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OCR for page 131
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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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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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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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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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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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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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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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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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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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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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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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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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.
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Representative terms from entire chapter:
nutrition information
