Characteristics of Allergen Labelling and Precautionary Allergen Labelling in Packaged Food Products Available in Latin America

The characteristics of food allergen labelling are relevant for avoiding accidental exposure to the allergens of interest but no Latin American country has evaluated these characteristics. Our aim was to evaluate the characteristics of food allergen labelling and precautionary allergen labelling (PAL) in six Latin American countries. All data were collected directly from the supermarkets surveyed. A total of 10,254 packaged food products were analyzed, of which 63.3% (n = 6494) and 33.2% (n = 3405) featured allergen labelling and/or PAL, respectively. Most products complied with local regulations (≥87.4% for both locally produced and imported). Thirty-three types of PAL statements were detected; the most frequent was “may contain traces of…” (35.1%). Countries without regulations on the characteristics of allergen labelling had two-fold more products that contained allergens in their ingredients lists but no food allergen labelling. The use of PAL in countries that regulate it (38.2%) was as high as that in countries without PAL regulations (19.2%–44.7%). The findings suggest that the lack of regulations for the characteristics of allergen labeling increases the risk of accidental exposure to allergens of interest. Our findings also suggest that beyond regulations, a scientific approach is required for minimizing and standardizing the use of PAL.

Calorie and nutrient trends in large U.S. chain restaurants, 2012-2018

INTRODUCTION

Large chain restaurants reduced calories in their newly-introduced menu items from 2012 to 2015. The objective of this study was to provide updated calorie trends through 2018 and examine trends in the macronutrient composition of menu items across this time period.

METHODS AND FINDINGS

Data were obtained from the MenuStat project and include 66 of the 100 largest revenue generating U.S. chain restaurants (N = 28,238 items) that had data available in all years from 2012 to 2018. Generalized linear models were used to examine per-item calorie and nutrient changes (saturated fat, trans fat, unsaturated fat, sugar, non-sugar carbohydrates, protein, sodium) among (1) items on the menu in all years (common items) and (2) newly introduced items (2013-2018). Overall, there were no significant changes in calories or nutrients among common items from 2012 to 2018. Among all newly introduced items, calories (-120 kcals, -25%, p = 0.01; p-for-trend = 0.02), saturated fat (-3.4g, -41%, p<0.01, p-for-trend = 0.06), unsaturated fat (-4.5g, -37%, p = 0.02; p-for-trend = 0.04), non-sugar carbohydrates (-10.3g, -40%, p = 0.02, p-for-trend = 0.69), and protein (-4.3g, -25%, p = 0.04, p-for-trend = 0.02) declined.

CONCLUSION

Newly introduced menu items in large chain restaurants have continued to decline in calories through 2018, which may help to reduce calorie intake. Other changes in macronutrient content were sporadic and not clearly toward improved dietary quality.

Growing the Business of Whole Grain in the Australian Market: A 6-Year Impact Assessment

The Australia New Zealand Food Standards Code does not regulate on-pack claims describing the amount of whole grain in foods. In July 2013, The Grains & Legumes Nutrition Council^™ (GLNC) established a voluntary Code of Practice for Whole Grain Ingredient Content Claims (the Code) providing guidance for whole grain claims, with cut-off values and suggested wording ≥8 g, ≥16 g, and ≥24 g per manufacturer serve (contains; high and very high in whole grain), based on a 48 g whole grain daily target intake. The aim of this impact assessment was to report the uptake of the Code by manufacturers, changes in numbers of whole grain products, and claims on-pack since 2013, including compliance. The impact assessment was undertaken in August 2019, comparing current registered manufacturers (“users”) and their products to the total number of products in the market deemed eligible for registration through GLNC product audits since 2013. Reporting included breakfast cereals, bread products, crispbreads, crackers, rice/corn cakes, rice, pasta, noodles, couscous, other grains (e.g., quinoa, buckwheat, freekeh), and grain-based muesli bars. As of 30 June 2019, there were 33 registered users and 531 registered products in Australia and New Zealand representing 43% of the eligible manufacturers and 65% of the eligible whole grain foods. Three-quarters (78% and 74%) of the eligible breakfast cereals and bread products were registered with the Code in 2019, followed by 62% of grain-based muesli bars. Only 39% of crispbread, crackers, rice/corn cakes, and rice, pasta, noodles, couscous, and other grains were registered. From 2013 there has been a 71% increase in the number of whole grain foods making claims, demonstrating strong uptake by industry, with clearer, more consistent, and compliant on-pack communication regarding whole grain content.

