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Community and public health nutrition

5-Consumer awareness 1a)food quality and safety

b) food labeling

Prepared by; Dr. Siham Gritly

"All things are poisons; nothing is without poison; only the dose determines whether there is a harmful effect“. Paracelsus (16th Century Philosopher)

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glossary

• hazard: a source of danger; used to refer to circumstances in which harm is possible under normal conditions of use.

• toxicity: the ability of a substance to harm living organisms. All substances are toxic if high enough concentrations are used.

• risk: a measure of the probability and severity of harm.• safety: the condition of being free from harm or danger.• foodborne illness: illness transmitted to human beings

through food and water, caused by either an infectious agent (foodborne infection) or a poisonous substance (food intoxication); commonly known as food poisoning.

• outbreaks: two or more cases of a similar illness resulting from the ingestion of a common food

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• Pathogens; a microorganism capable of producing disease.

• pasteurization: heat processing of food that inactivates some, but not all, microorganisms in the food; not a sterilization process. Bacteria that cause spoilage are still present.

• nutrient claims: statements that characterize the quantity of a nutrient in a food.

• health claims: statements that characterize the relationship between a nutrient or other substance in a food and a disease or health-related condition.

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Consumer awareness Discipline regulation to improve the health, nutrition, and well-being of individuals and groups within

communities’ members

Consumer protection and awareness should be a concerned of community members as well as ministry of health, ministry education, organizations, and media for the adverse effect and the consequences of food hazards

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Food control objectives is to ensure the quality, safety and nutritional value of food and to protect the consumer's health. It prohibit the sale of food not of the nature, substance or quality demanded by the purchaser. Food control is, therefore, a policing activity.

As food can be easily adulterated or contaminated through environmental pollution, safe practices need to be ensured when food is handled, processed, stored and distributed

Eating raw seafood is a risky proposition

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Objectives of a national food control system

1. Protecting public health by reducing the risk of food-borne illness

2. Protecting consumers from unsanitary, unwholesome, mislabeled or adulterated food

3. Contributing to economic development by maintaining consumer confidence in the food system and providing a sound regulatory foundation for domestic and international trade in food

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Elements of a national food control system

• Food law and regulations• Food control management• Official control services (inspection services)• Food monitoring and epidemiological data• Information and communication and

education, training

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many varieties of fruits and vegetables are imported from other countries. Ref. Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011, 2008 Wadsworth, Cengage Learning

Nutritional status and economic well-being are affected by food carrying pathogenic organisms and their toxins or poisonous chemicals. Food is easily contaminated when produced in an unhealthy or unclean environment.

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Ref. FAO/WHO

• Microbiological contamination and spoilage of food should be prevented, and the use of;

• pesticides, • fungicides, • food additives, • veterinary drugs • and numerous other chemicals that can

contaminate food should be controlled.

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Consumer awarenesshazard: a source of danger; used to refer to circumstances in which harm is possible under normal conditions of use.

Invisible microbiological hazardous in food

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Invisible chemical hazardous in foodref. FAO and WHO, 2003

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Legislation and consumers' rights

• food laws national legislation protects consumers invisible microbiological as well as invisible chemical hazardous in food

• AS suggested by FAO and WHO joined report that consumers are not aware of their rights and this prevents them from obtain full advantage from these measures.

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Food legislation shouldFAO and WHO, 2003

1- Provide a high level of health protection

Include clear definitions to increase consistency and legal security

2- Be based on high quality, transparent, and independent scientific advice following risk assessment, risk management and risk communication

3- Include provision for the use of precaution and the adoption of provisional measures where an unacceptable level of risk to health has been identified and where full risk assessment could not be performed

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4- Include provisions for the right of consumers to have access to accurate and sufficient information

5- Provide for tracing of food products and for their recall in case of problems

6- Include clear provisions indicating that primary responsibility for food safety and quality rests with producers and processors

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7- Include obligation to ensure that

only safe and fairly presented food is placed on the market

8- Recognize the country’s international obligations particularly in relation to trade

9- Ensure transparency in the development of food law and access to information

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Food Safety from Farms to ConsumersBefore reaching consumers, food passes through a complex system involving production (crop

cultivation, animal husbandry, etc.), postharvest handling, processing, storage, transport, distribution and sale through large or small retail outlets.

