1. Nutrition Labelling and Management of Diabetes Mellitus

2. Diabetes Mellitus A metabolic disorder
People with diabetes have either deficiency or resistance to insulin, a hormone produced by the pancreas. As a result, it affects the use of glucose in their bodies.
Uncontrolled diabetes can lead to severe complications, such as retinopathy, heart diseases, renal failure, and stroke.

3. Dietary Management of Diabetes
Dietary management and appropriate amount of physical activity play important roles in diabetic control
Balanced diet with a variety of foods
“3 Low, 1 High” principle, i.e. low fat, low sodium (or salt), low sugars and high fibre
Reduce intake of saturated fat, trans fat and sodium can lower the risk of developing heart diseases and hypertension
Controlling intake of energy for the purpose of weight reduction or maintenance.

4. Dietary Management of Diabetes
Apart from general healthy eating advice, people with diabetes need to be aware of their daily intake of carbohydrates, including sugars.
The amount of foods, particularly carbohydrates (including sugars), eaten by people with diabetes during mealtime should be matched with their diabetic conditions, medications and daily living needs, and kept consistent on a day-to-day basis for stabilizing blood glucose level.
People with diabetes should discuss their diabetic meal plans with a dietitian or healthcare professional, then make use of nutrition labels for choosing appropriate pre-packaged foods. A person with diabetes should not follow other people’s meal plans.

5. What Kinds of Food Contain Carbohydrates?
Cereals (Starch)
Root vegetables (Starch)
Legumes (Starch)
Dairy (Lactose)
Fruits (Fructose)
Sugars and Sugary food (Sucrose)

6. Diabetes and Nutrition Labelling
Using nutrition label can help people with diabetes to understand and find out the carbohydrates contents (including sugars) in food products for meeting the needs of the personal meal plan.

7. Read and Use Nutrition Labels

8. Examples of Recommended Format of Nutrition Label
Tabular format 1 7
Regarding the format of nutrition label, the new legislation requires that nutrition information must be presented in tabular format and the nutrition label must be placed in a conspicuous place on the prepackaged food.
Regardless of the size and/or format of the nutrition label, an appropriate heading is needed. It is recommended that heading, such as “Nutrition Label”, “Nutrition Information” or “Nutrition Facts” be displayed.
Furthermore, it is suggested that the terms “per 100g”, “per 100mL”, “per package” or “per serving” be placed at the appropriate position in the nutrition label.
There are no legal requirements on the order of nutrients. The suggested order is shown in the recommended formats in the slide.
Nutrition label can be written in the English language, the Chinese language or in both languages.

9. Examples of Recommended Format of Nutrition Label
Linear format
(for small packages with total surface area of less than 200 cm2)

10. Required Nutrients on Nutrition Labels
1+7 (energy plus seven nutrients specified for labelling) – i.e. energy, protein, total fat, saturated fat, trans fat, carbohydrates, sugars and sodium.
Nutrient(s) involved in nutrition claim(s) (when the nutrition claim is on any type of fat, the amount of cholesterol must be declared as well).
For other nutrients, declaration is voluntary
The amount of carbohydrates can be declared as “available carbohydrates” or “total carbohydrates”. However, if declared as “total carbohydrates”, the dietary fibre content must be declared as well.
When the nutrition claim is on any type of fat, the amount of cholesterol must be declared as well.
e.g. “fat free”, “low saturated fat”, “trans fat free” claims.
For detailed conditions, please refer to the Food and Drugs (Composition and Labelling)(Amendment: Requirements for Nutrition Labelling and Nutrition Claim) Regulation 2008 or Technical Guidance Notes on Nutrition Labelling and Nutrition Claims:

11. Making Use of Nutrition Label
Consumers can:
Compare the nutritional content among different foods for a healthier choice, e.g. choose food that is lower in fat, sodium (or salt) and sugars
Understand the nutritional content of food and estimate their contribution to the overall diet
To meet individual’s dietary needs

12. Three Simple Steps to Read Nutrition Label

13. Three Simple Steps to Read Nutrition Label
Take note of the reference amount of food being used in the nutrition label
Step 2 
Read the energy and nutrient content together with the reference amount
Step 3 
Refer to the percentage Nutrient Reference Value (%NRV), if available, to see if the food contains a lot or a little of energy or a nutrient in the food

14. Expressed as per 100 g (or per 100 mL) of food
Step 1: Take note of the reference amount of food being used in the nutrition label
Expressed as per 100 g (or per 100 mL) of food
It is a common way of which energy and nutrient values are expressed as per 100 g/mL.
Per 100 g is usually for solid food while per 100 mL is usually for liquid food.
For example, as shown in the figure, 100 g of the product contains 436 kcal of energy, 11 g of protein, 16 g of total fat, and so on.

