Issue 33, November 2012 ISSN 1446-6112

perspectivesnutrition news and views

CONTENTS The metabolic syndrome, cardiovascular

1 disease and carbohydrate by Alexandra Chisholm* The metabolic syndrome, cardiovascular disease and carbohydrate EFFECTS OF CARBOHYDRATES Alexandra Chisholm A volume of work exists on the metabolic effects of fat on these conditions; however carbohydrate 2 (CHO) is a major component of our diets and has EDITORIAL On the menu: Nutrient pathophysiological relevance to these disease states. quality, aged care, The effects of the proportion of dietary CHO on weight loss have been a consumer behaviour particular focus of recent investigations. In fact, intervention studies indicate change and food miles that both lower CHO and higher CHO interventions can achieve similarly Janelle Gifford successful weight loss and metabolic outcomes(1,2); although results may be influenced by dietary adherence(1) and intensity of contact in advice 3 Dietary intervention is a delivery(2). Obese women (mean BMI 32±6) randomly assigned to isocaloric Eating out: Mandatory cornerstone in the treatment of diets of either lower CHO (46% CHO, 34% protein) or higher CHO (64% menu board labelling of the metabolic syndrome (MetS) CHO, 17% protein) with good adherence over twelve weeks both achieved fast food products and cardiovascular disease (CVD), significant reductions in weight (7.3±0.3kg)(3). In this study, fasting LDL, Elizabeth Dunford both of which are responsible HDL, insulin, free fatty acids and C-reactive protein (CRP) all reduced with for a growing burden of death weight loss. However, those who began the study with higher triglycerides 4 and disability globally. Several (>1.5mmol/L) and were on the lower CHO diet lost more fat mass (P<0.05) Development of Nutrition definitions exist for MetS, and had a greater reduction in triglycerides (P<0.05). Thus, while weight and Menu Planning however the common elements loss is largely dictated by the degree of caloric deficit (independent of Standards for Residential comprise obesity (especially macronutrient composition), this may suggest that tailoring diet for different Aged Care Facilities central obesity), insulin metabolic profiles is warranted. in Australia and New resistance or glucose intolerance, Zealand dyslipidaemia, and hypertension, In the longer term, lower CHO diets have not been found to be more effective Anne Schneyder and Liz Beaglehole with CVD potentially occurring for weight loss than diets higher in wholegrain CHO(2,4,5), with caloric deficit alongside MetS. (6) 6 still seen to be key ; and there is consistent evidence that overall, high CHO (low fat) diets are not associated with heightened CVD risk(7,8). Unilever’s Five Levers for Change Key points Katherine Tocchini Effect of dietary CHO on MetS and CVD is clearly • Effect of dietary complex and requires discussion of CHO quality. 7 carbohydrate on Plant-based foods may not only beneficially effect Food miles: from paddock metabolic syndrome and to plate cardiovascular disease energy balance, but also lower the risk of coronary Corey Watts is complex and must be heart disease and beneficially influence glycaemia. seen in the context of a total eating pattern. The World Health Organisation has stated that 31% of deaths from ischemic receive perspectives heart disease and 11% of deaths from stroke worldwide were caused by • Diets rich in plant foods electronically diets poor in fruit and vegetables(9). Additionally, there is good evidence that include PUFA You can subscribe to the that greater consumption of wholegrain cereals, such as oats and barley, fats at the expense of is associated with reduced risk of CVD(10) with clinical trials showing reduction Perspectives e-newsletter SFA may beneficially in total and LDL cholesterol levels (see National Health and Medical by emailing your name to affect components of Research Council(11)). perspectives.nutrition@ metabolic syndrome and unilever.com cardiovascular disease. Plant foods high in specific fibres such as β-glucans found in oats and barley may facilitate a lower rise in both post-prandial triglycerides and glucose(12,13). Foods high in other viscous or gelling fibres and a higher proportion of resistant starch may also favourably influence acute blood glucose responses(14,15); however, effects are dependent on the specific fibre and food matrix(16).

