Choices Model forChoices Model for makinggy y healthy ...€¦ · Its all about chronic diseases of lifestyle (CDLs) •The disease profile of the world is changing rapidly, especially

Choices Model forChoices Model forChoices Model for making healthy dietary Choices Model for making healthy dietary g y ychoices

g y ychoices

Dr Nelia Steyn RD (SA) MPH PhDDr Nelia Steyn RD (SA) MPH PhDDr Nelia Steyn RD (SA), MPH, PhDChief Research Specialist

Dr Nelia Steyn RD (SA), MPH, PhDChief Research Specialist

Overview of the presentationOverview of the presentationOverview of the presentationOverview of the presentation

• Introduction of my organization• Introduction of my organization• Brief description of chronic diseases

(NCD ) d it d t i t l b ll(NCDs) and its determinants globally• Information on the Choices Model• Success stories (validation)• Can it work in China?Can it work in China?

Mission statementMission statementMission statementMission statementThe HSRC is a non-partisan, public-purpose organisation that

t i tifi k l d th h it h d l ti lgenerates scientific knowledge through its research and analytical work in the social and human sciences.

It undertakes and promotes research that is often large-scale, multi-year, and collaborative in nature. It produces high-quality scientific evidence to inform further analysis, debate, advocacy and decision-making by role players in government, the media,

d i d it b d iacademia, and community-based groupings.

Through its work the HSRC aims to inform policy development and good practice, thereby making a difference to the lives of people in South Africa and in the mother continent.

What we doWhat we do

>200 research projects, most touch peoplep j , p p

• Reduce poverty, grow economy and create jobs

• Improve quality of education

A l t i d li• Accelerate service delivery

• Reduce crimeReduce crime

• Develop youth

• HIV/AIDS control

• Understand our system of innovation

Africa-FocusAfrica-Focus

Its all about chronic diseases of Its all about chronic diseases of lifestyle (CDLs)lifestyle (CDLs)

•The disease profile of the world is changing rapidly, especiallyThe disease profile of the world is changing rapidly, especiallyin low and middle income countries.

% f C•In 2005, 60% of deaths in the world were attributable to CDL.The thirty-five million deaths from CDL in 2005 were double thenumber of deaths for all infectious diseases (HIV/AIDS,tuberculosis, malaria), maternal and perinatal conditions, andnutritional deficiencies combined.

•Approximately four out of five CDL deaths occurred in low andmiddle-income countries, with heart disease, stroke, cancer,chronic respiratory diseases and diabetes being the main oneschronic respiratory diseases and diabetes being the main ones•(WHO 2005)

• “Cancer diabetes and heart diseases• Cancer, diabetes and heart diseases are no longer the diseases of the wealthy Today they hamper the peoplewealthy. Today they hamper the people and the economies of the poorest populations even more than infectiouspopulations even more than infectious diseases. This represents a public health emergency in slow motion”health emergency in slow motion

By: Ban Ki-Moon, UNSG 2009

Causes of chronic diseasesCauses of chronic diseasesWhat can we change or improve?What can we change or improve?

Source: WHO, 2008

One of the major risk factors for NCDs is obesityOne of the major risk factors for NCDs is obesityin children and in adults in both developed and developing countriesin children and in adults in both developed and developing countries

The Global Strategy on Diet and PhysicalActivity of the World Health The Global Strategy on Diet and PhysicalActivity of the World Health yOrganisation makes specific dietary and physical activity recommendations for the prevention of chronic diseases

yOrganisation makes specific dietary and physical activity recommendations for the prevention of chronic diseasesfor the prevention of chronic diseases of lifestyle (WHO, 2004). The dietary guidelines include the following:

for the prevention of chronic diseases of lifestyle (WHO, 2004). The dietary guidelines include the following:following:following:

WHO recommendations WHO recommendations (WHO 2003, 2008)(WHO 2003, 2008)

• To achieve energy balance and healthy• To achieve energy balance and healthy weight

WHO recommendations (WHO WHO recommendations (WHO 2003, 2008)2003, 2008)

• To limit total fats saturated and trans fats• To limit total fats , saturated and trans fats

WHO recommendations WHO recommendations (WHO 2003, 2008)(WHO 2003, 2008)

• To increase intake of fruits and vegetables, legumes,To increase intake of fruits and vegetables, legumes, whole grains and nuts

• To limit intake of free sugars• To limit intake of sodium and • ensure that it is iodized

• Furthermore the global strategy emphasizes• Furthermore the global strategy emphasizes that both government and industry have important roles to play in informing p p y gconsumers about healthy diet

• This includes educating the public and responsible food labelling and advertising (WHO, 2004)

• HOW DO GOVERNMENT DEPT OF• HOW DO GOVERNMENT, DEPT. OF HEALTH, INDUSTRY AND FOOD PRODUCERS EDUCATE CONSUMERSPRODUCERS EDUCATE CONSUMERS IN A MANNER THAT MAKES THEM ADOPT HEALTHY EATINGADOPT HEALTHY EATING BEHAVIOURS?????

• IS FOOD LABELLING THE ANSWER?

