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.It has become, according to one description, the key Federal policy document on nutrition that serves as the basis forall Federal nutrition programs.It represents the Federal Government s bestadvice for persons 2 years of age and older about what to eat to stay healthy.Federal law requires the guidelines to be based on the best available medicaland scientific knowledge and to be used by  any Federal food, nutrition, orhealth program. 60Similar dietary guidelines have been adopted by many other coun-tries, but the American guidelines go beyond most of them in some impor-tant respects.The great majority of national dietary guidelines recommenda nutritionally adequate diet with a variety of foods; less fat, particularlysaturated fat; food intake sufficient to maintain proper weight; greater con-sumption of foods with complex carbohydrates and fiber; reduced salt con-sumption; and moderate alcohol use.The United States is one of very fewcountries that specifies dietary cholesterol levels and one of a minority thatrefers to polyunsaturated fats.61The Nutrition Labeling and Education Act of 1990 required practi-cally all processed foods to contain a label with specific nutrition informa-tion about the food.The law exempted most bulk and raw foods, includingfresh fruits, vegetables, meats, and poultry.Previously, food producers hadlisted nutritional information on food packages but, with a few exceptions,the information was voluntary and the manufacturer could choose the nu-trients.Under the new legislation, the nutritional information was manda- 336 Risk Factors and Coronary Heart Diseasetory and the Food and Drug Administration determined the nutrients tobe listed.The label listed the amount of each nutrient present in the foodfor a specified serving size and the appropriate minimum or maximumdaily consumption of the ingredient based on the recommended dietaryintake or the dietary guidelines.Descriptive advertising terms like light,lean, good source of, reduced, fewer, and more were defined, almost always tothe advantage of the food industry and the confusion of the consumer.Themost controversial issues were the size of the servings and the specific nutri-ents to be listed.62One of the most significant concessions to the food industry in thelegislation was the authorization of health claims for foods based on lan-guage specified by the Food and Drug Administration.Seven claims wereauthorized, three of which involved coronary heart disease: (1) low sodiumfoods may reduce the risk of high blood pressure; (2) foods low in saturatedfats and cholesterol may reduce the risk of coronary heart disease; and (3)fiber contained in fruits, vegetables, and grains (e.g., breakfast cereals) mayreduce the risk of coronary heart disease.Three other authorized claimswere permitted for foods that were thought to lower the risk of cancer:dietary fats; fiber-containing grain products; and fruits and vegetables.Last,products containing certain levels of calcium were permitted to claim thatthey reduced the risk of osteoporosis.With the exception of the calciumhealth claim, which also called for regular exercise, food producers using aspecific claim were not required to mention other risk factors associatedwith the listed diseases.63The FDA s most egregious capitulation to the food industry was theomission of any reference to total caloric intake.Michael Fumento hasdescribed this approach as the  calories-don t-count, only-fat-does thesis.The FDA and other agencies have recommended that individuals consumea maximum of 30% of their total calories from fat, but  the governmentdoesn t say how many calories the fat should be 30% of. Media healthcoverage has followed the lead of the government.The Center for Mediaand Public Affairs monitored news coverage from 37 different media out-lets for three months and found, according to Fumento, that  fat con-sumption occupied twice as much coverage as any other nutritional topic.The media warned against fat consumption four times as often as theoverconsumption of calories. A 1996 public opinion survey found that72% of the respondents used the fat content on the label in making foodchoices compared to 9% who used total calories.64The information on the nutrition label and the authorized healthclaims are especially important because consumers receive most of their Dietary Recommendations and Guidelines 337nutritional advice from commercial sources with close ties to the food in-dustry.One 1993 survey of 17,000 women found that 86% obtained nu-tritional advice from magazines, many of which receive a significant part oftheir revenue from food advertisements.In addition, 53% of the womenused food labels and advertising and 52% used books, but only 8% usedgovernment publications.65Health professionals and the media receive much of their informa-tion about foods from nutritionists and dietitians.Marion Nestle has ob-served that for food companies,  coopting experts especially academicexperts is an explicit corporate strategy. It involves consulting and lec-ture fees and research grants for individual scholars, and funding for aca-demic departments, conferences, journals, and professional societies.Foodcompanies fund large amounts of research that can be published in schol-arly journals only with their explicit permission.The American DieteticAssociation (ADA), which enrolls 70,000 registered dietitians, received 15%of its budget in 1995 from the food industry.According to Nestle,  Theassociation apparently is willing to enter into partnerships with any foodcompany or trade organization, regardless of the nutritional quality of itsproducts. Each of the ADA s approximately seventy fact sheets is spon-sored by a corporation, usually a manufacturer of the product being de-scribed.The New York Times noted that  nothing negative is ever includedin materials produced by the [ADA], a fact that critics attribute to its linkto industry. 66It is not surprising that public opinion surveys have indicated wide-spread consumer confusion.The most serious problem has been the inabil-ity of the public to differentiate more serious risk factors from less seriousones.One poll in the 1980s found that the public ranked  not smokingtenth  among the nation s health and safety priorities while health profes-sionals rated it first.With regard to dietary fat, a survey in 1988 found that55% of the respondents thought that dietary fat was a risk factor for coro-nary heart disease, but 35% thought that it was a risk factor for high bloodpressure and 70% could not differentiate the kinds of fats that did and didnot contain cholesterol [ Pobierz całość w formacie PDF ]