Choices-the way to make healthier

diets possible in a global framework

Choices-the way to make healthier

diets possible in a global framework

Nelia Steyn

Overview of the presentationOverview of the presentation

• Introduction of my organization

• Brief description of chronic diseases

(NCDs) and their determinants globally

• Information on the Choices Model

• Success stories (validation)

• Can it work in Israel?

Mission statementMission statement

The HSRC is a non-partisan, public-purpose organisation that

generates scientific knowledge through its research and analytical

work in the social and human sciences.

It undertakes and promotes research that is often large-scale,

multi-year, and collaborative in nature. It produces high-quality

scientific evidence to inform further analysis, debate, advocacy

and decision-making by role players in government, the media,

academia, and community-based groupings.

Through its work the HSRC aims to inform policy development

and good practice, thereby making a difference to the lives of

people in South Africa and in the mother continent.

What we doWhat we do

>200 research projects, most touch people

• Reduce poverty, grow economy and create jobs

• Improve quality of education

• Accelerate service delivery

• Reduce crime

• Develop youth

• HIV/AIDS control

• Understand our system of innovation

Africa-FocusAfrica-Focus

Its all about chronic diseases of lifestyle (CDLs)

Its all about chronic diseases of lifestyle (CDLs)

•The disease profile of the world is changing rapidly, especially

in low and middle income countries.

•In 2005, 60% of deaths in the world were attributable to CDL.

The thirty-five million deaths from CDL in 2005 were double the

number of deaths for all infectious diseases (HIV/AIDS,

tuberculosis, malaria), maternal and perinatal conditions, and

nutritional deficiencies combined.

•Approximately four out of five CDL deaths occurred in low and

middle-income countries, with heart disease, stroke, cancer,

chronic respiratory diseases and diabetes being the main ones

•(WHO 2005)

NCDsNCDs

• “Cancer, diabetes and heart diseases are no longer the diseases of the wealthy. Today they hamper the people and the economies of the poorest populations even more than infectious

diseases. This represents a public health emergency in slow motion”

By: Ban Ki-Moon, UNSG 2009

Causes of chronic diseasesWhat can we change or improve?

Causes of chronic diseasesWhat can we change or improve?

Source: WHO, 2008

Unhealthy diet (< 400g) WHO, 2008MABAT: First Israeli National Health and Nutrition

Survey 1999-2001

Unhealthy diet (< 400g) WHO, 2008MABAT: First Israeli National Health and Nutrition

Survey 1999-2001

Percentage of adults who are inactiveMABAT: First Israeli National Health and Nutrition

Survey 1999-2001

Percentage of adults who are inactiveMABAT: First Israeli National Health and Nutrition

Survey 1999-2001

Tobacco-use

[Health behaviour in school-aged children (HBSC) survey 1997/1998]

Tobacco-use

[Health behaviour in school-aged children (HBSC) survey 1997/1998]

Percent adults with raised BP (140/90 mmHg) MABAT: First Israeli National Health and Nutrition

Survey 1999-2001

Percent adults with raised BP (140/90 mmHg) MABAT: First Israeli National Health and Nutrition

Survey 1999-2001

One of the major risk factors for NCDs is obesity

in children and in adults in both

developed and developing countries

One of the major risk factors for NCDs is obesity

in children and in adults in both

developed and developing countries

https://apps.who.int/infobase/CountryProfiles.aspxhttps://apps.who.int/infobase/CountryProfiles.aspx

