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Food reformulation and nutritional quality of food consumption: an analysis based on households panel data in France

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Background/objectives: We aimed to quantify the contribution of food reformulation to changes in the nutritional quality of consumers' food purchases, and compare it with the impact of substitutions made by consumers. Subjects/methods: Using a brand-specific data set in France, we considered the changes in the nutrient content of food products in four food sectors over a 3-year period. These data were matched with data on consumers' purchases to estimate the change in the nutritional quality of consumers' purchases. This change was divided into three components: the reformulation of food products, the launching of new products and the consumers' substitutions between products. Key nutrients were selected for each food group: breakfast cereals (sugar, fats, SFA, fiber, and sodium), biscuits and cakes (sugar, fats, SFA, and fiber), potato chips (fats, SFA, and sodium) and soft drinks (sugar). Results: Product reformulation initiatives have improved existing products for most food group-nutrient pairs. In particular, the contribution of food reformulation to the change in nutritional quality of food purchases was strong in potato chips (the sales-weighted mean SFA and sodium contents decreased by 31.4% to 52.1% and 6.7% to 11.1%, respectively), and breakfast cereals (the sales-weighted mean sodium content decreased by 7.3% to 9.7%). Regarding the launching of new products, the results were ambiguous. Consumers' substitutions between food items were not generally associated to an improvement in the nutritional quality of the food purchases. Conclusions: Policies aiming to promote food reformulation may have greater impact than those promoting changes in consumer behavior.
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European Journal of Clinical Nutrition (2018) 72:228235
https://doi.org/10.1038/s41430-017-0044-3
ARTICLE
Food reformulation and nutritional quality of food consumption: an
analysis based on households panel data in France
Marine Spiteri1Louis-Georges Soler2
Received: 10 May 2017 / Revised: 12 September 2017 / Accepted: 8 October 2017 / Published online: 22 December 2017
© The Author(s) 2018. This article is published with open access
Abstract
Background/objectives We aimed to quantify the contribution of food reformulation to changes in the nutritional quality of
consumersfood purchases, and compare it with the impact of substitutions made by consumers.
Subjects/methods Using a brand-specic data set in France, we considered the changes in the nutrient content of food
products in four food sectors over a 3-year period. These data were matched with data on consumerspurchases to estimate
the change in the nutritional quality of consumerspurchases. This change was divided into three components: the refor-
mulation of food products, the launching of new products and the consumerssubstitutions between products. Key nutrients
were selected for each food group: breakfast cereals (sugar, fats, SFA, ber, and sodium), biscuits and cakes (sugar, fats,
SFA, and ber), potato chips (fats, SFA, and sodium) and soft drinks (sugar).
Results Product reformulation initiatives have improved existing products for most food group-nutrient pairs. In particular,
the contribution of food reformulation to the change in nutritional quality of food purchases was strong in potato chips (the
sales-weighted mean SFA and sodium contents decreased by 31.4% to 52.1% and 6.7% to 11.1%, respectively), and
breakfast cereals (the sales-weighted mean sodium content decreased by 7.3% to 9.7%). Regarding the launching of new
products, the results were ambiguous. Consumerssubstitutions between food items were not generally associated to an
improvement in the nutritional quality of the food purchases.
Conclusions Policies aiming to promote food reformulation may have greater impact than those promoting changes in
consumer behavior.
Introduction
To promote healthier diets, two types of interventions are
generally considered. The rst one aims at increasing con-
sumersawareness of the relationship between food and
health, through information and education campaigns. Prior
literature shows that these policies have positive albeit small
effects. The second type of intervention aims at improving
the food environment of consumers [1,2] in order facilitate
healthy choices. The reformulation of food products,
through the decrease in salt, fat or sugar contents, is an
example of this type of intervention made to favor a better
food environment [38]. In many countries, public health
agencies implement partnerships with the food industry and
the retail sector in order to improve the nutritional quality of
foods available on the market [913].
What can we expect from such policies focusing on the
supply side? The potential impact of food reformulation
initiatives on consumersintakes and public health has been
investigated in recent studies. Based on simulations, refor-
mulation scenarios related to salt [1418] or trans fats [19]
contents in foods, or based on the adoption of quality
standards by the food industry [2025], show that the
modication of the nutritional quality of foods may poten-
tially induce signicant health benets.
However, considering the available literature, it is worth-
while to note that most articles address the effects of
‘‘potential’’ changes in food quality and are based on refor-
mulation scenarios and simulations rather than ‘‘real’’ changes
implemented by the food industry. The reason that most
*Louis-Georges Soler
louis-georges.soler@inra.fr
1Toulouse School of Economics, INRA, University of Toulouse
Capitole, Toulouse, France
2INRA-Aliss UR 1303, 65 Boulevard de Brandebourg, 94205
Ivry sur Seine, France
1234567890
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articles address potential reformulation scenarios is linked to
the lack of precise data on quality changes and reformulation
initiatives implemented by the food industry [26,27].
Recently, however, such data sets have been developed in
some countries [2830], enabling researchers to evaluate not
only ‘‘potential’’ scenarios of food reformulation but also real
changes implemented by the food industry.
Based on data collected in France, the aim of this
article is to contribute to estimating the magnitude of refor-
mulation efforts implemented by the food industry and
quantifying their impact on the nutritional quality of con-
sumer purchases.
Methods and data
The changes in consumersnutrient intakes between two
dates may result from changes in consumption patterns
(consumer purchases switch from some products to others)
or changes in the quality of the food products available on
the market. These changes on the supply side can be caused
by the launching of new products and the removal of old
products or the reformulation (i.e., the change in the nutri-
tional composition) of already existing products. In order to
analyze the changes in salt intakes in the U.K., a recent
article [28] proposed a method to quantify these three
effects. Longitudinal data on the contents of the grocery
baskets of a nationally representative sample of households
showed that the average salt content of grocery purchases
fell by 5.1%, from 0.370 g in 2005 to 0.351 g in 2011. This
variation was divided into three components: reformulation
of existing food products by manufacturers, the net effect of
the launching/removal of products, and consumer switching
between products. We applied a similar method in France
by focusing on four specic food groups and considering a
larger set of key nutrients.
A focus on four food sectors
Four food groups were considered (breakfast cereals, biscuits
and cakes, potato chips, and soft drinks) for two reasons.
First, these food groups are strong contributors to the intake
of some nutrients that the French public health agency
recommends limiting (See https://www.anses.fr/fr/content/l%
E2%80%99anses-actualise-les-rep%C3%A8res-de-
consommations-alimentaires-pour-la-population-fran%C3%
A7aise). Second, voluntary commitments to food reformu-
lation have been taken by several companies involved in
these sectors (See http://solidarites-sante.gouv.fr/prevention-
en-sante/preserver-sa-sante/le-programme-national-nutrition-
sante/article/les-signataires-des-chartes-d-engagements-de-
progres-nutritionnels and http://agriculture.gouv.fr/alimenta
tion/accords-collectifs-pour-lamelioration-de-loffre-alimenta
ire). Data on the nutritional content of food products were
obtained from the French Food Quality Observatory (See
www.oqali.fr/oqali_eng/) (Oqali). The Oqali database is
brand-specic and is specically designed to follow, over
time, the changes in the nutrient contents of products sold on
the French market. Depending on the food groups, data were
rst collected between 2008 and 2010, and the same protocol
was repeated in 2011 or 2013 so that the observation period
covered two or 3 years. Key nutrients were selected for each
food category: sugar, fats, saturated fats (SFA), ber, and
sodium for breakfast cereals; sugar, fats, saturated fats, and
ber for biscuits and cakes; fats, saturated fats, and sodium
for potato chips; and sugar for soft drinks. Table 1displays
the number of products considered in each food category, the
covered market shares and the initial and second dates of data
collection. Within each food category, the sampled food
products were partitioned into three subgroups: products
removed from the market between t0and t1(Group X), paired
products present on the market at both t0and t1(Group C),
and new products launched before t1(Group N). Food
composition data were matched with purchase data from
Kantar Worldpanel (The Kantar Worldpanel database pro-
vides details on the quantities bought and the corresponding
food expenditures by a representative panel of 20,000
households in France) to compute the market share of each
product at dates t0and t1(The use of nutritional data was
approved by the steering committee of Oqali. We did not
have to ask for an ethical agreement as the food purchase
data were anonymous).
