Increasing fibre intakes is key to improving the nation’s health

Increasing fibre intakes is key to improving the nation’s health

The most recent government guidelines on fibre intake recommend 30g per day for adults. Levels are currently at just 20g per day for adult men and 17.1g per day for women – that’s an average 68% increase in intake needed to meet recommendations.

And it’s not just adults: there’s a significant disparity between recommended and actual fibre intake across all age groups.

So why is fibre so important? And what can we do to help people meet the recommended intake levels?

Here’s a quick overview. To explore the topic in more detail, join our upcoming Fibre NutriWebinar, on Wednesday 7 November.

The benefits of fibre 

Dietary fibre has long been recognised for its health benefits. But it’s only in recent years that our understanding and appreciation of it has significantly progressed.

Fibre’s health effects mainly result from two key factors – its physical properties (eg stool bulking, viscosity, binding ability) and its effect on the gut microbiota and luminal environment.

Amongst its many beneficial properties, clinical trials have proven that fibre:

  • Decreases blood pressure
  • Increases satiation
  • Decreases glucose absorption
  • Increases bacterial a faecal mass (commonly associated with health benefits including reduced risk of colon cancer)
  • Exerts benefits through gut microbiota

Where are we getting our fibre from?

The main sources of fibre in the UK are cereals, vegetable and potatoes, contributing to 70% of total intake.

Interestingly, white bread and potato products prepared with fat (eg chips and crisps) are significant contributors. This is despite the fact that they have comparatively low fibre content, showing that consumption is high.

One of our challenges is to educate the public on healthier fibre sources – fruit, vegetables, whole grains and pulses, rather than broad recommendations on increasing cereals.

Understanding and helping consumers

We know that despite the convincing body of evidence for the role of dietary fibre in many chronic conditions, translating and achieving fibre recommendations in practice can be challenging.

Understanding the key barriers faced by the public and putting forward strategies to overcome these is key to facilitating better health for all.

Find out more about the FREE Fibre NutriWebinar with Dr Megan Rossi, RD and register now.

It’s one of our ongoing NutriWebinar series examining key nutrition topics with experts in the field.

 

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Updated childhood obesity plan: But how does it measure up?

Updated childhood obesity plan: But how does it measure up?

The government recently announced new measures to halve rates of childhood obesity by 2030 and significantly reduce the health inequalities that persist – closing the gap in obesity rates between children from the most and least deprived areas.

This proposal builds upon the first chapter of the Childhood Obesity Plan, which was widely criticised at the time as lacking the breadth and depth of initiatives needed to effectively tackle such a widespread and entrenched issue.

Steve Brine, Public Health Minister has stated: “One in three children are now overweight or obese by the time they leave primary school. Overconsumption, combined with reduced activity, is having a catastrophic effect on our children’s health. As both a parent and minister, I am committed to driving today’s pledge of halving obesity over the next 12 years with bold new action.”

“Our updated plan will put parents in charge, providing more information and support. Our aim is to help families make healthier choices, which will in turn provide a better chance at a longer, healthier life for our children.”

Obesity – A systems issue

The financial burden of obesity is too great to ignore: it’s estimated that the NHS in England spent £6.1 billion on overweight and obesity-related ill-health in 2017/18, which, to put into context is more than was spent on the police, fire service and judicial system combined. The wider costs to society of these conditions are around £27 billion a year, if not higher.

Ever since the Foresight report was published over a decade ago, it has been recognised that obesity is a systems issue and one that therefore requires reform at many points, to deliver change. This idea and the fact that no plan to date has sought to address childhood obesity in a multi-sector way, was reiterated in the recent inquiry by the parliamentary Health and Social Care Committee into childhood obesity. Childhood Obesity: Time for Action argued for a change in narrative, making clear that obesity is everyone’s business and “an effective childhood obesity plan demands a holistic, joined-up, ‘whole systems’ approach with clear and effective leadership”.

How does the Childhood Obesity Strategy measure up?

