Abstract
In 2008, the Choices International Foundation developed its logo criteria, identifying best-in-class food products. More advanced, global and graded nutrient profiling systems (NPSs) are needed to substantiate different national nutrition policies. The objective of this work was to extend Choices NPS to identify five levels of the healthiness of food products, so that the Choices NPS can also be used to support other nutrition policies, next to front-of-pack labelling. Based on the same principles as the previous logo criteria, four sets of threshold criteria were determined using a combination of compliance levels, calculated from a large international food group-specific database, the Choices logo criteria, and WHO-NPSs developed to restrict marketing to children. Validation consisted of a comparison with indicator foods from food-based dietary guidelines from various countries. Some thresholds were adjusted after the validation, e.g., because intermediate thresholds were too lenient. This resulted in a new international NPS that can be applied to different contexts and to support a variety of health policies, to prevent both undernutrition and obesity. It can efficiently evaluate mixed food products and represents a flexible tool, applicable in various settings and populations.
Highlights
The World Health Organization (WHO) thresholds were thresholds were realistic was decided by looking at compliance levels C1 and C3: (1) one or more nutrient thresholds of the WHO nutrient profiling systems (NPSs) were at least 50% less restrictive than the comparable threshold of the Choices logo criteria
This paper describes the methodology used to extend the Choices criteria from a single threshold to four thresholds (T1 to T4), defining five levels of descending healthiness. This process, based on the existing Choices nutrient profiling methodology, considered the previous criteria and compliance levels, using a database of over 64,700 food products from basic food groups and non-basic food groups from eight countries worldwide developed by the George Institute in Australia [8], as well as various WHO NPS models for restriction of marketing to children
The Choices logo criteria were used as a benchmark for T1, and WHO NPSs were instead used for defining T3
Summary
Malnutrition is a hallmark of both obesity and undernutrition, and it is part of a vicious cycle, involving poverty and disease [1]. Despite many risk factors for all forms of malnutrition being known, no government or institution has implemented existing evidence-based policy recommendations in such a way that the malnutrition epidemic figures have been reversed. Swinburn et al [2] defined this situation as a form of ‘policy inertia’, attributable to the collective effects of lack of political leadership in the field of nutrition and public health, intense lobbying by interest groups and businesses, and a lack of demand for action by the general public. Efforts to address malnutrition by working in collaboration with industry through self-regulation appears insufficiently effective [2]
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