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How many foods in the UK carry health and nutrition claims,
and are they healthier than those that do not?
Asha Kaur
1
, Peter Scarborough
1
, Anne Matthews
1
, Sarah Payne
2
, Anja Mizdrak
1
and Mike Rayner
1,
*
1
British Heart Foundation Health Promotion Research Group, Centre on Population Approaches for
Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford,
Old Road Campus, Oxford OX3 7LF, UK:
2
University of Oxford School of Public Health, Oxford, UK
Submitted 4 November 2014: Final revision received 1 June 2015: Accepted 8 June 2015
Abstract
Objective: The present study aimed to measure the prevalence of different types of
health and nutrition claims on foods and non-alcoholic beverages in a UK sample
and to assess the nutritional quality of such products carrying health or nutrition
claims.
Design: A survey of health and nutrition claims on food packaging using a newly
defined taxonomy of claims and internationally agreed definitions of claim types.
Setting: A national UK food retailer: Tesco.
Subjects: Three hundred and eighty-two products randomly sampled from those
available through the retailer’s website.
Results: Of the products, 32 % (95 % CI 28, 37 %) carried either a health or nutrition
claim; 15 % (95 % CI 11, 18 %) of products carried at least one health claim and
29 % (95 % CI 25, 34 %) carried at least one nutrition claim. When adjusted for
product category, products carrying health claims tended to be lower in total fat
and saturated fat than those that did not, but there was no significant difference in
sugar or sodium levels. Products carrying health claims had slightly higher fibre
levels than products without. Results were similar for comparisons between
products that carry nutrition claims and those that do not.
Conclusions: Health and nutrition claims appear frequently on food and beverage
products in the UK. The nutrient profile of products carrying claims is marginally
healthier than for similar products without claims, suggesting that claims may have
some but limited informational value. The implication of these findings for guiding
policy is unclear; future research should investigate the ‘clinical relevance’of these
differences in nutritional quality.
Keywords
Health claims
Nutrition claims
Food labelling
A poor diet is a major modifiable risk factor for many
diseases including CVD and cancer
(1–3)
. Poor diet and low
physical activity levels, combined, were estimated to
account for 14·3 % of disability-adjusted life years in the UK
in 2010, exceeding even the impact of tobacco (11·8% of
disability-adjusted life years)
(4)
. Health and nutrition claims
could potentially help consumers make healthier food and
beverage purchases, and there is some research to show
that the presence of health and nutrition claims can influ-
ence the perceived healthiness of products
(5)
and can lead
to an increase in the sales of products bearing claims
(6–8)
.
In the UK, food labelling law is determined by the
European Union (EU). A health claim is defined by the EU
as, ‘any claim which states, suggests or implies that a
relationship exists between a food category, a food or one
of its constituents and health’
(9)
. A nutrition claim is
defined as, ‘any claim that states, suggests or implies that a
food has particular beneficial nutritional properties due to
the energy, nutrients or other substances it contains,
contains in reduced or increased proportions or does not
contain’
(9)
. The EU regulation
(9)
that contains these defi-
nitions separates nutrition claims into two sub-categories:
(i) ‘nutrient content claims’that refer to the amount of a
nutrient in a product (e.g. ‘low in fat’); and (ii) ‘nutrient
comparative claims’that compare the nutrient levels
between two or more products (e.g. ‘lower in fat than …’).
An additional sub-category of nutrition claims, i.e. ‘health-
related ingredient claims’that refer to substances other
than nutrients or energy, can also be distinguished.
The EU regulation separates health claims into three
different sub-categories, here referred to as: (i) ‘nutrient
and other function claims’, i.e. health claims that describe
Public Health Nutrition
Public Health Nutrition: page 1 of 10 doi:10.1017/S1368980015002104
*Corresponding author: Email mike.rayner@dph.ox.ac.uk
© The Authors 2015. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://
creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original
work is properly cited.
the ‘role of a nutrient or other substance in the growth,
development and the functions [both physiological and
psychological] of the body’(Article 13 claims); (ii) ‘reduc-
tion of disease risk claims’; and (iii) ‘general health claims’.
Full definitions for all the different types of health and
nutrition claims analysed in the present paper are provided
in the online supplementary material. These definitions are
those proposed by the International Network for Food and
Obesity/non-communicable disease Research, Monitoring
and Action Support (INFORMAS), which in turn are based
on the definitions for the different types of claim proposed
by the Codex Alimentarius Commission (Codex)
(10)
. The
online supplementary material also shows the equivalent
EU definitions where they exist.
While some types of claim e.g. reduction of disease risk
or nutrient and other function claims are relatively easy to
identify and categorise, some types of health claim are not.
