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Erschienen in: BMC Public Health 1/2017

Open Access 01.12.2017 | Research article

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

verfasst von: Jessica Yin Man Chan, Mary J. Scourboutakos, Mary R. L’Abbé

Erschienen in: BMC Public Health | Ausgabe 1/2017

Abstract

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.
Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-017-4362-0) contains supplementary material, which is available to authorized users.
Abkürzungen
CFG
Canada’s Food Guide
CFIA
Canadian Food Inspection Agency
EU
European Union
FLIP
Food Label Information Program
FDA
Food and Drug Administration
FDR
Food and Drug Regulations
NIP
Nutrition Information Panel
NFt
Nutrition Facts table
PHAA
Public Health Association of Australia
RACC
Reference Amount Customarily Consumed
UK
United Kingdom

Background

In recent years there has been a substantial increase in the prevalence of obesity in Canada. Presently 62.1% of Canadian adults are overweight, and 25% are obese [1]. The rise in obesity has been paralleled by the consumption of excess calories, partially due to increased portion sizes [2].
The Nutrition Facts table (NFt) is mandated to appear on nearly all packaged foods sold in Canada [3]. The serving size stated on the Nutrition Facts table determine the nutrient levels that will be reported on that label (for example, a smaller serving size reports fewer calories, while a larger serving size reports more calories). Traditionally, the serving sizes stated on the NFt on packaged foods sold in Canada were not standardized and could be determined by manufacturers, unlike in the United States, where the FDA regulates serving sizes [4]. Therefore, food companies could decide the serving size, and thus the number of calories a consumers sees when looking at a Nutrition Facts table. In other countries and jurisdictions, such as the EU, UK, and Australia, nutrition information is listed per 100 g to enable comparisons among similar products [5, 6]. The Canadian NFt does not feature nutrition information per 100 g.
Research has demonstrated that the reported serving sizes on NFts are often smaller than the portions typically consumed [7]. This suggests that food companies may be intentionally trying to reduce the reported calories on the nutrition label by using smaller serving sizes [8]. Additionally, research has demonstrated that using different serving sizes on the NFts of similar products, confuses consumers and makes comparisons among similar foods difficult. As a result, consumers have difficulty determining the energy content per serving and per package, and cannot accurately calculate calorie content when there is more than one serving per container [9]. Furthermore, anticipated guilt from consumption, purchase intentions, and choice behaviour, can be influenced by serving size manipulations, and may disproportionately influence weight-conscious consumers who are concerned about calories, but not serving size [8].
In Canada, two important government bodies i) Health Canada and ii) the Canadian Food Inspection Agency (CFIA) are responsible for Canadian food labelling regulations and public governance. Health Canada is responsible for administering the provisions of the Food and Drugs Act (FDR) that relate to public health, safety and nutrition [10]. Whereas the CFIA provides all federal inspection services related to food and enforces the food safety and nutritional quality standards established by Health Canada, i.e. responsible for the administration and enforcement of the Consumer Packaging and Labelling Act related to food [11]. The CFIA regulates the consistency, completeness and accuracy of the labelling and packaging of consumer goods. These regulations are intended to provide a fair and competitive marketplace by prohibiting deceptive labelling or advertising practices.
Reference amounts for the serving size on Nutrition Facts tables have been established by Health Canada and are set out in Schedule M of the Food and Drug Regulations (FDR) (B.01.001) [12]. Traditionally, these reference amounts were mandatory only as the basis for calculating the compositional criteria that manufacturers must meet for nutrient content claims and health claims [3]. For products without any nutrient content claims and health claims, the CFIA recommends manufacturers follow the range of serving sizes set in the CFIA Guide to Food Labelling and Advertising (CFIA guide), however, these ranges are not mandatory and only serves as a reference for manufacturers to stay within the recommended ranges [13]. In comparison, in the United States, standardized serving sizes used on the Nutrition Facts table have been regulated by the Food and Drug Administration (FDA) for more than 20 years and are required to conform to the Reference Amount Customarily Consumed (RACC) defined in section 101.12(b) of the food labelling regulations [14].
It was suggested that standardizing the serving sizes reported on the Canadian NFt could be an important policy intervention to help consumers make informed healthy food choices [3]. In December 2016, changes were made to the Food and Drug regulations in Canada that now require food manufacturers to use similar serving sizes for similar products [10, 15]. However, this new regulations will not be fully implemented until 2021. By modifying serving sizes to be more consistent and listing realistic measures, it is expected that Canadians will be more easily able to compare similar foods and make it easier to understand how many calories and nutrients they are consuming. This study was initiated before the new legislation was announced. Therefore, 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 CFIA recommended ranges, and Canada’s Food Guide (CFG) recommendations. The goal was to determine the number of foods that currently adhere to the voluntary Canadian FDR Schedule M serving size recommendations (reference amount) as well as the CFIA recommended serving ranges. Comparing serving sizes on food product NFTs to the CFG recommendations is needed to investigate the consistency between the serving sizes recommended in regulatory documents versus consumer education tools for healthy eating. Our second aim was to determine if food and beverage products that have a higher calorie density report a smaller serving size on the NFt, when compared to similar products with a larger serving size. Overall, the aim is for these results to shed light on the potential benefits of the new nutrition labelling changes, to be implemented on Canada, over the next five years.

