Food-intake patterns assessed by using front-of-pack labeling program criteria associated with better diet quality and lower cardiometabolic risk

Dietary indices underpinning front-of-pack nutrition labels and health outcomes: a systematic review and meta-analysis of prospective cohort studies

BACKGROUND

Nutrient profiling systems are increasingly used to characterize the healthfulness of foods for front-of-package (FOP) labeling, which have been proposed as an effective public health strategy to help people make healthier food choices.

OBJECTIVE

This study aimed to review available evidence from cohort studies that evaluated the association of dietary indices underpinning FOP nutrition labels with all-cause mortality and incidence of cardiovascular diseases (CVDs) or cancer.

METHODS

PubMed, Web of Science, and Scopus were systematically searched up to October 2023. We included articles if they were prospective cohort studies, if the exposure was any dietary index underpinning FOP nutrition labels [e.g., the modified Food Standard Agency-Nutrient Profiling System (FSAm-NPS) and the Health Star Rating System], and if outcomes were all-cause mortality or incidence of or mortality due to CVD and cancer. Random-effects models were used to calculate the pooled hazard ratios (HRs) and 95% CIs.

RESULTS

We identified 11 records (7 unique prospective studies), which were included in the systematic review. The meta-analysis comprised 8 studies analyzing the FSAm-NPS dietary index (DI) as exposure. The pooled HRs associated with a 2-unit increase in the FSAm-NPS DI of all-cause mortality, CVD, and cancer risk were 1.06 (95% confidence interval [CI]: 0.99, 1.13; I2: 80%), 1.08 (95% CI: 1.00, 1.18; I2: 70%), and 1.09 (95% CI: 1.00, 1.19; I2: 77%), respectively. The Chilean Warning Label score and the Health Star Rating systems were examined by 1 study each and were significantly associated with the outcomes.

CONCLUSIONS

DIs underpinning most common FOP nutrition labels and reflecting nutrient-poor diets show a tendency toward an increased incidence of CVD and cancer, but the observed effects are quite modest in magnitude. Further studies at the population level are needed to support the widely shared hypothesis that FOP labels, possibly in conjunction with other interventions, may contribute to reduce noncommunicable disease risk. This meta-analysis was registered at PROSPERO as CRD42021292625.

Criterion validation of nutrient profiling systems: a systematic review and meta-analysis

BACKGROUND

Nutrient profiling systems (NPSs) use algorithms to evaluate the nutritional quality of foods and beverages. Criterion validation, which assesses the relationship between consuming foods rated as healthier by the NPS and objective measures of health, is essential to ensure the accuracy of NPSs.

OBJECTIVE

We examined and compared NPSs that have undergone criterion validity testing in relation to diet-related disease risk and risk markers.

METHODS

Academic databases were searched for prospective cohort and cross-sectional studies published before November, 2022. NPSs were eligible if they incorporated multiple nutrients or food components using an algorithm to determine an overall summary indicator (e.g., a score or rank) for individual foods. Studies were included if they assessed the criterion validity of an eligible NPS. Validation evidence was first summarized in narrative form by NPS, with random effects meta-analysis where ≥2 prospective cohort studies assessed the same NPS and outcomes.

RESULTS

Of 4519 publications identified, 29 describing 9 NPSs were included in the review. The Nutri-Score NPS was assessed as having substantial criterion validation evidence. Highest compared with lowest diet quality as defined by the Nutri-Score was associated with significantly lower risk of cardiovascular disease (hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.59, 0.93; n = 6), cancer (HR: 0.75; 95% CI: 0.59, 0.94; n = 5), all-cause mortality (HR: 0.74; 95% CI; 0.59, 0.91; n = 4) and change in body mass index (HR: 0.68; 95% CI: 0.50, 0.92; n = 3). The Food Standards Agency NPS, Health Star Rating, Nutrient Profiling Scoring Criterion, Food Compass, Overall Nutrition Quality Index, and the Nutrient-Rich Food Index were determined as having intermediate criterion validation evidence. Two other NPSs were determined as having limited criterion validation evidence.

CONCLUSIONS

We found limited criterion validation studies compared with the number of NPSs estimated to exist. Greater emphasis on conducting and reporting on criterion validation studies across varied contexts may improve the confidence in existing NPSs.