For example, claims such as ‘full of goodness’or ‘to be
enjoyed as part of a healthy, active lifestyle’would be
categorised by some as general health claims but not by
others. The current study assesses how easily different
types of claims can be identified and categorised.
It has been suggested that health and nutrition claims
may lead consumers to overestimate the healthiness of
products
(11)
. In order to reduce this possibility and also the
possibility of producers making claims about beneficial
aspects of products while ‘hiding’their non-beneficial
properties (e.g. when making a ‘low fat’claim for a pro-
duct that is high in salt), the EU regulation proposes that
products making health or nutrition claims should meet
minimal nutritional criteria. These criteria were to be
defined using a nutrient profile model but to date the
European Commission has not succeeded in developing
such a model. Nutrient profiling has been defined by the
WHO as, ‘the science of classifying or ranking foods
according to their nutritional composition for reasons
related to preventing disease and promoting health’
(12)
.
Australia and New Zealand have recently agreed a
nutrient profile model, the Nutrient Profiling Scoring
Criterion (NPSC), to use for determining the eligibility of
products to make a health claim
(13)
. The USA has long used
a nutrient profile model for such a purpose. In the USA,
health claims are permitted only if they do not exceed set
thresholds for fat, saturated fat, cholesterol and sodium
(14)
.
The proportion of food and beverage products in the
UK that carry health and nutrition claims has never been
systematically assessed. An audit –simply involving visit-
ing retail outlets and identifying pre-packaged products
with health claims –was carried out in the UK in 2003
(15)
.
The audit examined 372 claims in relation to 182 products
and found that most health claims were ‘nutrient and other
function claims’. Our study sampled packaged products
available through the home-shopping website of the lar-
gest retailer in the UK (Tesco) to obtain an accurate esti-
mate of the prevalence of health and nutrition claims
within this defined population of foods. To date, it has also
not been clear whether those products that carry health or
nutrition claims in the UK have a better nutritional profile
than those that do not carry them and the current study
therefore investigates that question.
The research questions for the present study are
therefore:
1. Are health and nutrition claims easily identified and
categorised?
2. What is the prevalence of health and nutrition claims
for packaged food and non-alcoholic beverage pro-
ducts sold by Tesco in the UK?
3. Do products that carry a health or nutrition claim have
a better nutritional profile than products that do not
carry such claims?
Questions 2 and 3 are the focus of the current paper.
Methods
Sampling
The EU Food Information Regulation defines a ‘pre-
packaged foodstuff’as ‘any single item for presentation as
such to the ultimate consumer and to mass caterers, con-
sisting of a foodstuff and the packaging into which it was
put before being offered for sale, whether such packaging
encloses the foodstuff completely or only partially, but in
any case in such a way that the contents cannot be altered
without opening or changing the packaging’
(16)
. In our
study, we were concerned with pre-packaged foods and
non-alcoholic beverages that are consumed by adults or
children (but not babies, for whom health and nutrition
concerns are different). We were not concerned with
alcoholic beverages as the claims permitted on these
types of products are regulated differently. We included,
separately, product items that were available in different
sized packages, on the basis that the packaging for the
same product in different sized packages may carry
different health and nutrition claims.
The products were sampled from the home-shopping
website of Tesco, the retailer with the largest market share
in the UK at the time (November 2011). The following
types of products were excluded prior to sampling:
∙unpackaged foods;
∙products that could not be identified as a pre-packaged
food or beverage (e.g. there was no description
identifying the item as a food, there was no picture,
no nutritional information, etc.);
∙products that were marked as ‘product currently
unavailable’;
∙alcoholic beverages; and
∙baby and infant foods and beverages.
This left a total of 13 700 packaged products, from which
400 were randomly selected.
Public Health Nutrition
2 A Kaur et al.
The primary research question was what is the pre-
valence of health and nutrition claims for packaged food
and non-alcoholic beverage products sold by Tesco in the
UK? A power calculation was conducted to estimate the
precision of the prevalence estimates for different num-
bers of sampled products. After adjustment for a finite
population and assuming a prevalence rate for health and
nutrition claims of 50 %, 400 products would produce a
confidence interval of ±5 %, which was deemed to be
precise enough for the purpose of the present study.
Three different Tesco branches were visited –two in
Oxford and one in Abingdon (Oxfordshire, UK) –between
November 2011 and March 2012 in order to purchase the
products. The packaging was removed for data extraction.
Nutritional information for the content of energy, protein,
carbohydrate, sugars, fat, saturated fat, fibre and sodium
(g/mg/ml per 100 g/ml) was recorded from the Tesco
website, along with information on product name, brand
name, manufacturer, package size, price, etc.