15. Step 1: Take note of the reference amount of food being used in the nutrition label
Expressed as per serving (the serving size (in g or mL) and the no. of servings must be specified on the package)
It reflects the energy and nutrient content of a specified amount (which is called the serving size) of food.
Serving size is the amount of food people customarily consume per eating occasion. The serving size is determined by the manufacturer.
It is expressed in metric measurements such as gram (g) or millilitre (mL). Sometimes, it may also be expressed in units such as pieces, cups, tablespoons, teaspoons etc. as shown in the figure.
Besides noting the serving size, you may also find the number of servings in a package. The figure shows that there are 3 servings of biscuits in a package, each serving consists of 5 pieces and each piece weighs about 10 g on average. The whole package contains 15 pieces of biscuits.

16. Step 1: Take note of the reference amount of food being used in the nutrition label
Expressed as per package (if the package contains only a single serving )
For package that only contains a single serving of food (i.e. people usually eat or drink the whole pacakge in one occasion, for example, a carton of 236mL-milk), the amount of energy and nutrients may be expressed as per package.

17. Use nutrition label to compare between products
Step 2: Read the energy and nutrient content together with the reference amount
Use nutrition label to compare between products
Use nutrition label to calculate the amount of energy and nutrients you get from food

18. Step 2A: Use nutrition label to compare between products
Products with nutritional content expresssed in the SAME reference amount
(Partial) Nutrition label of Brand A biscuit
(Partial) Nutrition label of Brand C biscuit
Nutritional content of both products is expressed as per 100 g of food, therefore, their energy and nutrient values can be compared directly.
If reference amount is the SAME, you CAN COMPARE between the products DIRECTLY

19. Step 2A: Use nutrition label to compare between products
Products with nutritional content expresssed in DIFFERENT reference amounts
(Partial) Nutrition label of Brand A biscuit
(Partial) Nutrition label of Brand D biscuit
The nutritional content of the two products are expressed in different reference amounts of food (50 g and 35.5 g respectively), therefore, their energy and nutrient values cannot be compared directly.
You have to first convert the nutritional content values basing on the same reference amount (e.g. 100 g of food).
If reference amounts are DIFFERENT, you CANNOT COMPARE between the products DIRECTLY

20. Step 2A: Use nutrition label to compare between products
Products with nutritional content expresssed in DIFFERENT reference amounts
After conversion: Basing on 100 g of biscuits, the difference in total fat content between the two brands of biscuit is about 4 g. You should choose Brand A biscuit if you want to get less fat.

21. The more you eat, the more you get
Step 2B: Use nutrition label to calculate the amount of energy and nutrients you get from food
The more you eat, the more you get
If you eat 1 serving of biscuit
Get 8 g of fat, 3.5 g of saturated fat
If you eat 2 servings of biscuit
Get 16 g of fat, 7 g of saturated fat

22. Step 2B: Use nutrition label to calculate the amount of energy and nutrients you get from food
Energy and nutrient content expressed as per 100 g/mL

23. %NRV is usually on a scale from 0% to 100%.
Step 3: Refer to the percentage Nutrient Reference Value (%NRV), if available, to see if the food contains a lot or a little of energy or a nutrient in the food
%NRV is usually on a scale from 0% to 100%.
In addition to showing the exact amount of energy and nutrients, the energy and nutrient values may also be voluntarily expressed in a relative presentation (i.e. the percentage of a reference value which is called the nutrient reference value). The percentage Nutrient Reference Value (%NRV) is usually on a scale from 0% to 100%.
Nutrient Reference Value (NRV) is derived for nutrition labelling purposes making reference to the recommended intake levels of various nutrients. It is based on a 2000-kcal diet. The set of Chinese NRVs are more applicable for people in Hong Kong and the Mainland because they are derived for Chinese.
There are food products available which are imported from other overseas countries. Instead of using %Chinese NRVs, these products may use different reference values, such as %Daily Value (%DV) adopted in the US and Canada , or %Daily Intake (%DI) in Australia .
Note:
When referring to %NRV, you should also take note of the reference amount of food. As shown in the figure, the nutritional content and the %NRV are expressed as per package of the product, whereas in other products they may be expressed as per 100 g or per serving.
Further information:
For further information on Chinese NRV, please refer to the Annex of the booklet “How to Read Nutrition Label”.
For further information on %Daily Value (%DV), please refer to the following webpage of the US Food and Drug Administration:
For further information on %Daily Intake (%DI), please refer to the following webpage of Food Standards Australia New Zealand:

24. For nutrients that needed to limit their intake
Step 3: Refer to the percentage Nutrient Reference Value (%NRV), if available, to see if the food contains a lot or a little of energy or a nutrient in the food
For nutrients that needed to limit their intake
E.g. total fat, saturated fat, sodium and sugars
Look for foods that have lower %NRV
Get enough of nutrients that are good for health
E.g. dietary fibre
Look for foods that have higher %NRV
A high %NRV means the food contains a lot of a nutrient whereas a low %NRV means it contains just a little.
Note:
When using the information on nutrition labels, besides referring to the percentage, the best practice is to check the actual nutritional content whenever they are available to get a nutritional overview of the product and make healthy food choices.

25. Use Nutrition Label to Choose Healthy Food

26. Physical fitness cannot do without a balanced diet
Physical fitness cannot do without a balanced diet. Follow the "Food Pyramid" guide as you pick your food. Cereals should be taken as the major dietary source. The more vegetables, squashes and fruit, the better. Keep the consumption of meat, eggs, bean and dairy products and calcium food to an appropriate level. Reduce salt, oil and sugar.
(Source of information: Department of Health)

27. Principles of Healthy Eating
Choose a variety of food and eat cereals as the largest portion of food in every meal.
Eat a lot of vegetables and fruit.
Reduce the consumption of foodstuffs with high salt, fat and sugar content as well as those which are preserved.
A daily fluid intake of 6 to 8 glasses (including clear soup, fruit juice and tea).
Take meals regularly and in adequate amounts.
(Source of information: Department of Health)

28. Nutrition Labelling is a Useful Tool for Practising Healthy Eating
Nutrition label and nutrition claim can help consumers choose healthier food in accordance with healthy eating principles and the Food Pyramid, e.g.
Choose biscuits lower in fat and sodium (or salt)
Choose dairy products lower in fat
Choose beverages lower in sugars

29. How to Choose Prepackaged Food for People with Diabetes?

30. Choosing Prepackaged Foods for People with Diabetes
Find out the contents of carbohydrates (including sugars)
“3 Low, 1 High” dietary principle
Reduce intake of saturated fat and trans fat

31. Choosing Prepackaged Foods for People with Diabetes
Take note of relevant nutrition claim as a quick screening tool; and
Take three simple steps to read nutrition label
Note:
To choose healthier prepackaged food, one easy way is to look for the related claims. However, some manufacturers may choose not to use nutrition claims even though their products have met relevant specified conditions. A product without nutrition claims should not be perceived as inferior to others. Therefore, nutrition claims should only be used as a screening tool.
Regardless of the types of nutrition claim that may appear on the package, they only give a rough idea about the content of a particular nutrient, one should not make a food choice solely on the basis of a nutrition claim. Moreover, very often nutrition claims are made for a specific nutrient only. In order to eat healthily, we should take note of other nutrients as well.
For example, a product with a “low sugars” claim may have high fat content.
The best practice is to refer to the nutrition label for detailed information.

32. Choosing Prepackaged Foods for People with Diabetes
Pay attention to nutrition claims, for example –
“Sugars free” does not mean that the product does not contain sugars or carbohydrates (e.g. prepackaged sugars free moon cake)
“No added sugars” means that sugars or ingredients that contain sugars for sweetening purpose are not added during the food production process. The product may still contain sugars that are naturally present. (e.g. prepackaged pure fruit juice)
“Less sweet” means lower sweet intensity. Sweetness is a taste which is a subjective experience. Statements on sweetness may not be directly related to its sugars content. Therefore, a product with the “less sweet” claim does not necessarily mean that the product has low or no sugars.

33. Choosing Prepackaged Foods for People with Diabetes
Nutrition claim only gives a rough idea about the content of a particular nutrient, one should not make a food choice solely on the basis of a nutrition claim. In order to eat healthily, we should take note of other nutrients as well. For example, when buying a product with a “low sugars” claim, one should take note of the content of fat and other nutrients.

