10. FOOD LABELLING, ADDITIVES & DIETARY ASSESSMENT

Question 1

Why are food labels important for consumers and the Nutritionist?

Answer 1

• They are there to protect the customer.
• Food labels help consumers to
  select foods based on aspects of health and quality.
• Educating clients about food labels allows them to avoid unhealthy products / foods and they appear on all processed foods.

Question 2

Name 4 things you could find on a food packaging label to help achieve better health & that you could use to educate your clients?

Answer 2

• What type of fats / oils are used? Trans fats?
• How much sugar / salt per serving?
• Are there additives / preservatives
  / artificial colours?
• Is the food nutrient-dense or
  calorie-dense?
• Does it contain GMO ingredients?

Question 3

What needs to be on a Food label?

Answer 3

• Name: Clearly stated on packaging. Incl. name / address of manufacturer.
• Made-up name: Must not be misleading.
• Processing: Must include processing method, e.g., dried figs, roasted peanuts.
• Weight / volume: If packed in liquid — drained weight. Enables comparison of price per weight of similar products.
• Preparation and storage instructions:
• ‘Best before’ or ‘Use by’ date
• Temperature, time, method of storage.
• Before / after opening

Question 4

What must food labels include and in what order are they included?

Answer 4

Must include all ingredients (incl. water and additives).

• Listed according to the weight of each ingredient.
• Starts with highest weight ingredient.
• Sometimes listed as percentage of the weight of the food

Question 5

Give 2 reasons why along with the ingredients list, the percentage of an ingredient must be shown?

Answer 5

• It is highlighted by labelling or a picture, e.g., ‘extra blueberries’.
• It is mentioned in the name of the product, e.g., ‘blueberry and apple pie’.
• If consumers would generally connect an ingredient with a product, e.g., fruit in Summer Pudding.

Question 6

What is mandatory to be included on the Back-of-pack labelling of food products?

Answer 6

Energy value (kJ and kcal)
* Fat (g)
- Saturates
* Carbohydrates
- Sugars
* Protein
* Salt (sodium chloride)

per 100 g / ml — may also be displayed as per portion

Question 7

What can be included on the Back-of-pack labelling but is voluntary by the manufacturer?

Answer 7

Monounsaturates and polyunsaturates
* Polyols (used as sweeteners)
* Starch
* Fibre
* Any vitamins or minerals providing 15% or more of the nutrient reference value (NRV) is contained per 100 g / ml, or per serving,
depending which is smallest. For example, to declare calcium in 30 g of cheese, the 30 g serving must contain 15% x 800 mg
= 120 mg of calcium (800 mg is the NRV for calcium).

Question 8

What are Reference Intakes (RIs) and why did they replace Guideline Daily Amounts (GDAs) on food labelling?

Answer 8

• RIs are guidelines to help people make food choices and create balance in their diet. They show the maximum amount of calories, macronutrients and salt that should be consumed in a day.
• The term GDA suggested that these were specific amounts for people to aim for, so RIs are used instead to indicate that they are not targets.

Note: The % of RIs present in packaged food can be displayed either on the front or back of the pack — this is voluntary

Question 9

What are the RI’s for an average adult?

Answer 9

– Energy 2000 kcal / 8400 kJ.
– Fat less than 70 g of which saturates 20 g.
– Carbohydrate 260 g of which sugars 90 g.
– Protein 50 g.
– Salt less than 6 g.

Question 10

If a company chooses to provide
the traffic light system on the Front-of-pack labelling, list in what format they should put it?

Answer 10

– Energy value (kJ and kcal) alone.
– Energy value (kJ and kcal) plus amounts (in grams) of fat, saturates, sugars and salt.

Question 11

How many food allergens are there that must be highlighted if included as an ingredient or processing aid in pre-packed foods? List 4 of them that are plant based?

Answer 11

14 allergens
Gluten, Peanut, Soya, celery, Milk, Tree nuts, Mustard, Sesame, Sulphur Dioxide, Lupin, Molluscs, eggs, fish, crustaceans

Question 12

Name 4 products that require additional warnings on the label?

Answer 12

• Drinks with an alcohol content above 1.2%.
• GM ingredients above 0.9%.
• If the product has been irradiated.
• The words ‘packaged in a protective atmosphere’ if packaged using a gas.

