Dissecting Qualified Health Claims: Evidence From Experimental Studies

Have safety and efficacy assessments of bioactives come of age?

This article describes why the safety and efficacy assessment of non-nutrient bioactives for reducing chronic disease risk is so complicated, especially for dietary supplements and traditional medicines. Scientists, regulators, and the public have different and sometimes opposing perspectives about bioactives. Drug, food, and traditional medicine models used for bioactive safety assessment are based on different assumptions and use different processes. Efficacy assessment is seldom based on clinical trials of boactives' effects in reducing chronic disease risk. It usually consists of application of quality assurance measures and evaluation of label claims and commercial speech about ingredients or products to ensure conformity to regulations. Harmonization of safety and efficacy assessment on a global basis is difficult because of differences within and between regulatory systems. The recommendations provided may open the way for bioactives to play a larger health role in the future, fill gaps in data needed for crafting authoritative dietary guidance on intakes, and speed harmonization of global standards.

Nature of the evidence base and strengths, challenges and recommendations in the area of nutrition and health claims: a position paper from the Academy of Nutrition Sciences

The regulation of health claims for foods by the Nutrition and Health Claims Regulation is intended, primarily, to protect consumers from unscrupulous claims by ensuring claims are accurate and substantiated with high quality scientific evidence. In this position paper, the Academy of Nutrition Sciences uniquely recognises the strengths of the transparent, rigorous scientific assessment by independent scientists of the evidence underpinning claims in Europe, an approach now independently adopted in UK. Further strengths are the separation of risk assessment from risk management, and the extensive guidance for those submitting claims. Nevertheless, four main challenges in assessing the scientific evidence and context remain: (i) defining a healthy population, (ii) undertaking efficacy trials for foods, (iii) developing clearly defined biomarkers for some trial outcomes and (iv) ensuring the composition of a food bearing a health claim is consistent with generally accepted nutrition principles. Although the Regulation aims to protect the consumer from harm, we identify some challenges from consumer research: (i) making the wording of some health claims more easily understood and (ii) understanding the implications of the misperceptions around products bearing nutrition or health claims. Recommendations are made to overcome these challenges. Further, the Academy recommends that a dialogue is developed with the relevant national bodies about Article 12(c) in the Regulation. This should further clarify the GB Guidance to avoid the current non-level playing field between health professionals and untrained ‘influencers’ who are not covered by this Article about the communication of authorised claims within commercial communications.

Increase consumers’ willingness to pay a premium for organic food in restaurants: Explore the role of comparative advertising

Offering organic food is a new trend in the hospitality industry seeking sustainable competitiveness. Premiums and information barriers impede continued growth in organic consumption. This study aims to explore the role of comparative advertising (CA) in organic food communication. Three empirical studies were used to verify the effect of CA vs. non-comparative advertising (NCA) on consumers’ willingness to pay a premium (WTPP) for organic food, examining how benefit appeals (health vs. environmental) and consumers’ organic skepticism affects CA. The results indicate that matching CA and health appeals increase consumers’ WTPP, while environmental appeals have no significant differences between the CA and NCA groups (Study 1). Information persuasiveness mediates the interaction between CA and benefit appeal on WTPP (Study 2). CA increases WTPP among consumers with high organic skepticism, while the interaction between CA and health appeal is only effective for low skepticism consumers (Study 3). The findings unravel and explain the mechanics of how CA works in organic products, which can help restaurants, retailers and tourist destinations advertise organic food to increase consumers’ WTPP.

The impact of COVID-19 on consumers' eating and purchasing habits of agricultural products in China: key determinants and policy implications

BACKGROUND

The study looks at a changed in consumer's eating and purchasing habits during COVID-19 period. There are several modes of transmission but transmission through food as being speculated is one area that has not been confirmed through research. The study, therefore, looks at how speculations about COVID-19 spreading through food has affected consumers' eating and purchasing habits. This study through probit model analysed how consumers' eating and purchasing habits have been influenced.

