Nutrition Classification Schemes for Informing Nutrition Policy in Australia: Nutrient-Based, Food-Based, or Dietary-Based?

Sarah Dickie; Julie Woods; Priscila Machado; Mark Lawrence

doi:10.1093/cdn/nzac112

Nutrition Classification Schemes for Informing Nutrition Policy in Australia: Nutrient-Based, Food-Based, or Dietary-Based?

Curr Dev Nutr. 2022 Jul 4;6(8):nzac112. doi: 10.1093/cdn/nzac112. eCollection 2022 Aug.

Authors

Sarah Dickie¹, Julie Woods¹, Priscila Machado¹, Mark Lawrence¹

Affiliation

¹ Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.

Abstract

Background: Policy makers are increasingly using nutrition classification schemes (NCSs) to assess a food's health potential for informing nutrition policy actions. However, there is wide variability among the NCSs implemented and no standard benchmark against which their contrasting assessments can be validated.

Objectives: This study aimed to compare the agreement of nutrient-, food-, and dietary-based NCSs in their assessment of a food's health potential within the Australian food supply, and examine the conceptual underpinnings and technical characteristics that explain differences in performance.

Methods: A dataset combining food compositional data from the Mintel Global New Products Database and the Australian Food Composition Database (AUSNUT 2011-2012) (n = 7322) was assembled. Products were classified by 7 prominent NCSs that were selected as representative of one or other of 1) nutrient-based NCSs [the Chilean nutrient profile model (NPM), Health Star Rating (HSR), Nutri-Score, the WHO European Region's NPM (WHO-Euro NPM), and the Pan American Health Organization's (PAHO) NPM]; 2) food-based NCS (NOVA), and 3) dietary-based NCS [Australian Dietary Guidelines (ADGs)].

Results: The PAHO NPM classified the lowest proportion (22%) of products as "healthy", and the HSR the highest (63%). The PAHO NPM, NOVA, WHO-Euro NPM, and the Chilean NPM classified >50% of products as "unhealthy," and the ADGs, HSR, and Nutri-Score classified <50% of products as "unhealthy." The HSR and Nutri-Score had the highest pairwise agreement (κ = 0.7809, 89.70%), and the PAHO NPM and HSR the lowest (κ = 0.1793, 53.22%). Characteristics of NCSs that more effectively identified ultraprocessed and discretionary foods were: category-specific assessment, the classification of categories as always "healthy" or "unhealthy," consideration of level of food processing, thresholds for "risk" nutrients that do not penalize whole foods; and no allowance for the substitution of ingredients.

Conclusions: Wide variation was observed in agreement of the assessment of a food's health potential among the NCSs analyzed due to differing conceptual underpinnings and technical characteristics.

Keywords: NOVA; dietary guidelines; food regulation; front-of-pack labeling; nutrient profiling; nutrition classification schemes; nutrition policy; ultraprocessed foods.