Question 13

As you educate your client, give one reason why would you say ‘Free-from’ does not necessarily mean healthy?

Answer 13

Gluten-free labelled products can contain 20mg / kg gluten.

And food can be highly processed with various chemicals and products that are not necessarily healthy.

Question 14

What percentage is required for producers to label the presence of GMOs or ingredients produced from GMOs

Answer 14

if >0.9%

Question 15

Why you will discourage GMO food for your clients? What are the most common ones?

Answer 15

Varied research links GMOs to infertility, immune issues, impaired
insulin regulation and accelerated ageing.

Common GM crops: Corn, rice, soya and cotton

Question 16

What is the % required for pre-packed foods to be labelled as ‘organic’?

Answer 16

If at least 95% of the ingredients are organic.

Question 17

What aspects of food labelling could mislead a client who is trying to make positive food choices?

Answer 17

Misleading labels:
* Low calorie: The difference may be negligible.
* High fibre: (Cereal) ― may still be high in salt, sugar and highly processed.
* Low fat: May still be high in sugar, additives and preservatives.
* No added sugar: May still be high in naturally occurring sugars (fruit juice).
* No sugar: Has artificial sweeteners when taste is sweet.
* Natural: Not everything labelled ‘natural’ is healthy or natural!

Question 18

Give four possible pieces of information a client may be able to get from a food label that can positively influence their food choice?

Answer 18

1) If the food is GMO
2) The main ingredients and checking the level of processing
3) The sugar content and types of sugar like artificial sugars
4) Allergens are often in bold

Question 19

Define ‘food additives’ and give two examples of the Universal numbering of the 6 main categories.

Answer 19

Food additives are substances added to foods to perform particular functions, e.g., to prolong shelf life, alter taste,
texture or colour, to make food more appealing.

1. E100s - Colours
2. E200s - Preservatives
3. E300s + E586 - Antioxidants
4. E400s + E322 & E1103 - Emulsifiers, stabilisers, thickeners, gelling agents
5. E600s - Flavour enhancers
6. E900s + E420 & E421 - Sweeteners

Question 20

Name two food additives found naturally in foods?

Answer 20

E100 curcumin (turmeric) to colour foods yellow
E162 beetroot to colour foods red.

Question 21

What are the health concerns of these artificial food colourings:

E110 sunset yellow FCF
E104 quinoline yellow
E122 carmoisine
E129 allura red
E102 tartrazine
E124 ponceau 4R

Answer 21

Associated with hyperactivity and poor concentration.

Question 22

What are the health concerns associated with the following preservatives?

• E211 sodium benzoate: Used in carbonated beverages, fruit juices, pickles, salsa and dips.
• E220 sulphur dioxide: Used in dried fruit, fruit juice, pickled vegetables, sausages, cider, wine.
• E251 sodium nitrite: In processed meats (e.g., bacon and ham)

Answer 22

All three are linked to adverse effects (asthma and allergies).

Question 23

Why are antioxidants (E300s) used in foods?

Answer 23

These are used to decrease the chance of oils and fats turning rancid (vegetable oils, margarines, biscuits, cereals).
They are used to replace natural antioxidants lost during processing, extending shelf life.

Question 24

Why are emulsifiers, stabilisers E400s used and give two examples.

Answer 24

Emulsifiers mix ingredients that would normally separate.
* Used in dairy-free milks and yoghurts.

Question 25

You see the following emulsifiers on a label:
* polysorbate 80 (E433)
* carboxymethyl cellulose (E466)

What are the associated health concerns that raise the alarm bell for you?

Answer 25

Associated with an increased risk of inflammatory bowel disease and colon cancer (mediated in part by disruption to the microbiome).

Question 26

What is the function of in food manufacturing?
* Stabilisers
* Gelling agents (E440s)
Provide two examples of products in which each can be found.

Answer 26

Stabilisers such as lecithin, agar-agar, carrageenan and pectin prevent ingredients from separating again.
It is commonly used in ice-cream, margarine, dairy and dairy-free products, salad dressings and mayonnaise.

