Consumer understanding of sugars claims on food and drink products

Consumer objective and subjective knowledge about healthy foods: An approach to promote healthy lifestyle choices in South Africa

Unhealthy food choices and consumption, coupled with sedentary lifestyles among consumers, intensify public health concerns regarding the quadruple disease burden, despite Primary Health Care (PHC) policy. However, the current relationship between consumer knowledge about healthy foods and following a healthy lifestyle needs to be explored. Our study, therefore, aimed to determine the association between consumers' subjective and objective knowledge about healthy foods and various healthy lifestyle choices. A cross-sectional survey was conducted among employed consumers (N = 157) from South African corporate settings. We used structural equation modelling (SEM) to determine associations between subjective and objective knowledge about healthy foods and healthy lifestyle choices. Our findings showed that most participants scored high on making healthy lifestyle choices relating to avoiding smoking (69.5%) and limiting drinking alcohol (68.7%) but less so for food and sleep (44.4%) while neglecting exercise, relaxation (13.7%), and choices that require dedicated effort (25.2%). On average, participants had high levels of subjective (mean = 3.59; 5-point Likert scale) knowledge and objective knowledge about healthy foods (88.4-95.9% correct responses). However, their objective knowledge about weight and cholesterol had severe deficiencies (36.7%). SEM confirmed an association between subjective knowledge and most healthy lifestyle choice categories, while income contributed to dedicated effort lifestyle choices. By contrast, objective knowledge did not associate with such choices. Our structural model suggests that subjective knowledge about healthy foods contributes to healthy lifestyle choices. Therefore, subjective knowledge and the objective knowledge deficiencies we identified among corporate consumers can serve as a valuable starting point for informed education to promote PHC policy and healthy lifestyle choices.

Plant and Dairy-Based Yogurts: A Comparison of Consumer Sensory Acceptability Linked to Textural Analysis

Yogurt, readily available in plant and dairy-based formulations, is widely consumed and linked with health benefits. This research is aimed to understand the sensory and textural spectrum of commercially available dairy and plant-based yogurts. In a preliminary study, qualitative focus group discussions (4 groups; n = 32) were used to determine perceptions of 28 dairy and plant-based yogurts, identifying positive consumer perceptions of plant-based yogurts. A smaller subset of five spoonable and one drinkable yogurts-(Reference, Soy, Coconut, Cookies, Berry, and Drinkable) was subsequently selected for rheological and structural measurements, showing wide variations in the microstructure and rheology of selected yogurt samples. A quantitative blind sensory tasting (n = 117) showed varying yogurt acceptability, with Berry being the least-liked and Cookies being the most-liked yogurt, in terms of overall liking. The multi-factor analysis confirmed that compositional and textural elements, including protein content, gel firmness, and consistency coefficient, displayed a positive relationship with overall liking. In contrast, fat, sugar, and calories were negatively correlated to the overall liking. This research showed that texture and other compositional factors are significant determinants of the consumer acceptability of yogurt products and are essential properties to consider in product development.

Do the Colors of the Label and the Sweetening Agent Information Influence the Sensory Expectations Consumer? A Case Study with Skyr-Type Yogurt

The objective of this research was to evaluate the sensory expectation and buying intention of consumers from different Brazilian regions for skyr-type yogurt based on the colors and sweetener on its label. Ten images of skyr mango yogurt labels were created varying in color (orange, white, yellow, blue, and green) and sweetening agent (sucrose and natural sweeteners). Consumers (151 consumers) were asked to rate their expectation for the ideal of sweetness, healthiness, acceptance, and buying intention. Labels containing the information “sweetened with sucrose” had a higher percentage of expectation of sweeter than ideal. Label color and sweetening agent had a significant effect on the expectation of acceptance, with a higher percentage for yogurt sweetened with natural sweeteners. There were not statistical differences (p > 0.05) between the labels regarding expected healthiness. Results also showed that consumers had a low level of familiarity with skyr-type yogurts, but it is presented as a healthy yogurt alternative.

Assessment of Knowledge and Self-Reported Use of Nutrition Facts Labels, Nutrient Content, and Health Claims among Saudi Adult Consumers

Background

Few studies have investigated the knowledge and attitudes towards the nutrition facts label, the nutrient content and health claims (NHCs) among consumers from different countries/cultures.

Methods

This cross-sectional study assessed the knowledge and self-reported use of the nutrition facts label and NHCs among Saudi adults. A total of 722 participants were recruited using an online questionnaire.