Proliferation of labelling systemsProliferation of labelling systemsProliferation of labelling systemsProliferation of labelling systems

Pick the tickAustralia/New Zealand

KeyholesystemSweden

PepsiCoUnited Statesof America

Albert Heijn TheNetherlands

Healthier ChoiceSingapore

Zealand of America Netherlands

GDA McDonald’s

… is confusing consumers

GDA Tesco

g

Health RobotSouth AfricaMultiple Traffic Light

United Kingdom Sainsbury Traffic LightUnited Kingdom Sainsbury Traffic Light United Kingdom

Sensible Solution Kraft

Consumer research on food labellingConsumer research on food labellingConsumer research on food labellingConsumer research on food labelling

• Research by Cowburn & Stockley (2005) indicated thatResearch by Cowburn & Stockley (2005) indicated that vulnerable groups: lower educated, lower income; are least likely to read food labels

• We realize that this represents more than 80% of the globalWe realize that this represents more than 80% of the global population

• It has been shown that positive messages tend to have more impact on consumers than negative ones when promotingimpact on consumers than negative ones when promoting healthy behaviour such as eating healthy foods (Rothman & Salovey, 1997)

• This implies that in order to encourage people to adopt• This implies that in order to encourage people to adopt preventative behaviour (ie. If you eat that food you will be healthier) will be more effective than. If you eat that food you will increase risk of getting diseasewill increase risk of getting disease

What is the best Choice?What is the best Choice?What is the best Choice?What is the best Choice?

• What type of labelling is best not only for• What type of labelling is best not only for educated middle and high income consumers but also for the majority in low and middle income countries who arelow and middle income countries who are more vulnerable by virtue of low education and low income?education and low income?

Basic criteria of labelling for healthBasic criteria of labelling for healthBasic criteria of labelling for healthBasic criteria of labelling for health

• Should comply with international healthy nutrition guidelines• Should be very simple and front of packy p p• Should be accompanied by effective and localised nutrition

education which is not aimed at promoting specific products or brands

• Should not belong to any one company or brand • Any company should be able to use the system it if it meets

basic criteriabasic criteria• Should be the same globally ie. whether used in India or

South Africa

The Choices ProgrammeThe Choices ProgrammeThe Choices ProgrammeThe Choices Programme

Simple, Science based & International

• Worldwide programme• Initiated by food industryInitiated by food industry• Supported by nutritional scientists,

governments, NGOs• One front of pack stamp• One front-of-pack stamp• Independent benchmark• Open initiative• Internationally applicable

AimsAimsAims Aims

1 Help consumers make the healthier food choice easy1. Help consumers make the healthier food choice easy

2 Sti l t f d i d t t d d t i ti2. Stimulate food industry towards product innovation

Limit intake of nutrients with a negative impact on healthLimit intake of nutrients with a negative impact on health

Ensure intake of essential and beneficial nutrients

Promote appropriate energy intake

National governance structureNational governance structureNational governance structureNational governance structure

National BoardNational BoardChoices“Country”Country

Stamp Clearance&C li C l

Communication&Ed iCompliance Control Education

Company 1 Company 2 Company 3 Company …

International governance International governance structurestructure

ChoicesChoices International Board

InternationalScientificCommittee Board

National Board National Board National Board National BoardNational BoardChoicesThe Netherlands

National BoardChoicesBelgium*

National BoardChoicesPoland*

National BoardChoices…

* Currently being set up

Principles of the Choices Principles of the Choices benchmarkbenchmark

• Applicable to all foods and drinks• Applicable to all foods and drinks

Excluding alcohol, supplements, products to be used d di l i i d f d f hild 1

• Based on sound scientific evidence

under medical supervision and foods for children <1

Based on sound, scientific evidence• Transparent derivation of benchmarks• Regularly reviewed to keep up with scientific

consensusconsensus• Credible and easy to understand

• Practical to implement• Internationally applicable

The Choices benchmark (2)The Choices benchmark (2)The Choices benchmark (2)The Choices benchmark (2)

Choices independent benchmarkChoices independent benchmark

Thoroughreview

InternationalScientific

reviewCommittee

Choices international benchmark

10 July 2007 25 Prof Jaap Seidell

Advantages for the consumerAdvantages for the consumerAdvantages for the consumerAdvantages for the consumer

• One international system makes it easy and diblcredible

• Simple and positive label - appropriate for quick consumer decision in shopping environmentpp g

• No more confusion: one stamp for all producers and productsM ti ti b h i l h iti l• Motivating behavioural change: positively changing perception and usage intention of food products

• Complementary to other nutritional information labelling systems

10 July 2007 27 Prof Jaap Seidell

Dynamic systemDynamic systemDynamic systemDynamic system

• Aims to move benchmark more towards dietary recommendationsrecommendations

• Evaluation every 2 years according to latest scientific insights by an international scientific committee representing different co ntriesrepresenting different countries

• Evaluation research of effects on consumer and producer behavior

• Transition period for implementation• Continuous improvement of system

10 July 2007 28

Selection of nutrients Selection of nutrients

Basis: WHO Global Strategy on Diet, Physical Activity and Health (2004)Basis: WHO Global Strategy on Diet, Physical Activity and Health (2004)

