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s Labeling Coverage Health professionals have achieved a consensus on He characteristics of foods Americans should choose to have both a healthier diet and reduce the risk factors for chronic diseases and conditions. The Surgeon General's Report on Nutrition awl Health (DHHS, 1988) and the National Research Council (NRC) report, Diet and Health: Implications for Reducing Chronic Disease Risk MARC, 1989), set forth the scientific findings and recommended changes that should be made in dietary intake patterns and the need for expanded nutrition labeling described in this report. In addition, the Year 2000 Objectives for the Nation propose that there be an increase in nutrition labeling Hat provides information to facilitate choosing foods consistent with the Dietary Guidelines for Americans to at least 80 percent of processed foods and 40 percent of fresh meat, poultry, fruits, vegetables, baked goods, and ready-teat carry-away foods (DHHS, 1989~. MANDATORY NUTRITION LABELING If consumers are to make the dietary adjustments recommended by the health care community, they must be able to make informed judgments across the full spectrum of their daily shopping, cooking, and eating decisions. It is extremely unlikely that significant advances in consumer application of current dietary guidelines to everyday purchase and consumption decisions can be made if each label poses a new challenge to consumers. The lack of relevant information and the inconsistency of label formats among products are significant deterrents to making informed choices. Other issues include the 131
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132 NUI771TION LABEllNG quantity and complexity of information and comprehension issues (see Chapter 4~. Mandatory nutrition labeling requirements for most packaged foods and foods sold at various eating locations would present consumers with a consistent set of information in a uniform format. Committee Recommendations The Committee recommends that: The Food and Drug Administration (FDA) and the U.S. Department of Agri- culture (USDA) should promptly adopt regulations to institute mandatory and uniform nutrition labeling requirements for all packaged foods under their respective jurisdictions, with some exemptions as outlined in the next section. The agencies' legal authority to implement this recommendation is discussed in Chapter 8. Exemptions Exemptions could be provided for products that make no significant nu- tritional contribution per serving or that are physically unsuited to carry the nutrition panel. No exemption should be allowed for any food for which a nu- trition claim is made. Additionally, no exemption should be made unless all alternatives to nutrition labeling have been considered and found unreasonable, impractical, andlor costly. No Nutritional Significance If a food does not make, and is not generally expected to make, a significant nutritional contnbution, nutrition labeling should be optional, not required. Examples include tea bags, flavors, spices, and bottled water. However, the Committee recommends that The agencies should establish criteria for determining nutritional signifi- cance, such as a threshold for the number of calories (and/or other nutrients) per serving below which nutrition labeling would be optional. Package Size Foods sold In small packages also warrant consideration of exemption. If a package is too small to accommodate nutrition labeling and He package cannot reasonably accommodate a larger label, it would not be cost- effective, even if theoretically possible, to require mandatory labeling. However, the Committee recommends that: · Alternatives such as nutrition labeling on larger packages containing mul- tiple individually wrapped servings or other point-of-purchase alternatives be required for foods sold in small packages.
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LABELING COVERAGE 133 Baby Food The recommendations of recent reports linking nutrition and long-term health have been proposed for adults and children over age 2. The dietary needs of infants and toddlers up to age 2 differ from those of adults and older children. Although the labeling and minimum nutrient content of infant formulas are defined by specific FDA regulations (21 CF1t Part 107), the labeling of commercial baby foods and products intended for children under age 2 can be considered a special case in the revision of nutrition labeling policy. Because of the high rate of growth and organ development of infants up to age 2, their requirements for essential nutrients and energy differ markedly from those of adults, especially with respect to calories, protein, fat, cholesterol, and dietary fiber (AAP, 1985~. Consumption of foods that provide adequate caloric intalce is essential for maintaining appropriate rates of growth and development. In particular, fat is an important food component for infants and toddlers because of its high caloric density. However, fat does not need to be saturated or come from sources rich in cholesterol. Sugars and other carbohydrates represent additional sources of energy, although the relationship between sugar intake and dental caries is well recognized. Consumption of high-fiber diets is not beneficial for infants and young children; the immature intestinal tract may not tolerate excessive amounts of dietary fiber. Although not well documented in young children, impaired absorption of trace minerals may also occur when they consume diets high in fiber. It should be emphasized that these considerations apply only to foods intended for infants and children under age 2. The present scientific evidence indicates Rat the same dietary recommendations developed for adults generally apply to children over age 2 (NRC, 1989~. Despite earlier concern about the possible special needs of older children and adolescents for fat, cholesterol, and sodium, the best evidence now indicates that diets lower in saturated fatty acids, cholesterol, and sodium, as recommended for adults, are safe and also likely to be beneficial for children in those age groups. Current regulations require nutrition labeling to be provided on foods for children under age 4 (21 CF1< § lOl.9(h)~1~) using the U.S. Recommended Daily Allowances (U.S. RDA) for that group and in compliance with the other rules for nutrition labeling. Committee Recommer~attons Nutrition labeling of foods intended for children under age 2 should reflect the dietary principles discussed above. Nutrition labeling based on recommendations for adults (e.g., U.S. RDA) with respect to fat, cholesterol, and dietary fiber could be misleading to consumers (e.g., parents) who are
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134 NUTRlTlON LABEl~NG not familiar with the specie nutritional needs of infants and young children, promoting the selection of nutritionally inappropriate diets for Heir children. The Committee recommends that: · Labeling of calories, fat, cholesterol, protein, carbohydrate, dietary fiber, and sodium content should be required, by weight in gems or milligrams per serving, on foods designed for children under age 2. Declaration of calcium and iron content should be mandatory for baby food. In the absence of compelling nutritional justification with respect to other vitamins and minerals, label information on these nutrients should be provided on an optional basis as a percentage of the U.S. RDA for children under age 2 for which the food is intended. Institutional Packages and Commodity Foods mod packages used by commercial food service and the larger food packages used by institutions are currently exempted from nutrition labeling regulations (21 CFR § lOl.9(h)~8~. Nutrition labeling of large containers or provision of nutrition information through product specification sheets used by institutions makes nutrition information more accessible, and since containers are generally larger than those for foods purchased in grocery stores, nutrition labeling can easily be provided and can even be expanded. Specification sheets that include nutrition information are usually provided by suppliers; thus, food costs are not expected to rise if nutrition labeling is also required. The Commodity Distribution Reform Act of 1987 (Pr. 100 237) commis- sioned He National Advisory Council on Commodity Distribution to be formed to recommend changes through an annual report to the Secretary of USDA and the U.S. Congress. The purpose of the Council is to advise the Secretary on reg- ulations and policy development with respect to specifications for commodities and other issues. In its first annual report, the Council recommended that Nutrition analysis or nutritional labeling should be investigated for all USDA commodities, especially items used in the Commodity Supplemental Food Program and the Food Distribution Program on Indian Reservations (USDA, 1989b, p. 4~. Committee Recommendations The Committee recommends that: · I;DA and USDA should require nutrition labeling on packages or specifica- don sheets for products used by institutional food services. · USDA should require nutrition labeling on commodities distributed through the agency's food programs.
