Historic, Archive Document
Do not assume content reflects current scientific knowledge, policies, or practices.
TX360 .U6U54 1977a
PREPARED BY THE STAFF OF THE
SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDS UNITED STATES SENATE
FEBRUARY 1977
Printed for the use of the Select Oommittee on Nutrition and Human Needs
U.S. GOVERNMENT PRINTING OFFICE 81-«)5 O WASHINGTON : 1977
For sale by the Superintendent of Documents. U.S. Government Printing Office Washington, D.C. 20402 - Price 95 cents Stock No. 052-070-03913-2
National Agricultural Library
' COMMITTEE ON NDTBITION ANB HUMAN NEEDS
EDWARD M KBNNFnv M. 1. . CHARLES H. PERCY, lUlnols
GAYLORD NELSON w^iTr ^'"' ^^^^^ ^^^'^^
ALAN CRANSTON, CaWorZ ^r™"*^ BELLMON, Oklahoma
HUBERT H. HUMPHREY, Minnesota S^^.'^H^AxS'^fe^.^f
Alan J. Stone, staff Director Marshall L. Matz, General Counsel
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Document Delivery Services Branch USDA. National Agricultural Library Nal BIdg.
10301 Baltimore Blvd. Beltsville. MD 20705-2351
CONTENTS
Page
Foreword v
Statement of Senator George McGovern on the publication of Dietary Goals
for the United States 1
Statement of Dr. D. M. Hegsted, professor of nutrition, Harvard School
of Public Health, Boston, Mass 3
Statement of Dr. Beverly Winikoff, Rockefeller Foundation, New York,
N.Y 5
Statement of Dr. Philip Lee, professor of social medicine and director,
Health Policy Program, University of California, San Francisco, Calif-- 7 Part I. Dietary goals for the United States :
Introduction 9
U.S. dietary goals 12
The goals suggest the following changes in food selection and
preparation 13
Explanation of goals :
Goal 1. Increase carbohydrate consumption to account for approxi- mately 55 to 60 percent of the energy (caloric) intake 14
Heart disease 17
Diabetes 18
Fiber . 18
Vitamin and mineral sources 18
Obesity 20
Guide to increasing complex carbohydrate consumption 20
1. Fruit and vegetables 20
Refinement 22
2. Grain products 24
Conserving resources - 27
Selecting grain products 27
Goal 2. Reduce overall fat consumption from approximately 40 to
30 percent of energy intake 30
Obesity 32
Cancer 33
Goal 3. Reduce saturated fat consumption to account for about 10 percent of total energy intake ; and balance that with poly- unsaturated and monounsaturated fats, which should account
for about 10 percent of energy intake each 35
Heart disease 35
Goal 4. Reduce cholesterol consumption to about 300 mg. a day 37
Guide to reducing consumption of fat, saturated fat and cho- lesterol , 37
Goal 5. Reduce sugar consumption by about 40 percent to account
for about 15 percent of total energy intake 43
Nutrient danger 44
Diabetes 45
Tooth decay „ 45
Guide to reducing sugar intake 45
Goal 6. Reduce salt consumption by about 50 to 85 percent to about
3 gram/day 48
Hypertension 49
Other findings 49
Guide to reducing salt consumption 50
Effects of goals beyond nutritional concerns 52
1. Sociocultural implications 52
2. Food budget 54
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IV
Part I. Dietary goals for the United States — Continued Effects of goals beyond nutritional concerns — Continued
Page
Consumption of food additives 55
Nitrates and nitrites 56
BHT and BHA 56
Monosodium glutamate 56
Part II. Recommendations for governmental action :
Introduction , 57
U.S. experience 58
The impact of television food advertising 59
Advertising and low-income consumers 63
Lack of nutrition information 64
Recommendations 65
Bibliography „ 67
Appendixes :
A. Benefits from human nutrition research 71
B. Recommendation of 15 expert committees on dietary fat and coro-
nary heart disease 75
C. State of knowledge on nutritional requirements 76
D. Letter from T. W. Edminster, Administrator, Agricultural Research
Service, U.S. Department of Agriculture 77
FOREWORD
The purpose of this report is to point out that the eating patterns of this century represent as critical a public health concern as any now before us.
We must acknowledge and recognize that the public is confused about what to eat to maximize health. If we as a Government want to reduce health costs and maximize the quality of life for all Americans, we have an obligation to provide practical guides to the individual consumer as well as set national dietary goals for the country as a whole.
Such an effort is long over-due. Hopefully, this study will be a first major step in that direction.
I would like to thank Mr. Nick Mottern of the Committee staff for his extraordinary effort and the high degree of professionalism he used in the preparation of this publication.
George McGovern,
Chairman.
In addition to acting as a practical guide to promote good eating habits, this report, hopefully, will also serve as a catalyst for Govern- ment and industry action to facilitate the achievement of the recom- mended dietary goals. Without Government and industry commit- ment to good nutrition, the American people will continue to eat themselves to poor health. Government and industry have a responsi- bility to respond to the findings of the report. Action is needed to de- termine how chanofes can be made regarding the content of nutritional information provided to the public ; the kinds of foods produced ; how foods are processed and advertised ; and the selection of foods offered by eating establishments. Our national health depends on how well and how quickly Government and industry respond.
Charles H. Percy, Ranking Minxyrity Member.
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[Press Conference, Friday, January 14, 1977, Room 457, Dirksen Senate Office
Building]
STATEMENT OF SENATOR GEORGE McGOVERN ON THE PUBLICATION OF DIETARY GOALS FOR THE UNITED STATES
Good morning.
The purpose of this press conference is to release a Nutrition Com- mittee study entitled Dietary Goals jov the United States^ and to ex- plain why ^Ye need such a report.
I should note from the outset that this is the first comprehensive statement by any branch of the Federal Government on risk factors in the American diet.
The simple fact is that our diets have changed radically within the last 50 years, with great and often very harmful effects on our health. These dietary changes, represent as great a threat to public health as smoking. Too much fat, too much sugar or salt, can be and are linked directly to heart disease, cancer, obesit3% and stroke, among other killer diseases. In all, six of the ten leading causes of death in the LTnited States have been linked to our diet.
Those of us within Government have an obligation to acknowledge this. The public wants some guidance, wants to know the truth, and hopefully today we can lay the cornerstone for the building of better health for all Americans, through better nutrition.
Last year every man, woman and child in the United States con- sumed 125 pounds of fat, and 100 pounds of sugar. As you can see from our displays, that's a formidable quantity of fat and sugar.
The consumption of soft drinks has more than doubled since 1960 — displacing milk as the second most consumed beverage. In 1975, we drank on the average of 295, 12 oz. cans of soda.
In the early 1900's, almost 40 percent of our caloric intake came from fruit, vegetables and grain products. Today only a little more than 20 percent of calories comes from these sources.
My hope is that this report will perform a function similar to that of the Surgeon General's Report on Smoking. Since that report, we haven't eliminated the hazards of smoking, nor have people stopped smoking because of it. But the cigarette industry has modified its products to reduce risk factors, and many people who would otherwise be smoking have stopped because of it.
The same progress can and must be made in matters of nutritional health, and this report sets forth the necessary plan of action:
1. Six basic goals are set for changes in our national diet ;
2. Simple buying guides are recommended to help consumers at- tain these goals : and
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3. Recommendations are also made for action within Govern- ment and industry to better maximize nutritional health.
I hope this report will be useful to millions of Americans. In addi- tion to providing simple and meaningful guidance in matters of diet, it should also encourage all those involved with growing, preparing, and processing food to give new consideration to the impact of their de- cisions on the nation's health. There needs to be less confusion about what to eat and how our diet affects us.
With me this morning are three of the country's leading thinkers in the area of nutritional health. They have very graciously assisted the staff of the Select Committee in the preparation of this report. They will explain in greater detail its purpose and goals.
First, Dr. Mark Hegsted, Professor of Nutrition from the Harvard School of Public Health. Dr. Hegsted has a long and distinguished career in science, bringing conscience as well as great expertise to his work. Dr. Hegsted has worked very closely and patiently with the committee staff on this report, devoting many hours to review and counseling. He feels very strongly about the need for public educa- tion in nutrition and the need to alert the public to the consequences of our dietary trends. He will discuss these trends and their connec- tion with our most killing diseases.
Following his presentation. Dr. Beverly Winikoff of the Rocke- feller Foundation will discuss the changes necessary in food mar- keting and advertising practices if the consumer is to make more healthful food choices. Dr. Winikoff, who with Dr. Hegsted and Dr. Lee testified at our hearings in July, has also been extremely helpful in assisting: the committee staff in preparing this report.
Dr. Philip Lee, the Director of the Health Policy Program at the University of California in San Francico, and and a former Assistant Secretary for Health, will conclude our presentation with a dis- cussion of the costs of our current dietary trends. Dr. Lee has also consulted with the committee staff on this report and has offered much encouragement.
Before Dr. Hegsted begins, I would also like to note that the staff has also received valuable assistance from Dr. Sheldon Margen, a nutritionist with the University of California in Berkeley, who is traveling outside the country today.
I want to thank each of these people personally for their help and their spirted concern for the public interest.
The Committee will continue its investigation into the connection between diet and health on February 1 and 2, when hearings will be held concentrating on problems of diet and heart disease and obesity.
After the presentation today we will be glad to answer questions.
[Press Conference, Friday, January 14, 1977, Room 457, Dirksen Senate Office Building]
STATEMENT OF DR. D. M. HEGSTED, PROFESSOR OF NUTRITION, HARVARD SCHOOL OF PUBLIC HEALTH, BOSTON, MASS.
The diet of the American people has become increasingly rich — rich in meat, other sources of saturated fat and cholesterol, and in sugar. There will be people who will contest this statement. It has been pointed out repeatedly that total sugar use has remained rela- tively constant for a number of years. We would emphasize, however, that our total food consumption has fallen even though we still eat too much relative to our needs. Thus, the proportion of the total diet contributed by fatt}- and cholesterol-rich foods and by refined foods has risen. We might be better able to tolerate this diet if we were much more active physicaDy, but we are a sedentary people.
It should be emphasized that this diet which affluent people gen- erally consume is everywhere associated with a similar disease pat- tern— high rates of ischemic heart disease, certain forms of cancer, diabetes, and obesity. These are the major causes of death and dis- ability in the United States. These so-called degenerative diseases ob- viously become more important now that infectious diseases are, rel- atively speaking, under good control. I wish to emphasize that these diseases undoubtedly have a complex etiology. It is lut correct, strictly speaking, to say that they are caused by malnutrition but rather that an inappropriate diet contributes to their causation. Our genetic make- up contributes — not all people are equally susceptible. Yet those who are genetically susceptible, most of us, are those who would profit most from an appropriate diet. Diet is one of the things that we can change if we want to.
There will undoubtedly be many people who will say we have not proven our point ; we have not demonstrated that the dietary modifi- cations we recommend will yield the dividends expected. We would point out to those people that the diet we eat today was not planned or developed for any particular purpose. It is a happenstance related to our affluence, the productivity of our farmers and the activities of our food industry. The risks associated with eating this diet are demon- strabl}^ large. The question to be asked, therefore, is not why should we change our diet but why not? What are the risks associated with eating less meat, less fat, less saturated fat, less cholesterol, less sugar, less salt, and more fruits, vegetables, unsaturated fat and cereal prod- ucts— especially whole grain cereals. There are none that can be iden- tified and important benefits can be expected.
Ischemic heart disease, cancer, diabetes and hypertension are the diseases that kill us. They are epidemic in our population. We cannot afford to temporize. We have an obligation to inform the public of the current state of knowledge and to assist the public in^ niaking the correct food choices. To do less is to avoid our responsibility.
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[Press Conference, Friday, January 14, 1977, Room 457, Dirksen Senate Office Building]
STATEMENT OF DR. BEVERLY WINIKOFF, ROCKEFELLER FOUNDATION, NEW YORK, N.Y.
What are the implications of these dietary goals ?
The fact that the goals can be stated in nutritional terms first and then mirrored in a set of behavioral changes impels a closer look at why Americans eat the way they do. T\rhat people eat is affected not only by what scientists know, or by w^hat doctors tell them, or even by what they themselves miderstand. It is affected by Government deci- sions in the area of agricultural policy, economic and tax policy, export and import policy, and involves questions of good production, transportation, jjrocessing, marketing, consumer choice, income and education, as well as food availability and palat ability, ^^'utrition, then, is the end result of pushes and pulls in many directions, a response to the multiple forces creating the "national nutrition environment."
Even "personal dietary preferences" are not immutable but interact with other forces in the environment and are influenced by them. People learn the patterns of their diet not only from the family and its sociocultural background, but from what is available in the market- place and what is promoted both formally through advertising and informally through general availability in schools, restaurants, super- markets, work places, airports, and so forth.
It is generally recognized with regard to the overall economic cli- mate that both Avhat the Government does do and what it does not do shape the arena in which other forces interact. This is also true with regard to nutrition. In determining the parameters of the socio- economic system. Government also determines the nature of the na- tional buffet. Government policy, then, must be made with full aware- ness of this responsibilit}^
It is increasingly obvious that if new knowledge is to result in new behaviors then people must be able to act, without undue obstacles, in accordance with the information that they learn. The problem of edu- cation for health as it has been practiced is that it has been in isola- tion, not to say oblivion, of the real pressures, expectations, and norms of society which mold and constrain individual behavior. There must be some coordination between what people are taught to do and what they can do. Part of the responsibility for this coordination rests with the Government's evaluation and coordination of its own activities. Effective education must be accompanied by Government policies which make it easier, indeed likely, that an individual will change his or her lifestyle in accordance with the information offered.
At present, we see a situation in which the opposite is often the case. Nutrition and health education are offered at the same time as barrages of commercials for soft drinks, sugarv^ snacks, high-fat foods, ciga- rettes and alcohol. We put candy machines in our schools, serve high-
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fat lunches to our children, and place cigarette machines in our work places. The American marketplace provides easy access to sweet soft drinks, high-sugar cereals, candies, cakes, and high-fat beef, and more difficult access to foods likely to improve national nutritional health.
This trend can be reversed by specific agricultural policies, pricing policies, and marketing policies, as well as the recommendations out- lined in these "Dietary Goals for the United States."
In general, Americans have quite accurate perceptions of sound nutritional principles, as was demonstrated recently by a Harris poll conducted for the Mount Sinai Hospital in Chicago. However, people do lack understanding of the consequences of nutrition-related dis- eases. There is a widespread and unfounded confidence in the ability of medical science to cure or mitigate the effects of such diseases once they occur. Appropriate public education must emphasize the unfor- tunate but clear limitations of current medical practice in curing the common killing diseases. Once hypertension, diabetes, arteriosclerosis of heart disease are manifest, there is, in reality, very little that medical science can do to return a patient to normal physiological function. As awareness of this limitation increases, the importance of prevention will become all the more obvious.
But prevention is not possible solely through medical interventions. It is the responsibility of government at all levels to take the initiative in creating for Americans an appropriate nutritional atmosphere — one conducive to improvement in the health and quality of life of the American people.
[Press Conference, Friday, January 14, 1977, Room 457, Dirksen Senate Office Building]
STATEMENT OF DR. PHILIP LEE, PROFESSOR OF SOCIAL MEDICINE AND DIRECTOR, HEALTH POLICY PRO- GRAM, UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, CALIF.
The publication of Dietary Goals for the United States by the Sen- ate Select Committee on Nutrition and Hmnan Needs is a major step forward in the development of a rational national health policy. The public health problems related to what we eat are pointed out in Dietary Goals. More important, the steps that can and should be taken by individuals, families, educators, health professions, industry and Government are made clear.
As a Nation we have come to believe that medicine and medical technology can solve our major health problems. The role of such im- portant factors as diet in cancer and heart disease has long been ob- scured by the emphasis on the conquest of these diseases through the miracles of modern medicine. Treatment not prevention, has been the order of the day.
The problems can never be solved merely by more and more medical care. The health of individuals and the health of the population is determined by a variety of biological (host), behavioral, sociocultural and environmental factors. None of these is more important than the food we eat. This simple fact and the importance of diet in health and disease is clearly recognized in Dietary Goals for the United States.
The Senate Select Committee on Nutrition and Human Needs has made four recommendations to encourage the achievement of the very sound dietary goals incorporated in the report. These are :
1. a large scale public nutrition education program involving the schools, food assistance programs, the Extension Service of the Department of Agriculture and the mass media;
2. mandatory food labeling for all foods ;
3. the development of improved food processing methods for institutional and home use ; and
4. expanded federal support for research in human nutrition. It is important that Dietary Goals for the United States be made
widely available because it is the only publication of its kind and it will be an invaluable resource for parents, school teachers, public health nurses, health educators, nutritionists, physicians and others who are involved in providing people with information about the food they eat.
The recommendations, if acted upon promptly by the Congress, can help individuals, families and those responsible for institutional food services (schools, hospitals) be better informed about the consequences of present dietary habits and practices. Moreover, they provide a prac- tical guide for action to improve the unhealthy situation that exists.
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The effective implementation of the Senate Select Committee recom- mendations and the proposed dietary goals could have profound health and economic benefits. Not only would many people lead longer and healthier lives but the reduced burden of illness during the working lives of men and women would reduce the cost of medical care and increase productivity.
What can be done to assure sustained and effective action on these recommendations? First, the Congress can act to appropriate the needed funds for the proposed programs. In some instances, such as mandatory food labeling, it must also enact the authorizing legisla- tion. Second, the new Secretaries of Agriculture and Health, Educa- tion, and Welfare can act as soon as they take office to create a joint policy committee to address the issues raised by the Senate Select Committee and provide a means to assure that health considerations will no longer take a back seat to economic considerations in our food and agriculture policies. Finally, our greatest bulwark against the interests that have helped to create the present problems is an in- formed public.
Part I
DIETARY GOALS FOR THE UNITED STATES
Introduction
During this century, the composition of the average diet in the United States has changed radically. Complex carbohydrates — fruit, vegetables and grain products — which were the mainstay of the diet, now play a minority role. At the same time, fat and sugar consumption have risen to the point where these two dietary elements alone noAv comprise at least 60 percent of total calorie intake, up from 50 percent in the early lOOO's.^
In the view of doctors and nutritionists consulted by the Select Com- mittee, these and other changes in the diet amount to a wave of mal- nutrition— of both over- and under-consumption — that may be as pro- foundly damaging to the Xation's health as the widespread contagious diseases of the early part of the century.
