Slide 1 –
Healthier Nutrition, One Step at a Time……
By: Candace Miller RN Fall River DMR Area Office 
Updated : August 2005
Slide 2 –
Who Am I ?

•	I am a Registered Nurse, (+ 29 years nursing experience)
•	I am not a dietician, or a nutritionist
•	I have an intense interest in nutrition
•	Graduated from a High School Commercial Foods program, so I love to cook and bake.   And most of all EAT.
•	Attended many nutrition related classes/programs over the years

This lecture and PowerPoint presentation provides only recommendations. 
Before changing any individuals diet, or yours, it must first be discussed and approved by the Primary Care Physician

Slide 3 –
Quote from,   J AM Diet Association1997; 97:189
“Persons with developmental disabilities are at increased nutritional risk because of feeding problems, drug-nutrient interactions, metabolic disorders, decreased mobility and altered growth patterns.   In addition they may also be at risk due to insufficient income, limited nutrition knowledge, and / or care givers who may not provide an environment that promotes the intake of a nutritionally adequate diet.”

Today’s Agenda 
•	Overweight/Obesity Statistics - BMI 
•	Cardiovascular Disease Statistics 
•	Diabetes Statistics
•	The Exchange lists/ Food Pyramid
•	Reading a Food Label
•	Fat & Cholesterol
•	Dietary Fiber Recommendations
•	Sodium/salt
•	Water Requirements 
•	Swallowing Difficulties 
•	Physical Activity
OVERWEIGHT/OBESITY
•	The rates of overweight people have increased 50% in all populations since 1960
•	One in two adults and one in four children are overweight
•	Increase of Type 2 Diabetes, (insulin resistance)
•	Sugar, refined starches and grains are the primary sources of carbohydrates in the American diet

Assessing Weight using BMI chart
•	(Body Mass Index) And Waist Circumference. BMI is a measure of waist relative to height  (It can overestimate health risk  of a very muscular athlete)
•	Waist Circumference measures abdominal fat. 
•	You are more likely to develop heart disease, high blood pressure, diabetes, and certain cancers if your waist measurements are:
o	Woman with waist >35 inches
o	Man with waist > 40 inches
Health Risks Related to Obesity

•	Diabetes   (1 in 53) 
•	Heart Disease  (1 in 4) 
•	Stroke  (1 in 23)
•	High Blood Pressure
•	Gall Bladder Disease
•	Increase likelihood of certain cancers
•	Orthopedic problems, due to increased weight bearing on joints
•	Psychiatric problems; I.e., depression
•	Reproductive Disorders (Obese woman have risks of difficulty conceiving and obese men have reduced sperm counts)
•	Some people (Bodybuilders or other athletes with a lot of muscle) can weigh more than their height recommends (BMI) without being overweight or obese. (Muscle tissue weighs more than fat tissue) 
Obesity occurs when a person consumes more calories than he or she burns. Genetic, environmental, psychological and other factors may all play a part in obesity.
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Cardiovascular Disease Statistics
•	6.8 Million Americans have CVD, (CardioVascular Disease) #1 cause of death in both DMR population and general population.

•	CVD claimed 1 of every 2.5 deaths in U.S. in 2000.

•	CVD claims more lives each year than the next 5 leading causes of death combined. If all major forms of CVD were eliminated, life expectancy would rise by ~ 7 years. 
•	The cost of CVD and stroke in U.S., in the 2003 is estimated at $351.8 billion a year
Cardiovascular Disease Statistics
•	1 in 2.4 women’s death are from cardiovascular disease (1 in 29 for breast cancer)
•	Beginning at age 50, more women have a blood cholesterol >200mg/dL
•	Approximately 105 million Americans have a blood cholesterol >200 mg/dL
•	Reducing your weight as little as 10% can decrease or delay your chances of developing heart disease, by improving how your heart works, lowering blood pressure, and lowering the levels of blood cholesterol and triglycerides.
☺

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Diabetes
•	Diabetes is a disorder of carbohydrate metabolism, from inadequate production or utilization of the hormone insulin.
•	Type 1: autoimmune, idiopathic (unknown cause)
(Pancreas does not produce insulin) Onset before age 30
Thin
Treated with diet/insulin

•	Type 2: impaired insulin secretion; insulin cannot get into cell; eventually the pancreas fails to secrete insulin 
Onset after age 30 *  (* Occurring at Younger ages now!) 
Obese
Treated with diet / pills / insulin

•	Fastest growing disease in America ~ National Epidemic

•	6th  leading cause of death in America in 2002

Other Forms of Diabetes

Gestational diabetes mellitus (GDM)

Characterized by glucose intolerance with onset of pregnancy.