Included:• Trans fatty acids

S t t d f tt id

Considered but not included:• Fat quantity: is covered by

energy, focus: fat quality• Saturated fatty acids • Sodium• Added sugar (Free sugar)*

energy, focus: fat quality • Cholesterol: evidence is

probable (WHO/FAO, 2003)Added sugar (Free sugar)

In addition (for some product

• Total sugar: no distiction between intrinsic (fruit, milk) and added sugars*

groups):• Energy • Fibre (from ingredients e g

g• Other benefical nutrients:

However, more lenient criteria in the basic food groups vs• Fibre (from ingredients e.g.

whole grain)the basic food groups vs discretionary food groups

*Added sugar = Free sugar (WHO) which can be manipulated byAdded sugar = Free sugar (WHO), which can be manipulated by manufactures & related to “empty calories”

Generic criteriaGeneric criteria

Based on FAO/WHO international nutrient recommendations +30%1

Based on FAO/WHO international nutrient recommendations +30%1

Nutrient WHO/FAO1 +30% Generic it i

recommendations +30%1recommendations +30%1

criteria

Saturated fat [en%] < 10 +3 < 13Trans fat [en%] < 1 +0.3 < 1.3Sodium [mg/kcal] <1* +0.3 < 1.3Added s gar [en%] < 10 +3 < 13Added sugar [en%] < 10 +3 < 13Fibre [g/100 kcal] > 1.3** > 1.3* Based on 2000 kcal/d and WHO sodium recommendation 2 g/d Based on 2000 kcal/d and WHO sodium recommendation, 2 g/d** Based on 2000 kcal/d and WHO fibre recommendation, 25 g/d

In addition: for low energy-dense foods insignificancy levelsd fi d 5% f d ti 1 100

30

1Joint WHO/FAO consultation (2003)are defined as 5% of recommendations1 per 100g

Product groups

Subdivision in basic and non-basic product groupsSubdivision in basic and non-basic product groupsSubdivision in basic and non-basic product groupsSubdivision in basic and non-basic product groups

• Basic product groups deliver significant amounts• Basic product groups deliver significant amounts of essential nutrients in a daily menu

• Non-basic (or discretionary) product groups do not significantly contribute to the intake of g yessential nutrients

Division basic vs discretionary groups makes different criteria between these groups possible.

Definition (non) basic productDefinition (non) basic productDefinition (non) basic product groups

Definition (non) basic product groups

( )Basic product groups (deliver essential nutrients): Basic foods are the foundation for a healthy diet and they substantially contribute to the daily intake of essential or beneficial nutrients, such as carbohydrates, protein, fats, fibre vitamins and minerals including trace elementsfibre, vitamins and minerals including trace elements

Basic foods are categorized in basic groups, according to similarity in nutrient content, origin and use.*

Non basic or discretionary product groups:All other foods and drinks such as:Soups including bouillons/brothsp gSauces and dressingsSnacks including:

Ice-cream (incl. all kind of edible ice)Pastry and biscuits including mixes/combinations with basic foods (e.g. tiramisu..)Sweets snacks including sweets, chocolates and candy barsSavory snacks including crispsSavory snacks including crisps

Drinks (excl. alcohol, 100% pure juices and dairy)

Selecting product groups: Food groups that are mentioned in various international

Selecting product groups: Food groups that are mentioned in various international

Food Based Dietary Guidelines (FBDG)Food Based Dietary Guidelines (FBDG)

• International food guidelines used from: Australia, Belgium, USA, Canada, China, Denmark Finland France Germany Greece Hungary Ireland Italy Latvia MalaysiaDenmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Malaysia, Namibia, Netherlands, New Zealand, Singapore, Spain, UK (N=21)

Basic food groups mentionedg p• Vegetables (20)* Eggs (12) • Fruit (20) Milk and milk products (18)• Cereals (18) Potatoes, rice and pasta (18)• Legumes (7) Meat (18) • Spreads and Cooking prod (5) Olive oil (2) olive oil pulses nuts(3)• Bread (16) Red meat (1)

Fi h (19) S t (2)• Fish (19) Sweets (2)• Poultry (13) Whole grain products (1)• Water

* Number of systems including the food group

Product groups - conclusionProduct groups - conclusion• Generic criteria for all products showed to be too simplistic• Division in basic and discretionary food groups

Product groups conclusionProduct groups conclusion

• Division in basic and discretionary food groups• Basic food groups are defined based on Food Based Dietary Guidelines

from >20 countries July 27 2007

Basic food groupsProviding beneficial nutrients

Discretionary food groups

Fruits & vegetables Soups including bouillonsWater BeveragesBread, grains, potatoes, pasta, rice Meal sauces Meat, fish, poultry, eggs Water/emulsion based saucesMilk and diary products Snacks: ice-cream, pastry & biscuits,

savoury snacks, and sweet snacksFats, oils and spreadsH t l d d i h B d t iHot meals and sandwiches Bread toppings

Product group specific criteria

Product group specific criteriaProduct group specific criteriaProduct group specific criteriaProduct group specific criteria

• Generic criteria are used where possible

• Additional criteria for fibre and/or energy for some product groups

• Product specific criteria used only if necessary:• Taste • Technology/Safetygy y• Regulatory

