A comparison of four different Nutritional Profile models in their scoring of critical nutrient levels in food products targeted at Brazilian children

Abstract

The implementation of front‐of‐pack labelling to assist consumers in making healthier food choices requires an appropriate Nutritional Profile Model (NPM) to be defined. However, four different models have been proposed in Brazil: the Pan American Health Organization (PAHO), the Brazilian Association of Food Industries (ABIA) and National Health Surveillance Agency (ANVISA) less (1) and more restrictive (2) models. The present study aimed to use the information provided on the labels of eight ultra‐processed food categories selected from the most popular group of foods targeted at Brazilian children, to score critical nutrient levels according to the four different NPMs and compare the proportion of products categorised as ‘high’, ‘medium’ or ‘low’ according to each one. Labels (n = 409) were collected in supermarkets in Belo Horizonte‐MG, Brazil. Data were tabulated, and a comparison of the ‘high’ content of the four nutrients, total sugars, total and saturated fats and sodium, according to the four NPMs, was performed. Agreement between ‘high’, ‘medium’ and ‘low’ scores according to the different NPMs, in comparison with the PAHO model, was performed using the Kappa test. Of all ‘fruit’ drinks, 95% were considered as ‘high’ in total sugars by the PAHO model, while only 5% were categorised as ‘high’ by the ABIA and ANVISA 1 models. For total sugars, no product in the cakes, breakfast cereals and yogurts categories and only 5.7% of the sandwich cookies were categorised as ‘high’ by the ABIA model, while 100% of sandwich cookies were categorised as having a ‘high’ total sugars content by the PAHO and ANVISA models. Similar findings were observed for breakfast cereals, yogurts and corn snacks for the proportion of products scoring ‘high’ for saturated fats and sodium. Kappa's concordance analysis showed moderate to excellent agreement between the PAHO and ANVISA 2 models. It was observed that the PAHO model indicated more foods with a ‘high’ content of critical nutrients. We conclude that the ABIA model is more permissive when compared to the other models and the PAHO model more restrictive.

From the most to the least flexible nutritional profile: Classification of foods marketed in Brazil according to the Brazilian and Mexican models

“…If a food, not only has a high content of a certain nutrient, in this case, saturated fat, but also has a high energy content, the proportion is maintained and there is no extrapolation of the MNPM cutoff point, since, for these nutrients, the measure is relative (10% of the energy value) and not absolute. Although the number of products in this situation is small, this observation has been previously reported (10,48). It is worth mentioning that the same products were "high in" for calories (all), one for free sugars (the 50% soluble cocoa chocolate powder), and the snacks for sodium according to the MNPM.…”

“…Due to these difficulties and as a strategy to promote healthier diets, following recommendations by the World Health Organization (WHO) (4, 5), several countries have already adopted front-of-pack nutrition labeling (FoPNL) on food packages (6)(7)(8)(9). This type of labeling consists of simple and quick information about the nutritional quality of foods and is displayed on the main panel of labels to complement the nutritional information detailed on the back of packages and facilitate consumers' understanding of the composition of the products (5,10). Evidence suggests that FoPNL facilitates the interpretation of information by consumers and favors healthier choices and purchases, in addition to contributing to the reformulation of food by the industry (11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Comparison of two front-of-pack nutrition labels for Brazilian consumers using a smartphone app in a real-world grocery store: A pilot randomized controlled study

“…As noted above, although the number of scans was proportional for each arm of the study, the percentage of products that received warning information in the Brazilian FoPNL system arm was only 26.4% (n = 19) (Supplementary Data). This is due to the nutritional profile model recommended for this FoPNL, which is a more permissive profile compared to those used in other Latin American countries (22,23) and models proposed by the Brazilian regulatory agency and PAHO, it is, in fact, a model that categorizes fewer foods as containing excessive nutrients (11,24).…”

Bridging gaps in food labelling

“…Such unjustified penalties (and rewards) are troublesome for producers and might affect consumer trust in the labels. It remains challenging to come up with NPMs, which are evidence‐based and robust, sufficiently restrictive to benefit public health and yet supported across the range of the food industry on the other hand, including by start‐ups, small and medium‐sized enterprises (SMEs) and multinationals with dedicated nutrition teams (Silva et al, 2021).…”

“…This Virtual Issue on Food Labelling brings together ten papers recently published in Nutrition Bulletin discussing different aspects of food and nutrition labelling, including nutrient profiling models, food composition data, health claims and consumer understanding of nutrition labels (Chio et al, 2021;Gibson-Moore & Spiro, 2021;Jenneson et al, 2020;Jenneson & Morris, 2021;Lockyer et al, 2020aLockyer et al, , 2020bMansilla et al, 2021;Silva et al, 2021;Spiro & Wood, 2021;Traka et al, 2020). Despite ending up on the same packages, nutrition and environmental labels have had a rather independent course of development.…”