Modifications to Manage Seizure Disorders See all. Five years ago, a pilot study of human cancer patients by one of the study authors, Nicholas Gonzalez, M. Malnutrition refers to insufficient, excessive, or imbalanced consumption of nutrients by an organism. It should be well noted that differences between soluble fibers in the relative production of acetate, propionate, butyrate, and total short-chain fatty acids do exist. Mean number of decayed, missing due to disease , and filled teeth Sum of individual DMFT values divided by the population. In , Edith G. Head CT scans showed no abnormalities in either patient.
The genome map provided an excellent opportunity to study how millennia of domestication can alter a species. The researchers found important mutations in a gene designated TBC1D1, which regulates glucose metabolism. Another mutation that resulted from selective breeding is in the TSHR thyroid-stimulating hormone receptor gene.
In wild animals this gene coordinates reproduction with day length, confining breeding to specific seasons. The mutation disabling this gene enables chickens to breed—and lay eggs—all year long. Once chickens were domesticated, cultural contacts, trade, migration and territorial conquest resulted in their introduction, and reintroduction, to different regions around the world over several thousand years.
Archaeologists have recovered chicken bones from Lothal, once a great port on the west coast of India, raising the possibility that the birds could have been carried across to the Arabian Peninsula as cargo or provisions.
Chickens arrived in Egypt some years later, as fighting birds and additions to exotic menageries. Artistic depictions of the bird adorned royal tombs. Yet it would be another 1, years before the bird became a popular commodity among ordinary Egyptians. It was in that era that Egyptians mastered the technique of artificial incubation, which freed hens to put their time to better use by laying more eggs. This was no easy matter. Most chicken eggs will hatch in three weeks, but only if the temperature is kept constant at around 99 to degrees Fahrenheit and the relative humidity stays close to 55 percent, increasing in the last few days of incubation.
The eggs must also be turned three to five times a day, lest physical deformities result. The egg attendants kept their methods a secret from outsiders for centuries. Around the Mediterranean, archaeological digs have uncovered chicken bones from about B. Chickens were a delicacy among the Romans, whose culinary innovations included the omelet and the practice of stuffing birds for cooking, although their recipes tended more toward mashed chicken brains than bread crumbs.
Farmers began developing methods to fatten the birds—some used wheat bread soaked in wine, while others swore by a mixture of cumin seeds, barley and lizard fat. At one point, the authorities outlawed these practices. Out of concern about moral decay and the pursuit of excessive luxury in the Roman Republic, a law in B.
The practical Roman cooks soon discovered that castrating roosters caused them to fatten on their own, and thus was born the creature we know as the capon. He speculates that the big, organized farms of Roman times—which were well suited to feeding numerous chickens and protecting them from predators—largely vanished.
As the centuries went by, hardier fowls such as geese and partridge began to adorn medieval tables. Europeans arriving in North America found a continent teeming with native turkeys and ducks for the plucking and eating.
Some archaeologists believe that chickens were first introduced to the New World by Polynesians who reached the Pacific coast of South America a century or so before the voyages of Columbus.
Well into the 20th century, chickens, although valued, particularly as a source of eggs, played a relatively minor role in the American diet and economy.
Long after cattle and hogs had entered the industrial age of centralized, mechanized slaughterhouses, chicken production was still mostly a casual, local enterprise. Like most animals, chickens need sunlight to synthesize vitamin D on their own, and so up through the first decades of the 20th century, they typically spent their days wandering around the barnyard, pecking for food.
Now they could be sheltered from weather and predators and fed a controlled diet in an environment designed to present the minimum of distractions from the essential business of eating. The result has been a vast national experiment in supply-side gastro-economics: Factory farms turning out increasing amounts of chicken have called forth an increasing demand.
Modern chickens are cogs in a system designed to convert grain into protein with staggering efficiency. By comparison, around seven pounds of feed are required to produce a pound of beef, while more than three pounds are needed to yield a pound of pork. Gary Balducci, a third-generation poultry farmer in Edgecomb, Maine, can turn a day-old chick into a five-pound broiler in six weeks, half the time it took his grandfather.