continued on page 8 On the menu: Nutrient quality, aged care,

EDITORIAL consumer behaviour change and food miles by Janelle Gifford

Carbohydrate and its effect on chronic disease has been Evaluation of the impact of mandatory labelling on fast a fascinating conversation piece amongst dietitians and food purchasing behaviour will be needed to establish nutrition scientists for some time, and has recently been whether this move can produce behaviour change. discussed with some fervour. While dietary carbohydrate Some insight into the complexity of consumer behaviour was once favoured as a replacement for saturated fat change along with a suggested behaviour change model in cardiovascular disease risk reduction, a 2009 pooled is provided by Unilever Nutrition and Health team analysis of eleven cohort studies provided further member, Katherine Tocchini, in this issue. impetus for debate(1). The authors found that dietary saturated fats should be replaced by polyunsaturated Menu planning and nutrition standards in the much fats, but not monounsaturated fats or carbohydrate needed area of aged care has recently taken a step The current issue of Perspectives for prevention of coronary heart disease. However in forward with the release of Dietitians Association of covers a broad range of work, nutrition research, study design and dietary compliance Australia’s scoping project(3). Anne Schneyder and beginning with recent insights can impact on the ability to clearly expose the effects Liz Beaglehole summarise some of the main findings on carbohydrates (and fats) and of different dietary treatments. In this issue, Alexandra from this trans-Tasman report. Lastly, on the topic health, and moving through to Chisholm outlines recent literature on metabolic and of sustainability, Corey Watts gives a summary of his discussions on trends in quick cardiovascular health effects of carbohydrates and fats presentation on ‘food miles’ recently hosted by the service restaurant mandatory and highlights the need to focus on nutrition quality. Dietitians Association of Australia Food and Environment menu board labelling, nutrition Interest Group. standards for aged care in Elizabeth Dunford reports on recent activity supporting Australia and New Zealand and healthy food choice in quick service restaurants. I trust you will enjoy this issue of Perspectives. consumer behaviour change. Mandatory kilojoule menu board labelling (for larger An informative article on food quick service chains) was implemented in NSW earlier Janelle Gifford, PhD, Advanced Accredited Practising Dietitian. miles completes the issue. this year. Australians and New Zealanders frequently References eat out, and whilst they may be concerned about the 1. Jakobsen MU et al. Am J Clin Nutr 2009; 89: 1425-32. 2. Vadiveloo MK et al. Int J Behav Nutr Phys Act 2011; 8:51. healthiness of fast foods, they may find it difficult to To subscribe to Perspectives in 3. Williams P 2011. Scoping Project: Development of Nutrition and e-format, just email your name identify healthier options (see Dunford article). Indeed, Menu Planning Standards for Residential Aged Care Facilities in to perspectives.nutrition implementation of caloric labelling has not been entirely Australia and New Zealand- Literature Review and Final report. (2) Available at http://daa.asn.au/for-health-professionals/daa- @unilever.com successful elsewhere . projects/nutrition-and-menu-planning-standards-in-residential- aged-care-facilities-in-australia-and-new-zealand/.

Table 1: Energy content (mean and range) of fast food product categories per 100g and per serve from 2010 and 2012(4,5) (reference from page 3)

Serving size (g) Energy (kJ/100g) Energy (kJ/serve) Mean (range) Mean (range) Mean (range) Breakfast 2010 (n=27) 160 (55–280) 1066 (860–1490) 1670 (609–2836) 2012 (n=22) 152 (55–248) 1059 (873–1275) 1599 (616–3162) Burgers 2010 (n=55) 219 (95–383) 1000 (640–1266) 2185 (976–4228) 2012 (n=50) 223 (95–435) 1035 (754–1318) 2301 (979–4876) Chicken 2010 (n=43) 204 (17–600) 990 (440–1441) 1864 (174–5519) 2012 (n=28) 149 (24–464) 1050 (697–1441) 1438 (167–5519) Pizza 2010 (n=200) 77 (49–102) 1045 (786–1440) 796 (521–1085) 2012 (n=185) 76 (38–298) 1013 (498–1320) 756 (400–1642) Salads 2010 (n=27) 258 (85–450) 351 (65–830) 836 (68–2091) 2012 (n=16) 297 (90–450) 209 (62–673) 607 (70–1818) Sandwiches 2010 (n=50) 219 (98–331) 768 (521–1350) 1695 (696–3360) 2012 (n=46) 207 (98–307) 665 (518–1300) 1366 (570–2167) Sides 2010 (n=25) 158 (24–450) 1087 (290–1480) 1432 (329–4365) 2012 (n=28) 175 (24–506) 1184 (254–1620) 1948 (152–5834)