Results

Total knowledge score was 5.8 ± 2.5/13 points (45%). Approximately, 18%, 77%, and 5% of the participants had low, medium, and high levels of knowledge, respectively. Participants were more knowledgeable on the nutrition facts label (2.6 ± 1.6/5 points) and health claims (2.7 ± 1.2/4 points) versus nutrient content claims (0.5 ± 0.7/4 points). The total use score was 20.1 ± 5.7/30 points (67%); approximately, 2%, 61%, and 37% of the participants were classified as low, medium, and high use level, respectively. Participants’ use of the nutrition facts label, nutrient content claims, and health claims was 10.0 ± 3.1/15, 6.5 ± 2.2/9, and 3.6 ± 1.8/6 points, respectively.

Conclusion

This study highlights the need for more education and public awareness programs to enhance consumer knowledge and use of the nutrition facts label and NHCs, and consequently lead to healthy dietary choices.

The sugar content of foods in the UK by category and company: A repeated cross-sectional study, 2015-2018

BACKGROUND

Consumption of free sugars in the UK greatly exceeds dietary recommendations. Public Health England (PHE) has set voluntary targets for industry to reduce the sales-weighted mean sugar content of key food categories contributing to sugar intake by 5% by 2018 and 20% by 2020. The aim of this study was to assess changes in the sales-weighted mean sugar content and total volume sales of sugar in selected food categories among UK companies between 2015 and 2018.

METHODS AND FINDINGS

We used sales data from Euromonitor, which estimates total annual retail sales of packaged foods, for 5 categories-biscuits and cereal bars, breakfast cereals, chocolate confectionery, sugar confectionery, and yoghurts-for 4 consecutive years (2015-2018). This analysis includes 353 brands (groups of products with the same name) sold by 99 different companies. These data were linked with nutrient composition data collected online from supermarket websites over 2015-2018 by Edge by Ascential. The main outcome measures were sales volume, sales-weighted mean sugar content, and total volume of sugar sold by category and company. Our results show that between 2015 and 2018 the sales-weighted mean sugar content of all included foods fell by 5.2% (95% CI -9.4%, -1.4%), from 28.7 g/100 g (95% CI 27.2, 30.4) to 27.2 g/100 g (95% CI 25.8, 28.4). The greatest change seen was in yoghurts (-17.0% [95% CI -26.8%, -7.1%]) and breakfast cereals (-13.3% [95% CI -19.2%, -7.4%]), with only small reductions in sugar confectionery (-2.4% [95% CI -4.2%, -0.6%]) and chocolate confectionery (-1.0% [95% CI -3.1, 1.2]). Our results show that total volume of sugars sold per capita fell from 21.4 g/d (95% CI 20.3, 22.7) to 19.7 g/d (95% CI 18.8, 20.7), a reduction of 7.5% (95% CI -13.1%, -2.8%). Of the 50 companies representing the top 10 companies in each category, 24 met the 5% reduction target set by PHE for 2018. The key limitations of this study are that it does not encompass the whole food market and is limited by its use of brand-level sales data, rather than individual product sales data.

CONCLUSIONS

Our findings show there has been a small reduction in total volume sales of sugar in the included categories, primarily due to reductions in the sugar content of yoghurts and breakfast cereals. Additional policy measures may be needed to accelerate progress in categories such as sugar confectionery and chocolate confectionery if the 2020 PHE voluntary sugar reduction targets are to be met.

Influence of sugar label formats on consumer understanding and amount of sugar in food choices: a systematic review and meta-analyses

CONTEXT

Reducing population intakes of sugar has become a focus of many national and international public health policies. Packaged foods and beverages are key contributors to sugar intakes, and food labels can be an effective tool to reduce sugar consumption.

OBJECTIVE

The aim of this systematic review was to examine the influence of sugar label formats on 2 outcomes: consumers' understanding of sugar information, and the amount of sugar in consumers' food choices.

DATA SOURCES

Scopus, Web of Science, PubMed, CAB Abstracts, SciELO, and the Cochrane Library databases were searched up until February 4, 2020.

STUDY SELECTION

Randomized experiments or quasi-experiments were included if they investigated the influence of sugar label formats on consumers' understanding of sugar information or on the amount of sugar in consumers' food choices.

DATA EXTRACTION

Data were extracted independently by 2 authors. Mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs) plus 95%CIs were used to describe between-group differences for intervention label formats using random-effects models.

