Nutrition profiling: ‘Good’ Food; a ‘Bad’ Concept? 1. What is a Balanced Diet? The concept of a balanced diet is based on the premise that an individual’s daily, or more realistically weekly, food intake should ‘balance’ so as to include all the elements that the human body needs in terms of macro-nutrients (protein, fat and carbohydrate) and micro-nutrients (vitamins and minerals). Balance also means eating these nutrients in the right proportions and not eating too much of any one of them. No single food can provide all the essential nutrients needed by an individual and foods differ significantly in the amounts of nutrients they contain. Indeed, individual foods will vary markedly in their nutrient content. Cheese, for example, is high in fat, calcium, protein and salt; but low in vitamin C and fibre. In contrast, fruit is low in fat, calcium, protein and salt; but high in vitamin C and fibre. Taken together, however, these two foods can provide a good range and balance of nutrients. By extending this approach, it becomes evident why nutritionists encourage consumers to eat a wide range of foods. Many nutrition experts and dietitians believe that categorising foods as ‘good’ or ‘bad’ is contrary to the concept of a balanced diet and would not be helpful to consumers. Such categorisation has also been suggested as a means of restricting advertising of certain foods, especially to children and for pre-vetting of foods which can carry health claims or have nutrients added to them. Leaving aside the practicalities of implementing such a system, undesirable consequences of such labelling might include: Foods which are ‘blacklisted’ being considered undesirable by consumers and so unwisely discourage the consumption of a wide range of foods and consequential reduction in micro-nutrient intakes. o For example, because of its fat and salt content, cheese might be placed in a ‘less healthy’ category. In the overall diet, however, cheese provides much calcium and protein, as well as other essential nutrients such as vitamin A and B vitamins. o Similarly, some children’s breakfast cereals might be deemed too high in sugar and/or salt; yet they contribute much iron and folic acid to the diet. Iron, calcium and folic acid are all considered to be vulnerable nutrients, which recent dietary surveys have shown to be in short supply in many people’s diets, particularly teenage girls and young women. Some individuals feeling that consuming any ‘treat’ foods, labelled as ‘less healthy’, is wrong. This could lead to feelings of guilt, which could trigger disordered eating behaviour. Indeed, a new and growing eating disorder has been identified termed orthorexia nervosa, where sufferers become obsessed with only eating healthily and they feel compelled to eat in only a very controlled way. Experts have warned that the focus on ‘good’ and ‘bad’ foods is problematic and fuels an increasingly neurotic relationship with food in modern western society 2. Perversely, increased demand for ‘blacklisted’ products, as a reaction against prohibition. Individuals have differing nutrient needs (‘One man’s meat is another man’s poison’) Another problem of defining whether a food is ‘healthier’ or ‘less healthy’ is that people vary: an ‘ideal’ diet for one person will not suit everyone else. Dietitians are increasingly aware that many patients, in hospitals and in their outpatient clinics, are underweight and require building up. For such individuals, a low fat/sugar diet is not desirable. Similarly, some children and the elderly have small appetites and therefore cannot achieve sufficient calories with the bulk of a low energy dense diet. Athletes and sportsmen also require a high calorie diet which necessitates eating some calorie dense foods (which would be high in fat/sugar). To advise such groups to consume foods stigmatised as ‘unhealthy’ would be counter intuitive. Trying to classify a food according to a set of general nutrient profiles is not going to be appropriate for everyone. 