ÐÓ°ÉÔ­´´

EVERY three months, the Ministry of Agriculture, Fisheries and Food
(MAFF) publishes the latest results of the National Food Survey, which is
probably the most important and certainly the most widely quoted study of
trends in food consumption in Britain. Each quarter, the message from the
ministry is the same. ‘These trends represent continuing progress towards
a healthier national diet,’ said Richard Ryder, the junior agriculture minister,
on 20 March this year.

But is this optimism justified? This year the MAFF celebrates 100 years
as guardian of the nation’s food supply. It is an opportune moment to reassess
what people are really eating and what the MAFF should be doing about it.

Recent wrangles between the Department of Health and the MAFF over the
increasing incidence of food poisoning from the bacteria Salmonella and
Listeria, followed by the controversy over the safety of the pesticide alar
in apples, have obscured the scale and nature of the biggest public health
issue related to diet in Britain: coronary heart disease (CHD) is responsible
for more than 180 000 deaths a year.

In 1984, the government published national dietary targets, which, if
attained, would have a major impact on the incidence of CHD. These were
contained within the well-known, if misnamed, COMA report (Committee on
the Medical Aspects of food policy). This report also recommended that:
‘Consultations should take place between the relevant Government Departments
and the producers, manufacturers and distributors of food and drink and
caterers which will lead to legislation and to Codes of Practice to improve
public knowledge of the consumption of foods . . . and lead to the provision
of alternative preparations of some foods with lower contents of saturated
fat and . . . and/or common salt.’

This report was accepted by the Minister of Agriculture at the time,
Michael Jopling. The MAFF was thereby committed to ensuring that consumers
are provided with more information about what they eat and that the nutritional
quality of the food supply is improved.

The COMA report and some 25 other recent reports on diet and CHD are
in broad agreement that we should eat less fat, particularly less saturated
fat, less sugar, less salt and more dietary fibre. But is the nutritional
content of the British diet improving? The National Food Survey does seem
to suggest we have been eating less fat recently. It shows that the consumption
of fat has fallen from 105 grams per person per day in 1977 to 96 grams
per person per day in 1987: a drop of some 9 per cent. But a fundamental
and serious problem with the survey is that it covers only food eaten inside
the home, and we know from various sources that there has been a big increase
in the amount of food eaten outside the home.

Between 1977 and 1987, the average number of meals eaten per week outside
the home in cafes, restaurants, pubs, works canteens and from fast food
outlets rose from 3.0 per person to 3.5: an increase of some 17 per cent
(data from the National Food Survey). In 1977, consumers spent Pounds sterling
30 billion on food and drink, of which only 13 per cent was spent on meals
eaten out. But in 1987, they spent Pounds sterling 71 billion, of which
24 per cent was spent out (data from the Family Expenditure Survey). Between
1983 and 1987 alone, the turnover of fast food outlets in Britain increased
from Pounds sterling 565 million to Pounds sterling 1160 million: an increase
in real terms of 18 per cent (Euromonitor data).

So we know that people are eating more food outside the home. Yet it
is difficult to obtain accurate information about what this food consists
of and, in particular, how nutritious it is. One way of estimating what
is eaten both inside and outside the home is to calculate this from the
amount of food produced by British farmers minus exports plus imports. This
method has its problems – for example, it takes little account of food wastage
– but it should reveal trends if there are any. Such ‘supply side’ data,
published by the MAFF, show that the total consumption of fat has remained
unchanged over the past 10 years at around 135 grams per person per day.

The COMA report pointed out that the most important statistic as far
as the consumption of fat is concerned is the proportion of total energy
eaten as fat. Both National Food Survey data and supply side data show that
this has also remained unchanged over the past 10 years at about 42 per
cent (see Figure 1). The COMA report recommended that fat intake should
be around 35 per cent of total energy: Britain is clearly not reaching this
target.

What about the other dietary changes recommended by COMA and the other
expert reports? Even relying on National Food Survey data, the indications
are not encouraging. The intake of fibre increased slightly from 12.0 grams
per person per day in 1980 to 12.5 grams per person per day in 1988. The
COMA report gave no quantified recommendation, but a recent report from
the World Health Organization (WHO) recommends a target of around 18 grams
per person per day. (These figures for fibre intake are based on the new,
Englyst method of measuring the fibre content of foods.) The intake of salt
(excluding cooking and table salt) remained unchanged at 6.8 grams per person
per day between 1978 and 1988. The WHO recommends that the total consumption
of salt (including cooking and table salt) should be around 5 grams per
person per day. The MAFF does not analyse the National Food Survey data
for changes in the consumption of sugar.