The over-consumption of fat, generally, and saturated fat in par- ticular, as well as cholesterol, sugar, salt and alcohol have been related to six of the ten leading causes of death : Heart disease, cancer, cerebro- vascular disease, diabetes, arteriosclerosis and cirrhosis of the liver.
In his testimony at the Select Committee's July 1976 hearings on the relationship of diet to disease, Dr. D. Mark Heg-sted of Harvard School of Public Health, said :
I wish to stress that there is a great deal of evidence and it continues to ac- cumulate, which strongly implicates and. in some instances, proves that the major causes of death and disability in the United States are related to the diet we eat. I include coronary artery disease which accounts for nearly half of the deaths in the United States, several of the most important forms of cancer, hypertension, diabetes and obesity as well as other chronic diseases.
The over-consumption of food in general has become a major public health problem. In testimony at the same hearings. Dr. Theodore Cooper, Assistant Secretar^^ for Health, estimated that about 20 per- cent of all adults in the United States "are overweight to a degree that may interfere with optimal health and longevity."
At the same time, current dietary trends may also be leading to mal- nutrition through under-nourishment. Fats and sugar are relatively low in vitamins and minerals. Consequently, diets reduced to control weight and/ or save money, but which are high in fat and sugar, are likely to lead to vitamin and mineral deficiencies. As will be discussed later, low-income people may be particularly susceptible to induce- ments to consume high- fat/high- sugar diets.
1 The food supply estimates are based on Department of Agriculture data showing the amounts of food that "disappear" into civilian channels. These figures, while not on an ingested basis, provide the best current measure of food use.
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In testimony before the Select Committe in 1972, Dr. George Briggs, professor of nutrition at the University of California, Berkeley, esti- mated, based on a study by the Department of Agriculture, that im- proved nutrition might cut the Nation's health bill by one-third. The Department of Health, Education and Welfare's "Forward Plan for Health, Fiscal Year 1978-82," reports that health care expenditures in the United States in fiscal year 1975 totalled about $118.5 billion and predicts the cost could exceed $230 billion by fiscal year 1980.
Beyond the monetary saving, it is obvious then that improved nutrition also offers the potential for prevention of vast suffering and loss of productivity and creativity.
One in three men in the United States can be expected to die of heart disease or stroke before age 60 and one in six women. It is estimated that 25 million suffer from high blood pressure and that about 5 mil- lion are afflicted by diabetes mellitus.^
Furthermore, a' Department of Agriculture report prepared in 1971 suggests that substantial improvement in the Nation's health may be derived from improved nutrition, estimating, for example, a 25-per- cent reduction in heart and vasculatory problems through dietary changes (Appendix A).
Given the wide impact on health that has been traced to the dietary trends outlined, it is imperative, as a matter of public health policy, that consumers be provided with authoritative dietary guidelines or goals that will encourage the most healthful selection of foods.
Such goals may be controversial. First, they must be based primarily on epidemiological evidence, findings of associations between certain dietary factors and incidence of disease. In addition, it would be help- ful to base these goals on more current data on food consumption and health in the United States. Unfortunately, the nutrition surveys being conducted by the Departments of Agriculture, and Health, Edu- cation, and Welfare will not report findings until 1978 at the earliest. It is also doubtful that the surveys, because of their structures, timing and lack of funding and coordination, will be able to make useful correlations between food consumption patterns and health. Finally, regardless of epidemiological findings and survey results there will be honest professional disagreement over prescribed action.
Marc LaLonde, Canada's Minister of National Health and Welfare, speaks to this kind of problem in "A New Perspective on the Health of Canadians," published in 1974:
Even such a simple question as whether one should severely limit his con- sumption of butter and eggs can be a subject of endless scientific debate.
Faced with conflicting scientific opinions of this kind, it would be easy for health educators and promotors to sit on their hands ; it certainly makes it easy for those who abuse their health to find a real "scientific" excuse.
But many of Canada's health problems are suflSciently pressing that action has to be taken even if all scientific evidence is not in.
Based on (1) the Select Committee's July 1976 hearings on the rela- tionship of diet to disease and its 1974 National Nutrition Policy hear- ings, (2) guidelines established by governmental and professional bodies in the United States and at least eight other nations (Appendix
2 Statistics from reports and testimony presented to the Select Committee's National Nutrition Policy hearings, June 1974, appearing in National Nutrition Policy Study, 1974, Pt. 6, June 21, 1974, heart disease, p. 2633 ; high blood pressure, p. 2529, diabetes, p. 2523.
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B), and (3) a variety of expert opinion, the following dietary goals are recommended for the United States. Although genetic and other individual differences mean that these guidelines may not be appli- cable to all, there is substantial evidence indicating that they will be generally beneficial.
U.S. DIETARY GOALS
1. Increase carbohydrate consumption to account for 55 to 60 per- cent of the energy (caloric) intake.
2. Reduce overall fat consumption from approximately 40 to 30 percent of energy intake.
3. Reduce saturated fat consumption to account for about 10 per- cent of total energy intake ; and balance that with poly-unsaturated and mono-unsaturated fats, which should account for about 10 percent of energy intake each.
4. Reduce cholesterol consumption to about 300 mg. a day.
5. Reduce sugar consumption by about 40 percent to account for about 15 percent of total energy intake.
6. Reduce salt consumption by about 50 to 85 percent to approxi- mately 3 grams a day.
The goals are expressed graphically in Figure 1.
FiGUEE 1
CURRENT DIET
42% FAT
16% ' SATURATED
.2 6% POLY- AND MONO- UNSATURATED
12% PROTEIN
22% COMPLEX CARBOHYDRATE
46%
CARBOHYDRATE
DIETARY
GOALS
10% SATURA
TED I
20% POLY AND MONO- UNSATURATED
30% FAT
12% PROTEIN
40-45% COMPLEX CARBOHYDRATE
58%
CARBOHYDRATE
Sources for current diet : "Changes in Nutrients in the U.S. Diet Caused by Alterations in Food Intake Patterns." B. Friend. Agricultural Research Service. U.S. Department of Agriculture, 1974. Proportions of saturated versus unsaturated fats based on unpublished Agricultural Research Service data.
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The Goals Suggest the Following Changes in Food Selection and Preparation
1. Increase consumption of fruits and vegetables and whole grains.
2. Decrease consumption of meat and increase consumption of poul- try and fish.
3. Decrease consumption of foods high in fat and partially substi- tute poly-unsaturated fat for saturated fat.
4. Substitute non-fat milk for whole milk.
5. Decrease consumption of butterfat, eggs and other high choles- terol sources.
6. Decrease consumption of sugar and foods high in sugar content.
7. Decrease consumption of salt and foods high in salt content.
EXPLANATION OF GOALS
GOAL 1. INCREASE CARBOHYDRATE CONSUMPTION TO ACCOUNT FOR APPROXIMATELY 55 TO 60 PERCENT OF THE ENERGY (CALORIC) INTAKE
Carbohydrates have until relatively recently been the principal source of human energy. Of the two basic carbohydrate energy pro- viders— starch and sugar — starch was the main energy source.
However, as Figures 2 and 3 show, carbohydrates, and starch (or complex carbohydraites) within that grouping, have lost their pre- dominant place in the diet. Figure 4 shows the declines in consumption of specific complex carbohydrate sources since World War II. (These estimates of consumption are based on Department of Agriculture "disappearance" data, that is, reports of amoimts of commodities sold rather than direct food consumption survey data.)
FiGUBE 2
FOOD ENERGY, PROTEIN, FAT, CARBOHYDRATE
Per Capita Civilfan Consumption % OF 1909-13-^ 1 1 1 \
150 —
50 i! M I I I I I I I I I I I I I I I I ■ 1 I I I I I I I I I I I I i 1 1 I I I I I I I I I I I I I I I I I I I I M I I I M I t-l I I U
1910 1920 1930 1940 1950 1960 1970 1980
5-YEAR MOVING AVERAGE
O rMlLIMINAHV
ui Ot'it'vtNt .Of io\ luKl Nl' AH>U.W4 Mil AGRICUllURAl HtStARCM StBVICt
Source : "Changes in Nutrients in the U.S. Diet Caused by Alterations in Food Intake Patterns," B. Friend. Agricultural Research Service. U.S. Department of Agriculture.
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Figure 3
CARBOHYDRATE FROM STARCH AND SUGARS
1909-13
|
J 3 1 . 9 % |
68 . 1%
1957-59 P
r'' -
1976-^ C
' I 5 0.7
47 . 1
L.
52.9%
STARCH
SUGARS
1 Preliminary.
Source. Nutritional Review, National Food Situation, CFE (Adm.) 299-9, January 1975. Preliminary data for 1976 unpublished. Agricultural Research Service, U.S. Department of Agriculture.
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Figure 4. — Changes in pounds (per capita, per year) of complex carbohydrates consumed between 1947-49 and 1976.
• et «
<0 s e
« A O
e « Oi
e B> •
o > I
a o»-»4 o
1 -H K X
J
0) C 3 J! <U O
O H 'H
01 ^
^ 10 a
<U J= c > « 10
o e
♦Estimate.
••Fresh plus processed.
Source: Based on statistics In Nutritional Reviews CFE (Adm.) 299-11. January 1977. Agricultural Research Service, U.S. Department of Agriculture.
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There are several apparent reasons for the decreasing consumption of complex carbohydrates. A key factor may be the rise in real income, permitting a movement away from diets high in greens, beans and whole grains which had been enforced by economics.
In addition, there is a relatively small amount of advertising of fruits, vegetables and whole grains. This point was raised by Dr. Joan Gussow, chairperson of the Program m Nutrition at Teachers College, Columbia University, at the Select Committee hearings in 1974 on National Nutrition Policy :
No amount of information about the nutritive or non-nutritive qualities of the foods advertised will compensate for the total imbalance in the nature of the foods advertised on television. The nature of the foods advertised is largely highly processed foods, many of them snack foods, highly sugared, highly salted . . . We should have advertising of fruits and vegetables. They should be public service announcements selling people on those components of the diet which, in fact, they are not currently being sold on — dairy products, beans and rice and grains, and other forms of protein foods . . . And all these foods don't get sold because they do not have a high enough mark-up.
The emphasis of food advertising is discussed in detail in Part II of this report.
Heart Disease
The displacement of complex carbohydrates — fruit, vegetables and whole grains — may be a danger to health for several reasons. First, there is evidence that diets high in complex carbohydrates may reduce the risk of heart disease. Drs. William E. and Sonja J. Connor, writing in "Present Knowledge in Nutrition," published in 1976 by the Nu- trition Foundation, report :
Most population groups with a low incidence of coronary heart disease consume from 65 percent to 85 percent of their total energy in the form of car- bohydrate derived from whole grains (cereals) and tubers (potatoes).
This point is ma4e also by Dr. Jeremiah Stamler, chairman of the Department of Community Health and Preventive Medicine at North- western University, in "Atherosclerosis," a publication designed to educate doctors on the relationship of diet to heart disease. He argues that moderate carbohydrate consumption does not elevate blood tri- glyceride and cholesterol levels but, in fact, apparently results in reduction in these risk factors. He reports :
My research colleague, Mario Mancini, has demonstrated that blood triglyceride and cholesterol levels are lower in southern Italians than in Britons, Swedes or Swiss despite the fact that their carbohydrate intake is higher — 55 to 60 percent of calories instead of 40 to 55 percent — with most of it coming from starch.
Diet makes a difference in cholesterol levels as evidenced by the low levels among southern Italian workingmen who eat very little saturated (animal or dairy) fats, as compared to the upper-income southern Italians, northern Italians and Americans — all of whom eat more saturated fats.
Triglyceride and cholesterol levels usually have nothing to do with population or racial genetics because southern Italians who have emigrated to the United States develop the typical American higher blood levels as they become able to afford the high-saturated fat, high-cholesterol American diet.
In their report, Drs. Connor conclude that : high carbohydrate diets are quite appropriate for both normal individuals and for most of those with hyperlipidemia (high levels of fat in the blood), provided that the carbohydrate is largely derived from grains and tubers, that an energy excess is not consumed and that adiposity does not result.
18
The use of high carbohydrate diets by civilized man has an historical basis, is economically sound and shows clear indications of causing less, rather than more, disease, especially in the coronary heart disease- hyperlipidemia area.
Diabetes
The Connors also report that the high complex carbohydrate diet is important in the treatment of diabetics because it reduces the threat of atherosclerosis and hyperlipidemia, which are common to diabetics, by lowering cholesterol and saturated fat levels. The Connors note that some diabetics find a high carbohydrate diet also results in im- proved glucose tolerance; in others insulin requirements have been stabilized.
Fiber
A diet high in carbohydrate may also be beneficial with respect to fiber. Fiber may be divided generally into two categories, according to Dr. P. J. Van Soest, of the Department of Animal Science at Cor- nell University, the more mature, less fermentable and digestible bran fiber from grains, and the less mature, more fermentable and digestible fiber from fruits and vegetables. It is probable, he says, that both kinds of fiber are important to nutrition, but relatively little is known about the properties of fiber and its role in nutrition.
Dr. Denis P. Burkitt, among the first advocates of the high fiber diet, has postulated that an increase in fiber consumption, preferably natural fiber rather than fiber added to refined products such as white bread, will markedly reduce the incidence of bowel cancer and other diseases, primarily those of the intestine.
Vitamin and Mineral Sources
Increased consumption of fruit, vegetables and whole grains is also important with respect to supplying adequate amounts of micro-nutri- ents, vitamins and minerals. This is particularly important for those who are limiting their food intake to control weight or save money. For many people consumption may be reaching a critical level below which it may be difficult to obtain adequate levels of micro-nutrients from the volumes of food consumed. Under these circumstances, it is essential to eat foods that maximize the potential for consuming a broad range of micro-nutrients.
Fats and sugars, the principal dietary elements that have displaced complex carbohydrates, are, as Table 1 shows, relatively poor sources of micro-nutrients, particularly in view of the levels of calories they induce.
19
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It is important to note that knowledge of the full range of micro- nutrients has not been developed. For example, inquiry is only begin- ning into the function of elements such as chromium, selenium, vana- dium and others, which appear to have important regulatory func- tions in and between cells. Furthermore, there is only limited knowl- edge of human requirements for most nutritients, as shown in Ap- pendix C, prepared by the Department of Agriculture.
Consequently, although vitamin and mineral supplements and nu- trient fortification may improve chances for obtaining micro-nutrients, they cannot be seen as substitutes for food. Nor should they be seen as a means of continuing a high-fat, high-sugar diet. This course not only maintains a pattern shown to be dangerous with respect to fat intake but one which may mean loss of important micro-nutrients.
Obesity
Finally, an increase in the consumption of complex carbohydrates is likely to ease the problem of weight control. As suggested above, displacing fat and sugar reduces the risk of obesity. Furthermore, the high water content and bulk of fruits and vegetables and bulk of whole grain can bring satisfaction of appetite more quickly than do foods high in fat and sugar.
Guide to Increasing Complex Carbohydrate Consumption
1. fruit and vegetables
A Department of Agriculture report published in 1972 found that nutrient availability from fruits and vegetables had declined with increased use of canned, frozen and dried produce and shifts in con- sumption away from such vegetables as white and sweet potatoes, dark green and yellow vegetables, dry beans and dry peas, and grain prod- ucts. The report, entitled "Trends in Fresh Fruit and Vegetable Con- sumption and Their Nutritional Implications," said :
The shift from the uses of fresh fruits and vegetables to processed (shown in Figure 5), as well as changes in selection among different fruits and vege- tables, have resulted in some significant trends in nutrients obtained from this food group. The amount of vitamin A obtained from fruits and vegetables has declined 11 percent since 1925-29, and 18 percent since 1947-49. Vitamin Be and magnesium declined by nearly 20 percent since 1925-29, while the amount of thiamin obtained from fruits and vegetables declined almost 10 percent.
21
Figure 5. — Trends in consumption of fresh and processed fruits and vegetables.^
PER CAPITA, PER YEAR
POUNDS
60C- 50C-
5O0-
20C-
100"
I
i
t^RESH
1957-59
I
f<-PROCgSSEO
1571
1 Includes potatoes and sweet potatoes.
Source : "Trends in Fresh Fruit and Vegetable Consumption, Nutritional Qualities of Fresh Fruits and Vegetables," Futura Publishing Co., Mount Kisco, N.Y., 1974.
It appears that increased consumption of fresh fruits and vegetables, par- ticularly the high nutrient forms, would be beneficial for many persons in need of dietary improvement. Educating consumers, particularly those of low incomes, to the greater advantage of the most economical and most nutritious fruits and vegetables, would offer a great potential for dietary improvement.
If fruits and vegetables are used directly from the garden, it is likely that their nutrient content will exceed that of their processed counterparts, as indicated in a report by Dr, Owen Fennema, professor of Food Chemistry at Northwestern University, appearing in "Nutri- tional Evaluation of Food Processing.'' However, he and other ex- perts say that fresh fruits and vegetables in the supermarket may have undergone nutrient-depletion in shipping and storage, and conse- quently frozen varieties may provide equivalent or better nutritional values. A similar position is taken in "Diet and Exercise," published by the Swedish government to promote its nutrition and physical fitness program, which says: "Deep frozen and fresh vegetables are of equal value from a nutritional point of view."
On the other hand, it is also true that although considerable knowl- edge has been gathered about the nutritional impact of freezing, canning and other processing, this knowledge is not held for all nu- trients, all foods or all processes. Furthermore, it is important to understand the degree of our ignorance about what constitutes food value. Out of more than 50 known nutrients, Eecommended Dietary Allowances have been established for only IT. In addition, there is no definitive evidence that food composition described solely in terms of all known nutrients would be an accurate measure of total food value.
Consequently, it would seem advisable to create at least an even balance in the diet between the fresh and frozen produce. (Canned produce has significant nutritional value but is generally thought to
22
have retained less nutrients than frozen or fresh. )2 In addition, it would appear to be prudent to increase consumption of potatoes and dark green leafy vegetables because of nutrient content and the vari- eties of fiber they may offer.
A shift to use of fresh produce not only offers greater opportunity for micro-nutrient consumption, but increases control over use of food additives. Sugar and salt are the two foremost food additives. The health aspects of these additives and non-nutritive additives such as colorings and flavorings, will be discussed later.
