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Jost S, Herzig C, Birringer M. A Balancing Act-20 Years of Nutrition and Health Claims Regulation in Europe: A Historical Perspective and Reflection. Foods 2025; 14:1651. [PMID: 40361733 PMCID: PMC12071930 DOI: 10.3390/foods14091651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2025] [Revised: 04/24/2025] [Accepted: 05/06/2025] [Indexed: 05/15/2025] Open
Abstract
The Nutrition and Health Claims Regulation (NHCR) has introduced a new regulatory perspective in food manufacturing, along with influencing consumers' perception of health-related food claims. Since 2006, a new standard of science-based claims has significantly impacted the European health food market. Over the years, numerous additional decisions have been made, and the ongoing process remains challenging for policymakers striving to harmonize consumer protection and trade within and outside the European Union (EU). This paper presents the current state of the NHCR's implementation, along with key events aimed at enhancing understanding among consumer organizations and food industry stakeholders, while also offering an insider perspective on relevant policy issues. Additionally, we address two pertinent policy issues to elucidate the associated challenges and opportunities, providing insights to support informed decision-making by policymakers. We use the nutrient profiles framework as a case study to illustrate considerations underpinning the objective of "consumer protection", while the "probiotics" market serves as an example for exploring the goal of "facilitation of trade". This historical perspective and reflection lead us to propose possible solutions for future food regulation.
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Affiliation(s)
- Sonja Jost
- Center for Sustainable Food Systems, Justus Liebig University Giessen, Senckenbergstrasse 3, 35390 Giessen, Germany;
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, 36037 Fulda, Germany;
- Relationship Management, University of Freiburg, Loewenstrasse 16, 79098 Freiburg, Germany
| | - Christian Herzig
- Center for Sustainable Food Systems, Justus Liebig University Giessen, Senckenbergstrasse 3, 35390 Giessen, Germany;
| | - Marc Birringer
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, 36037 Fulda, Germany;
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Santos M, Assunção R. Food Choice, Nutrition, and Public Health. Foods 2025; 14:1243. [PMID: 40238469 PMCID: PMC11988923 DOI: 10.3390/foods14071243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2025] [Revised: 03/12/2025] [Accepted: 03/18/2025] [Indexed: 04/18/2025] Open
Abstract
Maintaining a healthy diet throughout life helps prevent all forms of malnutrition, thereby reducing the risk of non-communicable diseases (NCDs) and related conditions [...].
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Affiliation(s)
- Mariana Santos
- Food and Nutrition Department, National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisbon, Portugal;
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal
| | - Ricardo Assunção
- Food and Nutrition Department, National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisbon, Portugal;
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
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Tassy M, van Dijk R, Eldridge AL, Mak TN, Drewnowski A, Feskens EJM. Nutrient Profiling Models in Low- and Middle-Income Countries Considering Local Nutritional Challenges: A Systematic Review. Curr Dev Nutr 2025; 9:104530. [PMID: 39886080 PMCID: PMC11780086 DOI: 10.1016/j.cdnut.2024.104530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 11/01/2024] [Accepted: 12/05/2024] [Indexed: 02/01/2025] Open
Abstract
Micronutrient deficiencies, undernutrition, and overweight/obesity are prevalent in low- and middle-income countries (LMICs). Nutrient profiling models (NPMs), initially developed to help reduce the prevalence of diet-related chronic diseases in Western countries, could be one solution to promote nutrient-dense foods in LMICs. This study reviewed government-endorsed NPMs implemented in LMICs and assessed their key components in relation to country-specific nutritional challenges. The peer-reviewed and grey literature were systematically reviewed to identify government-endorsed NPMs implemented in LMICs to promote healthier choices among adults. Their key metrics, including scope, components, units, and validation method, were extracted. The prevalence of undernutrition; overweight/obesity; and iron, vitamin A, and iodine deficiencies were extracted from the Global Health Observatory and the Global Burden of Disease study. NPMs have been implemented in 16 LMICs to encourage healthier choices, mostly through front-of-pack labeling schemes. Warning Label schemes are used to strongly discourage the consumption of energy-dense products in countries where overnutrition affects most of the population, such as Latin American LMICs. A "Keyhole" front-of-pack labeling scheme was implemented only in North Macedonia. It limits sugar, fat, and salt while promoting fibers, fruits, vegetables, nuts, and legumes to prevent overnutrition and diet-related chronic diseases. "Choices" schemes that focus on positive messages have been implemented in Southeast Asia and Zambia where over- and undernutrition coexist. "Choices" criteria encourage the consumption of category-specific vitamins and minerals, in addition to advocating limiting certain nutrients. In LMICs, NPMs focus on discouraging the consumption of sugar, fat, and salt. Additionally, NPMs promote category-specific micronutrients in countries where undernutrition remains prevalent or food components associated with a reduced risk of diet-related chronic diseases, including whole grains and fibers, in countries where overnutrition is the main nutrition-related public health issue. This study was registered at PROSPERO as CRD42023468807.
