Dietary policy

Question 1

Nutritional status

Answer 1

Nutri􏰀onal status is the condi􏰀on of the body with respect to nutri􏰀on. It helps us determine whether a person has the appropriate level of nutrients to meet their needs. There is no single complete measure of nutri􏰀onal status. However, the following methods may be used alone or in combina􏰀on with each other to help inform it.

Question 2

Dietary analysis

Answer 2

A dietary analysis typically involves three main steps:
1. Recording everything a person ate for a period.
2. Comparing recorded intake levels to specific recommenda􏰀ons.
3. Determining whether the person’s nutrient status is adequate, deficient or excessive.
Historically, this process was labour intensive. First, consumed foods were recorded manually. Then, the nutrient profile of each food was found in a database. Finally, the total nutrient intake per day was compared to reference values.

Question 3

Acurate diet analysis

Answer 3

To get an accurate diet analysis, we must be as specific as possible with respect to the amounts and types of foods we eat. We also need to be careful with the effect feedback can have on our food intake. The awareness of what and how much we are ea􏰀ng may cause us to change our behaviour. While this feedback can be an effec􏰀ve behaviour change tool, it compromises the accuracy of a dietary analysis meant to assess current nutri􏰀onal status., This process can now be done more simply with a wide range of both free and commercial diet analysis so􏰂ware (Figure 2.1). This so􏰂ware is linked to a nutrients database that has the reference values for each nutrient embedded in its algorithm. People simply enter their daily food intake and the so􏰂ware does most of the work.

Question 4

Lab tests

Answer 4

A dietary analysis can give insight into whether our nutrient intake meets our needs, but it fails to account for what happens in the body when we eat food. We do not all digest, absorb and use nutrients the same way. Laboratory tests use blood samples to determine nutri􏰀onal status. For instance, a test called a blood lipid panel looks at the lev- els of certain lipid-based compounds in the body to see if they are within a healthy range (Figure 2.2). Having values of blood lipids outside of a healthy range can be associated with an increased risk of cardiovascular disease. If unhealthy levels are found, dietary modifica􏰀on can then be used to get levels into ranges that decrease disease risk.

Question 5

Health and disease

Answer 5

When assessing nutri􏰀onal status, another considera􏰀on is a person’s health or disease state. Dietary recom- menda􏰀ons are made for healthy people, but if someone has a specific health considera􏰀on, these recommenda􏰀ons may have to shi􏰂. For instance, hemochromatosis is a condi􏰀on where iron builds up in the body due, in part, to an in- crease in absorp􏰀on. If we simply assess the diet of someone with hemochromatosis without considering their condi􏰀on, we might make recommenda􏰀ons that promote excessively high iron levels. This could have serious complica􏰀ons, such as an increased risk of liver and heart disease.

Question 6

Dietary references intake

Answer 6

The dietary reference intakes (DRIs) are a set of scien􏰀fically determined reference values for nutrient require- ments. They tell us how much of a nutrient is required to meet the needs of an individual. These requirements vary depending on gender and stage of life. For example, compared to midlife, the daily requirement for calcium is higher in adolescence and older age. Also, from age 51–70, women have a higher calcium need than men. This is due, in part, to the hormonal changes of menopause that affect bone health. DRIs have a margin of safety, so it is unnecessary to hit the recommended value exactly in order to meet needs. At the individual level, they can be used to assess nutri􏰀onal status and determine whether an individual is inadequate, adequate or excessive for a nutrient (Figure 2.3). At the popula􏰀on level, they can be used to inform dietary recommenda􏰀ons. Canada and the USA use the same four DRIs.

Question 7

Estimated average requirement

Answer 7

es􏰀mated average requirement (EAR) is the amount of a nutrient that will meet the needs of 5o0% of the popula􏰀on. For example, the EAR for calcium for those aged 19–50 is 800 mg/day. If everyone consumed that amount, approximately half of all people would be adequate for calcium, while the other half would be deficient. Accordingly, the EARisrarelyusedasastandaloneDoRI.Itsmainroleistohelpsettherecommendeddietaryallowance

Question 8

Recommend dietary allowance

Answer 8

The recommended dietary allowance (RDA) is the amount of a nutrient that meets the needs of 97% of the pop- ula􏰀on. The RDA is set at two standard devia􏰀ons, about 20–25%, higher than the EAR. For example, the RDA for calcium for those aged 19–50 is 1000 mg/day, 25% higher than the EAR of 800 mg/day. If we cannot determine the EAR, then an RDA cannot be set. The RDA is the preferred DRI for determining adequacy. If everyone consumed this amount, only 3% of the popula􏰀on would be at risk for deficiency.