FarmWorkers must use safe methods of growing, harvesting, sorting, packing, and storing food to minimize contamination hazards

PROCESSINGProcessors must follow FDA guidelines concerning contamination, cleanliness,and education and training of workers and must monitor for safety at criticalcontrol points

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Ref. Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011, 2008 Wadsworth, Cengage Learning

TRANSPORTATIONContainers and vehicles transporting food must be clean. Cold food must be kept cold at all timesRETAIL GROCERY STORES AND RESTAURANTSEmployees must follow the FDA’s food code on how to prevent foodborne illnesses. Establishments must passlocal health inspections and train staff in sanitation

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With the benefits of a safe and abundant food supply comes the responsibility of consumer to select, prepare, and store foods safely

CONSUMERSConsumers must learn and use sound principles of food safety.Be aware that foodborne illness is a real possibility, and take steps to prevent it.

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Food-borne Illnesses Food-borne Infections

• Food-borne infections are caused by eating foods contaminated by infectious microbes. Among foodborne infections, Salmonella is the major cause of illness and Listeria is the major cause of death.

• These pathogens enter the GI tract in contaminated foods such as undercooked poultry and unpasteurized milk.

• Symptoms generally include abdominal cramps, fever, vomiting, and diarrhea.

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Foodborne IllnessesFood-borne Infections

Ref. Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011, 2008 Wadsworth, Cengage Learning

Foodborne Infections

Most Frequent Food Sources

Onset and General Symptoms

Prevention Methods

CampylobacteriosisCampylobacter bacterium

Raw and undercooked poultry, unpasturized milk, contaminatedwater

Onset: 2 to 5 days. Diarrhea, vomiting,abdominal cramps, fever; sometimes bloody stools; lasts 2 to 10 days

Cook foods thoroughly; use pasteurized milk; use sanitary food-handlingmethods.

CryptosporidiosisCrytosporidium parvum parasite

Contaminated swimming or drinking water, even from treated sources; highly chlorine-resistant; contaminated raw produce andunpasteurized juices and ciders

Onset: 2 to 10 days. Diarrhea, stomach cramps, upset stomach, slight fever; symptoms may come and go for weeks or months

Wash all raw vegetables and fruits before peeling; use pasteurized milk and juice; do not swallow drops of water while using pools, hot tubs, ponds, lakes, rivers, or streams for recreation.

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Food-borne IllnessesFood-borne Infections

CyclosporiasisCyclospora cayetanensis parasite

Contaminated water, contaminatedfresh produce

Onset: 1 to 14 days. Diarrhea, loss of appetite, weight loss, stomach cramps, nausea, vomiting, fatigue; symptoms may come and go for weeks or months.

Use treated, boiled, or bottledwater; cook foods thoroughly; peel fruits

E. coli infectionEscherichia coli bacterium

Undercooked ground beef, unpasteurized milk and juices, raw fruits and vegetables, contaminated water, and person-to person contact

Onset: 1 to 8 days. Severe bloodydiarrhea, abdominal cramps, vomiting;lasts 5 to 10 days

Cook ground beef thoroughly;use pasteurized milk; use sanitaryfood-handling methods; usetreated, boiled, or bottled water

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Foodborne IllnessesFoodborne Infections

GastroenteritiscNorwalk virus

Person-to-person contact; raw foods, salads, sandwiches

Onset: 1 to 2 days. Vomiting; lasts1 to 2 days.

Use sanitary food-handling methods

GiardiasisGiardia intestinalis parasite

Contaminated water; uncookedfoods

Onset: 7 to 14 days. Diarrhea (butOccasionally nstipation),abdominalpain, gas.

