How the food industry misleads consumers on sugar

The food industry uses misleading marketing and industry-supported interest groups to obscure the health consequences of added sugar in their products, according to a new report, Sugar-Coating Science: How the Food Industry Misleads Consumers on Sugar, from the Center for Science and Democracy at the Union of Concerned Scientists.

“Companies are going out of their way to promote products with added sugar in them as healthier than they really are,” said Deborah Bailin, lead author. “In many cases, they’re adding sugar to otherwise healthy foods and misleading customers about it. It’s not just soda and snacks, either. Added sugar is in everything from bread to salad dressing and even frozen dinners.”

Medical researchers have linked sugar overconsumption to diabetes, cardiovascular disease, and hypertension. Despite these dangers, companies advertise products with added sugar using healthy-sounding language. For instance, Apple Cinnamon Cheerios are marketed as “whole grain,” which they are, but the product also contains 10 grams of sugar—10 times the amount in General Mills’ regular Cheerios.

Since 1970, average daily U.S. sugar consumption has increased from 74.7 grams to 82.1 grams (20 teaspoons). That is more than double the U.S. Department of Agriculture’s dietary guideline recommendation of no more than 42 grams of sugar a day. The report documents that eating just a few sugar-added products during the day could easily cause someone to exceed the recommendation level.

The food industry spends nearly $7 billion annually advertising its products. About a quarter of its spending is directed at youth advertising and sugar-heavy products make up the bulk of that spending. GoGurt yogurt, for instance, contains large amounts of added sugar, but has been advertised as healthy because it is free of “high fructose corn syrup.” The report also tracks misleading marketing campaigns for sugar-added products that have been specifically directed at women, minorities and low-income consumers.

Food industry-supported interest groups also play a significant role in misinforming the public, the report finds. Court documents recently revealed that the Corn Refiners Association (CRA) paid Berman and Company to run a misleading ad campaign through the Center for Consumer Freedom, a nonprofit run by Berman and Company’s founder. The ads conveyed the message that all sugars—whether from corn, cane, and beets—are “natural” and pose no health concerns. This message is misleading, the report says, because it distracts people from the risks associated with over-consuming sugar in any form. In internal emails, CRA’s then-president Audrae Erickson counseled colleagues to deny that CRA was financing the campaign.

The report makes the following recommendations in order to hold the food industry and its interest groups accountable for their efforts to obscure the science on sugar and its detrimental health effects:

• The media should publicly call out sugar interests’ misstatements.
• Scientific experts should disclose all real or perceived conflicts of interest.
• Investors and citizens should pressure companies to align their public messaging with science and to cease funding to trade and front groups that spread misinformation.
• U.S. Congress should restore the Federal Trade Commission and Federal Communications Commission to their full capacity to regulate marketing to children so that the agencies can regulate youth-targeted marketing.
• The U.S. Food and Drug Administration should implement a strong rule requiring the labeling of added sugar in nutrition labels as the agency announced it intends to do.
• Federal, state, and local health agencies should develop aggressive public information campaigns to emphasize the scientific evidence demonstrating sugar’s health impacts and counter the misinformation from sugar interests.

The report is being released at the Science, Democracy, and a Healthy Food Policy forum on integrating public health science into U.S. food policy, sponsored by Union of Concerned Scientists and the University of Minnesota’s School of Public Health.

Citation:
1. Bailin D, Goldman G, Phartiyal P. Sugar-Coating Science: How the Food Industry Misleads Consumers on Sugar. Cambridge, Mass.: Union of Concerned Scientists, 2014.

Investing in fruits, vegetables can save lives, reduce health care costs

Increasing the consumption of fruits and vegetables could save more than 100,000 lives and $17 billion in health care costs from heart disease each year in the United States, according to a new report by the Union of Concerned Scientists.

The report, The $11 Trillion Dollar Reward, explains that better federal agricultural policies, designed to encourage production of healthy food instead of processed junk foods, will help reap those benefits.

