Front-of-pack labels: "Directive" versus "informative" approaches.

Front-of-pack labels (FOPLs) aim at communicating to consumers the health value of food items in support of public health policies. Two main types can be discerned: directive and semidirective FOPLs using color schemes (e.g., Nutri-Score) and informative FOPLs (e.g., Nutrinform Battery). Directive approaches tend to show a "wear-out effect" and, additionally, they tend to have various underlying conceptual problems. Usually, their nutritional scores are calculated using changing, arbitrary algorithms and involve a reductionist set of parameters of debatable validity. Thus, they overstate the effects of selected nutritional factors, such as saturated fat and energy, while overlooking the food matrix and the more holistic aspects of nourishment. Moreover, they do not reflect the portion that is consumed, ignore the preparation steps at home, and fail to serve as a useful basis for composing a healthy diet. Also, so long as the nutritional formulations match the algorithmic standards, they tend to allow ultra-processed products. Thus, this might confuse and mislead consumers. Overconfidence in green-colored labels could even result in unbalanced dietary choices, whereas avoidance of red products may eliminate certain foods from the diet that are rich in essential nutrients (e.g., cheese), leading to opposite results than aimed for. The latter is particularly relevant to vulnerable populations, such as the young, pregnant women, and older adults, or for individuals with specific needs. Taken together, directive FOPLs such as Nutri-Score contradict the declared intent of the European Commission to empower consumers to undertake healthy and balanced diets based on easily accessible and robust information. Although informative systems usually also keep the focus on a few selected nutritional parameters, they have are less paternalizing and obviate the need to classify foods as healthy or unhealthy. They also focus attention on the individual portions that are consumed (even if the definition of portion size remains contentious). Given the importance of dietary patterns, rather than individual foods or nutrients, directiveFOPLs of the Nutri-Score type represent a regretful case of nutritionism. Finally, attempts to associate the adoption of a FOPL with an improvement in the health status are few and mainly applied in virtual settings; none of which are longitudinal, nor have they been able to identify a causal link.

The influence of a front-of-pack nutrition label on product reformulation: A ten-year evaluation of the Dutch Choices programme.

Front-of-pack (FoP) labels are regarded as helpful tools to stimulate healthier product reformulation as they are based on nutrient criteria that products should comply with in order to obtain the label. Some FoP labelling programs revise criteria periodically. This is the first study investigating the impact of criteria revisions on product compositions over time. Nutrient contents of 4,343 products, including 27 basic and non-basic product (sub) categories with the Dutch Choices Logo were analysed between 2006 and 2016. The number of labelled products increased over time. Sodium and trans-fat contents reduced significantly in 10 and 11 product categories, respectively. Energy, saturated fat and added sugar decreased significantly whilst fibre increased in 4-6 product categories. Overall, labelled products had healthier compositions and more favourable trends in nutrient content compared with products generally on the Dutch market. The results of this study suggest an important role for FoP labels in product reformulation.

The effects of voluntary front-of-pack nutrition labels on volume shares of products: the case of the Dutch Choices.

OBJECTIVE: The study examines the impact of a front-of-pack label (Dutch Choices) on household purchase patterns. DESIGN: Change in households' volume share of products eligible for the label (treatment group) is estimated as a function of changes in the market share of products displaying the label (treatment), while controlling for other relevant factors. SETTING: Home-scan data for five food categories, subdivided into eighteen food groups, for households participating in a Dutch consumer panel. The data are from the period 2005 to 2009, which includes the date of the introduction of the Choices label. PARTICIPANTS: Between 831 and 7216 households from all over the Netherlands. RESULTS: An increase in the market share of products displaying the label led to an increase in the volume share purchased of products eligible for the label for dairy products, yoghurts and for sauces. For some of the products, the partial effect is considerable (e.g. a 10 percentage point (pp) increase in the share of products displaying the label is associated with a 11·5 and 14·0 pp increase in the volume share of eligible products for chocolate milk and quark, respectively). CONCLUSIONS: The results suggest a positive effect from the presence of the Choices label on the volume share of eligible products purchased. Provided that eligible products are healthier than non-eligible products, the Choices label is a good guide for consumers in order to help them make healthier food choices. The positive effect is found mainly in food groups with a mix of both healthy and unhealthy food products.

The use of food composition data in the Choices International Programme.

Food composition data have extensively been used in the Choices International Programme: they formed the basis of both criteria development and nutrient intake modeling. Criteria were developed for key nutrients linked to non communicable diseases by an independent scientific committee. The criteria can be used for the logo assignment on food products, in order to stimulate producers to improve their products and to stimulate consumers to purchase these products. Insights in steps of development of the criteria for the Choices program illustrates the importance of food composition data in this process. Modeling studies with the criteria for the Dutch Choices program showed an improved nutrient intake profile if consumers would choose products fulfilling the criteria of the Dutch logo as part of their diets. The role and availability of food composition databases in the development of the criteria and the modeling studies is discussed.

Potential effects of nutrient profiles on nutrient intakes in the Netherlands, Greece, Spain, USA, Israel, China and South-Africa.

