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Salt legislation should include 'traffic light' labels
- Paul Lincoln, Tim Lobstein, Peter Kopelman, Alexander Macara and Philip James. (1 May 2007)
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Salt intake and hypertension in Chile: the need for health interventions
- Vanessa Garcia-Larsen, Victor Zarate, Jorge Jimenez de la Jara (Departamento de Salud Publica, Pontificia Universidad Catolica de Chile) (4 July 2007)
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Paul Lincoln, Chief Executive National Heart Forum WC1H 9LG, Tim Lobstein, Peter Kopelman, Alexander Macara and Philip James.
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The Editor BMJ BMA House Tavistock Square London WC1H 9JR 1 May 2007 Dear Madam, We agree with Francesco Cappuccio that legislation to cut salt levels in processed foods is necessary and justified, and this should include ‘traffic light’ labelling on food products. We are alarmed by the insistence within large parts of the food industry to use what they call Guideline Daily Amounts (GDAs) for their front-of-pack nutrition advice to individual consumers. This flies in the face of the original purpose of population-based recommended nutrition goals and is likely to confuse, not educate, individuals seeking to improve their daily diets. The proposed GDAs are similar to, and partly based upon, the Dietary Reference Values (DRVs) published by the UK Department of Health fifteen years ago (1). However, the DRVs were explicitly cast in the form of a range of intakes (upper and lower values) designed to encompass the needs of most of the population, in order to avoid the problem found with previous tables of recommended amounts which, as the Department noted at the time, “were often used – wrongly – to assess the adequacy of the diet of an individual” (p1). By using single-value GDAs the food industry is repeating and compounding the original error. The use of such targets on food labels, in a format designed to encourage individuals to assess their intakes, is an abuse of the purpose of population targets and may create unnecessary anxiety in people who are eating diets that are perfectly appropriate for their needs. A significant proportion of a population will, by definition, fall below a specific target even when that population as a whole is achieving the target. Perversely, in such instances, the labelling could encourage some members of the population to alter their diets to the detriment of their health. Furthermore, we fear that the use of GDAs creates confusion between upper and lower levels of nutrients. Under the industry scheme, labels show the percentage of a GDA provided by a serving of the food, using identical presentations for dietary fibre and micronutrients (for which more is usually better) as they show for salt, sugars and saturated fats (for which less is generally better). Again, compliance with an implied need to meet 100% of all Guideline Amounts could lead many individuals to increase their consumption of salt, sugars and saturated fats. We are concerned that the use of GDAs by certain parts of the food industry will confuse consumers because it conflicts with the simple and understandable traffic light labelling recommended by the Food Standards Agency. The traffic light labelling has already been adopted by several producers and retailers. What is essential is consistency of messages that are easily comprehensible to every element of society. The failure to deliver consistent nutrition signposting on a voluntary basis will argue strongly for mandatory ‘traffic light’ labels. Yours faithfully, Paul Lincoln, Chief Executive, National Heart Forum,
1. Department of Health. Dietary Reference Values: A Guide. London: HMSO, 1991. Competing interests: None declared |
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Vanessa Garcia-Larsen, Post-Doctoral Research Associate NHLI, Imperial College London, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK, Victor Zarate, Jorge Jimenez de la Jara (Departamento de Salud Publica, Pontificia Universidad Catolica de Chile)
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Hypertension affects 33.7% of Chileans above 17 years old and increases to 53.7 % in those aged 45 to 64 years old [1]. Over half of the population presents some level of overweight. The same proportion has two or more risk factors for cardiovascular diseases, the leading cause of death in Chile (28% of all deaths in 2004) [2]. As Cappuccio points out in his editorial [3], it is estimated that only 20% of salt intake in developed countries comes from discretionary use. At present there are no accurate data on salt intake at a national level in Chile, but estimations suggest that the average consumption is around 10g/d [4]. Although Chile is still a developing country, its nutritional and epidemiological profiles are comparable to most European countries. Consumption of processed foods, carbohydrates and saturated fats accounts for a large percentage of the total daily energy intake, and it is likely that purchased foods and meals may account for over 70% of the daily intake of salt. The efforts of the Chilean Ministry of Health to reduce consumption of salt have been mirrored in the Educative Guidelines for a Health Life launched in 2005 [5]. Through this initiative the population is encouraged to reduce the amount of salt used in their meals and to check the labels of the foods before buying them. However, this has limitations, as salt- reduction recommendations alone are unlikely to have an impact in the population. In addition, lack of information on the labelling of foods remains a main hindrance, and many individuals choose foods unaware of their high content of sodium. Keeping in line with one of Cappuccio’s proposals, Finland and Norway have introduced a number of legal initiatives to protect consumers (e.g. legal taxation/subsidising of foods with high and low content of salt, respectively, and declaration of salt content in foods). The British Foods Standards Agency has started a campaign in the UK to reduce salt intake to 6g/day. Several large food manufacturers and public health organisations are participating, aiming at reducing salt levels in 85 food categories that contribute most to the amount of salt in the British diet. At present, there are commitments to cut the content of salt in bread and soups by 30%. In Chile, the Ministry of Health’s Advisory Committee on Diet and Nutrition has recently acknowledged the need for a strategic liaison with the food industry to create healthier food options [6]. Taking on board the current figures of cardiovascular diseases, and the high economic and social cost they involve for the country, it seems urgent to introduce measures to lower the current consumption of salt in the general population. A joint campaign with the collaboration of food manufacturers would be a good start. In addition, the introduction of a public health policy by which certain foods should not have more than a set amount of salt seems advisable. In August 2006, the burden of diet-related non communicable chronic diseases, including hypertension and high intake of salt and was addressed in the Chilean Senate [4]. The need for actions was widely acknowledged by the members of the Parliament and the Minister of Health welcomed the idea of a better legislation to protect the consumers, including the labelling of foods. Due to the magnitude and impact that hypertension has in the population, it seems appropriate to endeavour a legislation on this matter. References [1] Ministry of Health, Chile. Report on the First Chilean National Health Survey 2003. Available on: http://epi.minsal.cl/epi/html/invest/ENS/InformeFinalENS.pdf [2] Ministry of Health, Chile. Mortality for cardiovascular diseases in males and females 1990-2004. Accessed on 02/06/2007 http://deis.minsal.cl/deis/salidas06/mortalidad.asp?temp=CARDIO_9004.htm [3] Cappuccio FP. Salt and cardiovascular disease. BMJ 2007; 334: 859 -60. [4] Uauy R. The problem of obesity in Chile. Special session in the Parliament. 2006. http://www.senado.cl/prontus_senado/site/extra/sesiones/pags/fset/diar/21060811182410.html [5] Ministry of Health, Chile. Commission “Life Chile”. Educative guidelines for a healthy life. Guidelines on food intake, physical activity and tobaco 2005. Report No 76 [6] Araya H, Atalah E, Benavides M, et al. Food and nutrition interventions priorities in Chile. Rev Chil Nutr 2006; 33: 458-63 Competing interests: None declared |
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