All they want to do now is eat. It is hard to remember that these teeming, clucking, metabolizing and defecating hordes awaiting their turn in the fryer are the same animals worshiped in many parts of the ancient world for their fighting prowess and believed by the Romans to be in direct communication with Fate.
A chicken bred for the demands of American supermarket shoppers presumably has lost whatever magical powers the breed once possessed. Western aid workers discovered this in Mali during a failed attempt to replace the scrawny native birds with imported Rhode Island Reds.
Santería—the religion that grew up in Cuba with elements borrowed from Catholicism, native Carib culture and the Yoruba religion of West Africa—ritually sacrifices chickens, as well as guinea pigs, goats, sheep, turtles and other animals.
Devotees of Santería were the petitioners in a First Amendment case, in which the Supreme Court unanimously overturned local ordinances banning animal sacrifice. The scored PG-SGA represents a further development of the PG-SGA and incorporates a numeric score; it also allows categorizing of patients into three categories—well-nourished, moderate or suspected malnourishment, or severely malnourished—based on their global assessment.
The higher the score, the greater is the risk for malnutrition. It has been accepted by the Oncology Nutrition Dietetic Practice Group of the American Dietetic Association as the standard for nutrition assessment for patients with cancer. However, because it must be conducted by a trained health professional, in health settings with limited dietetic resources, it is not typically used in practice, other than at some cancer centers.
A nutritional assessment should be part of every health maintenance visit and is easily incorporated into routine care. For the well adolescent, screening questions during the history, routine anthropometric measurements, and a general physical examination usually suffice. Laboratory studies to assess nutritional status are not part of the routine screen and should be prompted by findings on the history or physical examination. Questions such as the following help guide the nutritional history: Tell me everything that you ate and drank yesterday from the time you woke up until the time you went to sleep.
Are there any types of foods that you do not eat? How often do you eat fast food? What do you usually drink? How often do you eat fruits and vegetables?
Do you take vitamins, minerals, or other supplements? How often do you skip meals? Have you made any changes in your diet? Do you want to weigh more, less, or the same as you weigh now? What do you do to achieve that goal? What questions or concerns do you have about your nutrition? The high incidence and prevalence of eating disorders during adolescence have prompted the development of brief screening tools for anorexia nervosa and bulimia.
Anstine and Grinenko found the following four-question screen to be both sensitive and specific for the identification of older adolescent females with eating disorders: How many diets have you been on in the past year? Do you feel you should be dieting? Do you feel dissatisfied with your body size? Does your weight affect the way you feel about yourself?
More than two diets to lose weight in the past year, a perceived need to diet, dissatisfaction with body size, and an effect of weight on self-esteem are associated with anorexia nervosa, bulimia nervosa, and other eating disorders. If the screening history raises nutritional concerns, the adolescent should be asked to keep a detailed food diary and to meet with a trained dietician who can both obtain and analyze intake data. Table summarizes the physical findings associated with nutrient deficiency and excess.
Although these findings may provide important clues to specific nutritional problems, the standard anthropometric measures described next remain the cornerstones of any nutritional assessment.
Body weight responds within days to a change in energy i. At every adolescent health care visit, weight should be measured on a calibrated standing scale with the patient barefoot and undressed. The measurement should be plotted on an age- and gender-adjusted weight curve available from the National Center for Health Statistics. Until the completion of puberty, growth in height is a long-term indicator of nutritional status.
It should be measured at least annually throughout childhood and adolescence and more frequently every to 6 months during periods of illness or known nutritional deficiency.
The most accurate and reliable measurements of height are obtained using a wall-mounted stadiometer. The measurement should be plotted on an age- and gender-adjusted height curve available from the National Center for Health Statistics.
As described previously for weight and height, BMI should be plotted on an age- and gender-adjusted curve available from the National Center for Health Statistics. An adolescent with a BMI greater than the 85th percentile is considered at risk for overweight, and an adolescent with a BMI greater than the 95th percentile is considered at risk for obesity.
