A Cross-Sectional Study of Sports Food Consumption Patterns, Experiences, and Perceptions amongst Non-Athletes in Australia

Sports foods are designed for athletes, yet their availability, type, and sales have increased over the past decade, likely driven by non-athlete use. This could lead to detrimental health outcomes via over/misuse or unwanted side effects. The aim of this study was to describe sports food consumption patterns and associated drivers, consumption reasons, perception of risks, and side effects experienced amongst non-athletes in Australia. In 2022, n = 307 non-athlete Australian adults (18-65 years) completed an online cross-sectional survey including closed-ended (consumption patterns, factors, and exercise participation) and open-ended questions (reasons for consumption, risk perception, and side effects experienced). Descriptive statistics (frequency and percent) described the sample. Ordinal logistic regression was used for univariate associations and a multivariate model was used to determine relationships between sports food consumption proxy and significant univariate associations. The themes were analysed via inductive thematic analysis using NVivo 14. Females consumed sports foods most frequently, 65% of participants consumed three or more sports foods, and participants with higher sports food consumption/frequency were less likely to perceive risks or experience side effects. The main reason for consumption was protein intake, digestion/stomach issues were the main perceived risks, and the main side effect was bloating. Despite understanding the risks and side effects, non-athlete consumers continue to use numerous sports foods, which appear to be influenced by sociodemographic factors and packaging labels. Tighter regulation of packaging-label information would ensure safer and more informed consumption.

Botanical Impurities in the Supply Chain: A New Allergenic Risk Exacerbated by Geopolitical Challenges

BACKGROUND

The supply chains of food raw materials have recently been heavily influenced by geopolitical events. Products that came from, or transited through, areas currently in conflict are now preferentially supplied from alternative areas. These changes may entail risks for food safety.

METHODS

We review the potential allergenicity of botanical impurities, specifically vegetable contaminants, with particular attention to the contamination of vegetable oils. We delve into the diverse types of botanical impurities, their sources, and the associated allergenic potential. Our analysis encompasses an evaluation of the regulatory framework governing botanical impurities in food labeling.

RESULTS

Unintended plant-derived contaminants may manifest in raw materials during various stages of food production, processing, or storage, posing a risk of allergic reactions for individuals with established food allergies. Issues may arise from natural occurrence, cross-contamination in the supply chain, and contamination at during production. The food and food service industries are responsible for providing and preparing foods that are safe for people with food allergies: we address the challenges inherent in risk assessment of botanical impurities.

CONCLUSIONS

The presence of botanical impurities emerges as a significant risk factor for food allergies in the 2020s. We advocate for regulatory authorities to fortify labeling requirements and develop robust risk assessment tools. These measures are necessary to enhance consumer awareness regarding the potential risks posed by these contaminants.

Consumer Interaction with Sustainability Labelling on Food Products: A Narrative Literature Review

Sustainability labelling on food products can help consumers make informed purchasing decisions and support the urgent transition to sustainable food systems. While there is a relatively robust body of evidence on health and nutrition labelling, less is known about the effectiveness of sustainability labelling in facilitating sustainable food choices. This paper investigates the impact of sustainability labelling on consumer understanding, attitudes, and behaviour to support a more nuanced, detailed, and holistic understanding of the evidence. Using a narrative literature review methodology, the paper assesses studies covering environmental, social, and/or animal welfare aspects of sustainability labelling on food products. We found that consumer understanding of sustainability information is often limited, which could hinder behaviour change. While sustainability labelling can influence consumer attitudes and purchasing behaviours, evidence from real consumer settings tends to show small effect sizes. Consumers are generally willing to pay more for sustainability-labelled products, and organic labelling often leads to the highest reported willingness to pay. The review emphasises the importance of trust, suggesting a preference for labelling backed by governments or public authorities. Sustainability labelling that uses intuitively understandable cues has an increased impact, with visual aids such as traffic light colours showing promise. We conclude that further research is needed in real-world settings, using representative populations and exploring the influence of demographic factors, values, and attitudes.

Qualitative menu labelling in university restaurants and its influence on food choices: A systematic review and synthesis without meta-analysis

Qualitative menu labelling can be defined as descriptive or non-numerical interpretive labels (e.g. traffic light labelling, healthy food symbols, messages or ingredient lists). Qualitative information seems to have a positive influence on consumers' food choices, particularly in institutional food service establishments, such as in universities. The aim of this systematic review was to assess the influence of different formats of qualitative menu labelling on food choices in university restaurants. This systematic review was guided by the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis Without Meta-Analysis (SWiM) and conducted vote counting of studies based on the direction of effect. Studies were retrieved from Cochrane Library, Scopus, MEDLINE, LILACS, SciELO and Web of Science databases and reference lists of selected articles. Experimental and quasi-experimental studies were included. Two independent researchers searched and extracted the data and assessed the methodological quality using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. From the initial search (460 records), four papers were selected, plus one paper identified in a previous study and a further six from an update search, totalling 11 included studies, reporting 14 different interventions (n = 499 174). Types of interventions included the use of symbols and the inclusion of traffic light labelling. Outcomes of interest were food choice, expressed as mean, median or percent healthy food choices or purchases. Qualitative menu labels increased healthy food choices and/or purchase behaviour, with 10 of 12 interventions favouring the intervention (83%; 95%CI 55-95%; p = 0.0386). Most of the studies favouring the intervention used healthy food symbols for healthier foods or food components, alone or in association with another intervention and were of moderate and weak quality. These findings may serve as a basis for the implementation of nutrition information policies in university restaurants.

The Power of Suggestion: Subjective Satiety Is Affected by Nutrient and Health-Focused Food Labelling with No Effect on Physiological Gut Hormone Release

Health claims on food labelling can influence peoples' perception of food without them actually eating it, for example driving a belief that a particular food will make them feel fuller. The aim of this study was to investigate whether nutrient and health claims on food labelling can influence self-reported, and physiological indicators of, satiation. A total of 50 participants attended two visits where they were asked to consume a 380 kcal breakfast (granola and yogurt) labelled as a 500 kcal 'indulgent' breakfast at one visit and as a 250 kcal 'sensible' breakfast at the other. The order of the breakfast descriptions was randomly allocated. Participants were unaware that the two breakfasts were the same product and that only the food labels differed. At each visit blood samples were collected to measure gut hormone levels (acylated ghrelin, peptide tyrosine-tyrosine and glucagon-like peptide-1) at three time points: 20 min after arrival (baseline), after 60 min (anticipatory, immediately prior to consumption) and after 90 min (post-consumption). Visual analogue scales measuring appetite (hunger, satiety, fullness, quantity and desire to eat) were completed prior to each sample. Between 60 and 90 min, participants consumed the breakfast and rated its sensory appeal. Participants reported a higher mean change in self-reported fullness for the 'indulgent' than the 'sensible' breakfast from anticipatory to post-consumption (mean difference: 7.19 [95% CI: 0.73, 13.6]; p = 0.030). This change was not observed for the other appetite measures at the other time points or gut hormone levels. This study suggests that nutrient and health claims on food labels may influence satiation as measured by self-reported fullness. It also suggests that the observed differences in satiety scores are not due to changes in the main appetite regulating gut hormones, but are more likely centrally mediated. More high-quality trials are required to confirm these findings.

Detection of Fish Allergens in Foods Using an In-House Real-Time PCR Targeting the Ribosomal 18S rRNA Gene

Fish is one of the major food allergens which, in sensitised individuals, can cause life-threatening allergic reactions, even when present in small amounts. To protect consumers' health, the correct labeling of foods is important. The objective of the present study was to validate an in-house real-time PCR method targeting the ribosomal 18S rRNA gene as universal DNA marker for the detection of fish in foods. The specificity of the primers was assessed on 20 fish species commonly marketed in the Mediterranean basin and other species of molluscs and crustaceans and foods of animal and plant origin. The absolute detection of the method was assessed using DNA extracted from a fish mixture and the SureFood^® QUANTARD Allergen 40 reference material. The relative amount was assessed on a fish and béchamel sauce blend. Commercial food samples either labelled with or without fish in the ingredient list, were tested for the presence of fish DNA. The primer showed high specificity against the selected fish species. The limit of detection (LOD) and limit of quantification (LOQ) of the in-house method were 0.5 pg/µL and 5 pg/µL, respectively. The relative quantification in fish and béchamel blend samples detected a concentration as low as 0.000025%, corresponding to 0.25 mg/kg of fish, indicating the suitability of the method in a food matrix. The presence of fish DNA was always detected in commercial samples in which the presence of fish was listed in the ingredient list. The method was able to detect the presence of fish DNA also in samples in which the presence of fish was indicated as traces or was not declared on the label. The proposed method was demonstrated to be a reliable, specific, and sensitive method for the detection of fish allergens in foods. Therefore, the proposed real-time PCR method could be used as a useful instrument in the verification of compliance with allergen labelling regulations.

