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UNDERSTANDING

FOOD LABELS &

FOOD SAFETY

NUTR 2050 Nutrition for Nursing Professionals

Mrs. Deborah A. Hutcheon, MS, RD, LD

Lesson Objectives At the end of the lesson, the student will be able to:

1. Identify ingredients in foods that denote whole grains, added sugar,

added fat, and added sodium.

2. Evaluate the nutrition and ingredient information on food labels to

make selections that meet specific dietary and health goals.

3. Distinguish among a health claim, nutrient content claim, and

structure-function claims.

4. Identify strengths and weaknesses of various nutrition labeling

systems on food packaging and calorie listings for food items.

5. List the 5 most common risk factors for foodborne illness and provide

risk minimization methods for each.

6. Identify common causes of food-borne illness, including the

identification of common pathogens, foods, risk factors, and

preventative measures for each.

UNDERSTANDING

FOOD LABELS

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Food Category Definitions

Conventional Food: unmodified whole foods.

Modified Food: altered from original form for nutrient provision

• Fortified: new nutrient added during processing.

• Enriched: nutrient added back post-processing.

• Includes: thiamin, riboflavin, niacin, iron, folate

• All refined grains products must be enriched

• Enhanced: bioactive components added into food.

The Food Label 1. Front & Sides of the Label

The Food Label 2. Ingredients List

Listed in order from greatest amount to least amount

Pay attention to…Whole Grains

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The Food Label 2. Ingredients List

Pay attention to…Added Sugar

The Food Label 2. Ingredients List

Pay attention to…Solid Fat…especially Trans Fat

The Food Label 2. Ingredients List

Pay attention to…Added Sodium (Salt)

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The Food Label – Test Your Knowledge

The Food Label

3. Serving Size &

Servings per

Container

“How much can I eat?”

vs.

“How much did I eat?”

The Food Label

4. Calorie Content

40 kcals = low

100 kcals = moderate

400 kcals = high

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The Food Label

5. Nutrient Content

• Mandatory vs. Voluntary

• Limit Cautionary Nutrients

6. % Daily Value

• Based on 2000 kcal diet

Proposed Label Changes

• Distinguishing between added sugar and inherent sugar

• Updating DVs for sodium, dietary fiber, vitamin D

• Require amount of potassium & vitamin D to be listed; no

longer require vitamin A & vitamin C to be listed

• List micronutrient amounts in addition to %DV

• Focus on type of fat and remove “Calories from Fat”

• Update serving sizes based on how people eat

• Label single-serve items based on entire package amount

• Re-design label—emphasis & location of content

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Proposed New Label Format

Health Claims Diets low in sodium may

reduce the risk of high blood pressure, a disease associated with many factors.

Diets low in saturated fat and cholesterol and rich in fruits, vegetables, and grain products that contain some types of dietary fiber, particularly soluble fiber, may reduce the risk of heart disease, a disease associated with many factors.

Soluble fiber from foods such as [name of soluble fiber source, and, if desired, name of food product], as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.

Nutrient Content Claims

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Structure/Function Claims

• Calcium maintains strong bones.

• Fiber maintains bowel regularity.

• Vitamin C helps support healthy immune system.

When using S/F claim, dietary supplements must

state: “This product is not intended to diagnose,

treat, cure, or prevent any disease.”

Claims on Labels

Nutrient Content

Claim Health Claim Structure-

Function Claim

Organic Food

1. No synthetic

pesticides and

fertilizers

2. No genetically

modified

organisms

(GMOs)

3. No hormones &

antibiotics used

4. No irradiation

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Purchasing Organic Food

Produce’s

“Dirty Dozen”

Produce’s

“Not-So-Dirty

Dozen”

Peaches

Apples

Sweet Bell

Peppers

Celery

Nectarines

Strawberries

Cherries

Pears

Grapes

Spinach

Lettuce

Potatoes

Papayas

Broccoli

Cabbage

Bananas

Kiwi

Sweet Peas

Asparagus

Mangoes

Pineapple

Sweet Corn

Avocados

Onions

• Buy local produce whenever possible. (www.localharvest.org)

• Grow your own produce when possible.

• Reduce pesticide residue by washing & scrubbing produce, removing peel.

• Eat a variety of produce from different sources.

• Prioritize purchasing of organic foods.

Food Allergen Labeling

• Required labeling of a food with a top 8 food allergen

1. Bolded in ingredients list

2. Listed separately by statement “Contains…”

• Top 8 Food Allergens:

Restaurant Labeling

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Packaging Terms—FDA Definitions

“Free-range”/“Free-roaming”: access to outside

“Fresh” (meat): internal temperature never <26°F

“Chemical-free”: may not be used on labels

“Hormone-free”: use with beef not poultry or pork

“Natural”: no artificial ingredient or added color

“Processed:” any food other than raw food that has

been canned, cooked, frozen, dehydrated, or milled

FOOD SAFETY

Foodborne Illness

What Is It?

A disease carried or transmitted to people by food;

any illness or injury that results from something that

has been eaten.

Statistics per the CDC

• 48 million (1 in every 6) people become ill each year.

• 128,000 people are hospitalized.

• 3,000 people die .

• Underreporting of incidences.

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Contamination of Food

• Bacteria & viruses are the most common contaminants.

• Contaminants may enter the food supply during food

processing, storage, or preparation.

• Contamination through the feces is common.

• From intestines in meat processing

• From animal manure used on vegetable crops

• From handling by people with dirty hands

Foodborne Illness

5 Most Common Risk Factors (per CDC)

1. Purchasing food from unsafe sources.

2. Failing to cook food adequately.

3. Holding food at incorrect temperatures.

4. Using contaminated equipment.

5. Poor personal hygiene.

Populations at High Risk

• Elderly people

• Preschool-age children

• People with compromised

immune systems

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Causes of Foodborne Illness

1. Biological (pathogens)—bacteria,

fungi (mold), yeast, virus, parasite =

Greatest threat to food safety!

2. Physical—metal, glass, paper

3. Chemical—cleaners, sanitizers,

pollutants, preservatives

Biological Contamination

Pathogen: a disease-causing microorganisms such as

1. viruses, 2. bacteria, 3. fungi, 4. parasites

Infection: illness resulting from live disease-causing or

pathogenic microorganisms (viruses & protozoa do not

reproduce in food)

Intoxication: illness caused by eating toxins (poisons)

produced by microorganisms

Viruses Parasites Fungi Bacteria

Biological Illness Transmission Communicable: transmitted from person to person

Direct vs. Indirect Means

Infected Person vs. Carrier

Common Modes of Transmission

1. Intestinal tract

2. Saliva

3. Respiratory tract

4. Open cuts or sores

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What Bacteria Need to Grow

F Food

A Acidity

T Temperature

High Sugar

High Protein

Neutral pH

to

Slightly Acidic

pH 4.7-7.5

Temperature

“Danger Zone”

41˚F to 135 ˚F

CAN CONTROL

T Time

O Oxygen

M Moisture

Aerobic

Anaerobic

Facultative

CAN CONTROL Water Activity (aw)

Water activity of

.85+ ideal for

growth (molds)

What Bacteria Need to Grow

Food Most Likely to Become Unsafe

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Listeria monocytogenes

• Illness: Listeriosis

• Grows in Cool, Moist Environments (refrigerators)

• Common Foods: deli meat, soft cheese,

unpasteurized milk & juice products

• Health Risk: miscarriage in pregnant women

Enterohemorrhagic and shiga toxin-

producing E. coli

• Bacteria: O157:H7, O26:H11, O111:H8, O158:NM

• Illness: hemorrhagic colitis

• Found in the intestines of animal…oral-fecal route

• Common Foods: raw ground beef, raw milk,

unpasteurized juices, contaminated produce

Clostridium botulinum • Illness:Botulism

• Do Not Grow in Highly Acidic Foods

• Grows Well Without Oxygen

• Produces a Lethal Toxin

• Foods: canned foods, baked potatoes, garlic & oil

mixtures, honey

• Health Concerns: neurological dysfunction

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Salmonella spp.

• Illness: Salmonellosis

• Avoid Cross-Contamination

• Foods: poultry, eggs, contaminated produce

• Health Concerns: N/V/D and Fever

Campylobacter jejuni

• Illness: Campylobacteriosis

• Foods: poultry, meat, raw milk, stews/gravies

• Health Concerns: N/V/D and Fever

Clostridium perfringens

• Does not grow at refrigerator temperature (warm temps)

• Foods: poultry, meat, stews/gravies

• Health Concerns: diarrhea and abdominal pain

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Hepatitis A

• A virus (vaccination available)

• Fecal-oral transmission

• Foods: shellfish, contaminated produce (strawberries)

• Health Concerns: nausea, fever, jaundice (liver damage)

Norovirus

• A virus – Highly Contagious!

• Outbreaks common on cruise ships & college campuses

• Fecal-oral transmission

• Foods: shellfish, contaminated produce (strawberries)

• Health Concerns: N/V/D

Parasites: Basic Characteristics

• Location: Require a host to live and reproduce

• Source: seafood, wild game, and food processed

with contaminated water, such as produce

• Most may be killed by cooking and/or freezing!

• Purchase food from approved, reputable suppliers

• Cook food to required minimum internal temp

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How to wash hands (should take at least 20 seconds):

1. Wet hands and arms. Use

running water as hot as you

can comfortably stand. It

should be at least

100°F(38°C).

3. Scrub hands and arms

vigorously. Scrub them

for 10 to 15 seconds.

Clean under fingernails

and between fingers.

4. Rinse hands and arms

thoroughly. Use running

warm water.

5. Dry hands and arms. Use a

single-use paper towel or hand

dryer. Consider using a paper

towel to turn off the faucet and

open the restroom door.

2. Apply soap. Apply

enough to build up a

good lather.

Good Personal Hygiene: Hand Washing

Keep Surfaces CLEAN

• Clean and sanitize all surfaces and equipment

• Use HOT soapy water or disinfectant sprays

• Use separate towels for hand washing, cleaning

surfaces, and drying dishes.

• Thoroughly clean produce before preparing or eating

• Clean & sanitize all work surfaces, equipment, &

utensils after EACH task. (wash, rinse, sanitize!)

SEPARATE to Prevent Cross-Contamination

• Double-bag meats

• Separate raw meat & other raw foods

• Consider contamination from reusable bags/totes

• Refrigerate/freeze foods ASAP

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• Store ready-to-eat foods & produce above raw food.

• Use separate equipment for each type of food

• Keep raw foods separate from cooked foods!

SEPARATE to Prevent Cross-Contamination

Thawing Food – CHILL & COOK • NEVER thaw food at room temperature!!!

1. Refrigerate food at product temp of 41°F or lower.

2. Submerge food under RUNNING water at a

temperature of 70°F or lower. Temp of food should

never go above 41°F for >4 hours.

3. Thaw food in microwave oven if it will be cooked

immediately afterward.

4. Thaw food as part of the cooking process as long as

product reaches required minimum internal cooking

temperature.

Product Minimum Internal Cooking

Temperature

Poultry 165°F for 15 seconds

Stuffing & Stuffed Products 165°F for 15 seconds

Reheated TCS Food 165°F for 15 seconds

Ground Meat & Seafood 155°F for 15 seconds

Shelled Eggs (Hot-Held) 155°F for 15 seconds

Pork, Beef, Veal, Lamb Steaks/Chops: 145°F for 15 sec

Roasts: 145°F for 4 minutes

Seafood 145°F for 15 seconds

Shell Eggs (Immediate Service) 145°F for 15 seconds

Plant-Based Products (Hot-Held) 135°F

Tea 175°F

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COOKing in the Microwave Oven Minimum internal cooking temp = 165°F (74°C)

Cover food to prevent the surface from drying out

Rotate or stir it halfway through cooking so heat

reaches the food more evenly

Let it stand for at least two minutes after cooking to

let the food temperature even out

Check the temperature in at least two places to

make sure the food is cooked through

A Closer Look at Microwave Cooking

Hot Food: 135°F or higher

Cold Food: 41°F of lower

Use thermometer to check INTERNAL temperature.

• Best: at least every 2 hours

• Never use hot-holding equipment to reheat.

• Stir food at regular intervals to redistribute heat.

General Rules for Holding Food

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• Cover food to protect from contamination.

• May hold cold food for up to 6 hours (must stay <70°F)

• May hold hot food for up to 4 hours (must stay <135°F)

General Rules for Holding Food

Food Recalls Actions taken by firm to remove product from market.

Governed by the FDA: http://www.recalls.gov/food.html

Class I recall: a situation in which there is a reasonable probability that the use of or exposure to a violative product will cause serious adverse health consequences or death

Class II recall: a situation in which use of or exposure to a violative product may cause temporary or medically reversible adverse health consequences or where the probability of serious adverse health consequences is remote

Class III recall: a situation in which use of or exposure to a violative product is not likely to cause adverse health consequences.

• Know facility policies re: food brought in from outside

• Food brought in must be handled properly – asking

probing questions to assure that food has been handled

properly…How could you do this?

• Consider any dietary restrictions to determine if allowed

Example: Neutropenic Diet (cancer patients)

• Consider any isolation precautions

Food Safety – Nursing Applications

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Menu

Hamburgers on the Grill

Potato Salad

Baked Beans

Fresh Fruit

Custard Pie

1. List 3 ways to reduce the risk of food poisoning that fits

into the CLEAN” category.

2. List 3 ways to reduce the risk of food poisoning that fits

into the “SEPARATE” category.

3. List 2 ways to reduce the risk of food poisoning that fits

into the “COOK” category.

4. List 3 ways to reduce the risk of food poisoning that fits

into the “CHILL” category.

Food Safety Activity

27 YOWM with AIDS – you are on a home care visit

• What food safety education should be provided?

82 YOBF with Alzheimer’s living alone in her apartment

• What counseling should be provided related to food safety?

32 yr old Hispanic female who is 3 months pregnant.

• What counseling should be provided related to food safety?

65 YOWF who is hospitalized with cancer. Family to bring food?

• What types of food can the family bring in for this patient?

Food Safety Case Study What would you do in the following situations?

Some Helpful Websites

http://www.foodsafety.gov/

http://www.homefoodsafety.org

http://www.cdc.gov/foodsafety/

http://www.fightbac.org/

http://www.foodinsight.org/