Smart food policy for healthy food labeling: Leading with taste, not healthiness, to shift consumption and enjoyment of healthy foods

Smart food policy models for improving dietary intake recommend tailoring interventions to people's food preferences. Yet, despite people citing tastiness as their leading concern when making food choices, healthy food labels overwhelmingly emphasize health attributes (e.g., low caloric content, reductions in fat or sugar) rather than tastiness. Here we compared the effects of this traditional health-focused labeling approach to a taste-focused labeling approach on adults' selection and enjoyment of healthy foods. Four field studies (total N = 4273) across several dining settings in northern California in 2016-2017 tested whether changing healthy food labels to emphasize taste and satisfaction rather than nutritional properties would encourage more people to choose them (Studies 1-2), sustain healthy purchases over the long-term (Study 3), and improve both the perceived taste of and mindsets about healthy foods (Study 4). Compared to health-focused labeling, taste-focused labeling increased choice of vegetables (OR = 1.73, 95% CI: 1.32, 2.26), salads (OR = 2.06, 95% CI: 1.06, 4.06), and vegetable wraps (OR = 3.09, 95% CI: 1.73, 5.65) in Studies 1-2. In Study 3, taste-focused labeling sustained vegetarian entrée purchases over a two-month period, while health-focused labeling led to a 45.1% decrease. In Study 4, taste-focused labeling significantly enhanced post-consumption ratings of vegetable deliciousness and improved mindsets about the deliciousness of healthy foods compared to health-focused labeling. These studies demonstrate that taste-focused labeling is a low-cost strategy that increased healthy food selection by 38% and outperforms health-focused labeling on multiple smart food policy mechanisms.

A New Age of Evolution: Protecting the Consumer's Moral and Legal Right to Know through the Clear and Transparent Labeling of All Genetically Modified Foods

The United States government, until recently, did not require the labeling of genetically modified organisms (GMOs). On July 29, 2016, President Barack Obama signed into law the National Bioengineered Food Disclosure Standard (NBFDS). This law directs the United States Department of Agriculture (USDA) to create regulations that require manufacturers to disclose certain bioengineered products on food labels. On December 20, 2018, the USDA released the final regulations for the NBFDS, which requires food manufactures, importers, and certain retailers to ensure bioengineered foods are appropriately disclosed. The final regulations include provisions that will leave the majority of GMO derived foods unlabeled. The final regulations also restrict approximately 100 million Americans from accessing GMO information by allowing QR codes to replace clear and transparent labeling, an issue that will be discussed in further detail later in this Note. This Note explores why you, as a consumer, may want to know whether your food contains GM products, and furthermore, why you as a consumer have a moral and legal right to know.

Changes in the nutritional quality of fast-food items marketed at restaurants, 2010 v. 2013

OBJECTIVE

To examine the nutritional quality of menu items promoted in four (US) fast-food restaurant chains (McDonald's, Burger King, Wendy's, Taco Bell) in 2010 and 2013.

DESIGN

Menu items pictured on signs and menu boards were recorded at 400 fast-food restaurants across the USA. The Nutrient Profile Index (NPI) was used to calculate overall nutrition scores for items (higher scores indicate greater nutritional quality) and was dichotomized to denote healthier v. less healthy items. Changes over time in NPI scores and energy of promoted foods and beverages were analysed using linear regression.

SETTING

Four hundred fast-food restaurants (McDonald's, Burger King, Wendy's, Taco Bell; 100 locations per chain).

SUBJECTS

NPI of fast-food items marketed at fast-food restaurants.

RESULTS

Promoted foods and beverages on general menu boards and signs remained below the 'healthier' cut-off at both time points. On general menu boards, pictured items became modestly healthier from 2010 to 2013, increasing (mean (se)) by 3·08 (0·16) NPI score points (P<0·001) and decreasing (mean (se)) by 130 (15) kJ (31·1 (3·65) kcal; P<0·001). This pattern was evident in all chains except Taco Bell, where pictured items increased in energy. Foods and beverages pictured on the kids' section showed the greatest nutritional improvements. Although promoted foods on general menu boards and signs improved in nutritional quality, beverages remained the same or became worse.

