Our food, our health

364 Pages·2006·1.58 MB·English

Our food, our health
Healthy and unhealthy diets receive a lot of attention nowadays, and there are good reasons
for this. Each year, overweight and unfavourable dietary composition account for thousands of
new cases of illness and unnecessary deaths. The number of young people and adults who are
overweight is increasing. Foodborne infections and allergic reactions to food constituents also
cause some health loss. This report addresses questions such as what is the health loss due to
unhealthy diets and unsafe food in the Netherlands? What are the causes of this problem?
What effects can we expect to see in the future?
The report shows that, in the Netherlands, a substantial portion of health loss can be prevented
by a healthier diet and safer food. This requires an integrated strategy, involving greater activity
on the part of all those involved. The main opportunities are to be found on the supply side, i.e.
in the hands of the private sector. But the consumer also has an important part to play, by making
the proper choices in terms of health. The government must first create the necessary conditions,
possibly followed by enforcement where appropriate.
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This report is a collaborative publication of the Nutrition, Medicines and Consumer Safety Division u
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and the Public Health and Health Services Division of the National Institute for Public Health and
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the Environment (RIVM). It is one of a series of reports on Public Health Forecasts in the Netherlands. o
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The report was originally published in Dutch under the title Ons eten gemeten: Gezonde voeding o
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C.F. van Kreijl | A.G.A.C. Knaap | J.M.A. van Raaij (Editors-in-Chief)
Our food, our health
RIVM Healthy diet and safe food in the Netherlands
National Institute
for Public Health
and the Environment
hier nog P.O. Box 1
3720 BA Bilthoven
de EAN-code The Netherlands
www.rivm.nl/en
plaatsen

Our food, our health
Healthy diet and safe food in
the Netherlands
C.F. van Kreijl, A.G.A.C. Knaap and J.M.A. van Raaij (Editors-in-Chief)
Editors:
M.C.M. Busch, A.H. Havelaar, P.G.N. Kramers, D. Kromhout,
F.X.R.van Leeuwen,H.M.J.A. van Leent-Loenen, M.C. Ocké
and H. Verkleij
Nutrition, Medicines and Consumer Safety Division
Public Health and Health Services Division
National Institute for Public Health and the Environment
P.O. Box 1, 3720 BA Bilthoven, The Netherlands
Tel:[phone]; fax: [phone]
Apublication by the
National Institute for Public Health and the Environment
P.O. Box 1
3720 BA Bilthoven
The Netherlands
All rights reserved
© 2006 National Institute for Public Health and the Environment, Bilthoven, The
Netherlands.
The report was originally published in Dutch under the title Ons eten gemeten:
Gezonde voeding en veilig voedsel in Nederland
Translation: Taalcentrum-VU, Amsterdam
The greatest care has been devoted to the accuracyofthis publication.Nevertheless,
the editors, authors and the publisher accept no liability for incorrectness or incom-
pleteness of the information contained herein. They would welcome any suggestions
concerning improvementsto the information contained herein.
All rights reserved. No part of this publication may be reproduced, stored in an auto-
mated database or made public in any form or by any means whatsoever, whether
electronic, mechanical, using photocopies, recordings or any other means, without
the prior written permission of the National Institute for Public Health and the Envi-
ronment. Inasmuch as the production of copies of this publication is permitted on the
basis of Article 16b, 1912 Copyright Act in conjunction with the Decree of 20 June
1974, Bulletin of Acts, Order and Decrees 351, as amended by the Decree of 23 August
1985, Bulletin of Acts, Orders and Decrees 471, and Article 17, 1912 Copyright Act, the
appropriate statutory fees should be paid to the Stichting Reprorecht (Publishing
Rights Organization), PO Box 882, 1180 AW Amstelveen, The Netherlands. Those
whishing to incorporate parts of this publication in anthologies, readers and other
compilations (Article 16, 1912 Copyright Act) should contact RIVM.
RIVM report number 270555009
ISBN 90-6960-135-4
ISBN 978-90-6960-135-9
NUR 882
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OUR FOOD, OUR HEALTH FOREWORD
FOREWORD
Food. We cannot survive without it. It is a primary life requirement for us all. But food
is more than that. Food also plays an important role in terms of our health. An opti-
mal diet helps to maintain good health.
In the Netherlands, an unhealthy dietary pattern is responsible for a large proportion
of the ill-health and deaths due to cardiovascular diseases, diabetes and cancer. An
increasing number of Dutch people are overweight. This is due to eating too much,
particularly fat-rich foods, and to insufficient physical activity. The increase in the
number of children with overweight is alarming. We must halt this trend by encour-
aging people to adopt a healthier diet and to be more physically active. The consump-
tion of enough fruit, vegetables and fish is good for the heart and blood vessels. The
quantity of food consumed is also important, and should be in line with the daily
amount of physical activity. In short, eating healthily and in moderation is good for
your health.
