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Unit 20
DISEASE RISK PREVENTION
Heart Disease, Cancer & Diabetes
Objectives
 To describe the risk factors for heart disease
 To consider the influence of dietary factors and the effectiveness of dietary
and lifestyle changes
 To understand the link between food and common cancers and how to
reduce the risk
 To describe the various types of diabetes and nutritional management for
this disease
 To be able to explain the Glycaemic Index and the best food choices for
people with diabetes
INTRODUCTION
Australia has one of the most wonderful and varied food supplies in the world. But, in
spite of such abundance, many people fail to choose an adequate diet. With all the
great tasting healthy foods available, why do so many people make poor choices? It
is partly because we have been taught so little about nutrition and the workings of the
human body24.
Over the past 50 years our eating habits have changed. Some of these changes
have been beneficial, but many have not24.
Diet can influence the risk of several major chronic diseases.
1.
2.
3.
4.
5.
6.
Heart disease
High blood pressure
Cancer
Diabetes
Obesity (Studied in Unit 19)
Osteoporosis5
HEART DISEASE
Heart and blood vessel disease is the leading cause of death in both Australia and
New Zealand18,19,22. In fact death rates are so high that every 10 minutes, someone
in Australia dies from heart and blood vessel disease18,22.
WHAT IS HEART DISEASE?
Heart disease is the general term used for:
 Coronary Heart Disease (CHD) accounts for 85% of all heart deaths3.
 All other Heart Disease, includes structural defects and rheumatic heart
disease from bacterial infection3.
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Coronary Heart Disease (CHD) is caused by the clogging and narrowing of the
coronary arteries – the special blood vessels which nourish the heart muscle. It is
due to an artery disease called atherosclerosis (hardening of the arteries) 3.
A heart attack or ‘coronary’ occurs if a coronary artery becomes completely blocked
and prevents blood from nourishing part of the heart muscle. Thus coronary heart
disease is really coronary artery disease. It is not due to disease of the heart muscle
itself, nor is it the inevitable result of aging. Atherosclerosis also occurs in arteries
elsewhere in the body, and may affect the brain, kidneys, legs etc. In total, artery
disease accounts for more than 50% of all deaths in Australia3.
RISK FACTORS FOR HEART DISEASE3,22
 Smoking (a major risk factor)
The risk of heart attack is doubled in heavy cigarette smokers. The risk of
sudden death from heart attack is 5 times higher than for non-smokers3.
 High blood cholesterol (a major risk factor)
While cholesterol in the body is essential to life, excess cholesterol and fat in
the blood contribute to unhealthy arteries. Heart disease may result.
Generally, the higher the level of cholesterol in the blood, the higher the risk of
heart disease. Diet influences blood cholesterol levels3.
 High blood pressure (a major risk factor)
People with high blood pressure have up to 4 times the risk of heart disease.
Even moderately raised blood pressure leads to a higher risk3.
 Stress and behaviour patterns
The high rate of heart disease in modern, industrialised countries parallels the
increasing complexity (and stress) of day-to-day living. Prolonged emotional
stress, changing lifestyle and particular behaviour patterns are implicated in
the progression of heart disease and in the incidence of fatal heart attack.
Stress initiates the release of hormones which affect the heart by increasing
heart rate, blood pressure, blood fats and the blood-clotting factor3.
 Family history of heart disease, age and gender
A family background of heart disease or high blood pressure may increase the
risk. The chance of heart disease increases with age. While we can’t change
our age, gender or family history of heart disease, there are diet and lifestyle
changes we can make to help eliminate or reduce the other risk factors for
heart disease3,22.
 Overweight
Obesity increases the risk of heart disease mainly by contributing to high blood
pressure, high cholesterol levels and diabetes. People who are more than
20% overweight have 3 times the risk of those slightly underweight 3.
 Diabetes
Heart disease is more common in people with diabetes, and often occurs at an
earlier age. Most diabetes occurring later in life is triggered by obesity3.
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 Physical inactivity
Regular exercise strengthens the heart and improves the circulatory system.