Gelling agents such as starches, pectins and gums are thickeners that increase the viscosity of foods.
Commonly used in soups, sauces and puddings.

Question 27

What are the potential health issues with E400’s?

Answer 27

They are linked with GI issues including:
Bloating, cramping, nausea and flatulence.

Question 28

What is the function of E600s in food? Provide two examples of where they are commonly used.

Answer 28

They are flavour enhancers.
* Used widely in savoury foods to make the existing flavour stronger.
* In crisps, salty snacks, processed meats, instant noodles, fast food, sports drinks.

Question 29

What health issues can E621 MSG (monosodium glutamate) be linked to? Name one red flag linked to this food additive.

Answer 29

MSG syndrome.

Can cause symptoms including headaches, skin flushing, sweating, muscle tightness, numbness or burning in the mouth, dizziness.

Red Flags:
* Chest pain and heart palpitations.
* Shortness of breath and throat swelling require immediate medical attention.

Question 30

What are E900s? Give an example of a natural and a synthetic form.

Answer 30

They are Sweeteners
* ‘Natural’ (stevia, xylitol)
* synthetic (aspartame, saccharin)

Question 31

How are sweeteners categorised? Give an example for each?

Answer 31

Categorised as:

• Intense sweeteners: E.g., saccharin, aspartame, ace K, stevia.
• Bulk sweeteners: Mainly sugar alcohols, e.g., sorbitol and xylitol.

Question 32

Why does more than 10 g /100 g of a bulk sweetener such as xylitol require a warning on the product label?

Answer 32

It can cause GIT upset

Question 33

What are 2 concerns in regards to artificial sweeteners such as aspartame, saccharin and acesulfame K?

Answer 33

• Can raise insulin levels and affect insulin sensitivity.
• Over-stimulate sugar receptors, making healthy, less sweet options such as fruit and vegetables unappealing.
• Addictive and increases cravings for sweet foods.
• Cause DNA damage (mutations)

Question 34

Which plant-derived sweetener is the safest alternative to sugar (but still concerning if processed)?

Answer 34

Stevia

Question 35

Which 2 food additive categories are linked to ADHD? Name two products where these can commonly be found.

Answer 35

Artificial colours:
* E102, 104, 110, 122, 124, 129.
Found in cheese, jam, tinned fruit, pickles, fruit squash and cordial, instant puddings, cakes, custard powder, ice-cream, sweets, yoghurt, packet and tinned soups.

Benzoate preservatives E210–219:
* Found in cooked pre-packed beetroot, jam, fruit juice, fruit pies, sweets, pickles, salad dressing, margarine, soft drinks, beer.

Question 36

Which colour additives are added to canned peas to give it an appealing green colour?

Answer 36

E133 (brilliant blue FCF) combined with
E102 (tartrazine) yellow to provide a shade of green.

Question 37

What is a key concern of colour additives in food for children?

Answer 37

They are linked to hyperactivity

Question 38

What would be the concern with colour additive E102 ?

Answer 38

E102 is Yellow Tartrazine. It is associated with rhinitis, itching, blurred vision, asthma.

Question 39

In addition to the 6 key E Number categories in food, give 4 more other range of other E Numbers?

Answer 39

regulators, anticaking agents, anti-foaming agents, bulking agents,
carriers and carrier solvents, flour treatment agents, foaming agents, glazing agents, modified starches, packaging gases, raising agents.

Question 40

Given an example of hidden additives and why you should be concerned?

Answer 40

Colour added to farmed salmon to increase the redness of flesh.

• Food companies use ‘tricks’ when labelling foods as this would not appear on the label.

Question 41

All additives are assessed for ‘safety’ before they can be used. Why would you still be concerned?

Answer 41

Several approved additives are linked with serious health concerns including asthma, allergic reactions, neurotoxicity
(ADHD, irritability, headaches) and increased cancer risk.

Question 42

Give 2 reasons why would you still be concerned by ‘natural’ additives?

Answer 42

Juice: By the time juice is extracted, processed and pasteurised, much of the flavour, aroma and health benefits are lost.

• Flavour packs are created from fruit essences and oils, which are broken down into their individual chemical constituents in a laboratory. They are then reassembled
  into a new compound and added back into the juice.
• Flavour packs don’t reflect anything found in nature. They are artificial BUT they can be labelled as natural, because individual components were originally extracted from fruit.