Use sanitary food-handling methods;avoid raw fruits and vegetables where parasites are endemic; dispose of sewage properly

HepatitisHepatitis A virus

Undercooked or raw shellfish

Onset: 15 to 50 days (28 days average).Diarrhea, dark urine, fever, headache, nausea, abdominal pain, jaundice lasts 2 to 12 weeks.

Cook foods thoroughly

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Foodborne IllnessesFood-borne Infections

ListeriosisListeria monocytogenes bacterium

Unpasteurized milk; fresh softcheeses; luncheon meats, hot dogs

Onset: 1 to 21 days. Fever, muscle aches; nausea, vomiting, blood poisoning, complications in pregnancy,a nd meningitis (stiff neck, severe headache, and fever).

Use sanitary food-handling methods;cook foods thoroughly; usepasteurized milk

Perfringensfood poisoningClostridium perfringens bacterium

Meats and meat products stored at between 120°F and 130°F

Onset: 8 to 16 hours. Abdominal pain, diarrhea, nausea; lasts 1 to 2 days

Use sanitary food-handling methods;use pasteurized milk; cook foods thoroughly; refrigerate foodspromptly and properly

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Foodborne IllnessesFoodborne Infections

Foodborne Infections

Most Frequent Food Sources

Onset and General Symptoms

Prevention Methods

SalmonellosisSalmonella bacteria (>2300 types

Raw or undercooked eggs, meats, poultry, raw milk and other dairyproducts, shrimp, frog legs, yeast, coconut, pasta, and chocolate

Onset: 1 to 3 days. Fever, vomiting,abdominal cramps, diarrhea;lasts 4 to 7 days; can be fatal.

Use sanitary food-handling methods;use pasteurized milk; cook foods thoroughly; refrigerate foods promptly and properly.

ShigellosisShigella bacteria (>30 types)

Person-to-person contact, raw foods, salads, sandwiches, and contaminated water

Onset: 1 to 2 days. Bloody diarrhea,cramps, fever; lasts 4 to 7 days.

Use sanitary food-handling methods;cook foods thoroughly; useproper refrigeration.

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Foodborne IllnessesFood-borne Infections

Vibrio infectionVibrio vulnifi cusd bacterium

Raw or undercooked seafood, contaminatedwater

Onset: 1 to 7 days. Diarrhea,abdominal cramps, nausea, vomiting; lasts 2 to 5 days; can be fatal

Use sanitary food-handling methods;cook foods thoroughly

YersiniosisYersinia enterocolitica bacterium

Raw and undercooked pork, unpasteurized milk

Onset: 1 to 2 days. Diarrhea, vomiting,fever, abdominal pain; lasts 1 to 3 weeks.

Cook foods thoroughly; use pasteurizedmilk; use treated, boiled, or bottled water

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Food Intoxications

• Food intoxications are caused by eating foods containing natural toxins or, microbes that produce toxins. The most common food toxin is produced by;

• Staphylococcus aureus• Clostridium botulinum

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• Staphylococcus aureus food poisoning• Staphylococcal toxin (produced by

Staphylococcus aureus bacterium• Toxin produced in improperly refrigerated

meats; egg, tuna, potato, and macaroni salads; cream-filled pastries

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• Clostridium botulinum, an organism that produces a deadly toxin in anaerobic conditions such as improperly canned (especially home-canned) foods and homemade garlic or herb-flavored oils stored at room temperature.

• Symptoms; the toxin paralyzes muscles, a person with botulism has difficulty seeing, speaking, swallowing, and breathing.

• death can occur within 24 hours of onset, botulism demands immediate medical attention.

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Foodborne Illnesses Food Intoxications

Foodborne Infections

Most Frequent Food Sources

Onset and General Symptoms

Prevention Methods

BotulismBotulinum toxin produced byClostridium botulinum bacterium,which grows without oxygen, in low-acid foods, and at temperaturesbetween 40°F and 120°F;

Anaerobic environment of low acidity (canned corn, peppers, green beans, soups, beets, asparagus, mushrooms, ripe olives, spinach, tuna, chicken, chicken liver, liver,luncheon meats, ham, sausage, stuffed eggplant, lobster, and smoked and saltedfish)

Onset: 4 to 36 hours. Nervous system symptoms, including double vision, inability to swallow, speechdifficulty, and progressive aralysisof the respiratory system; oftenfatal; leaves prolonged symptomsin survivors.

