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Background Health-related claims are statements regarding the nutritional content of a food (nutrition claims) and/or indicate that a relationship exists between a food and a health outcome (health claims). Their impact on food purchasing or consumption decisions is unclear. This systematic review measured the effect of health-related claims, on pre-packaged foods in retail settings, on adult purchasing decisions (real and perceived). Methods In September 2016, we searched MEDLINE, EMBASE, PsychINFO, CAB abstracts, Business Source Complete, and Web of Science/Science Citation Index & Social Science Citation Index for articles in English published in peer-review journals. Studies were included if they were controlled experiments where the experimental group(s) included a health-related claim and the control group involved an identical product without a health-related claim. Included studies measured (at an individual or population level); actual or intended choice, purchases, and/or consumption. The primary outcome was product choices and purchases, the secondary outcome was food consumption and preference. Results were standardised through calculating odds ratios and 95% confidence intervals (CI) for the likelihood of choosing a product when a health-related claim was present. Results were combined in a random-effects meta-analysis. Results Thirty-one papers were identified, 17 of which were included for meta-analyses. Most studies were conducted in Europe ( n  = 17) and the USA ( n  = 7). Identified studies were choice experiments that measured the likelihood of a product being chosen when a claim was present compared to when a claim was not present, ( n  = 16), 15 studies were experiments that measured either; intent-rating scale outcomes ( n  = 8), consumption ( n  = 6), a combination of the two ( n  = 1), or purchase data ( n  = 1). Overall, 20 studies found that claims increase purchasing and/or consumption, eight studies had mixed results, and two studies found consumption/purchasing reductions. The meta-analyses of 17 studies found that health-related claims increase consumption and/or purchasing (OR 1.75, CI 1.60–1.91). Conclusion Health-related claims have a substantial effect on dietary choices. However, this finding is based on research mostly conducted in artificial settings. Findings from natural experiments have yielded smaller effects. Further research is needed to assess effects of claims in real-world settings. Trial registration PROSPERO systematic review registration number: CRD42016044042 .

Heritable factors account for approximately 35% of colorectal cancer (CRC) risk, and almost 30% of the population in the UK have a family history of CRC. The quantification of an individual’s lifetime risk of gastrointestinal cancer may incorporate clinical and molecular data, and depends on accurate phenotypic assessment and genetic diagnosis. In turn this may facilitate targeted risk-reducing interventions, including endoscopic surveillance, preventative surgery and chemoprophylaxis, which provide opportunities for cancer prevention. This guideline is an update from the 2010 British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland (BSG/ACPGBI) guidelines for colorectal screening and surveillance in moderate and high-risk groups; however, this guideline is concerned specifically with people who have increased lifetime risk of CRC due to hereditary factors, including those with Lynch syndrome, polyposis or a family history of CRC. On this occasion we invited the UK Cancer Genetics Group (UKCGG), a subgroup within the British Society of Genetic Medicine (BSGM), as a partner to BSG and ACPGBI in the multidisciplinary guideline development process. We also invited external review through the Delphi process by members of the public as well as the steering committees of the European Hereditary Tumour Group (EHTG) and the European Society of Gastrointestinal Endoscopy (ESGE). A systematic review of 10 189 publications was undertaken to develop 67 evidence and expert opinion-based recommendations for the management of hereditary CRC risk. Ten research recommendations are also prioritised to inform clinical management of people at hereditary CRC risk.

Models that forecast non-communicable disease rates are poorly designed to predict future changes in trend because they are based on exogenous measures of disease rates. We introduce microPRIME, which forecasts myocardial infarction (MI) incidence, events and prevalence in England to 2035. microPRIME can forecast changes in trend as all MI rates emerge from competing trends in risk factors and treatment. microPRIME is a microsimulation of MI events within a sample of 114,000 agents representative of England. We simulate 37 annual time points from 1998 to 2035, where agents can have an MI event, die from an MI, or die from an unrelated cause. The probability of each event is a function of age, sex, BMI, blood pressure, cholesterol, smoking, diabetes and previous MI. This function does not change over time. Instead population-level changes in MI rates are due to competing trends in risk factors and treatment. Uncertainty estimates are based on 450 model runs that use parameters calibrated against external measures of MI rates between 1999 and 2011. Forecasted MI incidence rates fall for men and women of different age groups before plateauing in the mid 2020s. Age-standardised event rates show a similar pattern, with a non-significant upturn by 2035, larger for men than women. Prevalence in men decreases for the oldest age groups, with peaks of prevalence rates in 2019 for 85 and older at 25.8% (23.3-28.3). For women, prevalence rates are more stable. Prevalence in over 85s is estimated as 14.5% (12.6-16.5) in 2019, and then plateaus thereafter. We may see an increase in event rates from MI in England for men before 2035 but increases for women are unlikely. Prevalence rates may fall in older men, and are likely to remain stable in women over the next decade and a half.