Finally, the use of fresh produce also removes food from the proc- essing system in which a sizeable portion of food prices may result from non-food costs such as packaging, advertising and any added cost that may accrue to imperfect competition in food manufacturing, a condition which has been discussed in a variety of reports including that of the Food Marketing Commission in 1965 and more recently at hearings of the Select Committee in October 1975.
Refinement
Highly-refined fruits and vegetables generally should not be viewed as nutritional equivalents or substitutes for the same food in its fresh form. For example. Table 2 shows that potato chips and dehydrated potatoes should not be thought of as the nutritional equivalent of fresh, baked potatoes. In addition, it is apparent that potato chips carry significantly more fat than the baked or mashed form : potato chips are 40 percent fat compared to .1 percent fat in baked potatoes.
2 "Nutritional Evaluation of Food Processing," 1975. Nutritional Aspects of Food Processing Methods, pp. 11-15 ; Effects of Freeze-Preservation on Nutrients, pp. 244-288.
23
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Although it would be possible to restore vitamin C and certain other nutrients through fortification, it is doubtful that the numbers and balance of nutrients in the fresh form could ever be duplicated. In addition, it is not known how processing may affect fiber composition.
Several nutritionists and food technologists interviewed in prepara- tion of this report said that the decline in nutrient content in various individual food items may not be important because the nutrients needed for optimal health are likely to be readily available in the great abundance of food in the marketplace.
It is important to understand, however, that several studies suggest that more than 50 percent of the United States diet undergoes some form of processing before it enters the home.^ Given the need to maxi- mize micro-nutrient availability for those on reduced diets ; the need to ensure adequate nutrient availability to those who do not widely vary their diets; and the need to maximize the nutritional power of the food supply; it would seem prudent not only to increase use of fresh foods but also those undergoing the least processing.
2. GRAIN PRODUCTS
Of the grain products, bread is the most widely consumed (Figure 6). However, bread consumption has been declining in the United States, in part perhaps because it has been viewed, incorrectly, as fat- tening. Bread is of intermediate caloric density, and a relatively good protein source. Professor Olaf Mickelsen of Michigan State Univer- sity, reports in "Cereal Foods World," of July 1975 :
Figure 6
GRAIN PRODUCTS USED PER PERSON
Per Week by Region
lb
QUANTITIES AS PURCHASED ^ NORTHEAST, NORTH CENTRAL, WEST HOUSEHOLDS WITH INCOMES OF $5,000 -9,999 1 WEEK IN SPRING, 1965
U.S. DEPARTMENT OF AGRICULTURE NEG ARS . 5944-69 (4) AGRICULTURAL RESEARCH SERVICE
3 "Human Nutrition," Jean Mayer, 1972, pg. 657. "Total Consumer Buying of Fresh Versus Processed Foods Remains Stable." Alden C. Manchester. Economic Research Serv- ice, U.S. Department of Agriculture, NFS-144, May 1973 (Unpublished 1975 figures show trend stable.) "Anticipating Public Policy Issues: Nutrition Diet. Health and Food Qual- ity." Graham T. T. Molitor. Unpublished report prepared for the General Accounting Office. July 1976, pg. 164.
25
Contrary to what most people think, bread in large amounts is an ideal food in a weight reducing regimen. Recent work in our laboratory indicates that slightly overweight young men lost weight in a painless and practically effort- less manner when they included 12 slices of bread per day in their program. That bread was eaten with their meals. As a result, they became satiated before they consumed their usual quota of calories. The subjects were admonished to restrict those foods that were concentrated sources of energy : otherwise, they were free to eat as much as they desired. In eight weeks, the average weight loss for each subject was 12.7 pounds.
Another study by Mickelsen found that 12 young men could obtain 90 to 95 percent of their protein needs from white enriched bread. In some countries bread may contribute as much as 80 percent of protein needs.
There are also arguments, though somewhat less conclusive, sug- gesting not only that increased bread consumption is warranted but that more whole wheat bread should be eaten. There have been no studies that have found Avhole wheat flour to be superior nutritionally to white flour when consumed in a normal diet, and surprisingly few studies have even considered the question. However, whole wheat bread may provide more micronutrients and definitely provides more fiber than white bread.
White bread is made from wheat that has undergone a degree of milling that removes large amounts of bran and w^heat germ. A report at the 1976 Convention of the American Association of Cereal Chem- ists * estimated that the average milling level in the United States is 76 percent extraction, meaning that about 76 percent of the wheat kernel has been retained. One hundred percent extraction flour is whole wheat flour. Figure 7 shows how various levels of milling affect various micronutrients, and Table 3 from an unpublished report by Doris Baker, of the Department of Agriculture, shows the degree to which milling may reduce fi.ber content.
^ "Natural Levels of Vitamins and Minerals in Commercially Milled Wheat Flour in the United States and Canada." (Flour Base Line Study for the American Bakers Associa- tion Ad Hoc Industry Comrnitee on Fortification of Cereals.) Paul J. Mattern, University of Nebraska, chairman of panel presenting report.
26
Relation between extraction rate and proportion of total vitamins of the grain retained in flour. Source: "Wheat in Human Nutrition," Food and Agriculture Organization, Rome, 1970.
27
TABLE 3.-FIBER CONTENT IN WHITE VS. WHOLE WHEAT BREAD
Fiber content by various determinations
Type bread Crude fiber Acid Buffered Neutral
White:
No. 1 1.3 1.2 8.8 2.8
No.2 .9 1.5 9.3 2.9
Whole:
No. 1 2.7 2.8 12.3 6.6
No.2 2.6 2.6 12.9 5.1
No.3 3.2 3.1 11.5 7.3
Source: U.S. Department of Agriculture. "Fiber in Wheat Foods," a study presented by Doris Baker at 1976 Convention of the American Association of Cereal Chemists.
In bread, as with other foods undergoing processing, there is the danger that, as the degree of processing increases, nutrients, known and unknown, are removed or altered in ways not currently under- stood.
Conserving Resources
The reduction of milling also acts to conserve food resources, as pointed out in a compendium on bread, prepared for classroom use by Dr. Paul Seib, Associate Professor in the Department of Grain Sci- ence and Industry at Kansas State University :
White bread represents a less efficient use of the nutrients in wheat than whole wheat. If one uses whole wheat flour instead of white flour for every 100 gm. of wheat we gain 30 g of material containing : (a) 93 kcal in bread of which 73 percent is digestible energy for a net gain of 63 kcal, and (b) 4.65 g of pro- tein of which 73 percent is digestible for a net gain of 3.4 g of protein. Since flour-milling by-products go to animal feeds in the U.S., where they are con- verted to meat at an efficiency of about 10-25 percent, a loss in energy and pro- tein value is sustained by not eating whole wheat bread.
Even greater conservation of resources might be possible if grains carried a larger share of the protein burden, as they did earlier in the century.
Selecting Grain Products
Table 4 compares nutrients offered in various grains and grain products. Table 5, from Frances Moore Lappe's "Diet for a Small Planet," offers a comparison of costs of grain protein versus other protein sources.
As is apparent in Table 4, the common sidedish rice suffers consid- erably in processing. The hierarchy of nutrient value in rice, from most to least, is :
Brown rice.
Parboiled (converted) rice. Common white enriched rice. Instant rice.
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Table 5. — Protein cost
|
104- |
Daffy Products |
Legumes |
Grains, Cereals, & Flour |
Seafood |
Nutritional Additives |
NuU& Seeds |
|
20*- 30*- 40*- |
dried non-faf milk cottage cheese whole egg |
koybeana z black-eyed pees split peas |
_ whoto wheat flour rwhole-grain wheat rye flour (dark) |
turbot herring |
||
|
50*- 60*- 70*- 80*-i 90*- $1.00- |
buttermilk whole milk jhamburger j . Cheddar cheese - Ichlcken 1 Swiss cheesa Parmesan cheese |
lentils chick-peas - mung beans |
oatmeal "Roman Meal" gluten flour »• bulgur (red) " brown rice » maceroni barley flour - buckwheat flour egg noodles CQrnmea! ... |
- squfd - cod - perch -canned tuna catfish |
- brswar's ytast |
-* raw p«anut< - peanut butter -~ peanuts |
|
$1.50- |
blue mold cheese ■* . .ricotta cheese— - [pork] |
r" fjrairtes"" - salmon |
[■ "Tiger's Milk" |
-sunflower seeds - sesame seeds |
||
|
$2.00- |
1 steak 1 yogurt |
crab (in shell) |
— cashews |
|||
|
$2.50- $3.00- |
[lamb chops | |
(In shell) . oysters |
(roasted; |
|||
|
$3.50- |
- shrimp (canned) |
Source : Frances Moore Lappe, "Diet for a Small Planet," 1971.
Hot cooked breakfast cereals are generally less refined and proc- essed and less expensive than ready-to-eat cereals. Of the hot cereals (wheat, rye or oat) , wliole grained cereals are most nutritious, accord- ing to Euth Fremes and Dr. Zak Sabry in "NutriScore" (Fremes is a Canadian home economist and Sabry headed Nutrition Canada, that nation's recent nutrition survey). Less nutritious are cream of wheat and corn meal. The authors point out also that "instant" and "quick" hot cereals may have less nutrients than their longer-cooking counter- parts.
In ready-to-eat cereals, sugar-coated cereals should be avoided, and "XutriScore" explains that granola also offers high caloric intake for the amounts of nutrients available. The book says :
Granola does have slightly more protein, calcium, riboflavin and niacin than plain cereals, but the difference is not great enough to make this a special reason for buying it. Its major disadvantages are its high caloric value, its high fat content, the high saturation of fat in the shredded coconut and its high cost.
Flaked, shredded and puffed cereals may be enriched, but Fremes and Sabry note that many trace elements are not added, nor is fiber, and "So, the enriched refined cereal is never as good nutritionally as the wholesome unrefined cereal."
GOAL 2. REDUCE OVERALL FAT CONSUMPTION FROM APPROXIMATELY 40 TO 30 PERCENT OF ENERGY INTAKE
Figures 8 and 9 show the growth in fat consumption in the United States over this century, both in absolute terms and as a percent of calories.
Figure 8
PER CAPITA CONSUMPTION OF NUTRIENT FAT
% OF 1909-13
100
5Q 1-11 I I I I I I I I I I I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I I I I I I I I I I I I I I I I 1 I I I I I 1 1
1910 1920 1930 1940 1950 1960 1970 1980 5-YEAR MOVING AVERAGE
A PRBLIMINARY ESTIMATE. USDA
NEG> ARS 6067-76
Source : Handbook of Agricultural Charts, Agricultural Handbook No. 504, U.S. De- partment of Agriculture, 1976.
(30)
31
Figure 9. — Fat as a percent of calories, 1909-76 Percent
30.
20
10.
|
a> |
||||||
|
fH |
ro |
IT) |
||||
|
1 |
o> |
G\ |
||||
|
•H |
tH |
rH |
H |
o
Source: Nutrients in United States Food Supply, Review of Trends, 1909-13 to 1965. B. Friend. The American Journal of Clinical Nutrition. Vol. 20, No. 8, August 1967, pp. 907-914. Data after 1965 unpublished. Agricultural Research Service, U.S. Department of Agriculture.
32
Between the beginning of the century and 1973, the amount of nu- trient fat available per person per day rose from about 125 to 156 grams, according to a report by the Agricultural Eesearch Service, "Fat in Today's Food Supply— Level of Use and Sources." The report noted that this increase is equivalent to about 21/2 tablespoons of but- ter or regular margarine ; or a little more than 2 tablespoons a day of vegetable oil ; or about 24 pounds a year in nutrient fat.
Discussing the sources of the increase, the report says :
The same foods did not always account for the increase in fat throughout the 60-year period, but for most years salad and cooking oils were the chief contribu- tors. Following salad and cooking oils, dairy products and shortening shared equally in the contribution to the gain in nutrient fat during the first 15 years and margarine, shortening and meat, in that order during the next 40 years. However, in the last seven years, meat provided the largest increase in fat, followed by salad and cooking oils and then by shortening.
The higher fat consumption trends have been underway in other nations as well. Governmental and professional groups in the United States and eight other nations have recommended decreases in total fat consumption to ranges from 25 to 35 percent of total calorie con- sumption (Appendix B).
One of the principal reasons for reducing the consumption of fat is to make a place in the diet for complex carbohydrates which gen- erally carry higher levels of micro-nutrients than fat without the complications of fat, which are to be discussed.
Obesity
With respect to weight control, it should be understood that fat is the most concentrated source of food energy. As pointed out in "Fats in Food and Diet," published by the U.S. Department of Agriculture, fat supplies 9 calories per gram, whereas protein and carbohydrates, the other two energy sources, supply only 4 calories per gram. Alcohol supplies 7 calories per gram. Consequently, particularly for those not involved in heavy physical activity, the consumption of a d^'et deriv- ing 40 percent of its. calories from fat may result in a continual strug- gle to control weight.
Obesity is considered a risk factor in: cardiovascular disease, hy- pertension (high blood pressure), atherosclerosis, hernia, gallbladder disease, diabetes mellitus, and liver diseases. Testifying before the Select Committee in July 1976, Dr. Cooper said:
Obesity aggravates cardiovascular disease and osteoarthritis and increases the liability to hypertension, atherosclerosis, hernia, and gallbladder disease. It also may facilitate the emergence of latent diabetes in predisposed individuals as they approach an advanced age and adds to the hazards of surgery ; it makes for postural derangement, and in extreme cases, it is the cause of obesity dyspnea with pulmonary insuflSciency. It is also of interest that the mortality from cir- rhosis of the liver in obese males is 249 percent of that expected in the non-obese.
Now medioactuarial statistics make it quite clear that the obese do not live as long as the lean. The chief causes of death among overweight individuals are cardiovascular-renal diseases, diabetes, and disorders of the liver and biliary tract (the gallbladder).
Drs. Henry C. McGill and Glen E. Mott note in "Present Knowledge in Nutrition" that hyperuricemia (high levels of uric acid in the blood) has been related to obesity, and they report : "Reduction in obesity usually leads to reduction in serum lipid concentrations (reducing threat from heart disease), reduction of blood pressure
33
(reducing threat of stroke), and improvement in glucose tolerance (reducing the threat of diabetes) .
There is strong evidence suggesting that, for those overweight, the best protection against heart disease is weight reduction. Quoting a study by Drs. Franz Ashley and William Kannel, "Relation of Weight Change to Changes in Atherogenic Traits : The Framingham Study," Dr. Beverly Winikoff of the Eockefeller Foundation, told the Select Committee at its hearings in July 1976 :
Data from the Framingham study examined by Ashley and Kannel in 1973 indicate that each 10 percent reduction in weight in men 35-55 years old would result in about a 20 percent decrease in the incidence of coronary disease.
Conversely, each 10 percent increase in weight would result in a 30 percent increase in coronary disease.
Based on the estimate that 700,000 die in the United States each year of heart disease. Dr. Winikoff observed that a 20 percent decrease in incidence of coronary disease might save 140,000 lives a year.
Discussing the importance of obesity on heart disease, the Ashley- Kannel report says :
The clinical and preventive implications seem clear. Weight gain is accom- panied by atherogenic alterations in blood, lipids, blood pressure, uric acid and carbohydrate tolerance. It is uncertain whether the nutrient composition of excess calories, derived largely from saturated calories accompanied by cholesterol and simple carbohydrates, or the positive energy balance per se, is important. But whatever the cause, development of ordinary obesity encountered in the general population is associated with excess development of coronary heart disease.
Dr. Ernst Wynder, of the American Health Foundation, also testifying at the July hearing, noted that obesity has been found to increase the risk of cancer of the womb as well as female kidney cancer.
Cancer
In addition to the relationship of fat intake to obesity, and its apparent consequences, there is also evidence suggesting a connection between dietary fat and cancer of the breast and colon. Testifying before the Select Committee in July 1976, Dr. Gio Gori, Deputy Director of the ^^ational Cancer Institute, said :
There is a strong correlation betw^een dietary fat intake and incidence of breast cancer and colon cancer. As the dietary intake of fat increases, you have an almost linear increase in the incidence of breast and colon cancer.
And Dr. Gori said :
Colon cancer has also been shown to correlate highly with the consumption of meat, even though it is not clear whether the meat itself or its fat content is the real correlating factor. Mortality rates from colonic cancer are high in the United States, Scotland, and Canada, which are high meat consuming countries ; other populations such as in Japan and Chile where meat consumption is low, experi- ence also a low incidence of colon cancer. Seventh Day Adventists and Mormons have a restricted fat and meat intake when compared to other populations living in the same district and, as indicated, they suffer considerably less from some forms of cancer, notably breast and colon.
Dr. Wynder, testifying at the hearing, said that incidence of cancer seems to be related as much to unsaturated as saturated fats. As an example, he cited studies indicating that both types of fat, and cholesterol, may cause increased secretion in the breast of the hormone prolactin and that this section may induce tumors. A four-week
34
vegetarian diet in a group of American women resulted in a 40 to 60 percent decrease in prolactin secretion, he said.
The September 10, 1976, Washington Post noted that Dr. Bruce K. Armstrong, of Perth Medical Centre, Australia, presented to a con- ference at Cold Spring Harbor Laboratory in New York a report suggesting that diets high in animal fat might increase the risk of womb cancer.
Dr. Armstrong said principal risk factors included obesity, early onset of puberty, late onset of menopause, a mild case of diabetes and high blood pressure. With respect to high intake of fat, he said it may cause excessive secretion of estrogens that either cause cancer or stimu- late other cancer-causing agents. He also discussed findings suggesting that vegetarian women appeared to be at reduced risk, generally ex- periencmg earlier menopause and lower blood pressure than non- vegetarians.
A guide to reducing fat consumption follows the explanations of the saturated fat and cholesterol goals.
GOAL 3. REDUCE SATURATED FAT CONSUMPTION TO AC- COUNT FOR ABOUT 10 PERCENT OF TOTAL ENERGY INTAKE; AND BALANCE THAT WITH POLY-UNSATURATED AND MONO-UNSATURATED FATS, WHICH SHOULD AC- COUNT FOR ABOUT 10 PERCENT OF ENERGY INTAKE EACH
Figure 10, from the Department of Agriculture report, "Fat in Today's Food Supply — Level of Use and Sources," cited earlier, shows the trends in saturated, oleic (mono-unsaturated) and linoleic (poly- unsaturated fat) consumption in this century.
Figure 10
GRAMS - -
FIG. 10. Fatty acids. Per capita civilian consumption. A = prelim- inary.