It also helps to control other risk factors (e.g. raised blood fats, stress and
blood pressure). Inactive males have a 2 to 3 times greater risk of heart attack
compared to active males3.
Multiple risk factors
Combined risk factors do not simply add – they multiply the risk. A person with 3
major risk factors is about 10 times more likely to suffer heart disease than their
‘normal’ counterpart3.
MAINTAIN A HEALTHY WEIGHT22
For people who are overweight, weight loss can have a positive effect on other heart
disease risk factors, such as: lowering blood cholesterol levels, lowering blood
pressure and helping to control blood sugar levels in people with non-insulin
dependent diabetes22,26.
Eating a nutritious and well–balanced diet is a good start to weight control. The
general guidelines for such an eating plan is as follows:

Choose mostly, vegetables, fruits, wholegrain breads, cereals and pastas.

Choose moderately from reduced-fat dairy products, lean meats and eggs,
legumes, such as kidney beans, lentils and soybeans, including soy products,
nuts and seeds.

Choose least from fats, such as butter, margarine and cooking oils, fatty snack
foods and sugary sweets22.
Basing the diet around these guidelines and watching the fat intake, along with
keeping physically active, can help with weight control22.
KEEP AN EYE ON FATS22
Watching the amount and type of fats in the diet can help lower blood cholesterol
levels22.
There are three main groups of fats – saturated, polyunsaturated and
monounsaturated. These different fats have varying effects on our blood cholesterol
levels22.
Many saturated fats tend to increase the ‘bad’ type of cholesterol (LDL cholesterol)
and total cholesterol levels in the blood. The ‘bad cholesterol can ‘clog’ the arteries
when present in the blood at high levels22.
Saturated fats are found mainly in fatty meats and animal-based foods, such as fullcream dairy products. Many takeaway foods and processed foods, such as pastries
and commercial biscuits, can also be rich in saturated fats22.
Poly- and mono-unsaturated fats tend to lower both total and ‘bad’ cholesterol levels.
Mono-unsaturated fats can also increase the level of ‘good’ cholesterol (HDL
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cholesterol) in the blood. This type of cholesterol ‘mops’ up fats in the blood and
prevents their build up in the blood vessels22.
Many oils (such as safflower, soybean and grape seed) and margarines are high in
polyunsaturated fats, along with nuts, seeds, soybeans and ‘oily’ fish, such as
mackerel and sardines. Monounsaturated fats are found in some oils, such as olive
or canola, nuts, seeds and avocados22.
BEAT HIGH BLOOD PRESSURE22
Factors that can contribute to high blood pressure (hypertension) include 19,22:





Being overweight
Being inactive
Excessive alcohol intake
High salt intake
Smoking
While a high salt diet is linked to hypertension, the effects of sodium on blood
pressure can vary between different people. Most Western diets contain much more
salt than is needed for good health18, so it makes sense to reduce our consumption
of processed foods that may be high in salt (such as many salted chips and snack
type foods, biscuits, fish in brine, pickled foods and cured meats) as well as to add
less salt to foods (either during cooking or at the table) 22.
There is also evidence suggesting that diets which avoid excess fat, especially
saturated fat and which include plenty of fruits, vegetables and moderate amounts of
low-fat dairy products can reduce high blood pressure22,28.
KEEP ACTIVE22
Regular physical activity can help reduce our overall risk of developing heart
disease17. Exercise can also help lower high blood pressure and it can assist with
weight control and blood sugar level control in people with Non-Insulin Dependent
Diabetes17.
Health authorities recommend that we should do at least 30 minutes of moderateintensity physical activity on most days of the week8. Examples of moderate-intensity
physical activity include: walking, mowing the lawn, medium paced swimming or
cycling8. It is important to consult your doctor before starting any exercise program 22.
PROTECTIVE FOODS22
There are dietary factors that play an especially important role in protecting the body
from heart disease.
Soy Foods22
Research has shown that replacing all or part of the animal protein in the diet with
soy protein can lower elevated total and ‘bad’ cholesterol1. Interestingly, it seems
that the higher the cholesterol levels are to begin with, the greater the reductions that
can be achieved with soy protein1.