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LABELING COVERAGE PRODUCE, SEAFOOD, AND MEAT AND POULTRY Overview of the Issues in Labeling of Fresh Foods 135 A strong argument for point-of-purchase nutrition information for fresh food products is to provide consumers with sufficient information to promote the consumption of more unfits and vegetables and to be able to choose leaner meats. In general, fruits and vegetables (referred to here as produce) are major sources of vitamins, minerals, and dietary fiber. They do not contain cholesterol and are typically low in fat. Meat, poultry, and seafood (referred to here as muscle-based foods) are important dietary sources of high~uality protein and B vitamins. Both meat and seafood are sources of minerals (e.g., iron and zinc in beef and copper in seafood). Seafood is typically low in fat. Current dietary recommendations suggest that Americans should cut back their intakes of total fat, sate fatty acids, and cholesterol; eat more fnuts and vegetables; eat smaller portions of meat; choose leaner cuts of meat; and remove skin from poultry (DHHS, 1988; NRC, 1989~. Nutrition labeling of fresh foods should be an effective aid for health- conscious consumers, but the most appropriate method of labeling remains to be determined. Producers and retailers face special challenges in providing nutrition information on fresh produce. Before recommending a program for nutrition labeling of all produce, meat, poultry, and seafood, policymakers must consider the heterogeneity of foods, whether to list nutrient content data for the food in the manner in which it is purchased or prepared, He adequacy of the nutrient data bases, and potential technical problems. Heterogeneity of Foods As discussed in the section on analytical issues (see Chapter 4), foods are inherently heterogeneous, which is particularly true in the case of produce and muscle-based foods. This is in contrast to "pooled foods," such as flour or frozen orange juice, or formulated foods, which are more uniform in their composition and are batch tested. Variabilities in the nutrient content of plant-denved foods are due to factors such as biological variability, including genetic characteristics; climatic and seasonal effects, such as precipitation and photoperiod; type of soil; and agricultural practices, such as the fertilization regimen, stage of maturity at the time of harvest, and postharvest handling. The nutrient composition of animal- derived foods varies as a function of genetic and nutritional factors, stage of maturity at the time of slaughter, and animal husbandry methods. Seafood is subject to an even higher degree of nutrient variability both within and between species.
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136 Effects of Storage, Preparation, and Cooking NUrRlTlON LABELING Quits and vegetables are eaten both raw and cooked; muscle-based foods are primarily Eden cooked. In addition, many of these foods may be frozen or stored in the home for extended periods of time prior to consumption. All forms of food storage and preparation, whether commercial or in the home, cause some loss of nutrients (Adams and Er~nan, 1988~. Changes in food composition occur during cooking; for example, fat, water, and soluble nutrients are lost in drippings when meats are cooked, and leaching and various other modes of degradation of vitamins and minerals occur when fruits and vegetables are cooked. Changes in the bioavailabilities of certain vitamins, minerals, and amino acids may also occur during commercial or home preparation. The magnitude of differences between the effects of commercial processing and home preparation of foods is not clear given the wide range of cooking conditions used. However, commercial processing is generally conducted under controlled conditions to minimize the loss of labile nutrients (Lund, 1988~. In fact, greater losses of nutrients may occur during cooking in the home (Adams and Er~nan, 1988~. Variability in the effects of home preparation of foods, along with natural variations in food composition, pose obstacles to the provision of reasonably accurate data for a mandatory nutrition labeling program for all foods. Fruits and Vegetables Produce is eaten either raw or cooked. Storage, preparation, and cooking methods affect the nutrient composition of Quits and vegetables. These effects are not reflected in the nutrient composition data on raw produce. The level of maturity at the time of harvest and storage methods affect nutrient changes over time. For example' the vitamin A content of carrots and sweet potatoes increases with maturity (USDA, 1984a). Thus, because canned and frozen carrots are usually more mature than fresh carrots, they may have higher levels of vitamin A. The caloric value of Jerusalem artichokes actually increases with storage. A significant portion of their carbohydrates is in the form of inulin which has limited bioavailability. Over time, the inulin is converted to sugar (USDA, 1984a). Avocados harvested at different times display fat contents that range from 8 to over 20 percent. This change strongly affects the caloric content. Half of an avocado Queue vanety) has 80 kcal if harvested when it has 8.3 percent fat and 237 kcal if harvested when it has 22.8 percent fat (Slater et al., 1975~. Losses of certain vitamins begin with harvesting and can be accelerated by the method and/or length of storage and processing. Freshly harvested potatoes contain about 26 mg of vitamin C per 100 g. After 3 months of storage, the vitamin C content decreases to about 13 ma, and after 6 months it decreases to about 8 mgil00 g. During cooking or processing, nutrient composition values are
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LABELING COVERAGE 137 altered by the addition of fat, sodium (as salt), and carbohydrates (as sugar) and by the leaching of vitamins and minerals when foods are boiled. Most fruits and vegetables are naturally low in sodium. Thus, the amount of sodium in cooked vegetables reflects the amount of sodium or salt used in the cooking water, which is usually tap water (USDA, 1984a). This is true for all foods prepared in or with tap water. Food composition values for fruits and vegetables given in data bases may also overestimate the actual amounts of vitamins because of losses during food preparation. For example, chopping, shredding, and cutting of vegetables such as cabbage, lettuce, and squash result in the loss of vitamin C activity because of oxidation. Meat, Pouttry, and Seafood Methods of home cooking have different effects on the nutrient composition of muscle-based foods. The different levels of fat in various grades of muscle-based foods, the trimming of fat or removal of skin during preparation, and the method of preparation affect the final fat content of those foods after they are cooked. The contents of those other nutrients also change during preparation and cooking, most notably through the addition of salt. For meat, the percent change in fat content during cooking differs between grades. The total amount of fat in the cooked product, if prepamd by similar methods, would be greater in those that exhibit the highest initial fat content. Large differences in the fat content of fried and other broiled or steamed seafood have been reported (NRC, 1989~. In addition, breading