• Because:• Still a need to stimulate innovationStill a need to stimulate innovation• To ensure intake of beneficial nutrients

• The product group specific criteria:• Are replacing the generic criteria for that nutrient• Are replacing the generic criteria for that nutrient• Should not be in conflict with international dietary guidelines• Should take into account existing variation in products on the market• Should be challenging but technically feasible and acceptable in taste, stimulating innovation

Logic 1: All foods should contain low levels of Logic 1: All foods should contain low levels of nutrients that have a negative effect on health:

trans fat, saturated fat, sugar, sodiumnutrients that have a negative effect on health:

trans fat, saturated fat, sugar, sodium

• Generic guidelines are used where possible• Product specific benchmarks foods:Product specific benchmarks foods:

• Derived from national food standards & looking at existing variation in products on the market

• It should be challenging but technically feasible (e g a cheese needs a• It should be challenging but technically feasible (e.g. a cheese needs a minimum level of sodium for preservation) and acceptable in taste, thus stimulating industry to improve products

• Benchmarks for non basic foods benchmark may be somewhat stricter than• Benchmarks for non-basic foods benchmark may be somewhat stricter than for basic foods, but they should be feasible and stimulate industry to improve products or develop better alternatives

Logic 2: Basic foods need to deliver a Logic 2: Basic foods need to deliver a minimum to essential nutrientsminimum to essential nutrients

• Product specific benchmarks set for few basic groups• Selection of food groups is based on an overview of

international dietary guidelines and basic food groups• If most choices in a food group are naturally low in SAFA,

TFA, sodium and sugar (like vegetables, fish etc.) there is no need to add a specific benchmark to ensure provision of p pessential nutrients

• Where provision of essential nutrients is at risk (e.g. bread should contribute to fiber intake; meals to vegetable intake) a ; g )benchmark is proposed to identify healthier choices.

B l i b t i d k tB l i b t i d k tProduct group specific criteria:

Balancing between science and marketBalancing between science and market

Aim: set criteria - To help consumers select the healthy choices while shopping- To stimulate producers to innovate towards better products• Ultimate goal: to set final criteria for products leading to daily intakes in

line with international dietary guidelines SCIENCEline with international dietary guidelines SCIENCE• Market: often far from ideal dietary product MARKET

formulation

• If gap too large: no participation of producers• Criteria can be tightened over timeg• Result: producers join and have time to innovate• Result: consumers get used to taste changes

Product group specific criteriaProduct group specific criteriaProduct group specific criteriaProduct group specific criteria

•To ensure intake of essential and beneficial nutrients, choices from the basic product groups are stimulated through the definition of somewhat more lenient criteria compared to the pdiscretionairy product groups.

•A product group specific criterion has been defined based on i ti i d t i th k tvariation in products in the market.

•10-20% Rule

At least 20% of basic and approximately 10% of discretionary food products should be able to meet the qualifying criteria within a food group at the

beginning of the programbeginning of the program

10-20% Rule as appliedfor the current international criteria

10-20% Rule as appliedfor the current international criteriafor the current international criteriafor the current international criteria

At least 20% of basic and around 10% of discretionary food products should be able to meet the criteria

Food composition data (7000 products, 12 European countries)

60

80

100da

taba

seBasic foods Discretionary foods

20

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60

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Validation:

•Daily Menu Method•Daily Menu Method•Nutrient Intake Modelling

Daily diet validationDaily diet validation

Food intake dataFood intake data from the general

populationDerivation of a

typical diet

Replacement with Choices-

compliant products

Food intake data from the typical

diet with Choices-compliantp p products compliant products

44

Change in nutrient intakesChange in nutrient intakes

Typical diet withNutrient WHO guideline Typical diet*

Typical diet with Choices-compliant

productsEnergy [kcal] 2000 2119 1783Energy [kcal] 2000 2119 1783Saturated fat [en%] < 10 15.7 8.4Trans fat [en%] < 1 1.2 0.1[ ]Sodium [mg] < 2000 2858 2335Added sugar [en%] < 10 (free sugar) 13.2 5.6Fibre [g] > 25 18 25

*Average of three typical menus taking into account Dutch food-based dietary guidelines

By replacing regular variants with Choices productsyou can approach WHO/FAO dietary recommendations

45

you can approach WHO/FAO dietary recommendations

The daily diet validation was also applied to other countries

The daily diet validation was also applied to other countriesapplied to other countriesapplied to other countries

SAFA i k i "T i l" d "Ch i " D il M f 7SAFA intakes in "Typcial" and "Choices" Daily Menus from 7 countries (en%)

20

10

15

20

Typical

Maximal intake limit <10 en%

0

5Choices

Netherl

ands

Greece

Spain

USA

China

Israe

lSou

th Afric

a

Ne So

Change (en%) in saturated fatty acid intakesC a ge (e %) satu ated atty ac d ta es

Alternative Validation:P t ti l i t t i t i t k

Alternative Validation:P t ti l i t t i t i t kPotential impact on nutrient intakesPotential impact on nutrient intakes

Potential impact on nutrient intakes3 scenarios:

Potential impact on nutrient intakes3 scenarios:3 scenarios:3 scenarios:

1 Usual nutrient intakes (no manipulation1. Usual nutrient intakes (no manipulation of input data)

2. Usual intakes when everyone would eat only foods that comply with the Choicesonly foods that comply with the Choices criteria (based on the new food composition table)composition table)

3 Same as 2 but corrected for energy3. Same as 2, but corrected for energy intakes

Method Method

Output: distribution of usual nutrient intake in the population

Input: food intake data from national

consumption surveyconsumption survey

Monte Carlo Risk assessment model

Input: Food St ti ti l d t l l t

pcomposition data Statistical procedure to calculate

usual (nutrient, chemical) intakes based on the consumption survey, by multiple sampling (100 000by multiple sampling (100 000 times). Developed for food safety assessements.

Saturated fatty acids: intake dataSaturated fatty acids: intake dataDistributions of saturated fatty acid intake (g/d)

0.07

0.06

As measured Choices Choices, adjusted for energy

P50(Median) ≈ mean SFA

0.04

0.05P50(Median) ≈ mean SFA intake

0.03

0 01

0.02

0

0.01

0 10 20 30 40 50 60 70 800 10 20 30 40 50 60 70 80Maximal intake limit (< 22.2 g/d)

Sodium: intake dataSodium intake mg/d

0.0009

As measured Choices Choices (adjusted for energy)

0.0007

0.0008As measured Choices Choices (adjusted for energy)

0.0005

0.0006

0.0003

0.0004

0 0001

0.0002

0.0003

0

0.0001

0 1000 2000 3000 4000 5000 6000Maximal intake limit 2000mg/d

Change in median nutrient intakes (%)Percentage change in P50 ( di ) t i t i t kPercentage change in P50 ( di ) t i t i t k

40

60 (median) nutrient intakes(median) nutrient intakes

20

0

nerg

y

al fa

t

SAFA TF

A

dium

suga

r

otei

n

drat

e

Fibr

e

cium Iro

n

acid

MU

FA

PUFA

40

-20

En Tota S

Sod

Tota

l su

Pro

Tota

l car

bohy

d F

Cal

c

folic

M P

-60

-40 T

-80

Choices Choices, adjusted for energy

•Energy intakes reduce (15%)Energy intakes reduce (15%)

•Intakes of nutrients with maximal intake limits reduce

•Intakes of nutrients with minimal intake limits increase except for MUFA, PUFA

Validation - conclusionValidation - conclusionValidation conclusionValidation conclusion• It can be concluded that the Choices programme canIt can be concluded that the Choices programme can

potentially improve dietary nutrient intake in the direction of the international recommendations, taken into account an addition of 30% on top of the international dietary p yrecommendations might be an effective approach.

• It would be valuable to have this information for moreIt would be valuable to have this information for more countries in Europe and across the world.

Thank you for your interest!Thank you for your interest!Thank you for your interest!Thank you for your interest!

Back upBack up

Product group specific criteria Product group specific criteria G i it i i i ifi t l l d h ibl• Generic criteria or insignificant levels are used where possible.

• Product group specific criteria used only when necessary:• Product group specific criteria used only when necessary:1. No available alternative of a commonly consumed food2. No alignment with recommendations g3. No stimulation of innovation (taste, technology, regulation, or all

products comply)

• 10-20% Rule was applied (based on food composition data):At least 20% of basic and approximately 10% of discretionary food productsAt least 20% of basic and approximately 10% of discretionary food products

should be able to meet the qualifying criteria within a food group at the beginning of the program

Evaluation of (proposed)Evaluation of (proposed)Evaluation of (proposed) Choices criteria

Evaluation of (proposed) Choices criteria

Selection and preparation of Food Selection and preparation of Food C iti D t b (FCD )C iti D t b (FCD )Composition Databases (FCDs)Composition Databases (FCDs)

Selection of the FCDsSelection criteria

Selection of the FCDsSelection criteria- Selection criteria -- Selection criteria -

1 D hi t ti i ll i f th ld1. Demographic representation covering all regions of the world: 2. Availability of the Choices “key nutrients”:

• added / total sugars • saturated fatty acids• trans fatty acids• sodium

di t fib• dietary fibre• energy• (positive nutrients: Ca, Fe, K, Mg, Vit A, C, D, E)*

3 Be electronicall a ailable3. Be electronically available4. Be available in English 5. Number of foods included in the database6. Price & availability

Selection of the FCDsA l

Selection of the FCDsA l-An example-An example

REGION SUB-REGION COUNTRY FC DATABASE MISSING KEY NUTRIENTS

AMERICA NORTHERN United States USDA Added Sugars

LATIN LatAm Latinfoods Total Sugars, Added Sugars, TFA

EUROPE NORTHERN Denmark Danish FCD All key nutrients are available

WESTERN United Kingdom McCance&Widdowson Added Sugars

The Netherlands NEVO Added Sugars

Belgium NUBEL Added Sugars, TFA

EASTERN Poland Polish FCD Total Sugars*, Added Sugars, TFA

SOUTHERN Italy Italian FCD Added Sugars, TFA

EUROPE GENERAL EFSA Food Basket Added Sugars

OCEANIA Australia NUTTAB Added Sugars, TFA

AFRICA South Africa FOODFINDER 3 Added Sugars, TFA, Fibre

ASIA & THE MIDDLE EAST Turkey Turkish FCD Added Sugars, TFA

Israel Israel FCD Added Sugars, TFA

Singapore Singapore FCD Added Sugars, TFA

* Total sugar can be calculated from available CHO, fibre and starch data = total CHO - fibre - starch