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Nuts22
Research has shown that people who regularly eat nuts, have lower cholesterol
levels and suffer less from both fatal and non-fatal heart attacks16. There are a
number of factors why nuts may be so protective for the heart13.





Nuts are rich in poly-unsaturated and mono-unsaturated fats.
Nuts are high in fibre – which may have a cholesterol lowering effect.
Nuts contain vitamin E, a potent antioxidant, which prevents cholesterol being
changed into the harmful form that ‘clogs up’ blood vessels.
Nuts are rich in arginine, an amino acid, which can be made into nitric oxide –
a substance that can help keep blood vessels relaxed.
Nuts contain other minerals such as magnesium and copper, which may have
a protective role against heart disease.
People should eat small amounts of nuts on most days of the week16. While nuts are
quite high in fat, a handful (at least 30g16) each day can be used as a healthy
substitute for some high fat foods (such as chocolates and chips) already in the diet.
Alternatively, toss nuts through a stir-fry or salad, or make your own toasted nutty
muesli22.
Folate22
Research has shown that a high level of homocysteine (one of the amino acids) in
the blood may be associated with increased heart disease risk15. Studies have found
that blood levels of homocysteine tend to be high when folate levels in the blood are
low and that an increased intake of folate rich foods can actually help reduce the high
homocysteine levels15.
While we can’t yet draw the conclusion that getting enough folate can definitely
reduce the risk of heart disease, this is a possibility and eating more folate rich foods
is likely to be beneficial.
Good sources of folate include green leafy vegetables, fresh fruits and juices,
wholegrain breads and cereals (especially those with added folate, such as
Sanitarium Weet-Bix), legumes, Marmite and other folate-fortified foods22.
SUMMARY
Eating a well balanced diet, watching the amount and types of fat in foods eaten and
including more protective foods, such as soy foods, nuts and folate-rich foods may
help to reduce heart disease risk. In addition, regular physical activity is important for
keeping hearts healthy22.
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What Is Your Heart Score10?
Everyone plays the game of health whether you want to or not.
What’s your score?
What’s your risk of a heart attack?
HEREDITY
EXERCISE
AGE
WEIGHT
TOBACCO
FATS
1
1
1
0
0
1
No known
history of
heart disease
Intensive
exercise,
work, and
recreation
10-20 yrs
More than 2
kgs below
standard
weight
Non-user
No animal or
solid fat
0%
2
2
2
1
1
2
One relative
over 60 with
heart disease
Moderate
exercise,
work, and
recreation
21-30 yrs
+ 2 kgs
30 2 kgs
standard
weight
Use cigars or
pipe smoke
Very little
solid fat
10%
3
3
3
2
2
3
Two relatives
over 60 with
heart disease
Sedentary
work and
intensive
recreational
exercise
31-40 yrs
3 – 10 kgs
overweight
10 cigarettes
or less per
day
Little Fat
20%
4
5
4
4
4
4
One relative
under 60 with
heart disease
Sedentary
work and
moderate
recreational
exercise
41 –50 yrs
11-20 kgs
overweight
20 cigarettes
or more per
day
Average –
Much Fat
25-35%
6
6
6
6
6
5
Two relatives
under 60 with
heart disease
Sedentary
work and light
recreational
exercise
51-65 yrs
21-30 kgs
overweight
30 cigarettes
or more per
day
Very much
40%
Circle the number that most nearly describes you and add up your score.
4-9 Risk of heart attack very (Other conditions, such as
If you score remote
10-15 Risk well below average
16-20 Average risk of heart
attack
21-25 Moderate risk
26-30 Risk at dangerous level
31-35 Danger - urgent reduce score
10
284
stress, high blood pressure,
and increased blood
cholesterol, increase heart
attack risk and should be
evaluated by your doctor)
Unit 20
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Heart Disease, Cancer & Diabetes
THE LINK BETWEEN FOOD AND COMMON CANCERS20
Although the rates of cancers such as lung, colorectal, breast and prostate are on the
increase around the world, exciting findings of a scientific report called “Food,
Nutrition and the Prevention of Cancer: a global perspective” bring hope that 30 –
40% of all cancers can be prevented simply be adopting a healthy lifestyle 27.
