Nutrient profile of 23 596 packaged supermarket foods and non-alcoholic beverages in Australia and New Zealand

Evaluating nutrition quality of packaged foods carrying claims and marketing techniques in Brazil using four nutrient profile models

The present study aimed to evaluate the nutrient profile of packaged foods marketed in Brazil, giving insights into healthiness of the Brazilian supermarket packaged food environment, considering different food categories and levels of industrial food processing and presence of nutrition and health claims and marketing strategies. A cross-sectional survey was conducted on the labels of pre-packed foods marketed in a home-shopping website. A stratified random sample (n = 335) was obtained to be analysed by four nutrient profile models: Food Standards Australia New Zealand's Nutrient Profiling Scoring Criterion, UK Nutrient Profile from the Food Standards Agency, Nutrient profile model from Pan American Health Organization, and Nutrition Score from Unilever Food & Health Research (Unilever). Overall, the models shown agreement, besides some differences in the levels of approval. Ultra-processed foods were less healthy. Pass rates for products carrying nutrition and/or health claims have evidenced the presence of these claims may be indicative of slightly better nutritional quality. This did not apply for products with and without marketing techniques. These findings highlight the need for improvement of the supermarket packaged food environment in scenarios like Brazil by increasing efforts to reformulate products to make them healthier, together with appropriate food labelling regulation.

Evaluating intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model

PURPOSE

To investigate intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model.

METHODS

Dietary intakes of 12,153 participants from the Australian Health Survey (2011-12) aged 2 + years were evaluated. Food items reported during a 24 h recall were classified using the NOVA system. The Pan-American Health Organization Nutrient Profile Model (PAHO NPM) was applied to identify processed and ultra-processed products with excessive content of critical nutrients. Differences in mean intakes and prevalence of excessive intakes of critical nutrients for groups of the population whose diets were made up of products with and without excessive content in critical nutrients were examined.

RESULTS

The majority of Australians consumed daily at least three processed and ultra-processed products identified as excessive in critical nutrients according to the PAHO NPM. Individuals consuming these products had higher intakes of free sugars (β = 8.9), total fats (β = 11.0), saturated fats (β = 4.6), trans fats (β = 0.2), and sodium (β = 1788 for adolescents and adults; β = 1769 for children 5-10 years; β = 1319 for children aged < 5 years) (p ≤ 0.001 for all nutrients) than individuals not consuming these foods. The prevalence of excessive intake of all critical nutrients also followed the same trend.

CONCLUSION

The PAHO NPM has shown to be a relevant tool to predict intake levels of nutrients linked to non-communicable diseases in Australia and, therefore, could be used to inform policy actions aimed at increasing the healthiness of food environments.

Identifying Opportunities for Strategic Policy Design to Address the Double Burden of Malnutrition through Healthier Retail Food: Protocol for South East Asia Obesogenic Food Environment (SEAOFE) Study

Effective policies that address both the supply and demand dimensions of access to affordable, healthy foods are required for tackling malnutrition in South East Asia. This paper presents the Protocol for the South East Asia Obesogenic Food Environment (SEAOFE) study, which is designed to analyze the retail food environment, consumers' and retailers' perspectives regarding the retail food environment, and existing policies influencing food retail in four countries in South East Asia in order to develop evidence-informed policy recommendations. This study was designed as a mixed-methods sequential explanatory approach. The country sites are Malaysia, Indonesia, the Philippines, and Thailand. The proposed study consists of four phases. Phase One describes the characteristics of the current retail food environment using literature and data review. Phase Two interprets consumer experience in the retail food environment in selected urban poor communities using a consumer-intercept survey. This phase also assesses the retail food environment by adapting an in-store audit tool previously validated in higher-income countries. Phase Three identifies factors influencing food retailer decisions, perceptions, and attitudes toward food retail policies using semi-structured interviews with selected retailers. Phase Four recommends changes in the retail food environment using policy analysis and semi-structured interviews with key stakeholders. For the analysis of the quantitative data, descriptive statistics and multiple regression will be used, and thematic analysis will be used to process the qualitative data. This study will engage stakeholders throughout the research process to ensure that the design and methods used are sensitive to the local context.

A Cross-Sectional Audit of Nutrition and Health Claims on Dairy Yoghurts in Supermarkets of the Illawarra Region of New South Wales, Australia

Health and nutrition claims are used by consumers to guide purchasing decisions. In consequence, monitoring and evaluation of such claims to ensure they are accurate and transparent is required. The aim of this study was to investigate the use of nutrition and health claims on dairy-yoghurt products within select Australian supermarkets and assess their compliance with the revised Food Standards Code (FSC). Nutrition, health, and related claims on yoghurt products were assessed in a cross-sectional audit of five supermarkets in the Illawarra region of New South Wales. Claim prevalence, type, and compliance were assessed and products were compared against current rating measures. A total of n = 340 dairy yoghurt products were identified. Most products (97.9%) carried at least one nutrition and/or health claim, with nutrition-content claims (93.9%) the most prevalent. Most products (n = 277) met the nutrient profiling scoring criterion; while 87.9% of products did not carry the health star rating. Almost all claims surveyed (97.4%) were compliant with the FSC. Health and nutrition claims are highly prevalent across yoghurt categories, with the majority of these compliant with regulations. The ambiguity surrounding the wording and context of claims challenges researchers to investigate consumers’ interpretations of health messaging within the food environment.