RESULTS

Twenty-three studies, which examined 39 comparisons, were included. Label formats using "high in sugar" interpretative texts (traffic light labels [MD 41.6; 95%CI 37.9-45.4] and warning signs [OR 1.33; 95%CI 1.0-1.78]) were most effective in increasing consumers' understanding of the sugar content in packaged foods. Health warning messages (SMD -0.32; 95%CI -0.43 to -0.22), graphical depictions of sugar content in teaspoons (SMD -0.32; 95%CI -0.48 to -0.17), and warning signs (SMD -0.24; 95%CI -0.35 to -0.13) were most effective for influencing consumers to choose products with lower sugar content.

CONCLUSIONS

Formats that provide an interpretation of sugar information, particularly those indicating if a product is high in sugar, were more helpful than only numerical information for improving consumer understanding and promoting food choices with less sugar.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42018081222.

A qualitative study about college students' attitudes, knowledge and perceptions regarding sugar intake

Excessive sugar intake has been associated with multiple health conditions (e.g., higher risk for non-communicable diseases). Hence, health organizations have issued guidelines defining the maximum daily intake of free or added sugars. However, data from several countries suggests that these guidelines are rarely met, particularly by young adults. For example, almost half of Portuguese adolescents and young adults exceed the recommended sugar intake. In this work, we aim to further explore college students' attitudes, knowledge, and perceptions about sugar intake, as well as about sugar intake guidelines. A thematic analysis on data from five focus groups (N = 40) indicated that participants reported difficulty in the comprehension of added/free sugars definition and sugar intake recommendations. Overall, attitudes toward sugar were ambivalent. Sugar was simultaneously perceived as pleasurable and needed, but also as addictive and harmful. Although aware of the potential negative health outcomes associated with excessive sugar intake, most participants did not perceive being at risk due to their youth, exercise habits, or type of diet. The few concerns expressed were mostly associated with the negative impact of high sugar intake on body image (e.g., weight gain). The main barriers to reducing sugar intake identified were environmental (e.g., time restrictions, food available at the university). Still, participants could identify several individual strategies to effectively regulate sugar intake. By identifying knowledge gaps and sources of bias related to sugar consumption, our findings are useful to inform future interventions aiming to address the problem of high sugar intake among university students.

The Effect of an Online Sugar Fact Intervention: Change of Mothers with Young Children

Research indicates that high sugar intake in early childhood may increase risks of tooth decay, obesity and chronic disease later in life. In this sugar fact study, we explored whether an online intervention which focused on comprehensive and useful information about nutrition labels impacted mother's choice of low sugar food. The intervention was developed on the basis of the theory of planned behavior. In total, 122 mothers were recruited. Mothers were divided into an online-only group and a plus group. Knowledge of sugar and nutrition labels, behavioral attitudes, perceived behavioral control, behavioral intentions and behavior towards purchasing low-sugar products with nutrition labels were collected. After the intervention, both groups exhibited significantly enhanced sugar and nutrition label knowledge, perceived behavioral control, behavioral intentions and behavior. Compared to the online-only group, knowledge, perceived behavioral control and behavior of the plus group significantly improved. After the intervention, about 40% of the plus group and 80% of the online-only group still did not know the World Health Organization (WHO) sugar recommendations. Understanding sugar recommendations and using nutrition labels are crucial to help people control calorie and sugar intake. Further research with a larger sample is warranted to evaluate the effects of the intervention on long-term changes in shopping behavior. More efficient and convenient nutrition education is required to increase public awareness of sugar recommendations and help people control calorie and sugar intake.

Do Consumers Care about Nutrition and Health Claims? Some Evidence from Italy

This study investigates Italian consumer knowledge and use of nutrition and health claims (NHCs). Six specific claims are examined on the basis of a web survey carried out on a sample of 504 consumers. Our results show that there is little attention to NHCs and their use is not widespread; objective knowledge of the selected claims is fairly scant, generating misinterpretation and confusion about their real meaning. K-means cluster analysis allowed us to identify three segments of consumers, characterized by different levels in attention and use frequency of NHCs, with a specific profile in terms of motivation and nutritional knowledge. Our results suggest the advisability of policy interventions and communication efforts which target the three segments with a view to achieving greater attention to NHCs. In conclusion, to boost knowledge concerning the actual meaning of the claims and their relation with a healthy diet, especially to reach non-users, information should be provided both simply and clearly, avoiding the use of complex scientific terminology.

