Replacing Annexure 6 the science behind nutrient profiling

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Replacing Annexure 6 - the science behind
nutrient profiling

• Prof Edelweiss Wentzel-Viljoen

TReNDS
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What does Annexure 6 say?

• Foodstuffs not considered essential for a healthy
  diet and for which NO nutrient content, GI,
  certain comparative, health, slimming or any
  other claim with health or nutritional messages
  will be permitted
• Beverages
• Sweet biscuits and flour confectionary
• Candies and chocolate confectionary
• Fast foods
• Savoury foodstuffs
• Desserts
• Other Regulations 20 July 2007

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Why Annexure 6?

• Top 10 causes of mortality in South Africa
• HIV - 25.5
• Ischemic heart disease - 6.6
• CVA - 6.5
• TB 5.5
• Interpersonal violence 5.3
• Lower respiratory infections 4.4
• Hypertension 3.2
• Diarrhea related diseases 3.1
• Road accident 3.1
• Diabetes 2.6

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Achieving the MDG through mainstreaming nutrition

• Meeting of the Standing Committee on Nutrition of
  the UN (March 2006)
• WHO UNICEF World Bank top officials
• Agree on terminology
• Agree on the same priorities
• Simplify the message
• Monitor and evaluate the resulting national
  programs (Darnton-Hill, Bloem Chopra, 2006)

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What happened next?
NO! NO! Give us the SCIENCE
NO! NO! NO! Unscientific!
This is not what we want!
YES! YES! Nutrient Profiling
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What happened next?

• Meetings and meetings and .
• Heaps and heaps of documents ..
• And some more talking, meetings .
• Yes, NUTRIENT PROFILING looks GOOD

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CGCSA
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Nutrient Profiling

• 2 day meeting of EFSA (European Food Safety
  Authority) - Oct 2007
• European Commission request scientific advice on
• The setting of NP for their regulation on
  nutrition and health claims made on foods
• 87 delegates from all the EU countries plus UK,
  USA, Australia, South Africa
• Scientists, institutions, industry

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Nutrient Profiling

• Report to the CGCSA on the meeting
• Various things happen in-between
• Request for a proposal Dept of Health
• But no money available
• Request for a proposal CGCSA Oct 08
• Too expensive / will take too long ???
• New request March 09 April 09
• Next I dont know, but I know what should be
  done

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Nutrient Profiling - Definition

• Nutrient profiling of foods is defined as the
  science of ranking foods based on their nutrient
  composition (Drewnowski, 2005)
• It aims to benefit both consumers and food
  industry by ensuring that claims do not mask the
  overall nutrient content of the products, and
• Encouraging manufacturers to improve the
  nutritional quality of their products (EFSA,
  2007)

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Nutrient Profiling Model

• A nutrient profiling model / scheme should be
  based on generally accepted scientific evidence
  relative to the relationship between diet,
  nutrition and health

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Nutrient Profiling Model

• Take into account
• Dietary recommendations SAFBDG
• Public health considerations SA Profile
• Cultural diversity
• Dietary/culinary diversity, i.e. importance of a
  specific food
• Considerations of food industry
• Criteria
• Feasibility
• Simplicity
• Easy-to-use by stakeholders
• Protecting the interests of the consumers
• SA own Nutrient Profiling Model

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Nutrient Profiling Model A Systematic approach

• For what purpose is the model to be used?
• What group or population is the purpose relevant
  to?
• Are food-category-specific or across-the-board
  criteria more appropriate for the purpose?
• 4Which nutrients or other food components should
  be included?
• Which base or combination of bases should be
  used?
• What type of model should be used?
• What numbers should be used for the criteria
• The decision-making should be interactive
• (Scarborough et al, 2007)

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Nutrient Profiling Model 1. For what purpose
is the model to be used

• Replacement of Annexure 6
• Foodstuffs not considered essential for a healthy
  diet and for which NO nutrient content, GI,
  certain comparative, health, slimming or any
  other claim with health or nutritional messages
  will be permitted
• Should all foodstuffs considered OUT until
  proven IN OR
• IN until proven OUT
• Olive oil? Low fat margarine? Bread? etc

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Nutrient Profiling Model 2. What group or
population is the purpose relevant to?

• Children?
• Adolescents?
• Adults?
• Women planning pregnancy?
• Older people?

