Modelling Food Substitution Using the Ofcom Nutrient Profiling Model on Population Intakes from the Canadian Community Health Survey-Nutrition 2015.

This study aimed to model how substituting foods consumed by Canadians for alternatives with more favourable nutrient profiling (NP) scores would impact dietary intakes. The Ofcom NP system, developed to help the UK Office of Communication differentiate foods that can be advertised to children, was applied to foods consumed by Canadians aged 2 years and older in the 2015 Canadian Community Health Survey (CCHS) (n = 19,447). Foods were substituted for similar options from the Euromonitor branded food composition database (Scenario 1) or from the primarily aggregated food profiles in the CCHS survey food composition database (Scenario 2) with either the most favourable (optimistic; 1A and 2A) or a more favourable Ofcom score (realistic; 1B and 2B). Mean intakes of Ofcom scores, calories, saturated fat, sugars, and sodium from these scenarios were compared to baseline. Only 2.9% of foods consumed had a similar Euromonitor option with a lower Ofcom score. Scenarios 1A, 1B, and 2A had lower Ofcom scores, calorie, sodium, saturated fat, and sugar intakes compared to baseline. Scenario 2B had lower levels of all outcome measures, except for an increase in calories compared to baseline. Selection of foods with more favourable NP scores has the potential to decrease the Canadian intake of nutrients of concern.

The estimated dietary and health impact of implementing the recently approved 'high in' front-of-package nutrition symbol in Canada: a food substitution scenario modeling study.

Background: Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy food environments and to help consumers make healthier food choices. Consumer surveys report that after implementation of mandatory 'high in' FOPL symbols between 30 and 70% of consumers choose or were willing to choose products with fewer 'high in' symbols. Health Canada has recently published FOPL regulations that will require prepackaged food and beverages that meet or exceed thresholds for sodium, total sugars, or saturated fat to display a 'high in' FOPL nutrition symbol. Objectives: The aims were to estimate the potential (1) dietary impact of substituting foods with similar foods that would display at least one less 'high in' symbol, and (2) the number of diet-related noncommunicable disease (NCD) deaths that could be averted or delayed due to estimated dietary changes. Methods: Baseline and counterfactual intakes of sodium, total sugars, saturated fats, and energy were estimated among Canadian adults (n = 11,992) using both available days of 24 h-recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS). Similar foods to those reported in CCHS that would display at least one less 'high in' symbol (n = 239) were identified using a Canadian branded food composition database. Based on current FOPL consumer research, identified foods were substituted for 30, 50, and 70% of randomly selected CCHS-Nutrition adult participants and for all adult participants. Potential health impacts were estimated using the Preventable Risk Integrated ModEl. Results: Mean dietary reductions of between 73 and 259 mg/day of sodium, 2.0 and 6.9 g/day of total sugars, 0.2 and 0.5 g/day of saturated fats, and 14 and 46 kcal/day of energy were estimated. Between 2,148 (95% UI 1,913-2,386) and 7,047 (95% UI 6,249-7,886) of deaths due to diet-related NCDs, primarily from cardiovascular diseases (70%), could potentially be averted or delayed if Canadians choose products with fewer 'high in' symbols. Conclusion: Results suggest that FOPL could significantly reduce sodium and total sugar intakes among Canadian adults, the consequences of which could avert or delay an important number of diet-related NCD deaths. These findings provide relevant data to support the importance of the impending FOPL regulations.

Canadian Free Sugar Intake and Modelling of a Reformulation Scenario.