Discrepancy between Food Classification Systems: Evaluation of Nutri-Score, NOVA Classification and Chilean Front-of-Package Food Warning Labels

BACKGROUND

Currently, there are different food classification systems in order to inform the population of the best alternatives for consumption, considering all the diseases associated with the consumption of products of low nutritional quality. Reports indicate that these forms of labelling warnings correspond to a laudable strategy for populations that do not have the knowledge to discriminate between the wide range of products offered by the food industry. However, recent publications indicate that there may be inconsistencies between the different classification guidelines, and the guidelines that nations should adopt in their food guides are still a matter of debate. In view of this, the present study aimed to evaluate the quantitative and qualitative differences that exist between the NOVA, Nutri-Score and Chilean Front-of-package (FoP) food warning label according to the Chilean basic food basket list.

METHOD

An analytical study was carried out to classify a list of 736 foods according to three different systems, evaluating the distributions according to their methods of classifying the products. Quantitative differences were contrasted for each system, as well as between them, together with an analysis of the dimensions of each system.

RESULTS

According to the Nutri-Score classification, the most frequent category was A with 27% (high nutritional quality), followed by D with 22% (low nutritional quality) of the total. On the other hand, the NOVA classification showed that the most frequent categorization was ultra-processed food (NOVA 4) with 54%, followed by unprocessed (NOVA 1) with 19%. Regarding the FoP warning labels, 57% of the foods were categorized as free warning labels, followed by the category of foods with 3 warning labels (23%). Regarding the results of the principal component analysis, the Nutri-Score and FoP warning labels present a degree of similarity in their classification guidelines, being different than the dimension pointed out by NOVA.

CONCLUSION

The present work managed to demonstrate that there are quantitative and qualitative differences between the classification and recommendation guidelines of the Nutri-Score, NOVA and FoP warning labels, finding concrete discrepancies between them.

Consumer Attitudes and Purchase Intentions in Relation to Animal Welfare-Friendly Products: Evidence from Taiwan

Animal welfare, environmental sustainability, and food safety have become topics of international concern. With the rise of friendly rearing and green consumption consciousness, consumers can use animal welfare certification labels as references to make purchase decisions. This study adopts the theory of planned behavior (TPB) as its core and incorporates variables, such as moral affection, health consciousness, and trust in certification, to discuss the thoughts of Taiwanese consumers on buying animal welfare-friendly products and the factors that affect their purchase decisions. This study will be conducive in clarifying the consumption behavioral pattern of animal welfare-friendly products, which previous literature has mentioned but not tested, thereby filling this literature gap. This study collects 653 valid questionnaires and uses the partial least square-structural equation modeling to analyze the correlations between various variables. The research findings indicate the following. (1) Consumers' attitudes, subjective norms, and perceived behavioral control have significant and positive influences on the behavioral intention of purchasing fresh milk with animal welfare labels. (2) Moral affection positively influences customers' behavioral intention toward fresh milk with an animal welfare label through attitudes, subjective norms, and perceived behavioral control. (3) Trust in certifications will enhance moral cognition and positive attitudes toward fresh milk with animal welfare labels. According to the research findings of this study, we recommend that businesses strengthen the promotion of dairy products in line with friendly rearing, environmental sustainability, and other ethical consumption concepts to generate market segregation elements.

The Influence of Framing Plant-Based Products in Terms of Their Health vs. Environmental Benefits: Interactions with Individual Wellbeing

Significant reductions in the consumption of meat and dairy products are required to limit environmental damage and meet climate targets. However, individuals choosing to adopt plant-based diets still form a minority. Whilst different types of message framings have been suggested to be a potential means of encouraging the uptake of plant-based diets, recent findings have often failed to document any differences in people's willingness to reduce their consumption of animal products based on whether messages emphasize the health or environmental benefits of plant-based diets. This research examined whether individual wellbeing might interact with health versus environmental message frames to determine people's liking and willingness to pay for plant-based products. Across two experiments with a university (Study 1) and a non-student, adult sample (Study 2), participants were exposed to different hypothetical labels for plant-based foods and asked to rate their liking and willingness to pay for each. In line with existing findings, results demonstrated a trend whereby showing health (versus environmental) information on food labels did not in itself influence participants perceptions of the food products. Higher levels of positive wellbeing were associated with greater liking and willingness to pay for the plant-based foods (B values ranging from 0.04 to 0.45). Further, there was an interaction effect whereby levels of negative affect were differentially linked to liking and willingness to pay across the health and environmental framing conditions (B values ranging from 0.03 to 0.38). In particular, negative affect appears to have a greater negative impact on the product liking and willingness to pay when environmental label framings are used. This effect was most pronounced for the product liking dependent variable (B = -0.29 in the environmental framing condition). This research therefore extends understandings of the more specific instances in which message framings can impact perceptions of plant-based foods. The implications of the findings for understanding how best to promote uptake of plant-based diets are discussed.

Nutritional Quality of Meat Analogues: Results From the Food Labelling of Italian Products (FLIP) Project

Nowadays, the interest in meat substitutes is increasing, and consumers perceive their nutritional quality better than that of the animal products they intend to resemble. Therefore, this work aimed to investigate the overall nutritional quality of these new products. Regulated information [Regulation (EU) 1169/2011], the presence/absence of nutrition or health claim and organic declarations, the gluten-free indication, and the number of ingredients were collected from the food labels of 269 commercial meat analogues currently sold on the Italian market. Nutritional information of reference animal meat products was used to compare the nutrition profile. As an indicator of the nutritional quality, the Nutri-Score of meat analogues and counterparts was also determined. Plant-based steaks showed significantly higher protein, lower energy, fats and salt contents, and better Nutri-Scores than the other analogues. All the meat analogues showed a higher fibre content than meat products, while plant-based burgers and meatballs had lower protein contents than meat counterparts. Ready-sliced meat analogues showed a lower salt content than cured meats. Overall, all these plant-based products showed a longer list of ingredients than animal meat products. Results from this survey highlighted that plant-based steaks, cutlets, and cured meats have some favourable nutritional aspects compared to animal-based products. However, they cannot be considered a "tout-court" alternative to meat products from a nutritional point of view.

The Challenges and Dilemmas of Interpreting Protein Labelling of Prepackaged Foods Encountered by the PKU Community

Phenylketonuria (PKU) can lead to severe intellectual impairment unless a phenylalanine-restricted diet starts early in life. It requires expert user knowledge about the protein content of foods. The ability of adults or caregivers of children with PKU to calculate protein exchanges from food labels on manufactured foods and any difficulties they encounter in interpreting food labels has not been studied systematically. Individuals with PKU or their caregivers residing in the UK were invited to complete a cross-sectional online survey that collected both qualitative and quantitative data about their experience when calculating protein exchanges from the food labelling on prepackaged foods. Data was available from 246 questionnaire respondents (152 caregivers of patients with PKU aged <18 years, 57 patients with PKU aged ≥18 years or their caregivers (n = 28), and 9 teenagers with PKU). Thirty-one per cent (n = 76/246) found it difficult to interpret food protein exchanges from food labels. The respondents listed that the main issues with protein labelling were the non-specification of whether the protein content was for the cooked or uncooked weight (64%, n = 158/246); labels stating foods contained 0 g protein but then included protein sources in the list of ingredients (56%, n = 137/246); the protein content being given after a product was prepared with regular milk rather than the dry weight of the product (55%, n = 135/246); and the non-clarity of whether the protein content was for the weight of prepared or unprepared food (in addition to non-specification of cooked or uncooked weights on food labelling) (54%, n = 133/246). Over 90% (n = 222/246) of respondents had experienced problems with food labelling in the previous six months. Misleading or confusing protein labelling of manufactured foods was common. The food industry and legislators have a duty to provide accurate and clear protein food labelling to protect populations requiring low protein diets.