Obesity in SA 2003Obesity in SA 2003

Deaths per 100 0000 population deaths 2004

In Israel

Males Females All

I. Communicable, maternal, peri-natal, etc 33.3 34.2 33.8

II. Noncommunicable diseases 472.1 458.2 465.1

A. Malignant neoplasms 146.9 137.3 142.1

Stomach cancer 10.6 6.2 8.4

Colon and rectum cancers 22.7 21.4 22.0

Trachea, bronchus, lung cancers 29.8 12.8 21.2

Breast cancer 31.0 16.1

Prostate cancer 14.9 7.4

Lymphomas, multiple myeloma 11.1 9.8 10.5

Leukaemia 8.6 6.6 7.6

C. Diabetes (mellitus) 38.1 43.0 40.6

G. Cardiovascular diseases 163.9 157.2 160.5

Rheumatic heart disease 0.7 2.0 1.3

Hypertensive heart disease 6.9 11.2 9.1

Ischaemic heart disease 87.6 68.7 78.0

Cerebrovascular disease 33.4 37.4 35.4

H. Respiratory diseases 28.2 26.0 27.1

III. Injuries 44.6 17.4 30.8

The Global Strategy on Diet and PhysicalActivity of the World Health Organisation makes specific dietary and physical activity recommendations for the prevention of chronic diseases of lifestyle (WHO, 2004). The dietary guidelines include the following:

The Global Strategy on Diet and PhysicalActivity of the World Health Organisation makes specific dietary and physical activity recommendations for the prevention of chronic diseases of lifestyle (WHO, 2004). The dietary guidelines include the following:

WHO recommendations (WHO 2003, 2008)

WHO recommendations (WHO 2003, 2008)

• To achieve energy balance and healthy

weight

WHO recommendations (WHO 2003, 2008)

WHO recommendations (WHO 2003, 2008)

• To limit total fats , saturated and trans fats

WHO recommendations (WHO 2003, 2008)

WHO recommendations (WHO 2003, 2008)

• To increase intake of fruits and vegetables, legumes,

whole grains and nuts

• To limit intake of free sugars

• To limit intake of sodium and

• ensure that it is iodized

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

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

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

BEHAVIOURS?????

• IS FOOD LABELLING THE ANSWER?

Proliferation of labelling systemsProliferation of labelling systems

Pick the tick

Australia/New Zealand

Keyhole

system

Sweden

PepsiCo

United Statesof America

Albert Heijn

TheNetherlands

Health Robot

South Africa

Healthier Choice

Singapore

Multiple Traffic Light United Kingdom Sainsbury Traffic Light

United Kingdom

GDA Tesco

Sensible Solution Kraft

GDA McDonald’s

… is confusing consumers

Consumer research on food labellingConsumer research on food labelling

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

• We realize that this represents more than 80% of the global population and that it includes a substantial

• It has been shown that positive messages tend to have more

impact on consumers than negative ones when promoting healthy behaviour such as eating healthy foods (Rothman & Salovey, 1997)

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

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

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

Basic criteria of labelling for healthBasic criteria of labelling for health

• Should comply with international healthy nutrition guidelines

• Should be very simple and front of pack

• Should be accompanied by effective and localised nutrition education which is not aimed at promoting specific products or brands

• Should not belong to any one company or brand

• Any company should be able to use the system it if it meets basic criteria

• Should be the same globally ie. whether used in India or South Africa

The Choices ProgrammeThe Choices Programme

• Worldwide programme

• Initiated by food industry

• Supported by nutritional scientists, governments, NGOs

• One front-of-pack stamp

• Independent benchmark

• Open initiative

• Internationally applicable

Simple, Science based & International

Aims Aims

1. Help consumers make the healthier food choice easy

2. Stimulate food industry towards product innovation

⇨ Limit intake of nutrients with a negative impact on health

⇨ Ensure intake of essential and beneficial nutrients

⇨ Promote appropriate energy intake

National governance structureNational governance structure

National Board

Choices

“Country”

Company 1 Company 2 Company 3 Company …

Stamp Clearance

&

Compliance Control

Communication

&

Education

International governance structure

International governance structure

Choices

International

Board

National Board

ChoicesThe Netherlands

National Board

ChoicesBelgium*

National Board

ChoicesPoland*

National Board

Choices…

InternationalScientificCommittee

* Currently being set up

Principles of the Choices benchmark

Principles of the Choices benchmark

• Applicable to all foods and drinks

• Based on sound, scientific evidence

• Transparent derivation of benchmarks

• Regularly reviewed to keep up with scientific

consensus

• Credible and easy to understand

• Practical to implement

• Internationally applicable

Excluding alcohol, supplements, products to be used

under medical supervision and foods for children <1

10 July 2007 32 Prof Jaap Seidell

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

Thorough

review

International

Scientific

Committee

Choices international benchmark

Choices independent benchmark

Advantages for the consumerAdvantages for the consumer

• One international system makes it easy and credible

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

• No more confusion: one stamp for all producers and products

• Motivating behavioural change: positively changing perception and usage intention of food products

