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B Fooc! Guidance in the Unitec] States anc] Canada FOOD GUIDES The U. S. Food Guide Pyramid Dietary guidance began in the early 1900s in the United States with the development of food guides that iclentifieci food groups and patterns for eating. In the 1940s, the food groups were iclenti- fieci as the Basic 7. By 1960, guidance was simplified into the basic four food groups. As nutrition science evolved, so clici concern about some nutrients in excess (e.g., fats, saturated fat, cholesterol, sodium) and their relation to heart disease and cancer. These concerns leci to the promulgation of the U.S. Dietary Goals in 1977 by the Senate Select Committee on Nutrition and Human Neecis. The U.S. Depart- ment of Agriculture (USDA) responcleci by Rifling a fifth food group of fats, sweets, and alcohol at the bottom of the basic four, with the guidance "Use these in moderation" (PCRM, 1997~. The first eclition of the Dietary Guidelines for Americans was pub- lished in 1980 (USDA/HHS, 1980~. To assist people in putting the Guidelines into practice, USDA released the Food Guicle Pyramid (USDA, 1992~. The assumptions underlying the Food Guide Pyramid were that it would (1) promote overall health rather than treatment or preven- tion of a specific disease; (2) be baseci on up-to-date research on nutrient composition, foods commonly consumed, and nutrient recommendations such as the Recommended Dietary Allowances (RDAs) and the Dietary Reference Intakes (DRIs); (3) aciciress the 171

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172 DIETARY REFERENCE INTAKES total cliet; (4) be useful to the target audience the consumer; (~) be realistic; (6) be flexible; (7) be practical; and (8) be evolu- tionary. The Food Guicle Pyramid is baseci on the 1989 RDAs (NRC, 1989) and the 1990 Dietary Guidelines (Welsh et al., 1993) and incorpo- rates ciata on foocis used by the target population and ciata on nutrient composition of foocis. The nutritional goals for the Pyramid are to provide a guide for inclivicluals that is acloquate in protein, vitamins, minerals, and clietary fiber, without excessive amounts of calories, fat, saturated fat, cholesterol, sodium, sugars, and alcohol (Straw et al., 1996~. It has been widely used as a resource for nutri- tion educators. As science advances, the Pyramid, as with other clietary guidance programs, should be reassessed to see that it meets current nutrition recommendations. Canada's Food Guide to Healthy Eating Canada's Food Guide to Healthy Eating (Health Canada, 1991) was clevelopeci from the Nutrition Recommendations (Health Canada, l990b) and Canacia's Guidelines for Healthy Eating (Health Canada, 1990a), through the work of technical groups and task forces, con- sumer research, and consultations with stakeholcler groups. It pro- vicles details on ciaily food selection to meet nutritional neecis of individuals aged 4 years and over and is designed for the general public with a reacting level of gracle seven. The Food Guide is presented as a tear sheet with a consumer- orienteci booklet, Using theFood Guide (Health Canada, 1997), which explains the concepts of the tear sheet. Nutrition professionals engaged in health promotion have also clevelopeci fact sheets to assist in using the Food Guide. Nutritionists working with specific cultural groups or those with special dietary preferences, including Indigenous Peoples, have clevelopeci food guides that incorporate the local, cultural foocis. An example is the Food Guide for the Northwest Territories (Northwest Territories Aboriginal Head Start Program, 2002~. The Canaclian guides are also upciateci as new science and better unclerstancling of nutritional neecis become available. Uses of Food Guides in Planning for Individuals The U.S. Food Guide Pyramid contains basic information neecleci for an incliviclual to plan a clay's food choices. It lists major food groups and subgroups, the ranges in numbers of servings suggested,

