Salt content of prepacked cereal-based products and their potential contribution to salt intake of the Italian adult population: Results from a simulation study.

BACKGROUND AND AIMS: High sodium intake is one of the main risk factors for noncommunicable diseases, and its consumption should be reduced. This study aimed to simulate changes in the daily salt intake of the Italian adult population based on consumption scenarios of prepacked cereal-based foods sold in Italy. METHODS AND RESULTS: Information on food packages was retrieved from 2893 cereal-based products. Potential changes in salt intake were simulated based on food consumption scenarios that consider the daily consumption of cereal-based products suggested in the Italian Dietary Guidelines and their current daily consumption by Italian adults. The highest salt content was retrieved in bread (median, 25th-75th percentile: 1.3, 1.1-1.4 g/100 g) and bread substitutes (1.8, 1.0-2.2 g/100 g). If the suggested daily amounts were consumed, bread would contribute to 44% of the 5 g salt/day target, whereas bread substitutes, breakfast cereals, biscuits and sweet snacks would marginally contribute (1-2%). Compared to bread with median salt content, a -44% and +10% salt intake would be observed if products within the first and the last quartile of salt content were chosen, respectively. However, considering the actual intake of Italian consumers, bread would cover 25% and bread substitutes 7% of the daily salt target. CONCLUSION: Food labels have a pivotal role and efforts are required to encourage consumers to use them to make healthy choices. Moreover, these results may contribute to setting sodium benchmarks in cereal-based products and encourage the food industry to reduce the salt content in the products.

Time to define food salt targets in Italy starting with cereal-based products: A safe and practical way to reduce the heavy burden of cardiovascular disease.

BACKGROUND AND AIMS: Excess salt intake is the leading dietary risk factor for cardiovascular disease in most countries, including Italy. While the cost-effectiveness of interventions aimed to reduce salt intake has been proved, the WHO recommendation to reduce salt intake by 30 % at the global level by 2025 is far from being reached. METHODS AND RESULTS: In Italy, two surveys of the general adult population have established that the average salt intake is still almost twice the WHO recommendation although it was reduced by 1.2 g/day between 2008-12 and 2018-19. Previous investigations had shown that non-discretionary salt added by the industry or by local craft producers represents at least 50 % of the total intake and indicated cereal-based products as the main source of non-discretionary salt. Two recent studies conducted by the Italian Society of Human Nutrition "Young Working Group" have provided updated information on the salt content of almost three thousand cereal-based products currently available on the Italian food market and shown that most of the items evaluated had a sodium content much higher than the sodium benchmarks recently proposed by WHO. CONCLUSIONS: Italy has built the foundations of an effective population strategy for salt intake reduction: it is time however to proceed with full commitment to food reformulation if any substantial further progress has to be made. Salt benchmarks for Italy need to be defined for the food categories most relevant to population salt intake and their implementation should ideally be mandatory after consultation with food producers.

High hopes for front-of-pack (FOP) nutrition labels? A conjoint analysis on the trade-offs between a FOP label, nutrition claims, brand and price for different consumer segments.

An increasing number of studies investigate the effect of front-of-pack (FOP) nutrition labels on consumer choice without considering differences in consumer preferences for product attributes. This study used a choice-based conjoint analysis to test consumers' preferences for four product attributes (5 levels of a FOP nutrition label, absence/presence of a nutrition claim, brand (unfamiliar, private label or premium) and 5 levels of price) when they coexist (n = 1156). As the consumer preferences showed distinct patterns (multimodality), consumers were subsequently clustered based on how a FOP nutrition label (Nutri-Score) influenced their food choices. Three consumer segments were identified, each valuing the Nutri-Score label differently. The label effectively seems to nudge one segment toward healthier choices (n = 456), while in contrast, another segment is unexpectedly steered toward unhealthier food choices by the label (n = 343). The third segment is only consistently nudged by the FOP label's extremes (n = 357). The segments also differ in their preferences for other product attributes (brand and price), health involvement, and self-reported understanding and use of the Nutri-Score, but not in the measured socio-demographic variables (age, sex, education, social class), dieting or smoking habits. In summary, consumers vary in their food label preferences, and studies that pool consumers may fail to capture these nuances, leading to biased results. This study shows that FOP labels do not steer all consumers toward healthier choices and may even have adverse effects for some. This suggests combining different policies and marketing strategies to reach all consumer segments.