This update to the Childhood Obesity Strategy is a welcome step forward. It contains a raft of proposed measures that seek to tackle the issue using a co-ordinated range of policy levers. What is also good to see is that this new plan takes a firm but fair approach in how it will deliver change: using voluntary measures in the first instance but being clear that a harder tact with the likes of regulatory and fiscal measures will be considered where progress is deemed insufficient, or where a level playing field is required.

Here at Nutrilicious, we’ve taken a closer look at what’s in store and benchmarked the new childhood obesity plan against the World Cancer Research Fund’s NOURISHING framework, as well as the recommendations from the Health and Social Care Committee’s report mentioned earlier.

The NOURISHING framework

The NOURISHING Framework sets out that policies are needed within three core areas to improve diets: the food environment, food system and behaviour change communication.

N – Nutrition label standards and regulations on the use of claims and implied claims on food
O – Offer healthy food and set standards in public institutions and other specific settings
U – Use economic tools to address food affordability and purchase incentives
R – Restrict food advertising and other forms of commercial promotion
I – Improve nutritional quality of the whole food supply
S – Set incentives and rules to create a healthy retail and food service environment
H – Harness food supply chain and actions across sectors to ensure coherence with health
I – Inform people about food and nutrition through public awareness
N – Nutrition advice and counselling in health care settings
G – Give nutrition education and skills

Bearing in mind that some policies and actions targeting childhood obesity were in place prior to this strategy update, overlaying the new measures show how broad their impact alone intends to be:

New measures N O U R I S H I N G Nutrilicious notes
Improved food labelling to display ‘world-leading, simple nutritional information’ as well as information on origin and welfare standards following Brexit X
Strengthen School Food Standards to reduce sugar consumption X X We would like to see these universally applied and close the loophole that exists for some academies
Strengthen Government Buying Standards for Food and Catering Services* X X
Ban price promotions such as buy one get one free, multibuys or unlimited refills of unhealthy foods and drinks in the retail and out of home sector* X It is good to see a mandatory approach applied here, as this is what is undoubtedly needed when policies will impact businesses’ bottom line.
Ban the sale of energy drinks to children* X
Ban promotion of unhealthy food and drink by location e.g. positioning – checkouts, end of aisles and store entrances, in retail and out of home sector* X
Introduce a 9pm watershed on unhealthy food and drink advertising and similar protection online* X We would like to see similar controls applied to sports advertising
Review governance arrangements for advertising rules (currently overseen by the Committee of Advertising Practice and Advertising Standards Authority) X
Potentially bring ‘sugary milk drinks’ into the soft drinks levy if insufficient action on sugar reduction takes place X X
Introduce mandatory calorie labelling for out of home sector in England* X X
Sugar reduction plan for products aimed exclusively at babies and young children due in 2019* X
Calorie reduction plan due mid-2019* X
Develop trailblazer programme with local authority partners to highlight what can be done within existing powers X We would like to see greater powers for local authorities and health services
Develop plan to use Healthy Start vouchers to provide additional support to children from lower income families* X
Ofsted will review school curriculum to understand how it can better support healthy behaviours, including food choices X X We would like to see improved early years education for parents to support a healthy first 1000 days and compulsory home economics with healthy cooking skills at the core in both primary and secondary schools

*Proposal for further consultation

Is it enough?

While we applaud this latest round of the childhood obesity plan, we would also draw attention to the fact that there is still some way to go.

By mapping the proposed policy options against the NOURISHING framework, we can see that in this latest iteration of the plan much more focus has been given to shaping an environment that enables and supports healthier choices, which is great to see.

However, what is noticeably absent is the ‘I’ in terms of improving food and health literacy of the population. In a ‘post truth’ world where consumers are increasingly sceptical of messages coming from the scientific community, and when social media influencers are capturing the hearts and minds of the masses with questionable dietary advice, never has it been more important to provide clear, simple and authoritative information and advice. As such, we’d like to the see the government step-up their efforts on social marketing and educational campaigns.

