Evaluating the Consistency of the French Nutri-Score Front-of-Pack Scoring System with Canadian Dietary Guidelines

Abstract Objectives Nutrient profiling (NP) models, underpinning front-of-pack (FOP) labelling, can guide consumers towards healthier food choices and should be aligned with food-based dietary guidelines. In France, [the FSAm/HCSP NP model], underpinning the Nutri-Score (NS) FOP, ranks foods on both nutrients-to-limit (saturated fat, sodium, sugar) and nutrients-to-encourage (e.g., protein, fibre, fruits, vegetables, legumes and nuts) and was found to adequately align with dietary recommendations in Europe. However, investigations on the comparable ranking of foods by the FSAm/HCSP NP model with the new Canadian dietary guidelines is lacking. The objective was to assess the ability of the NS to discriminate the nutritional quality of foods and beverages in the Canadian food supply and their consistency with nutritional recommendations according to the Canada's 2019 Food Guidelines (CFG). Methods Using the University of Toronto Food Label Information Program 2017 database (n = 17,360), the nutritional scores for prepackaged foods and beverages were derived using the NS. These scores correspond to five grades of nutritional quality, ranging from green (A; highest quality) to red (E; lowest quality). Scores were assessed as binary where A/B were considered ‘in alignment’ with CFG recommendations while C/D/E were considered ‘not in alignment’. Results The NS system classified 21% of products as A, ranging from 99% of legumes to 0.45% of the sugars/sweets. The NS was able to discriminate the nutritional quality of foods within the same food groups (based on display of three grades represented within the Nutri-Score). Overall, there was 73% agreement between NS and CFG, ranging from 48% for combination dishes to 95% for eggs/egg substitute categories. The classification of foods according to the NS was consistent with the CFG; foods for which consumption is recommended were more favourably classified (e.g., 76% of vegetables were classified as A or B) than foods for which consumption should be limited (e.g., 79% of snacks were classified as C/D/E). Conclusions The NS FOP system is an effective tool to discriminate products across and within food categories. The classification of different food groups in the NS displayed a high consistency with the new Canadian dietary guidelines. Funding Sources Sanofi-Pasteur University of Toronto Université Paris-Descartes Collaborative Grant.

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The Health Canada Surveillance Tool could be an effective method for assessing alignment with 2019 Canada's Food Guide

Proceedings of The Nutrition Society ◽

10.1017/s0029665120005297 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Christine Mulligan ◽

Beatriz Franco-Arellano ◽

Mary R L'Abbe

Keyword(s):