Evaluating front-of-pack voluntary well-being messaging for milk powders targeting Chinese older adults: A hedonic price model.

This study examines the price structure of milk powders targeting Chinese older adults, with special emphasis on the assessment of front-of-pack (FOP) voluntary well-being messaging (VWM), using a hedonic price model. Data of 456 sets of product prices and attributes were collected from official stores at online shops, TMALL.com and JD.com, in China. Prices were recorded 10 d before, during, and 10 d after a major online promotion event (November 11, 2021). A hedonic price model was employed to decompose explicit market prices into individual product attributes implicit prices, including essential attributes, such as milk source, brand origin, package material, and nutritional composition, and nonessential attributes conveyed by FOP VWM, regarding nutrition, ingredients, health, sensory qualities, and certification. Results showed that above and beyond essential attributes, nonessential attributes conveyed by FOP VWM were significantly associated with price. Specifically, significant price premiums were associated with dietary fiber claims (+12.7%), no added sugar (+19.0%) and potential health benefits (+19.3%), as nutrition-, ingredient-, and health-related FOP VWM respectively. However, nutrition claims regarding calcium and fat were negatively associated with price (-21.2% and -8.0%, respectively, when they were presented). Additionally, nutrition claims for protein and vitamin D, introducing farm environment, referring to imported ingredients, declaring specific ingredients added, describing sensory characterizes and providing certificates on FOP were not significantly associated with price in this market. These findings provide manufacturers with information to better differentiate their products by producing and advertising attributes most valued by consumers.

Consumer and product-specific characteristics influencing the effect of nutrition, health and risk reduction claims on preferences and purchase behavior - A systematic review.

The research on nutrition, health, and risk reduction claims (NHR claims) shows a lack of consensus as to whether these claims have a positive or negative effect on consumer's preferences and purchase behavior. This issue has been highlighted by many authors. Therefore, a comprehensive literature review was performed to find reasons for contradictory results. First, a theoretical framework was developed which divided the determinants of the effects of NHR claims on consumers' preferences and purchase behavior into consumer and product-specific characteristics. Additionally, a categorization for the different NHR claim types was constructed to make the studies comparable. Afterwards, the scientific literature from the 1980s until May 2017 was scanned and 66 articles were found to be relevant. Consumer-specific characteristics such as nutrition knowledge, health motivation, familiarity, and socio-demographic characteristics were found to influence the NHR claim effect. Important product-specific characteristics were the perceived healthiness of the food product, the interaction between the product and the nutrient in the NHR claim, and the interaction between the claimed benefit and the NHR claim type. The consumer's nutrition knowledge and the product's perceived healthiness were deemed to be the most promising determinants for further investigation.

Nutrition labelling, marketing techniques, nutrition claims and health claims on chip and biscuit packages from sixteen countries.

OBJECTIVE: Food packages were objectively assessed to explore differences in nutrition labelling, selected promotional marketing techniques and health and nutrition claims between countries, in comparison to national regulations. DESIGN: Cross-sectional. SETTING: Chip and sweet biscuit packages were collected from sixteen countries at different levels of economic development in the EPOCH (Environmental Profile of a Community's Health) study between 2008 and 2010. SUBJECTS: Seven hundred and thirty-seven food packages were systematically evaluated for nutrition labelling, selected promotional marketing techniques relevant to nutrition and health, and health and nutrition claims. We compared pack labelling in countries with labelling regulations, with voluntary regulations and no regulations. RESULTS: Overall 86 % of the packages had nutrition labels, 30 % had health or nutrition claims and 87 % displayed selected marketing techniques. On average, each package displayed two marketing techniques and one health or nutrition claim. In countries with mandatory nutrition labelling a greater proportion of packages displayed nutrition labels, had more of the seven required nutrients present, more total nutrients listed and higher readability compared with those with voluntary or no regulations. Countries with no health or nutrition claim regulations had fewer claims per package compared with countries with regulations. CONCLUSIONS: Nutrition label regulations were associated with increased prevalence and quality of nutrition labels. Health and nutrition claim regulations were unexpectedly associated with increased use of claims, suggesting that current regulations may not have the desired effect of protecting consumers. Of concern, lack of regulation was associated with increased promotional marketing techniques directed at children and misleadingly promoting broad concepts of health.