Question 9

Adequate intake

Answer 9

Some􏰀mes, there is not enough scien􏰀fic data to establish the EAR and RDA. In such cases, an adequate intake (AI) value is used. The AI is typically determined by observing how much of that nutrient healthy people eat. Since these individuals do not show signs of deficiency, it is assumed that this amount is adequate for most healthy people. Com- pared to the EAR and RDA, less evidence is used to establish an AI. Therefore, it is more difficult to establish deficiencies using the AI alone (Ins􏰀tute of Medicine, 2000).

Question 10

Tolerable upper limit

Answer 10

Unlike the other DRIs, the tolerable upper limit (TUL), or upper limit (UL) is focused on excess. If we consume an amount of nutrient in excess of its UL, we are more likely to show signs of toxicity. For instance, the UL for calcium for those aged 19–50 is 2500 mg/day. Intakes above this may increase risk for calcium toxicity, which can promote the calci- fica􏰀on or hardening of the organs. No􏰀ce that the TUL for calcium is 2.5 􏰀mes higher than the RDA. There is typically a large range between the RDA/AI and the UL. Accordingly, there is a range of intake amounts that are adequate, but not excessive.

Question 11

Energy recommendation

Answer 11

The DRIs can help assess nutri􏰀onal status with respect to the micronutrients and macronutrients. However, they do not provide recommenda􏰀ons with respect to energy intake. Energy intake recommenda􏰀ons come in two main forms. The es􏰀mated energy requirement es􏰀mates the total amount of energy needed to maintain a person’s current size. In contrast, the acceptable macronutrient distribu􏰀on range gives recommenda􏰀ons for the percentage of energy to come from each of the three energy-yielding nutrients.

Question 12

Estimated energy requirements

Answer 12

Energy needs vary by person. To maintain energy balance, energy intake and energy expenditure need to match. When a person is consistently at energy balance, their weight remains fairly constant. If we are trying to gain energy and weight, we would consume energy in excess of the es􏰀mated energy requirement (EER). Alterna􏰀vely, if we are trying to lose energy and weight, energy intake levels would need to be consistently below the EER. If our goal is to maintain our current weight, on average, our daily energy intake should be close to our EER.
How much daily energy is required to maintain energy balance depends on sex, age, height, weight and ac􏰀vity levels. The best way to assess this is through certain laboratory approaches. Energy expenditure can also be es􏰀mated using the EER calcula􏰀on (Figure 2.4a). This equa􏰀on requires that we es􏰀mate our average ac􏰀vity levels, as energy re- quirements fluctuate depending on how much we move our bodies. Figure 2.4b lists the physical ac􏰀vity coefficients for the EER calcula􏰀on and what they signify.

Question 13

Acceptable macronutrient distribution range

Answer 13

The acceptable macronutrient distribu􏰀on range (AMDR, Table 2.1) outlines the recommended percentage of energy that should come from each of the three energy-yielding nutrients: carbohydrates, lipids and proteins. There is no RDA for lipids and carbohydrates, so the AMDR can be used to determine whether intake meets health needs. Protein has both an RDA (0.8 g/kg body weight) and an AMDR. To assess adequacy, both may be considered. These ranges have been set based on epidemiological data that suggests consump􏰀on within these levels is associated with reduced risk for chronic disease.
Ta

Question 14

Dietary guidelines

Answer 14

The DRIs are useful for an in-depth dietary analysis that is focused on finding nutrient deficiencies and excesses. However, they are not very prac􏰀cal for daily use. This is where dietary guidelines come in. Many countries put out food guides to simplify nutri􏰀on recommenda􏰀ons and help us make healthy dietary decisions.

Question 15

Canada food guide

Answer 15

Canada was one of the first countries to have a food guide. Canada’s Official Food Rules (Figure 2.5) were developed and distributed during the Second World War to help prevent nutri􏰀onal deficiencies, while also acknowledging the need for food ra􏰀oning (Health Canada, 2002). As the Cana- dian diet, food landscape and nutri􏰀on science have evolved, so too have our food guides. Other versions of Canada’s Food Guide included a recommended ea􏰀ng pa􏰁ern for breakfast, lunch and dinner (1949) as well as the four food groups concept of the 1970s and 1980s.
43, In 2013, Health Canada started the process of revamping many food policies. Canada’s Healthy Ea􏰀ng Strategy’s main objec􏰀ve was to make healthy ea􏰀ng easier for Canadians. One major change was an overhaul of the Canadian food guide (Health Canada, 2016b), whose previous itera􏰀on came out in 2007. The intent was to align recommenda- 􏰀ons with the current evidence and dietary pa􏰁erns of Canadians and to improve how dietary messages are communi- cated (Health Canada, 2016a). A range of stakeholders including nutri􏰀on and health experts were consulted to refine the recommenda􏰀ons and the way they were presented. The newest Canadian food guide was released in early 2019 (Figure 2.6). It has since been translated into many languages, including several Indigenous languages to reflect the diver- sity of Canadians.