Product categorisation
The products were categorised into fifteen product groups
using the FoodEx2 food classification system
(17)
. FoodEx2
categorises products into twenty broad product groups,
such as grains and grain-based products, vegetable and
vegetable products, milk and dairy products and sugar,
confectionery and water-based sweets. There are eight
levels of sub-categorisation within these broad products
groups, each with increasing specificity. The products
were also re-categorised at a later stage into five larger
product groups for a regression analysis of the nutrient
content of products with or without claims. The new
categories were: (i) beverages; (ii) fruit, vegetable and
grain-based products; (iii) fish, meat and ready meals; (iv)
milk and dairy products (including dairy imitates); and (v)
miscellaneous products. The first four product groups
mapped readily onto FoodEx2 product categories; how-
ever, the miscellaneous category contained a variety of
products such as confectionery and seasonings which
could not be re-categorised into the previous four cate-
gories. Further details of the re-categorisation can be
found in Table 3 below.
Claim detection and categorisation
Two researchers applied the INFORMAS taxonomy inde-
pendently and their decisions were compared (see below).
Use of this ‘expert’taxonomy in the study does not imply
that consumers would identify and classify health and
nutrition claims in the same way. Little is known about the
way consumers would classify claims into health and
nutrition claims and their different types if asked to do so.
Health or nutrition claims (as defined above) may take
the form of text (e.g. single words, phrases or sentences),
brand names (e.g. ‘Healthy Choices’), a symbol, logo or
picture (e.g. representing a party of the body or a bodily
process), or a prominent web address promising nutri-
tional advice (because we thought that the presence of
such a web address implies that the product is generally
healthy). In line with the INFORMAS taxonomy the fol-
lowing were not considered to be health or nutrition
claims:
∙the terms ‘natural’,‘organic’and ‘Halal’;
∙information on the absence of additives, preservatives,
colourings and flavourings;
∙allergy advice (e.g. ‘contains nuts’);
∙statements in relation to specific diets (e.g. dairy and/or
lactose free; wheat and/or gluten free; vegetarian or
vegan);
∙storage advice (e.g. ‘stays fresh for longer’);
∙reference to the presence of a ‘food or food group’in
the product that does not state, suggest or imply a health
benefit (e.g. ‘contains chocolate’);
∙advertising in relation to sport (e.g. ‘official product of
the Olympics’) or to health concerns unrelated, or only
loosely related, to a healthier diet (e.g. ‘supporting
breast cancer research’); and
∙nutrition labelling, either back-of-pack or front-of-pack
(e.g. traffic-light labelling for specific nutrient levels).
Claims were included if they could be observed on any
surface of the packaging which is observable to the pur-
chaser. Claims were not included if they could only be
observed once the packaging had been opened.
Health and nutrition claims were further categorised
according to the nutrient or other food component to which
they referred. Nutrient and other function claims were also
categorised according to their health-related function or
structure as classified by the International Classification of
Functioning, Disability and Health (ICF)
(18)
and reduction of
disease risk claims were categorised according to the
International Classification of Diseases (ICD)
(19)
.
Inter-rater reliability for the detection and
categorisation of claims
Inter-rater reliability was assessed for: (i) level of agree-
ment on whether the product packaging contained a
health or nutrition claim or not; and (ii) level of agreement
on how claims were categorised using the INFORMAS
taxonomy. For both of these levels, inter-rater reliability
was assessed using kappa scores generated with the sta-
tistical software package Stata version 11. All disagree-
ments were then discussed between the study co-authors
to reach agreement as to whether the text or graphic
should be considered as a health or nutrition claim, and
the claim category in which it should be included.
Comparison of the healthiness of products with or
without claims
First, the healthiness of products with or without claims
was examined by comparing the difference in mean levels
Public Health Nutrition
Health and nutrition claims in the UK 3
of energy, protein, carbohydrates, sugars, fat, saturated fat,
fibre and sodium (per 100 g, generally as sold) between
products that carried claims and those that did not, for all
products and for different food categories, using ttests.
The nutrients (plus energy) were selected because their
values were available through the Tesco website and are
commonly found in nutrient declarations under EU law
(16)
.
Differences in nutrient levels shown by these ttests
could be due to confounding by product group because
different product groups were found to have a different
prevalence of claims and have different nutritional
properties. For this reason a regression analysis was
conducted where the results were adjusted for the five
broad product groups shown in Table 3. For each nutrient,
two regression models were run: (i) model 1 which did not
adjust for product group (and therefore produces results
that are comparable to the results of the ttests); and
(ii) model 2 which did adjust for product group.
