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Frazao, ElizabethConsumer Concerns about Nutrition: Opportunities forthe Food Sector.Economic Research Service (DOA), Washington, D.C.AIB-705Oct 9423p.ERS-NASS, 341 Victory Drive, Herndon, VA 22070 ($9;add 25% for shipping to foreign addresses (including

Canada); may charge to Visa or MasterCard or sendcheck payable to ERS-NASS).Information Analyses (070)

MF01/PC01 Plus Postage.Adults; Behavior Patterns; *Consumer Economics;Dietetics; Federal Legislation; Federal Regulation;*Food Standards; *Health Promotion; *Nutrition;*Public Health; Social Change'; *Sociocultural

Patterns

The growing evidence of the link between diet andhealth has not been lost on consumers in the United States. Asawareness of the diet-health link has increased through nutritioneducation, consumers have changed their diets. Although there is

still considerable room for improvement in meeting Federalfood-guidance recommendations, nutritio- concerns have become animportant factor in food choices. Both the food sector and theFederal Government have responded to consumer concerns aboutnutrition through improvements in the nutrient profile of foodproducts, improved information on food labels, and nutritioneducation program such as "5 A Day For Better Health", aimed at

increasing consumption of fruits and vegetables. Technologicaladvances in food processing have given the food industry new tools

th,t are likely to accelerate the introduction of tasty healthier

foods. Changes in what, where, and how food products are produced

present unlimited opportunities for domestic and foreign producers

and food manufacturers who can identify, respond to, or create new

consumer food desires. The topics covered are: Diet and healthguidance; awareness of the linkage between diet and health; trends in

food consumption; intake levels and dietary guidelines; changes in

food consumption patterns, 1977-1988; responses of both the food

sector and the government; and likely impacts on agriculture. An

appendix provides the main sources of information. (Contains 42

references.) (Author/JB)

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from the original document.***********************************************************************

United StatesDepartment ofAgriculture

EconomicResearchService

AgricultureInformationBulletinNumber 705

Consumer ConcernsAbout NutritionOpportunities for theFood Sector

Elizabeth Frazao

U.S. DEPARTMENT OF EDUCATIONOfirce of Educational Research ana improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

This document has been reproduced asreceived from the person or organizationoriginating it.

Minor change': have been made toimprove reproduction quality

Points of view or opinions stated in thisdocument do not necessarily representofficial OERI position or policy

BEST COPY AVAILABLE2

Consumer Concerns About Nutrition: Opportunities for the Food Sector. ByElizabeth FrazAo, Commodity Economics Division, Economic Research Service, U.S.Department of Agriculture. Agriculture Information Bulletin No. 705.

Abstract

The growing evidence of the link between diet and health has not been lost amongconsumers in the United States. As awareness of the diet-health link has increased.consumers have changed their diets. Although there is still considerable room forimprovement in meeting Federal food-guidance recommendations, nutrit'on concernshave become an important factor in food choices. Both the food sector and theFederal Government have responded to consumer concerns about nutrition throughimprovements in the nutrient profile of food products and improved information onfood labels. Technological advances in food processing have given the food industrynew tools that are likely to accelerate the introduction of tasty healthier foods.Changes in what, where, and how food products are produced present unlimitedopportunities for domestic and foreign producers and food manufacturers who canidentify, respond to, or create new consumer food desires.

Keywords: Nutrition, diet-health awareness, food consumption patterns, nutritionlabeling, new food products, food marketing, food manufacturing.

Acknowledgments

The author would like to thank Alden Manchester for his suggestions, Jane Allshouseand Nedra Williams for the charts, and Teri Thrash for euitorial assistance.

1301 New York Ave., NW.Washington, DC 20005-4788 October 1994

Contents

Summary iii

Introduction 1

Diet and Health Guidance in the United States 2

Awareness of the Linkage Between Diet and Health 2

Trends in Food Consumption 3

Meat 3

Dairy Products 4Eggs 4Fats and Oils 4Flour and Cereal Products 6Fruits and-Vegetables 6Caloric Sweeteners 6

Current Intake Levels and the Dietary Guidelines 7

Changes in Food Consumption Patterns, 1977-88 7

The Food Sector Responds 9

The Government Responds 11

Likely Impacts on Agriculture 12

Fruits and Vegetables 12

Grains and Cereals 13

Dairy 13

Feed-Livestock Adjustments 13

Link Between Food Policy and Dietary Change 13

Conclusions 13

References 14

Appendix: Main Sources of Information 16

4

ii

Summary

As evidence of the link between die', and health grows in the United States, manyconsumers are changing their diets. Food consumption patterns have changeddramatically in the last 20 years. Eating patterns are slowly shifting toward healthier

diets, although there is still considerable room for improvement in meeting Federalfood guidance recommendations. The food sector is clearly aware that nutrition is

important to many consumers, and has been active in responding to consumer demand

for foods with improved nutrient profiles. Meats, for example, are much leaner now

than even 10 years ago, due to improved breeding practices and changes in meat-trimming practices.

Many consumers want to improve their diets, but claim they lack the information todo

so. Research has shown that many of the changes Americans have made in their foodchoices end up canceling each other out. To assist consumers in choosing a healthierdiet, the Federal Government has overhauled its nutrition labeling regulations. In mid-

1994, new nutrition labels became mandatory for most processed foods. Althoughnutrition labeling remains voluntary for fresh produce, meats, and seafood, theregulations contain strong incentives for the information to be made available toconsumers.

New or reformulated products have also abounc!ed. More than 4,500 claims weremade about the improved nutrient content of new foods in 1992--nearly four times the

number made in 1988. The number of nutrient content claims on new products fell

significantly in 1993, possibly related to the new mandatory nutrition labelingregulations. These regulations may push manufacturers to reformulate their productsto further improve their nutrient content to meet the new definitions and requirementsfor health claims and nutrient descriptors.

Although Americans are making some dietary changes, they enjoy the taste of high-fatfoods and do not seem willing to give them all up. If food companies can developlower fat products that taste like traditional high-fat foods, and provide consumers with

acceptable low-fat substitutes, the food industry can help consumers to eat less fatwithout having to greatly change their eating habits.

Advances in food technology are likely to accelerate the introduction of nutritiousfoods that taste good. Continued research and product development that alter thenutritional composition of the food supply should help improve nutrient intake levels in

the United States.

The success of new research and technology in improving the nutritional compositionof Americans' diets, however, depends on a number of factors. First, Federalregulators must approve the safety of novel ingredients and their use in food, a processthat can often be quite lengthy. Consumer acceptance of the new technology, as well

as price, will also affect how well the new products sell in the market.

Grocers have also responded to consumers' nutrition concerns and are giving morespace and attention to the fresh produce section. Today's medium-sized supermarketcarries more than 300 produce items. To reduce the time requirement of preparingfresh fruits and vegetables, the produce department has introduced a variety of precutand ready-to-eat fresh products, such as peeled and cut carrots, salad mixes, and peeled

and cored pineapples.

Nutrition education is another area in which the food sector has become activelyinvolved in response to consumers' nutrition concerns. An example of such a programis "5 a Day for Better Health," an active partnership between the National Cancer

iii

Institute, the produce industry, and the health community, aimed at increasingconsumption of fruits and vegetables.

Food advertising and labeling can be powerful mechanisms for educating consumersand informing groups of consumers that are not well reached by government andgeneral information sources. Whereas advertising and label claims can provideconsumers with more information about nutrition, they can also be misused asmanufacturers fight to gain a competitive edge for their products. The n2w nutritionlabeling regulations attempt to minimize the amount of misleading information on foodlabels.