Chinese consumers' psychology and behavior of the foods with nutrition claims based on AISAS model.

Objective: We analyzed the impact of nutrition claims on Chinese consumer psychology and behavior process based on the theoretical framework of AISAS (Attention-Interest-Search-Action-Share) model. Design: To adopt questionnaires to collect gender, age, income and other basic information of adult residents and a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) to collect data on residents' attention to nutrition claims, interest in nutrition claims, search on nutrition claim information, purchasing behavior on food with nutrition claims, sharing information on food with nutrition claims. Then to study the relationship between the basic situation of residents and their attention, interest, search, food purchase behavior and sharing of nutrition claims by using exploratory factor analysis, reliability and validity test, structural equation modeling estimation and hypothesis testing. Participants: Chinese adults. Setting: Multi-stage stratified random sampling method was used to collect the valid online questionnaire of 630 Chinese adults from Central, North, East, South, Northwest, Southwest, and Northeast China. Results: Younger adults and those with higher household incomes exhibited heightened attention to nutrition claims. Furthermore, consumers' attention to nutrition claims could be transformed into food information sharing through interest, information search, and food purchase. Consumers' interest in food with nutrition claims could be transformed directly into food purchase. Consumers' search for related information could be directly transformed into food information sharing. Conclusion: Chinese consumers' age and household income could be included in the AISAS model for the foods with nutrition claims, and the consumers' action and share could transform from their interest and search.

Nutrition cues on ready-to-drink alcoholic beverage containers sold in grocery stores in Québec City, Canada.

Nutrition cues on ready-to-drink alcoholic beverages (RTDs) may create an illusion of healthfulness; however, nutrition information on alcohol in Canada is seldom regulated. This research aimed to systematically record the use of nutrition cues on a subsample of RTDs sold in grocery stores. In July 2021, all available RTDs were purchased from three major grocery store banners in Québec City, Canada. Data regarding container size, purchase format, alcohol-by-volume (ABV), presence of nutrition cues (nutrient claims, other food-related claims and nutrition facts tables [NFTs]) and container surface occupied by nutrition cues were recorded. RTDs were classified as hard seltzers or pre-mixed cocktails and their ABV as "light-strength" (3.5%-4.0% ABV) and "regular-strength" (>4.0%-7.0% ABV). In total (n = 193), 23% were hard seltzers and 17% light-strength. Most RTDs (68%) had ≥1 type of nutrition cue, most often natural flavour claims (45%), an NFT (38%), and calorie claims (29%). Light-strength beverages were more likely than regular-strength to carry any nutrient claim (97% vs. 19%, p < 0.0001), an NFT (97% vs. 26%, p < 0.0001) and other food-related claims (e.g., natural flavour) (88% vs. 52%, p = 0.0002). In adjusted regression analyses, hard seltzers were more likely than pre-mixed cocktails to carry any nutrient claim (AOR = 19.1, 95% CI:7.5,48.7), any other food-related claim (AOR = 7.5, 95% CI:2.9,19.4), and an NFT (AOR = 45.5, 95% CI:12.6,163.9). The mean container surface occupied by nutrition cues was higher for hard seltzers compared to pre-mixed cocktails (13% vs 3%, p < 0.0001). The high proportion of RTDs carrying nutrition cues supports the need to further regulate labelling and marketing of RTDs.

"It's All Just Marketing", a Qualitative Analysis of Consumer Perceptions and Understandings of Nutrition Content and Health Claims in New Zealand.

Nutrition content and health claims are widely used globally on both food labels and in food advertising. This study explored how New Zealand consumers understand, perceive, and use nutrition content and health claims on food labels. A qualitative approach was used with semi-structured in-depth online interviews and in-person focus groups including 49 participants, aged ≥25 years responsible for household food shopping. Transcripts were analysed using reflexive thematic analysis using inductive coding, with development of five themes-(1) aware of claims but did not use, (2) mistrust and scepticism, (3) confusion and misinterpretation, (4) using claims to guide food choice, and (5) not all claims are equal. For theme 1, price and habit were found to be the most influential in driving food choice. Underlying theme 2 was the perception by most of nutrition and health claims as marketing. Scepticism was exacerbated when nutrient claims were displayed on inherently unhealthy products. However participants with specific dietary requirements did find claims helpful. Restricting nutrient claims to foods meeting a healthy nutrient profile aligned to the existing Health Star Rating system, education about regulation and supporting claims with more contextual information may increase trust, the perceived value of claims and therefore their utility.