Question 43

E407 is carrageenan and a food additive. What is it used for and why its a cause for concern?

Answer 43

Used as a Thickening, stabilising and gelling agent in condensed milks and dairy products, jellies and nut milks.

It is extracted from red seaweed and industrially produced with can cause GI inflammation, bloating and bowel disease.

Question 44

E330 is citric acid and a food additive. What is it used for and why its a cause for concern?

Answer 44

Used for flavouring and preservative in biscuits, tinned sauces, fruit / vegetables; ice cream, cake mix, frozen fish.

Naturally occurring in citrus fruit but as an additive is manufactured using cheap GM high fructose corn syrup with potential hazards to health.

Question 45

E926 (chlorine dioxide) is a commonly used food additive. How does it affects food and give 2 examples of where its used?

Answer 45

It is produced synthetically and decreases vitamin E content.

It is a Bleaching and oxidising agent for flour.

Bleaching of fats and oils, beeswax.

Purification of water.

Question 46

Give two side effects of the following colourings along with 2 examples of where it can be found:
a) E120 cochineal (carmine)
b) E160b (annatto)

Answer 46

a) Red colour dye. Severe allergic
reactions, can induce asthma.
Found in: Desserts, bakery products, toppings, soups,
sauces, pie fillings, soft drinks, confectionery, medications, cosmetics.

b) Headaches, hives, irritability, sleep, issues.
Found in: Cheese, coleslaw, crisps, custard, fish fingers, margarine, smoked fish, soft drinks.
Also used in face paint, digestive aids and expectorants.

Question 47

Give two side effects of Nitrates (E240–52) and 2 examples of where it can be found

Answer 47

Carcinogenic, mutagenic; associated with systemic lupus erythematosus, psoriasis, urticaria, atopic dermatitis.

Processed meat / cheese, inorganic fertilisers, water (through farming contamination), medications.

Question 48

List two side effects of the preservative sulphur dioxide (E220 ) and give 2 examples of where it can be found

Answer 48

Impedes oxygen carrying capacity of haemoglobin ― wheezing, shortness of breath, fatigue, coughing, asthma, hives, allergic rhinitis, nausea; disturbs gut microbiome. Destroys B1 in foods.

Dried fruit, processed meat, wine, pickled foods. Cosmetics and medications.

Question 49

Which preservative destroys Vitamin B1 in food and in which common beverage can it be found?

Answer 49

E220 sulphur dioxide

Wine

Question 50

E320 BHA and E320 BHT are artificial antioxidants and cannot be used in foods for babies or young children. However, they may still be eating foods containing BHA and BHT as use of these additives is widespread.

Names 4 foods that contain these additives for children?

What are the health concerns around them?

Answer 50

Chips, preserved meats, cereals, biscuits,

Note also oils, margarine, cosmetics

Health Concerns:
Urticaria, dermatitis,
headache, endocrine
disruptor, respiratory issues,
carcinogenic.

Question 51

E407 (carrageenan) is a Natural Thickener,
emulsifier.

Where are they commonly found? Give 4 examples and what are the health concerns around it?

Answer 51

Condensed milks and dairy products, jelly, nut milks, organic products.
Cosmetics, medications, supplements

Disturbs gut microbiome.
Causes inflammation and can lead to gastrointestinal ulcerations.

Question 52

E621 MSG is a Natural Flavour enhancer.

Give 4 examples of where it can be found and what are the health concerns around it?

Answer 52

Found: Stock cubes, takeaway
foods, hydrolysed protein,
chips, seasoning blends.
Medications (incl. vaccines).

Concern: Headache, muscle tightness,
paraesthesia, flushing,
fatigue, GIT symptoms,
heart conditions, depression.

Question 53

‘free’ glutamic acid in MSG (processed free glutamic acid is different to free glutamic acid found naturally in proteins) that causes adverse effects. How is it often hidden?

Answer 53

disguised as hydrolysed protein, yeast extract, protein isolate.

Question 54

E926 (chlorine dioxide) is used as a food additive. How does it affects food and give 2 examples where it’s used.

Answer 54

It is produced synthetically and decreases vitamin E content.