2 Eating out: Mandatory menu board labelling of fast food products by Elizabeth Dunford

Over 1 billion meals and takeaways of products at fast food outlets can then be compared are served by approximately 17,000 and choices can be made within this context. fast food chains and take-away Labelling information on other nutrients that have been food outlets in Australia each linked to chronic disease may also be needed to assist year(1). The average Australian eats consumers to make healthier choices. Specifically, it (2) would be useful to see the saturated fat and sodium out four times a week and one content of fast foods made available. However, it is yet quarter of household food purchase to be seen whether even the initial step in kilojoule expenditure in New Zealand is on labelling will make a difference to consumer behaviour; food from restaurants and ready-to- recent Australian evidence suggests that consumers do not purchase products marketed as ‘healthier (3) Key points eat outlets . menu options’(9). • The energy content of fast Fast food may be more energy dense, higher in While mandatory kilojoule menu board labelling teamed food products in Australia saturated fat and sodium, lower in micronutrients, with education is an important first step in the attempt and New Zealand (4) and eaten in larger portions relative to other foods . to make healthier choices easier for consumers, it varies widely, with some Australian research shows that fast food menu items is essential that robust evaluation is conducted to products up to half of vary greatly in energy and nutrient content (Table 1, determine the effect on both consumer knowledge and the recommended daily (5,6) page 2, and Figure 1, below) . Burgers may provide consumer purchasing behaviour. If evaluation shows intake. from 979kJ (11% Recommended Dietary Intakes; RDI) that mandatory kilojoule labelling on menu boards • Labelling information on per serve up to 4876kJ (56% RDI) per serve. Even helps change consumer purchasing behaviour in some other nutrients linked some sandwich menu items may be up to four times Australian states, then it may be worthwhile extending to chronic disease, higher in energy than others, providing between 570kJ this throughout Australia and also in New Zealand. like saturated fat and (7% RDI) and 2167kJ (25% RDI) per serve. A recent New Zealand study reported that less than 25% of sodium, may be needed Miss Elizabeth Dunford is the Global Database Manager in the Food Policy to assist consumers make menu items in fast food restaurants can be classified Group at The George Institute for Global Health. healthier choices. as ‘healthier’ options, and less than 1% of nutrition References information is available at the point-of-purchase(8). 1. Shrapnel B 2008. Fast food in Australia 2009 research proposal. • Mandatory kilojoule 2. National Heart Foundation of Australia 2006. Tick eating out. labelling on menu 3. Statistics New Zealand 2010. Household economic survey. National Heart Foundation research has shown that, boards may prove to Year ended June 2010. Statistics New Zealand, Wellington. although 60% of consumers are concerned about the 4. Nielsen SJ et al. J Am Med Assoc 2003; 289: 450-453. be a good first step in healthiness of fast food, most have trouble identifying 5. Dunford E et al. Appetite 2010; 55: 484-9. helping consumers make 6. The George Institute, unpublished data. healthier choices(2). To address this, since February healthier food choices. 7. Food Standards Agency 2007. Front of pack nutritional signpost 2012 the NSW Government has required all fast food labelling technical guide issue 2. Available at www.food.gov.uk/ chain outlets with twenty or more locations in NSW, or multimedia/pdfs/frontofpackguidance2.pdf. fifty or more nationally, to provide kilojoule information 8. Chand A et al. Appetite 2012; 58: 227-33. 9. Atkinson LF et al. Public Health Nutr 2012; 15: 495-502. on menu boards. The accompanying 8700 campaign further aims to educate consumers that the average person consumes 8700kJ each day; the energy content

Figure 1: Proportions of fast food categories meeting benchmark classifications for saturated fat and sodium(4)

A. Saturated Fat B. Sodium

0 0 100% 4 100% 7 6 22 22 20 27 27 33 33 26 32 80% 40 80% 37 49 48

60% 60% 67 100 48 71 59 94 40% 52 40% 78 80 47 74 71 67 63 48 51 Proportion in each category Proportion in each category 20% 20% 19 26 14 16 15 7 0% 0 0% 0 0 0 0 0 0 2

Pizza Total Pizza Sides Total Salads Sides Salads Burgers Burgers Chicken Chicken Breakfast Breakfast Sandwiches Sandwiches

■ Low (<=1.5g/100g) ■ Medium (>1.5 to <=5.0g/100g) ■ High (>5.0g/100g) ■ Low (<=120mg/100g) ■ Medium (>120 to <=600mg/100g) ■ High (>600mg/100g)

Notes: ‘Sides’ includes fries, potato and gravy, onion rings and garlic bread. Classification criteria for low, medium and high were based on those from the United Kingdom Food Standards Agency(7). 3 Development of Nutrition and Menu Planning Standards for Residential Aged Care Facilities in Australia and New Zealand by Anne Schneyder and Liz Beaglehole