Preparation of the FCDsp

• Preparation of the FCDs for evaluation against criteria implies deciding on the:p g

• Food product group classification

Trans Fatty Acid content [in case not available in the• Trans Fatty Acid content [in case not available in the FCDs]

• Added sugar content [in case not available in the FCDs]

• Serving sizes

Preparation of the FCDs

1. Food product group classification based on:

p- Assumptions made -

• Pragmatic application of equivalence criteria & 70% rule2. Trans Fatty Acid content based on:

• Recipe (ingredients, amounts & food processing)ec pe ( g ed e ts, a ou ts & ood p ocess g)• Total fat content in relation to the origin, in line with TRANSFAIR

Study (animal vs. dairy; ruminant vs. pork) 3. Added sugar content based on:g

• (assumed) fruit and milk sugars subtracted from the total sugar content

• Recipes (ingredients and amounts)p ( g )• Existing food regulations for fruit based food items like jam or

juice4. Serving sizes:g

• Pragmatic application of existing serving sizes as indicated by various nutrition organisations, while minimizing the variation

European Test Database (n=7,066) Distribution of Food CompositionDistribution of Food Composition Databases

7066

Danish Fødevaredatabanken v6.0; 14%Polish FCD 2005; 13%Poland: 13% Denmark: 14%

Belgium: 14%

EU Lim Food Basket; 21%

Nubel2004; 14%

EU FCD with 9 countries: 21%

Belgium: 14%

countries: 21%

NEVO 2006; 20%Netherlands: 20%

McCance and Widdowson's 6th ed; 17%UK : 17%20%

Energy criteria

Rationale for Energy criteriaRationale for Energy criteriaRationale for Energy criteriaRationale for Energy criteria• Energy criterion is established for:Energy criterion is established for:

• Main dishes• Filled sandwiches/rolls

N b i d t• Non basic product groups

• Because:• Main dishes and sandwiches etc are major components

of a daily diet• Non basic product groups do not substantiallyNon basic product groups do not substantially

contribute to the supply of essential nutrients, are eaten frequently ; they are important suppliers of energy

Rationale for Energy criteriaRationale for Energy criteriaRationale for Energy criteriaRationale for Energy criteria

2,000 kcal/dayRecommended energy

intake for women

Based on:

R d d< 200 kcal/dayDay’s beverage

intake(10 en%)

•Recommended energy intakes

•10% to come from Remaining calories

1,800 kcal/day

beverages

•Meal patternsBreakfast(20%E)

Lunch(30%E)

Dinner(30%E)

540 kcal/serve

3x In-Between meal product

(20%E)120 kcal/serve

Overview of recommended energy intake during the day: basis for energy criteria(as calculated for adult women)

Rationale for Energ criteriaRationale for Energ criteriaRationale for Energy criteriaRationale for Energy criteriaOverview of recommendations for daily energy intake and for main dishesOverview of recommendations for daily energy intake and for main dishesand snacks

Target group Daily energy recommendation Recommended energy from main dishes Recommended energy from snacks

Elderly 1800 kcal/d 486 kcal/serve 108 kcal/serve

Adult women 2000 kcal/d 540 kcal/serve 120 kcal/serve

Adult men 2500 kcal/d 675 kcal/serve 150 kcal/serve

Child 2 12 1 46 k l/d 9 k l/Children 2-12 1546 kcal/day 95 kcal/serve

Energy criterion: 400-700 kcal/serve Energy criterion: 110 kcal/serve

Rationale for Energ criteriaRationale for Energ criteriaRationale for Energy criteriaRationale for Energy criteria• Energy density is correlated with water content. • For products with high water content (>50% w/w) it was decided to use

100kcal/100g as criteria. While for products with low water content (<50% w/w) this is 350kcal/100g).

Non-basic product group Average water content (%, w/w) Energy criteria [kcal/100g]

SoupsMeal sauces Sauces emulsions

858048

100100350Sauces emulsions

Sauces non-emulsionsSnacksBeverages

4875

35010011032

Rationale Beverages:•stimulate innovation• Current regular drinks contain 10-12 g sugar per 100 ml

A fi t t it i t t 20 k l 5 100 l• As a first step: criterion set at 20 kcal = 5 g sugar per 100 ml• this is without forcing to use artificial sweeteners• intention is that this will be lowered in the futureA i b i l f th i•As energy in beverages mainly comes from sugar, there is no

need for an extra sugar criterion

Implementation of ChoicesImplementation of Choices

Two practical subjects:p j•Score products “as sold” or “as prepared”•Assigment to product groups•Assigment to product groups

Sold vs preparedSold vs preparedSold vs preparedSold vs prepared

Products are in principle registered and assessed asProducts are in principle registered and assessed as ‘as sold’.