may result in up to a fourfold increase in sodium content. The fat, carbohydrate, and sodium content of poultry products are affected by the method of cooking, removal of skin, breading, and seasoning. These factors clearly would not be reflected by nutrition labeling of raw muscle-based foods. Adequacy of Food Composition Data Bases The use of data bases would be a more practical alternative to routine laboratory analysis of fresh foods. Issues related to the use of data bases include whether the existing ones contain valid composition data and whether sampling has been adequate to ensure representative data Variability among samples is a factor in determining the final data that should be included in data bases. An additional issue concerns the accuracy of data bases that could serve as the basis for nutrition information in food labeling. USDA Primary Data Set The USDA National Nutrition Data Bank is the authoritative source of data on the nutrient composition of foods in the United States. This data base provides representative data for many raw, processed, and prepared foods. It is not complete, however, in the case of many species of
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138 NUTRITION LABELING seafood and certain varieties of fruits and vegetables. Additionally, data for many foods Mat have undergone some form of preparation are not included. The dew base is continually being expanded and periodically reevaluated and this improvement must continue. The current update began in 1976, and to date, 19 of the 22 volumes of data have been completed (Ruth Matthews, Human Nutrition Information Service, USDA, personal communication, 1990~. Other food composition data bases exist in the United States and throughout the world. Many non-USDA data bases are based on specialized analytical data, cover selected foods that are not covered in the USDA data base, or offer commercial calculations of nutrient intakes. Bergstrom (1988) reviewed the use of data bases and conducted limited comparisons of the USDA data base with those of four European countries. Although the values for water, protein, and energy were similar, wide variations were reported for total fat, fatty acids, vitamins, and minerals. These discrepancies are presumably due to both the limitations of analytical methods and the heterogeneities of the foods that were evaluated. Information from data bases cannot be as precise as that from direct laboratory analysis of a specific lot, but such laboratory analytical data also can be misleading because of wide lot-to-lot variation. Certainly the use of the USDA and other data bases can provide representative data for nutrition labeling. Data Bases for Meat and Poultry USDA composition data are rela- tively complete for a variety of cuts and grades of beef subjected to representa- tive cooking methods (USDA, 1990~. The data are presented for separate lean, edible portions and assume that there is some trimming prior to consumption. In addition, USDA composition data are fairly complete for poultry products (USDA, 1979~; pork products (tJS DA, 1983~; and lamb, veal, and game (USDA, 1989a). Data Bases for Seafood The creation of food composition data bases for seafood required considerable effort with respect to the diversity of domestically harvested species, the natural variabilities in their composition, and the further influence of cooking methods on nutrient content. An additional complication is the fact that approximately 70 percent of seafood eaten in the United States is imported (TOM, 1990~. Currently, there are composition data for 92 BW and 82 prepared seafood products (USDA, 1987~. Few other systematic sources of seafood composition data are available. However, a compilation of data on seafood harvested and consumed in the southeastern United States has been assembled by Sullivan and Otwell (19903. As indicated previously, the validity of much of the published nutrient composition data for seafood is frequently uncertain due to the high degree of natural variability of these products. Within most species, composition is influenced by various factors, including geographic location, season, stage of the reproductive cycle, age, and diet. One of the most variable aspects of seafood
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LABELING COVERAGE 139 composition is the quantity of total fat and the distribution of fatty acids. Studies of the seasonal and geographic variabilities of the fatty acid distribution of finfish have indicated wide variations even when samples involved thousands of finfish to minimize effects of within-group differences (Stansby, 1981~. For example, the percentage of eicosapentanoic acid, a major omega-3 fatty acid, ranged from 11.4 to 15.2 percent in herring oil from finfish caught off Alaska and from 3.9 to 8.8 percent in herring oil from finfish caught off Nova Scotia Substantial variation in the total content of lipid (fat or oil) also occurs. These findings illustrate the difficulty in determining "representative" data for seafood lipids. Stansby (1982) further examined the problems of within-species variability and proposed a classification system for seafood that was based on only five categories, by total fat and protein content. With approximately 85 percent of the seafood eaten in the United States being in the low-oil and high-protein category, such data could provide the starting point for developing a system of presentation of seafood composition data Data Bases for Fresh Produce The average supermarket has approxi- mately 240 items in its produce department (PMA, 1988~. The primary issue is whether current data bases are sufficient and appropriate for nutrition labeling of fruits and vegetables. Although available for most produce, data are incomplete for many varieties for the assessment of differences in nutrient content due to maturity, growing location, season, and environmental factors (USDA, 1982, 1984a,b). Where data are available for different varieties of fruits, weighted values for a given nutrient may be available based on production and marketing statistics. For example, California Valencia oranges are reported to have more vitamin A (23 retinal equivalents, RE) than Florida oranges (20 RE). Both have relatively less than the average orange (25 RE), a value derived from composite sampling based on marketing statistics for fresh oranges (i.e., California navel and Valencia oranges and Florida oranges). The nutritional and statistical significance of using average values is unclear. The differences in nutrient composition of different varieties of the same vegetable are generally too small to justify separate entries (USDA, 1984a). For example, the nutrient values given for raw potatoes represent a composite of Russet Burbank (35.8 percent), Kennebec (4.2 percent), Katahdin (30.3 percent), Superior (5.8 percent), Norgold (12.8 percent), Pontiac (5.6 percent), and White Rose (5.4 percent) (USDA, 1984a). The nutrient content of fruits and vegetables can vary depending on the soil in which the plants are grown (reveille, 1983~. This variation can be a special problem when reporting values for trace mineral content, because Were can be huge differences in the same type of food. Fbr example, the selenium content of New England-grown wheat may be quite different than that of Iowa-grown wheat.
