Download vol11 issue 2 - Asia Pacific Journal of Clinical Nutrition

APJCN June vol11 issue 2
87 Asia Pacific Clinical Nutrition Society 2002 Award
Rainer Gross Dipl Ing Agr, Oec Troph, Agr (Giessen)
88
Ocular manifestation of vitamin A deficiency among Orang Asli
(Aborigine) children in Malaysia
Nor F Ngah, Norhayati Moktar, Noor HM Isa, S Selvaraj, Md
Shahrom Yusof, Halimah A Sani, Zainal AA Hasan, Rohani A Kadir
This study determined the prevalence of ocular manifestation of vitamin A deficiency in Orang
Asli (Aborigine) children. Night blindness was found in 16.0% of the children, conjunctiva xerosis
in 57.3%, Bitot's spot in 2.8%, corneal xerosis in 0.5% and corneal scars in 5.6%. These findings
show that history of night blindness had sensitivity, specificity and predictive value (positive) of
47.2, 98.1 and 96.2%, respectively, compared with the standard diagnosis procedure using
luxometer readings.
92
Simultaneous analysis of retinol, -carotene and tocopherol levels in
serum of Vietnamese populations with different incomes
Nguyen Thi Minh Kieu, Kidokoro Yurie, Nguyen Thi Kim Hung,
Shigeru Yamamoto, Nguyen Van Chuyen
In this study, we clarified the status of the fat-soluble vitamins retinol and tocopherol, as well as
-carotene, as antioxidants in the prevention of cardiovascular disease in middle-aged Vietnamese
populations with different incomes. In order to measure simultaneously the serum concentrations
of retinol, -carotene and tocopherol, we carried out high-performance liquid chromatography
analysis with three separate detectors. The analytical method was modified, omitting the
saponification process, and used a multi-evaporating system with dry ice. This allowed the
analysis to proceed more rapidly, use a small amount of serum (40 L) and be free of hexane
contamination to the environment. The analyses reflected an adequate status of vitamin A (serum
retinol = 20 g/dL), but inadequate status of -carotene and vitamin E (serum -carotene < 40
g/dL; serum tocopherol < 600 g/dL) in all three Vietnamese populations. As large numbers of
Vietnamese subjects were observed with very low serum concentrations of -carotene and
tocopherol, higher consumptions of green and yellow vegetables, fruits, vegetable oils and other
foods rich in vitamin E are recommended for these Vietnamese populations.
98
Socioeconomic status and the prevalence of coronary heart disease
risk factors
Kanala KR Reddy, Alahari P Rao, Thavanati PK Reddy
South Asian countries have a high prevalence of coronary heart disease (CHD) in line with their
economic development. India, in particular, has a high burden of CHD. Hence, the aim of the
present study was to assess the prevalence of CHD risk factors in a semiurban population of
Andhra Pradesh, India, in different socioeconomic status (SES) groups. Information was collected
on socioeconomic status, physical activity, cigarette smoking, body mass, blood pressure (BP)
and serum lipid profiles among a healthy sample of 440 men and 210 women with an age range
of 20-70 years. Mean levels of serum cholesterol (SC), high density lipoprotein cholesterol
(HDLC), low density lipoprotein cholesterol (LDLC) and skinfold ratio were found to be higher
among women, whereas triglycerides (TG), systolic BP and diastolic BP were higher in men. No
statistically significant differences in body mass index (BMI) or pulse rate were observed between
the sexes. In men, a significant positive rank correlation (rho = P< 0.05) was observed between
SES and SC, TG, systolic and diastolic BP, pulse rate and BMI, but in women, the same trend
was found only with SC, TG, skinfold ratio and age. The prevalence (age standardized to the
world population of Segi, 95% CI) of obesity was 14.37% (11.06-17.68), hypertension 13.13%
(9.11-17.15), hypercholesterolemia 18.56% (13.88-23.24), hypertriglyceridemia 45.98% (36.4755.49) and low HDLC 31.01% (24.25-37.77). In both sexes, the prevalence of
hypercholesterolemia, hypertriglyceridemia and sedentary life style increased among higher SES
groups (P< 0.05). Also, an increase in the level of social class was positively associated with
mean levels of serum cholesterol and triglycerides in both men and women. The results
demonstrate that higher SES groups have greater prevalence of CHD risk factors than lower SES
groups. Preventive measures are required to reduce the risk factors among higher SES groups.
