Unregulated serving sizes on the Canadian nutrition facts table - an invitation for manufacturer manipulations.

BACKGROUND: Serving sizes on the Nutrition Facts table (NFt) on Canadian packaged foods have traditionally been unregulated and non-standardized. The federal government recently passed legislation to regulate the serving sizes listed on the NFt. The objective of this study was to compare the serving sizes on food product NFts to the recommendations in the 2003 Nutrition Labelling regulation (Schedule M) reference amounts, the Canadian Food Inspection Agency (CFIA) ranges, and Canada's Food Guide recommendations. An additional objective was to determine if food and beverage products that report smaller serving sizes have a higher calorie density, compared to similar products with a larger serving size. METHODS: Data for 10,487 products were retrieved from the 2010 Food Label Information Program (FLIP) database and categorized according to Schedule M categories. Correlations between calorie density and manufacturer stated serving size were tested and the proportion of products meeting recommendations were tabulated. RESULTS: 35% of products had serving sizes on the NFt that were smaller than the Schedule M reference amount and 23% exceeded the reference amount. 86% of products fell within the CFIA's recommended serving size ranges; however, 70% were within the lower-half of the range. Several bread and juice categories exceeded CFG's recommendations, while several dairy product categories were smaller than the recommendations. Of the 50 Schedule M sub-categories analyzed, 31 (62%) exhibited a negative correlation between serving size and calorie density. CONCLUSION: While most products fell within the CFIA's recommended serving size ranges, there was a tendency for products with a higher calorie density to list smaller serving sizes.

Cross-Sectional Analysis of Calories and Nutrients of Concern in Canadian Chain Restaurant Menu Items in 2016.

INTRODUCTION: The nutritional quality of restaurant foods in Canada is not monitored by government and limited research has evaluated the nutrient content of these foods. Given the increasing proportion of foods consumed outside the home, this study aims to assess levels of nutrients of public health concern in Canadian fast-food and sit-down restaurant menu items. METHODS: Levels of calories, saturated fat, sodium, and sugar of 10,285 menu items from 90 national chain restaurants in Canada were assessed. Data were collected in 2016, extracted and analyzed between 2018 and 2020, and presented overall and by category. Levels in fast-food and sit-down restaurant establishments were compared. RESULTS: Overall mean levels of saturated fat, sodium, and sugar were high. Entrées contained on average 52% of the total daily value for sodium (1,256 mg/serving) and 45% of the daily value for saturated fat (8.9 g/serving). Beverages and desserts had high levels of total sugar (mean=44 g and 32 g/serving, respectively) but tended to be low in sodium. Sit-down restaurant items had significantly (p≤0.0001) higher levels of calories, saturated fat, and sodium overall, although fast-food restaurant items had higher average sugar levels because of the higher number of beverage and dessert items. CONCLUSIONS: Levels of nutrients of concern in Canadian menu items are excessive among most food categories. As the frequency of eating out in restaurants rises, government policies to promote reformulation and increase transparency of the nutritional content of these items are required to reduce their negative impact on public health.

Assessing the Early Impact of Menu-Labeling on Calories in Chain Restaurants in Ontario, Canada.

INTRODUCTION: The objective of this study is to investigate the early impact of Canada's first provincewide mandatory menu-labeling legislation on calorie levels in foods offered on chain restaurant menus before, leading up to, and at the point-of-implementation. METHODS: Data were obtained from Menu-FLIP, a database of publicly available nutrition data from chain restaurants in Canada. Data were collected in 2010, 2013, 2016, and 2017. Core food products, newly introduced products, discontinued products, and full menus were compared before (2010, 2013, 2016) and at the point-of-implementation (2017) of the policy. Calories and serving sizes of 2,988 unique foods (excluding beverages) from 28 chains were analyzed using mixed models comparing time points while controlling for covariates. Sub-analyses were stratified by restaurant type. RESULTS: Full menu mean calories and serving sizes increased between 2010 and 2017 (>40 calories and 17 grams, respectively). There were no significant changes in mean calories or serving sizes among core menu items (p=0.47). New products in 2013 and 2017 were significantly higher in calories and serving size versus discontinued foods and foods already on the menu. Discontinued foods did not differ in calories or serving size compared with foods already on the menu; however, in 2017, the calories of discontinued foods in sit-down restaurants were higher than foods discontinued in 2013 (p=0.02). CONCLUSIONS: The results of this investigation show that at the point-of-implementation of the Ontario Healthy Menu Choices Act supply-side calories in core food products, new products, or full menus evaluated in this study did not significantly change.