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140 NI7TRlTlON LABELING There are concerns about the adequacy of much of the published data on the fiber content of foods. Insoluble dietary fiber was frequently determined by the neutral detergent fiber method in Be development of data between 1977 and 1988. Various applications of this method have been reviewed by T. and and Butrum (1986~. Originally developed for animal forages, the neutral detergent fiber method underestimates the total fiber in the human food supply. The soluble fiber in most fruits and vegetables in the USDA data base is measured as pectin, which underestimates the amount of soluble fiber, and data are not complete for all fruits and vegetables. The Prosky method, which was approved by the Association of Official Analytical Chemists (AOAC) in 1988, is currently the preferred method for determining total dietary fiber (see Chapter 4~. However, the USDA-provided fiber contents of fruits and vegetables Cat were published prior to 1988 (USDA, 1982, 1984a,b3 were not derived by the P=sly method. The Produce Marketing Association (PMA) is another source of data It has established a national nutrient data base for a number of different produce commodity groups in the United States. Data are collected so that information may be given for individual fruits and vegetables at the point of purchase in compliance with FDA guidelines. FDA has argued Cat the data base information may not be representative of the items sold. PMA has argued that the numbers that it has generated represent up-to-date information for specific items. The PMA Nutrition Labeling Program has been extended to include ar- tichokes, asparagus, bell peppers, broccoli cabbage, California dates, can- taloupes, carrots, cauliflower, celery, cucumbers, honeydew melons, iceberg let- tuce, kiwi fruit, Le Rouge Royale (red) peppers, mushrooms, onions, papayas, pineapples, potatoes, Dishes, spinach, strawberries, tomatoes, and watermelon. In contrast, the USDA data base responds more slowly to changes in the com- position of foods sold in the marketplace because of technological and funding constraints. USDA updates its data on a moving average, and it may be a number of years for the data base to reflect new information. These apparently trouble- some sources of variability recede somewhat in importance when considered in the context of a toad diet eaten over many years. The nutrient content of a specific lot is thus of less critical importance. Point-of-Purchase Nutrition Information Programs for Produce and Meat Within the past 10 years, several point-of-purchase nutrition information programs have been conducted in supermarkets. When signs containing nutrition information were provided in the produce departments of 300 stores of a major national supermarket chain, Be signs seemingly had no effect on the in-store purchasing behavior of customers during the 1-month study period (Achabal et al., 1987~. The limited number of produce items carrying information, the small
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LABELING COVERAGE 141 size and physical placement of the signs, and the short time frame for the study were suggested as reasons why the signs had no effect on sales. In 1984, the Minnesota Heart Health Program, in collaboration with the Minnesota Beef Council and the Minnesota Pork Producers Council, began a program to teach consumers how to select and prepare lean cuts of meat and choose appropriate portion sizes (Mullis and Pirie, 1988~. Labels on individual meat packages and rail strips identified and promoted various lean cuts at the meat case. On the basis of sales data, the program appeared to have an effect on purchases of specific lean cuts of meat; for example, 80 percent lean ground beef outsold 70 percent lean ground beef in participating stores, whereas the opposite was true in control stores (presumably due to cost differences). The Meat Nutri-Facts program, sponsored jointly by the American Meat Institute, the Food Marketing Institute, and the National Live Stock and Meat Board, was designed to provide consumers with accurate, up-fo~ate nutrition information on 3-ounce portions of trimmed and cooked red meat ~MB, 1990~. The Nutri-Facts program used cards with detailed nutrient data on over 30 cuts of beef, pork, and lamb; rail strips with calories; stickers for individual meat packages; and take-home brochures with nutrition and recipe information. The program was evaluated through consumer, meat manager, consumer affairs, and supermarket business surveys. About two-thirds of consumers surveyed reported using Nutri-Facts materials in making meat selections, and approximately 80 percent of respondents found the graphs and brochures to be "just about right" in terms of complexity and the content of information displayed. Meat managers and consumer affairs officials judged the information to be very or somewhat helpful for consumers; however, they both cited the amount of time needed to maintain the program as the main deterrent for continuation of the program beyond the study period. In a 1-year followup survey, responses from retailers revealed that over 60 percent had continued the Nutri-Facts program. Poultry and Seafood Nutn-~cts programs were subsequently initiated, but have not yet been formally evaluated. Additional consumer education and a longer evaluation period in studies such as these may reveal greater effectiveness. Current FDA Guidelines for Labeling of Fresh Fruits and Vegetables Although nutrition information for fresh produce is not currently required at the point of purchase, FDA requires that, when it is provided, it be based on up-to-date information about the item that the consumer purchases at the store. This requirement precludes the use of information from the USDA nutrient data bank if current laboratory methods and sampling procedures are not used. FDA's regulatory compliance assurance standards for nutrition labeling do not currency allow average values, such as those given in the USDA data base.