Increasing consumer demand for tasty and nutritious foods is likely to change what,where, and how food products are produced, presenting unlimited opportunities fordomestic and foreign food producers and manufacturers who can identify, respond to,or create new consumer food desires.

iv

Consumer Concerns About NutritionOpportunities for the Food Sector

Elizabeth Frazao

Introduction

Today's rapidly changing economic and socialenvironment provides many challenges to food producersand manufacturers all around the world. While thy-to-day survival is of paramount importance to firmsoperating in this dynamic arena, longrun survival andfinancial well-being require that the players understandand successfully anticipate consumers' food desires in theyears to come.

Slower population growth, changing age distributions,regional migration, increased longevity, employmentpatterns, and increasing standards of living, 11 name justa few significant demographic trends, present an ever-changing and uncertain environment within which thefood sector must operate and respond. Significantresearch has focused on explaining the effects of thesevariables and forecasting their effects on food demand.

Two new factors are emerging as importantconsiderations in consumers' food choices. The first isfood safety. This includes concerns about pesticide andherbicide residues; antibiotics and hormones in poultry,meat, and dairy products; irradiation; ml robialcontamination; and environmental contamination fromheavy metals such as mercury. Rising standards ofliving, an aging population (which tends to be a;. higherrisk of foodborne illness), and the fact that demand forfood safety appears to be income-sensitive are some ofthe forces likely to enlarge the market for food safety inthe future.

In the past 10 years or so, food safety incidents haveoccurred fairly regularly in the United States. The costsassociated with food safety incidents are borne not onlyby the consumers who suffer health consequences, but byfarmers, processors, and retailers, in terms of lostproduction and loss of consumer confidence in theirproduct. Both the food sector and the Government in theUnited States are taking aggressive steps to improve boththe safety of food products and consumer understandingabout the safety of the food supply.

In addition, a segment of the food sector has discoverednew marketing opportunities by differentiating andadvertising the food safety attributes of its products. Forexample, the market for "organic" foods - -foods producedwithout synthetic fertilizers or chemicals--is growing.Among new food products introduced in 1992, organicclaims represented more than 7 percent of the healthclaims (Prepared Foods). Besides fruits and vegetables,consumers can buy organically produced grains, meats,dairy products, and a wide variety of processed products,including breakfast cereals, baked goods, juices, wine,and coffee (Anton and Frazdo, 1993).

The second new factor influencing food choices, and theone this report focuses on, is the growing evidence of therelationship between diet and diseases such as coronaryheart disease, certain types of cancer, stroke, andhypertension (U.S. Department of Health and HumanServices, 1988; National Research Council, 1989). Tothe extent that consumers act on the belief that what theyeat can influence their health, awareness of the linkagebetween diet and health and knowledge about nutritionmay play a significant role in shaping the foods oftomorrow. Yet very little is known about the role thatnutritional concerns have on food consumption patternsand on the food sector in general.

Some information is beginning to emerge in the UnitedStates that may be useful to food producers andmanufacturers throughout the world. First, trendscurrently observed in the United States may soon occur inother countries. In fact, even in some countries whereinsufficient food intake represents a serious nutritionproblem, the problem of excessive intake of calories andfat is already becoming evident among some segments ofthe population. Second, today's trends in the UnitedStates may provide foreign producers and manufacturerswho export, or desire to export, food into the UnitedStates with opportunities to fill a gap not met by thedomestic food sector.

1

Diet and Health Guidance in theUnited States

Over the past three decades, research findings on diet-health relationships have received considerable attentionin the United States and have generated much publicinterest. Government and private organizations haveresponded to the emergence of scientific knowledge byissuing dietary guidance and making recommendations ondesired dietary changes for the U.S. population.

The idea behind disseminating information to the publicis that by providing consumers information about thelinkage between diet and health, and what a healthy dietshould consist of, consumers become aware of th; issueand will want to alter their diets to reduce the risk Ifchronic disease. This desire to improve their diets %if,then motivate consumers to get more information, al ertheir food choices and preparation techniques, andultimately change their total diets to meet reconuneniednutrient levels.

With the objective of informing the public, the FederalGovernment publishes and distributes "The DietaryGuidelines for Americans" (U.S. Department ofAgriculture/U.S. Department of Health and HumanServices, 1990). Although there is still much that is notknown about all the linkages between diet and health,nutrition authorities in the United States have agreed to aremarkable degree on what to eat and what not to eat tohelp prevent disorders such as obesity, coronary heartdisease, and cancer. Thus, the latest Dietary Guidelinesrecommend that consumers:

Eat a variety of foodsMaintain healthy weightChoose a diet low in fat, saturated fat, andcholesterol (keep fat intake at 30 percent or less ofcalories, and saturated fat below 10 percent)Choose a diet with plenty of vegetables, fruits, tudgrain productsUse sugars only in moderationUse salt and sodium only in moderationDrink alcoholic beverages in moderation, if at all

To help consumers put the guidelines into practice, theU.S. Department of Agriculture (USDA) also developed afood guide, which separates foods into six food groupsand recommends the number of servings from each foodgroup for a healthy diet. To graphically illustrate thefood guide, USDA developed the Food Guide Pyramid(U.S. Department of Agriculture, Human NutritionInformation Service, 1992), which recommends, on adaily basis:

2

6-11 servings of grains and cereals3-5 servings of vegetables2-4 servings of fruits2-3 servings of milk and dairy products2-3 servings of meat, poultry, fish, eggs, beans, andnuts (averaging about 6 oz per day)sparing use of fats, oils, and sweets

The Food Guide Pyramid attempts to improve consumers'eating patterns in two ways. First, it tries to changeconsumers' perceptions about the relative quantities ofeach food group in a healthy diet. Many Americans stillbelieve, for example, that "starchy foods are fattening"and therefore should be consumed sparingly. Second, theFood Guide Pyramid attempts to overcome an importantbarrier to effective nutrition education, wherein some ofthe Dietary Guidelines deal with iutrients (for example,"choose a diet low in fat"), but consumers choose andconswne foods, not nutrients. Consumers havedifficulties translating advice about nutrient intake intofood consumption behavior and need more practicaladvice (Food Marketing Institute. 1991, 1992, 1993).

Awareness of the Linkage Between Dietand Health

Investigators have historically measured consumerawareness of the linkages between diet and health by thepercentage of persons who, when questioned, say thatdietary fats and fatty foods are a major cause of heartdisease. Data from the Health and Diet Surveys that theFood and Drug Administration (FDA) conducted indicatethat, by this measure. awareness levels have greatlyincreased over time, rising from 8 percent in 1970, and29 percent in 1983, to reach 55 percent in 1988 (fig. 1).

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Although all segments of society have shown increases inawareness through time, the levels of awareness vary fordifferent groups. Comparing awareness levels fordifferent education groups at four different points in time,we note that, on average, individuals with highereducation levels became aware of the link between fatintake and heart disease before those with less education(fig. 2). Although there was little difference in awarenesslevels across education groups in 1977, by 1983, thesedifferences were clearly evident. And although awarenessmore than doubled between 1983 and 1988 for highschool-educated adults, and more than tripled amongadults with less than a high school education, awarenesslevels remained higher among higher educated adults.

This growing awarene-s is associated with consumerconcerns about nutrition, which is reflected in a numberof consumer surveys. In response to open-ended,unguided questions in a 1993 survey conducted by theFood Marketing Institute, 54 percent of the respondentsreported being concerned about the fat content of theirdiets. And two out of three shoppers believed their dietcould be at least somewhat healthier. The explosion of"light" and "healthy" food products in the last decade isfurther indication of increased consumer awareness andinterest in nutrition.

