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FDA perspectives on health claims for food labels.

The U.S. Food and Drug Administration's regulatory authority over health claims was clarified in 1990 legislation known as the Nutrition Labeling and Education Act (NLEA). This law established mandatory nutrition labeling for most foods and placed restrictions on the use of food label claims characterizing the levels or health benefits of nutrients in foods. NLEA set a high threshold for the scientific standard under which the U.S. Food and Drug Administration (FDA) may authorize health claims, this standard is known as the significant scientific agreement (SSA) standard. Subsequent legislation known as the Food and Drug Administration Modernization Act (FDAMA) provided an alternative to FDA review of the health claim where an U.S. government scientific body other than FDA concluded that there is SSA for a substance/disease relationship. Courts have since extended the scope of health claims to include qualified health claims (QHC) that are health claims not substantiated on evidence that meets the level of SSA standard, but include a qualifying statement intended to convey to the consumer the level of evidence for the claim. FDA has responded by developing an evidence-based ranking system for scientific data to determine the level of evidence substantiating a health claim. The following is an overview of FDA's regulations and evidence-based method for evaluating health claims.

Food Labeling↗

Food labeling: health claims; plant sterol/stanol esters and coronary heart disease. Food and Drug Administration, HHS. Interim final rule.

The Food and Drug Administration (FDA) is authorizing the use, on food labels and in food labeling, of health claims on the association between plant sterol/stanol esters and reduced risk of coronary heart disease (CHD). FDA is taking this action in response to a petition filed by Lipton (plant sterol esters petitioner) and a petition filed by McNeil Consumer Healthcare (plant stanol esters petitioner). Based on the totality of publicly available evidence, the agency has concluded that plant sterol/stanol esters may reduce the risk of CHD.

Coronary Disease↗

Knowledge and use of the food label among senior women in the management of type 2 diabetes mellitus.

Food selection is a key component in the management of diabetes. The foods selected affect the caloric and nutrient composition of the diet and blood glucose levels among people with diabetes. The nutrition information on the food label can guide decisions for food purchases. Whether senior women with diabetes use and comprehend the nutrition information on the food label has not been determined. Therefore, the purpose of this study was to assess knowledge and beliefs about the food label and diabetes management among women with type 2 diabetes mellitus =65 years of age. Focus groups were conducted and participants (n=24) completed a knowledge test about the food label. Analysis involved extensive review of the videotapes and transcripts of the focus groups. Participants reported that they referred to the nutrition information on the label when grocery shopping. Yet, comprehension of terms and product claims on the label was poor. The mean score on the food label knowledge test was only 49%. Misconceptions about the nutritional management of diabetes also were noted. Thus, senior women with diabetes need additional education about the food label to facilitate application of the information in meal planning and to manage diabetes successfully.

Aged↗

Patient understanding of food labels: the role of literacy and numeracy.

BACKGROUND: Comprehension of food labels can be important for patients, including those with chronic illness, to help follow dietary recommendations. Patient comprehension of food labels was examined, along with the relationship of comprehension to their underlying literacy and numeracy skills. METHODS: From June 2004 to April 2005, a cross-sectional study of 200 primary care patients was performed. A 24-item measure of food label comprehension was administered. Literacy was measured with the Rapid Estimate of Adult Literacy in Medicine (REALM), and numeracy with the Wide Range Achievement Test, third edition (WRAT-3). RESULTS: Most patients (89%) reported using food labels. While 75% of patients reported at least a high school education and 77% had 9th-grade literacy skills, only 37% had 9th-grade math skills. On average, patients answered 69% (standard deviation, 21%) of the food-label questions correctly. Common reasons for incorrect responses included misapplication of the serving size, confusion due to extraneous material on the food label, and incorrect calculations. For example, only 37% of patients could calculate the number of carbohydrates consumed from a 20-ounce bottle of soda that contained 2.5 servings. Higher comprehension of food labels was significantly correlated (all p values were less than 0.001) with higher income (rho=0.39), education (rho=0.49), literacy (rho=0.52), and numeracy (rho=0.67). CONCLUSIONS: Patients demonstrated deficits in understanding nutrition labels. Poor label comprehension was highly correlated with low-level literacy and numeracy skills, but even patients with higher literacy could have difficulties interpreting labels. Providers need to consider patients' literacy and numeracy when providing dietary recommendations. Opportunities may exist for the U.S. Food and Drug Administration to promote changes to make food labels more comprehensible.