• Complementary to other nutritional information labelling systems

10 July 2007 34 Prof Jaap Seidell

10 July 2007 35

Dynamic systemDynamic system

• Aims to move benchmark more towards dietary recommendations

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

• Evaluation research of effects on consumer and producer behavior

• Transition period for implementation

• Continuous improvement of system

Selection of nutrients

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

Selection of nutrients

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

Included:

• Trans fatty acids

• Saturated fatty acids

• Sodium

• Added sugar (Free sugar)*

In addition (for some product groups):

• Energy

• Fibre (from ingredients e.g. whole grain)

Considered but not included:

• Fat quantity: is covered by energy, focus: fat quality

• Cholesterol: evidence is probable (WHO/FAO, 2003)

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

• Other benefical nutrients: However, more lenient criteria in the basic food groups vs discretionary food groups

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

NutrientNutrientNutrientNutrient WHO/FAOWHO/FAOWHO/FAOWHO/FAO1111 +30% +30% +30% +30% Generic Generic Generic Generic criteriacriteriacriteriacriteria

Saturated fat [en%] < 10 +3 < 13

Trans fat [en%] < 1 +0.3 < 1.3

Sodium [mg/kcal] <1* +0.3 < 1.3

Added sugar [en%] < 10 +3 < 13

Fibre [g/100 kcal] > 1.3** > 1.3

Generic criteria

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

Generic criteria

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

37

* Based on 2000 kcal/d and WHO sodium recommendation, 2 g/d

** Based on 2000 kcal/d and WHO fibre recommendation, 25 g/d

1Joint WHO/FAO consultation (2003)

In addition: for low energy-dense foods insignificancy levels

are defined as 5% of recommendations1 per 100g

Product groups

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

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

• Non-basic (or discretionary) product groups do

not significantly contribute to the intake of

essential nutrients

Division basic vs discretionary groups

makes different criteria between these

groups possible.

Definition (non) basic product

groups

Definition (non) basic product

groupsBasic product groups (deliver essential nutrients):

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

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

Non basic or discretionary product groups:

All other foods and drinks such as:

Soups including bouillons/broths

Sauces and dressings

Snacks including:

Ice-cream (incl. all kind of edible ice)

Pastry and biscuits including mixes/combinations with basic foods (e.g. tiramisu..)

Sweets snacks including sweets, chocolates and candy bars

Savory snacks including crisps

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

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

Food Based Dietary Guidelines (FBDG)

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

Food Based Dietary Guidelines (FBDG)

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

Basic food groups mentioned

• Vegetables (20)* Eggs (12)

• Fruit (20) Milk and milk products (18)

• Cereals (18) Potatoes, rice and pasta (18)

• Legumes (7) Meat (18)

• Spreads and Cooking prod (5) Olive oil (2) olive oil pulses nuts(3)

• Bread (16) Red meat (1)

• Fish (19) Sweets (2)

• Poultry (13) Whole grain products (1)

• Water

* Number of systems including the food group

July 27 2007

• Generic criteria for all products showed to be too simplistic

• Division in basic and discretionary food groups

• Basic food groups are defined based on Food Based Dietary Guidelines from >20 countries

Basic food groupsBasic food groupsBasic food groupsBasic food groups

Providing beneficial nutrientsProviding beneficial nutrientsProviding beneficial nutrientsProviding beneficial nutrients

Discretionary food groupsDiscretionary food groupsDiscretionary food groupsDiscretionary food groups

