Notes on the 6mes Jownees Europeennes de Dietetique

BY SHEILA J. GUY Senior Therapeefic Dietitian, Mary$eld Hospital, Dundee

THREE VERY FULL and interesting days were spent in Amsterdam where the 6mes JouriiCes EuropCennes de DiCtC- tiqne was held from 17th-19th Septem- ber, 1962, with about 200 members attending. The venue was the new Hilton Hotel which had recently been opened on the south side of the city.

The Congress was opened by Prof. Dr. Muntendam, Director-General of the Ministry of Social Affairs and Public Health, after a speech of welcome by Prof. Dr. Dols, President of the Council of Nutrition in the Netherlands. The layout of the hall broke away from the traditional rows of chairs or lecture theatre in that it was set out with large circular tables with six or eight chairs to each, and after the opening ceremony coffee was served, giving a very in- formal atmosphere.

Renal failure The scientific sessions started with

one on “The Treatment of Renal Failure” and with Prof. Dr. Eorst (Amsterdam) presiding. The first paper was by Prof. Dr. Gloor-Meyer (Zurich) on “The Dietetics of Chronic Renal Insufficiency”. He outlined the three diffcrent types of renal insufficiency, stressing the need for ample calories to avoid loss of weight. The electrolyte balance was also stressed and mention of 50 p:r cent. glucose solution giving 1,000 Cal. from 500 ml. being used in uraemia. Prof. Dr. Verdonk (Ghent), known to many, gave details of the treatment of renal failure, mentioning intoxication by vitamin D and calcium as a cause, and speaking of the need to lower catabolism and watch the mineral intake during oliguria, and of the use of glucose to provide calories. Next came Dr. Wolthuis (Amsterdam) on

“Balance Studies on Protein Metabol- ism; significance for the treatment of renal failure”. In this paper he gave an account of various persons’ work in this field and came to the conclusion, with regard to their own studies, that with under 20 g. protein and around 2,500 Cal., negative nitrogen balance resulted. Diets containing 40g. protein in later stages of chronic nephritis caused elevated blood urea levels and 20g. or even less should be given. They also found that nitrogen equilibrium can only be maintained with a high protein intake, immobility having a catabolic influence on protein metabol- ism. The diets should be adequate in calories.

For the second psrt of the first day there were six different pip2rs including one by Prof. Dr. Kapp (Basle) on “Dietetics in Uraemia”, and one by Dr. Holtmeier (Freiburg im Breisgau) on “Low Salt Diets in Kidney Failure” who spoke mainly of sodium and chloride but also mentioned the part played by magnesium. He mentioned that there was more essential hyper- tension in women than men, and more symptomatic in men than women, also that the incidence had been much less during the war years. Dr. Roguski (Poznan) then gave a paper entitled “Nitrogen Balance in Renal Failure”, and following him Miss Kooreman (The Hague), speaking on “The Diet in Renal Failure”, outlined the methads used in Holland - usually 1,400 - 1,600 Cal. rising to 2,000 - 3,000 Cal. if more sweet dishes were used; the requirement for vitamins and calcium in chronic nephritis should be remembered.

Following the discussion, Prof. Dr. Audier (Marseille) told of the use of potassium in cardiac insufficiency, giving

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examples of the potassium and sodium intake in relation to protein, carbo- hydrate, fat and calories, enumerating the various amounts offered in the diet. The last speaker of the day was Dr. Schultheiss (Frankfurt) on “Food Ideas and Problems of the Dietitian”.

The second day had an unfortunate beginning in that the first and third speakers were indisposed. It therefore fell on Dr. Tremolieres (Paris) to open the day’s proceedings which for the first half were on “Recommended Dietary Allowances’’. Dr. Sinclair (Ox- ford) presided at this session; he briefly enumerated the various saturated and unsaturated fatty acids and helped to clarify in people’s minds the ones which could be converted or made in the human body.

Visit to Unilever When the morning session finished,

packed lunches were supplied by Kon- inklijke Verkade Fabrieken S.A. and we were taken to Vlaardingen, outside Rotterdam, where the Unilever Labora- tory is situated. We were shown the experimental margarine and heard of research work being done on human and animal reactions to various fats; we also saw the newer types of counter for finding radio-activity in various commodities.