"It's All Just Marketing", a Qualitative Analysis of Consumer Perceptions and Understandings of Nutrition Content and Health Claims in New Zealand

Nutrition content and health claims are widely used globally on both food labels and in food advertising. This study explored how New Zealand consumers understand, perceive, and use nutrition content and health claims on food labels. A qualitative approach was used with semi-structured in-depth online interviews and in-person focus groups including 49 participants, aged ≥25 years responsible for household food shopping. Transcripts were analysed using reflexive thematic analysis using inductive coding, with development of five themes—(1) aware of claims but did not use, (2) mistrust and scepticism, (3) confusion and misinterpretation, (4) using claims to guide food choice, and (5) not all claims are equal. For theme 1, price and habit were found to be the most influential in driving food choice. Underlying theme 2 was the perception by most of nutrition and health claims as marketing. Scepticism was exacerbated when nutrient claims were displayed on inherently unhealthy products. However participants with specific dietary requirements did find claims helpful. Restricting nutrient claims to foods meeting a healthy nutrient profile aligned to the existing Health Star Rating system, education about regulation and supporting claims with more contextual information may increase trust, the perceived value of claims and therefore their utility.

Nutritional Quality of Wholegrain Cereal-Based Products Sold on the Italian Market: Data from the FLIP Study

The consumption of wholegrains (WG) is encouraged worldwide, but the lack of a common legal definition of such products leads to an unclear classification and identification on the grocery store shelf. In Italy, several products are generally sold as WG, but it cannot be determined if they are made entirely with all WG cereal(s) or if they are partially produced with WG ingredients (PWG). The aims of this study were to (a) survey the number of cereal-based food items formulated with WG, PWG, or refined (RG) present on the Italian market; and (b) analyse the nutritional quality, intended as nutrition facts, of WG products in comparison to PWG and RG. Nutritional information and declarations were retrieved from packs of 3040 products belonging to five different categories: breakfast cereals, biscuits, sweet snacks, bread, and bread substitutes. A descriptive analysis of the products and comparison of energy, macronutrients, fibre and salt among RG, PWG and WG products within each category was performed. In all categories, a major portion of the products did not contain WG ingredients. Results showed that the nutritional quality of RG, PWG, and WG products varied in relation to the product category and that WG inclusion cannot be always considered a marker of the overall nutritional quality of foods. Instead, it is necessary to evaluate the global product characteristics, and it is important to pay attention to differences between WG and PWG products that can be perceived by consumers as equivalent.

Labelling Assessment of Greek "Quality Label" Prepacked Cheeses as the Basis for a Branded Food Composition Database

A labelling assessment study of Greek prepacked “quality label” cheeses was conducted with a view to provide an overview of the whole category. In total, 158 prepacked products belonging to 19 “quality label” cheeses were identified in the Greek market. Among them, Feta had the highest share followed by Kasseri, Graviera Kritis, Kefalograviera and Ladotyri Mitilinis with 81, 16, 15, 11 and 9 products found in the market, respectively. For the rest of the 14 cheeses, the share was limited, ranging from 1 to 4. All labelling indications, nutritional information, claims and other labelling data were recorded and analysed in relation to their compliance against European food law requirements. The results of the analysis showed that for only 6 of the 19 cheeses, all products fully complied with EU labelling legislation. Among the 14 mandatory labelling requirements, the lowest overall compliance was observed for allergens declaration (65%). The analysis of the nutritional data showed a remarkable variability between cheeses and products. Differences in the nutritional characteristics were more pronounced among soft, semi-hard, hard and whey cheese. The above data were entered into an archival database. Application of global harmonisation and standardisation guidelines and tools lead to the initialisation of a branded food composition database (BFCD), conceptualising a specialised database for “quality label” foods.

Anaphylaxis to foods purchased from food establishments in Australia

AIM

Food establishments that sell non-packaged foods are not required to have a food label directly on the food product detailing the ingredients. This practice could increase the risk of anaphylaxis among individuals with food allergy. The aim of the study is to understand whether anaphylaxis occurs commonly in individuals with food allergy as a consequence of eating food products purchased from food establishments.

METHODS

We undertook an anonymous on-line cross-sectional survey of food allergic individuals over a 9-month period. Anaphylaxis was defined as reported symptoms consistent with the Australasian Society of Clinical Immunology and Allergy definition of anaphylaxis.

RESULTS

A total of 268 responses were received over the study period and 264 consented and completed the questionnaire. Among our survey participants, the rate of anaphylaxis to food purchased from establishments was 27% (n = 67/246, 95% confidence interval 21.8-33.3%). Of those who reported an anaphylaxis (n = 67), 87% reported informing staff of their/their dependents food allergy/s. Most (81%) reported that they would like to see additional information, such as listing of allergen information next to dishes on the menu and 61% reported that staff pro-actively asking about food allergies would be beneficial.

CONCLUSION

Anaphylaxis from food purchased at food establishments is not uncommon despite a high proportion of individuals declaring their food allergy to staff. Consumers with food allergy would like to see allergen information listed on the menus and for staff to proactively enquire about food allergies. A food allergen matrix that is regularly checked/updated so staff and consumers have easy access to information on menu items and common allergens is required.

Bioimpedance-based Authentication of Defrosted Versus Fresh Pork at the End of Refrigerated Shelf Life

Correct food labeling is a legal requirement and helps consumers to make informed purchasing choices. Mislabeling defrosted meat as fresh is illegal in the EU. However, there are no standardized technologies to authenticate fresh versus defrosted meat. We address this by testing if bioimpedance-based measurements can separate defrosted meat from refrigerated-only meat at the end of shelf life, i.e., when also fresh meat shows deterioration. Pork sirloin samples from 20 pigs were first tested at 12 days postmortem ('fresh group'). This time point was chosen to represent a typical use-by date for refrigerated storage of fresh pork. Then, all samples were transferred to a -24°C freezer for 3 days and thawed for 2 days before final testing ('frozen-thawed group'). Bioimpedance analyses (BIA) were done in a frequency range of [10²-10⁶ Hz]. Weight, pH and electrode positioning were assessed to test for potential confounding effects. Statistics for treatment dependent differences were based on the established P_y parameter and phase angle, which were extracted from the BI spectra. We found that using bioimpedance testing with tetrapolar electrodes, P_y and phase angle allowed almost complete separation of fresh and previously frozen samples. However, within the whole sample population, there was some overlap between the spectra of fresh and frozen samples. Yet, based on P_y, only one fresh sample (5% of N_total=20) fell in the lowest P_y class with all the frozen samples. We used a multifactorial design that allowed to test the effects of potential confounding factors, such as electrode positioning and meat quality parameters. We found a relatively low explained variance for the P_y parameter, indicating that confounding effects from other factors or quality defects in fresh pork may affect the detection capacity of bioimpedance-based authentication of fresh pork. Our data, therefore, suggest that reliable fresh-label authentication with bioimpedance testing should be based on testing a small number of samples to represent a specific lot of pork that is to be inspected.

Misperceptions about added sugar, non-nutritive sweeteners and juice in popular children's drinks: Experimental and cross-sectional study with U.S. parents of young children (1-5 years)

BACKGROUND

Experts recommend against serving sugary drinks and non-nutritive sweeteners to young children, but misperceptions about drink ingredients may contribute to consumption.

OBJECTIVES

Assess parents' ability to identify added sugar, non-nutritive sweeteners and juice in children's drinks.

METHODS

Researchers recruited U.S. parents of young children (1-5 years) through an online survey panel (N = 1603). In a randomized experiment, participants indicated whether eight popular children's drink products contained added sugar or non-nutritive sweeteners and percentage of juice after viewing (a) front-of-package alone or (b) front-of-package plus nutrition/ingredient information. Participants also viewed common statements of identity on children's drinks to identify product ingredients.

RESULTS

When viewing front-of-packages alone, most participants accurately identified products with (83%-90%) and without (51%-65%) added sugar. Showing nutrition/ingredient information increased accuracy. However, the majority could not identify drinks with non-nutritive sweeteners (53%-58%), and many incorrectly believed that unsweetened juices contained added sugar (38%-43%), sweetened flavoured waters had no added sugar (24%-25%), and 100% juice contained less than 100% juice (37%). Furthermore, the majority could not identify product ingredients from statement of identity terms.

CONCLUSIONS

Misperceptions about product ingredients under current labelling practices indicate that updated regulations are necessary, including clear disclosures of sweetener and juice content on package fronts.

Breakfast Cereals Carrying Fibre-Related Claims: Do They Have a Better Nutritional Composition Than Those without Such Claims? Results from the Food Labelling of Italian Products (FLIP) Study

Nutrition claims (NCs) on food packaging are, from one side, an informative tool about the nutritional characteristics of the product. From another side, they could bias the consumer in perceiving such products as healthier than those without claims. In order to investigate whether products with NCs have a better nutritional composition that those without claims, the present study aimed to compare the nutrition facts of 376 breakfast cereals, with and without fibre-related NCs, available in 13 Italian retailer online stores. Among these products, 73 items claimed to be a "source of fibre" and 109 "high in fibre". In addition to a higher fibre content, products "high in fibre" showed higher protein and fat contents but lower carbohydrate, sugar and salt contents compared to both "source of fibre" and without fibre-related NC items. Overall, a high variability in nutritional values was also observed within products with the same type of fibre-related NC. In conclusion, the results suggested that fibre-related NCs should not be considered as a marker of a better nutritional composition of breakfast cereals, and thus consumers should be educated to carefully read the entire nutritional information reported in the food labelling.