Fruits & vegetables Soups including bouillons

Water Beverages

Bread, grains, potatoes, pasta, rice Meal sauces

Meat, fish, poultry, eggs Water/emulsion based sauces

Milk and diary products Snacks: ice-cream, pastry & biscuits, savoury snacks, and sweet snacksFats, oils and spreads

Hot meals and sandwiches Bread toppings

Product groups - conclusionProduct groups - conclusion

Product group specific criteria

Product group specific criteriaProduct group specific criteria

• Generic criteria are used where possible

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

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

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

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

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

trans fat, saturated fat, sugar, sodium

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

trans fat, saturated fat, sugar, sodium

• Generic guidelines are used where possible

• Product specific benchmarks foods:

• Derived from national food standards & looking at existing variation in

products on the market

• It should be challenging but technically feasible (e.g. a cheese needs a

minimum level of sodium for preservation) and acceptable in taste, thus

stimulating industry to improve products

• Benchmarks for non-basic foods benchmark may be somewhat stricter than

for basic foods, but they should be feasible and stimulate industry to

improve products or develop better alternatives

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

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

• Product specific benchmarks set for few basic groups

• Selection of food groups is based on an overview of

international dietary guidelines and basic food groups

• If most choices in a food group are naturally low in SAFA,

TFA, sodium and sugar (like vegetables, fish etc.) there is no

need to add a specific benchmark to ensure provision of

essential nutrients

• Where provision of essential nutrients is at risk (e.g. bread

should contribute to fiber intake; meals to vegetable intake) a

benchmark is proposed to identify healthier choices.

Balancing between science and marketBalancing between science and market

Aim: set criteria

- To help consumers select the healthy choices while shopping

- To stimulate producers to innovate towards better products

• Ultimate goal: to set final criteria for products leading to daily intakes in line with international dietary guidelines SCIENCE

• Market: often far from ideal dietary product MARKET

formulation

• If gap too large: no participation of producers

• Criteria can be tightened over time• Result: producers join and have time to innovate• Result: consumers get used to taste changes

Product group specific criteria:

Product group specific criteriaProduct group specific criteria

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

•A product group specific criterion has been defined based on variation in products in the market.

•10-20% Rule

At least 20% of basic and approximately 10% of discretionary food products

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

10-20% Rule as appliedfor the current international criteria

10-20% Rule as appliedfor the current international criteria

At least 20% of basic and around 10% of discretionary food

products should be able to meet the criteria

Food composition data (7000 products, 12 European countries)

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Basic foods Discretionary foods

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

Databases

7066

Danish Fødevaredatabanken v6.0; 14%

EU Lim Food Basket; 21%

McCance and Widdowson's 6th ed; 17%

NEVO 2006; 20%

Nubel2004; 14%

Polish FCD 2005; 13%

UK : 17%

EU FCD with 9

countries: 21%

Belgium: 14%

Netherlands:

20%

Poland: 13% Denmark: 14%

Validation:

•Daily Menu Method

•Nutrient Intake Modelling

Daily diet validationDaily diet validation

52

Change in nutrient intakesChange in nutrient intakes

53

Nutrient WHO guideline Typical diet*Typical diet with

Choices-compliant products

Energy [kcal] 2000 2119 1783

Saturated fat [en%] < 10 15.7 8.4

Trans fat [en%] < 1 1.2 0.1

Sodium [mg] < 2000 2858 2335

Added sugar [en%] < 10 (free sugar) 13.2 5.6

Fibre [g] > 25 18 25

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

By replacing regular variants with Choices products

you can approach WHO/FAO dietary recommendations

The daily diet validation was also applied to other countries

The daily diet validation was also applied to other countries

SAFA intakes in "Typcial" and "Choices" Daily Menus from 7

countries (en%)

0

5

10

15

20

Net

herla

nds

Gre

ece

Spain

USA

Chi

na

Isra

elSou

th A

frica

Typical

Choices

Maximal intake limit <10 en%

Change (en%) in saturated fatty acid intakes

Alternative Validation:Potential impact on nutrient intakes

Alternative Validation:Potential impact on nutrient intakes

Potential impact on nutrient intakes

3 scenarios:

Potential impact on nutrient intakes

3 scenarios:

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

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

3. Same as 2, but corrected for energy intakes

Output: distribution of usual

nutrient intake in the population

Method Method

Input: food intake data from national

consumption survey

Input: Food composition data

Monte Carlo Risk assessment model

Statistical procedure to calculate

usual (nutrient, chemical) intakes

based on the consumption survey,

by multiple sampling (100 000

times). Developed for food safety assessements.

