Food Reformulation Research Articles

Reduction of sugar, salt and fat content in foods over the period 2016-2021 in Spain: the National Food Reformulation Plan.

Population´s dietary intake of saturated fat, sodium, and sugars is higher than the current recommendations in Spain and most European countries. Nationwide food reformulation strategies have the potential to improve nutritional quality; however, evaluations are only available in a few countries and are difficult to compare. This study shows the degree of compliance with the nutrient reduction objectives included in a 4-year (2016-2020) Spanish food reformulation initiative. In 2016, baseline median nutrient content was established for 57 food subcategories. Agreed reduction (%) expressed as the median content to be reached by 2020 was set as the objective. In 2021, Spanish Food Safety and Nutrition Agency (AESAN) collected mandatory nutritional information from 3118 products belonging to the food subcategories included in the PLAN. Median nutrient content was calculated and compared with baseline data established in 2016 and PLAN objectives. Median nutrient content reduction was observed in all food subcategories. Relative reductions (%) ranged from 0.6 to 60% for added sugars, 4.8 to 33.3% for salt, 4.5 to 78.3% for saturated fat, and 24.9 to 36% for total fat. PLAN objectives were achieved in all subcategories except for one. The number of products involved, belonging to the highly consumed food categories, shows the potential of national reformulation strategies to improve the nutritional quality of the diet. Compliance with nutrient reduction agreements was 99%; however, the variability of nutrient content within subcategories shows that there is room for further reduction in selected nutrients and food subcategories.

7.A. Workshop: How could sustainable public food policies add to curbing childhood obesity in EU? Best-ReMaP case

Abstract Childhood obesity is a global public health problem in Europe and worldwide, influenced mainly by the nutrition and physical in/activity behaviours which are impacted by the structural food environment in which the child and his/her caregivers make lifestyle decisions. Individual eating behaviour is a complex societal practice, influenced by structural factors of the obesogenic environment with several health risks. Overweight and its associated chronic diseases (NCDs) reduce life expectancy in OECD countries by 2.7 years on average and 8.4% of the health budget of OECD countries will be spent to treat the consequences of overweight over the next thirty years. Including direct and indirect effects, overweight and obesity reduces GDP by 3.3% on average in both OECD countries and EU28 Member States. Joint Action ‘Best-ReMaP - Healthy Food for a Healthy Future’ (www.bestremap.eu)of 24 participating EU Member states (MSs) aims to contribute to positive changes in food environment in EU, by contributing to the improvement the quality of the food offer in EU, while placing public health at the centre of food systems-related policies and practice. With an ultimate goal to support EU and national efforts to reduce the burden of NCDs, Best-ReMaP addresses the selected food policies from three interrelated angles, which could influence children's food choices: (1) food reformulation (how the composition of the processed foods can be better monitored and producers more motivated to reformulate for healthier food options at the European and national levels); (2) reduction of food marketing (how the traditional and digital food marketing and advertising activities could be better monitored and regulated), and (3) public food procurements - PFP (how public institutions could procure foods that's healthier, of higher quality and more sustainable). Different actions have been considered, allowing for the possible sustainable implementation of the three up-mentioned policies, such as: three policy frameworks, food system indicator for the EU Semester, EU level branded foods database, different networks (experts, high level), equity aspects (existing knowledge and research gaps). The workshop is aiming to: • Showcase the value of monitoring of concrete food policies, to enable the regular reporting on the progress and implementation obstacles and argued engagement with stakeholders. • Increase participants’ understanding and awareness of the challenges of the concrete sustainable implementation of actions of the Best-ReMaP food policies. The workshop will offer an opportunity to: • Present the sustainable outputs of the Best-ReMaP implementation approaches, outlining the attempts in harmonizing monitoring actions for food reformulation and marketing, and piloting the PFP tools. • Inform participants about the benefits of the sustainable EU frameworks for three policy actions, and other sustainability mechanisms, developed by the Best-ReMaP consortium. Key messages • New evidence on the sustainable implementation of the policy actions in Best-ReMaP food policies (reformulation, marketing, public food procurement) are presented. • Three frameworks for action for EU and MSs, and food system indicator for the European Semester are discussed.

