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Nutrients 2017, 9(7), 701; doi:10.3390/nu9070701

Incorporating Added Sugar Improves the Performance of the Health Star Rating Front-of-Pack Labelling System in Australia

1
The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, UK
2
Carolina Population Center, The University of North Carolina, Chapel Hill, NC 27516, USA
3
The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia
4
The Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
5
National Institute for Health Innovation, University of Auckland, Auckland 1072, New Zealand
6
School of Public Health, Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia
7
Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21218, USA
*
Author to whom correspondence should be addressed.
Received: 31 May 2017 / Revised: 20 June 2017 / Accepted: 30 June 2017 / Published: 5 July 2017
(This article belongs to the Special Issue Consumption of Sugar and Impact on Overweight)
View Full-Text   |   Download PDF [946 KB, uploaded 5 July 2017]   |  

Abstract

Background: The Health Star Rating (HSR) is an interpretive front-of-pack labelling system that rates the overall nutritional profile of packaged foods. The algorithm underpinning the HSR includes total sugar content as one of the components. This has been criticised because intrinsic sugars naturally present in dairy, fruits, and vegetables are treated the same as sugars added during food processing. We assessed whether the HSR could better discriminate between core and discretionary foods by including added sugar in the underlying algorithm. Methods: Nutrition information was extracted for 34,135 packaged foods available in The George Institute’s Australian FoodSwitch database. Added sugar levels were imputed from food composition databases. Products were classified as ‘core’ or ‘discretionary’ based on the Australian Dietary Guidelines. The ability of each of the nutrients included in the HSR algorithm, as well as added sugar, to discriminate between core and discretionary foods was estimated using the area under the curve (AUC). Results: 15,965 core and 18,350 discretionary foods were included. Of these, 8230 (52%) core foods and 15,947 (87%) discretionary foods contained added sugar. Median (Q1, Q3) HSRs were 4.0 (3.0, 4.5) for core foods and 2.0 (1.0, 3.0) for discretionary foods. Median added sugar contents (g/100 g) were 3.3 (1.5, 5.5) for core foods and 14.6 (1.8, 37.2) for discretionary foods. Of all the nutrients used in the current HSR algorithm, total sugar had the greatest individual capacity to discriminate between core and discretionary foods; AUC 0.692 (0.686; 0.697). Added sugar alone achieved an AUC of 0.777 (0.772; 0.782). A model with all nutrients in the current HSR algorithm had an AUC of 0.817 (0.812; 0.821), which increased to 0.871 (0.867; 0.874) with inclusion of added sugar. Conclusion: The HSR nutrients discriminate well between core and discretionary packaged foods. However, discrimination was improved when added sugar was also included. These data argue for inclusion of added sugar in an updated HSR algorithm and declaration of added sugar as part of mandatory nutrient declarations. View Full-Text
Keywords: food policy; front-of-pack labelling; Health Star Rating; nutrition labels; public health food policy; front-of-pack labelling; Health Star Rating; nutrition labels; public health
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MDPI and ACS Style

Peters, S.A.E.; Dunford, E.; Jones, A.; Ni Mhurchu, C.; Crino, M.; Taylor, F.; Woodward, M.; Neal, B. Incorporating Added Sugar Improves the Performance of the Health Star Rating Front-of-Pack Labelling System in Australia. Nutrients 2017, 9, 701.

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