Saturated Fat ◽

Dietary Guidelines ◽

Food Label ◽

Food Category ◽

Total N ◽

University Of Toronto ◽

Label Information ◽

Total Fat ◽

Health Canada ◽

Kappa Agreement

AbstractThe Health Canada Surveillance Tool (HCST), a Canadian nutrient profile (NP) model, assesses products’ adherence to the 2007 Canada's Food Guide (CFG), using thresholds for total fat, saturated fat, sugars and sodium. In 2019, new dietary guidelines were published (i.e., CFG 2019); however; the HCST has not been updated to reflect changes implemented in this new guide. Given suggestions to adapt previously validated NP models rather than create new models, this research aimed to assess whether the HCST could be a useful tool to assess alignment with updated dietary guidance. Specifically, the objective of this study was to test the agreement between products’ alignment with the CFG 2007 (as per the HCST) and products’ alignment with the recently released CFG 2019 guidelines. This study analyzed data from the University of Toronto Food Label Information Program (FLIP) 2017 database. FLIP contains label and nutrition information for prepackaged food products from top Canadian grocery retailers. Products were categorized into Tiers based on HCST thresholds: Tiers 1 and 2 were considered “in line” with dietary guidance, while Tiers 3, 4 and “Other” (i.e. foods not addressed by CFG) were considered “not in line”. Two raters independently classified foods according to their alignment to CFG 2019. Proportions of products that were considered “in line” with CFG 2007 and 2019 were calculated. Overall agreement between alignment with CFG 2007 and 2019 was determined by cross-classifications of the proportion of products considered “in line” or “not in line” with both CFG versions. Cohen's Kappa (κ) statistic tested the level of agreement (Interpretation of κ: 0.01–0.20, “slight”; 0.21–0.40, “fair”; 0.41–0.60, “moderate”; 0.61–0.80, “substantial”; and 0.81–0.99, “almost perfect”). Analyses were conducted overall and by Health Canada's Table of Reference Amounts for Food category. In total, n = 16,973 products were analyzed, with 98% inter-rater reliability for CFG 2019 alignment. Overall, 30.2% and 28.2% of products were “in line” with CFG 2007 and 2019, respectively, with 80.4% overall agreement and “moderate” kappa agreement (κ [95% CI]: 0.49 [0.46, 0.49]). Overall agreement in individual food categories ranged from 100% (Dessert Toppings, Sauces, Sugars and Sweets; κ: N/A) to 54.8% (Eggs, κ: 0.21 [-0.01, 0.4]). From these results, the HCST appears to be an effective NP model for assessing alignment with CFG 2019. Further analysis could elucidate specific areas for adaptation of the HCST to optimize its functionality in this context.

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

Public Health Nutrition ◽

10.1017/s1368980020000051 ◽

2020 ◽

Vol 23 (12) ◽

pp. 2068-2077 ◽

Cited By ~ 1

Author(s):

Claire Elizabeth Pulker ◽

Heather Robertson Farquhar ◽

Christina Mary Pollard ◽

Jane Anne Scott

Keyword(s):

Nutritional Quality ◽

Cross Sectional Study ◽

Food Groups ◽

Cross Sectional ◽

Nutrition Labels ◽

Star Rating ◽

Photographic Images ◽

Corporate Social

AbstractObjective:To assess the nutritional quality of Australian supermarket own brand chilled convenience foods (SOBCCF), for example, ready meals, pizza, pies and desserts.Design:Cross-sectional.Setting:Two large supermarkets (Coles and Woolworths) in Perth, Western Australia were audited in February 2017.Participants:Data were extracted from photographic images of 291 SOBCCF, including front-of-pack information (i.e. product name, description and nutrition labels including Health Star Rating (HSR)) and back-of-pack information (i.e. nutrition information panel and ingredients list). SOBCCF were classified as healthy or unhealthy consistent with principles of the Australian Guide to Healthy Eating (AGTHE), NOVA classification of level of food processing and HSR score.Results:Fifty-four percentage of SOBCCF were classified as unhealthy according to AGTHE principles, 94 % were ultra-processed foods using NOVA and 81 % scored a HSR of ≥2·5, implying that they were a healthy choice. Some convenience food groups comprised more healthy choices overall including prepared vegetables, salad kits and bowls, soups and vegetarian food. A significantly larger proportion of SOBCCF from Coles were classified as unhealthy compared with Woolworths (70 v. 44 %, P < 0·05) using the AGTHE.Conclusions:The findings suggest there is potential for Australian supermarkets to improve the nutritional quality of their SOBCCF and highlights the differences between supermarkets in applying their corporate social responsibility policies. Policies to assist consumers to select healthier foods should address difficulties in identifying healthy convenience foods. The findings reveal misclassification of unhealthy SOBCCF as healthy by the HSR suggesting that its algorithm should be reformed to align with recommendations of the AGTHE.