The only dietary change recommended by the COMA report that is going
in the right direction is the proportion of fat eaten as saturated fat.
Fat can be classified into three main forms: polyunsaturated, monounsaturated
and saturated (depending on the number of double bonds in the constituent
fatty acid chains). The COMA report recommended a ratio of 0.45 for polyunsaturated/saturated
fat (P/S), and data from the National Food Survey show that this ratio has
risen from 0.22 in 1977 to 0.37 in 1987. Food supply data show the same
trend, which is encouraging, but the COMA report set a relatively low target:
the WHO recommends a P/S ratio of 1.0.

Has the improvement in the P/S ratio been sufficient to affect the rates
of CHD in Britain? Overall, CHD rates have fallen little over the past 10
years (15 per cent for men and 8 per cent for women between 1977 and 1987
compared with, for example, falls of 38 per cent and 36 per cent respectively
in the US). But there has been a sharp decrease in the rates at lower age
groups. For instance, rates of CHD in 35- to 45-year-olds have fallen by
30 per cent for men and 33 per cent for women.

We know from a wide body of research that diet is a major factor in
determining the level of cholesterol in the blood and that raised levels
of blood cholesterol in the population are a prerequisite for high rates
of CHD (see ‘Diet, drugs and heart disease’, New ÐÓ°ÉÔ­´´, 25 February
1989). A recent survey of levels of cholesterol in the blood of Britons
by Jim Mann from the University of Oxford, together with colleagues in Leicester,
London and Glasgow, suggested that, overall, there had been no change since
1974. However, there is no comprehensive system for monitoring blood cholesterol
levels in Britain and any change for specific age groups would not have
been picked up.

So has the change in the ratio of polyunsaturated/saturated fats in
the diet affected the CHD rates at younger ages? We do not know precisely.
There have been other changes in the lifestyle of young to middle-aged people
which may have been more important: notably, the decline in cigarette smoking.
In any case, the change in P/S ratio has been slight: at current rates of
progress, we will not reach the WHO’s target until the year 2010.

Despite little change in the balance of nutrients in the British diet
and, in particular, the total fat content, there have been some changes
in the actual food we eat. The MAFF regularly points to encouraging changes
in food eaten inside the home. It claims that: ‘Household consumption of
low fat milks, low fat and dairy spreads, fresh vegetables and fresh fruit
was higher in 1988 than in 1987. Conversely consumption of liquid whole
milk, butter, red carcase meat and standard white loaves has declined over
the same period.’ These changes are real and long term although not necessarily
as pronounced as the ministry tends to claim (see Figure 2).

The change in the P/S ratio has been brought about largely by a switch
from butter to margarine high in polyunsaturated fat (see Figure 3). But
other changes in the diet are also important, such as the decline in consumption
of fresh red meat and increasing consumption of chicken.

Yet these encouraging changes in foods eaten inside the home go hand
in hand with a worrying trend in high-fat foods eaten wholely or mainly
outside. For example, the consumption of chips increased from 21 grams (or
raw potato equivalent) per person per day in 1976 to 41 grams per person
per day in 1986. The consumption of crisps rose from 20 grams to 29 grams
(MAFF supply side data). Data from Euromonitor show that 7268 million packets
of crisps and savoury snacks were sold in Britain (equivalent to 2.5 packets
per person per week), representing an increase of 11 per cent since 1984.

While the total consumption of meat increased only slightly from 191
grams per person per day in 1978 to 201 grams per person per day in 1988,
meat eaten outside the home rose from 37 grams per person per day in 1978
to 46 grams in 1988 (Meat and Livestock Commission estimates from supply
side data). This reflects an increase in sales of burgers, fried chicken
and other meat products high in fat. For example, in 1988 there were 264
McDonalds outlets operating in Britain compared with only 166 in 1984.

The consumption of confectionery rose between 1983 and 1987 from 34
grams per person per day to 36 grams per person per day (Euromonitor estimates
based on Biscuit, Cake, Chocolate and Confectionery Alliance and other trade
data).