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Affiliation(s)
- Marie Tassy
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Ries van Dijk
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Alison L Eldridge
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Tsz Ning Mak
- Nestle Institute of Health Sciences Singapore Hub, Nestle Research, Singapore
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - Edith JM Feskens
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Alhumaidan OA, Alkhunein SM, Alakeel SA, Fallata GA, Alsukait RF, Binsheehah RH, Alnassar RF, Alqaseer HM. Computational model for policy simulation and prediction of the regulatory impact of front-of-package food labels. DISCOVER FOOD 2024; 4:110. [DOI: 10.1007/s44187-024-00192-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 10/07/2024] [Indexed: 01/03/2025]
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Lee JJ, Mulligan C, L'Abbé M. Development and validity testing of the Canadian Food Scoring System (CFSS), a nutrient profile model based on the recommendations of Canada's Food Guide 2019. Appl Physiol Nutr Metab 2024; 49:1363-1376. [PMID: 39013203 DOI: 10.1139/apnm-2024-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Canada's food guide (CFG) 2019 provides dietary guidance for all Canadians; however, there is no tool available to help Canadians easily determine how individual foods align with CFG. Therefore, the objectives of this study were (1) to develop a nutrient profile model, Canadian Food Scoring System (CFSS), to rank the healthfulness of individual foods according to the recommendations of CFG; and (2) to assess its validity. The CFSS was developed based on CFG, leveraging existing Canadian labelling regulations to set quantitative criteria for the CFG recommendations. The CFSS included three main steps: (1) classifying foods into the nutritious food categories and assigning points based on the alignment with the recommendations of CFG; (2) deducting points based on the levels of saturated fat, sugars, and sodium using thresholds from Canadian front-of-pack labelling regulations; and (3) calculating the final score from the first two steps to classify foods into one of five categories: "very poor," "poor," "fair," "good," or "excellent" choice. Convergent validity was assessed by examining the alignment of the CFSS with Health Canada's CFG-Food Classification System using a national food composition database and the Healthy Eating Food Index-2019 using nationally representative dietary intake survey data. The CFSS showed strong correlation with the CFG-Food Classification System (ρ = 0.782, p < 0.001) and moderate correlation with the Healthy Eating Food Index-2019 (r = 0.636, p < 0.001), indicating good convergent validity both at the food and dietary level. The newly developed CFSS can assess the alignment of individual foods with CFG, which can be used to help Canadians more easily make healthy food choices.
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Affiliation(s)
- Jennifer J Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Christine Mulligan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Mary L'Abbé
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, ON, Canada
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Takebayashi J, Takimoto H, Okada C, Tousen Y, Ishimi Y. Development of a Nutrient Profiling Model for Processed Foods in Japan. Nutrients 2024; 16:3026. [PMID: 39275341 PMCID: PMC11397564 DOI: 10.3390/nu16173026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/30/2024] [Accepted: 09/04/2024] [Indexed: 09/16/2024] Open
Abstract
Numerous nutrient profiling models (NPMs) exist worldwide, but Japan lacks an official NPM. Using the Australian and New Zealand Health Star Rating (HSR) as a reference, "Processed Foods in Japan version 1.0" (NPM-PFJ (1.0)) was developed to fit Japanese food culture and policies. In total, 668 processed foods from the Standard Tables of Food Composition in Japan were analyzed, excluding seasonings/spices, fats/oils, alcoholic beverages, and infant food. The NPM-PFJ (1.0) scoring algorithm was adapted from HSR, with revised reference values for energy, saturated fat, total sugars, sodium, protein, and dietary fiber in alignment with Japanese standards. Reference values for fruits, vegetables, nuts, and legumes (fvnl) remained unchanged. Median scores were 4.5 for HSR and 5.0 for NPM-PFJ (1.0), showing high correlation (r = 0.939, p < 0.01). Thereafter, food categories familiar and meaningful in Japan were defined based on a hierarchical cluster analysis of scoring patterns, creating six categories with distinct characteristics. Finally, the rating algorithm for NPM-PFJ (1.0) was created using each group's score distribution (10th percentile). The NPM-PFJ (1.0) was developed through a fully transparent and evidence-based process and is expected to facilitate the reformulation of food products by food industries and help consumers easily access healthier processed foods. This model marks a significant step forward in developing an NPM tailored to Japanese food culture and health policies, with the potential to enhance public health.