Eligibility and Prevalence of the American Heart Association Heart Check Certification Program in the US Packaged Food and Beverage Supply: A Cross-Sectional Study

Objective: Consumers in the US make choices within a food supply dominated by processed packaged foods and beverage products. Front-of-package nutrition labels (FOPL) equip consumers to make healthier choices, but further evaluation and regulation regarding FOPL format, scope, and display have been recommended by the World Health Organization. As a leader in consumer FOPL guidance, the American Heart Association's (AHA) Heart Check programme certifies food companies seeking to add an AHA Heart Check logo as a FOPL for qualifying heart healthy products. A cross-sectional assessment of the AHA Heart Check Standard Certification was conducted within the US packaged food and beverage supply to assess the eligibility and prevalence of the programme as a FOPL. Methods: Data were derived from Label Insight's Open Data initiative, which is the largest publicly-available US branded food composition database. The proportions of products that were certified and eligible to be certified for the Standard Certification were reported by nutrient attributes, grocery aisles and food brands. Results: Among 153,453 products examined, fewer than 1% exhibited the Heart Check certification on their label. Among products that were not Heart Check certified,13.8% were eligible for Standard Certification. The most common reason for ineligibility was the saturated fat content (52%), followed by total fat content (47%) and sodium content (47%). Heart Check certification and eligibility differed substantially across grocery aisle categories. Conclusions: The abundance of unhealthy products in the US packaged food and beverage supply and absence of harmonized FOPL policies suggest the need for FOPL like the Heart Check label to promote adherence to healthy diets. There are opportunities for food manufacturers and the AHA to certify more heart healthy foods and beverages. However, more consistent criteria and transparent labelling could enhance Heart Check certification to facilitate consumers' ability to make more informed and healthful purchases.

Redefining avoidable and inappropriate admissions

OBJECTIVES

Focusing on policy discourse in the United Kingdom, we examine the chain of causation that is characteristic of the ways in which the concepts of avoidability and inappropriateness are defined and used in these contexts. With a particular focus on diabetes complications, we aim to elucidate the way in which avoidable admission to hospital is conceptualised, measured, and applied to policy development and implementation and build a more inclusive model of identification as a basis for further research in this area.

STUDY DESIGN

Discourse analysis was used in combination with a scoping review.

METHODS

We searched the online databases of the UK Houses of Parliament Hansard, Official reports of the Northern Ireland Assembly and transcripts of the Scottish Parliament in October 2021. We also conducted an electronic search in October 2021 on MEDLINE, PubMed, Google Scholar, EMBASE, CINAHL and The Cochrane Library to review the available literature. In addition, an analysis of policies in place in Scotland, England and Northern Ireland relating to urgent diabetes care was conducted.

RESULTS

'Avoidable' and 'inappropriate' hospital admissions are categories used in health policy and practice internationally as ways of identifying targets for interventions intending to reduce the burden of care. Diabetes mellitus is a chronic condition that is often seen as a costly and avoidable use of health care services and so is a frequent target of such policies. Avoidable admission is interpreted as having a very long chain of causation. The assumption is that people requiring unscheduled hospital admission could have taken steps to prevent the onset of diabetes, or associated complications, arising in the first place. Definitions focus on primary and secondary prevention and largely place responsibility on the individual and their behaviour rather than on structural or social factors. Inadequate or inappropriate care prehospital or in the emergency department is seldom considered as a potential cause of avoidable admissions. Procedural definitions of avoidable admission are proposed whereby health care professionals and people living with diabetes collaborate to identify avoidable admissions in clinical audit rather than using statistical rates of avoidable admission within isolation in policy development and implementation.

CONCLUSIONS

Avoidability and inappropriateness are characteristics of cases in which conduct of the individual or attendant health care professionals was a proximate cause of hospital admission, and but for such conduct, admission could have been avoided. This process of definition seeks to provide a basis for contextualised and considered evaluation of where there are problems in care and where there are reasonable opportunities for prevention.

