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Journal of the New Zealand Medical Association, 25-November-2005, Vol 118 No 1226

Decreased red meat fat consumption in New Zealand:
1995–2002

Murray Laugesen

Abstract

Aim To review New Zealand red meat and meat fat supply trends before and after the introduction of the Quality Mark standard.

Methods Review of trends in: per capita meat fat supply estimates from the Food and Agriculture Organization (FAO); carcase and meat cut composition reports of knife dissection and chemical analyses; the fate of fat trim; and a Lincoln College study of home-cooked and trimmed beef.

Intervention From September 1997, the red meat industry’s Quality Mark required trimming of beef and lamb cuts to no more than 5 mm external fat.

Results (1) Trimming of fat from red meat before sale (supported by virtually all butchers) decreased the fat and saturated fat content of a red meat carcase by 30% (beef, -27%; lamb, -30%; tallow unchanged); by -8% in the total food supply; and by -17% across all meat. In 2002, fat comprised 7.4% of trimmed beef cuts, and 11.2% of all beef sold: cuts, mince, or sausages. In 2002, fat comprised 15.3% of lamb cuts; and 15.5% with mince included. (2) From 1995 to 2002, total saturated fat availability per capita in the food supply decreased by 19% (from 65 g to 53 g per day), mostly due to 7 g less saturated fat daily from red meat. (3) When combining effects (1) and (2), saturated fat per capita decreased: -27% in total food supply; -65% in red meat excluding tallow; -48% in red meat including tallow. In 1995 (without trimming), red meat contributed 25% of saturated fat in the total food supply whereas in 2002, red meat contributed 19% before (and 13% after) trimming. (4) Home trimming may remove an additional 27% of fat from beef steaks.

Conclusion Centralised meat processing, and Quality Mark labelling since 1997, ensured fat was trimmed from beef and lamb cuts, and reduced saturated fat in red meats by 30%. In 2002, mince and sausages accounted for nearly half of beef fat sold as red meat.

This study updates meat and meat fat supply trends during 1995–2002, and adjusts for trimming of fat from red meat. It updates Laugesen and Swinburn’s previous paper on meat fat in the food supply:1

Laugesen and Swinburn’s previous paper found high per capita supply of meat fat—In 1995, New Zealand had the highest per capita supply of butter and of meat fats among 24 OECD countries.1 In 1995, red meat (beef and sheepmeat) contributed one-quarter of the total saturated fat in the food supply.1
Food and Agricultural Organization (FAO) data assume a standard fat percentage per carcase—FAO food supply data, based on trade and production data, allow comparison of country food supplies internationally and down through time. Food supply statistics are about meat for sale, but may not account for pre-sale trimming of fat. FAO estimations are expressed in terms of the primary product (unprocessed meat). Since FAO set the original carcase-fat content percentages in 1948, animal breeding, processing, and meat cooking practices have changed considerably.
Food composition data are available for cuts but not for carcases—The FAO definition of beef is based on bone-in weight,3 so that edible beef is 17% less than the beef supply stated in the food balance.4 No carcase analysis of sheep meat since 19784, and of beef since 198612 was obtainable.
Changes at retail and in the national diet—Nutrition surveys (based on 24-hour recall) indicate that total fat as a percentage of energy in the food supply reduced from over 40% in 1977;5 to 37.5% in 1989;6 and to 34.9% in 1997.7 Data for the 1997 survey were collected between December 1996 and November 1997,7 largely before the red meat industry took action to trim fat and label with the Quality Mark standard in September 1997.

The New Zealand Ministry of Health estimated approximately 4700 deaths in 1997 (17% of all deaths) were attributable to higher than optimal total blood cholesterol—a measure driven largely by dietary saturated fat.8 Of these deaths, 87% were due to ischaemic heart disease and 13% due to stroke.8 In 2000, ischaemic heart disease still accounted for 22%, and stroke for 10%, of all deaths.9

Between 1995 and 2000, however, the age-standardised mortality rate for vascular disease (mainly ischaemic heart disease and stroke) at age 35–69 years decreased remarkably, by nearly one-third for men and one-fifth for women.9 Smoking prevalence at age 35 and over in 1995–2000 decreased from 23.3% to 21.3%10—which could not explain such a mortality reduction in both sexes. Meat fat trends merited further study.