The population of Australia and New Zealand is ageing, In October 2011, the Dietitians Association of Australia and the demand for places in residential aged care (DAA) contracted Associate Professor Peter Williams facilities (RACFs) is increasing. Currently, there are (Fellow of DAA) to conduct a scoping project to review over 250,000 residents in approximately 3700 homes literature and documentation relevant to nutrition and in Australia and New Zealand(1,2). Many older people menu planning standards in Australia and New Zealand. have multiple medical problems, increased nutrient All known Australian and New Zealand nutrition or requirements, special dietary needs, and poor appetites, menu standards, guidelines or checklists were reviewed meaning that it can be difficult to achieve adequate for their applicability for use in the aged care sector. nutrient intake. Key standards from the USA and UK were also compared. Thirty-four stakeholders were consulted, Anne Schneyder Studies have reported the rate of including dietitians working in aged care, service providers, government, regulators and advocacy groups. malnutrition among residents in Residential Aged Care Facilities can The majority (70%) of stakeholder respondents be as high as 50%(3-5). (including all 12 dietitians interviewed) agreed that there was a need for national menu planning standards or It is essential that RACFs have processes for identifying guidelines. Only three respondents, all of whom were residents who are at risk of malnutrition, and strategies responsible for managing RACFs, believed that the in place to improve nutritional intake. Good menu sector is already over-regulated and that mandatory planning is fundamental to ensuring that a nutritionally standards were not warranted. However, government appropriate diet can be provided and can meet the representatives in both Australia and New Zealand who needs of an increasingly frail and vulnerable population. are involved in management or auditing of RACFs did Providing a meal service that meets residents’ nutritional comment that best practice guidelines with regard to Liz Beaglehole requirements whilst offering food that they enjoy and menu planning would be welcome, but that an overly is within budgetary constraints is a complex and prescriptive approach (e.g. specific amounts of nutrients challenging task. for certain meals or foods) was not helpful. All agreed that guidelines should be practical and flexible. RACF accreditation standards in both countries are in Key recommendations from the scoping project were place and include nutrition and hydration standards(6,7). provided to DAA in February 2012 (see Figure 2)(13). However, these are very general and outcome based; standards addressing actual menu planning are limited Figure 2: Key recommendations from or non-existent. Currently, in Australia and New Zealand the Scoping Project: Development of there are no national nutrition and menu planning Nutrition and Menu Planning Standards for standards for RACFs. There are some guidelines for Residential Aged Care Facilities in Australia hospital catering and menu planning(8, 9, 10), but few and New Zealand(13) include any reference to aged care and may not be relevant for use with frail, elderly residents. Some • Aged care specific menu planning guidelines were designed as recipe specifications for catering should be developed. organisations to ensure that dishes have a minimum nutrient profile. The Australian National Health and • Guidelines should not be mandatory, but Medical Research Council(11) and the New Zealand should provide a Best Practice approach. Ministry of Health(12) have both developed guidelines for • Guidelines should be simply and clearly the nutrition needs of the elderly, but they are primarily written, practical and easily understood by intended for the healthy elderly person living in the non-dietitians. community. • Development of guidelines should involve dietitians in Australia and New Zealand, as well as representatives of the Institute of Hospitality in Health Care, major companies providing food services to RACFs, the Aged Care Standards and Accreditation Agency, and peak bodies such as the Aged Care Associations of Australia and New Zealand.