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Nutrient Profiling Model 3. Food-category-speci
fic or across-the-board

• Descriptors can be absolute or relative to other
  foods
• Low in fat
• Low in fat relative to all other foods? OR
• Similar foods / same category foods
• 3g per 100g (solids) / 1.5g per 100g (liquids)
• ? Relative to all other foods
• ? Category specific?
• Bread vs margarine
• Food-category or across-the-board

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Nutrient Profiling Model 3. Food-category-speci
fic or across-the-board

• What is the purpose of the model
• Encourage consumers to choose healthier foods
  within a food group
• Food-category-specific criteria
• Encourage consumers to switch to healthier food
  categories
• Across-the-board criteria
• Difficult to set criteria for both
• No universally accepted food categories
• What about composite dishes
• Comparison of eg breakfast cereals

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Nutrient Profiling Model 4. Which nutrients
and other food components

• Energy not a nutrient
• Food additives not a nutrient
• Nutrient All included
• WHO 37 nutrient other components linked with
  chronic disease
• Prioritization of nutrients necessary
• Which criteria should be used?

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Nutrient Profiling Model 4. Which nutrients
and other food components

• Which criteria should be used?
• Qualifying nutrients known to be beneficial to
  health (mostly vitamins and minerals) OR
• Disqualifying nutrients, mostly fats, sugars and
  sodium OR
• Some combination of both
• Fruit, veg, nut, or whole grain content
• Weighting / bioavailability of nutrients
• Fortification
• Different models uses different nutrients
• Setting of cut-points

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Nutrient Profiling Model 4. Which nutrients
and other food components

• Which nutrients
• NaCl vs sodium

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Nutrient Profiling Model 5. Which base or
combination of bases

• Amount of nutrients in a food expressed in
• Per 100gram
• Per 100kJ
• Per portion/serving
• Who decides on a portion/serving size?
• The industry / government / academia all will
  use different criteria
• CRUCIAL DECISION

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Nutrient Profiling Model 5. Which base or
combination of bases

• CRUCIAL DECISION
• Different bases will rank foods in different
  orders
• Per 100g fat in mustard / calcium in milk
• Per 100kJ ignore water content
• Amount of fat per 100kJ or per serving different
• For example
• Spaghetti bolognaise has less fat per 100g than
  mayonnaise, but more fat per serving
• In other models per 100kJ rarely used
• Combination possible

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Nutrient Profiling Model 6. Which model type

• Two types of approaches
• Categorical/threshold models
• divide foods into 2 or more groups
• Categorize two foods as high in salt, but will
  not indicate which food contains more salt
• Most often used in models
• Continuous / scoring systems
• Provide a ranking of foods
• More complex
• Calculating a score for each food which is then
  used to rank foods
• Can be changes to a categorical model by setting
  thresholds
• More flexible than categorical models
• Different score thresholds can be set for
  different food categories
• UK model semi-continuous model

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Nutrient Profiling Model 7. Choosing the
numbers to use

• 3 methods for setting threshold levels
• Chosen pragmatically
• Used in most models
• To include certain foods within a definition
  and/or so that the levels coincide with food
  producers vies of what are attainable
• Taken from respected sources Codex Alimentarius
  definitions
• Ensure that threshold levels or points scored are
  explicitly and logically linked to public health
  recommendations

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Nutrient Profiling Model Conceptual framework
NUTRIENT PROFILING
FBDG
SAFBDG
Educational
Disease profile
Regulatory
Health nutrient claims
Cultural diversity
Culinary diversity
Front of pack labeling
Traffic lights Health logos GDA
Food industry
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Nutrient Profile Model Validation (Drewnowski
Fulgoni III, 2008)

• A nutrient profile model need to be validated
  against some objective measure of diet quality
• Identifying healthy diets and then looking for
  correlations with indicator foods(Drewnowski
  Fulgoni III, 2008)
• Correlations between the consumption of index
  foods and selected health outcomes (Drewnowski
  Fulgoni III, 2008)

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Nutrient Profiling Model EFSA meeting Oct 2007

• Discussion topics
• Nutrient profiles across the board or by category
  of food
• Identification of critical nutrients
• Reference quantity, scoring vs threshold systems
• Testing methods
• No consensus was reached in any of the groups on
  any topic!

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Nutrient Profiling Model Conclusion

• It aims to benefit both consumers and food
  industry by ensuring that claims do not mask the
  overall nutrient content of the products, and
• Encouraging manufacturers to improve the
  nutritional quality of their products

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Nutrient Profiling Model Conclusion

• All parties need to be convinced that nutrient
  profiling of foods will result in healthier food
  choices, better diets, and a measurable
  improvement in the publics health (Drewnowski
  Fulgoni, 2008)

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Nutrient Profiling Model Way forward

• Industry ask
• Dept of Health says OK
• Time
• UK
• Time Money
• BUT, fortunately .

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Nutrient Profiling Model Where do we stand now?

• Industry lingers .
• Department waits .

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Nutrient Profiling Model Way forward

• NUTRIENT PROFILING ANNEXURE 6