Decomposing the contributions of the food industry
and consumer behavior changes
To measure the evolution of the nutritional quality of food
purchases, we considered the changes in the sales-weighted
average content of key nutrients between dates t0and t1in
each food group. To disentangle the effects of changes on
the supply side from those on the consumer side, we used
the method proposed by Grifth et al. [28]. Let us denote St
as the sales-weighted mean content of a specic key
nutrient for one food group at time t. This value is given at
t0and t1by
St0¼P
i
wit0sit0
St1¼P
i
wit1sit1
where iindexes individual food products, wit0is the market
share of the food product iat t0, and sit0denotes the content
of a given nutrient of the food product iat t0(similar
notation applies for t1). The change in the sales-weighted
mean content of a specic key nutrient between t0and t1is
dened as ΔS¼St1St0. The decomposition into supply
Food reformulation and nutritional quality of food consumption 229
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and demand effects is given by
ΔS¼X
i2C
wit0sit1sit0
ðÞ ð1Þ
þX
i2N
wit1sit1Sto
ðÞ
X
i2X
wit0sit0St0
ðÞ ð2Þ
þX
i2C
sit0St0
ðÞwit1wit0
ðÞþ
X
i2C
sit1sit0
ðÞwit1wit0
ðÞ
ð3Þ
In this expression, the rst term (1) accounts for the
effect of food reformulation carried out on products col-
lected at both t0and t1considering their market share at t0.
Thus, the contribution of a reformulated product to this term
will be greater if its market share at t0is high. The second
term (2) captures the impact of product renewal, more
precisely, the entry of products to the market or their
withdrawal between t0and t1. This term takes into account
the nutrient content of the new products or the removed
products (compared with the overall sales-weighted mean
nutrient content at t0) and their market shares. Thus, for
example, a new product with high sugar content will
increase the sales-weighted mean sugar content of the food
group. This effect will be more important if its market share
is high. The last term (3) reects consumer switching inside
group C (products collected at both t0and t1):
The sub-term P
i2C
sit0St0
ðÞwit1wit0
ðÞrepresents the
contribution of a change in the market share of a
product between t0and t1. For example, if consumers
shift toward products that have high sugar content
(compared with the sales-weighted mean sugar content
of the food group at t0), this step will raise the overall
sales-weighted mean sugar content.
The sub-term P
i2C
sit1sit0
ðÞwit1wit0
ðÞcaptures the
cross effect of changes in the nutrient content
and in the market shares of group C products. For
example, if consumers shift towards products that are
reformulated to have less sugar, this term will be
negative.
Data processing
The algorithm presented above is valid if the total market
shares covered at t0and t1are equal to 100% and the
nutritional composition of the sampled products is known.
This scenario is not exactly the case, as the Oqali samples
do not cover 100% of the sales volume. Two scenarios of
data processing, based on different assumptions, were
considered. A rst computation (scenario 1) was modeled
by assuming that the non-collected references had, on
average, the same characteristics as the whole sample and
followed the same evolution between t0and t1. This data
processing distorts the data less if the market coverage of
the samples studied is high and of the same order of mag-
nitude at t0and t1, and if the samples are representative of
the market at each time of data collection. A second com-
putation (scenario 2) was modeled by assuming that the
products that were not identied in the Oqali data set but
were present in the Kantar Worldpanel data set had, on
average, the same nutritional composition as the whole
sample and were stable over the period of observation.
Finally, missing nutrient composition data were inferred by
assuming that the products had not been reformulated.
Results
Figure 1displays the proportion of the three types of
products (X, C, and N) in each food group by applying
scenario 1. Around a quarter of the market was renewed
during the observation period. Tables 2to 5present the
effects of food reformulation, product renewal and con-
sumer switching. As expected, both scenarios led to similar
results, but the magnitude was lower with scenario 2, which
tends to overestimate the volumes of the group C products
and underestimate the magnitude of reformulation initia-
tives. In the following sections, the estimated effects of food
reformulation, product renewal and change in consumer
choice will be discussed as a range of results, with the low
range corresponding to the results obtained with scenario 2
and the high range corresponding to those obtained with
scenario 1.
Breakfast cereals
In the breakfast cereal sector, one can observe strong
changes in the sales-weighted average contents of fats and
saturated fats (+7.5 to 10.1% and +10.2 to 13.6%,
respectively). Evidently, it is consumer choices that mostly
15% of t market 21% of t market 9% of t market 5% of t market
-20%
0%
20%
40%
60%
80%
100%
Breakfast
cereals
Biscuits and
pastries
Potato chips Soft Drinks
New products
(group N)
Paired
products
(group C)
Removed
products
(group X)
74% 79%
64%
74%
26% 21%
36%
26%
Fig. 1 Partitioning of the samples into subgroups (in market shares)
230 M. Spiteri, L-G Soler
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explain the negative change, from a public health point of
view, of the weighted average contents of these nutrients.
One can also observe an interesting decrease in the sales-
weighted average sodium content in breakfast cereals (8.3
to 11.1%). This decrease is clearly the result of refor-
mulations that generated a 7.3 to 9.7% decrease in the
related mean sodium content, and to a lesser degree, con-
sumer switching (generated a 3.6 to 4.9% decrease). Con-
versely, the innovation/withdrawal effect partly offsets
these improvements, leading to a 2.6 to 3.5% increase in the
sales-weighted mean sodium content.
Finally, it appears that the sales-weighted average sugar
content slightly increased in breakfast cereals between t0
and t1(+0.5 to 0.7%). Despite some food reformulations
that led to decreases in the sales-weighted mean sugar
content by 2.3 to 3.0%, consumer switching and product
renewal resulted in an increase in the sales-weighted sugar
content.
Biscuits and cakes
Overall, in the biscuits and cakes sector, the changes in the
nutritional quality of food purchases between t0and t1were
small, except for SFA (the sales-weighted mean SFA con-
tent decreased by 2.4 to 3.7%).
Food reformulation and, to a lesser extent, consumer
switching contributed to decreasing the weighted mean SFA
content (by 1.9 to 2.7% and by 1.2 to 2.0%,
respectively). However, these improvements were partially
offset by product renewal, which led to an increase in the
related mean content of 0.7 to 1.0%.