The heart-health status of lean red meat—A recent review found that lean red meat was low in saturated fat and (if consumed in a diet low in saturated fats) was associated with reductions in LDL-cholesterol in both healthy and hypercholesterolemic subjects.11 Certainly New Zealanders remain high consumers of red meat (115 g per capita per day in 20022), and leanness of the red meat supply is of public health importance.

Because of these many factors, an updated assessment of red meat fat consumption was overdue. This study focused on meat fat derived from red meat (beef, and lamb), which contributes half of the meat fat in the food supply.

Methods and data sources

Red meat and meat fat definitions—Red meat here includes bovine or sheep meat. Fat from red meat, however, also includes the separable fats—fats (rendered to tallow) removed initially, and the fat discarded later by the butcher.

Food balance data—Data for 1995, 2000, and 2002 for New Zealand were updated from the 2004 versions of the food balance sheets.2 These balance sheets depend on agricultural surveys for estimation of beef and lamb production, surveys which were conducted annually until 1996, then published on the Ministry of Agriculture website for 1999 and 2002. Data for the balance sheets were collated by Statistics New Zealand and provided directly to FAO until 1996 (after which FAO collected its own data from publications and official websites).

Carcase fat content data—As in Laugesen and Swinburn’s previous paper,1 fat estimations were based on FAO data on carcase composition. The most recent large dissection study of beef carcases was in 1981–5.12 To estimate the fat content of meat cuts as sold, the chemical fatcontent in 2002 of each cut, as trimmed to 5 mm fat maximum,13 was multiplied by the weight of each saleable cut itemised in the price per kg for sale records of dressed carcases from a supermarket (J Dawber, Foodstuffs South Island Ltd, Personal Communication, December 2005) and from ‘The Mad Butcher,’ a popular low-cost independent franchise butchers’ chain.14 (These were mostly commercially sensitive data sources.) Beef carcases were described as P grade in 1981, 180 kg beef in 1985, P grade carcase in 1992-4, 206 kg carcase in 1999, and P grade carcase in 2002. Lamb carcases included a 23 kg hogget circa 1985 and 18 kg carcases in 1992 and 2002.

Fat trimming trend—Information relating to meat industry activities was gained from administrators, processors, and retailers. To study the effects of meat trimming and processing apart from farm and breeding effects, the fat content of the meat for sale from a 1992 beef carcase (23% fat in the edible carcase) was compared with the same grade and weight of carcase in 2002 (26% fat in the edible carcase).

Trend in saturated fat in total diet—The estimated fat content of fat-trimmed versus untrimmed beef and sheepmeat, derived as above, were entered into the Health New Zealand Ltd international food and nutrition database (HNZifn),1 a spreadsheet that enabled estimation of the effect of trimming meat to various fat content percentages, on saturated fat supply, while holding meat supply data unchanged.

HNZifn contains over 70 FAO food categories,2 uses British food composition tables,4and over 110 nutritional descriptors to estimate food and nutrition supply per capita. Fat content per 100 g of edible portion was listed as: 22.0 g for beef, 27.5 g for sheepmeat, and 93 g for animal fat (beef fat). Saturated fat content was listed as 6.75 g, 14.72 g, and 41.8 g respectively.

Fat loss in cooking and eating—To establish how much meat fat New Zealand consumers actually ate within the home, we reviewed a Lincoln University study of 191 pairs (one fatty, one already trimmed) of beef steaks for home cooking. Participants were asked to pan fry their steaks, collect all the fat trimmed, and note any fat added during cooking. They also collected any fat trimmed after cooking—i.e. plate waste. Fat was estimated by imaging, which correlated well with chemical measurements.15

The intervention—The Quality Mark (Table 2) was introduced by the Beef and Lamb Marketing Bureau and the red meat industry in September 1997 for beef and lamb. Abbatoirs supplied primary cuts to retail butchers who then trimmed the cuts for retail sale to no more than 5 mm of external fat (equivalent to 90% lean and 10% fat by chemical analysis). Consumers supported this move. Intermuscular fat may be removed but intramuscular fat is retained for taste reasons.