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LABELING COVERAGE 147 upon request. NRA's recipe evaluation service costs $10 per recipe (520 for nonmembers), with the per recipe cost decreasing as the quantity of recipes increases. To date, use of the NRA service has exceeded original expectations (Claire Regan, NRA, personal communication, 1990~. Many restaurants include a statement on their menus that encourages special requests, such as to cook foods without the use of added salt or to provide sauces on the side. In addition, many menus describe the manner of food preparation, such as broiled, grilled, or poached, which can aid consumers in selecting foods that better meet their nutritional desires. Table 5-3 shows the various methods used by NRA members to disseminate nutrient and ingredient information. Current Regulatory Requirements No specific federal laws or regulations require that the commercial food service industry provide nutrition information to consumers. However, FDA has taken the position that if nutrition labeling is provided, it must follow current agency regulations. A nutrition claim or nutrition information concerning a combination of restaurant foods, e.g., the total nutritional value of a meal consisting of a hamburger, french fries, and mink shake, may be included in advertising and/or in labeling (other than labels) without causing nutrition information to be required on the labelks) of each article of food: Provided, That complete nutrition information for the combination of foods (the combination as an entity without the nutritional value of each article being specified) in the format established by 21 CF11 § lOl.9(c) is TABLE 5-3 Method of Dissemination of Nutrition and Ingredient Infonnation by Food Chain Operators Method of Dissemination Nutrition Information Percent Number Percent Number Ingredient Information Operators with information 76 16 62 13 Through corporate headquarters 67 14 52 11 In panted material (booklets, pamphlets, etc.) 57 12 33 7 In units 29 6 10 2 Toll-free telephone request 14 3 10 2 Wall posters 10 2 0 On package 0 14 3 Interactive computer program 5 1 0 SOURCE: Adapted from National Restaurant Association. 1990. Current Issues Report: Nutrtion Awareness and die Foodservice Industry. NRC, Washington, D.C. 20 pp.
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148 NUTRITION LABELING effectively displayed to Me customer both when he orders the food and when he consumes We food. This statement of policy does not Apply to food dispensed in automatic vending machines (21 CFR §101.10~. There is little evidence that this policy has been used or enforced. In 1979, He U.S. Department of Heals, Education, and Welfare (I)HEW), USDA, and the Federal Trade Commission (FTC) considered the possibility of requiring ingredient labeling for restaurant foods (DHEW/USDA/FTC, 1979~. The agencies asserted that they had the legal authority to require ingredient listings on foods sold in limited-menu establishments, where food is generally served in individually wrapped portions, but they were concerned about en- forcement of such a requirement. FDA and USDA (FTC was not involved in this issue) expressed serious doubt about Heir authority to require ingredient information for foods sold unpackaged on plates. Neither agency took steps to implement labeling of any type for foods sold in restaurants. In 1985, USDA and FDA were petitioned to require ingredient labeling on food packages in limited-menu restaurants. The petitioners claimed that the lack of ingredient labeling of these foods was a violation of existing laws and regulations. They viewed the highly standardized nature of the food products, the limited number of items offered on the menu, and the use of serving wrappers as easily accommodating the ingredient information being requested. Both agencies subsequently denied the petition. In general, they concluded that the petition failed to demonstrate that a change from the current policy was necessary, and expressed doubt that a definition of fast food was practicable, that enforcement against a single segment of the food senice industry was equitable, or Hat the costs incurred would yield a real benefit to consumers. Both agencies also said that they regarded the regulation of the food senice industry to be the responsibility of state and local regulatory authorities. When He petition was denied, the attorneys general of several states threatened suit against five limited-menu restaurant chains to persuade them to provide ingredient and nutrition information about their products. In a negotiated settlement, McDonald's, Burger King, Jack in the Box, Kentucky Fried Chicken, and Wendy's agreed to distribute printed materials containing this information to consumers. The printed material was to be provided free at the point of purchase upon request; however, subsequent practice has shown that materials were not always available (Chicago Tribune, March 6, 1990~. Recently, McDonald's has begun distributing posters and placemats containing nutrition information on foods sold at the point of selection in their restaurants (Michael Goldblatt, Nutrition Division, McDonald's Corporation, personal communication, 1990~. Legislation to require nutrition and ingredient labeling in such restaurants has been introduced in several states but has not yet been enacted in any jurisdiction. Federal legislation to require nutrition information on the packaging of foods
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lABELING COVERAGE 149 sold in limited-menu restaurants has been introduced in the past three sessions of Congress, but it has yet to be passed. Current Status of Nutrition Labeling of Restaurant Foods Some health and consumer groups have urged that information be provided on Me ingredients and nutrient composition of foods sold in restaurants. Con- cerns about the consumption of salt, fat, sugar, and substances that cause allergic reactions in some people have led to increased attention to the nutritional pro- files of foods sold in restaurants. Although current attention has focused chiefly on the limited-menu segment of the industry, there is no evidence that meals served by the restaurant and lunchroom segment of the industry are more (or less) nutritious or likely to meet the guidelines provided in dietary recommen- dations. Although the Committee believes that improvements in nutrition labeling of foods purchased in grocery stores is the primary goal, it recognizes that Americans now spend almost half of their food dollar on meals consumed away from home. The Committee applauds the efforts of restaurants that are providing more nutrition information for the foods on their menus. The Committee does not consider direct laboratory analysis-based labeling to be feasible for foods sold in most restaurants, but foods sold in limited-menu restaurants represent a special case. Reports on the fat, salt, sugar, and caloric composition of meals served in these establishments have led to numerous pro- posals to require nutrition labeling in limited-menu restaurants (Massachusetts Medical Society, 1989; Shields and Young, 19903. Several of these proposals would require the provision of nutrition information on preprinted food packages. Representatives of the industry oppose the requirement of nutrition information on food wrappers and cups, primarily for economic reasons. The Committee believes that there is a convincing case for providing consumers of meals at limited-menu restaurants with information about the nutrient composition of those meals. Their consumers consist largely of people on the go, as well as many children and young adults who are experiencing rapid growth and who are beginning to learn about long-term health. Furthermore, many of the foods served in vast quantities are high in fat, cholesterol, and sodium, and low in fiber. The entire restaurant industry deserves credit for improving the nutritional quality of its product lines, but such innovations will be hastened if nutrition labeling is required. Consumers should come to expect and ask for this nutrition information in all restaurants. Many menu items become standard fare for the restaurants that serve them. Problems that make general labeling impractical for all restaurants at this time are less formidable in the context of limited-menu restaurants. Menu items are standardized, and their nutrient compositions are well characterized and carefully controlled across He country. In addition, many