Nutritional Quality of Wholegrain Cereal-Based Products Sold on the Italian Market: Data from the FLIP Study.

The consumption of wholegrains (WG) is encouraged worldwide, but the lack of a common legal definition of such products leads to an unclear classification and identification on the grocery store shelf. In Italy, several products are generally sold as WG, but it cannot be determined if they are made entirely with all WG cereal(s) or if they are partially produced with WG ingredients (PWG). The aims of this study were to (a) survey the number of cereal-based food items formulated with WG, PWG, or refined (RG) present on the Italian market; and (b) analyse the nutritional quality, intended as nutrition facts, of WG products in comparison to PWG and RG. Nutritional information and declarations were retrieved from packs of 3040 products belonging to five different categories: breakfast cereals, biscuits, sweet snacks, bread, and bread substitutes. A descriptive analysis of the products and comparison of energy, macronutrients, fibre and salt among RG, PWG and WG products within each category was performed. In all categories, a major portion of the products did not contain WG ingredients. Results showed that the nutritional quality of RG, PWG, and WG products varied in relation to the product category and that WG inclusion cannot be always considered a marker of the overall nutritional quality of foods. Instead, it is necessary to evaluate the global product characteristics, and it is important to pay attention to differences between WG and PWG products that can be perceived by consumers as equivalent.

The Effects of Nutrition and Health Claim Information on Consumers' Sensory Preferences and Willingness to Pay.

As marketing tools, nutrition claims (NCs) and health claims (HCs) can be used to convey the nutritional properties and health benefits of food to consumers, but their respective effects on consumers' perceptions of healthier meat products are inconsistent in the literature. Using a physical prototype of omega-3-enriched sausages as a research interest, this paper explores how HCs and NCs differently influence consumers' sensory preferences and willingness to pay (WTP). Sensory tests were carried out among 330 participants, followed by a choice-based conjoint (CBC) experiment to measure consumers' WTP. Results indicate that, in comparison with the uninformed condition, labeling an omega-3 nutrition claim increased consumers' sensory liking for omega-3-enriched sausages in the attributes of appearance and texture. Moreover, consumers were willing to pay more for healthier sausages, but labeling HCs did not significantly improve participants' WTP for omega-3-enriched sausages more than NCs. Hence, HCs did not significantly outperform NCs, when it comes to positively influencing consumers' sensory liking and paying intentions for omega-3-enriched sausages. The findings of this study have implications for the meat industry in developing healthier sausage formulations with greater likelihood of success in the market.

Breakfast Cereals Carrying Fibre-Related Claims: Do They Have a Better Nutritional Composition Than Those without Such Claims? Results from the Food Labelling of Italian Products (FLIP) Study.

Nutrition claims (NCs) on food packaging are, from one side, an informative tool about the nutritional characteristics of the product. From another side, they could bias the consumer in perceiving such products as healthier than those without claims. In order to investigate whether products with NCs have a better nutritional composition that those without claims, the present study aimed to compare the nutrition facts of 376 breakfast cereals, with and without fibre-related NCs, available in 13 Italian retailer online stores. Among these products, 73 items claimed to be a "source of fibre" and 109 "high in fibre". In addition to a higher fibre content, products "high in fibre" showed higher protein and fat contents but lower carbohydrate, sugar and salt contents compared to both "source of fibre" and without fibre-related NC items. Overall, a high variability in nutritional values was also observed within products with the same type of fibre-related NC. In conclusion, the results suggested that fibre-related NCs should not be considered as a marker of a better nutritional composition of breakfast cereals, and thus consumers should be educated to carefully read the entire nutritional information reported in the food labelling.

The Level of Processing, Nutritional Composition and Prices of Canadian Packaged Foods and Beverages with and without Gluten-Free Claims.