Recommendations suggest limiting the intake of free sugar to under 10% or 5% of calories in order to reduce the risk of negative health outcomes. This study aimed to examine Canadian free sugar intake and model how intakes change following the implementation of a systematic reformulation of foods and beverages to be 20% lower in free sugar. Additionally, this study aimed to examine how calorie intake might be impacted by this reformulation scenario. Canadians' free sugar and calorie intakes were determined using free sugar and calorie data from the Food Label Information Program (FLIP) 2017, a Canadian branded food composition database, and applied to foods reported as being consumed in Canadian Community Health Survey-Nutrition (CCHS-Nutrition) 2015. A "counterfactual" scenario was modelled to examine changes in intake following the reformulation of foods to be 20% lower in free sugar. The overall mean free sugar intake was 12.1% of calories and was reduced to align with the intake recommendations at 10% of calories in the "counterfactual" scenario (p < 0.05). Calorie intake was reduced by 3.2% (60 calories) in the "counterfactual" scenario (p < 0.05). Although the overall average intake was aligned with the recommendations, many age/sex groups exceeded the recommended intake, even in the "counterfactual" scenario. The results demonstrate a need to reduce the intake of free sugar in Canada to align with dietary recommendations, potentially through reformulation. The results can be used to inform future program and policy decisions related to achieving the recommended intake levels of free sugar in Canada.

Estimating Canadian sodium intakes and the health impact of meeting national and WHO recommended sodium intake levels: A macrosimulation modelling study.

BACKGROUND: Cardiovascular diseases (CVDs) are the second leading cause of total deaths in Canada. High blood pressure is the main metabolic risk factor for developing CVDs. It has been well established that excess consumption of sodium adversely affects blood pressure. Canadians' mean sodium intakes are well above recommended levels. Reducing dietary sodium intake through food reformulation has been identified as a cost-effective intervention, however, dietary sodium intake and the potential health impact of meeting recommended sodium intake levels due to food reformulation have not been determined in Canada. OBJECTIVE: This study aimed to 1) obtain robust estimates of Canadians' usual sodium intakes, 2) model sodium intakes had foods been reformulated to align with Health Canada's sodium reduction targets, and 3) estimate the number of CVD deaths that could be averted or delayed if Canadian adults were to reduce their mean sodium intake to recommended levels under three scenarios: A) 2,300 mg/d-driven by a reduction of sodium levels in packaged foods to meet Health Canada targets (reformulation); B) 2,000 mg/d to meet the World Health Organization (WHO) recommendation; and C) 1,500 mg/d to meet the Adequate Intake recommendation. METHODS: Foods in the University of Toronto's Food Label Information Program 2017, a Canadian branded food composition database, were linked to nationally representative food intake data from the 2015 Canadian Community Health Survey-Nutrition to estimate sodium intakes (and intakes had Health Canada's reformulation strategy been fully implemented). The Preventable Risk Integrated ModEl (PRIME) was used to estimate potential health impact. RESULTS: Overall, mean sodium intake was 2758 mg/day, varying by age and sex group. Based on 'reformulation' scenario A, mean sodium intakes were reduced by 459 mg/day, to 2299 mg/day. Reducing Canadians' sodium intake to recommended levels under scenarios A, B and C could have averted or delayed 2,176 (95% UI 869-3,687), 3,252 (95% UI 1,380-5,321), and 5,296 (95% UI 2,190-8,311) deaths due to CVDs, respectively, mainly from ischaemic heart disease, stroke, and hypertensive disease. This represents 3.7%, 5.6%, and 9.1%, respectively, of the total number of CVDs deaths observed in Canada in 2019. CONCLUSION: Results suggest that reducing sodium intake to recommended levels could prevent or postpone a substantial number of CVD deaths in Canada. Reduced sodium intakes could be achieved through reformulation of the Canadian food supply. However, it will require higher compliance from the food industry to achieve Health Canada's voluntary benchmark sodium reduction targets.

How Many Diet-Related Non-Communicable Disease Deaths Could Be Averted or Delayed If Canadians Reduced Their Consumption of Calories Derived from Free Sugars Intake? A Macrosimulation Modeling Study.

Free sugars are a major source of calories in diets and contribute to the burden of many non-communicable diseases (NCDs). The World Health Organization (WHO) recommends reducing free sugars intake to less than 10% of total energy. This study aimed to estimate the number of diet-related NCD deaths which could be averted or delayed if Canadian adults were to reduce their calorie intake due to a systematic 20% reduction in the free sugars content in foods and beverages in Canada. We used the Preventable Risk Integrated ModEl (PRIME) to estimate the potential health impact. An estimated 6770 (95% UI 6184-7333) deaths due to diet-related NCDs could be averted or delayed, mostly from cardiovascular diseases (66.3%). This estimation would represent 7.5% of diet-related NCD deaths observed in 2019 in Canada. A 20% reduction in the free sugars content in foods and beverages would lead to a 3.2% reduction in calorie intake, yet an important number of diet-related NCD deaths could be averted or delayed through this strategy. Our findings can inform future policy decisions to support Canadians' free sugars intake reduction, such as proposing target levels for the free sugars content in key food categories.