Data from the National Food Survey suggest that the consumption of biscuits
in the home has fallen from 24.8 grams per person per week in 1983 to 24.6
grams in 1986. But Euromonitor conclude that the total consumption of biscuits
rose from 32.5 grams to 34 grams and that the proportion of biscuits eaten
outside the home rose from 23.5 to 27.6 per cent.

To sum up, while food eaten inside the home is becoming a bit healthier
in one respect – people are eating a bit less saturated fat and more polyunsaturated
fat – there are strong indications that this is more than offset by worrying
trends in food eaten outside the home, particularly those with a high content
of fat.

So what is the MAFF doing about these trends? In particular, is it carrying
out its obligations under the COMA report to ‘improve consumer knowledge
of the composition of foods’ and to enhance the nutritional quality of the
food supply? In 1969 the ministry, together with the Medical Research Council,
began to fund research leading to one of the best sources of information
on the nutritional composition of foods in the world: McCance and Widdowson’s
The Composition of Foods. Since 1978, the MAFF has been responsible for
maintaining and updating what have become the official food tables, and,
in 1987, the ministry joined with the Royal Society of Chemistry to develop
a computerised National Nutrient Databank for Britain.

In the process of compiling these tables, researchers have accumulated
much useful information about methods of analysing foods for their nutrient
content and the effects of dietary components on human metabolism. Studies
into trends in the consumption of food depend on such data. But research
into the nutrient composition of foods is virtually valueless unless it
leads to foods being labelled for their nutrient content in a way that most
people who buy them can understand. Numerous health and consumer bodies,
from the Coronary Prevention Group to the Consumers Association, have called
for the compulsory labelling of the key nutrients in packaged foods.

Following the COMA report, statements from the MAFF implied that it
would be willing to introduce legislation that would make the labelling
of total fat, saturated fat, sugar, salt and dietary fibre compulsory, but
it claimed that legislation by the European Community prevented it from
doing so. In December 1986, the Coronary Prevention Group published a legal
report which pointed out that article 15 of the European Community’s 1979
Food Labelling Directive specifically allows member states to introduce
their own food labelling requirements if there are strong public health
grounds for doing so.

In reply, the MAFF claimed that it had never really intended to introduce
compulsory labelling for sugar, salt and fibre but that it would still like
to do so for fat and possibly saturated fat. But now, since the community
was about to publish proposals for a new directive that would regulate nutrition
labelling throughout Europe, the MAFF said that it was waiting to see what
form these proposals would take. The European Commission, the European Parliament
and the Council of Ministers are all still discussing the proposed directive
on nutrition labelling. It remains unclear how it will finally operate,
and in particular whether saturated fat will be included on the label. In
any case, the legislation is unlikely to be implemented before 1992, nearly
a decade after the publication of the COMA report.

What is it you’re eating?

For nutrition labelling to be meaningful, most (ideally all) labels
should have a common format so that consumers can easily compare products.
In January 1987, the MAFF issued a set of voluntary guidelines designed
to encourage food manufacturers and retailers to provide nutritional information
in a standard way. In the event, the guidelines gave 14 recommended formats.
A recent survey by the Consumers Association found that only 36 per cent
of products were labelled in a recommended way, and 25 per cent of foods
carried no nutritional labelling at all. Only 3 per cent used the format
which the ministry said it hoped would be the most widely adopted: this
format provides information about the saturated fat, sugar, salt and fibre
content of the food.

How could the policies of the MAFF operate so as ‘to lead to the provision
of alternative preparations of some foods’ which would allow a more balanced
diet? One way of approaching this question is to analyse current trends
in food consumption to see whether the ministry’s past and present policy
has had any effect on them.

It is simplistic to make sweeping generalisations in this area. Each
change, or lack of change in the foods we eat, probably has a different
cause or causes. It seems likely that the switch from whole milk to semi-skimmed
and skimmed milk, which began in about 1980, was brought about by the increasing
awareness of the need for a healthy diet. (Currently, about 1 in 4 pints
of milk drunk in Britain are skimmed or semi-skimmed.) The increasing consumption
of ice cream over the same period was largely unaffected by this growing
awareness. A recent survey of consumer attitudes to food found that 28 per
cent of people still think that ice cream is generally good for them.

The most important food trend in health terms has been the decline in
the consumption of butter and the increase in the consumption of polyunsaturated
margarine (see Figure 4).