Only in the case of dried products in powder form, concentrated or condensed products, food products may be registered as ‘as prepared’ but only if the method ofbe registered as as prepared , but only if the method of preparation is unambiguous. This refers for example to dried and concentrated products which have to bedried and concentrated products which have to be resolved/diluted in water/milk, such as soups, broths, sauces in powder form, concentrated meal mixes, potatoes in powder form and syrups. The nutrient declaration for these products is registered for the product as ‘as prepared’as as prepared .

Product can be placed in more categoriesProduct can be placed in more categoriesProduct can be placed in more categoriesProduct can be placed in more categories

• If a product can be placed in two or more• If a product can be placed in two or more categories the product will be placed in the category with the most stringent criteriag y g

• Examples: pfried potato chips from snack bar can be considered as potato product, but also as snack.ice cream can be considered as milk product but also as snack

Study on effectiveness of ChoicesStudy on effectiveness of Choices

Product innovation

Effectiveness: effects on product innovation

Title / Date

Method f &Product reformulation & innovation

N 47 i ( 39 5%)• N = 47 companies (response 39.5%)

N l d l d f l t d l d l io Newly developed, reformulated or already complyingo 821 products

SAFATFATFAAdded sugarSodiumFiberEnergy

Title / Date

Products per product groupProducts per product groupup

Figure 1. Choices products per product group: already complying, reformulated and new developed products

100

120

prod

uct g

rou

40

60

80

oduc

ts p

er p

0

20

umbe

r of p

roN

u

newreformulated

Title / Date Product group

reformulatedalready complying

Reformulated products

Product group Saturated fat Added sugar Dietary fibreFruit juice - - +53%j(n=6)

%(0.15-0.23 g/100g)

Processed meat(n=11)

-43%(3.09-1.75 g/100g)

- -

Dairy products(n=10)

-30%(1.26-0.88 g/100g)

-75%(5.74-1.46 g/100g)

+100%(0-0.18 g/100g)

Sandwiches - - +52%Sandwiches(n=16)

52%(2.4-3.64 g/100g)

Sauces(n=10)

- -13%(6.12-5.31 g/100g)

-( ) ( g g)

Title / Date75

Composition of newly developed products

Product group Saturated fat Added sugar SodiumProcessed meat - - -39%(n=17)

%(1018-626 mg/100g)

Dairy products(n=11)

-88%(1.26-0.15 g/100g)

-100%(5.74-0 g/100g)

-

Soups(n=21)

- - -25%(372-280 mg/100g)

Reference products: previously reformulated products of same product group

Title / Date76

Most reformulation: sodiumMost reformulation: sodium

-18% (average)

Meat products n=11

( g )1017 834mg/100g

-13 (average)

Soups: n=68

372 322 mg/100g

-42% (average)Breads: n=12

Title / Date

471 273mg/100g

Criteria

Title / Date

Product criteria per groupBasic product groupsBasic product groups

Product group Product criteria

Fresh or fresh frozen fruit, vegetables and legumes

All types of fresh fruit and vegetables, without additives

Processed fruit & vegetables Saturated fat ≤ 1.1 g/100 gTrans fatSodiumAdded sugar

≤0.1 g/100 g ≤100 mg/100 gnot added

Dietary fibre ≥ 1.3 g/100 kcalFruit juices Saturated fat

Trans fat≤ 1.1 g/100 g≤ 0.1 g/100 g

SodiumAdded sugarDietary fibre

g g≤ 100 mg/100 gnot added≥0.75 g/100 kcalDietary fibre

Energy≥0.75 g/100 kcal≤ 48 kcal/100 ml

Title / Date79



Water Saturated fatTrans fatSodium

≤ 1.1 g/100 g≤0.1 g/100 g ≤ 20 mg/100 g

Added sugar Not addedPotatoes (unprocessed) All unprocessed uncooked potatoes, without additives

Potatoes (processed) pasta Saturated fat ≤ 1 1 g/100 gPotatoes (processed), pasta, noodles

Saturated fatTrans fatSodiumAdd d

≤ 1.1 g/100 g≤ 0.1 g/100 g ≤ 100 mg/100 g

t dd dAdded sugarDietary fibre

not added≥ 1.3 g/100 kcal

Rice Saturated fat ≤ 1.1 g/100 gTrans fatSodiumAdded sugar

≤ 0.1 g/100 g ≤ 100 mg/100 gnot added

Title / Date

Dietary fibre ≥ 0.7 g/100 kcal

80



Bread Saturated fatTrans fatSodium

≤ 1.1 g/100 g≤ 0.1 g/100 g ≤ 500 mg/100 g

Added sugarDietary fibre

≤ 13 en%≥ 1.3 g/100 kcal

Grain and cereals Saturated fat ≤ 1.1 g/100 gGrain and cereals Saturated fatTrans fatSodiumAdded sugar