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Affiliation(s)
- Jun Takebayashi
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka Shinmachi, Settsu-shi, Osaka 566-0002, Japan
| | - Hidemi Takimoto
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka Shinmachi, Settsu-shi, Osaka 566-0002, Japan
| | - Chika Okada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka Shinmachi, Settsu-shi, Osaka 566-0002, Japan
| | - Yuko Tousen
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka Shinmachi, Settsu-shi, Osaka 566-0002, Japan
| | - Yoshiko Ishimi
- Tokyo NODAI Research Institute, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-ku, Tokyo 156-8502, Japan
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Agyemang P, Kwofie EM, Baum JI, Wang D. The design and development of a dashboard for improving sustainable healthy food choices. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 930:172726. [PMID: 38692329 DOI: 10.1016/j.scitotenv.2024.172726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
Over the last decade, several digital tools have been designed to provide consumers with nutritional and environmental impact information about their food choices post-consumption. Many of these tools lack behavioral change modules, have low user engagement, and ignore inherent environmental nutrition trade-offs to stimulate dietary change. This study presents the design and development of a decision support system to enhance consumer health while meeting sustainability goals from a pre-consumption perspective. The proposed decision support system, Dashboard for Improving Sustainable Healthy (DISH) food choices, employs behavioral features, traffic light labels, and nudges to inform end-users about the nutritional health performance and environmental impact of meals. DISH uses a simple metric that allows end-users to explore the potential minutes of healthy and productive life gained or lost from consuming 100 kcal of a meal. The metric combines the positive or negative nutritional health effects (μ-DALYs) of consuming a meal and environmental damage (endpoint impact expressed in DALYs) on human health. In the DISH application, end-users are rewarded or deducted EnCoins, which represent the number of silver or gold coins lost or gained based on the cost ($) of environmental damage (midpoint impacts) of a meal compared to reference sustainable healthy and unsustainable and unhealthy meal. DISH's gamification module enables end-users to track the potential minutes of healthy and productive life gained/lost and gold or silver rewards or deductions from consuming 100 kcal of a selected meal through cumulative minutes gained or lost and EnCoins. In promoting a sustainable diet culture, the gamification module enables users to create groups and communities where friends and families can track their sustainability performance through meal decisions. The DISH application is currently available online and can be accessed by an end-user through any device. Further pilot studies will focus on testing the technology in partner campus cafeterias.
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Affiliation(s)
- Prince Agyemang
- Bioresource Engineering Department, McGill University, Ste-Anne-de-Bellevue H9X 3V9, Quebec, Canada; Department of Biological and Agricultural Engineering, University of Arkansas, 203 Engineering Hall, Fayetteville, AR 72701, USA
| | - Ebenezer M Kwofie
- Bioresource Engineering Department, McGill University, Ste-Anne-de-Bellevue H9X 3V9, Quebec, Canada; Department of Biological and Agricultural Engineering, University of Arkansas, 203 Engineering Hall, Fayetteville, AR 72701, USA.
| | - Jamie I Baum
- Department of Food Science, University of Arkansas, 2650 N. Young Ave., Fayetteville, AR 72704, USA; Center for Human Nutrition, University of Arkansas System Division of Agriculture, Fayetteville, AR 72704, USA
| | - Dongyi Wang
- Department of Biological and Agricultural Engineering, University of Arkansas, 203 Engineering Hall, Fayetteville, AR 72701, USA
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Chen Q(J, Gillis M, Bernstein JT, Jacobs A, Morrison CL, Jessri M. Modelling Food Substitution Using the Ofcom Nutrient Profiling Model on Population Intakes from the Canadian Community Health Survey-Nutrition 2015. Nutrients 2024; 16:1874. [PMID: 38931231 PMCID: PMC11206488 DOI: 10.3390/nu16121874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
This study aimed to model how substituting foods consumed by Canadians for alternatives with more favourable nutrient profiling (NP) scores would impact dietary intakes. The Ofcom NP system, developed to help the UK Office of Communication differentiate foods that can be advertised to children, was applied to foods consumed by Canadians aged 2 years and older in the 2015 Canadian Community Health Survey (CCHS) (n = 19,447). Foods were substituted for similar options from the Euromonitor branded food composition database (Scenario 1) or from the primarily aggregated food profiles in the CCHS survey food composition database (Scenario 2) with either the most favourable (optimistic; 1A and 2A) or a more favourable Ofcom score (realistic; 1B and 2B). Mean intakes of Ofcom scores, calories, saturated fat, sugars, and sodium from these scenarios were compared to baseline. Only 2.9% of foods consumed had a similar Euromonitor option with a lower Ofcom score. Scenarios 1A, 1B, and 2A had lower Ofcom scores, calorie, sodium, saturated fat, and sugar intakes compared to baseline. Scenario 2B had lower levels of all outcome measures, except for an increase in calories compared to baseline. Selection of foods with more favourable NP scores has the potential to decrease the Canadian intake of nutrients of concern.
