Food Label Information Program Research Articles

Nutritional information on the labels of processed and ultra-processed foods and beverages marketed in a supermarket chain in Lima in 2022.

Motivation for the study. Peruvian Law No. 30021 establishes the use of warning octagons for foods with high content of critical nutrients (sugar, sodium, saturated and trans fats); however, the declaration of nutritional information is not mandatory. Main findings. Of a total of 4404 processed and ultra-processed foods marketed in supermarkets in Lima, only 71.4% declared some type of nutritional information. In addition, only 46.0% declared information on the content of critical nutrients regulated by Law No. 30021. Implications. There is a need for a mandatory and standardized declaration of nutritional information on packaged foods marketed in Peru, in order to allow the population to make healthy decisions when choosing their food and to monitor the correct use of warning octagons. . To estimate the number of processed and ultra-processed beverages and foods that provide nutritional information on their packaging, and to describe the characteristics of this information, as well as to determine the presence of nutritional information on products with octagons. Photographs were taken of the labels of 4404 processed and ultra-processed beverages and foods marketed in supermarkets in Metropolitan Lima. The information on the label was collected and registered in the mobile and web version of the Food Label Information Program (FLIP). We analyzed variables related to the nutritional information, the way in which such information is declared and the information in beverages and foods with octagons. Only 71.4% of the products had some type of nutritional information. Of these, 13.8% provided the nutritional information as a text and not in a table, and only 56.3% declared it per 100 grams or milliliters. Of the total number of foods with the octagon "Contains trans fats", only 19.2% declared their content. More than a quarter of the beverages and packaged foods in the Peruvian market did not provide nutritional information of any kind, and of those that did, only one did so in different formats and units. In addition, we found that a proportion of beverages and foods for each type of octagon did not declare information of the nutrient that is mentioned in the octagon.

Estimating Canadian sodium intakes and the health impact of meeting national and WHO recommended sodium intake levels: A macrosimulation modelling study.

Cardiovascular diseases (CVDs) are the second leading cause of total deaths in Canada. High blood pressure is the main metabolic risk factor for developing CVDs. It has been well established that excess consumption of sodium adversely affects blood pressure. Canadians' mean sodium intakes are well above recommended levels. Reducing dietary sodium intake through food reformulation has been identified as a cost-effective intervention, however, dietary sodium intake and the potential health impact of meeting recommended sodium intake levels due to food reformulation have not been determined in Canada. This study aimed to 1) obtain robust estimates of Canadians' usual sodium intakes, 2) model sodium intakes had foods been reformulated to align with Health Canada's sodium reduction targets, and 3) estimate the number of CVD deaths that could be averted or delayed if Canadian adults were to reduce their mean sodium intake to recommended levels under three scenarios: A) 2,300 mg/d-driven by a reduction of sodium levels in packaged foods to meet Health Canada targets (reformulation); B) 2,000 mg/d to meet the World Health Organization (WHO) recommendation; and C) 1,500 mg/d to meet the Adequate Intake recommendation. Foods in the University of Toronto's Food Label Information Program 2017, a Canadian branded food composition database, were linked to nationally representative food intake data from the 2015 Canadian Community Health Survey-Nutrition to estimate sodium intakes (and intakes had Health Canada's reformulation strategy been fully implemented). The Preventable Risk Integrated ModEl (PRIME) was used to estimate potential health impact. Overall, mean sodium intake was 2758 mg/day, varying by age and sex group. Based on 'reformulation' scenario A, mean sodium intakes were reduced by 459 mg/day, to 2299 mg/day. Reducing Canadians' sodium intake to recommended levels under scenarios A, B and C could have averted or delayed 2,176 (95% UI 869-3,687), 3,252 (95% UI 1,380-5,321), and 5,296 (95% UI 2,190-8,311) deaths due to CVDs, respectively, mainly from ischaemic heart disease, stroke, and hypertensive disease. This represents 3.7%, 5.6%, and 9.1%, respectively, of the total number of CVDs deaths observed in Canada in 2019. Results suggest that reducing sodium intake to recommended levels could prevent or postpone a substantial number of CVD deaths in Canada. Reduced sodium intakes could be achieved through reformulation of the Canadian food supply. However, it will require higher compliance from the food industry to achieve Health Canada's voluntary benchmark sodium reduction targets.

