SODIUM REDUCTION

An Annotated Bibliography

Nutrient Profile Modeling (Added November 2022)

Nutrient Profile Modeling (Added November 2022)

Nutrient profile models (NPMs) classify or rank food and drink products according to their nutritional composition and can be used to identify foods which are in excess of critical nutrients such as sugars, sodium, and saturated fats. NPMs can underpin a variety of nutrition policy interventions, such as marketing of foods to children, health and nutrition claims, product labelling logos or symbols, information and education, public food procurement, and fiscal policies.

Added November 2022: Labonté MÈ, Poon T, Gladanac B, et al. Nutrient Profile Models with Applications in Government-Led Nutrition Policies Aimed at Health Promotion and Noncommunicable Disease Prevention: A Systematic Review. Adv Nutr. 2018. 9(6):741-788.

A systematic review found 78 existing nutrient profiling models (NPM) with applications in government nutrition policies. In the past 10 years, adoption of NPMs in government-led policies has increased, including NPMs adapted from existing models from other countries (44% of models were adaptations of one or more other models). All models included nutrients to limit, most frequently sodium, saturated fat, and total sugars. 86% of models also considered nutrients to encourage (e.g. fiber). The most common NPM applications were regulating food in public and other settings (43/78), food labeling (front-of-package labeling or regulating claims) (19/78) and restriction of the marketing of food products to children (10/78). Most models (71/78) provided summary ratings of the nutritional quality of food products based on the amounts of ≥2 nutrients or food components, while 3/78 used nutrient specific thresholds. This article may be used to assist stakeholders in the selection of an appropriate NPM for establishing certain nutrition-related policies or regulation.

Added November 2022: Verhagen H, van den Berg H. A simple visual model to compare existing nutrient profiling schemes. Food Nutr Res. 2008. 52:10.3402.

This study presents a model to simplify the various choices required to develop a nutrient profile model (NPM) and to compare NPMs across countries. The key choices which are made when developing a scheme and selecting nutrients to include, are: 1) whether the system is based on specific food categories or ‘across the board’ amounts, 2) whether the NPM qualifies nutrients for and encourages consumption (e.g., vitamin C or fiber), or disqualifies ingredients aiming to reduce consumption (e.g., sugar, sodium, trans fat). 3) which reference to use (amount of nutrient per 100g/100 ml, 100 kcal/100 kJ, or per serving), and 4) whether to use a scoring system (ranking products by how healthy or unhealthy they are) or a threshold system (an either-or system). Also, the study provides examples of completed models comparing the US, UK, Sweden, the Netherlands, and industry NPM systems.

Added November 2022: Frank T, Thow AM, Ng SW, et al. A Fit-for-Purpose Nutrient Profiling Model to Underpin Food and Nutrition Policies in South Africa. Nutrients. 2021; 13(8):2584.

This article maps the process South Africa took to develop a nutrient profile model (NPM) suitable to the South African food supply and population that could underpin nutrition policies in that have proven successful in other countries, such as front-of-package labeling, marketing restrictions, taxation policies, and public food procurement. The process included: 1) determining the NPM’s purpose and target population, 2) selecting the appropriate nutrients to be included in the NPM, 3) determining the most suitable NPM type, criteria, and base unit of measure (e.g., per 100g/ml), and 4) selecting reasonable thresholds. Unhealthy processed packaged foods were chosen as the target they are the key drivers of diet-related NCDs in South Africa. The target population was adults and children over 6 months old. To determine which existing NPM to adapt and the nutrients to include, other NPMs were mapped against the food supply in South Africa. The ‘nutrients to limit’ chosen included saturated fat, sodium, non-sugar sweetener, and total sugar. The Chile 2019 NPM, with its across-the-board threshold on the basis of nutrient values per 100g/mL was identified as the most suitable model to adapt. The thresholds were adopted as-is for sodium, saturated fat and total sugar. Ultimately, the NPM performs well at identifying unhealthy products, and thus will be appropriate to use for future nutrition policies.

Added November 2022: Pandav C, Smith TL, Miles DR, et al. The WHO South-East Asia Region Nutrient Profile Model Is Quite Appropriate for India: An Exploration of 31,516 Food Products. Nutrients. 2021. 13(8):2799.

The thresholds defined by the WHO SEARO Nutrient Profile Model (NPM) can be used by the Indian government as the basis for developing a front-of-pack labelling (FOPL) regulation in India in hopes of reducing the growing burden of nutrition-related non-communicable diseases. The study applies both the SEARO NPM and the Chilean Warning Octagon (CWO) Phase 3 NPM to a database of food products available in the Indian market from 2015 to 2020 (n=10501 products). A previous study conducted with a much smaller sample size (n= 3316) concluded that he WHO SEARO model was too strict for use in India as 96% of the sample would meet the criteria for at least one warning label. With this larger and more comprehensive sample size, applying the SEARO model resulted in only 68% percent of products meeting the criteria for at least one warning label, and 63% meeting the Chilean model criteria.

For similar article, see:
Frank T, Ng SW, Miles DR, et al. Applying and comparing various nutrient profiling models against the packaged food supply in South Africa. Public Health Nutr. 2022. 25(8):2296-2307.

Nutrient Profile Modeling (Added November 2022)