Methods

Data collection

This was a cross-sectional analyses of the serving size and calories listed on the NFt on 10,487 packaged foods from Canadian grocery stores. Canadian food package label information, as reported on the NFt, was retrieved from the 2010 Food Label Information Program (FLIP) database at the University of Toronto [16]. All data were collected between March 2010 and April 2011 from outlets of the four largest grocery chains in Canada (Loblaws, Metro and Sobeys in Ontario) and one major western Canadian grocery retailer (Safeway, in Alberta). These chains represented approximately 75% of the market share of grocery food products sold in Canada; therefore, most national and private label branded food products were collected. A total of 10,487 unique food products were in the FLIP database. Additional details concerning the construction of the FLIP 2010 database can be found elsewhere [16].

Food classifications and reference serving sizes

All food items were categorized according to the Schedule M categories and sub-categories, as described in the Canadian Food Inspection Agency (CFIA) guide. Schedule M is a component of the Canadian Food and Drug Nutrition Labelling Regulations [B.01.001] and lists serving size reference amounts and recommended serving size ranges for 22 categories and 153 subcategories [3]. The reference amount is a specific regulated quantity of food (measured in grams) and it is meant to represent the portion that would typically be eaten by an individual at one sitting, but is not required to be used by manufacturers on the NFt (Additional file 1).
The CFIA guide provides a range of suggested serving sizes within each of the Schedule M subcategories to guide manufacturer determined serving sizes [3]. The ranges are meant to give manufacturers flexibility when determining the appropriate serving size to disclose on a product’s NFt, however, manufacturers are not required to follow these serving size reference amounts. Use of reference amounts are only mandatory as the basis for determining eligibility of a food to carry nutrient content claims and health claims.
In order to compare manufacturer stated serving sizes to a standardized serving size, schedule M reference amounts were assigned to each food product based on the sub-category that best matched the product’s description. To ensure that food items were categorized consistently, data were checked by a second independent reviewer. In any case of discrepancies, the CFIA was contacted to verify categorizations. A description of the Schedule M subcategories and the food products within each subcategory can be found in Additional file 1.

Inclusion and exclusion criteria

Of the 153 schedule M sub-categories, all sub-categories with at least 50 unique food items were included in this analysis leaving a total of 7494 foods for analysis. For categories with less than 50 food items, sample size might be too small to reflect all existing products across the country. Thus, excluding those categories might help reduce selection bias.
Data analysis
Descriptive statistics were calculated for the serving size and calorie content listed on the NFt (according to the manufacturer stated serving size). The proportion of products with serving sizes that were less than, equal to, or greater than the reference amount listed in Schedule M were tabulated. The proportions of products with serving sizes below, within, and above the range of recommended serving sizes set out in the CFIA Guide were also tabulated. Additionally, when a product’s serving size was within the CFIA range of recommended serving sizes, the proportion of products in the lower half and upper half of the range was calculated.
Each product’s calorie density (calculated as calories per 100 g and calories per reference amount) were calculated. For each product, scatter plots for the calories per reference amount in comparison to the food product’s stated serving size were created to study the association between calorie density and serving size. Correlations between calorie density and serving size were tested using Pearson correlation.
The sign test was used to detect differences between the calories per serving and calories per reference amount, within each food category. All statistical analyses were performed using Statistica, version 10 (Tulsa, OK). A p-value <0.05 was considered significant.