Distributions of saturated fatty acid intake (g/d)

0

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0 10 20 30 40 50 60 70 80

As measured Choices Choices, adjusted for energy

Maximal intake limit (< 22.2 g/d)

P50(Median) ≈ mean SFA intake

Saturated fatty acids: intake dataSaturated fatty acids: intake data

Sodium: intake data

Maximal intake limit 2000mg/d

Sodium intake mg/d

0

0.0001

0.0002

0.0003

0.0004

0.0005

0.0006

0.0007

0.0008

0.0009

0 1000 2000 3000 4000 5000 6000

As measured Choices Choices (adjusted for energy)

Change in median nutrient intakes (%)

-80

-60

-40

-20

0

20

40

60

Energ

y

To

tal fa

t

SA

FA

TF

A

Sod

ium

To

tal sugar

Pro

tein

To

tal car

bo

hydra

te

Fib

re

Cal

cium

Iron

folic a

cid

MU

FA

PU

FA

Choices Choices, adjusted for energy

Percentage change in P50 (median) nutrient intakes

Percentage change in P50 (median) nutrient intakes

•Energy intakes reduce (15%)

•Intakes of nutrients with maximal intake limits reduce

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

Validation - conclusionValidation - conclusion

• It can be concluded that the Choices programme can potentially improve dietary nutrient intake in the direction of the international recommendations, taken into account an addition of 30% on top of the international dietary recommendations might be an effective approach.

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

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

Back upBack up

Product group specific criteria Product group specific criteria

• Generic criteria or insignificant levels are used where possible.

• Product group specific criteria used only when necessary:

1. No available alternative of a commonly consumed food

2. No alignment with recommendations

3. No stimulation of innovation (taste, technology, regulation, or all products comply)

• 10-20% Rule was applied (based on food composition data):

At least 20% of basic and approximately 10% of discretionary food products

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

Evaluation of (proposed) Choices criteria

Evaluation of (proposed) Choices criteria

Selection and preparation of Food Selection and preparation of Food

Composition Databases (FCDs)Composition Databases (FCDs)

Selection of the FCDs- Selection criteria -

Selection of the FCDs- Selection criteria -

1. Demographic representation covering all regions of the world:

2. Availability of the Choices “key nutrients”:

• added / total sugars

• saturated fatty acids

• trans fatty acids

• sodium

• dietary fibre

• energy

• (positive nutrients: Ca, Fe, K, Mg, Vit A, C, D, E)*

3. Be electronically available

4. Be available in English

5. Number of foods included in the database

6. Price & availability

REGION SUB-REGION COUNTRY FC DATABASE MISSING KEY NUTRIENTS

AMERICA NORTHERN United States USDA Added Sugars

LATIN LatAm Latinfoods Total Sugars, Added Sugars, TFA

EUROPE NORTHERN Denmark Danish FCD All key nutrients are available

WESTERN United Kingdom McCance&Widdowson Added Sugars

The Netherlands NEVO Added Sugars

Belgium NUBEL Added Sugars, TFA

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

SOUTHERN Italy Italian FCD Added Sugars, TFA

EUROPE GENERAL EFSA Food Basket Added Sugars

OCEANIA Australia NUTTAB Added Sugars, TFA

AFRICA South Africa FOODFINDER 3 Added Sugars, TFA, Fibre

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

Israel Israel FCD Added Sugars, TFA

Singapore Singapore FCD Added Sugars, TFA

Selection of the FCDs-An example

Selection of the FCDs-An example

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

• Preparation of the FCDs for evaluation against

criteria implies deciding on the:

• Food product group classification

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

FCDs]