The Level of Processing, Nutritional Composition and Prices of Canadian Packaged Foods and Beverages with and without Gluten-Free Claims

Little is known about the healthfulness and cost of gluten-free (GF) foods, relative to non-GF alternatives, in Canada. This study compared the extent of processing, nutritional composition and prices of Canadian products with and without GF claims. Data were sourced from the University of Toronto Food Label Information Program (FLIP) 2013 (n = 15,285) and 2017 (n = 17,337) databases. Logistic regression models examined the association of NOVA processing category with GF claims. Calorie/nutrient contents per 100 g (or mL) were compared between GF and non-GF products. Generalized linear models compared adjusted mean prices per 100 g (or mL) of products with and without GF claims. The prevalence of GF claims increased from 7.1% in 2013 to 15.0% in 2017. GF claims appeared on 17.0% of ultra-processed foods, which were more likely to bear GF claims products than less-processed categories. Median calories and sodium were significantly higher in GF products; no significant differences were observed for saturated fat or sugars. Compared to non-GF products, adjusted mean prices of GF products were higher for 10 food categories, lower for six categories and not significantly different for six categories. Overall, GF claims are becoming increasingly prevalent in Canada; however, they are often less healthful and more expensive than non-GF alternatives, disadvantaging consumers following GF diets.

Comparison of requirements for using health claims on foods in the European Union, the USA, Canada, and Australia/New Zealand

Nutrition is recognized as one of the leading factors influencing the growing incidence of noncommunicable diseases. Despite society experiencing a global rise in obesity, specific populations remain at risk of nutrient deficiencies. The food industry can use health claims to inform consumers about the health benefits of foods through labeling and the broader promotion of specific food products. As health claims are carefully regulated in many countries, their use is limited due to considerable investments required to fulfill the regulatory requirement. Although health claims represent a driving force for innovation in the food industry, the risk of misleading of consumers need to be avoided. The health claim scientific substantiation process must be efficient and transparent in order to meet the needs of companies in the global market, but should be based on strong scientific evidence and plausible mechanisms of actions, to ensure highest level of consumer protection. The objective of this review is to compare the possibilities for using health claims on foods in the European Union, the USA, Canada, and Australia and New Zealand. In particular, we focused on differences in the classification of claims, on the scientific substantiation processes and requirements for health claims use on foods in the selected regions. Reduction of disease risk (RDR) claims are associated with relatively similar procedures and conditions for use, whereas several notable differences were identified for other types of claims. In all cases, RDR claims must be approved prior their introduction to the market, and only a few such claims have been authorized. Much greater differences were observed concerning other types of claims.

Ultra-processed foods and the nutrition transition: Global, regional and national trends, food systems transformations and political economy drivers

Understanding the drivers and dynamics of global ultra-processed food (UPF) consumption is essential, given the evidence linking these foods with adverse health outcomes. In this synthesis review, we take two steps. First, we quantify per capita volumes and trends in UPF sales, and ingredients (sweeteners, fats, sodium and cosmetic additives) supplied by these foods, in countries classified by income and region. Second, we review the literature on food systems and political economy factors that likely explain the observed changes. We find evidence for a substantial expansion in the types and quantities of UPFs sold worldwide, representing a transition towards a more processed global diet but with wide variations between regions and countries. As countries grow richer, higher volumes and a wider variety of UPFs are sold. Sales are highest in Australasia, North America, Europe and Latin America but growing rapidly in Asia, the Middle East and Africa. These developments are closely linked with the industrialization of food systems, technological change and globalization, including growth in the market and political activities of transnational food corporations and inadequate policies to protect nutrition in these new contexts. The scale of dietary change underway, especially in highly populated middle-income countries, raises serious concern for global health.

Food Outlets Dietary Risk (FODR) assessment tool: study protocol for assessing the public health nutrition risks of community food environments

BACKGROUND

Availability and accessibility of nutritious foods can vary according to the food outlets present within a neighbourhood or community. There is increasing evidence that community food environments influence food choice, diet and the risk of diet-related chronic disease, however contemporary community food environments assessments (e.g. unhealthy fast food outlets versus healthy supermarkets or fruit and vegetable shops) may be too simplistic to accurately summarise the complexities of their impacts on food choice. This study protocol describes the development of the Food Outlets Dietary Risk (FODR) assessment tool for use by local government in Perth, Western Australia.

METHODS

Similar to food safety risk assessment, the FODR assessment tool rates the potential harmful public health nutrition impact of food outlets by identifying and characterising the issues, and assessing the risk of exposure. Scores are attributed to six public health nutrition attributes: 1) availability of nutrient-poor foods; 2) availability of nutritious foods; 3) acceptability and appeal; 4) accessibility; 5) type of business operation; and 6) complex food outlet considerations. Food retail outlets are then classified as having a low, medium, high or very high dietary risk based on their total score.

DISCUSSION

A local government administered tool to rate the public health nutrition risk of food outlets requires data which can be collected during routine assessments or sourced from the internet. The ongoing categorical classification of foods available within food outlets as either unhealthy or nutritious will require nutrition scientists' input. An objective risk assessment of the dietary impact of food retail outlets can guide local government planning, policies and interventions to create supportive community food environments. It is intended that locally relevant data can be sourced throughout Australia and in other countries to apply the local context to the FODR assessment tool. Utility and acceptability of the tool will be tested, and consultation with environmental health officers and public health practitioners will inform future iterations.

Energy Density of New Food Products Targeted to Children

High dietary energy density (ED) is linked to childhood obesity and poor diet quality. The Australian Health Star Rating (HSR) system aims to assist consumers in making healthful food choices. This cross-sectional study used 2014-2018 data from the Mintel Global New Products Database to describe the ED of new food products targeted to children (5-12 years) released after the introduction of HSR and examine relationships between ED and HSR. Products were categorised by ED (low < 630 kJ/100 g, medium 630-950 kJ/100 g, high > 950 kJ/100 g) and HSR (no, HSR < 2.5 low, HSR ≥ 2.5 high). Non-parametric statistics were used to examine ED and HSR. A total of 548 products targeted children: 21% low, 5% medium, 74% high ED. One hundred products displayed an HSR: 24% low, 76% high; 53 products with both high HSR and ED. The EDs of products differed by HSR (p < 0.05), but both group's medians (HSR < 2.5: 1850 kJ/100 g, HSR ≥ 2.5: 1507 kJ/100 g) were high. A high proportion of new products had a high ED, and the HSR of these foods did not consistently discriminate between ED levels, particularly for high ED foods. Policies to promote lower ED foods and better alignment between ED and HSR may improve childhood obesity and diet quality.