If Americans consumed just one additional serving of fruits or vegetables a day, the nation would save $5 billion in health care expenditures and prevent 30,301 heart disease and stroke deaths annually. And if Americans were to go a step further and eat a full 2.5 cups of vegetables and two cups of fruit daily, as recommended by federal dietary guidelines, it could prevent 127,261 deaths each year and save $17 billion in medical costs. The economic value of the lives saved from cardiovascular diseases is an astounding $11 trillion, according to the report.

The report researchers advocate for cost-effective policies that increase access to and reduce the cost of domestically grown fruits and vegetables for consumers, especially for low-income consumers who are hardest hit by cardiovascular disease and other diet-related illnesses. Low-income neighborhoods–where some 30 million Americans reside–are often far from grocery stores and other sources of fresh produce, hindering access.

Current federal agricultural policies channel taxpayer dollars into subsidies for commodity crops, such as corn and soybeans, which are used as feed for livestock, biofuels and as processed food ingredients. These policies offer few incentives for farmers to grow fruits and vegetables–effectively discouraging production of the very foods federal dietary guidelines recommend.

A three-minute video produced by UCS summarizes how we can achieve an $11 trillion reward through forward-looking agricultural policies.

Citation:
1. O’Hara JK. The $11 Trillion Reward: How Simple Dietary Changes Can Save Lives and Money, and How We Get There. Cambridge, Mass.: Union of Concerned Scientists, 2013.

Physical activity recommendations for children

Physical activity recommendations in early childhood should be a focus of future cardiovascular disease prevention efforts, according to a study of 3,000 children age 2-9 years from eight European countries.

The age and sex of the children are important factors in determining the right physical activity requirements. Boys age six years or younger need at least 60 minutes of moderate-to-vigorous physical activity per day, whereas boys age 6-9 years need at least 80 minutes. Girls in either age group need approximately 15 minutes less. Recommendations should also include 20 minutes of vigorous physical activity per day in all children.

Clinicians should avoid using generalized physical activity guidelines and evaluate children at risk of cardiovascular disease on a case-by-case basis, the researchers said.

Citation:
1. Jiménez-Pavón D, Konstabel K, Bergman P, et al. Physical activity and clustered cardiovascular disease risk factors in young children: a cross-sectional study (the IDEFICS study). BMC Medicine 2013; 11: 172. (open access)
2. McMurray RG. Insights into physical activity and cardiovascular disease risk in young children: IDEFICS study. BMC Medicine 2013; 11: 173. (open access)

New report on urbanization and heart disease

The World Heart Federation has released a new report, Urbanization and Cardiovascular Disease: Raising Heart-healthy Children in Today’s Cities, which shows how urban life impacts heart-healthy behavior.

Although urbanization brings with it many opportunities—such as employment choices, healthcare, educational prospects, social connections and political mobilization—city life inherently comes with obstacles to adopting heart-healthy behaviors, according to the report.

For example, foods high in salt, sugar and fats are often more cheaply and readily available than fresh fruits and vegetables in urban settings. Children are particularly vulnerable to the negative health aspects associated with city life, as they have the least independence from, and are most manipulated by, their living environment. In addition, unplanned urbanization is accompanied by limitations on space for physical activity including lack of planning, crime, and heavy and dangerous traffic.

Heart disease is not just an issue of lifestyle and individual behavior choices, it is the environment around such diseases that have a major impact, the report emphasizes.

The report presents several case studies showing that informed action by governments and key stakeholders who take a whole-of-society approach can dramatically reduce the level of cardiovascular disease risk.

Download the full report or the executive summary here: www.worldheart.org/urbanization.

Citation:
1. Smith, S. et al. Urbanization and Cardiovascular Disease: Raising Heart-healthy Children in Today’s Cities. Geneva: World Heart Federation, 2012.

