Health horizons - Issue 1
Childhood nutrition and omega 3s
Five minutes with ...
Associate Professor Jennifer Keogh
Top foods and supplements to improve health and wellbeing
Food and nutrition-related research underway at the Sansom Institute
By Professor Kerin O'Dea AO
Shoppers will have the information they need to make healthy choices and Australia will lead the world in food labelling standards if the recommendations of Labelling Logic - the recent review into food labelling law and policy commissioned by the Australia and New Zealand Food Regulation Ministerial Council - are put into practice.
Chaired by Dr Neal Blewett AC, the five-member review panel has drawn upon its collective expertise in public health law, nutrition, food policy, communications and food marketing, consumer research and health promotion in this comprehensive and clearly-argued report.
In all there are 61 recommendations - each with a distinct rationale - covering the areas of public health and food safety, new technologies, consumer values, design and presentation of the label itself, and the critical areas of compliance and enforcement. (See below for a list of some of the key recommendations.)
One of the recommendations that I believe would make a major contribution to public health is the adoption of a traffic lights front-of-pack labelling system: green for foods that contribute to a healthy diet, yellow for consume in moderation, and red for foods that should be eaten only very occasionally. The review advises that such a system would be voluntary in the first instance, except where health claims are made. Other sensible suggestions include making added sugars and fats explicit, and including total and naturally occurring fibre and trans fatty acids.
I firmly believe that food labelling can help people make healthy choices, but labels have to be simple to understand and standards should be based on public health principles, not driven by marketing. As we have seen recently with the tobacco industry's campaign against plain packaging, any move aimed at limiting the effects of marketing spin will be vigorously opposed by those that stand to lose. Accusations of wowserism are a smokescreen: clearly a new food labelling system will not force people to change what they eat; what it will do is allow them to make better informed choices if they want to.
Just one example that highlights the confusing reality for consumers: at the moment, many people think they are making a healthy choice when they see the 'low fat' or '99% fat free' labels on yoghurt, when many of those products actually have more calories due to added sugars than do the full fat plain varieties.
I endorse Labelling Logic wholeheartedly and urge other health professionals and organisations to do likewise. It is vital that the report be implemented in its entirety with adequate funding to ensure the critical evaluation of the reforms' impact on the composition of the food supply and on markers of population health.
With rates of obesity and preventable, diet-related conditions like type 2 diabetes and Australia's number one killer, cardiovascular disease, at all-time-highs, we have everything to gain by getting behind Labelling Logic and nothing - but an unhealthy addiction to fatty and sugary foods - to lose.
The Director of the Sansom Institute for Health Research, Professor Kerin O'Dea AO is a leading nutrition scientist, public health researcher and National Health and Medical Research Council member.
Some of the key recommendations in Labelling Logic include:
- Adopting a food labelling issues hierarchy in descending order of food safety, preventive health, new technologies, and consumer values to guide food labelling policy.
- Amending the Food Standards Australia New Zealand Act 1991 to include a new definition of public health highlighting the importance of the promotion of health and disease prevention as well as health protection;
- Developing a comprehensive food policy that includes a framework for the role of the food panel (label);
- Introducing a multiple traffic lights front-of-pack labelling system (voluntary in the first instance, except where health claims are made);
- Changes to the nutrition information panel, including making added sugars and fats explicit, including total and naturally occurring fibre and trans fatty acids, salt content to be clarified (sodium and potassium identified), and removing the current mandatory 'per serve' column;
- A logical system for health and related claims;
- The ready identification of key additives, colourings and flavourings;
- In relation to alcohol: health risks (particularly for pregnancy), and energy content to be displayed;
- Nutrition information on menus in chain food service outlets and vending machines;
- Foods or ingredients processed by new technologies needing pre-market food safety assessments (such as nanotechnology) to be labelled for 30 years from when they are introduced into the food chain;
- A trans-Tasman food labelling bureau to be established under the FSANZ Act to implement the recommendations in the report;
- The review panel has also designed a system to involve key stakeholders (industry, consumers, public health advocates) in self- and co-regulatory measures.
Download the full report (external link)
The benefits of omega 3 fatty acids have been well documented - by more than 14,000 papers, in fact, since a seminal 1970s study first identified how the Greenland Inuits managed to avoid cardiovascular disease despite a fatty diet largely consisting of whale and seal meat.
But paradoxically, while evidence abounds of omega 3s' ability to do everything from improve brain function to reduce the risk of stroke, cancer and depression, intake of these wonder fats is on the decline - to the point where a recent NHMRC nutrition survey found that eight out of ten children and adolescents in Australia are consuming virtually no omega 3s, as well as falling far below national guidelines for fruit and veg intake.