A large proportion of consumers stated that they havemade changes, and are still changing their eating habits,due to interest in having a healthier diet. Many reportfrying foods less often and switching to reduced-fatmayonnaise and salad dressing in an effort to improve thehealthfulness of their diet (Food Marketing Institute andPrevention Magazine, 1992). In a 1993 survey, 62percent of the respondents reported eating more fruits andvegetables to ensure a healthy diet; 30 percent, less redmeat; 26 percent, less fats and oils; 14 percent, morechicken and turkey; and 10 percent, more fish (FoodMarketing Institute, 1993).

Figlao 2Consumer awareness of the link between fat intake and heartdisease has increased dramatically for all education levels.m401 were70

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To quantify the extent of changes in consumption ofdifferent food groups, we examine. (1) how eatingpatterns in the United States have been changing overtime; (2) how current intake levels compare with theDietary Guidelines; and (3) how eating patterns varyacross groups of individuals with different awarenesslevels. The main sources of data used in this analysis aredescribed in the appendix.

Trends in Food Consumption

Americans' eating habits have changed dramatically inthe last 20 years. Although Americans are consumingmore food (by weight) than ever, eating patterns seem tobe shifting toward healthier diets (Putnam, 1991).However, some changes have been slower than others,and many have even been inconsistent with dietaryrecommendations.

Animal products are a regular part of the diets of mostAmericans. When consumed in recommended amounts,they can provide important amounts of several essentialnutrients (such as iron and calcium), without resulting inexcessive intakes of fat, saturated fat, and cholesterol(Guthrie and Raper, 1992). In the past two decades, theamounts and types of animal products in the Americandiet have changed considerably, as described below.

Meat

Total per capita consumption of meat continues toincrease (fig. 3), but the proportion of red meatconsumption has been declining while poultry and fishconsumption has increased (Putnam and Allshouse, 1993).However, both pork and beef are leaner now comparedwith 10 years ago. Some of the improvements in fatcontent result from changes in breeding practices (fig. 4),and some result from changes in meat-trimming practices.Beef today is trimmed to 1/4-inch or less of outside fat,and more than 40 percent of retail beef cuts are marketedwith all the outside fat removed (Putnam, 1993). Onaverage, meats represent a large but decreasingcontributor to dietary fat, although they are largecontributors of iron and other essential nutrients (Guthrieand Raper, 1992).

The increase in fish consumption is not as large as onewould expect, given its "healthy" characteristics. Priceand the frequent negative reports on its safety may havecaused some consumers to eat less seafood.

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These trends support consumers' statements that they arecutting back on red meat and increasing theirconsumption of poultry and fish to ensure a healthier diet.

Dairy Products

As with meats, per capita consumption of all dairyproducts continues to increase (on a milk-equivalent,milkfat basis), although the mixture is changing. Thetrend is toward lower fat milk, but more cheese (Putnamand Allsbouse, 1993). In the past 10 years, whole milkwent from representing nearly 60 percent of all beveragemilk to 40 percent (fig. 5). Evidence of this trend isMcDonald's switch from whole milk to 2- percent milk in1986, and from 2-percent to 1-percent milk in 1991.Many food service operators now provide whole milk or2-percent milk, instead of cream, as coffee whiteners.Schools remain a large market for whole milk, anoffering in the federally funded National School LunchProgram (Putnam, 1993).

Consumption of cheese continues to increase (fig. 6),partly because of the growth in fast food away fromhome (two-thirds of the cheese consumed comes incommercially manufactured and prepared foods, such aspizza, nachos, and fast food sandwiches), and partlybecause consumers are not usually aware of the high fatcontent of cheese. With advances in food technology,lower fat cheeses have entered the market, but theycurrently account for only about 5 percent of total cheeseconsumption (Putnam, 1993). Because of this growingdemand for cheese (and also cream and cream products),overall use of milkfat has not declined significantly(Putnam and Allshouse, 1993). It will be interesting tosee whether the new nutrition labeling regulations (whichbecame effective in mid-1994, and which are discussedlater) will increase consumer awareness about the high fatcontent of cheese and subsequently reduce demand forhigh-fat cheese.

4

Eggs

Average annual consumption of fresh eggs continues todecline overall (fig. 7), largely due to consumer concernsabout the high cholesterol content of eggs. But withinthis decline, consumption of some egg products rose, dueto improved food technology and the food industry'sability to respond to new consumer demands. Forexample, more low-cholesterol, commercially processedegg products are available to health-conscious consumersconcerned with avoiding the cholesterol and fat in eggyolks. Similarly, availability of pasteurized liquefied eggshas increased for consumers and food service companiesconcerned about food-borne illnesses such as Salmonellaenteritidis (Putnam, 1993).

Fats and Oils

Data on fats and oils report the availability ofmanufactured products such as shortening, margarine, andsalad and cooking oils. but do not include the fats andoils that occur naturally in food, such as in meats, milkand milk products, and nuts.

Despite consumers' concerns about fat intake, and theirclaims about eating less fats and oils, the aggregateamount of manufactured fats and oils available forconsumption continues to increase (fig. 8). Some of thisincrease, however, is associated with the growth of away-from-home eating places, which discard significantamounts of fats used in frying foods, and thus may notaccurately reflect intake (Putnam and Allshouse, 1993).But, it is unlikely that all of the increase would reflectwaste. Because consumers claim to be eating less fatsand oils, this upward trend suggests that consumers maynot be very knowledgeable about the fat content of foods.Although they may be reducing their intake of visible fats(as in butter and margarine, and salad and cooking oils),consumers may be increasing their intake of foods withless-visible fat contents that are higher than they think(such as in the increased consumption of baked goodsand fried foods in fast food service outle's).

The increasing contribution of vegetable fame and oilsobserved in figure 8 likely reflects consumer concernabout the adverse effects of saturated fats on bloodcholesterol. This same concern resulted in McDonald'sand other fast food service establishments switching fromusing animal fats to an all-vegetable fat product for frying(Putnam and Allshouse, 1993). There is now somecontroversy about whether this swit benefitedconswners, due to the presence of trans-fatty acids inMcDonald's all-vegetable fat product for frying.'

Research suggests that transfatty acids can raise blood cholesterollevels. and therefore Increase the risk of coronary heart disease.

10

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Although the availability of manufactured fats and oilscontinues to increase, HNIS estimates that the total fatcontent of the food supply has actually decreased since1985 (Putnam and Allshouse, 1993). It may be that thereduced fat content of meats has offset some of theincreases in manufactured fats and oils.

Flour and Cereal Products

Consumption of flour and cereal products continues toincrease, spurred by a growing interest in healthy eating(fig. 9). For example, more than 1,500 new bakeryproducts were launched in 1992 alone, many of themaimed at satisfying consumers' demand for "lite" (low-calorie), "low salt," "no-fat," "no-cholesterol," or "oat-bran-based" food items (Prepared Foods).

Fruits and Vegetables

Although the time-series data on fruits and vegetables isnot very complete. the data available indicate thatconsumption of fruits and vegetables has increasedroughly 10 percent in the past decade (fig. 10). Much ofthis growth, however, is due to an increase in frozenpotato products, most of which are processedinto frozen french fries (Putnam and Allshouse, 1993).

The relatively small increase in fruit and vegetableconsumption is surprising, and may be partly due to alack of consumer awareness of the number ofrecommended daily servings. Two out of threeconsumers think that just one or two servings a day isenough for good health; only 8 percent of Americanadults are aware that they should be eating five or moreservings each day (Putnam, 1994). This upward trend isexpected to accelerate in the near future, as knowledgecontinues to accumulate about the importance of fruitsand vegetables to a healthy life.

