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Background The first 1000 days in a child’s life, from conception to age two, are a critical period for establishing a child’s health and development. One important element is the diet that children receive during this time. Dietary intake of infants in the UK has been shown to be high in sugar and salt, with overall energy intakes exceeding recommendations by the time they are two years of age. Commercial infant food, which forms approximately 40–60% of infants’ dietary intake, was identified in 2011 as the main contributor to sugar intake for infants aged 4–9 months in the United Kingdom. Further, evidence demonstrates inconsistencies between national recommendations on infant feeding and some of these products in terms of the type available, their nutritional value and product labelling and marketing. Given their role in infants’ diets, it is important to understand parental perceptions of these products and why they are chosen. Methods The study comprised the first phase of an in-depth, longitudinal qualitative study which explored parents’ experiences of introducing solid foods to their infants over the first year of feeding. 62 parents/ carers were recruited to this phase when their infants were four-six months old. Data collection involved semi-structured interviews and a photo-elicitation exercise. Data from interview transcripts which focused on the purchase and use of packaged purees and commercial snacks were analysed thematically. Results Parents/ carers drew on a range of reasons for buying both packaged purees and commercial snacks for their infants. These included anxiety over food preparation, food safety, convenience, cost effectiveness, the pull of brand eco-systems for packaged purees, and the way in which commercial snacks provide opportunities for safe development of motor skills, keep infants occupied, and allow them to take part in family rituals. Conclusion In considering the use of packaged products as a food source for infants in public health nutrition policy, it is important to understand the broad range of factors that shape parents decisions ranging from the way that products are advertised and perceived, to the non-nutritive roles that they play.

Background Dietary risk factors are the leading cause of death globally and in New Zealand (NZ). Processed packaged foods are prevalent in the food supply and contribute excess amounts of sodium, saturated fat, and sugar in diets. Improving the nutritional quality of these foods has the potential to reduce population chronic disease risk. We aimed to evaluate the healthiness using the Australasian Health Star Rating (HSR, from 0.5 to 5 stars, with 5 being the healthiest) and nutrient composition (sodium, saturated fat, and total sugar) of packaged products manufactured by the largest NZ-based food and beverage companies in NZ 2015–2019. This analysis relates to a larger study evaluating structured engagement with food companies to improve nutrition-related policies and actions. Methods Data was sourced from Nutritrack, a NZ-branded supermarket-sourced food composition database. The largest NZ-based companies from annual retail sales revenue ( n  = 35) were identified using 2019 Euromonitor data. All relevant products of the selected companies were extracted for analysis. Products included totalled 17,795 with a yearly range of 3462–3672 products. The primary outcome was a nutrient profile score estimated using HSR. Healthiness was defined as ≥ 3.5 stars. Secondary outcomes were sodium, total sugar, and saturated fat per 100 g/100 mL. All outcomes were assessed overall, by food company, and food category. Change over time was tested using linear mixed models, adjusting for major food categories and cluster effects of food companies controlling for multiple comparisons. Model-adjusted mean differences between years were estimated with 95% confidence intervals. Results There was a small statistically significant increase in mean HSR between 2015 and 2019 (0.08 [0.15,0.01], p  = 0.024). Mean total sugar content decreased over the same period (0.78 g/100 g [0.08,1.47], p  = 0.020), but there were no significant changes in mean sodium or saturated fat contents. Seven of the 13 categories showed small increases in mean HSR (0.1–0.2). Most categories (9/13) exhibited a reduction in mean total sugar content. Conclusions Between 2015 and 2019, there were slight improvements in the nutritional quality of selected packaged foods and drinks in NZ. Much more substantive changes are needed to address the health-related burden of unhealthy diets, supported by stronger government action and less reliance on voluntary industry initiatives.