Associations between Adherence to Four A Priori Dietary Indexes and Cardiometabolic Risk Factors among Hyperlipidemic Patients

Little is known about which currently available a priori dietary indexes provide best guidance for reducing cardiometabolic risk factors (CMRF) among hyperlipidemic patients. This study was designed to compare the associations between four a priori dietary indexes, including Diet Balance Index (DBI-16), Chinese Healthy Eating Index (CHEI), Mediterranean Diet Score (MDS) and Dietary Approaches to Stop Hypertension (DASH) and CMRF among hyperlipidemic patients. A total of 269 participants were enrolled into the cross-sectional study. DBI-16, CHEI, MDS, and DASH scores were calculated using established methods. CMRF was measured using standard methods. DBI-total scores (DBI-TS) were inversely associated with triglyceride concentrations and TC:HDL-C ratio, and positively associated with HDL-C and ApoA1 concentrations (all p < 0.05), while the results for DBI-low bound scores (DBI-LBS) were opposite. DBI-high bound scores (DBI-HBS) and DASH scores were positively and inversely associated with glucose concentrations, respectively (both p < 0.05). Higher diet quality distance (DQD) was positively associated with higher TC, LDL-C and ApoB concentrations, and TC:HDL-C and LDL-C:HDL-C ratios, and lower HDL-C and ApoA1 concentrations and ApoA1:ApoB ratio (all p < 0.05). CHEI scores were inversely associated with triglyceride concentrations (p = 0.036). None of the dietary indexes was associated with blood pressures. DBI-16 provided most comprehensive evaluations of the overall diet quality and balance for optimizing cardiometabolic health among hyperlipidemic individuals.

Effect of front-of-package nutrition labeling on food purchases: a systematic review

OBJECTIVES

This study systematically reviewed evidence from interventions on the effect of front-of-package (FOP) nutrition labeling on food purchases.

STUDY DESIGN

The study design used in this study is a systematic review.

METHODS

Keyword search was performed in PubMed, Web of Science, Scopus, and Cochrane Library.

RESULTS

Fifteen studies (10 randomized controlled trials, four pre-post studies, and one case-control study) met the eligibility criteria and were included in the review. Five studies were conducted in a controlled setting through the establishment of an online virtual supermarket or physical laboratory food store solely for the intervention. In contrast, the remaining ten studies were conducted in a naturalistic setting where people commonly purchase foods (e.g., supermarket, grocery store, school/hospital cafeteria, or vending machine). FOP labels assessed included traffic lights, health star rating, daily intake guides, health warnings, and high sugar symbol labels. Compared with the control, FOP labels were effective for helping participants make healthier food purchase decisions in five of the 12 studies that assessed traffic lights labels, in one of the two studies that assessed health warning labels, and in one study that assessed high sugar symbol labels. Three assessed health star ratings and one assessed daily intake guide labels, but none revealed an effect on food purchases compared with the control.

CONCLUSIONS

Findings on the effectiveness of FOP nutrition labels in 'nudging' consumers toward healthier food purchases remain mixed and inconclusive. Future studies should examine other types of FOP labels beside the traffic lights labels and explore the different effects by consumer affordability, population subgroup, and shopping environment.

Neighborhood physical food environment and cardiovascular risk factors in India: Cross-sectional evidence from APCAPS

There has been increasing interest in associations between neighborhood food environments and cardiovascular risk factors. However, results from high-income countries remain inconsistent, and there has been limited research from low- and middle-income countries. We conducted a cross-sectional analysis of the third wave follow-up of the Andhra Pradesh children and parents study (APCAPS) (n = 5764, median age 28.8 years) in south India. We examined associations between the neighborhood availability (vendor density per km2 within 400 m and 1600 m buffers of households) and accessibility (distance from the household to the nearest vendor) of fruit/vegetable and highly processed/take-away food vendors with 11 cardiovascular risk factors, including adiposity measures, glucose-insulin, blood pressure, and lipid profile. In fully adjusted models, higher density of fruit/vegetable vendors within 400 m of participant households was associated with lower systolic blood pressure [-0.09 mmHg, 95% confidence interval (CI): -0.17, -0.02] and diastolic blood pressure (-0.10 mmHg, 95% CI: -0.17, -0.04). Higher density of highly processed/take-away food vendors within 400 m of participant households was associated with higher Body Mass Index (0.01 Kg/m2, 95% CI: 0.00, 0.01), waist circumference (0.22 mm, 95% CI: 0.05, 0.39), systolic blood pressure (0.03 mmHg, 95% CI: 0.01, 0.06), and diastolic blood pressure (0.03 mmHg, 95% CI: 0.01, 0.05). However, within 1600 m buffer, only association with blood pressure remained robust. No associations were found for between neighborhood accessibility and cardiovascular risk factors. Lower density of fruit/vegetable vendors, and higher density of highly processed/take-away food vendors were associated with adverse cardiovascular risk profiles. Public health policies regarding neighborhood food environments should be encouraged in south India and other rural communities in south Asia.