Ultra-Processed Foods and Health Outcomes: A Narrative Review

The nutrition literature and authoritative reports increasingly recognise the concept of ultra-processed foods (UPF), as a descriptor of unhealthy diets. UPFs are now prevalent in diets worldwide. This review aims to identify and appraise the studies on healthy participants that investigated associations between levels of UPF consumption and health outcomes. This involved a systematic search for extant literature; integration and interpretation of findings from diverse study types, populations, health outcomes and dietary assessments; and quality appraisal. Of 43 studies reviewed, 37 found dietary UPF exposure associated with at least one adverse health outcome. Among adults, these included overweight, obesity and cardio-metabolic risks; cancer, type-2 diabetes and cardiovascular diseases; irritable bowel syndrome, depression and frailty conditions; and all-cause mortality. Among children and adolescents, these included cardio-metabolic risks and asthma. No study reported an association between UPF and beneficial health outcomes. Most findings were derived from observational studies and evidence of plausible biological mechanisms to increase confidence in the veracity of these observed associations is steadily evolving. There is now a considerable body of evidence supporting the use of UPFs as a scientific concept to assess the 'healthiness' of foods within the context of dietary patterns and to help inform the development of dietary guidelines and nutrition policy actions.

The nutritional quality of supermarket own brand chilled convenience foods: an Australian cross-sectional study reveals limitations of the Health Star Rating

OBJECTIVE

To assess the nutritional quality of Australian supermarket own brand chilled convenience foods (SOBCCF), for example, ready meals, pizza, pies and desserts.

DESIGN

Cross-sectional.

SETTING

Two large supermarkets (Coles and Woolworths) in Perth, Western Australia were audited in February 2017.

PARTICIPANTS

Data were extracted from photographic images of 291 SOBCCF, including front-of-pack information (i.e. product name, description and nutrition labels including Health Star Rating (HSR)) and back-of-pack information (i.e. nutrition information panel and ingredients list). SOBCCF were classified as healthy or unhealthy consistent with principles of the Australian Guide to Healthy Eating (AGTHE), NOVA classification of level of food processing and HSR score.

RESULTS

Fifty-four percentage of SOBCCF were classified as unhealthy according to AGTHE principles, 94 % were ultra-processed foods using NOVA and 81 % scored a HSR of ≥2·5, implying that they were a healthy choice. Some convenience food groups comprised more healthy choices overall including prepared vegetables, salad kits and bowls, soups and vegetarian food. A significantly larger proportion of SOBCCF from Coles were classified as unhealthy compared with Woolworths (70 v. 44 %, P < 0·05) using the AGTHE.

CONCLUSIONS

The findings suggest there is potential for Australian supermarkets to improve the nutritional quality of their SOBCCF and highlights the differences between supermarkets in applying their corporate social responsibility policies. Policies to assist consumers to select healthier foods should address difficulties in identifying healthy convenience foods. The findings reveal misclassification of unhealthy SOBCCF as healthy by the HSR suggesting that its algorithm should be reformed to align with recommendations of the AGTHE.

What role should the commercial food system play in promoting health through better diet?

Martin White and coauthors consider that the commercial food system has the potential to show leadership and support for dietary public health, but systemic change is needed first and this is likely to require governmental action

Ultra-processed food consumption drives excessive free sugar intake among all age groups in Australia

OBJECTIVE

To analyze the contribution of ultra-processed foods to the intake of free sugars among different age groups in Australia.

METHODS

Dietary intakes of 12,153 participants from the National Nutrition and Physical Activity Survey (2011-12) aged 2+ years were evaluated. Food items collected through two 24-h recalls were classified according to the NOVA system. The contribution of each NOVA food group and their subgroups to total energy intake was determined by age group. Mean free sugar content in diet fractions made up exclusively of ultra-processed foods, or of processed foods, or of a combination of un/minimally processed foods and culinary ingredients (which includes table sugar and honey) were compared. Across quintiles of the energy contribution of ultra-processed foods, differences in the intake of free sugars, as well as in the prevalence of excessive free sugar intake (≥ 10% of total energy) were examined.

RESULTS

Ultra-processed foods had the highest energy contribution among children, adolescents and adults in Australia, with older children and adolescents the highest consumers (53.1% and 54.3% of total energy, respectively). The diet fraction restricted to ultra-processed items contained significantly more free sugars than the two other diet fractions. Among all age groups, a positive and statistically significant linear association was found between quintiles of ultra-processed food consumption and both the average intake of free sugars and the prevalence of excessive free sugar intake.

CONCLUSION

Ultra-processed food consumption drives excessive free sugar intake among all age groups in Australia.

The Impact of Voluntary Policies on Parents' Ability to Select Healthy Foods in Supermarkets: A Qualitative Study of Australian Parental Views

Food packaging is used for marketing purposes, providing consumers with information about product attributes at the point-of-sale and thus influencing food choice. The Australian government focuses on voluntary policies to address inappropriate food marketing, including the Health Star Rating nutrition label. This research explored the way marketing via packaging information influences Australian parents' ability to select healthy foods for their children, and who parents believe should be responsible for helping them. Five 90-min focus groups were conducted by an experienced facilitator in Perth, Western Australia. Four fathers and 33 mothers of children aged 2-8 years participated. Group discussions were audio-recorded and transcribed verbatim and inductive thematic content analysis conducted using NVivo11. Seven themes were derived: (1) pressure of meeting multiple demands; (2) desire to speed up shopping; (3) feeding them well versus keeping them happy; (4) lack of certainty in packaging information; (5) government is trusted and should take charge; (6) food manufacturers' health messages are not trusted; (7) supermarkets should assist parents to select healthy foods. Food packaging information appears to be contributing to parents' uncertainty regarding healthy food choices. Supermarkets could respond to parents' trust in them by implementing structural policies, providing shopping environments that support and encourage healthy food choices.