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Affiliation(s)
- Qiuyu (Julia) Chen
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Misa Gillis
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jodi T. Bernstein
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Adelia Jacobs
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Conor L. Morrison
- Department of Statistics, Faculty of Science, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Mahsa Jessri
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Centre for Health Services and Policy Research (CHSPR) and Health Services and Policy (HSP), Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Seo D, Horn A, Abeliuk A, Burghardt K. What's On the Menu? Towards Predicting Nutritional Quality of Food Environments. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.08.23299691. [PMID: 38106109 PMCID: PMC10723558 DOI: 10.1101/2023.12.08.23299691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Unhealthy diets are a leading cause of major chronic diseases including obesity, diabetes, cancer, and heart disease. Food environments-the physical spaces in which people access and consume food-have the potential to profoundly impact diet and related diseases. We take a step towards better understanding the nutritional quality of food environments by developing MINT: Menu Item to NutrienT model. This model utilizes under-studied data sources on recipes and generic food items, along with state-of-the-art word embedding and deep learning methods, to predict the nutrient density of never-before-seen food items using only their name as input. The model achieves an R 2 = 0.77 , a substantial improvement over comparable models. We illustrate the utility of MINT by applying it to the Los Angeles restaurant food environment, and discover close agreement between predicted and ground truth nutrient density of restaurant menu items. This model represents a significant step towards a policy toolkit needed to precisely identify and target food environments characterized by poor nutritional quality.
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Affiliation(s)
- DongHyeon Seo
- Information Sciences Institute, Marina del Rey, CA, USA
| | - Abigail Horn
- Information Sciences Institute, Marina del Rey, CA, USA
- Department of Industrial and Systems Engineering, University of Southern California, LA, CA, USA
| | - Andrés Abeliuk
- Department of Computer Science, University of Chile, Santiago, Chile
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Onyeaka H, Nwaiwu O, Obileke K, Miri T, Al‐Sharify ZT. Global nutritional challenges of reformulated food: A review. Food Sci Nutr 2023; 11:2483-2499. [PMID: 37324840 PMCID: PMC10261815 DOI: 10.1002/fsn3.3286] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 03/09/2023] Open
Abstract
Food reformulation, the process of redesigning processed food products to make them healthier, is considered a crucial step in the fight against noncommunicable diseases. The reasons for reformulating food vary, with a common focus on reducing the levels of harmful substances, such as fats, sugars, and salts. Although this topic is broad, this review aims to shed light on the current challenges faced in the reformulation of food and to explore different approaches that can be taken to overcome these challenges. The review highlights the perception of consumer risk, the reasons for reformulating food, and the challenges involved. The review also emphasizes the importance of fortifying artisanal food processing and modifying microbial fermentation in order to meet the nutrient requirements of people in developing countries. The literature suggests that while the traditional reductionist approach remains relevant and yields quicker results, the food matrix approach, which involves engineering food microstructure, is a more complex process that may take longer to implement in developing economies. The findings of the review indicate that food reformulation policies are more likely to succeed if the private sector collaborates with or responds to the government regulatory process, and further research is conducted to establish newly developed reformulation concepts from different countries. In conclusion, food reformulation holds great promise in reducing the burden of noncommunicable diseases and improving the health of people around the world.
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Affiliation(s)
- Helen Onyeaka
- School of Chemical EngineeringUniversity of Birmingham, EdgbastonBirminghamUK
| | - Ogueri Nwaiwu
- School of Chemical EngineeringUniversity of Birmingham, EdgbastonBirminghamUK
| | - KeChrist Obileke
- Faculty of Science and AgricultureUniversity of Fort HareAliceSouth Africa
| | - Taghi Miri
- School of Chemical EngineeringUniversity of Birmingham, EdgbastonBirminghamUK
| | - Zainab T. Al‐Sharify
- School of Chemical EngineeringUniversity of Birmingham, EdgbastonBirminghamUK
- Department of Environmental Engineering, College of EngineeringUniversity of Al‐MustansiriyaBaghdadIraq
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Phulkerd S, Dickie S, Thongcharoenchupong N, Thapsuwan S, Machado P, Woods J, Mo-Suwan L, Prasertsom P, Ungchusak C, Khitdee C, Lawrence M. Choosing an effective food classification system for promoting healthy diets in Thailand: a comparative evaluation of three nutrient profiling-based food classification systems (government, WHO, and Healthier Choice Logo) and a food-processing-based food classification system (NOVA). Front Nutr 2023; 10:1149813. [PMID: 37266126 PMCID: PMC10230096 DOI: 10.3389/fnut.2023.1149813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/14/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction This study aimed to assess the nutritional quality of food and beverage products in Thailand by comparing four different food classification systems: the nutrient profiling-based food classification systems by the Department of Health (DOH), the WHO South-East Asia Region (WHO SEA), the Healthier Choice Logo (HCL), and the food-processing-based food classification system, NOVA. Methods This study used secondary data from the Mintel Global New Products Database (N = 17,414). Food subgroups were classified differently based on these four systems. The DOH classified food products into three groups: Group A-healthy pass or meeting standard, Group B-not meeting the standard, and Group C-far below standard. The WHO SEA classified food products into two groups: marketing prohibited products and marketing permitted products. The HCL classified food products into two groups: eligible products for the logo; and ineligible products for the logo. The NOVA classified food products into four groups: unprocessed or minimally processed foods (MP), processed culinary ingredients (PCI), processed foods (P), and ultra-processed foods (UPF). Descriptive statistics (percentage and frequency) were used for analysis. Agreement analysis was conducted using Cohen's kappa statistic between each pair of food classification systems. Results Of the total sample that could be classified by any of the four classification systems (n = 10,486), the DOH, the WHO SEA and the HCL systems classified products as healthy (Group A, marketing permitted or eligible for HCL logo) at 10.4, 11.1, and 10.9%, respectively. Only 5.6% were classified as minimally processed foods using NOVA and 83.1% were ultra-processed foods (UPFs). Over 50% of products classified as healthy by the nutrient profiling systems were classified as UPF according to the NOVA system. Products that were eligible for the HCL had the highest proportion of UPF products (84.4%), followed by the Group A products (69.2%) and the WHO marketing-permitted products (65.0%). Conclusion A hybrid food classification approach taking both nutrients and food processing into account is needed to comprehensively assess the nutritional quality of food and beverage products in Thailand.