The World Cancer Research Fund, together with the American Institute for Cancer
Research, released an international report which reviewed the findings from over
4000 published scientific papers on the link between diet and cancer and gives
specific dietary and lifestyle advise for prevention of cancer. In general, dietary
recommendations were only made where convincing (defined in the report as
‘conclusive’) or probable (defined in the report as ‘very strong’) evidence was found 20.
FACTORS THAT REDUCE THE RISK
OF SOME COMMON CANCERS20
Lung Cancer20
Lung cancer remains the leading cause of death in the world and smoking is mostly
responsible27. There in ‘convincing’ evidence that diets high in vegetables and fruits
are very protective against lung cancer – and that the carotenoids (natural plant
chemicals) found in these foods are probably responsible for at least some of this
effect. It is important to note, however, that smokers whose diet is protective are still
at a high risk of developing lung cancer27.
In contrast, the use of antioxidant supplements/tablets (such as beta-carotene,
vitamin A or vitamin E) has not been shown to provide any protective effects in wellnourished people27.
Breast Cancer20
On average breast cancer is the most common type of cancer in women worldwide 27.
Diets high in vegetables and fruits ‘probably’ reduce the risk of breast cancer.
Alcohol (even when consumed in small amounts, according to some studies)
‘probably’ increases the risk of breast cancer and should be avoided27.
Bowel Cancer20
Cancer of the colon and rectum (the lower part of the large intestine) is rated as the
fourth most common cancer in the world on average27.
The good news is that 70% of bowel cancer can be prevented by a healthy lifestyle 27!
There is now ‘convincing’ evidence that physical activity and a high vegetable intake
are protective, while red meat intake and alcohol consumption ‘probably’ increase the
risk of bowel cancer27.
Dietary fibre was found to possibly decrease the risk of colorectal cancer27.
The following are dietary recommendations from the World Cancer Research Fund
expert report that is considered to be most relevant to Australians and New
Zealanders, 2 years of age and older20,27.
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









Focus on plant foods
Maintain a healthy weight
Keep physically active
Eat more vegetables and fruits
Eat a variety of other plant foods
Avoid alcohol
If eating meat, use small amounts
Slow down on salt
Minimise salt-cured, pickled and smoked foods
Supplements aren’t necessary20
CANCER AROUND THE GLOBE
Geographical distribution of types of cancer tumours and the changing patterns of
cancer in migrants both point to nutrition as being a key factor in cancer
development23.
Cancer of the bowel is a killer disease in all affluent countries, including the USA,
Northern Europe, Australia and New Zealand, yet is little known in third world
countries23.
High intakes of saturated fat are prime suspects, but there is good research
suggesting that low fibre intake and beer consumption may contribute 23.
Cancer of the breast follows the same worldwide pattern as bowel cancer. A highkilojoule affluent diet from childhood onwards appears to alter the endocrine system,
causing girls to menstruate earlier. Studies of women with breast cancer show that
they tend to menstruate earlier than the average. Women who are overweight are at
greater than normal risk of breast cancer23. Scientists now feel that large fat stores
may produce an abnormal balance of hormones, which favours the growth of breast
cancers23.
Australian researchers have compared the diets of native-born Australians and
southern European migrants. People coming from Greece and southern Italy have
low rates of cancers of the pancreas, bowel and rectum. Their high intake of fibre
and antioxidants from vegetables, beans, bread and pasta and their low consumption
of animal fat are two anti-cancer factors in their favour23.
By contrast, cancers of the pancreas, bowel and rectum are common in Australians.
The researchers found that the longer the migrants lived in Australia, (as in an
average residence of 16 years) the more cancer rates increased, approaching those
of Anglo-Australians23.