Nutrition and Health Claims Spectra of Pre-Packaged Foods on Serbian Supermarket Shelves: A Repeated Cross-Sectional Study

Nutrition and health claims (NHCs) are a powerful tool that influence consumers’ final decision on the choice of food products. The purposes of this repeated cross-sectional study were to (i) assess the prevalence of pre-packaged food products containing nutrition and health claims among different food categories, (ii) to determine the type of NHCs labelled on the examined food products, and (iii) to evaluate the trend in the use of NHCs in comparison to the 2012 survey. The survey was conducted immediately before the full enforcement of the new national legislation on NHCs in 2020. It comprised 3141 pre-packaged food products from 10 product categories. In total, 21.2% of food products contained any claim (19.4% contained any nutrition claim; 8.2% contained any health claim). In comparison to the 2012 survey, we observed a rising trend in the presence of NHCs; the use of nutrition claims on food products increased three times and the use of health claims increased 1.3 times in the 2020 survey. Bearing in mind that NHCs are a powerful tool guiding consumers’ food purchase decisions, NHCs should be supported by precise legislation and strict surveillance by the public health authorities.

Two Dimensions of Nutritional Value: Nutri-Score and NOVA

Front-of-pack labels can improve the ability of consumers to identify which foods are healthier, making them a useful public health tool. Nutri-Score is a front-of-pack labelling system adopted by several European countries. This system ranks foods according to their nutritional quality, but does not consider other dimensions such as the degree of food processing. The aim of this study is to compare the nutritional quality (as assessed by Nutri-Score) and the ultra-processing (as assessed by the NOVA classification) of foods in the Open Food Facts database. A simple correspondence analysis was carried out to study the relationship between the two systems. Ultra-processed foods (NOVA 4) were found in all Nutri-Score categories, ranging from 26.08% in nutritional category A, 51.48% in category B, 59.09% in category C, 67.39% in category D to up to 83.69% in nutritional category E. Given the negative effect that the consumption of ultra-processed foods has on different aspects of health, front-of-pack labelling with Nutri-Score should at least be accompanied by complementary labelling indicating the level of processing, such as the NOVA classification.

The Availability and Quality of Food Labelling Components in the Canadian E-Grocery Retail Environment

Background: Although packaged foods sold in retail stores must follow food labelling regulations, there are no e-grocery food labelling regulations to mandate and standardize the availability and presentation of product information. Therefore, the objective of the study was to evaluate the availability and quality of food labelling components in the Canadian e-grocery retail environment. Methods: A sample of fresh and pre-packaged products was identified on eight leading grocery retail websites in Canada, to assess the availability and quality of food labelling components. Results: Out of 555 product searches, all products were accompanied by product images with front-of-pack images more readily available (96.0%) than back-of-pack (12.4%) and other side panel images (3.1%). The following mandatory nutrition information was available for 61.1% of the products: nutrition facts table (68.8%), ingredient (73.9%), and allergen (53.8%) information. The majority of the nutrition information was available after scrolling down, clicking additionally on the description page, or viewing only as an image. Date markings were not available; packaging material information was available for 2.0% of the products. Conclusions: There was wide variability and inconsistencies in the presentation of food labelling components in the e-grocery retail environment, which can be barriers in enabling Canadians to make informed purchasing decisions.

Current use of nutrition facts tables and attitudes towards new red and green front-of-package labels among Israeli consumers

Front-of-package labels (FOPL) are designed to simplify nutrition information and to help consumers make healthier food choices. The Israeli government has implemented new regulations requiring mandatory red warning FOPL for high levels of sodium, sugar, or saturated fats. A voluntary green positive FOPL for products fitting the national nutritional recommendations was concurrently encouraged. In order to characterise adult consumers' current use of Nutrition Facts Tables (NFT) and their attitudes towards the new FOPL, a nationally representative cross-sectional telephone survey was conducted. Most of the 1,042 survey respondents reported frequent NFT use (76.2%) and intentions to purchase fewer red-labelled (81.1%) and more green-labelled products (85.0%). Consumers with higher BMI and lower education expressed higher intentions to use the new FOPL, but not higher current use of NFT. This finding suggests that these high-risk groups, which the new labels are meant to target, may indeed benefit from the new policy.

Dietary Modelling to Explore the Impact of Potassium Chloride Replacement for Sodium in Bread for Adults with Chronic Kidney Disease

Food manufacturers are increasingly substituting potassium chloride (KCl) in food products so as to reduce the sodium chloride content. Bread and bread products are common staple foods in many Western households and are a target for recipe reformulation using KCl. Given that chronic kidney disease (CKD) is a medical condition of global importance that requires dietary potassium restriction in the later stages, we sought to evaluate the impact and safety of varying levels of KCl substitution in bread products. We undertook a secondary analysis of dietary data from the National Nutrition and Physical Activity Survey 2011–2012 for 12,152 participants (154 participants with CKD). The sodium chloride content in bread and bread-based products was substituted with 20%, 30%, and 40% of KCl. The contribution of these alterations in the dietary potassium intake to the total daily potassium intake were then examined. The replacement of sodium in bread with varying amounts of KCl (20%, 30%, and 40%) resulted in one third of people with CKD exceeding the safe limits for dietary potassium consumption (31.8%, 32.6%, and 33%, respectively). KCl substitution in staple foods such as bread and bread products have serious and potentially fatal consequences for people who need to restrict dietary potassium. Improved food labelling is required for consumers to avoid excessive consumption.

Deconstructing the Supermarket: Systematic Ingredient Disaggregation and the Association between Ingredient Usage and Product Health Indicators for 24,229 Australian Foods and Beverages

Unhealthy diets are underpinned by the over-consumption of packaged products. Data describing the ingredient composition of these products is limited. We sought to define the ingredients used in Australian packaged foods and beverages and assess associations between the number of ingredients and existing health indicators. Statements of ingredients were disaggregated, creating separate fields for each ingredient and sub-ingredient. Ingredients were categorised and the average number of ingredients per product was calculated. Associations between number of ingredients and both the nutrient-based Health Star Rating (HSR) and the NOVA level-of-processing classification were assessed. A total of 24,229 products, listing 233,113 ingredients, were included. Products had between 1 and 62 ingredients (median (Interquartile range (IQR)): 8 (3–14)). We identified 915 unique ingredients, which we organised into 17 major and 138 minor categories. ‘Additives’ were contained in the largest proportion of products (64.6%, (15,652/24,229)). The median number of ingredients per product was significantly lower in products with the optimum 5-star HSR (when compared to all other HSR score groups, p-value < 0.001) and significantly higher in products classified as ultra-processed (when compared to all other NOVA classification groups, p-value < 0.001). There is a strong relationship between the number of ingredients in a product and indicators of nutritional quality and level of processing.

Willingness to Pay for Enhanced Mandatory Labelling of Genetically Modified Soybean Oil: Evidence from a Choice Experiment in China

This study investigates consumers’ preferences for mandatory labelling conveying the health and safety attributes of genetically modified soybean oil. The enhanced mandatory labelling includes allergen presence labelling, nutrient and compositional change labelling and traceability codes. The data were collected from a consumer survey in the eastern, central and western regions of China, with a total sample size of 804 respondents. We evaluated consumer willingness to pay (WTP) for enhanced mandatory labelling using a choice experiment approach. The results show that Chinese consumers are most favorable to traceability codes with a WTP of RMB 8.92, followed by allergen presences labelling, with RMB 6.57. Eastern consumers would like to pay a higher premium for the three types of enhanced mandatory labelling information, while central consumers only show a positive preference for traceability codes. The results imply that the efforts and policy strategies for enhanced mandatory labelling will benefit residents. Further studies can be expended to other genetically modified (GM) foods. This study provides information for the agency to improve mandatory GM food labelling management. This paper contributes to the growing body of the GM food literature by explicitly investigating consumer preference and WTP for mandatory labelling conveying the health and safety attributes of the GM foods.

