The science of ranking foods based on their nutrient content is referred to as "nutrient profiling." A nutrient profile is a ranking, either on a continuous scale (e.g., 1 to 100) or categorical (such as low, medium, and high). Nutrient profiling is the basis for summary FOP and shelf label systems. Most systems are based on similar dietary recommendations, such as the 2005 DGA (U.S. Department of Health and Human Services & U.S. Department of Agriculture, 2005) and MyPyramid (U.S. Department of Agriculture, 2010a), which encourage the consumption of nutrient-dense foods to meet recommended nutrient intakes. FOP labeling systems use algorithms containing selected nutrients to calculate an overall summary score of nutritional quality. Summary FOP labeling schemes summarize the nutrient quality of a product and then award a rating, symbol, or icon only if a food meets certain thresholds for nutrient criteria.
The purpose of this section is to
- examine the nutrient criteria of selected summary systems, including FOP, shelf, and nutrient profiling systems;
- assess the ability of summary systems to rank foods according to contribution to diet quality; and
- identify criteria and considerations for developing summary systems.
The information about the specific systems included in this review reflects the information that was available and attainable at the time of this review. Thus, some details on the systems are not known. For example, a methodology paper on Guiding Stars is in press and may provide more transparency for the nutrient criteria. The review focuses on 13 specific systems that were identified based on literature searches, particularly on those systems that have been validated and systems mentioned in the scope of work for the task order. The systems include FOP or shelf-labeling systems (e.g., Guiding Stars, NuVal) or other nutrient profiling systems for deciding which foods can be advertised to children (e.g., Ofcom model) or to improve a manufacturer's product line (e.g., Unilever's Nutrition Enhancement Program) (Table 2-1).
The Heart Check Mark of the American Heart Association (AHA) was the first FOP system in the United States, launching in 1995. The intention of the system is to provide guidance to consumers for cardiovascular disease (CVD) risk reduction. The system has been periodically updated based on new scientific and regulatory labeling information that has become available. Food manufacturers followed with their own systems. For example, Kraft Foods introduced Sensible Solution for its product line in 2005. Guiding Stars was introduced as a shelf-labeling system in 2006 by Hannaford Supermarkets. The NuVal system was introduced as a shelf-labeling system in 2007 by an independent scientific panel supported by Griffin Hospital in Connecticut. The Nutrient Rich Food Index was developed by researchers based on the concept of nutrient density promoted by the Nutrient Rich Foods Coalition. Smart Choices was developed in 2008 by a coalition of scientists, food manufacturers, and retailers, but the program was suspended after complaints about the system appearing on sweetened breakfast cereals and a letter from FDA regarding concerns about the criteria used in the system.
Outside of the United States, the Keyhole system was developed in Sweden in 1989 and was expanded to Denmark and Norway. The Pick the Tick program was developed in 1991 by the Australia and New Zealand Heart Foundation. The Heart Check program was launched in 1999 by Canada's Heart and Stroke Foundation. The Choices Programme was developed based on criteria set by an independent international scientific committee and the program was implemented by the Choices International Foundation. The program was first introduced in the Netherlands in 2006. The UK Ofcom Nutrient Profiling Model is used to define healthy and unhealthy food products for television advertising to children. Two other nutrient profiling systems are the Nutrition Enhancement Program, developed by Unilever to evaluate and improve the nutritional quality of their products, and the Netherlands' Tripartite Classification System.