Association of the Dietary Index Underpinning the Nutri-Score Label with Oral Health: Preliminary Evidence from a Large, Population-Based Sample

The 2017 implementation in France of the front-of-package nutrition label known as ‘Nutri-Score’ was intended as a public health strategy to help individuals make healthier food choices at the point of purchase and thus help reduce chronic disease on the population level. Nutri-Score and the associated individual-level dietary index are based on the British Food Standards Agency Nutrient Profiling System (FSAm-NPS-DI). Prior research has shed light on the relation between the dietary index and various physical health outcomes, yet no studies have explored the link with oral health. We analyzed the cross-sectional association of the dietary index with oral health in a population-based sample of 33,231 adults from the French NutriNet-Santé cohort. Oral health (main dependent variable) was assessed in 2016 with the General Oral Health Assessment Index; FSAm-NPS-DI (main independent variable) was calculated using ≥3 non-consecutive 24-h dietary records, following established methodology; lower scores corresponded to better diet quality. Age-specific associations were explored via multivariable linear regression. Fully-adjusted models showed modest yet significant associations between the dietary index and oral health in younger (18–59 years) and older (60+ years) participants, with the strength of the model being more pronounced in the former compared with the latter age group (F value: 28.5 versus 6.3, both p < 0.0001). Higher diet quality was associated with a somewhat lower risk of oral health problems. Albeit preliminary, the findings support the relevance of dietary indices underpinning nutrition labels such as the Nutri-Score. Future research is needed to confirm the associations.

Public Health Approaches to Type 2 Diabetes Prevention: the US National Diabetes Prevention Program and Beyond

PURPOSE OF REVIEW

This article highlights foundational evidence, translation studies, and current research behind type 2 diabetes prevention efforts worldwide, with focus on high-risk populations, and whole-population approaches as catalysts to global prevention.

RECENT FINDINGS

Continued focus on the goals of foundational lifestyle change program trials and their global translations, and the targeting of those at highest risk through both in-person and virtual modes of program delivery, is critical. Whole-population approaches (e.g., socioeconomic policies, healthy food promotion, environmental/systems changes) and awareness raising are essential complements to efforts aimed at high-risk populations. Successful type 2 diabetes prevention strategies are being realized in the USA through the National Diabetes Prevention Program and elsewhere in the world. A multi-tiered approach involving appropriate risk targeting and whole-population efforts is essential to curb the global diabetes epidemic.

A Meta-Analysis of Food Labeling Effects on Consumer Diet Behaviors and Industry Practices

CONTEXT

The influence of food and beverage labeling (food labeling) on consumer behaviors, industry responses, and health outcomes is not well established.

EVIDENCE ACQUISITION

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Ten databases were searched in 2014 for studies published after 1990 evaluating food labeling and consumer purchases/orders, intakes, metabolic risk factors, and industry responses. Data extractions were performed independently and in duplicate. Studies were pooled using inverse-variance random effects meta-analysis. Heterogeneity was explored with I2, stratified analyses, and meta-regression; and publication bias was assessed with funnel plots, Begg's tests, and Egger's tests. Analyses were completed in 2017.