Caloric Sweeteners

The amount of sweeteners used per capita--in soft drinks,candy, sweet baked goods, and processed foods- -continues to grow (Putnam and Allshouse, 1993). In1992, each American consumed, on average, more thanone-third of a pound of added sweeteners a day. Onefactor behind this growth is the large increase ofsupermarkets with in-store bakeries.

The availability of specific sweeteners has changedstrikingly in the past two decades, with sucrose beingreplaced by corn sweeteners, mainly high fructose cornsyrup (11FeS) (fig. 11). This may become a nutritionalconcern, if new studies confirm preliminary evidence thatdiets high in fructose significantly increase blood lipidlevels (Putnam, 1994).

12

These trends generally indicate that American eatinghabits are changing, with the trend toward healthier diets.Ant several intake problems persist, and conflicting trendsin some products are .vorking to slow the shift towardhealthier diets. In many instances, consumers may besubstituting foods with undesirable traits of which theymay not be aware. For example, although Americans areeating more chicken, potatoes, and baked goods, much ofit is fried chicken, french fries, and fatty baked goods(Liebman, 1990). A survey by the National RestaurantAssociation found that while 37 percent of the populationis committed to ordering healthful dishes in restauraws,consumption of rich desserts has increased by 13 percentover the past :1 years (Washington Post, 1993).

A number of factors, such as the relative prices of foods,income, and changing population demographics,contribute to the observed changes in food consumptionpatterns. For example, part of the decline in per capitafluid milk consumption is attributed to declining 'lumbersof teenage males, only partially offset by rising numbersof infants (Putnam and Allshouse. 1993).

Current Intake Levels and the DietaryGuidelines

Although the trends in food consumption indicate aswitch towards a healthier diet, data from USDA's foodintake surveys indicate that the average American dietstill falls short of meeting the Dietary Guidelines. Intakeof foods from the bread, cereal, rice, and pasta group,fruits and vegetables, and dairy products are, on average,about half the recommended levels.

The public health community is particularly concernedabout the high fat intake of the American population.Although the proportion of total calories from fat hasfallen from an average of 40 percent in 1977-78 to anaverage of 35 percent in 1989-90, this is still above therecommended 30 percent or less (Tippett and Goldman,1994). Surveys show that while consumers do recognizethe importance of limiting fat intake, only about one-fourth of them met the recommendation for fat intake in1989-90 (Tippett and Goldman, 1994).

However, it is important to note that these are "average"values. Research indicates that eating habits vary widelyacross individuals, thus limiting use of national averages.Income, household size and type, race, age, sex, andeducation are significant explanatory variables of foodintake patterns. And, research is beginning to focus onthe role that nutrition knowledge and awareness of thediet-health link may have on food intake patterns.

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Changes in Food Consumption Patterns,1977-88

Until 1989, no available data sets simultaneouslymeasured awareness of the link between diet and healthand actual food intake behavior for the same individual.Ilowever, because awareness levels differ by educationlevels, researchers at the USDA used education levels as

13 7

a proxy for awareness of t.l.e diet-health relationship, andcompared the nutrient intake of women aged 19-50 years,from surveys done in 1977-78 and in 1985 through 1988,after controlling for demographic variables (Put ler andFrazAo, 1991). The most startling finding was thataverage fat intake (measured as the percentage of caloriesfrom fat) fell fairly evenly across all education levels,from 41 percent in 1977 to 36 percent in 1985, andremained fairly constant thereafter (fig. 12). Whenanalyzing sources of dietary fat, however, women withhigher education levels made much greater changes in therelative importance of different food groups in providingdietary fat compared with women having less education.

These findings are attributed to a combination of twofactors. First, between 1977 and 1985, women withhigher education levels altered their fat intake patternsprimarily by reducing their consumption of red meat andeggs (fig. 13). They also consumed more dairy productsand mixed grain, fruit, and vegetable hes, many ofthem high sources of hidden fat (such as cheese, pies. luidpastries). Second, between 1977 and 1985, changes inmeat-trimming practices and animal-breeding and otherproduction practices combined to make red meat productsleaner and to increase the availability of lower fat foodsubstitutes. The net effect of these two factors was thatwomen with higher education levels traded meat fat forother fat (mostly hidden fat in mixed grain, fruit, andvegetable dishes, and dairy fat), while total fat intake forall education levels declined.

Greater changes in food consumption patterns by womenwith higher education levels indicate that dietaryinformmon and education efforts have most directlyaffected the most-educated segments of society. Thisconfirms recent research showing that public informationand education programs on potential risks of dietary fatintake are more likely to influence the behavior of thosewho are best able to obtain and process the information.Consequently, public response to these programs is likelyto be stronger in specific groups of the population. andpractically nonexistent in other population groups.

Figura 12There is little difference in the proportion of calories women consumed fromfat across education levels.

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However, the lack of specificity in the nutritioninformation provided may have resulted in a substitutioneffect. Specifically, the incompleteness of theinformation resulted in consumers trading one kind offat for another (that is, reducing fat intake from redmeats, while increasing fat intake from mixed dishesand dairy products) without significantly altering totalfat intake.

Finally, even though only the more highly educatedsegment of society appears to have directly respondedto dietary information, these information programs maystill have indirectly benefited all segments of society.More-educated and aware consumers' movement awayfrom red meats and other high-fat products may havemotivated meat producers to develop a leaner product,food retailers to more closely trim meat, and foodmanufacturers to develop lower fat alternatives to high-fat products (for example, nonfat and lowfat regular andfrozen yogurt, reduced-fat cheeses, dairy desserts, andsalad dressings. and nonfat baked goods). In turn,these production and reformulation practices enabledconsumers with less education to lower their fat intakewithout having to make great changes in their foodconsumption patterns.

New survey data have recently become available thatmeasure awareness of diet-disease relationships,knowledge about nutrients, and actual food intakebehavior for the same individual (USDA's ContinuingSurvey of Food Intake by Individuals and the associatedDiet and Health Knowledge Survey).

Research is beginning to focus on measuring the effectsof nutrition awareness and knowledge on dietary behavior(Food Review, 1994). As has been hypothesized before,and studies are now showing, it is not enough to simplytell people to cut down on their fat intake. People eat fora number of reasons, including psychological reasons.Taste, income, convenience, prices, longstanding habits,and cultural factors are also important.

Figure 13Contribution of red meat and eggs to total fat intake of womendeclined between 1975 and 1985.Parent change Si fat Oar.

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Among those who wish to change their dietary intakes,however, nutrition-related knowledge may be important.Preliminary analyses show that individuals with highernutrition knowledge had higher intakes of fiber and weremore likely to meet dietary recommendations forsaturated fat and cholesterol (Stnallwood and Blaylock,1994; Fratho and Cleveland, 1994).

Recent research on bow much Americans know about thefat content of foods commonly eaten suggests that manyconsumers have mistaken concepts about what foods arehigh in fat (Cremer and Kessler, 1992). Many shoppersdo not know that lean ground beef is high in fat (FoodMarketing Institute and Prevention Magazine, 1992);many think that white bread is high in fat (Cremer andKessler, 1992); and many have difficulty identifying thedegree of fat in some foods, such as pizza, cheese, andbaked goods (U.S. Department of Health and HumanServices, 1992).