Second, the healthiness of foods with or without claims
was examined using a nutrient profile model: the NPSC.
Foods that do not meet the model’s criteria would not be
permitted to carry health claims in Australia and New
Zealand. The model was applied using Stata version 11
and a logistic regression was conducted to determine the
likelihood that a food carrying a claim would meet the
model’s criteria.
Results
Missing data
Eighteen out the 400 products sampled were unavailable for
purchase; therefore 382 products were collected and ana-
lysed. Twenty-eight products did not have any nutritional
information. These products were included in the claim
extraction phase but were not included when assessing the
healthiness of products carrying claims. An additional
twenty-three products had incomplete nutritional informa-
tion (one nutrient or more missing) and were included only
in the analyses for which data were available.
Research question 1: are health and nutrition
claims easily identified and categorised?
Table 1 shows that there was good agreement between
the two researchers over whether or not a food carried a
health claim or nutrition claim. Table 1 also shows that for
some health and nutrition claims there was more agree-
ment over their type than for others. For example, there
was very good agreement over the classification of
nutrient comparative claims but less good agreement over
the classification of health-related ingredient claims.
Nutrient comparative claims and reduction of disease risk
claims had the highest percentage agreement (>99 %).
Research question 2: what is the prevalence of
health and nutrition claims for packaged foods
and non-alcoholic beverages sold by Tesco
in the UK?
Table 2 shows that nutrition content claims were the most
frequent type of claim (sixty-three products with a total of
eighty-seven claims), while reduction of disease risks
claims were the least common claim type (three products
and a total of four claims). Table 2 also shows that in total,
32 % (95 % CI 28, 37 %) of products carried either a health
or nutrition claim, with 15 % (95 % CI 11, 18 %) of products
carrying at least one health claim and 29 % (95 % CI 25,
34 %) carrying at least one nutrition claim. On the 123
products that carried claims in our sample, we found a
total of 263 claims, an average of 2·1 claims per product
carrying a claim. Dairy products and beverages were the
product categories most likely to carry both health and
nutrition claims (Table 3).
Nutrients and ingredients referred to in health and
nutrition claims
Table 4 shows that of the 172 different nutrition claims the
most common nutrient or ingredient referred to was fat
(e.g. ‘less than 2 % fat’) followed by fruit and vegetables
(e.g. ‘contains one of your five-a-day’). Nutrition claims
that referred to nutrients that, at high levels of intake, can
Public Health Nutrition
Table 1 Inter-rater reliability across the presence and categorisation of claims on a random sample of food and non-alcoholic beverage
products available through the website of a national UK food retailer (Tesco), November 2011–March 2012
Agreement type Agreement (%) Expected agreement (%) κProb >Z
Presence of claims on the 382 products
Health or nutrition claim 92 59 0·80 <0·001
Nutrition claim 91 59 0·78 <0·001
Health claim 91 75 0·65 <0·001
Claim categorisation of the 274 claims identified by at least one researcher
Nutrition claim 82 51 0·65 <0·001
Nutrient content claim 89 60 0·77 <0·001
Nutrient comparative claim 99 89 0·87 <0·001
Health-related ingredient claim 85 65 0·58 <0·001
Health claim 84 60 0·60 <0·001
General health claim 86 65 0·60 <0·001
Nutrient or other function claim 97 93 0·66 <0·001
Reduction of disease risk claim 99 97 0·66 <0·001
4 A Kaur et al.
have a damaging effect on health (e.g. fat, sugar or
sodium) were more frequent (55 %) than nutrition claims
that referred to nutrients with a beneficial impact such as
fibre and protein (38 %). Health claims frequently did not
refer to a specific nutrient or ingredient. In fact, 70 % of
health claims did not do so (e.g. ‘healthy and delicious’).
Diseases and health-related functions and
structures referred to in health claims
Throughout the entire project, there were four disease risk
reduction claims identified. All four of these related to the
reduction of risk of CVD (Chapter I51·6 of ICD-10)
(19)
. The
twelve nutrient and other function claims referred to a
broad range of health-related functions and structures
(Table 5).
Research question 3: do products that carry health
or nutrition claims have a better nutritional profile
than products that do not carry such claims?
Table 6 shows the difference in the amount of selected
nutrients between products that carry claims and those
that do not using regression analysis. The results of
model 1 indicate that, across the board, products
with health claims were significantly lower in energy
density (232·6 kJ/100 g), fat (6·7 g/100 g), saturated fat
(3·1 g/100 g) and sodium (152·8 mg/100 g). When adjusted
for product group in model 2, the differences in fat and
saturated fat were smaller (5·7 g/100 g and 3·0 g/100 g,
respectively) but remained significant. The differences for
energy and sodium disappeared and a significant differ-
ence in fibre content appeared. A similar pattern of
differences was observed for nutrition claims.