Source : "Fat in Today's Food Supply — Level of Use and Sources." Journal of the American Oil Chemists' Society, vol. 51, No. 6, pp. 244-250, 1974.
Heart Disease
The level of saturated fat in the diet is of concern because it has been directly linked to excessive levels of cholesterol in the blood and therefore to heart disease. Feeding studies in animals in the early 1900's linked high cholesterol intake to atherosclerosis. Evidence that cholesterol could affect the same arterial lesions in man came from Scandinavian countries where atherosclerotic diseases appeared to decline during the war years when consumption of calories and animal fat declined.
The implication of cholesterol in heart disease became more clear in the 1950's. As reported by Drs. McGill and Mott in "Present Knowl-
(35)
36
edge in Nutrition," the Framingham study, mentioned earlier, deter- mined that of all risk factors in heart disease, "the strongest and most consistent risk factor was elevated serum cholesterol concentration. This finding has been confirmed in the United States and Western Europe in the past two decades." The authors note that in the early 1950's researchers discovered that serum cholesterol levels were low- ered by substituting vegetable for animal fats.
A twelve-year study of patients in two hospitals in Finland, started in 1958, reinforces this view. During the first six years, the patients in the trial hospital were fed an experimental diet which involved an overall reduction in fats and a reduction of the proportion of saturated fat. For that same time period, the patients in the control hospital were given a normal diet. During the next six years, the two diets were continued, but the two hospitals reversed their experimental roles. In both hospitals the coronary heart disease (CHD) mortality rate was dramatically reduced on the low- fat diet. The overall CHD incidence rate per 1,000 man-years for the experimental diet was 14.4 as opposed to a 33.0 rate experienced by those eating the normal or conti'ol diet.
Dr. Osmo Turpeinen reporting on the Finnish study in "Future Trends in Nutrition and Dietetics" (1975) , summarizes the evidence of the relation between diet and heart disease to date :
As all these studies have dealt with relatively small numbers of subjects and their design of experiment has shown certain shortcomings, these intervention studies may not yet have produced the final, irrefutable proof of the potentiality of dietary prevention of coronary heart disease. Nevertheless, they have furnished at least substantial evidence in favor of the view that a proper re-adjustment of the fatty acid composition and of cholesterol content of our commonly used diets may have considerable preventive effect.
(One of the reasons the results of these tests were inconclusive is that they involved older people who already had developed athero- sclerosis. Had tests been instituted earlier, the results might have been more striking.)
As Figure 10 suggests, the proportion of saturated fat in the diet has declined — from about 40 percent of total fat in the early 1900's to about 38 percent in 1975 — as consumption of the other fatty acids has grown more quickly than it, primarily due to increased use of salad and cooking oils.
Although saturated fat may be a declining proportion of total fat consumption, its level, and that of the other fatty acids, remains higher than recommended by the Inter- Society Commission for Heart Disease Resources, a body coordinating the development of guidelines for caring for cardiovascular patients.
Preliminary figures for 1976 indicate that saturated fat currently comprises about 16 percent of total calories, poly-unsaturated fat ac- counts for about 7 percent and mono-unsaturated, 19 percent. The Commission recommends that daily intake of saturated fat be less than 10 percent of total calories, tjp to 10 percent of total calories should be derived from poly-unsaturated fat, with the remaining 10 percent coming from mono-unsaturated fats. The limits conform generally with the recommendations of other United States and inter- national agencies (Appendix B), and provide a prudent balance among fat types.
Achieving this balance requires partial substitution of poly-unsatu- rated for saturated fat and the overall reduction of all fatty acids. A guide to these changes follows discussion of the next goal, reduction of cholesterol.
GOAL 4. REDUCE CHOLESTEROL CONSUMPTION TO ABOUT 300 MG. A DAY
There is evidence not only that fat and saturated fat tend to increase serum cholesterol levels but that direct consumption of cholesterol does so as well.
Drs. McGill and Mott report in "Present Knowledge in Nutrition" :
The average American ingests 600 mg. of cholesteroi per day, well above the 400 mg. limit below which there is a linear relationship with serum cholesterol. As in the controlled experiments, comparisons among populations with wide ranges of average cholesterol intake show a close relationship between dietary cholesterol and serum cholesterol concentrations. It is now widely accepted that a high dietary cholesterol intake is a major determinant of the high cholesterol concentrations found in the U.S. population as well as in other technically developed countries.
Professional and governmental bodies in the United States and other countries have generally recommended that cholesterol intake l^e decreased to 300 mg. a day or less (Appendix B).
Guide To Reducixg Consumption or Fat, Saturated Fat and
Cholesterol
High levels of fat, saturated fat and cholesterol most often enter our diets in the process of acquisition of protein, particularly through red meat. Consequently, the foregoing recommendations suggest that more of our protein needs be satisfied from fish and poultry and vege- table sources.
The proportion of calories in our diet derived from protein has remained relatively constant in this century at about 12 percent. As noted earlier, prior to increased meat consumption, a greater share of our protein was drawn from vegetable sources, especially grains. Tables 6, 7 and 8, show that, in general, increased use of vegetable source proteins will aid greatly in reducing not only the percentage of calories from fat but levels of saturated fat and cholesterol. (Only foods of animal origin have significant amounts of cholesterol.)
(37)
38
U
50%
40%
30%
20%
o
CM
I
Table 6
Percentage of Calories from Fat in Foods
Cream Cheese Weiners
Peanuts and peanut butter
Pork Lunch meats
Most cheese and cheese spreads
Tongue
Eggs
Ground beef — regular Salmon, tuna (carmed in oil) Pork — loin and butt Granola
Whole milk Ice cream Cream cheese
sandwich Peanut butter sandwich
Creamed cottage
cheese Lunch meat or Cheese spread sandwich
Chicken — roasted, flesh & skin Beef — porterhouse, T-bone, round
rump, lean ground, kidney Pork — fresh & cured ham & shoulder Lamb — shoulder, rib Salmon — red sockeye, canned
Beef — sirloin, arm, flank, heart Turkey — flesh & skin, dark meat Lamb — leg, loin Pork — heart, kidney Chicken — dark meat, roasted flesh
Beef — heel of round, pot roast
Liver — pork, chicken, lamb, beef
Fish — bass, ciscoe, oysters, salmon (pink)
Chicken — roasted, light meat broilers — no skin
Fish — haddock, cod, tuna, (water pack)
ocean perch, halibut, smelt, sole Shellfish — most Porridge Bread
Most peas, beans and lentils Skim milk cheese Uncreamed cottage cheese Skim milk
Most breakfast cereals (other than Granola type)
Source: ''NutriScore," Fremes, Sabry, 1976.
39
TABLE 7.— FAT CONTENT AND MAJOR FATTY ACID COMPOSITION OF SELECTED FOODS (IN DECREASING ORDER OF TOTAL SATURATED FATTY ACID CONTENT WITHIN EACH GROUP OF SIMILAR FOODS)
(In percent)
Fatty acids
Total Total
Total inonoun- polyun-
Food Total fat saturated saturated saturated
Animal fats:
Chicken
Lard
Beef tallow
Avocado -.
Beef products:
T-bone steak (cooked, broiled— 56 percent lean, 44 percent
fat)
Chuck, 5th rib (cooked or braised— 69 percent lean, 31
percent fat)
Brisket (cooked, braised, or pot roasted— 69 percent lean;
31 percent fat)
Wedge and round-bone sirloin steak (cooked or broiled—
66 percent lean; 34 percent fat)
Rump (cooked or roasted— 75 percent lean; 25 percent fat).. Round steak (cooked or broiled — 82 percent lean; 18 percent
fat)
Cereals and grains:
Wheat germ
Oats (puffed, without added ingredients)
Oats (puffed, with added nutrients, sugar covered)
Barley (whole grain)
Domestic buckwheat (dark flour)..
Cornmeal, white or yellow (whole-ground, unbolted)
Shredded wheat breakfast cereal
Wheat (whole grain, Hard Red Spring)
Wheat flakes breakfast cereal
Rye (whole grain)
Wheat meal breakfast cereal
Wheat flour, all purpose
Rice (cooked brown)
Bulgurfrom Hard Red Winter wheat
Oatmeal or rolled oats, cooked
Rye flour
Cornstarch
Rice (cooked white)
Farina (enriched, regular, cooked)
Corn grits, cooked
Dairy products:
Nondairy coffee whitener (powder)
Cream cheese
Cheddar cheese...
Light whipping cream
Muenster cheese
American pasteurized cheese
Swiss cheese
Mozzarella cheese
Ricotta cheese (from whole milk)
Vanilla ice cream
Half and half cream
Chocolate chip ice cream
Canned condensed milk (sweetened)
Ice cream sandwich
Cottage cheese (creamed).
Yogurt (from whole milk)
Cottage cheese (uncreamed)
Eggs: . ^ .
Fried in margarine
Scrambled in margarine
Fresh or frozen
Fish:
Eel, American
Herring, Atlantic .
Mackerel, Atlantic
Tuna, albacore (canned, light)
Tuna, albacore (white meat)
Salmon, sockeye
Salmon, Atlantic ...
Carp.
Rainbow trout (United States)
Striped bass—
Ocean perch
Red snapper
Tuna, skipjack (canned, light)
Halibut, Atlantic
Cod, Atlantic .
Haddock
|
100. 0 |
32. 5 |
45. 4 |
17. 6 |
|
100. 0 |
39. 6 |
44'. 3 |
u'. 8 |
|
100. 0 |
48. 2 |
42. 3 |
4' 2 |
|
15! 0 |
2. 0 |
9! 0 |
2* 0 |
|
43. 2 |
18. 0 |
21. 1 |
1. 6 |
|
36.7 |
15. 3 |
17. 5 |
1. 5 |
|
34. 8 |
14. 6 |
16. 7 |
1. 4 |
|
32.0 |
13. 3 |
15.6 |
1. 2 |
|
27.3 |
11. 4 |
13. 1 |
1! 2 |
|
It. 3 |
0. 0 |
D. 9 |
.7 |
|
10. 9 |
1.9 |
1.6 |
6.6 |
|
5. 5 |
1. 0 |
1*9 |
2. 2 |
|
3. 4 |
. 6 |
L 2 |
1. 4 |
|
2. 8 |
.'5 |
.3 |
1.3 |
|
2. 5 |
. 5 |
. 8 |
'. 9 |
|
3 9 |
'. 5 |
.9 |
2. 0 |
|
2. 5 |
'4 |
. 4 |
I. 3 |
|
2. 7 |
4 |
. 3 |
1! 3 |
|
2! 4 |
I4 |
'. 3 |
1! 2 |
|
2. 2 |
' 3 |
] 2 |
1! 1 |
|
1.4 |
. 3 |
] I |
'j |
|
1! 4 |
2 |
[ 1 |
'. 6 |
|
[3 |
\ 2 |
] 2 |
." 3 |
|
1! 5 |
" 2 |
'2 |
' 7 |
|
1. 0 |
2 |
.'4 |
4 |
|
1 4 |
' 2 |
\ 1 |
" g |
|
'.6 |
\\ |
] 1 |
!3 |
|
.2 |
. 1 |
!i |
.1 |
|
2 |
_ 1 |
||
|
1 |
' 1 |
||
|
35.6 |
32.6 |
1.0 |
|
|
33. 8 |
21. 2 |
9. 4 |
1. 2 |
|
32. 8 |
20. 2 |
9. 8 |
'9 |
|
32. 4 |
20. 2 |
9. 6 |
" 9 |
|
29. 8 |
19. 0 |
8. 7 |
,'7 |
|
28. 9 |
18. 0 |
8! 5 |
1! 0 |
|
27. 6 |
\i. 6 |
7. 7 |
1. 0 |
|
19 4 |
11! 8 |
5! 9 |
[ 7 |
|
14! 6 |
9' 3 |
4' I |
\ 4 |
|
19' ^ |
7' 7 |
3. 6 |
\ 5 |
|
11 7 |
7 3 |
3." 4 |
' 4 |
|
11 n 11. u |
3 |
2. 6 |
* 4 |
|
0. / |
u. u |
2 4 |
[ 3 |
|
0. L |
A 7 |
9' fi |
5 |
|
A n |
L, u |
1 1 1. i |
[ I |
|
0. 4 |
9 9 |
Q |
|
|
.4 |
.2 |
. 1 |
|
|
15.9 |
4.2 |
7.2 |
1.9 |
|
12.6 |
3.7 |
5.5 |
1.4 |
|
11.3 |
3.4 |
4.5 |
1.4 |
|
18.3 |
4.0 |
9.0 |
2.7 |
|
16.4 |
2.9 |
9.2 |
2.4 |
|
9.8 |
2.4 |
3.6 |
2.4 |
|
6.8 |
2.3 |
1.7 |
1.8 |
|
8.0 |
2.1 |
2.1 |
3.0 |
|
8.9 |
1.8 |
1.5 |
4.7 |
|
5.8 |
1.8 |
2.7 |
.5 |
|
6.2 |
1.3 |
2.7 |
1.4 |
|
4.5 |
1.0 |
1.5 |
1.4 |
|
.7 |
|||
|
2.1 |
.5 |
.6 |
|
|
2.5 |
.4 |
1.0 |
.7 |
|
1.2 |
.2 |
.2 |
.4 |
|
.8 |
.2 |
.2 |
.2 |
|
1.1 |
.2 |
.2 |
.4 |
|
.7 |
.1 |
.3 |
|
|
.7 |
'1 |
.2 |
40
TABLE 7.— FAT CONTENT AND MAJOR FATTY ACID COMPOSITION OF SELECTED FOODS (IN DECREASING ORDER OF TOTAL SATURATED FAHY ACID CONTENT WITHIN EACH GROUP OF SIMILAR FOODS)— Continued
[In percent]
Food
Fatty acids
Total fat
Total saturated
Total monoun- saturated
Total polyun- saturated
Fowl:
Chicken (broiler/fryer, cooked or roasted dark meat)
Turkey (cocked or roasted dark meat)
Chicken (broiler/fryer, cccked or roasted light meat)
Turkey (cooked or roasted light meat)
Lamb and veal:
Shoulder of lamb (cooked or roasted, 74 percent lean; 26 per- cent fat)
Leg of lamb (cooked or roasted, 83 percent lean; 17 percent
fat)
Veal foreshank (cooked or stewed, 86 percent lean; 14 per- cent fat)
Nuts:
Coconut
Brazil nut
Peanut butter
Peanut
Cashew
Walnut, English
Pecan
Walnut, black
Almond
Pork products:
Bacon _
Sausage, cooked
Deviled ham, canned
Liverwurst, braunschweiger, liver sausage.
Bologna
Pork loin (cooked or roasted, 82 percent lean ; 18 percent fat)..
Ham (cooked or roasted, 84 percent lean; 16 percent fat)
Fresh ham (cooked or roasted, 82 percent lean; 18 percent fat).
Canadian bacan (cooked and drained)
Chopped ham luncheon meat...
Canned ham
Salad and cooking oils:
Coconut
Palm
Cottonseed
Peanut
Sesame
Soybean, hydrogenated
Olive
Corn
Sunflower
Saffiower
Shellfish:
Eastern oyster
Pacific oyster
Ark shell claim
Blue crab
Alaska king crab
Shrimp
Scallop ..
Soups:
Cream of mushroom (diluted with equal parts of water)
Cream of celery (diluted with equal parts of water)
Beef with vegetables (diluted with equal parts of water)
Chicken noodle (diluted with equal parts of water)
Minestrone (diluted with equal parts of water)
Vegetable (diluted with equal parts of water)
Clam chowder, Manhattan style (diluted with equal parts of
water)
Table spreads:
Butter
Margarine (hydrogenated soybean oil, stick)
Margarine (corn oil, tub)
Margarine (corn oil, stick)
Margarine (saffiower oil, tub)
Vegetable fats (household shortening)
|
9.7 |
2.7 |
3.2 |
2.4 |
|
5.3 |
1.6 |
1.4 |
1.5 |
|
3.5 |
1.0 |
.9 |
.9 |
|
2.6 |
.7 |
.6 |
.7 |
|
26.9 |
12.6 |
11.0 |
1.6 |
|
21. 2 |
9. 6 |
8. 5 |
1. 2 |
|
10. 4 |
4. 4 |
4. 2 |
. 7 |
|
03. 0 |
31. 2 |
2. 2 |
. 7 |
|
68. 2 |
17. 4 |
22. 5 |
25. 4 |
|
52. 0 |
10. 0 |
24. 0 |
15. 0 |
|
49. 7 |
9. 4 |
22. 9 |
15.0 |
|
45. 6 |
9. 2 |
26. 4 |
7. 4 |
|
63.4 |
6.9 |
9.9 |
41.8 |
|
71.4 |
6.1 |
43.1 |
17.9 |
|
59. 6 |
5. 1 |
10. 8 |
40. 8 |
|
53. 9 |
4. 3 |
36. 8 |
10. 1 |
|
49. 0 |
18. 1 |
22. 8 |
5. 4 |
|
32. 5 |
11.7 |
15. 1 |
3.9 |
|
32. 3 |
11. 3 |
15.2 |
3.5 |
|
32.5 |
11.0 |
15.5 |
4.1 |
|
27.5 |
10.6 |
13.3 |
2.1 |
|
28. 1 |
9.8 |
13. 1 |
3. 1 |
|
22. 1 |
7. 8 |
10. 4 |
2. 4 |
|
20.2 |
7. 1 |
9. 5 |
2. 2 |
|
17.5 |
5.9 |
7.9 |
1. 8 |
|
17.4 |
5.7 |
8. 3 |
2. 2 |
|
11.3 |
4.0 |
5.3 |
1.2 |
|
100 0 |
86 0 |
6 0 |
2.0 |
|
mo |
4719 |
38.4 |
9.3 |
|
100.0 |
26.1 |
18.9 |
50.7 |
|
100.0 |
17.0 |
47.0 |
31.0 |
|
100.0 |
15.2 |
40.0 |
40.5 |
|
100.0 |
15.0 |
23. 1 |
57.6 |
|
100.0 |
14.2 |
72. 5 |
9.0 |
|
100.0 |
12.7 |
24.7 |
58.2 |
|
100.0 |
10.2 |
20.9 |
63. 8 |
|
100.0 |
9.4 |
12.5 |
73.8 |
|
2.1 |
.5 |
.2 |
.6 |
|
2.3 |
.5 |
.4 |
.9 |
|
1.5 |
.4 |
.3 |
.3 |
|
1.6 |
.3 |
.3 |
.6 |
|
1.6 |
.2 |
.3 |
.6 |
|
1.2 |
.2 |
.2 |
.5 |
|
.9 |
.1 |
.4 |
|
|
3.9 |
.7 |
.8 |
|
|
2.3 |
^!6 |
.5 |
1.0 |
|
.8 |
.3 |
.3 |
|
|
1.0 |
.3 |
.4 |
.2 |
|
1.1 |
.2 |
.3 |
.5 |
|
.9 |
.2 |
.3 |
.4 |
|
.9 |
.2 |
.2 |
.5 |
|
80.1 |
49.8 |
23.1 |
3.0 |
|
80.1 |
14.9 |
46.5 |
14.4 |
|
80.3 |
14.2 |
30.4 |
31.9 |
|
80.0 |
14.0 |
38.7 |
23.3 |
|
81.7 |
13.4 |
16.1 |
48.4 |
|
100.0 |
25.0 |
44.0 |
26.0 |
Source : Consumer and Food Economics Institute, U.S. Department of Agriculture, Agricultural Research Service, Hyattsville, Maryland. "Comprehensive Evaluation of Fatty Acids in Foods," Journal of The American Dietetic Association, May 1975 ; July 1975 ; August 1975 ; October 1975 ; March 1976 ; April 1976 ; July 1976 ; September 1976 ; November 1976 ; January 1977 ; unpublished data on shellfish and margarine.