What is more, a number of recommendations made in the Health and Social Care Committee are notably absent, including:

  • Establishing a Cabinet-level committee to review the implementation of the plan, ensuring it gets the high-level traction it requires
  • Proposing further measures around early years and the first 1,000 days of life, including targets to improve rates of breastfeeding
  • Banning the advertising and promotion of follow-on formula milk
  • Providing local authorities with further powers to limit unhealthy food and drink advertising near schools (the only powers available to local authorities extend to the positioning of the billboards themselves, not the content of the advertising)
  • Introducing services for children living with obesity

Finally, while this plan is overtly focussed on limiting unhealthy foods and drinks and making processed, packaged foods a little better through reformulation (lower in salt etc), we would also like to see equal attention given to measures that work improve the quantity and quality of foods that we do want people to eat more of. Changing the dietary landscape will require strong efforts to provide families with the tools and knowledge to instil these healthier behaviours in a sustainable way.

The full plan for action can be viewed here:

https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action

 

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Latest advice on infant feeding: has anything changed?

Latest advice on infant feeding: has anything changed?

The final ‘Feeding in the First Year of Life’ report published by the Scientific Advisory Committee on Nutrition (SACN) supports current government recommendations including breast is best, introduction of allergenic foods from six months and the importance of variety and textures.

Covering infant feeding from birth to 12 months, it provides its recommendations to government based on the best available evidence for the short- and long-term health outcomes for infants and mothers.

The one note of significant difference to existing advice is the recommendation that vitamin A supplements for infants should be discontinued. This will cause some inconvenience as most infant vitamin drops, which were developed on government advice, include vitamin A.

What is the SACN recommending to government?

  • More strategies and support to help mums breast feed exclusively for the first six months of the infant’s life and to continue breast feeding alongside weaning for the first year.
  • Where breast feeding is not possible, infant formulae based on either cows’ or the more recent goats’ milk are the only suitable alternative options. Soya-based formulae should only be introduced under medical advice.
  • Only breast milk, formula or water as a drink should be offered between six and 12 months.
  • Solids should be introduced from around six months of age, ‘having achieved developmental readiness’. The SACN found no evidence for the critical window of opportunity (four-six months) for increased acceptance of solids.
  • Reducing risk of ‘fussy eaters’. Based on the evidence available, it is recommended that perseverance with repeated exposure of a variety of textures and flavours should be encouraged.
  • Introduction of textures is critical for the development of munching and chewing. Textures should be introduced incrementally depending on the infant’s individual development rate.
  • Baby-led weaning: due to too few studies, the SACN could not make any recommendations. However, it did make the point that the limited evidence to date is promising for earlier self-feeding and less food fussiness.
  • All allergenic foods should be introduced from six months in small quantities and one at a time. This is of course for infants not at high risk of or diagnosed with an allergy. It is particularly important for peanuts and hen’s eggs, where the evidence is strong that delayed introduction increases the risk of allergy later in life. Additionally, nuts such as peanuts should not be given whole until the age of five years to prevent choking risk.
  • Vitamin D intakes remain a concern for infants who are being breast fed or on less than 500ml formula daily. The SACN acknowledges the poor update of vitamin drops for babies but continues to emphasise the importance of encouraging breast feeding mums to use vitamin D supplements from birth.
  • Iron continues to be an issue beyond six months of age and greater emphasis should be placed on the introduction of iron rich foods, rather than supplements, from the start of weaning.
  • Vitamin A supplementation should no longer be encouraged as risk of deficiency is low and advises the government to review its current baby vitamin drop recommendations.
  • Energy intakes remain too high and infant weights exceed standard weight charts. There is a need to better monitor overweight and obesity in infants.
  • Salt and sugars intakes remain high in infants, with commercial baby foods, especially fruit purees, being the main contributors.
  • Throughout the report, the SACN make no distinction in their advice between commercial or home-made complementary foods – could this be a sign that reality and practicality has been taken into consideration?

The Public Health England (PHE) sugar reduction programme for complementary foods will be far more controversial than the new SACN recommendations.

