Salt and cardiovascular disease

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,

Dr Tim Lobstein, International Association of Consumer Food Organizations,

Prof Peter Kopelman, Dean, Faculty of Health, University of East Anglia,

Sir Alexander Macara, Chairman, National Heart Forum,

Prof WPT James, London School of Hygiene and Tropical Medicine.

1. Department of Health. Dietary Reference Values: A Guide. London:
HMSO, 1991.

Competing interests:
None declared