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Cut salt and saturated fat levels in processed food to save thousands of lives, says NICE

Tens of thousands of lives could be saved, and millions of people spared the suffering of living with the effects of heart disease and stroke, simply by producing healthier food says new NICE guidance today (Tuesday 22 June). The guidance calls for the food industry to further reduce the salt and saturated fats in the food it produces, building on the good work already started.

Trans fats, which have been shown to increase the risk of heart disease and are classified as toxic by the World Health Organisation, should be eliminated from the food we eat, say the NICE recommendations.

In the UK, nearly three million women and three million men are living with the devastating and disabling effects of cardiovascular disease - which includes heart disease and stroke. Over 40,000 people die from premature cardiovascular disease each year. However, cardiovascular disease is a largely preventable condition and it can be effectively tackled by making simple changes to diet, smoking and physical activity.

This new guidance from the National Institute for Health and Care Excellence (NICE) focuses mainly on food production and its influence on the nation's diet. This is the first time that all of the evidence has been brought together in one place on what works in improving food production, together with the figures showing how much health improves as a result. The NICE recommendations are aimed at making small changes across the whole population, because these will translate into very big improvements in health overall. This guidance sets out very clearly what the government and industry can do to make it easier for people to make healthy choices and thus improve the health of the whole nation.

Professor Mike Kelly, Public Health Director at NICE, said: “This guidance aims to save lives and reduce the terrible toll of ill health caused by heart disease and stroke. Making the simple changes recommended could prevent around 40,000 premature deaths in people aged under 75 each year. Taking action now will also save many millions of pounds every year. The guidance focuses on what government and industry can do to make it easier for people to make healthy choices, by producing food in a healthier way as standard. This isn't about telling individuals to choose salad instead of chips - it's about making sure that the chips we all enjoy occasionally are as healthy as possible. And the best way to do this is to encourage the companies who provide our food to build on the good work they've already done. That means making further reductions in the salt, trans fats and saturated fats in the food we eat everyday.”

The guidance recommendations include:

  • Speeding up the reduction in salt intake in the population, aiming for a maximum intake of 6g per day per adult by 2015 and 3g daily by 2025
  • Encouraging manufacturers to substantially reduce hidden saturated fat in all food products, and considering supportive legislation if necessary
  • Ensuring low salt products and low saturated fat foods are sold more cheaply than their higher content equivalents
  • Eliminating industrially-produced trans fats from processed food and take-aways.

Professor Klim McPherson, Chair of the NICE Guidance Development Group and professor of epidemiology at Oxford University, said: “This NICE guidance is vital in helping to save the estimated 40,000 lives lost each year because of premature cardiovascular disease - a largely preventable condition. The guidance sets out a range of evidence-based recommendations for effective action to help reduce CVD levels. Where food is concerned, we want the healthy choice to be the easy choice. Going even further, we want the healthy choice to be the less expensive, more attractive choice. Just one of the recommendations is reducing saturated fats and removing trans fats from the diet - this can save over 20,000 lives every year.

“Put simply, this guidance can help the Government and the food industry to take action to prevent huge numbers of unnecessary deaths and illnesses caused by heart disease and stroke. Now is precisely the time to push harder and to work together better to reduce the risks of cardiovascular disease still further, beginning with children and young people, to reduce their risks in later life. This way people will have healthier lives and the NHS can save the substantial expense it would otherwise incur to treat these conditions. This NICE guidance has a string of recommendations all launched today to do just that.”

Professor Simon Capewell, Vice Chair of the guidance group and public health physician said: “There is an urgent need for this guidance. Around 90% of premature (early) cardiovascular disease is avoidable, because it's due to well known factors that we can change, particularly diet and smoking. High levels of salt can cause high blood pressure, leading to stroke and coronary disease. There has been encouraging progress in reducing the level of salt and saturated fats in our diet over the last 10 years, but the rate of change needs to be speeded up urgently. The guidance therefore recommends reducing daily salt intake by 3g to a maximum level of 6g per day for adults by 2015. This action alone would result in 15,000 - 20,000 fewer deaths from heart disease and stroke every year. The benefits of doing this will be seen remarkably quickly, within 2-3 years, along with corresponding savings to the NHS. And there's also clear evidence that cutting dietary salt levels works: it's already been done in Japan and Finland, and the USA is also taking action. If salt levels in food are reduced by 5% -10% a year, most consumers don't even notice any difference in taste - their taste buds simply adjust. Meanwhile they will benefit from better health and less risk of heart disease and stroke.”

The NICE guidance also considered the evidence on wider policy actions that can support a healthier food environment. Clear, colour-coded food labelling is recommended as an effective way to help people understand what is in their food. This specific system is proven to help shoppers make a healthy informed choice about what they and their families eat. Along with changes to food production, importantly this guidance also calls for more action on regulating the way food is marketed to children. Further recommendations include:

  • Extending restrictions on TV advertising for foods high in saturated fats, salt and sugar to 9pm to protect children
  • Establishing the Food Standards Agency's front-of-pack traffic light labelling system as the national standard for food and drink products in England, and considering using legislation to ensure universal implementation
  • Encouraging local planning authorities to restrict planning permission for take-aways and other food retail outlets in specific areas.