CONCLUSIONS

Foods, and to a lesser extent, beverages, promoted on menu boards and signs in fast-food restaurants showed limited improvements in nutritional quality in 2013 v. 2010.

Barriers and facilitators to implementation of menu labelling interventions to support healthy food choices: a mixed methods systematic review protocol

BACKGROUND

Menu labelling is continuing to gather public and legislative support as one of the potential environmental strategies for addressing the obesity pandemic. However, issues relating to implementation have been reported in countries where menu labelling has been introduced on a voluntary or mandatory basis. The aim of this mixed methods systematic review is to synthesise the empirical evidence on the barriers and facilitators to implementation of menu labelling interventions to support healthy food choices.

METHODS

This review will use the 'best fit' framework synthesis approach to synthesise qualitative, quantitative and mixed methods evidence. Peer-reviewed publications will be accessed through PubMed, EMBASE, CINAHL, PsycINFO, Web of Science and Scopus. Grey literature will be accessed through Google Scholar, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies will be undertaken. There will be no restriction on menu labelling scheme or format, publication year or language; however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. At least two independent reviewers will perform study selection, data extraction and quality appraisal; if consensus is required, another independent reviewer will be consulted. A combination of deductive coding, using the Consolidated Framework for Implementation Research as the a priori framework, and inductive analysis, using secondary thematic analysis, will be used. The overall process will assist in the construction of a new evidence-based conceptual model regarding the implementation of menu labelling interventions. The new model will be assessed for bias and a sensitivity analysis performed.

DISCUSSION

Given the growing consensus that a systemic, sustained portfolio of obesity prevention strategies, delivered at scale, is needed to address the obesity epidemic, greater understanding of the practical issues relating to implementation of such strategies is required. Findings from this review will be used to develop a set of best-practice guidelines to enhance the adoption, implementation and sustainability of menu labelling interventions across countries worldwide.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017083306.

Making food labels social: The impact of colour of nutritional labels and injunctive norms on perceptions and choice of snack foods

Recent studies report that using green labels to denote healthier foods, and red to denote less healthy foods increases consumption of green- and decreases consumption of red-labelled foods. Other symbols (e.g. emoticons conveying normative approval and disapproval) could also be used to signal the healthiness and/or acceptability of consuming such products. The present study tested the combined effects of using emoticons and colours on labels amongst a nationally representative sample of the UK population (n = 955). In a 3 (emoticon expression: smiling vs. frowning vs. no emoticon) × 3 (colour label: green vs. red vs. white) ×2 (food option: chocolate bar vs. cereal bar) between-subjects experiment, participants rated the level of desirability, healthiness, tastiness, and calorific content of a snack bar they had been randomised to view. At the end they were further randomised to view one of nine possible combinations of colour and emoticon labels and asked to choose between a chocolate and a cereal bar. Regardless of label, participants rated the chocolate as tastier and more desirable when compared to the cereal bar, and the cereal bar as healthier than the chocolate bar. A series of interactions revealed that a frowning emoticon on a white background decreased perceptions of healthiness and tastiness of the cereal bar, but not the chocolate bar. In the explicit choice task selection was unaffected by label. Overall nutritional labels had limited effects on perceptions and no effects on choice of snack foods. Emoticon labels yielded stronger effects on perceptions of taste and healthiness of snacks than colour labels. Frowning emoticons may be more potent than smiling emoticons at influencing the perceived healthiness and tastiness of foods carrying health halos.

Consumers believe nutrition facts labeling for added sugar will be more helpful than confusing

OBJECTIVE

Consumer beliefs regarding the usefulness of information about added sugars proposed for addition to the Nutrition Facts panel on U.S. food labeling were assessed.

METHODS

A representative sample of 500 U.S. adults was recruited in July 2014 for an anonymous, voluntary online survey. Respondents were shown a Nutrition Facts panel with added sugars included and were asked how helpful or confusing the added sugars information would be and why. A 5-point scale captured responses about helpfulness, and reasons were captured as free text. Descriptive statistics were calculated and multi-linear regression performed to determine whether any demographic variables were statistically significant predictors of survey responses.

RESULTS

A clear majority (63%) of respondents indicated that knowing the amount of added sugar in a food product would be helpful. Relatively few (18%) thought it would be confusing. None of the demographic variables were statistically significant, with the exception of gender. Being female was a statistically significant predictor of how helpful the information was perceived to be (P < 0.03).