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

• Serving sizes

Preparation of the FCDs

1. Food product group classification based on:

• Pragmatic application of equivalence criteria & 70% rule

2. Trans Fatty Acid content based on:

• Recipe (ingredients, amounts & food processing)

• Total fat content in relation to the origin, in line with TRANSFAIR Study (animal vs. dairy; ruminant vs. pork)

3. Added sugar content based on:

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

• Recipes (ingredients and amounts)

• Existing food regulations for fruit based food items like jam orjuice

4. Serving sizes:

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

Preparation of the FCDs- Assumptions made -

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

Databases

7066

Danish Fødevaredatabanken v6.0; 14%

EU Lim Food Basket; 21%

McCance and Widdowson's 6th ed; 17%

NEVO 2006; 20%

Nubel2004; 14%

Polish FCD 2005; 13%

UK : 17%

EU FCD with 9

countries: 21%

Belgium: 14%

Netherlands:

20%

Poland: 13% Denmark: 14%

Energy criteria

Rationale for Energy criteriaRationale for Energy criteria

• Energy criterion is established for:

• Main dishes

• Filled sandwiches/rolls

• Non basic product groups

• Because:

• Main dishes and sandwiches etc are major components of a daily diet

• Non basic product groups do not substantially

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

Rationale for Energy criteriaRationale for Energy criteria

Remaining calories 1,800 kcal/day

Breakfast(20%E)

Lunch(30%E)

Dinner(30%E)

540 kcal/serve

3x In-Between meal product

(20%E)120 kcal/serve

2,000 kcal/dayRecommended energy intake for women

< 200 kcal/dayDay’s beverage

intake(10 en%)

Based on:

•Recommended energy intakes

•10% to come from beverages

•Meal patterns

Overview of recommended energy intake during the day: basis for energy criteria

(as calculated for adult women)

Rationale for Energy criteriaRationale for Energy criteria

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

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

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

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

Children 2-12 1546 kcal/day 95 kcal/serve

Energy criterion: 400-700 kcal/serveEnergy criterion:

110 kcal/serve

Overview of recommendations for daily energy intake and for main dishes and snacks

Rationale for Energy criteriaRationale for Energy criteria• Energy density is correlated with water content.

• For products with high water content (>50% w/w) it was decided to use

100kcal/100g as criteria. While for products with low water content

(<50% w/w) this is 350kcal/100g).

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

Soups

Meal sauces

Sauces emulsions

Sauces non-emulsions

Snacks

Beverages

85

80

48

75

100

100

350

100

110

32

Rationale Beverages:

•stimulate innovation

• Current regular drinks contain 10-12 g sugar per 100 ml

• As a first step: criterion set at 20 kcal = 5 g sugar per 100 ml

• this is without forcing to use artificial sweeteners

• intention is that this will be lowered in the future

•As energy in beverages mainly comes from sugar, there is no

need for an extra sugar criterion

Implementation of ChoicesImplementation of Choices

Two practical subjects:

•Score products “as sold” or “as prepared”

•Assigment to product groups

Sold vs preparedSold vs prepared

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

Only in the case of dried products in powder form,

concentrated or condensed products, food products may

be registered as ‘as prepared’, but only if the method of preparation is unambiguous. This refers for example to

dried and concentrated products which have to be resolved/diluted in water/milk, such as soups, broths,

sauces in powder form, concentrated meal mixes,

potatoes in powder form and syrups. The nutrient declaration for these products is registered for the product

as ‘as prepared’.