It is a Bleaching and oxidising agent for flour.

Bleaching of fats and oils, beeswax.

Purification of water.

Question 55

E950 (acesulfame K) is an artificial sweetener.

Give 4 examples and what are the health concerns around it?

Answer 55

Found: Chewing gum, baked goods, desserts, canned foods, alcoholic beverages.

Concern: Headaches, nausea, depression.
Carcinogenic

Question 56

E951 (aspartame) is an artificial sweetener.

Give 4 examples and what are the health concerns around it?

Answer 56

Found: Diet drinks, sugar-free products; e.g., ice cream, yoghurt, chewing gum, sweets, breakfast cereal.

Concern: Irritability, depression, impaired spatial orientation, carcinogenic, impaired neurotransmitters, compromised blood brain barrier.
Contraindicated in phenylketonuria, PKU (inability to break down phenylalanine, an amino acid, causing neurological damage).

Question 57

What advise could you give to your client to reduce food additives?

Answer 57

Reducing food additives:
* Prioritise consuming fresh, homemade food.
* Avoid additive-laden, packaged foods.
* Consider the nutritional value; levels of sugar, trans fats; is the food calorie-dense or nutrient-dense?

Question 58

The following is a simple healthy ice cream alternative recipe for your client.

Explain the health benefits of the chosen ingredients and which season they can have it and why?

Give also a reason if they are buying premade non-dairy why they should check?

Dairy-free ice cream:
* 1 cup frozen cherries
* 1 frozen banana
* ½ cup–1 cup of non-dairy milk*
* 1 tbsp cashew butter
* Process in blender and serve.
*Such as almond, coconut, oat ― if
buying pre-made, check ingredients.

Question 59

How can you help your client to to reduce the amount of chemicals on fruit and vegetables?

Why would you encourage them to opt for organic?

Answer 59

1. Wash in a 2% salt solution or wash in a white distilled vinegar / water solution (10% / 90%).
2. Let them sit for 15 to 20 minutes.

This will only clear surface pesticides.
* Chemicals incorporated into the fruit / vegetable won’t be removed.

Question 60

Why is plastic packaging a problem? What would be an alternative you would suggest to your client?

Answer 60

• Plastics allow leaching of chemicals into foods
  ― bisphenol A (BPA) is one such chemical.
• BPA and other compounds found in plastics
  are called xenoestrogens (chemicals that
  mimic oestrogen in the body).
• Xenoestrogens can bind to oestrogen
  receptors, disrupting normal function.
• They have been implicated in hormone-related diseases including
  certain cancers (e.g., breast, prostate), and fertility problems.

Packaging alternatives:
* Use greaseproof paper or wax paper
(can often be used more than once).
* Try reusable beeswax wraps
or vegan soy wax wraps.
* Use glass or stainless-steel
containers, water bottles and jars

Question 61

Plastics most known to cause human health issues include:
* PET (polyethylene terephthalate)
* PVC and DEHA (polyvinyl chloride, bis (2-ethylhexyl) adipate)
* PS (polystyrene)
* PC (polycarbonates)

Where are they used?

Answer 61

• PET (polyethylene terephthalate) ― used for soft drink, juice and water bottles and peanut butter containers.
• PVC and DEHA (polyvinyl chloride, bis (2-ethylhexyl) adipate) ― used in clingfilm, plastic squeeze bottles and cooking oil bottles.
• PS (polystyrene) ― used in Styrofoam food trays, egg cartons, takeaway food containers, disposable cups.
• PC (polycarbonates) ― used in plastic baby bottles and ‘sippy’ cups, sports water bottles, metal food can liners

Question 62

Why is irradiation used on food?

How many categories of food can be irradiated in the EU? and what are they?

How would you know a product is being radiated on the packaging?

Answer 62

*Used to prolong shelf life using high energy electron beams,
X-rays or gamma rays.

7 Categories
Fruit and vegetables, cereals, bulbs and tubers, dried aromatic
herbs, spices and seasonings, fish and shellfish, poultry.

Irradiation of foods or ingredients within a food must be declared
on the label as ‘irradiated’ or ‘treated with ionising radiation’.