Adult↗

Australian consumers are sceptical about but influenced by claims about fat on food labels.

OBJECTIVES: To explore the beliefs and attitudes of Australian consumers to claims about fat made on the labels of packaged food. DESIGN: Content analysis of transcripts from focus group discussions. SUBJECTS: A total of 26 female and 10 male participants aged 20-80 y, recruited by advertisement into six focus groups, stratified by age, sex and health status. RESULTS: Awareness of claims about fat was high in this sample of Australians and participants admitted that they influenced their purchase decisions. The most preferred form of claim was 'X% fat free'. Claims were considered most useful on foods that were high in fat. There was considerable scepticism about all nutrient claims, and consumers preferred to check claims about fat against the values in the nutrition information panel. Many claims were seen as advertising that could be misleading, deceptive or confusing. While claims about fat might prompt product trial, factors such as price, taste, naturalness, as well as other nutritional factors, also influenced purchase decisions. Some consumers believe low fat claims encourage over consumption of foods. CONCLUSIONS: Changes to regulations governing nutrition claims on food labels should be made to enhance their credibility and support their role in assisting consumers to make healthier food choices.

Adult↗

Reliability and validity of nutrition knowledge, social-psychological factors, and food label use scales from the 1995 Diet and Health Knowledge Survey.

OBJECTIVE: To test the reliability and validity of scales on nutrition knowledge, social-psychological factors, and use of food labels developed from the 1995 Diet and Health Knowledge Survey (DHKS) questions. DESIGN: The 1995 DHKS questions within a section were pooled together as a scale and their reliability and validity were examined. PARTICIPANTS: US adults (> or =20 years) in the 1995 DHKS who responded to questions selected for this study (n = 1196). VARIABLES: Nutrition knowledge about the diet-disease relationship and nutrient content of products, perceived barriers and benefits of food labels, perceived ease of understanding food labels, food label use, and importance of healthful eating. ANALYSIS: Scales validity, Cronbach alpha, item total correlation, alpha if the item was deleted, and discriminant, convergence, and correspondence validity. RESULTS: Scales on perceived ease of understanding the food label, benefits of using food labels, food label use, and importance of healthful eating were reliable (Cronbach alpha =.78,.82,.91, and.82, respectively) and valid. CONCLUSION AND IMPLICATIONS: Accurate findings and interpretation of survey data depend on the use of reliable and valid instruments. This study identified the scales in the DHKS that can substantiate the conclusion on which effective nutrition education strategies should be established.

Adult↗

Food label use by older Americans: data from the Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey 1994-96.

This study examined older Americans' use of food labels as a tool to moderate dietary risk factors for heart disease. Data from the USDA's Continuing Survey of Food Intakes by Individual (CSFII) 1994- 96 and the Diet and Health Knowledge Survey (DHKS) from 2,846 respondents aged 51 years and older was used. Indices were constructed to measure and correlate dietary intake, label use and understanding, and health status data. Understanding and use of food labels was lower among older age groups, while heart-related health problems increased. Use of food labels and percent energy intake from fat were inversely related (P < 0.01). Older Americans would benefit from education on food label use and interpretation to decrease their dietary risk factors for heart disease.

Aged↗

Consumer perspectives on food labels.

The symposium "Dietary Reference Intakes (DRIs) for Food Labeling" explored the scientific debate about the most appropriate DRI values to use in establishing Daily Values on food labels. An important goal of nutrition and ingredient information is to help consumers make healthful dietary choices. This summary provides highlights from recent quantitative and qualitative research on consumers' use and understanding of food label information.

Consumer Behavior↗

How well do consumers understand percentage daily value on food labels?