Needless to say, our food must also be safe. Much has been done in past centuries to
ensure that this is the case. Production techniques have been greatly improved, the
quality of our food is continually monitored, and control systems have been intro-
duced. In the Netherlands, responsibility for food safety is shared by the Ministry of
Health, Welfare and Sport, and the Ministry of Agriculture, Nature and Food Quality.
Although much has been achieved in terms of food safety, we must not rest on our
laurels. New developments and emerging threats must be addressed. New products
are being introduced all the time,such as food with health-promoting additions and
genetically modified foods.Their safetymust also be assured.
This report, which was commissioned by the Ministry of Health, Welfare and Sport,
considers the various health-related aspects of diet and nutrition. It offers an overview
of current knowledge concerning the effects of diet and foods upon health. It not only
provides information about past trends and the current situation, but also considers
future developments with regard to the nutritional value and safety of our food.
The report has been written in such a way as to make it useful to both scientists and
policy-makers. It will undoubtedly make a substantial contribution to the production
and consumption of healthy, safe food.
The Minister of Health, Welfare and Sport,
H.Hoogervorst
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ACKNOWLEDGEMENTS OUR FOOD, OUR HEALTH
ACKNOWLEDGEMENTS
This report, originally published in Dutch under the title Ons eten gemeten, is a col-
laborative publication of the Nutrition, Medicines and Consumer Safety Division and
the Public Health and Health Services Division of the National Institute for Public
Health and the Environment (RIVM). The report is one of a series of reports on Public
Health Forecasts in the Netherlands.
The report, moreover, contains contributions from other institutes and universities,
which are gratefully acknowledged. The institutions in question are: Wageningen Uni-
versity, TNO Quality of Life, Vrije Universiteit Amsterdam, and Maastricht University.
Many individuals have made valuable contributions to this report. These include
authors from RIVM and other institutes (mentioned above), reviewers and other
experts consulted, as well as the members of the Policy Advisory Group. To acknow-
ledge and underline the importance of their input, the names of all those involved
have been included in Appendices 1-3.
The European Food Safety Authority (EFSA) considers this report to be a significant
contribution to the international discussion on the risks and benefits of food, as well
as an important reference guide for its Scientific Committee and Scientific Panels. For
this reason,EFSA has provided financial support for the translation of this report into
English. The RIVM would like to thank the European Food Safety Authority for this
financial contribution.
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OUR FOOD, OUR HEALTH TABLE OF CONTENTS
TABLE OF CONTENTS
FOREWORD 5
ACKNOWLEDGEMENTS 6
KEY MESSAGES 13
PART A OUR FOOD, OUR HEALTH: 19
Summary of the main findings of the report
1 INTRODUCTION 21
2 MAIN FINDINGS 22
2.1 How healthy is the Dutch diet ? 22
2.2 How safe is Dutch food ? 28
2.3 Healthy diet and safe food in balance 32
3 SIGNIFICANCE OF THE FINDINGS 35
4 OPPORTUNITIES FOR PREVENTION 39
5 MONITORING AND RESEARCH 43
PARTB OUR FOOD,OUR HEALTH: 45
Healthy diet and safe food in the Netherlands
1 INTRODUCTION 47
REFERENCES 54
2 HOW HEALTHY IS THE DUTCH DIET ? 55
2.1 Introduction 55
2.2 Diet in relation to health and disease 56
2.2.1 Dietary factors in relation to chronic diseases 57
2.2.2 Dietarystandards,Guidelines for Good Nutrition and Rules for a
healthy diet 65
2.3 Food consumption and the intake of nutrients 66
2.3.1 The general population 67
2.3.2 Food consumption of specific age groups 71
2.3.3 Food consumption among the lower socio-economic and
ethnic groups 74
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TABLE OF CONTENTS OUR FOOD, OUR HEALTH
2.4 Potential health gain through improvements to the diet 75
2.4.1 Current health loss in the Dutch population: the maximum
scenario 79
2.4.2 The realistic health gain: middle scenario 83
2.5 Options for dietary interventions 85
2.5.1 Food supply and other environmental factors 85
2.5.2 Interventions targeting personal factors 88
2.5.3 Interventions will vary according to target group 89
2.5.4 The integrated approach and comparison with interventions
targeting smoking 92
2.6 Summary and conclusions 92