Use proper canning methods forlow-acid foods; commercially prepared foods withleaky seals or with bent, bulging,or broken cans.Do not give infants honey becauseit may contain spores of Clostridiumbotulinum, which is a commons ource of infection for infants.

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Foodborne Illnesses Food Intoxications

Foodborne Infections

Most Frequent Food Sources

Onset and General Symptoms

Prevention Methods

Staphylococcal (food poisoningStaphylococcal toxin (produced byStaphylococcus aureus bacterium)

Toxin produced in improperlyrefrigerated meats; egg, tuna,potato, and macaroni salads

Onset: 1 to 6 hours. Diarrhea, nausea, vomiting, abdominal cramps, fever; lasts 1 to 2 days

Use sanitary food-handling methods;cook food thoroughly; refrigeratefoods promptly and properly;use proper home-canning methods.

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to avoid food hazardous

• In the grocery store, consumers should buy items before the “sell by” date

• inspect the safety seals (A broken seal, bulging can lid)

• inspect the wrappers of packages. • Look for fresh commodities

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Consumer Awareness To avoid microbial food-borne illness• Clean hands, food contact surfaces, and fruits and vegetables.• Separate raw, cooked, and ready-to-eat foods while shopping,

preparing, or storing foods.• Cook foods to a safe temperature to kill microorganisms.• Chill (refrigerate) perishable foods promptly and defrost foods

properly.• Meat and poultry should not be washed or rinsed.• Avoid raw (unpasteurized) milk or any products made from

unpasteurized milk, raw or• partially cooked eggs or foods containing raw eggs, raw or

undercooked meat and poultry,• unpasteurized juices, and raw sprouts

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• Consumer Awareness• Food label

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The food labelNutrition labeling can help you make food choices that meet

Dietary Guidelines and promote a lifetime of good health

Consumers read food labels to learn about the nutrient contents of a food or to compare similarfoods.

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• According to the Nutrition Labeling and Education Act, all food labels must contain the following information:

• Common name of the product• Name and address of the product’s manufacturer• Net contents in terms of weight, measure or count, • Ingredient List – Lists the ingredients in

descending order of predominance and weight

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1-list of ingredients;

• must list all ingredients—including• additives used to preserve or enhance foods,

such as vitamins and minerals added to enrich or fortify products.

• Listed in descending order by weight

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2-serving size;

• Each package must identify the size of a serving.

• The nutritional information given on the label is based on one serving of the food they must identify the size of the serving.

• The Food and Drug Administration (FDA) has established specific serving sizes for various foods and requires that all labels for a given product use the same serving size.

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• Amount per serving for the following;• Total calories• Calories from fat• Total fat, saturated fat, trans fat, cholesterol• Sodium• Total carbohydrate• Dietary fiber • Sugar• Protein• Vitamins A,C, Calcium, iron

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• each package must identify the quantities of specified nutrients and food constituents for one serving.

• The most important thing to remember is this: • 1 gr. fat = 9 calories• 1 gr. protein = 4 calories• 1 gr. carbohydrate = 4 calories• 1 gr. alcohol = 7 calories• Therefore, we can tell the percentages of each

nutrient in a package

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Household and Metric Measures ref, Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition,

Twelfth Edition. 2011, 2008 Wadsworth, Cengage Learning

1 teaspoon ( tsp) = = 5 milliliters (mL)

1 tablespoon (tbs) = 15 mL

1 cup (c) = 240 mL

1 fluid ounce (fl oz) 30 mL

1 ounce (oz) = 28 grams (g)

For example, the standard serving size for all ice creams is ½ cup and for all beverages, 8 fluid ounces

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3-Nutrition Facts

• designed to provide information on the nutrients that are of major concern for consumers

• the Nutrition Facts panel on food labels present nutrient information in two ways

• in quantities (such as grams) • and as percentages of standards called the

Daily Values.