Success story of food reformulation monitoring, building capacities from French good practice to implementation in 19 EU member states

Abstract Obesogenic environments stimulate the consumption of excess calories through HFSS foods. Therefore, activities aimed at reformulating foods into healthier alternatives are the first crucial step in improving the food supply for children. Harmonised EU monitoring of the reformulation actions was addressed as one of the key approaches in creating healthier options for children and their caregivers. Supported by the EU AP on childhood obesity 2014-2020, access to an improved and healthier food offer in supermarkets should be made easier. Currently, only a few European countries are monitoring processed food supply at the brand level, and this deprives European and national policy makers of an objective description of the situation to define and assess nutrition policies. JA Best-ReMaP, building on the JANPA and EUREMO outcomes, aimed to fill in the reformulation monitoring gap and to add to the improved access to high quality foods for the European citizens, especially for children. To do so, in 19 European countries, JA Best-ReMaP implemented a standardised European monitoring system for processed food reformulation. Such a tool, at a country level, enables to monitor food offerings and nutritional content of individual monitored processed foods, as well as to identify best formulation and room for reformulation of the food produced, sold, and consumed. Complex steps were taken in the project implementation, including the identification of the priority processed food groups for a European monitoring of the food supply, exploration of the new technologies and new sources of data capacities for nutrition data collection, development of the knowledge to conduct and analyse own data collection in the participating EU MSs, explorative development of an open European branded foods database, and first attempt of the European analysis of the trends of the nutritional quality of processed food and their impacts.

Rapid review of evidence to inform the Northern Ireland Obesity Prevention Strategy 2023-33

Abstract Background The Department of Health in Northern Ireland is leading on the development of a 10-year strategy on obesity prevention (2023-33). The Institute of Public Health conducted a rapid review to identify international policies relating to obesity prevention to populate a ‘policy options matrix’ and support obesity policy development. Methods A rapid review was conducted on nine policy measures. The search was conducted in May 2022 and included any systematic review published in the English language in the last ten years available on PubMed and had no conflicts of interest declared. Where no systematic review evidence was available the criteria were expanded to include any type of review level evidence. The search was conducted by two researchers who assessed returned articles in a two-stage screening process. Results 51 review articles (48 systematic reviews, two scoping and one narrative review) met all inclusion criteria. The articles were summarised into a policy options matrix under the headings; author/year, aim, country/countries, type of evidence, evidence quality, target population, results, equity impact and unintended consequences. The findings were summarised and categorised as follows: food labelling, food packaging, food reformulation, taxation/subsidies, advertising, marketing and sponsorship, food and physical activity environment, and target population policy measures including socially disadvantaged groups and indigenous groups. Conclusions The majority of review articles reported low to moderate evidence quality. The most consistent evidence was for policies that aimed to make healthier options the most accessible, cheapest, and appealing and in policies which reduced access to and/or increased the prices of food and drinks high in fat, salt or sugar. Key messages • The most effective policies are those improve the food and physical activity environment in which people are born, live, and learn. • Evidence also supports policies which target specific population groups.

Piloting a branded food database for reformulation monitoring in Ireland

Abstract Branded food databases (BFDs) are used to monitor changes in nutrition composition as a result of reformulation and innovation of pre-packed foods. There is no established BFD with market wide coverage of pre-packed foods within and across food categories in Ireland. To address this gap, we aimed to pilot a BFD for reformulation monitoring in Ireland. In 2020, a review of existing BFDs was complete and the Nutrition Composition and Labelling Information System (CLAS) developed by the Nutrition Institute in Ljubljana, Slovenia was identified and a partnership established. The CLAS tool and data collection methodology were translated, tested and adopted for use. CLAS-IRE was deployed to collect nutrition composition of seven food categories in December 2021-February 2022. The mean (SD) nutrition composition per food category (100g) was calculated using IBM SPSS V27 and sugar is presented here as an example. The review identified BFDs using different methods to collect nutrition composition of foods e.g. in-store, web-scraping and crowd-sourcing. A tool for instore collection was selected as 40% (n = 2) of Irish grocery retailers had online stores in 2020. CLAS-IRE was used to collect n = 2256 food products (biscuits n = 181, breakfast cereal n = 188, yogurt n = 297, carbonated sugar-sweetened beverages n = 132, confectionary n = 980, cakes n = 180 and savoury snacks n = 298). The average sugar content per food category was: biscuits 31.7g (9.4), breakfast cereals 15.8g (8.9), yogurt 9g (4), carbonated sugar-sweetened beverages 6.8 (3.6), confectionary 51.58g (10.7), cakes 33.5g (13.8) and savoury snacks 4.9g (9.3). Taking a partnership approach to piloting a branded food database for reformulation monitoring in Ireland allowed for a fast and cost-effective solution. This approach will enable cross country comparative analysis of nutrition composition of food products sold in both countries. The CLAS - IRE tool is established and available for nutrition research in Ireland. Key messages • Pre-packed foods are widely available in Ireland. The CLAS – IRE tool is established and available for nutrition research on pre-packed foods. • A branded food database can support the implementation, monitoring and evaluation of nutrition related policies and strategies in Ireland, including food reformulation.