The confusion stems in part from the complexity of theinformation. Consuming a balanced diet is not easy.Some people are good at making choices within a foodgroup--for example, switching from whole milk to skimmilk. It may be more difficult to make tradeoffs betweenfood groups, such as estimating how much of a richdessert they can eat if they delete the steak. The endresult is that many give up the steak but overdo it on therich dessert (Sugarman, 1991).

Consumers admit to being confused and uncertain aboutmow to improve their diets, what foods to eat, and how tocut down on fat, However, without correct knowledgeabout the nutrient composition of the different foods thatmake up their diets, it may be difficult for consumers tochange their nutrient intake levels.

In addition, despite the many lowfat and nonfat productsavailable in the market, choosing a diet low in fat likelyrequires a number of changes in behavior and eatingpractices, as well as commitment to those changes.Attitudes towards diet, and knowledge about nutrition andthe nutritional content of foods can affect motivation andability to put dietary guidelines into practice. To choosea diet low in fat, saturated fat, and cholesterol, consumersmust make many complex decisions about what foods tochoose, how to prepare them, and how much of eachindividual food to eat in order to balance their desires forgood health, taste, convenience, economy, andsatisfaction.

The Food Sector R1 sponds

Although the food industry at one time believed thatnutrition would not sell, by the 1980's, nutrition had

become a powerful selling force, illustrated by the growthin the number of new products introduced in response tonutrition concerns (Gallo, 1992). More than 4,500nutrient content claims were made on foods introduced in1992--nearly four times the number in 1988 (fig. 14). It

is not yet clear why the number of nutrient content claimsfell by nearly 50 percent in 1993--it is possible that someof the earlier claims no longer conformed with the newnutrition labeling regulations.

Figure 15 illustrates some interesting differences innutrient content claims on new products introduced in1992 and 1993. For example, 30 percent of dairyproducts claimed to be reduced fat, low-fat, or nonfat in1992, but only 24 percent claimed so in 1993. Amongbreakfast cereals and bakery products. the proportionswere similar for each year. However, for meat, poultry.and seafood, entrees, desserts, and fruits and vegetables.1993 claims for reduced fat, low-fat, or nonfat productswere nearly half those in 1992.

Among the 13 food categories monitored, bakeryproducts, prepared entrees. and processed and freshmeat/poultry /seafood were popular categories for newreduced fat, low-fat, or nonfat products in 1992, withmore than 100 of such products introduced in each of

Fogure 14Food manufacturers have discovered that 'nutrition' sells.

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Figure 15Oairy products and breakfast cereals were the main food groupsintroducing lower fat products in 1993.Po gni of now ontoduclons 00.5.1. lower 141

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15

these three categories. In 1993, only dairy and bakeryproducts had more than 100 reduced fat, low-fat, ornonfat products introduced in each category (PreparedFoods).

One obstacle to offering foods lower in fat is thatreducing the fat often means sacrificing taste. Fat addsflavor to many foods, such as meats and dairy products.Some manufacturers have been able to offer a satisfactoryalternative by reformulating their products using nonfatingredients. For example, Kraft General Foods, ownersof Entenmann's Inc., a bakery products firm, appliesnew processing techniques to produce fat-free bakedgoods using skim milk and egg whites. Othermanufacturers have reduced the fat content of friedproducts by par-frying to develop crispness and color, andfinishing in an oven to minimize fat absorption. Othershave incorporated film-forming cellulose into theirproducts to reduce fat absorption and retain moisture.Still others have devoted considerable resources todevelop fat substitutes that allow the lower fat products totaste and function like traditional high-fat foods(Morrison, 1992).

Continued research and product development that alter thenutritional composition of foods will likely be animportant contribution to improving nutrient intake levelsin the United States. Although Americans are makingsome dietary changes, they enjoy the taste of high-fatfoods and do not seem willing to give them all up. Iffood companies can develop lower fat products that tastelike traditional high-fat foods, and provide consumerswith acceptable low-fat substitutes, the food inaustry canhelp consumers to eat less fat without having to greatlychange their eating habits.

For example, a market research firm that has beentracking Americans' eating habits for the past 13 yearsdiscovered that the reason that people are eating healthieris not because of large changes in behavior. Actually,little difference was found in the top 10 foods people atefor lunch and dinner in 1982 and in 1992. The top foodconsumed in both years was a ham sandwich. Thedifference was that, in 1992, the ham sandwich was morelikely to be made with turkey ham, lite mayonnaise, andwhole-wheat bread - -small behavior changes madepossible due to new products developed by the foodindustry (Sugarman, 1993).

The success of new research and technology in improvingthe nutritional composition of Americans' diets, however,depends on a number of factors. First, Federal regulatorsmust approve the safety of novel ingredients and their usein food, a process that can often be quite lengthy.Procter and Gamble (P&G) has been working with FDAsince 1987 to obtain approval for olestra. an undigestible

10

fat substitute. In an attempt to speed up approval, P&Gnarrowed its initial petition seeking general use of olestrain shortenings and oils to use in just fried snack foods(Morrison, 1992).

Consumers' perceptions of safety are also important.Negative consumer reaction could jeopardize sales offood as well as other products made by the food company(Morrison, 1992). Two examples are whether consumerconcern over pesticide residues, particularly as they mayaffect children, will present a barrier to greaterconsumption of fruits and vegetables, and whethercontroversial publicity surrounding recombinant bovinesomatotropin (rBST) will hurt consumption of dairyproducts now that rBST has been approved. Finally,price competitiveness and marketing strategies also play amajor role in whether new products and ingredients willbe successful in the n... et (Morrison, 1992).

Grocers have also responded to consumers' nutritionconcerns and are giving more space and attention to thefresh produce section. Today's medium-sizedsupermarket carries more than 300 produce items,compared with 150 in 1980 and 64 in 1970. Largesupermarkets average 400 items (Putnam, 1994). Toreduce the time requirement of preparing fresh fruits andvegetables, the produce department has also introduced ahost of new products and services. Cut and peeledcarrots, celery, broccoli, cauliflower, and salad mixes,peeled and cored pineapples, citrus, and melons--a wholevariety of fresh products - -are now being washed,prepared, and packaged so consumers can pick them up attheir retail outlet, open the package, and start eating(Putnam, 1994).

Fast food places and restaurants have also increased theiravailability of fruits and vegetables. Restaurant saladbars, introduced in the mid- and late 1970's, have becomeso popular that major hamburger chains and supermarketseventually jumped on the bandwagon. Burger Kingstarted with salad bars in 1983, but switched in 1988 toprepackaged salads to accommodate the increasing drive-thru traffic. McDonald's began offering prepackagedsalads in 1986. Most supermarket chains added saladbars during 1982-84. Most now offer a wide array ofprepared salads (Putnam, 1994).

Nutrition education is another area in which the foodsector has become actively involved in respons t toconsumers' nutrition concerns. An example of such aprogram is "5 a Day for Better Health," an activepartnership between the National Cancer Institute (NCI),the produce industry, and the health community, aimed atincreasing consumption of fruits and vegetables. Thisprogram provides an unprecedented opportunity for thefood industry to mount a cooperat;ve generic promotion

16

with the support of a leading health authority. As of June1992, more than 250 retailers had signed licenseagreements to participate in the 5 a Day program,representing more than 30,000 supermarket chain andindependent grocery stores. in addition, some 200merchandisers and suppliers were licensed. This sectionof the industry includes growers, shippers, packers,commodity boards, manufacturers, and other nonretailers.Overall, the produce industry spent $18 million in 1992on 5 a Day promotion. Total spending by the produceindustry and NCI over the life of the 10-year program islikely to top $200 million (Putnam, 1994).