Question 16

Plate portion

Answer 16

main feature of the guide is that it is now illustrated as a plate with recommended food propor􏰀ons:
50% of the plate is vegetables and fruits. Note that the word vegetable comes before the word fruit. This is
meant to communicate the founda􏰀onal role of these plants in the diet.
25% of the plate is whole grains. These foods are the staples in many diets and the guide communicates the importance of consuming unrefined versions of them.
25% of the plate is protein-rich foods. While protein can be found in all sec􏰀ons of the plate, the foods in this quadrant are especially high in protein. These protein-rich op􏰀ons are of both animal and plant origin, so both vegetarians and omnivores can build a healthy plate that fits their lifestyle.
44

Question 17

Key themes im plate guide

Answer 17

The guide also has several key themes:
* Variety. The plate has a wide range of foods in each sec􏰀on.
* Accessibility. The plate features foods that are rela􏰀vely inexpensive for most people.
* Cultural relevance. Given the diversity of the Canadian popula􏰀on, there are foods that are key staples to many ethnic diets, such as rice and beans.
* Availability. The guide features op􏰀ons that are available at 􏰀mes of year in different forms, either fresh, frozen, canned or dried.

Question 18

Veggies and fruits

Answer 18

Vegetables and fruits (Figure 2.7) are a good source of fiObre, vitamins and minerals. Large-scale epide- miological studies have repeatedly found that diets high in vegetables and fruits are associated with a reduced
risk of diseases such as heart disease and cancer (Alissa & Ferns, 2017; Riboli & Norat, 2003). The food guide recom- mends consuming whole vegetables and fruits over juices and concentrates, which tend to be processed and high
in added sugar. Fresh, frozen and canned vegetables are recommended as healthy op􏰀ons, especially those with no added sodium, sugars or seasonings. Healthier cooking op􏰀ons such as baking, roas􏰀ng, steaming and s􏰀r-frying are recommended, as is flavour enhancement with olive oil, lemon juice, flavoured vinegar and herbs and spices.
Prac􏰀cal sugges􏰀ons for increasing vegetable and fruit intake include pre-chopping and refrigera􏰀ng vegetables and fruits or buying them pre-chopped so that they are easy to grab and use. Also, cucumbers, grape tomatoes and peppers can be easily served raw as an addi􏰀on to a meal. Further, trying recipes with different leafy greens such as kale, spinach and bok choy can be helpful.

Question 19

Whole grain foods

Answer 19

Whole grains are those that have had been mini- mally processed and make use of the en􏰀re grain in food prepara􏰀on (Figure 2.8). They include whole-grain wheat, whole-grain bran and whole-grain rye. Whole-grain foods are a good source of fibre, vitamins and minerals. System- a􏰀c reviews of epidemiological evidence have found that choosing whole grains over refined grains is associated with a lower risk of type 2 diabetes, heart disease, cancer and all- cause mortality (McRae, 2017; Zhang et al., 2018).
The food guide suggests consuming a variety of
whole grains such as whole-grain pasta, bread and rice as
well as whole oats and oatmeal. When consuming these
foods, minimize those with extra sodium, sugar and saturat-
ed fat such as muffins, crackers and refined bread. The food

Question 20

Protein rich foods

Answer 20

whole grain followed by the name of the grain in the ingre-
dients list. Limi􏰀ng the addi􏰀on of salts, sauces and spreads based diet can also decrease the intake of saturated fat, high in sugar, salt and oil is also recommended.
Figure 2.8: Canada’s Food Guide recommends that whole grains account for a quarter of our food consump􏰀on.
Protein-rich foods are also typically high in vitamins and minerals. While, in general, animal products are be􏰁er sources of protein, a diet with a variety of plant-based proteins can also sa􏰀sfy protein needs (Figure 2.9). A plant-
while increasing the amount of fibre, both of which may be Figure 2.9: Canada’s Food Guide recommends that protein- beneficial for heart health. Accordingly, the food guide rec-
rich foods account for a quarter of our food consump􏰀on. ommends choosing more plant-based than animal-based Both animal and plant products can contain protein.
protein sources. It priori􏰀zes beans, peas, len􏰀ls, nuts and seeds over animal-based protein. As for animal products, more fish and shellfish are recommended as compared to other animal proteins including milk and other dairy prod- ucts. The food guide recommends consuming leaner sourc- es of animal protein and those that are lower in sodium and saturated fat. This can be done by draining the extra fat off a􏰂er cooking, trimming the fat off before prepara- 􏰀on, removing the skin of poultry and minimizing the use of sauces, bu􏰁er and gravy. Baking, grilling, roas􏰀ng and poaching can also help minizine the overconsump􏰀on of saturated fat.