RESULTS

The result shows that age, gender and education have negatively influenced consumer's eating and purchasing habits during the COVID-19 pandemic compared to pre-pandemic period. The preference for imported food items, preference for frozen food, been infected or knowing someone who has been infected by the virus, and been infected through agricultural source or knowing someone who has been infected by the COVID-19 through agricultural source have negatively affected consumers' eating and purchasing habits compared to pre-pandemic period. The result, however, suggests that consumers who trust in the cold-chain food systems ability to limit the spread of the COVID-19 still maintain a positive eating and purchasing habits.

CONCLUSIONS

The study provides evidence on the impact of COVID-19 on consumer's eating and purchasing habits. Therefore, there is the need to institute proper sanitary measures, especially at cold-chain food systems to help curb the spread and also boost consumers' confidence.

Consumer Preferences and Socioeconomic Factors Decided on Plantain and Plantain-Based Products in the Central Region of Cameroon and Oyo State, Nigeria

Plantain is a key staple food in Central and West Africa, but there is limited understanding of its market in Africa. In addition, the cooking methods for enhancing the nutritional value, consumer preference, and willingness to pay for plantain and plantain-based products are not well understood. The knowledge gaps in the market and consumer dimension of the food chain need to be known to increase plantain utilization and guide breeding efforts. This research contributes by examining the cooking methods, consumer preference, and willingness to pay for plantain and plantain-based products in Cameroon and Nigeria. A household survey sample of 454 Cameroonian consumers in four divisions of Central Region and 418 Nigerian consumers in seven government areas of Oyo State in southwest Nigeria was the basis for the analysis. The results showed some levels of similarity and difference in the consumption and cooking of boiled, roasted, and fried plantain in both countries. The trend in consumption of all plantain-based products was constant in Cameroon but increased in Nigeria. The most important factor influencing Cameroonian consumers’ choice of plantain and its products was taste, while the nutrition trait influenced Nigerian consumers. Both Cameroonian and Nigerian consumers considered packaging, location of produce, and size and quantity as the least important factors. In addition, socioeconomic characteristics were significant determinants of consumers’ choices to consume plantain and its products. Gender significantly influenced (p < 0.05) taste, while nutrition was significantly driven (p < 0.05) by education and annual income. Household size played a significant role (p < 0.05) in consumers’ choices when the price was considered. These findings serve as a guideline to improve existing products to match the needs of consumers in each country and develop products for different consumer segments and potentially increase production.

Perception of Older Adults about Health-Related Functionality of Foods Compared with Other Age Groups

The proportion of older adults in the population is significantly growing in the EU, therefore, wellbeing of the older population has become a social challenge. Functional foodstuffs are food products with nutritional composition that may reduce the risk of diet-related diseases or enhance physiological functions. Therefore, they could play an important role in prevention and mitigation of health-related problems, and in promotion of healthy ageing. The aim of this study is to present the impact of age on consumer preferences about functionality of foods, covering attitude aspects, nutrition claims, possible carriers, some particular health problems and expectations about sustainable production. The results are based on a representative quantitative survey. Findings highlight statistically significant (p < 0.05) differences in preferences of older adults compared to other age segments. They generally accept functional foods, especially when functionality is attached to increased vitamin, protein, and fiber content. Older adults also prefer products with lower salt and sugar content, which were less relevant for other age groups. Products of fruit and vegetable origin are distinguished as carriers of functional traits. Compared to other segments, older adults accept products of animal origin (especially milk products) and even breakfast products on a higher level. The paper provides details about particular health issues that could be addressed by functional foods based on actual consumer concerns.

Consumers' responses to health claims in the context of other on-pack nutrition information: a systematic review

Context

The presence of health claims on food packaging can positively bias consumers' evaluations of foods. This review examined whether cognitive biases endure when other sources of nutrition information [the nutrition facts panel (NFP) and front-of-pack labels] appear on-pack with health claims. The following databases were searched: Web of Science, Ovid, Google Scholar, ScienceDirect, Scopus, ProQuest, and Wiley Online Library. The search terms ("health claim*" OR "nutri* claim") AND ("food label*" OR "front of pack") were used to identify studies. Twenty-four studies that examined health claims and front-of-pack labels or the NFP were included. The NFP can reduce bias, but only if consumers view it and interpret it correctly, which often does not occur. Front-of-pack labels show greater promise in reducing bias created by health claims. These findings are relevant to policymakers who are considering the effectiveness of mandating an NFP and/or a front-of-pack label alongside health claims.