One Sansom Institute initiative is working to turn this trend around, by providing hundreds of school kids in the Northern Territory with omega 3 supplements (or placebo) and observing the difference in learning, cognition and behaviour.
Supported by an ARC linkage grant and Vifor Pharma, the project is being led by Dr Natalie Sinn, a Sansom research fellow whose PhD in psychology investigated the effects of micronutrients and omega-3 fatty acids on learning and behaviour in children with ADHD.
Dr Sinn says that while omega 3 intake has declined all over Australia, the trend is more pronounced in remote Indigenous populations. "There are so many obstacles in remote areas, a big one being that most of the foods that contain omega 3s - like seafood, leafy green veggies, nuts and seeds - are either not available or affordable," she says.
While the use of supplements can overcome some of these barriers, Dr Sinn says more education is required to ensure sustainability beyond the period of the study - which is why the project is school-based. "As well as showing parents how important omega 3s are for children's learning and behaviour, we want to extend this to a whole range of nutrients and gain evidence to support programs to make healthy food more accessible."
And while supplements are a convenient way to up omega 3 intake, Dr Sinn says limiting unhealthy fats - such as the omega 6s found in processed foods - is an equally important measure that warrants further attention. "In traditional diets there was a one to one ratio of omega 3 and omega 6 intake, now it's more like one to twenty," she says. "We need to be doing more to reduce the amount of processed foods we're eating."
Dr Sinn applauds mass-media education campaigns like the 5-veg 2-fruit initiative, but says such messages are being undermined by marketers' attempts to make processed, branded foods appear healthier. "While advertising has a lot to answer for, there's still a lot parents can do to counter such messages and ensure their children are eating well."
But what are parents to do when faced with the combined forces of fussy eaters, misleading ads and pester power?
Dr Sinn has the following advice for parents struggling to convince their kids to eat their greens:
- Create a positive environment around food for children. "Role model healthy behaviours and involve them in gardening and cooking."
- Give them healthy food options. "Don't have junk food in the house and you won't be tempted to use it as a bribe."
- Don't offer them bread for dinner if they won't eat their veggies or try to tempt them with the promise of a sugary desert. "Research shows children will prefer the desert meal, so continually offering it as a bribe only undermines attempts to get them to enjoy vegetables."
- If at first you don't succeed, try and try again. "Studies show that children who are regularly exposed to healthy foods will start to eat them in time if you keep offering them."
A qualified dietitian with more than 35 years' experience in Australia and the UK, Associate Professor Jennifer Keogh is an expert on diet in relation to obesity and heart disease, and in particular the effects of high salt diets.
You're currently leading an NHMRC-funded project examining salt intake and blood vessel function. How did the project come about and what do you hope the research will achieve?
This latest project follows on from a previous study I supervised that found if you reduce salt in the diet you improve blood flow and blood vessel function, and improve it in a way that's more complex than simply lowering high blood pressure. It took three attempts before we won the grant so it goes to show that persistence pays!
We're now going to assess the effects of salt in the diet on blood vessel function over a longer period of time. We want to understand the mechanisms behind how the salt affects endothelial function and use that knowledge to a) empower people to take notice of their salt intake to improve their health and reduce the risk of diabetes and heart disease, and b) inform the public policy debate to bring about salt reduction.
As one of the dietitians who contributed to the hugely successful CSIRO Total Wellbeing Diet (and its subsequent three follow-ups, including the latest, Diabetes Diet and Lifestyle Plan) it must be gratifying to see your work reach such a wide and appreciative audience. Why do you think it was so successful?
I was working as a research dietitian at the CSIRO at the time the book was written. It was a wonderful opportunity to be involved in translating research into a format that people can use in their everyday lives. It's why we do research isn't it? - to benefit the health of the nation. The first book sold over a million copies and consumer research has indicated that around 500,000 people lost weight on the diet, losing an average six kilograms each. I think part of the reason for its success was that it had a positive message, letting people know that they have power to improve their health, and giving them the knowledge and motivation to make changes.
Most people are generally aware that diets that are high in salt diets are not conducive to good health, but what practical measures can individuals take to minimise their risk of disease and optimise health?
The NHMRC recommends that we don’t have more than six grams of salt each day, but it's a target that's really hard to achieve in reality. People think they are doing well by not adding salt to their cooking, without realising that 70-85 per cent of the salt that we eat is in manufactured food - and it's not just in chips and salted nuts but things like bread, biscuits, cheese and processed meats.
It's important to eat fresh food as much as possible because food like fruit and vegetables, eggs, and fresh meat and fish are naturally very low in sodium. When you're in the supermarket you can look for products that are labelled 'salt reduced' or 'low salt', as well as checking out the nutritional information panel on the back. If a food contains 120 mgs of sodium or less it's allowed to call itself low salt according to FSANZ (Food Standards Australia and New Zealand). However a lot of brands don't trumpet their low salt status as it can turn consumers off, so it's definitely worth reading the fine print. It's also worth looking for foods with more potassium in them as potassium reduces the negative effects of sodium.