CONCLUSIONS

Most consumers believed food labeling for added sugars will be more helpful than confusing.

Food labels, autonomy, and the right (not) to know

Food labelling has been overlooked in the emerging body of literature concerning the normative dimensions of food and drink policies. In this paper, I argue that arguments normally advanced in bioethics and medical ethics regarding the "right to know" and the "right not to know" can provide useful normative guidelines for critically assessing existing and proposed food labelling regimes. More specifically, I claim that food labelling ought to respect the legitimate interests and the autonomy of both consumers who seek knowledge about their food in order to make informed dietary choices and consumers who prefer to remain ignorant about the contents and effects of their food in order to avoid the emotional and psychological harm, or more simply the loss of enjoyment, which may result from receiving that information.

Food labels, genetic information, and the right not to know

Many people believe that individuals have a right not to know their genetic disease risk. Here it is argued that, if this is correct, individuals also have a right not to know their diet-related disease risk. Reasons to remain ignorant are analogous in the case of risk related to diet and genetic susceptibilities. It follows that any policy to promote healthy diets (e.g. through "judgmental" food labels, such as traffic light labels, or, hypothetically, scary pictures similar to those found in cigarette packets) ought to protect the individual right not to know.

New nutritional composition data on selected traditional foods consumed in Black Sea Area countries

BACKGROUND

Traditional foods are an important part of the culture, history, identity and heritage of a region or country and are key elements in dietary patterns. In most countries there is limited information on the nutritional composition of such foods and therefore there is a need to investigate, register and promote traditional foods. One of the aims within the 'Sustainable exploitation of bioactive components from the Black Sea Area traditional foods' (BaSeFood) project is to generate for the first time new data on the nutritional composition of traditional foods from six Black Sea Area countries to promote their sustainable development and exploitation.

RESULTS

Thirty-three traditional foods were analysed in an accredited laboratory to determine their nutritional composition, and the data were fully documented. The nutrient content varied widely because of the nature and variety of the analysed foods. The energy content ranged between 4 kcal per 100 g for kvass southern and 900 kcal per 100 g for mustard oil, with the exception of the analysed teas, which did not contribute to energy intake.

CONCLUSION

The use of a common methodology for the study of traditional foods will enable countries to further investigate these foods. Moreover, a new nutritional knowledge base of traditional foods from Black Sea Area countries will contribute to promote local biodiversity and sustainable diets by maintaining healthy dietary patterns within local cultures.

Nourishing change. Partnership enlists dozens of hospitals to put healthier food on their menus and kick junk food out of the cafeteria

More than 150 hospitals have signed on to the Partnership for a Healthier America's push to ditch the deep-fat fryer in their cafeterias and bulk up on fruit and veggies. "Our focus is to ensure that if people want to make a healthy choice, they can," says Larry Soler, left, president and CEO of the partnership, which is working to reduce childhood obesity.

Use of nutritional information in Canada: national trends between 2004 and 2008

OBJECTIVE

To examine longitudinal trends in use of nutrition information among Canadians.

DESIGN

Population-based telephone and Internet surveys.

SETTING AND PARTICIPANTS

Representative samples of Canadian adults recruited with random-digit dialing sampling in 2004 (n = 2,405) and 2006 (n = 2,014) and an online commercial panel in 2008 (n = 2,001).

MAIN OUTCOME MEASURES

Sociodemographic predictors of label use, use of nutrition information sources, and nutrient content information.

ANALYSIS

Linear and logistic regression models to examine predictors and changes over time.

RESULTS

Food product labels were the most common source of nutritional information in 2008 (67%), followed by the Internet (51%) and magazines/newspapers (43%). The Internet was the only source to significantly increase during the study period (odds ratio = 1.39; P < .001); however, the frequency of reading food product labels increased since 2004. Food selection based on trans fat increased significantly in 2006 (odds ratio = 1.43; P < .001) after mandatory labeling of trans fat on packaged foods. Taste and nutrition were consistently the primary factors guiding food choice.

CONCLUSIONS AND IMPLICATIONS

Food product labels and the Internet are nutrition information sources with broad reach. More comprehensive labeling regulations were associated with increased use of labels and nutrient information over time.