41
TABLE 8.~CH0LESTER0L CONTENT OF COMMON MEASURES OF SELECTED FOODS (In ascending order]
Cholesterol
Food Amount (mil.igrams)
Milk, skim, fluid or reconstituted dry 1 cup 5
Cottage cheese, uncreamed H cup 7
Mayonnaise, commercial 1 tablespoon 10
Lard do 12
Yogurt, made from fluid and dry nonfat milk, plain or vanilla Carton (227 grams) i 17
Cream, light table 1 fluid ounce 20
Cottage cheese, creamed Mcup 24
Cheese, pastuerized, processed American 28 grams (25)
Cheese, pastuerized, processed Swiss do— (26)
Cream, half and half H, cup 26
Ice cream, regular, approximately 10 percent fat H cup 27
Cheese, cheddar 1 ounce 28
Milk, whole 1 cup 34
Sausage, frankfurter, all meat, cooked 1 frank 34
Butter 1 tablespoon 35
Beef and vegetable stew, canned 1 cup 36
Cake, baked from mix, yellow 2 layer, made with eggs, water, chocolate 75 grams 36
frosting.
Oysters, salmon 3 ounces, cooked .„ 40
Clams, halibut, tuna do . 55
Chicken, turkey, light meat do 67
Beef, pork, lobster, chicken, turkey, dark meat do 75
Lamb, veal, crab do 85
Tuna, canned in oil, drained solids 184 grams 116
Lobster, cooked, meat only 145 grams 123
Shrimp 3 ounces, cooked. __ 130
Heart, beef ....do 230
Egg 1 yolk or 1 egg 250
Liver, beef, calf, hog, lamb 3 ounces, cooked... 370
Kidney do 680
Brains 3 ounces, raw >1,700
1 Estimates in parenthesis imputed.
Source: "Cholesterol Content of Foods," R. M. Feeley, P. E. Criner, and B. K. Watt., J. American Dietetic Association 61:134, 1972.
Although the changes just described will assist in approaching the goals outlined, it is necessary also to (1) select foods from within the fish, poultry and vegetable groups that are relatively low in fat, saturated fat and cholesterol; (2) reduce fat use and consumption of foods high in fat; and (3) make partial substitution of polyunsatu- rated fat for saturated fat. Tables 6, 7 and 8 provide guidance in these areas.
With respect to overall fat consumption, using Tables 6 and 7, it may be useful to follow a strategy of selecting greater numbers of foods that derive 30 percent or less of their calories from fat.
The following excerpt from a presentation by the American Heart Association to the Federal Trade Commission compares consumption goals to commonly used food measures :
A relatively small number of foods do contribute a major proportion of the cholesterol and saturated fat in the American diet. For example, in our 1972 report, the Inter-Society Commission for Heart Disease Resources recommended the reduction of dietary cholesterol to less than 300 mg. per day. We noted that the average American daily cholesterol intake was approximately 600 mg. per day. A single egg yolk, however, contains 250 mg. cholesterol by itself, nearly the daily allowance. We further recommended an intake of less than 20 percent of total calories to be obtained from saturated fat. Assuming a caloric intake of 2,500 calories per day, the average American should take in no more than 250 calories or less than 27 grams of saturated fat per day. One cup of whole milk contains 5 grams saturated fat. One cup of ice cream contains 8 grams ; six ounces of ham approximately 8 grams. These are very substantial portions of the maximum recommended allowance for a day. Therefore the contribution of individual foods to the cholesterol and saturated fat intake in the diet can be highly significant.
42
Fremes and Sabry point out in "NutriScore" that food labels rarely if ever indicate the type and saturation of fats used in processed foods. They report that the saturated fats, palm oil and coconut oil, are used interchangeably in powdered, frozen or liquid coffee creamers used at home and in restaurants and coffee machines. They say :
But what of all the other products like chips, convenience spreads and cookies? What oil is in them? We don't know and won't know without some government regulations and industry cooperation. Until it becomes mandatory for manu- facturers to declare the type of oil on the labels of foods with vegetable oil listed, we would recommend that you stay away from all commerical snack foods, in- cluding potato chips, baked goods, crackers and all mixes. If you must use a whipped topping occasionally, consider this : packaged synthetic toppings are just as saturated as real whipped cream, and real milk or table cream has much less fat than whipped cream or the substitutes.
GOAL 5. REDUCE SUGAR CONSUMPTION BY ABOUT 40 PER- CENT TO ACCOUNT FOR ABOUT 15 PERCENT OF TOTAL ENERGY INTAKE
Figure 3, from an article by Louise Page and Berta Friend, of the Department of Agriculture, appearing in ''Sugars in Xutrition," published by the Nutrition Foundation, shows that various kinds of sugar accounted for only about 32 percent of total carbohydrate con- sumption in the period 1909 to 1913. However, by 1976, sugar had replaced starch, or complex carbohydrates, as the predominate carbo- hydrate energy source.
The largest components of the sugar categorj^ are refined sugar and syrups, molasses and honey, accounting in 1976 for about 14 percent and 4 percent of total calories, respectively. The remainder occurs naturally in fruit and milk products.
The greatest impetus for increased sugar use apparently has come from the addition of refined sugar to processed foods. Figure 11, also from the Page/Friend article, shows the dramatic increase in use of sugar added outside the control of the consumer.
Page and Friend report :
Use in processed food products and beverages has increased more than three- fold from nearly 20 to 70 lbs., while household purchase has dropped one-half from a little more than 50 to about 25 lb. Currently, food products and beverages account for more than two-thirds of the refined sugar consumed — 70 lb. out of a little over 100 lb. Moreover, beverages now comprise the largest single industry use of refined sugar, accounting for over one-fifth of the total refined sugar in the United States diet, or nearly 23 lb. Furthermore, the amount used in bever- ages has increased nearly sevenfold since early in the century when 3i/^ lb./ person/year was used in these products. Use of refined sugar in beverages is now second only to household use.
Figure 11
REFINED SUGAR
Type of Use Per Person
|
1909-13 |
1 |
||
|
wmm |
76.4 lb.
19.3 lb.
52.1 lb.
5.0 lb.
1971
i
101.5 lb.
FOOD
PRODUCTS,
BEVERAGES
U S DEPARTMENT OF AGRICULTURE
70.2 lb.
DIRECT CONSUMER USE
UNPUBLISHED DATA
NcG. APS 6048-72(10)
24.7 lb. 6.6 lb.
INSTITUTIONAL, OTHER
AGRICULTURAL RESEARCH SERVICE
(43)
44
Table 9, provided by Page and Friend, show changes in sugar use in this century.
Table 9. — ^Refined sugar, estimated per capita consumption by type of use, selected periods, 1909-13 to 1971.*
|
Type of use |
1909-13 (lb) |
1925-29 Ob) |
1935-39 Ob) |
1947-49 Ob) |
1957-59 m |
1965 Gb) |
1971 (prelim i p ftry ) Gb) |
|
In processed foods: |
|||||||
|
Cere&l &Dd bakery products |
4 5 |
7.7 |
9.7 |
12 9 |
15 4 |
17,6 |
|
|
Confectionery products |
6.5 |
8.0 |
8^2 |
9^8 |
9.6 |
10!4 |
11.0 |
|
Processed fruits and vegetables' |
3.0 |
4.6 |
4.4 |
9.0 |
9.8 |
9.5 |
10.4 |
|
1 .5 |
2.3 |
2.4 |
4.6 |
4.9 |
5.3 |
5 8 |
|
|
Other food producta' |
0.3 |
0.7 |
1.2 |
l!5 |
l!7 |
2^5 |
2!6 |
|
Total food products |
15.8 |
23.4 |
25.9 |
37.8 |
41.4 |
43.3 |
47.4 |
|
Beverages Qargely in soft, drinks) |
3.5 |
5.0 |
5.2 |
10.6 |
12.6 |
16.9 |
22.8 |
|
Total processed food and beverages |
19.3 |
28.4 |
31.1 |
48.4 |
54.0 |
60.2 |
70.2 |
|
Other food uses: |
|||||||
|
Eating and drinking places'' |
4.5 |
5.7 |
6.3 |
7.7 |
7.3 |
6.2 |
5.5 |
|
Household use* |
52.1 |
65.0 |
58.8 |
37.4 |
33.1 |
28.2 |
24.7 |
|
Institutional and other use^ |
0.5 |
0.9 |
0.9 |
1.3 |
1.0 |
1.4 |
1.1 |
|
Total |
57.1 |
71.6 |
66.0 |
46.4 |
41.4 |
35.8 |
31.3 |
|
Total food use |
76.4 |
100.0 |
97.1 |
94.8 |
95.4 |
96.0 |
101.5 |
|
Nonfood use' |
0.3 |
0.4 |
0.4 |
0.4 |
0.7 |
0.6 |
0.9 |
|
Total consumption |
76.7 |
100.4 |
97.5 |
95.2 |
96.1 |
96.6 |
102.4 |
• Prepared by Food Consumption Section, Economic Research Service, U.S. Department of Agriculture.
' Canned, bottled, and frozen foods (processed fruit and vegetable products); jams, jellies, and preserves.
' Includes miscellaneous food uses such as meat curing, and syrup blending.
'' Includes hotels, motels, restaurants, cafeterias, and other eating and drinking establishments.
' Household use assumed synonymous with deliveries in consumer-sized packages Qess than 50 lb).
' Largely for military use.
' Includes use in pharmaceuticals, tobacco, and other nonfood use.
Source : "Sugars in Nutrition," Levels of Uses of Sugar in the United States, L. Page, B. Friend, 1974.
This increased use of sugar is traceable in large part to the desire of food manufacturers to create unique food products with a compe/titive edge. Just recently, for example, Nabisco introduced an Oreo cookie with double the amount of sugar filling. Eobert Buzzell and Eobert Nourse in "Product Innovation in Food Processing" report that the addition of sugar to cereal in 1948 was the direct cause of recovery of slumping cereal sales. Since then, the varieties of sweetened cereals have grown dramatically. The profusion of varieties of cereals, soft drinks and other products represent efforts to protect market shares.
Nutrient Danger
The impact on health of these increases in sugar use are not well understood. The most immediate problem often cited by nutritionists is the danger in displacing complex carbohydrates which are high in micro-nutrients, with sugar, which is essentially an energy source of- fering little other nutritional value. This not only increases the po- tential for depriving the body of essential micro-nutrients but, noted Dr. Jean Mayer in an article in the "New York Times Magazine" in June 1976, sugar calories may actually increase the body's need for certain vitamins.
( Sugar calories ) increase requirements for certain vitamins, like thiamin, which are needed (for the body) to metabolize carbohydrates. They may increase the need for the trace mineral, chromium, as well.
Thus, a greater burden is placed on the other components of the diet to con- tribute all the necessary nutrients— other foods need to show extraordinary "nutrient density" to compensate for the emptiness of the sugar calories.
45
Sugar has been implicated in cardiovascular disease, notably by Dr. John Yudkin. Ho^Yever, the Connors* as well as other experts, report that no clear links have been established between sugar and heart disease.
Diabetes
There is some evidence, though, connecting sugar with diabetes. Dr. A. M. Cohen and associates report in ''Sugars in Nutrition'' that rats with a genetic predisposition to diabetes will develop the disease when exposed to high sugar diets and that they can be prevented from contracting it with a sugar-free diet. Dr. Mayer noted in an article in the Los Angeles Times in October 1975, that several epidemiological studies indicate a connection between high-sugar use and diabetes. For example, Yemenite Jewish immigrants to Israel had a low incidence of diabetes until they had consumed a Westernized diet high in sugar for several years.
Tooth Decay
Sugar has also been implicated in tooth decay, which may be the most widespread disease related to nutrition. Dr. Mayer, citing a gov- ernment survey said in the Times article :
In nations of the Far East, where sugar intake per person per year ranged (at the time) from 12 to 32 pounds, the national averages for decayed, missing or filled teeth in adults 20 to 24 years old ran from 0.9 to 5. By contrast, in South American nations, where sugar intake was high (44 to 88 pounds per person annually) the averages for decayed, missing or filled teeth in the same age group ran from 8.4 to 12.6. As for the United States today, it has been esti- mated that 98 percent of American children have some tooth decay ; by age 55 about half of the population of this country have no teeth.
These considerations have led a number of governmental and pro- fessional health organizations in the United States, and other nations, cited earlier, to recommend a general decrease in sugar consumption (Appendix B).
In ''Sugars in Nutrition," Dr. Arvid Wretlind, of the Nutrition Unit, Karolinska Institutet, Stockholm, writing about sugar usage in Europe, suggests that sugar consumption be reduced to 10 percent of calories.
In Europe there has been, and in some countries still is, a continuous increase in sugar consumption. In some of these countries the sugar content of the diet has reached a level between 15 and 18 percent of calories, llie increase in sugar consumption, followed by an increased fat intake will, generally speaking, result in a decreased content of essential nutrients and in a reduced consumption of other foods which contain not only energy but also valuable nutrients. The con- clusion is that the amount of sugar in a moderate diet should be moderate. A maximum level of 10. cal/percent is proposed.
'While such a level might be ultimately desirable, a reduction of sugar consumption to about 15 percent of caloric consumption appears to be a more realistic goal for the United States, one which would take sugar consumption to a point slightlv lower than that of the early 1900's.
Guide To Eeducing Sugar Intake
In reviewing ways of cutting sugar consumption, the most obvious item for general reduction is soft drinks. Total elimination of soft drinks from the diet, for many people, woiild bring at least half the recommended reduction in sugar consumption.
46
Soft drink consumption in the United States doubled between 1960 and 1975, rising from 13.6 gallons a year to 27.6, as shown in Table 10 from the Department of Agriculture's "Sugar and Sweetener Re- port," September 1976. This translates into 221 sixteen-ounce cans and 21.5 pounds of sugar a year.
TABLE 10— SOFT DRINK SALES, PER CAPITA CONSUMPTION AND AMOUNTS AND VALUE OF SUGAR USED IN
MANUFACTURE, 1960-75
Per capita soft drink Per capita
consumption sugar Value of
Sales consumption sugar
(millions) 16-ounce Gallons (pounds) (millions)
Year:
1960 $1,857 109 13.6 11.3 $188
1965 3,195 154 19.2 15.2 274
1970... 5,016 193 24.1 19.2 420
1975 9,426 221 27.6 21.5 1,218
Source: Sugar and Sweetener Report, Vol. 1, No. 8, September 1976 Economic Research Service, U.S. Department of Agriculture.
This increase has evidently been made at the expense of more nu- tritious beverages. As Table 11 shows, between 1962 and 1975, soft drinks became the second most highly consumed beverage, displacing milk. Currently, soft drinks compete with coffee for first place.
TABLE 11.— TRENDS IN BEVERAGE CONSUMPTION [Gallons, per capita, per year]
|
Beverage |
1962 1 |
1975 |
|
Coffee . __ |
40.4 |
31.6 |
|
Milk |
25.6 |
24.4 |
|
Soft drinks _ |
16.8 |
31.4 |
|
Juices |
4.3 |
6.2 |
1 Earliest data available.
Source: Copyright, John C. Maxwell Jr., Maxwell Associates. Richmond, Va.
Another source of concern is the caffeine in cola soft drinks, which account for about 65 percent of total soft drink consumption (at least one non-cola also contains caffeine). Medical World News, of Janu- ary 1976, reports that suspected connections between caffeine and ulcers, heart disease and bladder cancer have been investigated but that evidence is not strong enough to cause caffeine to be adjudged a risk factor in these diseases. There have been findings of withdrawal symptoms of headache, nervousness and irritability among subjects deprived of normal coffee doses as well as similar symptoms among those who may have ingested too much caffeine. The report said colas are of special concern since they are the major caffeine source for most children.
(Doctors, particularly pediatricians) have reported signs — including irrita- bility, headaches, and nervousness — of what has come to be known as "caf- feinism" among cola-guzzling youngsters whose total caffeine intake (30 mg per 8-oz. can) may be boosted by cocoa or hot chocolate (up to 50 mg per 5-oz. cup) and chocolate bars (25 mg).
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Reduction in soft drink consumption also offers the advantage of reducing consumption of non-nutritive additives, colors, flavors, and preservatives.
The second major area for consideration in cutting sugar consump- tion is baked goods, reported by Page and Friend to be the second highest source of sugar use. In this area, as in others, home prepara- tion provides greater control over sugar as well as fat use.
Finally, it is important to remember that sugar has been added to a wide range of products, but labeling regulations do not currently require sugar content to be described. As noted earlier, use of fresh food enables greater protection against hidden sugar.
GOAL 6. REDUCE SALT CONSUMPTION BY ABOUT 50 TO 85 PERCENT TO ABOUT 3 GRAM/DAY
Salt (sodium chloride) consumption in the United States is esti- mated to range from about 6 to 18 grams a day, according to "Kecom- mended Dietary Allowances," published in 1974 by the National Academy of Sciences. Drs. George Meneely and Harold Battarbee, in "Present Knowledge in Nutrition," suggest, however, that the aver- age human requirement for salt is probably only about half a gram. The three gram a day allowance which is derived from the Academy report, the authors say, "is more than enough."