We have heard this week that PHE have just finished their scoping work for their sugar reduction programme of complementary foods for infants and are preparing for discussions with industry, NGOs and other interested parties.

Setting sugar reduction targets for this category will be challenging, to say the least.

  1. The complementary foods’ regulation, which PHE cannot over-ride, permits significantly high levels of sugars: up to 20g total sugars per 100g for ‘fruit only’ products and up to 25g per 100g for desserts and puddings.
  2. There are huge discrepancies between PHE’s classification of ‘free sugars’ and regulatory and labelling classifications of ‘added sugars’. Sugars naturally present in fruit and vegetable purees are classified as ‘free sugars’ by PHE but not as ‘added sugars’ by foods or labelling regulations.
  3. Some will argue that pureed formats of fruit and vegetable are essential as first foods, especially by those from the ever-exploding pouch market, and as such should be excluded from the ‘free sugars’ classification. However, there should be a strong opposition from health experts and very active pressure groups:
    • There is a growing consensus that fruit and sweet tastes should no longer be recommended as first foods in order to reduce the infants’ continued preference for sweetness.
    • Additionally, with the SACN’s affirmation that complementary feeding should start around six months, purees are no longer essential. At that age the infant is ready, and should be encouraged, to develop their munching and chewing skills which means the need for textures. Pureed food on the other hand only rely on an infant’s innate skills of sucking and swallowing.

Interesting times…let’s wait and see.

Complementary foods regulation update – will this rock the boat?

The updated version of the 2006 regulation on processed cereal-based foods and baby foods for infants and young children has yet to be published. The revised regulation was rejected last year for numerous reasons, including pesticide and sugar upper limits being too high.

The next version should be with us this year and it will be interesting to see how it aligns with the SACN’s and PHE’s recommendations – especially with regard to sugars and when solid foods should be introduced. Currently, the regulation (and the failed 2017 revision) permitted solid food introduction from four months.

Welcoming the findings

Only recently, the BBC reported the potential benefits of feeding solids as early as three months, which is likely to have caused confusion for parents.

So we’re pleased that this new SACN report helps to give support for the current advice in the UK: babies should ideally be exclusively breastfed for six months, and solid foods should be introduced after this. Or, as Dr Alison Tedstone, Chief Nutritionist at Public Health England (PHE) put it: “SACN’s robust advice puts to bed any arguments about a beneficial effect of early introduction of solid foods.”

We do however notice the very precise wording of ‘around six months’.

There is some concern amongst dietetic paediatric experts that setting a specific time for solid food introduction is unrealistic, may place some infants at risk and is an added pressure for mums on top of guilt faced by those who do not wish to or cannot breast feed.

The important factor is that solid foods should only be introduced when an infant is developmentally ready: when they can sit with minimal support and hold their head steady; can co-ordinate eyes, hands and mouth; and are able to reach out to pick up food and bring it to their mouth. Some infants may be ready before six months; a few may not be ready yet at that stage.

It’s important government advice should ensure mums understand that there is flexibility ‘around’ the six months.

Further advice on early feeding and breastfeeding
In the UK we have some of the lowest breastfeeding rates in the world, so it is important to provide help and support to mothers wishing to breastfeed. The NHS gives information about where to get help.

See also:

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New review concludes omega-3 fats have no benefits for heart health… or does it?

New review concludes omega-3 fats have no benefits for heart health… or does it?

An extensive detailed analysis of the current scientific evidence into omega-3 seems to have thrown a spanner in the works for heart health dietary advice.

Conducted by Cochrane, the review concludes that there is no correlation between cardiovascular health and intakes of the long chain omega-3 fats eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) over a one- to six-year period.

Long chain omega-3 fats have long been associated with reductions in blood triglycerides, blood pressure and thrombosis; producing anti-inflammatory and anti-arrhythmia effects as well as improving endothelial function and insulin sensitivity.

This most recent publication will raise many eyebrows within the heart health professional arena and likely to be taken up by media editors who seem to enjoy questioning the trustworthiness of public health guidelines. These recommend a diet including omega-3, especially found in oil-rich fish such as salmon, tuna and mackerel.

