Enabling patients to make informed food choices: Appropriate Applications of Food Composition Data

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Enabling patients to make informed food choices
Appropriate Applications of Food Composition Data

• April 3, 2009
• Diabetes Update 2009
• Toronto, Ontario

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Disclosure

• As a federal government employee of Health Canada
  no external support or affiliations are permitted
• There exists no apparent conflict of interest
  concerns with this presentation

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Objectives

• Introduction to nutrient data in Canada
• Introduction of our national reference food
  composition database
• Demonstration of how to access the nutrient data
• Investigation of the sources of nutrient data
• Applications of nutrient data concepts of
  generic foods, types of nutrient data, mean
  values /- a range
• Complexity and limitations with carbohydrate data
  
• Grain of salt informed decision making
  recognizing all of the facts and limitations

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Canadian Nutrient File (CNF)

• Canadas computerized national reference food
  composition database
• 143 food components described for over 5500 foods
• Reflective of Canadas regulations, culture,
  market
• Bilingual food names, metric measures
• 2007b version is the 11th edition since inception
  in 1981
• 2009 version due late in the year

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Activity 1

• How do you access nutrient data?
• 1 Use the CNF online application/download
• 2 Use the Nutrient Value of Some Common Foods
• 3 Use USDAs website
• 4 Use the Nutrition Facts Table
• 5 Use software

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My own curiosity

• How did you access nutrient data prior to 2005?
• 1 Downloaded the CNF data files
• 2 Used the Nutrient Value of Some Common
  Foods
• 3 Used USDAs website
• 4 Used label data when available
• 5 Used software

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Traditional Applications of the CNF

• A tool to support surveillance, policy
  formulation, risk assessments, research,
  nutritious food baskets, general compliance
  guidance
• Commodity group promotion, product development,
  clinical, food inventory, media, nutrition
  students
• Self-knowledge, healthy food choices

• Health Canada
• AAFC
• Statistics Canada
• Ministry of Indian and Northern Affairs
• Canadian Food Inspection Agency

• Canadian food industry
• Dietitians/hospitals
• Educators

• General public

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Basic Foods in the CNF

• Generic Foods
• Very little brand name data
• Supports nutrition survey programs
• Prevents misleading information in the database
  when companies reformulate
• Favoured by government agencies for any nutrition
  related projects

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CNF Generic Food Name Examples

• COOKIE, CHOCOLATE CHIP, COMMERCIAL, 18-28 FAT
• CHEESE, MOZZARELLA, PARTIALLY SKIM, (52 WATER,
  16.5 M.F.)
• PINEAPPLE, CANNED, JUICE PACK, SOLIDS LIQUID
• CORN, SWEET, YELLOW, FROZEN KERNELS OFF COB,
  BOILED, DRAINED, SALTED

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Nutrient Values in the CNF

• Provides the average amounts of nutrients in
  foods available in Canada.
• Nutrient composition of a specific apple or
  cookie are not found in the CNF.
• Local foods may have a different profile than the
  national average.
• Ideally a mean value /- SE

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Mean SE
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The Canadian Nutrient File (CNF) Sources of
Nutrient Data
CNF
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CNF Source Codes
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(No Transcript)
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USDA Standard Release 21
http//www.nal.usda.gov/fnic/foodcomp/search/
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USDA Nutrient Database vs. CNF

• Foods
• Exclusion of those foods not sold in Canada
• Addition of foods unique to the Canadian food
  supply
• Cuts and grades of beef
• Food and Drug Act and Regulations
• Fortification
• Specific nutrients which should not be added or
  must be added at certain levels
• Metric system
• Bilingual

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Cereals, ready-to-eat, CHEERIOS
Value per 100grams Nutrient Units USDA
CNF Iron mg 32.0 13.5 Zinc mg
16.0 2.1 Vitamin C mg 24.0
0 Vitamin A IU/RE 2888.0 0
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USDA dictates CNF