Development of a food frequency questionnaire to monitor protein intake in Flanders, Belgium

Abstract Background To improve planetary and dietary health, the Flemish government adopted the ‘Green Deal Protein Shift on our plate’ policy which aims to reverse the ratio between animal-based and plant-based protein-rich products in our diet to 40/60 by 2030. The Green Deal provides a platform for actions that unites players from across the food system. To guide the development of actions and assess their effectiveness it is crucial to closely monitor the protein consumption of the population. Methods We developed a semi-quantitative Food Frequency Questionnaire (FFQ) to be self-completed annually (2023-2030) by a representative sample of 1000 adults (18-65 years). The food list of the FFQ was developed using a stepwise approach based on the Belgian food consumption survey 2014, selecting the 90% most contributing foods to protein intake. New foods retrieved from a market research and expected innovations were added. Similar foods were combined into survey items, and portion size questions added. Protein intake was estimated using the weighted mean protein intake of the 90% most consumed foods represented in each item. A content validation study was performed to assess question comprehension, food identification and quantification. Results will allow to estimate average protein intake and evolution of protein sources over time. Results The FFQ includes 60 food items. The average completion time was 16 minutes. The content validation let to re-ordering of food items and reformulation of portion descriptions. Conclusions The newly developed FFQ will strengthen the Flemish public health surveillance system: monitoring protein intake and the ratio of animal-based versus plant-based and alternative protein will allow to guide actions and track progress towards policy objectives of the ‘Green Deal Protein Shift on our plate'. Key messages • This study highlights the role of public health surveillance systems in monitoring new policy actions and progress towards policy objectives. • This study highlights the development of rapid screening tools using a database approach and market research data.

5.A. Workshop: Reducing and monitoring sugar, fat, and salt in packaged food: Germany and the European context

Abstract Today, packaged food constitutes more than 50 % of the food supply in most European households. Many of those products are high in energy, sugar, fat, and salt, and consuming them is positively associated with overweight and obesity. Measures such as taxation and reformulation of packaged food high in sugar, fat, or salt are considered effective means to improve food environments and facilitate healthier food choices for individuals. However, the measures as well as their implementation and evaluation vary across Europe. The aim of this workshop is to give an overview of the different actions taken to stimulate the reformulation of food and beverages. Furthermore, we will present the German monitoring of packaged food, including selected findings, as one example to guide such reformulation initiatives. In the first part of our workshop we summarize existing measures in Europe to facilitate health-promoting food choices, focusing on reformulation measures and related monitoring approaches: Presentation 1 will give a systematic overview of measures to reduce sugar, fat, and salt content of food and beverages in selected European countries (Abstract 1). With presentation 2, we will give methodological insights into the German monitoring of the energy and nutrient content in packaged food (Abstract 2). Presentation 3 will focus on the latest results of the German product monitoring, with an emphasis on sugar reduction in soft drinks, yoghurts, and breakfast cereals. Furthermore, we will compare our results to those of other European countries and highlight methodical differences (Abstract 3). In the second half of the workshop, we aim to discuss our findings with the participants. Participants are encouraged to contribute further examples and experiences from their countries, which then will be discussed and documented. Opening questions and polls will be used to stimulate active involvement. Our workshop aims to contribute to better reporting of existing measures and reformulation monitoring methods in Europe, as information is often limited and only available in respective national languages. Moreover, we hope to create a community of practice to continue exchange on the effectiveness of the respective measures and good practice models across Europe. Key messages • The workshop gives an overview of different measures to reduce sugar, fat, and salt content in packaged food in Europe, incl. related monitoring. • The workshop provides a platform to exchange experiences in packaged food monitoring and stimulate scientific exchange and transparency within this area.