104
Influence of fish consumption on the distribution of serum cholesterol
in lipoprotein fractions: comparative study among fish-consuming and
non-fish-consuming populations
Gandham Bulliyya
The objective of this study was to investigate serum lipoprotein levels in order to assess
cardiovascular disease (CVD) risk factors between fish-consuming populations and non-fishconsuming populations, as it has been speculated that fish intake reduces CVD risk. A
representative sample of one thousand subjects (529 men and 471 women) were selected, with
ages ranging from 20 to 70 years, from 40 villages belonging to fish-consuming (500) or non-fishconsuming (500) populations. Serum lipoprotein lipids such as total cholesterol (TC), high-density
lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were analysed
biochemically using standard procedures. The ratios of TC : HDL-C and LDL-C : HDL-C were
computed. Mean values of serum LDL-C and the ratios of LDL-C : HDL-C and TC : HDL-C were
significantly lower and HDL-C levels were higher in fish-consumers than in non-fish-consumers.
The concentrations of HDL-C decreased with increasing age, while the reverse was true for LDLC and for the LDL-C : HDL-C and TC : HDL-C ratios. There were significant sex differences for
certain age groups in both of the population groups. The 5th, 50th and 95th percentile cut-off
values for these parameters were lower in fish-consumers than in non-fish-consumers. The
prevalence of individuals at risk of CVD because of low HDL-C (<35 mg/dL), high LDL-C (>130
mg/dL) and their atherogenic ratios (LDL-C : HDL-C > 3.5 and TC : HDL-C > 4.5) was
significantly greater in non-fish-consumers. This study highlights that the fish-consuming
population had a lower atherogenic risk than the non-fish-consuming population. The intake of
fish may have substantial implications for public health and health economy by decreasing the
risk of CVD. However, more studies are warranted to better define the mechanisms of
cardioprotection by dietary fish and fish oils.
112
Serum fatty acids, lipoprotein (a) and apolipoprotein profiles of middleaged men and women in South Vietnam
Nguyen Thi Minh Kieu, Etsuko Yasugi, Nguyen Thi Kim Hung, Toshimi Kido,
Kazuo Kondo, Shigeru Yamamoto, Nguyen Van Chuyen, Mieko Oshima
In Vietnam, increasing fat consumption is a trend recognized recently in urban areas. To obtain a
reasonable nutrition status and prevent cardiovascular disease (CVD), it is necessary to obtain
information on habitual fat intake and biochemical parameters as risk factors for CVD in
Vietnamese populations. Therefore, from the analysis of serum fatty acid composition, fat
consumption patterns in Vietnamese populations in South Vietnam, with different incomes, are
discussed in this study. In addition, some risk factors for premature CVD, serum lipoprotein (a)
and apolipoprotein concentrations are also assessed in these Vietnamese populations. The study
was carried out in men and women aged 40-59 in three different districts: urban (n = 100),
suburban (n = 98) and rural (n = 98). The results of serum fatty acid composition analysis
reflected differences in quality fat intake among the three populations. The urban population was
estimated to consume more vegetable oil but less fish than their rural counterparts. Although
serum lipoprotein (a) and apolipoprotein B levels were below the ranges associated with
atherogenesis, ongoing attention to dietary fat intake for the prevention of CVD in Vietnamese
populations is required.
117
Effects of haemoglobin and serum ferritin on cognitive function in
school children
Rassamee Sungthong, Ladda Mo-suwan, Virasakdi Chongsuvivatwong
The association between iron deficiency anaemia and cognitive function impairment has been
widely reported in young children, but whether the impairment is a result of iron deficiency per se
or a combination of iron deficiency and anaemia, and how these conditions interact, is still
questionable. Four hundred and twenty-seven school children from two schools in
socioeconomically deprived communities were selected in southern Thailand. Iron status was
determined by haemoglobin and serum ferritin concentrations. Cognitive function in this study
was measured by IQ test and school performance, including Thai language and mathematics
scores, using z-scores based on distributions within the same grade and school. Data on
demography and socioeconomic status were collected by questionnaire answered by the parents.
