1. Nutrition Labelling and the Elderly

2. Problems of the Elderly
Bodily function changes along with ageing.
Eating problems can result in an imbalanced diet that may subsequently affect nutritional status.
Increased risk of developing chronic diseases such as diabetes, high blood pressure and heart diseases.
Other common problems among the elderly, e.g.
Osteoporosis
Constipation

3. Osteoporosis Osteoporosis is a metabolic disease of bone.
It leads to a reduction in bone density, and the affected bones become thinner and are more likely to break (fracture).
It may result in pain and other complications, including loss of independence.
(Source of information: Department of Health)

4. Osteoporosis
As it is necessary to build strong and healthy bones starting at an early age, everyone should maintain balanced diet and perform regular exercise over a lifetime to avoid osteoporosis later in life.
Balanced diet
Eat calcium-rich foods
Ensure adequate vitamin D intake
Avoid salty (high sodium) food which affects calcium absorption
Eat calcium-rich foods, e.g.:
Dairy products such as milk, yogurt, and cheese (low-fat milk and skimmed milk contain less saturated fat and are healthier choices)
Seafood eaten with bones or shells, such as whitebait, dried silver fish and dried shrimps
Soya bean products such as tofu, fortified soy milk, soy chicken, beancurd stick and beancurd sheet
Dark green leafy vegetables, e.g. white cabbage, broccoli and Chinese flowering cabbage
Nuts, e.g. almond and sesame
Ensure adequate vitamin D intake
E.g. egg yolk and fortified milk
Perform outdoor activities to absorb sunlight which will help the body to produce more vitamin D in order to enhance the absorption of calcium. Beware of sunburn.
Avoid salty (high sodium) food which affects calcium absorption
E.g. salted fish and soy sauce
(Source of information: Department of Health)

5. Constipation
If the faeces are very hard or if there is great difficulty in passing it out, then it is constipation.
Peristalsis of the intestine in the elderly is usually weakened, hence they are more prone to constipation.
Inadequate water or lack of fibre in food leads to hard faeces.
(Source of information: Department of Health)

6. Constipation Eating tips Take a high fibre diet
Drink adequate fluid like water, soup and fruit juice.
Exercise everyday can help increase peristaltic movement of the bowel; be relaxed.
Take a high fibre diet
Eat two servings of fruits (e.g. orange, water melon) and vegetable (more than 240 gram) everyday.
Choose high fibre cereals such as whole wheat bread, oatmeal and whole grain rice.
(Source of information: Department of Health)

7. Nutrition Labelling and the Elderly
The use of nutrition labelling can help the elderly and their carers choose suitable foods

8. Read and Use Nutrition Labels

9. 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.

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

11. 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:

12. Making Use of Nutrition Label
Consumers can:
Compare the nutritional content among different foods for a healthier choice, e.g. to 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.

13. Three Simple Steps to Read Nutrition Label

14. 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

15. 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.

16. 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.

17. 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.

18. 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

19. 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

20. 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

21. 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.

22. 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

23. Energy and nutrient content expressed as per 100 g/mL
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

24. %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:

25. 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.