Comparing the nutritional composition of foods and beverages in the Canadian Nutrient File to a large representative database of Canadian prepackaged foods and beverages.

BACKGROUND: Nutrient information used to code dietary intakes in the Canadian Community Health Survey (CCHS) may not be reflective of the current Canadian food supply and could result in inaccurate evaluations of nutrient exposures. OBJECTIVE: To compare the nutritional compositions of foods in the CCHS 2015 Food and Ingredient Details (FID) file (n = 2,785) to a large representative Canadian database of branded food and beverage products (Food Label Information Program, FLIP) collected in 2017 (n = 20,625). METHOD: Food products in the FLIP database were matched to equivalent generic foods from the FID file to create new aggregate food profiles based on FLIP nutrient data. Mann Whitney U tests were used to compare nutrient compositions between the FID and FLIP food profiles. RESULTS: In most food categories and nutrients there were no statistically significant differences between the FLIP and FID food profiles. Nutrients with the largest differences included: saturated fats (n = 9 of 21 categories), fiber (n = 7), cholesterol (n = 6), and total fats (n = 4). The meats and alternatives category had the most nutrients with significant differences. CONCLUSION: These results can be used to prioritize future updates and collections of food composition databases, while also providing insights for interpreting CCHS 2015 nutrient intakes.

The relationship between voluntary product (re) formulation commitments and changes in the nutritional quality of products offered by the top packaged food and beverage companies in Canada from 2013 to 2017.

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.

Algorithm-based mapping of products in a branded Canadian food and beverage database to their equivalents in Health Canada's Canadian Nutrient File.

Introduction: There is increasing recognition of the value of linking food sales databases to national food composition tables for population nutrition research. Objectives: Expanding upon automated and manual database mapping approaches in the literature, our aim was to match 1,179 food products in the Canadian data subset of Euromonitor International's Passport Nutrition to their closest respective equivalents in Health Canada's Canadian Nutrient File (CNF). Methods: Matching took place in two major steps. First, an algorithm based on thresholds of maximal nutrient difference (between Euromonitor and CNF foods) and fuzzy matching was executed to offer match options. If a nutritionally appropriate match was available among the algorithm suggestions, it was selected. When the suggested set contained no nutritionally sound matches, the Euromonitor product was instead manually matched to a CNF food or deemed unmatchable, with the unique addition of expert validation to maximize meticulousness in matching. Both steps were independently performed by at least two team members with dietetics expertise. Results: Of 1,111 Euromonitor products run through the algorithm, an accurate CNF match was offered for 65% of them; missing or zero-calorie data precluded 68 products from being run in the algorithm. Products with 2 or more algorithm-suggested CNF matches had higher match accuracy than those with one (71 vs. 50%, respectively). Overall, inter-rater agreement (reliability) rates were robust for matches chosen among algorithm options (51%) and even higher regarding whether manual selection would be required (71%); among manually selected CNF matches, reliability was 33%. Ultimately, 1,152 (98%) Euromonitor products were matched to a CNF equivalent. Conclusion: Our reported matching process successfully bridged a food sales database's products to their respective CNF matches for use in future nutritional epidemiological studies of branded foods sold in Canada. Our team's novel utilization of dietetics expertise aided in match validation at both steps, ensuring rigor and quality of resulting match selections.

The Level of Processing, Nutritional Composition and Prices of Canadian Packaged Foods and Beverages with and without Gluten-Free Claims.