Linear regression models were used to investigate the effect of anaemia and iron deficiency,
reflected by haemoglobin and serum ferritin concentration, on cognitive function and school
performance. We found that cognitive function increased with increased haemoglobin
concentration in children with iron deficiency, but did not change with haemoglobin concentration
in children with normal serum ferritin level. Children with iron deficiency anaemia had consistently
the poorest cognitive function (IQ, 74.6 points; Thai language score, 0.3 SD below average; and
mathematics score, 0.5 SD below average). Children with non-anaemic iron deficiency but with
high haemoglobin levels had significantly high cognitive function (IQ, 86.5 points; Thai language
score, 0.8 SD above average; and mathematics score, 1.1 SD above average). This study found
a dose-response relationship between haemoglobin and cognitive function in children with iron
deficiency, whereas no similar evidence was found in iron sufficient children.
123
Therapeutic effects of NaFeEDTA-fortified soy sauce in anaemic
children in China
Junsheng Huo, Jing Sun, Hong Miao, Bo Yu, Tao Yang, Zhaoping Liu,
Chengqian Lu, Junshi Chen, Ding Zhang, Yuzhen Ma, Anxu Wang, Yongli Li
The therapeutic effects of NaFeEDTA-fortified soy sauce on anaemic students were investigated.
Three hundred and four iron-deficient anaemic school children (11-17 years) were randomly
assigned to three treatment groups: control group (consuming non-fortified soy sauce), lowNaFeEDTA group (consuming fortified soy sauce, providing 5 mg Fe/day) and high-NaFeEDTA
group (consuming fortified soy sauce, providing 20 mg Fe/day). Blood haemoglobin (Hb) levels
were determined before and after 1 month, 2 months and 3 months of intervention. In addition,
serum iron (SI), serum ferritin (SF), free erythrocytic porphyrin (FEP), total iron binding capability
(TIBC) and transferritin (TF) were measured before and after consumption of soy sauce for 3
months. The results obtained herein show that the parameters measured were not changed
remarkably within the 3-month intervention in the control group (P< 0.05). However, increased
Hb, SI, SF and TF levels and decreased TIBC and FEP levels were observed in both the highNaFeEDTA group (P< 0.01) and the low-NaFeEDTA group (P< 0.05). The effectiveness of iron
intervention in the low-NaFeEDTA group and high-NaFeEDTA group had no statistical
significance after 3 months. It was concluded that nutritional intervention for anaemic students
using NaFeEDTA-fortified soy sauce could play a positive role in the improvement of iron status
and control of anaemia.
128
Sources of dietary iron in urban and provincial 4-year-old children in
Iran
Fatemeh V Zohouri, Andrew J Rugg-Gunn
Iron-deficiency anaemia is prevalent in childhood, especially in developing countries. Nutritional
deficiency is one of the main causes of iron-deficiency anaemia, although absorption varies
considerably between different dietary items. Information on the sources of iron in young children
is limited. A study was therefore undertaken to investigate the different dietary sources of iron in
151 healthy children aged 4 years who were selected from two districts of Fars province, Iran.
Two 3-day dietary diaries with pre- and post-interview were used to record the dietary intake of
the children. Food and drinks were categorised into four groups (animal, plant, drinks and other)
to measure the relative importance of different sources of iron. Sixty-eight percent of the children
completed the 3-day dietary diaries in both summer and winter. The results showed no
statistically significant differences in total daily iron intake between the two seasons or between
genders. However, the difference in the total daily iron intake between children in the city and the
provincial district was significant: 7.73 ± 1.75 mg/day and 10.33 ± 2.9 mg/day, respectively (P<
0.001). About 75 and 60% of iron intake came from plant sources in the provincial district and
city, respectively. The three most important sources of iron for children of the provincial district
were bread (51%), fruit and vegetables (12%) and meat (7%). This pattern was also observed for
children living in the city, but with different percentages: 27%, 16% and 16%, respectively. In
conclusion, total iron intakes were similar to those recorded in European countries, but little of the
intake came from animal sources and substantial differences between city and provincial children
were recorded.