Potato chips
In the potato chip sector, we observed very strong changes
in the sales-weighted average nutrient content in two cases:
sodium (the related mean content decreased by 10.2 to
12.6%) and SFA (the related mean content decreased by
47.4 to 58.5%). In both cases, these changes were mainly
due to the reformulation effect and, to a lesser degree
(approximately half the size), to the innovation/withdrawal
effect. Conversely, consumer switching weakened these
changes as they slightly increased the sales-weighted mean
contents of SFA (by 1.8 to 16%) and sodium (by 2.7% with
scenario 1). This difference is mainly explained by con-
sumers turning away from products that were reformulated
to have less SFA and sodium. However, according to the
innovation/withdrawal effect, it is worth noting that the
consumers switched toward new products with less sodium
and SFA.
Soft drinks
Finally, in the soft drink sector, it appears that the sales-
weighted average sugar content slightly decreased between
t0and t1. This decrease was clearly the result of the refor-
mulation effect that generated a 1.7 to 2.2% decrease and
the innovation/withdrawal effect that generated a 2.2 to
2.4% decrease in the weighted mean sugar content. Con-
versely, consumer switching offset these effects, leading to
a 3.8 to 4.4% increase in the sales-weighted mean sugar
content.
Discussion
In this study, we aimed to quantify the contribution of food
reformulation to changes in the nutritional quality of con-
sumer food purchases. We compared the contribution of
food reformulation to that of other factors affecting: the
renewal of products on the market and substitutions made
by consumers among existing products.
This study clearly has some limitations. The most
important one is linked to the non exhaustive coverage of
the products available on the market in the Oqali data set.
The algorithm used to decompose the variation of the
nutritional quality of food purchases into the three effects
presented above, imposed to have a full coverage of the
market at t0and t1. As it was not the case in our data set, we
had to make some assumptions about the nutritional content
of non-collected items. Two scenarios were considered.
Even if the magnitude of the effects differs depending on
the scenario, the results seem robust as the general con-
clusions are the same in both cases.
Overall, the results show that, in the four food groups,
product reformulation initiatives implemented by the food
Table 1 Characteristics of the samples of food products
Date t0Date t1
Year Number of products Covered market share (%) Year Number of products Covered market share (%)
Breakfast cereals 2008 254 75.1 2011 362 74.6
Biscuits and cakes 2008 1436 70.4 2011 1824 65.4
Potato chips 2009 135 60.4 2011 217 81
Soft drinks 2010 619 78.1 2013 1208 86.3
Food reformulation and nutritional quality of food consumption 231
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Table 2 Changes in the sales-weighted average content of key nutrients between dates t0and t1in Breakfast cereals
Breakfast cereals Weigthed average at t0Weigthed average at t1Variation of the weighted
average t1/t0
Reformulation New products and
product withdrawals
Consumers switching
(a)(b)(c)(d)(e)(f)
Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2
Sugar 27.7 27.9 27.8 0.7% 0.5% 3.0% 2.3% 1.4% 1.0% 2.4% 1.8%
Total fats 7.4 8.1 7.9 10.1% 7.5% 0.8% 0.6% 1.0% 0.8% 11.9% 9.0%
SFA 3.0 3.4 3.3 13.6% 10.2% 0.6% 0.4% 1.4% 1.0% 12.8% 9.6%
Fiber 5.1 5.1 5.1 1.4% 1.1% 2.9% 2.2% 5.1% 3.8% 0.8% 0.6%
Sodium 0.3 0.3 0.3 11.1% 8.3% 9.7% 7.3% 3.5% 2.6% 4.9% 3.6%
(a) Sales-weighted mean nutrient content at t0(g/100 g)
(b) Sales-weighted mean nutrient content at t1(g/100 g)
(c) Total change in the sales-weighted mean nutrient content between t0and t1(%)
(d) Contribution of reformulation of existing food products to changes in the sales-weighted mean nutrient content (%)
(e) Contribution of product renewal (launching/removal of products) to changes in the sales-weighted mean nutrient content (%)
(f) Contribution of consumers switching between existing products to changes in the sales-weighted mean nutrient content (%)
(c)=(d)+(e)+(f)
Table 3 Changes in the sales-weighted average content of key nutrients between dates t0and t1in Biscuits and Cookies
Cookies and biscuits Weigthed average at t0Weigthed average at t1Variation of the weighted
average t1/t0
Reformulation New products and
product withdrawals
Consumers switching
(a)(b)(c)(d)(e)(f)
Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2
Sugar 32.3 32.8 32.6 1.7% 1.1% 0.1% 0.1% 0.8% 0.5% 0.7% 0.5%
Total fats 18.9 18.8 18.9 0.5% 0.3% 1.2% 0.8% 0.2% 0.2% 0.9% 0.7%
SFA 9.4 9.1 9.2 3.7% 2.4% 2.7% 1.9% 1.0% 0.7% 2.0% 1.2%
Fiber 2.8 2.8 2.8 1.3% 0.9% 0.8% 0.6% 2.2% 1.4% 0.0% 0.0%
(a) Sales-weighted mean nutrient content at t0(g/100 g)
(b) Sales-weighted mean nutrient content at t1(g/100 g)
(c) Total change in the sales-weighted mean nutrient content between t0and t1(%)
(d) Contribution of reformulation of existing food products to changes in the sales-weighted mean nutrient content (%)
(e) Contribution of product renewal (launching/removal of products) to changes in the sales-weighted mean nutrient content (%)
(f) Contribution of consumers switching between existing products to changes in the sales-weighted mean nutrient content (%)
(c)=(d)+(e)+(f)
232 M. Spiteri, L-G Soler
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Table 4 Changes in the sales-weighted average content of key nutrients between dates t0and t1in Potato Chips
Potato chips Weigthed average at t0Weigthed average at t1Variation of the weighted
average t1/t0
Reformulation New products and
product withdrawals
Consumers switching
(a)(b) (c) (d)(e)(f)
Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2
Total fats 34.7 34.5 34.6 0.4% 0.4% 0.2% 0.1% 0.3% 0.4% 0.3% 0.1%
SFA 8.4 3.5 4.4 58.5% 47.4% 52.1% 31.4% 22.4% 17.7% 16.0% 1.8%
Sodium 0.7 0.6 0.6 12.6% 10.2% 11.1% 6.7% 4.2% 3.4% 2.7% 0.1%
(a) Sales-weighted mean nutrient content at t0(g/100 g)
(b) Sales-weighted mean nutrient content at t1(g/100 g)
(c) Total change in the sales-weighted mean nutrient content between t0and t1(%)
(d) Contribution of reformulation of existing food products to changes in the sales-weighted mean nutrient content (%)
(e) Contribution of product renewal (launching/removal of products) to changes in the sales-weighted mean nutrient content (%)
(f) Contribution of consumers switching between existing products to changes in the sales-weighted mean nutrient content (%)
(c)=(d)+(e)+(f)
Table 5 Changes in the sales-weighted average content of key nutrients between dates t0and t1in Soft drinks
Soft drinks Weigthed average at t0Weigthed average at t1Variation of the weighted
average t1/t0
Reformulation New products and product
withdrawals
Consumers switching
(a)(b)(c)(d)(e)(f)
Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2 Scenario 1 Scenario 2
Sugar 6.5 6.5 6.5 0.1% 0.1% 2.2% 1.7% 2.4% 2.2% 4.4% 3.8%
(a) Sales-weighted mean nutrient content at t0(g/100 g)
(b) Sales-weighted mean nutrient content at t1(g/100 g)
(c) Total change in the sales-weighted mean nutrient content between t0and t1(%)
(d) Contribution of reformulation of existing food products to changes in the sales-weighted mean nutrient content (%)
(e) Contribution of product renewal (launching/removal of products) to changes in the sales-weighted mean nutrient content (%)
(f) Contribution of consumers switching between existing products to changes in the sales-weighted mean nutrient content (%)
(c)=(d)+(e)+(f)
Food reformulation and nutritional quality of food consumption 233
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industry have improved existing products (available on the
market at t0and t1) for most targeted food group-nutrient
pairs (except for the sugar content of biscuits and cakes and
the total fat content of chips). It is likely that some of these
changes are linked to individual or collective agreements
implemented by the food industry and the French govern-
ment since 2008. In the breakfast cereal sector, for instance,
several agreements were signed between 2008 and 2011, in
which two large food manufacturers and several retailers
were involved. Another example is given by the potato
chips sector. The saturated fat levels in potato chips sharply
declined between 2009 and 2011, mainly thanks to refor-
mulations (which led to a 2.6 to 4.4 g/100 g decrease in
the sales-weighted average content of saturated fats in this
sector). This decrease was the result of a collective self-
action by the industry to replace the palm oil used for frying
chips with sunower oil, which contains less saturated fat.