Results

Fifty schedule M sub-categories containing 7494 food products were analysed. The 50 sub-categories included in this study are listed in Table 1.
Table 1
The proportion of products with manufacturer stated serving sizes that are equal to, less than, or greater than the Schedule M reference amounts and recommended ranges
Food group
Number
Schedule M Reference Amountsa
CFIA Recommended Serving Size Rangesb
< reference amount
═ reference amount
> reference amount
< recommended serving size
within recommended serving size
> recommended serving size
Among products within the recommended range
Lower-half
Upper-half
Bakery Products
 1. Bread
183
67 (37%)
15 (8%)
101 (55%)
2 (1%)
135 (74%)
46 (25%)
65 (48%)
70 (52%)
 2. Bagels, tea biscuits, scones etc.
227
84 (37%)
6 (3%)
137 (60%)
3 (1%)
221 (98%)
3 (1%)
123 (56%)
98 (44%)
 7. Coffee cakes, doughnuts, danishes etc.
89
42 (47%)
6 (7%)
41 (46%)
27 (30%)
57 (64%)
5 (6%)
55 (96%)
2 (4%)
 8. Cookies, graham wafers
294
116 (39%)
63 (22%)
115 (39%)
116 (40%)
166 (56%)
12 (4%)
139 (84%)
27 (16%)
 9. Crackers, hard bread sticks etc.
238
54 (23%)
83 (35%)
101 (42%)
7 (3%)
220 (92%)
11 (5%)
184 (84%)
36 (16%)
 14. Croutons
53
0 (0%)
41 (77%)
12 (23%)
0 (0%)
51 (96%)
2 (4%)
46 (90%)
5 (10%)
 15. French toast, pancakes, and waffles
93
87 (94%)
5 (5%)
1 (1%)
0 (0%)
92 (99%)
1 (1%)
67 (73%)
25 (27%)
 17. Grain-based bars with filling and coating
85
38 (45%)
20 (23%)
27 (32%)
0 (0%)
85 (100%)
0 (0%)
79 (93%)
6 (7%)
 18. Rice cakes and corn cakes
62
39 (63%)
2 (3%)
21 (34%)
2 (3%)
54 (87%)
6 (10%)
39 (73%)
15 (27%)
 19. Pies, tarts, cobblers, turnovers
94
66 (70%)
6 (6%)
22 (24%)
16 (17%)
77 (82%)
1 (1%)
35 (45%)
42 (55%)
Cereals and Other Grain Products
 28. Hot breakfast cereals
57
32 (56%)
5 (9%)
20 (35%)
4 (7%)
33 (58%)
20 (35%)
12 (36%)
21 (64%)
 30. Breakfast cereals without fruit or nuts
85
19 (22%)
51 (60%)
15 (18%)
0 (0%)
85 (100%)
0 (0%)
78 (93%)
7 (7%)
 31. Breakfast cereals with fruit and nuts
145
52 (36%)
66 (46%)
27 (18%)
26 (18%)
119 (82%)
0 (0%)
119 (100%)
0 (0%)
 34. Grains, such as rice or barley
85
10 (12%)
44 (52%)
31 (36%)
0 (0%)
54 (64%)
31 (36%)
7 (13%)
47 (87%)
 35. Pastas without sauce
383
58 (15%)
290 (76%)
35 (9%)
7 (2%)
376 (98%)
0 (0%)
37 (10%)
339 (90%)
Dairy Products and Substitutes
 39. Cheese
380
106 (28%)
246 (65%)
28 (7%)
23 (6%)
357 (94%)
0 (0%)
352 (99%)
5 (1%)
 43. Quark, fresh cheese and fresh dairy desserts
63
62 (98%)
1 (2%)
0 (0%)
57 (90%)
6 (10%)
0 (0%)
6 (100%)
0 (0%)
 49. Plant-based beverages
138
33 (24%)
102 (74%)
3 (2%)
5 (4%)
130 (94%)
3 (2%)
3 (2%)
127 98%)
 52. Yogurt
95
68 (72%)
27 (38%)
0 (0%)
30 (32%)
65 (68%)
0 (0%)
65 (100%)
0 (0%)
Desserts
 53. Ice cream, ice milk, frozen yogurt, sherbet
282
11 (4%)
269 (95%)
2 (1%)
0 (0%)
282 (100%)
0 (0%)
282 (100%)
0 (0%)
 54. Dairy desserts, frozen
97
78 (80%)
6 (6%)
13 (14%)
15 (15%)
82 (85%)
0 (0%)
55 (67%)
27 (33%)
Fats and Oils
 64. Butter, margarine, shortening, lard
91
2 (2%)
88 (97%)
1 (1%)
0 (0%)
91 (100%)
0 (0%)
91 (100%)
0 (0%)
 65. Vegetable oil
105
0 (0%)
82 (78%)
23 (22%)
0 (0%)
105 (100%)
0 (0%)
82 (78%)
23 (22%)
 67. Dressings for salad
227
209 (92%)
18 (8%)
0 (0%)
0 (0%)
227 (100%)
0 (0%)
209 (92%)
18 (8%)
Marine and Fresh Water Animals
 72. Marine and fresh water animals
132
94 (71%)
13 (10%)
25 (19%)