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150 NUTRITION LABELING of the foods are already served in packages or wrappers designed for a particular food item on which the nutrition information could be placed. ~hermore, there are numerous other options for the presentation of nutrition information at the point of selection. The serving size for foods in these restaurants would be standardized, and therefore, nutrient content information would be based on these portion sizes. For other restaurants, where food is not proportioned, nutrient content information will need to be based on a normative-sized portion determined by the agencies. The Committee believes that FDA and USDA should determine precisely how nutrition labeling should be provided in limited-menu restaurants. The Committee suggests that these agencies explore the most appropriate options with the affected industry, recognizing that nutrition labeling for some foods can be provided on the outside of the container or wrapper, whereas for others, placards at the point of selection may be appropriate. Committee Recommendations Considering the extent to which U.S. consumers are eating meals away from home, with nearly 50 percent of the food dollar being spent in these settings, the Committee believes that more complete nutrition information needs to be available to consumers at the point of selection. The Committee recommends that . . All restaurants should be required to have standard menu items evaluated for their nutritional profiles and provide this information to patrons upon request. This evaluation can be performed by using the service provided by NRA, a comparable senice, or computer software that is readily available and inexpensive. Laboratory analysis should not be required. Restaurant menus should be required to state that "nutrient evaluation is available upon request," so that consumers can, if they desire, obtain such information. · FDA and USDA should, through regulations, allow the use of nutrient data bases to provide nutrient evaluation of menu items. Food service establishments above a specified size andJor volume (limited- menu and regionaVnational restaurant chains) should be required to provide nutrition analysis of food items at the point of purchase. This requirement can be met by placing the information either on package wrappers and containers or at some other point-of-purchase location that allows consumers easy access and use. Restaurants should be encouraged to participate in programs and/or other- wise provide for appropriate symbols or descriptors on menu items that iden- tify foods that meet criteria for low-calorie, low-fat, low-cholesterol, and/or .
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LABELING COVERAGE 151 low-sodium. Comparable definitions for symbols and descriptors should be established by PDA and USDA. · FDA and USDA should define the categories and size of restaurant ~ erations for which regulations based on the above recommendations are applicable. FOODS SOLD BY NONCOMMERCIAL FOOD SERVICES The Committee divided food senice operations into two categories: com- mercial and noncommercial. Noncommercial food services comprise operations in locations such as day-care programs, elementary and secondary schools, col- leges and universities, prisons, military installations, and health care facilities such as hospitals and nursing homes. Food service operations in these various institutions are subject to multiple statutes, regulations, and guidelines under He jurisdiction of various agencies at He federal, state, and local levels. ~ many cases, individuals have no or very limited choices as to the meals and snacks provided at these institutions; however, programs generally must meet minimum guidelines for nutritional quality and variety. Like restaurant operations, institutional food services have grown substan- tially in recent years (NRA, 1990b). People of all age groups are eating more meals prepared in institutional or congregate settings than in home kitchens. Children are eating more breakfasts as well as lunches at school. Long- and short-term care facilities are feeding a larger percentage of elderly individuals. Militay installations, correctional facilities, and colleges arid universities are also feeding an increased number of people. The DHHS Year 2000 Objectives for the Nation recommend an "increase to at least 75 percent He proportion of institutional food service operations with menus that are consistent with the Dietary Guidelines for Americans" (DHHS, 1989, p. 1-5). Child Nutrition Programs Child nutrition programs include the National School Lunch, Breakfast, and Milts programs and the Child Care and Summer Food programs. Lunches served as part of the National School Lunch Program (NSLP3 must meet USDA minimum meal pattern requirements that are designed to provide one-third of the RDA for the age group (7 CFPc § 210.10(b)). The NSLP operates in over 90 percent of the nation's schools, serving over 24 million children daily (ASFSA, 1989). Other child nutrition programs have minimum meal pattern guidelines for meals and snacks that are designed to provide a wide variety of nutritious foods (21 C:~K Parts 220, 225, 226~. In 1990 He Special Supplemental Food Program for Women, Infants,
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152 Nl~NTlON LABELING and Children CIVIC) is expected to serve over 4 million low-income, at-risk pregnant or lactating women, infants, and children Trough heals services, food supplements, and nutrition education to improve nutritional status and pregnancy outcome (IJ.S. Congress, 1988~. Foods offered through WIC include juices, milk, cheese, eggs, breakfast cereals, dry beans and peas, peanut butter, and infant formula and cereal. Many WIC foods are not labeled with nutrition information. The Child Nutrition and WIC Reauthonzadon Act of 1989 (Pat. 101-147) requires the Secretaries of DHHS and USDA to develop nutrition guidance for child nutrition programs to help program managers construct menus and snacks consistent with current dietary recommendations. Legislation in several stakes has addressed additional requirements for nutrition content and education in child nutrition programs. The DHHS Year 2000 Objectives for the Nation include an objective aimed at child nutrition programs: "Increase to at least 95 percent the proportion of school lunch and breakfast services with menus that are consistent win the Dietary Guidelines for Americans" (DHHS, 1989, p. 1-5~. Feeding Programs for Elderly Individuals Congregate and home-delivered meal programs served over 337 million meals in 1988 (Mary Tonore, Louisiana Department of Aging, personal com- munication, 1990~. These meal programs are regulated under provisions of Title III-C of the Older Americans Act (PL. 100-175), which is administered by the Administration on Aging (AoA). The Act requires that all meals meet one- third of the RDA for people age 51 and older (OAA, Title III, Part C, § 331~. Louisiana has additional restrictions that limit fat to 35 percent of total calories and sodium to 1,300 mg per meal. AoA does not have data on other states that may have adopted such similar requirements. Title III-C also requires a nu- trition education component that provides information on nutrition and health. The quantity and quality of the nutrition education varies greatly, but at least the most basic information reaches some elderly participants. Military Installations All branches of the U.S. military have taken the initiative to provide healthy food alternatives for their personnel. NRA estimated that food and beverage sales and purchases for military food services were $2.4 billion in 1989. Garrison menus, which comprised 68.5 million meals in fiscal year 1989, are planned within standards set forth in the Triservice Regulation on Nutrition MOD, 1989~. Although there are no mandatory regulations for food service in the military, U.S. Department of Defense (DOD) Food Planning Board policies provide guidance on the purchase and selection of the special dietary products used in military menus.