4 The scoping report identified a number of tools and Ms Anne Schneyder is an Advanced Accredited Practising resources that dietitians currently use to assess the Dietitian in Private Practice at Nutrition Professionals Australia Key points nutritional adequacy of menus. The Best Practice Ms Liz Beaglehole is a New Zealand Registered Dietitian and Consultant Dietitian, Aged Care • There are no Food and Nutrition Manual for Aged Care Facilities comprehensive national (developed by dietitians at the NSW Central Coast Area References 1. Department of Health and Ageing 2011. Aged Care Data and aged care-specific menu Health Service(14) and the New Zealand Menu Audit Services List. Available at http://www.health.gov.au/internet/ planning guidelines Tool for Aged Care Facilities, developed by Dietitians main/publishing.nsf/Content/ageing-rescare-servlist-download. in Australia and New New Zealand (Dietitians NZ)(15), were identified in the htm. 2. Grant Thornton NZ Ltd 2010. Aged residential care service review. Zealand. scoping project as the most commonly used and useful. Grant Thornton, Auckland. In practice, dietitians, food service managers, and care 3. Banks M et al. Nutr & Diet 2007; 64: 172-178. • A scoping project has staff use a combination of the available guidelines, along 4. Gaskill D et al. Aus J Ageing 2008; 127: 189-194. been conducted on with their own experience and input from a variety of 5. Woods J et al. J Nutr Health Aging 2009; 13: 693-698. behalf of the Dietitians 6. Aged Care Accreditation and Standards Agency Accreditation sources (including the resident and their families) to Standards. Available at http://www.accreditation.org.au/site/ Association of Australia plan menus for RACFs. uploads/30985_AgedCare_ASENGLISHV1_3.pdf. to review literature and 7. Standards New Zealand 2008. Health and Disability (Core) documentation relevant Standards. NZS 8134.1:2008. Standards New Zealand, to nutrition and menu There are a number of challenges Wellington. 8. Department of Human Services (Victoria), 2009. Nutrition planning standards for RACFs in the implementation of Standards for Menu Items in Victorian Hospitals and Residential in Australia and New Aged Care Facilities. Available at http://www.health.vic.gov.au/ menu planning guidelines, including archive/archive2011/patientfood/nutrition_standards.pdf. Zealand. financial limitations and the skills 9. State-wide Foodservices Policy and Planning Queensland Health • The Dietitians Association 2011. Draft Queensland Health Nutrition Standards for Meals and needed to translate the guidelines Menus. Queensland Health, Brisbane. of Australia and into practical food choices. 10. NSW Agency for Clinical Innovation 2011. Nutrition standards Dietitians New Zealand for adult inpatients in NSW hospitals. Available at http://www. are well placed to lead aci.health.nsw.gov.au/__data/assets/pdf_file/0004/160555/ The scoping report also identified possible barriers ACI_Adult_Nutrition_web.pdf. the development of a to implementing menu planning guidelines. 11. National Health and Medical Research Council 1999. Dietary statement of best practice Guidelines for Older Australians. Australian Government guidelines for menus and These included industry resistance and lack of support Publishing Service, Canberra. for guidelines, the perception that guidelines will 12. Ministry of Health 2010. Food and Nutrition Guidelines for Healthy nutrition care in residential Older People: A background paper, 2010. New Zealand Ministry of aged care facilities. increase food costs, and that the guidelines do not Health, Wellington. address the training needs for cooks and chefs working 13. Williams P 2011. Scoping Project: Development of Nutrition and in the RACF’s(13). Menu Planning Standards for Residential Aged Care Facilities in Australia and New Zealand – Literature Review and Final report. Available at http://daa.asn.au/for-health-professionals/daa- Dietitians have unique skills to assist facilities in menu projects/nutrition-and-menu-planning-standards-in-residential- planning to meet nutrition requirements for different aged-care-facilities-in-australia-and-new-zealand/. 14. Bartl R et al 2004. Best practice food and nutrition manual for populations. Dietitians in Australia and New Zealand aged care facilities: addressing nutrition, hydration and catering are specifically trained in food service management and issues. Central Coast Health. (Recently revised – new edition there are many dietitians who have developed expertise pending). 15. Dietitians New Zealand, 2010. Menu audit tool for aged care in this area. It is important that RACFs seek advice from facilities. Available at http://www.google.com.au/url?sa=t&r dietitians with experience in the aged care setting. ct=j&q=dietitians+new+zealand+menu+audit+tool&source= The DAA, in conjunction with Dietitians NZ, is well- web&cd=9&ved=0CFcQFjAI&url=http%3A%2F%2Ftreatdiet. biz%2Fmedia%2FMenu-Audit-Tool-Review-2010.doc&ei=mo44T7 placed to lead the development of a statement of best nkBoGUiQeQyMnqAQ&usg=AFQjCNGNyoszMmKqGMFNSrK1ozMIT practice guidelines for menus and nutrition care in MmNXA&sig2=JlwSsLQeuq_Vr6NPURqLxA. residential aged care facilities, to support the work of dietitians consulting in this area.

5 Unilever’s Five Levers for Change by Katherine Tocchini*

Creating a sustainable future will require fundamental Figure 3: Unilever’s Five Levers for Change changes in attitude and behaviour across society. In November 2011, Unilever published the ‘Five Levers for Change’ (Figure 3), a behaviour change model which is used by the business to encourage sustainable changes in consumer living habits(1).