In 2004, the two main suppliers to the New Zealand market sold 97% of their beef and lamb cuts under the Quality Mark (H Bayliss, Land Meat New Zealand Ltd and D McClenaghan, Auckland Meat Processors; personal communication; December 5, 2004). The Mad Butcher chain also used Quality Mark. The few rural home-kill butchers were not part of this scheme. In 2000–2004, over 90% of all beef and lamb cuts (especially steaks and chops) were probably sold under Quality Mark, or dressed to an equivalent fat trim. Quality Mark does not include processed meats such as luncheon meat, nor mutton, cow, or bull meat.

Table 1. Changes in the fat content of red meat products consumed since 1997

Pre-1997	% Fat*	Since 1997	% Fat*
Beef, carcase 1981-512 Lamb, carcase, UK 19784	23.3 30.5	Beef carcase, trimmed, 2002 Lamb carcase, trimmed, 2002	7.1 15.5
Sausages 1995 (one major supplier)	25–30	Food Standards Code 2002	<25
Sausages 1995 (one major supplier)	25–30	Two supermarkets, 2004	3–23
Mince, UK, 19783	16.2	Quality Mark mince 1997	<10
Sirloin roast lean and fat3 Topside roast lean and fat3	21.1 12.0	Cooked beef steaks, as eaten, trimmed at home; grilled. 2003.14	4–8

*As percentage of the edible carcase or product. Assumes no trimming of fat prior to sale before 1997.

Results
Changes in the fattiness of retailed meat

Saleable beef as a percentage of the carcase weight, declined from 67% in the 1981–5 survey12 to 63% in the 2002 carcase. No trend in the fat trimmed off was discernable from the few cutting records obtainable. Fat as a percentage of the meat sold (including cuts, mince and sausages) remained steady across the cutting records studied—at 6.8% in 1992, 7.1% in 1999, 7.1% in 2002—although the grade and breed were not stated.

Two typical heifer half carcases (of 100 kg within the same grade) ten years apart, processed by the same organisation using the same cuts were butcher dissected. The 2002 carcase yielded 63.2 kg (7.6 kg less) saleable meat, comprising 19 kg (7.3 kg more) mince, 1.6 kg (4.0 kg less) for sausages, with 13.0 kg (1.7 kg more) fat left over, and 2.5 kg more bone and waste.

Meat sold as chuck steak, for example, reduced from 6.23 kg to 4.45 kg, thus indicating greater trimming of fat. The 1.7 kg net reduction in fat retained for sale (as meat cuts, mince, or sausages) in the 2002 half-carcase was equivalent to 9.4% of the total carcase fat (trimmable or not) in 1992.

Meat cuts

In 2002, chemical fat content per 100g edible portion in beef cuts (trimmed to a 5 mm fat margin) varied from 2% fat (topside) to 11% (sirloin), thus averaging around 6% fat.13 Lamb cuts varied from 7% fat (lamb shoulder lean) to 28% fat (lamb shoulder chop trimmed to 5 mm fat).13

Mince

Mince, whether made from butchers’ meat trimmings or from mutton, must contain less than 10% fat to qualify for the Heart Foundation’s ‘Pick the Tick’ program or a Quality Mark. Most mince sold in the shops inspected made no such claims, and tested at 20% fat.13

Sausages

The Food Standards Code, introduced at the end of 200216 required sausages to contain no more than 33% fat. A major sausage supplier said their sausages were 25%-30% fat in 1995, whereas voluntary labelling listed fat content between 12% and 18% fat. Fat content labelling is voluntary, but should be accurate. Some brands did not state any fat content. Other brands were labelled at 3.4% and 23% fat, commonly 16% fat. Heart Foundation’s ‘Pick the Tick’ required less than 10% fat content, but even without the tick, some brands were labelled as 11% fat.

Processed meat

The Quality Mark scheme excludes processed meats such as sausages and luncheon meat. The Code requires that meat products be true to their name, so that a steak and kidney pie must state that it contains no less than 25% steak and kidney, although there is no fat maximum. Processed meat must contain no less than 30% meat.

Offal

FAO estimated offal supply per capita in 2002 at 14.0g including 0.4 g fat.2 Kidneys contain 3% fat, but processors now package liver and kidney fat-free to retailers.

The fate of meat fat

Fat sold in meatcuts, mince, or sausages—Of a 100 kg side of dressed beef carcase in 2002, 24 kg was inedible bone, 13.0 kg fat was discarded, and 63.1 kg was saleable meat containing 7.1 kg fat comprising:

3.1 kg fat left in (or on) 42.5 kg of trimmed meat cuts (7% fat);
An estimated 0.2 kg fat in 1.6 kg sausages (12.5% fat);
3.7 kg fat in 19 kg of mince (20% fat).