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Socioeconomic and racial/ethnic disparities in the nutritional quality of packaged food purchases in the U.S., 2008-2018

Public Health Nutrition ◽

10.1017/s1368980021000367 ◽

2021 ◽

pp. 1-34

Author(s):

Allison Lacko ◽

Joanna Maselko ◽

Barry Popkin ◽

Shu Wen Ng

Keyword(s):

Nutritional Quality ◽

Ethnic Disparities ◽

Saturated Fat ◽

The United States ◽

Future Research ◽

Food Groups ◽

Processed Meats ◽

Packaged Foods ◽

Over Time

Abstract Objective: To determine whether disparities exist in the nutritional quality of packaged foods and beverage purchases (PFPs) by household income, education, and race/ethnicity and if they changed over time. Design: We used Nielsen Homescan, a nationally representative household panel, from 2008-2018 (n=672,821 household-year observations). Multivariate, multilevel regressions were used to model the association between sociodemographic groups and a set of nutritional outcomes of public health interest, including nutrients of concern (sugar, saturated fat, sodium) and calories from specific food groups (fruits, non-starchy vegetables, processed meats, sugar-sweetened beverages and junk foods). Setting: Household panel survey Participants: Approximately 60,000 households each year from the United States. Results: Disparities were found by income and education for most outcomes, and widened for purchases of fruits, vegetables, and the percent of calories from sugar between 2008 and 2018. The magnitude of disparities was largest by education. Disparities between Black and White households include the consumption of processed meats and the percent calories from sugar, while no disparities between White and Hispanic households were found. Disparities have been largely persistent, as any significant changes over time have been substantively small. Conclusions: Policies to improve the healthfulness of packaged foods must be expanded beyond SSB taxes and future research should focus on what mediates the relationship between education and diet so as not to exacerbate disparities.

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Performance of the Front-of-Pack Nutrition Label Nutri-Score to Discriminate the Nutritional Quality of Foods Products: A Comparative Study across 8 European Countries

Nutrients ◽

10.3390/nu12051303 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1303 ◽

Cited By ~ 2

Author(s):

Louise Dréano-Trécant ◽

Manon Egnell ◽

Serge Hercberg ◽

Pilar Galan ◽

Juliette Soudon ◽

...

Keyword(s):

Nutritional Quality ◽

Nutritional Composition ◽

European Countries ◽

Food Groups ◽

Dietary Recommendations ◽

Animal Fat ◽

Nutritional Recommendations ◽

Vegetable Products ◽

Quality Of Products

In Europe, discussions are currently ongoing to harmonize front-of-pack nutritional labelling, while some countries have adopted or are considering implementing the Nutri-Score. However, its adaptability to multiple nutritional contexts in Europe requires further investigation. This study aimed to evaluate the applicability of the Nutri-Score in various European countries, regarding its ability to discriminate the nutritional quality of foods and its consistency with national dietary recommendations. The European Food Information Resource (EUROFIR) nutritional composition databases from eight European countries (Finland, France, Norway, Poland, Portugal, Slovakia, Sweden, and Switzerland) were used. The distribution of foods across the Nutri-Score classes within food groups was assessed, as well as the discriminating performance of the label, and the adequacy of nutritional recommendations. The Nutri-Score demonstrated high discriminating ability for all food groups, with similar trends in the eight countries, and consistency with nutritional recommendations. For instance, fruit and vegetable products were mainly classified in the two healthiest Nutri-Score categories, while sugar and animal fat products were mainly classified in the two less healthy categories of the Nutri-Score. Our results support the fact that the Nutri-Score would be a relevant tool to discriminate the nutritional quality of products within and across relevant food groups in different European countries, with consistency with nutritional recommendations.

