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Letter published on 9 June 2018, see Nutrients 2018, 10(6), 746.
Open AccessArticle

Defining ‘Unhealthy’: A Systematic Analysis of Alignment between the Australian Dietary Guidelines and the Health Star Rating System

by Alexandra Jones 1,2,*, Karin Rådholm 1,3 and Bruce Neal 1,2,4
1
The George Institute for Global Health, Sydney 2042, Australia
2
Charles Perkins Centre, University of Sydney, Sydney 2006, Australia
3
Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Department of Local Care West, County Council of Östergötland, Linköping University, 581 83 Linköping, Sweden
4
Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
*
Author to whom correspondence should be addressed.
Nutrients 2018, 10(4), 501; https://doi.org/10.3390/nu10040501
Received: 20 March 2018 / Revised: 11 April 2018 / Accepted: 13 April 2018 / Published: 18 April 2018
The Australian Dietary Guidelines (ADGs) and Health Star Rating (HSR) front-of-pack labelling system are two national interventions to promote healthier diets. Our aim was to assess the degree of alignment between the two policies. Methods: Nutrition information was extracted for 65,660 packaged foods available in The George Institute’s Australian FoodSwitch database. Products were classified ‘core’ or ‘discretionary’ based on the ADGs, and a HSR generated irrespective of whether currently displayed on pack. Apparent outliers were identified as those products classified ‘core’ that received HSR ≤ 2.0; and those classified ‘discretionary’ that received HSR ≥ 3.5. Nutrient cut-offs were applied to determine whether apparent outliers were ‘high in’ salt, total sugar or saturated fat, and outlier status thereby attributed to a failure of the ADGs or HSR algorithm. Results: 47,116 products (23,460 core; 23,656 discretionary) were included. Median (Q1, Q3) HSRs were 4.0 (3.0 to 4.5) for core and 2.0 (1.0 to 3.0) for discretionary products. Overall alignment was good: 86.6% of products received a HSR aligned with their ADG classification. Among 6324 products identified as apparent outliers, 5246 (83.0%) were ultimately determined to be ADG failures, largely caused by challenges in defining foods as ‘core’ or ‘discretionary’. In total, 1078 (17.0%) were determined to be true failures of the HSR algorithm. Conclusion: The scope of genuine misalignment between the ADGs and HSR algorithm is very small. We provide evidence-informed recommendations for strengthening both policies to more effectively guide Australians towards healthier choices. View Full-Text
Keywords: nutrient profiling; front-of-pack labelling; dietary guidelines; nutrition policy; health star rating nutrient profiling; front-of-pack labelling; dietary guidelines; nutrition policy; health star rating
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Jones, A.; Rådholm, K.; Neal, B. Defining ‘Unhealthy’: A Systematic Analysis of Alignment between the Australian Dietary Guidelines and the Health Star Rating System. Nutrients 2018, 10, 501.

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