Although a high BMI usually indicates excess adiposity, an elite athlete may have an elevated BMI due to high lean muscle mass and low body fat. Other measurements, such as those described next, are helpful in these circumstances. Waist Circumference and Waist—Hip Ratio: Waist circumference is a reliable test of adiposity in adolescents and adults. Top normal cut-points are The waist—hip ratio, calculated as waist circumference divided by hip circumference, provides a reliable estimate of truncal adiposity in adults but does not correlate well with truncal fat mass in children and young adolescents.
Complications of obesity are associated with a waist—hip ratio greater than 1. Skin folds, measured with specialized calipers at the triceps, biceps, subscapular area, and abdomen have shown to correlate well with body fat in adults, adolescents, and children. However, the reliability of intra- and inter-observer measurements are low and the technique has only been studied in Caucasian populations.
The history and physical examination guide the laboratory component of a nutritional assessment. The evaluation of an overweight or obese adolescent is discussed in Chapter Serum levels of specific vitamins or minerals can be measured in adolescents with suspected excessive or deficient intake.
In other situations, the laboratory evaluation can identify nutritional problems before clinical findings emerge. Examples include the use of red cell indices to detect iron deficiency anemia or anemia of chronic disease, hypophosphatemia to monitor refeeding after a period of malnutrition, and prealbumin and albumin as indicators of protein and energy intake during the preceding 1- and 3-week periods, respectively.
A proper assessment is the foundation on which further recommendations on proper diet for the prevention and treatment of disease can be based. These assessments are routinely performed by registered dietitians and nutritionists and should also be used by physicians when evaluating the nutritional status of any patient. A complete assessment proceeds in three parts:. Define the patient's nutritional status with respect to energy, protein, vitamin, and mineral intake.
Establish optimal levels of nutritional intake for the individual patient's needs and make dietary recommendations based on those needs. Conduct assessments in a serial fashion to assess the effects of dietary recommendations on health. A complete medical history is the first step in the assessment. In the past medical history and surgical history, specific inquiry of cardiovascular disease, diabetes mellitus, gout, alcoholism, cancer, immunodeficiencies, and pulmonary, gastrointestinal, or renal diseases should be made.
The disease itself or medical or surgical interventions used to treat it may affect the nutritional status of the patient.
In addition to standard medications and allergies, the patient should be asked whether he takes any vitamins, minerals, or supplements and whether he has any food allergies or sensitivities, including lactose intolerance. Certain medications, such as laxatives, diuretics, and antacids may directly affect the nutritional status of a patient or, in the case of vitamin K—containing green vegetables, may present problems of drug-nutrient interactions.
A family history of osteoporosis, cardiovascular disease, diabetes, hypertension, or obesity is important to note. The patient's social history should be evaluated for caffeine, alcohol, and tobacco use. A complete understanding of the patient's social background will improve the clinician's ability to formulate a successful dietary recommendation, and a specific dietary history should be elicited at this time Table ; a daily food log may be helpful as well.
A complete review of systems is useful to further elicit any other significant problems a patient may have that can herald a nutritional concern. The review of systems is subjective and organ system based and should be appropriately tailored to the age and general health of the patient. Gastrointestinal symptoms such as heartburn, dyspepsia, abdominal bloating, gas, constipation, and diarrhea may be particularly salient.
The physical examination provides more objective measurements of the nutritional status of a patient. For example, a patient who, according to his history, has no medical problems, takes no medicines, refrains from alcohol and tobacco, and claims to eat a low-fat diet rich in fruits and vegetables yet appears morbidly obese, hypertensive, and is noted to have acanthosis nigricans should immediately focus the attention of the physician on a nutritional imbalance.
Malnutrition may cause a myriad of physical findings in any number of organ systems, the specifics of which are beyond the scope of this chapter. Education was inversely correlated with prevalence of untreated root caries: Current smokers had a higher prevalence of untreated root caries Prevalence of filled roots was higher among non-Hispanic white adults 9.