EVIDENCE SYNTHESIS

From 6,232 articles, a total of 60 studies were identified, including 2 million observations across 111 intervention arms in 11 countries. Food labeling decreased consumer intakes of energy by 6.6% (95% CI= -8.8%, -4.4%, n=31), total fat by 10.6% (95% CI= -17.7%, -3.5%, n=13), and other unhealthy dietary options by 13.0% (95% CI= -25.7%, -0.2%, n=16), while increasing vegetable consumption by 13.5% (95% CI=2.4%, 24.6%, n=5). Evaluating industry responses, labeling decreased product contents of sodium by 8.9% (95% CI= -17.3%, -0.6%, n=4) and artificial trans fat by 64.3% (95% CI= -91.1%, -37.5%, n=3). No significant heterogeneity was identified by label placement or type, duration, labeled product, region, population, voluntary or legislative approaches, combined intervention components, study design, or quality. Evidence for publication bias was not identified.

CONCLUSIONS

From reviewing 60 intervention studies, food labeling reduces consumer dietary intake of selected nutrients and influences industry practices to reduce product contents of sodium and artificial trans fat.

Fighting obesity: Non-pharmacological interventions

The abnormal or excessive fat accumulation that impairs health is one of the criteria that fulfills obesity. According to epidemiological data, obesity has become a worldwide public health problem that in turn would trigger additional pathologies such as cardiorespiratory dysfunctions, cancer, gastrointestinal disturbances, depression, sleep disorders, just to mention a few. Then, the search for a therapeutical intervention aimed to prevent and manage obesity has been the focus of study during the last years. As one can assume, the increased prevalence of obesity has translated to search of efficient pharmaceuticals designed to manage this health issue. However, to further complicate the scenario, scientific literature has described that obesity is the result of interaction between multiple events. Therefore, pharmacological approaches have faced a serious challenge for develop the adequate treatment. Here, we argue that a wide range of non-pharmacological/invasive techniques can be used to manage obesity, such as diets, cognitive behavioral interventions, exercise and transcranial direct current stimulation. Combining these techniques may allow improving quality of life of obese patients.

Nutrition Labelling Use and Higher Adherence to Mediterranean Diet: Results from the DiSA-UMH Study

The aim of this study was to identify determinants of the nutrition labelling (NL) use and explore its association with the adherence to Mediterranean Diet (MD) in Spanish health university students. We performed a cross-sectional analysis of the baseline data from 1026 university students aged 17-35 years enrolled in the DiSA-UMH (Dieta, Salud y Antropometría-Universidad Miguel Hernández) cohort study. Students were asked about their NL use by the following question: "Do you usually read the nutrition labelling of packaged foods?" (No, Yes). Dietary intake was assessed using a validated food frequency questionnaire and the adherence to MD was measured by relative Mediterranean Diet score (rMED). Socio-demographic, lifestyle, and anthropometric variables were also collected. Multiple logistic regression models were applied for the analysis. Fifty-eight percent of the students were NL users and were most likely to be women (Odds Ratio (OR): 1.38; 95% Confidence Interval (CI): 1.01-1.89), be older (OR per year: 1.08; 95% CI: 1.03-1.13), be physically active/very active (OR: 1.68; 95% CI: 1.17-2.41), and spend less time watching television (OR per hour: 0.84; 95% CI: 0.74-0.95). After adjusting for potential confounding factors, our findings suggested that those university students who had higher adherence to MD used NL greatly (OR per 2 points increase: 1.30; 95% CI: 1.18-1.43) and had a larger consumption of fish (OR per 100 g/day: 1.94; 95 CI: 1.38-2.71), vegetables (OR per 100 g/day: 1.15; CI 95%: 1.08-1.12), and fruits (OR per 100 g/day: 1.22; 1.11-1.34) and a smaller intake of meats (OR per 100 g/day: 0.76; 95% CI: 0.58-0.99). Our approach contributes to exploring the role of NL use as a suitable tool to make healthier food choices from a different wider perspective based on dietary patterns such as MD, which can also indicate an overall healthy lifestyle. Given the lack of research in Mediterranean areas, further studies focused on exploring the potential role of NL in promoting healthy dietary habits are required.