Paul Lincoln, Guidance Developer and Chief Executive of the National Heart Forum, said: “NICE has carefully considered the policy measures that affect the production of our food and the impact of these policies on the public's cardiovascular health. The recommendations are wide-ranging from reform of the common agricultural policy to nutritional standards for food provided by the public sector. Future reforms of the EU's Common Agricultural Policy should be guided by their potential for improving the public's health. There should also be a major shift to promote and provide opportunities for physically active travel, especially walking and cycling as routine modes of transport. Enormous health benefits can be gained by moving to a culture where healthy choices are the default choices.

“The NICE recommendations also help to promote and protect the health of children and young people, especially the most vulnerable and disadvantaged. We want to see the next generation growing up largely free from potentially avoidable conditions such as heart disease and stroke, which have a devastating impact on our society. We have the public health evidence on how to virtually eliminate these conditions, so it's vital to take action now to save lives.”

Robin Ireland, Guidance Developer and Chief Executive of Heart of Mersey cardiovascular health charity, said: “People know that healthy living advice is to be more active, don't smoke and eat a balanced diet. But this time the healthy living advice is for local authorities, Government and the food industry - they have a vital chance to greatly help improve everyone's health. The guidance recommends that local authorities should use planning applications and bye-laws to control fast food outlets - for example limiting the concentration of those based within walking distance of schools, and within local communities. All of these steps will help reduce heart disease and improve the health of the nation.”

About the guidance

1. The NICE guidance, ‘Prevention of cardiovascular disease at population level', is available at www.nice.org.uk/PH25.

2. NICE public health guidance applies to England only.

3. Professor Sir Michael Marmot, Director, International Institute for Society and Health and author of the strategic review of health inequalities in England, welcomed the guidance saying: "Reduction of the societal burden of cardiovascular disease will take action at the level of society. This NICE guidance, based on evidence, has the real potential to improve the health and well being of the population."

4. Professor Steve Field, Chairman of the Royal College of General Practitioners said: “GPs want to help people live longer, healthier and productive lives - and to prevent them becoming ill in the first place - but we are confronted with the harsh reality of cardiovascular disease on a daily basis. The recommendations in the new NICE guidance will be welcomed by GPs as they provide sensible ways in which individuals and society as a whole can make small changes that could lead to a big difference in reducing the risk of this life-threatening but largely preventable disease.
“We particularly welcome the onus placed on fast food and take away outlets to significantly reduce the amount of salt and transfats in their food which, if left uncontrolled, could eventually pose as big a threat to the well-being of the nation as smoking and excessive drinking.”

5. Betty McBride, Director of Policy and Communications at the British Heart Foundation, said: “We know that keeping the nation's hearts healthy is a task that requires many actors to do their bit. Creating an environment that makes healthy choices easy is vital. Government, the health service, industry and individuals must all play their part and as such we welcome the multi-faceted guidance from NICE today.

“NICE's guidance reiterates that front-of-pack food labels including traffic light colours are best for helping shoppers understand what's in the food they're buying. Meanwhile, the food industry should take the initiative to adopt clear and consistent food labels to help their customers and countrymen protect their health.

“We've already seen some progress by industry on reducing levels of salt in processed food. We must see industry making major efforts now to reformulate products with less saturated fat. Cutting our ‘sat fat' intake would have a major impact on heart disease. ”

6. Background on cardiovascular disease (CVD): Cardiovascular disease (CVD) is generally due to reduced blood flow to the heart, brain or body caused by atheroma (fatty deposits causing hardening of the arteries) or thrombosis (blood clot). Plaques (plates) of fatty atheroma build up in different arteries during adult life. These can eventually cause narrowing of the arteries, or trigger a local thrombosis which completely blocks the blood flow. CVD is more common after the age of 60.

7. Trans fats: Industrially-produced trans fatty acids (IPTFAs) are also known as partially hydrogenated vegetable oils. Because they are produced by partial hydrogenation they are not normally present in naturally in foods and have no known health benefits. The WHO review defines IPTFAs as industrial additives, and recommends that restaurants, food and cooking fat manufacturers avoid their use. Trans fats are believed to act in a similar in the body to saturated fats.

8. Saturated fats: these fats are hard at room temperature. Diets that are high in saturated fat can raise the level of cholesterol in the blood, increasing the risk of developing heart disease.

9. Salt: High levels of salt are linked to high blood pressure, which in turn can lead to stroke and coronary disease.

10. The UK and international economic evidence is very consistent. Any population-wide intervention achieving even a modest reduction in any major CVD risk factor (diet, smoking or physical activity) would produce a substantial net cost saving to the public sector, as well as improving peoples' health.

11. The guidance also make recommendations on physically active travel, including creating an environment which promotes physical activity, and addressing factors that discourage this, such as subsidised parking.

About NICE

12. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

13. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

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This page was last updated: 29 June 2010

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.