The average requirement could normally oe achieved without add- ing salt to any food. Drs. Meneely and Battarbee cite studies indicat- ing that desire for salt is not a physiological necessity but an acquired taste.
The authors point also to evidence that there is an important bal- ance between sodium and potassium, required for the proper flow of fluids among and through cells. (The Academy describes a require- ment for potassium of 2.5 grams a day.) They provide the following Tables 12 and 13 showing the impact of various processing methods on sodium and potassium content, and say :
Aside from the rather uncertain matter of treks to salt licks, there are no ter- restrial mammals except man which add salt to their food. Table 12 which traces the changes in sodium and potassium in 100 g of peas exemplifies the extent to which potassium is depleted and sodium increased during canning and freez- ing. Peas, drained and before butter and salt are added for serving at table, thus contain 255 times as much sodium as the fresh product and more than half of the potassium is gone. Sodium intake is thereby greatly increased, potassium reduced. The sodium and potassium content of several other foods are shown in Table 13.
Consumer purchase of salt has declined somewhat as his use of processed and prepared foods has increased. Sodium intake is more and more determined by the food processors rather than by the individual.
TABLE 12.— CHANGES IN SODIUM AND POTASSIUM CONTENT OF PEAS
Food (100 g edible portion)
Na (mg)
K(mg)
Fresh peas
Frozen peas
Canned peas, liquid poured off... Add salt, serve with salted butter.
0.9
380 160 180 (?)
100
230
(?)
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49
TABLE 13 -SODIUM AND POTASSIUM CONTENT OF SEVERAL FOODS
Food (100 g edible portion)
Na (mg)
K(mg)
Olives
White bread
Cornflakes
Cheddar cheese... Dried nonfat milk.
Bacon
Chipped beef
Smoked ham, raw.
Frankfurter
Salami
Canned crabmeat.. Canned salmon.. .
2.400 507 660 700 525 1,770 4, 300 2,530 1,100 1,260 1,000 540
55 105 165
82 1,335 225 200 248 230 302 110 330
Source: Present Knowledge in Nutrition: sodium and potassium, G. Meneely, H. Battarbee, 1976.
Salt is added to processed food principally as a flavoring agent rather than as a preservative. In some instances it is the primary flavoring agent and may be used to mask other, less appealing, flavors.
Hypertension
Salt has been found to cause an increase in blood pressure, hyperten- sion, among some individuals, but others do not seem genetically sus- ceptible. There is some evidence that imbalance with potassium intake may be a factor in hypertension. Drs. Meneely and Battarbee esti- mate that 20 percent of the United States population is susceptible to hypertension and up to 40 percent of older people. They recommend reduction of salt intake as an important countermeasure.
Millions of children and youths are moving toward hypertension. Excess dietary sodium is clearly an adverse factor in some, if not in most, people prone to hypertension. The evidence indicates that a systematic effort to reduce dietary sodium chloride intake and increase dietary potassium intake would result in the amelioration of much suffering among those who are prone and would increase both duration and quality of life for many millions of people.
Other Findings
Di^. Meneely and Battarbee, who also describe excessive salt as "noxious per se,'' report observations of possible connections between high sodium intake and heart disease. Researchers have found that in- creases in sodium from 4 grams to 24 grams a day in humans altered the ability to clear intravenously administered fat from the blood stream. Other researchers have found improvement in vascular disease resulting from a decline in salt consumption even when blood pressure failed to decline.
They also report findings of possible connections between high salt intake and changes in levels of gastric acid secretion, stomach cancer and cerebrovascular disease.
Dr. John Brainard, reporting in Minnesota ^Medicine, April 1976, draws a connection between migraine headaches and salt. Twelve mi- graine suffers were advised to avoid all known factors in migraine, such as sodium nitrite and monosodium glutamate, and also sodium chloride by following a salt restriction which entailed "avoiding all salted snack foods, such as pretzels, nuts and potato chips before
50
dinner." Ten out of 12 responded favorably, the report said, with a few saying migraine no longer was a problem. And the report noted :
It has not been appreciated that the sudden salt load of a handful of salted nuts or potato chips, particularly if taken on an empty stomach, can cause a severe migraine six or twelve hours later. The reason for the lag period is not known.
Finally, in "Human Nutrition," Dr. Jean Mayer warns of hyper- tension that may develop as a result of high salt intake by children. He reports :
Clinically, it is well known that the tendency for edema to develop in prema- turely-born infants is a function of the sodium content of the diet. It has also been demonstrated that a high salt content of the diet increases the likelihood of renal cast formation (an indication of possible kidney damage) in these infants.
Although there is some evidence that increased potassium intake might help offset possible adverse effects of high sodium consumption, the most prudent course appears to be to reduce salt intake to at least the level of 3 gm a day.
Guide To Eeducing Salt Consumption
The goal of 3 gm of salt a day amounts to about three-fifths of a teaspoon and 1,200 mg of sodium alone. (Salt is about 40 percent sodium.) However, as mentioned earlier, the daily goal will be met for most in the United States without the addition of salt to food or consumption of foods on which the salt is visible, such as pretzels and potato chips.
Furthermore, commonly-used seasoning may also be relatively high in sodium. For example, based on Agriculture Handbook 456, a table- spoon of catsup plus the salt on 10 french fries would result in sodium ingestion of about 370 mg. or about 25 percent of the allowance sug- gested by the foregoing goal. The same french fries would bring only 2 mg of sodium if served unsalted.
In pursuing a diet with reduced sodium, it may be helpful to follow guidelines for achieving mild salt reduction contained in Dr. Mayer's "Human Nutrition."
Foods That May Be Eaten (Fresh, Frozen, Canned)
Low in Sodium
Fruits : all fruits and fruit juices.
Fats: Avocado, Butter, margaine, Cooking oils or fats( except bacon fats), Cream, sweet or sour, Mayonnaise, and Unsalted nuts.
Moderately High in Sodium
Vegetables: all kinds except those listed under "Foods to avoid."
Breads and cereals: Barley, Bread, (white and whole wheat), Biscuits, Muffins, Matzo, Grits, Cornbread, Cornmeal, Cornstarch, Wheat meal, Rolled wheat, Oatmeal, Rice, Tapioca, Farina, Dry cereal, Crackers, Griddle cakes and waffles, Macaroni, Noodles, and Spaghetti.
High in Sodium
Milks : Whole, Skim, Buttermilk, Powdered, and Evaporated.
Meats : Beef, Pork, Lamb, Veal, Rabbit, Brain, Kidney, Liver, Tongue, Chicken, Duck, Quail, and Turkey.
Fish : All kinds, except those listed under "Foods to avoid."
Cheese: (lightly salted) Swiss, American, Cottage.
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Breads and cereals : Barley, Bread, (white and whole wheat), Biscuit, Muffins, Matzo, Oatmeal, Bice, Tapioca, Farina, Dry cereals, Crackers, Grits, Cornbread, Cornmeal, Cornstarch, Wheat meal, Rolled wheat. Griddle cakes and waffles, Macaroni, Noodles, and Spaghetti.
Eggs : in modera tion.
Other foods : Alcoholic beverages. Fountain beverages, Baking chocolate, Cocoa, Candy, Coffee or coffee substitute, Gelatin, Pudding mixes, Syrups, Honey, Molasses, Leavening agents such as Baking powder. Baking soda, for baking only. Potassium bicarbonate, and Yeast.
Foods to Avoid {Very High in Sodium)
Meats: (Salted or smoked, Bacon, Bologna, Corned beef, Ham, Luncheon meats, Sausage, and Salt pork.
Fish: (Salted or smoked). Anchovies, Sardines, Caviar, Dried cod, and Herring.
Peanut butter, unless low-sodium dietetic.
Flavorings : Commercial bouUion, Catsup, Celery, onion or garlic salts. Chili sauce, Meat extracts, sauces or tenderizers, unless low-sodium dietetic. Prepared mustard. Relishes, Salt substitutes, Cooking wine.
Cheeses : Processed cheese, Cheese spreads, Roquefort, Camembert, and Other strong cheeses.
Vegetables : Salted or packed in brine, Pickles, sauerkraut, etc. Miscellaneous : Breads with salt topping. Potato chips. Popcorn, Other salted snacks. Bacon and bacon fat, Pretzels, Salted nuts, and Olives.
GENEEAL REMINDERS
Milks, meats, fish, cheese and eggs are quite high in sodium. Vegetables, breads and cereals have moderate amounts of sodium, which vary greatly among the different vegetables.
Fruits and fats are low in sodium or have only trace amounts. Highly salted snack foods should be avoided.
Halve the amount of salt, soy sauce, and monosodium glutamate used in cooking and at the table.
Do not add salt to foods already salted in freezing and canning.
Try different flavorings except those listed under "Foods to avoid."
Do not use a salt substitute unless the physician has recommended it.
When eating out or buying prepared canned or frozen foods, try to avoid those with an unlisted salt content.
EFFECTS OF GOALS BEYOND NUTRITIONAL CONCERNS
1. SOCIO-CULTURAL IMPLTCATIOXS
The social, cultural and psychological significance of food in our lives can scarcely be overestimated. Sharing of food is one of the prime social contacts ; provision of food is one of the prime signs of caring. Just as the general meaning of food in our lives should not be under- estimated, changes in our eating behavior must not be underestimated in terms of their potential impact on our whole way of life. A sub- stantive discussion of the socio-cultural impact of profound changes in eating habits (both those which have in fact occurred in 20th cen- tury America and those recommended here) is beyond the scope of this report. Nevertheless, it is possible to illustrate the growing con- cern that a diet increasingly dependent on highly processed, highly packaged food, i.e., an increasingly mechanized approach to the pro- vision of food, may have not only potential for negative nutritional effect but also a negative psychological effect.
All of the following examples refer directly only to institutional environments. In such situations it is clear that the tendency toward mechanization of the feeding process is particularly strong — stronger, by far, because of the necessities of institutional management, than the same tendency in the home. Nevertheless, observations on the psycho- logical impact of different kinds of eating environments, made in institutional settings, may be appropriately applied to the home-eating situation when the difference in degree is acknowledged.
In May of 1976, the Washington Post reported on the overhaul of food service practices at the Montgomery County Detention Center in Maryland. Inmates had been fed for five or six years on frozen TV- type meals served in aluminum foil pans. While fed this way, groups of inmates, on a regular weekly basis, threw their trays against the wall in anger. When a sAvitch was made to fresh foods, prepared on the premises by an inmate chef, complaints about the food dropped to ''almost nothing."
It is plausible to speculate that feelings about taste and nutrition were not the sole motivators of the inmates' disgust over the way they were being fed. The feeding status quo had been de-humanized and was therefore, de-humanizing. The switch not only improved nutrition (more fresh fruits, vegetables and salads; the option of whole wheat bread; and steps toward reducing sugar intake) and saved money (20 to 30 cents per day per capita), but perhaps even more important, as soon as the frozen dinners were replaced, "morale picked up immediatel}'."
Schools, as another example of an institutional mass-feeding situ- ation in which there is a strong temptation to turn to mass-produced food, are relying increasingly on pre-plated convenience meals and formulated foods. While the children may not have rebelled, many
(52)
53
parents and concerned outsiders have objected, and not simply on nutritional grounds. Marian Burros, in a Washington Post article in August of 1976, cited the following general objection to the trend toward using formulated foods to save time and/or money : . . such a position ignores the concept that the feeding of children in any school program should be an integral part of their education process and not just something to get out of the way as quickly as possible."'
Others have more explicitlj' described the reasons behind that con- cept which they feel is being ignored. A Washington Star editorial in June of 1976, praising the work of Mary Goodwin, Montgomery County public health nutritionist, in combating the convenience trend, made the following comments :
The pleasures of seeing, smelling and tasting food that looks, smells and tastes good, nourish the personality with sensuous experience even as the vita- mins and minerals are making their contribution to the growth of bone and muscle. An awareness of real people preparing and serving the foods helps too.
Which is to say that if you eat enough precooked, frozen, reheated foil-and- plastic packed lunches out of machines, part of you will starve to death. On-site food preparation — most important of all — is, in her (Mary Goodwin's) words, "a way of keeping children in contact with the real world rather than a highly mechanized, impersonal one."
Dr. Bruno Bettelheim, a noted child psychiatrist, believes that eat- ing plays a central psychological role in human life, and that in this regard not only what the food is, but also where and how it is served makes a difference. Several quotes from Bettleheim's article, "Food to Nurture the Mind," in the ]\Iay 1975, School Review, summarize his case. Concerning the general psychological significance of food, he ssijs :
Eating and being fed are intimately connected with our deepest feelings. They are the basic interactions between human beings on which rest all later evalua- tions of oneself, of the world, and of our relationship to it. Eating experiences condition our entire attitude to the world, not so much because of how nutritious is the food we are given, but because of the feelings and attitudes with which it is given.
Concerning the specific importance of the sharing of food and the effect it has on inter-personal relations, he says :
The social climate of a mental institution changes immediately if the entire staff, up to the top of the hierarchy, takes its meals with the patients. The fact that patients, staff, and doctors eat together, and eat the same fare, immediately reduced the levels of tension, the potentiality of violent outbreaks. And this not just at mealtime but all during the day and throughout the institution. Nothing is more divisive than when people eat a different fare, in different rooms.
At a time when more and more meals are being taken away from the home, removed from the company of family members, perhaps more consideration should be given to the possibility that this trend is a factor that substantially contributes to the stresses found in modern family life.
Perhaps the most significant statement in Dr. Bettelheim's article is the following:
The distinction between physical and emotional need, between body and in- tellect, is, in reality, a false one.
The impact of changed eating patterns in the home as well as in institutions, on our whole way of life is, no doubt, unquantifiable. It
54
may even be indescribable. It is important in examining historical trends in eating habits, and in assessing the need for future changes in eating habits, to remember that we are dealing with an aspect of our lives which is by no means limited to the physical.
2. FOOD BUDGET
A shift to the dietary goals outlined offers potential for significant reduction in food costs. Savings can be achieved through home prep- aration and through reduction of and substitution for fats, sugar and expensive, fatty protein sources.
Table 5, from "Diet for a Small Planet," comparing costs of protein sources, shows that every legume listed and every grain product ex- cept one provides the daily protein allowance for less than one dollar, whereas the majority of meat protein sources cost over one dollar a day.
Within the category of grain products, choosing the less processed, more nutritious products may often mean a savings. For instance, in one sampling, brand-name converted rice cost more than 25 percent less than the low-priced store brand of instant rice. Slightl}^ processed hot cereals like oatmeal are generally less expensive than ready-to-eat cereals.
The most dramatic savings made by a reduction in sugar consump- tion result from cutting back on or eliminating purchases of candy, sweet baked goods, and soft drinks. Costs are also cut when the con- sumer chooses the unsweetened as opposed to the presweetened version of a particular food item ; the prime example is breakfast cereals.
Eeducing fat consumption, and particularly consumption of sat- urated fats, may also yield cost savings in several areas. Liver and chicken, lower in the saturated fat categories among the meat and poultry products, may average less than half the price of the beef, pork and lamb cuts. Butter, on a per teaspoon basis, is generally more expensive than even the most costly of the unsaturated vegetable oils. Reduced use of prepared salad dressing, catsup, and sauces can not only cut expenses but reduce fat and/or salt and sugar consumption.
Greater home preparation can also yield savings in some areas as well as greater control over diet composition. A recent study by the Department of Agriculture comparing the costs of various convenience foods with their home-prepared counterparts found that out of 25 meat dishes tested, 21 were more expensive per serving when pur- chased ready-made. Many of the cost differentials were dramatic. The report said :
The cost of home-prepared batter-dipped chicken was less than one-third that of the convenience products. Both chicken a-la-king frozen in a pouch and canned chicken salad spread, were about 60 percent more expensive per serving. . . . Consumers paid approximately 40 cents more per serving for frozen turkey dinner or tetrazzine than for the separate ingredients.
Many will find it impossible to change food preparation patterns drastically. However, it is evident that home-preparation can offer savings as well as nutrition advantages.
55
COXSUMPTION OF FoOD AdDITIVES
There are more than 1,300 food additives currently approved for use as colors, flavors, preservatives, thickeners and other agents for controlling physical properties of food.
The exact amounts of additives now in use are not known, but more accurate measures may be available after a survey being planned by the Food and Drug Administration for 1977. A study prepared by the FDA in 1976 estimates that the average daily consumption of artificial colors alone among children aged 1 to 5 may be about 60 milligrams and average consumption for children aged 6 to 12 may be about 75 milligrams. The study finds, as shown in Table 14, that the largest single category contributing to artificial coloring consumption among children is beverages.
TABLE 14.-AVERAGE MILLIGRAMS OF ALL FD AND C COLORS IN FOOD INTAKE BY FOOD CATEGORY AMONG TWO
GROUPS OF CHILDREN
Color intake
Average diet eaters only Diets of total age group (mg), age— (mg), age-
Food category 1-5 6-12 1-5 6-12
Candy and confections 5.2 6.0 0.9 1.2
Beverages 21.1 29.3 8.5 13.6
Dessert powders 18.0 20.7 1.8 1.9
Cereals 8.4 10.6 3.8 4.6
Maraschino cherries 8.4 (0
Bal<ery goods 3,5 5.1 2.5 3.8
Icecream 2.6 3.6 .8 1.3
Sausage 7.5 9.2 1.6 2.3
Snack food 3.0 3.4 .5 .8
Miscellaneous 48.6 55.4 38.8 46.4
Food with color, less miscellaneous 21.3 30.3 20.5 29.3
Food with color, including miscellaneous 60.0 76.2 59.2 75.5
1 Less than 0.05 milligrams.
Source: Arietta Beloian, Food and Drug Administration memorandum: Estimates of average, 90th percentile and maximum daily intakes of FD & C artificial food colors in one day's diets among two age groups of children. July 30, 1976.
The food additives now in use are considered safe by the FDA based on varying degrees of testing, review of scientific literature, expert opinion and long-time usage. The most testing, according to an FDA official, has been given to artificial colors, most of which have had animal toxicity testing by the food industry. The FDA will begin in 1977 a re-evaluation of the safety of colors, flavors, and "direct" addi- tives. Artificial flavors have had the least animal testing of the three additive categories.
