Choosing an effective food classification system for promoting healthy diets in Thailand: a comparative evaluation of three nutrient profiling-based food classification systems (government, WHO, and Healthier Choice Logo) and a food-processing-based food classification system (NOVA)

Sirinya Phulkerd; Sarah Dickie; Natjera Thongcharoenchupong; Sasinee Thapsuwan; Priscila Machado; Julie Woods; Ladda Mo-Suwan; Piyada Prasertsom; Chantana Ungchusak; Chiraporn Khitdee; Mark Lawrence

doi:10.3389/fnut.2023.1149813

Choosing an effective food classification system for promoting healthy diets in Thailand: a comparative evaluation of three nutrient profiling-based food classification systems (government, WHO, and Healthier Choice Logo) and a food-processing-based food classification system (NOVA)

Front Nutr. 2023 May 17:10:1149813. doi: 10.3389/fnut.2023.1149813. eCollection 2023.

Affiliations

¹ Institute for Population and Social Research, Mahidol University, Salaya, Thailand.
² Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
³ Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
⁴ Bureau of Dental Health, Department of Health, Ministry of Public Health, Mueang, Nonthaburi, Thailand.
⁵ Thailand Healthy Lifestyle Plan, Thai Health Promotion Foundation, Bangkok, Thailand.

Abstract

Introduction: This study aimed to assess the nutritional quality of food and beverage products in Thailand by comparing four different food classification systems: the nutrient profiling-based food classification systems by the Department of Health (DOH), the WHO South-East Asia Region (WHO SEA), the Healthier Choice Logo (HCL), and the food-processing-based food classification system, NOVA.

Methods: This study used secondary data from the Mintel Global New Products Database (N = 17,414). Food subgroups were classified differently based on these four systems. The DOH classified food products into three groups: Group A-healthy pass or meeting standard, Group B-not meeting the standard, and Group C-far below standard. The WHO SEA classified food products into two groups: marketing prohibited products and marketing permitted products. The HCL classified food products into two groups: eligible products for the logo; and ineligible products for the logo. The NOVA classified food products into four groups: unprocessed or minimally processed foods (MP), processed culinary ingredients (PCI), processed foods (P), and ultra-processed foods (UPF). Descriptive statistics (percentage and frequency) were used for analysis. Agreement analysis was conducted using Cohen's kappa statistic between each pair of food classification systems.

Results: Of the total sample that could be classified by any of the four classification systems (n = 10,486), the DOH, the WHO SEA and the HCL systems classified products as healthy (Group A, marketing permitted or eligible for HCL logo) at 10.4, 11.1, and 10.9%, respectively. Only 5.6% were classified as minimally processed foods using NOVA and 83.1% were ultra-processed foods (UPFs). Over 50% of products classified as healthy by the nutrient profiling systems were classified as UPF according to the NOVA system. Products that were eligible for the HCL had the highest proportion of UPF products (84.4%), followed by the Group A products (69.2%) and the WHO marketing-permitted products (65.0%).

Conclusion: A hybrid food classification approach taking both nutrients and food processing into account is needed to comprehensively assess the nutritional quality of food and beverage products in Thailand.

Keywords: NOVA food classification system; Thailand; healthy diets; non-communicable diseases; nutrient profiling; ultra-processed foods.