Finally, food advertising and labeling can be powerfulmechanisms for educating consumers and reachinggroups of consumers that are not well reached bygovernment and general information sources. Whereasadvertising and label claims can provide consumerswith more information about nutrition, they can also bemisused, as manufacturers fight to gain a cripetitiveedge for their products. Two examples of tic .v claimscan influence consumer information and behavior arediscussed below.

Research suggests that after information about the linkbetween fiber and cancer became available on cerealboxes, sales of high-fiber cereals increased 37 percentwithin 1 year. As consumers' awareness increased, thefood industry responded by introducing more high-fibercereals. Increases in intake of high-fiber cereals werelargest among nonwhite, low-educated women, suggesting'that advertising was more effective at exposing the fiberinformation to consumers with limited access to scientificevidence and information put out by the Government(Ippolito and Mathios, 1989). Research also suggests thatalthough Americans appear to lack an understanding ofthe fiber content of foods, they tend to be aware of thehigh fiber content of bran flakes, which is attributed tothe abundant advertising of high-fiber cereals (Cremerand Kessler, 1992).

On the other hand, claims such as "low cholesterol" or"no cholesterol," which have been widely used in recentyears as a marketing toot, have led some consumers tolose confidence in the claim. Part of the problem wasthat consumers often made wrong inferences about thenutritional content of the food, based on the partialinformation the claim provided. For example, consumersoften assumed that a product labeled "no cholesterol" wasalso low in fat, or that a product labeled "95% fat free"was low in fat. (It need not be, because the claim "95%fat free" is based on product weight. A cup of waterwith one tablespoon of butter may be 95% fat free, byweight, but it still provides the same 12 grams of fat asone tablespoon of butter.)

17

The Government Responds

To assist consumers in choosing a healthful diet, andeliminate some of the confusion in labeling, theGovernment passed new nutrition labeling regulations(U.S. Department of Agriculture, 1993; U.S. Departmentof Health and Human Services, 1993). Both the foodindustry and consumer groups supported theGovernment's efforts, although each group has criticizedsome of the specifics of the new regulations.

Nutrition labeling is regulated by two different agencies.The USDA regulates labels on meat and poultry products,and the FDA regulates the labels on all other foodproducts. (A third agency, the Federal TradeCommission, regulates advertising.) Both FDA andUSDA have allowed food packages to provide nutritionlabeling on a voluntary basis (except when a nutritionclaim is made or when a nutrient is added to the food).Thus, as of 1992. consumers faced many products thatdid not provide a nutrition label; it is estimated that only4 percent of meat and poultry products and 40 percent ofnonmeat and nonpoultry products contained nutritioninformation (U.S. Department of Agriculture, 1993; U.S.Department of Health and Human Services, 1993). Whenprovided, the nutrition label had to follow a prescribedformat, but contained information of little use to theconsumer. The prescribed format, designed in 1973,focused on the nutrients of concern at that time (such asthe B-vitamins), and not on the nutrients of healthconcern today (such as cholesterol, saturated fat, andfiber). Further, the information was often confusing- -such as when a label advertised "no cholesterol," whichconsumers often mistook t ) mean "low in fat."

In November 1990, the U.S. Congress passed theNutrition Labeling and Education Act (NLEA), makingnutrition labeling mandatory for most nonmeat andnonpoultry products. Regulations issued in January 1993made nutrition labeling mandatory for most processedproducts as of May 1994 (U.S. Department ofAgriculture, 1993; U.S. Deparunent of Health and HumanServices, 1993). The regulations change the requirednutrients, define nutrient content claims (such as "light,""reduced," "low," and "lean"), make serving sizes moreuniform across product lines, and list permissible healthclaims for nonmeat and nonpoultry products. Raw fruitsand vegetables, raw seafood, and raw meat and poultryproducts fall under a voluntary nutrition labelingregulation, which could become mandatory if complianceis low. The regulations provide some exemptions,' suchas for small businesses and foods in small packages.

The nutrition labeling regulations were based on thepremise that consumers will use the new labels to change

11

their food choices and, in particular, eat less fat. Using amodel that estimates the declines in mortality fromcoronary heart disease and cancer associated withreductions in fat intake, the Government estimated thatsavings in health benefits would surpass $6 billion over a20-year period (U.S. Department of Agriculture, 1993;U.S. Department of Health and Human Services, 1993).

There is much controversy, however, about the benefitsthat consumers will actually derive from mandatorynutrition labeling. Critics question the assumptions thatconsumers will (1) read the labels, (2) changeconsumption and nutrient intake, and (3) experience fewerchronic diseases. There are no hard data to support theseassumptions, although a supermarket experiment withshelf-labeling showed changes in food purchases(Schucker and others, 1992).

The benefits above are conservative, in that they donot include (1) health savings associated with the reducednumber of cases of other diet-related diseases, (2) anyeffects the NLEA's nutrition education efforts may haveon label use and nutrient intake, and (3) benefits byconsumers who do not read nutrition labels but who maybenefit if manufacturers reformulate their products toimprove their nutritional value. In addition, theestimates do not take into account nonconsumptionbenefits of mandatory nutrition labeling, such asincreased consumer confidence in the quality of food andin the food industry.

Costs of the nutrition labeling regulations were estimatedat $1.6-2.6 billion over a 20-year period (U.S.Department of Agriculture, 1993; U.S. Department ofHealth and Human Services, 1993). Most of the costswere attributable to (1) analytical costs of determiningthe nutrient content of the food product, and (2) costsof printing new labels. To minimize the burden on thefood industry, manufacturers may use nutrient databases,rather than chemical analyses, to compute the nutrientcontent of foods. Also, the food industry was givenan additional extension to use up old labels and thendevelop new ones.

How well consumers understand and apply theinformation on the new labels to choose a healthful dietwill strongly depend on the success of public and privatenutrition education activities. Timely assessment of theeffects on consumer behavior and adequate oversight ofimplementation will also be important.

The mandatory nutrition labeling is expected to give thefood industry incentive to reformulate many of theirproducts to improve their nutritional profile, furtheraiding consumers to improve their nutrient intake.

12

Likely Impacts on Agriculture

If consumers use the new nutrition labels and make largeshifts in their demand for basic commodities as theymove toward healthier diets, how would that affect U.S.and foreign agriculture?

If demand moved in the direction of meeting the DietaryGuidelines, the volume and mix of products producedwould have to change, along with how and where theyare produced, and their price (O'Brien, 1994). Thefollowing sections describe potential farm-level effects.

Fruits and Vegetables

Meeting the increased demand for fruits and vegetablesassociated with healthier diets could have far-reachingimplications, given the distinctly different nature ofhorticultural operations compared with the grain-oilseed-livestock operations that currently dominate U.S.agriculture. Fruit and vegetable production tends to behighly intensive, using a disproportionately large share ofthe sector's capital, labor, and purchased inputs such asfertilizers and pesticides. Production is also heavilyconcentrated in areas such as Florida, California, andMichigan. Thus, responding to increased demand couldchange the regional composition of U.S. agriculture. Asimproved refrigeration and transportation enable expandedsupply sources, much of the increased demand couldcome from imports, particularly during "off" seasons fortropical products with limited or no U.S. productionpossibilities, and for the most labor-intensive products.

Whether from domestic or foreign supply, an increaseddemand for fruits and vegetables might be associated witha troubling increase in agrochemical use that could in turnraise concerns about food and environmental safety.While use of fertilizers and pesticides varies widely bycrop and location, chemical use, particularly pesticide use,is typically many times greater per acre and per pound ofproduct harvested for fruits and vegetables than for grainsand oilseeds (fig. 16). Production studies suggest that

Nun 10Heavy use of fertilizers and agrochemicals affects productionof fruits and vegetables

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chemical pest control plays a critical part in keepingAmerican horticulture profitable, supplies large, andprices low.