The Five Levers for Change offers a coherent approach to thinking about behaviour change and putting it into practice. The model has been Key points used overseas to successfully change • Achieving consumer laundry, handwashing and tooth behaviour change is (1) complex; however having brushing behaviours , however it an understanding of it is could also be applied to nutrition essential for dietitians, key behaviours. Note: The most effective application includes all the Levers, however influencers and others they do not need to be applied in sequential order(1). who facilitate the change The Five Levers include: • Make it rewarding – demonstrates the proof process. and payoff; knowing the behaviour is being • Unilever’s Five Levers for • Make it understood – raises awareness and done correctly and getting some reward for it. Change methodology may encourages acceptance; being aware of the A campaign for Suave® (US hair care brand), increase the likelihood behaviour and its relevance. In India, Indonesia, showed families that by turning off the shower of positive results from Pakistan and Bangladesh ultra-violet light while lathering hair they could save up to $150 a behaviour change demonstrations have shown children that germs year on utility bills and have a positive impact on programs(1). are left behind on their hands when they wash with the environment by cutting hot water use. water alone. Hands washed again with Lifebuoy® soap were shown as germ-free under the same • Make it a habit – is about reinforcing and ultra-violet light. reminding; helping people to maintain the behaviour change. Lifebuoy® soap’s handwashing • Make it easy – establishes convenience and campaign reinforced children’s behaviour change confidence; how this fits into day-to-day life, through a daily sticker chart, and encouraged knowing what to do and feeling confident doing it. children to participate in activities designed to In many parts of the world where water is scarce, deliver the handwashing message in an engaging laundry is washed by hand. Live demonstration and memorable way (e.g. comic books, and events and product samples (Comfort One songs). Rinse® fabric conditioner) have helped to show convenience in terms of saving time and water, and Consumer behaviour change is a challenge, with no easy built confidence that the new way of rinsing (with solution. Unilever has achieved some success with using one instead of three buckets of water) was enough this Five Levers for Change methodology(1). Sharing the to remove all residues. model may benefit others by increasing the likelihood of positive results from behaviour change programs(1). • Make it desirable – is about self and society; how

this fits in with aspirational self-image and relating Katherine Tocchini is Nutrition & Health Manager (Spreads) at Unilever to others. Eating lower sodium products may Australasia. The Five Levers of Change was one of the highlights at establish healthier nutrition practices for the whole Unilever’s Behaviour Change for Better Health Symposium held in The Netherlands in June 2012. family, thus motivating the purchaser. *This article has been completed with the assistance of the Editor. Editor’s note: readers may be interested in accessing the youtube recording on the Five Levers for Change at http://www.youtube.com/ watch?v=jEaGM8kDac4.

References 1. Pradeep BV. In Inspiring Sustainable Living: Expert Insights Into Consumer Behaviour & Unilever’s Five Levers for Change, 2011. Available at http://www.unilever.com/images/slp_5-Levers-for- Change_tcm13-276807.pdf.

6 Food miles: From paddock to plate by Corey Watts

When humans started trading foods over large distances Sixty per cent of food grown in we embarked on a transformation: from ‘ecosystem Australia is exported. Research by the people’ dependent on only what our local environment yielded, to ‘biosphere people’ sourcing much of our World-Wide Fund for Nature shows food from far afield. The freedom to choose a huge that Australia has a higher ecological variety of different foods from all over the world, largely footprint than the global average unimpeded by seasonality, comes with consequences. and many other countries including (3) Putting a meal on the table today Japan, Italy and the UK .