Pre-diabetes; affects at least 20 million people in US

1. Impaired glucose tolerance (IGT)

2. Impaired fasting glucose (IFG)
IGT / IFT are associated with cardiovascular disease A1C should be maintained < 6.5% without major hypoglycemia, ADA goal >7. (American Diabetes Association)

Having Diabetes almost TRIPLES the risk of heart disease. ~   Amputations, kidney disease, kidney failure.

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Diabetes

Symptoms of diabetes,
Glycosuria (sugar in urine) and hyperglycemia (Increased sugar levels in blood)
The 3 “P’s”                                              Infections, esp. vaginal itching Polyuria (producing excessive urine)        Wounds that will not heal Polydispisa   (excessive thirst)                    Feeling tired
Polyphagia   (abnormality   increase of appetite)      Extreme hunger
Management of disease involves frequent feedings. (5-6 times a day) The 5 M’s = Meal planning, monitoring, motion, medication and
management.
Balanced diet of carbohydrates, proteins and fats.
Usually 1200-2500 calories. (As recommended by the doctor) Complications of diabetes; End Stage Renal Disease, (ESRD), adult blindness, nontraumatic lower extremity amputations, CVD,  and impotence.
Heart disease and stroke are 2- 4 times more common in people with diabetes.
Total cost related to diabetes in the U.S. is over $132 billion per year.

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Food Pyramid

This is the OLD Pyramid ………

The New Food Pyramid 2005

What counts as a serving?

Fruit group
1 med. Apple, banana, orange, pear
½ cup chopped , cooked or canned fruit
¾ cup fruit juice

Vegetable group
1 cup raw leafy vegetables
½ cup of other vegetable – cooked or raw
¾ cup of vegetable juice

Breads, cereal, rice, and pasta
(Whole grains and refined)
1 slice of bread
1 cup ready to eat cereal
½ cup cooked cereal, rice or pasta
Meat, poultry, fish, dry beans, eggs,
and nuts group.
2-3 ounces of cooked lean meats, poultry or fish

½ cup cooked dry beans, or ½
cup of tofu counts as 1 lean meat
2 ½ soy burgers or 1 egg counts as 1
ounce of lean meat
2 TBSP of peanut butter or 1/3 cup of nuts counts as 1 lean meat

Milk, yogurt, and cheese group.
1 cup of milk** or yogurt
1 ½ ounces of natural cheese**
( such as cheddar)
2 ounces of processed cheese
( such as American)

** Choose fat free or reduced fat dairy products

Serving Sizes

•	1 cup, 1 medium fruit, or vegetable = Fist
•	1 teaspoon = Finger tip
•	1 Tablespoon = Thumb tip
•	1-2 ounces dry = Cupped hand
•	1 ounce of meat or cheese = 4 dice or a thumb length
•	3 ounces meat poultry or fish = size  of deck of cards or hand (This does not include the fingers)
Your Plate Portions
•	Plate size should be approximately 9 inches round
•	½ of the plate should be fruits and vegetables
•	¼ plate should be whole grains, and/or complex carbohydrates
•	¼ plate should be lean protein 
www.theportionplate.com

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Nutrition Fact Label
* In January 2006 Label will list products content of Trans fatty acids.

Ingredient lists
(small sample of ingredients in the ingredient lists)

•	WHITE BREAD: Ingredients: Bleached enriched wheat flour, malted barley flour,   water, high fructose corn syrup, wheat gluten, soybean and or canola oil, yeast, salt, and honey
•	WHEAT BREAD: Ingredients: Enriched wheat flour, water, high fructose corn syrup, wheat gluten, soybean and / or canola oil, yeast, salt, caramel coloring and honey.
•	WHOLE WHEAT BREAD: Ingredients: Whole wheat flour, water, high fructose corn syrup, wheat gluten, soybean and / or canola oil, yeast, salt, water and honey. 
•	Refined grains are low in fiber and low in the protective substances that accompany fiber.
•	Enriched grains are grain products with added thiamine, riboflavin, niacin, folic acid, and iron.