Child-appealing packaged food and beverage products in Canada-Prevalence, power, and nutritional quality.

Children are frequently exposed to marketing on food packaging. This study evaluated the presence, type and power of child-appealing marketing and compared the nutritional quality of child-appealing vs. non-child-appealing Canadian packaged foods and examined the relationship between nutrient composition and marketing power. Child-relevant packaged foods (n = 5,850) were sampled from the Food Label Information Program 2017 database. The presence and power (# of techniques displayed) of child-appealing marketing were identified. Fisher's Exact test compared the proportion of products exceeding Health Canada's nutrient thresholds for advertising restrictions and Mann Whitney U tests compared nutrient composition between products with child- /non-child-appealing packaging. Pearson's correlation analyzed the relationship between nutrient composition and marketing power. 13% (746/5850) of products displayed child-appealing marketing; the techniques used, and the power of the marketing varied ([Formula: see text] 2.2 techniques; range: 0-11). More products with child-appealing packaging than with non-child appealing packaging exceeded Health Canada's thresholds (98% vs. 94%; p < .001). Products with child-appealing packaging (vs. non-child-appealing) were higher in total sugars (median: 14.7 vs. 9 g/RA; p < .001) and free sugars (11.5 vs. 6.2 g/RA; p < .001), but lower in all other nutrients. There was weak overall correlation between marketing power and nutrient levels. Results varied by nutrient and food category. Unhealthy products with powerful child-appealing marketing displayed on package are prevalent in the food supply. Implementing marketing restrictions that protect children should be a priority.

Canadian Free Sugar Intake and Modelling of a Reformulation Scenario.

Recommendations suggest limiting the intake of free sugar to under 10% or 5% of calories in order to reduce the risk of negative health outcomes. This study aimed to examine Canadian free sugar intake and model how intakes change following the implementation of a systematic reformulation of foods and beverages to be 20% lower in free sugar. Additionally, this study aimed to examine how calorie intake might be impacted by this reformulation scenario. Canadians' free sugar and calorie intakes were determined using free sugar and calorie data from the Food Label Information Program (FLIP) 2017, a Canadian branded food composition database, and applied to foods reported as being consumed in Canadian Community Health Survey-Nutrition (CCHS-Nutrition) 2015. A "counterfactual" scenario was modelled to examine changes in intake following the reformulation of foods to be 20% lower in free sugar. The overall mean free sugar intake was 12.1% of calories and was reduced to align with the intake recommendations at 10% of calories in the "counterfactual" scenario (p < 0.05). Calorie intake was reduced by 3.2% (60 calories) in the "counterfactual" scenario (p < 0.05). Although the overall average intake was aligned with the recommendations, many age/sex groups exceeded the recommended intake, even in the "counterfactual" scenario. The results demonstrate a need to reduce the intake of free sugar in Canada to align with dietary recommendations, potentially through reformulation. The results can be used to inform future program and policy decisions related to achieving the recommended intake levels of free sugar in Canada.

Comparing the nutritional composition of foods and beverages in the Canadian Nutrient File to a large representative database of Canadian prepackaged foods and beverages.

Nutrient information used to code dietary intakes in the Canadian Community Health Survey (CCHS) may not be reflective of the current Canadian food supply and could result in inaccurate evaluations of nutrient exposures. To compare the nutritional compositions of foods in the CCHS 2015 Food and Ingredient Details (FID) file (n = 2,785) to a large representative Canadian database of branded food and beverage products (Food Label Information Program, FLIP) collected in 2017 (n = 20,625). Food products in the FLIP database were matched to equivalent generic foods from the FID file to create new aggregate food profiles based on FLIP nutrient data. Mann Whitney U tests were used to compare nutrient compositions between the FID and FLIP food profiles. In most food categories and nutrients there were no statistically significant differences between the FLIP and FID food profiles. Nutrients with the largest differences included: saturated fats (n = 9 of 21 categories), fiber (n = 7), cholesterol (n = 6), and total fats (n = 4). The meats and alternatives category had the most nutrients with significant differences. These results can be used to prioritize future updates and collections of food composition databases, while also providing insights for interpreting CCHS 2015 nutrient intakes.

