YL5: 08.

15 Deciphering Nutrition Labels

01/18/2019 Gastrointestinal System and Nutrition
10:00-11:00 Leticia Ibañez-Guzman, MD, MSc

TABLE OF CONTENTS Serving Size

I. NUTRITIONAL LABEL...................................................................... 1
A. PARTS OF THE NUTRITION LABEL ...................................... 1
II. LABELING ...................................................................................... 2
A. FAT ........................................................................................ 2
B. SALT...................................................................................... 2
C. SUGAR .................................................................................. 3
D. LIGHT OR LITE ...................................................................... 3 Figure 2. Serving Size of California Raisins
E. MILK ...................................................................................... 3
F. 10-WAY NUTRITION LABEL ................................................... 3 • Refers to the portion of food used as a reference on the nutrition
III. GOVERNMENT PROGRAM ........................................................... 3 label and the number of servings per package
QUICK REVIEW ................................................................................. 4
• Are standardized to make it easier to compare similar food items.
SUMMARY OF TERMS .............................................................. 4
REFERENCES ................................................................................... 4 They come in familiar measurements (e.g. “cups”, metric amount)
REQUIRED ................................................................................ 4 • Size of serving influences the number of calories and all nutrient
amounts on the top part of the label.
• Pay attention to the number of servings
I. NUTRITIONAL LABEL  Example:
▪ A box of oatmeal contains two packs. If you eat the whole
box, you would eat two packs, which doubles the
calories and other nutrient numbers including the %Daily
Values.

Calories
• Calories is a unit of measurement used to express the amount of
energy in the food.
 Energy content can also be expressed in kilocalories,
calories, or kilojoules (1kcal = 4.2kJ)
▪ For purposes of nutrition, sometimes kcal = Cal
▪ If “kJ” is written, divide it by 4 and this will give you an
approximate of its equivalent in kcal
• Check for the calories per serving and the calories per fat (see
figure 2)
 “Calories from fat”
▪ Refers to calories obtained from fat
▪ If it is 50% or more of the total calories (calories per
serving), it is usually not healthy
• Too much calorie intake can increase risk of overweight and
obesity which increases the risk of heart diseases, diabetes, and
cancer

General Guide to Calories (Basis: 2000-calorie diet)

• Low = 40 calories
• Moderate = 100 calories
• High = 400 calories

Calories/g of Nutrient
• Carbohydrates = 4 cal/g
Figure 1. Parts of a Nutrition Facts Label (US FDA, 2013) • Proteins = 4 cal/g
• Fats = 9 cal/g
• A.K.A. nutrition label, nutrition facts label, or food label • Alcohol = 7 cal/g
• Are nutrients from one serving of the food
• List of food ingredients including spices, herbs, and preservatives Limited Nutrients
from highest to lowest
• Functions:
 Allows us to make quick informed food choices that contribute
to a healthy diet
 Helps us select healthier versions of our favorite food
• Sometimes, companies purposely make the font smaller to avoid
catching the customer’s attention
Figure 3. Limited Nutrients

NOTE • These are nutrients that should be low or in limited amounts

• Doc skipped most of the details regarding the parts of the • Excessive amounts may increase risk of chronic diseases such as
nutrition label, so most of the information comes from the 2022 heart diseases, cancer, or high blood pressure
trans • Rule of thumb (US Food and Drug Administration, 2018)
 Low = ≤5% DV
A. PARTS OF THE NUTRITION LABEL  High = ≥20% DV
• To read a nutrition label, start with S and continue to F
Table 1. Recommended daily values of nutrients (2000-calorie diet)
 Serving size
Nutrient Daily Value
 Calories
Total fat < 65 g
 Limited Nutrients
Saturated fat < 20 g
 Maximized Nutrients
Trans fat 0 g (< 0.5 g is reported as 0)
 Footnotes
Cholesterol < 300 mg
Sodium < 2400 mg

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 Maximized Nutrients
• These are nutrients that are beneficial to one’s health, and thus,
must be taken in increased amounts.
• Eating enough of these nutrients are proven to improve health and
reduce the risk of developing some diseases and condition.
• Mnemonic: Maximized nutrients = More

Figure 5. Footnote as Presented on a Nutritional Label (US FDA, 2013)

Upper Limit - Eat “Less Than”