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APPENDIX B 173 and the amounts to count as a serving for each group. It also gives a range of servings intencleci to meet various caloric neecis. Canada's Food Guide to Healthy Eating can be used for different people in various life stages by attention to the top statement and the sicle bar describing number of servings (a lower and higher number of servings are given). Practitioners counseling inclivicluals or inclivicluals themselves can adjust the recommendation for age, body size, gentler, activity level, pregnancy, breast-feecling, and incli- viclual variation. The Canaclian Food Guide assumes that choosing foocis according to the Guide can provide all nutrients neecleci for good health of most people. It recommencis that supplements for special neecis (e.g., for iron and folate cluring pregnancy) should be chosen after consultation with a physician or dietitian (Health Canada, 1997~. A physiological counterpart to Canada 's Food Guide to Healths Eating ~ ~7 is the Handbook for Canada's Physical Activity Guide to Healthy Active Living (Health Canada, 1998~. This guide provides a simple, consis- tent set of guidelines to achieve health benefits by being physically active. Silhouette figures on the Food Guide refer to the Vitality program, which integrates guidance (enjoy eating well, being active, and feeling good about oneself that leacis to an enhanced quality of life and maintenance of healthy weight. FOOD LABELING AND NUTRIENT CONTENT CLAIMS Food labels are an important and direct means of communicating product information between buyers (including the consumer) and sellers. They provide basic product information (e.g., name, ingre- clients, gracle, etch; they may provide health, safety, and nutrition information; and they serve as a vehicle for food marketing, promo- tion, and competition such as nutrition claims. Development of Nutrition Labels United States In 1969 the White House Conference on Food, Nutrition, and Health recommencleci that the federal government consider clevel- oping a system for identifying the nutritional qualities of food. In 1973 the Food and Drug Administration (FDA) issued regulations requiring nutrition labeling on foocis that contained one or more acicleci nutrients or that haci a label or advertising that inclucleci claims about the food's nutritional properties or its usefulness in the ciaily cliet. The term "U.S. RDA" was also established at that time by FDA as the food label reference values for vitamins, minerals, and protein to be used in the companion voluntary nutrition label-

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174 DIETARY REFERENCE INTAKES ing program resulting from this legislation. The U.S. RDAs were baseci on the adult age and gentler groups with the highest values in the 1968 Recommencleci Dietary Allowances established for vari- ous population groups (NRC, 1968~. Nutrition labeling took effect in 1975 for foocis containing acicleci nutrients or advertising claims and became voluntary for almost all other foocis. In 1990, Congress passed the Nutrition Labeling and Education Act, which required nutrition labeling for most foocis (except meat and poultry) and authorized the use of nutrient content claims and appropriate FDA-approveci health claims. These rules went into effect in 1994. In aciclition, voluntary nutrition information pro- grams became effective in 1992. Nutrition information was macle available uncler FDA's voluntary point-of-purchase nutrition infor- mation program for many raw foocis, including the 20 most fre- quently eaten raw fruits, vegetables, and fish, and uncler USDA's program for the 45 best-selling cuts of meat. Figure B-1 presents the Nutrition Facts panel that appears on cur- rent labels in the United States. The label reference value, Daily Value (DV), comprises two sets of clietary stanciarcis: the Daily Refer- ence Values (DRVs) and Reference Daily Intakes (RDIs). Only the Daily Value term appears on the label. DRVs have been established for macronutrients that are sources of energy: fat, saturated fat, , and protein, as well as for total carbohydrate Including fiber) cholesterol, sodium, and potassium. - r- DRVs for the energy-proclucing nutrients are baseci on an intake of 2,000 calories per clay. This level was chosen, in part, because it approximates the caloric requirements for postmenopausal women, the life stage and gentler group that has the highest risk for exces- sive intake of calories and fat. DRVs for the energy-producing nutrients and fiber are calculated as follows: fat baseci on 30 percent of calories saturated fat baseci on 10 percent of calories carbohydrate baseci on 60 percent of calories protein baseci on 10 percent of calories (the DRV for protein applies only to adults and children over 4 years of age; RDIs for protein for special groups have been established) fiber baseci on 11.5 g of fiber per 1,000 calories The DRVs for some nutrients represent the uppermost limit that is considered desirable under current public health recommenda- tions. For example, the DRVs for total fat, saturated fat, cholesterol,

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APPENDIX B Sugars 59 Calories from Fat 11 Percent Dally Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs: Calories: Total Fat Less than Sat Fat Less than Cholesterol Less than Sodium Less than Total Carbohydrate Dietary Fiber FIGURE B-1 U.S. food label. SOURCE: FDA (2000~. 175 65g 20g 300mg 2,500 and sodium are less than 65 g, 20 g, 300 ma, and 2,400 ma, respec- tively. Dai;ly Values Reference Dai;ly Intakes The percent of DV stated on food labels for vitamins and minerals is based on the RDIs. The term RDI replaces the term U.S. RDA in current food labeling. However, most of the RDI values are the same as the U.S. RDAs that were proviclecT on food labels in the past, and thus are also based on the 1968 RDAs. RDI values have