Trends in the Use of Low and No-Calorie Sweeteners in Non-Alcoholic Beverages in Slovenia

Excessive sugar intake and the associated increased obesity risk indicate that food reformulation is needed. Non-alcoholic beverages are often high in free sugars, making reformulation with low and no-calorie sweeteners (LNCS) a common choice. Our knowledge of the use of LNCS in the European food supply is, however, very limited. This study aimed to evaluate the trends in the use of LNCS in different non-alcoholic beverages in the Slovenian food supply over the course of two years. We assessed which LNCS are most used and how the use of LNCS affects energy and sugar content. We analyzed labeling information of non-alcoholic beverages in selected grocery stores, covering the majority of the Slovenian food supply. Selected grocery stores were located in the capital city (Ljubljana). LNCS were present in 13.2% and 15.5% of non-alcoholic beverages in the years 2017 and 2019, respectively. The use of LNCS has significantly increased only in energy drinks (p < 0.01). The most used LNCS in 2017 were acesulfame K, aspartame, and cyclamates. In 2019 the use of sucralose increased significantly (p < 0.01) to become the second most used LNCS. Energy and sugar content varied between subcategories, which depended on the presence of added sugar and LNCS. Comparison between the energy value and the presence of the LNCS showed an almost 50% lower energy content of beverages containing both added sugar and LNCS (E₂₀₁₇ = 92.8 kJ; E₂₀₁₉ = 96.2 kJ per 100 mL), compared with beverages with only added sugar (E₂₀₁₇ = 161.8 kJ; E₂₀₁₉ = 159.0 kJ per 100 mL). In beverages sweetened only with LNCS, the difference was even more noticeable (E₂₀₁₇ = 22.3 kJ; E₂₀₁₉ = 14.3 kJ per 100 mL). Results show that the use of LNCS can help producers reduce the energy value of non-alcoholic beverages. Still, compared to other countries, the offer of such products in the Slovenian food supply is relatively low. However, due to possible public health risks of excessive use of LNCS, producers should be further encouraged for reformulation and production of less sweet products without LNCS, enabling consumers to adapt to less sweet taste of beverages. Further monitoring of LNCS in the food supply is therefore recommended, preferably also with consideration of sales data.

Looking Ahead: Health Impact Assessment of Front-Of-Pack Nutrition Labelling Schema as a Public Health Measure

This study aimed to describe the underlying process, used methods and major recommendations emerging from a comprehensive and prospective health impact assessment of the endorsement of a front-of-pack nutrition labelling (FOP-NL) system by the Portuguese health authorities. A mixed-methods approach was used to gather information on the impact of four FOP-NL schemes on consumers' selection of food products according to the perception of their nutritional quality, combining a systematic literature review, focus groups (FG), in-depth individual interviews, and an open-label crossover randomized controlled study. The relevance of FOP-NL as a public health promotion policy has emerged as a consensual idea among either FGs' participants (i.e., consumers and experts), or interviewed stakeholders. Although all of the evaluated FOP-NLs result better than no system on promoting the choice of the healthiest product, the effectiveness of easy-to-interpret FOP-NL among vulnerable groups raised concerns related to the need of integrating specific nutritional information to promote a better self-management of chronic diseases, and related to the level of literacy of consumers, which could impair the usage of FOP-NL. Educational campaigns addressing skills to use FOP-NL is recommended. Furthermore, a monitoring strategy should be considered to evaluate the long-term effectiveness of this policy in promoting healthier food choices, and in reducing diet-related non-communicable diseases burden.

Nutritional Quality of Pasta Sold on the Italian Market: The Food Labelling of Italian Products (FLIP) Study

Pasta represents a staple food in many populations and, in recent years, an increasing number of pasta items has been placed on the market to satisfy needs and trends. The aims of this work were: (i) to investigate the nutritional composition of the different types of pasta currently sold in Italy by collecting the nutrition facts on their packaging; (ii) to compare energy, nutrient and salt content per 100 g and serving in fresh and dried pasta; (iii) to compare the nutrition declaration in pairs of products with and without different declarations (i.e., gluten free (GF), organic, and nutrition claims (NC)). A total of 756 items, made available by 13 retailers present on the Italian market, were included in the analysis. Data showed a wide difference between dried and fresh pasta, with high inter-type variability. A negligible amount of salt was observed in all types of pasta, except for stuffed products, which had a median high quantity of salt (>1 g/100 g and ~1.5 g/serving). Organic pasta had higher fibre and lower protein contents compared to conventional pasta. GF products were higher in carbohydrate and fat but lower in fibre and protein than not-GF products, while only a higher fibre content was found in pasta with NC compared to products not boasting claims. Overall, the results show high variability in terms of nutrition composition among the pasta items currently on the market, supporting the importance of reading and understanding food labels for making informed food choices.

Consumers' perception of nutritional facts table and nutritional traffic light in food products' labelling: A qualitative study

BACKGROUND AND OBJECTIVE

Traffic light labelling (TLL) policy has been adopted to improve consumers' food choices. This qualitative study examined the consumers' perception of TLL and nutritional facts table (NFT) in Iran.

DESIGN

We applied a qualitative method to explore public views and perceptions of NFT and TLL in Iran. Participants ageing 20-75 years old were selected by maximum diversity sampling and interviewed using a semi-structured in-depth interview. The interviews were continued until data saturation was achieved after interviewing 35 participants with five more interviews to ensure no new emerging perception. Data was analysed by directed content analysis in MAXQDA 10 software.

FINDINGS

Findings indicated that a large number of the participants were not aware of NFT and TLL. There are some reasons for not paying attention to NFT and TLL, which include lack of enough knowledge about NFT and TLL concepts and defects in appearance and details written in these labels, lack of appropriate education about labels, place of putting the labels and lack of enough time for using the labels during shopping.

CONCLUSIONS

It is concluded that educational interventions should be applied to ensure their effectiveness in improving healthy food choices.

Protein Labelling Accuracy for UK Patients with PKU Following a Low Protein Diet

A phenylalanine (protein)-restricted diet is the primary treatment for phenylketonuria (PKU). Patients are dependent on food protein labelling to successfully manage their condition. We evaluated the accuracy of protein labelling on packaged manufactured foods from supermarket websites for foods that may be eaten as part of a phenylalanine-restricted diet. Protein labelling information was evaluated for 462 food items (“free from”, n = 159, regular, n = 303), divided into 16 food groups using supermarket website data. Data collection included protein content per portion/100 g when food was “as sold”, “cooked” or “prepared”; cooking methods, and preparation instructions. Labelling errors affecting protein content were observed in every food group, with overall protein labelling unclear in 55% (n = 255/462) of foods. There was misleading, omitted, or erroneous (MOE) information in 43% (n = 68/159) of “free from” foods compared with 62% (n = 187/303) of regular foods, with fewer inaccuracies in “free from” food labelling (p = 0.007). Protein analysis was available for uncooked weight only but not cooked weight for 58% (n = 85/146) of foods; 4% (n = 17/462) had misleading protein content. There was a high rate of incomplete, misleading, or inaccurate data affecting the interpretation of the protein content of food items on supermarket websites. This could adversely affect metabolic control of patients with PKU and warrants serious consideration.

Nutritional Composition of Gluten-Free Labelled Foods in the Slovenian Food Supply

The market of gluten-free (GF) foods has been expanding in recent years. GF foods are consumed not only by those with medical predispositions for avoiding gluten, but also by a specific segment of consumers, searching for “healthier” food choices. For these, such practices can present a serious limitation in the variability of food choices. Considering that GF foods are commonly perceived as healthier alternatives, there is a lack of knowledge on the nutritional profile and content of specific nutrients of GF-labelled foods compared to general food supply. A comparison of nutritional composition of GF/non-GF packed foods in the Slovenian food supply was conducted. The nutrient profiling scoring criterion (NPSC) and content of specific nutrients/energy was compared between GF-labelled and regular foods. The highest proportion of GF-labelled products were found in food categories, which typically do not contain gluten (Cheese imitates, Milk imitates, Yoghurt imitates, Canned fish and seafood and Processed meat). Significant differences in the nutrient profile between GF-labelled and regular products were found in Cakes, muffins and pastry, Crisps and snacks, Desserts and Milk imitates. GF-labelled foods often had lower protein and sugar content. Energy value was comparable in most categories and no significant differences in salt content were found, compared to non-GF products. In conclusion, GF-labelled foods will unlikely bring health benefits to those who are not medically required to follow GF diet. Public health initiatives should aim towards promotion of consuming non-processed foods and provision of reliable information about who is required to consume GF foods.

