Front-of-Package Nutrition Info Backed by ACC to Improve CV Health

The American College of Cardiology (ACC), with a new concise clinical guidance document, has thrown its support behind putting nutrition labels on the front of food packaging to help consumers make better, heart-healthy choices and, in turn, drive down the burden of chronic diseases like CVD.

The idea is that front-of-package labeling will contain information in an easy-to-understand format about the content of specific nutrients—like saturated fat, added sugar, and sodium—that should be limited. In some countries that have adopted this approach, the labels use a graphical “traffic light” system with three or five colors to simplify interpretation.

The authors of the ACC document, published online last week in JACC, say the goal is to highlight a select number of critical nutrients, typically three to five, on the front of food packages, based on evidence indicating that simpler designs are more impactful. These labels would be complementary to, and not in place of, the more detailed nutrition facts found elsewhere on packages.

In January, the US Food and Drug Administration proposed adding front-of-package nutrition information to food labels, reflecting the percentages of saturated fat, sodium, and added sugar, although the rule has not yet been finalized following a public comment period that ran through July 15.

Those three nutrients create an “epidemic amount of coronary heart disease and heart failure, and cardiovascular diseases in general, in this country,” Kim Allan Williams Sr, MD (University of Louisville, KY), chair of the writing committee of the new ACC guidance and a past president of the college, told TCTMD. “The vast majority of what we do would be eliminated if people fix their diet.”

Poor diet has been linked to various chronic diseases, with a disproportionate burden felt by individuals from racial/ethnic minority groups and those with low socioeconomic status.

A healthy dietary pattern low in saturated fat, cholesterol, sodium, added sugars, and ultraprocessed foods, on the other hand, has been associated with lower risks of obesity, cardiovascular disease, type 2 diabetes, and certain types of cancer. Morbidity and mortality are both lower when people consume diets rich in whole grains, fruits, vegetables, legumes, nuts, seeds, fiber, and unsaturated fats.

A Tool for Change?

Front-of-package nutrition labeling is one proposed tool to help consumers make healthier choices, with a growing body of evidence from 44 countries that have adopted the strategy indicating that it improves consumer awareness, increases healthier purchasing patterns, and—in some cases—causes manufacturers to reformulate their products to improve the nutritional content.

The new concise clinical guidance from the ACC outlines the rationale for supporting the FDA-led front-of-package labeling initiative based on what’s known about the link between various dietary patterns and cardiovascular health; reviews evidence of effectiveness from parts of the world where such labels have been introduced; and provides details about various types of labels and considerations for implementation to improve CV health.

A fundamental problem is that “we have low levels of understanding of what food is healthy,” Williams said. With this document, readers “can capture the entire world of what’s healthy and what’s not healthy and make choices for themselves, their families, their communities, their churches, and their country.”

We have low levels of understanding of what food is healthy. Kim Allan Williams Sr

It’s not just about knowing which nutrients to avoid, but also about knowing which ones should be consumed at higher amounts, Williams pointed out. Plant-based, fiber-rich diets with unsaturated fat sources, such as beans, grains, nuts, seeds, fruits, vegetables, and mushrooms, have been shown to reduce disease risks, he said. “And that is the kind of thing that we should be involved in as cardiologists and as healthcare practitioners in getting everyone to understand.”

To that end, the document provides information that clinicians can use to have conversations with their patients about healthy eating, with its authors noting that formal training in nutrition is limited. A checklist in the paper includes items like encouraging a plant-forward diet as recommended in the 2019 primary prevention guidelines from the ACC and the American Heart Association; educating patients on how to read nutrition information on both the front and back of food packages; and making specific dietary recommendations around getting enough fiber, limiting sodium, and avoiding processed meats and sugary drinks.

“As the FDA moves toward implementation, clinician engagement is essential,” the authors write. “This concise clinical guidance supports evidence-based front-of-package labeling as a catalyst for improving diet quality, reducing CVD risk, and advancing public health equity.”