Many consumers rank agrochemical use as the numberone food safety concern (Food Marketing Institute, 1993).The 1991 residue monitoring report by the FDA foundthat less than 1 percent of the fruits sampled and lessthan 2 percent of the vegetables sampled containedresidues in excess of FDA's tolerance limits, but morethan 40 percent of the fruits sampled and 33 percent ofthe vegetables sampled contained detectable pesticideresidues (Food and Drug Administration, 1992). As aresult of consumer concerns, a number of growers andretailers have initiated their own pesticide residue testingprogram (Cook, 1991; Kaufman and Newton, 1990; VanRavenswaay, 1989). In add.tion, the Federal Governmentis reviewing registered pesticides for their safety.

Growing consumer willingness to pay premiums andefforts to legislate agrochemical use at the State andFederal levels is generating farmer interest in alternativeproduction methods. A recent survey found that fruit andvegetable producers used more than 30 different practicesin addition to using pesticides to control pests (O'Brien,1994). These practices involve mixing pesticide use withother conventional pest-control methods (such as croprotation and releasing beneficial insects that prey oninsect pests) and unconventional methods (such as usingpheromone traps to disrupt mating). Interest is alsogrowing in genetic engineering to develop pest-resistantcrops and in organic production.

Grains and Cereals

Adjustments in food grains would be appreciably smallerbut still significant (O'Brien, 1993). The sector alreadyhas the physical capacity to expand grain production tomeet greater food demand. Bringing into use the wheatand rice land currently idled under USDA's supplymanagement programs would push supplies above themidpoint of the recommended range. Moreover,expanding output would do little to affect the regionalcomposition or the nature of agricultural production.

Dairy

Adjustments in the dairy sector would be marked andwould extend from farmers through to consumers(O'Brien, 1993). The farm sector would be called on toincrease output more than a third, adding to pressure onproducers to accelerate adoption of the latest breeding andfeeding technologies despite consumer concerns about thesafety of some of these technologies. However, thecomposition of the milk produced and marketed wouldhave to be quite different. with producers accelerating the

move away from butter fat toward nonfat solids that hasbeen underway for more than a decade.

Adjustments would also be marked beyond the farm gate,where milk processing and manufacturing decisions aremade. Convincing Americans to eat more dairy products,but a lower fat mix of products, will depend onexpanding the range of products available in the marketand boosting their consumer appeal.

Feed-Livestock Adjustments

Adjustments in the feed-livestock complex would befarther reaching than the small changes in the broad meatcategory would suggest (O'Brien, 1993). Meeting therecommendations to "consume more lean meats" wouldinvolve accelerating the trends toward leaner red meatand more fish and poultry. This would likely generate amarked change in livestock operations and a significantdownsizing of the feed industry.

19

Link Between Food Policy and Dietary Change

Strengthening the link between food policy and dietarychange could also facilitate transition. Shifting directUSDA purchases for the food assistance programs (suchas school lunch programs) to reinforce dietaryrecommendations rather than disposing of surpluses (suchas cheese, butter, red meats) would ease the transition bysending farmers consistent production signals. Realigningmarketing policies--such as revamping grades andstandards to facilitate better transmittal of market signalsbetween consumers and producers--would also acceleratethe adjustment.

Conclusions

The growing evidence of the link between diet and healthhas not been lost among American consumers. Asconsumers have become more aware of this relationship,they have made some changes to their diets, and areeating less red meat and fewer eggs, and are drinking lesswhole milk.

There is still considerable room for improvement to meetFederal food guidance recommendations. Consumptionof grains and cereals and fruits and vegetables is muchlower than the recommended amounts, while intake of fatand saturated fat remains above the recommended levels.Consumers admit to being confused about the conflictinginformation they receive. For example, first they learnthat margarine is better for you than butter, then theylearn that margarine contains high levels of trans-fattyacids that may actually increase blood cholesterol levels(Nutrition Week, 1993). It is not surprising that many

13

consumers seem to have stopped worrying aboutnutrition. In a 1993 survey, concern about the nutritionalcontent of the diet was mentioned by 54 percent of therespondents, compared with 64 percent in 1992 (FoodMarketing Institute, 1993).

Among consumers who desire to improve their diets,many claim they lack the information to do so. Researchshows that many of the changes Americans have made intheir food choices end up cancelling each other out. Newnutrition labeling regulations, and Ludr concomitantnutrition education activities, may be instrumental inhelping consumers change food consumption behavior.

The food sector has actively responded to consumerdemands for more nutritious foods, although at times itsefforts have confused consumers. However, the foodsector remains an important participant in the movetoward healthier diets, with its required changesin the volume, mix, and nutritional composition of theproducts marketed. Technological advances in foodproduction and processing have given the food industrynew tools - -such as protein- or carbohydrate-based fatreplacers--that are likely to accelerate the introduction oftasty reduced-fat foods.

The food sector also faces an enormous challenge incomplying with the new nutrition labeling regulations,while still using nutrition as a marketing and advertisingtool. Finally, the food sector is an important partner withthe Government and other health institutions in thedevelopment and dissemination of nutrition inform2tion toeducate consumers as to how to improve their dietaryintakes.

Changes in what, where, and how food products areproduced present unlimited opportunities for producersand food manufacturers who can identify, respond to, orcreate new consumer food desires that are not being metby the domestic food sector.

References

Anton, J., and B. FrazAo. "Organic Certification:Standards in the Works," Agricultural Outlook, pp. 26-31. Aug. 1993.

Cook, Roberta L. "Consumer Demand for Food Safety-Oriented Marketing Labels: Implications for SustainableAgriculture." Paper presented at the InternationalAgricultural Economics Association Meeting, Tokyo,Japan, Aug. 1991.

Cremer, Steven A., and Larry G. Kessler. "The Fat andFiber Content of Foods: What Americans Know,"

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Journal of Nutrition Education, Vol. 24, No. 3, pp. 149-52. 1992.

Food and Drug Administration. "Residue Monitoring1991," Journal of AOAC International, Vol. 75. Sept. -Oct. 1992.

Food Chemical News. "Diet Failure in Obese PeopleLinked to Caloric Underreporting," p. 15. January 4,1993.

Food Marketing Institute. Trends in the United States:Consumer Attitudes and the Supermarket 1993.Washington, DC. 1993.

. Trends in the United States: ConsumerAttitudes and the Supermarket 1992. Washington, DC.1992.

. How Consumers Are Shopping theSupermarket 1991. Washington, DC. 1991.

Food Marketing Institute and Prevention Magazine.Shopping for Health. A Report on Food and Nutrition.Prepared by Princeton Survey Research Associates,Princeton, New Jersey. 1992.

FrazAo, Betsy, and Linda Cleveland. "Diet-HealthAwareness About Fat and Cholesterol--Only A Start,"FoodReview, Vol. 17, No. 1, pp. 15-22. Jan.-Apr. 1994.

Gallo, A.E. "Record Number of New Products in 1991,"FoodReview, Vol. 15, No. 3, pp. 19-21. July-Sept. 1992.

Guthrie, J.F., and N. Raper. "Animal Products: TheirContribution to a Balanced Diet," FoodReview, Vol. 15,

No. 1, pp. 29-34. 1992.

Ippolito, Pauline M., and Alan D. Mathios. HealthClaims in Advertising and Labeling: A Study of theCereal Market. Bureau of Economics Staff Report,Federal Trade Commission. 1989.