INTRODUCTION: Nutrient profiling is defined as the science of categorising foods based on their nutrient composition. The Choices Programme is a nutrient profile system with criteria that determine whether foods are eligible to carry a "healthier option" stamp. The Daily Menu Method which has been developed to evaluate these criteria is described here. This method simulates the change in calculated nutrient intakes which would be the result of consumers changing their diets in favour of food products that comply with the criteria. METHODS: Average intakes of energy, trans fatty acids (TFA), saturated fatty acids (SAFA), sodium, added sugar and fibre were derived from dietary intake studies and food consumption surveys of 7 countries: The Netherlands, Greece, Spain, the USA, Israel, China and South Africa. For each of the key nutrients, these average intakes were translated into three Typical Daily Menus per country. Average intakes based on these three menus were compared with average intakes from three Choices Daily Menus. To compose the Choices Menus, foods from the Typical Menus that did not comply with the Choices criteria were replaced with foods that did comply and are available on the market. RESULTS: Comparison of intakes from the Choices Menus with the survey data showed that calculated intakes of energy, SAFA, TFA, sodium and added sugar were reduced. Fibre intakes were increased. The size of the effect differed per country. CONCLUSION: The Daily Menu Method is a useful means to predict the potential effects of nutrient profiles such as the Choices criteria, on daily nutrient intakes. The method can be applied internationally and confirms that the criteria of the Choices Programme are in line with the aim of the programme: to improve nutrient intakes in the direction of the recommendations.

A front-of-pack nutrition logo: a quantitative and qualitative process evaluation in the Netherlands.

This study aimed to perform a quantitative and qualitative process evaluation of the introduction of the Choices logo, a front-of-pack nutrition logo on products with a favorable product composition, adopted by many food producers, retail and food service organizations, conditionally endorsed by the Dutch government, validated by scientists, and in the process of international dissemination. An online questionnaire was sent to adult consumers 4 months after the introduction of the logo (n = 1,032) and 1 year later (n = 1,127). Additionally, seven consumer focus groups (n = 41) were conducted to provide more insight into the questionnaire responses. Quantitative analyses showed that exposure to the logo had significantly increased. Elderly and obese respondents reported to be more in need of a logo than younger and normal-weight individuals. Women perceived the logo more attractive and credible than men did. Further qualitative analyses indicated that the logo's credibility would improve if it became known that governmental and scientific authorities support it. Elderly respondents indicated that they needed a logo due to health concerns. Consumers interested in health reported that they used the logo. Further research focusing on specific target groups, forming healthful diets, and health outcomes is needed to investigate the effectiveness of the Choices logo.

The Choices programme: a simple, front-of-pack stamp making healthy choices easy.

Some food products fit better within a healthy diet than others, but how can consumers tell? The Choices programme is a simple and internationally-applicable programme to help consumers make a healthy choice on food and beverages and to stimulate industry towards healthy product innovation in all food groups. The essence of the programme is a front-of-pack stamp on products that pass an evaluation against scientific criteria. To that end generic criteria have been established for levels of saturated fat, trans fat, sugars and sodium, which are based on international dietary guidelines (FAO/WHO). For some food categories there are specific criteria for these nutrients as well as for dietary fibre and calories. In this way the criteria are challenging without being impossible to meet. The programme has been initiated by food industry and is open to all companies in food industry, retail and catering. The approach is also supported by nutritional scientists, governments and NGOs. An independent scientific committee is responsible for designing and periodically reviewing the qualifying criteria. The current qualifying criteria were developed by scientific committees in the Netherlands and Belgium. These criteria will now be reviewed by an International Scientific Committee, consisting of internationally-recognised food and nutrition experts. To accommodate the developments in nutrition science and food technology, this review will take place every two years.

DNA mismatch repair deficiency stimulates N-ethyl-N-nitrosourea-induced mutagenesis and lymphomagenesis.

The primary role of the mismatch repair (MMR) system is the avoidance of mutations caused by replication and recombination errors. Furthermore, the lethality of methylating agents has been attributed to the processing of O(6)-methylguanine lesions in DNA by MMR. Loss of the MSH2 protein completely abolishes repair function and results in reduced cell killing by methylating agents and accelerated accumulation of methylation-damage-induced mutations. This has raised the question as to whether MMR is also involved in the cellular response to other genotoxic insults. Here we describe that in mice deficient for Msh2, lymphomagenesis was strongly accelerated by an ethylating agent, N-ethyl-N-nitrosourea (ENU), given at a dose that did not induce lymphomas in wild-type mice. This suggests that MMR deficiency and ENU-induced mutagenesis synergistically collaborate in inducing tumorigenesis. To study the interaction between MMR and ENU-induced DNA damage, we compared the lethality and mutagenicity of ENU in MSH2-proficient and -deficient mouse embryonic stem cells. Although MSH2-deficiency only slightly reduced the lethality of ENU, it strongly enhanced the mutagenicity of ENU. Mutation analysis of ENU-induced Hprt mutants revealed that base substitutions occurred predominantly at A-T base-pairs. These results suggest that MMR modulates the processing of ethylation damage at AT base-pairs.