• This is listed first on the footnote of larger labels, eg: Figure 5
presented above
Figure 4. Maximized Nutrients and % Daily Values  Recommended that you eat below the Daily Value nutrient
amounts listed per day as these are oftentimes overestimated
• Rule of thumb applies to these nutrients  Eg: in Figure 5, someone who requires a 2000-calorie diet
 High amount (ideal): 20% DV or higher should consume less than 65g of total fat daily
 Low amount: 5% DV or lower
Lower Limit - Eat “At Least”
Dietary Fiber • This applies to dietary fiber and total carbohydrates found in food
 Is necessary to be taken in increased amounts to promote healthy to some extent
bowel function and prevent constipation.  The DV for dietary fiber is 25g (assuming 100% DV). It is
 there are two kinds of dietary fiber: recommended that one consumes at least this amount of
 Insoluble fiber dietary fiber per day.
 mostly found in whole-grain products (e.g. wheat, bran,
cereal, vegetables and fruit) Table 2. Example of nutrient DVs versus % DVs (2000 calorie diet)
 This kind of fiber provides “bulk” for stool formation and Nutrient DV %DV Goal
helps waste to move quickly through the colon. Total Fat 65 g = 100% DV Less Than
 Soluble fiber Saturated Fat 20 g Less Than
 Found in rice, seeds, beans, many vegetables and fruits. Cholesterol 300 mg Less Than
 It slows down the digestion of carbohydrates, helps Sodium 2400 mg Less Than
stabilize blood sugar in diabetics, lowers “bad Total Carbohydrates 300 g At Least
cholesterol” or LDLs, and reduce the risk of developing Dietary Fiber 25 g At Least
heart disease.
 Ideal daily intake: 25g/day
NOTE
Vitamin A • Doc skipped most of the details regarding the parts of the
 Associated with vision development and cellular growth and nutrition label, so most of the information comes from the 2022
maintenance. trans

Vitamin C
II. LABELING
 Aids the body in the formation of collagen found in blood vessels,
A. FAT
bones, cartilage and muscle.
 Excess Vitamin C in the body is excreted, therefore
Table 3. Fat content terms and descriptions
overconsumption is not recommended.
Term Description
Calcium Fat Free < 0.5 g of total fat for a given reference amount
Calorie-free < 5 calories
 It is necessary for the development of strong bones and teeth in
% Fat Free ≤ 3 g total fat
childhood and adolescence, and to maintain bone mass in
adulthood. Cholesterol-free < 2 mg cholesterol and ≤ 2 g saturated fat
 Increasing your consumption of osteoporosis reduces the risk of Saturated Fat-free < 0.5 g saturated fat and ≤ 0.5 g of trans fatty
osteoporosis. (This is highly recommended for menopausal acids
women). Low Fat ≤3 g total fat
Low Calorie ≤ 40 calories (except sugar substitutes)
Iron Low Cholesterol ≤ 20 mg cholesterol and ≤ 2 g saturated fat
 Essential for many bodily functions Low Saturated Fat ≤ 1 g saturated fat and ≤ 15% of calories from
• Deficiency in iron, as in Iron-deficiency anemia or IDA, increases saturated fat
the body’s susceptibility to infection, slows its cognitive
development (due to hypoxemia or decrease of oxygen content in B. SALT
the blood), and is associated with problems in thermoregulation. • The ideal intake of sodium per day is 2400 mg.
 According to Guyton, required daily amounts of sodium is 3.0 g
Footnotes • Amount of sodium in salt: 40% (salt)
• Footnotes specify that the %DVs presented in the nutritional label  3 grams of salt x 40% = 1.2 grams or 1200 mg Sodium
are based on a certain caloric diet. The 2000-calorie diet is often • % Daily Value tells us if food contributes a little or a lot to our total
used as basis for %DVs. daily diet
• %DVs vary depending on one’s caloric needs (determined by age,  Low: 5% DV (120 mg) or less of Na per serving
sex, height, weight and physical activity)  High: 20% DV (480 mg) or more of Na per serving
• Footnotes also illustrate the recommended amounts for each type  Anything above 480 mg is high.
of nutrient based on 2000- and 2500-calorie diet, which serves as  The lower the sodium, the better.
a guide for consumers.
From 2021 trans
NEED TO KNOW  “Salt” and “sodium” are often used interchangeably, but they do
• Doc noted that one shouldn’t easily follow the recommended not mean the same thing.
daily values. Daily values vary and can be higher or lower  There are food that don’t taste salty yet still contain high amounts
depending on one’s nutrient needs. of sodium. Taste alone is not enough to judge a food’s sodium
content.

