Sugar‐free or reduced‐sugar foods and beverages are very popular in the United States and other countries, and the sweeteners that make them possible are among the most conspicuous ingredients in the food supply. Extensive scientific research has demonstrated the safety of the 5 low‐calorie sweeteners currently approved for use in foods in the United States–acesulfame K, aspartame, neotame, saccharin, and sucralose. A controversial animal cancer study of aspartame conducted using unusual methodology is currently being reviewed by regulatory authorities in several countries. No other issues about the safety of these 5 sweeteners remain unresolved at the present time. Three other low‐calorie sweeteners currently used in some other countries–alitame, cyclamate, and steviol glycosides–are not approved as food ingredients in the United States. Steviol glycosides may be sold as a dietary supplement, but marketing this product as a food ingredient in the United States is illegal. A variety of polyols (sugar alcohols) and other bulk sweeteners are also accepted for use in the United States. The only significant health issue pertaining to polyols, most of which are incompletely digested, is the potential for gastrointestinal discomfort with excessive use. The availability of a variety of safe sweeteners is of benefit to consumers because it enables food manufacturers to formulate a variety of good‐tasting sweet foods and beverages that are safe for the teeth and lower in calorie content than sugar‐sweetened foods.

Cardiac output and blood flow to the uterus, ovary and placenta were determined at day 21 of gestation in rats fed ad libitum a standard diet or 50% of control intake from day 5 of gestation. Restricted rats had lower body weights, smaller fetuses and placentas and a marked reduction in blood flow to ovary and placenta but not to endometrium and myometrium. These animals also had a marked reduction in cardiac output. However, the percent distribution of cardiac output in the whole uterus, ovary and placenta was similar in control and restricted rats. Results suggest that food restriction decreases expansion in uterine and placental blood flow by interfering with the expansion in cardiac output which normally occurs in pregnancy.

Severe obesity (SO) is increasing faster than obesity in adults and in children. Because it is associated with numerous comorbidities, SO accounts for more health care expenditures than any other medical condition. Furthermore, it is associated with poor pregnancy outcomes for mother, fetus, and infant and a high risk of offspring obesity carried into adulthood. Bariatric surgery is the treatment of choice for SO because nonoperative methods fail to provide medically significant durable weight loss and because it is both preventive and therapeutic. The number of operations has sharply increased globally, yet only a small fraction of eligible patients are referred for surgical treatment demonstrating the need for improved access, especially for those disproportionately affected by SO. The risks of surgery mandate careful postoperative long-term multidisciplinary follow-up care. Education is critical for truly informed consent and must continue postoperatively, especially for women with reproductive potential. Even so, surgical treatment of SO remains cost-effective compared to conventional nonoperative treatment, which also requires long-term care. Just as obesity affects all medical disciplines (from allergology and immunology to oncology, urology and women’s health), so does postoperative management of bariatric surgery patients. We offer wide-ranging recommendations for policymakers and others to consider in addressing SO.

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A large body of scientific evidence associates the moderate intake of alcohol with reduced mortality among middle-aged and older people in industrialized societies. This association is due largely to a reduced risk of death from coronary heart disease, which appears to outweigh any possible adverse effects of moderate drinking. The regular consumption of small amounts of alcohol is more healthful than the sporadic consumption of larger amounts. No beneficial effect of moderate drinking on mortality has been demonstrated in young adults (premenopausal women and men who have not reached their forties). It is theoretically possible that moderate drinking in young adulthood might reduce the risk of later heart disease; however, this has not been clearly demonstrated. For some individuals (e.g., those who cannot keep their drinking moderate, pregnant women, and those who are taking medications that may interact adversely with alcoholic beverages), the risks of alcohol consumption, even in moderation, outweigh any potential benefits. Because even small amounts of alcohol can impair judgment and coordination, no one should drink alcoholic beverages, even in moderation, before driving a motor vehicle or performing other activities that involve attention and skill.

Dietary supplements are extensively used in the United States, especially by people age 50 and over. Surveys have shown that magazines and other news media are an important source of information about nutrition and dietary supplements for the American public. It is uncertain, however, whether magazines provide their readers with adequate information about the safety aspects of supplement use. This report presents an analysis of supplement safety information in articles published during 1994-1998 in 10 major magazines popular among older readers. This time period was chosen to allow the impact of the 1994 Dietary Supplement Health and Education Act (DSHEA) to be assessed. The evaluation included 254 magazine articles. More than two-thirds of the articles did not include comprehensive information about the safety aspects of the dietary supplements that were discussed. Information about safety issues such as maximum safe doses and drug-supplement interactions was often lacking even in otherwise informative and well-researched articles. A total of 2,983 advertisements for more than 130 different types of supplements were published in the magazines surveyed. The number of advertisements per year increased between 1995 and 1998. Supplements of particular interest to older adults (such as antioxidants, calcium, garlic, ginkgo biloba, joint health products, liquid oral supplements, and multivitamins) were among the most frequently advertised products. Although magazines popular among older readers contain extensive information about dietary supplements, these publications cannot be relied upon to provide readers with all of the information that they need in order to use supplements safely.

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The early time course of the absorption of duodenally infused 14C-labeled Intralipid into either the hepatic portal circulation or systemic circulation was measured. Plasma radioactivity did not increase significantly at either site until 30 min after the intestinal infusion began and was maximal between 60 and 120 min. In studies on the effects of intestinal lipid infusions on sham feeding in rats we find significant suppressions of sham feeding after only 10 min. Thus the time course for lipid absorption is different from that of the satiating effects of duodenally infused fats. These results are consistent with the hypothesis that the satiating effect of fats infused into the small intestine occurs before entry of absorbed fats into the blood and is not dependent on recently absorbed circulating fat.