The reverse pattern has occurred for Japanese people who have left Japan (which
has one of the highest rates of stomach cancer) for the USA, where stomach cancer
is uncommon. In studies of successive generations of Japanese, the incidence of
stomach cancer dropped from very high to very low, even though there was no
intermarriage with Americans. Thus, the grandchildren of the original migrants end
up with the same stomach cancer rate as Americans23.
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Unfortunately, they also develop the higher American rates of bowel and breast
cancer23.
SUMMARY20
Overall, the best option is to follow a healthy lifestyle which includes a predominantly
plant-based and varied diet, as well as regular exercise, maintaining a healthy weight
and avoiding smoking and alcohol20.
This type of lifestyle – which is also protective for other so called ‘Western diseases’
– is a good health insurance policy that you can provide for you and your family’s
future well being20.
DIABETES
WHAT IS IT?
Diabetes Mellitus is a condition where the body is unable to maintain normal levels of
blood glucose (or sugar)14. Foods you eat are broken down into glucose, which is
then transported around your body in the blood stream. Glucose is needed by all the
cells in your body as an important source of energy. The hormone insulin (produced
in your pancreas) helps glucose to move into your body’s cells from the blood
stream21.
People with diabetes generally have an increased risk of developing heart and blood
vessel disease. In the case of coronary heart disease, the risk is doubled in men and
quadrupled in women with diabetes21,26.
There are three main types of diabetes21:

Type 1 (Insulin Dependent Diabetes Mellitus or Juvenile)
Type 1 is most common in children and young adults but can occur at any age.
People with Type 1 diabetes have a pancreas that produces essentially no insulin,
so they must receive their insulin from an injection.
The cause of this lack of insulin is unknown, however, it is thought that viruses
may act as a trigger of this type of diabetes26. Lifestyle factors, such as diet,
exercise and maintaining a healthy weight are important for people with Type 1
diabetes to lower their risk of future health problems21.
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
Type 2 (Non Insulin Dependent Diabetes Mellitus or Adult-Onset)
Type 2 is found more commonly in people over the age of 40 7. The pancreas
produces insulin, but the amount is insufficient, or its action is ineffective due to
insulin resistance. Consequently, the body is unable to maintain normal blood
glucose levels21.
This type of diabetes is generally inherited and a family history of diabetes and
being over weight, is common26. Treatment for Type 2 diabetes includes a
balanced eating plan, regular physical activity, weight reduction (if over weight)
and possibly oral medication or insulin21.

Gestational Diabetes Mellitus (GDM)
This type of diabetes develops during pregnancy. The pancreas needs to
produce much more insulin to regulate blood glucose levels during pregnancy25.
In women unable to meet the increase in insulin demand, GDM results. In most
cases, GDM disappears after the baby is born. However, women who have had
GDM are more at risk of developing Type 2 diabetes later in life25 and need to
maintain a healthy weight and a good level of activity21.
GDM is generally controlled by diet and regular self-monitoring of blood glucose
levels at home, although insulin is sometimes required25. This ensures that
normal blood glucose levels are maintained which is important for the health of
both the mother and the baby21, 25.
HEALTHY EATING21
People with diabetes have the same nutritional needs as the general population.
They need to eat a balanced diet choosing from a wide variety of foods. A healthy
diet is based on mostly wholegrain breads, cereals and other grain foods, vegetables
(including legumes) and fruits. Foods, such as dairy (preferably low-fat), eggs, lean
meat (if desired) and nuts should be eaten in moderation. Added fats such as butter,
margarine and cooking oils, fatty snack foods and sugary sweets and drinks should
only be eaten in small amounts21.
Fat

Watch the amount and type of fat in the diet is particularly important for people
with diabetes. Reducing excess fat intake is important for weight control as fat
contains approximately twice as many kilojoules (or calories) per gram than
carbohydrate or protein and is stored more readily as fat in the body11.
Reducing saturated fat intake is particularly important for lowering blood
cholesterol levels21.
Carbohydrate

All carbohydrates in foods are broken down in the body (by digestion) to their
simplest form, glucose. For this reason, if you have diabetes, carbohydraterich foods are important to monitor in the diet. Your carbohydrate intake
should be spread evenly throughout the day to supply a steady flow of glucose
to the body’s cells21.
