“High in” nutrition symbol may improve consumer diet and reduce diet-related diseases, study flags

07 Aug 2023 --- Substituting foods with lower “high in'' indications on front-of-pack labeling (FOPL) has shown significant reductions in dietary intake and diet-related non-communicable disease (NCD). The results were found during the evaluation of dietary impact research done by researchers from the universities of Toronto, Wageningen, São Paulo and Harvard.

According to the study published in Frontiers in Nutrition, consumer surveys show that after implementing mandatory “high in” FOPL symbols, 30-70% of consumers chose or were willing to choose products with fewer “high in” indications. 

The researchers calculated reductions of 73-259 mg a day in sodium, up to 6.9 g of total sugars, 0.5 g a day of saturated fats and between 14-46 kcal of energy in Canadians, the study’s target group. 

They estimate that 2,148 to 7,047 diet-related deaths, mainly cardiovascular diseases, could be averted if consumers choose products with fewer “high in” indications. Excessive intake of sodium and sugar increases the risk for many NCDs such as hypertension, diabetes and renal disease.

The estimated health gains highlighted in the study were more meaningful for men than women, specifically for ischemic heart disease, where the number of deaths that could be averted were double that estimated for women. This was validated by the differences in nutrient intake and diet-related NCD mortality burden between Canadian men and women.

Advocating for mandatory “high in” FOPL
FOPL has been identified as a cost-effective policy to help consumers make healthier food choices. In 2022, Health Canada published new FOPL guidelines which require a nutrition symbol on most prepackaged foods with a Nutrition Facts table, specifically, those that exceed the thresholds for saturated fat, sugars or sodium. 

The thresholds correspond to a percentage of the daily value (DV) per reference amount or serving size for saturated fat, sugars or sodium, whichever is greater.

The intake of sodium, total sugar, saturated fat and energy were evaluated in 11,992 Canadians using data from the 2015 Canadian Community Health Survey-Nutrition. Foods selected by a food composition database were substituted in up to 70% of the adult participants and the health impacts estimated.Consumers are willing to buy less “high in” foods when there are mandatory warnings. 

The study’s findings suggest that substitution with a healthier food alternative, based on the display of fewer “high in” FOPL symbols, could improve dietary intake of sodium and sugar. 

Recently, the WHO released new guidance recommending countries implement comprehensive mandatory policies to protect children of all ages from being marketed foods and non-alcoholic beverages high in saturated fatty acids, trans-fatty acids, free sugars and salt.

Nutrient warning systems
Mandatory nutrient warning FOPL systems for “high in” or “excess” foods have already been adopted in Argentina, Brazil, Chile, Colombia, Israel, Mexico, Peru, Uruguay and Venezuela and more recently in Canada.

Health Canada highlighted the need to provide consumers with easy-to-understand nutrition labeling to help them make healthier food choices, specifically on packaged foods to limit high in salt, sugar and fats (HFSS) foods. 

In Canada, a study showed that in experimental conditions, 70% of consumers used the “high in” FOPL symbol to compare foods within the same food category, to choose foods that did not display a symbol (69%), and to choose healthier alternatives when available (40%). 

The current study suggests that with increased awareness and exposure to the “high in” symbol, consumers became more efficient at selecting healthier food alternatives.

However, fiber was not included in the FOPL regulations but merely as an exploratory analysis. Evidence suggests that using FOPL improves dietary quality by reducing the intake of “nutrients to limit,” such as sugars, and increasing intakes of “nutrients to encourage”, such as fiber.

Meanwhile, the FDA proposed an updated definition of products labeled as “healthy” and a deeper insight into nutrient content. The agency also wants product labels consistent with federal dietary guidelines and nutrition science to help consumers make more informed purchasing decisions.

By Inga de Jong