Fat formed 7.4% of the weight of the meat cuts, and 11.2% of the 63.1 kg of meat sold. In this carcase, more fat went into mince and sausages that was sold in meat cuts.

Raw animal fat—According to FAO food balance sheets, under half of the raw knife-separable animal fats retained for domestic supply in 2002 entered the food supply, providing 14.6 g of fat per capita per day,2 mostly from beef. The amount of beef fat returned to the food supply (apart from fat in sausages and mince) amounted to 27% by weight of the weight of beef sold as cuts, sausages or mince. Tallow from sternal, kidney, channel, or omental fat deposits (which are easier to render into edible tallow) is used for making cooking margarine, dripping (used in frying oils), and baked goods. Inedible tallow is used for soap. Sheep fat has a characteristic odour limiting its inclusion with other animal fats for food.

Fat trim was either sold to tallow or by-product companies. Small independent butchers were restricted by Food Standards Code16 as to the permitted fat content in sausages, burgers, and processed meats.

Meat fat supply trends

As Table 2 shows, from 1995 to 2002, total fat per capita entering the food supply from meat and meat products in total declined 16% (from 76.1 g a day in 1995 to 64.3 g in 2002), whereas fats from red meat declined 27% (from 59.0g in 1995 to 42.9g in 2002). In contrast, fats of white meat origin (pork, bacon, ham, poultry) increased, from 13 g to 19 g. These changes reflected changes in the meat supply, without allowing for any change in the fattiness of each class of meat.

Carcase composition trends

Lamb and mutton

From 1997 onwards, meat cuts were sold with less fat attached. From 1948, FAO estimated the bone-in carcase to be 22.8% fat; which at 83% edibility4 would equate to 27.5% fat. This increased to 30.5% fat for a dressed bone-out UK carcase in 1978.4

In the 2002 lamb carcase of 18 kg, and based on chemical analysis of the cuts, half (50%) of the fat was trimmed off and half sold as meat (including mince and sausages). Total fat content of the edible carcase was 26.7% and (of the portions sold in 2002) fat was estimated at 15.5%. According to the data, the fattiness of the sheepmeat carcase has changed little in 25 years, but 42% of sheepfat is now discarded.

Beef

In 1948, FAO estimated that an average (untrimmed) dressed beef carcase contained 18% fat. Based on 83% edibility,4 this would equate to 22% of the edible dressed carcase. In 1978, British tables found that fat comprised 24.3% of the edible dressed carcase weight. In 1981–5, for a P grade heifer, knife-separable fat was 17%, and non-separable fat 10% of the lean (by visual estimate).12

In the 1999 butcher-trimmed beef carcase14 edibility was 82% of the dressed carcase. Meat cuts with fat trimmed, mince, and sausages comprised 72% of the dressed carcase and bone was 16%. Total fat was 20% of the dressed carcase (12.5% discarded, plus 7.5% sold on, or in the meat cuts, or in mince and sausages). Fat content of a beef carcase was only 2 percentage points less than half a century before.1

Of the trimmed and discarded fat that comprised 12.5% of the carcase weight, less than half would have reappeared as edible tallow,2 whereas 72% of the dressed carcase was sold as meat. If meat cuts, mince, and sausages were all included, estimated fat content of the edible dressed beef carcase (as prepared for sale at retail in 2002) was 11.2%. For 2002, FAO estimated a daily per capita supply of 59.3 g beef (of which 3.9 g was fat) and 15.4 g of raw beef fat (mostly tallow).2

Trends in fat and saturated fat of the food supply (Tables 2 and 3)

With respect to meat fat, after combining food composition and FAO food supply data for 2002 in the Health New Zealand database1 without allowing for trimming of meatfat, per capita daily supply was estimated at 13.0g beef fat, 14.6 g separable fat, 15.3 g lamb or mutton fat, 9.7 g pig fat, 11.1g poultry fat, and 0.6 g game fat—a total of 64.3 g meat fat.2 (Table 2).

After trimming of fat in 2002, 11.2% of the meat from a dressed (bone-in) beef carcase, and 15.5% of the meat from a lamb carcase (trimmed, cut and presented for sale at retail) was fat.14 For beef, the 11.2% value allowed for fat sold as mince or sausages, which accounted for 46% of the beef fat sold.