Question 21

Healthy eating habits

Answer 21

Be midnful , cook more, enjoy food , eat with others , use food labels limit sugar foods

Question 22

Midnful of eating

Answer 22

Being mindful of our ea􏰀ng habits means being aware of how, why, when, how much and where we eat. This recommenda􏰀on is meant to help us develop a more posi􏰀ve rela􏰀onship with foods and to be aware of the feelings, thoughts, emo􏰀ons and behaviours that are associated with food intake. Part of mindful ea􏰀ng is crea􏰀ng a healthy ea􏰀ng environment for food consump􏰀on. It also includes an apprecia􏰀on for the sight, smell, textures and flavours of food. These changes may help us become more conscious of the foods we are ea􏰀ng, so that we enjoy them more while also making healthier decisions.

Question 23

Cook more

Answer 23

We consume a lot of meals outside of the home. When we grab food at convenience stores, fast-food loca􏰀ons and vending machines, we are less likely to find whole, unprocessed foods. Cooking more o􏰂en can help us include more whole foods in our diet, while also improving the experience we have with food. The guide suggests that we cook once and eat twice (Figure 2.10). This means cooking larger batches of food that can extend to another meal. This can help lower the 􏰀me and conve- nience barrier of cooking. Using 􏰀mesaving tools like a chopper, blender and a slow or pressure cooker can also be helpful. Keep- ing staple cooking ingredients such as broths, pre-cut vegetables and canned vegetables and beans on hand can further speed up food prepara􏰀on. Baking, grilling, broiling, roas􏰀ng, steaming and s􏰀r-frying are recommended cooking methods as they mini- mize the amount of added fat and calories.

Question 24

Enjoy food

Answer 24

The guide suggests using 􏰀me and a􏰁en􏰀on to enjoy our food. This can help improve the experience of ea􏰀ng and our rela􏰀onship with food. Many of us eat quickly while on the run and without being mentally present. This mind- less ea􏰀ng may increase the amount of food we consume. Strategies to help us enjoy our food include learning and experiencing where our food comes from, preparing and cooking food at home and cooking and ea􏰀ng with others.

Question 25

Eat with others

Answer 25

Ea􏰀ng meals with others can not only improve our expe- rience with food but can also promote social and mental health (Figure 2.11). Planning meal dates with friends, si􏰃ng down to family dinner and having community meals with neighbours can all improve our food experience. When we share meals with others and talk during that 􏰀me, it can help us slow down our ea􏰀ng process so that we enjoy our meals more. Ea􏰀ng slower may also decrease total food consump􏰀on, because it gives our brain more 􏰀me to register how much we have eaten. Ea􏰀ng with others can also help us learn about and try different foods, while strengthening our social networks.

Question 26

Use food labels

Answer 26

When consuming pre-packaged foods, reading labels can help us compare products and be aware of the types of ingredients and nutrients in foods. This can help us make more informed and healthy food decisions. In addi􏰀on to the 2019 food guide, Health Canada’s overhaul of its food policy includes a change to food labels, which will be fully implemented by 2022. In par􏰀cular, changes to the nutri􏰀on facts table, ingredients list, nutri􏰀on claims, date labelling and food allergen labelling have been made. These changes are meant to increase the capacity of Canadians to make choices that be􏰁er match the current nutri􏰀on evidence.

Question 27

Limit sugar foods

Answer 27

ltra-processed foods tend to be higher in sodium, sugar and fat. They are o􏰂en added in to make foods taste be􏰁er and last longer, at a lower price. Recall that ultra-processed foods include sugar-sweetened beverages, candy, frozen dinners and desserts, bakery foods like muffins and donuts, and processed meat like sausages, deli meats and bacon (Figure 2.12). While it is recommended to limit these foods in the diet, that does not mean that they must be completely removed. However, according to the food guide, whole foods should remain the founda􏰀on of the diet. These will typically be naturally low in sodium, sugar and fat.

