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Nutrition Today:
doi: 10.1097/NT.0b013e3181cb457c
Issues for the 2010 Dietary Guidelines

Front-of-the-Pack and On-Shelf Labeling: Tools for Spotting Nutritious Choices at the Supermarket Shelf

Carlson, Lisa A. MS, RD

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Author Information

Lisa A. Carlson, MS, RD, is development nutritionist for Unilever Foodsolutions and resides in Riverside, Illinois. Previously, she was director of health and wellness/sustainability communications for PepsiCo, working with the Gatorade, Quaker, and Tropicana brands.

Correspondence: Lisa A. Carlson, MS, RD, Unilever Foodsolutions, 2200 Cabot Dr, Lisle, IL 60523 (lisa.carlson@unilever.com).

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Abstract

As nutrition scientists study and debate the causes of obesity and look to improve the quality of the American diet, there is a renewed interest in nutrition resources to help people make more healthful dietary choices at the grocery store. New, voluntary front-of-the-package nutrition labels on food products and new on-shelf labeling systems in grocery stores are emerging as viable tools to help lead consumers to more nutritious diets. Although more studies are needed to see which front-of-the-package or on-shelf labeling systems are most effective, it is clear that consumers and health professionals want easier and clearer ways to identify healthful food products for themselves and their families

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The Evolution of Front-of-Pack and On-Shelf Labeling Systems

New front-of-the-package (FOP) nutrition symbols on food products and on-shelf nutrition labeling systems at grocery stores have recently received a lot of attention-some good, some not so good-as a way to help guide consumers to make healthful food choices. These front-of-the-label symbols and on-shelf icons (such as check marks, guiding stars, ratings, and calories per serving) are viewed as an at-a-glance guidance system and complement to the more detailed Nutrition Facts panel located on the back of the food label. The Nutrition Facts panel, developed by the US Food and Drug Administration (FDA) and enacted in 1994 under the National Labeling and Education Act, is often used as a key source of nutrition/food product information. The new voluntary FOP labels (and on-shelf systems in grocery stores) are supposed to make it easier for people to choose more nutritious foods and beverages that fit into their daily calorie needs. Several of the programs have received criticism because of their nutrition criteria or lack of transparency in their coding system. This article reviews the newest FOP and on-shelf nutrition labeling systems so that health professionals are aware of this rapidly evolving area of nutrition advice.

Although at-a-glance nutrition labels and symbols are one way to help educate consumers, the concept is not new. In fact, on-pack nutrient and health logos have appeared on food packages for at least a decade. For example, the American Heart Association grants the "heart check mark" to specific foods that meet guidelines for saturated fat, sodium, total fat, and cholesterol and the FDA's criteria for a "healthy" food claim (low in fat, saturated fat with limited amounts of cholesterol and sodium). More recently, the Whole Grains Council, an educational alliance, developed the "whole grain stamp" to identify food products with whole grains; it now appears on more than 2,000 products. The fruit-and-vegetable trade association Produce for Better Health created the Fruit & Veggies More Matters campaign and on-pack seal to identify and encourage consumption of different forms of fruits and vegetables.

Over the last few years, food manufacturers have initiated their own on-pack symbols using slightly different criteria (most based on US FDA guidelines and the Dietary Guidelines for Americans). Although their approaches and on-pack logos may have varied, their goal was generally the same: to help consumers make informed food choices and identify those foods that meet specific nutrition and health standards.

PepsiCo, for example, was one of the first food manufacturers to launch a FOP nutrition label program, Smart Spot, in 2004, featuring a green check mark to identify products that met authoritative nutrition standards. Unilever initiated a Choices check mark as part of their Eat Smart, Drink Smart program, whereas Kraft promoted a sunburst symbol with Sensible Solutions. General Mills and the Kellogg Company also launched FOP labeling in 2007, based on the European Guideline Daily Amount (GDA) system, featuring a snapshot of the Nutrition Facts panel with calories and daily percentage values for several nutrients to limit and promote. The cereal giants favored the European GDA system because it provides concise, fact-based nutrition information in one horizontal line across the top of the cereal box.