133
Socioeconomic profile and nutritional status of children in rubber
smallholdings
Zamaliah Mohd Marjan, Mirnalini Kandiah, Khor Geok Lin, Tee E Siong
This paper will present the socioeconomic profile and nutritional status of children aged 1-6 years
in the rubber smallholdings of Peninsula Malaysia. A total of 323 households were involved in this
study. The sociodemographic data were obtained through interviews with heads of households
using a set of questionnaires. Anthropometric measurements were taken from 506 children aged
1-6 years from these households. The weight and height of the children were compared with the
reference values of the National Center for Health Statistics (NCHS) and the nutritional status
was classified based on the recommendations of WHO. The average age of the fathers was 39.9
± 8.6 years and 34.4 ± 7.0 years for the mothers. The mean household size was 6.67 ± 2.27. The
majority (49.7%) of the heads of households received 4-6 years of formal education and 7.9%
received no formal education. Based on the monthly per capita income, 24.0% were found to be
in the hardcore poor category, 38.3% fall into the poor category and 37.7% in the above poverty
income group. The prevalence of stunting and underweight among children between the ages of
1-6 years were highest among children from the hardcore poor, followed by the poor category
and above the poverty line income group. Wasting was present in all income groups, with a
prevalence of 4.2% found among the hardcore poor, 9.4% among the poor group and 8.4% in the
above poverty income group. The Pearson Product Moment Correlation showed significant
relationships between household total income and height-for-age (r = 0.131, P = 0.05) and
weight-for-age (r = 0.127, P = 0.05). There were also significant correlations between monthly per
capita income with height-for-age (r = 0.16, P< 0.01) and weight-for-age (r = 0.13, P< 0.05). The
acreage of land utilised was correlated with height-for-age (r = 0.11, P< 0.05), weight-for-age (r =
0.17, P< 0.05) and weight-for-height (r = 0.16, P< 0.05). However, stepwise multiple regression
analysis indicated that the predictor of height-for-age was monthly per capita income (R2 = 0.03,
P< 0.01) and acreage of land utilised was a predictor for weight-for-age (R2 = 0.03, P< 0.01) and
weight-for-height (R2 = 0.01, P< 0.01). Because income and acreage of land utilised have been
shown to be associated with nutritional status, it is recommended that intervention programs that
focus on generation of income and diversification of land utilisation should be undertaken. A
multidiscipline approach involving the family, community and government agencies should be
applied to any type of intervention program.
142
Dietary calcium intake in postmenopausal Malaysian women:
comparison between the food frequency questionnaire and three-day
food records
WSS Chee, AR Suriah, Y Zaitun, SP Chan, SL Yap, YM Chan
The objective of this study was to compare the dietary calcium intakes assessed by a quantitative
food frequency questionnaire (FFQ) and the three-day food record method in 230 Chinese
postmenopausal women aged 50-65 years in Kuala Lumpur. The results showed that the mean
calcium intake from the dietary records was 447 ± 168 mg/day and 499 ± 211 mg/day from the
FFQ. The mean difference in intake by the two methods was 51.3 mg (95% CI = - 30.8 - 77.9; SD
= 181.2, P> 0.05), which did not differ significantly from zero. Pearson's correlation coefficient of
0.56 was obtained between the two methods. Ninety-five percent of the individuals classified by
food records fell into the same or within-one-quartile category when classified by FFQ. Forty-eight
percent were classified into the same quartile by both methods. No subjects were grossly
misclassified by the FFQ. The FFQ correctly identified subjects with calcium intakes below the
Malaysian recommended daily allowance (450 mg/day) with 60% specificity and with 92%
specificity for women consuming less than 800 mg calcium/day. In conclusion, the FFQ
developed was a useful, rapid clinical tool for assessing calcium intake and identifying
postmenopausal Chinese women with low calcium intakes in Malaysia.
147
Assessment of a rapid method for assessing adequacy of calcium
intake
J Hilary Green, Chris L Booth, Richard LW Bunning
The purpose of this study was to assess the agreement between the 24 h diet recall and a short
17-item 24 h food intake recall in assessing calcium intake. The calcium intakes of 21 women
over the age of 50 were assessed by both methods on four occasions. The mean calcium intakes
were similar using both methods, being 1034 ± 398 mg/day by 24 h diet recall and 822 ± 412
mg/day (SD) by 17-item 24 h food intake recall. The 17-item 24 h food intake recall tended to
underestimate calcium intake compared with the 24 h diet recall, with the limits of agreement
being between -1197 and -727 below and 370 and 682 mg/day above 24 h diet recall values over
the four assessments. The 17-item 24 h food intake recall identified 8% more women with
inadequate calcium intakes than the 24 h diet recall method did. Although there is poor
agreement in calcium intake between the 24 h diet recall method and the 17-item 24 h food intake
recall, the latter provides a quick and simple means for assessing extremes of calcium intake and
whether day to day calcium intake is adequate.