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176 DIETARY REFERENCE INTAKES also been established for nutrients for which RDAs were not estab- lisheci in 1968 (e.g., vitamin K, chromium). The RDI term was aclopteci to avoid confusion that might arise between the U.S. RDA used on food labels and the RDAs published by the National Academy ~ ~ . 01 ;,clences. On the current label's "Nutrition Facts" panel, manufacturers are required to provide information on certain nutrients. The mancia- tory (unclerlineci) and voluntary components and the order in which they must appear are listed in Box B-1. The nutrients that are required on the label were selected because they aciciress tociay's health concerns. The order in which they must appear was clesigneci to reflect the priority of the then current clietary recommendations. The nutrition information is presented in a clefineci serving size, which is the amount of food customarily eaten at one time. The serving sizes that appear on food labels are baseci on lists of Refer- ence Amounts Customarily Consumed Per Eating Occasion, estab- lished by FDA ( 1999~ . Current Nutrient Content Claims United States The following is a list of core terms that may be used to describe the level of a nutrient in a food uncler current regulations (FDA, 1999~. Free. This term means that a product contains no amount of, or only trivial or "physiologically inconsequential" amounts of, one or more of these components: fat, saturated fat, cholesterol, sodium, sugars, and calories. Low. This term can be used on foocis that can be eaten frequently without exceeding clietary guidelines for one or more of these com- ponents: fat, saturated fat, cholesterol, sodium, and calories. Thus, descriptors are low fat: 3 g or less per serving; low saturated fat: 1 g or less per serving; low sodium: 140 mg or less per serving; very low sodium: 35 mg or less per serving; low cholesterol: 20 mg or less and 2 g or less of saturated fat per serving; low calorie: 40 calories or less per serving. Lean and extra lean. These terms can be used to describe the fat content of meat, poultry, seafood, and game meats. Lean: less than 10 g of fat, 4.5 g or less of saturated fat, and less than 95 mg of cholesterol per serving and per 100 g; extra lean: less than ~ g of fat, less than 2 g of saturated fat, and less than 95 mg of cholesterol per serving and per 100 g.

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APPENDIX B 177 High. This term can be used if the food contains 20 percent or more of the DV for a particular nutrient in one serving. Good source. This term means that one serving of a food contains 10 to 19 percent of the DV for a particular nutrient. Reduced. This term means that a nutritionally altered product contains at least 25 percent less of a nutrient or calories than the regular, or reference, product. However, a "reduced" claim cannot be macle on a product if its reference food already meets the requirement for a "low" claim. Less. This term means that a food, whether altered or not, con- tains 25 percent less of a nutrient or calories than the reference food. Development of Food Labels Canada Since 1961 the Guide for Food Manufacturers and Advertisers has been the reference document on policies and regulations for the labeling and advertising of foocis in Canada (CFIA, 1996~. The current Guide to Food Labelling and Advertising (CFIA, 1996) pro-

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178 DIETARY REFERENCE INTAKES vices labeling and advertising requirements, policies, and guide- lines that deal with statements and claims made for foods, including alcoholic beverages. Guidelines and provisions set out in the Food and Drugs Act and Food and Drugs Regulations, the Consumer Packaging and Labeling Act (CPLA), and other relevant legislation are provided. The responsibility for the administration of food related provisions in the CPLA was transferred to the Canadian Food Inspection Agency in 1999. Nutrition labeling in Canada has been voluntary, but under new regulations it has become mandatory on prepacked foods, with few exceptions. The nutrition label has a consistent format and always includes information on calories and the following 13 nutrients: fat, saturated fat, bans fat, cholesterol, sodium, carbohydrate, fiber, sugars, protein, vitamin A, vitamin C, calcium, and iron. Nutrient content is declared for a stated serving size, which may be different than that noted on the food guide. Vitamins and minerals are expressed as percent of a DV. Initially, DVs will be the same as the Recommended Daily Intakes that were developed for food labeling only, and are based on the highest Recommended Nutrient Intakes (RNIs) for individuals aged 2 and above from the 1983 Canadian RNIs, excluding needs during pregnancy and lactation. Figure B-2 provides an example of the new label, which is similar to the U.S. Nutrition Facts label. Current Nutrient Content Claims Canada Amendments to the Canadian Food and Drugs Regulations (CFIA, 1996) regulate the compositional criteria and specific labeling requirements for all permitted nutrient content claims. Permitted nutrient content claims include claims that a product is "free" of a substance (e.g., fat-free, free of bans fatty acids, calorie-free, sugar- free); is "low in" or "reduced or lower in" a substance (e.g., calories, fat, saturated fatty acids, bans fatty acids, cholesterol, sugar); has "no added" sodium, salt, or sugar, or is a "source of," a "high source of," a "very high source of," or an "excellent source of" a nutrient (e.g., protein, fiber, vitamins, and minerals). In each case, composi- tional criteria must be met. For example, a food claiming it is "cho- lesterol-free" would have less than 2 mg of cholesterol per standard serving size, and would also need to meet the criteria to be "low in saturated fatty acids." The proposed amendments to the Food and Drugs Regulations will also allow for five diet-related health claims to be made relative to reduced risk of high blood pressure, osteoporosis, heart disease,

