Title: Healthy diet recommendations

Key words: vegetables, fruit, frozen foods, asthma, cancer, cardiovascular disease, cataracts, diabetes, inflammatory bowel disease, smoking, cancers, immune system, flavonoids, obesity, NHS plans, implementation,

Date: May 2001

Category: Macronutrients

Type: Article

Author: Dr M Draper

Healthy diet recommendations

Introduction

From 1940 onwards there has been a decline in vegetable consumption and an increase in fruit consumption (1) and the COMA Committee noted a reduction in consumption of traditional vegetables such as fresh potato,swede, parsnip, and sprouts in favour of frozen vegetables and salads and increases in citrus fruits and fruit juices (2).

These trends are evident from the National Food Surveys ( 1989-1999) with fresh vegetable consumption 4% lower , frozen potato products 40% higher and a 17% rise in fresh fruit compared with 10 years ago (3).

Evidence

The current recommendations to eat at least five (80gm) portions of vegetables (excluding potatoes) and fruit a day (400gms) are based largely from research on the role of antioxidant nutrients in preventing degenerative chronic diseases. Antioxidants reduce free radicals (Radical oxygen species) which have been implicated in asthma, cancer, cardiovascular disease, cataracts, diabetes, inflammatory bowel disease and other inflammatory processes (4). While smoking is the most preventable risk factor, there is good evidence that a diet high in a range of fruit and vegetables lowers the risk of coronary heart disease, post-menopausal breast and endometrial cancers. Moderate evidence for protection against bladder, cervical, colorectal, pancreatic and prostate cancers but not enough evidence to support a beneficial effect in breast, lung,

oesophageal, ovarian or testicular cancers (5 ).

There are benefits to the immune system especially against viral infections. Recently a 15 day human experimental study with 10 servings of fruit and vegetables raised the levels of the plasma oxygen radical absorbance capacity (ORAC) above the subjects baseline which correlated with their estimated daily intake of 5 servings for the previous year (6).

Flavinoids including pycnogenols and anthocyanidins, terpenes, limonoids, coumarins, isothiocyanates, ellagic acid, allium compounds and lycopenes may have a protective role in the incidence and/ or progression of cancer.

Obesity has trebled over the past 20 years and is linked to increased risk of heart disease, diabetes (type 2) and is linked to certain cancers eg breast (7). Fruit and vegetables contain very little fat, have a lower energy density and may assist in weight loss.

 

Implementation

The Nutrition Task Force (NTF)'s action plan 'Eat well', aimed at the whole population had set out a program to help acheive the Health of the Nation targets on diet and nutrition, then with the change to a Labour government, this was by followed by Saving Lives: our Healthier Nation. This set out new initiatives with Health

Development Agency, NHS plan, NHS Cancer plan, Health Action Zones and Healthy Living Centres. A new emphasis on physical activity for adults and school children and ' The Balance of Good Health ' for healthcare professionals to give the following guidelines for a healthy diet:

# Enjoy your food

# Eat a variety of different foods

# Eat the right amount to be a healthy weight

# Eat plenty of foods rich in starch and fibre

# Eat plenty of fruit and vegetables

# Don't eat too many foods that contain a lot of fat

# Don't have sugary foods too often

# If you drink alcohol , drink sensibly .

The NHS plan continues the national campaign to recommend at least five portions of fruit and vegetables (8) and by 2004 a national fruit scheme for every child in nursery and 4-6 year olds at school ( pilots under way this autumn ). Other objectives include

to work with industry to improve access and provision and with the Food Standards Agency to look at salt, sugar and fat in the food processing industry.

Potential Problems in implementaion

There are numerous obstacles to the message 'Five a day'.

The change of government has meant a change in terminology, new plans, and a redressing of the policies and priorities. The more fundamental problems remain the same and include availability (geographic variation eg in Scotland), socioeconomic (unemployment, single parent/ low income families, institutions especially for the elderly) and food buying behaviour (accessibilty, storage, time for preparation, eating habits and preferences of taste and texture). The program will need the co-operation of the food producers, retailers, caterers in institutions especially schools, hospitals, nursing homes and residential homes as well as all other consumers. The present crisis in UK agriculture, with firstly the BSE crisis and now the Foot and Mouth pandemic, will once again draw the publics attention to their diet and the issues surrounding the provision of food. This may be an opportunity to publicise on TV the benefits of vegetables and fruit.

(1) Trends in Patterns of Disease and diet: Fact File No 10: 1993 National Dairy

Council. London.

(2) Department of Health 1994. Nutritional Aspects of Cardiovascular Disease.

Report of the Cardiovascular review Group, Committee on Medical Aspects of

Food Policy. Report on Health and Social Subjects No 46 .London:HMSO.

(3) MAFF National Food Survey 1999. London HMSO.

(4) MILLER,A, Antioxidant Flavonoids: Structure , Function and Clinical Usage.

Alt Med Rev 1996 : Vol 1 No 2 p103-111.

(5) Department of health 1998 .Nutritional aspects of the Development of Cancer.

Report of the Working group on Diet and Cancer of the Committee on Medical

Aspects of Food and Nutrition Policy. No 48. London HMSO.

(6) CAO,G et al. Increases in human plasma antioxidant capacity after consumption of

controlled diets high in fruit and vegetables.

Am J Clin Nutr, 1998;68:5,1081-7.

(7) Food, Nutrition and the Prevention of cancer: a global perspective.1997

World Cancer Research Fund.

(8) The National Heart Forum 1997 ; At Least Five a Day. Strategies to increase

vegetables and fruit consumption . HMSO. London .

& The National Heart Forum 1997; Preventing coronary heart disease: The role of

Antioxidants, Vegetables and Fruit. HMSO London.

Other resource material

(9) BUTRESS, J. Implementing nutrition policy and dietary change.

British Nutrition Foundation. MSc in Nutritional Medicine Lecture UOS.

(10) The Department of Health , Eat Well 1: 1994 ; An action plan from the Nutrition

Task Force to acheive the Health of the Nation targets on diet and nutrition.

HMSO London

(11) The Department of Health , Eat well 11: 1996 ; Aprogress reprot from the

Nutrition Task Force on the action plan to acheive the Health of the Nation

targets on diet and nutrition. HMSO London.

(12) The Department of Health, 1999 ; Saving Lives: Our Healthier Nation.

HMSO London.