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Examining the nutritional quality of the product portfolios of major packaged food and beverage companies in Canada

Proceedings of The Nutrition Society ◽

10.1017/s0029665120000786 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Laura Vergeer ◽

Mavra Ahmed ◽

Lana Vanderlee ◽

Mary L'Abbé

Keyword(s):

Food Supply ◽

Nutritional Quality ◽

Soft Drink ◽

Saturated Fat ◽

Food Label ◽

Food Category ◽

Food And Beverage ◽

Packaged Food ◽

Product Portfolios

AbstractCanada's food supply is abundant in energy-dense products containing excess amounts of sodium, saturated fat and free sugars, increasing Canadians' risk of developing obesity and non-communicable diseases. Food companies shape the food supply through their control over the formulation of their products; however, no studies have examined the healthfulness of products offered by different companies in Canada. This study aimed to assess and compare the nutritional quality of the product portfolios of major packaged food and beverage companies in Canada. Twenty-two top food companies were selected for study, representing a combined 50% and 73% of Canadian packaged food and beverage sales in 2018, respectively. This included 18 multinational companies, 2 Canadian manufacturers and 2 retailers with private-label brands. Nutritional information for products was sourced from the University of Toronto Food Label Information Program 2017 database. The nutritional quality of all products offered by the sampled companies that were included in the database (n = 8,211) were evaluated using the Health Star Rating (HSR) system, with HSRs ranging from 0.5 (less healthy) to 5 (healthier). Descriptive analyses and analysis of variance with post-hoc tests examined the HSRs of each company's products overall and by food category (n = 24). Mean HSRs of companies’ overall product portfolios ranged from 1.8 to 3.7 (μx̅ = 2.7, σx̅ = 0.5) and differed significantly between companies (p < 0.001). Mean HSRs differed between companies for all food categories except eggs (p = 0.5), seafood (p = 0.2), legumes (p = 0.1), nuts and seeds (p = 0.4), and vegetables (p = 0.08). Variation in mean HSRs of products offered by different companies was greatest for beverages (range = 1.3–5.0, μx̅ = 2.0, σx̅ = 1.0), fats/oils (range = 0.7–4.4, μx̅ = 3.6, σx̅ = 1.6), fruit/fruit juices (range = 0.8–4.0, μx̅ = 2.6, σx̅ = 0.9), and sauces/dips/gravies/condiments (range = 0.5–3.4, μx̅ = 2.3, σx̅ = 1.0). These findings demonstrate that the nutritional quality of products offered by leading food manufacturers in Canada varies significantly overall and by food category, with many of these products considered less healthy according to the HSR system. Differences between companies may reflect the nature of their products; for example, products offered by dairy companies were healthier than those of confectionary and soft drink manufacturers, on average. Variation in nutritional quality within food categories illustrates the need and potential for many companies to improve the healthfulness of their products. By identifying companies that offer less healthy products compared with others in Canada, this study may prompt reformulation.

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Indices for the assessment of nutritional quality of meals: a systematic review

British Journal Of Nutrition ◽

10.1017/s0007114516000994 ◽

2016 ◽

Vol 115 (11) ◽

pp. 2017-2024 ◽

Cited By ~ 9

Author(s):

B. M. Gorgulho ◽

G. K. Pot ◽

F. M. Sarti ◽

D. M. Marchioni

Keyword(s):

Systematic Review ◽

Nutritional Quality ◽

Dietary Assessment ◽

Assessment Method ◽

Population Characteristics ◽

Food Groups ◽

Quality Indices ◽

Dietary Recommendations ◽

Meal Quality

AbstractThis systematic review aimed to synthesise information on indices developed to evaluate nutritional quality of meals. A strategy for systematic search of the literature was developed using keywords related to assessment of meal quality. Databases searched included ScienceDirect, PubMed, Lilacs, SciELO, Scopus, Cochrane, Embase and Google Scholar. The literature search resulted in seven different meal quality indices. Each article was analysed in order to identify the following items: authors, country, year, study design, population characteristics, type of meal evaluated, dietary assessment method, characteristics evaluated (nutrients or food items), score range, index components, nutritional references, correlations performed, validation and relationship with an outcome (if existing). Two studies developed instruments to assess the quality of breakfast, three analysed lunch, one evaluated dinner and one was applied to all types of meals and snacks. All meal quality indices reviewed were based on the evaluation of presence or absence of food groups and relative contributions of nutrients, according to food-based guidelines or nutrient references, adapting the daily dietary recommendations to one specific meal. Most of the indices included three items as components for meal quality assessment: (I) total fat or some specific type of fat, (II) fruits and vegetables and (III) cereals or whole grains. This systematic review indicates aspects that need further research, particularly the numerous approaches to assessing meals considering different foods and nutrients, and the need for validation studies of meal indices.