Regulatory environment and claims - limits and opportunities

During the past decade, the use of claims became more and more important in many countries in relation to the increased awareness of consumer about the link between foods and health, offering to industry a valuable opportunity to differentiate and valorize their products and to promote innovation. However, more and more stringent regulations are developed, all based on the general principles adopted by the Codex Alimentarius Commission. In addition to the different regulatory processes and administrative requirements according to the country, the high level (and cost) of scientific substantiation of claims, the constraints introduced by nutrient profiles and the poor knowledge of the impact on consumer depending on the cultural contexts may limit these opportunities or, at least complicate their use. All these issues are briefly analyzed, highlighting some striking convergences and differences between countries.

[Supervision of foods containing components of genetically modified organisms and the problems of labeling this type of products]

Commercial production of genetically modified (GM) crops as food or feed is regarded as a promising social area in the development of modern biotechnology. The Russian Federation has set up a governmental system to regulate the use of biotechnology products, which is based on Russian and foreign experience and the most up-to-date scientific approaches. The system for evaluating the quality and safety of GM foodstuffs envisages the postregistration monitoring of their circulation as an obligatory stage. For these purposes, the world community applies two methods: enzyme immunoassay and polymerase chain reaction. It should be noted that there are various approaches to GM food labeling in the world; this raises the question of whether the labeling of foods that are prepared from genetically modified organisms, but contain no protein or DNA is to be introduced in Russia, as in the European Union.

Brain food: bringing psychological insights to bear on modern nutrition labeling efforts

Food and drug law presents legislators and policy makers with a powerful tool to inform individual dietary decisions and improve public health: mandatory nutritional labeling. Most Americans report that they consult nutritional information when making food purchases; yet, knowing whether individuals report consulting nutritional information is different than knowing how they actually process and utilize that information. Although the latter question is more difficult to answer, it holds the key for efficient and effective food labeling. This article argues that psychological research can answer that question. It does so by explaining well-established psychological findings that have the greatest potential application to food labeling efforts. It then examines two recent nutritional labeling initiatives from a psychological lens, illustrating how well each initiative reflects findings from the field. By doing so, this paper aims to help government regulators and private businesses develop more targeted and effective labeling initiatives.

[Health and nutrition claims made on food: what future?]

The number of foods bearing health and nutrition claims is growing in line with consumers' expectations. This market offers attractive prospects of profit for industry and commerce. The question is whether such foods really have health effects, and whether the general population or specific groups really benefit from their use. Specific regulations are needed to define the conditions of validation, communication and follow-up of such claims. The European Community's internal market is currently governed by a fragmented set of regulations and enforcement systems. Member states' national regulations differ in substance and application. For these reasons, the European Commission is seeking to create and adopt a common regulation. The following article considers the main stakes relating to consumers' health expectations, public health, and industrial and commercial interests, together with the origins of the concept of "functional foods". In contrast to the 'product based' approach in other cultures (Japan, North America, etc.), Europe has chosen a 'science based' approach focusing on physiological functions. In particular, Europe funded the FUFOSE program (Functional Food Science in Europe) coordinated by ILSI (International Life Science Institute). The bases of true functional food science are considered--how to identify beneficial interactions between food components and specific body functions, and to understand the underlying mechanisms in order to construct hypotheses for testing on volunteers. A methodology based on biological markers has been developed Europe then funded the PASSCLAIM program (Process for the assessment of scientific support for claims on foods) aimed at identifying relationships between a functional effect (normal or enhanced function) and a health benefit or a reduced risk of disease. Selected aspects of these 10-year programs illustrate the scientific bases for a European regulation of nutrition claims and so-called health claims (improved function and reduced risk of disease). The main points of the proposal are summarized The most important questions are the need for prior authorization of health claims, and the possible banning of any claim on some foods, due to their bad "nutritional profile". This implies that such claims will have to be firmly grounded in science. However, these restraints were contested by the European Parliament, which preferred a simple notification procedure and suppressed the reference to "nutritional profiling" for identifying good and bad foods. These recent political episodes reflect the lobbying aimed at preserving innovation and development, mainly by small companies that are unable to support the cost of heavy research files. In addition, there is no scientific agreement on how to determine the nutritional profile of a given food. However, the Council of Europe restored the initial text, which will again be examined by the European Parliament in the coming months. The author emphasizes the fine line that must be drawn between scientific accuracy and regulatory rigidity when validating nutrition claims, which consumers are only too willing to accept at face value.