Development of a Holistic Assessment Framework for Industrial Organizations

The evaluation and selection among the best production practices beyond the conventional linear models is, nowadays, concerned with those holistic approaches drawn toward environmental assessment in industry. Therefore, researchers need to develop an analysis that can evaluate the performance of industrial organization in the light of their environmental viewpoint. This study implemented a pilot co-integrated scheme based on an innovative in-house Holistic Assessment Performance Index for Environment (HAPI-E) industry tool while assimilating the principles of circular economy through the Eco-innovation Development and Implementation Tool (EDIT). For the latter, nine qualitative indicators were motivated and enriched the weighting criteria of the questionnaire. The decomposition of the complexity and preferences mapping was accompanied by a multi-criteria holistic hierarchical analysis methodology in order to synthesize a single index upon a need-driven scoring. This multi-criteria decision approach in industry can quantify the material and process flows, thus enhancing the existing knowledge of manipulating internal resources. The key-criteria were based on administrative, energy, water, emissions, and waste strategies. Subsequently, the HAPI-E industry tool was modeled on the food industry, being particularly focused on pasta-based industrial production. Then, the parameters of this tool were modeled, measured, and evaluated in terms of the environmental impact awareness. The magnitude of necessary improvements was unveiled, while future research orientations were discussed. The HAPI-E industry tool can be utilized as a precautionary methodology on sustainable assessment while incorporating multifaceted and quantification advantages.

"Cutting Down on Sugar" by Non-Dieting Young Women: An Impact on Diet Quality on Weekdays and the Weekend

Restricted sugar intake is an important part of a healthy lifestyle and may contribute to the prevention of diet-related diseases. The aim of the study was to investigate whether declared sugar restriction is reflected in actual sucrose intake and diet quality of young non-dieting women, with differentiation between the weekend and weekdays. A convenient sample of 192 non-dieting women aged 20–30 years old was recruited. The sample was divided into two groups based on each woman’s declaration: “restricting sugar” (RS, n = 76) and “not restricting sugar” (nRS, n = 116). Comparisons between groups were made separately for seven days of the week, five weekdays and two weekend days without and with an adjustment for 2000 kcal of energy. Relative differences (RD, in %) in mean diet nutritional values between groups were calculated, where RD (%) = (RS − nRS) × 100/nRS, and were verified with a two-tailed t-test. In the seven-day diet of the RS group, in comparison to the nRS group, a lower daily intake of sucrose (by 22%) and MUFA (by 8%) and a higher content of most nutrients (by 7–38%) was found. No significant differences were observed in energy intake between RS and nRS women over the course of seven days, including weekdays and the weekend. Daily intake for the weekend, in comparison to weekdays, in RC and nRC women was higher with respect to energy (by 530 and 512 kcal, i.e., 37% and 34%, respectively), sucrose (44% and 23%, respectively), and most nutrients (by 17–98% and 16–42%, respectively). However, after the adjustment for 2000 kcal of energy, the daily intake of most nutrients in the weekend was lower (by 6–30% and 3–27%, in RS and nRS groups, respectively), than during weekdays. The intention to restrict sucrose has improved diet quality by decreasing sucrose intake and increasing the content of most nutrients, but had no effect on energy intake throughout the week. The quality of the women’s diet during the weekend was compromised, regardless of restricting or not restricting sugar. Encouragement to restrict sugar intake throughout the week and control the food intake during the weekend may be an effective strategy for young women to maintain a healthy diet.

Added sugar and sodium levels in New Zealand processed fruit and vegetable-based products

AIM

Fruit and vegetables are strongly promoted because of the nutrients they provide; many processed products contain added sugar and sodium. The present study aims to quantify the sugar and sodium content of pre-packaged fruit and vegetable-based products that are available in New Zealand supermarkets.

METHODS

Nutrition Information Panel data were collected from non-frozen, processed fruit and vegetable products in New Zealand supermarkets (including soups, sauces, jams and spreads, pickles, chutneys and dips, and canned/bottled fruit and vegetables) where fruit and/or vegetables were the majority ingredient(s).

RESULTS

With the exception of canned/bottled vegetables, more than 60% of products contained added sugar. Per serve, the median sugar content was highest in canned/bottled fruit (17.8 g). More than 75% of soups, vegetable-based sauces, pickles/chutneys and canned/bottled vegetables contained added sodium, with soups (722 mg) recording the highest median values per serve.

CONCLUSIONS

Consumers need to be aware that although they are encouraged to eat a diet high in fruit and vegetables, there may be large quantities of added sugar and sodium in manufactured fruit and vegetable products that can have significant negative impacts on their health. Government health promotion campaigns encouraging the consumption of fruit and vegetables should be careful to target fresh, frozen and home-prepared foods, and work on educating the public about the lower nutritional quality associated with most processed fruit and vegetable products.