34. Choosing Prepackaged Foods for People with Diabetes
Nutrient content claims on sugars are classified into “Free” and “Low” claims.
Specific Conditions of Nutrient Content Claims –
Claim：
Free; No; Zero; Without; Does not contain
Low; Little; Low source; Few; Contains a small amount of
Meaning of Claim :
Insignificant amount of a particular nutrient found in the food
A small amount of nutrient found in the food
Example: Sugars free
(Contain not more than 0.5g of sugars per 100g/mL of food)
Example: Low sugars
(Contain not more than 5g of sugars per 100g/mL of food)

35. Choosing Prepackaged Foods for People with Diabetes
Three Simple Steps to Read Nutrition Label
Step 1 
Take note of the reference amount of food being used in the nutrition label
Step 2 
Read and compare the nutritional content
After selecting the food that is healthier, people with diabetes should calculate the intake amount of carbohydrates, so that they can calculate the intake amount of other foods in the day
Step 3 
Refer to the percentage Nutrient Reference Value (%NRV) (If available)
Step 1 
Take note of the reference amount of food being used in the nutrition label
Comparison should be made basing on the same reference amount.
e.g. per 100 g vs per 100 g, per 50-gram serving vs per 50-gram serving, but not per 100 g vs per 50-gram serving.
Step 2 
Read and compare the nutritional content
Based on the same reference amount of food, consumers can make comparison among the content of fat, sugars, sodium (i.e., “3 Low”), and the combined amount of saturated fat and trans fat of various products. Then choose the one that is lower in these nutrients.
If weight maintenance is required, consumers can also make comparison among the content of energy. Then choose the one that is lower in energy.
After selecting the food that is healthier, people with diabetes should calculate the intake amount of carbohydrates, so that they can calculate the intake amounts of other foods in the day.
Step 3 
Refer to the percentage Nutrient Reference Value (%NRV) (If available)
In case the %NRV of saturated fat or sodium is at the high-end (if weight maintenance is required, also take note of the %NRV of energy and fat), think twice before making the purchase of that particular food product as it is very likely that the food may contribute a great proportion of your daily allowances of these nutrients.

36. Choosing Prepackaged Foods for People with Diabetes (Example 1)
Milk Beverage A
Milk Beverage B
Based on the same reference amount of food, consumers can make comparison among the content of total fat, sugars, sodium (i.e., “3 Low”), and the combined amount of saturated fat and trans fat of various products. Then choose the one that is lower in these nutrients. If weight maintenance is required, consumers can also make comparison among the content of energy. Then choose the one that is lower in energy.
After selecting the food that is healthier, people with diabetes should calculate the intake amount of carbohydrates, so that they can calculate the intake amounts of other foods in the day.
Milk Beverage A and B have comparable amount of carbohydrates and sugars.
Milk Beverage B is a better choice as it has much less energy, total fat, saturated fat and trans fat in each package (i.e. 236 mL). Because each carton of Milk Beverage B contains 12g of carbohydrate, if people with diabetes consume one carton of Milk Beverage B, they have intake 12g of carbohydrates.

37. Choosing Prepackaged Foods for People with Diabetes (Example 2)
Corn Flakes C
Corn Flakes D
Based on the same reference amount of food, consumers can make comparison among the content of total fat, sugars, sodium (i.e., “3 Low”), and the combined amount of saturated fat and trans fat of various products. Then choose the one that is lower in these nutrients. If weight maintenance is required, consumers can also make comparison among the content of energy. Then choose the one that is lower in energy.
After selecting the food that is healthier, people with diabetes should calculate the intake amount of carbohydrates, so that they can calculate the intake amounts of other foods in the day.
Corn Flakes C is a better choice as it has much less sugars and less sodium in each 100g. Because ½ bowl of Corn Flakes weighs approximately 25g and contains 21.5g of carbohydrates, if people with diabetes consume ½ bowl of Corn Flakes C, they have intake 21.5g of carbohydrates.

38. Choosing Prepackaged Foods for People with Diabetes (Example 3)
Soup E
Soup F
Based on the same reference amount of food, consumers can make comparison among the content of total fat, sugars, sodium (i.e., “3 Low”), and the combined amount of saturated fat and trans fat of various products. Then choose the one that is lower in these nutrients. If weight maintenance is required, consumers can also make comparison among the content of energy. Then choose the one that is lower in energy.
After selecting the food that is healthier, people with diabetes should calculate the intake amount of carbohydrates, so that they can calculate the intake amounts of other foods in the day.
Soup E and Soup F have small differences in the amount of carbohydrates and sugars.
Soup F is a better choice as it has much less total fat and saturated fat and less energy and sodium in each serving (i.e. 200g). Because each serving of Soup F (i.e. 200g) contains 13.4g of carbohydrates, if people with diabetes consume one serving of Soup F, they have intake 13.4g of carbohydrates.

39. ENDS