15 (12%)
94 (71%)
23 (17%)
94 (100%)
0 (0%)
 73. Marine and fresh water animals, canned
116
11 (9%)
16 (14%)
89 (77%)
1 (1%)
106 (91%)
9 (8%)
65 (61%)
41 (39%)
 Fruits and Fruit Juices
 75. Fruit, fresh, canned or frozen
168
129 (77%)
9 (5%)
30 (18%)
7 (4%)
161 (96%)
0 (0%)
122 (76%)
39 (24%)
 77. Dried fruit
69
10 (14%)
47 (68%)
12 (18%)
4 (6%)
53 (77%)
12 (17%)
4 (8%)
49 (92%)
 83. Juices, nectars and fruit drinks
554
155 (28%)
399 (72%)
0 (0%)
82 (15%)
472 (85%)
0 (0%)
63 (13%)
409 (87%)
Legumes
 86. Beans, peas and lentils
78
27 (35%)
50 (64%)
1 (1%)
0 (0%)
77 (99%)
1 (1%)
21 (27%)
56 (73%)
Meat, Poultry, Their Products and Substitutes
 90. Luncheon meats
107
26 (24%)
24 (23%)
57 (53%)
0 (0%)
105 (98%)
2 (2%)
24 (23%)
81 (77%)
 91. Sausages
102
36 (35%)
9 (9%)
57 (56%)
0 (0%)
98 (96%)
4 (4%)
59 (60%)
39 (40%)
 93. Patties, cutlettes, chopettes etc.
103
14 (14%)
27 (26%)
62 (60%)
5 (5%)
65 (63%)
33 (32%)
39 (60%)
26 (40%)
 96. Meat and poultry with sauce
106
80 (75%)
12 (12%)
14 (13%)
6 (6%)
92 (87%)
8 (7%)
54 (59%)
38 (41%)
Miscellaneous category
 99. Bread crumbs and batter mixes
151
22 (15%)
12 (8%)
117 (77%)
3 (2%)
145 (96%)
3 (2%)
56 (39%)
89 (61%)
Combination Dishes
 107. Measurable
366
175 (48%)
27 (7%)
164 (45%)
76 (21%)
282 (77%)
8 (2%)
218 (77%)
64 (23%)
 108. Not measurable
304
144 (48%)
13 (4%)
147 (48%)
25 (8%)
266 (88%)
13 (4%)
223 (84%)
43 (16%)
 109. Hor d’oeuvres
104
39 (38%)
6 (6%)
59 (56%)
2 (2%)
74 (71%)
28 (27%)
57 (77%)
17 (23%)
Nuts and Seeds
 110. Nuts and seeds
67
3 (4%)
24 (36%)
40 (60%)
3 (4%)
64 (96%)
0 (0%)
64 (100%)
0 (0%)
Sauces, Dips, Gravies and Condiments
 120. Sauces for dipping
117
2 (2%)
112 (96%)
3 (2%)
0 (0%)
114 (97%)
3 (3%)
114 (100%)
0 (0%)
 121. Dips
92
36 (39%)
18 (20%)
38 (41%)
1 (1%)
91 (99%)
0 (0%)
82 (90%)
9 (10%)
 122. Major main entree sauce
145
20 (14%)
125 (86%)
0 (0%)
11 (8%)
134 (92%)
0 (0%)
134 (100%)
0 (0%)
 123. Minor main entree sauce
102
39 (38%)
55 (54%)
8 (8%)
36 (35%)
63 (62%)
3 (3%)
61 (97%)
2 (3%)
 124. Major condiments
100
1 (1%)
97 (97%)
2 (2%)
0 (0%)
100 (100%)
0 (0%)
98 (98%)
2 (2%)
 125. Minor condiments
48
0 (0%)
45 (94%)
3 (6%)
0 (0%)
45 (94%)
3 (6%)
45 (100%)
0 (0%)
Snacks
 126. Chips, pretzels, popcorn, extruded snacks
375
147 (39%)
228 (61%)
0 (0%)
82 (22%)
293 (78%)
0 (0%)
293 (100%)
0 (0%)
 127. Nuts or seeds for use as snacks
88
19 (22%)
66 (75%)
3 (3%)
3 (3%)
82 (94%)
3 (3%)
82 (100%)
0 (0%)
 Sugars and Sweets
 137. Jams, jellies, marmalades etc.
145
0 (0%)
143 (99%)
2 (1%)
0 (0%)
143 (99%)
2 (1%)
143 (100%)
0 (0%)
 141. syrups
50
34 (68%)
15 (30%)
1 (2%)
9 (18%)
40 (80%)
1 (2%)
25 (63%)
15 (37%)
Vegetables
 150. Pickles
54
20 (37%)
28 (52%)
6 (11%)
N/A
N/A
N/A
N/A
N/A
All Food Groups
7494
2616 (35%)
3162 (42%)
1716 (23%)
756 (10%)
6429 (86%)
300 (4%)
4470 (70%)
1959 (30%)
aSchedule M of the Nutrition Labelling regulations3 lists reference amounts that are used as the basis for determining qualifying/disqualifying criteria for nutrient content claims and health claims. Their use on the Nutrition Facts table is not mandatory and manufacturers can determine the serving size used on the Nutrition Facts table
bThe CFIA guide suggests recommended serving size ranges for each Schedule M food category, but manufacturer’s adherence to these ranges is not mandatory [13]