Little is known about the healthfulness and cost of gluten-free (GF) foods, relative to non-GF alternatives, in Canada. This study compared the extent of processing, nutritional composition and prices of Canadian products with and without GF claims. Data were sourced from the University of Toronto Food Label Information Program (FLIP) 2013 (n = 15,285) and 2017 (n = 17,337) databases. Logistic regression models examined the association of NOVA processing category with GF claims. Calorie/nutrient contents per 100 g (or mL) were compared between GF and non-GF products. Generalized linear models compared adjusted mean prices per 100 g (or mL) of products with and without GF claims. The prevalence of GF claims increased from 7.1% in 2013 to 15.0% in 2017. GF claims appeared on 17.0% of ultra-processed foods, which were more likely to bear GF claims products than less-processed categories. Median calories and sodium were significantly higher in GF products; no significant differences were observed for saturated fat or sugars. Compared to non-GF products, adjusted mean prices of GF products were higher for 10 food categories, lower for six categories and not significantly different for six categories. Overall, GF claims are becoming increasingly prevalent in Canada; however, they are often less healthful and more expensive than non-GF alternatives, disadvantaging consumers following GF diets.

Methodology for the Determination of Fruit, Vegetable, Nut and Legume Points for Food Supplies without Quantitative Ingredient Declarations and Its Application to a Large Canadian Packaged Food and Beverage Database.

Nutrient profiling (NP) models are useful tools for objectively and transparently quantifying the nutritional quality of packaged foods and beverages. Many NP models incorporate ingredients beneficial for health (e.g., fruits, vegetables, nuts, legumes (FVNL)) in addition to less healthful nutrients or components, assigning points based on the proportion of the product that contains FVNL ingredients. However, with food labelling in most countries lacking mandatory quantitative ingredient declarations (QUIDs), there is potential for the estimation of FVNL points to be ambiguous and inconsistent. The purpose of this article was to describe the development and application of methodology for estimating FVNL points for products without QUIDs, based on the position of FVNL components within the ingredients list. Using this method, FVNL points were calculated for packaged foods and beverages in the University of Toronto Food Label Information Program 2017 database (n = 17,337). Distributions of FVNL points were examined overall and by food category. This study provides evidence of the feasibility of this method in distinguishing between products with differing amounts of FVNL ingredients. This method will be valuable for researchers and policymakers in ensuring consistent, objective and reproducible estimations of FVNL points-and consequently, assessments of product healthfulness-for food supplies without QUIDs.

Reformulation of sugar contents in Canadian prepackaged foods and beverages between 2013 and 2017 and resultant changes in nutritional composition of products with sugar reductions.

OBJECTIVE: To quantify total sugar reformulation in Canadian prepackaged foods and beverages between 2013 and 2017 and identify changes in the nutritional composition of the foods and beverages reformulated to be lower in total sugar. DESIGN: Longitudinal examination of foods and beverages present in both 2013 and 2017 collections of the University of Toronto's Food Label Information Program database (n 6628 matched products). The proportion of products with changes in sugar levels was determined. Wilcoxon signed-rank test was used to examine changes in sugar levels overall for products lower or higher in sugar and changes in nutrient composition for products lower in sugar. SETTING: Largest grocery retailers by market share in Canada. PARTICIPANTS: Canadian prepackaged foods and beverages. RESULTS: The majority (76·6 %) of products had no change in total sugar content, 12·4 % were reformulated to be lower in sugar and 11·0 % were higher in sugar. A median sugar reduction of 19·0 % (1·6 g) was seen among products lower in sugar which was offset by a median 18·0 % (1·5 g) increase among products higher in sugar. Overall, median levels of energies and other nutrients stayed the same or decreased among products reformulated to be lower in sugar, the exception was for starch, which increased. CONCLUSIONS: Limited progress was made to reformulate foods and beverages to be lower in total sugar between 2013 and 2017. Results from this study identify areas in the food supply where attention may be needed to avoid unintended consequences of sugar-focused reformulation in terms of overall nutritional composition.

Evaluating the Canadian Packaged Food Supply Using Health Canada's Proposed Nutrient Criteria for Restricting Food and Beverage Marketing to Children.