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

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

• Examples:

fried potato chips from snack bar can be considered as potato product, but also as snack.

ice cream can be considered as milk product but also as snack

Study on effectiveness of ChoicesStudy on effectiveness of Choices

Product innovation

Title / Date

Effectiveness:

effects on product innovation

Title / Date

Method

Product reformulation & innovation

• N = 47 companies (response 39.5%)

oNewly developed, reformulated or already complying

o821 products

�SAFA

�TFA

�Added sugar

�Sodium

�Fiber

�Energy

Title / Date

Products per product group

0

20

40

60

80

100

120

Nu

mb

er

of

pro

du

cts

per

pro

du

ct

gro

up

Product group

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

new

reformulated

already complying

Title / Date

Product group Saturated fat Added sugar Dietary fibre

Fruit juice(n=6)

- - +53%(0.15-0.23 g/100g)

Processed meat(n=11)

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

- -

Dairy products(n=10)

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

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

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

Sandwiches(n=16)

- - +52%(2.4-3.64 g/100g)

Sauces(n=10)

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

-

Reformulated products

83

Title / Date

Composition of newly developed products

84

Product group Saturated fat Added sugar Sodium

Processed meat(n=17)

- - -39%(1018-626 mg/100g)

Dairy products(n=11)

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

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

-

Soups(n=21)

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

Reference products: previously reformulated products of same product group

Title / Date

Most reformulation: sodium

-18% (average)1017� 834mg/100g

-13 (average)372�322 mg/100g

-42% (average)471�273mg/100g

Meat products n=11

Soups: n=68

Breads: n=12

Title / Date

Criteria

Title / Date

Product criteria per groupBasic product groups

Product group Product criteria

Fresh or fresh frozen fruit, vegetables and legumes

All types of fresh fruit and vegetables, without additives

Processed fruit & vegetables Saturated fat

Trans fat

Sodium

Added sugar

Dietary fibre

≤ 1.1 g/100 g

≤0.1 g/100 g

≤100 mg/100 g

not added

≥ 1.3 g/100 kcal

Fruit juices Saturated fat

Trans fat

Sodium

Added sugar

Dietary fibre

Energy

≤ 1.1 g/100 g

≤ 0.1 g/100 g

≤ 100 mg/100 g

not added

≥0.75 g/100 kcal

≤ 48 kcal/100 ml

87

Title / Date

Product criteria per groupBasic product groups

Product group Product criteria

Water Saturated fat

Trans fat

Sodium

Added sugar

≤ 1.1 g/100 g

≤0.1 g/100 g

≤ 20 mg/100 g

Not added

Potatoes (unprocessed) All unprocessed uncooked potatoes, without additives

Potatoes (processed), pasta, noodles

Saturated fat

Trans fat

Sodium

Added sugar

Dietary fibre

≤ 1.1 g/100 g

≤ 0.1 g/100 g

≤ 100 mg/100 g

not added

≥ 1.3 g/100 kcal

Rice Saturated fat

Trans fat

Sodium

Added sugar

Dietary fibre

≤ 1.1 g/100 g

≤ 0.1 g/100 g

≤ 100 mg/100 g

not added

≥ 0.7 g/100 kcal

88

Title / Date

Product criteria per groupBasic product groups

Product group Product criteria

Bread Saturated fat

Trans fat

Sodium

Added sugar

Dietary fibre

≤ 1.1 g/100 g

≤ 0.1 g/100 g

≤ 500 mg/100 g

≤ 13 en%

≥ 1.3 g/100 kcal

Grain and cereals Saturated fat

Trans fat

Sodium

Added sugar

Dietary fibre

≤ 1.1 g/100 g

≤ 0.1 g/100 g

≤ 100 mg/100 g

≤ 2.5 g/100g

≥ 1.3 g/100 kcal

Breakfast cereals Saturated fat

Trans fat

Sodium

Added sugar

Dietary fibre

≤ 1.1 g/100 g

≤ 0.1 g/100 g

≤ 500 mg/100 g

≤ 20 g/100g

≥ 1.3 g/100 kcal

89

Title / Date

Product criteria per groupBasic product groups

Product group Product criteria

Milk (-products) Saturated fat

Trans fat*

Sodium

Added sugar

≤ 1.4 g/100 g

≤ 0.1 g/100 g

≤ 100 mg/100 g

≤ 5 g/100g

Cheese (-products) Saturated fat

Trans fat*

Sodium

Added sugar

≤ 15 g/100 g

≤ 0.1 g/100 g

≤ 900 mg/100 g

Not added

Meat, poultry, eggs (unprocessed) Saturated fat

Trans fat*

Sodium

Added sugar

≤ 1.1 g/100 g or 13 en%

≤ 0.1 g/100 g

≤ 100 mg/100 g

Not added

Processed meat, meat products and meat substitutes

Saturated fat

Trans fat*

Sodium

Added sugar

≤ 1.1 g/100 g or 13 en%

≤ 0.1 g/100 g

≤ 900 mg/100 g

≤ 2.5 g/100 g

90

*Naturally occurring trans fat is excluded.