Products carrying health claims were 61 % more likely
to meet the NPSC model criteria than products that did not
carry such claims; a difference that was reduced after
adjusting for product group (53 %). However these
differences were not statistically significant. Products
carrying nutrition claims were significantly more (18 %)
likely to pass the NPSC model criteria. This difference was
increased after adjusting for product group (22 %).
Of the products that did not carry any health or nutrition
claims, 51 % (95 % CI 46, 56 %) met the NPSC model
criteria, while 62 % (95 % CI 49, 76 %) of the products
carrying health claims and 66 % (95 % CI 57, 75 %) of
products carrying nutrition claims did so.
Table 7 shows that the main categories responsible for
the differences in fat and saturated fat between foods with
and without claims were ‘Fish, meat and ready meals’and
‘Milk and dairy products’. It is products in the ‘Fruit,
vegetable and grain-based products’category which were
responsible for the differences in fibre content.
Discussion
The present study found that health and nutrition claims
can be relatively easily identified and categorised. It also
found that nutrition claims are almost twice as common as
health claims (29 % of products carried at least one
nutrition claim compared with 15 % of products carrying at
least one health claim). In addition it was found that the
nutrient profile of products carrying claims tends to be
healthier, in some respects (e.g. in their fat and saturated
fat content), than that of products not carrying claims.
We have not yet done a systematic review of previous
studies of the prevalence of health and nutrition claims, so
here we compare our results with three selected recent
studies
(20–22)
. Our study found a higher prevalence of
health claims than the EU-funded project ‘Food labelling to
advance better education for life’(FLABEL)
(21)
but a lower
prevalence than the surveys carried out in Australia
(20)
and
Ireland
(22)
.
The UK arm of the FLABEL study found that health
claims and health logos are found on only a small
percentage of products (e.g. it found that only 4–6% of
products carried health claims, including symbolic health
claims). However, the FLABEL study did not randomly
sample across all product categories and instead focused
only on five (breakfast cereals, soft drinks, biscuits,
yoghurts and pre-packed fresh ready meals). Furthermore,
in the FLABEL study the researchers were not required to
record the wording of any claims for further analysis.
Public Health Nutrition
Table 2 Prevalence of health and nutrition claims on a random sample of food and non-alcoholic beverage products (n382) available
through the website of a national UK food retailer (Tesco), November 2011–March 2012
Claim type
No. of products
with claims No. of claims
% of products with
claims
95 % CI for % of products
with claims
Nutrition claim 111 172 29·124·5, 33·6
Nutrient content claim 63 87 16·512·8, 20·2
Nutrient comparative claim 17 18 4·52·4, 6·5
Health-related ingredient claim 59 68 15·411·8, 19·1
Health claim 56 91 14·711·1, 18·2
General health claim 46 75 12·08·8, 15·3
Nutrient or other function claim 10 12 2·61·0, 4·2
Reduction of disease risk claim 3 4 0·80·0, 1·7
Health or nutrition claim 123 263 32·227·5, 36·9
Health and nutrition claims in the UK 5
Public Health Nutrition
Table 3 Prevalence of claims, by product category, on a random sample of food and non-alcoholic beverage products (n382) available through the website of a national UK food retailer (Tesco),
November 2011–March 2012
Description FoodEx2 categories
No. of
products
No. of
products with
health claims
%of
products with
health claims
95 % CI for % of
products with
health claims
No. of products
with nutrition
claims
% of products
with nutrition
claims
95 % CI for % of
products with
nutrition claims
No. of
health
claims
No. of
nutrition
claims
Beverages Coffee, cocoa, tea and infusions
Fruit and vegetable juices and
nectars
Water and water-based beverages
36 10 27·813·1, 42·41952·836·5, 69·11626
Fruit, vegetable
and grain-
based products
Fruit and fruit products
Vegetables and vegetable products
Starchy roots or tubers and products
thereof, sugar plants
Grains and grain-based product
129 16 12·46·7, 18·13627·920·2, 35·62457
Fish, meat and
ready-meals
Fish, seafood, amphibians, reptiles
and invertebrates
Meat and meat products
Composite dishes
105 10 9·53·9, 15·11716·29·1, 23·21722
Milk and dairy
products (incl.
dairy imitates)
Milk and dairy products
Products for non-standard diets, food
imitates and food supplements or
fortifying agents
39 12 30·816·3, 45·32256
·440·8, 72·02038
Miscellaneous
foods
Animal and vegetable fats and oils
Sugar, confectionery and water-
based sweet desserts
Seasoning, sauces and condiments
73 8 11·03·8, 18·11723·313·6, 33·01430
TOTAL 382 56 14·711·1, 18·3 111 29·124·6, 33·7 91 173
6 A Kaur et al.
The Australian survey
(20)
reported a higher prevalence
of health and nutrition claims than our study but did not
randomly sample across all food categories and instead
concentrated on three product groups known to carry a
high number of health claims. Similarly a survey of health
claims in Ireland
(22)
found that 18 % of products carried a
health claim and that 47 % of products carried a nutrition
claim; however, the study used a convenience sample that
covered only a small number of product categories.