In some cases, the magnitudes of the observed changes
seem to be modest, but it is important to keep in mind that
the period of observation was only 3 years.
Considering now the second effect related to the renewal
of the food supply, the results are more ambiguous. Indeed,
the launching of new products and the removal of existing
ones did not necessarily contribute to the improvement in
the nutritional quality of food purchases.
In the soft drink and potato chip sectors, the launching of
new products contributed to reducing the sales-weighted
mean content of ‘‘negative’’ nutrients. This effect con-
tributed to decreasing the sales-weighted mean sugar con-
tent in the soft drink sector by 2% and the sales-weighted
mean SFA content in the potato chips sector by 18 to 22%.
However, in the breakfast cereal and biscuits and cakes
sectors, it turns out that the renewal of the food supply
contributed negatively to achieving public health goals.
Indeed, new products with high market shares belonged to
categories with poorer nutritional quality compared to the
sector average (and vice versa for product withdrawal). The
consequence is that, over the observation period, this effect
contributed, for instance, to increases of approximately 3%
in the sales-weighted mean sodium content in breakfast
cereals and to decreases of approximately 2% in the sales-
weighted mean ber content in biscuits and cakes.
How to explain why supply renewal does not system-
atically improve the nutritional quality of food purchases? If
we assume that consumers do not generally demand pro-
ducts with less salt or less fat and prioritize taste over health
[31], then it is understandable that food reformulation
initiatives are primarily made to improve the nutritional
quality of products already adopted by consumers, provided
that the changes in the nutrient content do not affect the
product taste (and then they remain small), and they are
silently implemented so as not to cause product rejection by
consumers. Rather, commercial and communication
strategies associated with the launching of new products
aim to attract new consumers by promoting taste and
pleasure rather than health. Then, integrating more stringent
nutritional constraints into the design of new products may
be considered ‘‘too risky’’ in some food sectors.
The third effect induced by consumer switching from
some products to others did not generally lead to an
improvement in the nutritional quality of food purchases
during the observation period. In several cases, consumer
switching offset the reformulation effect. For instance, in
the breakfast cereal sector, it was mainly the consumer
switching that explained the negative trend (from a public
health point of view) in the weighted average contents of
total fat and SFA. It is worth noting that our analysis does
not provide any insights to explain consumer changes. They
may have changed because they perceived some alteration
in taste after product reformulation, or they may have
moved for other exogenous reasons (food prices, economic
crisis, advertising, etc.).
Conclusion
Our results converge with other studies [28] that suggest
that policies targeting changes in the food supply may have
greater impact than those promoting changes in consumer
behavior. However, we have shown the complexity of the
food reformulation issue, as food companies may act dif-
ferently depending on the nutrient and food category.
These ndings argue for the development of a proper
strategy for monitoring the nutrient composition of foods at
the brand level in order to evaluate the impact of food
reformulation initiatives more precisely [26,29,30].
Acknowledgements We want to thank the steering committee of Oqali
for providing the data used in the article. They also thank Florence
Stevenin and Oualid Hamza for their contributions to the matching of
the data sets and preliminary treatments. Both authors are responsible
for the design and implementation of the study, as well as the writing
and nal content of the article. This research was funded by the EU
Horizon 2020 Program under Grant Agreement no. 633692
(SUSFANS).
Compliance with ethical standards
Conict of interest The authors declare that they have no competing
interests.
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Food reformulation and nutritional quality of food consumption 235
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... Indeed, food reformulation (reducing overconsumed nutrients such as sugar, fat and salt) is an interesting way to first focus on products' quality and properties. An improved product quality might automatically positively impact consumers' intake, without largely changing consumers eating habits (Gressier et al., 2021;Spiteri & Soler, 2018). ...
... Food reformulation is an interesting leverage to reduce over-consumed nutrients having negative health effects (sugar, fat, salt) in processed foods. Some works showed that food reformulation can enhance our diet and health (Gressier et al., 2021;Nijman et al., 2007;Spiteri & Soler, 2018). ...
... Food reformulation is an interesting lever to reduce over-consumed nutrients (such as sugar, fat and salt) and to enhance our diet and health (Gressier et al., 2021;Spiteri & Soler, 2018). A successful reformulation makes it possible to move towards a healthier food offer without largely changing consumers eating habits. ...
Thesis
In many parts of Europe, over 10% of children aged 5-19 are now obese, with overweight affecting up to a third of the children in some countries. Food reformulation is one lever to move toward a healthier food offer and to improve children’s’ diet. However, it faced with many challenges implying to consider food reformulation as a holistic approach including composition, sensory, physicochemical, liking or behavior dimensions. In this context, the aim of this PhD work was to propose a multicriteria approach to develop healthier products for children, while maintaining or optimizing sensory perception, liking and behavior. We chose to focus on chocolate-chip cookies as a case study.The first step of this work concerns the study of the recipe diversity of commercial cookies in France to select a representative subset of products. Nutrition, composition, economic, water content, and sensory information were thus analyzed on the cookies of the French market. Then, sensory, physicochemical analyses and liking evaluation with children (n=151, aged 7-12 years old) were conducted on a reduced subset of products to identify key opportunities for reformulation.In a second step, sensory-led formulation of cookies was proposed, based on a mixture design including four key ingredients (sugar, fat, chocolate-chips, oat bran), combined with one process factor (baking degree). Thirty reformulated cookies were thus developed and characterized on multiple criteria, including in vitro glycemic index or evolution during oral processing (time in mouth before swallowing). As main result, this approach led to propose possible reduction of the kcal (-5.9%), sugar (-15.9%), fat (-24.7%), and chocolate-chip (-20%) per cookie and increase in oat bran (+49.3%), with also improvement of the calculated glycemic index (-8.2%) and the Rayner score (-8.7%). This work led thus to sensory modeling and recipe optimization for healthier products.In addition, children’s perception, satiation and satiety and liking (n=80, aged 10-12 years) were evaluated for four of these reformulated cookies. Keeping a high level of liking by children was confirmed. In addition, we highlighted that cookies’ texture plays a key role in reformulation for children and oat bran might be an interesting lever to increase biscuits’ viscosity and therefore food oral processing.Thus, this multicriteria food reformulation approach might reinforce food reformulation as a promising tool to improve the food quality for children.