Although food additives as a category may not justifiably be con- sidered harmful, the varying degrees of testing and quality of testing and the continuing discoveries of apparent connections between certain additives and cancer, and possibly hyperactivity, give justifiable cause to seek to reduce additive consumption to the greatest degree possible.
In NutriScore, Fremes and Sabry suggest that "necessity should be the touchstone for the use of additives." They argue, as do others, that only those additives that serve a necessary function should be permitted in food. They do not define necessary, but it is apparent that necessity most strictly defined has to do with protecting food safety.
56
There are several additives commonly considered under the heading of preservatives and flavor enhancers that Fremes, Sabry and others classify as unnecessary and possibly a hazard to health.
Nitrates and Nitrites "NutriScore" comments :
While these additives are not in themselves harmful, they may combine with other chemicals in food or in the intestine to form nitrosa mines, which are known to cause cancer. The advantages of using nitrites in processed foods is that they maintain a pinkish- red color, which makes the meat look fresh and attractive, and they check the growth of bacteria. Some of these bacteria, like botulinum, produce deadly poisons. Government should therefore limit the addition of nitrites to the amount needed to check the growth of botulinum bacteria and no more.
This has been done in Canada, where the Canadian Health Protection Branch has recently reduced the amounts of nitrates and nitrites allowed in cured and processed meats. Industr}^ for its part, should find a preservative other than nitrite that will be effective against bacteria, yet will not present a cancer hazard.
BET and BHA
These chemical preservatives are judged safe by the Food and Drug Administration, but neither is essential. "Nutrition Scoreboard" points out that foods not using the chemicals can be found readily.
Monosodium Glutamate
"NutriScore" recommends against use of foods containing mono- sodium glutamate, saying it may be associated with headaches, flushes in the head and body and tingling in the spine. The chemical is a flavor enhancer but not a necessary food ingredient. Eesearchers at Yale University School of Medicine said in a letter to the editor of the Novemxber 4, 1974 Journal of the American Medical Association that their studies indicated :
That MSG offers a hazard to those endangered by excessive sodium intake : its moderate saltiness fails to warn the user about its high sodium content and can therefore lead to increased sodium ingestion.
Part II
RECOMMENDATIONS FOR GOVERNMENTAL ACTION
Introduction
The dietary trends in the United States described in Part I have occurred in other nations as well, in several cases prompting govern- mental action. In 1968, the medical boards of Finland, Norway and Sweden published "Medical Viewpoints on the National Diet in Scan- dinavian Countries"' which recommended:
1. The dietary energy supply should, in many cases, be reduced to prevent overweight.
2. The total fat consumption, at present about 40 percent, should be decreased to between 25 and 80 percent of total calories.
3. The use of saturated fat should be lowered, and the consumption of poly-unsaturated fat should be simultaneously increased.
4. The consumption of sugar and products containing sugar should be less.
5. The consumption of vegetables, fruits, potatoes, skimmed milk, fish, lean meat and cereal products should be increased.
In 1969, the Swedish National Board of Health and Welfare moti- vated by "the decidedly negative results of the changed food habits in our country during the last 30-40 years (and) the enormous costs of medical care of disease related to these changes," began a 10-year campaign to encourage the public to exercise more and alter their diets. Table 15 shows recommended dietary changes.
Table 15. — Example of changes desirable in the average consumption of foods in Sweden. The proposed changes are expressed percent of the mean con-
sumption in 1960. Food group
1. Green vegetables, dried peas and beans +100
2. Fruit +50
3(a). Potatoes +25
(b). Other root vegetables +100
4. Standard milk +25
5. Meat, fish and eggs ±0
6. Flour, meal macaroni for direct consumption +25
Crispbread and soft bread +25
7. Fats and oils —25
Other products : sugar, syrup, sweets, etc —25
Source : "Activities in Sweden to Improve Dietary Habits," Nutr. Diet., No. 19, pp. 154-165 (Karger, Basel. 1973).
The impact of Sweden's program has not been completely measured. An interview survey conducted in 1974 found that sugar consumption had declined from 61.5 to 47.8 pounds a year and fresh vegetable con- sumption had risen from 31.5 to 44.8 pounds a year. Poultry con-
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58
sumption rose from 3.3 to 8.8 pounds, but potato consumption dropped from 191.4 to 144.9 pounds. Consumption of certain fruits also declined.
In addition, the percentage of energy in the diet derived from fats declined from about 41 percent in 1965 to 38.5 percent in 1974.
In 1975, Norway's ministry of agriculture presented to the nation's legislative body a report on nutrition and food policy which described trends in food consumption such as those in the United States and said:
The aforementioned unfavorable health tendencies, particularly with respect to cardiovascular disease, as well as the gradual understanding that is being gained of the connection between nutrition and health, make it necessary for the Government to base itself on the experts' recommendations, issued by the National Nutrition Council, when planning the Norwegian nutrition and food policy.
The report noted that the government would therefore take steps to try to reduce total fat intake to 35 percent of energy intake and compensate by increasing consumption of starchy foods, principally cereals and potatoes. A reduction in sugar consumption is sought as well as an increase in use of poly-unsaturated fats.
United States Experience
The United States' most recent experience with governmental diet counselling occurred during World War II when the government in- tervened to control food prices, and required production of the most nutritious foods, as well as attempting to educate the public in prin- ciples of nutrition.
The education program, aimed primarily at fighting nutrient de- ficiencies, enlisted the aid of the food industry, advertisers and edu- cators and revolved around the Seven Basic Food Groups. After the war, the Basic Seven concept was simplified to the Basic Four.
The basic food group concept has been criticized for a variety of reasons. First, it recommends eating foods in all groupings, but does not caution about risk factors that may be associated with over-con- sumption of the dietary elements outlined in Part I. In addition, critics have said that the wide variety of choices by grouping does not ensure adequate nutrition. It has also been said that : the groupings are not designed to meet current nutrition problems; that they give too much emphasis to animal source products; and that they do not take ethnic food preferences into adequate consideration.
There was optimism at the close of the war that advances in nutri- tion would continue at the wartime pace. HoAvever. in a speech in 1948, Hazel K. Stiebeling, chief of the Bureau of Human Nutrition and Home Economics in the Department of Asfriculture, anticipated haz- ards to soimd nutritional health for the United States.
We do not yet understand the dynamics of modifying food habits well enough to apply . . . laws (of nutrition) in a fully effective way. But we are all aware of the bewilderment that household food buyers feel over mucli of the current advertising — advertising that attempts to push to the maximum of human ca- pacity the consumption of every separate commodity — indiscriminately. Surely in the education of the public and in the orientation, of food production and trade for bettering consumption patterns, we should look at the physiological research, and at the relative economy and usefulness of various foods to serve these needs. And science should speak with one voice in broad over-all terms about food choice and food use. This will have to be done if we are to progress at a pace in keeping with scientific knowledge and potentialities.
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The Impact of Television Food Ad\'ertisixg
Since World War II, the largest expenditure for public information on diet in the United States has been made by the food industry. In 1975, according to Leading Xational Advertisers, Inc., about $1.15 billion was spent on food advertising, which represents about 28 per- cent of total television advertising spending.
The most recent study to suggest the possible impact of current food advertising on the nation's nutritional health has been prepared by Lynne Masover and Dr. Jeremiah Stamler, of Xorthwestern Univer- sity Medical School, and presented to the 1976 convention of the American Public Ilealth Association. The study, which analysed the food advertising on four Chicago television stations during the period August 4-10, 1975, reported:
A detailed look at this weekly food advertising time — restaurants excluded — found that the group of non-nutritive beverages was, by far, the single most- advertised food group, capturing approximately two-fifths of time, of which nearly one-third was for vAne and beer. Sweets took up about 11 percent of the time ; non-nutritive beverages plus sweets — all items low in nutrients and most of them high in calories — commanded an absolute majority of time. Add to these the oils, fats, and margarines, baked goods, snack foods, and relishes, and the proportion of advertising going to low-nutrient, generally high-calorie foods was nearly 70 percent ! . . .
Of the restaurants advertised, nearly all were of the limited-menu, fast-food type specializing in foods high in saturated fats and cholesterol.
The study found that only about 25 percent of the time was devoted to "nutritious groups," such as bread, cereal, pasta, meat, fish and sea- food, dair}' products, fruits and vegetables, soups and nut products.
More specificall3\ Table 16 shows that on weekdays during the period of analysis, almost 70 percent of the time devoted to food ad- vertising promoted foods generally high in fat, saturated fat, cho- lesterol, sugar and/or salt. However, only 3 percent of the time was devoted to fruit and vegetables. Of that total, no time was spent for the promotion of fresh vegetables and 0.7 percent was devoted to fresh fruit and juices. Fish, seafood and poultry received about the same advertising exposure as beef, 3.2 percent of the time compared to 3.5 percent for beef.
Table 17 indicates an even less healthful balance of weekend food advertising in which about 85 percent of time is devoted to foods high in fat, saturated fat, cholesterol, sugar and/or salt. During the sample weekend period, no advertising time was given to fresh fruit or vegetables.
Table 16. — Total weekday food advertising hy food groups on four Chicago Tele- vision stations, August 4-10, 1915 {including local and network advertising)*
Percent time of all stations
Food group combined Nonnutritive beverages 37. 5
Carbonated (with sugar) 13.2
Carbonated (sugar-free) 2.9
Beer and wine 9. 2
Drink mixes 7. 2
Coffee and tea 5. 0
Grain 17. 5
See footnotes at end of table.
60
Table 16. — Total weekday food advertising by food groups on four Chicago Tele- vision stations, August Jf-10, 1975 {including local and network advertising)'^' — Continued
Percent time Gf all stations
Food group comhined
Bread, cereal, and pasta 13. 4
Baked goods 4. 1
Sugars and sweets 10. 3
Candy, frosting, syrups 5. 2
Cliewing gum (sugar) 2.6
Chewing gum (sugar-free) 1.5
Gelatin, pudding 1. 0
Oil, fat, margarine 8. 5
Oil, fat, margarine 4. 2
Salad dressing 4. 3
Food stores 7. 0
Food store-item unspecified 4. 0
Food store-low fat dairy 1. 5
Food store-fresh beef 1. 0
Food store-all other . 5
Processed meat, fish, poultry 5. 7
Fish, seafood, poultry 3. 2
Beef, pork, lamb 2. 5
Snack foods 2. 9
Potato chips 1. 3
Corn chips . 7
All other snack foods . J)
Dairy 3. 1
High fat dairy 2. 4
Low fat dairy . 7
Relishes, condiments, sauces 2. 6
Vegetables 1-3
Processed vegetables, juices 0. 9
Fresh vegeta})les, juices • 0
Processed potato products . 4
Fruit 1. 7
Processed fruii; juices 1. 0
Fresh fruit, juices . 7
Soup 1. 1
Sugar substitutes . 5
Nuts, nut products . 3
Egg substitutes 0
Total 100.0
Total food advertising time (minutes) 7.")1. 5
*Restaurants and food preparation equipment excluded.
Source : Unpublished thesis material, Lynne Masover> Department of Community Health and Preventive Medicine, Northwestern University Medical School, Chicago, 111.
61
Table 17. — Total weekend food adverfisi nr/ hy food groups on four Chicago Tele- vision stations, August J^-IO, 1915 (including local and network advertising)*
All stations
Food group comhined Nonnutritive beverage 51. 7
Beer and wine 24. 3
Carbonated (with sugar) 17.9
Carbonated (sugar-free) 2.0
Drink mixes 4. 0
Coffee and tea 3. 5
Gr:iin 19.8
Bread, cereal, and pasta 10. 7
Baked goods 9. 1
Sugar and sweets 12. 9
Candy, frosting, syrups 7. 0
Chewing gum (sugar) 4.2
Chewing gum (sugar-free) 1.2
Gelatin, pudding . 5
Oil, fat, and margarine 5. 7
Oil, fat and margarine 3. 2
Salad dressing 2. 5
Snack foods 3. 7
Corn chips 1. 7
Potato chips 1. 0
All other snack foods 1. 0
Dairy 2.0
High fat dairy 1. ')
Low fat dairy . 5
Vegetables 1. 7
Processed vegetables, juice 1. 2
Fresh vegetables. 0
Processed potato products . 5
Relishes, condiments, sauces 1. 2
Processed meat, fish, poultry . 6
Fish, seafood, poultry . 3
Beef, pork, lamb . 3
Sugar substitutes . 2
Eggs and egg substitutes 0
Food store specials 0
Fruit 0
Infant foods 0
Nut products 0
Soup 0
99.5
Total food advertising time (minutes) 100.12
^Restaurants and food preparation equipment excluded.
Source : Unpublished thesis material, Lynne Masover, Department of Community Health and Preventive Medicine, Northwestern University Medical School, Chicago, 111.
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With respect to restaurant and fast food advertising, not included in the above totals, the percent of total general advertising time de- voted to them rose from 2.8 percent on weekdays to 3.2 percent on weekends.
In the report's conclusion, Masover and Stamler said :
When this outlay of food advertising is juxtaposed with what is known about the prevalence in the United States of malnutrition of both the under-nutrition and over-nutrition types, coronary heart disease, hypertension, diabetes, and alcoholic liver cirrhosis, it is reasonable to conclude that on weekdays over 70 percent and on weekends over 85 percent is negatively related to the nation's health needs . . . Television is the primary source of information for the Ameri- can public today. On the other hand, positive nutrition education from other sources is comparatively miniscule in the country. Thus it is reasonable to infer further that these combined circumstances are significant contributors to the current array of nutrition-related health problems. Therefore it is further reasonable to inquire why food advertising time on television should not be used exclusively to present the viewing audience with good rather than bad food choices?
A report prepared by Eichard Manoif for the Ninth International Congress of Nutrition in 1972 suggests that more than 50 percent of the money spent on television food advertising may be negatively re- lated to health. Calculations based on Table 18, provided in his re- port, indicate that a minimum of 48 percent of the money spent on television food advertising in 1971 went for items that may be gen- erally characterized as high in fat, saturated fat, cholesterol, sugar, salt or alcohol. This is a conservative estimate, not including sugared cereals and certain cake mixes, meat products, eggs, butter and cheeses that may be high in one or more of the dietary risk factors. In addi- tion, coffee, tea and cocoa are not included in this calculation.
TABLE 18.— U.S. FOOD AND BEVERAGE ADVERTISING EXPENDITURES [In thousands of dollars]
1971
6-media total 1 TV
Sugars, sirups, and jellies 10,125.2 25^993.2
Shortening and oils... 39,547.7 = 34, 498. 6
Flour and prepared baking mixes 18, 580. 6 12, 603. 6
Seasons, spices, and extracts 6,576.1 24^363.9
Desserts and dessert ingredients 32,361.4 2 22,824.3
Condiments, pickles, and relishes 10, 785. 2 2 g, 056. 3
Sauces, gravies, dips 13,214.8 210,986.2
Salad dressings and mayonnaise 20,506.1 215,814.6
iVIiscellaneous ingredients 14,753.0 12,639.3
Soups 25,608.5 17,028.7
Cereals 89,144.0 81,645.5
Health and dietary foods 9, 893. 2 4, 047. 1
Infant foods 3,074.0 2,161.3
Pastas 25,426.4 21,010.0
Prepared dinners . 27,850.9 22,305.3
Milk, butter, and eggs 30,358.8 25,622.8
Cheese 11,170.4 8,651.2
Ice cream and sherbets 4,575.3 24,195.5
Fruits and vegetables 36,239.5 24,198.5
Meats, poultry, fish 50, 131. 5 42, 631. 1
Bread and rolls 50,183.2 34,454.8
Cakes, pies, cookies 24, 244. 7 2 21, 189. 0
Coffee, tea, cocoa 82, 084. 7 75, 691. 4
Fruit and vegetable juice 23,105.0 19,991.8
Candy, gum, snacks 104,190.2 293,298.3
Soft drinks 108,050.4 296,055.8
Beer, vi^ine, liquor 231,785.6 2 104, 712. 7
Total food and beverage 3 1, 159, 522. 6 890, 882. 4
1 Total of measured media excluding spot radio.
2 Used to determine percent advertising that may be negatively related to health.
3 Including combination copy advertising whkh is not detailed.
Source: LNA Competitive Brand Cumulative for 1970 and 1971 (4), presented in "Potential Uses of Mass Media in Nutrition Programs," R. K. Manoff, and appearing in the proceedings of the 9th International Congress on Nutrition, Mexico, 1972, vol. 4, pp. 256-277 (Karger, Basel 1975).
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It is important to point out that the amounts of advertising for various kinds of foods are not dictated by any overall plan for the achievement of a healthful diet but by needs of various firms at any given moment. Furthermore, those foods most heavily advertised are predominantly processed foods since it is difficult to develop brand loyalties for relatively undifferentiated raw staples.
Ad\^ktising axd Low-Ixcome Consumers
It is likel}^ that those most influenced by food advertising are low- income and elderly consumers who are least capable of comprehending written guidance on food selection and least able to make comparisons between foods based on the nutrition labelling and price.
A report quoted by James T. Parker of the Division of Adult Edu- cation of the U.S. Office of Education at the Department of Agricul- ture's 1976 Outlook Conference, found that, with respect to consumer economics, almost 30 percent of the population falls into the lowest category of functional literacy :
In terms of the general kno\Yledge areas, the greatest area of difficulty ap- pears to be consumer economics. Almost 30 percent of the population falls into the lowest level (those adults who function only with difficulty because of their unsatisfactory mastery of the requirements for functional literacy), while one- third of the population is categorized as (those adults who are functional, but not proficient).
This means, the report said, that about 34.7 million adults "func- tion with difficulty" within consumer economics and an additional 39 million "are functional (but not proficient).'' As an example, the report noted :
When given pictures of three competing packaged cereals marked by net weight and price, only three out of four respondents identified the cereal which, in the sense of lowest cost per ounce, was the "best buy."
The report finds that the level of general competency decreases as levels of education and income decline. And the report finds ". . . the general trend is that the older the individual, the more likely that he/she is incompetent.*'
In a test gauging nutrition knowledge, 71 percent correctly selected tuna when asked to choose an item for a high-protein dinner from the list: tuna, macaroni, peaches and spinach. The report shows the lowest percent choosing the correct answer, 60 percent, was in the lowest income grouping, under $5,000 family income. In this group, 26 percent selected spinach, the most often chosen incorrect answer among all groups.
Scores by age grouping were: 18-29 years, 62 percent correct; 30- 39 years, 79 percent correct; 40-49 years, 80 percent correct; 50-59 years, 72 percent correct, 60-65 years, 66 percent correct.