How much fat should I have? 
•	It depends upon your caloric needs. (Your doctor will help you determine this)
•	The 2005 Dietary Guidelines recommend that Americans limit fat in their diets to 25-30% of daily calories. (Based on 2000 calorie diet)
•	Fat grams are very high in calories
•	Each gram of fat is equal to 9 calories
•	660 calories fat ÷ 9 = 73 grams of fat
•	A B C D
•	You need fat in your diet to metabolize vitamins
•	A, D, E and K    (Fat soluble vitamins)

Normal Portions of Fat

•	1 pat of butter
•	2 tablespoons of salad dressing
•	1 tablespoon of mayonnaise
•	4 ounces lean (80% or higher) ground beef
•	2 ounces cheese
•	8 ounces whole milk
o	(Better choice is 1% or skim milk) 
Remember low fat does not always mean low calorie.
Example of 30% fat menu (1800 calorie)

BREAKFAST= 2 scrambled eggs

2 slices whole grain toast (>1 gm fiber/serving)

½ cup O.J.

8 ounces skim milk

Coffee/tea – (splenda/equal/sweet-n-low)

1 tsp margarine

LUNCH = 3 oz sliced turkey breast

2 slices whole grain bread                                            Mid afternoon snack=

1 c raw vegetables (cukes,tom,carrots,lettuce)               3 graham cracker sq

4TBSP low calorie salad dressing                                            H2O, Diet soda

1 medium piece of fruit

H2O or diet soda, crystal lite

DINNER = 4 oz baked skinless chicken/or fish            Bedtime snack =

2/3 cup sweet potatoes                                                         8 oz skim milk

1 c   broccoli                                                                        ½ c shredded wheat

1 tsp margarine                                                                         1 c berries

H2O or diet soda, crystal lite

2

Are some types of fats worse than others? Eating too many saturated fats raise blood cholesterol levels in many people, increasing their risk of heart disease

Normal total blood cholesterol levels should be ≤ 180

LDL ≤ 100  (The main source of cholesterol buildup and blockage in arteries)

HDL ≤ 40 low, ≥ 60 high  (HDL helps keep cholesterol from building up in the arteries)

Triglycerides ≤ 150  (Another form of fat)

Dietary Guidelines recommend limiting saturated fats to less than 10 % of calories

Two types of fats:

Saturated , and unsaturated (Monounsaturated, and polyunsaturated)

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Saturated Fats

•	Found in the largest amounts in fat from meat and dairy products and in some vegetables such as coconut, cocoa butter, palm oils, hydrogenated vegetable oil, and the skin on poultry.  (The skin is the high saturated fat item)

•	Tend to raise blood cholesterol levels
•	Limit use of products that contain large amounts of saturated fats
o	Examples are nondairy creamers, rich baked products such as pie crusts and other pastries, cakes and cookies 
•	Most saturated fats are solid at room temperature, like lard 
This is the worst fat of all

How to Avoid Saturated Fat
•	Use lean meats, skim or low fat dairy products     (1% or less fat)
•	Use unsaturated vegetable oils and margarines that list liquid vegetable oil as first ingredient on the label
•	Read food labels to check types and amounts of fat they contain
•	Saturated fatty acids should be 8-10% of the total calories of a healthy diet.

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Polyunsaturated Fats
•	Found mainly in safflower, sunflower, corn, soybean, sesame oil, walnuts, cottonseed oils and some fish
•	Most unsaturated fats are liquid at room temperature, like corn oil
•	Should be up to 10 % of total calories of a healthy diet.

This is the second best choice of fats

☺ Monounsaturated Fats

•	Are found mainly in olive, peanut and canola oils, olives, avocados, peanuts, cashews, and   pecans.
•	They do not raise blood cholesterol levels
•	Usually liquid at room temperature
•	Should be up to 15 % of total calories of a healthy diet
•	Use these more often

Best choice of fats

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Cholesterol

•	Cholesterol is vital for hormonal and other functions of the body.