Comparison of serving sizes in relation to schedule M reference amounts

Table 1 compares the manufacturer stated serving sizes reported on the NFt with the Schedule M reference amount and CFIA recommended serving size ranges. 35% of products had serving sizes that were lower than the reference amount in schedule M, 42% of products had serving sizes that were consistent with the reference amount, and 23% exceeded the reference amount. In nine categories, (representing 18% of all categories) more than 70% of products had serving sizes that were smaller than the reference amount. The nine categories were ‘French toast, pancakes, and waffles’; ‘Pies, tarts, cobblers, turnovers’; ‘Quark, fresh cheese and fresh dairy desserts’; ‘Yogurt’; ‘Dairy desserts, frozen’; ‘Dressings for salad’; ‘Marine and fresh water animals’; ‘Fruit, fresh, canned or frozen’ and ‘Meat and poultry with sauce’. Furthermore, in an additional twelve categories, (representing 24% of all categories) more than half of the products had serving sizes that were smaller than the reference amount.

Comparison of serving sizes in relation to CFIA recommended serving size ranges

When compared to the CFIA recommended serving size ranges, 10% of products had manufacturer stated serving sizes that were smaller than the recommended range, 86% were within the recommended range, and 4% were larger than the recommended range. However, among products whose serving size fell within the recommended range, 70% fell within the lower-half of the recommended range, while 30% fell within the higher half of the recommended range.

Comparison of serving sizes in relation to Canada’s food guide

Only a limited number of categories could be compared to the Canada Food Guide recommended serving sizes due to different food categorization systems. In addition, the recommended serving sizes in CFG were primarily based on cooked food portions, whereas the serving size on food product NFts were based on raw food portions, this further limited the number of categories that could be compared. In ‘bread’; ‘bagels, tea biscuits, scones’; and ‘juices, nectars and fruit drinks’, 80–90% of products had manufacturer stated serving sizes that were higher than those recommended by Canada’s food guide. Meanwhile in ‘cheese’ and ‘quark, fresh cheese and fresh dairy desserts’, 90–99% of products had manufacturer stated serving sizes that were smaller than the Canada Food Guide Recommended Serving Sizes.

Comparison of calorie content currently listed on the NFt versus the reference amount