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• The Nutrition Facts panel must provide the nutrient amount, percent Daily Value, or both for the following

• Total food energy (kcalories)• Food energy from fat (kcalories)• Total fat (grams and percent Daily Value)• Saturated fat (grams and percent Daily Value)• Trans fat (grams)

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• Cholesterol (milligrams and percent Daily Value)• Sodium (milligrams and percent Daily Value)• Total carbohydrate, which includes starch, sugar,

and fiber (grams and percent Daily Value)• Dietary fiber (grams and percent Daily Value)• Sugars, which includes both those naturally present

in and those added to• the food (grams)• Protein (grams

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• The labels must also present nutrient content information as a percent Daily Value

• for the following vitamins and minerals:• Vitamin A• Vitamin C• Iron• Calcium

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Nutrition Facts

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Serving Size Volume weight (English) AND mass (metric)Also estimated serving per package

Calories per serving – not necessarily the entire container. Calculated calories from fat (9 Cal/g of fat)

Under fat optional listing of: Monounsaturated fat Polyunsaturated fat Option listing of potassium after sodium Option under carbohydrate: Soluble and insoluble fiber, Sugar alcohols, Other carbohydrate

This is the minimum set of nutrients required. B vitamins and other vitamins and mineral can be listed. This is more of a marketing tool.

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Daily Values (DV):

• Daily Values (DV): reference values developed by the FDA specifically for use on food labels. reflect dietary recommendations for nutrients and dietary components that have important relationships with health.

• Daily Values for both a 2000-kcalorie and a 2500-kcalorie diet

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Daily Values for Food Labels Food labels must present the “% Daily Value” for these nutrients.

Food Component Daily Value Calculation Factors

Fat 65 g 30% of kcalories

Saturated fat 20 g 10% of kcalories

Cholesterol 300 mg

Carbohydrate (total) 300 g 60% of kcalories

Fiber 25 g 11.5 g per 1000 kcalories

Protein 50 g 10% of kcalories

Sodium 2400 mg

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Daily Values for Food Labels

Food Component Daily Value Calculation Factors

Potassium 3500 mg

Vitamin C 60 mg

Vitamin A 1500 μg —

Calcium 1000 mg

Iron 18 mg

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Percent Daily Value (%DV):

• the percentage of a Daily Value recommendation found in a specified serving of food for key nutrients based on a 2000-kcalorie diet.

• The “% Daily Value” estimate of how individual foods contribute to the total diet.

• A 2000-kcalorie diet is considered about right for sedentary younger women, active older women, and sedentary older men.

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How to Calculate Personal Daily Values

• The Daily Values on food labels are designed for a 2000-kcalorie intake, but you can calculate a personal set of Daily Values based on your energy allowance. Consider a 1500-kcalorie intake, for example. To calculate a daily goal for fat, multiply energy intake by 30 percent:

• 1500 kcal × 0.30 kcal from fat• = 450 kcal from fat

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• The “kcalories from fat” are listed on food labels, so you can add all the “kcalories from fat” values for a day, using 450 as an upper limit. A person who prefers to count grams of fat can divide this 450 kcalories from fat by 9 kcalories per gram

• to determine the goal in grams:• 450 kcal from fat ÷ 9 kcal/g• = 50 g fat

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• Alternatively, a person can calculate that 1500 kcalories is 75 percent of the 2000-kcalorie intake used for Daily Values:

• 1500 kcal ÷ 2000 kcal = 0.75• 0.75 × 100 = 75%

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• Then, instead of trying to achieve 100 percent of the Daily Value, a person consuming 1500 kcalories will aim for 75 percent.

• Similarly, a person consuming 2800 kcalories would aim for 140 percent:

• 2800 kcal ÷ 2000 kcal = 1.40 or 140%

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guideline for consumers to judge the product they are purchasing

• The Percent Daily Value is what is used to calculate the nutritional values.