151
Gastrointestinal tolerance of a new infant milk formula in healthy
infants: multicenter study conducted in Taiwan
Nancy Chen, Pedro A Alarcon, Gail M Comer, Randall L Tressler
The objective of this study was to test whether the gastrointestinal tolerance of a new infant
formula equalled or exceeded the tolerance of other milk-based infant formulas, and to compare
the tolerance of the new formula to that of human milk. This prospective, observational,
multicenter, open-label study was conducted in Taiwan. Healthy, full-term infants aged 28-98
days were enrolled on their current feeding regimen (no treatment assigned). Feeding regimens
included human milk (HM), a new infant formula (NF, Similac Advance®), other marketed infant
formulas (OF, mainly Enfalac® or S-26®), HM + NF and HM + OF. Data for stool frequency, stool
consistency and gastrointestinal intolerance symptoms were recorded in study diaries by parents
for a period of two weeks. Gastrointestinal tolerance was evaluated in 967 infants, of whom 481
(49.7%) received NF, 312 (32.2%) received OF, 101 (10.4%) received HM + NF, 41 (4.2%)
received HM + OF and 32 (3.3%) received HM. Infants fed HM only had softer and more frequent
stools than those who received NF only or OF only (P< 0.001). Infants fed NF only had softer
stools than those fed OF only (P< 0.001), including those fed either Enfalac® or S-26® (P<
0.001). There were no significant differences between feeding groups for the incidence of general
intolerance, spit-up or flatulence. All feeding regimens were well tolerated. We thereby concluded
that NF is well tolerated in healthy infants and results in stool consistencies that more closely
resemble those of infants fed human milk than those of infants fed other formulas.
157
Effect of Cassia auriculata leaf extract on lipids in rats with alcoholic
liver injury
Rajagopal Senthil Kumar, Manickam Ponmozhi, Periyasamy Viswanathan,
Namasivayam Nalini
We studied the effect of administering Cassia auriculata leaf extract to rats with experimentally
induced liver damage. Hepatotoxicity was induced by administering 9.875 g/kg bodyweight
ethanol for 30 days by intragastric intubation. C. auriculata leaf extract was administered at a
dose of 250 mg/kg bodyweight daily in one group and 500 mg/kg bodyweight daily in another
group of alcohol-treated rats. All rats were fed with standard pellets. The control rats were also
given isocaloric glucose solution. The average bodyweight gain was significantly lower in alcoholtreated rats, but improved on supplementation with C. auriculata leaf extract. Alcohol
supplementation significantly elevated the cholesterol, phospholipid and triglyceride concentration
in the liver, brain, kidney and intestine, as compared with those of the normal control rats.
Treatment with C. auriculata leaf extract and alcohol significantly lowered the tissue lipid levels to
almost normal levels. Microscopic examination of alcohol-treated rat liver showed inflammatory
cell infiltrates and fatty changes, which were reversed on treatment with C. auriculata leaf extract.
Similarly, alcohol-treated rat brain demonstrated spongiosis, which was markedly reduced on
treatment with C. auriculata. In conclusion, this study shows that treatment with C. auriculata leaf
extract has a lipid-lowering effect in rats with experimentally induced, alcohol-related liver
damage. This is associated with a reversal of steatosis in the liver and of spongiosis in the brain.
The mechanism of C. auriculata leaf extract lipid-lowering potential is unclear.
164
Kiwifruit promotes laxation in the elderly
Elaine C Rush, Meena Patel, Lindsay D Plank, Lynnette R Ferguson
Numerous anecdotal reports have suggested that kiwifruit (Actinidia deliciosa) has laxative
effects. This could be an acceptable dietary supplement, especially for elderly people who often
present with constipation. We wished to obtain objective evidence as to whether or not kiwifruit
eaten regularly could promote laxation in elderly people. Thirty-eight healthy adults of age > 60
years consumed their normal diet, with or without one kiwifruit per 30 kg bodyweight for three
weeks, followed by a 3-week crossover period. Daily records were taken on frequency of
defecation and characteristics of the stools. Kiwifruit significantly enhanced all tested measures of
laxation in these adults. The regular use of kiwifruit appeared to lead to a bulkier and softer stool,
as well as more frequent stool production. Kiwifruit as a natural remedy appears palatable to most
of the population and provides improved laxation for elderly individuals who are otherwise
healthy. It is likely that a number of factors in the whole fruit are involved, but the nature of the
stools suggest fibre is important. This study provides evidence of the potential for improvement in
bowel function, health and well-being through changes in diet.