So, do we need to change dietary guidelines on the importance of omega-3 and oil-rich fish?

Before we jump the gun, it’s important to put things into context:

1. The shortcomings of the review

a. The studies investigated in this review predominantly used omega-3 supplements. Thus the outcomes cannot be related to oil-rich fish consumption which is the main dietary source of EPA and DHA.

b. The studies were also of one to six years’ duration, which is a relatively short period to assess disease and mortality risk. And conclusions cannot be reached for a lifetime consumption of foods rich in EPA or DHA.

c. Many of the studies may not have used adequate number pf subjects in the studies to elicit a result. This is especially the case for studies conducted in healthy individuals (and therefore low risk of heart disease), which would require very high numbers to demonstrate a difference in the omega-3 and non-omega-3 study groups.

d. Any studies conducted over the last two decades of people at risk of cardiovascular disease (CVD) will be in individuals already medicated with statins and other cardio-protective drugs, which may mask the effect, if any, of additional omega-3.

2. Omega-3 benefits go beyond heart health

Long chain omega-3 fats are critical for eye and brain development of the foetus and young children. Therefore, food sources should be included in a healthy balanced diet of children and adults planning for a family.

3. Oil-rich fish is not just omega-3. It offers so many health benefits.

a. Unlike omega-3 supplements, oil-rich fish is a rich source of not only the long chain omega-3 fats but also of selenium, zinc, vitamin D and iodine; woefully lacking in the UK diet.

b. Oil-rich fish has a healthier fat profile when compared to red meat and other animal proteins. Replacing saturated fat with unsaturated fat in the diet has been proven to have a positive effect on blood lipids and cardiovascular health (as confirmed by Cochrane’s 2015 review and the SACN’s & the WHO’s draft 2018 reports). See our saturated fat blog

Indeed, the authors themselves remind us of the other nutritional benefits of oil-rich fish and that this review does not negate public health advice that consuming oil-rich fish is beneficial to health.

The Nutrilicious view

Taking vitamin and mineral supplements as a substitute for eating a healthy balanced diet has never been encouraged by health professionals. However, dietitians recognise that when demands for specific nutrients are high, or when an individual’s nutritional intake is at proven risk of being compromised, supplements can play an important role. For example, pregnancy and folic acid; under-5 year olds and vitamins C and D; or sufferers of osteoporosis and calcium and vitamin D.

Therefore, these findings do not come as any surprise: omega-3 supplements are not a solution to better heart health. There are numerous dietary and lifestyle factors that impact on heart health. It should always be about food rather than the benefits of single nutrients.

As Linda Main, Dietitian and dietary advisor for cholesterol charity HEART UK, explains: “We continue to advise the lifelong consumption of a heart healthy diet centred around eating whole foods rather than the emphasis being on nutrients.

“Eating patterns such as the Mediterranean, DASH or the UCLP© diets result in the consumption of a nutritionally appropriate diet. This is characterised by eating plenty of vegetables, fruits, wholegrains, vegetable proteins such as nuts and soya, seeds, vegetable oils and spreads. In those who consume animal proteins, the inclusion of low fat dairy, lean and largely unprocessed meat and white and oily fish and seafood are recommended.

“Omega-3 supplements are not currently advised by HEART UK and would not be our first choice, except when prescribed by a recognised qualified health professional or when needed to safeguard the intake of the essentially fatty acid – alpha-linolenic acid.”

As oil-rich fish is an excellent low saturated fat protein source, and the main dietary source of long-chain omega-3 fats as well as other crucial nutrients, it should continue to be part of dietary guidelines.

Additionally, for those wishing to follow a more plant-based diet, it’s reassuring that the report finds consumption of the shorter chain omega-3 fats found in plant foods (like rapeseed and soya oil) has cardio-protective qualities. This supports findings from population studies that vegetarians and vegans have a lower incidence of cardiovascular events and mortality compared to non-vegetarians.