Most of these food manufacturers reported that although their customers generally liked the quick-read, FOP nutrition labels to identify more healthful choices, they also had difficulty making sense of all the different on-pack programs. A 2008 American Dietetic Association survey of consumers found that although 67% of those surveyed rate diet and nutrition as "very important," only 35% found on-pack nutrition and health symbols to be credible sources of nutrition information.1 Research that evaluated several on-pack systems in 4 European countries showed that FOP nutrition symbols can be helpful to shoppers and that simpler quick-glance symbols (backed up with details elsewhere on the package) may work best in the multistimulus shopping environment. The research also showed that although European consumers liked simple on-pack logos, they preferred the logo when it integrated a few different systems (eg, use color coding and some text or numbers to clarify the information).2

Research continues to show that easy-to-use, science-based labels are what consumers want and what health educators and scientists judge to be helpful for most consumers. Wendy Reinhardt, MS, RD, director of health and nutrition at the International Food Information Council, confirms this and says that consumers are open to information from a variety of sources if it helps guide them to make sound food choices. "Research we have gathered over the years indicates that consumers are receptive to nutrition information on the front of the package. Our most recent food labeling research shows that when consumers see information on the front of the label-a symbol, a nutrient content, or health claim-it often leads them to look for more information on the Nutrition Facts panel."3

A recent comprehensive evaluation of the European on-pack labeling systems shows that there were generally high levels of comprehension for all different FOP labels tested (traffic light colors, percentage of GDA, and text); however, the strongest labels were ones that combined all 3 elements (some color symbols, text, and GDAs), appealing to different learning styles.4 More research is needed to see if awareness and comprehension lead to more healthful food choices and better diets.

The reason for this is that not all consumers-US or European-need the same amount of hand holding. According to research conducted by International Food Information Council,3 nutrition-savvy consumers are more likely to use the more detailed information on the Nutrition Facts panel than are their less-nutrition-savvy counterparts, especially if they are choosing a new food product.

Richard Black, PhD, vice president of nutrition for Kraft Foods, agrees. "Our consumer research shows that there are several different types of consumers, and they reflect different levels of interest in nutrition labeling." A small group of consumers, he says, will always read the Nutrition Facts panel and understand the information. Others, such as teenage boys, will never look at the panel. And then there are those consumers in the middle, who are interested yet confused by conflicting messages. He said this is why an at-a-glance nutrition label based on science can be helpful to reach all consumers.

According to Susan Crockett, PhD, RD, vice president and senior technology officer of health and nutrition at General Mills and the Bell Institute, consumers want user-friendly formats and icons to help them make quick but smart decisions.

"Consumers want clean, truthful information, nothing complicated," says Crockett. "Our research shows that consumers want the facts, but then they don't want to be told [what to do with them]. They've told us over and over to keep it simple, [they're] too busy to understand and use a tiered system."

The fact is that most consumers are willing to spend only a few seconds deciding if they will actually purchase an item, says Douglas Balentine, PhD, director of nutrition for Unilever, the Americas, quoting from the company's consumer research. Consumers may spend a few more seconds reviewing new food purchases, he says, but overall, shoppers are looking for a way to decode facts and figures easily-and a system for doing so that appeals to their many levels of understanding.

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The Quest to Clear the Labeling Clutter

Recently, several different coalitions of nutrition educators, scientists, and academicians have teamed up with either food companies or supermarkets to study ways to help consumers make more informed food decisions. What has emerged is the latest generation of on-pack or on-shelf nutrition labeling programs. Food manufacturers such as ConAgra, Kraft, General Mills, PepsiCo, Unilever, and many others that typically compete in the marketplace came together as part of a coalition to help create a unified approach to on-pack labeling systems with the Smart Choices Program. A handful of supermarket chains brought together experts to create their own on-shelf systems that would work for their customers resulting in Guiding Stars, Nutrition iQ, and Healthy Ideas. In addition, a physician led a team of experts to create another supermarket nutrition profiling system with NuVal.

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Decoding the On-Pack and On-Shelf Labels

Here's a look at some of the current FOP and on-shelf labeling systems available to consumers. Health professionals, especially dietitians, may want to become familiar with these programs to help answer consumer questions and to help guide them to make more healthful food choices. As of this writing, the FDA has decided to intervene and research various nutrition logo systems and nutrition criteria to determine if one approach would make it easier for consumers to select a healthful diet. The Grocery Manufacturers of America said that its members will work with the FDA to provide useful nutrition information to consumers (Table 1).