Kaufman, Phil, and Doris J. Newton. "Retailers ExploreFood Safety and Quality Assurance Options," National

Food Review, Vol. 13, No. 4. Oct.-Dec. 1990.

Liebman, Bonnie. "The Changing American Diet."Nutrition Action Healthletter, pp. 8-9. May 1990.

Morrison, Rosanna M. "Fat Substitutes in Foods:Growing Demand and Potential Markets." Paperpresented at the 20th International Society for FatResearch World Congress/83rd American Oil Chemists'Society Annual Meeting, Toronto, Canada, May 10-14,1992.

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National Research Council. Diet and Health:Implications for Reducing Chronic Disease Risk.Washington, D.C.: National Academy Press, 1989.

Nutrition Week. Community Nutrition Institute, No. 26, p.8. July 16, 1993.

O'Brien, Patrick M. "Dietary Shifts and Implications forU.S. Agriculture." Paper presented at the Harvard Schoolof Public Health's Conference on Public HealthImplications of Traditional Diets, Jan. 1993.

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Put ler, Daniel S., and Elizabeth FrazAo. "Assessing theEffects of Diet/Health Awareness on the Consumptionand Composition of Fat Intake," Economics of FoodSafety. Julie A. Caswell, ed. New York, NY: ElsevierScience Publishing, pp. 247-70. 1991.

Putnam, Judith J. "American Eating Habits Changing:Part 2--Grains, Vegetables, Fruits, and Sugars,"Food Review, Vol. 17, No. 2. May-Aug. 1994.

. "American Eating Habits Changing: Part 1 --Meat, Dairy, and Fats and Oils," Food Review, Vol. 16,No. 3, pp. 2-11. Sept.-Dec. 1993.

. "Food Consumption, 1970-90,"Food Review, Vol. 14, No. 3, pp. 2-12. July-Sept. 1991.

Putnam, Judith J., and Jane E. Allshouse. FoodConsumption, Prices, and Expenditures, 1970-92. U.S.Department of Agriculture, Economic Research Service,SB-867. Sept. 1993.

Schucker, Raymond E., Alan S. Levy, Janet E. Tenney,and Odonna Mathews. "Nutrition Shelf-Labeling andConsumer Purchase Behavior," Journal of NutritionEducation, Vol. 24, No. 2, pp. 75-80. Mar.-Apr. 1992.

Smallwood, David M., and James R. Blaylock. "Fiber:Not Enough of a Good Thing?," FoodReview, Vol. 17,No. 1, pp. 23-29. Jan.-Apr. 1994.

Sugarman, Carole. "Changing the Habits of a Lifetime,"Washington Post. June 1, 1993.

"How Are We Doing?." Supermarket

Business, pp. 30-35. Sept. 1991.

Tippett, Katherine S., and Joseph D. Goldman. "DietsMore Healthful, But Still Fall Short of DietaryGuidelines," FoodReview, Vol. 17, No. 1, pp. 8-14.Jan.-Apr. 1994.

U.S. Department of Agriculture, Agricultural ResearchService. Food and Nutrition Research Briefs. July-Oct.1992.

U.S. Department of Agriculture, Food Safety andInspection Service. "Nutrition Labeling of Meat andPoultry Products; Final Rule," Federal Register, Vol. 58,No. 3, pp. 632-91. Jan. 6, 1993.

U.S. Department of Agriculture, Human NutritionInformation Service. Food Guide Pyramid. Home andGarden Bulletin No. 252. Aug. 1992.

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. C'SPI, Nationwide Food ConsumptionSurvey, Continuing Survey of Food Intakes by Individuals,Women 19-50 Years and Their Children 1-5 Years, 1Day, 1986. Report (NFCS. CSFII) No. 86-1. Hyattsville,MD. 1987.

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Surgeon General's Report on Nutrition and Health.DHHS (PHS) Publication No. 88-50210. 1988.

U.S. Deparunent of Health and Human Services, Foodand Drug Administration. "Food Labeling; GeneralProvisions; Nutrition Labeling; Label Format; NutrientContent Claims; Health Claims; Ingredient Labeling; Stateand Local Requirements; and Exemptions; Final Rules,"Federal Register, Vol. 58, No. 3, pp. 2,066-2,964. Jan. 6,1993.

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15

Van Ravenswaay, Eileen. "The Food Industry Respondsto Consumers' Pesticide Fears," National Food Review,Vol. 12, No. 3. July-Sept. 1989.

Washington Post. June 2, 1993.

Appendix: Main Sources of Information

USDA's food intake surveys. These surveys collectinformation on what individuals say they eat over aperiod of 1-3 consecutive days.

USDA had conducted the Nationwide Food ConsumptionSurvey (NFCS) approximately every 10 years since 1936.The survey collected information on demographics andhousehold food use for a 1-week period from a nationallyrepresentative sample of households. In 1965-66, theNFCS began collecting individual food intake data for allfoods consumed by individuals over a 1 -day period. In

1977-78 and in 1987-88, information was collected onindividual food intake for up to 3 consecutive days.

Realizing that 10 years was too long a time betweensurveys, the USDA began a series of smaller surveys in1985, the Continuing Surveys of Food Intake byIndividuals (CSFII). These surveys were to be conductedannually, focusing on specific subpopulation groups (forexample, 1985 and 1986 focused on women aged 19-50years and their preschool children). In 1989-91, theUSDA launched the second series of CSFII. covering allage groups. These surveys collected data on all the foodsconsumed by individual members of the household over1-3 consecutive days. The third series of CSFII surveyscovers 1994-96. and includes collection of food intakeover 2 nonconsecutive days by individuals of all ages.

In 1989, a telephone follow-up survey to the CSFII, theDiet and Health Knowledge Survey (DHKS) was initiatedto collect information on the nutrition knowledge andattitudes of the main meal planner/preparer of thehousehold. The 1989-91 CSFII and the 1989-91 DHKSwere designed so that their respondents' information

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could be linked, for the first time providing researchersdata on nutrition knowledge and attitudes and foodconsumption for the same individual.

A common criticism of individual food intake surveys isthat individuals may either omit items or misjudge thequanitities consumed. This is reflected in experimentsdemonstrating that "average" people eating the "average"diet identified in the surveys experience significant weightloss, suggesting an understatement bias (U.S. Departmentof Agriculgure, Agricultural Research Service, 1992;Food Chemical News, 1993).

USDA's Food Consumption, Prices, and Expenditurestime series. This series estimates the amount of foodthat enters the marketing channels and is, therefore,available for human consumption. The data are useful asan indicator of food availability at the national level. Percapita food disappearance is calculated by estimating theamount of a product available for food use (production +imports exports - feed - seeds - other nonfood uses -stock changes) and dividing it by population. The datatake into account some losses that occur in foodprocessing, preparation, and plate waste, but is not able toaccount for all nonfood uses. The numbers thereforerepresent an upper boundary of the amount individualsactually eat (Putnam and Allshouse, 1993). However, thetrends captured in the time series should reflect thedirections of change in food consumption patterns.

The data are available for large product groups andcannot pick up changes in product characteristics that canbe particularly important in evaluating their impact onnutrit.an. For example, although the data capture changesthat have been occurring in meat trimming practices, theydo not capture the tower fat content in meats due tochanges in breeding practices over time. Similarly, thedata do not capture changes in the average amount of fatin salad dressings, spreads, and cheese, due to the use offat substitutes, the incorporation of air into spreads, andnew technologies. These changes tend to move nutrientintakes toward healthier levels, but are not captured bythe food disappearance data.

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