is a process inextricably linked to Food can make up a large proportion of our overall Corey Watts, Regional Projects fossil fuels. This age of climate impact on the environment, so we – producers, Manager at The Climate hauliers, processors, retailers, consumers – can make Institute, summarises his recent change requires us to examine the a difference in the value chain through producing less presentation to members of the sustainability of the whole food waste and pollution. Unfortunately, there are no hard Dietitians Association of Australia chain, with food miles an important and fast rules for eating sustainability, and it certainly is Food and Environment dimension. not as simple as sourcing only within a hundred miles Interest Group. of your home. Australians today enjoy the benefits The term ‘food miles’ was coined by British researchers of a wonderful multicultural smorgasbord. The good in the early 1990s, and has been the subject of debate news is that a healthy diet – mostly plants, mostly Key points and discussion since. In essence, it refers to the fossil unprocessed, not too much – often goes hand-in-hand energy or fuel used to shift food, from paddock to with sustainability. However, leadership from government • ‘Food miles’ refers to plate (and even to the tip). Most items on an ordinary and food industry is essential. the fossil energy or fuel supermarket shelf have travelled incredible distances. used to shift food, from Gaballa and Abraham(1) found that ingredients in Mr Corey Watts is Regional Projects Manager at The Climate paddock to plate a typical Melbournian’s weekly shopping basket Institute, Melbourne. • Anything we can do, (excluding packaging) had travelled the equivalent of References as producers, hauliers, two round-the-world trips, or three times the length of 1. Gaballa S et al, 2008. Food Miles in Australia: A preliminary study processors, retailers, of Melbourne, Victoria. CERES Community Environment Park, the Australian coastline. The carbon pollution produced East Brunswick. consumers, to make would be equivalent to that produced by almost 3,000 2. Grant T et al. Aust J Exp Agric 2008; 48: 375-381. our part of the value cars for a year. 3. Ewing B et al 2010. The Ecological Footprint Atlas. Global Footprint chain less wasteful and Network, Oakland. less polluting makes a However, there is more to the carbon footprint of food sizeable difference to the than distance travelled. Some modes of transport, like environmental impact. rail and shipping, are generally less carbon-intensive • A healthy diet of than aeroplanes and long-haul trucking. How food is mostly plants, mostly produced can be equally, if not more, important than unprocessed food, and ‘food miles’. For example, the biggest impact from a (2) not too much, often packet of corn chips is the packaging and processing . goes hand-in-hand with Some foods simply have a bigger carbon footprint sustainability than others: red meat and dairy products, derived from ruminant animals produce methane, a potent greenhouse gas. Worldwide, emissions from livestock are increasing with escalating demand, although differences in diet, breeding and environmental conditions can result in profound differences in the impact of one beef business compared with another.