... By integrating changes in nutritional composition of the food offer with changes in sales, this approach also provides insights into the 'true' average nutrient contents sold to consumers through different packaged food and soft drinks categories. Despite not measuring exactly what individuals have consumed, market data can be used by researchers and policymakers to keep track of the overall nutritional quality of the packaged food and drinks offered to and purchased by citizens [18][19][20][21][22][23][24]. ...
... Based on these estimates, we later calculated per capita nutrient sales values (g/pc/day) using mid-year population data for 2015 and 2018 from the European Health for all Database (HFA-DB) [28] and scaled these estimates according to the respective market coverage (as presented in Table 1) to represent 100% of the retail market. Therefore, while we are able to identify the contribution of specific products/brands to the overall quantity of nutrients sold within major packaged food and soft drinks categories in the EU, we followed [20,22] and assumed that the remainder of the market presents the same characteristics and evolution as our sample. This assumption minimizes data distortion given that many categories present a relatively high market coverage, and its magnitude remained stable across the analysed years [22]. ...
... Therefore, while we are able to identify the contribution of specific products/brands to the overall quantity of nutrients sold within major packaged food and soft drinks categories in the EU, we followed [20,22] and assumed that the remainder of the market presents the same characteristics and evolution as our sample. This assumption minimizes data distortion given that many categories present a relatively high market coverage, and its magnitude remained stable across the analysed years [22]. Additionally, this assumption is founded on the fact that small and local companies represented by the remainder of the market are less likely to have the capacity for reformulation [20]. ...
Article
Full-text available
The availability, purchase and consumption of foods high in fat, sugars and salt and low in fibre are linked to the high health and economic burden of noncommunicable diseases, including cancer, in Europe. Therefore, assessing the quality of the food offer is key as feedback to decision makers, as well as to identify good practices and areas of the food supply still requiring urgent action. We combined detailed market share and sales data with nutrition composition data to evaluate the nutritional quality of 14 packaged food and soft drinks categories sold across 22 European countries over the 2015–2018 period. Our analysis shows great variability of the nutritional composition within and among packaged food and soft drinks categories across European countries. Our estimates of the market-share weighted mean, a measure that integrates possible changes in nutrient content with the amount of a product sold to consumers, as well as daily per capita nutrient sale estimates, suggest a small but statistically significant progress in certain food categories only. Overall, the amounts of sugars, saturated fat, salt and fibre being sold to European citizens through these products is not improving to an extent to meet public health objectives.
... Several systematic reviews on strategies to improve diets also found that reformulation reduced sodium intakes (16,17). In addition, a study on the nutritional quality of French purchases in 4 categories using a similar methodology found a stronger improvement due to reformulation, while the effects of product renewal and changes in food choices did not have such impacts (18). ...
... To our knowledge, this is the first study where the decomposition method has been applied to a diet survey. Previously, this method has been applied to food purchase data from household panels (9,18). Applying this method to the NDNS allowed us to understand how the sodium density of all foods consumed changed over time, while purchase data from household panels normally only record foods purchased for home consumption and for the whole household. ...
Article
Full-text available
Background The UK salt reduction program started in 2003, consisting of education campaigns to raise awareness about the risks associated with a high-salt diet and of a reformulation strategy for food manufacturers. This program is often cited as an example of a successful public health program. Objectives This study aimed to assess: 1) the impacts of changes in food composition and changes in consumer behavior on sodium intakes; and 2) whether changes were similar across socioeconomic groups. Methods Food intakes for the UK population were derived from food diaries in the UK National Diet and Nutrition Survey for 2008/09 (year 1; n = 1334) and 2016/17 (year 9; n = 995). Year-specific sodium densities of foods were used to calculate the average sodium density of all food and beverage consumed. Changes in sodium density between the 2 years were explained by changes in food composition (change in sodium density of products) and/or changes in behavior (type and quantity of food consumed) using a decomposition approach. Results The program was linked to a 16% (95% CI: −21% to −12%) decrease in sodium intake between years 1 and 9, while the sodium density of foods consumed decreased by 17% (95% CI: −21% to −12%). This decrease was largely driven by reformulation (−12.0 mg/100 g). Changes in food choices reinforced the effects of the program, but had a smaller impact (−1.6 mg/100 g). These effects were similar across socioeconomic groups, whether stratified by education or income, with a consistent effect of reformulation across groups and no differences between groups in behavioral responses to the program. Conclusions A multi-component sodium reduction strategy deployed in the United Kingdom starting in 2003 corresponded to an important reduction in sodium intakes for the population. This reduction was mostly driven by changes in the food environment (reformulated food products to reduce the sodium density of foods) and, to a smaller extent, by changes in food choices. Impacts were consistent across socioeconomic groups.
... However, it is not always easy for them to choose the healthy option, living in an environment of over-abundance (Frank-Podlech et al. 2021). To support the transition of consumers to healthier diets, it is necessary to increase awareness of the relation between food choices and health, through nutritional advice, information and education, and to also improve the food environment to facilitate healthy choices (Spiteri and Soler 2018). An important contribution to this would be the reformulation of products toward healthier versions lower in calories, sugar, salt and fat, particularly products targeted to vulnerable populations like children. ...
Article
The food industry has recently been under unprecedented pressure due to major global challenges, such as climate change, exponential increase in world population and urbanization, and the worldwide spread of new diseases and pandemics, such as the COVID-19. The fourth industrial revolution (Industry 4.0) has been gaining momentum since 2015 and has revolutionized the way in which food is produced, transported, stored, perceived, and consumed worldwide, leading to the emergence of new food trends. After reviewing Industry 4.0 technologies (e.g., artificial intelligence, smart sensors, robotics, blockchain, and the Internet of Things) in Part I of this work (Hassoun, Aït-kaddour, et al., 2022), this complimentary review will focus on emerging food trends (such as fortified and functional foods, additive manufacturing technologies, cultured meat, precision fermentation, and personalized food) and their connection with Industry 4.0 innovations. Implementation of new food trends has been associated with recent advances in Industry 4.0 technologies, enabling a range of new possibilities. The results show several positive food trends that reflect increased awareness of food chain actors of the food-related health and environmental impacts of food systems. Emergence of other food trends and higher consumer interest and engagement in the transition towards sustainable food development and innovative green strategies are expected in the future.
... Reformulation of products in the packaged food supply to improve their nutritional quality is a cost-effective policy measure for addressing the obesity and NCD burden [11][12][13]. Notably, reformulation is likely to have more impact on diet quality than interventions relying on behaviour changes from consumers [14][15][16]. Reformulation has been shown by systematic reviews of empirical and modeling studies to improve the healthfulness of food purchases, nutrient intakes and health outcomes, particularly for sodium and trans fat [12,17]. According to the Organisation for Economic Cooperation and Development, a 20% calorie reduction in energydense foods high in sugars, sodium and saturated fats in Canada could prevent 387,000 NCDs between 2019 and 2050, save CAD $339 million in annual healthcare expenses, and "increase employment and productivity by the equivalent of 15 thousand full-time workers per year" [18]. ...