Current UK heart health dietary advice remains unchanged:

  • Lower the amount of food eaten which is high in saturated fat and replace it with foods high in unsaturated fats (which Cochrane’s 2015 review supports, SACN 2017 Saturated fat draft guidance).
  • Increase our intake of fibre (especially from beans, pulses, oats and barley), nuts.
  • Consume at least five servings of fruit and vegetables daily.
  • Reduce intakes of red meat and avoid/limit processed meat.
  • Consume two portions of fish weekly – one of which should be oil rich.
  • Increase intakes of leaner and plant-sources of protein.
  • Use sterol or stanol fortified products (if blood cholesterol is raised after other dietary changes have been made).

It’s interesting to note that, unlike the US, the UK does not (and has never) recommended taking dietary supplements of omega-3 fish oil.

For up to date expert advice on heart health visit: heartuk.org.uk

Further references

Saturated fat and heart health reports

Supplements for specific groups
NHS UK: Vitamins for children; Vitamins, supplements and nutrition in pregnancy

 Vegetarian and vegan diets and health outcomes

  • Rizzo N, Jaceldo-Siegl K, Sabate J et al. Nutrient profiles of vegetarian and non-vegetarian dietary patterns. J Acad Nutr Diet.. 2013;113(12):1610-9.
  • Sobiecki J, Appleby P, Bradbury K et al. High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: results from the European Prospective Investigation into Cancer and Nutrition-Oxford study. Nutr Res.. 2016;36(5):464-77.
  • Springmann M, Godfray H, Rayner M et al. Analysis and valuation of the health and climate change cobenefits of dietary change. Proc Natl Acad Sci U S A.. 2016;113(15):4146-51.
  • Clarys P, Deliens T, Huybrechts I et al. Comparison of nutritional quality of the vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diet. Nutrients.. 2014;6(3):1318-32.

Cochrane is an established body of researchers, health professionals and patients across the globe renowned for their high quality scientific reviews of nutrition and health evidence.

 

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The links between diet, nutrition, physical activity and cancer

The links between diet, nutrition, physical activity and cancer

One in two people in the UK will be affected by cancer at some point in their lives. The important new expert report by the World Cancer Research Fund (WCRF) has been published, evaluating the links between diet, nutrition, physical activity and cancer and the past decade of cancer prevention research.

It finds that around 40% of cancers could be prevented by making healthy lifestyle choices.

Here’s a summary of the key findings, along with WCRF recommendations about how we can best help prevent cancer.

Key lifestyle factors linked to cancer

1. Body fatness

  • There is strong evidence that greater body fatness is a cause of many cancers – including pancreatic cancer, liver cancer and ovarian cancer. Science in relation to the link has grown over the last decade.Rates of overweight and obesity have been rising in most countries. Figures released on obesity just this week show that in the UK almost 60% more children in their last year of primary school are classified as ‘severely obese’ than in their first year.WCRF says that if current trends continue, being overweight or obese is likely to overtake smoking as the number one risk factor for cancer.
  • Whilst greater weight gain in adulthood increases the risk of post-menopausal breast cancer, evidence showed that being overweight or obese as an adult before menopause decreases the risk of pre-menopausal breast cancer. Also, being overweight or obese between the ages of 18 and 30 years decreased the risk of pre- and postmenopausal breast cancer.Despite the findings, it is important to know that WCRF recommend maintaining a healthy weight throughout all stages of life.

WCRF Expert Panel opinion – Keep weight within the healthy BMI range (18.5kg/m2 – 24.9kg/m2) and avoid weight gain in adult life. WCRF explain more about BMI and provide a useful BMI calculator.

2. Dietary factors

a. Wholegrains, vegetables and fruit

  • Wholegrains and other foods containing dietary fibre decrease the risk of colorectal cancer. This includes both foods that naturally contain fibre and foods that have had fibre added.
  • Beta-carotene in foods or supplements is unlikely to have a substantial effect on the risk of prostate cancer.
  • Foods contaminated by aflatoxins (toxins found in some fungi) increase the risk of liver cancer. Find out more about what this means on the WCRF website.
  • Foods preserved by salting increase the risk of stomach cancer.