Effects of dietary polyphenols on metabolic syndrome features in humans: a systematic review

Dietary polyphenols constitute a large family of bioactive substances potential beneficial effect on metabolic syndrome (MetS). This review summarizes the results of clinical studies on patients with MetS involving the chronic supplementation of a polyphenol-rich diet, foods, extracts or with single phenolics on the features of MetS (obesity, dyslipidemia, blood pressure and glycaemia) and associated complications (oxidative stress and inflammation). Polyphenols were shown to be efficient, especially at higher doses, and there were no specific foods or extracts able to alleviate all the features of MetS. Green tea, however, significantly reduced body mass index and waist circumference and improved lipid metabolism. Cocoa supplementation reduced blood pressure and blood glucose. Soy isoflavones, citrus products, hesperidin and quercetin improved lipid metabolism, whereas cinnamon reduced blood glucose. In numerous clinical studies, antioxidative and anti-inflammatory effects were not significant after polyphenol supplementation in patients with MetS. However, some trials pointed towards an improvement of endothelial function in patients supplemented with cocoa, anthocyanin-rich berries, hesperidin or resveratrol. Therefore, diets rich in polyphenols, such as the Mediterranean diet, which promote the consumption of diverse polyphenol-rich products could be an effective nutritional strategy to improve the health of patients with MetS. © 2016 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity.

Parental Nutrition Knowledge Rather Than Nutrition Label Use Is Associated With Adiposity in Children

OBJECTIVE

Determine how parental nutrition label use, label literacy, and nutrition knowledge may be associated with cardiovascular health in parents and their children.

DESIGN AND SETTING

Cross-sectional analyses of 2006 data from the Healthy Heart Project in Montreal, Canada.

PARTICIPANTS

Among community recruited families, parents were predominantly mothers (n = 127 [80%]; mean age, 45.0 years) and half of their children were female (44%; mean age, 12.5 years).

MAIN OUTCOME MEASURES

Blood pressure, lipids, and weight. Nutrition label use, label literacy, and nutrition knowledge among parents were collected using existing scales.

ANALYSES

Multivariable linear regression models.

RESULTS

Among parents, nutrition label use was associated with lower total cholesterol (B[SE] = -.53 [.20]; P = .009), lower low-density lipoprotein (B[SE] = -.57 [.21]; P = .007), and lower total cholesterol/high-density lipoprotein cholesterol ratio (B[SE] = -.82 [.30]; P = .008) but was not associated with adiposity. Among children, greater parental nutrition knowledge was associated with lower body mass index percentiles (B[SE] = -3.6 [1.49]; P = .02), lower waist circumference (B[SE] = -1.27 [.55]; P = .02), and lower percent body fat (B[SE] = -1.28 [.47]; P = .008). Parental nutrition label use or nutrition knowledge was not associated with children's lipids.

CONCLUSIONS AND IMPLICATIONS

Parents with greater nutrition label use had more favorable lipids, but children's lipids were unaffected. Children of parents with greater nutrition knowledge had lower adiposity. Further research on the correlates of label use and health is needed.

The 5-CNL Front-of-Pack Nutrition Label Appears an Effective Tool to Achieve Food Substitutions towards Healthier Diets across Dietary Profiles

BACKGROUND

Front-of-pack (FOP) nutrition labels are considered helpful tools to help consumers making healthier food choices, thus improving their diet. In France, the implementation of a FOP nutrition label-the 5-Colour Nutrition Label (5-CNL)-is currently under consideration. Our objective was to investigate dietary profiles in a French adult population using the 5-CNL, and to assess its potential impact in improving the diet through substitution of foods.

METHODS AND FINDINGS

Subjects included in the NutriNet-Santé cohort, who had completed three 24-h dietary records were included in this cross-sectional analysis. Mutually exclusive clusters of individuals were identified using the percentage of energy derived from foods of each of the 5-CNL colours as input variables. Three scenarios of substitution of foods for healthier alternative using the 5-CNL were tested. Food group and dietary intakes, socio-demographic and lifestyle data were compared across clusters using ANOVAs or Chi-square tests, as appropriate. We identified three mutually exclusive dietary profiles: 'Healthy' (N = 28 095, 29.3% of the sample), with high consumption of fruit, vegetables, whole cereals and fish; 'Western' (N = 33 386, 34.8%); with high consumption of sweetened beverages, breakfast cereal, cheese, fatty and sugary foods; 'Traditional' (N = 34 461, 35.1%), with high consumption of potatoes, bread, meat and dairy desserts. Overall, substitutions strategies led to an increase in the number of subjects reaching the recommended intakes in energy, macro and micronutrients. Increases were particularly high in the 'Western' pattern for lipids and saturates intakes: from 16.2% reaching the recommended amount for lipids (13.5% for saturates) to 60.6% and 85.7% respectively.