•	Cholesterol comes from two sources; what your body produces and what you eat
o	Cholesterol:   two types: LDL     and    HDL

•	Food Cholesterol is only found in animal products
o	Egg yolks (limit 3 a week) Organ meats, kidney, liver etc. Lobster, crab and shrimp Sardines
o	Whole milk
o	2% milk
o	Butter

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Ways to decrease Triglycerides
•	Triglycerides can raise your risk for heart disease 
•	Decrease or eliminate sweets
•	Decrease or eliminate alcohol
•	Decrease refined carbohydrate containing foods
•	Choose foods rich in Omega 3 fatty acids (the good fats) Maintain a healthy weight
•	Adopt an eating plan low in saturated fats and fried foods
•	Avoid trans fatty acids and hidden fats
•	Choose higher fiber foods
•	Eat more plant foods
•	Replace red meat with lower fat sources of protein
•	Exercise regularly   (30-60 minutes daily)

What are Trans-fatty acids?
•	Fat that is hydrogenated; it stays more solid at room temperature
•	Is man made, mutated, refined fats. (Used to keep foods fresher on shelves. Longer shelf life.)
•	Most recent entry to the BAD FATS      Keep Trans fatty acid consumption as low as possible.
•	Typical products high in Trans-fatty acids are; potato chips, processed baked products, some margarines/spreads, boxed macaroni and cheese, donuts, etc…….. READ YOUR FOOD LABELS !
•	If you see “hydrogenized” or “partially hydrogenized” on the label, you can be sure it contains trans fatty acids. Choose soft margarines, not hard. (Food label should be 2 grams saturated fat/TBSP or less)
•	Tend to raise LDL, and lower HDL. This increases your risk of heart disease
•	In Jan. 2006 food fact labels will reflect the amounts of trans fatty acids in products, per FDA (Food & Drug Administration)
Fiber Should Be Your Friend

•	Two types of fiber: They both aid in digestion and help Maintain a healthy weight.
•	Soluble fiber helps to lower cholesterol which may help lower the risk of heart disease, helps control blood sugar levels. Dissolves in the intestines and forms a gel

•	Insoluble fiber help to prevent constipation may reduce certain cancers. Doesn’t dissolve in the intestinal fluids, but instead soaks up water like a sponge, adding bulk and preventing constipation by making it easier for the Intestines to move waste matter
•	Types of processed vs. unprocessed.
•	Don’t forget to increase the water intake when fiber is added
•	Don’t increase fiber suddenly, gradual is best   (May cause abdominal cramping)
•	Don’t be fooled by advertising, read your labels. ( Wheat bread and coloring)

Examples of Soluble and Insoluble Fiber
Soluble, Found in fiber of, Oats, beans barley, certain fruits and vegetables like apples, strawberries and peas.
Insoluble, Found in, whole grains wheat bran legumes cereals certain fruits and vegetables like apple skin, carrots, and corn.
U.S. Department of Agricultural recommends 25-35 grams fiber a day
Sodium/salt
Sodium is an essential mineral and we need it for life

Dietary guidelines for healthy Americans recommend dietary intake of less than 2300 milligrams a day.
(1 teaspoon of salt = 2400mg)
¼ tsp = 600mg, ½ tsp = 1200mg, etc….
1 tsp baking soda = 1000mg sodium
You should not eat less than 500 mg of salt/sodium a day
(Need sodium for critical body functions)

Unfortunately, excessive sodium contributes to a silent killer called HYPERTENSION.   The effects are the greatest to those who are overweight
Try to cut back on your sodium intake

Most of the sodium people eat are from processed foods
Not the salt shaker.
How to decrease sodium intake……
•	Choose fresh, unprocessed foods
•	Choose frozen or canned foods without salt

•	Look for “low sodium” or “Unsalted” on package labels less than 5% of Daily value, (shown on the right side of food fact labels), are considered low sodium.
•	Don’t add salt during cooking or at the table
•	Read the nutrition facts of the food label for the milligrams of sodium. (140 mg or less = low sodium) Ask for restaurant meals to be prepared without salt Limit trips to fast food restaurants

•	Be aware of hidden sodium on labels, such as MSG,monosodium glutamate, baking soda, baking powder, disodium phosphate, sodium alginate, sodium benzoate, sodium hydroxide, sodium nitrate, sodium propionate, sodium sulfate, also found in some medications as antacids.
•	If antacids have more than 5 mg of sodium in a single dose then the label should reflect this

Water

•	Water (No calories) vs. juice (usually loaded with calories)
•	Water regulates body temperature,

•	maintains equilibrium, and helps the liver break down and release fat from our bodies.
•	Water carries every nutrient, mineral, vitamin, protein and hormone. It’s the chemical messenger in our bodies. Daily energy depends upon water; Chemical reactions are water based.
•	Weight loss increases your water need

•	Drink at least 6 to 8 , 8 ounces of water or other hydrating, low caloric fluids daily
•	Be aware that caffeine and alcohol act as diuretics.