Association between salt substitutes/enhancers and changes in sodium levels in fast-food restaurants: a cross-sectional analysis.

BACKGROUND: Restaurant foods have high sodium levels, and efforts have been made to promote reductions. The objective of this study was to understand if salt substitutes and enhancers are associated with changes in sodium levels in fast-food restaurants. METHODS: A longitudinal database (MENU-FLIP) containing nutrition information for Canadian chain restaurants with 20 or more locations nationally was created in 2010 and updated in 2013 and 2016. In 2016, when available, ingredient lists were collected from restaurant websites and searched for the presence of salt substitutes/enhancers. Changes in sodium levels (per serving) and the prevalence of salt substitutes/enhancers in 222 foods from 12 of the leading fast-food restaurant chains were compared across 3 time points. RESULTS: Sixty-nine percent of foods contained a salt substitute/enhancer. Substitutes/enhancers were found in every restaurant chain (n = 12) for which ingredient data were available. The most common substitutes/enhancers were yeast extracts (in 30% of foods), calcium chloride (28%), monosodium glutamate (14%) and potassium chloride (12%). Sodium levels in foods that contained substitutes/enhancers decreased significantly more (190 ± 42 mg/serving) over the study period than those in foods that did not contain a substitute/enhancer (40 ± 17 mg/serving, p < 0.001). INTERPRETATION: Salt substitutes and enhancers are prevalent in restaurant foods and are one means by which restaurants may be lowering sodium levels in their foods. At this time, the potential consequences of these findings, if any, are uncertain.

Correction: Scourboutakos, M.J.; et al. Mismatch between Probiotic Benefits in Trials versus Food Products. Nutrients 2017, 9, 400.

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Mismatch between Probiotic Benefits in Trials versus Food Products.

Probiotic food products contain a variety of different bacterial strains and may offer different health effects. The objective was to document the prevalence and dosage of probiotic strains in the Canadian food supply and to review the literature investigating these strains in order to understand what health benefits these products may offer. The Food Label Information Program was used to identify probiotic-containing products in the food supply. PubMed, Web of Science, and Embase were searched for randomized controlled trials that tested the health effects of these strains in humans. There were six probiotic strains/strain combinations identified in the food supply. Thirty-one studies investigated these strains and found that they are associated with decreased diarrhea and constipation, improved digestive symptoms, glycemic control, antioxidant status, blood lipids, oral health, and infant breastfeeding outcomes, as well as enhanced immunity and support for Helicobacter pylori eradication. There were a limited number of studies investigating these strains. Many studies were funded by the food industry and tested dosages that were up to twenty-five times the dosage found in most food products. Probiotic food products could have health benefits not currently reported on their labels. However, many dosages are too low to provide the benefits demonstrated in clinical trials. Further research is needed to enable more effective use of these functional foods.

Testing a Beverage and Fruit/Vegetable Education Intervention in a University Dining Hall.

OBJECTIVE: To test the effect of a nutrition intervention that included education and 2 labeling components on students' food choices. DESIGN: Repeat cross-sectional study taking place on 6 dinner occasions before and 6 afterward. SETTING: The study was conducted during dinner meals in a buffet-style dining hall in a university campus residence, where students paid a set price and consumed all they cared to eat. PARTICIPANTS: University students (n = 368 to 510) visited the cafeteria on each of the data collection dates. INTERVENTION: Fruit and vegetable consumption were encouraged; sugar-sweetened beverage consumption was discouraged using physical activity calorie equivalent labeling. MAIN OUTCOME MEASURES: Beverage choices and vegetable/fruit bar visits. ANALYSIS: Logistic regression was used to compare the proportion of student who selected each beverage, fruit, or vegetable before and after the intervention, while controlling for menu and gender as covariates. RESULTS: There was a significant decrease in the proportion of students selecting a sugar-sweetened beverage before vs after the intervention (49% vs 41%, respectively; P = .004) and an increase in students choosing water (43% vs 54%, respectively; P < .001). There was a significant increase in students who took fruit after the intervention (36%; P < .001) vs before (30%). The number of students visiting the vegetable bar significantly increased from 60% to 72% (P < .001). CONCLUSIONS: This intervention may be a way to encourage healthy dietary choices in campus dining halls.

Added sugars in kids' meals from chain restaurants.