Question 28

Be aware of food marketing

Answer 28

Adver􏰀sing’s main goal is to sell products, not to promote health. Branding, event sponsorship, television and social media adver􏰀sing, and sale promo􏰀ons are some of the many ways foods are marketed. O􏰂en it is not the prod- uct that is being directly promoted, but a feeling or a lifestyle – love, friendship, happiness, freedom or living an “ex- treme” lifestyle. If we think of some major brands and their adver􏰀sing slogans, we may no􏰀ce that they rarely refer to the taste, smell or any other sensory aspects of the food. Instead, it is feelings or lifestyle pa􏰁ers that are being sold to
us. The food guide encourages us to be cri􏰀cal of adver􏰀sements and to recognize marke􏰀ng and its goal. 48

Question 29

Healthy eating while pregnant and breastfeeding

Answer 29

The food guide also outlines considera􏰀ons for pregnant or breas􏰄eeding women. Since what a mother eats can affect the growth and development of her child and affect the energy levels and experience of the mother, proper nutri- 􏰀on during these stages is important. Ea􏰀ng well during pregnancy and lacta􏰀on has many similari􏰀es to other stages of life. There is an emphasis on nutrient-dense whole foods, specifically vegetables, fruits, whole grains and proteins. Also, the recommenda􏰀on to minimize sodium, sugar and saturated fat is s􏰀ll relevant. However, there are addi􏰀onal needs specific to pregnancy and breas􏰄eeding. Some of the food guide’s recommenda􏰀ons are outlined in Table 2.2.

Question 30

First nations healthy food guide

Answer 30

Na􏰀ons are one of the three main Indigenous groups in Canada, the others being the Inuit and Mé􏰀s. Within the First Na􏰀ons group, there is a wide diversity of na􏰀ons, each with their own cultural prac􏰀ces and beliefs. As such, there is not a single set of tradi􏰀onal or current dietary prac􏰀ces. That said, there is consensus that tradi􏰀onal aboriginal diets had many healthy principles (Earle, 2013). For one, they were environmentally sustainable, as they focused on local seasonal plants and animals. They were also nutrient-dense, low in fat and high in omega-3 fa􏰁y acids (Compher, 2006). Their tradi􏰀onal foods are also seen as more economical compared to foods bought at grocery stores, especially for those living in remote areas of the country (Assembly of First Na􏰀ons, 2007). With coloniza􏰀on came the loss of cultural prac􏰀c- es, gatherings and tradi􏰀onal foods that were important for the physical, mental, social and spiritual health of Indigenous individuals. There is accordingly an interest in preserving tradi􏰀onal foods and shi􏰂ing away from some of the coloniza- 􏰀on-associated changes that have promoted nega􏰀ve health outcomes.
While there is no single set of dietary recommenda􏰀ons for Indigenous people, The First Na􏰀ons Health Author- ity of Bri􏰀sh Columbia provides the following guidelines to reduce the risk of chronic disease and improve health (First
Na􏰀ons Health Authority, 2014).
* Make the community healthier by working together to change the nutri􏰀on environment.
* Increase the use of tradi􏰀onal foods by protec􏰀ng, restoring and relying on them more.
* Decrease the use of sugar-sweetened beverages to help protect teeth and children’s health.
* Increase the intake of vegetables and fruits. Indeed, many tradi􏰀onal plants and animals
are believed to have medicinal, nutri􏰀on and healing proper􏰀es.
* Serve healthier foods in reasonable por􏰀ons. There is a focus on reducing the amount of fat, sugar and salt. Also,
the concept of a balanced plate (Figure 2.13) can help with por􏰀oning meals.
* Increase number of community gardens to both provide nutri􏰀ous food and bring the community together.

Question 31

Canadian food policy

Answer 31

The updated Canadian food guide was part of a larger overhaul of food policy in Canada. Canada’s Healthy Ea􏰀ng Strategy involves various changes directed at making healthy choices easier. For instance, Health Canada worked with food processors and manufacturers to reduce the sodium content in prepacked foods. They also worked with the food and hospitality sectors to develop reasonable sodium targets. Since vitamin D deficiency is prevalent in Canada, Health Canada is expanding its vitamin D for􏰀fica􏰀on program in milk and margarine. Another target of this strategy was to eliminate ar􏰀ficially produced trans fats from the food supply. As of September 17, 2018, par􏰀ally hydrogenated oils that contain trans fats are prohibited in food processing (Health Canada, 2017). While these changes may be unno􏰀ceable to most consumers, they could have a significant affect on the overall health of Canadians. Other changes that may be more no􏰀ceable include the guidelines on food labels and the permi􏰁ed claims that can appear on them.