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Affiliation(s)
- Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Salaya, Thailand
| | - Sarah Dickie
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | | | - Sasinee Thapsuwan
- Institute for Population and Social Research, Mahidol University, Salaya, Thailand
| | - Priscila Machado
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Julie Woods
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Ladda Mo-Suwan
- Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Piyada Prasertsom
- Bureau of Dental Health, Department of Health, Ministry of Public Health, Mueang, Nonthaburi, Thailand
| | - Chantana Ungchusak
- Thailand Healthy Lifestyle Plan, Thai Health Promotion Foundation, Bangkok, Thailand
| | - Chiraporn Khitdee
- Bureau of Dental Health, Department of Health, Ministry of Public Health, Mueang, Nonthaburi, Thailand
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Mondal DD, Chakraborty U, Bera M, Ghosh S, Kar D. An overview of nutritional profiling in foods: Bioanalytical techniques and useful protocols. Front Nutr 2023; 10:1124409. [PMID: 37025612 PMCID: PMC10070841 DOI: 10.3389/fnut.2023.1124409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/27/2023] [Indexed: 04/08/2023] Open
Abstract
Maintaining a nutritious diet is essential for humans if they want to live a healthier life. Several food businesses and food safety organizations play a significant role and offer useful ways for improving nutritional quality that assists consumers in making informed selections. Making poor food choices and consuming unhealthy meals are the main causes of non-communicable diseases (NCDs). Nutritional profiling (NP) models are developed to evaluate the nutritional value, calorie content, and the amount of micronutrients and macronutrients contained in a given food accompanied by additional details on the nutritional anomaly provided by published standard nutrients and nutritional databases. To construct an ideal nutritional model that can facilitate food consumption, bioanalytical methods such as chromatography, microscopic techniques, molecular assays, and metabolomics can be applied. With the use of these technologies, one can learn more about the health advantages of nutrition and how to prevent disease. A wider element of NP is also provided by the developing technologies in the area of nutrition research, such as nanotechnology, proteomics, and microarray technology. In this review, we are focusing on the different bioanalytical techniques and the various protocols of NP and their application and refinement of the models. We have evaluated various NP techniques currently used in the food industry for the detection of different components present in food items.
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Affiliation(s)
- Deb Duhita Mondal
- Department of Biotechnology, Heritage Institute of Technology, Kolkata, India
| | - Ushashi Chakraborty
- Department of Biotechnology, Heritage Institute of Technology, Kolkata, India
| | - Manotosh Bera
- Department of Biotechnology, Heritage Institute of Technology, Kolkata, India
| | - Subhrojyoti Ghosh
- Department of Biotechnology, Heritage Institute of Technology, Kolkata, India
| | - Debasish Kar
- Department of Biotechnology, Ramaiah University of Applied Sciences, Bengaluru, India
- *Correspondence: Debasish Kar
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Zhao X, Zhu M, Ren X, An Q, Sun J, Zhu D. A New Technique for Determining Micronutrient Nutritional Quality in Fruits and Vegetables Based on the Entropy Weight Method and Fuzzy Recognition Method. Foods 2022; 11:foods11233844. [PMID: 36496652 PMCID: PMC9740144 DOI: 10.3390/foods11233844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/12/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
The human body needs nutrients to maintain its regular physiological activity. It requires 40 essential nutrients, including macronutrients (carbohydrates, protein, and fat) and micronutrients (vitamins and minerals). Although macronutrient intake has been improved in China due to people's increased social awareness, the population's micronutrient intake remains insufficient. OBJECTIVE The current food evaluation system is primarily used to assess macronutrients, while an effective assessment method for micronutrients is still lacking. Fruits and vegetables are low-energy food sources that mainly provide vitamins and minerals and supply the human body with various micronutrients. METHODS In this paper, the entropy and fuzzy recognition methods were used to construct the Vitamin Index (Vitamin Index = Vitamin A Index + Vitamin Comprehensive Index + Vitamin Matching Index) and Mineral Index (Mineral Index = Calcium Index + Mineral Comprehensive Index + Mineral Matching Index) and to evaluate the micronutrient quality of 24 vegetables and 20 fruits. RESULTS The assessment results showed that Chinese dates displayed the highest Vitamin and Mineral Index among fruits (Vitamin Index = 2.62 and Mineral Index = 2.63), while collard greens had the highest Vitamin Index of the vegetables, at 2.73, and red amaranth had the highest Mineral Index, at 2.74. CONCLUSIONS The study introduces a new method for assessing the nutritional quality of micronutrients, which provides a new idea for assessing the nutrient quality of agricultural products.