• Note that fats, cholesterol and sodium should be limited. Fats should make up less than 30% of you total calories, and saturated fats should make up less than 10% of your calories.

• The amount of specific nutrient you should be consuming is dependant upon age, sex, if you are recovering from injury, pregnant, lactating, and other factors.

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5-Nutrient Claims:

• statements that characterize the quantity of a nutrient in a food.

• phrases such as “good source of fiber” or “rich in calcium”

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5-Health Claims

• health claims: statements that characterize the relationship between a nutrient or other substance in a food and a disease or health-related condition

• Consumers reading “Diets low in sodium may reduce the risk of high blood pressure,”

• for example, knew that the FDA had examined enough scientific evidence to establish a clear link between diet and health.

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Reliable Health Claims on Food Labels

• Diets adequate in calcium may reduce the risk of osteoporosis.

• Diets low in sodium may reduce the risk of high blood pressure.

• Diets low in saturated fat and cholesterol, and as low as possible in trans fat, may reduce the risk of heart disease.

• Diets low in total fat may reduce the risk of some cancers.

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The FDA also provides guidelines about the claims and descriptions manufacturers may use in food labeling to promote their products:

ClaimRequirements that must be met before using the

claim in food labeling

Fat-Free Less than 0.5 grams of fat per serving, with no added fat or oil

Low fat 3 grams or less of fat per serving

Less fat 25% or less fat than the comparison food

Saturated Fat Free Less than 0.5 grams of saturated fat and 0.5 grams of trans-fatty acids per serving

Cholesterol-Free Less than 2 mg cholesterol per serving, and 2 grams or less saturated fat per serving

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Low Cholesterol 20 mg or less cholesterol per serving and 2 grams or less saturated fat per serving

Reduced Calorie At least 25% fewer calories per serving than the comparison food

Low Calorie 40 calories or less per serving

Extra Lean Less than 5 grams of fat, 2 grams of saturated fat, and 95 mg of cholesterol per (100 gram) serving of meat, poultry or seafood

Lean Less than 10 grams of fat, 4.5 g of saturated fat, and 95 mg of cholesterol per (100 gram) serving of meat, poultry or seafood

Light (fat) 50% or less of the fat than in the comparison food (ex: 50% less fat than our regular cheese)

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Light (calories) 1/3 fewer calories than the comparison food

High-Fiber 5 grams or more fiber per serving

Sugar-Free Less than 0.5 grams of sugar per serving

Sodium-Free or Salt-Free Less than 5 mg of sodium per serving

Low Sodium 140 mg or less per serving of sodium

Very Low Sodium 35 mg or less per serving of sodium

Healthy A food low in fat, saturated fat, cholesterol and sodium, and contains at least 10% of the Daily Values for vitamin A, vitamin C, iron, calcium, protein or fiber.

"High", "Rich in" or "Excellent Source"

20% or more of the Daily Value for a given nutrient per serving

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"Less", "Fewer" or"Reduced"

At least 25% less of a given nutrient or calories than the comparison food

"Low", "Little", "Few", or "Low Source of"

An amount that would allow frequent consumption of the food without exceeding the Daily Value for the nutrient – but can only make the claim as it applies to all similar foods

"Good Source Of", "More", or "Added"

The food provides 10% more of the Daily Value for a given nutrient than the comparison food

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References

• 1997-2012 HealthCheck Systems• Sareen Gropper, Jack Smith and James Groff, Advanced Nutrition and Human

Metabolism, fifth ed. WADSWORTH

• Melvin H Williams 2010; Nutrition for Health, Fitness and Sport. 9th ed, McGraw Hill

• • Heymsfield, SB.; Baumgartner N.; Richard and Sheau-Fang P. 1999. Modern

Nutrition in Health and Disease; Shils E Maurice, Olson A. James, Shike Moshe and Ross A. Catharine eds. 9th edition

• Guyton, C. Arthur. 1985. Textbook of Medical Physiology. 6th edition, W.B. Company

• FAO/WHO/UNU expert consultation (WHO, 1985) report

• Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011, 2008 Wadsworth, Cengage Learning