Article
Full-text available
Background Food companies shape Canada’s food supply through voluntary actions and commitments concerning product (re)formulation; however, the extent that these initiatives translate into actual improvements in nutritional quality is unclear. This study examined changes in the nutritional quality of products offered by the top 22 packaged food and beverage companies in Canada from 2013 to 2017, in relation to the strength of their product (re) formulation actions and commitments. Methods The Food Company Reformulation (FCR) scoring tool was used to quantify the strength of companies’ reported recent actions and commitments to reduce energy and nutrients of concern in their products, with higher scores signifying stronger voluntary actions/commitments. Nutritional information for products was sourced from the University of Toronto FLIP 2013 (n = 6490) and 2017 (n = 8277) databases (n = 4074 matched products). Changes in product healthfulness were assessed using the Health Star Rating (HSR) system (with higher HSRs denoting healthier products) and calories, sodium, saturated fat, trans fat, and total and free sugar levels per 100 g/mL. Generalized estimating equations examined changes in nutritional quality in relation to FCR scores. Results Overall, mean HSRs increased significantly for 5 companies’ product portfolios and were reduced in 1 company’s product portfolio. There were significant reductions in calories, sodium, saturated fat in 2 companies’ portfolios and increases in 4, 3, and 8 companies’ portfolios, respectively. Trans fats increased significantly in 2 companies’ portfolios. Total and free sugars decreased significantly in 4 and 5 companies’ portfolios, respectively, and increased in 1 company’s portfolio. There was little change in the healthfulness of matched products. Higher FCR scores were not associated with greater increases in HSRs, or reductions in calories or nutrient amounts. FCR scores were negatively associated with HSRs and positively associated with total and free sugars. No relationship was observed between FCR scores and calories, sodium, saturated fat or trans fat. Conclusions Reporting stronger voluntary product (re) formulation actions and commitments was not associated with greater improvements in the healthfulness of products offered by Canada’s leading packaged food and beverage companies from 2013 to 2017, suggesting a need for stronger industry initiatives or mandatory government interventions to improve the healthfulness of the food supply.
... Food reformulation is an interesting lever to reduce overconsumed nutrients (such as sugar, fat, and salt) and to enhance our diet and health (1,2). A successful reformulation makes it possible to move toward a healthier food offer without largely changing consumers eating habits. ...
Article
Full-text available
Consuming too much fat, sugar, and salt is associated with adverse health outcomes. Food reformulation is one possible strategy to enhance the food environment by improving the nutritional quality of commercial products. However, food reformulation faces many hindrances. One way to alleviate some of these hindrances is to embrace a multicriteria approach that is based on a market inventory. In this objective, additional sensory screening and water content analyses allow going beyond nutrition and composition information on the packaging. However, due to feasibility reasons for later in-depth analyses, it is necessary to work with several reduced and manageable products. To the best of the authors' knowledge, in the literature, there is no sample selection approach taking into account multiple criteria as a base for future food reformulation. The overall aim of this paper is to propose a method to select the best representative products from the market base, for future reformulation by going beyond nutrition and composition information on the packaging. This approach considered therefore nutrition, composition, economic, water content, and sensory information with the example of the cookies market. The first step is the creation of an extensive cookie database including sensory and water content information. In total 178 cookies among the French market were identified, then focus was placed on 62 chocolate chip cookies only. Sensory screening and water content analyses of all 62 products were conducted. The second step is to make an informed subset selection, thanks to a cluster analysis based on 11 nutrition, composition, and water content variables. A representative subset of 18 cookies could be derived from the obtained clusters. The representativity was evaluated with statistical uni- and multivariate analyses. Results showed a broad variety of chocolate chips cookies with a large nutritional, compositional, water content, and sensory differences. These results highlighted the first paths for future reformulation in this product category and showed the importance to include physical product information beyond the information on the packaging. This complete database on the selected cookies constituted a solid base for identifying future reformulation levers, in order to improve the nutritional quality and health.
... As a result, the nutrient database from 2014 was used to determine the nutrient composition for all products irrespective of whether that product was listed in the FFQ in 1986 (first FFQ cycle in these cohorts) or in 2015 (the latest available FFQ cycle in these cohorts). The use of the nutrient database from 2014 likely confers a healthier nutrient composition to products that have been subject to reformulation (24,25) . Second, changes to the grade of processing over time because reformulation of the products was not captured by the present approach. ...
Article
Full-text available
This manuscript details the strategy employed for categorising food items based on their processing levels into the four NOVA groups. Semi-quantitative food frequency questionnaires (FFQs) from the Nurses’ Health Studies (NHS) I and II, the Health Professionals Follow-up Study (HPFS) and the Growing Up Today Studies (GUTS) I and II cohorts were used. The four-stage approach included: (i) the creation of a complete food list from the FFQs; (ii) assignment of food items to a NOVA group by three researchers; (iii) checking for consensus in categorisation and shortlisting discordant food items; (iv) discussions with experts and use of additional resources (research dieticians, cohort-specific documents, online grocery store scans) to guide the final categorisation of the short-listed items. At stage 1, 205 and 315 food items were compiled from the NHS and HPFS, and the GUTS FFQs, respectively. Over 70 % of food items from all cohorts were assigned to a NOVA group after stage 2. The remainder were shortlisted for further discussion (stage 3). After two rounds of reviews at stage 4, 95⋅6 % of food items (NHS + HPFS) and 90⋅7 % items (GUTS) were categorised. The remaining products were assigned to a non-ultra-processed food group (primary categorisation) and flagged for sensitivity analyses at which point they would be categorised as ultra-processed. Of all items in the food lists, 36⋅1 % in the NHS and HPFS cohorts and 43⋅5 % in the GUTS cohorts were identified as ultra-processed. Future work is needed to validate this approach. Documentation and discussions of alternative approaches for categorisation are encouraged.
Article
Growing global concern about obesity and diet-related non-communicable diseases has raised interest in fiscal policy as a tool to reduce this disease burden and its social costs, especially excise taxes on sugar-sweetened beverages (SSBs). Of particular interest have been nutrient-based taxes to improve diet quality. These can incentivize producers to reformulate existing products and introduce healthier alternatives into their ranges. In 2018, South Africa adopted a sugar-based tax on SSBs, the Health Promotion Levy (HPL). Early findings suggest that purchases of higher-sugar taxable beverages fell and purchases of no- and lower-sugar beverages increased, alongside significant reductions in the sugar content of overall beverage purchases. However, underlying these changes are consumption shifts as well as product reformulation and changes in producers’ product portfolios. Drawing on a household scanner dataset, this study employed a descriptive approach to decompose changes in the sugar content of households’ non-alcoholic beverage purchases into producer factors (reformulation and product entry and exit) and consumer factors (product switching and volume changes as a result of price changes, changing preferences, or other factors). We look at these factors as the tax was announced and implemented across a sample of over 3000 South African households, and then by Living Standard Measures (LSM) groups (middle vs. high). The sugar content of beverage purchases fell by 4.9 g/capita/day overall, a 32% decrease. Taken in isolation, consumer switching and volume changes together led to a reduction equivalent to 71% of the total change, while reformulation accounted for a decrease equal to 34% of that change. Middle-LSM households experienced larger reductions than high-LSM households due to larger changes on the consumer side. For both LSM groups, reformulation-led reductions mostly occurred after implementation, and most changes came from taxable beverage purchases. As sugary drink tax designs evolve with broader implementation globally, understanding both supply- and demand-side factors will help to better assess the population and equity potential of these policies.