3. Experience with nutrition profiling of foods ‘Profiling’ is the setting of levels for a range of specified nutrients, typically ‘high’, ‘medium’ and ‘low’ for salt, fat and sugar. These criteria are then used to assess an individual food in terms of its composition. If the food falls outside the profile for any one of the specified nutrients, because its content exceeds the maximum level set, it is deemed to have ‘failed’ and therefore to be ‘less healthy’. In Annex X, examples are given of products which have been labelled according to a scheme currently used by a UK retailer. These examples serve to show how nutrient profiling results in a range of value judgements (high, medium and low) for the nutrient content of a single food. It is, however, unclear how this information is intended to be interpreted, and more importantly will be interpreted by consumers, in considering the contribution which the food would make to their diet if consumed. An extension of this approach is the ‘traffic lights’ concept (with red indicating a ‘high’ level of the specified nutrient, amber ‘medium’ and green ‘low’) where each nutrient chosen to be ‘profiled’ will be apportioned an appropriately coloured ‘spot’). Annex Y includes examples of this type of labelling. Such a scheme is very misleading as it 2 bases the decision on how the various nutrients fair in that food by assuming that this one food makes up the whole day’s diet. This is not how people eat, and one food cannot possibly be deemed as ideal. Indeed a day’s diet which was made up of all foods carrying only green traffic lights would probably be deficient in calories and many other nutrients. Dr Mike Rayner recently presented a profiling model for defining ‘unhealthy food’ as a means of deciding which foods could or could not be advertised to children: this was based on the FSA criteria of what constitutes ‘a lot’ (anything over one fifth of the Guideline Daily Amount (GDA)). This model ruled out most sources of iron-rich food and a variety of foods supplying several other vulnerable micronutients. It also ruled out most energy dense foods, leaving only foods with a low energy density. 80% of children are not overweight or obese, and some have high energy needs which cannot be met by a bulky diet which has a low energy density. The DH What counts? group is also trying to establish criteria that would allow composite foods to carry the ‘5-a-Day’ logo. The proposed profile was tested on a wide range of composite foods containing fruit and vegetables. Only 10% of these foods ‘passed’: even fruit juice and canned fruit in natural juice failed and so neither would have been eligible to carry the logo. Consequently, the profiling was ‘fudged’ to allow these foods to be included in the scheme, presumably because they were somehow judged to be ‘good’ and their consumption desirable. The two schemes above also fail to acknowledge any positive attributes of a food, such as its micronutrient content; fail to take account of the amount of the food that is consumed; and the frequency of consumption of that food. For example a high fat food that is seldom eaten is not going to contribute to the national obesity problem. At the end of last year, a consultant (Lynn Stockley) was appointed by FSA to compare several different profiling criteria that had been developed in various countries. The different methods of profiling resulted in completely different lists of which foods ‘passed’ or ‘failed’, thus demonstrating the real practical difficulty of devising a system that is objective and useful. This difficulty arises from the fundamental flaw in assuming that an individual food, rather than an individual’s diet, can be categorised as ‘good’ or ‘bad’, ‘healthier’ or ‘less healthy’. The British Dietetic Association has a mantra: ‘all food fits’ - i.e. all food can be considered as part of a healthy balanced diet. 4. Other arguments against classifying foods as ‘good’ or ‘bad’ Different countries also have varying ideas on what constitutes a healthy diet, for example the percentage of energy that should come from fat or sugar. Different cultures have differing ideas about which foods are, or are not, important. It would be quite wrong and insensitive to deem a food that is important in a particular culture as being ‘bad’. 