Do Nutrient-Based Front-of-Pack Labelling Schemes Support or Undermine Food-Based Dietary Guideline Recommendations? Lessons from the Australian Health Star Rating System
Abstract
:1. Introduction
People eat whole foods rather than single nutrients … For this reason, these Guidelines make recommendations based only on whole foods … rather than recommendations related to specific food components and individual nutrients.[6] (p. 3)
There is limited capacity for including energy-dense discretionary foods in nutritious dietary patterns within the energy requirements of many Australians.[6] (p. 67)
When asked how effective the implementation of the HSR system has been in meeting the overall objectives, 12% of respondents indicated that the HSR is satisfactory or very effective, with the majority (73%) nominating unsatisfactory or ineffective.[19] (p. 7)
2. Materials and Methods
2.1. Data Collection
2.2. Data Analysis
- (i)
- Five food group foods (2.5–5 stars). The authors’ rationale for setting a minimum 2.5 stars (a ‘pass’ rating) for all FFG foods is that the ADG review process obtained epidemiological evidence that these foods were associated with healthy dietary patterns as reflected in the ADG advice to “enjoy a wide variety of nutritious Five Food Group foods” [6].
- (ii)
- Discretionary foods: ‘compromise target’ (0.5–2 stars). The authors’ rationale for setting a maximum 2 stars (a ‘fail’ rating) for all discretionary foods is that the ADG review process obtained epidemiological evidence that these foods were associated with unhealthy dietary patterns as reflected in the ADG advice to “limit intake of non-nutritious ‘discretionary’ foods” [6].In addition, this maximum level is clearly below the minimum level of the range set for FFG foods to avoid any rating overlap that otherwise would obscure the necessary rating demarcation between the two categories.
2.3. Statistical Analysis
3. Results
3.1. Five Food Group Category Anomalies
- (i)
- Anomaly 1: Five food group foods displaying less than 2.5 starsAn example of a FFG food displaying less than 2.5 stars is a smooth ricotta cheese displaying 1.5 stars [26].
- (ii)
- Anomaly 2: Minimally processed, whole five food group foods displaying relatively modest HSRs and therefore inconsistent with the intent of ADG qualified adviceAn example of a minimally processed, whole FFG food displaying a relatively modest HSR (3 stars) is a raw, unsalted nuts product [27]. The ADG document advises that its recommendations are based on “whole foods”, and its Appendix G refers to concerns about the increasing consumption of processed foods [6]. Moreover, despite one intention of the HSR scheme being to create an incentive for foods to reformulate their composition in accordance with the ADGs, it is not physically possible for these foods to be reformulated and gain a higher score to display a higher number of stars.
- (iii)
- Anomaly 3: Five food group foods displaying HSRs inconsistent with the intent of ADG qualified advice about its relative desirability, serve size and/or frequency of consumptionAn example of a FFG food displaying an HSR inconsistent with the intent of ADG qualified advice about its relative desirability, serve size and/or frequency of consumption is an apple juice displaying 5 stars [28]. The ADGs classify fruit juice as a FFG food [6] however the classification is accompanied by the qualification that “whole fruit is preferable to juice” and a 125 mL serve of fruit juice should be consumed “only occasionally”.
3.2. Discretionary Food Category Anomalies
- (i)
- Anomaly 1: Discretionary foods displaying greater than 2 stars despite containing a significant amount of added sugarAn example of a discretionary food displaying greater than 2 stars despite containing a significant amount of added sugar is a flavoured ice confection displaying 3 stars [29]. The ingredient list for the food product on which this relatively high HSR is being displayed indicates that added sugar contributes approximately 99% of the product’s energy content.
- (ii)
- Anomaly 2: Discretionary foods displaying greater than 2 stars and containing substantial amounts of added nutrients/ingredients that increases ‘positive’ nutrient scoringAn example of a discretionary food displaying and containing substantial amounts of added nutrients/ingredients that increases ‘positive’ nutrient scoring is a protein bar displaying 4 stars [30]. This product’s ingredient list indicates that it contains significant amounts of added whey protein isolate, milk protein concentrate, hydrolysed collagen and oligofructose. The HSR scheme’s algorithm calculates a significant number of positive points for the presence of these added protein and fibre ingredients, resulting in this discretionary food being eligible to display a relatively high HSR.
- (iii)
- Anomaly 3: Discretionary foods displaying greater than 2 stars despite containing few nutrientsAn example of a discretionary food displaying greater than 2 stars despite its ingredient list indicating it contains few nutrients is a recipe base displaying 4 stars [31].
