0.11

0.35

40.1

Fish, cisco, raw

0.10

0.26

0.35

40.1

Table 7 Continued

Fish/seafood

EPA (g)

DHA (g)

EPA + DHA (g)

Oz. to provide ~4 g EPA + DHA

Fish, rockfish, Pacific, raw

0.14

0.20

0.35

40.9

Fish, mullet, striped, raw

0.22

0.11

0.33

43.4

Crustaceans, crab, blue, raw

0.17

0.15

0.32

44.1

Fish, mackerel, king, raw

0.14

0.18

0.31

45.1

Fish, pike, walleye, raw

0.09

0.23

0.31

45.4

Fish, snapper, mixed species, raw

0.05

0.26

0.31

45.4

Crustaceans, crab, dungeness, raw

0.22

0.09

0.31

46.0

Fish, ocean perch, Atlantic, raw

0.08

0.21

0.29

48.5

Fish, sturgeon, mixed species, raw

0.19

0.09

0.29

49.2

Fish, catfish, channel, farmed, raw

0.07

0.21

0.27

51.5

Fish, tuna, light, canned in water

0.05

0.22

0.27

52.3

Fish, sheepshead, raw

0.14

0.12

0.26

54.1

Fish, tuna, fresh, skipjack, raw

0.07

0.19

0.26

55.1

Fish, perch, mixed species, raw

0.08

0.17

0.25

55.8

Fish, grouper, mixed species, raw

0.03

0.22

0.25

57.1

Fish, whiting, mixed species, raw

0.09

0.13

0.22

63.0

Fish, croaker, Atlantic, raw

0.12

0.10

0.22

64.1

Fish, tuna, fresh, yellowfin, raw

0.04

0.18

0.22

64.7

Fish, cod, Pacific, raw

0.08

0.14

0.22

65.6

Fish, flatfish (flounder and sole species), raw

0.09

0.11

0.20

70.9

Mollusks, scallop, mixed species, raw

0.09

0.11

0.20

71.3

Fish, haddock, raw

0.06

0.13

0.19

76.3

Fish, cod, Atlantic, raw

0.06

0.12

0.18

76.7

Fish, burbot, raw

0.07

0.10

0.17

85.0

Mollusks, octopus, common, raw

0.08

0.08

0.16

89.9

Fish, eel, mixed species, raw

0.08

0.06

0.15

96.0

Crustaceans, crayfish, farmed, raw

0.12

0.03

0.14

98.0

Mollusks, clam, mixed species, raw

0.07

0.07

0.14

99.4

Crustaceans, crayfish, wild, raw

0.10

0.04

0.14

99.4

Mollusks, snail, raw

0.12

0.00

0.12

118.6

Fish, sunfish, pumpkin seed, raw

0.04

0.07

0.11

129.4

Fish, dolphinfish, raw

0.02

0.09

0.11

130.6

Fish, pike, northern, raw

0.03

0.07

0.11

131.9

Mollusks, cuttlefish, mixed species, raw

0.04

0.07

0.11

134.4

Turtle, green, raw

0.02

0.03

0.06

252.0

Mollusks, abalone, mixed species, raw

0.05

0.00

0.05

287.9

Frog legs, raw

0.01

0.02

0.03

415.0

From U.S. Department of Agriculture, Agricultural Research Service (2003) USDA National Nutrient Database for Standard Reference, Release 16. Available at www.nal.usda.gov/fnic/foodcomp.

The increase in obesity is seen in all ethnic, gender, and age groups. This problem is not confined to the average American; the US military reported that more than 50% of military personnel were overweight and more than 6% were obese in the late 1990s, despite high physical activity levels due to the rigors of basic training and regular field exercises. For the military, this reflects a trend that mirrors what is happening in the general population.

Globally, more than 1 billion adults are classified as overweight and approximately 300 million as clinically obese, ranging from less than 5% in China, Japan, and some African nations to more than 75% in urban Samoa. Alarmingly, this epidemic has spread to children, with 17.6 million children younger than 5 years of age estimated to be overweight worldwide. Data from the United States indicate that 15% of children and adolescents 6-19 years of age are overweight, a figure at least three times higher than that reported in the period from 1960 to 1970. Overweight children are at risk of becoming overweight adults but, more important, are likely to experience chronic health problems (including hypertension) associated typically with only adult obesity.

The World Health Organization has recommended an integrated, multifaceted, population approach be implemented to bring about effective weight management for those at risk of overweight and obesity. The key elements for developing such an environmental support include the following:

• Availability and access to a variety of low-fat, high-fiber foods

• Opportunities for physical activities

• Promotion of healthy behavior to encourage, motivate, and enable individuals to lose weight by

Eating more fruits, vegetables, nuts, and whole grains

Engaging in moderate physical activity for at least 30 minutes a day

Reducing the amounts of fat and sugar in the diet

Changing from a diet containing saturated animal fats to one emphasizing unsaturated vegetable oils

• Proper training of clinical personnel to ensure effective support for those trying to lose weight or avoid further weight gain

Obviously, it is essential to maintain a healthy body weight and thus necessary to keep a focus on energy intake in an effort to prevent overweight. Regarding hypertension, weight reduction appears to be the most promising answer in terms of potential impact on lowering blood pressure. Losing as few as 4.5 kg, or 10 pounds, of body weight can reduce blood pressure. Adopting healthy eating patterns yields additional benefits.

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