Do you think greater regulation of foods that are high in salt is required? Why?
I think we need clearer labelling that helps people to make informed choices about the food they eat. Most people don't have the time to read the nutritional information on the back and for older people it's so small you'd have to bring a magnifying glass to the supermarket. The Heart Foundation tick is a good initiative but it's not universal and only appears on products that have opted in. I'd like to see traffic lights on the front of packaging with green for healthy foods, amber for those that should be consumed in moderation and red for those that are high in salt and saturated fats.
With hundreds - if not thousands - of vitamins and nutritional supplements on the market purporting to help with everything from weight loss to digestion and brain function, consumers can find it difficult to choose the right supplement - let alone gain optimal nutrition from diet alone. Sansom Institute member and leader of the Nutritional Physiology Research Centre, Associate Professor Jon Buckley, has overseen numerous studies examining the effects of bioactive components found in food, and says there are several that stand out from the pack with scientifically-proven health benefits that extend beyond basic nutrition. His top tips are:
Literally thousands of studies have shown that long chain omega 3 fatty acids have a wide range of benefits, with considerable evidence of improvements in cardiovascular health, and growing evidence of benefits for aiding weight loss and reducing obesity and improving cognitive function. Some of the best sources include oily fish such as salmon, mackerel and sardines, and of course supplements.
The flavonoids in cocoa have been shown to help reduce blood pressure and improve cardiovascular health, with improved learning and memory and lowered LDL cholesterol other likely benefits. But before you go reaching for that block of chocolate, note that such benefits have only been achieved via the consumption of pure cocoa or cocoa powder - and to a lesser extent, dark chocolate - as the sugar, fats and cooking processes associated with most chocolate is thought to counter any health-boosting properties.
It may be a comparatively new kid on the supplement scene, but Buckley says there is good evidence showing that resveratrol can help maintain healthy artery function and improve cardiovascular health. There have also been animal studies pointing to potential anti-cancer and anti-ageing properties. Resveratrol is found in the skins of red grapes and in red wine (but only in small quantities), and to a lesser extent in mulberries and blueberries, making supplements the ideal way to gain maximum health benefit.
One to watch: Vitamin D
About half of the Australian population have sub-optimal levels of vitamin D, a concerning trend that Buckley says brings with it a wide range of health implications including poorer musculoskeletal and cardiovascular health, and increased mortality. Exposure to sunlight, fatty fish, dairy foods, cod liver oil and vitamin supplements are all sources of Vitamin D.
These are just some of the food and nutrition-related projects underway at the Sansom Institute:
- Effects of omega-3 fatty acid supplementation on learning and behaviour of children in predominantly Indigenous Northern Territory schools
- Can bone-derived vitamin D regulate bone cell activity?
- Sustained effects of resveratrol on circulatory function in obese adults
- Efficacy of lutein-milk for improving exercise self-efficacy and exercise participation in older adults
- Effects of modification of dietary salt intake on endothelial function in obese subjects
- Early life nutrition (ages 0-5) and physiological risk, adiposity and neurocognitive development in later childhood and adolescence
- Nutrition practices in SA Child Care Centres: comparison with state and national guidelines
- Development of the first validated index to describe the diet quality of Australian children and adolescents
- Effects of changing from regular-fat to low-fat dairy foods on children's total diet and metabolic health
- Evaluation of peanuts as a source of bioactive nutrients for enhancement of endothelial function and cognitive performance
Areas of study and research
- Health Research
- Alliance for Research in Exercise, Nutrition and Activity (ARENA)
- Centre for Cancer Biology
- Centre for Drug Discovery and Development
- Centre for Population Health Research
- Centre of Research Excellence for the Prevention of Chronic Conditions in Rural and Remote High Risk Populations
- International Centre for Allied Health Evidence
- Medicine and Device Surveillance CRE
- Quality Use of Medicines and Pharmacy Research Centre
and Social Sciences
- Art, Architecture and Design
- Communication, International Studies and Languages
- Psychology, Social Work and Social Policy
- Hawke Research Institute
- Asia Pacific Centre for Work Health and Safety
- Australian Centre for Child Protection
- Barbara Hardy Institute
- Centre for Research in Education
- Hawke EU Jean Monnet Centre of Excellence
- Centre for Islamic Thought and Education
- International Centre for Muslim and non-Muslim Understanding
- Research Centre for Languages and Cultures
- Zero Waste SA Research Centre for Sustainable Design and Behaviour (sd+b)
IT, Engineering and
- Future Industries Institute
- UniSA College