To compare the degree of strictness and agreement of different nutrient profiling models (NPM) used to identify which foods would be required to show front-of-package (FOP) warning labels. Using data of 11 434 packaged foods found in the five largest food retailers in Brazil, we used two published NPM: the Pan American Health Organization (PAHO) model and the NPM used in the Chilean nutritional FOP labelling policy, and compared them with a NPM proposed by the Brazilian National Health Surveillance Agency (Anvisa). The proportion of foods that would be required to show FOP warning labels was calculated overall and by food category. We also tested whether a modified version of the PAHO NPM would behave similarly to the original version. Brazil. Two-thirds of the packaged products (62 %) would receive FOP warning labels under the PAHO NPM, as compared with 45 % of products using the proposed Anvisa NPM and 41 % if the Chilean NPM was applied. The PAHO NPM identified more foods high in critical nutrients such as sweetened dairy and non-dairy beverages, canned vegetables and convenience foods. Overall agreement between models was considered good with kappa coefficient ranging from 0·57 to 0·92 but was lower for some food categories. We found variations in the degree of strictness and agreement between assessed NPM. The PAHO NPM identified more foods and beverages high in sugar which are among the top contributors to sugar and energy intake in Brazil.

Purpose Provision of nutrition information is mandated for packaged foods, but few countries regulate serving sizes. Our objective was to develop a methodology to establish globally consistent portion size recommendations for both nutrient-dense and discretionary foods. Methods A stepwise systematic approach incorporated portion values from serving size regulations ( n  = 10), food-based dietary guidelines (FBDG; n  = 90, aggregated into 6 regions), and reported food intakes from Europe and Australia. Global Portion Values (GPVs) for 50 food groups were derived as the median of all data inputs. Consistency was evaluated using 25th and 75th percentiles and dispersion of input values (percent of median absolute deviations (MAD)/median). Results GPVs were calculated for 50 food groups organized into nine food categories: Milk/Dairy ( n  = 6 food groups), Protein Foods ( n  = 5), Mixed Dishes ( n  = 4), Grains ( n  = 7), Fruits/Vegetables ( n  = 5), Snacks/Sweets ( n  = 12), Sauces/Condiments ( n  = 5), Fats/Oils/Sugars ( n  = 4) and Beverages ( n  = 2). Data inputs for each portion value ranged from 6 to 18; only 4 foods had < 10 inputs; 21 had ≥ 15. Dispersion ranged from 0 to 33%; 88% of GPVs were considered “consistent” (dispersion < 25%) and 9 groups had 0% variation, indicating high consistency. Example GPVs include: 240mL for milk (16 inputs, 8% dispersion); 90 g for meat/poultry/fish main dishes (16 inputs, 13% dispersion); 50 g for bread/rolls (18 inputs, 20% dispersion); 130 g for canned vegetables (10 inputs, 2% dispersion); 30 g for chocolate (15 inputs, 17% dispersion); and 250mL for soft drinks (17 inputs, 20% dispersion). Conclusions This standardized approach provides clear and consistent portion recommendations that, if adopted, could help consumers make informed choices about appropriate portions.

Background The high availability and marketing of unhealthy foods has contributed to unhealthy diets. Unhealthy diets are a major risk factor for a range of non-communicable diseases (NCDs). However, the availability and marketing of pre-packaged foods haven’t been assessed in Senegal. Nutrient profiling models have been developed to identify less healthy foods that could be subject to marketing restrictions, particularly when targeted at children. The aim of this study was to assess the nutritional quality and on-pack promotion of pre-packaged food sold in major supermarkets in Senegal using the Nutrient Profile Model for the WHO African Region (NPM-WHO/AR), the Nutri-Score labelling system and the NOVA classification. Methods A cross-sectional survey was conducted in two major supermarkets in Dakar between August and September 2021. Data were collected for all pre-packaged foods, with the exception of the fresh food and alcoholic beverages categories. Pre-packaged foods were classified into fifteen food categories and five beverage categories according to the NPM-WHO/AR, with the exception of the categories “fresh and frozen meat, fish and sea food” and “fresh and frozen fruits and vegetables, legumes and tubers”. Nutritional information was extracted from product labels and products were evaluated using 3 classification systems: NPM-WHO/AR, Nova classification as an indicator of the degree of food processing and Nutri-Score, a nutritional labelling system based on a 5-colour scale from dark green to red, associated with letters ranging from A (high nutritional quality) to E (low nutritional quality), established according to nutritional value and fruits, vegetables and legumes content. Depending on the classification system used, foods were rated on the basis of the nutritional information declared as relevant for this rating. Thus, 5,542 products were evaluated for their nutritional composition, 5,280 products were evaluated according to the NPM-WHO/AR and 5,407 products were evaluated according to both the Nutri-Score and the Nova classification. A pre-packaged food was classified as “non-permitted” to be marketed to children if the content of defined nutrients exceeded the threshold set in the model for the corresponding product category. Data analysis was performed using RStudio. Results Ultra-processed foods (71.1%) and processed foods (18.8%) were the most common in Senegalese supermarkets. According to the Nutri-Score, pre-packaged foods were most frequently classified as Nutri-Score D (24.4%) and Nutri-Score E (22.1%). Almost 63.3% of the products were classified as non-permitted to be marketed to children according to the NPM-WHO/AR. Of these foods, 12.5% had on-pack promotions. Non-permitted foods to be marketed to children with the highest number of on-pack promotions were “breakfast cereals” (50.0%), “chocolate and sugar confectionery” (31.3%), “milk and dairy based drinks” (28.1%) and “cakes, sweet biscuits and pastries” (17.7%). However, the comparison between the NPM-WHO/AR and the Nutri-Score showed that some NPM-WHO/AR prohibited foods were classified into Nutri-Score A and B. Conclusions This study shows that pre-packaged foods available in major supermarkets in Senegal are predominantly non-permitted to be marketed to children. In the context of increasing levels of obesity and diet-related NCDs, effective policies should be established to regulate the promotion of these foods.