Evaluating the potential implications of canadian front-of-pack labelling regulations in generic and branded food composition databases

BackgroundCanada proposed the implementation of mandatory front-of-pack (FOP) labelling regulations, whereby foods meeting or exceeding thresholds for nutrients-of-concern (i.e., total sugars, saturated fat, sodium) must display a ‘high-in’ FOP symbol (FOP). The objective of the study was to evaluate the potential implications of the proposed regulations using Canadian generic and branded food composition databases.MethodsA generic food composition database of products consumed by Canadians, Canadian Nutrient File (CNF) 2015 (n = 3,677), and a branded food composition database of packaged foods and beverages, Food Label Information Program (FLIP) 2017 (n = 17,521), were used to evaluate the number and proportion of foods that would display a FOP symbol based on the details of the proposed FOP labelling regulations published in 2018.ResultsOverall, 35.5% (n = 1,306) of products in CNF 2015 and 63.9% (n = 11,193) of products in FLIP 2017 would display a FOP symbol for at least one nutrient-of-concern exceeding proposed thresholds. Soups, Combination Dishes, and Desserts categories in CNF 2015 and Combination dishes, Soups, and Meats categories in FLIP 2017 would have the highest proportion of products that would display a FOP symbol. Although displaying a FOP symbol for one nutrient was most common in both CNF 2015 (n = 992; 27.0%) and FLIP 2017 (n = 7,296, 41.6%), the number (i.e., 0–3) and type (i.e., saturated fat, sodium, total sugar) of nutrients displayed varied by food category.ConclusionWhile the generic database, containing both packaged and unpackaged foods, revealed a low prevalence of foods that would display a FOP symbol, the branded database showed that the proposed FOP labelling regulations would identify over 60% of packaged foods with excess contents of nutrients-of-concern. Considering the high prevalence of packaged foods in Canada that would meet or exceed the thresholds of nutrients-of-concern, the proposed FOP labelling regulations should be implemented in a timely manner to help consumers easily identify foods high in nutrients-of-concern and encourage manufacturer-driven product reformulations.

Automation of the Updated Food Label Information Program (FLIP 2020): A Comprehensive Canadian Branded Grocery and Restaurant Food Composition Database

ObjectivesTraditional methods for creating food composition databases struggle to cope with the large number of products and the rapid pace of turnover in the food supply. The objective is to overview the updated Food Label Information Program (FLIP2020), a big data approach for the evaluation of the Canadian food supply and present the latest methods used in the development of this database.MethodsThe University of Toronto's Food Label Information Program (FLIP) is a database of Canadian prepackaged and chain restaurant foods and beverages collected since 2010. FLIP 2020 was developed using website “scraping” and machine learning (ML) coupled with artificial intelligence-enhanced optical character recognition (AI-OCR) to collect and manage food labelling information (e.g., nutritional composition, price, product images, ingredients, brand, etc.) on all foods and beverages available on seven major Canadian e-grocery retailer websites and 201 Canadian chain restaurants between May 2020 and February 2021.ResultsFLIP 2020 is comprised of 74,445 prepackaged food products and 21,225 menu items available on websites of seven retailers, 2 location-specific duplicate retailers and 141 chain restaurants. Food products were classified under multiple national and international categorization systems, in order to analyse similar foods under different systems. Of 57,006 food and beverage products available on seven retailers’ websites, nutritional composition data were available for about 60% of the products and ingredients were available for about 45%. Data for energy, protein, carbohydrate, fat, sugar, sodium and saturated fat were present for 54–65% of the products, while fibre information was available for 37%. Of the 201 eligible chain restaurants with ≥ 20 national outlets, 70% provided nutritional information. All provided energy, 84% provided saturated fat, total sugar and sodium, and 50% provided all 13 required nutrients listed on the Nutrition Facts table.ConclusionsFLIP, with its comprehensive sampling and granularity and use of ML/AI-OCR, is a powerful tool for evaluating and monitoring the Canadian food supply environment.Funding SourcesThis research was supported by funds from a Canadian Institutes of Health Research Project Grant.

Consumption of Ultra-Processed Foods Is Associated with Free Sugars Intake in the Canadian Population.