Nutrition Claims Frequency and Compliance in a Food Sample of the Spanish Market: The BADALI Study

Nutrition claims (NCs) have been shown to affect customers’ perceptions and behaviour. In Europe, they are regulated by Regulation (EC) No 1924/2006. The aim of this work was to analyse the prevalence and compliance of NCs according to this regulation in Spain. For this purpose, we used the BADALI database, which included 3197 foods present in the Spanish market. Our results show that 36.1% of all foods carried NCs, at a rate of 3.3 NCs/food. The prevalence was very heterogeneous among food groups. Nuts and seeds, legumes and non-alcoholic beverages were the groups with the highest prevalence. Micronutrients, fat, fibre and sugars were the nutrients most referred to in NCs. Overall, the compliance was low, with 49.2% NCs correct. Fibre and proteins were the nutrients with most correct NCs. Vegetables and non-alcoholic beverages were the food groups with the highest proportion of correct NCs. The main reason for incorrect NCs was because the amount of the nutrient was not stated in the label. The results of our study reveal that the aim of the European Commission to ensure a high level of protection for consumers regarding NCs has not been fulfilled. Therefore, we consider it crucial that European institutions invest in guaranteeing regulation compliance.

What Makes a Front-of-Pack Nutritional Labelling System Effective: The Impact of Key Design Components on Food Purchases

The relative impacts on food purchases of many alternative front-of-pack nutritional labelling systems were tested, with various methods—from opinion pool to nationwide experiments. Clearly, some systems induce better purchasing responses, having better nutritional impacts on food baskets. Nonetheless, we still ignore what the ingredients of an efficient label are. Here, we propose guidance for label designers. To do so, we first propose a typology that breaks down established labelling systems into four elementary components: Directiveness, Scope and Gradation, Set of Reference and Sign. On this basis, we then build seven alternative generic labelling systems that we test in a framed-field experiment enabling us to measure the effect of each component on food purchases in isolation. Our results show that an effective front-of-pack labelling system should be Food-Directive (instead of Diet-Directive) and be displayed on both healthy and unhealthy food. The reference set, which is across categories or within categories, produces the same average nutrition score but generates contrasting behavioural responses.

The Effect of Labelling and Visual Properties on the Acceptance of Foods Containing Insects

Introducing insects as a source of nutrients (e.g., protein) plays a key role in many countries' environmental policies. However, westerners generally reject insects as an ingredient of food products and meals. The aim of our study was to assess if explicitly labelling food as containing insects and/or implying it by manipulating the appearance of food influences the participants' perception of food products or their behavioral reaction to such products. Participants were asked to try a range of foods, none of which contained ingredients derived from insects. However, the experimental conditions varied with regard to food labelling (insect content) and appearance (traces of insect-like ingredients). We observed the participants' non-verbal behavioral reactions to the foods. Next, the respondents filled in a questionnaire evaluating the food's properties. Additionally, we asked the participants to fill in a set of questionnaires measuring other variables (food neophobia, disgust, variety seeking, etc.) The results showed that products labelled as containing insects are consumed with reluctance and in lower quantities despite their appearance. In addition, people with lower general neophobia and a higher tendency to seek variety tried the insect-labelled samples sooner than people from the other groups. Recommendations for marketing strategies are provided.

Uniformity of Food Protein Interpretation Amongst Dietitians for Patients with Phenylketonuria (PKU): 2020 UK National Consensus Statements

In phenylketonuria (PKU), variable dietary advice provided by health professionals and social media leads to uncertainty for patients/caregivers reliant on accurate, evidence based dietary information. Over four years, 112 consensus statements concerning the allocation of foods in a low phenylalanine diet for PKU were developed by the British Inherited Metabolic Disease Dietitians Group (BIMDG-DG) from 34 PKU treatment centres, utilising 10 rounds of Delphi consultation to gain a majority (≥75%) decision. A mean of 29 UK dietitians (range: 18-40) and 18 treatment centres (range: 13-23) contributed in each round. Statements encompassed all foods/food groups divided into four categories based on defined protein/phenylalanine content: (1) foods high in protein/phenylalanine (best avoided); (2) foods allowed without restriction including fruit/vegetables containing phenylalanine ≤75 mg/100 g and most foods containing protein ≤0.5 g/100 g; (3) foods that should be calculated/weighed as an exchange food if they contain protein exchange ingredients (categorized into foods with a protein content of: >0.1 g/100 g (milk/plant milks only), >0.5 g/100 g (bread/pasta/cereal/flours), >1 g/100 g (cook-in/table-top sauces/dressings), >1.5 g/100 g (soya sauces)); and (4) fruit/vegetables containing phenylalanine >75 mg/100 g allocated as part of the protein/phenylalanine exchange system. These statements have been endorsed and translated into practical dietary management advice by the medical advisory dietitians for the National Society for PKU (NSPKU).

Whole Grains and Consumer Understanding: Investigating Consumers' Identification, Knowledge and Attitudes to Whole Grains

Whole grains may assist in reducing risk of non-communicable disease, but consumption is limited in many countries. In Australia, the reasons for poor consumption are not well understood. The aim of this study was to investigate consumers' knowledge, attitudes and identification of whole grains, incorporating an exploration of factors influencing consumption, promotion and provision. An online semi-structured questionnaire was used to gather responses from 735 participants (61% complete responses). Although 92% of respondents consumed grains, only 8% reported an intake consistent with age and gender recommendations. Refined pasta and rice were the most frequently purchased grain foods followed by wholemeal/whole grain bread. Of whole grain foods, bread and breakfast cereals were consumed more frequently. However, overall, participants did not prioritise consumption of whole grains. Despite this, 93% of participants had seen food packaging information drawing attention to whole grain content, with a high proportion describing whole grain as less processed (72%) or high in dietary fibre (67%). Two-thirds were aware of health benefits but stated that if they had further information, they would be more likely to swap to whole grain. Further education, increasing exposure, accessibility and extensive promotion of whole grain health benefits are required to facilitate whole grain consumption. Furthermore, removing the negative stigma associated with carbohydrate foods, including grains, will be necessary to improve consumption.

Unintended consequences in traffic-light food labeling: A call for mixed methods in public health research

Nudge theory describes how indirect suggestions and positive reinforcement can influence decision-making. We used nudge theory to implement a traffic-light labeling and choice architecture (modifying product placement) intervention at Harvard University cafeterias, but found no significant change in sales. Survey and focus group data showed that some students thought the labeling may exacerbate eating disorders, however, there is extremely limited research on potential negative consequences of labeling. One way to describe these findings is through 20th century philosopher Michel Foucault's concept of biopower. Biopower manipulates cultural norms and nudges individuals to engage in self-surveillance and self-discipline, de facto subjugating themselves to certain ways of being. Biopower may lead to the creation of an in-group and an out-group based on who can adopt the new behaviors, such as healthy eating. Those in the out-group may face additional unintended consequences, highlighting the need for mixed-methods research to better evaluate public health interventions.

Uptake of Australia's Health Star Rating System 2014-2019

In June 2014, Australia and New Zealand adopted a voluntary front-of-pack nutrition label, the Health Star Rating (HSR) system. Our aim was to assess its uptake in Australia in the five years following adoption and examine the feasibility of proposed targets for future uptake. Numbers and proportions of products eligible to carry a HSR were recorded each year between 2014 and 2019 as part of an annual survey of four large Australian retail outlets. Uptake was projected to 2024. Mean HSR values were determined for products that were, and were not labelled with a HSR logo, and summary data presented overall, by HSR score, by major food category, by manufacturer and manufacturer group. Differences in mean HSR were assessed by independent samples t-test. HSR uptake continues to increase, appearing on 7118/17,477 (40.7%) of eligible products in 2019. Voluntary display of the HSR logo was increasing linearly at 6.8% annually. This would need to be maintained to reach 70% by 2024. Of those products displaying a HSR logo, more than three quarters (76.4%) had a HSR ≥ 3.0. Products displaying a HSR logo had a significantly higher mean HSR (3.4), compared to products not displaying a HSR logo (2.6) (p < 0.001). One hundred and thirty-nine manufacturers were using HSR, but retailers Coles, Woolworths and ALDI were together responsible for the majority of uptake (55.9%). Manufacturer members of the Australian Food and Grocery Council were responsible for 28.6% of uptake. Our findings illustrate the limits of commercial goodwill in applying HSR voluntarily. Ongoing implementation must pair clear targets and timelines for uptake with a firm pathway to make HSR mandatory if sufficient progress is not achieved.