OBJECTIVE: To analyze the added sugars in kids' meals from Canadian chain restaurants in relation to the World Health Organization's proposed sugar recommendation (less than 5% of total daily calories should come from added sugars) and current recommendation (less than 10% of total daily calories should come from added sugars). METHODS: Total sugar levels were retrieved from the websites of 10 fast-food and 7 sit-down restaurants in 2010. The added sugar levels in 3178 kids' meals from Canadian chain restaurants were calculated in 2014 (in Toronto, Canada) by subtracting all naturally occurring sugars from the total sugar level. RESULTS: The average amount of added sugars in restaurant kids' meals (25 ± 0.36 g) exceeded the WHO's proposed daily recommendation for sugar intake. There was a wide range of added sugar levels in kids' meals ranging from 0 g to 114 g. 50% of meals exceeded the WHO's proposed daily sugar recommendation, and 19% exceeded the WHO's current daily sugar recommendation. CONCLUSION: There is a wide range of sugar levels in kids' meals from restaurants, and many contain more than a day's worth of sugar.

Changes in sodium levels in chain restaurant foods in Canada (2010-2013): a longitudinal study.

BACKGROUND: Several restaurant chains have committed to reducing sodium levels in their foods; however, how much sodium levels have changed over the past few years is unknown. The objective was to measure changes in sodium in restaurant foods from 2010 to 2013. METHODS: Data for the serving size, calorie and sodium level of 3878 foods were collected from the websites of 61 Canadian restaurant chains in 2010 and 2013. A longitudinal study of changes in sodium levels in foods available from the restaurants in 2010 and 2013 (n = 2198) was conducted. Levels in newly reported and discontinued foods were also investigated. RESULTS: Sodium levels (mg/serving) decreased in 30.1% of foods, increased in 16.3% and were unchanged in 53.6%. The average change in foods with a decrease in sodium was -220 (standard deviation [SD] ± 303) mg/serving (a decline of 19% [SD ± 17%]), whereas the average change in foods with an increase in sodium was 251 (SD ± 349) mg/serving (a 44% [SD ± 104%] increase). The prevalence and magnitude of change varied depending on the restaurant and food category. Overall, there was a small, yet significant, decrease in sodium per serving (-25 [SD ± 268] mg, p < 0.001); however, the percentage of foods exceeding the daily sodium adequate intake (1500 mg) and tolerable upper intake level (2300 mg) remained unchanged. INTERPRETATION: The observed increases and decreases in sodium show that industry efforts to voluntarily decrease sodium levels in Canadian restaurant foods have produced inconsistent results. Although the lower levels in some foods show that sodium reduction is possible, the simultaneous increase in other foods demonstrates the need for targets and timelines for sodium reduction in restaurants.

Restaurant menu labelling: Is it worth adding sodium to the label?

OBJECTIVE: Several provincial and federal bills have recommended various forms of menu labelling that would require information beyond just calories; however, the additional benefit of including sodium information is unknown. The objective of this study was to determine whether sodium information on menus helps consumers make lower-sodium choices and to understand what other factors influence the effect of menu labelling on consumers' meal choices. METHODS: A total of 3,080 Canadian consumers completed an online survey that included a repeated measures experiment in which consumers were asked to select what they would typically order from four mock-restaurant menus. Subsequently, consumers were randomly allocated to see one of three menu-labelling treatments (calories; calories and sodium; or calories, sodium and serving size) and were given the option to change their order. RESULTS: There was a significant difference in the proportion of consumers who changed their order, varying from 17% to 30%, depending on the restaurant type. After participants had seen menu labelling, sodium levels decreased in all treatments (p<0.0001). However, in three of the four restaurant types, consumers who saw calorie and sodium information ordered meals with significantly less sodium than consumers who saw only calorie information (p<0.01). Consumers who saw sodium labelling decreased the sodium level of their meal by an average of 171-384 mg, depending on the restaurant. In the subset of consumers who saw sodium information and chose to change their order, sodium levels decreased by an average of 681-1,360 mg, depending on the restaurant. Sex, intent to lose weight and the amount of calories ordered at baseline were the most important predictors of who used menu labelling. Eighty percent of survey panelists wanted to see nutrition information when dining out. CONCLUSION: Including sodium information alongside calorie information may result in a larger decrease in the amount of sodium ordered by restaurant-goers.

trans Fatty acids in the Canadian food supply: an updated analysis.