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High-fibre, low-fat carbohydrate foods are a good choice for people with
diabetes as fibre may provide a number of health benefits, including
maintaining bowel health and helping with weight control2. Soluble fibre, found
in fruits, vegetables, legumes, oats, rice and barley, can help lower blood
cholesterol levels and also slow the rise of blood glucose levels21,26.
Higher fibre carbohydrate foods include:
 Wholegrain breads, wholegrain breakfast cereals and grain foods (such as
wholemeal pasta and brown rice).
 Fruits, including dried, frozen and canned (but not fruit juice).
 Vegetables, including legumes, such as kidney beans, soybeans and
lentils21.
Salt

A high salt diet has been linked with high blood pressure, which increases the
risk of developing heart and blood vessel disease. The Western diet contains
much more salt than is needed for good health26, so it makes sense to reduce
your consumption of processed foods that may be high in salt. Such foods
include many canned foods, crisps, biscuits, fish in brine, pickled foods and
cured meats. When shopping look for ‘no added salt’, salt-reduced or low-salt
alternatives. In addition, adding less salt to foods, both during cooking and at
the table, can help reduce our salt consumption21.
What About Sugar?

In the past, people with diabetes were told to avoid all sugars. This was
because it was thought that sugar caused blood glucose levels to rise very
high at a fast rate. The effect of food on blood glucose levels depends on a
range of factors, including the composition of the food and how it is
processed26. High-fibre, low-fat foods that contain a moderate amount of
sugar are now seen as acceptable for people with diabetes12,21.
GLYCAEMIC INDEX
The rate at which carbohydrate is broken down to provide glucose in the blood
stream is called ‘Glycaemic Index (GI) of the food. Foods with low GI values
generally cause a lower and more gradual rise in blood glucose levels, which is
beneficial for people with diabetes21.
In contrast, foods with a higher GI value are broken down rapidly, causing a quick
rise in blood glucose levels4. The GI can differ between foods for a number of
reasons, including methods of processing and cooking used, as well as the size and
nature of starch molecules present in food4,21.
In general, low GI foods are those with a GI below 55, while high GI foods are those
over 704. Most legumes, oats, barley, pasta and many fruits have a low GI. Other
healthy choices include low-fat milk or soy drinks, multi-grain, kibbled and barley
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breads, some varieties of rice (such as Doongara and Basmati), and vegetables
(such as peas, sweet corn and sweet potato) 4,21.
Low-fat, low GI foods make good dietary choices for people with diabetes. Low GI
foods eaten as part of a meal can lower the overall GI of the meal6, thereby slowing
the rise of glucose in the blood stream after the meal. Try to include low GI foods in
meals and snacks where possible21.
Fat in foods can delay the emptying of food from the stomach 4. This explains why
some high-fat foods have a low GI4. However, to limit excess fat intake, choose lowfat, low GI foods in preference to low GI foods that are high in fat 21.
The Glycaemic Index (GI) of Common Foods4
Low
Apple, pear, orange
Barley
Mixed grain bread
Porridge
Pasta, eg spaghetti
Peas, sweet potato
Milk, So Good
Lentils, most legumes
Low-fat Yoghurt
Moderate
Banana, apricot, pineapple
Basmati and Doongara rice
Rye bread
Weet-Bix
Gnocchi
Sweet corn
Orange cordial, diluted
New, boiled or canned potato
High
Watermelon
Calrose white rice
White bread
Puffed wheat
Baked, pale skin potato
Broad beans
SUMMARY
Eating a nutritious well-balanced diet that is low in fat, high in fibre and based mostly
on plant foods is important for everyone, including people with diabetes. Eating well
can help control blood glucose levels and lower the risk of health problems
associated with poorly controlled diabetes. In addition other lifestyle factors that are
important for everybody, such as maintaining a healthy body weight and staying
physically active, are vital for people with diabetes to stay healthy21.