The afternoon session in the main Unilever building in Rotterdam, with Prof. Dr. Azerad presiding, consisted of four papers on “The Treatment of Steatorrhoea”. Dr. Demole (Gcneva) spoke of the dietetic indications in the microscopic steatorrhoeas in which he stressed the need for finding the cause and, in the dietetic treatment, the necessity for protein, calcium and vitamins. He mentioned the various types of illnesses in which there is mal- absorption and the lowered protein intake if protein absorption was affec- ted. The next speaker was Prof. Dr. Lederer (Louvain) who dealt with “The Diversification of the Diet Ther- apy - according to the origin of stcator- rhoea” - high protein, low fat in

coeliac; moderate butter and fat in steat- orrhoea and in tropical sprue where there is bad absorption of carbohydrate. He also mentioned the necessity for lipopro- teins. The third paper was by Dr. Van de Kamer (Utrecht), a name well known in this field. His subject, “Diag- nosis and Treatment of Fermentative Diarrhoees”, ,brought in the toxicities from unabsorbed foods and the lactic acid formation in the diarrhoeas, also the enzymes which were deficient, the intestinal cells and not the lumen being affected. In children invertase may be missing and diarrhoea results. Tests included various disaccharide loading curves - flat curves result if enzymes are missing. Diarrhoea stopped when saccharide was omitted or enzyme was added. The last paper was by Mlle. Tollens (Anvers) on “Treatment of Steatorrhoeas with Antibiotics and Corticosteroids”. If gliadin is at fault corticosteroid gives no response but there is a response to antibiotics.

The visit to Rotterdam concluded with cocktails and an extremely pleasant dinner by Unilever S.A. with beautiful floral arrangements on the tables.

The final day, presided over at the first session by Prof. Dr. Kapp, com- menced with a paper by Prof. Dr. Azerad (Paris), the morning subjcct being “Training Medical Students and Physicians in Dietetics”. He spoke of teaching the theory of nutrition to this group, mentioning that few werc in- terested in nutrition and outlining the methods used in France. The second paper was in two parts, by Prof. Dr. Mogena and Dr. Vivanco (Madrid), on “Teaching Nutrition in Spain”. Dr. Bramstedt (Hamburg) described what he hoped would be the situation in Germany in order that the public would be informed of nutrition. This was followed by Mme. Dupont (Paris) who stressed the importance of the dietitian. During the discussion several people spoke of the curriculum in their countries. The final paper in the morn- ing session was by Dr. Bertrand (Ville- cresnes) which was mainly a colour

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film showing the work done in his clinic. Mlle. Dr. Pekkarinen (Ke!sinki) opened the last session, Prof. Dr. Verdonk acting as president, which was on “The Methodology of the Assess- ment of Food Consumption”, by show- ing work done in Finland in her paper entitled “Weighing Method in Dietary Surveys”; she gave the advantages and disadvantages of this type of survey and compared it with the inventory methods. Dr. Mancini (Rome) spoke on methods and investigations into “the Nutritional Status in Italy”, fol- lowing it with a film showing one of the poorer districts in his country with a food survey being undertaken. Mlle. Dr. van Schaik (The Hague) meiltioned in her paper, “National and Inter- national Dietary Surveys, Factors De- terminating the Methods to be Em- ployed”, that the cross-check method of Burke was used. Finally Mme. Dr. Vajna and Dr. Holtmeier (Freiburg im Breisgau) spoke on “Modern Methods

and Results of Inquiry into Food Consumption.”

On the first day of the Congress lunch was given to the participants by Nutricia S.A., makers of infant foods. In the evening a sight-seeing tour of the canals was arranged. This was a most memorable ,trip emphasised by the flood lighting accentuating the different forms of architecture. We disembarked at the Rijksmuseum where there was an official reception by the Minister of Education, the Minister of Agriculture and Fisheries and the Burgomaster of Amsterdam. The final day’s sessions were interspzrsed with a ‘frozen lunch‘ given by Iglo SA.- a sister of Bird’s Eye, and everyone sat down to a meal wrapped in foil. After the final papers on the third day a farewell dinner ended the Congress. It was announced that the next JournCes EuropCennes de DiCtCtique will take place in Paris in two years’ time.

F ~ ~ ~ r ~ d ~ t i ~ ~ - a Nutrition Society Symposium THE NUTRITION SOCIETY held a Sympo- sium on Saturday, October 6th, 1962, on a question of topical concern- Fluoridation. The six papers covered all aspects of fluoridation: its effective- ness; its acceptability to the public; its mode of zction and its safety.

Dr. R. Duckworth gave an extremely useful background to the whole discus- sion in his paper on “Clinical dentistry and fluoride”. He emphasised that dental health was undermined by two diseases; dental caries and periodontal disease. The latter was largely a disease of cddts and uninfluenced by fluoride. The former was seen at its worst in childhood and adolescence ; treatment with fluoride was one means of pre- vention. He pointed out that while

knowledge of the aetiology of dental caries was still incomplete some of the essential factors were known. Caries almost invariably started at a site of food stagnation where a plaque, in which bacteria were present, developed. These may attach the plaque to the teeth as well as fermenting simple carbohydrates. In animal experiments, dental caries have been prevented by the elimination of bacteria. This was obviously impossible in practice in man but the restriction of their substrate, easily fermentable carbohydrate, especi- ally between meals and the removal. of food debris by ensuring oraI hygiene reduced the incidence of dental caries. If bacteria cannot be eliminated the enamel could be made more resistant

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