Do Health Claims and Front-of-Pack Labels Lead to a Positivity Bias in Unhealthy Foods?

Health claims and front-of-pack labels (FoPLs) may lead consumers to hold more positive attitudes and show a greater willingness to buy food products, regardless of their actual healthiness. A potential negative consequence of this positivity bias is the increased consumption of unhealthy foods. This study investigated whether a positivity bias would occur in unhealthy variations of four products (cookies, corn flakes, pizzas and yoghurts) that featured different health claim conditions (no claim, nutrient claim, general level health claim, and higher level health claim) and FoPL conditions (no FoPL, the Daily Intake Guide (DIG), Multiple Traffic Lights (MTL), and the Health Star Rating (HSR)). Positivity bias was assessed via measures of perceived healthiness, global evaluations (incorporating taste, quality, convenience, etc.) and willingness to buy. On the whole, health claims did not produce a positivity bias, while FoPLs did, with the DIG being the most likely to elicit this bias. The HSR most frequently led to lower ratings of unhealthy foods than the DIG and MTL, suggesting that this FoPL has the lowest risk of creating an inaccurate positivity bias in unhealthy foods.

Are Front of Pack Claims Indicators of Nutrition Quality? Evidence from 2 Product Categories

American grocery shoppers face an array of front of pack (FOP) nutrition and health claims when making food selections. Such systems have been categorized as summary or nutrient specific. Either type should help consumers make judgments about the nutrition quality of a product. This research tests if the type or quantity of FOP claims are indeed good indicators of objective nutrition quality. Claim and nutrition information from more than 2200 breakfast cereals and prepared meals launched between 2006 and 2010 were analyzed using binary and multinomial logistic regression models. Results suggest that no type or number of front of pack claims could distinguish "healthy" foods. However, some types and frequencies of FOP claims were significant predictors of higher or lower levels of certain key nutrients. Given the complex and crowded label environment in which these FOP claims reside, one may be concerned that such cues are not closely related to objective measures of nutrition quality.

Differences in the nutritional content of baby and toddler foods with front-of-package nutrition claims issued by manufacturers v. governments/health organizations

Objective

Nutritional information panels are required on all packaged food products in the USA, yet are perceived as difficult to use by consumers. Nutritional symbols have been developed by various groups to assist consumers in making healthier food purchases. Different nutritional criteria are used depending on the authorizing body of these symbols. The present study assesses the nutrient profile of baby and toddler foods in light of their accompanying nutritional symbols.

Design

Kruskal–Wallis and χ2 tests were used to assess differences in the nutritional content of products based on the presence and issuing body of nutritional symbols.

Setting

Nine grocery, drug and department stores in Philadelphia, PA, USA.

Subjects

Two hundred and forty packaged baby and toddler foods.

Results

Products whose nutritional symbol was issued by government/health professionals contained significantly more Ca (P = 0·002), fibre (P = 0·001), protein (P = 0·005), vitamin A (P = 0·011), vitamin C (P < 0·001) and Zn (P < 0·001) and less sugar (P = 0·004) per serving than products without a nutritional symbol and products whose nutritional symbol was issued by the manufacturer.

Conclusions

Products with a nutritional symbol issued by government/health professionals were healthier than foods with nutritional symbols issued by the manufacturer directly and foods with no nutritional symbols.

Characteristics of consumers using 'better for you' front-of-pack food labelling schemes - an example from the Australian Heart Foundation Tick

OBJECTIVE

The Heart Foundation Tick aims to help consumers make healthier food choices and overcome confusion in understanding food labels. Little is known about what factors differentiate frequent from infrequent users and the effectiveness of this scheme in helping Australians make healthier food choices.

DESIGN

A cross-sectional survey was used to explore use of the Tick and associations with a range of individual characteristics.

SETTING

A national panel of Australians, living in each state and territory, completed an online survey (n 1446).

SUBJECTS

Adult men (41 %) and women participated in the study.