To model population health impacts of dietary changes associated with the redevelopment of the UK food-based dietary guidelines (the 'Eatwell Guide'). Using multi-state lifetable methods, we modelled the impact of dietary changes on cardiovascular disease, diabetes and cancers over the lifetime of the current UK population. From this model, we determined change in life expectancy and disability-adjusted life years (DALYs) that could be averted. Changing the average diet to that recommended in the new Eatwell Guide, without increasing total energy intake, could increase average life expectancy by 5.4 months (95% uncertainty interval: 4.7 to 6.2) for men and 4.0 months (3.4 to 4.6) for women; and avert 17.9 million (17.6 to 18.2) DALYs over the lifetime of the current population. A large proportion of the health benefits are from prevention of type 2 diabetes, with 440,000 (400,000 to 480,000) new cases prevented in men and 340,000 (310,000 to 370,000) new cases prevented in women, over the next ten years. Prevention of cardiovascular diseases and colorectal cancer is also large. However, if the diet recommended in the new Eatwell Guide is achieved with an accompanying increase in energy intake (and thus an increase in body mass index), around half the potential improvements in population health will not be realised. The dietary changes required to meet recommendations in the Eatwell Guide, which include eating more fruits and vegetables and less red and processed meats and dairy products, are large. However, the potential population health benefits are substantial.

Background Young adults (18–25) face significant risk for weight gain and transitioning to a higher body mass index category when compared to other adult groups. As active internet users, they encounter food-related content across digital platforms, yet little is known about their behavioural and cognitive responses to this compound exposure. Methods This pre-registered mixed-methods systematic review features primary studies about participants aged 18 to 25 exposed to digital food communication and assessed for behavioural or cognitive responses towards food and nutrition. We evaluate consumption and food purchase as behavioural responses; intentions to consume and/or purchase, and attitudes towards food and nutrition as cognitive responses. We searched PubMed, PsycINFO, Global Index Medicus, and Business Source Ultimate for studies published from database inception to August 1, 2024. Quality appraisals were conducted using a modified version of the Newcastle-Ottawa Quality Assessment Form, the ROB1 Tool for randomised trials, the JBI Quasi-Experiment Checklist for quasi-experiments and the Critical Appraisal Skills Programme (CASP) checklist for qualitative studies. We used a three-pronged method for analysis. Meta-analyses combined findings from randomised trials for behavioural and cognitive responses, while observational studies were summarised narratively. The thematic synthesis approach informed our qualitative synthesis of young adults’ narratives of their responses after exposure to digital food communication. Finally, a cross-study matrix synthesised analytical qualitative themes and quantitative findings. Results Of the 6132 studies identified, 45 are included in the systematic review, representing 8,914 young adults in 16 countries. Meta-analyses on behavioural and cognitive responses demonstrate statistical significance with effect sizes of 0.34 (95% CI: 0.18-0.50) and 0.19 (95% CI: 0.10-0.28), respectively. Observational studies confirmed the findings of the meta-analyses. Difficulty deciphering what represents good nutrition, critical distinctions when engaging with content viewed as helpful versus misleading and balancing intentions versus actual behaviours were barriers to the effectiveness of digital food communication. Using a cross-study synthesis matrix, we developed ten recommendations to improve digital dietary interventions and their assessed implementation by experimental studies in the review. Conclusions Our results illustrate the need to approach digital food communication as a digital determinant of dietary health for young adults, shaping behaviours and cognition.