Thesis
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Nutrition is a major modifiable determinant of health. National nutrition surveys are essential tools to monitor the population nutritional status and guide nutrition policies. Switzerland conducted its first national survey, menuCH, in 2014-2015. A total of 2 086 Swiss residents aged 18 to 75 years old were interviewed and their diet assessed using two 24-hour dietary recalls. This thesis aimed at 1) describing dietary intake of Swiss adult population using menuCH data, and 2) developing recommendations for the next national nutrition surveys and future nutrition policies. menuCH data indicated that the vast majority of the Swiss adult population poorly adhered to the national dietary guidelines. The population consumed insufficient plant-based products, and excessive ultra-processed and/or animal-based foods. Moreover, food consumption patterns substantially differed between the German, French and Italian-speaking parts of Switzerland. Finally, we showed that regularly consuming a breakfast rich in fruit, unsweetened cereal flakes, nuts and yogurt was associated with reduced abdominal obesity. Since menuCH did not survey children nor collect bio-samples, we tested child-specific dietary assessment methods and evaluated acceptability of bio-sample collection in a feasibility study to prepare the next national nutrition survey. We recruited a population-based sample of 53 children aged 3 to 17 years in Lausanne. The developed dietary assessment tools (e.g., 24-hour food diary, food questionnaire) were well accepted by participants and their caregiver(s). Compliance with the collection of spot urine, venous and capillary blood, and toenails was high in the different age groups. As shown above, dietary behaviours in Switzerland are not optimal. Classically, public health can propose two types of interventions to improve the situation: 1) provide information to encourage behavioural modifications (individual level), or 2) change the environment to reduce exposition (population level). I wrote an essay about a novel instrument designed to improve diet, i.e., precision nutrition. I concluded that providing personalized advice at a large scale via smartphones (individual level) might have a limited effect on dietary behaviours and obesity, if environments promoting unhealthy food are not modified in parallel (population level). We have shown that Switzerland needs public health interventions to improve dietary behaviours. We suggest that these interventions target in priority the food environments to facilitate access to healthy foods. Furthermore, the next national nutrition surveys should include children, strengthen dietary assessment methods, and collect bio-samples for relying on objective nutritional biomarkers. We believe that this will improve the assessment of dietary intake and nutritional status at both individual and population levels to further fine-tune national dietary guidelines and guide future nutrition policies.
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Background In an effort to prevent and reduce the prevalence rate of people with obesity and diabetes, South Africa implemented a sugar-content-based tax called the Health Promotion Levy in April 2018, one of the first sugar-sweetened beverage (SSB) taxes to be based on each gram of sugar (beyond 4 g/100 ml). This before-and-after study estimated changes in taxed and untaxed beverage intake 1 year after the tax, examining separately, to our knowledge for the first time, the role of reformulation distinct from behavioral changes in SSB intake. Methods and findings We collected single-day 24-hour dietary recalls from repeat cross-sectional surveys of adults aged 18–39 years in Langa, South Africa. Participants were recruited in February–March 2018 (pre-tax, n = 2,459) and February–March 2019 (post-tax, n = 2,489) using door-to-door sampling. We developed time-specific food composition tables (FCTs) for South African beverages before and after the tax, linked with the diet recalls. By linking pre-tax FCTs only to dietary intake data collected in the pre-tax and post-tax periods, we calculated changes in beverage intake due to behavioral change, assuming no reformulation. Next, we repeated the analysis using an updated FCT in the post-tax period to capture the marginal effect of reformulation. We estimated beverage intake using a 2-part model that takes into consideration the biases in using ordinary least squares or other continuous variable approaches with many individuals with zero intake. First, a probit model was used to estimate the probability of consuming the specific beverage category. Then, conditional on a positive outcome, a generalized linear model with a log-link was used to estimate the continuous amount of beverage consumed. Among taxed beverages, sugar intake decreased significantly ( p < 0.0001) from 28.8 g/capita/day (95% CI 27.3–30.4) pre-tax to 19.8 (95% CI 18.5–21.1) post-tax. Energy intake decreased ( p < 0.0001) from 121 kcal/capita/day (95% CI 114–127) pre-tax to 82 (95% CI 76–87) post-tax. Volume intake decreased ( p < 0.0001) from 315 ml/capita/day (95% CI 297–332) pre-tax to 198 (95% CI 185–211) post-tax. Among untaxed beverages, sugar intake increased ( p < 0.0001) by 5.3 g/capita/day (95% CI 3.7 to 6.9), and energy intake increased ( p < 0.0001) by 29 kcal/capita/day (95% CI 19 to 39). Among total beverages, sugar intake decreased significantly ( p = 0.004) by 3.7 (95% CI −6.2 to −1.2) g/capita/day. Behavioral change accounted for reductions of 24% in energy, 22% in sugar, and 23% in volume, while reformulation accounted for additional reductions of 8% in energy, 9% in sugar, and 14% in volume from taxed beverages. The key limitations of this study are an inability to make causal claims due to repeat cross-sectional data collection, and that the magnitude of reduction in taxed beverage intake may not be generalizable to higher income populations. Conclusions Using a large sample of a high-consuming, low-income population, we found large reductions in taxed beverage intake, separating the components of behavioral change from reformulation. This reduction was partially compensated by an increase in sugar and energy from untaxed beverages. Because policies such as taxes can incentivize reformulation, our use of an up-to-date FCT that reflects a rapidly changing food supply is novel and important for evaluating policy effects on intake.
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Background and objective: Approximately 20% of US children and adolescents consume pizza on any given day; and pizza intake is associated with higher intakes of energy, sodium, and saturated fat. The reformulation of pizza products has yet to be evaluated as a viable option to improve diets of the US youth. This study modeled the effect on nutrient intakes of two potential pizza reformulation strategies based on the standards established by the Nestlé Nutritional Profiling System (NNPS). Methods: Dietary intakes were retrieved from the first 24hr-recall of the National Health and Nutrition Examination Survey (NHANES) 2011-12, for 2655 participants aged 4-19 years. The composition of pizzas in the NHANES food database (n = 69) were compared against the NNPS standards for energy, total fat, saturated fat, sodium, added sugars, and protein. In a reformulation scenario, the nutrient content of pizzas was adjusted to the NNPS standards if these were not met. In a substitution scenario, pizzas that did not meet the standards were replaced by the closest pizza, based on nutrient content, that met all of the NNPS standards. Results: Pizzas consistent with all the NNPS standards (29% of all pizzas) were significantly lower in energy, saturated fat and sodium than pizzas that were not. Among pizza consumers, modeled intakes in the reformulation and substitution scenarios were lower in energy (-14 and -45kcal, respectively), saturated fat (-1.2 and -2.7g), and sodium (-143 and -153mg) compared to baseline. Conclusions: Potential industry wide reformulation of a single food category or intra-category food substitutions may positively impact dietary intakes of US children and adolescents. Further promotion and support of these complimentary strategies may facilitate the adoption and implementation of reformulation standards.
