Public health nutrition: still flavour of the month

Nutrition remains high on the political agenda around the world, as is evident from several articles in this issue. This editorial attempts to pull together some of the strands. In the UK, following publication of the Public Health White Paper Choosing Health in December 2004 (http://www.doh.gov.uk) (see Foster & Buttriss 2005 for a commentary), Action Plans on Food and Health and on Physical Activity were published in mid March (DH 2005a, 2005b). These summarise plans and provide target dates for action. The Food Standards Agency's involvement in taking forward aspects of Choosing Health is described in the Food Standards Agency's (FSA) strategic plan published at the end of 2004 (http://www.food.gov.uk) and are incorporated into the Action Plans published in March 2005. The FSA will lead Government in the development of improvements to food labelling (e.g. they plan to simplify nutrition labelling and seek to make its use mandatory) and in matters concerned with advertising and promotion of food to children (see Buttriss 2004a). Part of the FSA's work programme focuses on the promotion of food to children. A consultation has been conducted on a proposed model for nutrient profiling of foods promoted for children. The consultation ended on 25 February and the British Nutrition Foundation's (BNF) response can be found at http://www.nutrition.org.uk Towards the end of the consultation period, nutrition scientists working in academic settings were invited to a workshop to discuss the strengths and weaknesses of the model, particularly in relation to its use as a discriminator for TV advertising of foods, but recognising that other uses might be considered. The general feeling emerging from the discussion was that the model is not yet perfect and has a number of limitations. In summing up, the chairperson concluded that more work needs to be done, but in the context of specific uses such as TV advertising, the FSA could move forward, reassess some aspects of the model and in particular do more testing with foods relevant to the target group, including considering different approaches for ready meals vs. snacks vs. commodities/ingredients. Whether or not the model is applicable beyond the age range for which it has been developed (ages 11–16) needs more work, especially in relation to young children and older adults. There is also a need to check for consistency with other FSA and EU recommendations and legislation on labelling. Issues that need particular consideration are assessment of carbohydrate quality (including dietary fibre) and iron (haem vs. non-haem). For example, the model currently includes non-milk extrinsic sugars as a criterion, which is problematic as this cannot be measured directly. More effective measures of carbohydrate quality were discussed, e.g. a combination of total sugars and dietary fibre, with incorporation of measures to counteract any adverse effect on fruit or milk (sources of fructose and lactose respectively) of using total sugars in the quantification of carbohydrate quality. According to the Food and Health Action Plan (DH 2005a), in June 2005, the FSA plans to publish nutritional criteria that can be used as the basis for advertising and food promotion to children (in mid 2005 Ofcom will consult on tighter broadcasting rules). In September 2005, the FSA plans to publish the nutrient profiling model for children's foods in light of the public consultation initiated in November 2004 and which ended on 25 February (see DH 2005a for details). Developments in the FSA's work on nutrient profiling may have far reaching consequences and are being watched with keen interest across Europe as discussions progress at EU level on directives on nutrition and health claims and on additions of vitamins and minerals to foods. In parallel with the work on nutrient profiling, the FSA has also been assessing various sign posting formats. The first stage of the work identified consumer preferences for different formats, e.g. a single traffic light (which could utilise the nutrient profiling model); vs. a set of traffic lights, one for each of several nutrients, vs. a format providing a comparison with guideline daily amounts (GDAs) (see below). The second stage is focusing on consumer understanding and usage of a selection of these formats, including at least one format that is based on GDAs, and seeks to establish which format works best. Publication of this work is expected in July 2005 and will be followed by a consultation on a package of guidance based on the nutrient profile model on high-medium-low descriptors for salt, fat and sugar levels in children's foods, signposting and nutrition and health claims (see DH 2005a for details). Publication of the results of this consultation is promised for October 2005. The target date for adoption of nutritional signposting by the food industry is March 2006. In BNF's view, focusing on GDAs has advantages over simply flagging up