Based on the 11.2% fat content of beef and the 15.5% fat content of lamb after trimming as estimated above, and not counting separable fats, we estimated that in 2002 trimming of fat nearly halved the fat sold as red meat: from 28.3 g of fat per capita per day untrimmed, to 15.2 g fat per day trimmed (Table 2); and from 12.2 g of saturated fat per day untrimmed to 6.6 g fat per day trimmed (Table 3).

Saturated fat consumption decreased by 12 g between 1995 and 2002 (from 65.3g to 53.2g; 19%); most of this decrease was due to decreased red meat supply causing a 7 g decrease in saturated fat. (Table 3)

Table 2. Meat fat supply per capita in New Zealand in 1995–2002, adjusting for trimming of red meat cuts

Variable	Untrimmed			After Trimming
Variable	1995	2000	2002	2002
Red meat fats Beef fat Separated animal fat Mutton fat	23.8 13.0 22.2	15.7 14.4 14.4	13.0 14.6 15.3	6.6 14.6 8.6
White meat fats Pig meat Poultry	7.9 8.3	9.0 9.6	9.7 11.1	9.7* 11.1*
Other meat fats Game, offal	0.9	0.6	0.6	0.6
Total meat fats Red meat fat fraction	76.1 0.78	63.9 0.69	64.3 0.66	51.2 0.58

*Unadjusted.
Source: Health New Zealand food and nutrition database, based on FAO meat supply data, and FAO percentage fat estimates for the carcase, after allowing for inedible fractions. Raw animal fat (tallow) is estimated as 93% fat, and assumed to be all from beef.

Between 1995 and 2002, combining the change to trimming of red meat fat with a decreased red meat supply (Table 3), saturated fat sold as beef, mince, or sausages declined 72%, and sold as lamb, declined 61%. In the total food supply overall, saturated fat reduced 27% after allowing for both the reduced supply of red meat and the increased leanness of red meat cuts sold (Table 3).

Ulbricht and Southgate’s17 atherogenicity index in the 2000 and 2002 food supply, based on the balance of fats in the total diet, was unchanged by trimming, but the thrombogenicity index,17 was 3% to 4% lower.

Changes in the amount of trimming of fat at home after purchase

In 1990 (and again in 1997) approximately two-thirds of consumers said they trimmed fat from their meat6 7 though to an unknown extent. In a 2003 Lincoln University study, 191 consumers were each asked to cook one already-trimmed and one untrimmed steak; participants knife-trimmed the fat before or after cooking. An average lean steak lost 70% of its fat in cooking, and a fatty steak lost about 60%, mostly due to home trimming. After frying or grilling, average fat content was 9.5g of fat per 100g of porterhouse steak, but this varied according to the fattiness of the steak. A fatty steak (24–39% fat) resulted in 13.0 g fat per 100 g as eaten whereas a lean steak (14%–23% fat) resulted in 5.5g of fat per 100g steak as eaten.18

Discussion

Principal findings

The fattiness of the beef or lamb carcase appears to have changed little over half a century, but in 2002, 30% of the total fat from a red meat carcase was discarded before sale. Less meat in the food supply and reductions in the fattiness of red meat available for sale, combined to reduce meat fat from red meat (excluding tallow) in the food supply by 65% between 1995 and 2002. Including tallow, the reduction was 48%.

Per capita supply of beef and sheep meat decreased by 36% between 1995 and 2002. Assuming no change in the fattiness of red meat, then the supply of fat and saturated fat from red meat also decreased in this proportion.

If, however, we also adjust for the trend to knife-trimming of fat from meat by processing butchers, then meat fat and saturated meat fat from red meat decreased by a further 29%. The Heart Foundation had urged trimming of meat fat since its first Food Festival campaign in 1987. In the 1990s two-thirds of consumers said they trimmed fat from meat.6 7 From 1997, the industry’s Quality Mark, (requiring central processors and supermarket chains to trim to 5 mm fat) ensured that leaner cuts became the norm for virtually everyone buying meat as steaks or chops.