WCRF Expert Panel opinion – For wholegrains and other foods containing dietary fibre, the evidence shows that, in general, the more people consume, the lower the risk of some cancers.

We are advised to consume at least 30 grams of fibre per day (see the fibre fact sheet from the British Dietetic Association for more information on how to achieve this).

A diet high in all types of plant foods is recommended including at least five portions of vegetables and fruit per day. This poster from WCRF shows what counts as a portion.

b. Animal products

  • Red meat and processed meat increase the risk of colorectal cancer.
  • Cantonese-style salted fish increases the risk of nasopharyngeal cancer.
  • Dairy products decrease the risk of colorectal cancer.

WCRF Expert Panel opinion – For people who eat meat, limit consumption of red meat, such as beef, pork and lamb, to no more than three portions per week: 350–500g cooked weight. Eat little, if any, processed meat.

c. Alcoholic drinks

  • Consuming alcoholic drinks increases the risk of:
    • Mouth, pharynx and larynx cancers
    • Oesophageal cancers
    • Breast cancer (pre- and post-menopause)
  • Two or more alcoholic drinks a day increase the risk of colorectal cancer.
  • Three or more alcoholic drinks a day increase the risk of stomach cancer and liver cancer.
  • Up to two alcoholic drinks a day decrease the risk of kidney cancer (though note, WCRF advise that this is far outweighed by the increased risk for other cancers).

WCRF Expert Panel Opinion – The evidence shows that, in general, the more alcoholic drinks people consume, the higher the risk of many cancers.

WCRF advise that for cancer prevention, it’s best not to drink any alcohol at all. Indeed, there is no threshold for the level of consumption below which there is no increase in the risk of at least some cancers.

3. Physical activity

  • Being physically active decreases the risk of:
    • Colon cancer
    • Breast cancer (post-menopause)
    • Endometrial cancer
  • Vigorous physical activity (e.g. running or fast cycling) decreases the risk of:
    • Pre- and post-menopausal breast cancer

WCRF Expert Panel Opinion – The evidence implies that, in general, the more physically active people are, the lower the risk of some cancers.

We are advised to do at least 150 minutes of moderate intensity activity (examples include brisk walking, cycling, household chores, swimming, dancing) or 75 minutes of vigorous activity (examples include running, aerobics, squash, netball, fast cycling) per week.

4. Other factors related to cancer

The report also covers links between cancer and other dietary factors (including glycaemic load, vitamin supplements and non-alcoholic drinks); height and birth weight; and lactation. For more information, see the summary report.

The 10 cancer prevention recommendations

The report includes 10 key recommendations for cancer prevention. Shown here as an overview infographic, there’s lots more useful detail in the report itself.

For lifestyle factors as discussed within this report, incorporating the recommendations into our lives as a whole package, rather than just focusing on a few individually, will be the most conducive for cancer prevention. It is interesting to know that between 30-50% of all cancer cases are estimated to be preventable through healthy lifestyles and avoiding exposures to occupational carcinogens (substances capable of causing cancer), environmental pollution and certain long-term infections.

NEW resources to help with cancer prevention:

  • Cancer Health Check – A new online questionnaire check has been launched to help individuals find out where they are doing well and where they could make changes to their lifestyle to help reduce the risk of cancer.
  • Toolkit – WCRF have published a downloadable toolkit which shows key points from the report using lots of visual representations of the findings.
  • Interactive Cancer Risk Matrix – This tool gives information on how different aspects of diet, as well as body weight and physical activity, might be linked to cancer risk based on the strength of the evidence.
  • Individual sections of the report – these can be accessed digitally as PDFs or as toolkits. This allows us to zoom in on specific dietary factors or different cancers and find out the evidence from the main report.
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Sugar Reduction Programme – PHE one year progress report

Sugar Reduction Programme – PHE one year progress report

This week, Public Health England (PHE) published their first assessment on the government’s sugar reduction programme, introduced to help reduce rates of childhood obesity.