Trans fatty acids in human milk in Canada declined with the introduction of trans fat food labeling

Trans fatty acids in human milk have raised concerns because of possible adverse effects on infant growth and development. Analyses of human milk in the late 1990s in Canada showed high amounts of trans fatty acids from partially hydrogenated oils. Canada introduced labeling of trans fatty acids on retail foods in 2003. We analyzed trans and cis unsaturated and saturated fatty acids in human milk collected from 87 women in 2004-2006 and compared the levels to those in milk collected from 103 women in 1998 and analyzed using similar methods. The total trans fatty acids (mean +/- SEM, g/100 g fatty acids) in human milk in Canada decreased significantly, from 7.1 +/- 0.32 in 1998 to 6.2 +/- 0.48, 5.3 +/- 0.49, and 4.6 +/- 0.32 over 3 consecutive 5-mo periods from November 2004 to January 2006. The milk total trans fatty acids were significantly and inversely related to 16:0, 18:2(n-6), 18:3(n-3), 20:4(n-6), 22:4(n-6), and 22:5(n-6) and positively related to 18:0 and conjugated linolenic acids (P < 0.05, n = 190). The estimated exposures of exclusively breast-fed infants to trans fatty acids decreased from a mean and 95th percentile intake of 2.0 and 4.4 g x infant(-1) x d(-1) in 1998 to 1.33 and 2.41 g x infant(-1) x d(-1), respectively, in late 2005. The estimated intake of the mothers was 4.0 (range 0.51-12.3) and 2.2 (0.56-7.65) g x person(-1) x d(-1) in 1998 and late 2005, respectively. Our studies show trans fatty acids have decreased in human milk in Canada, which suggests a concomitant decrease in trans fatty acid intake among lactating women and breast-fed infants.

Quality assurance, information tracking, and consumer labeling

Reducing marine-based public health risk requires strict control of several attributes of seafood products, often including location and conditions of catch or aquaculture, processing, and handling throughout the supply chain. Buyers likely will also be interested in other attributes of these products such as eco-friendliness or taste. Development of markets for improved safety, as well as for other quality attributes, requires an effective certification and tracking of these attributes as well as their communication to buyers. Several challenges must be met if labeling, particularly consumer labeling, is to support the development of markets for improved seafood safety.

Government perspective: food labeling

The Food and Drug Administration acknowledges the severity of the obesity epidemic. The Food and Drug Administration recognizes the importance of food labeling as a vehicle for dietary messages and, thus, enforces stringent guidelines to maintain the integrity of the food label. As food labels await another upgrade to make them more effective and easier to understand, the Food and Drug Administration considers what information will be most useful for consumers to make healthy choices. The causal relationship between food labels and subsequent diet choice is not well understood; more research in this area is needed. The Commissioner of the Food and Drug Administration has recently appointed an Obesity Working Group to develop proposals on pertinent topics of obesity, including the role of food labeling as a dietary guide.

Tracking genes from seed to supermarket: techniques and trends

Analytical techniques to track plant genes in the environment and the food chain are essential for environmental risk assessment, government regulation and production and trade of genetically modified (GM) crops. Here, I review laboratory techniques to track plant genes during pre-commercialization research on gene flow and post-commercialization detection, identification and quantification of GM crops from seed to supermarket. At present, DNA- and protein-based assays support both activities but the demand for fast, inexpensive, sensitive methods is increasing. Part of the demand has been generated by stringent food labeling and traceability regulations for GM crops. The increase in GM crops, changes in GM crop design, evolution of government regulations and adoption of risk-assessment frameworks will continue to drive development of analytical techniques.

Trends in food label use associated with new nutrition labeling regulations

OBJECTIVES

This study compared use of food labels before and after implementation of new Food and Drug Administration regulations in 1994.

METHODS

Data were obtained by random-digit-dial surveys of Washington State residents in 1993 (n = 1001) and 1996 (n = 1450).

RESULTS

After implementation of the new regulations, usual label use increased significantly, by 8.5 percentage points in women and 11.3 percentage points in men. More respondents looked for information on fat content and fewer failed to use labels because they "take too much time" or "are too hard to understand.

CONCLUSIONS

Use of food labels and satisfaction with their content have increased, but 70% of adults still want labels to be easier to understand.

