What Is the Nutritional Quality of Pre-Packed Foods Marketed to Children in Food Stores? A Survey in Switzerland.

Food marketing targeting children influences their choices and dietary habits, and mainly promotes food high in fat, sugar, and salt as well as ultra-processed food. The aim of this study was to assess the nutritional quality of food and beverages marketed to children over the age of 3 and available on the Swiss market. Products with at least one marketing technique targeting children on the packaging were selected from five food store chains. Three criteria to assess nutritional quality were used: (1) nutritional composition (using the Nutri-Score), (2) degree of processing (NOVA classification), and (3) compliance with the World Health Organization (WHO) Nutrient Profile Model (NPM). A total of 735 products were found and analyzed. The most common marketing techniques used were childish names/fonts (46.9%), special characters (39.6%), and children's drawings (31.3%). Most products had a Nutri-Score of D or E (58.0%) and were ultra-processed (91.8%). Only 10.2% of products displayed the Nutri-Score. The least processed products generally had a better Nutri-Score (p < 0.001). Most products (92.8%) did not meet the criteria of the WHO NPM. Products that met the WHO NPM criteria, organic products, and products with a nutritional claim generally had a better Nutri-Score and were less processed (ps < 0.05). Pre-packaged foods and beverages marketed to children in the Swiss market were mostly of poor nutritional quality. Public health measures should be adopted to improve the nutritional quality of foods marketed to children in Switzerland and restrict the marketing of unhealthy foods to children.

Nutritional impact of no-added sugar fruit puree consumption at different eating occasions: a modelling study on French children.

OBJECTIVE: The recommended level of five fruits and vegetables per day is reached by a minority of French children. No-added sugars fruit puree (NASFP) can be consumed as a complement of fresh fruit to meet the recommendation for fruits and vegetables. The objective was to simulate the nutritional impact of an increase in consumption of NASFP among French children, together with a reduction in sweetened foods. DESIGN: The study was conducted on French children aged 1-17 years. The simulation consisted in introducing NASFP on four different eating occasions (breakfast, lunch, snack and dinner) to reach one serving and removing the same serving of sweetened foods. Intakes in nutrients to favour, nutrients to limit and prevalence of adequacy to nutritional requirements were compared between observed and simulated diets in the whole sample and in five different age groups. SETTING: France. PARTICIPANTS: Children from 1 to 17 years of age in the last available French representative dietary survey (INCA3). RESULTS: Simulated diets were more nutrient-dense thanks to increases in nutrients to favour from NASFP (especially fibres, iodine, Se, and vitamin A and C) associated with reductions in energy and nutrients to limit (especially free sugars) coming from sweetened foods. Prevalence of adequacy increased from 2 to 14·5 points for fibres and from 4·5 to 12 points for free sugars according to age group and eating occasion. CONCLUSION: Promoting NASFP in replacement of sweetened products is a promising strategy to improve the nutritional quality of French children's diet through a better adherence to national guidelines.

Nutritional Quality and Degree of Processing of Children's Foods Assessment on the French Market.

Food packaging marketing techniques which appeal to children (such as cartoon characters and brand mascots) affect children's choices, preferences, and eating habits. Several studies have assessed the nutritional quality of food intended to children in various countries and concluded that most were high in fat, salt, and sugar (HFSS) and ultra-processed foods. The aim of this study is to analyse products intended for children over the age of 3 (foods and beverages with relevant marketing elements on the packaging) available on the French market as regards: (1) nutritional quality, based on the Nutri-Score labelling system, (2) compliance with expected nutritional profile suitable for children, according to the criteria of the WHO Europe Nutrient Profile Model, and (3) degree of processing, as defined by the NOVA classification, from packaging collected in 20 stores (hyper/supermarkets, hard-discount retail chains, and organic food stores). The marketing strategies most often used on children's products are cartoons (97.22%; n = 1120) and mascots (77.78%; n = 896). A total of 1155 products were included in the study, most of which were sugary foods: almost a quarter of the products in the sample (23.81%; n = 275) list a sweetener as the first ingredient, and most of them (89.52%; n = 1034) contain free sugars according to the WHO definition. All the products included in our study feature marketing elements targeting on the packaging, yet 94.88% do not meet the criteria of the WHO Europe Nutrient Profile Model. Most (58.68%; n = 676) belong to Nutri-Score groups D and E, with the highest proportion in group D (39.32%; n = 453) and are ultra-processed (87.97%; n = 1016), especially through the use of flavourings and ultra-processed sugars. Using the Nutri-Score, the WHO Europe Nutrient Profile Model, and the NOVA classification, this study suggests that a significant share of pre-packaged foods marketed to children do not have an adequate nutritional profile. As such, measures are needed to regulate what marketing elements aimed at children can be included on packaging, based on these criteria.