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14
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McSweeney MB. The effect of health-related claims on consumers’ sensory perception. Curr Opin Food Sci 2022. [DOI: 10.1016/j.cofs.2022.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch-Ernst KI, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Peláez C, Pentieva K, Thies F, Tsabouri S, Vinceti M, Bresson JL, Siani A. Scientific advice related to nutrient profiling for the development of harmonised mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. EFSA J 2022; 20:e07259. [PMID: 35464873 PMCID: PMC9016720 DOI: 10.2903/j.efsa.2022.7259] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver scientific advice related to nutrient profiling for the development of harmonised mandatory front‐of‐pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. This Opinion is based on systematic reviews and meta‐analyses of human studies on nutritionally adequate diets, data from the Global Burden of Disease framework, clinical practice guidelines, previous EFSA opinions and the priorities set by EU Member States in the context of their Food‐Based Dietary Guidelines and associated nutrient/food intake recommendations. Relevant publications were retrieved through comprehensive searches in PubMed. The nutrients included in the assessment are those likely to be consumed in excess or in inadequate amounts in a majority of European countries. Food groups with important roles in European diets have been considered. The Panel concludes that dietary intakes of saturated fatty acids (SFA), sodium and added/free sugars are above, and intakes of dietary fibre and potassium below, current dietary recommendations in a majority of European populations. As excess intakes of SFAs, sodium and added/free sugars and inadequate intakes of dietary fibre and potassium are associated with adverse health effects, they could be included in nutrient profiling models. Energy could be included because a reduction in energy intake is of public health importance for European populations. In food group/category‐based nutrient profiling models, total fat could replace energy in most food groups owing to its high‐energy density, while the energy density of food groups with low or no fat content may be well accounted for by the inclusion of (added/free) sugars. Some nutrients may be included in nutrient profiling models for reasons other than their public health importance, e.g. as a proxy for other nutrients of public health importance, or to allow for a better discrimination of foods within the same food category.
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16
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Water–Energy–Food Nexus and Life Cycle Thinking: A New Approach to Environmental and Nutritional Assessment of Potato Chips. Foods 2022; 11:foods11071018. [PMID: 35407105 PMCID: PMC8997988 DOI: 10.3390/foods11071018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
The water–energy–food (WEF) nexus has become a key concept to promote the cross-sectoral coordination toward sustainable development. In particular, understanding the interdependences of these pillars, as well as addressing a life cycle perspective, is essential when evaluating food production systems. This study explores the environmental impacts and nutritional quality of potato chips, addressing life cycle thinking and a WEF nexus approach. For this purpose, the combined application of life cycle assessment (LCA) and the Nutrient-Rich Food 9.3 (NRF9.3) index was considered to identify the main environmental hotspots and advanced opportunities. The results indicated a major contribution of the cultivation stage on water use, whereas the processing accounted for most of the impacts in energy-related indicators and eutrophication potentials. Improvement opportunities reside in the joint application of drip irrigation, allowing to achieve important water savings, as well as the use of natural gas or pellets instead of diesel, which constitute cleaner energy sources. On the other hand, a poor nutritional density of potato chips became evident from the quantification of the NRF9.3, which can be significantly improved if potatoes undergo a roasted process instead of frying.