In another test related to nutrition, only 56 percent correctly cal- culated the number of calories in question. Again, the lowest scores fell in the lowest income and highest age groups. In the under-$5000 ^•^mily income group, only 38 percent achieved the correct answer.
64
Lack of Nutrition Information
While constantly presented with persuasive messages on the kinds of food to buy, the consumer has had remarkably little information on the nutritional characteristics of the food itself.
Currently, nutrition labelling is voluntary and therefore not avail- able on many food packages. Moreover, labels rarely provide infor- mation on the types of fats in food, or amounts of sugar, cholesterol or calories. Food additives are listed for some foods but not others.
In short, the situation is one in which the consumer is under intense pressure to buy certain foods but at the same time is ignorant of some of their most important nutritional characteristics.
The following recommendations are based on the premise that the first step toward improving the nation's health through diet is pro- vision of information that will enable food growers, processors, whole- salers, retailers and consumers to make more healthful food choices.
RE COMMENDATIONS
To encourage the achievement of the foregoing dietary goals, it is recommended :
1. That Congress provide money for a public education program in nutrition based on the foregoing or similar goals. The initial mini- mum period for the promotion of these dietary goals should be five years.
Such a campaign should involve the following five functional areas :
(1) health and nutrition education in the classroom and cafe- terias of our schools ;
(2) nutrition and health education for school food service workers;
(3) nutrition education in the federally-funded food assist- ance programs ;
(4) nutrition education conducted by the Extension Service of the Department of Agriculture ; and
(5) extensive use of television to educate the public in the po- tential benefits of following certain dietary goals.
2. That Congress require food labelling for all foods, containing the following information to enable the consumer to make informed com- parisons between foods :
(1) percent and type of fats ;
(2) percent sugar ;
(3) milligrams of cholesterol ;
(4) milligrams of salt ;
(5) caloric content:
(6) a complete listing of food additives for all foods, includ- ing those now covered by standards of identity ; and
(7) nutrition labelling w^hich is currently voluntary.
3. That Congress provide money to the Departments of Agricul- ture and Health, Education, and Welfare to jointly conduct studies and pilot projects that would develop new techniques in food process- ing and institutional and home meal preparation aimed at reducing risk factors in the diet.
4. That Congress increase funding for human nutrition research in the Department of Agriculture in accordance with the plan of the Agricultural Research Service, contained in Apoendix D, and that Congress establish a committee for the coordination of human nutri- tion research undertaken by the Departments of Agriculture and Health, Education, and Welfare.
5. That the Department of Agriculture and Department of Health, Education, and Welfare form a joint committee to periodically con- sider the implications of nutritional health concerns on agricultural policy.
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APPENDIX A BENEFITS FROM HUMAN NUTRITION RESEARCH
[By C. Edith Weir]
This report is part of a study conducted at the direction of the Agricul- tural Research Policy Advisory Committee, U.S. Department of Agri- culture. A joint task group representing the State Agricultural Experi^ ment Stations and the U.S. Department of Agriculture was assigned the- responsibility for making the study. Task group members were:
Dr. Virginia Trotter, co-chairman, dean, College of Home Economics,. University of Nebraska; Dr. Steven C. King, co-chairman, associate director, Science and Education Staff, U.S. Department of Agriculture; Dr, Walter L. Fishel, assistant professor. Department of Agriculture and Applied Economics, University of Minnesota; Dr. H. Wayne Bitting, program planning and evaluation staff. Agricultural Research Service, U.S. Department of Agriculture; Dr. C. Edith Weir, Assistant Director, Human Nutrition Research Division, Agricultural Research- Service, U.S. Department of ^Agriculture.
Better health, a longer active lifespan, and greater satisfaction from work, family and leisure time are among the benefits to be obtained from improved diets and nutrition. Advances in nutrition knowledge and its application during recent decades have played a major role in reducing the number of infant and maternal deaths, deaths from infectious diseases, particularly among children, and in extending' the productive lifespan and life expectancy. Significant benefits are- possible both from new knowledge of nutrient and food needs and from more complete application of existing knowledge. The nature and magnitude of these benefits is estimated in Table 1. Potential benefits may accrue from alleviating nutrition-related health problems, from increased individual performance and satisfactions and in- creased efficiency in food services. A vast reservoir of health and economical benefits can be made available by research yet to be done on human nutrition.
Major health problems are diet related. — Most all of the health problems underlying the leading causes of death in the United States (Fig. 1) could be modified by improvements in diet. The relationship of diet to these health problems and others is discussed in greater detail later in this report. Death rates for many of these conditicns are higher in the U.S. than in other countries of comparable economic development. Expenditures for health care in the U.S. are skyrocket- ing, accounting for 67.2 billion dollars in 1970 — or 7.0 percent, of the entire U.S. gross national product.
The real potential from improved diet is preventive. — Existing evidence is inadequate for estimating potential benefits from improved diets in terms of health. Most nutritionists and clinicians feel that the real
Source. Human Nutrition Research Division, Agricultural Research Service, U.S. Department of Agriculture. Issued August 1971 by Science and Education Staff, United States Department of Agriculture,- Washington, D.C.
72
poteDtial from improved diet is preventative in that it may defer or modify the development of a disease state so that a cKnical condition does not develop. The major research thrust, nationwide, has been on the role of diet in treating health problems after they have devel- oped. This approach has had limited success. USD A research emphasis has been placed on food needs of normal, healthy persons and findings from this work have contributed much of the existing knowledge on their dietary requirements.
Benefits would he shared by all. — Benefits from better nutrition, made possible by improved diets, would be available to the entire population. Each age, sex, ethnic, economic, and geographic segment would be benefited. Ihe lower economic and non white population groups would benefit most from effective application of current knowledge.
These savings are only a small part of what might be accomplished for the entire population from research yet to be done. Some of the improvements can be expressed as dollar benefits to individuals or to the nation. The social and personal benefits are harder to quantify and describe. It is difficult to place a dollar figure on the avoidance of pain or the loss of a family member; satisfactions from healthy, emotionally adjusted families; career achievement; and the oppor- tunity to enjoy leisure time.
Major health benefits are long range. — Predictions of the extent to which diet ma}^ be involved in the development of various health problems have been based on current knowledge of metabolic path- ways of nutrients, but primarily of abnormal metabolic pathways developed by persons in advanced stages of disease. There is little understanding of when or why these metabolic changes take place. The human body is a complex and very adaptive mechanism. For most essential metabolic processes alternate pathways exist which can be utilized in response to physiological, diet, or other stress. Frequently, a series of adjustments take place and the ultimate result does not become apparent for a-long time, even years, when a metabolite such as cholesterol accumulates. Early adjustment of diet could prevent the development of undesirable long-range effects. Minor changes in diet and food habits instituted at an early age might well avoid the need for major changes, difficult to adopt later in life.
Regional differences in diet related problems. — The existence of regional differences in the incidence of health problems has been generally recognized and a wide variation in death rates still exists among geographic areas. These differences in death rate may reflect the cumulative effect of chronic low intake levels of some nutrients throughout the lifespan and by successive generations. A number of examples of regional health problems attributable to differences in the nutrient content of food or to dietary pattern could be given. Perhaps the best known is '^tlie goiter belt" where soils and plants w^ere low in iodine and the high incidence and death rate of goiter was reduced when the diet was supplemented with iodine. Another situa- tion existed in some of the southern states where pellagra was a scourge a few decades ago. Corn was the major food protein source for low income families in these areas. The resulting niacin deficiency raised the incidence of pellagra to epidemic proportions.
73
Migration from the high death rate areas almost always results in a reduction in the death rate, although the improvement never ap- proaches the level achieved by those who were bom and continued to live in the low rate areas. Similarly, persons who move from low rate areas into higher rate areas lose part of the advantage. If the death rate for one of the high death rate areas, Wilkes Barre, Pennsylvania, were applied to the entire U.S. population, 140,489 more persons under 65 3'ears would have died per year during the period 1959-61. If the death rate for one of the lower rate areas, Nebraska, had prevailed, there would have been 131,634 fewer deaths. The highest death rate areas generally correspond to those where agriculturists have recog- nized the soil as being depleted for several years. This suggests a possible relationship between submarginal diets and health of succeed- ing generations.
TABLE 1.— MAGNITUDE OF BENEFITS FROM NUTRITION RESEARCH
Potential savings from improved Health problem Magnitude of loss diet
PART A. NUTRITION RELATED HEALTH PROBLEMS
Heart and vasculatory Over 1,000,000 deaths in 1967—
Over 5 million people with definite or suspect heart 25-percent reduction, disease in 1960-62.
$31.6 billion in 1962. 20-percent reduction.
Respiratory and infectious 82,000 deaths per year
246 million incidents in 1967 20 percent fewer incidents.
141 million work-days lost in 1955-66 15-20 percentfewer days lost
166 million school days lost. Do.
$5 million in medical and hospital costs $1 million.
$1 billion in cold remedies and tissues $20 million.
Mental health 2.5 percent of population of 5.2 million people are 10 percent fewer disabilities.
severely or totally disabled. 25 million people have manifest disability.
Infant mortality and repro- Infant deaths in 1967— 79,000 50 percent fewer deaths.
duction. Infant death rate 22.4 per 1,000 Do.
Fetal death rate 15.6 per 1,000 Do,
Maternal death rate 28.0 per lOC.COO live births Do.
Child death rate (1-4 yrs.) 96.1 per 100,000 in 1%4 Reduce rate to 10 per 100,000.
15 million with congenital birth derects 3 million fewer children with
birth defects.
Early aging and lifespan 49.1 percent of population, about 102 million people 10 million people without Im-
have one or more chronic impairments. pairments People surviving to age 65: Percent
White males 66 1 percent improvement per year
Negro males 50 to 90 percent surviving.
White females 81
Negro females 64
Life expectancy in years:
White males 67,8 Bring Negro expectancy up to
Negro males 61. 1 to White.
White females 75. 1
Negro females 68. 2
Arthritis 16 million people afflicted 8 million people without
afflictions,
27 million work days lost 13.5 million work days.
500, 000 people unemployed... 125,000 people employed.
Annual cost $3.6 billion.. $900 million per year.
Dental health 44 million with gingivitis; 23 million with advanced 50 percent reduction in incidence,
periodontal disease; $6.5 billion public and private severity and expenditures, expenditures on dentists' services in 1967; 22 mil- lion endentulous persons (1 in 8) in 1957; \^ of all people over 55 have no teeth.
Diabetes and carbohydrate 3.9 million overt diabetic; 35,000 deaths in 1967; 79 50 percent of cases avoided or disorders, percent of people over 55 with impaired glucose improved,
tolerance.
Osteoporosis 4 million severe cases, 25 percent of women over 40... 75 percent reduction.
Obesity 3 million adolescents; 30 to 40 percent of adults; 80 percent reduction in incidence,
60 to 70 percent over 40 years. Anemia and other nutrient See improved work efficiency, growth and develop- deficiencies, ment, and learning ability.
Alcoholism 5 million alcoholics; Yi are addicted 33 percent.
About 24,500 deaths in 1967 caused by alcohol Do,
Annual loss over $2 billion from absenteeism, lowered Do. production and accidents.
74
TABLE l.-MAGNITUDE OF BENEFITS FROM NUTRITION RESEARCH-Continued
Health problem
Magnitude of loss
Potential savings from improved diet
Eyesight. 48.1 percent, or 86 million people over 3 years wore
corrective lenses in 1966; 81,000 become blind every year; $103 million in welfare.
Cosmetic -.. 10 percent of women ages 9 or more with vitamin
intakes below recommended daily allowances.
Allergies 32 million people (9 percent) are allergic
16 million with hayfever asthma
7-15 million people (3-6 percent) allergic to milk
Over 693 thousand persons (1 in 3,000) allergic to gluten.
Digestive 8,495 thousand work-days lost; 5,013 thousand school-
days lost; About 20 million incidents of acute condi- tion annually.
$4.2 billion annual cost; 14 million persons with duodenal ulcers; $5 million annual cost; 4,000 new cases each day.
Kidney and urinary 55,000 deaths from renal failure; 200,000 with kidney
stones.
Muscular disorders... 200,000 cases
Cancer 600,000 persons developed cancer in 1968; 320,000
persons died of cancer in 1968.
PART B. INDIVIDUAL SATISFACTIONS INCREASED
20 percent fewer people blind or with corrective lenses.
20 percent people relieved.
90 percent people relieved. Do.
25 percent fewer acute conditions.
Over $1 billion in costs.
20 percent reduction in deaths
and acute conditions. 10 percent reduction in cases. 20 percent reduction in incidence and deaths.
Improved work efficiency 5 percent increase in on the job
Improved growth and de- velopment.
Improved learning ability...
Improved efficiency in food
preparation and menu
planning. Reduced losses of nutrients
in food storage, handling,
and preparation. Improved efficiency in food
selection. Improved efficiency in food
programs.
productivity.
113,000 deaths from accident. 324.5 million work-days 25 percent fewer deaths and
lost; 51.8 million people needing medical attention work-days lost.
and/or restricted activity.
Over 6.5 million mentally retarded persons with l.Q. Raise l.Q. by 10 points for persons
below 70; 12 percent of school age children need with l.Q. 70-80.
special education.
PART 0. INCREASED EFFICIENCY IN FOOD SERVICES Not estimated.
Do.
LEADING CAUSES 0? DEATH
Rates per lOO.QGO, U.S. 1969
Diseases of Heart
Molignont Neoplasms
Vosculcr lesions effecHng > car.tral nervous system
Accidents
influenza and Pneumonia Certoln diseases of early infancy Diabetes Mellitus Genera! Arteriosclerosis Other Bronchopulmonic diseases Cirrhosis of Liver AiS other causes
364.!
145.3
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APPENDIX C
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APPENDIX D
U.S. Department of Agriculture,
Agricultural Research Service, Washington, D.C, November 12, 1976,
Hon. George McGo\^rn,
Chairniun, Select C&mmittee on Nutrition and Human Needs, U,S, Senate, Washington, B.C.
Dear Mr. Chairman : We welcome the opportunity to respond to your recent request concerning the implementation of a national, com- prehensive human nutrition research program under the leadership of the Agricultural Research Service.
The Department of Agriculture and the Agricultural Research Service have a comprehensive mandate to perform human nutrition research, including human requirements for nutrients, studies of food consumption patterns, study of nutrient content of foods and means of preserving and enhancing its nutrient quality. The Agricultural Research Service ongoing program is funded at a $13 million level.
A significant amount of research has been accomplished in this area but many important questions remain to be answered. For example, only limited knowledge exists concerning proper diets for humans. This was confirmed during recent Congressional Hearings on the rela- tionship between diet and disease when the Assistant Secretary for Health, the nation's top health officer, stated: "AAHiile scientists do not yet agree on the specific causal relationships, evidence is mounting and there appears to be general agreement that the kinds and amount of food and beverages we consume and the style of living common in our generally affluent, sedentary society may be the major factors as- sociated with the cause of cancer, cardiovascular disease, and other chronic illnesses."
The agricultural research community believes that major break- throughs of knowledge can result from an expanded nationally coordi- nated human nutrition program. Potential savings in terms of human lives and resources devoted to health care can be immense. Increased knowledsre of human requirements for nutrients and how this can be accomplished by changes in crop and animal production practices and food processing techniques can result in increased efficiency in food consumption patterns. Overall, an expanded nutrition research pro- gram can contribute to strengthening the nation's economy and to the well being of its citizens.
National program managers feel that major breakthroughs can occur and long term needs met by building on research knowledge already known and by concentrating efforts in five major areas of work. Rationale for recommended long-range studies and recurring additional funding: requirements are summarized below :
1. Human requirements for nutrients necessary for optium growth well-being— $66.6 million.
(77)
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Our dietary guidance for families is hindered by inadequate knowl- edge about the nutritional needs at different stages of life, and the consequences of inadequate nutrition. This knowledge is needed to guide major USDA feeding programs for groups believed to be at nutritional risk. This research would establish the extent of biological variability for nutrients in individuals differing in age, sex, and gene- tic background. Many of these population groups have never been studied to quantitate their requirements for a particular nutrient.
2. The nutrient composition of foods and the effects of agricultural practices, handling, food processing and cooking on the nutrients they contain — $11 million.
Nutritional needs must be translated into the foods or food patterns that can best meet these needs. Up-to-date information on the composi- tion of all important foods for the many nutrients required by man is a research goal that requires additional support.
3. Surveillance of nutritional benefits in the evaluation of the USDA food programs — $9.5 million.
The major USDA programs in child nutrition, food stamps for low-income families, and the nutrition education efforts among the hard-to-reach poor need continual surveillance and evaluation in terms of measures of nutritional health of the recipients. Research is needed on the relationship between specific foods in the diet and health.
4. Factors affecting food preferences and food habits — ^$4.8 million. The nutrition educator is faced with a problem of helping people
to change and improve their nutrition through diet. There is insuffi- cient knowledge about food habits, choice, and motivations. Factors affecting food preference, such as odor, taste, and texture, need in- creased attention.
5. Techniques and equipment to guide consumers in the selection of food for nutritionally adequate diets in the home or in institu- tions— $4.7 million.
Guidance of consumers toward nutritionally adequate diets must include research-based knowledge on food management procedures and preparation of foods for the table, to assure retention of both nutritional and eating qualities and to avoid food-borne illness.
National pro2:ram managers recommend that $60 to $65 million of the proposed $95 million (about 70%) be used to finance research performed by Land-Grant Colleges and other qualified public and private institutions. It is envisioned that the bulk of this research would be performed through the Land-Grant College System.
Estimated funding and distribution of effort in the five cateefories listed above for the expanded human nutrition program is as follows :
Category: 1.... 2.„. 3.... 4..„ 5..„
Jntramura! Agricultural Extramural land-grant and Research Service other institutions
AmoLTit Percent Amount Percent
[Dollar amounts in millions!
$21.3 70.0 $44.8 70
3.1 10.0 6.4 10
3.1 10.0 6.4 10
1 c t; 1 5 9 r
Total
100
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We appreciate your interest in human nutrition research and hope that the information provided meets your needs. All estimated fund- ing levels are provided for information. They have not had the ap- proval of Department officials or the Office of Management and Budget and should not be considered a request for funds. If I can be of further assistance, please do not hesitate to contact us. Sincerely,
T. W. Edmixster, Administrator.
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NATIONAL AGRICULTURAL LIBRARY
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