The food industry – including retailers, manufacturers, restaurants, cafes and pub chains – was given the target to cut 20% of sugar from a range of products by 2020, with a 5% reduction in the first year. The first year of the programme was from August 2016 to August 2017.

What does the assessment show?

  • Retailers and manufacturers have achieved only a 2% reduction in sugar.
  • Sugar has been reduced by 11% by retailers and manufacturers in drinks that are included in the Soft Drinks Industry Levy and average calories per portion has been reduced by 6%.
  • New guidelines have been published for the drinks industry to reduce sugar in juice and milk-based drinks.

Importantly, PHE highlight that there are forthcoming sugar reduction plans from the food industry and that some changes of products were not captured in the data (as the changes took effect after the one-year mark measured). This all points towards hopefully seeing greater reductions in future assessments.

Measuring the progress
Ten food categories were measured that contribute the most sugar to children’s diets, although breakfast pastries and cakes were not included due to insufficient data. Some of the key findings from the assessment include:

  • Reductions in sugar levels were seen across five of the categories.
  • Yogurts and fromage frais, breakfast cereals, and sweet spreads and sauces have all met or exceeded the initial 5% sugar reduction ambition.
  • Biscuits and chocolate confectionary have seen no change at all in sugar levels.
  • The puddings category has actually seen a slight (1%) increase in sugar content overall.
  • It has been noted that for the eating out of home sector, portion sizes in products likely to be consumed in one go are substantially larger (on average more than double) those of retailers and manufacturers.
  • Calories in products likely to be consumed in one go have reduced in four categories. Of these, ice cream, lollies and sorbets, and yogurts and fromage frais have reduced average calories by more than 5%. Often this is due to smaller portion size.

The British Retail Consortium (BRC) provided an interesting infographic showing how the food industry has been cutting sugar.

In response to the PHE assessment, Andrew Opie, Director of Food Policy at the BRC, stated: “Retailers are fully committed to helping improve the health of their customers and have led the way in reducing sugar in their products. Thousands of tonnes of sugar have been removed from retailers’ own product ranges to date and continuing work will result in even greater reductions over the next few years.

“Retailers have shown that reducing sugar levels across a wide range of products is possible but all food businesses must follow suit if we are to see significant reductions in the level of sugar in the nation’s diet.”

The British Dietetic Association‘s Head of External Affairs, Jo Instone, said: “We recognise that there are limitations in the data and that these are the early stages of the reformulation programme. However, it is disappointing to have such significant gaps and for a number of manufacturers to have refused to allow information on their progress to be published.”

“Clearly, it will be important for the BDA, the Obesity Health Alliance and others to continue working with Public Health England and the government to drive this programme forward. We would hope that the 2019 report can fill in a number of gaps and that we will see more substantial progress made across the board.”

Milk based drinks and juice
Following our concern about sugar levels in fruit juice, we’re pleased to see new plans by PHE encouraging the drinks industry to achieve the following by mid-2021:

  • Reduce sugar in juice-based drinks by 5% (excluding single juice – that is, products with juice from a single fruit with nothing added to it).
  • Cap all juice-based drinks (including blended juices, smoothies and single juices) likely to be consumed in one go to 150 calories.
  • Reduce sugar in milk (and milk substitutes) based drinks by 20% and cap products likely to be consumed in one go to 300 calories.

What’s next?
Some progress has been made, but it seems we’re still well off hitting targets for sugar reduction. It’s clear that more work is needed – by manufacturers and retailers, but also cafes and restaurants, where calorie intake tends to be significantly higher.

The next progress report from PHE is due in Spring 2019 and should give a clearer picture on the programme’s progress.

Of course, this is only one of the many strategies needed to help combat the obesity crisis. Along with the BDA and many others, we’re looking forward to hearing government measures for issues including broadcast advertising, in-store promotions and other interventions to help tackle the problem.

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