Tooth Retention and Edentulism. Mean number of teeth was inversely correlated with age: Non-Hispanic white and Mexican-American adults had more teeth Adults with more than a high school education had more teeth Persons who reported never smoking had more teeth Prevalence of edentulism increased with age: Mexican-American adults had a lower prevalence of edentulism 5. An inverse correlation was observed between edentulism and education: A correlation also was observed between edentulism and smoking: Overall, edentulism decreased from The prevalence of fluorosis was lowest among persons aged years Figure Non-Hispanic blacks had higher proportions of very mild and mild fluorosis than did non-Hispanic white participants Figure Posterior teeth were more affected by enamel fluorosis than were anterior teeth Figure A nine percentage point increase in the prevalence of very mild or greater fluorosis was observed among children and adolescents aged years when data from were compared with those from the NIDR survey of school children from Dental caries and tooth loss were among the most common causes for rejection of young men from military service during the Civil War and the two World Wars So widespread was the disease in the early 20th century that Klein designed and introduced the DMFT index as a sensitive tool to describe the distribution of the disease by counting the number of decayed, missing, and filled teeth affected 6.
The introduction of fluorides for preventing dental caries, starting with water fluoridation in the mids, changed the pattern of disease occurrence. During , NCHS conducted the first national survey that included clinical assessments of dental caries in adults This was followed by two similar national surveys during among children aged years and youth aged years 21, Historically, a decline in dental caries in primary teeth was reported until the mids, when data from the two NIDR surveys were compared However, later reports have suggested that this decline has slowed or reversed in the United States and elsewhere 26, Data from this report support those findings.
These reductions in dental caries also are reflected in increased tooth retention and reduced levels of edentulism, as has been reported elsewhere for selected populations However, as the population ages and persons retain more teeth, more root surfaces become exposed and are at increased risk for tooth decay These findings highlight the importance of developing strategies for preventing and controlling dental caries in older adults.
Despite gains in oral health associated with dental caries, disparities remain. Overall, non-Hispanic white survey participants had a lower prevalence and severity of disease and lower prevalence of untreated decay compared with non-Hispanic black and Mexican-American participants. In addition, these results also support an association between tobacco use, dental caries, and tooth loss , which might have both a biologic and socioeconomic etiologic link.
Dental sealants are highly effective in preventing dental caries that occur on the surfaces of teeth that have pits and fissures. School-based sealant programs also are cost-saving In , the Task Force on Community Preventive Services strongly recommended school-based or school-linked sealant programs for the prevention and control of dental caries The increase in sealant prevalence might be attributable to increases in both dental office-delivered and school-based and -linked sealant programs.
The increased prevalence of sealants from to was observed across all sociodemographic groups and might have contributed to the reported decrease in dental caries in permanent teeth.
Despite these gains, profound disparities still exist. School-based and -linked programs in the United States generally target vulnerable populations less likely to receive private dental care e. An expansion in the number of these programs might decrease disparities in the prevalence of sealants The findings in this report indicate that the prevalence of tooth loss continues to decline in the United States and provides further evidence that edentulism is not inevitable with advanced age.
The decrease in the prevalence of edentulism between the two surveys might in part be attributed to the increased adoption of preventive regimens such as dental sealants, community water fluoridation, use of fluoride toothpaste and mouth rinse, and support for these approaches by health-care providers, health decision makers, and public health officials. Despite improvements in tooth loss and edentulism, disparities remain.
Older adults and smokers were consistently worse off than their counterparts. These population subgroups are probably at increased risk for adverse consequences of tooth loss and other dental problems on quality of life and general health.
These consequences can include limitations in chewing, dissatisfaction with appearance, avoidance of social contacts, and trouble speaking 30, Findings also suggest that Mexican-Americans continue to have the lowest prevalence of edentulism, although non-Hispanic whites also have experienced a decline in edentulism since Tooth loss and edentulism reflect differences in healthy behaviors, attitudes toward oral health and dental care, and access to and use of dental services and types of treatment received 30, In addition, tooth loss is influenced by expectations about health.