They do not replace water they waste it.

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Eat    S   L   O  W   L   Y

•	It takes approximately 20 minutes for your stomach to signal the brain that it is full
•	Put your fork down between bites and chew your food well
•	Drink liquids with meal (low caloric or water)
•	If you eat too quickly, you will probably overeat Monthly or weekly weights should be obtained to monitor weight gain or loss (Individualized) Healthy diet usually consists of 10-35% Protein
•	45-65 % carbohydrates, 20-35% fats

Using the NEW FOOD GUIDELINES 2005
Did you know?

•	The average American consumes
•	20 % of their daily calories from sugar ? On a 2,000 calorie diet that is 400 calories or the equivalent of 25 teaspoons of sugar a day.
•	An average American consumes 130 pounds of sugar a year. The ideal is HALF of this.

Physical Activity of US Adults

Benefits of Physical Activity

Check with your doctor first !

Not being physically active is a major risk factor for heart disease
Regular physical activity can lower your LDL cholesterol and triglycerides, and raise your HDL ☺ cholesterol levels Physical activity makes you feel good
Helps build and maintain bones, muscles and joints
Enhances flexibility and posture
Improves self esteem and feeling of well being Can reduce feelings of depression and anxiety Maintains a healthy weight
Increase physical activity in increments, slowly…….
You should try to be physically active for at least 30-60
minutes on most, if not all days, 3-5 times a week.

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Examples of activity physically challenged people can perform 
Strength training, moving arms and legs in reputations, muscle balance & gentle stretches
Walk if able – tread mill Take a nature walk Dancing
Wash the car
Mow the lawn – with supervision
Yoga
Basketball – shoot baskets
Soccer – kick the ball around
Hand cycle or participate in wheelchair sports
Riding a bike, or stationary bike
T’ia Chi
Swimming – water aerobics
Use the stairs
Can perform upper arm lifts/movements, stretches of extremities
14JUST  HAVE  FUN  MOVING  MORE THAN YESTERDAY

Signs and Symptoms of Swallowing Difficultly

In 2001 and 2002 aspiration pneumonia was the 2nd  cause of death among the DMR population.   In 2003 it is the third leading cause of death among the DMR population.

•	Coughing before, during or after eating

•	Recurrent Pneumonia’s or Upper Respiratory Infections. May also be silent aspirations.

•	Resistance to eating (loosing weight)

•	Moist breathing, wet breathing during/after eating

•	Clearing the throat while eating/drinking

If any of the above symptoms occur, notify the primary care physician. The individual may benefit from a swallowing study and/or evaluation by an O.T. or S.L.P.
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DESIRED CHARACTERISTICS OF FOOD TEXTURE
Strained:  The food texture is strained through a fine mesh strainer. It is smooth, moist and of absolute uniform, pudding – like consistency.   Soup may be thick or thin, but should be of uniform consistency.
Puree:  The food texture is pureed. It is smooth, moist, pudding – like and contains no lumps. All food items should drop off the spoon in globs when the spoon is tilted.  They should not run off in a steady stream, nor be pasty or sticky.   Soup may be thick or thin, but should be of uniform consistency.
Ground:  The food texture is thick, moist, stays on the spoon when the spoon is tilted and is not pasty or sticky.   It may include small pieces of any food item, up to the size of couscous that flattens easily when rolled between finger and thumb.   It includes a good amount of sauce to moisten dry food and/or to bind food items together.  Soup may be thick or thin, but should be of uniform consistency.
Minced:  The food texture consists of small pieces of each food item up to the size of an apple seed.   It includes a good amount of sauce to moisten dry food and/or to bind food items together.  Soup may be thick or thin, but should be of uniform consistency.
Chopped:   The food texture consists of food items chopped to pea size (1/4”).  Each food item is soft or cooked until soft.  Each food item is recognizable for what it is.   Soup may be thick or thin, but should be of uniform consistency.
Cut-up:  The food texture consists of a regular diet hand-cut by direct service staff into ½’ cubes or bite-sized pieces.  Food will be plated in regular form.   Soup may be thick or thin and contain small pieces of food.
Regular:  The food texture consists of meat, vegetables, and desserts served restaurant style.   Green salads should be cut into bit-sized pieces.   Individual items in the salad should be no larger than a grape.  Soup may be thick or thin and contain small pieces of food.