In the present study we found that some types of health
and nutrition claims were relatively easy to identify –
particularly nutrient content claims, nutrient comparative
claims and reduction of disease risk claims. However,
health-related ingredient claims and general health claims
were more difficult to identify and categorise. These
problems have not been identified or quantified in
previous studies.
Even using a predefined and agreed approach and a
clear taxonomy, there were still disagreements on
approximately one in ten products. There were also types
of text and graphics that do not seem to have been
anticipated by Codex or EU legislators. For example: does
a website address that offers healthy eating advice
constitute a health claim? We have taken it that it does.
The present study benefited from using a previously
developed taxonomy based on international (Codex)
Public Health Nutrition
Table 4 Nutrients and ingredients referred to in health and nutrition claims on a random sample of food and non-alcoholic beverage products
(n382) available through the website of a national UK food retailer (Tesco), November 2011–March 2012
Nutrition claims % of all nutrition claims Health claims % of all health claims
Nutrient
Energy 8 5 7 8
Protein 3 2 2 2
Sugar/sugars 12 7 0 0
Fat 45 2 6 0 0
Saturated fatty acids 11 6 1 1
Omega 3 fatty acids 2 1 1 1
Fibre 17 10 3 3
Beta-glucan 0 0 1 1
Sodium/salt 6 3 0 0
Cholesterol 1 1 1 1
Folic acid 1 1 0 0
Vitamin C 2 1 0 0
Vitamin D 2 1 0 0
Phosphorus 1 1 0 0
Calcium 7 4 2 2
Magnesium 1 1 0 0
Nitrite 1 1 0 0
Multiple nutrients 11 6 3 3
Ingredient
Caffeine 3 2 0 0
Fruit and vegetables 23 13 0 0
Wholegrain 7 4 3 3
Other ingredients 4 2 3 3
Unspecified nutrient or ingredient 4 2 64 70
TOTAL 172 100 91 100
Table 5 Health-related functions and structures referred to in nutrient or other function claims on a random sample of food and non-alcoholic
beverage products (n382) available through the website of a national UK food retailer (Tesco), November 2011–March 2012
Health-related functions Health-related structures Example No.
Mental functions (B1) Structures of the nervous system (S1) 0
Sensory functions and pain (B2) The eye, ear and related structures (S2) 0
Voice and speech functions (B3) Structures involved in voice and speech
(S3)
‘So sip on soya and help build stronger
teeth’
3
Functions of the cardiovascular, haematological,
immunological and respiratory systems (B4)
Structures of the cardiovascular,
immunological and respiratory systems
(S4)
‘Oats contain soluble oat fibre which is
proven to be good for your heart’
7
Functions of the digestive, metabolic and
endocrine systems (B5)
Structures related to the digestive,
metabolism and endocrine systems
(S5)
‘Dairy free soya drink is naturally kind
on tummies’
2
Genitourinary and reproductive functions (B6) Structures related to genitourinary and
reproductive system (S6)
0
Neuromusculoskeletal and movement-related
functions (B7)
Structures related to movement (S7) 0
Functions of the skin and related structures (B8) Skin and related structures (S8) 0
Health and nutrition claims in the UK 7
definitions. This taxonomy has been developed by
the INFORMAS project
(10)
. In addition, internationally
recognised methods for categorising foods (FoodEx2)
(17)
,
diseases (ICD-10)
(19)
and health-related functions and
structures (ICF)
(18)
were used for the analysis of the
results.