Ultra-processed foods and recommended intake levels of nutrients linked to non-communicable diseases in Australia: evidence from a nationally representative cross-sectional study

OBJECTIVE

This study aimed to describe the consumption of ultra-processed foods in Australia and its association with the intake of nutrients linked to non-communicable diseases (NCDs).

DESIGN

Cross-sectional study.

SETTING

National Nutrition and Physical Activity Survey (2011-2012).

PARTICIPANTS

12,153 participants aged 2+ years.

MAIN OUTCOME MEASURES

Average dietary content of nutrients linked to NCDs and the prevalence of intake outside levels recommended for the prevention of NCDs.

DATA ANALYSIS

Food items were classified according to the NOVA system, a classification based on the nature, extent and purpose of industrial food processing. The contribution of each NOVA food group and their subgroups to total energy intake was calculated. Mean nutrient content of ultra-processed food and non-ultra-processed food fractions of the diet were compared. Across quintiles of the energy contribution of ultra-processed foods, differences in the intake of nutrients linked to NCDs as well as in the prevalence of intakes outside levels recommended for the prevention of NCDs were examined.

RESULTS

Ultra-processed foods had the highest dietary contribution (42.0% of energy intake), followed by unprocessed or minimally processed foods (35.4%), processed foods (15.8%) and processed culinary ingredients (6.8%). A positive and statistically significant linear trend was found between quintiles of ultra-processed food consumption and intake levels of free sugars (standardised β 0.43, p<0.001); total (β 0.08, p<0.001), saturated (β 0.18, p<0.001) and trans fats (β 0.10, p<0.001); sodium (β 0.21, p<0.001) and diet energy density (β 0.41, p<0.001), while an inverse relationship was observed for dietary fibre (β -0.21, p<0.001) and potassium (β -0.27, p<0.001). The prevalence of non-recommended intake levels of all studied nutrients increased linearly across quintiles of ultra-processed food intake, notably from 22% to 82% for free sugars, from 6% to 11% for trans fat and from 2% to 25% for dietary energy density, from the lowest to the highest ultra-processed food quintile.

CONCLUSION

The high energy contribution of ultra-processed foods impacted negatively on the intake of non-ultra-processed foods and on all nutrients linked to NCDs in Australia. Decreasing the dietary share of ultra-processed foods would substantially improve the diet quality in the country and help the population achieve recommendations on critical nutrients linked to NCDs.

An Audit of the Nutrition and Health Claims on Breakfast Cereals in Supermarkets in the Illawarra Region of Australia

Nutrition and health claims can promote healthier food choices but may lead to consumer confusion if misused. Regular monitoring of claims is therefore required. This study aimed to explore the prevalence of nutrition and health claims carried on breakfast cereals in supermarkets, and to assess claim compliance with regulations. Nutrition and health claims on breakfast cereal products across five supermarkets in the Illawarra region of New South Wales, Australia, were recorded in a cross-sectional audit. Prevalence of claim type and claim compliance was determined. Claims were compared across categories of breakfast cereal. Almost all (95.7%) products audited carried at least one nutrition or health claim; nutrition content (n = 1096) was more prevalent than health claims (n = 213). Most claims (91.6%) were compliant with regulations. Additionally, claim prevalence and type differed according to breakfast cereal category, with the highest proportion of claims appearing on ‘health and wellbeing’ and ‘muesli’ products. There is a high prevalence of nutrition and health claims on breakfast cereals, with most claims compliant with regulations. Research should investigate consumer interpretation of claims and the impact of applying nutrient profiling for all claims to assist consumers to make informed health choices.

The Nature and Quality of Australian Supermarkets' Policies that can Impact Public Health Nutrition, and Evidence of their Practical Application: A Cross-Sectional Study

Improving population diets is a public health priority, and calls have been made for corporations such as supermarkets to contribute. Supermarkets hold a powerful position within the food system, and one source of power is supermarket own brand foods (SOBFs). Many of the world’s largest supermarkets have corporate social responsibility (CSR) policies that can impact public health, but little is known about their quality or practical application. This study examines the nature and quality of Australian supermarkets’ CSR policies that can impact public health nutrition, and provides evidence of practical applications for SOBFs. A content analysis of CSR policies was conducted. Evidence of supermarkets putting CSR policies into practice was derived from observational audits of 3940 SOBFs in three large exemplar supermarkets (Coles, Woolworths, IGA) in Perth, Western Australia (WA). All supermarkets had some CSR policies that could impact public health nutrition; however, over half related to sustainability, and many lacked specificity. All supermarkets sold some nutritious SOBFs, using marketing techniques that made them visible. Findings suggest Australian supermarket CSR policies are not likely to adequately contribute to improving population diets or sustainability of food systems. Setting robust and meaningful targets, and improving transparency and specificity of CSR policies, would improve the nature and quality of supermarket CSR policies and increase the likelihood of a public health benefit.

Nutrient Profiling Is Needed to Improve the Nutritional Quality of the Foods Labelled with Health-Related Claims

Health-related claims on food products influence consumers and their food preferences. None of the European countries have restricted the use of health claims to foods of high nutritional quality despite the regulatory background provided by the European Union in 2006. We evaluated the nutritional quality of foods labelled with claims available in the Slovenian market using two nutrient profile models—Food Standards Australia New Zealand (FSANZ) and European World Health Organization Regional office for Europe model (WHOE)—and compared the results to the nutritional quality of all available foods. Data for prepacked foods in the Slovenian food supply were collected in 2015 on a representative sample (n = 6619) and supplemented with 12-month product sales data for more accurate assessments of the food supply. A considerable proportion of foods labelled with any type of health-related claim was found to have poor nutritional quality. About 68% of the foods labelled with health-related claims passed FSANZ criterion (75% when considering sales data) and 33% passed the WHOE model (56% when considering sales data). Our results highlight the need for stricter regulations for the use of health-related claims and to build upon available nutrient profiling knowledge to improve nutrition quality of foods labeled with health-related claims.