• If an irradiated food is not pre-packed,
  wording must be displayed next to the food.
• May also (optionally) show the international icon for irradiated food ― the Radura symbol.

Question 63

The key purpose of food irradiation is to extend shelf-life, allowing extensive storage and long-distance shipping. Why would you have concerns with food irradiation? Give 4 reasons?

Answer 63

• During the process, compounds called ‘radiolytic products’ are formed, some of which are mutagens and carcinogens.
• Toxic chemicals including benzene (carcinogen), formic acid and formaldehyde can also be produced.
• Chromosomal abnormalities and cancer have been demonstrated in animals exposed to irradiated foods.

*toxins produced by bacteria can survive the process.

More Answers:

• may have a mutagenic effect on bacteria and viruses that survive, leading to more virulent strains.
• Can be misused to mask unhygienic food production and allow sale of sub-standard food.
• The vitamin content of foods is reduced by anywhere between 2 and 95% (with vitamin B1 and vitamin C most affected).

Question 64

What are Dietary reference values (DRVs) ?

Why can it be problematic giving an example?

Answer 64

They are a set of estimates concerning the amount of macronutrients, micronutrients and energy needed by different groups of healthy people.

DRVs give a ballpark figure of how much of a nutrient a person needs. They don’t guide the person to a nutritious food source. They are not set for highly active or unhealthy individuals.

E.g., the DRV for protein is 50 grams per adult on a 2000 calorie-a-day diet (regardless of age or sex).
* In choosing the source of protein it is imperative to consider quality, nutrient synergy, absorption.

Question 65

There are 4 types of DRVs estimates, what are they?

Answer 65

• EAR (estimated average requirement) ― needed by a group (i.e., about 50% of people will need less and 50% will need more).
• RNI (reference nutrient intake) ― 97.5%
  of the population’s requirement is met.
• LRNI (lower recommended nutritional intake) ― only 2.5% of the population’s requirement is met, i.e., most need more.
• Safe intake ― used where there is not enough evidence to set an EAR, RNI or LRNI. An amount considered to be enough for most people but below a level that could have undesirable effects.

Question 66

DRVs serve the industry, not the therapist or individual client. Give 4 reasons why DRVs are still useful for government and industries?

Answer 66

• To assist governments to make decisions on food policy.
• Provision of food aid or supplements.
• To inform decisions on fortification of foods.
• To provide nutritional education and informative labels.

More answers:

• To assist the food industry in developing and marketing products.
• For researchers and health professionals to assess the nutritional
  adequacy of the diets of groups and individuals.
• For institutions and caterers to assess the requirements of groups
• and devise nutritionally adequate menus.

Question 67

Food fortification is widely used to replace the nutrients lost during processing. Give 3 examples of fortified foods naming a mandatory one?

Answer 67

Iron, thiamine and niacin to white and brown flour;

breakfast cereals (B vitamins, iron);

margarine (vitamins A and D).

Question 68

Give an example of mandatory and voluntary food fortification

Answer 68

• Mandatory fortification: All flour except wholemeal, self-raising and wheat malt flours must be fortified with:
  – Calcium carbonate: 235–390 mg / 100 g.
  – Iron: Not less than 1.65 mg / 100 g.
  – Thiamine: Not less than 0.24 mg / 100 g.
  – Nicotinic acid or nicotinamide: Not less than 1.60 mg / 100 g.
• Voluntary fortification: Manufacturers can choose to add approved nutrients to foods except unprocessed foods and beverages containing more than 1.2% alcohol by volume.

Question 69

What is the problem with fortification? And what would you advise your client?

Answer 69

– Uses mostly synthetic ‘nutrients’.
– Doesn’t encourage healthy eating.
– There is no need to strip foods of nutrients.
– Portrays fortified food as healthy when it is not.
– Sugar-laden foods are often fortified despite their health risks.

Advice: Eat fresh whole foods. Minimise packaged, processed foods.

Question 70

What are Food composition tables?

Answer 70

Composition tables are used in nutritional therapy.

This knowledge was initially provided in tables giving the composition of foods such as McCance and Widdowson’s book series, The Composition of Foods, which contains nutrient composition data on well over 3400 foods commonly consumed in the UK.

Question 71

What is the limitation of Food composition tables ?