REFERENCES 94
3 WHAT IS THE GOVERNMENT DOING TO PROMOTE A HEALTHY DIET ? 99
3.1 Introduction 99
3.2 Policy: objectives, target groups, roles and responsibilities 100
3.3 Instruments and measures 104
3.4 The effectsof policyin practice 107
3.5 Efforts targeting the main nutritional problems 109
3.6 Summary and conclusions 112
REFERENCES 113
4 HOW SAFE IS DUTCH FOOD ? 115
4.1 Introduction and scope 115
4.2 Pathogenic micro-organisms in our food 118
4.2.1 Introduction 118
4.2.2 Overview of pathogenic micro-organisms and other infectious
agentsin food 119
4.2.3 The scale of foodborne infections in the Netherlands and their
effect on public health 120
4.2.4 Factors which influence microbial food quality 128
4.2.5 The most important foodborne pathogenic micro-organisms
in terms of possible health gain 137
4.2.6 Summary and conclusions 140
4.3 Harmful chemical constituents in our food 142
4.3.1 Introduction 142
4.3.2 Harmful chemical constituents in food: a general overview 143
4.3.3 Risk assessment,admission policyand setting standards 150
4.3.4 Factors which influence chemical food quality 155
4.3.5 The main chemical substances in food in terms of potential
health gain 156
4.3.6 Summary and conclusions 160
4.4 Food safety in perspective 161
REFERENCES 167
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OUR FOOD, OUR HEALTH TABLE OF CONTENTS
5 WHAT IS THE DUTCH GOVERNMENT DOING TO ENSURE SAFE FOOD ? 173
5.1 Introduction 173
5.2 Policy: objectives and priorities 174
5.3 Measures targeting food safety 177
5.4 Supervision of food safety 182
5.5 Efforts targeting the main threats to food safety 184
5.5.1 Microbiological hazards 184
5.5.2 Chemical hazards 185
5.6 Summary and conclusions 186
REFERENCES 187
6 HOW HEALTHY AND SAFE ARE FUNCTIONAL FOODS AND DIETARY
SUPPLEMENTS ? 189
6.1 Introduction 189
6.2 Overview of functional foods and health products 191
6.3 Legislation 192
6.3.1 Functional foods 192
6.3.2 Health products 194
6.3.3 Claims 195
6.4 Potential health gain 198
6.4.1 Who is likely to benefit from the use of functional foods
and health products? 198
6.4.2 Health gain in practice 200
6.5 The converse situation: possible risks to public health 201
6.6 Consumption of functional foods and dietarysupplementscontaining
vitamins and minerals in the Netherlands 203
6.6.1 Functional foods containing vitamins and minerals 204
6.6.2 Dietarysupplementscontaining vitamins and minerals 205
6.7 Criteria for weighing health gain against health risk 209
6.7.1 Health gain 209
6.7.2 Health risks 210
6.7.3 Pitfalls 211
6.8 Summary and conclusions 212
REFERENCES 213
7 HEALTH GAIN AND HEALTH LOSS: HEALTHY DIET AND SAFE FOOD IN
ABROADER CONTEXT 215
7.1 Introduction:what questions are to be posed ? 215
7.2 Health versus safety in common foods 216
7.2.1 Approach 216
7.2.2 Results of the comparison 218
7.3 Health versus safety in functional foods and health products 224
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TABLE OF CONTENTS OUR FOOD, OUR HEALTH
7.4 Healthy diet compared with other lifestyle interventions 228
7.4.1 Calculations for three lifestyle factors 228
7.4.2 Comparison of lifestyle factors with diet and BMI 233
7.5 DALYs lost through dietary factors and other causes 235
7.6 Summary and conclusions 237
REFERENCES 239
8 WHAT DETERMINES CONSUMER EATING BEHAVIOUR AND RISK PERCEPTION? 241
8.1 Introduction 241
8.2 The consumer and the determinants of eating behaviour 241
8.2.1 What determines behaviour ? 241
8.2.2 Proximal determinants 242
8.2.3 Distal determinants 245
8.2.4 Ultimate determinants 247
8.2.5 Conclusions with regard to interventions 248
8.3 The consumer and the perception of food safety 248
8.3.1 Introduction 248
8.3.2 ‘Objective’ risk assessment 248
8.3.3 Other characteristics of risks 249
8.3.4 Characteristics of risk observation 250
8.3.5 Individual differences in risk perception 252
8.3.6 Cultural factors 252
8.3.7 Conclusions with respect to risk communication 253
8.4 Conclusions and recommendations 256
REFERENCES 258
9 WHATWILL THE FUTURE BRING ? 261
9.1 Introduction 261
9.2 External factors 261
9.2.1 Socio-demographic factors 262
9.2.2 Socio-cultural factors 263
9.2.3 Legislation/Policy 263
9.2.4 Macro-economic factors 264
9.2.5 Science 264
9.2.6 Miscellaneous factors 265
9.3 Developments in the food supply and eating behaviour 266
9.3.1 Developments in the food supply 266
9.3.2 Developmentsin eating behaviour 269
9.4 Effects on public health 271
9.4.1 Will the Dutch diet be healthier ? 271
9.4.2 Will food become safer ? 272
9.4.3 Effects on public health 274
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