Unlike most previous studies of the prevalence of health
and/or nutrition claims
(20–22)
or food labelling elements in
Public Health Nutrition
Table 7 Difference in nutritional quality for products carrying health or nutrition claims compared with those that do not carry health or
nutrition claims, by product category, for a random sample of food and non-alcoholic beverage products (n382) available through the website
of a national UK food retailer (Tesco), November 2011–March 2012
Category
Beverages
(n36)
Fruit, vegetable and
grain-based products
(n129)
Fish, meat and ready
meals (n105)
Milk and dairy products
(including imitates) (n39)
Miscellaneous
foods (n73)
Diff. PDiff. PDiff. PDiff. PDiff. P
Health claims
Energy (kJ/100 g) +214·70·237 +239·20·165 −294·90·035** −519·70·005 −398·30·215
Protein (g/100 g) +2·00·244 +2·80·024** +0·60·801 −3·80·245 +10·00·025**
Carbohydrates (g/100 g) +7·60·284 +16·30·010** −1·90·591 −4·50·140 +2·70·817
Sugars (g/100 g) +5·40·192 +5·60·221 −0·30·636 −2·70·208 −14·30·115
Fat (g/100 g) +1·40·258 −2·80·332 −7·40·030** −10·20·014** −10·00·177
Saturated fat (g/100 g) +1·30·124 −1·20·320 −2·40·124 −6·30·018** −7·00·118
Fibre (g/100 g) +0·90·090 +2·40·001** −0·20·582 +0·30·112 −1·00·481
Sodium (mg/100 g) +120·90·121 −33·80·538 −215·00·059 −104·30·265 −252·80·441
Nutrition claims
Energy (kJ/100 g) +77·20·658 −68·70·592 −211·90·059 −692·00·000** −402·00·092
Protein (g/100 g) +0·90·604 +0·40·682 +2·20·219 −5·80·053 +3·50·303
Carbohydrates (g/100 g) +3·10·654 +2·70·567 −3·70·199 −3·30·250 −12·60·139
Sugars (g/100 g) +4·00·332 −1·90·577 −0·30·551 −0·80·700 −13·90·041**
Fat (g/100 g) +0·50·658 −3·90·065 −5·10·063 −14·40·000** −4·50·414
Saturated fat (g/100 g) +0·80·332 −2·50·005** −2·30·065 −9·70·000** −3·40·318
Fibre (g/100 g) +0·80·121 +1·50·009** −0·20·571 −0·10·637 −0·10·940
Sodium (mg/100 g) +92·20·232 −5·30·900 +20·70·818 −169·40·054 −222·60·367
Diff., difference; + denotes an increase; −denotes a reduction.
** P<0·05.
Table 6 Difference in nutritional quality for products carrying health or nutrition claims compared with those that do not carry health or
nutrition claims for a random sample of food and non-alcoholic beverage products (n382) available through the website of a national UK food
retailer (Tesco), November 2011–March 2012
Model 1 Model 2
Nutrient Diff. PDiff. P
Health claims
Energy (kJ/100 g) −232·60·02 −118·10·20
Protein (g/100 g) + 1·10·39 + 2·10·06
Carbohydrates (g/100 g) +1·50·70 +5·30·09
Sugars (g/100 g) −0·60·79 −0·40·86
Fat (g/100 g) −6·70·00** −5·70·00**
Saturated fat (g/100 g) −3·10·00** −3·00·00**
Fibre (g/100 g) +0·30·44 +0·70·05**
Sodium (mg/100 g) −152·80·02** −97·50·14
NPSC odds ratio†1·61 0·118 1·53 0·182
Nutrition claims
Energy (kJ/100 g) −310·60·00** −235·40·00**
Protein (g/100 g) −0·90·37 +0·50·58
Carbohydrates (g/100 g) −3·80·20 −2·30·36
Sugars (g/100 g) −2·30·23 −3·20·08
Fat (g/100 g) −6·10·00** −5·30·00**
Saturated fat (g/100 g) −3·20·00** −3·30·00**
Fibre (g/100 g) +0·20·55 +0·50·07
Sodium (mg/100 g) −115·70·03** −56·20·30
NPSC odds ratio†2·18 0·001** 2·22 0·002**
Model 1, no adjustment for food groups; model 2, adjustment for food groups; Diff., difference; NPSC, Nutrient Profiling Scoring Criterion; + denotesan
increase; −denotes a reduction.
** P<0·05.
†These results were calculated through a logistic regression analysis and report the odds that a product carrying a claim passes the NPSC model before
(model 1) and after (model 2) adjusting for food groups.
8 A Kaur et al.
general, the present study used a random sample of
products across the majority of food categories, from a
defined ‘population’of foods. While sampling a broad
range of products is more costly and time-consuming than
sampling specific food categories, it gives a more com-
plete picture of the prevalence of food labelling elements.
However, it should be noted that the sampling methods
used for our study did not generate a representative
sample of all products available for purchase in the UK as
products were sampled from just one supermarket (albeit
the one with the largest market share). While it has been
estimated that up to 90 % of food purchases in the UK are
made in supermarkets
(23,24)
, it might be expected that
foods sold in other types of stores would have a higher
prevalence of health claims (e.g. health food shops) or a
lower prevalence (e.g. discount stores)
(15)
.