BACKGROUND: Dietary trans fatty acids (TFAs) increase the risk of heart disease. In 2007, Canada set voluntary TFA limits for industrial TFAs added to food and encouraged substitution of TFAs with unsaturated fats during reformulation. No longitudinal follow-up assessment of TFA amounts in foods has occurred in Canada since termination of a government-led Trans Fat Monitoring Program (TFMP). OBJECTIVE: The objective was to conduct an updated assessment and longitudinally evaluate TFA amounts in the food supply and to determine whether saturated fats have replaced TFAs in reformulation. DESIGN: This was a cross-sectional study that used 3 databases: TFMP (Health Canada, 2005-2009; n = 921), the University of Toronto Food Label Information Program (2010-2011; n = 5544), and the Restaurant Database (2010; n = 4272). Outcomes were TFAs as a percentage of fat, proportion of foods meeting TFA limits, and saturated fat amounts in foods with high or low TFAs. RESULTS: The proportion of foods meeting TFA limits improved from 75% in 2005-2009 to 97% in 2010-2011, particularly in the following packaged foods: croissants (25% to 100%), pies (36% to 98%), cakes (43% to 90%), and garlic spreads (33% to 100%). Most restaurant categories assessed by the TFMP had 100% of foods meeting TFA limits. Some categories had a large proportion that exceeded TFA limits: dairy-free cheeses (100%), frosting (72.0%), lard and shortening (66.7%), coffee whiteners (66.7%), and restaurant-prepared biscuits and scones (47.4%). Saturated fat amounts were significantly higher (P < 0.05) among some foods with the lowest TFAs, such as cookies, brownies and squares, cakes with pudding/mousse, dessert toppings, and lard and shortening. CONCLUSIONS: There has been an impressive improvement in TFA amounts in the Canadian food supply since the termination of the TFMP. However, action by the food industry is required to reduce TFAs in foods that exceed the recommended TFA limits and to minimize the use of saturated fats in replacing TFAs during reformulation.

Sodium levels in Canadian fast-food and sit-down restaurants.

OBJECTIVE: To evaluate the sodium levels in Canadian restaurant and fast-food chain menu items. METHODS: Nutrition information was collected from the websites of major sit-down (n=20) and fast-food (n=65) restaurants across Canada in 2010 and a database was constructed. Four thousand and forty-four meal items, baked goods, side dishes and children's items were analyzed. Sodium levels were compared to the recommended adequate intake level (AI), tolerable upper intake level (UL) and the US National Sodium Reduction Initiative (NSRI) targets. RESULTS: On average, individual sit-down restaurant menu items contained 1455 mg sodium/serving (or 97% of the AI level of 1500 mg/day). Forty percent of all sit-down restaurant items exceeded the AI for sodium and more than 22% of sit-down restaurant stir fry entrées, sandwiches/wraps, ribs, and pasta entrées with meat/seafood exceeded the daily UL for sodium (2300 mg). Fast-food restaurant meal items contained, on average, 1011 mg sodium (68% of the daily AI), while side dishes (from sit-down and fast-food restaurants) contained 736 mg (49%). Children's meal items contained, on average, 790 mg/serving (66% of the sodium AI for children of 1200 mg/day); a small number of children's items exceeded the children's daily UL. On average, 52% of establishments exceeded the 2012 NSRI density targets and 69% exceeded the 2014 targets. CONCLUSION: The sodium content in Canadian restaurant foods is alarmingly high. A population-wide sodium reduction strategy needs to address the high levels of sodium in restaurant foods.

Restaurant menus: calories, caloric density, and serving size.

BACKGROUND: The increasing trend toward eating out, rather than at home, along with concerns about the adverse nutritional profile of restaurant foods has prompted the introduction of calorie labeling. However, the calorie content in food from sit-down and fast-food restaurants has not been analyzed. PURPOSE: The calorie content of restaurant foods was analyzed in order to better understand how factors that determine calorie content may potentially influence the effectiveness of calorie labeling. METHODS: Nutritional information was collected from the websites of major (N=85) sit-down and fast-food restaurants across Canada in 2010. A total of 4178 side dishes, entrées, and individual items were analyzed in 2011. RESULTS: There was substantial variation in calories both within and across food categories. In all food categories, sit-down restaurants had higher calorie counts compared to fast-food restaurants (p<0.05). Both serving size and caloric density were positively correlated with calories; however, serving size was more strongly correlated (r = 0.62) compared to caloric density (r = 0.29). On average, items that were higher in calories had a larger serving size compared to items that were lower in calories (p<0.05); however, they were often not different in terms of caloric density. CONCLUSIONS: Variation in calories per serving was seen when comparing various types of food, types of establishments, and the specific establishments that provided the foods. Compared to caloric density, serving size was shown to be a more important driver of calories per serving in restaurant foods.