Global supermarkets' corporate social responsibility commitments to public health: a content analysis

Background

Supermarkets have unprecedented political and economic power in the food system and an inherent responsibility to demonstrate good corporate citizenship via corporate social responsibility (CSR). The aim of this study was to investigate the world’s largest and most powerful supermarkets’ publically available CSR commitments to determine their potential impact on public health.

Methods

The world’s largest 100 retailers were identified using the Global Powers of Retailing report. Thirty-one supermarkets that published corporate reports referring to CSR or sustainability, in English, between 2013 and 2018, were included and thematically analysed.

Results

Although a large number of themes were identified (n = 79), and there were differences between each business, supermarket CSR commitments focused on five priorities: donating surplus food to charities for redistribution to feed the hungry; reducing and recovering food waste; sustainably sourcing specific ingredients including seafood, palm oil, soy and cocoa; governance of food safety; and growing the number of own brand foods available, that are made by suppliers to meet supermarkets’ requirements.

Conclusions

CSR commitments made by 31 of the world’s largest supermarkets showed they appeared willing to take steps to improve sustainable sourcing of specific ingredients, but there was little action being taken to support health and nutrition. Although some supermarket CSR initiatives showed promise, the world’s largest supermarkets could do more to use their power to support public health. It is recommended they should: (1) transparently report food waste encompassing the whole of the food system in their waste reduction efforts; (2) support healthful and sustainable diets by reducing production and consumption of discretionary foods, meat, and other ingredients with high social and environmental impacts; (3) remove unhealthful confectionery, snacks, and sweetened beverages from prominent in-store locations; (4) ensure a variety of minimally processed nutritious foods are widely available; and (5) introduce initiatives to make healthful foods more affordable, support consumers to select healthful and sustainable foods, and report healthful food sales as a proportion of total food sales, using transparent criteria for key terms.

The extent and nature of supermarket own brand foods in Australia: study protocol for describing the contribution of selected products to the healthfulness of food environments

BACKGROUND

While public health experts have identified food environments as a driver of poor diet, they also hold great potential to reduce obesity, non-communicable diseases, and their inequalities. Supermarkets are the dominant retail food environment in many developed countries including Australia. The contribution of supermarket own brands to the healthfulness of retail food environments has not yet been explored. The aim of this protocol is to describe the methods developed to examine the availability, nutritional quality, price, placement and promotion of supermarket own brand foods within Australian supermarkets.

METHODS

Photographic audits of all supermarket own brand foods present in three major food retail outlets were conducted. Two researchers conducted the supermarket audits in Perth, Western Australia in February 2017. Photographs showing the location of the in-store product display, location of products on shelves, use of display materials, and front-of-pack and shelf-edge labels were taken for each supermarket own brand food present. An electronic filing system was established for photographs from each of the supermarkets and an Excel database constructed. The following data were extracted from the photographs: front-of-pack product information (e.g. product and brand name, pack weight); packaging and label design attributes (e.g. country of origin; marketing techniques conveying value for money and convenience); shelf-edge label price and promotion information; placement and prominence of each product; and nutrition and health information (including supplementary nutrition information, nutrition and health claims, and marketing statements and claims). Nutritional quality of each product was assessed using the principles of the Australian Guide to Healthy Eating, the NOVA classification of level of food processing, and the Health Star Rating score displayed on the front-of-pack.

DISCUSSION

Approximately 20,000 photographic images were collected for 3940 supermarket own brand foods present in this audit: 1812 in the Woolworths store, 1731 in the Coles store, and 397 in the IGA store. Analysis of findings will enable researchers to identify opportunities for interventions to improve the contribution of supermarket own brands to healthful retail food environments. This protocol is unique as it aims to investigate all aspects of retail food environments and address the contribution of supermarket own brands.

Evaluation of Alignment between the Health Claims Nutrient Profiling Scoring Criterion (NPSC) and the Health Star Rating (HSR) Nutrient Profiling Models

In Australia, manufacturers can use two government-endorsed approaches to advertise product healthiness: the Health Star Rating (HSR) front-of-pack nutrition labelling system, and health claims. Related, but different, algorithms determine the star rating of a product (the HSR algorithm) and eligibility to display claims (the Nutrient Profiling Scoring Criterion (NPSC) algorithm). The objective of this study was to examine the agreement between the HSR and NPSC algorithms. Food composition information for 41,297 packaged products was extracted from The George Institute’s FoodSwitch database. HSR and the NPSC scores were calculated, and the proportion of products in each HSR category that were eligible to display a health claim under the NPSC was examined. The highest agreement between the HSR scoring algorithm and the NPSC threshold to determine eligibility to display a health claim was at the HSR cut-off of 3.5 stars (k = 0.83). Overall, 97.3% (n = 40,167) of products with star ratings of 3.5 or higher were also eligible to display a health claim, and 94.3% (n = 38,939) of products with star ratings less than 3.5 were ineligible to display a health claim. The food group with greatest divergence was “edible oils”, with 45% products (n = 342) with HSR >3.5, but 64% (n = 495) eligible to display a claim. Categories with large absolute numbers of products with HSR <3.5, but eligible to display a claim, were “yoghurts and yoghurt drinks” (335 products, 25.4%) and “soft drinks” (299 products, 29.7%). Categories with a large number of products with HSR ≥3.5, but ineligible to display a claim, were “milk” (260 products, 21.2%) and “nuts and seeds” (173 products, 19.7%). We conclude that there is good agreement between the HSR and the NPSC systems overall, but divergence in some food groups is likely to result in confusion for consumers, particularly where foods with low HSRs are eligible to display a health claim. The alignment of the NPSC and HSR scoring algorithms should be improved.