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17
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Greenberg D, Drewnowski A, Black R, Weststrate JA, O'Shea M. A Progressive Nutrient Profiling System to Guide Improvements in Nutrient Density of Foods and Beverages. Front Nutr 2022; 8:774409. [PMID: 35004807 PMCID: PMC8733001 DOI: 10.3389/fnut.2021.774409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Improving the nutrient density of processed foods is one way to bring the global food supply closer to the WHO Sustainable Development Goals. Nutrient profiling (NP) has emerged as the preferred method of monitoring the progress toward product innovation and reformulation. This paper presents PepsiCo Nutrition Criteria (PNC), a new internal NP model that was designed to guide and monitor improvements in nutrient density and overall nutritional quality of foods and beverages. The new PNC NP model assigns food products into four classes of increasing nutritional value, based on the content of nutrients to limit, along with nutrients and ingredients to encourage. The nutrient standards used for category assignment followed those developed by global dietary authorities. Standards are proposed for calories, sodium, added sugars, saturated, and industrially produced trans fats. Also included are minimum values for food groups to encourage, low-fat dairy, and for country-specific gap nutrients. Internal use of the NP model has spurred product changes that are consistent with WHO goals for industry transparency. An audited review of company products showed that 48% met added sugar, 65% met sodium, and 71% met saturated fat goals. By the end of 2020, in the top 26 regions in which products are sold, 48% of the total sales volume of global beverages had 100 kcal or less from added sugars per 355 ml serving representing 80% of beverage volume and over 90% of food volume sold globally. The PNC NP model is not consumer-facing but is specifically intended for internal use to motivate stepwise and incremental product innovation and reformulation. Transparent and published NP models further WHO goals of engaging industry stakeholders in the (re)formulation of processed foods and beverages consistent with public health goals.
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Affiliation(s)
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - Richard Black
- PepsiCo, Inc., Research and Development, Purchase, NY, United States
| | - Jan A Weststrate
- PepsiCo, Inc., Research and Development, Purchase, NY, United States
| | - Marianne O'Shea
- PepsiCo, Inc., Research and Development, Purchase, NY, United States
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18
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Nascimento A, Santiago S, Coelho I, Ventura M, Gueifão S, Santos M, Castanheira I. Sodium and potassium contents in food samples from the first Portuguese total diet pilot study. J Food Compost Anal 2021. [DOI: 10.1016/j.jfca.2021.104091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Fernández-Ríos A, Laso J, Campos C, Ruiz-Salmón I, Hoehn D, Cristóbal J, Batlle-Bayer L, Bala A, Fullana-I-Palmer P, Puig R, Aldaco R, Margallo M. Towards a Water-Energy-Food (WEF) nexus index: A review of nutrient profile models as a fundamental pillar of food and nutrition security. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 789:147936. [PMID: 34082212 DOI: 10.1016/j.scitotenv.2021.147936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
The Water-Energy-Food (WEF) nexus approach should be promoted as a tool for sustainable management of resources through the interconnection of these three fundamental pillars. Particularly, food security must ensure healthy and balanced diets for everyone, but selecting individual indicators to assess all slants covered by this element is not an easy task. Hence, the objective of this paper is two-fold, to review nutrient profiling (NP) models that allow to categorize foods and evaluate diets based on their nutritional quality, and to choose the most appropriate model to be used within a WEF nexus index. To address this issue, a total of 159 documents were assessed, appraising the geographic distribution, and time evolution of the publications, as well as the characteristics and potential applications of the NP systems. The review concludes that the NRF9.3. model is the most liable option to be used in a WEF nexus index, presenting the best characteristics by means of the definition of scores and thresholds, and the use of an 'across-the-board' criteria and a reference quantity of 100 kcal, alongside offering higher ability to assess diets and foods than the other competitive model (HEI) through the evaluation of nutrients to encourage instead of foods. A secondary outcome of the review is the identification of the NP models as a useful tool to enable institutions with information to establish policies in the field of public health and facilitating the decision-making process according to the current healthy claims.
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Affiliation(s)
- Ana Fernández-Ríos
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Jara Laso
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Cristina Campos
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Israel Ruiz-Salmón
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Daniel Hoehn
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Jorge Cristóbal
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
| | - Laura Batlle-Bayer
- UNESCO Chair in Life Cycle and Climate Change ESCI-UPF, Pg. Pujades 1, 08003 Barcelona, Spain
| | - Alba Bala
- UNESCO Chair in Life Cycle and Climate Change ESCI-UPF, Pg. Pujades 1, 08003 Barcelona, Spain
| | - Pere Fullana-I-Palmer
- UNESCO Chair in Life Cycle and Climate Change ESCI-UPF, Pg. Pujades 1, 08003 Barcelona, Spain
| | - Rita Puig
- Department of Computer Science and Industrial Engineering, University of Lleida (UdL), Pla de la Massa, 8, 08700 Igualada, Spain
| | - Rubén Aldaco
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain.