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Purpose To describe the Nestlé Nutritional Profiling System (NNPS) developed to guide the reformulation of Nestlé products, and the results of its application in the USA and France. Design The NNPS is a category-specific system that calculates nutrient targets per serving as consumed, based on age-adjusted dietary guidelines. Products are aggregated into 32 food categories. The NNPS ensures that excessive amounts of nutrients to limit cannot be compensated for by adding nutrients to encourage. A study was conducted to measure changes in nutrient profiles of the most widely purchased Nestlé products from eight food categories (n = 99) in the USA and France. A comparison was made between the 2009–2010 and 2014–2015 products. Results The application of the NNPS between 2009–2010 and 2014–2015 was associated with an overall downwards trend for all nutrients to limit. Sodium and total sugars contents were reduced by up to 22 and 31 %, respectively. Saturated Fatty Acids and total fat reductions were less homogeneous across categories, with children products having larger reductions. Energy per serving was reduced by <10 % in most categories, while serving sizes remained unchanged. Conclusions The NNPS sets feasible and yet challenging targets for public health-oriented reformulation of a varied product portfolio; its application was associated with improved nutrient density in eight major food categories in the USA and France. Confirmatory analyses are needed in other countries and food categories; the impact of such a large-scale reformulation on dietary intake and health remains to be investigated.
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Hypertension is a major modifiable risk factor for cardiovascular disease and mortality, which could be lowered by reducing dietary sodium. The potential health impact of a product reformulation in the Netherlands was modelled, selecting packaged soups containing on average 25% less sodium as an example of an achievable product reformulation when implemented gradually. First, the blood pressure lowering resulting from sodium intake reduction was modelled. Second, the predicted blood pressure lowering was translated into potentially preventable incidence and mortality cases from stroke, acute myocardial infarction (AMI), angina pectoris, and heart failure (HF) implementing one year salt reduction. Finally, the potentially preventable subsequent lifetime Disability-Adjusted Life Years (DALYs) were calculated. The sodium reduction in soups might potentially reduce the incidence and mortality of stroke by approximately 0.5%, AMI and angina by 0.3%, and HF by 0.2%. The related burden of disease could be reduced by approximately 800 lifetime DALYs. This modelling approach can be used to provide insight into the potential public health impact of sodium reduction in specific food products. The data demonstrate that an achievable food product reformulation to reduce sodium can potentially benefit public health, albeit modest. When implemented across multiple product categories and countries, a significant health impact could be achieved.
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Public health action to reduce dietary salt intake has driven substantial reductions in coronary heart disease (CHD) over the past decade, but avoidable socio-economic differentials remain. We therefore forecast how further intervention to reduce dietary salt intake might affect the overall level and inequality of CHD mortality. We considered English adults, with socio-economic circumstances (SEC) stratified by quintiles of the Index of Multiple Deprivation. We used IMPACTSEC, a validated CHD policy model, to link policy implementation to salt intake, systolic blood pressure and CHD mortality. We forecast the effects of mandatory and voluntary product reformulation, nutrition labelling and social marketing (e.g., health promotion, education). To inform our forecasts, we elicited experts' predictions on further policy implementation up to 2020. We then modelled the effects on CHD mortality up to 2025 and simultaneously assessed the socio-economic differentials of effect. Mandatory reformulation might prevent or postpone 4,500 (2,900-6,100) CHD deaths in total, with the effect greater by 500 (300-700) deaths or 85% in the most deprived than in the most affluent. Further voluntary reformulation was predicted to be less effective and inequality-reducing, preventing or postponing 1,500 (200-5,000) CHD deaths in total, with the effect greater by 100 (-100-600) deaths or 49% in the most deprived than in the most affluent. Further social marketing and improvements to labelling might each prevent or postpone 400-500 CHD deaths, but minimally affect inequality. Mandatory engagement with industry to limit salt in processed-foods appears a promising and inequality-reducing option. For other policy options, our expert-driven forecast warns that future policy implementation might reach more deprived individuals less well, limiting inequality reduction. We therefore encourage planners to prioritise equity.
Article
Background The Dutch ‘Task Force for the Improvement of the Fatty Acid Composition’ initiated fatty acid reformulations in branches using vegetable oils and fats to reduce the trans(TFA) and saturated fatty acid (SFA) content of foods. Objective This study estimates the impact of recent reformulations in the task force food groups by estimating changes in median intake of TFA and SFA in Dutch young adults. Methods This is a modelling study with food consumption data of young adults. Intakes were estimated before reformulation using food composition data of 2001 as a reference and while including most recent fatty acid composition of foods for task force food groups. Food composition of other foods and food consumption was assumed unchanged. Results Average TFA intake signifi cantly decreased from 1.0 E% in the reference to 0.8 E% in the reformulation scenario. Pastry, cakes and biscuits, and snacks contributed most to the decrease of TFA. Estimated SFA intake did not change. When solid baking and spreading fats were additionally replaced with fl uid ones, SFA intake decreases from 12.9 E% to 12.1 E%. Conclusion Fatty acid reformulation in the task force food groups contributed to reductions in TFA intake. For further reductions in SFA intake a different food choice is primordial.
Article
Improving diet quality has been a target of public health policy. Governments have encouraged consumers to make healthier food choices and firms to reformulate food products. Evaluation of such policies has focused on the impact on consumer behaviour; firm behaviour has been less well studied. We show that the recent decline in dietary salt intake in the UK was entirely attributable to product reformulation; consumer switching between products worked in the opposite direction and led to a slight increase in grocery salt intensity. These findings point to the important role that firms can play in achieving public policy goals.
Article
Globally, excess salt intake is a significant cause of preventable heart disease and stroke, given the established links between high salt intake, high blood pressure, and cardiovascular disease. This paper describes and evaluates the voluntary approaches to salt reduction that operate in the United Kingdom and the United States, and proposes a new strategy for improving their performance. Drawing on developments in the theory and practice of public health governance, as well as theoretical ideas from the field of regulatory studies, this paper proposes a responsive regulatory model for managing food reformulation initiatives, including salt reduction programs. This model provides a transparent framework for guiding industry behavior, making full use of industry's willingness to participate in efforts to create healthier products, but using 'legislative scaffolding' to escalate from self-regulation towards co-regulation if industry fails to play its part in achieving national goals and targets. (C) 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/4.0/).
Article
Background/objectives: Policies focused on food quality are intended to facilitate healthy choices by consumers, even those who are not fully informed about the links between food consumption and health. The goal of this paper is to evaluate the potential impact of such a food reformulation scenario on health outcomes. Subjects/methods: We first created reformulation scenarios adapted to the French characteristics of foods. After computing the changes in the nutrient intakes of representative consumers, we determined the health effects of these changes. To do so, we used the DIETRON health assessment model, which calculates the number of deaths avoided by changes in food and nutrient intakes. Results: Depending on the reformulation scenario, the total impact of reformulation varies between 2408 and 3597 avoided deaths per year, which amounts to a 3.7-5.5% reduction in mortality linked to diseases considered in the DIETRON model. The impacts are much higher for men than for women and much higher for low-income categories than for high-income categories. These differences result from the differences in consumption patterns and initial disease prevalence among the various income categories. Conclusions: Even without any changes in consumers' behaviors, realistic food reformulation may have significant health outcomes.European Journal of Clinical Nutrition advance online publication, 16 December 2015; doi:10.1038/ejcn.2015.201.
Article
Up to now, most nutritional policies have been set up to inform consumers about the health benefits induced by more balanced diets. Reviews of the impacts of these policies show that the effects are often modest. This has led governments to implement, in more recent times, policies focused on the market environment, especially on the characteristics of the food supply. The goal of this paper is to review theoretical and empirical studies focusing on changes in the food supply induced by alternative policies, and to attempt to draw from them policy guidelines and conjectures to test in future research.