7 continued from page 1

In contrast, it has been suggested that fructose may have benefit on insulin sensitivity of a diet rich in MUFA, PUFA or particularly adverse effects on total and visceral fat mass ‘complex’ carbohydrates compared to SFA was found in a and insulin resistance(17). However, much of the clinical long-term study of 417 persons with metabolic syndrome(29). research has used very high fructose loads, and similar In an acute meal based study, with three meals high in effects may be observed with hyper-caloric high-fat or either SFA, MUFA or PUFA, replacing SFA with PUFA Advisory Panel high-glucose diets, suggesting that excess energy may had a beneficial effect on postprandial insulin sensitivity, Associate Professor Manny Noakes (18) be the main contributor to the development of MetS . possibly through lower uptake of lipids in skeletal muscle, CSIRO Human Nutrition, Adelaide The importance of fructose specifically, at dietary-relevant thereby protecting against the development of insulin Professor Peter Clifton intakes, is currently an area of considerable debate. resistance(30). MUFA has also been shown to be superior to CSIRO Human Nutrition, Adelaide SFA in buffering ß cell hyperactivity and insulin intolerance Professor Caryl Nowson Higher glycaemic index (GI)/glycaemic load (GL) diets post-prandially, in persons with high fasting triglyceride Deakin University, Melbourne (19-22) (31) may increase the risk of CHD , particularly in the concentrations . Professor Linda Tapsell overweight(19,20), and type 2 diabetes(21). Lower GI/GL diets University of Wollongong, may achieve positive outcomes on health markers, however CONCLUSION Wollongong it is difficult to differentiate the effects of fibre, carbohydrate Studies examining the effect of dietary CHO and fat on MetS Associate Professor Rachael Taylor type, energy density and weight. and CVD are complex and must be seen in the context of University of Otago, Dunedin a total eating pattern. Issues of dietary compliance and the EFFECTS OF FATTY ACIDS dominance of energy deficit impact the interpretation of Editor A discussion of the effects of different dietary fats along study results. Current evidence indicates that diets rich in Janelle Gifford PhD Advanced Accredited with CHO is warranted since a reduction in dietary CHO plant foods that include PUFA fats at the expense of SFA Practising Dietitian may result in a concomitant increase in dietary fat and vice may beneficially affect components of MetS and CVD. versa. Saturated fats (SFAs) have traditionally been targeted All correspondence to: in MetS and CVD risk reduction. Dr Alexandra Chisholm is a Senior Lecturer in the Department of Human Janelle Gifford Nutrition at University of Otago, Dunedin, NZ Editor of Perspectives *This article has been completed with the assistance of the Editor. Assistance 20 Cambridge Street Results from a pooled analysis was provided by David Mela, Peter Zock, and Marjan Alssema of Unilever. Epping NSW 2121, Australia Editor’s note: readers may be interested this recent review: Hauner, H, et al, of eleven cohort studies have [email protected] Evidence-Based Guideline of the German Nutrition Society: Carbohydrate Intake suggested that replacing SFAs with and Prevention of Nutrition-Related Diseases. Ann Nutr Metab 2012;60 polyunsaturated fats (PUFAs) rather (suppl 1):1-58. The views expressed in References Perspectives are those of the than monounsaturated fats (MUFAs) 1. Dansinger ML et al. J Am Med Assoc 2005; 293: 43-53. authors and do not necessarily or CHO prevents coronary heart 2. Sacks FM et al. New Engl J Med 2009; 360: 859-873. reflect those of the Advisory 3. Noakes M et al. Am J Clin Nutr 2005; 81: 1298-306. (23) Panel or Unilever’s nutrition policy. disease over a wide range of intakes . 4. Dale KS et al. Can Med Assoc J 2009; 180: E39-E46. 5. McAuley KA et al. Diabetologia 2005; 48: 8-16. Paper stock manufactured from 6. Bray GA. Am J Clin Nutr 2011; 93: 481-2. Another meta-analysis of eight randomised controlled 55% recycled/45% oxygen 7. Howard BV et al. J Am Med Assoc 2006; 295: 655-666. studies predicted that the effect of replacing SFA with PUFA bleached pulp. FSC Certified. 8. Lagiou P et al. Br Med J 2012; doi 10.1136/bmj.e4026. resulted in 10% CHD risk reduction for each 5% energy of 9. World Health Organisation 2002. The World Health Report 2002: Elemental Chlorine Free. ISO 14001 increased PUFA (RR = 0.90, 95% CI = 0.83–0.97)(24). Reducing Risks, Promoting Healthy Life. World Health Organisation, environmental accreditation. Geneva. 10. Liu S et al. Am J Clin Nutr 1999; 70: 412-419. The different SFA in the diet can have varying effects on 11. National Health and Medical Research Council 2011. A review of the cholesterol and possible CVD risk. For example, meta- evidence to address targeted questions to inform the revision of the analysis data has shown that stearic acid (found in foods Australian Dietary Guidelines. Commonwealth of Australia, Canberra. 12. Mozaffarian D et al. Circulation 2011; 123: 2870-2891. like meat and dairy) increases LDL and HDL cholesterol 13. El Khoury D et al. J Nutr Metab 2012; doi 10.1155/2012/851362. (25) less than the other SFAs . Whilst many studies focus 14. McCory MA et al. Adv Nutr 2010; 1: 17-30. on the effect on cholesterol to indicate CVD risk, dietary 15. Higgins JA. Nutr & Metab 2012; doi 10.1155/2012/829238. manipulation may also have effects on other important 16. Papathanasopoulos A et al. Gastroenterology 2010; 138: 65-72. 17. Bremer AA et al. Pediatrics 2012; 129: 557-570. CVD risk factors. A five week randomised controlled trial 18. Tappy L et al. Nutrition 2010; 26: 1044-1049. Perspectives is a service replacing of 8% of fats with specific fatty acids with various 19. Dong J-Y et al. Am J Cardiol 2012; 109: 1608-1613. to health professionals by 20. Beulens et al. J Am Coll Cardiol 2007; 50: 14-21. SFA and trans-MUFA in the diets of 50 men had differing Unilever Australasia. 21. Barclay et al. Am J Clin Nutr 2008; 87: 627-37. adverse effects on fibrinogen, the inflammatory markers www.unileverhealthcarenutrition.com.au 22. Burger KNJ et al. PLoS ONE 2011; doi 10.1371/journal.pone.0025955. CRP and interleukin-6 (IL-6), and the vascular function 23. Jakobsen MU et al. Am J Clin Nutr 2009; 89: 1425-32. (26) marker E-selectin . 24. Mozaffarian D et al. PLoS Med 2010; doi 10.1371/journal. pmed.1000252. SFA and trans fats appear to promote insulin resistance 25. Mensink RP et al. Am J Clin Nutr 2003; 77: 1146-55. 26. Baer DJ et al. Am J Clin Nutr 2004; 79: 969-73. whereas cis-unsaturated fatty acids increase insulin 27. Mozaffarian D et al. Eur J Clin Nutr 2009; 63(Suppl 2): S5-21. (27,28) sensitivity . Longer term research on insulin sensitivity 28. Vessby et al. Diabetologia 2001; 44: 312-9. has demonstrated improved insulin sensitivity when SFA 29. Tierney AC et al. Int J Obes 2011; 35: 800-809. is replaced by MUFA in healthy individuals(26), however no 30. Jans A et al. Am J Clin Nutr 2012; 95: 825-36. 31. Lopez S et al. Am J Clin Nutr 2011; 93: 494-9.

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