Background High intakes of red and processed meat, trans fats, sodium and low intakes of fibre and minimally processed plant foods such as wholegrains, fruits, nuts, seeds, and vegetables are major dietary risk factors for the development of non-communicable diseases. Despite the acknowledged health and environmental benefits of many plant foods, consumers lack accessible tools to identify the healthy plant content of packaged foods. This study aimed to develop an algorithm for predicting levels of healthy plant content of packaged foods (namely fruit, vegetables, legumes, whole-grains, nuts and seeds, while excluding oils, ultra-processed ingredients, and plant ingredients with high levels of sugar, such as dried fruit, fruit and vegetable juices, pastes, purees and gels) and to apply this algorithm to the Australian packaged food supply. Methods A five-step method of estimating plant content was developed and applied to 19,269 packaged foods in the 2022 Australian FoodSwitch database. This database contains nutrition composition data for products available in-store across major supermarkets in Australia. The mean (SD) plant content was calculated for different food categories within the food supply and across each of the plant components. Results In total, 1154 unique ingredients were identified in the packaged food sample, 38.4% of which contained healthy plant content. The mean weight of healthy plant content was 24.6 g/100 g (range 0–100 g/100 g). This was mostly driven by vegetable content (10.0 g/100 g, 40.7% of the total weight), followed by nuts/seeds (5.2 g/100 g, 21.1%), whole-grains (3.9 g/100 g, 15.9%), fruit (3.1 g/100 g, 12.6%) and legumes (2.4 g/100 g, 9.8%). Categories with the highest mean healthy plant content included ‘fruits, vegetables, nuts, and legumes’ (66.7 (34.1)g/100 g), ‘snack foods’ (43.4 (29.5)g/100 g), and ‘sauces, dressings, spreads, and dips’ (36.0 (34.3)g/100 g). There was wide variation in the healthy plant content within food categories (e.g., 0.0 g to 78.4 g/100 g for ‘cereal and grain products’). Conclusions The healthy plant content of packaged food in Australia varies substantially between and within product categories. This suggests the potential utility of this algorithm for providing consumers with key information to make healthier and more sustainable food choices.

Background Canada proposed the implementation of mandatory front-of-pack (FOP) labelling regulations, whereby foods meeting or exceeding thresholds for nutrients-of-concern (i.e., total sugars, saturated fat, sodium) must display a ‘high-in’ FOP symbol (FOP). The objective of the study was to evaluate the potential implications of the proposed regulations using Canadian generic and branded food composition databases. Methods A generic food composition database of products consumed by Canadians, Canadian Nutrient File (CNF) 2015 (n = 3,677), and a branded food composition database of packaged foods and beverages, Food Label Information Program (FLIP) 2017 (n = 17,521), were used to evaluate the number and proportion of foods that would display a FOP symbol based on the details of the proposed FOP labelling regulations published in 2018. Results Overall, 35.5% (n = 1,306) of products in CNF 2015 and 63.9% (n = 11,193) of products in FLIP 2017 would display a FOP symbol for at least one nutrient-of-concern exceeding proposed thresholds. Soups, Combination Dishes, and Desserts categories in CNF 2015 and Combination dishes, Soups, and Meats categories in FLIP 2017 would have the highest proportion of products that would display a FOP symbol. Although displaying a FOP symbol for one nutrient was most common in both CNF 2015 (n = 992; 27.0%) and FLIP 2017 (n = 7,296, 41.6%), the number (i.e., 0–3) and type (i.e., saturated fat, sodium, total sugar) of nutrients displayed varied by food category. Conclusion While the generic database, containing both packaged and unpackaged foods, revealed a low prevalence of foods that would display a FOP symbol, the branded database showed that the proposed FOP labelling regulations would identify over 60% of packaged foods with excess contents of nutrients-of-concern. Considering the high prevalence of packaged foods in Canada that would meet or exceed the thresholds of nutrients-of-concern, the proposed FOP labelling regulations should be implemented in a timely manner to help consumers easily identify foods high in nutrients-of-concern and encourage manufacturer-driven product reformulations.