SUPPLEMENT
Seminar on nutrition labelling and health claims: scientific substantiation
and opportunities for harmonization
S65
E-Siong Tee
S68 Nutrition labelling: purpose, scientific issues and challenges
Annoek WEM Van den Wijngaart
Nutrition labels describe the nutrient content of a food and are intended to guide the
consumer in food selection. The nutrition information provided must be selected on the
basis of consistency with dietary recommendations. Selection of the specific nutrients or
food components to be listed should further take into account label space, the analytical
feasibility of measuring the particular nutritional component within the food matrix, and the
relative costs of such analyses. Nutrition information provided on labels should be truthful
and not mislead consumers. At the same time, labelling regulations should provide
incentives to manufacturers to develop products that promote public health and assist
consumers in following dietary recommendations. It is likely that in many countries, there
would be some segments of the population that would benefit from information about the
composition of foods. In these cases, countries should consider the need to provide for
appropriate labelling and its presentation relative to existing guidelines and approaches.
As nutrition-labelling efforts have evolved, different approaches and legal requirements
have been established. These create difficulties in developing and harmonizing nutrition
information listings, which have broad international applications. For these reasons, the
Codex Guidelines on Nutrition Labeling play an important role to provide guidance to
member countries when they want to develop or update their national regulations and to
encourage harmonization of national standards with international standards. These
Guidelines are based on the principle that no food should be described or presented in a
manner that is false, misleading or deceptive. The Guidelines include provisions for
voluntary nutrient declaration, calculation and presentation of nutrient information. The
Guidelines on Claims establish general principles to be followed and leave the definition
of specific claims to national regulations. Definitions are provided for a number of claims
(nutrient content, comparative claims, nutrient function claims) as well as general
requirements concerning consumer information in relation with claims. Nutrition labelling
by itself cannot solve nutrition problems. It should be seen as one of the elements of
nutrition policy and should be envisaged in the larger perspective of consumer education,
which in its turn is part of an overall development policy. Exchange of information at the
regional and subregional level is important, as each country can learn from the experience
of others and regional co-ordination and co-operation can be developed.
S72
Nutrition labelling: perspectives of a bi-national agency for Australia
and New Zealand
Margaret A Curran
Australia New Zealand Food Authority (ANZFA) is a bi-national government agency
forming a partnership between all of Australia's States and Territories and the New
Zealand government. Australia New Zealand Food Authority employs scientific, legal
policy, communication and administrative staff in our Australia and New Zealand offices.
Prior to 1991 each of Australia's States and Territories had their own food standards;
however, in 1991 Commonwealth legislation was introduced to consolidate responsibility
for developing food standards in one specialist agency and to ensure the uniformity of
Standards across all States and Territories in Australia. This was extended to New
Zealand in 1995 when we became a bi-national agency following the signing of a Treaty
between Australia and New Zealand to develop joint food standards for both countries.
Australia New Zealand Food Authority's objectives in setting food standards are to:
protect public health and safety; provide adequate information to enable consumers to
make informed choices; and prevent misleading or deceptive conduct. Health Ministers
have recently approved a new Joint Food Standards Code for Australia and New Zealand.