Food fried in olive or sunflower oil is not linked to heart disease

Eating food fried in olive or sunflower oil is not associated with an increased risk of coronary heart disease or death, according to a study of more than 40,000 adults aged 29-69 years in Spain.

The benefits of olive or sunflower oil can be attributed to the fact that they are less prone to deteriorating during frying, compared to other oils.
The oil used for frying deteriorates, especially when reused, through oxidation and hydrogenation, leading to a loss of unsaturated fats and an increase in trans fats. When food is fried it loses water and absorbs this degredated oil, increasing its energy density.

The study researchers pointed out that these results are directly applicable only to other Mediterranean countries with frying methods similar to those in Spain. For example, oil (mainly olive and sunflower) rather than solid fat is used for frying in Spain. And these oils are not likely to be reused multiple times for foods eaten at home. Finally, consumption of fried snacks high in salt is fairly low in Spain, whereas in other countries such as the United States they provide an important percentage of energy intake.

“Frying with other types of fats, reusing oils several times, or consuming fried snacks high in salt may still be harmful,” the study concluded.

Citation:
1. Guallar-Castillón P, Rodríguez-Artalejo F, Lopez-Garcia E, et al. Consumption of fried foods and risk of coronary heart disease: Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study. BMJ 2012; 344: published 24 Jan 2012. (open access)

Adults in southern China at high risk of metabolic syndrome

A study indicates that close to eight percent of adults in Guangdong, China, have the metabolic syndrome. The metabolic syndrome is the constellation of cardiovascular risk factors including abdominal obesity, raised blood-sugar and high cholesterol. The metabolic syndrome is known to increase the risk of diabetes, heart disease and subsequent death.

The results of the study translate to a total of about four million adults age 20 years and older with the metabolic syndrome in this Chinese province of 85 million residents. More than 60 percent were found to have at least one individual component of the metabolic syndrome. Urban residence were more likely to have the syndrome than the rural population (close to 11 percent compared to four percent).

As China continues to be the fastest economic development in the world, it is expected to further increase its rate of modernization and urbanization–translating to more people consuming energy-dense diets and living increasingly sedentary lifestyles. The prevalence of the metabolic syndrome and related cardiovascular disease is therefore expected to increase enormously, according to the study.

“Urgent public health actions are needed to control this observed worsening situation in China,” the study concludes.

Citation:
1. Lao XQ, Zhang YH, Wong MCS, et al. The prevalence of metabolic syndrome and cardiovascular risk factors in adults in southern China. BMC Public Health 2012; 12: 64. (open access)

Mexico study: Heart disease risk determined by quality of fat

Quality, rather than quantity of fat, is the determinant of heart disease risk, according to a study conducted in Mexico. The study found that although fat intake among three-quarters of Mexicans fell within World Health Organization recommendations, their saturated fat and trans fat intake exceeded healthy diet recommendations–placing them at higher risk for heart disease.

Around 60 percent of Mexicans surveyed had a high intake of saturated fats and a low intake of polyunsaturated fats, which help reduce the risk of heart disease and promote cardiovascular health.

“Public policies should be enacted to reduce the intake of saturated fats by improving the quality of baking lard and promoting the consumption of defatted milk,” the study recommended. These two foods are among the main sources of saturated fats in the Mexican diet.

In addition, consumption of foods rich in n-3 and n-6 fatty acids (such as fish and nuts) are very low in the typical Mexican diet; thus, alternatives like promoting a larger consumption of canola or soy bean oils or addition of n-3 fatty acids to cooking oils from other sources must be considered, the study concluded.

Citation:
1. Ramírez-Silva I, Villalpando S, Moreno-Saracho JE, Bernal-Medina D. Fatty acids intake in the Mexican population. Results of the National Nutrition Survey 2006. Nutrition & Metabolism 2011; 8: 33. (open access)

Management of diabetes and associated cardiovascular risk factors in seven countries

A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries, according to a multi-country study using nationally representative health examination surveys from Colombia, England, Iran, Mexico, Scotland, Thailand and the United States.