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META-ANALYSIS OF THE EFFECTS OF SOY PROTEIN INTAKE
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DIETARY FIBRE, THE NON-STARCH POLYSACCHARIDES AND
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Food Aust 1996;48(3 suppl):S3-S35
3. Borushek A & J; COMPLETE AUSTRALIAN HEART DISEASE
PREVENTION MANUAL
Family Health Publications 1988: 3-5
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4. Brand Miller J, Foster-Powell K, Colagiuri S, Leeds, A:
THE G.I. FACTOR – 2nd EDITION
Netley, Hodder & Stoughton 1998
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VEGETARIAN COOKING DEMONSTRATOR’S MANUAL –
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APPLICATION OF GLYCEMIC INDEX TO MIXED MEALS
Am J Clin Nutr 1988;47:53-56
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NATIONAL DIABETES STRATEGY AND IMPLEMENTATION PLAN
Canberra, Diabetes Australia 1998
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NUTRITION AND WELLNESS
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WHAT IS YOUR HEART SCORE?
School of Public Health, Loma Linda University
11. Danforth E;
DIET AND OBESITY
Am J Clin Nutr 1985;41(5 suppl):1132S-1145S
12. Diabetes Australia;
FOOD CHOICES FOR PEOPLE WITH DIABETES
May 1994
13. Dreher M, Maher C;
THE TRADITIONAL AND EMERGING ROLE OF NUTS IN
HEATHFUL DIETS
Nutr Rev 1996;54(8):241-245
14. Garrow J, James W, Pearson D;
HUMAN NUTRITION AND DIETETICS – 9th EDITION
DIABETES Singapore, Churchill Livingstone 1993:521-533
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15. Homocysteine Lowering Trialists’ Collaboration;
LOWERING BLOOD HOMOCYSTEINE WITH FOLIC ACID BASED
SUPPLEMENTS: META-ANALYSIS OF RANDOMISED TRIALS
BMJ 1998;316:894-898
16. Hu F, Stampfer M, Manson J, Rimm E, Colditz G, Rosner B, Speizer F,
Hennekens C, Willett W;
FREQUENT NUT CONSUMPTION AND RISK OF SORONARY
HEART DISEASE IN WOMEN: PROTECTIVE COHORT STUDY
NBJ 1998;317:1341-1345
17. Miller T, Balady G, Fletcher G;
EXERCISE AND ITS ROLE IN THE PREVENTION AND
REHABILITIATION OF CARDIOVASCULAR DISEASE
Ann Behav Med 1997;19 (3):220-229
18. National Heart Foundation of Australia;
WEBSITE – Statistics 1999
19. National Heart Foundation of New Zealand;
HEART FACTS – September 1997
20. Sanitarium Nutrition Education Service;
CANCER - THE FOOD CONNECTION
Sanitarium Health Food Company March 1999
21. Sanitarium Nutrition Education Service;
EATING FOR HEALTH - DIABETES
Sanitarium Health Food Company November 1999
22. Sanitarium Nutrition Education Service;
HEART HEALTH
Sanitarium Health Food Company March 1999
23. Saxelby C;
NUTRITION FOR LIFE
Hardie Grant Books South Yarra Victoria. 1999:120-121
24. Stanton R;
EATING FOR PEAK PERFORMANCE
Allen & Unwin Australia Pty. Ltd, North Sydney, NSW
1988:2
25. Thomas B;
MANUAL OF DIETETIC PRACTICE, - 2nd EDITION
Cambridge, Blackwell Science 1994
26. Wahlqvist M. L; FOOD AND NUTRITION – Australasia, Asia and the Pacific
Allen & Unwin Pty Ltd Crows Nest NSW 1997:249-254,384-393
292
Unit 20
DISEASE RISK PREVENTION
Heart Disease, Cancer & Diabetes
27. World Cancer Research Fund & American Institute for Cancer Research;
FOOD, NUTRITION AND THE PREVENTION OF CANCER:
A GLOBAL PERSPECTIVE 1997
28. Zemel M;
DIETARY PATTERN AND HYPERTENSION: THE DASH STUDY
Nutr Rev 1997;55 (8):303-8
293