Sugar content of soft drinks, breakfast cereals, and yogurt: Results from the German product monitoring in the European context

Abstract Introduction The German food reformulation initiative is guided by an annual monitoring of selected groups of packaged food. One selection criterion is a high contribution to sugar intake, as is the case for soft drinks, breakfast cereals, and yogurt. For these groups, the respective industry associations have self-committed to reduce sugar content by 15-20 % by 2025, largely focusing on products targeted at children (PTAC). Methods Labelled sugar content of soft drinks, breakfast cereals, and yogurt on the German market was assessed at group and subgroup level in 2016/2018, 2019, and 2022. Data were presented as mean, median, quartiles, and range. PTAC were analysed in separate subgroups. Welch's ANOVA with post-hoc test was used to examine significant changes over time. The results were compared to those of other European countries. Results In 2022, the monitoring included 2.579 soft drinks, 1.499 breakfast cereals, and 975 yogurts, with the share of PTAC ranging from 15 % in breakfast cereals to 5 % in soft drinks and yogurt. For soft drinks overall, median sugar content was 6.5 g/100 ml. At subgroup level, soft drinks showed significant sugar reductions as well as increases. For breakfast cereals, median sugar content was 15.1 g/100 g, with a 20.3 % drop from baseline and the highest reduction seen in PTAC (-38.4 %). For yogurt, median sugar content was 12.1 g/100 g, with a reduction of 12.7 % for the overall group and 20.2 % for PTAC. Compared to data of Portugal, Belgium, and UK, sugar reductions were in a similar range or higher for breakfast cereals and yogurt but lower for soft drinks. Conclusions The monitoring shows significant sugar reductions for soft drinks, breakfast cereals, and yogurt. Judged against the WHO Europe nutrient profile model, however, further reduction efforts appear desirable for public health. Observed results were in a range similar to other European countries, but more harmonized monitoring methods would aid better comparability.

JAPreventNCD

Abstract The EU has approved a proposal for a Joint Action on Cancer and other NCDs prevention - action on health determinants. This is a large and ambitious initiative with more than 20 participating EU member states along with Iceland, Norway, and Ukraine. The aim of the Joint Action is to support strategies and policies designed to reduce the burden of cancer and other non-communicable diseases (NCDs). Cancer and other NCDs constitute a large proportion of the total burden of disease in Europe, and a large part of this disease burden can be prevented. The objectives of this Joint Actions are: • To improve joint capacities of Member states to plan and implement cancer and other NCD prevention policies and activities both at a national, regional, and local level. • To improve data and the monitoring system for cancer and other NCDs and their common risk factors. • To contribute to reduced social inequalities in cancer and other NCDs. • Engage with and support key actors in the field of cancer and NCD prevention, including decision makers at all levels of government, civil society organizations, professionals, the general population, and patients’ groups to facilitate cooperation and joint efforts. As part of the JA Best-ReMaP, we have seen important development regarding tools and methodology related to policies that can influence the food consumed by children. This includes policies related to food reformulation, reduction of food marketing, and public food procurements. While the new JA-PreventNCD will cover NCD prevention more broadly through the various life stages, specific tasks are being planned for that will allow us to build on and expand the valuable work performed as part of the JA Best-ReMaP.

Changes in the Sodium Content in Branded Foods in the Slovenian Food Supply (2011-2020).

High sodium intake is the leading diet-related risk factor for mortality globally. Many countries have introduced policies to support the reformulation of foods and to reduce sodium intake, mainly on a voluntary basis, but there are limited data available about the long-term efficiency of such measures. Slovenia implemented salt reduction policies for the period of 2010-2020; these policies also included the voluntary reformulation of foods with the lowering of sodium content. This study's aim was to explore the nationally representative branded food datasets collected in the years 2011, 2015, 2017, and 2020 to investigate the changes in the sodium content in prepacked branded foods. The study was conducted with datasets collected from food labels using standard food monitoring studies and included all the major retailers. Differences in market shares were adjusted by sales weighting, which was conducted using the yearly sales data provided by the major retailers. The food categories with a major contribution to the overall sales of sodium in prepacked branded foods were processed meat and derivatives (19.0%), canned vegetables (7.1%), water (6.7%), bread (7.2%), and cheese (6.3%). Considering the available food products, a notable decreasing sodium content trend was observed in biscuits, breakfast cereals, pizza, and spreads. Year-to-year differences were much less expressed after the correction for market share differences, and neutral trends were most frequently highlighted. This indicates that sodium was less frequently reduced in market-leading products. The study results revealed that very limited progress in sodium food reformulation was achieved in the 10-year period, indicating the need for more efficient policy approaches. The study demonstrated the importance of the systematic monitoring of the food supply for the evaluation of food policies.