The figures range from 24 percent of women in Scotland and the United States to 62 percent of men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure, and serum cholesterol was very low, ranging from one percent of male patients in Mexico to about 12 percent in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States.

Based on this comparison of how well these seven countries are performing in terms of population-level management of diabetes, hypertension and high cholesterol, the study researchers make the following recommendations:

1. It is critical to track diabetes care at the population level and to focus on actual outcomes, rather than on the process of care. It is also critical to study other countries with larger numbers of individuals with diabetes, such as China and India, for which nationally representative studies are not readily available.
2. It is important to prioritize the development and implementation of national guidelines and the use of new incentive programs for the management of hypertension and high cholesterol among individuals with diabetes in developing countries. The study findings suggest that such progress may be more feasible and more likely to have a larger population health impact than blood glucose control.
3. There are opportunities for innovation in providing incentives, in the technology of diabetes management and in improving financial access to care.

Real progress at the population level in the management of diabetes will likely require all three: monitoring performance in meeting treatment targets, expanding management of hypertension and high cholesterol in individuals with diabetes, and innovations in the delivery of and access to care.

The estimated global prevalence of diabetes is around 6.4 percent and more than 280 million people in the world have diabetes—the majority live in the developing world. Projections indicate that diabetes accounted for almost four million deaths worldwide in 2010. The burden of diabetes will only continue to grow, since the number of adults with diabetes in developing countries is projected to rise by more than two-thirds between 2010 and 2030.

Source:
1. Gakidou E, Mallinger L, Abbott-Klafter J, et al. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bulletin of the World Health Organization 2011; 89: 172-183. (open access)

High blood pressure, high cholesterol and diabetes rates in Switzerland

High blood pressure, high cholesterol and diabetes rates in Switzerland have increased in the last decade, according to data from three national health surveys conducted in 1997-2007.

The prevalence of self-reported hypertension, hypercholesterolemia and diabetes was 22.1 percent, 11.9 percent and 3.3 percent in 1997, respectively; and increased to 24.1 percent, 17.4 percent and 4.8 percent in 2007.

Self-reported treatment rates among people with these three cardiovascular risk factors also increased from 52.1 percent, 18.5 percent and 50 percent in 1997 to 60.4 percent, 38.8 percent and 53.3 percent in 2007 for hypertension, hypercholesterolemia and diabetes, respectively.

Self-reported control levels increased from 56.4 percent, 52.9 percent and 50 percent in 1997 to 80.6 percent, 75.1 percent and 53.3 percent in 2007. Finally, screening during the last 12 months increased from 84.5 percent, 86.5 percent and 87.4 percent in 1997 to 94 percent, 94.6 percent and 94.1 percent in 2007.

Source:
1. Estoppey D, Paccaud F, Vollenweider P, Marques-Vidal P. Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997-2007. BMC Public Health 2011; 11: 114. (open access)

Physical inactivity, depression and heart disease-related death in older adults

Research has indicated that depressed older individuals are at higher risk of dying than their counterparts without depression. In addition, physical inactivity accounted for a significant proportion (25 percent) of the risk of cardiovascular death due to depression in adults age 65 years and older, according to a 5,900-person U.S. study.

“These data suggest that preventive health and wellness programs in older adults, particularly those with depression, should focus on encouraging enrollment and continued participation in exercise programs,” the study concluded.

The study also added that positive financial incentives, health insurance rebates, transportation vouchers or health club memberships might enhance participation of older adults with depression in these programs and thereby reduce healthcare utilization and the risk of cardiovascular events.

Source:
1. Win S, Parakh K, Eze-Nliam CM, et al. Depressive symptoms, physical inactivity and risk of cardiovascular mortality in older adults: the Cardiovascular Health Study. Heart 2011; 97: 500-505. (open access)