Table 2 shows the median calories in each category as currently listed on the NFt in comparison to the amount that would be listed if manufacturers were required to use the reference amounts for standardized serving sizes. In 21 of the 50 categories analysed (42% of categories), the median amount of calories reported on the NFt (for that category) was significantly lower than the amount that would be stated if manufacturers were required to adhere to the reference amount serving sizes. In contrast, there were only seven categories (14% of categories) where the median calories based on the manufacturer stated serving size was significantly higher than the amount of calories that would be stated if reference amounts were required. Notably ‘Quark, fresh cheese and fresh dairy desserts’; ‘Dressings for salad’ and ‘Syrups’ had the highest differences in calorie levels which would be stated 317%, 200% and 183% larger, respectively, if the standardized reference amounts were used on the NFt. Categories showing a moderately low manufacturer stated serving size (20% to 30%, when compared to schedule M reference amounts) included: ‘Yogurt’; ‘Marine and fresh water animals’; ‘Meat and poultry with sauce’; and ‘Minor main entree with sauce’.
Table 2
Comparison between the median calories currently listed on the Nutrition Facts Table (NFT) and the calories per reference amount
Food group
Number
Median Calories (kcal)/manufacturer stated serving size on NFT (g)
Median Calories (kcal)/reference amount (g)
p*
Minimum calories (kcal)/serving size on NFT† (g)
Maximum calories (kcal)/serving size on NFTa (g)
Bakery Products
 1. Bread
183
130
127
0.011
60
230
 2. Bagels, tea biscuits, scones etc.
227
150
147
0.001
40
350
 7. Coffee cakes, doughnuts, danishes etc.
89
200
215
0.913
60
520
 8. Cookies, graham wafers
294
140
141
0.999
30
250
 9. Crackers, hard bread sticks etc.
238
90
90
na
60
247
 14. Croutons
53
35
30
0.001
25
110
 15. French toast, pancakes, and waffles
93
140
167
0.001
90
230
 17. Grain-based bars with filling and coating
85
110
123
0.215
90
230
 18. Rice cakes and corn cakes
62
60
64
0.028
30
230
 19. Pies, tarts, cobblers, turnovers
94
305
321
0.001
80
430
Cereals and Other Grain Products
 28. Hot breakfast cereals
57
150
155
0.127
90
210
 30. Breakfast cereals without fruit or nuts
85
120
116
0.607
80
130
 31. Breakfast cereals with fruit and nuts
145
210
214
0.022
90
270
 34. Grains, such as rice or barley
85
160
160
0.349
110
360
 35. Pastas without sauce
383
300
302
0.007
110
342
Dairy Products and Substitutes
 39. Cheese
380
90
100
0.001
20
190
 43. Quark, fresh cheese and fresh dairy desserts
63
90
286
0.001
60
190
 49. Plant-based beverages
138
120
130
0.001
30
230
 52. Yogurt
95
100
140
0.001
35
260
Desserts
 53. Ice cream, ice milk, frozen yogurt, sherbet
282
140
140
na
60
340
 54. Dairy desserts, frozen
97
180
250
0.001
40
360
Fats and Oils
 64. Butter, margarine, shortening, lard
91
70
70
na
25
90
 65. Vegetable oil
105
80
80
0.001§
80
130
 67. Dressings for salad
227
45
90
0.001
10
160
Marine and Fresh Water Animals
 72. Marine and fresh water animals
132
170
223
0.001
65
540
 73. Marine and fresh water animals, canned
116
90
71
0.001
25
240
Fruits and Fruit Juices
 75. Fruit, fresh, canned or frozen
167
80
91
0.001
30
220
 77. Dried fruit
69
120
122
0.831
40
270
 83. Juices, nectars and fruit drinks
553
120
125
0.001
10
200
Legumes
 86. Beans, peas and lentils
78
340
350
0.001
35
420
Meat, Poultry, Their Products and Substitutes
 90. Luncheon meats
107
60
61
0.001
30
170
 91. Sausages
102
150
142
0.03
40
370
 93. Patties, cutlettes, chopettes etc.
103
230
211
0.001
70
550
 96. Meat and poultry with sauce
106
190
252
0.001
90
410
Miscellaneous category
 99. Bread crumbs and batter mixes
151
150
118
0.001
30
350
Combination Dishes
 107. Measurable
366
275
284
0.957
110
700
 108. Not measurable
304
290
309
0.907
80
660
 109. Hor d’oeuvres
104
155
124
0.055
70
452
Nuts and Seeds
 110. Nuts and seeds
67
260
190
0.001
80
380
Sauces, Dips, Gravies and Condiments
 120. Sauces for dipping
117
60
60
na
10
170
 121. Dips
92
60
63
0.907
15
170
 122. Major main entree sauce
145
70
70
0.001§
20
270
 123. Minor main entree sauce
102
20
25
0.001
10
310
 124. Major condiments
100
20
20
na
5
70
 125. Minor condiments
48
5
5
0.248
0
80
Snacks
 126. Chips, pretzels, popcorn, extruded snacks
375
240
250
0.001
40
330
 127. Nuts or seeds for use as snacks
88
280
290
0.021
160
440
Sugars and Sweets
 137. Jams, jellies, marmalades etc.
145
50
50
0.479
5
80
 141. Syrups
50
120
220
0.001
30
468
Vegetables
 150. Pickles
54
10
9
0.025
3
70
a NFT = Nutrition Facts Table, the mandatory nutrition labelling required on all packaged food products
*because data was non-normal, p-values reflect significance according to the Sign Test
indicates categories where the median calories per reference amount is significantly greater than the median calories per stated serving
§In two instances the p-value is significant but there is no difference in the median, this is due to the fact that signficance was determined according to the sign-test