Excess sugar consumption can lead to noncommunicable diseases (NCDs) such as type 2 diabetes. Increasingly, ultra-processed foods (UPF) are suspected to be great contributors to free sugars intake in the population’s diet. Thus, the aim of this study was to investigate the association between UPF consumption and free sugars intake in the Canadian population. We used data from one 24 h-recall of the nationally representative 2015 Canadian Community Health Survey–Nutrition (CCHS). Food items were classified according to the NOVA system, and to estimate free sugars intake, we used the University of Toronto’s Food Label Information Program (FLIP) 2017 database. Results: Almost half of the population’s energy intake (45.7%) came from UPF. On average, 221.5 kcal/day came from free sugars, and most of these calories (71.5%) came from UPF. Public health policies aiming to decrease consumption of UPF should be a priority considering their important contribution to sugar intake in the population.

Development of the Food Label Information Program: A Comprehensive Canadian Branded Food Composition Database.

ObjectivesTraditional methods for creating food composition databases struggle to cope with the large number of products and the rapid pace of turnover in the food supply. This paper introduces Food Label Information Program (FLIP), a big data approach to the evaluation of the Canadian food supply and presents the latest methods used in the development of this database.MethodsThe Food Label Information Program (FLIP) is a database of Canadian food and beverage package labels by brand name. The latest iteration of the FLIP, FLIP 2020, was developed using website “scraping” to collect food labeling information (e.g., nutritional composition, price, product images, ingredients, brand, etc.) on all foods and beverages available on seven major Canadian e-grocery retailer websites between May 2020 and February 2021.ResultsThe University of Toronto's Food Label Information Program (FLIP) 2020 was developed in three phases: Phase 1, database development and enhancements; Phase 2, data capture and management of food products and nutrition information; Phase 3, data processing and food categorizing. A total of 74,445 products available on websites of seven retailers and 2 location-specific duplicate retailers were collected for FLIP 2020. Of 57,006 food and beverage products available on seven retailers, nutritional composition data were available for about 60% of the products and ingredients were available for about 45%. Data for energy, protein, carbohydrate, fat, sugar, sodium and saturated fat were present for 54–65% of the products, while fiber information was available for 37%. Food products were classified under multiple categorization systems, including Health Canada's Table of Reference Amounts, Health Canada's sodium categories for guiding benchmark sodium levels, sugar-focused categories and categories specific to various global nutrient profiling models.ConclusionsFLIP is a powerful tool for evaluating and monitoring the Canadian food supply environment. The comprehensive sampling and granularity of collection provides power for revealing analyses of the relationship between nutritional quality and marketing of branded foods, timely observation of product reformulation and other changes to the Canadian food supply.

Methodology for the Determination of Fruit, Vegetable, Nut and Legume Points for Food Supplies without Quantitative Ingredient Declarations and Its Application to a Large Canadian Packaged Food and Beverage Database.

Nutrient profiling (NP) models are useful tools for objectively and transparently quantifying the nutritional quality of packaged foods and beverages. Many NP models incorporate ingredients beneficial for health (e.g., fruits, vegetables, nuts, legumes (FVNL)) in addition to less healthful nutrients or components, assigning points based on the proportion of the product that contains FVNL ingredients. However, with food labelling in most countries lacking mandatory quantitative ingredient declarations (QUIDs), there is potential for the estimation of FVNL points to be ambiguous and inconsistent. The purpose of this article was to describe the development and application of methodology for estimating FVNL points for products without QUIDs, based on the position of FVNL components within the ingredients list. Using this method, FVNL points were calculated for packaged foods and beverages in the University of Toronto Food Label Information Program 2017 database (n = 17,337). Distributions of FVNL points were examined overall and by food category. This study provides evidence of the feasibility of this method in distinguishing between products with differing amounts of FVNL ingredients. This method will be valuable for researchers and policymakers in ensuring consistent, objective and reproducible estimations of FVNL points—and consequently, assessments of product healthfulness—for food supplies without QUIDs.

Reformulation of sugar contents in Canadian prepackaged foods and beverages between 2013 and 2017 and resultant changes in nutritional composition of products with sugar reductions.