Little is known about the healthfulness and cost of gluten-free (GF) foods, relative to non-GF alternatives, in Canada. This study compared the extent of processing, nutritional composition and prices of Canadian products with and without GF claims. Data were sourced from the University of Toronto Food Label Information Program (FLIP) 2013 (n = 15,285) and 2017 (n = 17,337) databases. Logistic regression models examined the association of NOVA processing category with GF claims. Calorie/nutrient contents per 100 g (or mL) were compared between GF and non-GF products. Generalized linear models compared adjusted mean prices per 100 g (or mL) of products with and without GF claims. The prevalence of GF claims increased from 7.1% in 2013 to 15.0% in 2017. GF claims appeared on 17.0% of ultra-processed foods, which were more likely to bear GF claims products than less-processed categories. Median calories and sodium were significantly higher in GF products; no significant differences were observed for saturated fat or sugars. Compared to non-GF products, adjusted mean prices of GF products were higher for 10 food categories, lower for six categories and not significantly different for six categories. Overall, GF claims are becoming increasingly prevalent in Canada; however, they are often less healthful and more expensive than non-GF alternatives, disadvantaging consumers following GF diets.

Effects of Low-Calorie Nutrition Claim on Consumption of Packaged Food in China: An Application of the Model of Consumer Behavior.

More and more packaged products in China have been labeled as low-calorie products since the official implementation of nutrition claims in 2007. But little was known about the impact of such claims on the Chinese consumption of low-calorie food on the background of increasing rates of obesity among the Chinese population. This study sought to fill the gap by applying a consumer behavior model to a nationally representative online survey by means of structural equation modeling. The findings revealed that nutrition claims significantly affect the consumption of low-calorie products. Specifically, marketing stimulus on low-calorie products first affected consumer psychology, then consumer decision-making, and finally consumer responses. Despite the significant role of consumer psychology and decision-making in consumption, consumers were susceptible to the influence of targeted marketing strategies for foods with a low-calorie claim. It is recommended that appropriate use of low-calorie nutrition claims by manufacturers and choices of low-calorie food by consumers according to their own needs should be encouraged.

Potential Nutrition and Health Claims in Deastringed Persimmon Fruits (Diospyros kaki L.), Variety 'Rojo Brillante', PDO 'Ribera del Xúquer'.

In Europe, nutrition and health claims made on food must be based on scientific evidence, which means a comprehensive evaluation by the European Food Safety Authority (EFSA) prior to authorisation. Processed foods are subject to numerous claims derived from the presence of bioactive compounds; however, natural food products, often the original sources of those compounds, are not habitually the subject of these claims. Although the consumption of persimmon fruit has important health benefits, up to date no specific health claims are authorised for this fruit. In this work, 'Rojo Brillante' persimmon fruits (Diospyros kaki L.), Protected Designation of Origin (PDO) 'Ribera del Xúquer' were characterized regarding the presence of fiber (soluble and insoluble), vitamin C (ascorbic and dehydroascorbic acids), carotenoids (neoxanthin, violaxanthin, ß-cryptoxanthin, lycopene, ß- carotene) and mineral elements (Fe, Cu, Zn, Mn, Ca, Mg, Na, K). Different fruit batches harvested in different seasons were analyzed by standardized analytical methods (Association of Official Analytical Chemists, AOAC), high-performance liquid chromatography with ultraviolet detection (HPLC-UV) and atomic absorption spectroscopy. Based on the results, Persimon® is potentially able to show two nutrition claims "Source of fiber" and "Sodium-free/salt-free". This work could set the ground for future studies and to start considering natural food products as candidates for the use of approved claims.

Consumers' Willingness to Pay for Imported Milk: Based on Shanghai, China.

Against the backdrop of the continuous large-scale growth of imported milk in China, in this research 310 consumers in Shanghai were used as a sample, and a choice experiment was conducted to study consumer preference and willingness to pay for imported milk. The following product attributes were included: nutrition claim, fat content, flavor, country of origin, and price. Our results show that, excepting price, consumers consider flavor the most important attribute, followed by nutrition claim, fat content, and country of origin. Consumers can be delineated into four segments based on consumer preference for the attributes of imported milk: "nutrition claim seekers" are willing to pay the highest price for imported milk with nutrition claims, "indifferent" consumers pay little attention to imported milk attributes, "flavor-oriented" consumers have a strong preference for strawberry-flavored imported milk, and "price-sensitive" consumers weigh the price when choosing imported milk.