Another potential weakness of the study is that the
nutrient profilemodelusedtoassessthehealthinessof
products with and without claims –the NPSC –was devel-
oped for use in Australia and New Zealand and the present
studyinvestigatedproductssoldintheUK.Howeverit
should be noted that that NPSC model is a modified version
of a nutrient profile model first developed in the UK
(25,26)
.
The statistical power of our study was set to estimate the
prevalence of health and nutrition claims in the total
population of 13 700 products with an accuracy of ±5%,
but the study is under-powered to estimate differences in
prevalence between food categories and under-powered
to detect small differences in nutrient content between
products that carry and those that do not carry claims.
Our study found what to some might seem to be a sur-
prisingly high prevalence of health and nutrition claims on
the packaging of foods and non-alcoholic beverages sold
though a major retailer in the UK. This high prevalence, in
and of itself, suggests that health and nutrition claims are
important ways of marketing such products to consumers. If
this marketing is effective, there may be important public
health implications to justify the regulation of claims.
The current study also confirms that nutrition claims
appear much more frequently than health claims. How-
ever, much more attention has been paid to the regulation
of health claims –and in particular the comparatively rare
forms of health claims, i.e. nutrient and other function
claims and disease risk reduction claims –than to the
regulation of nutrition claims.
One of the reasons why we identified a high prevalence
of health claims was due to our inclusion of general health
claims such as ‘healthy’,‘good for you’,‘full of goodness’
and ‘consume responsibly as part of a healthy diet’, within
the category of health claims. Over 80 % of health claims in
our study were classified as general health claims
(seventy-five claims on forty-six products). In the future,
such claims will only be permitted in the UK if accom-
panied by a more specific claim. The EU regulation on
health and nutrition claims specifies that, from 24 January
2013 (i.e. after the data for the present study were
collected), ‘Reference to general, non-specific benefits of
the nutrient or food for overall good health or health-
related well-being may only be made if accompanied by a
specific health claim included in the lists provided for in
Article 13 or 14’. It will be interesting to see whether the
prevalence of general health claims changes in the light of
the implementation of the legislation.
Conclusions
The present study has also shown that, in general,
products that carry health and nutrition claims have a
slightly more favourable nutritional profile than those that
do not. The main differences were in fat and saturated fat.
However, it is difficult to say whether these differences
were ‘clinically relevant’. For example, products carrying
health and nutrition claims had a fat content that was 6 g
per 100 g less than products without claims but it is this
enough to justify such claims? At this point we are not clear
how best to judge whether our results are ‘clinically rele-
vant’or not. We think modelling the health effects of
consuming products with and without claims could
provide some answers but currently we do not have
enough data to parameterize a model.
As noted above, the EU regulation
(9)
proposes that there
should be a nutrient profile model which sets minimal
quality criteria for the nutrition content of products bearing
health or nutrition claims. Had the results revealed that
products bearing health or nutrition claims were less
healthy than products not bearing health or nutrition
claims then they would have demonstrated a clear need
for further regulation to ensure a minimum nutritional
quality for products that carry health or nutrition claims.
Our observation that products bearing health or nutrition
claims are slightly healthier than foods not bearing claims
might imply, on the one hand, that there is no need for
such a nutrient profile model or, on the other, that the
difference is so slight that a model is urgently required.
There is a need for further research that addresses the
impact of potential nutrient profile models to regulate
health and nutrition claims. Also, more work is required to
understand consumer perception and reactions to health
and nutrition claims to ascertain whether these claims are
informative or misleading.
Acknowledgements
Acknowledgements: The authors thank Sophie Hieke of
the CLYMBOL project and Amanda Wood for their help in
developing some of the concepts in this paper. Financial
support: This research received no specific grant from any
funding agency in the public, commercial or not-for-profit
sectors. A.K., P.S., A.Ma., A.Mi. and M.R. are funded by the
British Heart Foundation; S.P. received no specific funding
Public Health Nutrition
Health and nutrition claims in the UK 9
for this project. Conflict of interest: None. Authorship:
A.K.: development of methods, data extraction, data ana-
lysis, writing paper. P.S.: development of methods, writing
paper. A.Ma.: development of methods, data collection
and extraction, feedback on paper. S.P.: development of
methods, data extraction, feedback on paper. A.Mi.: data
analysis, feedback on paper. M.R.: development of
methods, feedback on paper. Each author has seen and
approved the contents of the submitted manuscript. Ethics
of human subject participation: Ethical approval was not
required.
Supplementary material
To view supplementary material for this article, please visit
http://dx.doi.org/10.1017/S1368980015002104
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