• High level of dependency on USDA
• Consistent nutrient codes
• Sum of nutrient category components another
  nutrient
• i.e., sum of fatty acids total fat
• Traditional nutrient list is easiest to
  maintain
• i.e., Unspecified fatty acids versus cis and
  trans isomers

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CNF on the Web

• Downloadable files
• Searchable application
• Recipe proportions
• Nutrient Value of Some Common Foods

www.healthcanada.gc.ca/cnf
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Recipe Proportions
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CNF Online
www.healthcanada.gc.ca/cnfonline

• User-friendly application launched in 2005
• Search by Food
• Search by Nutrient

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Food list
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Activity 2
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Activity 2

• Entering milk in the search box would return 205
  foods containing the word milk. If you wanted to
  narrow that down to find just milk (2) which
  additional term would best accomplish this?
• 2
• Fluid
• Drink

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Serving size
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Nutrient Profile Report
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CNF Online
www.healthcanada.gc.ca/cnfonline

• User-friendly application launched in 2005
• Search by Food
• Search by Nutrient

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Search by Nutrient
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Nutrient Report
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Nutrient Value of Some Common Foods - Updated
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Nutrient Value of Some Common Foods - Updated
List of nutrients Energy in Kcal Energy in KJ
Protein Carbohydrate Total fat Total Dietary
Fibre Saturated Fat Cholesterol Calcium Iron Sodi
um Potassium Magnesium Phosphorus Vitamin
A Vitamin C Vitamin B12 Folate Total
Sugars Thiamin Niacin Lycopene Beta-carotene Vita
min D Caffeine DHA EPA Trans Fat Monounsaturated
Fat Polyunsaturated Fat Vitamin E Alcohol

• Set of 19 nutrients varies for different food
  groupings (ex cholesterol present in meat but
  not in fruits and vegetables)
• 1100 foods
• Values are taken from the 2007b version of the
  CNF
• Given in terms of common household measure of the
  ready-to-eat form of the food
• Emphasis has been placed on mixed dishes rather
  than individual ingredients
• More ethnic foods

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(No Transcript)
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Activity 3You choose the nutrients

• Which of the following would you exclude for the
  vegetable category?
• 1 Protein
• 2 Phosphorus
• 3 Folic acid
• 4 Calcium

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Activity 4

• Which of the following would you exclude in the
  poultry category?
• 1 Carbohydrates
• 2 Iron
• 3 Vitamin B12
• 4 Polyunsaturated fat

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Nutrient Value of Some Common Foods

• To order a booklet (cost0)
• By internet www.healthcanada.gc.ca/nvscf
• By phone [phone]
• By email publications_at_hc-sc.gc.ca
• Also available in PDF version on the same website
  page

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Resources that use the CNF
Beef Information Centre
Microgesta Logiform (FUEL) CANDAT FORMDAT Foodsmar
t ESHA
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Nutrition Facts Tables

• Found on all pre-packaged foods
• 13 nutrients plus energy
• Per serving size as stated
• Product specific values
• must be within 20
• of the amount found in
• the serving size stated
• No range about the mean

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Activity 5

• Which of the following foods would require a
  Nutrition Facts Table
• 1) fresh fruit salad
• 2) bakery bread
• 3) bag of carrots
• 4) bag of chips
• 5) deli potato salad

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CNF Value result of sampling and
analysis 71.0g/100g Or 23g/32.55g bar
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Carbohydrates A Mixed BagDegree of
Polymerization

• Sugars (1-2) Monosaccharides Glucose
  Fructose Galactose
• Disaccharides Sucrose
• Lactose
• Maltose
• Sugar Alcohols Sorbitol
• Mannitol
• Oligosaccharides Malto-oligosacc Maltodextri
  ns
• (3-9) Other Raffinose etc.
• Fructo-oligosacchs
• Polysaccharides Starch Amylose/amylopectin
• (9) Modified Starches
• Non-starch polysacc Total Dietary Fibre