The effectiveness of food system policies to improve nutrition, nutrition-related inequalities and environmental sustainability: a scoping review

AbstractA global transformation of food systems is needed, given their impact on the three interconnected pandemics of undernutrition, obesity and climate change. A scoping review was conducted to synthesise the effectiveness of food system policies/interventions to improve nutrition, nutrition inequalities and environmental sustainability, and to identify double- or triple-duty potentials (their effectiveness tackling simultaneously two or all of these outcomes). When available, their effects on nutritional vulnerabilities and women’s empowerment were described. The policies/interventions studied were derived from a compilation of international recommendations. The literature search was conducted according to the PRISMA extension for scoping reviews. A total of 196 reviews were included in the analysis. The triple-duty interventions identified were sustainable agriculture practices and school food programmes. Labelling, reformulation, in-store nudging interventions and fiscal measures showed double-duty potential across outcomes. Labelling also incentivises food reformulation by the industry. Some interventions (i.e., school food programmes, reformulation, fiscal measures) reduce socio-economic differences in diets, whereas labelling may be more effective among women and higher socio-economic groups. A trade-off identified was that healthy food provision interventions may increase food waste. Overall, multi-component interventions were found to be the most effective to improve nutrition and inequalities. Policies combining nutrition and environmental sustainability objectives are few and mainly of the information type (i.e., labelling). Little evidence is available on the policies/interventions’ effect on environmental sustainability and women’s empowerment. Current research fails to provide good-quality evidence on food systems policies/interventions, in particular in the food supply chains domain. Research to fill this knowledge gap is needed.

Consumer trust in organic food producers and its influence on consumers’ attitudes toward food reformulation and its sensory consequences

In Europe, high targets of 25 % are set for the expansion of organic agriculture farmland by 2030. As organic food is a credence good, consumer trust is of particular importance. In this research, it is examined to what extent consumers differ in their trust in organic food producers and whether consumers have different attitudes toward reformulation measures in Germany. The sample consists of 1038 participants. Confirmatory factor analysis in combination with latent profile analysis was used to analyze the data. The results show that three segments exist. The first segment (9.15 %) does not trust, the second segment (63.87 %) shows neither trust nor distrust, while the third segment (26.97 %) shows a high level of trust toward organic food producers. The findings about the different levels of trustworthiness among the different consumer profiles can be used by food producers to design communication strategies specifically targeted at each segment.

Nutritional Value of Meals Designed for a School-Based Food Aid Program and Comparison with Similar Commercial Products: An Example of Good Practice from the DIATROFI Program.

Providing meals of high nutritional value should be the principal objective of large-scale school-based food aid programs. This study aimed at highlighting the nutritional value of meals distributed in the school-based food assistance DIATROFI Program by comparing them to their commercially available counterparts. For the purpose of this study, n = 13 DIATROFI meals and n = 50 commercial products from the 2016-2017 school year, and n = 12 DIATROFI meals and n = 40 commercial products from the 2022-2023 school year were selected. The protein, carbohydrate, total sugar, dietary fiber, total fat, sodium/salt content, and fatty acid methyl ester profile of DIATROFI meals were estimated through recipe simulation and national/international food databases, and verified through laboratory analyses while the relevant information was extracted from the label for commercial products. As verified by laboratory analyses and in comparison with food labels, most DIATROFI meals had lower total fat, saturated fatty acid, and sugar content, and most had higher dietary fiber content during both years. Many recipes' nutrient profiles also improved over time. DIATROFI meals present significant advantages over available commercial products. Such tailored-made school meals can prove to be advantageous in terms of nutrition profile compared to commercially available, which have yet to be impacted by food reformulation.

Tackling (Childhood) Obesity through a Voluntary Food Reformulation Policy: A Repeated Cross-Sectional Study Investigating Nutritional Changes in the Out-of-Home Sector.