This is the result of over 6 year's work and many rounds of public consultation. The new
Code has had extensive input from government agencies, industry and consumers. In
drafting the new code our emphasis has been on making decisions based on sound
science and the most up-to-date information available. We also recognized the need for
Standards to be practical in not imposing unnecessary costs on food manufacturers with
an inevitable flow on effect to consumer prices. The Joint Code will replace both the
existing Australian Food Standards Code and the New Zealand Food Regulations after a
2-year transition period. During the development of the Joint Code a wide range of
matters were considered in relation to labelling. Amongst these were consumer needs,
costs to industry, voluntary versus mandatory, enforcement issues, relationship to
advertising and exemptions. A number of features of the new Code relate specifically to
labelling and include: warning and advisory statements; ingredients lists; date marking;
directions for use and storage; nutrition information; legibility requirements; and
percentage labelling. One of the key features of the Joint Code is the requirement for
most packaged foods to bear a nutrition information panel (NIP). Information must be
presented on the amount of fat, saturated fat, protein, energy, carbohydrates, sugars and
sodium. For the majority of foods the label is the first and only source of information
regarding the nutritional content of food purchased. Mandatory nutrition labelling will
ensure that consumers are provided with key nutritional information about foods. Single
ingredient produce such as fruit and vegetables, and some other foods such as spices,
tea and coffee will be exempt. The new requirements will give consumers more nutritional
information to allow product comparison. All products will be required to provide
information on these nutrients on both a per 100 g basis and in terms of an average
serving. In addition to the mandatory nutrient declarations NIP are also required to carry
additional data for any substance for which a nutrition claim is made. During the 2-year
transition period to December 2002 ANZFA will be working with industry, enforcement
agencies and consumers to help to ensure that there is a smooth transition to the Joint
Food Standards Code.
S77
Nutrition labelling: European Union and United Kingdom perspectives
Eva Hurt
The growing public interest in the relationship between diet and health and increasing
public health problems in Europe were among the determining factors which led the
European Commission to propose harmonized legislation on nutrition labelling. The
Directive which was adopted in 1990 primarily aimed at providing information which helps
consumers to make an informed choice and assist action in the area of nutrition education
for the public. The provisions of the Directive are voluntary but become obligatory if the
manufacturer decides to make a 'nutritional claim'. Where nutrition labelling is applicable,
the information may be given in two formats: group 1, energy value and the amounts of
protein, carbohydrate and fat ('Big 4'); or group 2, energy value and the amounts of
protein, carbohydrate, sugars, fat, saturates, fibre and sodium ('Big 8'). A claim for one of
the following sugar, saturated fat, fibre or sodium automatically triggers group 2
information. Additional information can be provided on the amounts of starch, polyols,
mono-unsaturates, poly unsaturates, cholesterol and any of the vitamins or minerals. The
nutrition information must be given per 100 g or 100 mL of food but may also be declared
per quantified serving of food, or per portion where the number of portions is indicated on
the label. The information must be presented together in one place in tabular form. A
revision of the Nutrition Labelling Directive is due and will address issues such as the
voluntary character of the legislation, the amount of information given and its presentation,
legibility and consumer understanding.
S80
Current status of nutrition labelling and claims in the South-East Asian
region: are we in harmony?
E-Siong Tee, Suryani Tamin, Rosmulyati Ilyas, Adelisa Ramos, WeiLing Tan, Darwin Kah-Soon Lai, Hataya Kongchuntuk
This review includes the situation of nutrition labelling and claims in six countries in SouthEast Asia: Brunei, Indonesia, Malaysia, Philippines, Singapore and Thailand. With the
exception of Malaysia, there is no mandatory nutrition labelling requirements for foods in
these countries except for special categories of foods and when nutritional claims are
made for fortified or enriched foods. Nevertheless, several food manufacturers, especially
multinationals, do voluntarily label the nutritional content of a number of food products.
There is, therefore, increasing interest among authorities in countries in the region to start
formulating regulations for nutrition labelling for a wider variety of foods. Malaysia has
proposed new regulations to make it mandatory to label a number of foodstuffs with the
four core nutrients, protein, carbohydrate, fat and energy. Other countries have preferred
to start with voluntary labelling by the manufacturers, but have spelt out the requirements
for this voluntary labelling. The format and requirements for nutrition labelling differ widely
for countries in the region. Some countries, such as Malaysia, closely follow the Codex
guidelines on nutrition labelling in terms of format, components to be included and mode
of expression. Other countries, such as the Philippines and Thailand, have drafted
nutrition labelling regulations very similar to those of the Nutrition Labeling and Education
Act (NLEA) of the United States. Nutrition and health claims are also not specifically
permitted under food regulations that were enacted before 1998. However, various food
products on the market have been carrying a variety of nutrition and health claims. There
is concern that without proper regulations, the food industry may not be certain as to what
claims can be made. Excessive and misleading claims made by irresponsible
manufacturers would only serve to confuse and mislead the consumer. In recent years,
there has been efforts in countries in the region to enact regulations on nutrition claims.