Question 32

Food labels

Answer 32

Food labels communicate informa􏰀on about packaged foods so consumers can make informed decisions. These
labels must adhere to requirements s􏰀pulated by the Food and Drug Regula􏰀ons. The regula􏰀ons were amended in
2016 and have undergone significant changes as compared to previous labelling guidelines. The food industry was then
given a five-year period to change their labels to comply with the new regula􏰀ons. Labelling changes will con􏰀nue un􏰀l
2022, when all prepackaged foods must comply with the new labelling standards (Canadian Food Inspec􏰀on Agency,
2016). Raw animal products, fresh fruits and vegetables and foods prepared fresh in stores, such as salads and muffins,
do not require a label. Neither do alcoholic beverages, as they are not considered foods and are regulated under differ-
ent legal acts.
There are six mandatory pieces of informa􏰀on that must appear on a Canadian food label (Figure 2.15).
This informa􏰀on must be printed in both French and English to comply with the Official Languages Act. They are ex- plained on the next page.

Question 33

Required components cansdian food label

Answer 33

The common name of the food. This name must appropriately represent the food. For instance, a food cannot claim to be apple juice if it is made from apple flavouring and sugar. A brand name may also appear on a food label, but this is not mandatory. The brand name must not mislead the consumer in any way.
2. Net quan􏰀ty. This tells the consumer the total weight, volume and/or contents of the en􏰀re package. The com- mon name and net quan􏰀ty must appear on the primary display panel of the package – the part of the package that is primarily displayed or visible to the consumer.
3. Name and address of the producer and/or distributor. This is meant to provide accountability for the product, so the consumer can contact them if necessary.
4. Date marking. Also known as the best-before date, the date marking tells the consumer the date a􏰂er which the product will lose its quality characteris􏰀cs. This includes the 􏰀me it might take for freshness, taste and appearance to diminish. These are mandatory on foods with a shelf life of less than 90 days. Ingredients list. Ingredients must be wri􏰁en
in descending order of each ingredient’s weight be-
fore being combined with any other ingredients during prepara􏰀on. In other words, the first ingredient listed in a product’s ingredient list is present in the greatest amount by weight. Recent changes to the ingredients list require- ments are highlighted in Figure 2.16.
Figure 2.16: Changes to ingredients list.
6. Nutrient facts box. This outlines the nutri􏰀onal composi􏰀on of the food according to the key nutrients mandated by Health Canada. New labelling requirements have shi􏰂ed which nutrients are included and how the box is represented. These changes are shown in Figure 2.17. The nutrient amounts are o􏰂en expressed in grams and daily values. The daily value compares the amount of nutrient in a serving size to an appropriate DRI. In some cases the amount of nutrient is compared to its RDA or AI as a means to promote adequacy. In other cases, it is compared to its UL, to reduce toxicity. For instance, if the daily value of potassium is 10%, that means that it has 10% of the recommended daily allowance
for potassium. However, if the daily value for sodium is 10%, that means it contains 10% of the tolerable upper limit for sodium. Whether the daily value compares the nutrient content to the RDA or the UL, respec􏰀vely, depends on whether it promotes or compromises health.

Question 34

Major change to food label

Answer 34

Another major change to the nutrient facts box was how serving sizes are represented. Nutrient facts boxes list the nutrient and calorie breakdown for one serving of food. Historically, there has been more than one serving size per container, and the listed serving size did not properly represent how much of that food people typically consumed. For example, a 751-mL bo􏰁le of cola used to state that a serving size was 375 mL – half the contents. However, since it was packaged in what appeared to be a single serving container, many people consumed the whole bo􏰁le as a serving. Twice the serving size means twice the calories and nutrients that were stated in the nutrient facts box. Now, a serving size must adequately reflect a common serving.

Question 35

Food label claims

Answer 35

In addi􏰀on to these mandatory changes to food labelling, food packaging may also display certain claims to high- light a nutrient, health-associated factor or the nature of a food. These claims are voluntary, cannot purposely deceive consumers and must abide by the regula􏰀ons set out by the Food and Drug Regula􏰀ons of Canada. The Food Inspec􏰀on Agency of Canada provides detailed informa􏰀on on their website to help food manufacturers abide by these regula􏰀ons.
Words or images can be used to showcase an ingredient, the nature of the food or a flavour component found in the product. Table 2.3 highlights some permi􏰁ed composi􏰀on claims and their restric􏰀ons.

Question 36

Nutrient content claims

Answer 36

Nutrient content claims describe the amount of energy or specific nutrient in a food. These include statements such as low in fat, lower in Calories and high in fibre. In order to make such a claim on a package, the product must comply with the requirements for that statement. For instance, to state that a product is low in fat, it must contain 3 g or less of fat per serving and 30% or less of the energy in that product can come from fat (Canadian Food Inspec􏰀on Agency, 2014a). To state that something is high in fibre, it must have 4 g or more of fibre per serving, whereas a product that is labelled very high in fibre must have more than 6 g per serving. Sodium-free denotes that a product has less than 5 mg of sodium per reference amount and stated serving size. The full list of permi􏰁ed nutrient content claims and their require- ments are found on the Canadian Food Inspec􏰀on Agency’s website.