whether a food has been classified as green, amber or red, because it enables consumers to understand how the foods contribution to one or more nutrients compares with typical daily needs for that nutrient. For example, if a ready meal provides 20 g fat, compared with the GDAs for men and women of 95 and 70 g per day, respectively, this would be quite reasonable, whereas if a serving of a snack product provided this much, this would signal the need to cut portion size or frequency of consumption such that this food made only a minor contribution to typical food intake. GDAs are increasingly used on pack to provide additional information on energy, fat and salt content. The Institute of Grocery Distribution (IGD) is spearheading some pioneering work and is leading a working group, of which BNF is a member, to develop a wider range of GDAs, e.g. for sugars and fibre, and to extend the age ranges to which they apply to include children. We hope to have an article on this work in a future issue. A summary of the key aspects of the Department of Health’s Action Plans for England can be found at http://www.nutrition.org.uk The stated aim of the Food and Health Action Plan (FAHAP) is to improve health in England by reducing the prevalence of diet-related disease, and to reduce obesity in England by improving the nutritional balance of the average diet. It presents actions that the Government will take in terms of facilitating provision of healthy eating information for consumers and enabling increased availability of healthier choices; and encouraging healthy eating behaviours in children, in communities, NHS settings and in the workplace. The first target is to substantially reduce mortality rates by 2010 from heart disease and stroke and related disease by at least 40% in people under 75, and with at least a 40% reduction in the inequalities gap between the fifth of areas with the worst health and deprivation indicators and the population as a whole. Other targets are to substantially reduce mortality rates by 2010 from cancer by at least 20% in people under 75, again with a focus on reducing the inequalities gap (by at least 6%); to halt the year-on-year rise in obesity among children under 11 years by 2010 in the context of a broader strategy to tackle obesity in the general population; and to reduce inequalities by 10% (by 2010) as measured by infant mortality and life expectancy at birth. Dietary targets are to increase daily fruit and vegetable consumption from 2.8 to at least 5 portions per day; to increase fibre from 13.8 to 18 g per day; to reduce salt from an average of 9.5 to 6.0 g per day by 2010; to reduce average saturated fatty acid intake from 13.3% to 11% of food energy; to maintain the current trend in the average total intake of fat at 35% of food energy (currently 35.3%); and to reduce average intake of added sugar to 11% of food energy (currently 12.7%). An Oral Health Action Plan will be published later in 2005 and an Alcohol Harm Reduction Strategy is already underway, under the auspices of the Prime Minister's Strategy Unit. A new cross-Government obesity education campaign, led by the Department of Health, is promised, which will be piloted in 2006 and launched nationally in March 2007. Government plans to seek contributions to funding for this and other health information and education campaigns from the food industry. In consultation with industry, considerable achievements have already been made in reduction of the sodium content of foods. A DH-funded tool kit for health professionals on salt and hypertension is promised for May 2005. Also by May 2005, the Department of Health and the FSA plan to have agreed scoping plans for reducing fat and sugar levels in processed foods and to be working with industry to identify interim and long-term targets by December 2005, with a view to publishing these by June 2006. A new service, Health Direct, will act as a ‘virtual health trainer’, offering the public (especially children, young people, health professionals and employers) a series of electronic gateways. A DH-accredited online practical health assessment, the Personal Health Guide, will also be offered as a core educational module for the public, employers, health professionals and other community support mentors. With regard to young children, the first phase of the roll-out of Healthy Start (which replaces the Welfare Food Scheme) is planned for July 2005, with the national roll-out taking place in mid 2006. In order to give more emphasis to breastfeeding, infant formula and follow on formula regulations are under review and further support and training for health professionals is promised. The launch of the Food In Schools toolkit took place in April 2005, and will be followed by training throughout England for Healthy Schools Coordinators (and others) in its use and the launch of the Food in Schools website (see future issues of Nutrition Bulletin). Work on the school fruit and vegetable scheme will continue. During 