Background Health-related claims (HRCs) are statements found on food packets that convey the nutritional quality of a food (nutrition claims) and/or its impact on a health outcome (health claims). The EU stated that HRCs should be regulated such that they can only appear on foods that meet a specified nutrient profile (NP). A NP model has been proposed, but not agreed by the European Commission. Methods To model the impact of HRCs on health impacts in the UK, we built a front-end model to a pre-established non-communicable-disease (NCD) scenario model, the Preventable Risk Integrated ModEl (PRIME) by combining data from a meta-analysis examining the impact of HRCs on dietary choices and a survey of pre-packaged foods examining the prevalence of HRCs and the nutritional quality of foods that carry them. These data are used to model the impact of regulating HRCs on the nutritional quality of the diet and PRIME is used to model the health outcomes associated with these changes. Two scenarios are modelled: regulating HRCs with a NP model (the FSANZ NPSC and a draft EU model) so that only foods that pass the model are eligible to carry HRCs, and reformulating HRC-carrying foods that fail the model. Results Regulating the use of HRCs with a NP model (the FSANZ NPSC) would have unclear impacts on population health and could potentially lead to less healthy diets. This is because HRCs are currently more likely to be found on products with a better nutritional profile and restricting their use could shift consumers to less healthy diets. Two hundred fifty-eight additional deaths (95% Uncertainty Intervals [UI] -6509, 8706) were predicted if foods did not change in their nutrient composition. If all foods that currently carry HRCs were reformulated to meet the NP model criteria then there would be a positive impact of using the model: (4374 deaths averted (95%UI -2569, 14,009)). The largest contributor to the uncertainty is the underpowered estimates of nutritional quality of foods with and without claims. Conclusions Regulating HRCs could result in negative health impacts, however the wide uncertainty intervals from this analysis demonstrate that a larger health impact assessment is necessary.

Front-of-pack nutrition labelling (FOPNL) is a key policy to tackle diet-related non-communicable diseases. All types of FOPNL require an underlying nutrient profile model (NPM). Nutrient profiling is a scientific method for classifying foods according to their nutritional composition. This review aimed to identify all NPMs developed and/or used for FOPNL, to assist with the selection of appropriate NPMs to underpin nutrition policies, namely supporting the WHO Regional Office for Europe developing template NPMs for FOPNL. We searched peer-reviewed databases (MEDLINE, CAB Abstracts, OvidSP, and Scopus) and grey literature (Overton and Google). Searches were limited to articles published in English, Spanish or Portuguese, and published between Jan 1, 2016, and May 4, 2023, building on a comparable review conducted by Labonté et al. in 2016. To be eligible for inclusion, NPMs developed for FOPNL had to allow for the classification or ranking of individual foods, be developed or endorsed by governmental or inter- governmental organisations and have a publicly available algorithm. From the 957 publications retrieved in the searches, 39 NPMs were included: 13 for warning labels, 12 for nutrient-specific systems (including ‘traffic-light’ labelling), 10 for health endorsements and four for graded summary indicators. Of these, 26 NPMs have been developed and four models updated since 2016. The WHO Region with highest number of models was the Americas (n=13, 33%), followed by the European Region (n=9, 23%) and the Western-Pacific Region (n=7, 18%). There has been a proliferation of new NPMs for FOPNL posing a potential challenge for policymakers in the selection of appropriate models for FOPNL policies. This systematic review facilitates the comparison of these models, demonstrating considerable heterogeneity in the NPMs underlying FOPNL, indicating there is little consensus in what constitutes the most appropriate model and reinforcing the need for more guidance and regional alignment. MB's DPhil is supported by the Nuffield Department of Population Health and St Cross College Joint Scholarship, as well as by the Saven European Scholarship. JR is funded by the ESRC (SALIENT: Food System Trials for Healthier People and Planet project, Award ID/ref: ES/Y00311X/1). AK is funded by the Nuffield Department of Primary Care Health Sciences, University of Oxford, the Wellcome Trust (SHIFT (Sustainable Healthy Interventions for Food Transition, Award ID: 227132/Z/23/Z), and the NIHR PHR (COPPER: CO-designing for healthy People and Planet: food Economic policy Research. Award ID: NIHR133887). MR is funded by the Nuffield Department of Population Health, University of Oxford.