Table 1
Table 1
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Guiding Stars

In September 2006, the New England-based chain of Hannaford Brothers (and, more recently, the Southeast chain Food Lion, both owned by Delhaize Group in Belgium) implemented the Guiding Stars program, after learning that 84% of their consumers said that they would welcome a rating system to help them buy nutritious products.

Jeffrey Blumberg, PhD, of Tufts University-along with an advisory panel of leading nutritionists, scientists, and physicians-developed the exclusive formula that evaluates and rates a food product according to its "healthfulness" based on a proprietary algorithm. Ratings are based on a food's nutrient density, which is defined as nutrition per 100 calories. This standard allows for consistent measurement, regardless of package and serving sizes. Only nutrient information included on the food label and regulated by the FDA and/or the US Department of Agriculture is considered in the system's algorithm.

Here is how the system works. Points are added for the presence of vitamins, minerals, dietary fiber, and whole grains and then subtracted for the presence of trans-fats, saturated fats, cholesterol, sugars, and added sodium. Points are then tallied up and given a star rating of 0 to 3 stars: 0 means the food product does not meet the nutritional criteria to receive a Guiding Star; 1 star means "good nutritional value"; 2 stars means "better nutritional value"; and 3 stars means "best nutritional value."

Although the company says that the Guiding Stars system supports the recommendations of the US Dietary Guidelines for Americans 2005 and relies on information "readily available to the consumer and provided through the Nutrition Facts label and the ingredient list," the specific algorithm is a secret; its formula has not been published. However, it is available to other supermarkets, which can pay a licensing fee to use the Guiding Stars program.

It would not be surprising if many supermarkets at least gain inspiration from their system, given Hannaford's results. After just a year of implementing the program-and assigning ratings to some 25,500 of its products-Hannaford managers noticed a spike in sales figures for those bearing the FOP star icon: with sales of packaged foods more than doubling those of packaged foods without the star rating and the sales of breakfast cereals and yogurt more than tripling.

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Healthy Ideas

The Healthy Ideas nutrition program was developed for Stop & Shop and Giant Food by an internal advisory panel of nutritionists, with the review and advice of a scientific panel of medical experts led by George L. Blackburn, MD, PhD, associate professor/director, Division of Nutrition, Harvard Medical School. Unlike the Guiding Stars program, Healthy Ideas rates foods using nutrition threshold criteria versus a proprietary algorithm. To be rated, foods must first meet the FDA definition of "healthy" and provide at least 10% of the daily recommended intake for 1 or more of the following nutrients: fiber, protein, vitamin A or C, calcium, and iron. Only about 30% of edible products in the Stop & Shop and Giant grocery stores-or some 4,500 packaged goods-qualify for the on-shelf symbol, a green and blue symbol with the words "healthy ideas." All fresh fruits and vegetables automatically qualify for the program.

"We wanted to create a system that would offer consumers a more practical tool for evaluating foods," says Paulette Thompson, MS, RD, manager of health and wellness for Stop & Shop, Giant Foods, who adds that the program has been in the works for some time. "Our research showed us that consumers wanted the program to be transparent, not proprietary, and the symbol needed to be easy to understand, easy to use." Thompson said that, with so many choices in the supermarket, their customers are looking for easy clues that translate into a "thumbs up" that it may be a good food choice. The Healthy Ideas symbol is a starting point to help consumers eat a healthier diet, she added. "Then we help consumers put it all together with recipes, 'Simple Swaps' and menu planning tips on our Web site and in brochures."

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Nutrition iQ

SuperValu recently introduced the Nutrition iQ shelf signage at its Albertsons stores, with more grocery stores involved in the rollout in the coming months. The Nutrition iQ profiling system uses color-coded shelf tag to identify foods that meet specific nutrient thresholds for sodium, saturated fat, and, in some cases, sugar. Each product is compared with nutrient claims criteria established by the FDA, such as "low sodium" or "good" or "excellent" sources of calcium. The color-coding system uses specific colors for identifying calcium (blue), fiber (orange), foods with 10% daily value protein (yellow), low calorie (purple), low saturated fat (red), sodium (dark green), and whole grains (dark orange). The program will be rolled out in a 2-phase process. First, the center-of-the-store products will be labeled. Approximately 10% of the food items in the supermarket will have tags. The program was developed in collaboration with nutrition experts at Joslin Diabetes Center.