Misleading nutrition claims on cracker packages prior to and following implementation of the Nutrition Labeling and Education Act of 1990

OBJECTIVES

This study compared patterns in selected health claims on snack cracker packaging and fat content prior to and following enforcement of the Nutrition Labeling and Education Act of 1990 (NLEA).

METHODS

Through observations at supermarkets in 1991 and 1995, the prevalence on packages of health claims that consumers associate with heart disease prevention was evaluated. The fat content of each product also was recorded. Criteria for potentially misleading claims were developed.

RESULTS

Analysis of both cross-sectional data and products that were available in both years showed that fat content, as well as the number of products containing target claims, had significantly decreased by 1995. The prevalence of potentially misleading claims also declined significantly, from 77% in 1991 to 49% in 1995.

CONCLUSIONS

Although the data regarding the changes from 1991 to 1995 are encouraging, the prevalence of potentially misleading health claims for this food category continues to be high.

Nutrition labelling of sugar-containing foods in 1996 compared with 1989

OBJECTIVE

To record the prevalence of nutrition labelling of foodstuffs with respect to sugar content in selected supermarkets in the UK in 1996 and to compare the prevalence with results reported for 1989.

RESEARCH DESIGN

Examination of the labelling of foodstuffs to see whether the labelling of the nutrition content conformed to Government guidelines. Foodstuffs were grouped into 12 types of sugar-containing foods.

RESEARCH SETTING

Three large food supermarkets in Newcastle upon Tyne.

MAIN OUTCOME MEASURES

Conformity with government guidelines on nutrition labelling of foodstuffs.

RESULTS

Most labelling conformed to guidelines. Prevalence had increased considerably between 1989 and 1996. Foods with high sugars content, particularly confectionery, were the least likely to be labelled for sugars content.

CONCLUSIONS

Although substantial progress in nutrition labelling for sugars content has occurred, voluntary compliance appears to allow inadequate labelling of high sugar foods.

Derivation of daily values used for nutrition labeling

Daily Values (DVs) are the daily dietary intake standards used for nutrition labeling. Information on the derivation of DVs is important for dietetics professionals and nutrition educators who use DVs to educate and instruct patients and students about diet planning and evaluation and about adherence to modified diets. The first daily intake standards for nutrition labeling were established in 1973 and were referred to as the US Recommended Daily Allowances (US RDAs). They were based on the 1968 Recommended Dietary Allowances (RDAs) developed by the National Academy of Sciences. These intake standards were mandatory for 8 and optional for 12 food components on nutrition labels. Regulations revising the daily intake standards for nutrition labeling were published in 1993. The new standards included Reference Daily Intakes (RDIs) for 19 food components and Daily Reference Values (DRVs) for 8 food components. The RDIs were based on the 1973 US RDAs, and the DRVs were based on consensus recommendations. On the nutrition label, the RDIs and DRVs are referred to as DVs. Percent DVs are mandatory on nutrition labels for 10 food components and optional for 16 food components. In 1995, DVs were established by regulation for 6 additional food components; these DVs are optional for nutrition labels. The DVs established in 1995 were based on information from the 1980 and 1989 revisions of the RDAs and Estimated Safe and Adequate Daily Dietary Intakes. Currently, percent DVs are mandatory on nutrition labels for 10 food components and optional for 22. Optional percent DVs become mandatory if claims are made about the food components or if the food components are added to the food through fortification or as food additives.

'Healthy' developments in the food industry

The food industry has a long history of providing food products in line with nutritional requirements. Examples are vitamin-enriched margarines, low fat products, and high fibre products. Communication about the nutrition and health aspects of these products is essential, since a consumer cannot 'see' from the product what its health properties are. Governments are regulating health messages to prevent overstatements and misleading of consumers. The discussion on the degree of regulation has intensified because of new developments in the Functional Foods area.

Review of nutrition labeling formats

This article examines nutrition labeling history as well as the findings of nine research studies of nutrition labeling formats. Nutrition labeling regulations were announced in 1973 and have been periodically amended since then. In response to requests from consumers and health care professionals for revision of the labeling system, the Food and Drug Administration initiated a three-phase plan for reform of nutrition labeling in 1990. President Bush signed the Nutrition Labeling and Education Act in November 1990. Literature analysis revealed that only nine studies with an experimental design have focused on nutrition labeling since 1971. Four were conducted before 1975, which was the year that nutrition labeling was officially implemented, two were conducted in 1980, and three were conducted after 1986. Only two of the nine studies supported the traditional label format mandated by the Code of Federal Regulations, and one study partially supported it. Four of the nine studies that evaluated graphic presentations of nutrition information found that consumer comprehension of nutrition information was improved with a graphic format for nutrition labeling: three studies supported the use of bar graphs and one study supported the use of a pie chart. Full disclosure (ie, complete nutrient and ingredient labeling) was preferred by consumers in two of the three studies that examined this variable. The third study supported three types of information disclosure dependent upon socioeconomic class. In those studies that tested graphics, a bar graph format was significantly preferred and showed better consumer comprehension than the traditional format.