To quantify total sugar reformulation in Canadian prepackaged foods and beverages between 2013 and 2017 and identify changes in the nutritional composition of the foods and beverages reformulated to be lower in total sugar. Longitudinal examination of foods and beverages present in both 2013 and 2017 collections of the University of Toronto's Food Label Information Program database (n 6628 matched products). The proportion of products with changes in sugar levels was determined. Wilcoxon signed-rank test was used to examine changes in sugar levels overall for products lower or higher in sugar and changes in nutrient composition for products lower in sugar. Largest grocery retailers by market share in Canada. Canadian prepackaged foods and beverages. The majority (76·6 %) of products had no change in total sugar content, 12·4 % were reformulated to be lower in sugar and 11·0 % were higher in sugar. A median sugar reduction of 19·0 % (1·6 g) was seen among products lower in sugar which was offset by a median 18·0 % (1·5 g) increase among products higher in sugar. Overall, median levels of energies and other nutrients stayed the same or decreased among products reformulated to be lower in sugar, the exception was for starch, which increased. Limited progress was made to reformulate foods and beverages to be lower in total sugar between 2013 and 2017. Results from this study identify areas in the food supply where attention may be needed to avoid unintended consequences of sugar-focused reformulation in terms of overall nutritional composition.

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.

Gluten-Free Claims Are Displayed Mostly on Processed and Ultra-Processed Foods in Canada

Abstract Objectives Celiac disease is an autoimmune condition characterized by an adverse response to gluten ingestion. While only 1% of the population must follow a gluten-free diet (e.g., those with celiac disease), gluten-free products are becoming increasingly prevalent in Canada, particularly among packaged products, which are largely processed or ultra-processed. Yet, excess consumption of processed and ultra-processed foods has been associated with poor diet quality, a risk factor for obesity and other non-communicable diseases. Objectives To examine whether the presence of gluten-free claims (GFC) on packaged food and beverage products was associated with level of processing. Methods Cross-sectional analysis of the University of Toronto Food Label Information Program 2017. GFC were identified by systematically reviewing the photographs of food labels (n = 17,267). Products were classified into 22 main food categories as determined by the Health Canada's Table of Reference Amounts for Foods. Using the NOVA food processing classification system, products were also classified into two groups: 1) Unprocessed or minimally processed and processed culinary ingredients; and 2) processed or ultra-processed. Proportions of products displaying GFC were calculated overall, by food category and by level of processing. Binomial logistic regression models examined the association of GFC with level of processing. Results Fifteen % of products displayed GFC. Categories displaying the largest proportion of GFC were snacks (32%), meat and poultry products (28%), and nuts and seeds (26%). The presence of GFC claim was associated with foods being processed or ultra-processed (β = 1.63, P &amp;lt; 0.001). In 8 of the 22 food categories, 100% of products displaying GFC were processed or ultra-processed, while more than 80% of foods displaying GFC in 17 of 22 categories were considered processed or ultra-processed. Conclusions About 1/6 of prepackaged foods and beverages displayed gluten-free claims in the Canadian Food supply. Most of them were considered processed and ultra-processed foods. Funding Sources Canadian Institutes of Health (CIHR) Scholarships [BFA, LV], Department of Nutritional Sciences Graduate Student Fellowship [BFA; LV], Ontario Graduate Scholarship [LV], CIHR Research Grant 2016PJT-152,979 [MRL].

A comparison of the nutritional quality of products offered by the top packaged food and beverage companies in Canada

BackgroundCanada’s food supply is abundant in less healthy products, increasing Canadians’ risk of obesity and non-communicable diseases. Food companies strongly influence the food supply; however, no studies have examined differences in the healthfulness of products offered by various companies in Canada. This study aimed to compare the nutritional quality of products offered by the top packaged food and beverage companies in Canada.MethodsTwenty-two top packaged food and beverage manufacturing companies were selected, representing > 50% of the Canadian market share in 2018. Nutritional information for products (n = 8277) was sourced from the University of Toronto Food Label Information Program 2017 database. Descriptive analyses examined the nutritional quality of products based on: 1) the Health Star Rating (HSR) system; 2) calories, sodium, saturated fat and total sugars per 100 g (or mL) and per reference amounts (RAs) defined by Health Canada; and 3) “high in” thresholds for sodium, saturated fat and total sugars proposed by Health Canada for pending front-of-package labelling regulations. Kruskal-Wallis tests compared HSRs of products between companies.ResultsMean HSRs of companies’ total product offerings ranged from 1.9 to 3.6 (out of 5.0). Differences in HSRs of products between companies were significant overall and for 19 of 22 food categories (P < 0.05), particularly for fats/oils and beverages. Calories, sodium, saturated fat and total sugars contents varied widely between companies for several food categories, and depending on whether they were examined per 100 g (or mL) or RA. Additionally, 66.4% of all products exceeded ≥1 of Health Canada’s “high in” thresholds for sodium (31.7%), saturated fat (28.3%) and/or sugars (28.4%). The proportion of products offered by a company that exceeded at least one of these thresholds ranged from 38.5 to 97.5%.ConclusionsThe nutritional quality of products offered by leading packaged food and beverage manufacturers in Canada differs significantly overall and by food category, with many products considered less healthy according to multiple nutrient profiling methods. Variation within food categories illustrates the need and potential for companies to improve the healthfulness of their products. Identifying companies that offer less healthy products compared with others in Canada may help prompt reformulation.