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Assessing nutritional value of ready-to-eat breakfast cereals in the province of Quebec (Canada): a study from the Food Quality Observatory

Public Health Nutrition ◽

10.1017/s1368980021001361 ◽

2021 ◽

pp. 1-8

Author(s):

Julie Perron ◽

Sonia Pomerleau ◽

Pierre Gagnon ◽

Joséane Gilbert-Moreau ◽

Simone Lemieux ◽

...

Keyword(s):

Food Quality ◽

Food Supply ◽

Nutritional Quality ◽

Saturated Fat ◽

Nutritional Composition ◽

Breakfast Cereal ◽

Food Category ◽

Breakfast Cereals ◽

Sales Data

Abstract Objective: The Food Quality Observatory was created in the province of Quebec (Canada) in 2016. In this study, the Observatory aimed to generate a methodology to (1) test the use of sales data combined with nutrient values to characterise the nutritional composition of ready-to-eat (RTE) breakfast cereals offered and purchased in the province of Quebec (Canada) and (2) verify the extent to which a front-of-pack label based on the percentage of daily value (DV) for total sugar, as a strategy to improve the food supply, would be distributed in this food category. Design: Nutritional information were obtained by purchasing each RTE breakfast cereal available in the Greater Montreal area. Cereals were then classified according to their processing type. Setting: The nutritional values of 331 RTE breakfast cereals available in Quebec were merged with sales data covering the period between May 2016 and May 2017. A total of 306 products were successfully cross-referenced. Results: Granola and sweetened cereals were the most available (36·6 % and 19·6 %, respectively) and purchased (19·8 % and 40·9 % of sales, respectively). When compared with other types of cereals, granola cereals had a higher energy, fat, saturated fat, protein content and a lower Na content. A larger proportion of chocolate (65 %) and sweetened cereals (49 %) were above 15 % of the DV for sugar. Conclusions: This study showed that the methodology developed generates important data to monitor nutritional quality of the food supply and ultimately contribute to improve the nutritional quality of processed foods.

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

Nutrients ◽

10.3390/nu13041183 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1183

Author(s):

Laura Vergeer ◽

Beatriz Franco-Arellano ◽

Gabriel B. Tjong ◽

Jodi T. Bernstein ◽

Mary R. L’Abbé

Keyword(s):

Linear Models ◽

Saturated Fat ◽

Nutritional Composition ◽

Gluten Free ◽

Food Label ◽

Nutrient Contents ◽

Logistic Regression Models ◽

University Of Toronto ◽

Information Program ◽

Label Information

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

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Nutritional Quality of Undergraduate Student Meals in an All-You-Care-to-Eat Campus Dining Facility (P04-156-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.p04-156-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Audrey Olson ◽

Katie Vieyra ◽

Alexandra Polasky ◽

Amy Best ◽

Lois Durant ◽

...

Keyword(s):