Title / Date

Product criteria per groupBasic product groups

Product group Product criteria

Fresh or fresh frozen fish, shellfish and crustaceans

Saturated fat

Trans fat

Sodium

Added sugar

≤ 1.1 g/100 g or 30% of total fat

≤ 0.1 g/100 g

≤ 100 mg/100 g

Not added

Processed fish or fish products Saturated fat

Trans fat

Sodium

Added sugar

≤ 1.1 g/100 g or 30% of total fat

≤ 0.1 g/100 g

≤ 450 mg/100 g

Not added

Oils, fats and fat containing spreads

Saturated fat

Trans fat

Sodium

Added sugar

≤ 30% of total fat

≤ 1.3 en%

≤ 1.3 mg/kcal

Not added

91

Title / Date

Product criteria per groupBasic product groups

Product group Product criteria

Main course Saturated fat

Trans fat

Sodium

Added sugar

Dietary fibre

Energy

≤ 1.1 g/100 g or 13 en%

≤ 0.1 g/100 g or 1.3 en%

≤ 2.2 mg/kcal

≤ 2,5 g/100 g or 13 en%

≥1.25 g/100 kcal

400-700 kcal/serving

Filled sandwiches/rolls Saturated fat

Trans fat

Sodium

Added sugar

Dietary fibre

Energy

≤ 1.1 g/100 g or 13 en%

≤ 0.1 g/100 g or 1.3 en%

≤ 1.9 mg/kcal

≤ 2,5 g/100 g or 13 en%

≥ 0.8 g/100 kcal

350 kcal/serving

92

Title / Date

Product criteria per groupDiscretionary product groups

Product group Product criteria

Soups Saturated fat

Trans fat

Sodium

Added sugar

Energy

≤ 1.1 g/100 g

≤ 0.1 g/100 g

≤ 300 mg/100 g

≤ 2,5 g/100 g

100 kcal/100 g

Meal sauces Saturated fat

Trans fat

Sodium

Added sugar

Energy

≤ 1.1 g/100 g

≤ 0.1 g/100 g

≤ 450 mg/100 g

≤ 2,5 g/100 g

100 kcal/100 g

93

Title / Date

Product criteria per groupDiscretionary product groups

Product group Product criteria

Other sauces

(on water basis)

Saturated fat

Trans fat

Sodium

Energy

≤ 1.1 g/100 g

≤ 0.1 g/100 g

≤ 750 mg/100 g

100 kcal/100 g

Other sauces

(emulsions)

Saturated fat

Trans fat

Sodium

Added sugar

Energy

≤ 1.1 g/100 g or 30% of fat

≤ 0.1 g/100 g or 1.3 en%

≤ 750 mg/100 g

≤ 2,5 g/100 g or 13 en%

350 kcal/100 g

94

Title / Date

Product criteria per groupDiscretionary product groups

Product group Product criteria

Snacks Saturated fat

Trans fat

Sodium

Added sugar

Energy

≤ 1.1 g/100 g or 13 en%

≤ 0.1 g/100 g or 1.3 en%

≤ 400 mg/100 g

≤ 20 g/100 g

110 kcal/100 g

Beverages Saturated fat

Trans fat

Sodium

Energy

≤ 1.1 g/100 g

≤ 0.1 g/100 g

≤ 100 mg/100 g

20 kcal/100 ml

Bread toppings Saturated fat

Trans fat

Sodium

Added sugar

≤ 13 en%

≤ 1.3 en%

≤ 400 mg/100 g

≤ 30 g/100 g

95