Evaluating the Canadian Packaged Food Supply Using Health Canada’s Proposed Nutrient Criteria for Restricting Food and Beverage Marketing to Children

Federally mandated restrictions on food and beverage marketing to kids (M2K) have been re-introduced as a national public health priority in Canada by the newly elected government, following the failure to implement a similar policy first proposed in 2016. This study examined the extent to which Canadian packaged foods, including products already displaying M2K on the packaging, would be permitted to be marketed, based on the nutrient criteria for marketing restrictions defined by Health Canada (in December 2018) as part of the previous policy proposal. Products from the University of Toronto Food Label Information Program 2013 database (n = 15,200) were evaluated using Health Canada’s published criteria: thresholds for sodium, sugars and saturated fats that products cannot exceed in order to be M2K. The proportion of products exceeding no thresholds (i.e., permitted to be M2K), the number of thresholds exceeded, and the proportion exceeding each individual threshold were calculated overall and in the subsample of products displaying M2K on the packaging (n = 747). Overall, 18.0% of products would be permitted to be M2K, versus 2.7% of products displaying M2K. Sodium was the most exceeded threshold overall (57.5% of products), whereas sugars was the most exceeded by products displaying M2K (80.1%). Only 4.7% of all products versus 10.4% of products displaying M2K exceeded all three thresholds. These results highlight the importance of reintroducing federal regulations restricting M2K in Canada and including marketing on product packaging in the regulatory scope.

Examining the relationship between sugars contents of Canadian foods and beverages and child-appealing marketing.

In 2016, legislation to restrict child-appealing marketing (M2K) of "unhealthy" foods and beverages ("foods") (i.e., foods that exceed roughly 5-10% of the Daily Value (DV) for total sugars, sodium, or saturated fats) was proposed in Canada. The objective of this study was to examine the relationship between foods with on-pack M2K and excessive free sugars contents (≥ 10% calories from free sugars) and the potential for a 5% total sugars DV threshold to restrict M2K on these products. Cross-sectional analysis of the University of Toronto's Food Label Information Program (FLIP) 2013 database (n = 15,259, after exclusions). Odds ratios were used to determine the association between excess free sugars contents and presence of M2K, stratified by major food category. The proportion of products with excessive free sugars levels, or with M2K, that would be restricted from M2K if a 5% DV threshold for total sugars was implemented was also determined. 77.8% of foods with M2K had excess free sugars levels compared with 38.4% without M2K. M2K was more likely to be present on foods with excess free sugars levels in 8 of 14 food categories that contained products with M2K. A 5% DV threshold for total sugars would restrict M2K on 83% of foods with excess free sugars levels and on 75% of current foods that had M2K. Findings demonstrate that foods with M2K are less healthy, particularly in regard to free sugars levels. This highlights the importance of ensuring policies aimed at supporting healthy dietary habits among children carefully consider free sugars levels.

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

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.