RESULTS

Most trusted the Heart Foundation (79 %), and used the Tick at least occasionally (19 % regularly, 21 % often, 35 % occasionally, 24 % never). A majority was classified as overweight/obese (60 %), 3·5 % were diagnosed with CHD, 5·2 % with diabetes and 23 % with hypertension. Many did not meet recommendations for the consumption of red meat (30 %), processed meat (23 %), vegetables (78 %), fruit (43 %) and fast foods (47 %). Female frequent users tended to have hypertension, be married/de facto, older than 45 years, rural dwellers, and limit their intake of fast foods. Male frequent users tended to have hypertension, meet recommendations for fruit, vegetables and processed meats, but not have a tertiary education.

CONCLUSIONS

The Heart Foundation Tick is a highly trusted, highly recognizable food labelling scheme and helpful to consumers who are motivated to make healthier food choices. More inter-sector collaboration is required to incorporate these schemes into public health campaigns to help consumers make healthier food choices.

Development and implementation of the guiding stars nutrition guidance program

PURPOSE . To describe the collaborative process between a grocery retailer and a panel of nutrition experts used to develop a nutrition guidance system (Guiding Stars) that evaluates the nutrient profile of all edible products in the supermarket, and to report the results of the food and beverage ratings. DESIGN . A collaboration between a private retailer and members of the scientific community that led to the development of a scoring algorithm used to evaluate the nutritional quality of foods and beverages. SETTING/SUBJECTS . Northeast supermarkets (n  =  160). MEASURES . Food and beverage nutrition ratings and distribution of stars across different grocery categories. ANALYSIS . Descriptive statistics for rating distributions were computed. T-tests were conducted to assess differences in mean nutrient values between foods with zero versus three stars or a dichotomized variable representing all foods with one to three stars. RESULTS . All edible grocery items (n  =  27,466) were evaluated, with 23.6% earning at least one star. Items receiving at least one star had lower mean levels of sodium, saturated fat, and sugars and higher amounts of fiber than products not earning stars. CONCLUSION . The Guiding Stars system rates edible products without regard to brand or manufacturer, and provides consumers with a simple tool to quickly identify more nutritious choices while shopping. The low percentage of products qualifying for stars reflects poorly on the food choices available to Americans.

Swedish consumers' cognitive approaches to nutrition claims and health claims

Introduction and Aim

Studies show frequent use of nutrition claims and health claims in consumers' choice of food products. The aim of the present study was to investigate how consumers' thoughts about these claims and food products are affected by various types of food-related experiences.

Material and Methods

The data collection comprised 30 individual interviews among Swedish consumers aged 25 to 64 years.

Results

The results indicated that participants who expressed special concern for their own and their families' health were eager to find out the meaning of concepts and statements made. A lack of understanding and lack of credibility of concepts and expressions often caused suspicion of the product. However, in some cases this was counterbalanced by confidence in manufacturers, retailers, and/or the Swedish food legislation.

Discussion and Conclusion

To achieve effective written communication of food products' health-conducive properties on food labels, there is a need to consider the importance many consumers attach to understanding the meaning of concepts and expressions used and the importance of credibility in certain expressions. Consumers' varying cognitive approaches are suggested as a basis for pre-tests of nutrition claims and health claims.

Nutrition communication: consumer perceptions and predicting intentions

Health claims on food products, which aim at informing the public about the health benefits of the product, represent one type of nutrition communication; the use of these is regulated by the European Union. This paper provides an overview of the research on health claims, including consumers’ perceptions of such claims and their intention to buy products that carry health-related claims. This is followed by a discussion on the results from some recent studies investigating public perceptions and willingness to use products with health claims. In these studies, claims are presented in the form of messages of different lengths, types, framing, with and without qualifying words and symbols. They also investigate how perceptions and intentions are affected by individual needs and product characteristics. Results show that adding health claims to products does increase their perceived healthiness. Claim structure was found to make a difference to perceptions, but its influence depended on the level of relevance, familiarity and individuals’ need for information. Further, the type of health benefit proposed and the base product used also affected perceptions of healthiness. The paper concludes that while healthiness perceptions relating to products with health claims may vary between men and women, old and young and between countries, the main factor influencing perceived healthiness and intention to buy a product with health claim is personal relevance.

