Elsevier

Public Health

Volume 125, Issue 10, October 2011, Pages 717-724
Public Health

Original Research
Improvement of the nutritional quality of foods as a public health tool

https://doi.org/10.1016/j.puhe.2011.07.004Get rights and content

Summary

Objectives

To assess the potential contribution of improving the nutritional quality of processed foods on individuals’ nutritional intake and food supply. This paper also discusses the means to encourage firms to implement these reformulations, particularly in public/private partnerships.

Study design

The French Observatory of Food Quality was created by the Government for the quantification and follow-up of food reformulation by the food industry. This nutritional composition database on branded products was matched with two consumption databases: TNS Kantar Worldpanel, which provides details on quantities bought and food expenditures; and INCA 2, an individuals’ food consumption survey completed by the French Food Safety Agency. Three food groups were considered: breakfast cereals (355 items in 2008), biscuits and pastries (1805 items in 2008), and bread-based products (620 items in 2009).

Methods

First, the variability in nutrient composition within food categories was determined, which made it possible to consider several food composition modification scenarios within each category. The formulation of the food items with the lowest nutritional quality was modified to three different levels to improve the overall level of quality in a given category. Second, the quantities of sugars, fat, fibre and sodium delivered to the French market through breakfast cereals, biscuits, pastries and bread-based products were calculated for each scenario. Finally, the distribution of individuals’ nutrient consumption from the three food groups among the French population was assessed.

Results

These scenarios generated important improvements of 1–22% (increase in the amount of fibre or decrease in the amounts of sugars, fat and sodium delivered to the market), depending on the scenario, the food group and the nutrient considered. Improvement of the products with the lowest nutritional quality would also lead to significant variation in individuals’ nutrient consumption for the average adult and child consumers of the three groups (range 4.2–18.8%, depending on the scenario, the food group and the nutrient considered).

Conclusion

Encouraging the reformulation of foods, especially for products with the lowest nutritional quality in each category of processed foods, is a worthy target for health policy makers. The methodology presented in this paper provides information for negotiations between policy makers and firms to quantify commitments in terms of their potential impacts on individuals’ nutrient intake, and to check that the firms’ commitments are actually met.

Introduction

In confronting the problem of chronic diseases linked to food consumption, improving the nutritional quality of processed foods has become a crucial issue for health policy makers. Indeed, a policy focused on food quality is intended to facilitate healthy choices by consumers, even those who are not fully informed about or conscious of the links between food consumption and health. Decreasing the salt and fat content in foods1, 2, 3, 4, 5, 6 and increasing the wholegrain content7 are good examples of changes being made to food composition to address health-related issues.8

Despite the importance of such a policy orientation, only a small number of articles have analysed ways to improve food quality that are consistent with public health objectives. This issue raises two closely related questions which are addressed in this paper.

Food reformulation can necessitate innovative processing or the use of new ingredients, resulting in higher production costs or additional investments that can limit voluntary changes by firms.9 Taste modifications induced by decreases in sugars, fat or sodium content may also lead to rejection by consumers that can limit a firm’s initiative to make such changes.10 The first question addressed in this study is as follows. If one assumes that individuals continue to consume the same amounts within each food category, but that the nutritional characteristics of each food category have been improved in a realistic way (i.e. acceptable from both a technological and a sensorial point of view), what would be the impact on the nutritional intake of individuals?

To answer this question, detailed data on both the nutritional characteristics of food items and individuals’ consumption patterns are required. Several authors have noted that the availability of such data has become a major issue for policy makers, as the existing publicly available nutrition databases are insufficient to analyse the impact of food supply evolution on public health matters.11, 12, 13 The creation of new information systems is underway in several countries, and such databases are often focused on a specific nutrient, such as salt in the USA,14 the UK15 and Australia.13 In France, in line with these new approaches, the Ministries of Food and Agriculture, Health and Consumption decided to fund the creation of an Observatory of Food Quality (Oqali) in 2008.16 This study used the Oqali database to study several scenarios involving food modification, and to assess their potential impacts on individuals’ consumption in the French population.

Once the potential contribution of food modification to individuals’ nutritional intake has been identified, the second question addressed in this paper is how to encourage such an increase in the nutritional quality within each food category. Food labelling, corporate social responsibility and legal pressure can contribute to food modification.17, 18, 19, 20, 21 However, the modifications implemented may remain limited to expensive lines of products, justifying more direct public interventions to improve the nutritional quality of foods across the industry.22, 23, 24, 25, 26

An interplay between the food industry and the health policy community has been underway in France since 2007 to encourage the voluntary reformulation of foods, especially for products with the lowest nutritional quality in each category of processed foods. In line with this new approach, a goal of Oqali is to establish an independent system of observation to assess the nutritional composition of food items marketed by all brands sold in the French market, and to follow the efforts implemented by the food industry. Oqali was implemented as part of the Second National Nutrition and Health Programme (2006–2010), which also proposed that firms sign ‘charters of commitments to nutritional improvement’ with the Government.27 The final section of this paper discusses the extent to which the methodology, databases and simulation tools presented may support this new approach based on these charters of commitments.28

Section snippets

Food quality database

In the Oqali database, each branded product is described according to several parameters, including nutrient content (energy, protein, fat, saturated fat, carbohydrates, sugars, fibre and sodium), list of ingredients, nutrition and health claims, serving size and nutrition guidelines included on the packaging. Oqali collects nutritional data from several sources, including the product packaging. Manufacturers and retailers may be additional sources of data. Nutrient analyses are performed to

Results

Fig. 1 shows the fat and sugars content scatter plot of the 355 breakfast cereals available on the French market. The variability in food composition is not only due to differences between product categories, but also due to composition variability within the majority of food categories. Thus, Table 1 gives the sugars, fat, fibre and sodium content of the food items within the categories in the breakfast cereal group. Variability within the food categories was assessed by the relative

Discussion

Differences in energy density, nutrient content and costs between food groups have been widely reported.30, 31 More recently, product composition variability within food categories has been investigated. For instance, recent research has shown large variability in sodium content within many food categories.13, 32 In response to these results, several initiatives targeting a reduction in salt consumption have been implemented worldwide.14, 15 Indeed, the focus on salt can be justified because it

Ethical approval

None sought.

Funding

ANR research Project AlimInfo and French Ministries in charge of Food and Health.

Competing interests

None declared.

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