Federally mandated restrictions on food and beverage marketing to kids (M2K) have been re-introduced as a national public health priority in Canada by the newly elected government, following the failure to implement a similar policy first proposed in 2016. This study examined the extent to which Canadian packaged foods, including products already displaying M2K on the packaging, would be permitted to be marketed, based on the nutrient criteria for marketing restrictions defined by Health Canada (in December 2018) as part of the previous policy proposal. Products from the University of Toronto Food Label Information Program 2013 database (n = 15,200) were evaluated using Health Canada's published criteria: thresholds for sodium, sugars and saturated fats that products cannot exceed in order to be M2K. The proportion of products exceeding no thresholds (i.e., permitted to be M2K), the number of thresholds exceeded, and the proportion exceeding each individual threshold were calculated overall and in the subsample of products displaying M2K on the packaging (n = 747). Overall, 18.0% of products would be permitted to be M2K, versus 2.7% of products displaying M2K. Sodium was the most exceeded threshold overall (57.5% of products), whereas sugars was the most exceeded by products displaying M2K (80.1%). Only 4.7% of all products versus 10.4% of products displaying M2K exceeded all three thresholds. These results highlight the importance of reintroducing federal regulations restricting M2K in Canada and including marketing on product packaging in the regulatory scope.

Examining the relationship between sugars contents of Canadian foods and beverages and child-appealing marketing.

OBJECTIVE: In 2016, legislation to restrict child-appealing marketing (M2K) of "unhealthy" foods and beverages ("foods") (i.e., foods that exceed roughly 5-10% of the Daily Value (DV) for total sugars, sodium, or saturated fats) was proposed in Canada. The objective of this study was to examine the relationship between foods with on-pack M2K and excessive free sugars contents (≥ 10% calories from free sugars) and the potential for a 5% total sugars DV threshold to restrict M2K on these products. METHODS: Cross-sectional analysis of the University of Toronto's Food Label Information Program (FLIP) 2013 database (n = 15,259, after exclusions). Odds ratios were used to determine the association between excess free sugars contents and presence of M2K, stratified by major food category. The proportion of products with excessive free sugars levels, or with M2K, that would be restricted from M2K if a 5% DV threshold for total sugars was implemented was also determined. RESULTS: 77.8% of foods with M2K had excess free sugars levels compared with 38.4% without M2K. M2K was more likely to be present on foods with excess free sugars levels in 8 of 14 food categories that contained products with M2K. A 5% DV threshold for total sugars would restrict M2K on 83% of foods with excess free sugars levels and on 75% of current foods that had M2K. CONCLUSION: Findings demonstrate that foods with M2K are less healthy, particularly in regard to free sugars levels. This highlights the importance of ensuring policies aimed at supporting healthy dietary habits among children carefully consider free sugars levels.

The Calorie and Nutrient Density of More- Versus Less-Processed Packaged Food and Beverage Products in the Canadian Food Supply.

The association between the degree of processing and healthfulness of foods remains unclear. Most evidence of this relationship is based on dietary intake surveys rather than individual products and varies depending on the food processing classification system used. This study aimed to compare the nutritional quality of more- versus less-processed packaged foods and beverages in Canada, using a large, branded food database and two processing classification systems. Nutritional information for products (n = 17,269) was sourced from the University of Toronto FLIP 2017 database. Products were categorized using the NOVA and Poti et al. processing classification systems. Calories, sodium, saturated fat, total and free sugars, fibre and protein per 100 g (or mL) were examined by processing category using descriptive statistics and linear regression. Overall, the most-processed products under both systems were more likely to be lower in protein, and higher in total and free sugars, compared with less-processed foods (p < 0.05); the direction and strength of the association between other nutrients/components and level of processing were less consistent. These findings demonstrate that calorie- and nutrient-dense foods exist across different levels of processing, suggesting that food choices and dietary recommendations should be based primarily on energy or nutrient density rather than processing classification.

Assessment of Packaged Foods and Beverages Carrying Nutrition Marketing against Canada's Food Guide Recommendations.