Potential pitfalls of health claims from a public health nutrition perspective

The European Union is implementing a new regulatory framework for nutrition and health claims (HCs) that will greatly impact the communication of health messages on foodstuffs. In particular, approved HCs will be included in a positive register of generic claims. In the currently available literature, assessment of the relevance of HCs has mainly been related to scientific substantiation, and the issue of relevance in terms of public health has tended to be overlooked. Interestingly, the new regulation states that claims must be well understood by the average consumer. This article delves beyond the issue of scientific substantiation of claims and reviews possible discrepancies between consumer perception/understanding of HCs and the public health nutrition reality, which can confuse or mislead the consumer and ultimately impact public health nutrition. Six pitfalls are described herein and a comprehensive overview of the critical examination of any HC is proposed.

Korean consumers' perceptions of health/functional food claims according to the strength of scientific evidence

In this study, we investigated that consumers could differentiate between levels of claims and clarify how a visual aid influences consumer understanding of the different claim levels. We interviewed 2,000 consumers in 13 shopping malls on their perception of and confidence in different levels of health claims using seven point scales. The average confidence scores given by participants were 4.17 for the probable level and 4.07 for the possible level; the score for the probable level was significantly higher than that for the possible level (P < 0.05). Scores for confidence in claims after reading labels with and without a visual aid were 5.27 and 4.43, respectively; the score for labeling with a visual aid was significantly higher than for labeling without a visual aid (P < 0.01). Our results provide compelling evidence that providing health claims with qualifying language differentiating levels of scientific evidence can help consumers understand the strength of scientific evidence behind those claims. Moreover, when a visual aid was included, consumers perceived the scientific levels more clearly and had greater confidence in their meanings than when a visual aid was not included. Although this result suggests that consumers react differently to different claim levels, it is not yet clear whether consumers understand the variations in the degree of scientific support.

Assessment of health claims, content, and safety of herbal supplements containing Ginkgo biloba

BACKGROUND

European Regulation 1924/2006 states that all health claims made on foods need to be substantiated scientifically.

OBJECTIVE

To apply the PASSCLAIM criteria for the scientific substantiation of health claims on foods to herbal supplements containing Ginkgo biloba. Evaluation of three selected claimed health effects for G. biloba (improvement of blood circulation, improvement of symptoms of old age, and improvement of memory) was achieved through review of publicly available scientific data. A total of 35 human intervention studies were evaluated. Commercially available products claimed to contain mainly G. biloba (N=29) were randomly sampled in the Netherlands and analyzed for their content on ginkgo extract. Also, a toxicological risk assessment was performed.

RESULTS

The three selected health claims investigated could not be substantiated. This was mainly because of a lack of data from studies in healthy volunteers. In most studies results performed with a 24% standardized G. biloba extract were described. However, our chemical analysis showed that 25 of the 29 sampled products did not contain the required minimum 24% standardized extract. Moreover, in most preparations the content of substances typical for G. biloba did not conform to what was declared on the label. Since toxicity data for G. biloba are very limited, a safety limit could not be established.

CONCLUSIONS

Evidence is lacking for three health claims of herbal products with G. biloba. Neither safety nor efficacy can be guaranteed at the recommended daily dose. The multidisciplinary approach described in this paper provides good insight into issues that are relevant for the evaluation of health claims for herbal food supplements.

Effect of a health claim and personal characteristics on consumer acceptance of fruit juices with different concentrations of açaí (Euterpe oleracea Mart.)

This study evaluates the effect of a health claim and personal characteristics on the acceptance of two unfamiliar açaí fruit juices that have a low (40% açaí) versus a high (4% açaí) a priori overall liking. Hedonic and sensory measures as well as health- and nutrition-related attribute perceptions and purchase intention were rated before and after health information was presented. Differences in information effects due to interactions with juice type, consumer background attitudes and socio-demographics were investigated. Providing health information yielded a positive, though rather small increase, in overall liking, perceived healthiness and perceived nutritional value of both juices, as well as in their purchase intention. Sensory experiences remained predominant in the acceptance of the fruit juices, although the health claim had a stronger effect on the perceived healthiness and nutritional value of the least-liked juice. Background attitudes and socio-demographic characteristics influenced consumers' acceptance of both unfamiliar fruit juices. Health-oriented consumers were more likely to compromise on taste for an eventual health benefit, though they still preferred the best tasting juice. Consumers with a high food neophobia reported a lower liking for both unfamiliar fruit juices. Older respondents and women were more likely to accept fruit juices that claim a particular health benefit.