Policy Research for Front of Package Nutrition Labeling: Developing and Testing a Summary System Algorithm. 2.4 Nutrient Criteria for Summary Systems

05/01/2011

The nutrient criteria used to develop summary systems are based on

  • dietary recommendations set by governmental or other authoritative organizations,
  • scientific and epidemiological evidence regarding associations with nutrients and chronic disease risk, and
  • nutrient intake shortfalls among the general population or subgroups.

Some practical limitations preclude the inclusion of some nutrients in scoring systems, such as the nutrient information not being readily available on the NFP or in computerized nutrient databases.

Many of the summary FOP systems in the United States focus on nutrients of concern as identified in the 2005 DGA (U.S. Department of Health and Human Services & U.S. Department of Agriculture, 2005). The 2005 DGA note particular nutrients of concern that are consumed in less than optimal amounts by the population, such as fiber; vitamins A, C, and E; and calcium, magnesium, and potassium. The 2005 DGA report notes additional nutrients of concern for specific subpopulation groups: iron, folic acid, vitamin B12, and vitamin D. The 2005 DGA also recommend Americans limit their intake of total fat, saturated fat, trans fat, cholesterol, sodium, and sugar based on scientific evidence linking excess intake of these nutrients with a disease. The DGA were recently updated, and the 2010 DGA specify nutrients of concern consumed in low amounts by the U.S. population, such as fiber, vitamin D, calcium, and potassium; and nutrients of concern for specific subpopulations include iron, folic acid, and vitamin B12 (U.S. Department of Agriculture & U.S. Department of Health and Human Services, 2010). The 2010 DGA report that Americans consume excessive energy (particularly from solid fats and added sugars), saturated fats as a percentage of total energy, cholesterol (men only), sodium, and refined grains.

FDA criteria for nutrition labeling regulations and claims may also be a basis for nutrient criteria in summary FOP systems. For FDA to consider a food healthy, the food has to contain at least 10% of the daily value of one or more of these six nutrients: protein, fiber, vitamin A, vitamin C, calcium, or iron per reference amount. Foods are disqualified from making a health claim if they contain ≥13 g of fat, ≥4 g of saturated fat, ≥60 mg of cholesterol, or ≥480 mg of sodium per reference amount (Code of Federal Regulations, 2001 amended).

FOP labeling systems use algorithms containing selected nutrients to calculate an overall score of nutritional quality. Nutrient selection involves choosing positive or negative nutrients:

  • Positive nutrients are those associated with health effects and are to be encouraged.
  • Negative nutrients are related to obesity and chronic disease when consumed in excess and should be limited.

Nutrient profiling systems use either positive, negative, or both type of nutrients (Table 2-2). Some systems use food groups (e.g., the Ofcom model includes criteria for fruit, vegetable, and nut content) or additional nutrition-related concepts (e.g., NuVal includes glycemic load and protein quality). For some systems, foods are only awarded an icon if they meet the threshold criteria for both positive and negative nutrients. Other systems score foods according to the amount of positive and negative nutrients (e.g., NRFI, NuVal), therefore allowing positives to potentially compensate for negatives. A philosophy of systems that require the food meets thresholds for both positive and negative nutrients (e.g., Smart Choices, NEP) is that positive nutrients should not compensate for negative nutrients (Lupton et al., 2010; Nijman et al., 2007).

Table 2-2. FOP and Nutrient Profiling Systems and their Nutrients or Nutrition-Related Components
Name of System Negative Nutrients Positive Nutrients
Guiding Stars (GS) Saturated fat
Trans fat
Cholesterol
Added sugars
Added sodium
Vitamins A, C
Calcium
Iron
Zinc
Fiber
Whole grains
Heart Check Mark (AHA) Total fat
Saturated fat
Trans fat
Cholesterol
Sodium
Vitamins A, C
Calcium
Iron
Protein
Fiber
Whole grains
Beta-glucan (whole oat soluble fiber)
Smart Choices Program (SC) Total fat
Saturated fat
Trans fat
Cholesterol
Added sugars
Sodium
Vitamins A, C, E
Calcium
Potassium
Magnesium
Fiber
Whole grains
Fruits
Vegetables
Nonfat/low-fat dairy
Nutrient Rich Foods Index (NRFI) Saturated fat
Added sugars
Sodium
Protein
Fiber
Vitamins A, C, E
Calcium
Iron
Magnesium
Potassium
NuVal (NV) Energy density
Saturated fat
Trans fat
Cholesterol
Total sugar
Added sugar
Sodium
Glycemic load
Protein quality
Fiber
Vitamins A, C, D, E, B6, B12
Folate
Calcium
Iron
Zinc
Magnesium
Potassium
Fat quality
Omega-3 fatty acids
Total bioflavonoids
Total carotenoids
Sensible Solution (SS) Energy
Total fat
Saturated fat
Trans fat
Added sugars
Sodium
Protein
Vitamins A, C, E
Calcium
Iron
Magnesium
Potassium
Fiber
Whole grain
UK Ofcom Nutrient Profiling Model (Ofc) Energy
Saturated fat
Total sugars
Sodium
Protein
Fiber
"Fruit, vegetables, and nuts"
Choices Programme (CP) Energy
Saturated fat
Trans fat
Added sugars
Sodium
Fiber
Keyhole symbol (K) Total fat
Saturated fat
Total sugars
Refined sugars
Sodium
Fiber
Pick the Tick (Tick) Energy density
Total fat
Saturated fat
Trans fat
Partially hydrogenated fat
Sodium
Protein
Calcium
Fiber
Whole grains
Vegetables
% of key ingredients (e.g., fish)
Heart Check (HC) Total fat
Saturated fat
Trans fat
Sodium
Protein
Vitamins A, C
Folate
Calcium
Iron
Fiber
Nutrition Enhancement Program (NEP) Saturated fat
Trans fat
Total sugars
Added sugars
Sodium
(None)
Netherlands Tripartite Classification System (NTri) Saturated fat (include trans) Vitamin C
Fiber