What is known about consumer nutrition environments in Australia? A scoping review of the literature

OBJECTIVE

Food environments can influence food selection and hold the potential to reduce obesity, non-communicable diseases and their inequalities. 'Consumer nutrition environments' describe what consumers encounter within a food retail outlet, including products, price, promotion and placement. This study aimed to summarize the attributes that have been examined in existing peer-reviewed studies of Australian consumer nutrition environments, identify knowledge gaps and provide recommendations for future research.

METHODS

A systematic search of peer-reviewed literature was conducted. Sixty-six studies that assessed an aspect of within-store consumer nutrition environments were included.

RESULTS

Most studies were published from 2011 onwards and were conducted in capital cities and in supermarkets. Studies assessed the domains of product (40/66), price (26/66), promotion (16/66) and placement (6/66). The most common research themes identified were assessment of the impact of area socioeconomic status (13/66), remoteness (9/66) and food outlet type (7/66) on healthy food prices; change in price of healthy foods (6/66); variety of healthy foods (5/66); and prevalence of unhealthy child-orientated products (5/66).

CONCLUSIONS

This scoping review identified a large number of knowledge gaps. Recommended priorities for researchers are as follows: (1) develop consistent observational methodology, (2) consider consumer nutrition environments in rural and remote communities, (3) develop an understanding of food service outlets, (4) build on existing evidence in all four domains of product, price, placement and promotion and (5) determine effective policy and store-based interventions to increase healthy food selection.

Examining the Nutritional Quality of Canadian Packaged Foods and Beverages with and without Nutrition Claims

Nutrient content claims, health claims, and front-of-pack symbols (henceforth referred to as “nutrition claims” in the present study) are often found on food labels in Canada. However, it is currently unknown whether foods and beverages (F&Bs) carrying nutrition claims have a more favourable nutritional profile than those without such claims. This study examined differences in the global nutritional quality, as determined by the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (FSANZ-NPSC), of Canadian F&B bearing nutrition claims as compared to those without, as well as in their nutritional composition. Data (n = 15,184) was obtained from the University of Toronto 2013 Food Label Information Program. Forty-two percent of F&Bs carrying nutrition claims (n = 2930/6990) were found to be ineligible to carry claims based on the FSANZ-NPSC, in comparison to 66% of F&Bs without (n = 5401/8194, p < 0.001). Sugars and sweets, and miscellaneous products were the food categories with larger proportions of foods carrying nutrition claims not meeting the FSANZ-NPSC eligibility criteria. F&Bs with nutrition claims had fewer calories, less saturated fat, sodium, and sugar, and higher content of protein and fibre than comparable products without nutrition claims (p < 0.05 in all cases). In conclusion, nearly half of F&Bs carrying nutrition claims in Canada did not meet the FSANZ-NPSC threshold, although Canadian products carrying nutrition claims have an overall “healthier” profile than their counterparts without such claims.

Nutritional quality of new food products released into the Australian retail food market in 2015 - is the food industry part of the solution?

BACKGROUND

Food manufacturers have made public statements and voluntary commitments, such as the Healthier Australia Commitment (HAC), to improve the nutritional quality of foods. However, limited information about the nutritional quality or healthfulness of new products makes it difficult to determine if manufacturers are doing this. The purpose of this study was to assess the healthfulness of new food products released into the Australian retail market in 2015, and whether those companies who were HAC members released healthier food options compared to non-HAC members.

METHODS

This cross-sectional study assessed the healthfulness of all new retail food products launched in Australia in 2015 as indexed in Mintel's Global New Products Database. Healthfulness was assessed using three classification schemes: Healthy Choices Framework Victoria, Australian Dietary Guidelines and NOVA Food Classification System. Descriptive statistics and chi-squared tests described and compared the number and proportions of new foods falling within each of the food classification schemes' categories for companies that were and were not HAC members.

RESULTS

In 2015, 4143 new food products were launched into the Australian market. The majority of new products were classified in each schemes' least healthy category (i.e. red, discretionary and ultra-processed). Fruits and vegetables represented just 3% of new products. HAC members launched a significantly greater proportion of foods classified as red (59% vs 51% for members and non-members, respectively) discretionary (79% vs 61%), and ultra-processed (94% vs 81%), and significantly fewer were classified as green (8% vs 15%), core foods (18% vs 36%) and minimally processed (0% vs 6%) (all p < 0.001).

CONCLUSIONS

This study found that the majority of new products released into the Australian retail food market in 2015 were classified in each of three schemes' least healthy categories. A greater proportion of new products launched by companies that publicly committed to improve the nutritional quality of their products were unhealthy, and a lower proportion were healthy, compared with new products launched by companies that did not so commit. Greater monitoring of industry progress in improving the healthfulness of the food supply may be warranted, with public accountability if the necessary changes are not seen.

The SENS algorithm-a new nutrient profiling system for food labelling in Europe

BACKGROUND/OBJECTIVES

In response to the European regulation on nutrition and health claims, France proposed in 2008 the SAIN,LIM profiling system that classifies foods into four classes based on a nutrient density score called 'SAIN', a score of nutrients to limit called 'LIM', and one primary threshold on each score. We present here the SENS algorithm, a new nutrient profiling system adapted from the SAIN,LIM to be operational for simplified nutrition labelling in line with the European regulation on food information to consumers.

SUBJECTS/METHODS

The main changes made to SAIN,LIM to get SENS were to introduce food categories and sub-categories ('Beverages', 'Added Fats' and 'Other Solid Foods' sub-categorised into 'cereals', 'cheese', 'other dairy products', 'eggs', 'fish' and 'others'), reduce the number of nutrients, introduce category-specific nutrients and category-specific weighting for some nutrients, replace French recommendations with European reference intakes, and add secondary thresholds. Each food and non-alcoholic beverage from the 2013-CIQUAL French composition database (n = 1065) was assigned one SENS class. Distribution of foods according to the four SENS classes was described by food groups (n = 26).