Dairy and Fruit Listed as Main Ingredients Improve NRF8.3 Nutrient Density Scores of Children's Snacks.

Background: The US Food and Drug Administration has modified its regulations on nutrient content claims by considering healthy dietary ingredients as well as nutrients. Objective: To assess the relation between dairy and fruit as main ingredients in children's snacks and the Nutrient Rich Food (NRF8.3) nutrient density score. Methods: Commonly consumed children's snacks in the United States, Canada, France, and the United Kingdom (n = 261) were assigned into USDA What We Eat in America (WWEI) categories. Nutrient composition data came from industry websites, open-source government databases (USDA Standard Reference SR28; CIQUAL), and back-of-pack food labels. Nutrient density was calculated using the Nutrient Rich Food Index NRF8.3. Snacks with dairy or fruit as the first listed ingredient (n = 115) were compared to those that listed neither (n = 146). Snacks that contained fruits-vegetables-nuts (FVN) (n = 88) were compared to those that did not (n = 173). Results: NRF8.3 scores were higher for snacks listing dairy or fruit as main ingredients. Dairy or fruit when listed as the first ingredient were associated with higher percent daily values of protein, fiber, calcium, vitamin A, vitamin C, and vitamin D, lower saturated fat content and a 30-point increment in NRF8.3 scores. The presence of FVN was associated with a 22-point increment in NRF8.3 scores. Conclusion: The correspondence between back-of-pack food ingredients and the nutrient based NRF8.3 scores suggests that ingredients can also be used to communicate the nutritional value of foods to the consumer. Dairy and fruit, when listed as first ingredients, were an important component of the NRF8.3 nutrient density score.

Nutrient density and bioaccessibility, and the antioxidant, satiety, glycemic, and alkalinizing potentials of fruit-based foods according to the degree of processing: a narrative review.

Epidemiological studies suggest that the protective effects of fruits against chronic diseases may vary according to their extent of processing. We therefore reviewed what the scientific literature states about the potential mechanisms underlying this "processing" effect by focusing on the most significant nutritional properties, namely, the nutritional density of bioactive compounds, the digestive bio-accessibility of nutrients, and the antioxidant, satietogenic, alkalizing and glycemic potentials. When possible, we have ranked fruits according to the international NOVA classification as un-/minimally processed, processed (mainly with added sugars), and ultra-processed fruits. Our literature review confirms that the more fruits are processed, the lower are their alkalizing, antioxidant and satietogenic potentials. For the glycemic index, the results are more difficult to interpret because fruits are a significant source of fructose with a very low glycemic index that "distorts" the "processing" effect. However, fruits in sirup tend to have a higher glycemic index, probably because of the highly bioavailable added sugars. Overall, the destructuration of the fruit fibrous matrix by thermal and mechanical treatments, combined with the addition of simple sugars, constitute the treatments that most degrade the fruit nutritive quality by diluting the nutritional density and attenuating the "matrix" effect. The new technological processes described as "nonthermal" (e.g., pulsed electric fields, high pressures, supercritical CO2, radiation, etc.) seem promising as they limit vitamin C and antioxidant phytonutrient losses in fruit while allowing satisfactory storage time. To preserve fruit longer, drying appears to be an interesting alternative to maintain the health potential of fruit, although it causes antioxidant losses. Finally, although "5 fruits and vegetables a day" is a well-known nutritional recommendation, in view of the results reviewed here, it would be relevant to be precise and include "preferably minimally processed".

Association between consumption of fruit or processed fruit and chronic diseases and their risk factors: a systematic review of meta-analyses.

CONTEXT: The degree of fruit processing is rarely considered in epidemiological studies of fruit consumption. OBJECTIVE: Pooled analyses and meta-analyses of cohort studies and randomized controlled trials that linked fruit consumption with the risk of chronic disease and metabolic deregulation were reviewed systematically to examine the effects of fruit processing. DATA SOURCES: The Web of Science and Cochrane Library databases were searched until June 2018. Search terms, querying the article title only, were based on multiple combinations and included the following: type of publication, fruit products, and chronic diseases and their risk factors. STUDY SELECTION: The selection of studies and the systematic review were carried out in accordance with the PRISMA statement. DATA EXTRACTION: The literature search identified 189 pooled analyses and meta-analyses, 10 of which met the inclusion criteria. RESULTS: The results showed that the degree of processing influences the health effects of fruit-based products. Fresh and dried fruits appeared to have a neutral or protective effect on health, 100% fruit juices had intermediary effects, and high consumption of canned fruit and sweetened fruit juice was positively associated with the risk of all-cause mortality and type 2 diabetes, respectively. CONCLUSIONS: The results support the need to consider the degree of food processing in future epidemiological studies and randomized controlled trials in order to adjust official recommendations for fruit consumption.