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

  • Jessica Yin Man Chan1, 2,
  • Mary J. Scourboutakos1 and
  • Mary R. L’Abbé1Email author
BMC Public HealthBMC series – open, inclusive and trusted201717:418

https://doi.org/10.1186/s12889-017-4362-0

Received: 15 August 2016

Accepted: 2 May 2017

Published: 8 May 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.

Keywords

Nutrition facts table Serving size Standardized serving size Reference amount Nutrition labels Nutrition labelling Calorie density Public health Schedule M Health Canada

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.

Abbreviations

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

Declarations

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.

Consent for publication

Not applicable.

Ethics approval and consent to participate

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

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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.

Authors’ Affiliations

(1)
Faculty of Medicine, Department of Nutritional Sciences, University of Toronto
(2)
Prenetics Ltd.

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Copyright

© The Author(s). 2017