26. Use Nutrition Label to Choose Prepackaged Food Suitable for the Elderly

27. Healthy Eating - Food Pyramid
Variety in food choices enables us to enjoy different tastes and helps to ensure health and adequate nutrition. A balanced diet should include correct proportions of different food groups. The best way to do so is to follow the food pyramid.
Food groups
Eat the most
bread, cereal, rice, and pasta group: Food from grains such as bread, cereal, rice, and pasta are the foundation of a healthy diet. We should avoid eating high-fat foods such as fried rice, fried noodles, or instant noodles which may lead to ingestion of excessive calories and cause weight gain. Whole grain food such as whole wheat bread and oatmeal are higher in dietary fibre and nutrient contents than refined grain foods such as white bread and white rice. On average we need about 3 to 5 bowls of rice (1 bowl of rice = 2 slices of bread) each day.
Eat more
vegetable and fruit group: Fruits and vegetables are rich in dietary fibre, vitamins, and minerals such as vitamin A and C and potassium. We should select more of those with bright colours such as spinach, carrot, tomato, and papaya as they are often richer in vitamins and minerals. We should avoid overcooking vegetables to minimize nutrient loss. Vegetables can be chopped up into small pieces for the elderly with chewing problems. On average we need about 6 taels of vegetables and 2 fruits each day.
Eat moderate amount
meat, poultry, fish, eggs, and dried beans group: Lean meat, skinless poultry, fish, or dried beans are lower in saturated fat and are healthier choices. Meat can be minced or chopped up for easy chewing. On average we need about 5 to 6 taels of meat each day.
milk, yogurt, and cheese group: Low-fat milk and fat-free milk are lower in saturated fat and are healthier choices. On average we need about 1 to 2 cups of milk each day. People who cannot tolerate milk can eat other calcium-rich foods such as fortified soy milk, soybeans, tofu, dark green leafy vegetables, canned sardines (eat with bones), etc.
Eat the least
Fat, sugar, salt, and other food additives: Avoid foods which are high in fat, sugar, and salt such as cakes, sausages, salted fish, and preserved vegetables. The use of natural seasoning such as ginger, green onions, garlic, and pepper powder can bring out the flavours of foods without adding sodium, sugar, or other food additives.
(Source of information: Department of Health)

28. 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)

29. Nutrition Labelling is a Useful Tool for Practising Healthy Eating
Nutrition label and nutrition claim can help the elderly choose suitable prepackaged food in accordance with healthy eating principles, as well as their own physical conditions and dietary modification, e.g.
Choose food lower in fat, sodium (or salt) and sugars (“3 Low”)
Choose food higher in calcium
Choose food higher in dietary fibre

30. Choose Prepackaged Food Suitable for the Elderly
Use nutrition claim as a quick screening tool; and
Take three simple steps to read nutrition label
Note:
To choose prepackaged food suitable for the elderly, 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.

31. Use Nutrition Claim to Choose Suitable Prepackaged Food
The words below are considered as synonyms for nutrition claims, they may help the elderly choose food lower in fat, sodium and sugars:
Claim
Meaning of Claim
Free; No; Zero; Without;
Does not contain
Insignificant amount of a particular nutrient found in the food
Very low; Extremely low;
Super low
This category of claim applies to sodium only, meaning a very small amount of sodium found in the food
Low; Little; Low source; Few;
Contains a small amount of
A small amount of nutrient found in the food
Specified Conditions for Nutrient Content Claims in Relation to Fat, Sodium and Sugars
Low fat Contain not more than 3 g of fat per 100 g of solid food; or
Contain not more than 1.5 g of fat per 100 mL of liquid food
Fat free Contain not more than 0.5 g of fat per 100 g/mL of food
Low sodium Contain not more than 120 mg of sodium per 100 g/mL of food
Very low sodium Contain not more than 40 mg of sodium per 100 g/mL of food
Sodium free Contain not more than 5 mg of sodium per 100 g/mL of food
Low sugars Contain not more than 5 g of sugars per 100 g/mL of food
Sugars free Contain not more than 0.5 g of sugars per 100 g/mL of food

32. Use Nutrition Claim to Choose Suitable Prepackaged Food
The words below are considered as synonyms for nutrition claims, they may help the elderly choose food higher in calcium and dietary fibre:
Claim
Meaning of Claim
Source; Contains; With; Provides; Has
A significant amount of a particular nutrient found in the food.
High; Good source; High source; Rich in; Plenty of
A very significant amount of a particular nutrient found in the food.
Specified Conditions for Nutrient Content Claims in Relation to Calcium and Dietary Fibre
High calcium
Contain not less than 240 mg of calcium per 100 g of solid food; or
Contain not less than 120 mg of calcium per 100 mL of liquid food
Source of calcium
Contain not less than 120 mg of calcium per 100 g of solid food; or
Contain not less than 60 mg of calcium per 100 mL of liquid food
High dietary fibre
Contain not less than 6 g of dietary fibre per 100 g of solid food; or
Contain not less than 3 g of dietary fibre per 100 mL of liquid food
Source of dietary fibre
Contain not less than 3 g of dietary fibre per 100 g of solid food; or
Contain not less than 1.5 g of dietary fibre per 100 mL of liquid food