Trends in the use of gluten-free claims on Canadian food labels between 2013–2017 and assessment of their nutritional quality

AbstractGluten-free claims (GFC) on food labels are becoming popular despite the fact that 1% and 6% of the population have celiac disorder or gluten sensitivity, respectively. A previous Canadian study found that GFC were displayed on 8% of food labels; however, certain food categories (e.g., snacks, meat products) were among the ones carrying most GFC. This study aimed to assess trends in the use of GFC on Canadian food labels in top food categories carrying GFC from 2013 to 2017 and to determine the nutritional quality between products with and without GFC.This study was a repeated cross-sectional analysis of the University of Toronto Food Label Information Program 2013–2017. GFC were identified by systematically reviewing the photographs of food labels (n = 9,179) in seven food categories previously identified as carrying larger proportions of GFC: 1) desserts; 2) desserts toppings and fillings; 3) meat products; 4) nuts and seeds; 5) sauces and dips; 6) snacks; and 7) soups. GFC were coded as present, if a gluten-free declaration or symbol was made on package, otherwise products were coded as claim absent. Proportions of products displaying GFC were calculated overall and by food category. Mean contents of saturated fat (g per 100g/ml), sodium (mg per 100g/ml) and sugar (g per 100g/ml) were calculated for products with and without GFC. Chi-square and Mann-Whitney-Wilcoxon tested differences in proportions and mean contents of those nutrients between years.Results showed that among these categories, GFC have significantly increased from 11% in 2013 to 23% in 2017 (p &lt; 0.001). At a category level, snacks had the greatest increase of GFC as their prevalence doubled (15% to 33%, p &lt; 0.001), followed by nuts and seeds (12% to 27%, p &lt; 0.001) and meat products (15% to 28%, p &lt; 0.001), respectively for 2013 and 2017. The proportion of GFC in dessert toppings and fillings remained constant (16% in 2013 and 14% in 2017, p = 0.74). When the nutritional composition was examined, results were mixed: in dessert toppings and filling, meat products and, nuts and seeds, products with GFC had higher contents of saturated fat, sodium and sugar in comparison to their counterpart without claims, whereas the opposite was true for foods within desserts, sauces and dips, snacks, and soups categories (p &lt; 0.001 for all nutrients, except for saturated fat in nuts and seeds). In conclusion, prevalence of GFC has doubled in the Canadian food supply; such claims are not indicative of better nutritional composition.

The impact of proposed nutrient criteria for the display of mandatory front-of-package ‘high-in’ symbols in the Canadian prepackaged foods supply

AbstractBackground: Front-of-package (FOP) nutrition labelling has become a core component of policy recommendations to address the growing burden of diet-related non-communicable disease globally. The CODEX Committee on Food Labelling is in the process of establishing standardized criteria for the definition of “high-in” for use with FOP labels highlighting excessive amounts of fats, sugars and sodium in foods. Recently, as part of Health Canada's Healthy Eating Strategy, regulations requiring the mandatory display of high-in FOP symbols have been published. The aim of this study was to investigate the extent to which these symbols would appear on foods and beverages in the Canadian prepackaged food supply, both overall and by food category.Methods: Foods and beverages in the University of Toronto's Food Label Information Program database 2013 (n = 15,277) were assessed for the prevalence of products that would have to display a symbol based on criteria published in the draft Canadian regulations. The criteria include thresholds based on the % Daily Value (DV) for each nutrient, above which, products would be required to display a FOP symbol for that nutrient. Exemptions are provided for fruits and vegetables without added sodium, sugars, or saturated fats, non-flavoured whole or partly skimmed milk, eggs, sweetening agents (i.e. sugar, honey, syrups and molasses) and table salt.Results: 61.7% (n = 10,251) of products would be required to display at least one symbol. Of these, 52.3% (n = 5,358) would have a sodium symbol, 41.9% (n = 4,295) a saturated fats symbol and 41.0% (n = 4,207) a sugars symbol. Overall, 37% of products would display a symbol for more than one nutrient. The highest concentration of symbols were found on processed meats (93.8%), soups (93.0%), desserts (87.2%), sugars and sweets (82.3%), dairy (76.9%) and bakery products (71.0%).Discussion: This is the first study to evaluate the impact of proposed regulations for the mandatory display of FOP symbols on Canadian prepackaged foods. Findings identify a high concentration of symbols in categories contributing meaningfully to dietary sodium, sugars, and saturated fats intakes, but also in categories for which consumption is discouraged in national dietary guidelines (e.g. processed meats, desserts). The findings presented here will inform ongoing discussions on how best to optimize criteria underpinning the display of FOP “high-in” labels.

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

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 &lt; 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.