Answer 71

• Tables don’t tell you how much of a nutrient will be absorbed. Absorption varies depending on the individual nutrient status. Nutrients are often more efficiently absorbed when the body has insufficient amounts.
• Nutrient absorption can be affected by:
  – Dietary antagonists ― phytates, tannins, etc.
  – Nutrient competition or enhancement.
  – Malabsorption diseases.
  – Medications.
  – Poor digestive function.

Foods are biological materials. Their composition naturally varies, e.g., the
vitamin E content of pumpkin seeds can vary between 41–620 mg / kg.

• Food composition is affected by many different outside factors such as:
  – Growing conditions.
  – How the food is harvested, stored, processed and prepared.
• Original data for foods at all stages of preparation is seldom available

Question 72

What are the 3 main reasons for
measuring food intake?

Answer 72

1. To evaluate the adequacy and safety of the food (public health).
2. To study the interrelationships between food intake and physiological function (research).
3. To assist with the diagnosis and treatment of diet‐related conditions (most relevant for nutritional therapists).

Question 73

Measuring food intake of individuals can be divided into two basic approaches. What are they?

Answer 73

1. Reports of foods consumed on specified days:
   * Menu records.
   * Weighed records.
   * Estimated records.
   * 24-hour recalls.
2. To construct typical food patterns:
   * Diet histories — longer periods; less detailed.
   * Food frequency questionnaires.

Question 74

What is menu record and when is it useful?

Answer 74

Menu records is the
* Simplest way of recording food intake.
* Requires the description of the food / drink eaten.
* Counts each meal / snack a day without quantifying the portions.

Menu records are useful when:
* Assessing compliance with special diets.
* Assessing frequency of specific food use.
* Assessing food patterns over a longer time.
* Clients have difficulties measuring food
portions, e.g., elderly client.

Question 75

What is weight record and when is it useful?

Answer 75

Weighed records
* Requires the client to weigh each item of
food or drink at the time it is consumed.
* Usually kept for 3–7 days.
* Client needs clear instructions on how food
should be weighed or compliance may be poor.

Weighted records are useful for:
* Metabolic studies carried out to determine
absorption and retention of specific nutrients
from measurements of intake and excretion.
* To quantify the actual amounts of each macro- and micronutrient consumed and determine whether intake is adequate.

Question 76

What are Estimated records and when is it useful?

Answer 76

Estimated records are:
* The amounts of food and beverages
consumed are assessed by volume rather
than by weight (cups, teaspoons, etc.).
* These descriptive items are converted
to weights by the assessor.
Estimated records are useful when:
* Assessing a big number of people over a large
geographic area as scales don’t need to be provided.
* Assessing food intake in countries / cultures which
normally use spoon and cup measures in recipes.

Question 77

DRVs serve the industry, not the therapist or individual client. Give 4 reasons what are DRVs is still useful for government and industries?

Answer 77

• To assist governments to make decisions on food policy.
• Provision of food aid or supplements.
• To inform decisions on fortification of foods.
• To provide nutritional education and informative labels.

More answers:

• To assist the food industry in developing and marketing products.
• For researchers and health professionals to assess the nutritional
  adequacy of the diets of groups and individuals.
• For institutions and caterers to assess the requirements of groups
• and devise nutritionally adequate menus.

Question 78

A 24-hour recall is the most widely-used method of obtaining information on food intake from individuals. What does it involves and the disadvantage of it?

Answer 78

It involves asking individuals to recollect the
types and amounts of food they have eaten.
* A recall may consist of a face‐to‐face (i.e.,
during a consultation) or telephone interview.
* Therefore, it does not influence the type of food consumed in the way that a food record may do.

• However, it is open to misrepresentation of the dietary pattern, with subjects reporting a ‘good’ dietary pattern in order to project a good self- image (i.e., telling the practitioner what they want to hear).

Question 79

How many stages are there in multiple pass 24-hour recall giving a brief detail?

As a Nutrition Therapist what should you pay attention to?

Answer 79

3 stages:
* Stage one: The subject provides a list of all foods eaten on the previous day using any recall strategy.
* Stage two: The practitioner obtains a more detailed list by probing for additions to foods such as cream in coffee, milk in tea, which gives the client an opportunity
to recall food items that were initially forgotten.
* Stage three: The practitioner reviews the list of foods to prompt reports of other foods consumed.