The Lincoln College consumers study highlights the importance of pre-sale trimming, and the advantages of an industry-wide change to make this happen, rather than relying only on health education of consumers. Although 87% of consumers were sufficiently concerned to trim meat fat at home, those cooking pre-trimmed steaks ate much less fat than those eating untrimmed steaks (5.5 g versus 13.0 g per 100 g edible beef).

We estimated the approximate additional effect of home trimming of beef to be a 26% reduction in fat, (from 7.4% average fat for meat cuts estimated for the 2002 side of beef to 5.5% achieved in this home cooking study), as the ‘lean’ steaks in the home cooking study were fattier than the 2002 side of beef.

The fat content of most mince and sausages is higher than in most meat cuts. The main factors now affecting meat fat consumption are the ratio of mince and sausages to meat cuts, and the fat content of mince and sausages—for which fat labelling is voluntary.

How the findings compared with other sources

For 2002, FAO estimated 59.3g of beef, and 55.7g of sheepmeat per person per day in the food supply, besides 15.4g of separated fat (mainly tallow). This study estimated 29.4g of fat per person per day after trimming: 6.6g in beef, 8.6 g fat in sheepmeat, and raw fat 14.2g. FAO estimated fats from red meats totalling 33.8g per person per day: 3.9g in beef, 14.5g in sheepmeat, the rest being raw fat.2 For 2002, the FAO-compiled data were consistent with the trimming of fat from beef but not from sheepmeat.

Strengths and weaknesses of the study

New Zealand-derived food composition data tables13 described most cuts of meat. For a few cuts of unknown composition we conservatively assumed 10% fat content after trimming. Few cutting records of carcases with which to assess trimming trends were obtainable, making it difficult to distinguish time trends from individual carcase variation.

In 2002, an estimated 5.5 g of saturated fat (Table 3) and 13.1 g of total fat per capita per day (Table 2) were trimmed off total meat due to trimming of red meat. If white meats were also trimmed, then the 19% reduction in saturated fat in the total diet due to red meat (Table 3) is an underestimate. If the coverage of the Quality Mark was only 80%, then the reduction in fat is correspondingly reduced; however the mark has made trimming of fat the norm.

The annual FAO food balances, begun in 1961, were collated by Statistics New Zealand up until 1996. It is unclear if FAO statistics reflect all the changes in meat processing. For example, the fat composition data of trimmed cuts for this study require purchase10 and may not have been electronically available to the FAO.

The way forward

Red meat cuts as sold have undoubtedly become leaner in recent years. The meat industry monitors the end product, but there is as yet no statistical system to report back this achievement to the consumer.

The Quality Mark scheme applies to almost all red meat, and merits formal on-going monitoring, with the results published annually based on methods such as:

Random checks of the fat content of mince and sausages; and
Monitoring of the ratio of sold weight of mince and sausages to total meat cuts, using sentinel stores or other means.

The actual data and formulae used by FAO in calculating meat and meat fat balances for New Zealand should be monitored by and transparent to New Zealand producers and health groups, so that the data and can be interpreted correctly by all concerned.

Further improvements are occurring. In 2004, one supermarket chain in 2004 introduced central processing and distribution of retail cuts ready for sale, enabling tighter control of fat content. In 2005, closer trimming of fat on all red meat cuts was under consideration.

In summary, the Quality Mark applies to virtually all red meat sold and further improvements are possible. Trimming of red meat before sale has decreased the fattiness of red meat (cuts, mince, sausages, plus separable fat) by 30%. From 1995 to 2002, coupled with a decreased red meat supply saturated fat per capita from red meat decreased 65%.

What this paper adds

The fat composition of the beef and lamb carcase has remained much the same for half a century, but red meat cuts as sold are now 30% leaner, following on from the introduction of a Quality Mark standard and industry-wide pre-sale trimming of red meat cuts in 1997.

In 2002, after trimming, a dressed beef carcase (cuts, mince, and sausages as sold) averaged 11% fat, and a lamb carcase 15%.

Home trimming of meat fat after purchase may have further decreased saturated fat consumption.

Author information: Murray Laugesen, Public Health Physician, Health New Zealand Ltd, South Auckland

Acknowledgements: This work was supported by the New Zealand Beef and Lamb Marketing Bureau.

Correspondence: Dr Murray Laugesen, 23 Keven Rd, RD 4, Pukekohe 1800, South Auckland. Tel (0274) 884 375; email: laugesen@healthnz.co.nz

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