PurposeTo examine the nutritional quality and nature of gluten-free (GF) products targeted to children.Design/methodology/approachAll child-targeted foods were collected from two national grocery retailers in Calgary, Alberta, Canada. Child-targeted products with a GF claim were compared with those without such a claim using two nutrient profiling models, the Pan American Health Organization Nutrient Profiling Model (PAHO) and the 2023 World Health Organization (WHO) Nutrient Profile Model. A secondary analysis then compared the nutrient profile of child-targeted GF products to their product “equivalents”.FindingsApproximately 15% (n = 65) of the 448 products assessed had a GF claim. All products – those with and without a GF claim – had similar levels of protein, fat, saturated fat and trans fat, while 80% of GF claim products had high sugar levels. Ninety-eight percent of GF products exceed nutrients of concern for fat, sugars and/or sodium according to PAHO criteria. When examined using WHO criteria, only 1.5% of GF products would be permitted to be marketed to children—an ironic finding given that all products were included in the study because they were designed to appeal to children. No products in the paired analysis would be permitted to be marketed to children (per WHO).Originality/valueChild-targeted GF foods do not warrant the health halo accorded to such products by many consumers. Almost all GFC products exceed thresholds of concern for either sugar, sodium and/or fat. Parents who believe these products are “healthier” options for their children are mistaken.

PurposeThe World Health Organization recommends limiting the intake of free sugars, which can be added to packaged foods and may appear on labels under different terms. The aim of this research was to analyse the evidence related to the declaration of free sugars from fruits on packaged food labels.Design/methodology/approachA scoping review was conducted following the recommendations of the Joanna Briggs Institute (JBI).FindingsTen eligible studies, conducted in seven countries, were included in this review. The percentage of packaged foods in which free sugars were identified ranged from 52.5 to 86.5%. In three studies, terms related to sugars were identified inductively by reading the entire ingredient list, whereas in the other studies sugars were identified by searching for a list of predefined terms. Studies differed in the definition of sugars and the terms used to identify them. Nine studies included fruit sugars within the terms used to identify free sugars. However, they lacked consistency in the types of fruit sugars considered and did not discuss their agreement with the adopted definitions of sugars.Originality/valueAs far as can be ascertained, this is the first review that addresses the declaration of free sugars from fruits on packaged food labels. Overall, there is a scarcity of literature focused on identifying and discussing the range of free sugars from fruits declared on food labels.

The World Health Organization (WHO) has set a goal of prompt, complete and sustained elimination of industrially produced trans fats (iTFA) in the global food supply by 2023. We aimed to assess the number of products in the Australian packaged food supply likely to contain iTFA. Using a large pre‐packaged food monitoring database collected in 2018, we searched the ingredient list using specific and non‐specific ingredient terms to identify products likely to contain iTFA. In total, 28,349 foods were included for analysis: 131 (0.5%) products contained specific ingredients indicative of iTFA, and 1,626 (5.7%) products contained non‐specific ingredients that may indicate the presence of iTFA. Bread and bakery products, cereal and grain products and confectionery were the top three food groups that contained specific ingredients indicative of iTFA. Only 19 (14.5%) products with specific iTFA‐indicating ingredients declared the amount of trans fats. Compared to other countries, the use of iTFA‐containing ingredients is low in Australia, but repeated exposure to products containing iTFA could still put consumers at risk of excessive consumption. Legislation to eliminate iTFA should be considered to minimise the exposure to these harmful chemicals.