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Functional Classification

• Digested in the small intestine
• Most glycemic (provide glucose for metabolism)
• Glucose, maltose, galactose
• malto-oligosaccharides (dextrins)
• amylopectin
• Less glycemic
• Fructose, sucrose
• amylose
• Fermented in the intestine
• Raffinose, stachyose, fructo-oligosaccharides
• Modified and retrograde starch
• hydrocolloids
• Any energy yield unlikely
• Cellulose, Lignin, psyllium

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Carbohydrates in Food Tables

• North American databases by difference
• 100 (protein fat moisture ash)
• UK and some European databases
• Monosaccharide equivalents a sum
• Australia, New Zealand, Denmark
• By difference minus the fibre available CHO

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Available CHO

• CHO by difference Total Dietary Fibre (TDF)
• In potatoes which have been cooked and cooled is
  this accurate?
• In oatmeal?
• In a product high in fructose?
• In a product containing high amylose corn starch
  (modified corn starch)?

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Carbohydrate fractions in Food Tables

• Total Sugar
• Both in the CNF database and on the Nutrition
  Facts Tables
• Sum of monosaccharides and disaccharides
• Other sugars removed from the database
• Starch very little data
• Resistant Starch not quantified/qualified
• Total Dietary Fibre

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Activity 6

• Carbohydrate and total sugar in Corn Syrup
• 77g CHO 0g Fibre 26g Total Sugar
• What is the remaining 51g of the CHO?
• 1. Starch
• 2. Fructose
• 3. Dont know
• 4. Maltodextrin

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Energy kcal and kJ

• Metabolic yield of CHO
• Digested carbohydrates 4kcal/g
• Fermented carbohydrates 2kcal/g
• Modified or retrograded ?kcal/g
• Calculation of energy values
• General Atwater factors 4/9/4
• Specific Atwater factors used in the CNF
• Nutrition Facts Tables - either

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Activity 7

• Energy in a high bran cereal
• Atwater Factor
• CHO 76 1.82
• Protein 12 2.80
• F at 3 8.37
• Energy using 4/9/4 379 kcal/100g
• Energy using Atwater factors specific to this
  food 187 kcal/100g

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Total fat

• Crude fat
• Includes TGs, sterols, phospholipids, other minor
  lipid fractions
• Triglyceride equivalents
• Accounts only for the energy yielding TG
• Used for labelling
• Not a good indicator of food quality for making
  healthy food choices

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Fatty Acids (46)

• Saturated fatty acids
• Trans fatty acids
• Monounsaturated fatty acids
• Polyunsaturated fatty acids

Cis and trans isomers Double bond positioning
isomers
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Glycemic Index

• Not in the CNF
• Limitations
• Dependence on available CHO calculations
• Serving size dependent
• Large standard deviation even with subjects under
  experimental conditions
• Comparison of foods between categories with no
  educational component
• Glycemic Glucose Equivalents

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Strengths of the CNF

• National Canadian resource
• Unbiased, quality control measures, metadata
• Easy access in different formats
• Backbone of nutrition policy and programs in
  Canada
• Guide for informed food choices

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Limitations of the CNF

• Limited resources
• Dependency in large part on external data sources
• Size
• Keeping pace
• Food markets
• Research
• Generic data versus product specific data
• Different applications require different types of
  nutrient data
• Carbohydrate by difference
• What are we missing? phytosterols, flavonoids,
  antioxidant index etc.

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RD Role

• Inform patients about the limitations and
  appropriate use of such tools which they now have
  access to
• Know the evidence and translate it into practice
• Teach patients to understand their food product
  labels and not necessairily on generic data
• Teach the functional role of foods in health
• Learn about diverse cultural foods that our
  patients use , etc..

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Contact Us

• cnfusers_at_hc-sc.gc.ca