Prevalence of Product Claims and Marketing Buzzwords Found on Health Food Snack Products Does Not Relate to Nutrient Profile

Growth in the consumer health and wellness industry has led to an increase of packaged foods marketed as health food (HF) products. In consequence, a ‘health halo’ around packaged HF has arisen that influences consumers at point-of-purchase. This study compared product claims (nutrient content claims (NCC), health claims and marketing ‘buzzwords’) displayed on packaged HF snack products sold in HF stores and HF aisles in supermarkets to equivalent products sold in regular aisles (RA) of supermarkets. Product Health Star Rating (HSR), nutrient profile and price were also compared. Data were collected for 2361 products from three supermarket chains, two HF chains and one independent HF store in Sydney, Australia. Mann-Whitney U tests compared the product claims, HSR, nutrient composition and unit ($) price. HF snacks displayed significantly more product claims per product compared to RA foods (HSR ≤ 2.5), median (IQR) 5.0(4.0) versus 1.0(2) and (HSR > 2.5) 4.0(4.0) versus 3.0(4), respectively (p < 0.001). A significantly different HSR was evident between HF and RA snack products, median 2.5(0) versus 2.0(1.5), respectively (p < 0.001). HF snacks cost significantly more than RA snack foods, irrespective of product HSR (p < 0.001). These findings support the recommendation for revised labelling regulations and increased education regarding consumers food label interpretation.

Front of pack nutritional labelling schemes: a systematic review and meta-analysis of recent evidence relating to objectively measured consumption and purchasing

BACKGROUND

Front of pack labelling (FOPL) provides visible nutritional information and appears to influence knowledge and reformulation. However, a recent Cochrane review found limited and inconsistent evidence for behaviour change. The present review aimed to examine studies published subsequent the Cochrane review, focusing on prepackaged foods, examining the impact of FOPL on purchasing and consumption.

METHODS

Controlled experimental/intervention and interrupted time series (ITS) studies were included, with no age/geography restrictions. Exposures were FOPL with objectively measured consumption/purchasing outcomes. Thirteen databases were searched (January 2017 to April 2019) and forward citation searching was undertaken on the included studies. Purchasing data from experimental studies were meta-analysed. Two series of meta-analyses were undertaken; combined FOPL versus no-FOPL and specific FOPL scheme versus no-FOPL. Outcomes were sugar (g 100 g^-1 ), calories (kcal 100 g^-1 ), saturated fat (g 100 g^-1 ) and sodium (mg 100 g^-1 ).

RESULTS

We identified 14 studies, reporting consumption (experimental; n = 3) and purchasing (n = 8, experimental; n = 3, ITS). Meta-analysis of experimental studies showed sugar and sodium content of purchases was lower for combined FOPL versus no-FOPL (-0.40 g sugar 100 g^-1 , P < 0.01; -24.482 mg sodium 100 g^-1 , P = 0.012), with a trend for lower energy and saturated fat (-2.03 kcal 100 g^-1 , P = 0.08; -0.154 g saturated fat 100 g^-1 , P = 0.091). For specific FOPL, products purchased by 'high in' FOPL groups had lower sugar (-0.67 g sugar 100 g^-1 , P ≤ 0.01), calories (-4.43 kcal 100 g^-1 , P < 0.05), sodium (-33.78 mg 100 g^-1 , P = 0.01) versus no-FOPL; Multiple Traffic Light had lower sodium (-34.94 mg 100 g^-1 , P < 0.01) versus no-FOPL. Findings regarding consumption were limited and inconsistent. FOPL resulted in healthier purchasing in ITS studies.

CONCLUSIONS

This review provides evidence from experimental and 'real-life' studies indicating that FOPL encourages healthier food purchasing. PROSPERO CRD42019135743.

Sugar Content and Nutritional Quality of Child Orientated Ready to Eat Cereals and Yoghurts in the UK and Latin America; Does Food Policy Matter?

Ready to eat breakfast cereals (REBCs) and yoghurts provide important nutrients to children's diets, but concerns about their high sugar content exist. Food reformulation could contribute to sugar reduction, but policies across countries are not uniform. We aimed to compare the sugar content and nutritional quality of child-orientated REBCs and yoghurts in Latin American countries with the UK. In a cross-sectional study, nutritional information, marketing strategies, and claims were collected from the food labels and packaging of products available in Guatemala, Mexico, Ecuador and the UK. Nutritional quality was assessed using the UK Ofcom Nutrient Profiling System. In total, 262 products were analysed (59% REBCs/41% yoghurts). REBCs in the UK had a lower sugar content (mean ± SD) (24.6 ± 6.4) than products in Ecuador (34.6 ± 10.8; p < 0.001), Mexico (32.6 ± 7.6; p = 0.001) and Guatemala (31.5 ± 8.3; p = 0.001). Across countries, there were no differences in the sugar content of yoghurts. A large proportion (83%) of REBCs and 33% of yoghurts were classified as "less healthy". In conclusion, the sugar content of REBCs in Latin America is higher than those of the UK, which could be attributed to the UK voluntary sugar reduction programme. Sugar reformulation policies are required in Guatemala, Mexico and Ecuador.

Growing the Business of Whole Grain in the Australian Market: A 6-Year Impact Assessment

The Australia New Zealand Food Standards Code does not regulate on-pack claims describing the amount of whole grain in foods. In July 2013, The Grains & Legumes Nutrition Council^™ (GLNC) established a voluntary Code of Practice for Whole Grain Ingredient Content Claims (the Code) providing guidance for whole grain claims, with cut-off values and suggested wording ≥8 g, ≥16 g, and ≥24 g per manufacturer serve (contains; high and very high in whole grain), based on a 48 g whole grain daily target intake. The aim of this impact assessment was to report the uptake of the Code by manufacturers, changes in numbers of whole grain products, and claims on-pack since 2013, including compliance. The impact assessment was undertaken in August 2019, comparing current registered manufacturers (“users”) and their products to the total number of products in the market deemed eligible for registration through GLNC product audits since 2013. Reporting included breakfast cereals, bread products, crispbreads, crackers, rice/corn cakes, rice, pasta, noodles, couscous, other grains (e.g., quinoa, buckwheat, freekeh), and grain-based muesli bars. As of 30 June 2019, there were 33 registered users and 531 registered products in Australia and New Zealand representing 43% of the eligible manufacturers and 65% of the eligible whole grain foods. Three-quarters (78% and 74%) of the eligible breakfast cereals and bread products were registered with the Code in 2019, followed by 62% of grain-based muesli bars. Only 39% of crispbread, crackers, rice/corn cakes, and rice, pasta, noodles, couscous, and other grains were registered. From 2013 there has been a 71% increase in the number of whole grain foods making claims, demonstrating strong uptake by industry, with clearer, more consistent, and compliant on-pack communication regarding whole grain content.

Front-of-pack nutrition labelling to promote healthier diets: current practice and opportunities to strengthen regulation worldwide

Unhealthy diets are a leading cause of death and disability globally. The WHO recommends Member States implement front-of-pack (FOP) nutrition labels to guide consumers towards healthier food choices, as part of comprehensive strategies to prevent diet-related non-communicable diseases. Interest in FOP nutrition labelling is increasing, but there is limited guidance for policymakers developing regulations necessary for effective implementation. A rapidly evolving evidence base, limited regulatory capacity and possibility of legal challenge by affected food industry stakeholders can create 'regulatory chill', whereby governments are dissuaded from progressive public health policymaking. We use a framework for analysing public health law and available best-practice guidance to evaluate key components of 31 FOP nutrition labelling regulations endorsed by governments up to June 2019. Analysis of regulatory form shows recent rapid uptake of label formats that are easier for consumers to understand and increasing use of mandatory legislation. However, policymakers must decide much more than whether to apply 'stars', 'traffic lights' or 'stop signs'. The substance of effective regulation must contain strategic regulatory objectives, clear specifications for displaying the label on pack, a valid scoring mechanism and a justified scope for including foods. While there are limited data on current practice, good governance of FOP nutrition labelling regulation also requires transparency and accountability in processes of label development, implementation, evaluation and enforcement to promote continuous improvement and withstand undue commercial interference. Whether developing new FOP nutrition labels or reforming existing ones, our findings support policymakers to design and implement best-practice, evidence-informed regulation.