One hundred four adults completed a multiple choice food label comprehension questionnaire and a food frequency questionnaire. Most respondents were able to accurately rate the fat content of five different foods using only the food label information. However, some underestimated food content for some foods. Also, only 29% correctly selected the definition of % daily value for fat (%DV), as "percent of the maximum daily recommended amount of fat."

Adult↗

Evaluation of a food label nutrition intervention for women with type 2 diabetes mellitus.

OBJECTIVE: To evaluate an educational intervention about the food label designed specifically for women with type 2 diabetes mellitus. DESIGN: A pretest-posttest control group design. Participants received random group assignment. SUBJECTS/SETTING: Forty-three women aged 40 to 60 years with type 2 diabetes living in a rural community in Pennsylvania participated. Forty participants (93%) completed the program. INTERVENTION: Nine weekly group sessions were developed on the basis of findings from previous research among this sample. Principles from Ausubel's learning theory were also incorporated into program design and evaluation. MAIN OUTCOME MEASURES: The effectiveness of the food label education program on participants' knowledge was determined using a multiple-choice test designed to measure declarative and procedural knowledge. A skills inventory assessed participants' perceived confidence in using the food label. The validity and reliability of the instruments had been established previously. STATISTICAL ANALYSES: Analysis of variance was performed to compare groups. Paired t tests compared pretest and posttest results. RESULTS: The experimental group showed a greater gain than the control group in total knowledge (P < .001), declarative knowledge (P < .001), and procedural knowledge (P < .01) at posttest. Posttest data showed a significant increase (P < .01) in experimental participants' perceived confidence in using the food label. CONCLUSIONS: Women with diabetes need more education about the food label. This intervention is an effective outpatient education program. Participant knowledge and perceived confidence in using the food label improved significantly as a result of the intervention. Future research should assess retention of knowledge gained and the impact of the intervention on metabolic measures of diabetes management and control.

Adult↗

Dietary Reference Intakes for food labeling.

The annual American Society for Nutritional Sciences/American Society for Clinical Nutrition Public Information Committee symposium for 2005 titled "Dietary Reference Intakes (DRIs) for Food Labeling" served as a platform to address the use of DRIs in food labeling, a change that could affect the processing of foods and supplements and the nutrient intakes of consumers. Speakers from science, industry, trade organizations, and the government came together to provide critical thinking about the most appropriate DRI values to use in food labeling. The proceedings of the symposium cover consumer perspectives on food labels, the regulatory process for revising labeling relative to the DRIs, the food industry's perspective on the use of the new DRIs in food labeling, and differing opinions on whether to use Recommended Dietary Allowances or Estimated Average Requirements to set Daily Values.

Diet↗

Agency information collection activities; announcement of OMB approval; Food Labeling: Nutrition Labeling of Dietary Supplements on a "Per Day" Basis. Food and Drug Administration, HHS. Notice.

The Food and Drug Administration (FDA) is announcing that a collection of information entitled "Food Labeling: Nutrition Labeling of Dietary Supplements on a "Per Day" Basis" has been approved by the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995.

Dietary Supplements↗

Food allergens submitted to compulsory food labelling in the 50 highest-selling drugs in France.

Many active ingredients and excipients present in allopathic drugs derive from food allergens normally associated with compulsory food labelling. This study was undertaken to evaluate the presence of these components in the various pharmaceutical formulations of the 50 highest-selling drugs in French pharmacies in 2002 (in quantity and/or value), and to assess their labelling on the packaging of these drugs. The 174 pharmaceutical formulations of 86 drugs were studied and the composition of each one was identified using data-processing software. An excipient deriving from an allergen with obligatory labelling in food is present in 58.6% of the studied pharmaceutical formulations. Almost one third (32.2%) of these medications are correctly labelled since the excipients in question are already known to have adverse effects. This study demonstrates the actual presence of components derived from allergens with compulsory food labelling in the 50 highest-selling p maceutical products in France (in value and/or volume). Given the absence of clear labelling of food allergens in drugs, allergologists must inform both the medical and public communities of this potential risk. It is equally important that the pharmaceutical laboratories implement clear, informative labelling of food allergens, similar to that of the food industry.

Allergens↗