| | - María Margallo
- Department of Chemical and Biomolecular Engineering, University of Cantabria, Av. de Los Castros s/n, 39005 Santander, Spain
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Pinho-Gomes AC, Kaur A, Scarborough P, Rayner M. Are the Eatwell Guide and Nutrient Profiling Models Consistent in the UK? Nutrients 2021; 13:2732. [PMID: 34444892 PMCID: PMC8401171 DOI: 10.3390/nu13082732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/26/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022] Open
Abstract
A nutrient profiling model (NPM) was developed in 2005 in the UK to regulate the marketing of foods to children. It was revised in 2018, but the new version has not been finalised. The Eatwell Guide (EWG) is the UK's official food-based dietary guidelines. The aim of this study was to evaluate the agreement between the 2005 and 2018 versions of the NPM and the EWG. Using recent National Diet and Nutrition Surveys, we estimated the healthiness of individual diets based on an EWG dietary score and a NPM dietary index. We then compared the percentage of agreement and Cohen's kappa for each combination of the EWG score and NPM index across the range of observed values for the 2005 and 2018 versions. A total of 3028 individual diets were assessed. Individuals with a higher (i.e., healthier) EWG score consumed a diet with, on average, a lower (i.e., healthier) NPM index both for the 2005 and 2018 versions. Overall, there was good agreement between the EWG score and the NPM dietary index at assessing the healthiness of representative diets of the UK population, when a low cut-off for the NPM dietary index was used, irrespective of the version. This suggests that dietary advice to the public is broadly aligned with NPM-based food policies and vice-versa.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- Faculty of Life Sciences & Medicine, School of Population Health & Environmental Sciences, King’s College London, London WC2R 2LS, UK;
- The George Institute for Global Health, London W12 0BZ, UK
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; (A.K.); (P.S.)
| | - Asha Kaur
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; (A.K.); (P.S.)
| | - Peter Scarborough
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; (A.K.); (P.S.)
| | - Mike Rayner
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; (A.K.); (P.S.)
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21
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Santos M, Matias F, Rito AI, Castanheira I, Torres D, Loureiro I, Assunção R. Breakfast Cereals Intended for Children: Opportunities for Reformulation and Potential Impact on Nutrient Intake. Foods 2021; 10:1772. [PMID: 34441549 PMCID: PMC8394760 DOI: 10.3390/foods10081772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
Ready-to-eat cereals (RTECs) have become a popular breakfast option claiming to provide important nutrients to children's diets, despite being a source of excess sugar and, therefore, a health concern. Thus, food reformulation constitutes an important public health strategy that could benefit from inputs provided by nutrient profiling. This study aimed to assess the adequacy of the RTECs for children available in Portuguese supermarkets, applying three nutrient profile models (NPMs)-the nutrient profile model of the World Health Organization's Regional Office for Europe (WHO-EURO), the profile of the private-sector EU Pledge (EU-Pledge), and the national model developed by the Directorate-General of Health (NPM-PT)-in order to explore the potential for reformulation of the RTECs identified as not adequate and evaluate the impact of RTECs' reformulation on the nutritional quality of Portuguese children's diets. In total, 78 RTECs intended for children were assessed and two scenarios-current (not considering reformulation) and alternative (considering reformulation to accomplish the nutrient profile requirements)-were considered to assess the impact of reformulation on nutritional quality. Across all RTECs, only 5.1% could be promoted to children according to the considered NPMs. The most common nutrients requiring reformulation were sugar, saturated fatty acids (SFA), salt, and dietary fiber. The scenarios of reformulation considered could reduce the RTECs average content of total sugars, SFA, and salt by 43%, 8.7%, and 1.1%, respectively, and dietary fiber intake could be increased by 34%. Thus, these results support policies to implement reformulation strategies for developing healthier food products to be promoted to children.
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Affiliation(s)
- Mariana Santos
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Av Padre Cruz, 1649-016 Lisboa, Portugal; (M.S.); (F.M.); (A.I.R.); (I.C.)
- NOVA National School of Public Health, NOVA University of Lisbon, Av Padre Cruz, 1600-560 Lisboa, Portugal
| | - Filipa Matias
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Av Padre Cruz, 1649-016 Lisboa, Portugal; (M.S.); (F.M.); (A.I.R.); (I.C.)
| | - Ana Isabel Rito
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Av Padre Cruz, 1649-016 Lisboa, Portugal; (M.S.); (F.M.); (A.I.R.); (I.C.)
- Center for Studies and Research in Social Dynamics and Health (CEIDSS), Av Padre Cruz, 1649-016 Lisboa, Portugal
| | - Isabel Castanheira
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Av Padre Cruz, 1649-016 Lisboa, Portugal; (M.S.); (F.M.); (A.I.R.); (I.C.)
| | - Duarte Torres
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Rua Das Taipas 135, 4050-091 Porto, Portugal;
- Faculty of Nutrition and Food Sciences, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Isabel Loureiro
- NOVA National School of Public Health, Public Health Research Center (CISP), Comprehensive Health Research Center, NOVA University of Lisbon, Avenida Padre Cruz, 1600-560 Lisboa, Portugal;
| | - Ricardo Assunção
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Av Padre Cruz, 1649-016 Lisboa, Portugal; (M.S.); (F.M.); (A.I.R.); (I.C.)
- NOVA National School of Public Health, Public Health Research Center (CISP), Comprehensive Health Research Center, NOVA University of Lisbon, Avenida Padre Cruz, 1600-560 Lisboa, Portugal;
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
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