Canadians' food purchases consist largely of packaged processed and ultra-processed products, which typically fall outside the "core" foods recommended by Canada's Food Guide (CFG). Almost half of packaged products in Canada carry nutrition marketing (i.e., nutrient content and health claims). This study assessed whether packaged foods carrying nutrition marketing align with recommendations outlined in the 2007 CFG. Label data (n = 9376) were extracted from the 2013 Food Label Information Program (FLIP). Label components (including nutrition marketing) were classified using the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) labelling taxonomy. The Health Canada Surveillance Tool (HCST) was used to assess the alignment of products to CFG. Each food or beverage was classified into one of five groups (i.e., Tier 1, Tier 2, Tier 3, Tier 4, "Others"). Products in Tier 1, 2 or water were considered "in line with CFG". Most products in the analyzed sample were classified as Tier 2 (35%) and Tier 3 (27%). Although foods with nutrition marketing were significantly more likely to align to CFG recommendations (p < 0.001), many products not "in line with CFG" still carried nutrition marketing. This study provides important baseline data that could be used upon the implementation of the new CFG.

Examining the Nutritional Quality of Canadian Packaged Foods and Beverages with and without Nutrition Claims.

Nutrient content claims, health claims, and front-of-pack symbols (henceforth referred to as “nutrition claims” in the present study) are often found on food labels in Canada. However, it is currently unknown whether foods and beverages (F&Bs) carrying nutrition claims have a more favourable nutritional profile than those without such claims. This study examined differences in the global nutritional quality, as determined by the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (FSANZ-NPSC), of Canadian F&B bearing nutrition claims as compared to those without, as well as in their nutritional composition. Data (n = 15,184) was obtained from the University of Toronto 2013 Food Label Information Program. Forty-two percent of F&Bs carrying nutrition claims (n = 2930/6990) were found to be ineligible to carry claims based on the FSANZ-NPSC, in comparison to 66% of F&Bs without (n = 5401/8194, p < 0.001). Sugars and sweets, and miscellaneous products were the food categories with larger proportions of foods carrying nutrition claims not meeting the FSANZ-NPSC eligibility criteria. F&Bs with nutrition claims had fewer calories, less saturated fat, sodium, and sugar, and higher content of protein and fibre than comparable products without nutrition claims (p < 0.05 in all cases). In conclusion, nearly half of F&Bs carrying nutrition claims in Canada did not meet the FSANZ-NPSC threshold, although Canadian products carrying nutrition claims have an overall “healthier” profile than their counterparts without such claims.

A free sugars daily value (DV) identifies more "less healthy" prepackaged foods and beverages than a total sugars DV.

Regulatory changes in Canada will require food labels to have a benchmark [% Daily Value, %DV] for total sugars, based on 100 g/day, while US labels will require a %DV for added sugars, based on 50 g/day. The objective of this study was to compare two labelling policies, a total sugars DV (100 g/day) and a free sugars DV (50 g/day) on food labels. This cross-sectional analysis of the Food Label Information Program database focussed on top sources of total sugars intake in Canada (n = 6924 foods). Products were categorized as "less healthy" using two sets of criteria: a) free sugars levels exceeding the WHO guidelines (≥10% energy from free sugars); and b) exceeding healthfulness cut-offs of the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (FSANZ-NPSC). The proportion of "less healthy" products with ≥15%DV (defined as "a lot" of sugars i.e. high in sugars, based on Health Canada's %DV labelling footnote and educational message for dietary guidance) were compared for each sugar labelling scenario. The free sugars DV showed better alignment with both methods for assessing "healthfulness" than the total sugars DV. The free sugars DV identified a greater proportion of "less healthy" foods with ≥15%DV, based on both the FSANZ-NPSC (70% vs. 45%, p < .0001) and WHO guidelines (82% vs. 55%, p < .0001); particularly in sweet baked goods, sugars and preserves, chocolate bars, confectionery, and frozen desserts categories. Compared to total sugars DV labelling, using a free sugars DV identified more "less healthy" foods. Findings support the adoption of free sugars labelling.

Healthfulness and nutritional composition of Canadian prepackaged foods with and without sugar claims.