Question 37

Health claims

Answer 37

There are a limited number of health claims permi􏰁ed on Canadian food labels. These claims link the food or part of the food with health. There are two general categories of health claims: disease reduc􏰀on claims and func􏰀on claims.
Disease reduc􏰀on claims link a food or its ingredients with a reduced risk of developing a specific disease. In or- der to make these claims, a prescribed type of wording must be used, and the food must meet the criteria set out by the Food and Drug Act. Some examples are found in Table 2.4. Note that the wording of the claims cannot make the product itself seem to reduce disease risk. It can only link a component of the food (e.g., potassium, calcium) to its known dis- ease-reducing link.

Question 38

Function claims

Answer 38

Func􏰀on claims note the associa􏰀on between consuming a nutrient or diet factor with its role in the normal bi- ological func􏰀on of the body. There are two permi􏰁ed nutrient func􏰀on claims that can be used for all nutrients: Energy (or name of the nutrient) is a factor in the maintenance of good health and Energy (or name of the nutrient) is a factor in normal growth and development.
There are also specific acceptable nutrient func􏰀on claims for several nutrients, including protein, fat, omega-3 fa􏰁y acids and certain vitamins and minerals. Table 2.5 outlines a few of these. A complete list can be found on the Cana- dian Food Inspec􏰀on Agency’s website (Canadian Food Inspec􏰀on Agency, 2014c).
If a company wants to include a claim that is not on the full list, it must apply to Health Canada’s Food Director- ate to have that claim assessed. During the assessment process, the available evidence regarding this claim is evaluated. This process can take years and does not guarantee approval.

Question 39

Front of package labels

Answer 39

Another change to food labels is mandatory front-of-package labelling for foods high in sodium, sugar and saturated fat. These nutrients are excessive in the Canadian diet and are associated with an increased risk of disease when consumed in excess. This new front-of-package labelling will emphasize the content of these three nutrients in the product. The final graphic that will be used to represent these nutrients was not established at the 􏰀me this textbook was published. However, public consulta􏰀on suggests that the final choice will be similar to what is found in Figure 2.18. Table 2.6 shows the proposed thresholds for what is deemed to be high for these nutrients (Health Canada, 2018b)

Question 40

Food safety

Answer 40

Symptoms of foodborne illness, o􏰂en called food poisoning, are unpleasant and can involve nausea, diarrhea, vomi􏰀ng, abdominal cramps and fa􏰀gue. In some cases, as in the case of E. coli or botulism poisoning, it can be fatal. Foodborne illness occurs due to harmful infec􏰀ous agents that can some􏰀mes be present in food. Health Canada and the Food Inspec􏰀on Agency of Canada help to ensure that food is safe from these agents. Many steps along the food chain have strict regula􏰀ons requiring manufacturers and distributors to use proper food handling and storage prac􏰀ces. At home, we also have a responsibility to make sure our foods are safe. Some of these recommenda􏰀ons are found in Figure 2.19. Further general food safety 􏰀ps can be found on Health Canada’s website (Health Canada, 2015, 2018a).

Question 41

Natural healthy products

Answer 41

Items sold as vitamins, minerals, mul􏰀vitamins, probio􏰀cs, amino acids and essen􏰀al fa􏰁y acids, as well as ho- meopathic and tradi􏰀onal medicines are considered natural health products (NHPs). NHPs are neither foods nor drugs. They are naturally occurring substances that may be used to address health needs. They are sold over the counter and do not require a prescrip􏰀on and are some􏰀mes referred to as complementary or alterna􏰀ve medicines. These prod- ucts are regulated by the Natural and Non-prescrip􏰀on Health Products Directorate (NNHPD), which has its own set of labelling requirements.
While NHPs are generally safe with few side effects, there are certain risk considera􏰀ons. There is a chance that the product contains incorrect ingredients, the stated claims may not be fully supported by evidence or that the NHP promotes unwanted side effects like allergic reac􏰀ons or nega􏰀ve interac􏰀ons with other NHPs or prescrip􏰀on drugs (Health Canada, 2010). Health Canada recommends talking to a doctor or other healthcare prac􏰀􏰀oner before using an NHP, especially if pregnant, breas􏰄eeding, over 65 or with a medical condi􏰀on. They further recommend being skep􏰀cal of NHP adver􏰀sing and suggest that we do our own research before buying.