Consumers' Trade-Off between Nutrition and Health Claims under Regulation 1924/2006: Insights from a Choice Experiment Analysis.

The aim of this paper is to investigate consumers' preferences and willingness to pay (WTP) for functional mozzarella cheese whose health benefits (reduced fat and enrichment in omega-3) are communicated by using nutrition claims (article 8) and health claims (articles 13 and 14) of the EU Regulation 1924/2006. In order to achieve the stated objective a choice survey was developed and administered to a sample of Italian respondents. The product attributes and attribute levels included in the choice experiment were obtained from in-depth interviews conducted with stakeholders working on the development of this new product in the Italian region of Puglia. Results show that many participants were not aware of functional food. Marketing segmentation performed via latent class analysis indicates that the development of this hypothetical product should be based on the addition of naturally enriched omega-3. In terms of health communication under Regulation 1924/2006, heterogeneity of preferences of the nine identified segments reveals that respondents have a clear preference for products from the Puglia region, for the combined nutrition claim over single nutrition claims and for the reduction of disease health claim (article 14) over the health claim (article 13). In monetary terms, willingness to pay for health claims is higher than nutrition claims.

Nutrient Profiling Is Needed to Improve the Nutritional Quality of the Foods Labelled with Health-Related Claims.

Health-related claims on food products influence consumers and their food preferences. None of the European countries have restricted the use of health claims to foods of high nutritional quality despite the regulatory background provided by the European Union in 2006. We evaluated the nutritional quality of foods labelled with claims available in the Slovenian market using two nutrient profile models-Food Standards Australia New Zealand (FSANZ) and European World Health Organization Regional office for Europe model (WHOE)-and compared the results to the nutritional quality of all available foods. Data for prepacked foods in the Slovenian food supply were collected in 2015 on a representative sample (n = 6619) and supplemented with 12-month product sales data for more accurate assessments of the food supply. A considerable proportion of foods labelled with any type of health-related claim was found to have poor nutritional quality. About 68% of the foods labelled with health-related claims passed FSANZ criterion (75% when considering sales data) and 33% passed the WHOE model (56% when considering sales data). Our results highlight the need for stricter regulations for the use of health-related claims and to build upon available nutrient profiling knowledge to improve nutrition quality of foods labeled with health-related claims.

Nutrition and health claims in products directed at children via television in Spain in 2012.

OBJECTIVE: To describe the use of nutrition and health claims in products directed at children via television in Spain and to analyse their nutrient profile. METHODS: A cross-sectional study of television food advertisements over 7 days in five Spanish television channels popular among children. The products were classified as core, non-core or miscellaneous, and as either healthy or less healthy, according to the United Kingdom Nutrient Profile Model. We registered all claims contained on the product (packaging and labelling) and its advertisement. We calculated the frequency distributions of health and nutrition claims. RESULTS: During the 420hours of broadcasting, 169 food products were identified, 28.5% in the dairy group and 60.9% in the non-core category. A total of 53.3% of products contained nutrition claims and 26.6% contained health claims; 62.2% of the products with claims were less healthy. Low-fat dairy products were the food category containing the highest percentage of health and nutrition claims. CONCLUSION: Over half of all food products marketed to children via television in Spain made some type of nutrition or health claim. Most of these products were less healthy, which could mislead Spanish consumers.

Prevalence of Nutrition Labeling and Claims on Processed, and Packaged Foods / 대한지역사회영양학회지

This study investigated the prevalence of nutrition labeling and claims on processed and packaged foods. The final database consists of 1,287 foods, which were collected in two supermarkets in the Seoul area from September to November, 2006. An estimated 78% of KFDA-regulated processed, and packaged foods have nutrition labels. Nutrient content claims on food labels were identified in 21% of the foods which have nutrition labels. The prevalence of nutrition labels in this study is much higher than in previous studies due to the current expansion of the mandatory labeling regulation. However, false labeling and misleading contents claims were also identified. The food label is an important tool for enhancing the public's understanding of healthy choices of processed foods. Therefore, to maximize the benefits of the nutrition labeling regulation, industries, government agencies and health professionals should work together to help consumers make healthy dietary choices and improve their health.