≤ 1.1 g/100 g≤ 0.1 g/100 g ≤ 100 mg/100 g≤ 2 5 g/100gAdded sugar

Dietary fibre≤ 2.5 g/100g≥ 1.3 g/100 kcal

Breakfast cereals Saturated fatTrans fat

≤ 1.1 g/100 g≤ 0 1 g/100 gTrans fat

SodiumAdded sugar Di t fib

≤ 0.1 g/100 g ≤ 500 mg/100 g≤ 20 g/100g≥ 1 3 /100 k l

Title / Date

Dietary fibre ≥ 1.3 g/100 kcal

81



Milk (-products) Saturated fatTrans fat*SodiumAdded sugar

≤ 1.4 g/100 g≤ 0.1 g/100 g ≤ 100 mg/100 g≤ 5 g/100gAdded sugar ≤ 5 g/100g

Cheese (-products) Saturated fatTrans fat*Sodium

≤ 15 g/100 g≤ 0.1 g/100 g ≤ 900 mg/100 gSodium

Added sugar≤ 900 mg/100 gNot added

Meat, poultry, eggs (unprocessed) Saturated fatTrans fat*

≤ 1.1 g/100 g or 13 en%≤ 0.1 g/100 g

SodiumAdded sugar

g g≤ 100 mg/100 gNot added

Processed meat, meat products and Saturated fat ≤ 1.1 g/100 g or 13 en%meat substitutes Trans fat*

SodiumAdded sugar

≤ 0.1 g/100 g ≤ 900 mg/100 g≤ 2.5 g/100 g

Title / Date82

*Naturally occurring trans fat is excluded.



Fresh or fresh frozen fish, shellfish and crustaceans

Saturated fatTrans fat Sodium

≤ 1.1 g/100 g or 30% of total fat≤ 0.1 g/100 g≤ 100 mg/100 g

Added sugar Not addedProcessed fish or fish products Saturated fat

Trans fat≤ 1.1 g/100 g or 30% of total fat≤ 0.1 g/100 gTrans fat

SodiumAdded sugar

≤ 0.1 g/100 g≤ 450 mg/100 gNot added

Oils fats and fat containing Saturated fat ≤ 30% of total fatOils, fats and fat containing spreads

Saturated fatTrans fat SodiumAdded sugar

≤ 30% of total fat≤ 1.3 en%≤ 1.3 mg/kcalNot addedAdded sugar Not added

Title / Date83



Main course Saturated fatTrans fatSodium

≤ 1.1 g/100 g or 13 en%≤ 0.1 g/100 g or 1.3 en%≤ 2.2 mg/kcal

Added sugarDietary fibreEnergy

≤ 2,5 g/100 g or 13 en%≥1.25 g/100 kcal400-700 kcal/servinggy g

Filled sandwiches/rolls Saturated fatTrans fatSodium

≤ 1.1 g/100 g or 13 en%≤ 0.1 g/100 g or 1.3 en%≤ 1 9 mg/kcalSodium

Added sugarDietary fibreEnergy

≤ 1.9 mg/kcal≤ 2,5 g/100 g or 13 en%≥ 0.8 g/100 kcal350 kcal/servingEnergy 350 kcal/serving

Title / Date84

Product criteria per groupDiscretionary product groupsDiscretionary product groups


Soups Saturated fatTrans fatSodium

≤ 1.1 g/100 g≤ 0.1 g/100 g≤ 300 mg/100 g

Added sugarEnergy

≤ 2,5 g/100 g100 kcal/100 g

Meal sauces Saturated fat ≤ 1.1 g/100 gMeal sauces Saturated fatTrans fatSodiumAdded sugar

≤ 1.1 g/100 g≤ 0.1 g/100 g≤ 450 mg/100 g≤ 2 5 g/100 gAdded sugar

Energy≤ 2,5 g/100 g 100 kcal/100 g

Title / Date85



Other sauces (on water basis)

Saturated fatTrans fatSodium

≤ 1.1 g/100 g≤ 0.1 g/100 g≤ 750 mg/100 g

Energy 100 kcal/100 gOther sauces (emulsions)

Saturated fatTrans fat

≤ 1.1 g/100 g or 30% of fat≤ 0.1 g/100 g or 1.3 en%(emulsions) Trans fat

SodiumAdded sugarEnergy

≤ 0.1 g/100 g or 1.3 en%≤ 750 mg/100 g≤ 2,5 g/100 g or 13 en%350 kcal/100 gEnergy 350 kcal/100 g

Title / Date86



Snacks Saturated fatTrans fatSodium

≤ 1.1 g/100 g or 13 en%≤ 0.1 g/100 g or 1.3 en%≤ 400 mg/100 g

Added sugarEnergy

≤ 20 g/100 g110 kcal/100 g

Beverages Saturated fat ≤ 1.1 g/100 gBeverages Saturated fatTrans fatSodiumEnergy

≤ 1.1 g/100 g≤ 0.1 g/100 g≤ 100 mg/100 g20 kcal/100 mlEnergy 20 kcal/100 ml

Bread toppings Saturated fatTrans fatSodium

≤ 13 en%≤ 1.3 en%≤ 400 mg/100 gSodium

Added sugar≤ 400 mg/100 g≤ 30 g/100 g

Title / Date87

Documents

Choices Model forChoices Model for makinggy y healthy ...€¦ · Its all about chronic diseases of lifestyle (CDLs) •The disease profile of the world is changing rapidly, especially