Source:   Diet Manual written by the Department of Food and Nutrition Services, Marriot Health Care Services in collaboration with the Clinical Dieticians, Occupational Therapists and the Contract Monitors form the Developmental Centers for the Massachusetts Department of Mental Retardation.

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Summary of today……
Change eating habits slowly as not to “starve” or forbid oneself.     (Success more longstanding)
Portion sizes are important, remember portion plate, 9” Eat more complex carbohydrates
Eat more fiber, fiber rich fruits, vegetables and whole grains
Eat less sugar and caloric sweeteners
(Excess sugar eaten alone causes increased production of insulin and increased insulin promotes fat storage)

Eat less saturated fats (10%), and less than 300mg/day cholesterol, and limit trans fatty acids, focus on polyunsaturated and monounsaturated fatty acids such as fish, nuts, and vegetable oils.   (20-35% of daily calories)
Eat less salt, less canned foods, less processed foods

(Limit intake to less than 2300mg/day)

Choose brightly colored fruits and vegetables

Start One Step at a Time, by changing your food eating habits, and also get moving more than you did yesterday.
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BEAT OBESITY WITH NEW HABITS

ONE STEP

AT

A

TIME

Thank you for your participation today 
Spread the word.

Remember……One Step at a Time

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RESOURSES
“Portion Distortion 1 & 2”, downloadable at www.nhlbi.nih.gov
Diabetes-Cardiovascular Disease Toolkit, A CD-ROM containing reproducible patient education tools. American Diabetes Association, Call
1-800-342-2383 and request the Toolkit CD.   Or www.diabetes.org on the internet.
BOOKLETS;
“Dietary Guidelines for Americans” 2005, UPDATED AS OF JAN. 2005
http://www.health.gov/dietaryguidelines/dga2005/document/pdf/DGA2005.pd
“The DASH Diet”, http://dash.bwh.harvard.edu
“The Healthy Heart Diet”
“How Much are You Eating?” www.pueblo.gsa/cic_text/food/howm-much/eat.pdf
“ Get Moving…..” www..cnpp.usda.gov/Pubs/brochures/getmoving_scree.pdf
BOOKS,
“The Doctors Pocket Calorie, Fat & Carbohydrate Counter”, 2004, by Allan Borushek, paperback.
Web Resources and Booklets

Recipe and nutrition information sites;
•	www.americanheart.org
•	www.justmove.com
•	www.cookinglight.com
•	www.mealtime.org
•	www.cyberdiet.com
•	www.diabetic.org
•	www.eatright.com
•	www.calorieking.com  (Food products are updated daily)
•	http://www.nutrition.tufts.edu
•	www.healthierus.gov/dietary guidelines
•	www.healthierus.gov/exercise.html
•	www.health.gov/dietaryguidelines
•	www.health.gov/dietaryguidelines/dga2005/recommendations.htm
4
Web Resources
•	www.ivillage.com
•	www.nlm.nih.gov/medlineplus
•	www.mayoclinic.com
•	www.eatright.com
•	www.kitchenkapers.com
•	www.nhlbisupport.com
•	www.a-guide-for-seniors.com
•	www.kwwd.com
•	www.diabetes.org
•	www.eatef.org/textures
•	www.qualitymall.org
•	www.portionplate.com
•	www.deliciosdecisions.org
•	www.mass.gov/eeohs2/docs/dmr/mortalityreport2002.pdf
•	www.hsph.harvard.edu/nutritionsource/pryamids.html

•	www.apha.confex.com/apha/130am/techprogram/paper_49520.htm
•	www.198.102.218.57/dietaryguidelines/dga2005/default.htm
•	www.shapeup.org
•	www.cnpp.usda.gov
•	www.obseity.org
•	www.plainsense.com/health/weight
•	www.nutritionnavigator.org
•	www.fda.gov
•	www.americanheart.org
•	www.lifespan.org
•	www.cancer.org
•	www.eatef.org/textures