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LABELING COVERAGE 153 The DOD Health Promotion Directive requires all branches of the military to implement a nutrition education program. Each branch's nutrition educator has the responsibility of educating the military community in its selection of healthful food products that are commonly available in military food service operations. The nutrition education materials used include posters, table tents, bulletin boards, and pamphlets displayed in dining halls. The army, for example, offers Guide to Good Eating, which provides personnel with information on calories, seeing sizes, and levels of fat, sodium, and other nutrients in foods (Celia Adolphi Office of the Deputy Chief of Staff for Logistics, U.S. Army, personal communication, 1990~. Correctional Institutions In 1989, there were approximately 710,000 inmates in correctional institu- tions under state and federal jurisdiction and an additional 395,000 inmates at local and county detention facilities (U.S. Deparunent of Justice, 1990a,b). Food service operations at correctional institutions provide over 3 million meals each day. Correctional facilities have generally been required, through internal pol- icy and/or accreditation standards of the American Correctional Association, to provide a nutritionally balanced diet based on the RDAs, medically therapeutic diets, and diets to meet the requirements of religious preference. College and Universitr Food Services There are no federal regulations governing college and university food services, but most adhere to policies set forth by the National Association of College and University Food Service (NACUFS, 1986~. NACUFS guidelines require a nutrition education program that uses various forms of communication to reach students and staff. Health Care Facilities To participate in the Medicaid and Medicare programs, hospitals and acute care facilities must meet standards set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), a private accreditation body comprising the American College of Physicians, American Medical Association, and Amer- ican Hospital Association. There are currently 6,780 hospitals in the United States, of which 5,400 are accredited by JCAHO (1989~. State licensing boards regulate hospitals that are not accredited by JCAHO. The dietetic departments of accredited hospitals must be administered by an expert in food service management. JCAHO standards require that patients' nutrient intakes be assessed and recorded. Modified diets must be approved and monitored by a qualified dietitian, and menus must be planned to meet individual
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154 NUTRITION LABELING patients' nutritional requirements based on both the RDAs and medical factors. Patients on modified diets are required to receive written instructions and individualized counseling before they are discharged. Requirements for patients on regular diets are less stringent, but selection of menu items provides an opportunity for delivery of nutrition information. Intermediate- and long-term-care facilities include skilled and intermeddle nursing facilities and mental health, mental retardation, psychiatric, hospice, rehabilitation, and retirement centers. All must comply with federal (Medicare and Medicaid) and/or state requirements to receive reimbursement for care. The minimum federal standards require that meals be planned in accordance win each resident's individual nutritional needs, based on both the RDAs and medical factors (21 CF1( §§483.10, 483.410~. Committee Recommendations Institutions and other noncommercial food service operations present a distinctive set of characteristics when one considers proposals for food labeling. Almost all have program or menu requirements that provide some assurance that participants receive a proportion of a days' nutrition requirements. Several programs include nutrition education components, and food choices are restricted or nonexistent. However, nutrition information at point of purchase or point of selection for foods in such settings would be very valuable for nutrition education efforts. On the basis of program requirements and the multijunsdictional nature of noncommercial food service operations, the Committee recommends ~at: · The agencies at the federal, state, and local levels that oversee or support noncommercial food services encourage voluntary nutrition labeling of meals at the point of purchase or point of selection as part of overall nutrition education efforts. REFERENCES AAP (Amencan Academy of Pediatrics). 1985. Pediatric Nutrition Handbook, 2nd ed. Committee on Nutrition. AAP, Elk Grove Village, Ill. 421 pp. Achabal, D.D., S.H. McIntyre, C.H. Bell, and N. locker. 1987. The effect of nutrition P-O-P signs on consumer attitudes and behavior. J. Retailing 63:9-24. Adams, C.E., and J.W. Erdman. 1988. Effects of home food preparation practices on nutrient content of foods. Pp. 557~05 in Nutritional Evaluation of Ed Processing, 3rd ea., E. Karmas and R.S. Harris, eds. Van Nostrand Reinhold Co., Inc., New York. ASFSA (American School Food Service Association). 1989. School Food Service Re- search Review, Fall 1989. ASFSA, Alexandria, Vat 191 pp. Bergstrom, L. 1988. Nutrient data banks for nutrient evaluation in foods. Pp. 745-764