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 Salt
 Crystal-like compound that is abundant in nature. Table 5. Differences of Spam Classic and Spam Lite
 It is used for flavoring and for preserving food. Spam Classic Spam Lite
 Sodium Calories 180 cal 110 cal, 39% decrease
 It is a chemical found in salt. Calories from Fat 140 cal 70 cal, 50% decrease
 It is used in a handful of things -- curing meat, baking, Sodium Content 767 mg 580 mg, 24% decrease
thickening, retaining moisture, enhancing flavor, and as a
preservative. E. MILK
 It is commonly found in additive used to enhance the flavor of
• A comparison between Reduced Fat Milk and Nonfat Milk
food.
nutritional labels reveals that Nonfat milk contains less calories
 This includes: monosodium glutamate (MSG), sodium
because it contains no fat.
bicarbonate (baking soda), sodium nitrite and sodium
• Interestingly, both types of milk contain the same amounts of
benzoate.
calcium.
 Sodium attracts water.
 According to Guyton, the average required daily amount of calcium
 A high sodium diet will draw more water into the bloodstream.
for adults is 1.2 g.
More water in the bloodstream results into an increase in
blood volume and an increase in blood pressure.
 The increase in blood volume will cause the heart to pump
harder, and the increased force of the blood flow can cause
damage to the vessels and organs.
 Blood pressure normally rises in age
 Vessels are less flexible due to their age and the further
buildup of fat deposits or plaque in the vessels causing an
increase in blood pressure.
 Limited sodium intake becomes important.
 Eating less sodium can help lower blood pressure.

Table 4. Sodium content terms and descriptions

Term Description
Salt/Sodium-free < 5mg of Na per serving
Very low sodium ≤ 35mg of Na per serving
Low sodium ≤ 140mg of Na per serving
Reduced sodium At least 25% less than regular product
Light in sodium/lightly At least 50% less than regular product
salted
No salt added/unsalted No salt is added during processing; may
not be salt/sodium-free unless stated

C. SUGAR
Figure 7. Reduced Fat Milk VS Nonfat Milk
• Sugars ending in -ose
 Lactose, sucrose, maltose, dextrose, fructose, glucose, F. 10-WAY NUTRITION LABEL
galactose, high fructose corn syrup, glucose solids, etc.
• Information found in nutrient labels
• Regardless of how they sound, the following are also sugars:
 Serving amounts
 Cane juice (dehydrated, solids, crystals), dextrin,
 Calorie content
maltodextrin, dextran, barley malt, beet sugar, corn syrup,
corn syrup solids, caramel, buttered syrup, carob syrup,  Nutrients obtained by eating one serving of the food
brown sugar, date sugar, malt syrup, diatase, diatastic malt,  List of ingredients containing all the food’s constituents,
fruit juice, golden syrup, fruit juice concentrate, dehydrated including spices, herbs and preservatives
fruit juice, fruit juice crystals, turbinado, sorghum syrup, • Using the information of nutrition labels allows the selection of
refiner’s syrup, ethyl maltol, maple syrup, yellow sugar healthier food alternatives.
• 10 Ways nutrition labels help you make healthy choices:
D. LIGHT OR LITE  Portion control
• Food with >50% calories from fat, the light product must be reduced  Count calories
in fat by ≥50%  Monitor total fat intake
• Food with <50% calories from fat, the light product must have less  Eliminate trans fat
calories by ≥1/3 or reduced fat by ≥50%  Decrease cholesterol and saturated fat intake
• Food with modified Na content, the light product must be reduced  Reduce salt intake
by ≥50%  Eat food with fiber
 Get your vitamins and minerals
 Estimate nutrient intake
 Eat healthy food

III. GOVERNMENT PROGRAM

The Salty Six
• The American Heart Association recommends an ideal limit of
1,500 mg of sodium per day for most adults.
• The following are the six food can add high levels of sodium into
your diet:
 Breads and Rolls
▪ Bread adds up to a lot of sodium. Even though each
serving may not seem high in sodium, one piece can
have as much as 230 milligrams of sodium
 Pizza
▪ A slice of pizza with several toppings can contain more
than half of your daily recommended dietary sodium.
▪ Limit the cheese and add more veggies
 Sandwiches
▪ A sandwich or burger from a fast food restaurant can
contain more than 100 percent of you daily suggested
dietary sodium
Figure 6. Spam Classic VS Spam Lite

