Comparison between the Choices Five-Level Criteria and Nutri-Score: Alignment with the Dutch Food-Based Dietary Guidelines.

The current food environment in The Netherlands is considered obesogenic. Eighty percent of the products in supermarkets are unhealthy. The Wheel of Five is the well-established, science-based Dutch food-based dietary guideline (FBDG) developed to stimulate healthier choices. In addition, simple directions on food packaging, such as front-of-package (FOP) health logos, could also be helpful. However, these tools should be in line with each other, in order not to confuse the consumer. To study this, we evaluated two FOP nutrient profiling systems (NPSs) for their alignment with the Wheel of Five: Choices five-level criteria and Nutri-Score. For this, a small but representative sample of 124 products was selected from the Dutch food composition database (NEVO). For these products, the scores for Choices and Nutri-Score were calculated using the published criteria, while compliance with the Wheel of Five was established by using the criteria from Netherlands Nutrition Center (NNC). The Wheel of Five food groups were used to categorize the products. Differences between the Wheel of Five and Choices are smaller than with Nutri-Score, concluding that Choices is more consistent with the Wheel of Five and might be an attractive alternation for a FOP health logo on the Dutch market.

Development of the Choices 5-Level Criteria to Support Multiple Food System Actions.

In 2008, the Choices International Foundation developed its logo criteria, identifying best-in-class food products. More advanced, global and graded nutrient profiling systems (NPSs) are needed to substantiate different national nutrition policies. The objective of this work was to extend Choices NPS to identify five levels of the healthiness of food products, so that the Choices NPS can also be used to support other nutrition policies, next to front-of-pack labelling. Based on the same principles as the previous logo criteria, four sets of threshold criteria were determined using a combination of compliance levels, calculated from a large international food group-specific database, the Choices logo criteria, and WHO-NPSs developed to restrict marketing to children. Validation consisted of a comparison with indicator foods from food-based dietary guidelines from various countries. Some thresholds were adjusted after the validation, e.g., because intermediate thresholds were too lenient. This resulted in a new international NPS that can be applied to different contexts and to support a variety of health policies, to prevent both undernutrition and obesity. It can efficiently evaluate mixed food products and represents a flexible tool, applicable in various settings and populations.