Of the six U.S.-based systems reviewed, five stated that the 2005 DGA was the basis for developing nutrient criteria. The Heart Check Mark uses criteria in line with the FDA health claim regulations for coronary heart disease (CHD). As demonstrated in Table 2-3, many of the nutrients identified in the 2005 DGA as of concern for the population (as discussed previously) are commonly used by FOP systems in the United States and outside the United States. Outside the United States, criteria for systems are based on country-specific dietary recommendations or World Health Organization (WHO) guidelines for nutrition and chronic disease (WHO, 2003).

Table 2-3. Nutrients or Nutrition-Related Components and the Number of FOP Systems Including Them as Criteria
Nutrient or Component Number Systems
GS, Guiding Stars; AHA, Heart Check Mark; SC, Smart Choices Program; NRFI, Nutrient Rich Foods Index; NV, NuVal; SS, Sensible Solution; Ofc, UK Ofcom Nutrient Profiling Model; CP, Choices Programme; SK, Swedish Keyhole Symbol; Tick, Pick the Tick, HC, Heart Check; NEP, Nutrition Enhancement Program; NTri, Netherlands Tripartitite Classification System
Negative
Energy 5 Ofc, CP, NV, SS, Tick
Total fat 6 AHA, SS, SC, K, Tick, HC
Saturated fat 13 GS, AHA, Ofc, CP, NRFI, NV, SS, SC, K, Tick, HC, NEP, NTri
Trans fat 10 GS, AHA, CP, NV, SS, SC, Tick, HC, NEP, NTri
Partially hydrogenated fat 1 Tick
Cholesterol 4 GS, AHA, NV, SC
Total sugars 4 Ofc, NV, K, NEP
Added sugars 6 GS, CP, NRFI, SS, SC, NEP
Refined sugars 1 K
Sodium 11 AHA, Ofc, CP, NRFI, NV, SS, SC, K, Tick, NEP, HC
Added sodium 1 GS
Glycemic load 1 NV
Positive
Protein 6 AHA, Ofc, NRFI, SS, Tick, HC
Protein quality 1 NV
Vitamin A 7 GS, AHA, NRFI, NV, SS, SC, HC
Vitamin C 8 GS, AHA, NRFI, NV, SS, SC, HC, NTri
Vitamin D 1 NV
Vitamin E 4 NRFI, NV, SS, SC
Vitamin B6 1 NV
Folate 2 NV, HC
Vitamin B12 1 NV
Calcium 8 GS, AHA, NRFI, NV, SS, SC, Tick, HC
Iron 6 GS, AHA, NRFI, NV, SS, HC
Zinc 2 GS, NV
Magnesium 4 NRFI, NV, SS, SC
Potassium 4 NRFI, NV, SS, SC
Fiber 12 GS, AHA, Ofc, CP, NRFI, NV, SS, SC, K, Tick, HC, NTri
Whole grains 5 GS, AHA, SS, SC, Tick
Beta-glucan 1 AHA
Fat quality 1 NV
Omega-3 fatty acids 2 GS, NV
DHA/EFA 1 GS
Total bioflavonoids 1 NV
Total carotenoids 1 NV
Nonfat/low-fat dairy 1 SC
Fruits 1 SC
Vegetables 2 SC, Tick
Fruit, vegetables, and nuts 1 Ofc
% of key ingredients (e.g., fish) 1 Tick