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NuVal (Formerly Overall Nutrition Quality Index)

The NuVal system-a continuous ranking system of foods and beverages on a scale of 1 to 10-was developed by an advisory panel of 16 scientists, physicians, and nutrition experts and initially supported by Griffin Hospital, a small institution outside New Haven, Connecticut. Led by David Katz, MD, of Yale-Griffin Prevention Center, today it is funded by Topco Associates LLC, a group of food wholesalers, food service companies, and supermarket chains.

Katz says that the algorithm used to score foods is based on the Overall Nutrition Quality Index or ONQI (pronounced on-key) formula that considers 30 nutrients, the glycemic load, and a host of other factors (eg, if vitamins are naturally occurring in a product or added). The higher the ONQI score, the higher the food rating. More than 33,000 food products to date have been analyzed and scored using the ONQI formula. All foods and beverages are analyzed using the same set of ONQI criteria, so the nutritional score of an orange (rated a perfect "100") can be compared with that of an apple (in the fruit category) or a granola bar (in the snack category). Katz says this scoring will help shoppers compare foods within specific categories (such as fruit) or within broader categories (such as snacks).

According to Katz, the NuVal scoring system will offer consumers a unique chance to identify healthy bargains because the "price per unit" sits right next to the NuVal score in the stores using the system. "It may allow consumers to think about food value in an entirely different way-as nutritional value for the dollar," he says.

Although the complicated formula and system have received some criticism because the algorithm has not yet been published or subjected to peer review, Katz says that "their system is transparent as far as what is measured, but that the exact recipe is proprietary." A recent article in the American Journal of Health Promotion examined the ONQI scores for 7 days of the DASH (Dietary Approaches to Stop Hypertension) diet, which is designed to lower blood pressure, compared with a typical American diet. Not surprising, food selected as part of the DASH diet scored higher ("more nutritious") ONQI values than did the typical diet.5

Currently, the program is in Hy-Vee (Midwest), Price Chopper (East coast), and Meijer's (Midwest) stores, with several more grocery store chains to come. Those who are interested pay a licensing fee to be part of the program and have food products analyzed by the NuVal system.

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Smart Choices Program

The Smart Choices Program, a FOP labeling program, was created as a collaborative effort among industry and nutrition experts, based on the latest authoritative dietary guidance. The Keystone Center, a nonprofit organization that specializes in coalition-based solutions to public health issues, assembled a group of experts from diverse sectors such as academia, government, food companies, supermarkets, and nonprofit health organizations (such as the American Dietetic Association and the American Diabetes Association) to look at labeling changes that could help consumers make more healthful and informed choices. (The Center for Science in the Public Interest was also involved but dropped out at the end of the development stage in support of a project led by the Institute of Medicine [IOM] to review all FOP labeling and also because of some disagreement with the final criteria.) Phase 1 of the IOM project, with the FDA and Centers for Disease Control and Prevention as sponsors, involves establishing a study committee of experts to fully evaluate all FOP options and reviewing the advantages and disadvantages of each system. Phase 2 will consider the potential benefits of a single, standardized FOP food guidance system regulated by the FDA.)

As of this writing, the Smart Choices Program, the result of a 2½-year collaborative process that included qualitative and quantitative consumer research, has been temporarily suspended by the sponsors because of recent news coming from the FDA. In a press release, the FDA signaled that it intends to review all FOP labeling programs and will, in the next few months, develop its own criteria so that there is uniformity in the marketplace.

For Smart Choices, products that were already granted the check-mark logo will continue to show up on supermarket shelves for the time being; however, no new food products will carry the logo.

The Smart Choices Program features a FOP check-mark symbol that identifies more nutritious choices within specific product categories and provides calorie information (calories per serving and servings per container) on the FOP, with the intent to help people stay within their daily calorie needs.