The Childhood Obesity Plan aimed to reduce sugar and energy in foods through a voluntary sugar-reduction programme. Our primary objective was to determine whether this implementation strategy had been successful, focusing on the out-of-home sector. We used a repeated cross-sectional design to evaluate nutritional changes in desserts served by leading chain restaurants. We extracted nutrition information from online menus in autumn/winter 2020, for comparison with baseline (2017) and interim (2018) values extracted from third-party datasets. We assessed compliance with the 20% sugar-reduction target and category-specific energy targets by product category and for pooled desserts. Overall, sugar/portion and energy/portion decreased by 11% and 4%, respectively. Policy targets were achieved in one of five categories (ice-cream: -38% sugar, p < 0.001; -30% energy, p < 0.001). Secondary outcomes were analysed for subgroups with the necessary data. Few chains significantly reduced sugar and/or energy across their dessert range. Energy/portion was positively associated with portion weight and sugar/portion but not with sugar/100 g. More than half of adults' desserts contained excessive sugar and/or saturated fat compared with dietary guidelines. Children's desserts less frequently exceeded guidelines. These results demonstrate that voluntary measures can drive substantial change when technical, commercial, and operational barriers can be overcome.

Preparation, nutritional and glycemic properties of multigrain instant “adai” mix

Abstract Background and Objectives: “Adai” is a traditional South Indian breakfast prepared using the wet ground batter of white rice and pulses. Convenience foods are gaining popularity and owing to the increasing prevalence of noncommunicable diseases such as diabetes, there is a need for food products with lower glycemic index (GI). The current study aimed to develop an instant adai mix using brown rice, millets, pulses, and spices. Materials and Methods: The instant adai mix was prepared by blending pulverized brown rice, sorghum, and pulses (green gram, horse gram, decorticated and split red gram, black gram, and chickpea) along with roasted cumin, red chilies, and salt. The nutritional composition of the instant adai mix was analyzed, and GI of “adai” was evaluated in healthy human volunteers using International organization for standardization protocol. Results: The instant adai mix was rich in whole grains (48%) and pulses (45%). Nutritional profiling of the instant adai mix revealed that it is rich in protein and dietary fiber. One hundred grams of instant adai mix fulfill 27.8% of protein and 29.6% of dietary fiber requirements of recommended dietary allowance of adult male. Likewise, 100 g of instant adai mix fulfill 34.9% of protein requirements of the estimated average requirement of an adult male. The “adai” prepared from the instant mix exhibited medium GI (65.1). Conclusion: The instant “adai” mix was found to be nutritionally superior, and the adai prepared from the mix showed a medium GI. It can be a healthy option compared with instant mixes containing refined grains such as white rice. More formulation trials are needed to prepare an adai mix to achieve a low GI. Reformulation of traditional foods with nutritious ingredients and achieving a lower GI can expand the healthier food choices for this vulnerable population who are at risk for type 2 diabetes.

Effective and Scalable Interventions to Reduce Sodium Intake: a Systematic Review and Meta-Analysis.

High-sodium intake is a main risk factor for increased blood pressure and cardiovascular disease, the leading cause of death worldwide. Reducing sodium intake at the population level is one of the most cost-effective strategies to address this. The aim of the present systematic review and meta-analysis are to examine data from recent studies that measure the effectiveness and scalability of interventions aimed at reducing sodium intake at both the population and individual level. Worldwide, sodium intake is higher than the World Health Organization recommendations. Structural interventions such as mandatory reformulation of foods, food labeling, taxes or subsidies, and communication campaigns have shown to be the most effective in reducing the population's sodium consumption. Interventions in education, particularly those that use a social marketing framework with short duration, food reformulation, and combined strategies, have the potential to decrease sodium intake.

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.

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.

Dietitians as change agents for promoting healthy and sustainable food systems

Dietitians as change agents for promoting healthy and sustainable food systems

Global nutritional challenges of reformulated food: A review.

Food reformulation, the process of redesigning processed food products to make them healthier, is considered a crucial step in the fight against noncommunicable diseases. The reasons for reformulating food vary, with a common focus on reducing the levels of harmful substances, such as fats, sugars, and salts. Although this topic is broad, this review aims to shed light on the current challenges faced in the reformulation of food and to explore different approaches that can be taken to overcome these challenges. The review highlights the perception of consumer risk, the reasons for reformulating food, and the challenges involved. The review also emphasizes the importance of fortifying artisanal food processing and modifying microbial fermentation in order to meet the nutrient requirements of people in developing countries. The literature suggests that while the traditional reductionist approach remains relevant and yields quicker results, the food matrix approach, which involves engineering food microstructure, is a more complex process that may take longer to implement in developing economies. The findings of the review indicate that food reformulation policies are more likely to succeed if the private sector collaborates with or responds to the government regulatory process, and further research is conducted to establish newly developed reformulation concepts from different countries. In conclusion, food reformulation holds great promise in reducing the burden of noncommunicable diseases and improving the health of people around the world.