The objective of this study was to evaluate differences in calories, nutrient content, overall healthfulness, and use of sweetener ingredients between products with and without sugar claims. Consumers assume products with sugar claims are healthier and lower in calories. It is therefore important claims be found on comparatively healthier items. This study is a cross-sectional analysis of the University of Toronto's 2013 Food Label Database. Subcategories where at least 5% of products (and n ≥ 5) carried a sugar claim were included (n = 3048). Differences in median calorie content, nutrient content, and overall healthfulness, using the Food Standards Australia/New Zealand Nutrient Profiling Scoring criterion, between products with and without sugar claims, were determined. Proportion of products with and without claims that had excess free sugar levels (≥10% of calories from free sugar) and that contained sweeteners was also determined. Almost half (48%) of products with sugar claims contained excess free sugar, and a greater proportion contained sweeteners than products without such claims (30% vs 5%, χ2 = 338.6, p < 0.0001). Overall, products with sugar claims were "healthier" and had lower median calorie, free sugar, total sugar, and sodium contents than products without claims. At the subcategory level, reductions in free sugar contents were not always met with similar reductions in calorie contents. This study highlights concerns with regards to the nutritional composition of products bearing sugar claims. Findings can support educational messaging to assist consumer interpretation of sugar claims and can inform changes in nutrition policies, for example, permitting sugar claims only on products with calorie reductions and without excess free sugar.

Comparison of global nutrient profiling systems for restricting the commercial marketing of foods and beverages of low nutritional quality to children in Canada.

Background: The Canadian government recently committed to introduce legislation to restrict the commercial marketing of unhealthy foods and beverages to children.Objective: We compared the degree of strictness and agreement between nutrient profile (NP) models relevant to marketing restrictions by applying them in the Canadian context.Design: With the use of data from the University of Toronto 2013 Food Label Information Program (n = 15,342 prepackaged foods), 4 NP models were evaluated: the Food Standards Australia New Zealand-Nutrient Profiling Scoring Criterion (FSANZ-NPSC), the WHO Regional Office for Europe (EURO) model, the Pan American Health Organization (PAHO) model, and a modified version of the PAHO model (Modified-PAHO), which did not consider the extent of food processing because the application of this characteristic was prone to ambiguity. The number and proportion of foods that would be eligible for marketing to children was calculated with the use of each model, overall and by food category.Results: The Modified-PAHO and PAHO models would permit only 9.8% (95% CI: 9.4%, 10.3%) and 15.8% (95% CI: 15.3%, 16.4%) of foods, respectively, followed by the EURO model [29.8% (95% CI: 29.0%, 30.5%)]. In contrast, the FSANZ-NPSC would consider almost half of prepackaged foods as eligible for marketing to children [49.0% (95% CI: 48.2%, 49.8%)]. Cross-classification analyses showed that only 8.1% of foods would be eligible based on all models (e.g., most pastas without sauce). Subanalyses showed that each model would be more stringent when evaluating food items that specifically target children on their package (n = 747; from 1.9% of foods eligible under Modified-PAHO to 24.2% under FSANZ-NPSC).Conclusions: The degree of strictness and agreement vary greatly between NP models applicable to marketing restrictions. The discrepancies between models highlight the importance for policy makers to carefully evaluate the characteristics underlying such models when trying to identify a suitable model to underpin regulations restricting the marketing of unhealthy foods to children.

Examining the Relationship between Free Sugars and Calorie Contents in Canadian Prepacked Foods and Beverages.

To align with broader public health initiatives, reformulation of products to be lower in sugars requires interventions that also aim to reduce calorie contents. Currently available foods and beverages with a range of nutrient levels can be used to project successful reformulation opportunities. The objective of this study was to examine the relationship between free sugars and calorie levels in Canadian prepackaged foods and beverages. This study was a cross-sectional analysis of the University of Toronto's 2013 Food Label Database, limited to major sources of total sugar intake in Canada (n = 6755). Penalized B-spline regression modelling was used to examine the relationship between free sugar levels (g/100 g or 100 mL) and caloric density (kcal/100 g or 10mL), by subcategory. Significant relationships were observed for only 3 of 5 beverage subcategories and for 14 of 32 food subcategories. Most subcategories demonstrated a positive trend with varying magnitude, however, results were not consistent across related subcategories (e.g., dairy-based products). Findings highlight potential areas of concern for reformulation, and the need for innovative solutions to ensure free sugars are reduced in products within the context of improving overall nutritional quality of the diet.