Nutrition Education ◽

Undergraduate Students ◽

Nutritional Quality ◽

Fruits And Vegetables ◽

Saturated Fat ◽

Whole Grains ◽

Research Award ◽

George Mason University ◽

Reported Data

Abstract Objectives To assess the overall nutritional quality of meals chosen by undergraduate students during weekday lunches at campus all-you-care-to-eat dining halls. Methods A previously validated exit survey was used to collect self-reported data from undergraduate students on foods and beverages they consumed during a single visit to two all-you-care-to-eat dining halls on the George Mason University Fairfax campus, during 4 weeks. (n = 468) Nutritional quality of each meal was evaluated on a 7-point rubric, according to the ‘Wellness Meal’ standards from the Partnership for a Healthier America: ≤700 kilocalories, ≤10% calories from saturated fat, ≤800 mg sodium, ≥2 ounces whole grains, ≥1 cup lowfat dairy, ≥ 1.75 cups fruits and vegetables, and ≥ 2 ounces lean protein. Results Of the maximum score of 7 on the meal nutritional quality rubric, 4 participants earned the highest score of 5, whereas 43, 150, 132, 88, and 51 participants had scores of 4, 3, 2, 1, and 0, respectively. The most commonly attained rubric standard was saturated fat, where 60% of participants consumed ≤ 10% calories from saturated fat and average consumption was 9.1% (± 5.4%) of calories. The least achieved rubric category was lowfat dairy, where only 2% of students consumed 1 cup equivalent, followed by only 9% of participants having consumed the 2 ounce equivalent of whole grains. Approximately one-third of students met calorie, lean protein, sodium, and fruit/vegetable standards. Conclusions Despite a wide variety of food options in the campus all-you-care-to-eat dining halls during the lunch hours, most undergraduate students consumed meals of subpar nutritional quality, with the vast majority meeting fewer than half the categories on the meal nutritional quality rubric. All-you-care-to-eat university dining halls may be a prime location for nutrition education and interventions. Funding Sources This research was funded by the George Mason University Provost's Multidisciplinary Research Award.

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Menu Descriptions and Nutrient Content of Food Items in U.S. Restaurants (FS02-01-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.fs02-01-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Danielle Krobath ◽

William Masters ◽

Megan Mueller

Keyword(s):

Saturated Fat ◽

Nutrient Content ◽

The United States ◽

Dietary Guidelines ◽

Health Claims ◽

Trans Fat ◽

Dietary Recommendations ◽

Food Items ◽

Significant Difference ◽

Nutrient Data

Abstract Objectives This study concerns how the description of foods on restaurant menus relates to their nutrient content as disclosed on company websites. We aimed to test halo effects, regarding how claims about some desirable features might be associated with the presence of other attributes. Methods We used item descriptions and nutrient data for food items (n = 92,949) at the top-selling restaurant chains (n = 92) from 2012 through 2017 in the United States, compiled by the MenuStat project. We classified items into 4 types (mains, appetizers, desserts, sides) and claims into 3 groups using 29 search terms based on consumer interests in health (e.g., “nutritious”), product sourcing (e.g., “local” or “organic”), and vegetal items (vegetarian or vegan). Nutrient data focus on 4 dietary recommendations to limit sodium (mg), trans-fat (g) and saturated fats (% of energy), and to increase fiber (g). We also report calories per item (kcal) and its share from carbohydrates, protein and total fat (%). We used multiple regression to test whether nutrient content was associated with menu claims, controlling for year and restaurant brand, the item being marked as “shareable”, on a kid's menu, or regional and limited-time offerings. Methods and hypotheses were preregistered on As-Predicted.com. Results Contrary to our prediction, nutrient content was more often aligned with U.S. dietary guidelines when their description did include claims. With 3 claim types, 4 food types and 4 recommendations we test 48 possible cases. In 25 (52%) we found alignment between claims and nutrient recommendations, e.g., main dishes with health-related claims had 2% less calories from saturated fat (P < 0.01) and 142 mg less sodium (P < 0.01). In 3 of 48 cases (7%), claims were contrary to recommendations, all of which were desserts with sourcing claims which had more sodium, more trans-fat and more saturated fat than other desserts (all P < 0.01). In 20 of 48 cases (42%) there was no significant difference between items with and without claims. Conclusions Items described as vegetarian/vegan or with sourcing and health claims had nutrient contents that were more often aligned with dietary guidelines than other items. Menu labeling that communicates meal content more directly, such as nutrient fact panels, could inform choice and build trust in restaurant meals. Funding Sources None.

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