Options to change food and nutrient intakes

Options to change food and nutrient intakes

Once the above analysis is complete and peer reviewed, definite directions in the consumption of nutrients and foods become apparent. In this section we focus on some of the options but the reader should always bear in mind that all options are possible and none is exclusive. Broadly speaking we can think of two con-trasting options: “supply-driven” nutrition policy and “demand-driven” nutrition policy.

Supply-driven nutrition policy takes the food supply and in some way modifies it so that individuals consuming a habitual diet will have their nutrient intake altered without having to make any major changes in food choice. Mandatory fortification of foods with micronutrients is by far the best example of supply-driven food nutrition policy. There are certain essential prerequisites to the development of a successful supply-driven fortification program.

 Let us now consider these factors for a typical for-tification process, the mandatory addition of folic acid to flour in the USA to reduce the incidence of the neural tube birth defect, spina bifida.

 Demand-driven nutrition policy is based on edu-cating the consumer to demand newer and healthier types of foods from the food supply. This is a chicken-and-egg situation. Consumers may want something that is not within the scope of industry to produce either for economic or technical reasons. Equally many companies have developed food products with very obvious health benefits which were market fail-ures because the consumer saw no benefit. The success of this area is thus very market driven. Industry made spreadable fats low in SFAs, which consumers liked. They developed immune-boosting probiotics, choles-terol-lowering phytosterols, high-fiber ready-to-eat cereals and cereal bars, juices with various antioxi-dants, low-fat milks, n-3 PUFA-enriched eggs, and so on. For demand-driven food supply to work, we need to invoke a major new area of public health nutrition- communication.

The only way that this can be understood is to study what consumers feel and believe before we can expect them (a) to listen to our communication, (b) believe it, (c) understand it, or (d) care about it. The present section assumes that is a given. In terms of nutrition communication, there are three very impor-tant areas to consider: nutrition labeling, nutrition claims, and nutrition profiling.

Nutrition labeling

In most countries, packaged foods bear a label listing particular nutrients in particular ways. The number of nutrients listed can vary either because of the prevailing food policy or because it suits a manufac-turer to have more or less nutritional information imparted to the consumer. The standard format is to express the target nutrients per 100 g of the food or per some specified portion of the food. Generally, nutrition labeling was a “back of pack” issue, generally considered less important. Today, it is becoming increasingly a “front of the pack” issue, with visuals to immediately let the consumer see what a typical serving supplies in terms of target nutrients and then to express these as a percentage of some reference intake. Often colors are used where a serving greatly exceeds some nutritional standard (red) or green if it is well below.

Nutrition labels fulfill a very important role in nutrition communication – helping the consumer see the nutrient content of the food. However, there are aspects that are not so obvious which we need to bear in mind. Comparisons of the nutritional com-position of different foods are often difficult to interpret. For example, in choosing a packaged sand-wich, the consumer can unite their gastronome preferences with nutritional data to make a choice. On the other hand, if the choice was a carton of ready-to-eat soup versus a sandwich, the comparison is much more difficult; when it comes to making a decision on any two foods versus another set of two foods, then the decision process is exceeded for almost everybody. Another limitation of nutritional labeling is that fresh foods are often not packaged and thus are not labeled for nutritional content. The same is true for meals, snacks outside the home, in bars, restau-rants, canteens, delicatessens, and the like. Notwith-standing the shortcomings, nutrition labeling is a very positive step in helping consumers make informed choices.

Nutrition claims

In general, claims in the field of food and health can be divided in several ways in matrix form. The first division is into claims which are “generic” (any manu-facturer can use it if they meet the criteria) and claims which are “unique,” that is specific to a brand which has some unique attribute on which a claim can be made. In the USA, the Food and Drug Administration (FDA) has favored generic claims such as “saturated fats raise cholesterol” or “calcium helps bone health.” The FDA accepts petitions in this area where industry groupings put forward a scientific case as to why such a generic claim might be used. If accepted, the regula-tor can now decide what the conditions for making a claim are. For example, a typical serving of the food would have to achieve a minimum percentage of some reference value before a claim could be made. A product where a serving size gave 1% of the require-ment for calcium would surely not be allowed to make any claim on bone health.

The other type of claim can be classified into three levels (Table 12.4)

At the time of writing, there are developments in different parts of the world as to how such claims can be handled. As one goes up from level 1 to level 3, the scientific rigor must increase exponentially. Quite probably, level 2 and level 3 will need to be accompa-nied by significant supportive evidence from human dietary intervention studies. Again, such claims will require that certain specified attributes of the food be met before a claim can be made, and different parts of the globe are taking various approaches to these issues. As with many aspects of labeling communica-tion, some reflection will help reveal the complexity of the task. If companies are to innovate and develop new foods with enhanced nutritional properties or functions, they need to invest in research and devel-opment. If their research, industry supporting human intervention studies, shows clear evidence of an effect in lowering the risk of a disease or condition, they need to be able to make that claim and to prevent others who have not done this research from simply adopting that claim. In that way, they stand a chance of developing a market leader and of recouping their research investment. This approach is perfectly under-standable but it does cause problems for smaller com-panies and for industrial sectors in less developed countries for which such high stakes are unthinkable. The terms and conditions for the use of such claims has led to a third area in nutrition communication – nutrition profiling.

Nutrition profiling

This is by far the newest area and without doubt the most controversial. In the EU, the law now requires that for a food to make a claim, it must meet certain nutritional standards. This is often referred to as the Jelly Bean Rule – that is, if you added zinc to jelly beans, would one support the promotion of jelly bean consumption on the grounds that increased zinc intake may assist in minimizing poor immune func-tion. The idea is that if the food supply needs zinc to be added, then a more suitable vehicle needs to be found. In principle this is not complex. In the real world it is an intellectual minefield. In terms of devel-oping nutrient profiles for whatever reason, there are two approaches in operation. One seeks to take a single set of criteria and apply that universally to all foods. This has been the approach of what is called the UK Traffic Light System. All foods are classified into three types, which can be described as good (green), bad (red), or neither (orange). Inevitably, the application of such a simple system to something as complex as the human food chain leads to exceptions. Walnuts might get a red color because of their high fat content, and yet walnuts have been shown along with other nuts to be protective against heart disease. Maybe walnuts are now exceptionally excluded from a red sign. But the process goes on to exceptionally include or exclude and the objectivity of the simple approach becomes gradually replaced with the sub-jectivity of exceptions.

The second nutrient-profiling approach is to take each food category separately and devise nutritional standards for each category. An example of this is the Swedish Keyhole Method. For breads, certain stan-dards are set and breads that meet these standards carry the keyhole symbol, which consumers recognize as a mark of nutritional quality. The huge advantage of this system is that the standards are not universal. One is judging packet soups against packet soups as an example but not against mayonnaise or chocolate or breakfast cereals. At present, the area of nutrition profiling is very much at the development stage and it remains to be seen how exactly this progresses. Besides the use of nutrient profiling for permitting claims, there is interest in its use in deciding signifi-cant nutrition policy issues about individual foods. Advertising of foods is one critically important area where this approach may be applied.