Each Smart Choices coalition member was interested in the collaborative approach. Instead of continuing to compete on different interests and agendas, they decided to bond together to come up with a joint system that laid the foundation for the Smart Choices Program-one that called for a unified logo and set of science-based criteria with which to rate products by their nutritional profiles.

"Participants decided very quickly that the goal was to harmonize front-of-the-pack labels as each had passion for a unified front label logo system for packaged foods," says Joanne R. Lupton, PhD, distinguished professor, chair in nutrition at Texas A&M University, member of the 2005 Dietary Guidelines Committee, and Keystone Roundtable participant. Those signing on to the fee-based self-regulated Smart Choices Program agreed to remove their current FOP labeling once new labels go into effect.

Administered by the American Society for Nutrition and the NSF International, the Smart Choices Program is category specific. Food is evaluated by the specific qualifying criteria derived from the 2005 Dietary Guidelines for Americans, FDA standards, reports from the IOM, and other sources of consensus nutrition guidance and developed for 19 different categories (eg, beverages, cereals, and dairy), based on the presence of

* nutrients to limit (eg, fats and added sugars) and

* nutrients (eg, calcium and potassium) and food groups (eg, fruits, vegetables, whole grains) to encourage.

The consensus was that knowing these things quickly and easily would allow consumers to easily choose the more nutritionally appealing product within a category. In addition to nutrients, the coalition also determined that calories were meaningful, which is why having them listed along with the Smart Choices Program symbol on the front of the label was important. Unlike other labeling systems, the Smart Choices criteria are entirely transparent and are detailed on its Web site (www.SmartChoices.org).

"The food industry wants to create nutritious products that will also taste good, but they want to do that within well-accepted criteria," says Lupton. "Calories do count, and so we followed 2005 Dietary Guidelines to choose calories wisely."

Eileen T. Kennedy, DSc, RD, dean of the Friedman School of Nutrition Science and Policy at Tufts University and a coalition participant, points out that research still needs to be done to see what works for US consumers.

"We've created a program that shows promise in assisting people in making positive dietary changes to help enhance public health," Kennedy said. "Now, the litmus test will be to evaluate all of these new, on-pack and on-shelf labeling systems and see what really moves people to change."

The Smart Choices Program has, however, received some criticism over its nutrition criteria as some food products receiving the Smart Choices check-mark symbol seemed difficult to justify (eg, some presweetened cereals). Proponents of the program point out that the nutrition criteria were based on authoritative science and the 2005 Dietary Guidelines and that the Smart Choices Program is stricter than most of the individual food company FOP programs. In addition, food scientists at participating companies reported a positive outcome of the Smart Choices Program, even if it was temporarily suspended: Food developers have improved many of their food offerings (eg, reduced calories, saturated fat) so that they could qualify for a check mark. Data presented at the Obesity Society meeting in November 2009 showed that nutrient profiling based on the Smart Choices Program can impact energy and nutrient intakes and be favorable for health. The modeling study showed that a diet with Smart Choices products in place of similar, non-Smart Choices products showed a 24% reduction in overall calories and substantial increases in nutrients to encourage and reductions in nutrients to limit.6

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Conclusion

It remains to be seen what exactly the FDA will do and what their criteria will be. Whether one of the existing systems will be favored or a new system is developed and mandated by the FDA is unclear.

Others believe that there may be an opportunity for FOP and on-shelf systems to coexist, at least in the meantime, and be helpful for consumers. "A food product might have a high ONQI score (under NuVal), a Smart Choices logo, and a few stars from the Hannaford system," says Susan Borra, RD, executive vice president of Edelman Public Relations, who participated in the Keystone Center Roundtable for the Smart Choices Program. "Still, will that be confusing to consumers? Not necessarily. I think it tells the consumer that a particular product is a good choice. What we've found is that health professionals may want to know how good is good, whereas many consumers may just want to know if a product is good. For the mom who wants to get in and out of the store, a simple system to assist her and that's based on science is a great help."

This is especially true when you consider that more consumers are looking for healthy options. According to the Food Marketing Institute's 2009 survey on trends, 44% of respondents said that their meals cooked at home could be somewhat healthier, 13% said that they could be a lot healthier, and 35% said that they were not healthy enough.7

With those kinds of data, it is hard to argue with Borra-or the fact that any kind of FOP nutrition labeling would be helpful. With that said, almost all researchers and nutrition experts agree that more research is needed to understand which (if any) system will, in the end, work the best and if multiple systems can work harmoniously to provide another valuable tool to consumers in the stay-healthy tool kit.