Pay attention:
* It is important to ask specific questions about the intake of foods that may be initially omitted by the client (e.g., junk food, alcohol).

Question 80

Why would you take a diet history with your client?

Answer 80

• To obtain information on the habitual
  food intake of a client.
• It is obtained by means of an open interview and followed by a crosscheck against a list of commonly-consumed foods (intake, frequency).
• Firstly food eaten on a typical day is reviewed.
• Then food intake for given time periods is
  explored — previous months, years (to detect past poor dietary habits which have already been changed but may have contributed to health problems).

Question 81

What does Food frequency questionnaires entails?

Answer 81

• Provide a list of foods and a selection of
  options for how often each food is consumed.
• The length and contents of the food list
  depends on the focus of interest.
• E.g., if the purpose is to estimate calcium intake then only main calcium sources are listed.
• Only obtains information on the frequency of consumption of a food over a given period and not on meal patterns or nutritional status overall.

Question 82

How accurate do you think each
of these methods of dietary
assessments are and what problems might be encountered?

Answer 82

The problem that can be encountered is the accuracy of the assessment like weighing food (like someone doesn’t have accurate scale or how to use the scales)

Problem of compliance

Estimated records and perception of what’s a handful of nuts looks like?

Client wanting their diet to appear better to the nutritionist. Sacred to be judged.

Acuracy of remembering food they ate few days or weeks ago?

Question 83

3. As nutritionists, what do you feel
   is the best way to assess a diet?

Answer 83

Not just rely on the data but asking open questions helping client to talk through.

How much detail is required depends upon the individual

Asking them why they have come to the consultation.

What is their goal and want to achieve?

Question 84

4. What do you feel are the most
   important dietary aspects to
   initially explore?

Answer 84

Start with the big stuffs: the macronutrients intake.

Like water!

Then get to the finer details.

Question 85

What are some of the questions you can ask when helping a client make healthy food choices?

Answer 85

Is the food good quality (fresh, unprocessed, organic)?
* How far has the food travelled / been stored?
* How has the food been prepared if pre-packed or what will the preparation method be (raw, cooked, boiled, fried, baked…)?
* Does a meal contain nutrients which work in synergy? (E.g., Fe / Vit C.)
* Are there factors that can impede nutrient absorption (smoking, medications, alcohol, caffeine, stress, over- or under-exercise)?
* Any major illness which impacts nutrient requirements? (E.g., cancer)
* Is the client’s food intake consistent or are there fluctuations?
* How active is the client (higher energy intake, protein needs)?

Question 86

What the benefit of Food diaries? list 4 benefits?

Answer 86

Food diaries help to collect valuable nutritional information
and should contain a range of details such as:

• All meals / snacks consumed during the timeframe.
• Portions of fruit and vegetables consumed.
• All fluids, coffee, tea, alcohol, carbonated drinks.
• Methods of food preparation (cooked, fried, bought).

More:
* Symptoms following meals (identify triggers).
* Triggers for eating particular foods (mood, energy).
* Time of meals.
* Supplements and medications taken each day

Question 87

DRVs serve the industry, not the therapist or individual client. Give 4 reasons why DRVs are useful for government and industries?

Answer 87

• To assist governments to make decisions on food policy.
• Provision of food aid or supplements.
• To inform decisions on fortification of foods.
• To provide nutritional education and informative labels.

More answers:

• To assist the food industry in developing and marketing products.
• For researchers and health professionals to assess the nutritional
  adequacy of the diets of groups and individuals.
• For institutions and caterers to assess the requirements of groups
• and devise nutritionally adequate menus.

Question 88

A nutritionist aims to promote optimal health. Optimal intake: The “intake that maximises physiological and mental function and minimises the development of degenerative diseases.

What are the criteria of optimum nutrition compared to DRVs

Answer 88

– The level that prevents deficiency symptoms.
– The level that optimises body stores of the nutrient.
– The level that optimises biochemical and physiological function.
– The level that minimises a risk factor for chronic disease.
– The level that minimises the incidence of a disease.