Further research is needed to determine why Mexican-Americans retain more teeth than non-Hispanic blacks and non-Hispanic whites despite having more dental caries in the younger cohorts. Certain studies have focused on tooth loss and its relation to diet and nutritional status. Two studies have documented that the intake of fruits and vegetables was negatively affected by the loss of teeth 44, Persons who have lost all or a substantial number of their teeth consumed fewer important nutrients, including dietary fiber 44, Biochemical levels of important nutrients were lower among those missing all or a substantial number of teeth In addition, persons who had lost a substantial number of teeth were more likely to be obese than those with more teeth 48, These findings underscore the concept of a possible threshold number of teeth necessary for a "functional dentition" Despite the overall decrease in tooth loss, continued research and tailored preventive efforts to eliminate those disparities are needed.
Enamel fluorosis is a hypomineralization of enamel, characterized by greater surface and subsurface porosity than normal enamel, and is related to fluoride ingestion during periods of tooth development by young children 55 first 6 years of life for most permanent teeth.
Although use of fluoride in various modalities has been important in the prevention and control of dental caries, it also introduces the risk for enamel fluorosis. The milder forms of enamel fluorosis typically are not noticeable; however, more severe levels might be objectionable for cosmetic reasons. Historically, a low prevalence of the milder forms of fluorosis has been accepted as a reasonable and minor consequence balanced against the substantial protection afforded by dental caries from the use of fluoridated drinking water and foods, beverages, and oral care products that contain fluoride.
Reported risk factors for the more severe forms of fluorosis include drinking water with high natural fluoride levels, dietary fluoride supplements particularly when prescribed for children with other sources of systemic fluoride , ingestion of fluoride toothpaste, and having multiple sources of ingested fluoride These two surveys are the only sources of national data on enamel fluorosis. The surveys differed in sampling and representation schoolchildren versus household survey and in procedures followed 14 examiners during versus four during Examiner reliability was considered acceptable in both surveys 4, The cohort aged years had fewer premolars and molars erupted, limiting comparison to other cohorts Figure In analyzing these cohort effects and their causes, two things need to be considered: Studies on use of fluorides exist , but they do not provide information on combined exposures.
Furthermore, not until the early s were public health approaches introduced to limit the exposure to systemic fluoride from toothpaste and supplements 66 , when the risk for fluorosis for most teeth in the age year cohort was no longer subject to change. A potentially important source of fluoride is toothpaste.
By , proportionately more young children were using fluoride toothpaste than were earlier cohorts 62, In addition, although professional interest in limiting the amount of fluoride toothpaste delivered to young children and supervising their toothbrushing was expressed earlier in the s 65 , only during the early s was this approach adopted broadly as a public health measure 66 , which was too late to alter the risk for fluorosis among the year age cohort in NHANES No clear explanation exists why fluorosis was more severe among non-Hispanic black children than among non-Hispanic white or Mexican-American children.
This observation has been reported elsewhere , and different hypotheses have been proposed, including biologic susceptibility or greater fluoride intake Anterior teeth were less affected by enamel fluorosis than were posterior teeth. This finding also was reported in the NIDR survey 71 and has been attributed to cohort effects, attrition, or a combination of the smaller anatomical surface and longer formation time of posterior teeth compared with anterior teeth 18, Further research also is needed to improve public health surveillance of fluoride exposure.
The difficulties observed in comparing data from the NIDR and NHANES surveys and the time lapse between exposure and clinical presentation suggest the need for new and more timely methods to measure total fluoride exposure. Methods such as fingernail analysis and urinary fluoride excretion have shown promise, but only with limited samples. Research in these areas could result in the development of valid and reliable techniques to monitor total fluoride exposure in children, allowing adjustment in public health practice and recommendations to reduce the cosmetic consequences of fluoride exposure while preventing and controlling dental caries.
Epidemiologic data from Australia indicate that targeting reduction in discretionary intake of supplements and toothpaste can reduce the prevalence of enamel fluorosis Information is not available to evaluate the effects of these changes in the United States after they were implemented in the early s.