While academics will measure success with research, food companies will monitor the sales of food products with nutrition logos, according to Douglas Balentine from Unilever. "The front-of-pack logo and authoritative standards will encourage companies to reformulate and innovate so that more products will qualify for the symbol. That's a good thing," he said.

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REFERENCES

1. Nutrition and you: trends 2008 survey, American Dietetic Association. http://Eatright.org/media. Accessed May 18, 2009.

2. Feunekes G, Gortemaker I, Willems A, Lion R, van der Kommer M. Front of pack nutrition labeling: testing effectiveness of different nutrition labeling formats front-of-pack in four European countries. Appetite. 2008;50:57-70.

3. International Food Information Council Foundation. IFIC Foundation food label consumer research project: qualitative research findings summary report. April 2008. http://www.ific.org/research/foodlabelres.cfm. Accessed May 18, 2009.

4. Malan S, Clegg S, Kirwan S, McGinigal S. British Market Research Bureau (BMRB) report: comprehension and use of UK nutrition signpost labelling schemes. May 2009.

5. Katz DL, Njike VY, Faridi Z, et al. The stratification of foods on the basis of overall nutritional quality: the overall nutritional quality index. Am J Health Promot. 2009;24(2):133-143.

6. Kovacs EMR, Dotsch-Kler M, Roodenburg AJC, Balentine DA. Potential impact of nutrient profiling on energy and nutrient intakes in the United States population. Obesity. 2009;17(suppl 2):S165.

7. Food Marketing Institute (FMI) 2009 US Grocery Shopper Trends report.

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Feeding the Clock

When you eat may be just as vital to your health as what you eat, according to a new study. The authors' experiments in mice revealed that the daily waxing and waning of thousands of genes in the liver-the body's metabolic clearinghouse-are mostly controlled by food intake and not by the body's circadian clock, as conventional wisdom had it.

The researchers' findings could explain why shift workers are unusually prone to metabolic syndrome, diabetes, high cholesterol levels, and obesity. In mammals, the circadian timing system is composed of a central circadian clock in the brain and subsidiary oscillators in most peripheral tissues. The master clock in the brain is set by light and determines the overall diurnal or nocturnal preference of an animal, including sleep-wake cycles and feeding behavior. The clocks in peripheral organs are largely insensitive to changes in the light regime. Instead, their phase and amplitude are affected by many factors, including feeding time.

The clocks themselves keep time through the fall and rise of gene activity on a roughly 24-hour schedule that anticipates environmental changes and adapts many of the body's physiological function to the appropriate time of day. Despite its importance, it was not clear whether the circadian rhythms in hepatic transcription were solely controlled by the liver clock in anticipation of food or responded to actual food intake.

To investigate how much influence rhythmic food intake exerts over the hepatic circadian oscillator, the researchers put normal and clock-deficient mice on strictly controlled feeding and fasting schedules while monitoring gene expression across the whole genome. They found that putting mice on a strict 8-hour feeding/16-hour fasting schedule restored the circadian transcription pattern of most metabolic genes in the liver of mice without a circadian clock. Conversely, during prolonged fasting, only a small subset of genes continued to be transcribed in a circadian pattern even with a functional circadian clock present.

For example, genes that encode enzymes needed to break down sugars rise immediately after a meal, whereas the activity of genes encoding enzymes needed to break down fat is highest when we fast. Consequently, a clearly defined daily feeding schedule puts the enzymes of metabolism in shift work and optimizes burning of sugar and fat.

Although the importance of robust metabolic rhythms for our health has been demonstrated by shift workers' increased risk of developing metabolic syndrome, the underlying molecular reasons are still unclear. The researchers speculate that the oscillations serve 1 big purpose: to separate incompatible processes, such as the generation of DNA-damaging reactive oxygen species and DNA replication.

Source: Proceedings of the National Academy of Sciences. 2009;106:21453Y21458.

© 2010 Lippincott Williams & Wilkins, Inc.

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