RESULTS

The SENS classification was consistent with the recommendations to consume large amounts of whole grains, vegetables and fruits, and moderate intake of fats, sugars, meats, caloric beverages and salt. For most groups (19/26), foods were distributed across at least three SENS classes.

CONCLUSIONS

The SENS is a nutrition-sensitive system that discriminates foods between and within food categories. It preserves the strengths of the initial SAIN,LIM while making it operational for simplified nutrition labelling in Europe.

Do nutrition labels influence healthier food choices? Analysis of label viewing behaviour and subsequent food purchases in a labelling intervention trial

BACKGROUND

There are few objective data on how nutrition labels are used in real-world shopping situations, or how they affect dietary choices and patterns.

DESIGN

The Starlight study was a four-week randomised, controlled trial of the effects of three different types of nutrition labels on consumer food purchases: Traffic Light Labels, Health Star Rating labels, or Nutrition Information Panels (control). Smartphone technology allowed participants to scan barcodes of packaged foods and receive randomly allocated labels on their phone screen, and to record their food purchases. The study app therefore provided objectively recorded data on label viewing behaviour and food purchases over a four-week period. A post-hoc analysis of trial data was undertaken to assess frequency of label use, label use by food group, and association between label use and the healthiness of packaged food products purchased.

RESULTS

Over the four-week intervention, study participants (n = 1255) viewed nutrition labels for and/or purchased 66,915 barcoded packaged products. Labels were viewed for 23% of all purchased products, with decreasing frequency over time. Shoppers were most likely to view labels for convenience foods, cereals, snack foods, bread and bakery products, and oils. They were least likely to view labels for sugar and honey products, eggs, fish, fruit and vegetables, and meat. Products for which participants viewed the label and subsequently purchased the product during the same shopping episode were significantly healthier than products where labels were viewed but the product was not subsequently purchased: mean difference in nutrient profile score -0.90 (95% CI -1.54 to -0.26).

CONCLUSIONS

In a secondary analysis of a nutrition labelling intervention trial, there was a significant association between label use and the healthiness of products purchased. Nutrition label use may therefore lead to healthier food purchases.

Ultra-processed family foods in Australia: nutrition claims, health claims and marketing techniques

Objective

To objectively evaluate voluntary nutrition and health claims and marketing techniques present on packaging of high-market-share ultra-processed foods (UPF) in Australia for their potential impact on public health.

Design

Cross-sectional.

Setting

Packaging information from five high-market-share food manufacturers and one retailer were obtained from supermarket and manufacturers’ websites.

Subjects

Ingredients lists for 215 UPF were examined for presence of added sugar. Packaging information was categorised using a taxonomy of nutrition and health information which included nutrition and health claims and five common food marketing techniques. Compliance of statements and claims with the Australia New Zealand Food Standards Code and with Health Star Ratings (HSR) were assessed for all products.

Results

Almost all UPF (95 %) contained added sugars described in thirty-four different ways; 55 % of UPF displayed a HSR; 56 % had nutrition claims (18 % were compliant with regulations); 25 % had health claims (79 % were compliant); and 97 % employed common food marketing techniques. Packaging of 47 % of UPF was designed to appeal to children. UPF carried a mean of 1·5 health and nutrition claims (range 0–10) and 2·6 marketing techniques (range 0–5), and 45 % had HSR≤3·0/5·0.

Conclusions

Most UPF packaging featured nutrition and health statements or claims despite the high prevalence of added sugars and moderate HSR. The degree of inappropriate or inaccurate statements and claims present is concerning, particularly on packaging designed to appeal to children. Public policies to assist parents to select healthy family foods should address the quality and accuracy of information provided on UPF packaging.

An Innovative Method for Monitoring Food Quality and the Healthfulness of Consumers' Grocery Purchases

This study presents a method laying the groundwork for systematically monitoring food quality and the healthfulness of consumers' point-of-sale grocery purchases. The method automates the process of identifying United States Department of Agriculture (USDA) Food Patterns Equivalent Database (FPED) components of grocery food items. The input to the process is the compact abbreviated descriptions of food items that are similar to those appearing on the point-of-sale sales receipts of most food retailers. The FPED components of grocery food items are identified using Natural Language Processing techniques combined with a collection of food concept maps and relationships that are manually built using the USDA Food and Nutrient Database for Dietary Studies, the USDA National Nutrient Database for Standard Reference, the What We Eat In America food categories, and the hierarchical organization of food items used by many grocery stores. We have established the construct validity of the method using data from the National Health and Nutrition Examination Survey, but further evaluation of validity and reliability will require a large-scale reference standard with known grocery food quality measures. Here we evaluate the method's utility in identifying the FPED components of grocery food items available in a large sample of retail grocery sales data (~190 million transaction records).

Effects of interpretive nutrition labels on consumer food purchases: the Starlight randomized controlled trial