There are several possible reasons for this switch:

The impact of price Since joining the Common Market in 1973, Britain
has kept the price of butter artificially high relative to margarine and
this must have had an important effect on consumption. In 1987, consumers
paid on average 50 pence per 250 grams of butter (the price on the world
market was around 19 pence) while they paid only 22 pence for the same amount
of margarine.

The effects of income As income rises people change from margarine to
butter, supposedly because butter is regarded as a ‘luxury good’. Average
income has been rising over the past decade, which should have caused the
consumption of butter to rise.

Technological change in the food industry Improvements in the taste
and keeping quality of margarine may have led people to eat more.

Effects of other trends in food consumption Over the same period, there
has been a fall in the consumption of bread. How has this affected the sales
of butter and margarine?

Advertising and health education Current expenditure on the advertising
of margarine is Pounds sterling 23 million per year compared with Pounds
sterling 8 million per year for butter (see Figure 5). There has also been
a growing volume of information on the links between diet and CHD. This
may have had some impact.

In March, Richard Ryder, commenting on trends in food consumption, including
the switch from butter to margarine said: ‘I very much welcome these trends
which reflect the Government’s policy of providing information to consumers
on what constitutes a balanced diet and allowing them to make their own
informed choice from the wide variety of foods available.’ This implies
that such trends are largely the result of changes in the attitudes of consumers
to food and health, brought about by government-inspired health education.

Most economists, however, agree that price differentials have played
an important role. For example, George Jones of the University of Oxford
has analysed the butter/margarine market using a ‘static’ economic model.
Using data from Audits of Great Britain, he has shown that the consumption
of butter fell by some 8.3 per cent from January 1980 to March 1988. Jones
argues that some 4.5 per cent of this fall could be attributed to the effects
of price, advertising and technological change; 4.8 per cent may be linked
to changes in attitudes to food and health; and a positive trend of 1 per
cent could be linked to the rise in consumer expenditure (giving a total
fall of 8.3 per cent). Jones also argues that the butter/margarine market
is relatively ‘price elastic’: that is, any price change would have pronounced
effects on consumption. But prices have been held relatively stable recently
because of the Common Agricultural Policy (CAP).

This sort of analysis has led several agricultural economists to conclude
that the CAP has had beneficial effects on consumption patterns. Christopher
Ritson, professor of agricultural economics at the University of Newcastle
upon Tyne, has argued that: ‘In the case of the EEC it is a particular accident
of the CAP that it happens to bring about a pattern of consumer prices,
in particular for dairy products and sugar, which seems consistent with
the ‘food goals’ of health and nutrition.’ This argument, which has been
further developed by David Colman, professor of agricultural economics at
the University of Manchester, and others, is based on the assumption that
trends in food consumption are generally going in the right direction, and
as we have seen, this ‘ain’t necessarily so’.

That the price support systems of the CAP have had beneficial effects
on the consumption of butter in the home is certainly not the whole story.
While the consumption of butter fell by some 54 per cent between 1977 and
1987, production rose by 15 per cent from 153 000 tonnes in 1977 to 176
000 tonnes in 1987 (peaking at 206 000 tonnes immediately before milk quotas
were introduced in 1984). In other words, while home consumption of butter
may have been hit by the CAP, the dairy industry is still producing nearly
as much.

Moreover, with the declining home consumption of butter and growing
butter mountains, the EEC has devised schemes for subsidising the sale of
cheap butter to manufacturers of ice cream, confectionery, cakes and biscuits.
This may partly explain the relatively low prices for these products and
their increasing consumption. All in all, it is extremely difficult to assess
what effect the MAFF and the CAP policies have on consumption. But it is
clear that the issue is not simple.

The Coronary Prevention Group recommends that the National Food Survey
should be supplemented with a regular survey of foods eaten outside the
home. The MAFF should also press the European Community to introduce legislation
to make the nutritional labelling of all packaged foods compulsory. Food
should be labelled for its content of energy, protein, carbohydrate, fat,
saturated fat, sugar, salt and dietary fibre. The ministry should develop
a simple pictorial or graphical system for labelling the saturated fat,
sugar, salt and fibre content. And it should oppose those elements of the
CAP that run counter to the national dietary guidelines as recommended by
the COMA report.

Dr Mike Rayner is senior research officer at the Coronary Prevention
Group in London. He is grateful to Euromonitor and Media Expenditure Analysis
Limited (MEAL) for permission to quote their data.