2005, the Department of Education and Skills (DfES) is leading on a review of secondary school meals standards following the review of current practice published last summer (Nelson et al. 2004). The return of nutrient-based standards is being considered. This will be followed by a review of meals in primary schools. The aim is to bring into force new statutory requirements for primary and secondary school meals by September 2006, with a view to extending these to cover food available across the school day by August 2007. Other activities in schools include the start of Ofsted inspections of school food in September 2005. Key to the success of many aspects of the FAHAP will be ensuring that health professionals and others charged with delivering the actions are appropriately trained in at least basic nutrition and that appropriate monitoring is in place to ensure that patients and members of the general public seeking information about food and nutrition receive good quality, consistent advice. The development of such training and monitoring may also provide an opportunity for Government to consider the lack of regulation around the use of the term ‘nutritionist’, which has the potential to confuse individuals seeking advice, and of more concern increase the risk of people receiving advice that is not evidence based and has the potential to do harm (Buttriss 2004b; Foster & Buttriss 2005). Effective evaluation of the many activities is also clearly very important and the FAHAP summarises how the National Diet and Nutrition Survey (NDNS) programme (see Marriott & Buttriss 2004), Defra's Expenditure and Food Survey and the FSA-commissioned Low-income Diet and Nutrition Survey will be used in this process, along with other indicators such as the health poverty index. This issue of Nutrition Bulletin carries an article by Bethany Yon and Rachel Johnston (page ??) describing the new US/Canadian recommendations (dietary reference intakes, DRIs) for energy, macronutrients and also physical activity levels. Recognising the increasing health burden posed by obesity, recommended levels for physical activity have been raised from 30 min on most days of the week to 60 min and are now twice the levels recommended in the UK in 2004 in the report by the Chief Medical Officer (Department of Health 2004). This spring also saw the publication of new recommendations on energy by the Food and Agriculture Organisation (FAO 2005). New values for energy requirements for infants, children and adolescents were published and different energy requirements were proposed for populations with various lifestyles and levels of habitual activity. The report also includes revised recommendations for the levels of physical activity required to maintain fitness and health and to reduce the risk of developing obesity. The rising prevalence of obesity and its co-morbidities such as type 2 diabetes and the cluster of symptoms known as the metabolic syndrome is a concern across Europe, with particularly high prevalence now being recorded in parts of Eastern Europe and rates continuing to rise in most member states. Considerable EU-funding is being directed towards research focusing on the metabolic syndrome, notably the Lipgene project in which BNF is a partner (FOOD-CT-2003–505944; http://www.nutrition.org.uk; http://www.lipgene.tcd.ie) and also a new project called Diogenes (see article by Saris in this issue of Nutrition Bulletin). The Commission has paved the way for an orchestrated public health approach to obesity prevention across the EU by establishing the European Platform for Action on Diet, Physical Activity and Health, launched on 15 March 2005. The initiative has grown from the work of a Round Table on Obesity, which brought together senior representatives of retailers, food producers and processors, the food service sector, the advertising business, consumer and health NGOs, the medical professions, and present and incoming presidencies. The focus has been on the contributions that economic operators, consumer organisations/NGOs and the Commission can make to reversing current obesity trends. The process is under the direction of Robert Madelin, DG-SANCO, and the Platform will be under the leadership of the European Commission to ensure that a co-operative and action-orientated approach is respected, and to make sure that the activities associated with the Platform are in harmony with the work of the European Network on Nutrition and Physical Activity and with discussions in the Council of the European Parliament. The Platform will provide an opportunity to report on and review action, in order to build a comprehensive evidence base and to discuss progress. Data will be reported and reviewed on an annual basis. The first meeting is likely to focus on agreeing a work schedule, collecting baseline information on ongoing activities of Platform members, and adopting terms of reference for two dedicated working groups.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.