Increased efforts are needed to disseminate published recommendations about appropriate use of fluoride to health professionals and the public. This report documents improvements in the oral health of the civilian, U. The report documented important differences in disease prevalence and severity by sociodemographic characteristics that public health officers, the dental profession, and the community should consider in implementing interventions to prevent and control disease and to reduce the disparities observed.
The following is a list of seven important findings in this report:. The authors thank former members of the U. Dushanka Kleinman and Dr. We would also like to thank Dr. Finally, our thanks to Dr. Mean number of decayed and filled surfaces in primary teeth Sum of individual dfs values divided by the population.
MT Number of missing permanent teeth due to caries or periodontal disease does not count teeth extracted for reasons other than caries or periodontal disease.
FT Number of filled permanent teeth teeth with carious lesions decayed teeth that have been restored. Missing teeth are excluded because in adults, some missing teeth may have been lost due to reasons other than caries, including periodontal diseases and extracted for prosthetic reasons.
DS Number of decayed surfaces in permanent teeth. MS Number of missing tooth surfaces due to caries or periodontal disease does not count surfaces of teeth extracted for reasons other than caries or periodontal disease. FS Number of filled surfaces in permanent teeth carious surfacesdecayedthat have been restored.
Missing surfaces are excluded because in adults, some missing teeth might have been lost because of reasons other than caries, including periodontal diseases and extracted for prosthetic reasons.
Mean number of decayed, missing due to disease , and filled surfaces in permanent teeth Sum of individual DMFS values divided by the population. Mean number of decayed, missing due to disease , and filled teeth Sum of individual DMFT values divided by the population. Dental fluorosis See enamel fluorosis. Dental sealants Also called pit-and-fissure sealants, these are thin plastic coatings that are applied to pits and fissures in teeth to prevent decay.
Dentate Having one or more natural permanent tooth present in the mouth excluding third molars. Edentulous Having no natural permanent teeth in the mouth excluding third molars. Also called complete tooth loss or edentulism. Enamel fluorosis A hypomineralization of enamel, characterized by greater surface and subsurface porosity than normal enamel caused by fluoride ingestion during periods of tooth development first 6 years of life for most permanent teeth.
FPL Federal poverty level. Federal poverty thresholds are defined by the U. Census Bureau based on family income and size of family. A series of surveys fielded by the National Center for Health Statistics. Root caries Tooth decay in the tooth root that it is exposed to the oral environment because of gum recession this part of the tooth that is normally below the gums in a healthy mouth.
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CDC is not responsible for the content of pages found at these sites. This conversion may have resulted in character translation or format errors in the HTML version. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.
Contact GPO for current prices. Reliability of Examinations Dental examiners were calibrated periodically by the survey's reference dental examiner. Diagnostic Criteria A list of terms and abbreviations is included to facilitate the reading and interpretation of the diagnostic criteria and results.
Discussion Dental Caries Dental caries and tooth loss were among the most common causes for rejection of young men from military service during the Civil War and the two World Wars Dental Sealants Dental sealants are highly effective in preventing dental caries that occur on the surfaces of teeth that have pits and fissures. Tooth Retention and Edentulism The findings in this report indicate that the prevalence of tooth loss continues to decline in the United States and provides further evidence that edentulism is not inevitable with advanced age.
Enamel Fluorosis Enamel fluorosis is a hypomineralization of enamel, characterized by greater surface and subsurface porosity than normal enamel, and is related to fluoride ingestion during periods of tooth development by young children 55 first 6 years of life for most permanent teeth. Conclusions This report documents improvements in the oral health of the civilian, U. The following is a list of seven important findings in this report: The decline in the prevalence and severity of dental caries in permanent teeth, reported in previous national surveys, continued during and It has benefited children, adolescents, and adults.
A notable proportion of untreated tooth decay was observed across all age groups and sociodemographic characteristics. No reductions were observed in the prevalence and severity of dental caries in primary teeth. The use of dental sealants among children and adolescents increased substantially. This increase was probably the result of both public and private efforts and denotes a continuing interest in using dental sealants for the prevention of tooth decay.
Older adults are retaining more of their teeth and fewer are losing all their teeth.