Influence of Mothers' Nutrition Knowledge and Attitudes on Their Purchase Intention for Infant Cereal with No Added Sugar Claim

A higher sugar intake in infancy might result in a predisposition to a higher sugar intake in later childhood. In Taiwan, many commercial infant and toddler foods with nutrition claims have high sugar content. This study explored the influence of mothers’ knowledge and attitudes on their purchase intention for infant food with nutrition claims. This study was a cross-sectional survey. An online survey was distributed to 940 mothers who had a child aged between 4 months and 3 years; 40% of mothers tend to misunderstand that “no added sugar” (NAS) indicates no sugar or less sugar content and, thus, that NAS infant cereal is healthy. Approximately 50–70% of mothers believe that NAS infant cereal is more natural, healthier, and contains less sugar. Attitude toward the NAS claim was found to be a mediating variable between sugar-related knowledge and purchase intention. The lower the level of sugar-related knowledge was, the more positive the attitude toward NAS infant cereal and the higher the purchase intention for NAS infant cereal were. In the future, regulation of no added sugar is needed to avoid the misleading information and mothers’ sugar-related knowledge need to be improved through nutrition education.

Healthfulness and nutritional composition of Canadian prepackaged foods with and without sugar claims

The objective of this study was to evaluate differences in calories, nutrient content, overall healthfulness, and use of sweetener ingredients between products with and without sugar claims. Consumers assume products with sugar claims are healthier and lower in calories. It is therefore important claims be found on comparatively healthier items. This study is a cross-sectional analysis of the University of Toronto's 2013 Food Label Database. Subcategories where at least 5% of products (and n ≥ 5) carried a sugar claim were included (n = 3048). Differences in median calorie content, nutrient content, and overall healthfulness, using the Food Standards Australia/New Zealand Nutrient Profiling Scoring criterion, between products with and without sugar claims, were determined. Proportion of products with and without claims that had excess free sugar levels (≥10% of calories from free sugar) and that contained sweeteners was also determined. Almost half (48%) of products with sugar claims contained excess free sugar, and a greater proportion contained sweeteners than products without such claims (30% vs 5%, χ² = 338.6, p < 0.0001). Overall, products with sugar claims were "healthier" and had lower median calorie, free sugar, total sugar, and sodium contents than products without claims. At the subcategory level, reductions in free sugar contents were not always met with similar reductions in calorie contents. This study highlights concerns with regards to the nutritional composition of products bearing sugar claims. Findings can support educational messaging to assist consumer interpretation of sugar claims and can inform changes in nutrition policies, for example, permitting sugar claims only on products with calorie reductions and without excess free sugar.

Are restrictive guidelines for added sugars science based?

Added sugar regulations and recommendations have been proposed by policy makers around the world. With no universal definition, limited access to added sugar values in food products and no analytical difference from intrinsic sugars, added sugar recommendations present a unique challenge. Average added sugar intake by American adults is approximately 13% of total energy intake, and recommendations have been made as low 5% of total energy intake. In addition to public health recommendations, the Food and Drug Administration has proposed the inclusion of added sugar data to the Nutrition and Supplemental Facts Panel. The adoption of such regulations would have implications for both consumers as well as the food industry. There are certainly advantages to including added sugar data to the Nutrition Facts Panel; however, consumer research does not consistently show the addition of this information to improve consumer knowledge. With excess calorie consumption resulting in weight gain and increased risk of obesity and obesity related co-morbidities, added sugar consumption should be minimized. However, there is currently no evidence stating that added sugar is more harmful than excess calories from any other food source. The addition of restrictive added sugar recommendations may not be the most effective intervention in the treatment and prevention of obesity and other health concerns.

Definition and documentation of traditional foods of the Black Sea Area Countries: potential nutrition claims

BACKGROUND

Nutrition and health claims are permitted in foods marketed in the European Union under Regulation 1924/2006. Quality products such as traditional foods might benefit from this act, as it can highlight their nutritional richness. In this study the nutritional content of 33 traditional foods from the Black Sea Area Countries was evaluated against the thresholds of the Regulation for nutrition claims.

RESULTS

Most of the foods were eligible to bear several nutrition claims, mostly related to their fat, sugar, fiber and sodium content. The average number of claims per traditional food was two, with a range between zero and nine. Overall, about 72 nutrition claims were potentially relevant for the 33 traditional foods studied. Foods linked with the most claims were nuts and seeds.

CONCLUSION

The inclusion of traditional foods under this standardized European scheme could be an efficient way to highlight their possible beneficial nutritional properties. The production and marketing of traditional foods could be of benefit to both the health of consumers and the economic viability of producers, especially small- and medium-size enterprises.