Correlation between calorie density and serving size

There was a significant negative correlation between serving size and calorie density in 31 categories (62% of categories) (Table 3). In 22 of these categories (44%), the negative correlation was significant (p < 0.05). ‘Juices, nectars and fruit drinks’ showed the strongest negative correlation (−0.9, p < 0.0001) while ‘Croutons’, ‘Quark, fresh cheese and fresh dairy desserts’, ‘Plant-based beverages’, ‘Measurable combination dishes’, ‘Not measurable combination dishes’ and ‘Major main entree with sauce’ also showed a significant negative correlations ranging from −0.4 to −0.6 (p < 0.001).
Table 3
Correlation between serving size and calorie density in each Schedule Ma food category
Food group
Number
Pearson Correlation - r
p
Bakery Products
 1. Bread
183
−0.3493
0
 2. Bagels, tea biscuits, scones etc.
227
0.006
0.0001
 7. Coffee cakes, doughnuts, danishes etc.
89
−0.3107
0.003
 8. Cookies, graham wafers
294
−0.0972
0.0961
 9. Crackers, hard bread sticks etc.
238
−0.2227
0.0005
 14. Croutons
53
−0.6452
0
 15. French toast, pancakes, and waffles
93
−0.2151
0.0384
 17. Grain-based bars with filling and coating
85
0.1998
0.0667
 18. Rice cakes and corn cakes
62
0.5732
0
 19. Pies, tarts, cobblers, turnovers
94
−0.3318
0.0011
Cereals and Other Grain Products
 28. Hot breakfast cereals
57
0.2337
0.0802
 30. Breakfast cereals without fruit or nuts
85
−0.3751
0.0004
 31. Breakfast cereals with fruit and nuts
145
0.0097
0.9079
 34. Grains, such as rice or barley
85
0.2446
0.0241
 35. Pastas without sauce
383
−0.008
0.8757
Dairy Products and Substitutes
 39. Cheese
380
0.2066
0.00005
 43. Quark, fresh cheese and fresh dairy desserts
63
−0.4323
0.0004
 49. Plant-based beverages
138
−0.4618
0
 52. Yogurt
95
−0.0726
0.4845
Desserts
 53. Ice cream, ice milk, frozen yogurt, sherbet
282
0.2197
0.0002
 54. Dairy desserts, frozen
97
0.5856
0
Fats and Oils
 64. Butter, margarine, shortening, lard
91
−0.202
0.0548
 65. Vegetable oil
105
0.2112
0.0306
 67. Dressings for salad
227
0.0552
0.408
Marine and Fresh Water Animals
 72. Marine and fresh water animals
132
−0.353
0.00003
 73. Marine and fresh water animals, canned
116
0.2288
0.0135
Fruits and Fruit Juices
 75. Fruit, fresh, canned or frozen
167
−0.2265
0.0032
 77. Dried fruit
69
−0.2073
0.0874
 83. Juices, nectars and fruit drinks
553
−0.9073
0
Legumes
 86. Beans, peas and lentils
78
−0.227
0.0457
Meat, Poultry, Their Products and Substitutes
 90. Luncheon meats
107
0.1014
0.2989
 91. Sausages
102
−0.0376
0.0014
 93. Patties, cutlettes, chopettes etc.
103
0.1431
0.1493
 96. Meat and poultry with sauce
106
−0.3741
0.00008
Miscellaneous category
 99. Bread crumbs and batter mixes
151
−0.2137
0.0084
Combination Dishes
 107. Measurable
366
−0.5304
0
 108. Not measurable
304
−0.6052
0
 109. Hor d’oeuvres
104
−0.2401
0.0141
Nuts and Seeds
   
 110. Nuts and seeds
67
−0.2491
0.0421
Sauces, Dips, Gravies and Condiments
 120. Sauces for dipping
117
−0.2977
0.0011
 121. Dips
92
−0.0984
0.3506
 122. Major main entree sauce
145
−0.4883
0
 123. Minor main entree sauce
102
0.2153
0.0298
 124. Major condiments
100
0.2593
0.0092
 125. Minor condiments
48
0.1166
0.43
Snacks
 126. Chips, pretzels, popcorn, extruded snacks
375
0.5575
0
 127. Nuts or seeds for use as snacks
88
−0.1716
0.1099
 Sugars and Sweets
 137. Jams, jellies, marmalades etc.
145
0.0318
0.7042
 141. syrups
50
−0.0321
0.8323
Vegetables
 150. Pickles
54
−0.1669
0.2278
50 of the 153 categories in schedule M had greater than 50 foods and thus were included in the analysis
aSchedule M is a component of the Food and Drug Regulations (B.01.001) which includes reference amounts and recommended serving sizes for the Nutrition Facts table on packaged food products. These references are voluntary and are only mandatory when manufacturers are aiming to meet the compositional criteria for nutrient content claims and health claims