One small step in the right direction

Nutrient profile models (NPMs) are algorithms that classify or rank foods according to their nutritional composition. An NPM was developed in 2005 in the UK to regulate marketing of foods to children. The model uses a scoring system that balances points awarded for the protein, fibre, fruit, vegetable, and nut content of foods and drinks against points awarded for energy, saturated fats, sodium, and sugars. Foods that score above 4 and drinks that score above 1 face marketing restrictions. The NPM was revised in 2018, but this version has not been finalised. The Eatwell Guide, the UK's food-based dietary guidelines, provides healthy eating advice. The aim of this study was to evaluate the extent that the 2005 and the 2018 versions of the NPM are consistent with the Eatwell Guide. In this observational study, we obtained individual-level data from years 9 to 11 (2016/17 to 2018/19) of the National Diet and Nutrition Survey (NDNS). The NDNS is an annual survey measuring food consumption in the UK from a representative sample of approximately 1000 people per year. We estimated the healthiness of individuals' diets according to an Eatwell Guide dietary index (ie, number of food-based and nutrient-based recommendations achieved) and an NPM dietary index (ie, a weighted average of the NPM score of all foods eaten). We compared the agreement between diet healthiness according to the Eatwell Guide and the NPM indices by calculating the Cohen's κ coefficient. No specific ethics approval or patient consent was required for this analysis of NDNS data. 3028 individual diets were assessed. Individuals with a higher (ie, healthier) Eatwell Guide index score consumed a diet with, on average, a lower (ie, healthier) NPM index score both for the 2005 and 2018 versions. Agreement between the Eatwell Guide and the NPM dietary index in classifying a diet as “healthy” was moderate for relatively healthier diets, irrespective of the NPM version (Cohen's κ 0·39 [p<0·0001] for the 2005 version and 0·46 [p<0·0001] for the 2018 version, using an NPM cutoff of 4). This study suggests that the Eatwell Guide and NPM dietary indices are broadly concordant when assessing the healthiness of UK diets. As NPMs and food-based dietary guidelines evolve it is crucial to improve alignment between dietary advice and NPM-based food policies to ensure consistent information is conveyed to the public. NIHR Academic Clinical Fellowship, Nuffield Department of Population Health (University of Oxford), NIHR Oxford Biomedical Research Centre, and the British Heart Foundation.

Health-related claims (HRCs) are statements found on food packets that convey the nutritional quality of a food (nutrition claims) and/or its impact on a health outcome (health claims). Foods carrying HRCs have a slightly improved nutritional profile than foods without HRCs, however, it's unclear whether this translates into dietary improvements. We conducted a modelling study to measure the effect of HRCs on diet. As HRCs are already present on foods it is assumed that any impact that they have upon diet are already in effect. We modelled the impact on food purchases of removing HRCs, by assuming that the sales boost they receive is neutralised. These results can be inverted to estimate the current dietary impact of HRCs. Using the Living Costs Food (LCF) survey data, we calculate the average purchases and nutrient intake per person, per day. The LCF data is divided into sales of products with HRCs and sales of products without HRCs through solving mathematical equations combining LCF sales data with odds ratios from a meta-analysis examining the impact of HRCs on choices and data from a survey of foods examining the prevalence of HRCs and the nutritional quality of foods that carry them so that the sum of the sales of products with HRCs and without HRCs is equal to the total sales of products. Similarly, mathematical equations are solved that combine nutritional composition data with the sales of foods carrying and not carrying HRCs. In the baseline scenario foods carrying HRCs made-up 37% of the total purchases, and contributed 29% (559kcal) of the total kcals purchased (1907kcal). When HRCs are removed from foods there is an average increase of 18kcal/d (95% Uncertainty Intervals [UI] -15, 52), + 2g/d increase in total fat (95% UI -1, 4) and saturated fat (95% UI 1, 3), smaller changes are seen for protein (+ 0.5g/d, 95% UI -1, 2), total sugar (+ 0.5g/d, 95% UI -4, 7) and carbohydrate (-0.5g/d, 95% UI -5, 7). There is reduction in the amount of fruit (-11g/d, 95% UI -34, 26) but an increase in vegetables (+ 6g/d, 95% UI -6, 19). These results should be interpreted with caution due to the large uncertainty intervals. When HRCs are removed, we see a small deterioration in the quality of the average diet. If we invert these findings we can assume HRCs currently have a positive, albeit small, impact on diet.