Nutrition labeling: issues and directions for the 1990s

This report will become a part of the comment and rule-making process that FDA and USDA will conduct to achieve food and nutrition labeling reform. The agencies have requested interested parties to comment on the report's recommendations. The report will be of interest to Congress in developing legislative proposals to clarify the legal basis for anticipated reforms. For the food industry, health professionals, and consumer groups, it will be of interest in terms of their own objectives in promoting nutrition labeling changes that are in line with current dietary recommendations and in product development. Dietitians will want to comment on the recommendations in the Institute of Medicine report and on provisions of the proposed regulations. Dietitians should encourage their elected officials in Congress to support legislation for food labeling reform.

Hypertension and the Department of Health and Human Services

Hypertension affects from 17% to 25% of all Americans. Because of its fundamental charge to help protect the public health, the Department of Health and Human Services (HHS) is substantially concerned with the condition. Additionally, hypertension represents a significant source of underwriting risk to which HHS is exposed in its role as health insurer of the poor and the elderly. HHS has invested hundreds of millions of dollars in hypertension research, development and testing of treatment regimens, and education of health care providers and consumers. However, much of the etiology of hypertension still eludes us. Sodium's apparent importance as a "causal" agent to the development of hypertension, and in its treatment, has waxed and waned over the past several generations; research to date has not yet finally settled the issue. Is sodium or some other cation the key? While research on this issue continues, HHS is currently faced with deciding whether and how to require inclusion of sodium content in nutrition labelling. In the debate, attention has to be given not only to the current best evidence on sodium; additional issues of consumer choice, costs, and education are also of importance.

RDA and related tracking systems concerned with sodium

The U.S. Food and Drug Administration (FDA) and the Department of Health and Human Services have developed a five-point set of sodium initiatives aimed at moderation of sodium consumption, improved sodium-related information for consumers and health professionals, and improved consumer choice in the marketplace. Implimentation is fundamentally based on a voluntary premise, and indications to date are that the program is working. FDA has established a series of tracking systems to measure change over time, particularly relative to changes in the sodium content of the food supply, in the sodium content of American diets, in sodium labeling -- both quantitative and qualitative, in consumer understanding of the sodium-and-hypertension problem, and in consumer food purchasing practices. Some of these efforts are conducted in cooperation with other Federal agencies such as the National Heart, Lung, and Blood Institute and the Department of Agriculture. The epidemiological approach to measurement of the prevalence of hypertensive disease as provided by the periodic National Health and Nutrition Examination Surveys is at the center of all other tracking systems to measure effectiveness of the national effort to reduce sodium intakes and thereby hopefully moderate the magnitude and severity of hypertensive disease as a major public health problem in the United States.

Problems in implementing a good food and nutrition policy in Britain

There is no co-ordinated food and nutrition policy in Britain, primarily because it is still not recognized that diet has an important role to play in the development of many diseases of affluence. The demand for absolute proof of the dietary component of disease on a population level ignores both the innate biological susceptibility in only a portion of the population to a particular nutrient as well as the increasing evidence from studies on non-human primates that diet plays a key role in several conditions including heart disease. Government remains unsure of how to implement its own current recommendations and the traditional paternalistic and conservative approach delays action. Vested interests, seeking only short-term gains, are not confined to industrial concerns. Marketing Boards are allowed almost unfettered freedom to promote nutritionally undesirable eating habits. Health education in schools remains inadequate with most of the involved teachers still promoting incorrect concepts. The medical profession is still unwilling to take a physician maintaining treatment programmes for marginal effects on a public health problem. General practitioners are better able to start practising preventive medicine but they need to be helped by community physicians who should begin on their main task of implementing policies for preventing disease rather than limiting themselves to their current preoccupation with systems analyses and operational research.