Question 42

Approval process

Answer 42

must be safe, effec􏰀ve and appropriately labelled. In order to receive a licence, the manufacturer must pro- vide safety and efficacy evidence to the government. Clinical trials and studies published in reputable scien􏰀fic journals or publica􏰀ons are permi􏰁ed types of evidence. A list of medicinal and non-medicinal ingredients, as well as the source, dose, strength and recommended uses must also be provided. Health Canada will then spend 􏰀me reviewing the submis- sion to evaluate whether a licence can be granted. This process can take years.
Once an NHP has been approved, it will receive a licence and either a natural product number (NPN) or homeo- pathic medicine number (DIN-HM). These must appear on the label, as shown in Figure 2.20.
In addi􏰀on to the product licence number, NHP labels must include the product name, the net quan􏰀ty of prod- uct in the container, a complete list of medical and non-medical ingredients, the recommended dose, specific storage condi􏰀ons, if applicable, as well as any warnings or cau􏰀onary statements and poten􏰀al side effects (Health Canada, 2010). A nutri􏰀on facts table is not required. NHPs may have nutrients and energy in them, but the nutri􏰀on breakdown is not on the label. Accordingly, NHPs can some􏰀mes be high in calories and sugar without it being evident. However, since the manufacturer is required to list the non-medicinal as well as medicinal ingredients on the label, we can look at the ingredients list for clues about its nutri􏰀onal quality.

Question 43

Menu labeling

Answer 43

About a third of the food budget of Canadians comes from meals purchased in restaurants (Sta􏰀s􏰀cs Canada, 2017). While many foods found in grocery stores will have nutri􏰀on informa􏰀on prominently displayed, there is current- ly no Canada-wide regula􏰀on requiring restaurants and other eateries to list nutri􏰀onal informa􏰀on on their menus. Conversely, according to the Affordable Care Act in the USA, American chains with more than 20 restaurants must pro- vide calorie informa􏰀on to their consumers (Food and Drug Associa􏰀on, 2019).
In 2015, Ontario became the first province to enact menu-labelling legisla􏰀on as outlined in their Healthy Menu Choice Act of 2015 (Government of Ontario, 2016). The purpose of this act was to help people make informed decisions that would reduce risk of disease. The focus is on calorie informa􏰀on, as an excessive intake of calories is associated with diseases such as obesity, type 2 diabetes, hypertension and some forms of cancer.
The act s􏰀pulates that food service places with more than 20 loca􏰀ons in Ontario (known as “food chains”) must display calories on their menus along with a contextual statement. Specifically, these eateries must state that, “Adults and youth (ages 13 and older) need an average of 2,000 calories a day, and children (ages 4 to 12) need an average of 1,500 calories a day. However, individual needs vary.”

Question 44

Informed dining

Answer 44

The Informed Dining Program, which began in 2012, is a voluntary menu-labelling program. It began in Bri􏰀sh Columbia in 2012 and was rolled out na􏰀onwide in 2013. Food establishments can opt in to the program and must then display the program logo (Figure 2.21) as well as a statement saying that nutri􏰀onal informa􏰀on is available upon re- quest (HealthLink BC, 2016). In other words, while o􏰂en not prominently displayed, a consumer can find the nutri􏰀onal informa􏰀on either online or from another source provided by the establishment.

Question 45

Effectivnees snd mandatory labeling

Answer 45

Researchers were interested in whether a voluntary menu-labelling program is enough to influence food choic- es. They accordingly conducted exit surveys of customers outside of restaurants in 2012, 2015 and 2017 in Toronto and Vancouver (Vanderlee et al., 2019). The surveys were done outside of the fast-food chains McDonald’s, Burger King, Wendy’s, Starbucks, Subway and A&W and the sit-down chains The Keg, Milestones and Swiss Chalet. It was found that menu labelling was universally employed by all restaurants in Toronto as of 2017, but the Informed Dining Program was more sporadic in both ci􏰀es. They also found no significant difference between consumers no􏰀cing nutri􏰀on informa- 􏰀on if there was an Informed Dining Program compared to having no program at all. Conversely, consumers were more than twice as likely to no􏰀ce the calorie labelling on menus at places with Ontario’s mandatory program. When an es- tablishment had no program or used the Informed Dining Program, only 12% of patrons said that nutri􏰀on informa􏰀on influenced their food choices. Conversely, when calories were labelled on the menu, 38% of patrons said that the infor- ma􏰀on influenced their food purchase. Two main conclusions can be drawn from this study that are further supported by other Canadian and interna􏰀onal studies (Breck et al., 2014; Vanderlee & Hammond, 2014). First, people are more likely to no􏰀ce nutri􏰀on informa􏰀on if it is prominently displayed. Second, when nutri􏰀on informa􏰀on is prominently displayed on menus, it can influence the choices that consumers make.