4. Discussion
The food matrix may exhibit a different relation with health indicators compared to single nutrients studied in isolation. … the nutritional values of dairy products should not be considered on the basis of the biofunctionality of the nutrients within dairy structures.[40] (p. 1033)
4.1. Outcomes
We’ve also got running a collaborative called the healthy food partnership, we are driving that with the health star ratings.[48]
4.2. Strengths and Limitations
4.3. Strengthening the Alignment of the Health Star Rating System with the Australian Dietary Guidelines
- All minimally processed, whole FFG foods to be eligible to display five health stars
- Definitions for nutrients and ingredients which positively contribute to HSR scores need to exclude the addition of ingredients with negligible health benefit. For example, preventing the inclusion of soy isolate for protein points and preventing fruit juice concentrates being added to discretionary foods to garner extra HSRs.
- Increase penalties for ‘added’ sugar and remove penalties for naturally occurring sugar (lactose, fructose) present in FFG foods. One study has reported that reforming the HSR algorithm to include added sugar will improve discrimination between FFG and discretionary foods, though the criteria for classifying FFG and discretionary foods was not explained [35].
- Amend the HSR Style Guide to close the ‘as prepared’ loop hole so that the HSR is calculated on the food ‘as sold’ and not on a manufacturer’s claim about how it might be prepared with other foods and/or ingredients.
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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ADG Food Group | n (%) | HSR Median | Min, Max | IQR | n HSR ≤ 2 | n HSR ≥ 2.5 |
---|---|---|---|---|---|---|
FFG Foods | 726 (57.2) | 4 | 0.5, 5 | 1 | 25 (3.4% *) | 701 (96.6% *) |
Grains | 195 (27) * | 4 | 1.5, 5 | 1.0 | 6 | 189 |
Fruit | 113 (15.6) * | 4.5 | 1.5, 5 | 1.0 | 1 | 112 |
Vegetables | 100 (13.8) * | 4.5 | 3, 5 | 1.3 | 0 | 100 |
Meat/legumes/nuts/seeds/eggs | 150 (20.7) * | 4 | 1.5, 5 | 1.0 | 10 | 140 |
Dairy/alternatives | 48 (6.6) * | 4 | 0.5, 5 | 1.5 | 6 | 42 |
Mixed meals | 120 (16.5) * | 3.5 | 2, 5 | 0 | 2 | 118 |
Discretionary Foods | 524 (41.3) | 2.5 † | 0.5, 5 | 2.1 | 227 (43.3% *) | 297 (56.7% *) |
Snacks | 143 (27.3) * | 4 | 1, 5 | 1.0 | 28 | 115 |
Bakery | 107 (20.3) * | 1.5 | 0.5, 4 | 2.0 | 76 | 31 |
Other Foods | 19 (1.5) | 4.5 | 3, 5 | 1.0 | 0 (0%) | 19 (100%) |
Culinary | 8 (0.6) | 4 | 3, 4 | 1 | 0 | 8 |
Formulated Supplementary Foods | 6 (0.5) | 4.5 | 4.5, 5 | 0.1 | 0 | 6 |
Water | 5 (0.4) | 5 | 5, 5 | - | 0 | 5 |
Total Sample | 1269 | 3.5 | 0.5, 5 | 1.5 | 277 | 992 |
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Lawrence, M.A.; Dickie, S.; Woods, J.L. Do Nutrient-Based Front-of-Pack Labelling Schemes Support or Undermine Food-Based Dietary Guideline Recommendations? Lessons from the Australian Health Star Rating System. Nutrients 2018, 10, 32. https://doi.org/10.3390/nu10010032
Lawrence MA, Dickie S, Woods JL. Do Nutrient-Based Front-of-Pack Labelling Schemes Support or Undermine Food-Based Dietary Guideline Recommendations? Lessons from the Australian Health Star Rating System. Nutrients. 2018; 10(1):32. https://doi.org/10.3390/nu10010032
Chicago/Turabian StyleLawrence, Mark A., Sarah Dickie, and Julie L. Woods. 2018. "Do Nutrient-Based Front-of-Pack Labelling Schemes Support or Undermine Food-Based Dietary Guideline Recommendations? Lessons from the Australian Health Star Rating System" Nutrients 10, no. 1: 32. https://doi.org/10.3390/nu10010032
APA StyleLawrence, M. A., Dickie, S., & Woods, J. L. (2018). Do Nutrient-Based Front-of-Pack Labelling Schemes Support or Undermine Food-Based Dietary Guideline Recommendations? Lessons from the Australian Health Star Rating System. Nutrients, 10(1), 32. https://doi.org/10.3390/nu10010032