Recently enacted regulations or amendments to existing regulations of almost all the
countries reviewed have included provisions for nutrition claims. Malaysia is in the
process of gazetting regulations to clearly stipulate the permitted nutrition claims and the
conditions required to make these claims along the guidelines of Codex Alimentarius
Commission. Only two countries in the region permit health claims to be made - Indonesia
and Philippines. Other countries in the region are following developments in Codex and
examining the need for allowing these claims. There are more differences than similarities
in the regulations on nutrition labelling and claims among countries in the South-East
Asian region as no previous efforts have been made to address these. Hopefully, through
this first regional meeting, countries can initiate closer interaction, with a view to working
towards greater harmonization of nutrition labelling and health claims in the region.
Biomarkers, yesterday, today and tomorrow: the basis for
health claims
DCK Roberts
The development of useful and accurate biomarkers for predicting
outcomes of food based interventions is becoming more and more
important, given the emphasis being placed on ingredients in foods
contributing to disease risk reduction and optimal health promotion.
With the human genome now laid bare, opportunities abound to
barcode individuals with their risk profiles. The massive increase in
DNA sequence information together with the development of new
technologies such as genomics, proteomics and bioinformatics, has
resulted in a much greater capacity to determine individual risk profiles.
Screening for biomarkers at the gene or protein expression level using
microarray technology has the potential to identify new biomarkers for
disease diagnosis. Whether these techniques will enable a better
understanding of food-gene interactions to permit health claims rather
than better therapeutic treatment (at high economic cost) remains to be
demonstrated.
S90
International guidelines and experiences on health claims in Europe
Eva Hurt
The relationship between nutrition and health is gaining public acceptance and
consumers are increasingly health-conscious and want to obtain more information
about the food they buy. There is a legal void with regard to health claims in the
European Union. The framework labelling legislation prohibits 'attributing to any
foodstuff the property of preventing, treating or curing a human disease or referring to
such properties'. In the absence of a specific Directive on claims for foodstuffs, EU
member states apply different interpretations of the existing labelling legislation.
Therefore, it may occur that a claim which is permitted in one country may be prohibited
in another one, and vice versa. Because of this, manufacturers have to deal with a
variety of regulations, guidelines and codes of conduct. As regards national selfregulation systems (guidelines, consensus documents, voluntary codes of practice, joint
interpretation of law), increasingly their development in EU countries (UK, France,
Belgium, Netherlands, Spain, Sweden, Finland), is an attempt to remedy the situation of
legal uncertainty. In most countries, a coalition of industry experts, enforcement
authorities, consumer representatives, and scientists was involved in the elaboration of
rules for the scientific justification and formulation, communication and presentation of
health claims. At the international level, Codex Alimentarius is currently debating a draft
on Enhanced Function Claims and Reduction of Disease Risk Claims. The draft
recommendation is currently at step 3 of the Codex procedure. A lot of work has been
undertaken internationally (Codex), in the EU (FUFOSE) and beyond (Council of
Europe) in order to demonstrate that scientific substantiation of claims is possible and
to establish valid criteria for this process.
S94
Newly established regulation in Japan: foods with health claims
Toshio Shimizu
The Japanese government enacted a new regulatory system called 'Foods with health
claims' in April 2001, which consists of 'Foods for Specified Health Use' (FOSHU) and
'Foods with Nutrient Function Claims' (FNFC). The FOSHU was set up by the Ministry
of Health and Welfare in 1991 to approve descriptions on a label regarding an effect of
food on the human body. It was enacted as a part of 'food for specified dietary use'
under the Nutrition Improvement Law. There are three important requirements for
FOSHU approval. The first is scientific evidence of the efficacy, including clinical
testing. The second is safety for consumption. The third is analytical determination of
the effective component. At present there are 293 items approved as FOSHU. Most of
the descriptions of foods under the FOSHU system are similar to the category of
enhanced function claims of Codex. Under FNFC, 12 vitamins (vitamin A, B1, B2, B6,
B12, C, E, D, biotin, pantothenic acid, folic acid, and niacin) and two minerals (calcium
and iron) are standardized. These claims are similar to the nutrient function claims
approved by Codex in 1997. It is desirable that the Japanese administration and the
food industry cooperate with ASEAN countries to work together in the development and
promotion of nutrition and health claims on foods.