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  Cold Cuts and Cured Meat REVIEW QUESTIONS
▪ One 2 oz. serving, or 6 thin slices of deli meat can 1. As a general rule, 5 percent or less is low, and 10 percent or more
contain as much as half of your daily recommended is high.
dietary sodium. a) TRUE
▪ Some sodium is added because these meats would spoil b) FALSE
quickly without the added sodium solution 2. Which of the following is not part of the Nutritional Label?
 Soup a) Serving size
▪ One cup of canned chicken noodle soup can have up to b) Calories
940 milligrams of sodium c) Limited Nutrients
▪ It is better to make your own and freeze the leftovers d) Ingredients
 Poultry e) Footnotes
▪ Sodium levels in poultry can vary based on preparation 3. Which is a unit of measurement used to express the amount of
methods. energy in the food
▪ You will find a wide range of sodium in poultry. Even a) Kilocalories
fresh poultry is often injected with added sodium b) Calories
solutions c) Gram
 Nuggets tend to have a lot of added salt. d) Kilojoules
▪ Just 3 ounces of frozen and breaded nuggets (about the e) Both A and B
size of the palm of your hand) can add nearly 600 f) None of the above
milligrams of sodium. 4. Fats have how many calories per gram?
a) 1
Pinggang Pinoy b) 3
• A visual tool made by the Food and Nutrition Research Institute c) 4
(FNRI) to guide Filipinos consume the right amount of food in every d) 7
meal. e) 9
• This is in collaboration with the World Health Organization (WHO), 5. The following are nutrients that should be low or limited in amount
Department of Health (DOH), and National Nutrition Council except for:
(NNC). a) Cholesterol
• The Pinggang Pinoy is intended to guide meal planners in b) Carbohydrates
preparing food that is proportional according to current nutritional c) Sodium
guidelines for different age groups. d) Saturated fat
e) Trans fat
6. The following are nutrients that should be taken in increased
amounts except for:
a) Dietary fiber
b) Calcium
c) Iron
d) Vitamin C
e) Vitamin D
7. Which of the following values refers to the term, Fat free’s range:
a) < 0.5 g
b) < 2 mg
c) < 3 g
d) < 5 cal
8. The ideal amount for the intake of sodium is:
a) 1400 mg
b) 1500 mg
c) 2000 mg
Figure 8. Spam Pingang Pinoy Logo d) 2400 mg
9. The following food add high levels of sodium into a person’s diet
QUICK REVIEW except for:
SUMMARY OF TERMS a) Breads and rolls
b) Pizza
• Fat Free: <0.5 g of total fat for a given reference amount
c) Sandwiches
• Calorie-free: <5 calories
d) Soups
• % Fat Free: ≤ 3 g of total fat
e) Red meat
• Cholesterol-free: ≤ 2 mg of cholesterol and ≤ 2 g of saturated fat f) Poultry
• Saturated Fat-free: < 0.5 g saturated fat and ≤ 0.5 g of trans fatty 10. Among the following reasons, what is not the reason why Spam lite
acids is called “lite”?
• Low Fat: ≤ 3 g total fat a) Reduced Sodium
• Low Calorie: ≤ 40 calories (except sugar substitutes) b) Reduced Fat
• Low Cholesterol: ≤ 20 mg cholesterol and ≤ 2 g saturated fat c) Reduced Vitamin
• Low Saturated Fat: ≤ 1 g saturated fat and ≤ 15% of calories from d) Increased Protein
saturated fat
• Salt: crystal-like compound that is abundant in nature that is used
for flavoring and preserving food Answers
• Sodium: chemical compound found in salt that is used to enhance 1B, 2D, 3E, 4E, 5B, 6E, 7A, 8D, 9E, 10C
the flavor of food
• Salt/Sodium-free: ≤ 5 mg of Na per serving REFERENCES
• Very low sodium: ≤ 35 mg of Na per serving REQUIRED
• Low sodium: ≤ 140 mg of Na per serving (1) Ibanez-De Guzman, MD, MHPEd, MSc. January 30, 2018.
• Reduced sodium: At least 25% less than regular product Deciphering Nutritional Labels [Lecture slides].
• Light in sodium/lightly salted: At least 50% less than regular (2) ASMPH Batch 2022. 2018. Deciphering Nutrition.
product
• No salt added/unsalted: No salt is added during processing; may
not be salt/sodium free unless stated

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