Background: Nutrition labeling is a prominent policy to promote healthy eating.Objective: We aimed to evaluate the effects of 2 interpretive nutrition labels compared with a noninterpretive label on consumer food purchases.Design: In this parallel-group randomized controlled trial, we enrolled household shoppers across New Zealand who owned smartphones and were aged ≥18 y. Eligible participants were randomly assigned (1:1:1) to receive either traffic light labels (TLLs), Health Star Rating labels (HSRs), or a control [nutrition information panel (NIP)]. Smartphone technology allowed participants to scan barcodes of packaged foods and to receive allocated labels on their smartphone screens. The primary outcome was the mean healthiness of all packaged food purchases over the 4-wk intervention period, which was measured by using the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC).Results: Between October 2014 and November 2015, 1357 eligible shoppers were randomly assigned to TLL (n = 459), HSR (n = 443), or NIP (n = 455) labels. Overall difference in the mean transformed NPSC score for the TLL group compared with the NIP group was -0.20 (95% CI: -0.94, 0.54; P = 0.60). The corresponding difference for HSR compared with NIP was -0.60 (95% CI: -1.35, 0.15; P = 0.12). In an exploratory per-protocol analysis of participants who used the labeling intervention more often than average (n = 423, 31%), those who were assigned to TLL and HSR had significantly better NPSC scores [TLL compared with NIP: -1.33 (95% CI: -2.63, -0.04; P = 0.04); HSR compared with NIP: -1.70 (95% CI: -2.97, -0.43; P = 0.01)]. Shoppers who were randomly assigned to HSR and TLL also found the labels significantly more useful and easy to understand than the NIP (all P values <0.001).Conclusions: At the relatively low level of use observed in this trial, interpretive nutrition labels had no significant effect on food purchases. However, shoppers who used interpretive labels found them to be significantly more useful and easy to understand, and compared with frequent NIP users, frequent TLL and HSR users had significantly healthier food purchases. This trial was registered at the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366446&isReview=true) as ACTRN12614000644662.

Effects of a healthier snack on snacking habits and glycated Hb (HbA1c): a 6-week intervention study

Dietary behaviour modification may change eating habits and reduce the impact of poor nutrition. This study aimed to evaluate the effects of daily consumption of a healthier snack bar on snacking habits and glycated Hb (HbA1c) within a 6-week intervention. In all, twenty-eight participants were randomly allocated to two groups to either consume the bars as the main snack for 6 weeks (n 14) or receipt of the bars was delayed for 6 weeks (n 14) following a stepped-wedge design. All participants had HbA1c concentrations measured at weeks -1, 0, 4, 6, 10 and 12. A short dietary habits questionnaire was self-completed at weeks 0, 6 and 12. Participants consumed the bars they received instead of other snacks, and found that the healthier snack bar was acceptable as part of their daily dietary pattern. Over the 12 weeks, there was a significant reduction in intake of biscuits, cakes and pies (approximately 2 servings/week, P<0·05) in both groups. Fruit juice intake was reduced (approximately 1 serving/week, P=0·029) in the first group. In all, twenty participants (71·4 %) experienced a decrease (n 15) or no change (n 5) in HbA1c (range 0-4 mmol/mol), whereas eight participants experienced an increase in HbA1c (range 0·5-2·5 mmol/mol). There was high compliance with the healthier snack intervention and a trend towards a favourable effect on glucose homoeostasis. Habitual snacking behaviour has the potential to be improved through changes in the food supply, and in the longer term may reduce the impact of poor nutrition on public health.

Nutrition and health claims on healthy and less-healthy packaged food products in New Zealand

Nutrition and health claims are displayed to influence consumers' food choices. This study assessed the extent and nature of nutrition and health claims on the front-of-pack of 'healthy' and 'less-healthy' packaged foods in New Zealand. Foods from eight categories, for which consumption may affect the risk of obesity and diet-related chronic diseases, were selected from the 2014 Nutritrack database. The internationally standardised International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support (INFORMAS) taxonomy was used to classify claims on packages. The Nutrient Profiling Scoring Criterion (NPSC) was used to classify products as 'healthy' or 'less healthy'. In total, 7526 products were included, with 47 % (n 3557) classified as 'healthy'. More than one-third of products displayed at least one nutrition claim and 15 % featured at least one health claim on the front-of-pack. Claims were found on one-third of 'less-healthy' products; 26 % of those products displayed nutrition claims and 7 % featured health claims. About 45 % of 'healthy' products displayed nutrition claims and 23 % featured health claims. Out of 7058 individual claims, the majority (69 %) were found on 'healthy' products. Cereals displayed the greatest proportion of nutrition and health claims (1503 claims on 564 products), of which one-third were displayed on 'less-healthy' cereals. Such claims could be misleading consumers' perceptions of nutritional quality of foods. It needs to be explored how current regulations on nutrition and health claims in New Zealand could be further strengthened (e.g. using the NPSC for nutrition claims, including general health claims as per the INFORMAS taxonomy) to ensure consumers are protected and not misled.

Investigating nutrient profiling and Health Star Ratings on core dairy products in Australia

OBJECTIVE

To determine whether the ratings from the Australian front-of-pack labelling scheme, Health Star Rating (HSR), and the ability to carry health claims using the Nutrient Profiling Scoring Criterion (NPSC) for core dairy products promote foods consistent with the Australian Dietary Guidelines.

DESIGN

The Australian nutrient profiling model used for assessing eligibility for health claims was compared with the nutrient profiling model underpinning the HSR system to determine their agreement when assessing dairy products. Agreement between the extent to which products met nutrient profiling criteria and scored three stars or over using the HSR calculator was determined using Cohen's kappa tests.

SETTING

The four largest supermarket chains in Sydney, Australia.

SUBJECTS

All available products in the milk, hard cheese, soft cheese and yoghurt categories (n 1363) were surveyed in March-May 2014. Nutrition composition and ingredients lists were recorded for each product.

RESULTS

There was 'good' agreement between NPSC and HSR overall (κ=0·78; 95 % CI 0·75, 0·81; P<0·001), for hard cheeses (κ=0·72; 95 % CI 0·65, 0·79; P<0·001) and yoghurt (κ=0·79; 95 % CI 0·73, 0·86; P<0·001). There was 'fair' agreement for milk (κ=0·33; 95 % CI 0·20, 0·45; P<0·001) and 'very good' agreement for soft cheese (κ=0·84; 95 % CI 0·75, 0·92; P<0·001). Generally, products tended to have HSR consistent with other products of a similar type within their categories.

CONCLUSIONS

For dairy products, the HSR scheme largely aligned with the NPSC used for determining eligibility for health claims. Both systems appeared be consistent with the Australian Dietary Guidelines for dairy products, with lower-fat products rating higher.