Evaluation of the Nutritional Quality of Breakfast Cereals Sold on the Italian Market: The Food Labelling of Italian Products (FLIP) Study

Breakfast cereals are present on the market as different types and, in general, are one of the food categories in which voluntary information, such as nutrition or health claims (NHC) or gluten free (GF) declarations, have the largest distribution. The aims of the present study were to compare (i) the nutritional declaration among different types of breakfast cereals, as well as among products with and without NHC or GF declarations; and (ii) the salt and sugar contents with the “Italian shared objectives for the improvement of the nutritional characteristics of food”. To this aim, the nutrition declarations of 371 different breakfast cereal items, available in 13 retailers present on the Italian market, were analysed. Data showed an elevated inter-product variability, with cereal bars and muesli having the highest energy, total fat, and saturate contents per 100 g. Limited differences were found comparing products with and without NHC, as well as those with GF declaration. Most of the breakfast cereals were compliant to the shared objectives, although some items with NHC or GF declaration still have sugar or salt contents higher than these objectives. In conclusion, these data suggest that the different characteristics and the regulated information reported on the food label should not be considered as a marker of the overall nutritional quality. Thus, this study supports the importance of reading and understanding the information made on food label.

A comparison of the healthiness of packaged foods and beverages from 12 countries using the Health Star Rating nutrient profiling system, 2013-2018

We compared the healthiness of packaged foods and beverages between selected countries using the Health Star Rating (HSR) nutrient profiling system. Packaged food and beverage data collected 2013-2018 were obtained for Australia, Canada, Chile, China, India, Hong Kong, Mexico, New Zealand, Slovenia, South Africa, the UK, and USA. Each product was assigned to a food or beverage category and mean HSR was calculated overall by category and by country. Median energy density (kJ/100 g), saturated fat (g/100 g), total sugars (g/100 g) and sodium (mg/100 g) contents were calculated. Countries were ranked by mean HSR and median nutrient levels. Mean HSR for all products (n = 394,815) was 2.73 (SD 1.38) out of 5.0 (healthiest profile). The UK, USA, Australia and Canada ranked highest for overall nutrient profile (HSR 2.74-2.83) and India, Hong Kong, China and Chile ranked lowest (HSR 2.27-2.44). Countries with higher overall HSR generally ranked better with respect to nutrient levels. India ranked consistently in the least healthy third for all measures. There is considerable variability in the healthiness of packaged foods and beverages in different countries. The finding that packaged foods and beverages are less healthy in middle-income countries such as China and India suggests that nutrient profiling is an important tool to enable policymakers and industry actors to reformulate products available in the marketplace to reduce the risk of obesity and NCDs among populations.

Narrow-Leafed Lupin Main Allergen β-Conglutin (Lup an 1) Detection and Quantification Assessment in Natural and Processed Foods

The increasing prevalence of lupin allergy as a consequence to the functional characteristics of a growing number of sweet lupin-derived foods consumption makes the imperious necessity to develop analytical tools for the detection of allergen proteins in foodstuffs. The current study developed a new highly specific, sensitive and accurate ELISA method to detect, identify and quantify the lupin main allergen β-conglutin (Lup an 1) protein in natural and processed food. The implementation of accurate standards made with recombinant conglutin β1, and an anti-Lup an 1 antibody made from a synthetic peptide commonly shared among β-conglutin isoforms from sweet lupin species was able to detect up to 8.1250 ± 0.1701 ng (0.0406 ± 0.0009 ppm) of Lup an 1. This identified even lupin traces present in food samples which might elicit allergic reactions in sensitized consumers, such as β-conglutin proteins detection and quantification in processed (roasted, fermented, boiled, cooked, pickled, toasted, pasteurized) food, while avoiding cross-reactivity (false positive) with other legumes as peanut, chickpea, lentils, faba bean, and cereals. This study demonstrated that this new ELISA method constitutes a highly sensitive and reliable molecular tool able to detect, identify and quantify Lup an 1. This contributes to a more efficient management of allergens by the food industry, the regulatory agencies and clinicians, thus helping to keep the health safety of the consumers.

Are the Claims to Blame? A Qualitative Study to Understand the Effects of Nutrition and Health Claims on Perceptions and Consumption of Food

Nutrition and Health Claims (NHCs) have been found to influence perceptions of food and consumption behaviour. While previous quantitative research has identified factors that may explain these effects, the current study aimed to address the dearth of in-depth exploration as to the underlying reasons why and how claims may impact upon perceptions and behaviour and the relationships between key factors. Seventy-eight participants took part in 10 focus groups. Discussions were transcribed verbatim and Nvivo 11 was used for thematic analysis. Six themes were developed from the data: 1. Target populations for NHCs; 2. Influence of NHCs on purchasing behaviour; 3. Characteristics/perceptions of products displaying NHCs; 4. Believability of NHCs; 5. Superior yet superficial knowledge; 6. Consumption of products displaying NHCs. Knowledge was a key factor influencing how much individuals believe claims (Believability of NHCs) and their perceptions (Characteristics/perceptions of products displaying NHCs). These perceptions and the characteristics of products displaying claims also impacted believability, as well as purchasing behaviour and consumption. Future research should be cognisant of the role of knowledge and characteristics or perceptions of products in the relationship between NHCs and consumer behaviour, and modelling of these relationships would allow their relative strength to be identified.

A review of polyols - biotechnological production, food applications, regulation, labeling and health effects

Food research is constantly searching for new ways to replace sugar. This is due to the negative connotations of sugar consumption on health which has driven consumer demand for healthier products and is reflected on a national level by the taxation of sugary beverages. Sugar alcohols, a class of polyols, are present in varying levels in many fruits and vegetables and are also added to foods as low calorific sweeteners. The most commonly used polyols in food include sorbitol, mannitol, xylitol, erythritol, maltitol, lactitol and isomalt. Of these, microorganisms can produce sorbitol, mannitol, xylitol and erythritol either naturally or through genetic engineering. Production of polyols by microbes has been the focus of a lot of research for its potential as an alternative to current industrial scale production by chemical synthesis but can also be used for in situ production of natural sweeteners in fermented products using microbes approved for use in foods. This review on the generation of these natural sweetening compounds by microorganisms examines the current understanding and methods of microbial production of polyols that are applicable in the food industry. The review also considers the health benefits and effects of polyol usage and discusses regulations which are applicable to polyol use.

Confused health and nutrition claims in food marketing to children could adversely affect food choice and increase risk of obesity

OBJECTIVES

To investigate the nutritional quality of foods marketed to children in the UK and to explore the use of health and nutrition claims.

DESIGN

This cross-sectional study was carried out in a wide range of UK food retailers. Products marketed to children above the age of 1 year containing any of a range of child friendly themes (i.e. cartoons, toys and promotions), and terms suggesting a nutritious or healthy attribute such as 'one of 5-a-day', on product packaging were identified both in stores and online. Information on sugar, salt and fat content, as well as health and nutrition claims, was recorded. The Ofcom nutrient profiling model (NPM) was used to assess if products were healthy.

RESULTS

Three hundred and thirty-two products, including breakfast cereals, fruit snacks, fruit-based drinks, dairy products and ready meals, were sampled. The use of cartoon characters (91.6%), nutrition claims (41.6%) and health claims (19.6%) was a common marketing technique. The one of 5-a-day claim was also common (41.6%), but 75.4% (103) of products which made this claim were made up of less than 80 g of fruit and vegetables. Sugar content (mean±SD per 100 g) was high in fruit snacks (48.4±16.2 g), cereal bars (28.9±7.5 g) and cereals (22.9±8.0 g). Overall, 41.0% of the products were classified as less healthy according to the Ofcom NPM.

CONCLUSION

A large proportion of products marketed to children through product packaging are less healthy, and claims used on product packaging are confusing. Uniform guidance would avoid confusion on nutritional quality of many popular foods.

The performance and potential of the Australasian Health Star Rating system: a four-year review using the RE-AIM framework

OBJECTIVE

The Health Star Rating (HSR) is a front-of-pack nutrition labelling system, implemented voluntarily in Australia and New Zealand since 2014. Our aim was to evaluate HSR's performance.

METHOD

We used data from peer-reviewed publications and government-commissioned monitoring and evaluation, websites and communiqués to evaluate HSR's performance between June 2014 and October 2018 using the RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) framework.

RESULTS

Thirty-three peer-reviewed publications, 21 government and three independent reports informed the assessment. Awareness and trust in HSR was increasing, though campaign reach remained low. Consumers liked, could understand and use the HSR logo, though effects on purchasing were largely unknown. The algorithm was the focus of a formal review. HSR was present on 20-28% of products but biased to those that scored better (HSR≥3.0). Necessary stakeholders were mostly engaged.

CONCLUSIONS

A substantial body of work supports continuation and strengthening of HSR. Reasonable refinements to HSR's star graphic and algorithm, action to initiate mandatory implementation, and strengthened HSR governance present the clearest opportunities for improving public health impact. Implications for public health: Development and implementation of government-led front-of-pack nutrition labelling systems have the potential to improve public health, while engaging a diverse set of stakeholders.