CONCLUSION

The use of the 5-CNL as an indicator of food choice meaningfully characterizes clusters of dietary habits and appears as an effective tool to help improving the nutritional quality of the diet.

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.

Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC)

BACKGROUND AND AIMS

The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers.

METHODS

International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR).

RESULTS

The outcome was a scientific consensus statement which recognized the importance of postprandial glycemia in overall health, and the GI as a valid and reproducible method of classifying carbohydrate foods for this purpose. There was consensus that diets low in GI and GL were relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity. Moderate to weak associations were observed for selected cancers. The group affirmed that diets low in GI and GL should always be considered in the context of diets otherwise understood as healthy, complementing additional ways of characterizing carbohydrate foods, such as fiber and whole grain content. Diets of low GI and GL were considered particularly important in individuals with insulin resistance.

CONCLUSIONS

Given the high prevalence of diabetes and pre-diabetes worldwide and the consistency of the scientific evidence reviewed, the expert panel confirmed an urgent need to communicate information on GI and GL to the general public and health professionals, through channels such as national dietary guidelines, food composition tables and food labels.

Relationships among food label use, motivation, and dietary quality

Nutrition information on packaged foods supplies information that aids consumers in meeting the recommendations put forth in the US Dietary Guidelines for Americans such as reducing intake of solid fats and added sugars. It is important to understand how food label use is related to dietary intake. However, prior work is based only on self-reported use of food labels, making it unclear if subjective assessments are biased toward motivational influences. We assessed food label use using both self-reported and objective measures, the stage of change, and dietary quality in a sample of 392 stratified by income. Self-reported food label use was assessed using a questionnaire. Objective use was assessed using a mock shopping task in which participants viewed food labels and decided which foods to purchase. Eye movements were monitored to assess attention to nutrition information on the food labels. Individuals paid attention to nutrition information when selecting foods to buy. Self-reported and objective measures of label use showed some overlap with each other (r=0.29, p<0.001), and both predicted dietary quality (p<0.001 for both). The stage of change diminished the predictive power of subjective (p<0.09), but not objective (p<0.01), food label use. These data show both self-reported and objective measures of food label use are positively associated with dietary quality. However, self-reported measures appear to capture a greater motivational component of food label use than do more objective measures.

Calorie labeling and consumer estimation of calories purchased

Background

Studies rarely find fewer calories purchased following calorie labeling implementation. However, few studies consider whether estimates of the number of calories purchased improved following calorie labeling legislation.

Findings

Researchers surveyed customers and collected purchase receipts at fast food restaurants in the United States cities of Philadelphia (which implemented calorie labeling policies) and Baltimore (a matched comparison city) in December 2009 (pre-implementation) and June 2010 (post-implementation). A difference-in-difference design was used to examine the difference between estimated and actual calories purchased, and the odds of underestimating calories.

Participants in both cities, both pre- and post-calorie labeling, tended to underestimate calories purchased, by an average 216–409 calories. Adjusted difference-in-differences in estimated-actual calories were significant for individuals who ordered small meals and those with some college education (accuracy in Philadelphia improved by 78 and 231 calories, respectively, relative to Baltimore, p = 0.03-0.04). However, categorical accuracy was similar; the adjusted odds ratio [AOR] for underestimation by >100 calories was 0.90 (p = 0.48) in difference-in-difference models. Accuracy was most improved for subjects with a BA or higher education (AOR = 0.25, p < 0.001) and for individuals ordering small meals (AOR = 0.54, p = 0.001). Accuracy worsened for females (AOR = 1.38, p < 0.001) and for individuals ordering large meals (AOR = 1.27, p = 0.028).

Conclusions

We concluded that the odds of underestimating calories varied by subgroup, suggesting that at some level, consumers may incorporate labeling information.