3 Some foods require a certain level of salt/sugar so that they are microbiologically safe. Some foods made to a recipe that is traditional, or prescribed in law, need set levels of certain nutrients so that they can comply with that recipe. It is not simply the food’s composition that needs to be considered in determining its contribution to an individual’s diet, but also the amount consumed – and the frequency of consumption. Raisins have a sugars content of 70g/100g, but make a negligible contribution to most people’s dietary intake. Fat criteria could be misleading if they resulted in the following foods being deemed to be ‘bad’ and claims for other nutrient were thereby disallowed: 1. whole milk could not claim its calcium content 2. olive oil could not state that it is a good source of vitamin E or that it has benefits for heart health 3. spreading fats could not make claims of any sort, including those margarines that help to reduce cholesterol levels 4. marbled beef could not claim its iron content 5. nuts, because of their high fat content, could not indicate that they have heart health properties Imposing strict nutrient criteria on foods may reduce the incentive to industry to try and modify the composition of their products. If the alternate product is still deemed to be ‘bad’, there would be no opportunity to draw attention to a modest but nutritionally significant change in, say, the fat content. Any cut off point for a food to be deemed ‘healthier’ or ‘less healthy’ is likely to be arbitrary. If the fat criterion is set at 20g per 100g, a product with a fat content of 20.1 g would be deemed less healthy than one that has a fat content of 19.5g. Conclusion FDF questions the merits, in terms of the benefit to consumers in assessing and balancing their diets, of a subjective system of nutrition profiling whereby individual foods might be perceived by consumers as ‘good’ or ‘bad’. 4 Annex X Example Food Labels Nutrition Product 1 (Typical Values per 100g): Energy Value 110kg (25 kcal), Protein 1g MEDIUM, Carbohydrate 5g MEDIUM (of which Sugars 5g HIGH), Fat 0.3g LOW (of which Saturates 0.1g LOW), Fibre 7g HIGH, Sodium Trace g LOW Product 2 (Typical Values per 100g): Energy Value 140kj (35 kcal), Protein 4g HIGH, Carbohydrate 2g LOW (of which Sugars 2g MEDIUM), Fat 0.9g MEDIUM, (of which Saturates 0.2g MEDIUM), Fibre 3g HIGH, Sodium Trace g LOW Product 3 (Typical values 100g): Energy Value 60kj (15kcal), Protein 0.8g MEDIUM, Carbohydrate 2g MEDIUM (of which Sugars 2g HIGH), Fat 0.5g MEDIUM (of which Saturates 0.1g LOW) Fibre 1g HIGH, Sodium Trace g LOW Product 4 (Typical values 100g): Energy Value 70kj (20kcal), Protein 0.7g MEDIUM, Carbohydrate 3g MEDIUM, (of which Sugars 3g HIGH) Fat 0.3g LOW, (of which Saturates 0.1g MEDIUM), Fibre 1g HIGH, Sodium 0.1g HIGH, Salt Nil g Product 5 (Typical values 100g): Energy Value 610kj (150kcal), Protein 13g HIGH, Carbohydrate Trace g LOW (of which Sugars Trace g LOW), Fat 11g HIGH (of which Saturates 3g HIGH), Fibre Nil g, Sodium 0.1g MEDIUM Products: 1 – Raspberries 2 – Broccoli 3 - Lettuce 4 – Plum Tomatoes 5 – Eggs – NB the front of the box labels eggs as having no Salt (the nutritional info inside says 0.1g/100g) 5 Annex Y Examples of Traffic Light Labelling The table below shows the high, medium and low values for specific nutrients according to the Coronary Prevention Group’s (CPG) Nutrition Banding Scheme. Nutrient Total Sugar (%) Total Fat (%) Saturated Fat (%) Total Salt (g/10MJ) Population Dietary Goal 17 33 10 6 Low <8.5 <16.5 <5 <3 Medium 8.5 to 25.5 16.5 to 49.5 5 to 15 3 to 9 High >25.5 >49.5 >15 >9 This table outlines the percentage sugar, total fat and saturated fat content of 4 foods or food products and their salt content in g per 10MJ. Product Sugar (%) Total Fat (%) Sat. Fat (%) Salt (g/10MJ) Broccoli Chinese Chicken and cashew nuts Sundried Tomato Risotto with chargrilled chicken 22.8 MED 23.8 MED 5.3 MED Trace LOW 12.4 MED 45.8 MED 10.8 MED 22.12 HIGH 13.4 MED 16.7 MED 3.2 LOW 10.7 HIGH Organic Falafels 8.7 MED 42.2 MED 4 LOW 16.29 HIGH Wholemeal Bread Rolls 2.5 LOW 23.08 MED 12.6 MED 10.09 HIGH Orange Juice 77.8 HIGH 0g LOW 0g LOW 0g LOW Broccoli Sugar Total Fat Sat’ Fat Salt Fat Nutrition Information (Typical Values per 100g): Energy Value 140kj (35kcal), Protein 4g HIGH, Carbohydrate 2g LOW (of which Sugars 2g MEDIUM), Fat 0.9g MEDIUM, (of which Saturates 0.2g MEDIUM), Fibre 3g HIGH, Sodium Trace g LOW 6 Chinese Chicken and Cashew nuts Sugar Total Fat Sat’ Fat Salt Fat Nutrition Information Typical Composition Energy Protein Carbohydrate Of which sugars Fat Of which saturates Mono-unsaturated Polyunsaturated Fibre Sodium This pack (350g) provides 1582kj 378kcal 33.3g 17.2g 12.3g 19.6g 4.6g 11.9g 2.5g 2.1g 1.5g 100g (3.50z) provide 452kj 108kcal 9.5g 4.9g 3.5g 5.6g 1.3g 3.4g 0.7g 0.6g 0.4g A serving (350g) contains the equivalent of approx. 3.9g of salt 7 Sundried Tomato Risotto with Chargrilled Chicken (weight reduction eating range) Sugar Total Fat Sat’ Fat Salt Fat Nutrition information Typical Values Energy kj kcal Protein g Carbohydrate g Of which sugars g Fat Of which saturates Fibre g Sodium g Equivalent as salt Per 100g Per 330g Pack 465 110 6.3 16.6 3.9 2.1 0.4 0.9 0.18 0.5 1535 365 20.8 54.8 12.9 6.9 1.3 3.0 0.60 1.7 8 Organic Falafel Sugar Total Fat Sat’ Fat Salt Fat Nutrition Information Energy Protein Carbohydrate Of which sugars Fat Of which saturates Dietary Fibre Sodium Salt Per 100g 921kj 220kcal 8.0g 23.3g 5.0g 10.5g 1.0g 7.6g 0.6g 1.5g Per falafel (25g) 230kj 55kcal 2.0g 5.8g 1.3g 2.6g 0.3g 1.9g 0.2g 0.5g 9 Wholemeal Bread Rolls Sugar Total Fat Sat’ Fat Salt Fat Nutritional Information Typical Values Per 100g Per Roll 1090 260 11.9 37.4 1.7 6.8 3.7 4.4 0.45 1.1 810 190 8.8 27.7 1.2 5.1 2.7 3.3 0.34 0.8 Energy kj kcal Protein g Carbohydrate g Of which sugars g Fat Of which saturates Fibre g Sodium g Equivalent as salt Orange Juice Sugar Total Fat Sat’ Fat Salt Fat Nutritional Information (Typical Values per 100ml): Energy Value 185kj (43kcal), Carbohydrate 9g (of which Sugars 9g) NB – it is considered that all sugar in fruit juice products are extrinsic. Therefore orange juice contains 73% NMES (well above the 10% population dietary goal). 10 Points to Note Whole milk (3.9% fat by weight) would be classed as “high fat” as it is 53% energy from fat. But this is the same as clotted cream (63.5% fat by weight and 97% energy from fat) and butter (81.7% fat by weight and 99% energy from fat). Orange juice would have to be labelled “high NMES” as it is only 8.8% sugars by weight but 96% energy from NMES. This would be the same “high NMES” label as full sugar jam (which is 69% NMES by weight and 99% energy from NMES) and reduced sugar jam (31.9% NMES by weight and 97% energy from NMES). The traffic light labelling for orange juice would also be identical to that of most sugar sweetened drinks. Worked Examples Method of calculating for fat and sugar (based on CPG scheme) Conversion Factors (g to kJ): Sugar Fat 16 kJ/g 37 kJ/g 3.75 kcal/g 9 kcal/g % energy (kJ/100kJ) = fat/sugar (g/100g) x Conversion factor (kJ/g) for fat and sugar Energy (kJ/100g) x 100 Worked example for sugar in Broccoli: [(2 x 16) / 140] x 100 = 22.8% (MEDIUM) Method of calculating for salt (based on CPG scheme) salt (g/10MJ) = salt (g/100g) energy (MJ/100g) x 10 Worked example for salt in organic falafels: NB – energy needs to be converted from kJ to MJ, do this by dividing by 1000 (1.5 / 0.921) x 10 = 16.29 g/10MJ 11