Discussion

This study demonstrates that 35% of Canadian food products had manufacturer stated serving sizes that were lower than the Schedule M reference amount. While many products fell within the CFIA recommended serving size ranges (which are quite large), the majority (70%) were within the lower half of the range. Furthermore, in the majority of food categories, products with a smaller manufacturer stated serving size tended to have a higher calorie density. Therefore, the lack of regulated serving sizes on the NFt on packaged foods in Canada has led to a tendency for food manufacturers to state smaller serving sizes and consequently display lower calorie levels, particularly in high calorie density foods. Collectively, these results suggest that there is an urgent need to regulate and standardize the NFt serving sizes, as the current unregulated system has led to a large proportion of food products with a higher calorie density to report smaller serving sizes, which can be misleading to consumers.
These findings are concerning because it has been shown that only knowledgeable consumers will be motivated to spend time analyzing nutrition information accurately and few are able to do the calculations necessary to compare products with different serving sizes [13]. These results also illustrated the very wide range of serving sizes (some as high as ten-fold) within categories, used by manufacturers in Canada. Health Canada consumer research has shown that consumers find it difficult to compare products, particularly when different serving sizes are used on the Nft [13]; thus consumers may be falsely led to believe that they are consuming fewer calories, when in fact, they are simply eating less food. Data illustrate that the current non-standardized serving size system in Canada is confusing and can lead to dramatic underestimation of calorie intakes [7, 17]. Additionally, this is worrisome, because research has highlighted that certain consumers, such as those who are sensitive to potentially negative nutrients (such as calories), as well as those with less knowledge of nutrition, are likely to be most susceptible to serving size manipulations [18].
This study also illustrates the need to update the serving size recommendations and ranges outlined in Schedule M, to be more in line with the serving size recommendations in Canada’s Food Guide. For example, in the ‘juices, nectars and fruit drinks’ category, most of the product’s serving sizes were in agreement with the reference amount, yet greater than 84% of products exceeded the recommended serving size in CFG. This finding illustrates the disparities between the serving sizes recommended in regulatory documents versus consumer education tools for healthy eating. Therefore, while schedule M and the CFIA make their recommendations based on what is typically consumed, this may not reflect what is recommended in Canada’s Food Guide. Using the amount typically consumed, rather than the recommended serving sizes, as the criteria for labelling, may in fact, promote increased serving sizes and food intakes and contribute to the increasing rate of obesity in Canada.
Standardizing serving sizes as well as aligning them with recommended servings in Canada’s Food Guide, is only one potential solution to this problem. For example, in the food regulations set out by the Food Standards Australia New Zealand, products are required to present nutrient levels both per serving size and per 100 g/mL using a dual-column system, thus enabling comparisons amongst products irrespective of their serving sizes [17]. The EU similarly avoids the need to regulate serving sizes by reporting nutrient levels per 100 g [19]. Interestingly, the “Labelling Logic Review” in Australia, recommended that serving sizes be removed from the Nutrition Information Panel (NIP), aiming to simplify requirements for the mandatory NIP and reduce the regulatory burden on industry [20]. However, no further work has been be undertaken on this recommendation due to the perceived lack of benefit [21]. The Public Health Association of Australia (PHAA) stated that removing the serving size column would not solve the problem of consumer confusion and recommended that the only approach to dealing with the inconsistency in serving sizes is to mandate serving sizes within food categories, as is being currently implemented in Canada [15].
Furthermore, the more fundamental question is, what types of nutrition label information actually assists consumers to make healthier food choices? For example, Roberto and Khandpur had suggested package design might also help educate consumers about appropriate serving sizes by having markers on the outside of food packaging that denote serving size amounts; or having clear indicators of pre-portioned servings in the package design [22]. Not to mention, effective consumer education is an essential co-requirement to enable consumers to understand the valuable information on the NFt.
This study evaluated a large number of foods from a wide variety of food categories. Limitations include the fact that Schedule M serving sizes were not available for a number of sub-categories. In addition, our study only investigated calories, and did not analyze other nutrient levels in relation to the manufacturer stated serving size. Hunter et al. noted that discrepancies in serving-size are often attributed to the use of food products for different purposes [23], thus a higher serving size could be advantageous if the manufacturer inflates the content of a healthy nutrient. Our study did not investigate other factors that could motivate serving size manipulations.

Conclusion

These findings provide data to support the benefits of standardized serving sizes on Nutrition Facts tables. The study also reinforces findings from previous research studies which suggest that in jurisdictions where serving sizes are not standardized, manufacturers can alter consumer perceptions of the healthfulness of a product—particularly its calorie level—simply by decreasing the serving size, without changing the overall nutritional quality of the product, as illustrated by the negative correlation between serving size and calorie density. Therefore, in light of the obesity and diet-related chronic disease epidemic, further research is required to inform policies to help consumers make sense of the NFt amidst a confusing food environment. Nutrition labelling policies that assist consumers to make informed food selection choices are one step towards addressing this pressing public health issue.

Acknowledgements

The authors thank all members from the L’Abbé Lab who contributed to the creation of the FLIP 2010 database.

Funding

This work was supported by the Dr. Lorus J Milne and Dr. Margery J Milne Award (JC); Canadian Institutes of Health Research, Vanier Canada Graduate Scholarship (MS), Strategic Training Program in Public Health Policy (MS); Cancer Care Ontario/CIHR Training Grant in Population Intervention for Chronic Disease Prevention: A Pan-Canadian Program (Grant No. 538932)(MS); McHenry Unrestricted Research Grant from the University of Toronto (ML). The funding agencies were not involved whatsoever in the study design, data collection, analysis/interpretation or writing of the manuscript.

Availability of data and materials

The datasets analysed during the current study available from the corresponding author on reasonable request.

Authors’ contributions

Formulation of the research question (JC, MS, ML); study design (JC, MS); data collection (JC); data analysis (JC, MS); data interpretation (JC, MS, ML); drafting of the manuscript (JC, MS); critical review of the manuscript (JC, MS, ML). All authors have read and approved the final version of the manuscript.

Competing interests

The authors declare that they have no competing interests.
Not applicable.
Ethics approval was not required for this study as it does not involve human subjects and is based solely on food package data

Publisher’s Note

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.
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Metadaten
Titel
Unregulated serving sizes on the Canadian nutrition facts table – an invitation for manufacturer manipulations
verfasst von
Jessica Yin Man Chan
Mary J. Scourboutakos
Mary R. L’Abbé
Publikationsdatum
01.12.2017
Verlag
BioMed Central
Erschienen in
BMC Public Health / Ausgabe 1/2017
Elektronische ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4362-0

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