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APPENDIX B FIGURE B-2 Canadian food label. SOURCE: Health Canada (2002~. 179 some types of cancer, and dental caries. The amendments specify the wording for the permitted health claim and the compositional criteria that foocis would have to meet in order to qualify for the claim. . . DIETARY GUIDELINES IN THE UNITED STATES AND CANADA The current U.S. and Canadian dietary guidelines are not gener- ally related to micronutrients, with the exception of guidelines per- taining to "variety." The intent of these guidelines (i.e., Canadian "Enjoy a variety of foocis" and U.S. "Let the Pyramid guide your food choices") is to promote a greater likelihood of meeting recom- mencleci intakes of all nutrients through choosing a variety of foocis.

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180 DIETARY REFERENCE INTAKES Dietary Guide;tines for Americans The fifth eclition of the Dietary Guidelinesfor Americans was released in 2000 (USDA/HHS, 2000~. The focus of the Guidelines is on good health, including reducing risk for chronic diseases. The Guidelines are baseci on fitness, the Food Pyramid, food safety, and the ability to choose foocis sensibly. The concept of the Guidelines began with the 1977 Dietary Goals of the United States clevelopeci by the Senate Select Committee on Nutrition and Human Neecis. These goals focused on reducing the incidence of chronic disease rather than on reducing nutritional deficiencies, and recommencleci quantifiable targets for carbo- hycirates, fats, and cholesterol in the American cliet. The Dietary Guidelines for Americans (Box B-2), clevelopeci jointly by USDA and the Department of Health and Human Services (HHS), was first published in 1980 and subsequently revised in 1985, 1990, 1995, and 2000. It provides recommendations baseci on current sci- entific knowledge about the association between clietary intake and risk of major chronic diseases. The National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101-445, Title III) required publication of the Guidelines at least every five years be- ginning in 1985. This legislation also required review by the secre- taries of USDA and HHS of all federal clietary guiciance-relateci pub- lications for the general public. The Guidelines serve as a framework for consumer education messages. They also form the basis of federal food, nutrition ecluca-

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APPENDIX B 181 tion, and information programs and are used for incliviclual coun- seling, in group education settings such as schools and outpatient settings, and for general food and nutrition planning. The Guicle- lines are widely available through professional nutritionists' and dietitians' associations, health clinics, government-sponsoreci health settings, the food industry, and the merlin. Nutrition Recommendations for Canadians In Canada, national guidelines for consideration of nutrition pro- grams and policies have been in effect for more than 60 years. They have been used by professional and other organizations, govern- ment at all levels, the food and food service industry, and by incli- viclual consumers. The most recent review of Canacia's national nutrition guidelines took place from 1987 to 1989 by two commit- tees: one that consiclereci revisions to the RNIs and one that consici- ereci consumer acivice and implementation strategies. This work resulted in the current Nutrition Recommendations (Health Canada, l990b), and, ultimately, Canada's Food Guide to Healthy Eating (Health Canada, 1991~. The Nutrition Recommendations (Box B-3)

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182 DIETARY REFERENCE INTAKES were clirecteci to health professionals and describe desirable charac- teristics of the cliet in relatively technical terms. These recommencia- tions were "translated" to Canacia's Guidelines for Healthy Eating (Box B-4), which provide key messages clirecteci to consumers. These guidelines were clesigneci to be action-orienteci, positive state- ments that would leaci to the selection of cliets that meet the Nutri- tion Recommendations.