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LABELING COVERAGE 155 in Nutritional Evaluation of Food Processing, 3rd ea., E. Karmas and R.S. Harris, eds. Van Nostrand Reinhold Co., Inc., New York. Chicago Tribune. March 6, 1990. Nutrition data on front bumer; fast food chains broke pledge, consumer group says. Sec. 3, p. 5. DHEW/USDA/FIC (U.S. Department of Health, Education, and Welfare, U.S. Depart- ment of Agriculture, and Federal Trade Commission). 1979. Food Weling Back- ground Papers. Govemment Printing Office, Washington, D.C. 124 pp. DHHS (U.S. Department of Health and Human Services). 1988. The Surgeon General's Report on Nutrition and Health. Government Printing Office, Washington, D.C. 727 PP. DHHS (U.S. Department of Health and Human Services). 1989. Promoting Health/Pre- venting Disease: Year 2000 Objectives for the Nation. Draft for Public Review and Comment. Public Health Service, Washington, D.C. DOC (U.S. Department of Commerce). 1987. P. A-9 in 1987 Census of Retail Trade. Eating and Drinking Places (SIC Major Group 58~. Government Printing Office, Washington, D.C. DOD (U.S. Department of Defense). 1989. Triservice Regulation on Nutrition. DOD, Washington, D.C. 10 pp. IOM (Institute of Medicine). 1990. Seafood Safety. Committee on Evaluation of the Safety of Fishery Products, Food and Nutrition Board. National Academy Press, Washington, D.C. In press. JCAHO Point Commission on Accreditation of Healthcare Organizations). 1989. Joint Commission 1990 Accreditation Manual for Hospitals. JCAHO, Chicago. Lanza, E., and R.K. Butrum. 1986. A review of food fiber analysis and data. J. Am. Diet. Assoc. 86:732-743. Leveille, G.A. 1983. Nutrients in Foods. The Nutrition Guild, Cambridge, Mass. 291 pp. Lund, D.B. 1988. Effects of heat processing on nutrients. Pp. 319-354 in Nutritional Evaluation of Food Processing, 3rd ea., E. Karmas and R.S. Harris, eds. Van Nostrand Reinhold Co., Inc., New York. Massachusetts Medical Society Committee on Nutrition. 1989. Fast Food Fare: Consumer Guidelines. Prepared by Connie Roberts. N. Engl. J. Med. 321:752-756. Mullis, R.M., and P. Pirie. 1988. Lean meats make the grade: A collaborative nutrition education program. J. Am. Diet. Assoc. 88~2~:191-195. NACUFS (National Association of College and University Food Service). 1986. Profes- sional Standards Manual. NACUFS, E. Lansing, Mich. NLMB (National Live Stock and Meat Board). 1990. In-Store Nutrition Information on Fresh Meat Issues and Insights. Research Report No. 100-1. NLMB, Chicago. 18 PP- NRA (National Restaurant Association). 1986. 1986 G~lup PoD results. N~, Wash- ington, D.C. NRA (National Restaurant Association). 1989. Survey of Chain Operators. NRA. Washington, D.C. 16 pp. NRA (National Restaurant Association). 1990a. Foodservice Industry: 1988 in Review. NRA, Washington, D.C. 12 pp. NRA (National Restaurant Association). 1990b. Food Service Industry Forecast. NRA, Washington, D.C. 24 pp.
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156 NUTRITION LABELING NRC (National Research Council). 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Report of the Committee on Diet and Health, Food and Nu- tntion Board, Commission on Life Sciences. National Academy Press, Washington, D.C. 749 pp. PMA (Produce Marketing Association). 1988. Produce Retailing: Performance and Pro- ductivity. Food Marketing Institute and Produce Marketing Association, Wilming- ton, Del. Riehle, H. 1990. Consumer commitment to nutrition increases. Restaurants USA March: 3~39. Shields, J.E., and E. Young. 1990. Fat in fast foods—evolving changes. Nutr. Today 25~2~:32-35. Slater, G.G., S. Shankiman, J.S. Shepherd, and R.B. Alfin-Slater. 1975. Seasonal variation in the composition of California avocados. J. Agric. Food Chem. 23:468- 474. Stansby, M.E. 1981. Reliability of fatty acid values purporting to represent composition of oil from different species of fish. J. Am. Oil Chem. Soc. 58:13-16. Stansby, M.E. 1982. Properties of fish oils and the* applications to handling of fish and to nutritional and industrial use. Pp. 75-92 in Chemistry and Biochemistry of Marine Food Products, R.E. Martin, G.J. Flick C.E. Hedbard, and D.R. Ward, eds. AVI Publishing Co., Westport, Conn. Sullivan, A.L., and W.S. Otwell. 1990. A Nutrient Data Base for Southeastem Seafood: A Comprehensive Nutrient and Nomenclature Handbook for Selected Southeastern Species. Produced in cooperation between the Florida Department of Natural Resources and the University of Florida, Gainesville. In press. Sweet, C.A. 1989. Rethinking eating out. FDA Consumer (November): 8-13. U.S. Congress. 1988. Subcommittee on Elementary, Secondary, and Vocational Educa- tion, Committee on Education and Labor. Child Nutrition Programs: Issues for the 101st Congress. 101st Cong., 2nd Sess., U.S. House of Representatives, Washing- ton, D.C. USDA (U.S. Department of Agriculture). 1979. Composition of Foods: Poultry Products. Agriculture Handbook No. 8-5. Govemment Printing Office, Washington, D.C. 330 PP. USDA (U.S. Department of Agriculture). 1982. Composition of Foods: Fruit and Huit Juices. Agriculture Handbook No. 8-9. Government Printing Office, Washington, D.C. 283 pp. USDA (U.S. Department of Agriculture). 1983. Composition of Foods: Pork Products. Agnculture Handbook No. 8-10. Government Printing Office, Washington, D.C. 206 pp. USDA (U.S. Department of Agnculture). 1984a Composition of Foods: Vegetables and Vegetable Products. Agriculture Handbook No. 8-11. Government Printing Office, Washington, D.C. 502 pp. USDA (U.S. Department of Agriculture). 1984b. Composition of Foods: Nut and Seed Products. Agriculture Handbook No. 8-12. Government Printing Office, Washington, D.C. 137 pp. USDA (U.S. Department of Agriculture). 1987. Composition of Foods: Finfish and
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lABELING COVERAGE 157 Shellfish Products. Agriculture Handbook No. 8-15. Government Printing Office, Washington, D.C. 192 pp. USDA (U.S. Department of Agriculture). 1989a Composition of Foods: L=nb, VeaL and Game. Agriculture Handbook No. 8-17. Govemment Printing Office, Washington, D.C. 251 pp. USDA (U.S. Department of Agriculture). 1989b. National Advisory Council on Com- modity Distribution, 1989 Annual Report. First Report to the President and the Congress. Government Printing Office, Washington, D.C. 12 pp. USDA (U.S. Department of Agriculture). 1990. Composition of Foods: Beef Products. Agriculture Handbook No. 8-13. Govemment Printing Office, Washington, D.C. 412 pp. U.S. Department of Justice. 1990a. Prisoners in 1989. Office of Justice Programs, Bureau of Justice Statistics. U.S. Department of Justice, Washington, D.C. 11 pp. U.S. Department of Justice. 1990b. Jail Inmates, 1989. Of lice of Justice Programs, Bureau of Justice Statistics. U.S. Department of Justice, Washington, D.C. 5 pp.
Representative terms from entire chapter: