Special

Nutrition
American
industry,
James

labeling
and public health: survey of
Institute of Nutrition
members,
food
and consumers13

T Heimbach,

PhD

and

ABSTRACT
list

from

the

responded

Raymond

Five

hundred

food

industry,

to a survey

Nutr

KEY

WORDS

public

opinion,

PhD

thirty-one

members

and

dealing

heart
disease
as the major
calories,
sodium,
fat, protein,
J Clin

C Stokes,

107 consumers
with

nutrition

diet-related
iron, calcium,

of the
from
labeling

national
health
and carbohydrates

American

a Food
of

and
foods.

Institute
Drug

of

Nutrition,

Administration

They

identified

177
mailing

obesity

problems
and chose
information
as most useful
to the public.

and
about
Am

1982:36:700-708.

Food
public

labeling,

government

Introduction
In December
1969 the White
House
Conference
on Food,
Nutrition,
and Health
proposed
that:
Information
about
nutrition
properties
which
are significant
to consumers
in relation
to the use of a given
food in the
daily
diet
should
be required
to be made
available
to consumers.
Insufficient
data are
available
to show what nutrition
information
is significant
for the various
foods,
or what
type of nutrition
information
is meaningful
and useful
to consumers
( 1 ). In response,
the
Food
and Drug
Administration
(FDA)
initiated a nutrition
labeling
program,
and, with
the cooperation
of the food industry,
nutritionists,
and consumer
groups,
began
investigating
what nutrition
information
should
be
made
available
and which
formats
would
be
most suitable.
These
efforts
culminated
in the
publication
in the Federal
Register
of a preliminary
proposal
for nutrition
labeling
in
1972 (2) and a final
regulation
in 1973 (3)
with
an effective
compliance
date
of July
1975. The proportion
of packaged
processed
foods
which
were nutrition
labeled,
based
on
retail
sales, reached
40% by 1977 (4) and 44%
by 1979 (5).
The American

programs,

nutrition

labeling,

product

labeling,

policy

Juurnol

ofClinical

Beginning
with a series
of public
hearings
in the latter
half of 1978 (cosponsored
by the
US Department
of Agriculture
and the Federal
Trade
Commissions
Bureau
of Consumer
Protection),
the FDA
has solicited
information
about
the adequacy
ofcurrent
food
labeling,
with particular
emphasis
on the flutrition
label and the ingredient
list.
The
general
publics
usage
of food
label
information,
along
with
their
desires
for
changes
in labeling,
was also investigated
in
the FDA
1978 Consumer
Food Labeling
Survey, using
a national
probability
sample
of
I

Drug
2

Food
Street,
.1

From

the

Division

Administration,
Address
reprint

of Consumer
Washington,
requests
to:

Studies,

Food

and

DC 20204.
Dr James
T Heimbach,

and Drug Administration,

Bureau
SW, Washington,
DC 20204.
This article
discusses
only the most

of Foods,

200 C

important

find-

ings of the survey.

Questions
were also asked
about
such
other
issues
as specifying
carbohydrates
and
types
of
sugars,
methods
ofdeclaring
micronutrients,
and making
disease-related
claims.
A full report
is available
in either
microfiche
(AOl,
$4.00)
or hard
copy
(A04,
$9.00)
through
the National
Technical
Information
Service,
Springfield,
VA, under
the title, Nutrition
Labeling
for
Todays
Needs
(NTIS
no PB 82 154402).
Received
December
1, 1981.
Accepted
for publication
March
16, 1982.

Nutrition

36: OCTOBER

1982

American

1982, pp 700-708.
Society

Printed

for Clinical

in USA
Nutrition

Downloaded from www.ajcn.org by guest on July 18, 2011

persons

700

Article

NUTRITION

participating
were the American
Bakers
Association,
the
American
Meat
Institute,
the Food
Marketing
Institute,
the Grocery
Manufacturers
of America,
the Milk Industry Foundation,
and the National
Food
Processers
Association.
No claim
is made
that this survey
provides
a
statistically
representative
sample
of the food industry,
but it does reach
major
segments
of the industry,
including both
food manufacturers
and retailers,
and may be
taken
as generally
reflecting
the views
of the processed
food industry.
The organizations
included,
along
with
the number
ofquestionnaires
mailed,
the number
ofcompleted
questionnaires
returned,
and the response
rates, are shown
in
Table
I.
Data

coding

and

tabulation

Completed
questionnaires
were returned
to the Division of Consumer
Studies
in FDAs
Bureau
of Foods,
where
written
answers
were content-analyzed
and coded
for tabulation.
Coding
was divided
among
four persons.
A sample
of 20 questionnaires
was coded
by all four,
with an overall
interrater
reliability
index
(IT)
ofO.94
(8).

Results

and discussion

Diet-related

health

problems

Because
a major
goal of nutrition
labeling
is to help consumers
avoid
or reduce
dietary
excesses
and nutritional
deficiencies
that may
result
in health
problems,
it is of value
to
learn
what
nutritionists
perceive
to be the
major
diet-related
health
problems.
Respondents
were
asked
to: List
below
what
you
see as the most
important
dietrelated
health
problems
in this
country.
Please
list them
in order
of importance,
with
the most important
problem
listed
first.
On
TABLE

Organizations

surveyed

and

Organization

response

rates

Question.
natres
mailed

Question.
natres
returned

rate

1747

531

30

Response
#{149}

Methods
American
Survey

populations

and

response

Questionnaires
were
mailed
by FDA
directly
to
United
States
members
of the American
Institute
of
Nutrition
(AIN)
and to interested
consumers
from
a
list maintained
by FDAs
Office
of Consumer
Affairs
of
people
who have
expressed
a continuing
interest
in receiving
information
about
FDA issues and activities
(not
necessarily
food-related
matters).
This list includes
food
and
health
professionals,
teachers,
representatives
of
community
consumer
groups,
and
other
people
concerned
about
foods
and drugs.
It is not a representative
sample
of American
consumers
and is referred
to as the
consumer
panel
in order
to differentiate
it from true
probability
samples.
In addition,
a number
of food industry
trade associations
agreed
to mail FDAs
questionnaires
to their
members.
The
industry
organizations

Institute

of

Nutrition

Industry
groups
American
Bakers

As-

987
15

177
7

18
47

Insti-

150

65

43

In-

300

20

Grocery
Manufacturers
of America
Milk Industry
Foundation
National
Food
Proc-

297

41

14

125

21

17

100

23

23

900
3634

107
815

12
22

SoCiation

American
Meat
tute
Food
Marketing
stitute

essors

Consumer
Total

Association

panel

Downloaded from www.ajcn.org by guest on July 18, 2011

households
(6). Some
of this studys
findings
regarding
nutrition
labeling
are summarized
as follows.
1 ) One problem
with current
nutrition
labeling
is its complexity.
Many
people
do not
understand
much
of the technical
terminology and they express
uncertainty
over how to
use the information.
2) Many
people
want
different
or more
detailed
information
than
is now
available
concerning
the nutritive
value
of their food,
with
particular
interest
in calories,
sodium,
cholesterol,
sugars,
and fatty acids.
3) The public
is more
interested
in information
about
dietary
constituents
they might
consume
too much
of or wish to avoid
(eg,
sodium,
cholesterol)
than about
constituents
of which
they might
consume
too little (such
as vitamins
and minerals).
Such fmdings
suggest
that many people
are
apprehensive
about
the safety
of their
food
supply.
In a later FDA
survey
(1), about
half
(52%)
of the public
expressed
concern
about
possible
adverse
health
effects
of the foods
they consume.
Many
are uneasy
about
chemical additives
(especially
preservatives
and
artificial
colors
and flavors),
and about
their
consumption
of sugars,
fat, sodium,
and cholesterol.
The study
reported
here, while including
a
small nonrepresentative
sample
of consumers
for comparison
purposes,
focuses
on the
views
of food
and
nutrition
professionals,
both
inside
and
outside
the food
industry,
with
regard
to what
nutrition
information
they
believe
would
be most
useful
to consumers
in improving
their
nutritional
status
and reducing
dietary
health
problems.

701

LABELING

702

HEIMBACH

TABLE
The

AND

most

important

Health

diet-related

health
AIN
members

problem

sponses
response

problemst
Food
,ndustrv

has
of

been
kept
atherosclerosis,

to

minimum.
for example,

was not coded

as cardiovascular
disease,
but was given its own code. Similarly,
excess
consumption
ofsaturated
fat was coded
sep-

Con-

;:

(,

STOKES

arately
from excess
consumption
of fat.
The most serious
diet-related
health
problem, in the opinion
of these groups,
is obesity

Obesity/overweight/excess

75

66

61

calories
Heart/coronary

48

41

47

23
19
15
2

23
22
8
10

27
26
8
3

or excess
caloric
consumption.
Obesity
was
identified
by three-quarters
of AIN members
and
nearly
two-thirds
of the other
respondents
as an important
health
problem
(Table
2). Indeed,
it was listed
first-as
the most

28
24

24
27

24
44

important
single
problem-by
half
of the
respondents
from
AIN and industry
and by
37% of the consumer
panel.
No other
single
problem
was listed
first by even
10% of any
f the three groups.

diseases-to-

tal
Hypertension
Heart

disease

Cardiovascular
disease
Atherosclerosis/arteriosclerosis

Stroke
Diabetes
Excessive
tal
Alcohol

consumption-to-

14

Sugars
Fats
Saturated
fats
Cholesterol
Additives/chemicals

4
3

9
2
4
14

I
22

3
10

2
8

18

22
19

24
23

29
28

others)
pointed
sodium,
which
hypertension,

19
15
I I
5
S

15
18
3
2
I

20
15
13
6
6

consumption
of fats, saturated
fats, or cholesterol
(Table
2). Some
of those
who
cited
overconsumption
of fat, however,
appeared
to be concerned
primarily
with
its caloric
content
rather
than
with possible
cardiovas-

2
2

:
deficien-

cies-total

Iron
Calcium
Other
vitamin/mineral
Unbalanced
diets-total
Generally
unbalanced
diets
Food
faddism
Cancer
Dental
caries
Malnutrition-total
Of the elderly
Of pregnant
women
Of infants
Of other
groups
or general
Allergies/intolerances
Insufficient
consumption
of
fiber
Insufficient
consumption
of
protein
Metabolic
diseases/disorders
Insufficient
consumption
of

5
3

?6
1

9
4

2
1

1
1

1
2

calories

Includes

all

responses

by about
one respondent
in four (23% of AIN
members
and industry
and 27% of the consumer
panel).
These
figures
are probably
underestimates
of concern
with cardiovascular
problems,
however,
since
a number
of respondents

Hypoglycemia
Hyperkinesis/hyperactivity
n
Mean
number
of problems
named
per respondent
a

Ranked
second
to obesity
were heart
and
cardiovascular
diseases,
named
by nearly
50%
of the respondents
in all groups.
Hypertension or high
blood
pressure
alone
was cited

5
4
3

Protein

Fiber
Carbohydrates
Vitamin/mineral

1
531

3.5
given

by 2% or

177

107

3. 1

4.0

more

of any

group.

the average,
respondents
listed
three
to four
problems,
although
some
named
only
one
and a few cited more than 10. These
responses
are shown
in Table
2. Interpretation
of re-

(6%

of AIN

members

to excessive
is thought
and
others

and

15% of

consumption
of
to be related
to
named
excessive

cular
effects.
Diabetes
was named
by 28% of AIN members
and
one-quarter
of others,
placing
it
third
after
obesity
and coronary
disease
in
frequency
of mention.
Overconsumption
of one or more
specific
substances
was named
as a major
national
health
problem
by one-quarter
of the respondents
from
AIN
and the food
industry
and
by nearly
one-half
(44%)
of the consumer
panel
(Table
2). No single
substance
was
consistently
named
as a source
of concern,
although
it is likely
that many
respondents
who are concerned
about
diseases
related
to
overconsumption
named
the disease
rather
than
the substance.
AIN
members
most frequently
expressed
concern
about
alcohol,
sodium,
sugars,
and fats. Industry
respondents
most often
cited overconsumption
of sodium

Downloaded from www.ajcn.org by guest on July 18, 2011

Sodium/salt

NUTRITION

TABLE
Median

3
order

health

problems

of mention

of diet-related

AIN
Health

problem

memhers

Iooil

industry

(onamer
panel

2
2
2
3

2
3

of

2
2
2
2

of satu-

Obesity/overweight/excess

cal-

ones

Heart
disease
Excessive
consumption
Cardiovascular

Excessive

of fat

disease

consumption

sugars

Excessive
rated

consumption
fats

Atherosclerosis/arteriosclerosis

Excessive

consumption

of ad-

consumption

of cho-

diets
consumption

of so-

3
3

2
3

3
3

ditives

Excessive
lesterol

Unbalanced
Excessive
dium/salt

Food

faddism

Hypertension

Malnutrition

of the

elderly

Diabetes

Iron deficiency/underconsumption
of iron
Malnutrition
of pregnant
women
Dental
caries
Excessive
consumption

of alco-

3
3

3
3

3
3

3
3

hol

Malnutrition
of infants
Calcium
deficiency/underconsumption
of calcium
Cancer
Allergic
reactions/intolerances
Vitamin/mineral
deficiencies
other
than iron/calcium
Underconsumption
of fiber
Metabolic
disease/disorders
*

Fewer

than

10 responses:

median

3
4

4
4
4

4
5
5

2
3

4
5

was

not calculated.

Obesity
remains
the most
important
dietrelated
health
problem
in the opinion
of all
groups
of respondents,
whether
the criterion
is total
frequency
of mention,
frequency
of
listing
first
as most
important,
or median
priority
of mention
(Table
3). Coronary
diseases
were generally
mentioned
early
in the
listings
except
for hypertension
which,
although
the most frequently
cited type of cardiovascular
disease,
was
placed
somewhat
lower
in the rankings.
Most types of overconsumption
were given high priority,
especially
that
of fats, saturated
fats, and sugars
(all
with median
=
2 for AIN
members).
Food
faddism
and
unbalanced
diets
appeared
in about
the middle
of the rankings

Downloaded from www.ajcn.org by guest on July 18, 2011

(14%),
followed
by sugars,
fats, and saturated
fats.
The
consumer
panel
named
overconsumption
ofsugars
(25%), sodium
(17%), food
additives
(14%),
and fats (9%).
Micronutrient
(vitamin
or mineral)
deficiencies
were cited by 22% of AIN members
but by less than
10% of others
(Table
2). The
micronutrient
of most widespread
concern
is
iron. Underconsumption
or deficiency
of iron
was named
by 18% of the respondents
from
AIN
and 7% of the food
industry
respondents,
but only
1% of the consumer
panel.
The
second
most
frequently
named
deficiency
was
calcium,
cited
by 7% of AIN
members.
About
5% ofeach
group
mentioned
one or more other
minerals
or vitamins;
however,
no other
single
mineral
or vitamin
deficiency
was named
by even 1% ofany
group.
However,
some
of the concern
about
unbalanced
diets and malnutrition
of certain
populations
is probably
based
on vitamin
and
mineral
deficiencies.
Nearly
one-quarter
of the
respondents
complained
about
unbalanced
diets or food
faddism
without
naming
a specific
deficiency
or
overconsumption
problem;
similarly,
about
10% cited
malnutrition,
usually
of a
specific
group
such
as elderly
or pregnant
women,
again
without
detailing
the exact nature of the malnourishment.
A number
of diseases
or disorders
other
than cardiovascular
disease
and diabetes
were
named
frequently:
cancer
(especially
cancer
of the colon)
by about
20%, dental
caries
by
15%, and allergies,
metabolic
disorders,
and
hypoglycemia
by smaller
numbers
(Table
2).
Because
respondents
had
been
asked
to
name
diet-related
national
health
problems
in order
of importance,
these
orderings
were
examined
by calculating
the median
position
of each problem.
(In order
to assure
a degree
of stability,
medians
were calculated
only for
health
problems
cited by at least
10 respondents.)
Table
3 shows
the health
problems
listed in descending
median
order
of mention
by AIN
members.
Where
more
than
one
health
problem
had
the same
median,
the
mean
(not a wholly
legitimate
statistic
in this
case since
it requires
equal-interval
scaling)
was used strictly
to provide
an objective
basis
for ordering
those
problems
with
the same
median.
The
median
orders
of mention
of
dietary
health
problems
by food industry
respondents
and by the consumer
panel
were
similar
to those of AIN members
(Table
3).

703

LABELING

704

HEIMBACH

AND

(Table
3), while malnutrition
appeared
somewhat further
down.
Specific
vitamin
and mmeral deficiencies
were ranked
quite
low: even
iron deficiency
was not generally
listed above
third
or fourth
position
and deficiencies
in
calcium
or other
minerals
or vitamins
were
even lower
in the rankings.

TABLE
Ratings

4
of utility

to consumers
.

Type

The second
question
provided
a list of 38
types of nutrition
information
(Table
4 shows
the list ordered
by ratings
given
by AIN
members),
asking
respondents
to judge
which
specific
nutrition
information
you

MN
members

Food
industry

55
53

92
70
73
76
54
52
70
37
40
44
41
35
39

55
55

that
that

is fiber
is sugars

Vitamin

53

44

Vitamin

Vitamin

52
46
46
45
43
43
41
37
35
34
34
30
29
28
22
20
19
17
17
15
13
12
12
11
42.5
531

40
37
39
39
38
27
30
30
21
16
9
10
24
11
11
13
9
7
7
5
4
7
6
6
31.9
177

Thiamine
Riboflavin
Niacin

Amount
Vitamin
Vitamin
Iodine
Phosphorus
Folacin
Zinc

of carbohydrate
B
B,2

E
Magnesium
Pantothenic
Vitamin
K
Copper
Manganese
Biotin
Selenium
Chromium
Choline/lecithin
Molybdenum
Inositol
Mean
rating
n

that

is starches

Vitamin

Rating

or dont

From

1: From
separate
mediur

Not

acid

score
scores

know

based
enough

on
=

the

following

weighting:

very

Consumer
panel

94
81
80
78
70
67
62
56
53

(salt)

Carbohydrates
Polyunsaturated
fat (%)
Saturated
fat (%)
Cholesterol
Potassium
Amount
ofcarbohydrate
Amount
of carbohydrate

information

information*

of information

Nutrition

useful

Consumers
.
in I978t

95
95
88
87
75
72
80
76
77
80
67
64
70
67
61
57
53
55
53
54
56
57
46
29
25
31
48
35
28
37
24
28
22
22
20
24
20
19
52.6
107
100,

of

some

MN
tn I9704
.

87
73
77
81
74
64
72
64
63
74
47
58
75
78
63
62
40
30
36
65
50
58
47
28
12
25
52
23
14
36
17
16
10
9
10
25
10
9
45.6
884
use

50,

of

74
55
69
81
70
68
48
1

Downloaded from www.ajcn.org by guest on July 18, 2011

Calories
Sodium
Fat
Protein
Iron
Calcium

of nutrition

STOKES

35

70
71
62
58
54
49
37
38
47
35
34
27
24

NA
824
little

or no use

0.

Heimbach
and Stokes
(6).
Call and Hayes
(9). Rating
scores
percent
saturated
and
polyunsaturated
priority
=
50, low priority
=
0.
applicable.

for

the 22 types
of information
fats)
based
on the following

(including
weighting:

fatty
acids
rather
high
priority

than
100,

NUTRITION

705

presented
in Table
4. AIN members
gave the
highest
rating
to information
about
calorie
content.
The
rating
of 94 indicates
nearly
universal
judgment
of calorie
information
as
very
useful.
Sodium,
fat, and protein
received
scores
of about
80, followed
by information
about
iron,
calcium,
and
carbohydrates,
all rated
above
60. Nutrient
data
judged
to be of medium
utility,
receiving
scores
in the 50s, included
percentages
of
polyunsaturated
and saturated
fats, cholesterol, potassium,
fiber, sugars,
vitamin
C, and
vitamin
A. Information
about
the other
23
nutrients
was judged
to be relatively
less useful to consumers.
Although
the ratings
given
by the food
industry
correlated
highly
with those
offered
by AIN
members
(r = 0.964),
their
absolute
value was considerably
lower (p < 0.01), with
the mean
rating
score being
3 1.9 versus
42.5
for nutritionists
(Table
4). The
consumer
panels
ratings
were
the highest
(p < 0.01),
with a mean
of 52.6 and no ratings
below
19,
but correlated
highly
with those ofAIN
members (r = 0.965)
and industry
respondents
(r
=

0.947).

Arbitrarily
defining
notably
higher
as 15
points
higher
(all cited differences
are statistically
significant
at p < 0.01), AIN members
ratings
were
notably
higher
than
those
of
food industry
respondents
for iron, calcium,
polyunsaturated
fat, fiber,
starch,
phosphofiGs, folacin,
zinc, and magnesium;
they were
never
notably
lower
(Table
4).
Using
the same
15-point
criterion,
the ratings given by consumers
in 1978 were notably
higher
than
AIN
members
current
ratings
for cholesterol,
sugars,
starch,
and vitamins
C, D, B12, E, and K, and notably
lower
for
riboflavin
and folacin
(Table
4). These
differences
(all statistically
significant
at p <
0.01) are probably
attributable
in part to the
relative
lack
of sophistication
in nutrition
science
among
consumers.
There
has been a
great deal of media
attention
given
to cholesterol
and
sugar,
and consumers
have
long
been
interested
in vitamins.
Riboflavin
and
folacin,
however,
are terms
unfamiliar
to
many
consumers:
of those
who were
interviewed
in 1978, 72% admitted
that they were
not familiar
with folacin
and 40% with riboflavin
(6).

Downloaded from www.ajcn.org by guest on July 18, 2011

think
consumers
should
pay attention
to or
would
find
helpful
on food
packages.
For
each
nutrient,
indicate
whether
you
think
information
about
it is very useful,
of some
use, or of little or no use to consumers
in
maintaining
or improving
their
nutritional
status
and health
or in helping
them
reduce
or eliminate
health
problems.
In order
to
simplify
presentation
and
interpretation
of
the responses,
they were converted
to rating
scores.
Responses
of very useful
were given
a score
of 100, of some
use was scored
as
50, and of little or no use and dont
know
enough
were scored
as 0. The rating
score is
then
the mean
of the responses,
and has a
theoretical
range
of 0 (if no one indicated
that the information
would
be at all useful)
to 100 (if everyone
considered
it very
useful).
Data
from
two other
sources
have
been
included
for comparison.
In 1970, Call and
Hayes
(9) conducted
a mail survey
of AIN
members,
receiving
824 returns.
They
presented
a similar
but shorter
list (which
did
not include
types ofcarbohydrates
or as many
vitamins
and minerals),
asking
respondents
to set each nutrients
priority
for label space
as high,
medium,
or low.
Although
this scale is not identical
to that used in the
present
study,
it is sufficiently
similar
that
calculation
of rating
scores
(using
high
priority
=
100, medium
priority
=
50, and
low priority
=
0) for comparison
purposes
may be legitimate.
The acceptability
of this
comparison
can be estimated
by comparing
the mean
and SD ofCall
and Hayes
rescored
data to current
AIN data for the 22 nutrients
rated
both
times
to determine
whether
they
appear
to share
a common
metric.
The mean
and standard
deviation
of the 1970 data
are
3( = 52.5 and SD = 16.25 versus
=
53.0 and
SD = 18.23 for the current
data.
This correspondence
indicates
sufficient
similarity
of
metric
to allow
legitimate
comparison.
A second
source
of comparison
data is the
FDA
1978 Consumer
Food
Labeling
Survey
(6), which
asked
the usefulness
of information
about
the same
38 nutrients
of a national
probability
sample
of 884 primary
food
shoppers
(the person
in the household
who
does most of the food shopping)
who claimed
to note nutrition
information.
These
data are

LABELING

706

HEIMBACH

STOKES

most useful
and list them
in order
of usefulness.
The responses
to this question
paralleled
the ratings
given
in the previous
question:
the
product-moment
correlation
between
the rating
of the usefulness
of each
nutrient
and its frequency
of inclusion
as one
of the most useful
seven types of information
was over 0.80 for each group.
The median
rank order
of listing
was calculated
for each type of information
cited by
10 or more
respondents
(Table
5). Calorie
content
was most often
listed
first, followed
by protein,
fat, carbohydrates,
and
sugars.
Sodium
generally
appeared
later in the listings than might
have been anticipated
by its
frequency
of inclusion
or its rated
usefulness.
Members
of AIN
showed
a clear
pattern
of
listing
macronutrient
data as the most useful
information,
followed
by vitamins
and min
erals.
All macronutrients
(except
polyunsaturated
fat) had median
positions
of fourth
or
less, while
the median
positions
of micronutrient
data
were invariably
fifth or lower.
A

TABLE

5
Median
order
of mention
most useful
types of
nutrient
information
Type

of information

Calories

Protein
Fat
Carbohydrates
Sugars
Starch
Polyunsaturated/saturated
fat ratiof
Fiber
Cholesterol
Saturated
fats
Vitaminst

Sodium
(salt)
Polyunsaturated
Vitamin

fats

Iron
Calcium
Mineralst
Potassium
Vitamin

Folacin
Vitamin

of the

seven

AIN
members

Food
industry

Consumer
panel

1
2
3
3

1
2
4
3

1
2
4
3

3
4

5
5
5
5
5
5
5
5
5
5

5
5
4
5
5
5

4
4
5

5
6
*

6
6
6
5
*

6
6
6
6
6

Zinc
Riboflavin
Thiamine
Iodine
*

Fewer

Nonprecoded

than

10 responses:
response.

median

was

not calculated.

Downloaded from www.ajcn.org by guest on July 18, 2011

The correspondence
between
major
health
problems
and the nutrition
information
seen
as most
important
can hardly
escape
notice.
Obesity
was listed
as the number
one health
problem
(Table
2) and calorie
content
was
seen as the most useful
nutrition
information
(Table
4). Sodium
content
was rated
as very
useful
information,
corresponding
to the perceived
severity
of hypertension
as a public
health
problem.
Iron
and calcium
both
appeared
high
in the ratings,
far ahead
of the
other
micronutrients,
as would
be expected
from the perceived
importance,
on a national
scale, of deficiencies
in iron and calcium
versus other
minerals
and vitamins.
Information
on total fats, fatty acids,
and cholesterol
was
rated
as very useful,
most likely
due to the
possible
link of these substances
with cardiovascular
diseases.
Information
about
protein
content
does
not appear
to be as closely
related
to major
public
health
problems
as are
the preceding,
but significant
numbers
of respondents
(Table
2) expressed
concern
about
malnutrition
and
unbalanced
diets,
which
may
include
underconsumption
of protein,
while
others
cited
excessive
consumption
of
protein
as a problem.
It is apparent
that the nutrition
information
seen as most useful
relates
to overconsumed
rather
than
underconsumed
nutrients,
ie,
those
that people
might
target
for reductions
in consumption.
Protein,
iron,
and calcium
were
the only
clear
exceptions
among
AIN
members
10 highest
rated
types
of information (the position
ofpolyunsaturated
fat being
somewhat
ambiguous).
On the other
hand,
all of the vitamins
and all minerals
except
iron, calcium,
and potassium
were among
the
25 lowest
rated
types
of information.
It is of interest
to compare
AIN members
current
ratings
with those
of 1970 (Table
4).
There
have
been
notable
(15-point)
increases
in the rated
value
of information
about
calories,
sodium,
and cholesterol
and
decreases
for vitamins
C, A, and D (all differences
are significant
at p < 0.01).
Ratings
of iron and calcium,
among
others,
have not
changed
significantly;
thus,
these
decreases
appear
to reflect
lower
concern
specifically
about
vitamins
C, A, and D rather
than with
vitamins
and minerals
in general.
The
next
question
asked
respondents
to
pick the seven types of information
from the
previous
question
which
you
consider
the

AND

NUTRITION

LABELING

TABLE

Suggestions

for revising

the

food

label*
AIN

Comment

Food
.
industry

members

Consumer
panel

36
10

49
16

31
9

7
4

12
6

9
6

4
13

2
22

3
20

14
6
3

17
13
6

4
1
1

195
37

101
57

Simplify
food labels-total
Limit
amount
of information
Use basic food groups
Do not list micronutrients
Use graphs/symbols
Other simplification
ideas
More
consumer
education
Keep
costs in mind
Have
book in store with
details

n
Percent

of sample

respond-

35
33

Percentages

are

based

on the

number

of respondents

who provided
suggestions;
includes
by 5% or more of any group.

all suggestions

similar

by

spondents

pattern
and

was
the

shown
consumer

industry

made

re-

panel.

Comments
Finally,
respondents
were
asked
for any
comments
which
might
be helpful
in revising the food label.
The most frequently
offered
comment,
by all three
groups,
was
simplify,
while
the second
most
frequent
comment
was to provide
more consumer
education
related
to labeling
(Table
6).
Conclusions
There
was
remarkable
similarity
in the
opinions
of the three
groups
surveyed
as to
what information
should
be available
on the
nutrition
label.
This indicates
that the belief
that
there
is widespread
disagreement
and
controversy
on basic nutrition
matters
is not
entirely
true.
Furthermore,
types
of information
recommended
were
generally
consistent
with
perceptions
of the major
dietrelated
public
health
problems.
Top
priority
nutrition
information
included:
calories,
sodium,
protein,
total
carbohydrates,
total
fat, iron,
and calcium.
A
lower priority
was placed
on cholesterol,
fatty
acids
(polyunsaturated
and
saturated
fats),
potassium,
sugars,
fiber,
vitamin
A, and vitamin
C. Information
about
other
nutrients

was seen
as useful
in varying
degrees,
but
definitely
less so than the foregoing.
In the first group
the seven nutrients
about
which
information
is most
useful
to consumers
in the opinion
of AIN
members
and
the food industry
are listed.
It also includes
the top five (and the eighth
and ninth
rated)
according
to the consumer
panel
and all but
one (vitamin
C) of the highest
ratings
given
by consumers
interviewed
in 1978 (6).
The second
group
of seven
nutrients
again
corresponds
with the highest
usefulness
ratings given
by members
of AIN.
Respondents
from
industry
gave
high
ratings
to all but
fiber.
The two lists together
include
the 14
most
highly
rated
types
of information
according
to the consumer
panel
and 12 of the
14 nutrients
that were most highly
rated
by
consumers
in the 1978 survey
(6). (The other
two were
starch
and vitamin
D, both
rated
above
potassium
and fiber.)
Making
the label clear and understandable
is a priority
concern.
The label
information
seen
as the most
useful
is that
related
to
known
public
health
problems,
and there
appears to be recognition
of the fact that, where
information
is concerned,
more
is not always
better.
Information
about
nutrients,
such
as
the B-vitamins,
not perceived
as being related
to widespread
overconsumption
or deficiency
problems
was rated
as less useful
than information
seen as more
congruent
with public
health
needs.
It is important
to note the distinction
between
the value
or importance
of a nutrient
itself and that of information
about
that nutrient.
The fact that a nutrient
may be essential for good
health
does
not automatically
mean
that information
about
it deserves
high
priority.
For example,
the results
of a deficiency
of pantothenic
acid have
been
fairly
well documented,
but, unless
artificially
induced,
such
a deficiency
is virtually
unknown.
Thus,
information
about
pantothenic
acid content
would
be of little value
to consumers.
Although
less clear-cut,
the case may
be similar
with
some
of the other
vitamins
and many
minerals,
as the respondents
implied
in assigning
low usefulness
ratings
to
information
about
them.
It is recognized
that nutrition
labeling
may,
by emphasizing
the nutritional
quality
of
foods
to consumers
and to the food industry,
lead
to changes
in the food
supply
which
benefit
all consumers
regardless
of whether

Downloaded from www.ajcn.org by guest on July 18, 2011

ing

707

708

HEIMBACH

AND

References
1. White
House
Conference
on Food,
Nutrition,
and
Health.
Final
Report.
Washington,
DC: US Government
Printing
Office,
1970:121.
2. Federal
Register
1972:37:6493.
3. Federal
Register
1973:38:6950.
4. Schucker
RE. A surveillance
of nutrition
labeling
in
the retail
packaged
food supply.
Washington,
DC:
Food
and Drug
Administration,
1978.
5. Stewart
ML.
Food
label
and
package
surveillance
program:
comparison
of 1976 with
1978. Washington, DC: Food
and Drug
Administration,
1981.
6. Heimbach
JT, Stokes
RC. FDA
1978 consumer
food
labeling
survey.
Washington,
DC: Food and Drug
Administration,
1979.
7. Heimbach
JT. Yesterday,
today,
and tomorrow:
consumer
perceptions
of food safety.
Report
no 2 of the
FDA 1980 survey
of consumers.
Washington,
DC:
Food
and Drug
Administration,
1981.
8. Scott WA. Reliability
ofcontent
analysis:
the case of
nominal
scale
coding.
Public
Opinion
Q
1955; 19:321-5.

9. Call
DL,
Hayes
nutrient
labeling
1970:23:1347-52.

MG.
of

Reactions
foods.

of
Am

nutritionists
J Clin

to
Nutr

Downloaded from www.ajcn.org by guest on July 18, 2011

or not they
read
the label.
Nevertheless,
if
people
cannot
understand
and use the information
on the food label, it is not fulfilling
its
potential.
Through
education
it may be possible to teach
people
to understand
and use
the most essential
nutrition
information,
but
the difficulty
of any such effort
is magnified
if the label
itself
is not well designed.
This
means
that label
information
must
be carefully
selected
to avoid
overwhelming
consumers
with more information
than they want
or need, and the information
that is presented
must
be given
in the clearest
and simplest
manner
possible.
Nothing
has happened
in
the last decade
to require
change
in Call and
Hayes
(8) final
sentence
(emphasis
added):
The
success
of [a nutrient
information]
project would
depend
upon
a good
nutrition
education
program
for the consumer
and minimal label
information
in a simple,
uniform
style.

STOKES