33. Use Nutrition Label to Choose Suitable Prepackaged Food
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
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, compare among the nutritional content of various products and then choose the suitable food (e.g. the one that is lower in fat, sodium and sugars; the one that is higher in calcium and dietary fibre).
Step 3 
Refer to the percentage Nutrient Reference Value (%NRV) (If available)
In case the %NRV of fat, sodium or sugars is at the high-end, 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 the daily allowances of these nutrients.
According to individual dietary needs, may choose food that have a higher %NRV in those nutrients that are good for health (e.g. calcium and dietary fibre).

34. How to Choose Prepackaged Food Suitable for the Elderly – Example 1
Nutrition Information營養資料
Servings Per Package/每包裝所含食用分量數目: 1
Serving Size/食用分量: 236mL/236毫升
Per Package
每包裝
Energy/ 能量
156kcal/千卡
Protein/ 蛋白質
7.8g/克
Total fat/ 總脂肪
9.0g/克
- Saturated fat/ 飽和脂肪
5.9g/克
- Trans fat/ 反式脂肪
0.2g/克
Carbohydrates/ 碳水化合物
11g/克
- Sugars/ 糖
Sodium/ 鈉
97mg/毫克
Calcium/ 鈣
114mg/毫克
Nutrition Information營養資料
Servings Per Package/每包裝所含食用分量數目: 1
Serving Size/食用分量: 236mL/236毫升
Per Package
每包裝
Energy/ 能量
84kcal/千卡
Protein/ 蛋白質
8.5g/克
Total fat/ 總脂肪
0.2g/克
- Saturated fat/ 飽和脂肪
- Trans fat/ 反式脂肪
0g/克
Carbohydrates/ 碳水化合物
12g/克
- Sugars/ 糖
Sodium/ 鈉
104mg/毫克
Calcium/ 鈣
156mg/毫克
Based on the same reference amount of food, compare among the nutritional content of various products and then choose the suitable food (e.g. the one that is lower in fat, sodium and sugars; the one that is higher in calcium and dietary fibre).
Milk Beverage B is a better choice as it has much less total fat and more calcium in each package (i.e. 236 mL).
Milk Beverage A
Milk Beverage B

35. How to Choose Prepackaged Food Suitable for the Elderly – Example 2
Corn Flakes C
Corn Flakes D
Based on the same reference amount of food, compare among the
nutritional content of various products and then choose the suitable
food (e.g. the one that is lower in fat, sodium and sugars; the one that
is higher in calcium and dietary fibre).
Corn Flakes C is a better choice as it has much less sugars in each
100 g.

36. How to Choose Prepackaged Food Suitable for the Elderly – Example 3
Nutrition Information
Servings Per Package: 5
Serving Size : 3 pieces (50 g)
Per Serving
%Chinese NRV
Energy
271kcal
14%
Protein
2.9g 5%
Total fat
13.8g
23%
- Saturated fat
8.4g
42%
- Trans fat 0g
Carbohydrates
33.7g
11%
- Sugars
21.7g
Dietary fibre
1.5g 6%
Sodium
80mg 4%
Nutrition Information
Servings Per Package: 5
Serving Size : 3 pieces (50 g)
Per Serving
%Chinese NRV
Energy
170kcal 9%
Protein
4.7g 8%
Total fat
1.1g 2%
- Saturated fat
0.2g 1%
- Trans fat 0g
Carbohydrates
35.3g
12%
- Sugars
1.6g
Dietary fibre
5.8g
23%
Sodium
90mg 5%
Based on the same reference amount of food, compare among the nutritional content of various products and then choose the suitable food (e.g. the one that is lower in fat, sodium and sugars; the one that is higher in calcium and dietary fibre).
Biscuit F is a better choice as it has much less total fat and sugars, and more dietary fibre in each serving (i.e. 50 g).
Biscuit E
Biscuit F

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