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Objectives: To describe four different methods of identifying indicator foods that are high, medium or low in fat with reference to dietary patterns and to use these indicator foods to test three sets of definitions of 'high', 'medium' and 'low' in fat from 'banding schemes' developed by the Coronary Prevention Group (CPG), the Food Standards Agency (FSA) and Sainsbury's.Methods: Indicator foods were developed using food intake data from the UK National Diet and Nutrition Survey and two parameters: (i) probability of the food being consumed by an individual with a high-fat diet (Method 1); and (ii) the contribution of the food to the fat intake of the average diet of consumers (Methods 3 and 4). Method 2 used both parameters. The three banding schemes were tested by assessing their levels of agreement with methods in categorising indicators.Results: Sensitivity in identifying high, medium and low fat indicators was highest with the CPG banding scheme (high and medium fat indicators) and Sainsbury's scheme (low fat indicators) (Methods 2, 3 and 4). The levels of agreement (kappa coefficient) were 0.68 for the CPG scheme; 0.51 for the Sainsbury's scheme; and 0.41 for the FSA scheme (Method 3).Conclusions: It is possible to use indicator foods related to dietary patterns of a specific population to generate more rational definitions of 'high', 'medium' and 'low' in fat. This could be the starting point for the development of indicator foods for testing more complex nutrient profile models (i.e. those that consider more than one nutrient). [ABSTRACT FROM AUTHOR]

Objectives: This paper describes the development of an online questionnaire for testing nutrition professionals' perceptions of the 'healthiness' of individual foods and the results of administering that questionnaire. The questionnaire was designed to produce a standard ranking of foods that can be used as a tool for testing nutrient profile models.Design: The questionnaire asked respondents to categorise 40 foods (from a master list of 120) in one of six positions, ranging from less to more healthy. The 120 foods were selected to be representative of the British diet. The questionnaire was sent via email to nutrition professionals from the British Dietetic Association and the (British) Nutrition Society.Results: Eight hundred and fifty responses were received. These responses were used to rank the 120 foods by the average score which they received from the nutrition professionals. A regression analysis was also carried out to examine the relationship between the scores awarded by the nutrition professionals and various features of the foods: their nutritional content, their average serving size, their frequency of consumption, whether they were drinks or foods, etc. Nearly 50% of the variance in the average scores was explained by the nutritional content of the foods. When other variables were included in the analysis the percentage of variance that was explained increased to 64%.Conclusions: The average scores of the foods produce a standard ranking, which can be used as a tool for validating and comparing nutrient profile models. The regression analysis provides some information about how nutrition professionals rank the 'healthiness' of individual foods. [ABSTRACT FROM AUTHOR]

Objective: Nutrient profiling can be defined as the 'the science of categorising foods according to their nutritional composition'. The purpose of the present paper is to describe a systematic and logical approach to nutrient profiling.Design: A seven-stage decision-making process is proposed and, as an illustration of how the approach might operate in practice, the development of a nutrient profiling model for the purpose of highlighting breakfast cereals that are 'high in fat, sugar or salt' is described.Results: The nutrient profile model developed for this paper calculates scores for foods using a simple equation. It enables breakfast cereals to be compared with each other and with other foods eaten at breakfast.Conclusion: Nutrient profiling is not new, but hitherto most nutrient profiling models have been developed in an unsystematic and illogical fashion. Different nutrient profiling models are needed for different purposes but a key requirement should be that they are developed using a systematic, transparent and logical process. This paper provides an example of such a process; approaches to validating nutrient profiling models are described elsewhere. [ABSTRACT FROM AUTHOR]

Objective: To compare nutrient profile models with a standard ranking of 120 foods.Design: Over 700 nutrition professionals were asked to categorise 120 foods into one of six positions on the basis of their healthiness. These categorisations were used to produce a standard ranking of the 120 foods. The standard ranking was compared with the results of applying eight different nutrient profile models to the 120 foods: Models SSCg3d and WXYfm developed for the UK Food Standards Agency, the Nutritious Food Index, the Ratio of Recommended to Restricted nutrients, the Naturally Nutrient Rich score, the Australian Heart Foundation's Tick scheme, the American Heart Association's heart-check mark and the Netherlands tripartite classification model for foods. Rank correlation was assessed for continuous models, and dependence was assessed for categorical models.Results: The continuous models each showed good correlation with the standard ranking (Spearman's rho = 0.6-0.8). The categorical models achieved high chi(2) results, indicating a high level of dependence between the nutrition professionals' and the models' categorisations (P < 0.001). Models SSCg3d and WXYfm achieved higher scores than the other models, implying a greater agreement with the standard ranking of foods.Conclusions: The results suggest that Models SSCg3d and WXYfm rank and categorise foods in accordance with the views of nutrition professionals. [ABSTRACT FROM AUTHOR]

International experience of Policy Councils on food and nutrition has developed over recent decades but they have not received the attention that is due to them. The 1992 International Conference on Nutrition recommended that governments create Food Policy Councils but few have been created. There has been more experience in local and sub-national policy councils, particularly in North America. Developing country experience of attempting to improve food policy integration stems from the 1970s. The UK's House of Commons' (Parliamentary) Health Committee, in its 2004 report on obesity, reviewed current policy determinants of the rise in obesity, concluding that national food and health policy lacked coherence, integration and effectiveness. To address this vacuum, it proposed the creation of a new 'Council of Nutrition and Physical Activity to improve co-ordination and inject independent thinking into strategy'. The case for creating such a Council in the UK is reviewed, as are possible organisational options, functions and remit. A Council could be created under the forthcoming Public Health Act. The purpose of the new Council would be to provide independent advice and strategic advice as well as monitor the linkages between policies on food, nutrition and physical activity, noting their environmental implications. [ABSTRACT FROM AUTHOR]

Objective: This paper provides the rationale for the Guideline Daily Amounts (GDAs) for fat, saturated fat and other nutrients that appear on food labels in the UK. These GDAs are provided voluntarily by manufacturers and retailers and were developed to help people make better use of nutrition labelling--the format of which is prescribed by the European Union's nutrition labelling directive. The paper also describes the basis to some Rules of Thumb for what counts as 'a lot' or 'a little' of fat, saturated fat and other nutrients, in an individual food.Design: The paper gives the background to, and purpose of, the GDAs and Rules of Thumb and explains how they were calculated. It briefly describes their subsequent usage by food producers and others.Results: Both GDAs and the Rules of Thumb first appeared in a leaflet developed by the authors and published in 1996 by the Ministry of Agriculture, Fisheries and Food. GDAs for fat, saturated fat and energy were adopted subsequently by the Institute of Grocery Distribution and then by many retailers and some manufacturers. The Rules of Thumb for fat, saturated fat, sugar and sodium have recently been republished in some leaflets published by the Food Standards Agency in the UK.Conclusions: GDAs and Rules of Thumb may provide useful ways of helping consumers make sense of nutrition labelling. The current GDAs and the Rules of Thumb could usefully be updated in the light of recent developments. [ABSTRACT FROM AUTHOR]

Objective: The UK Soft Drinks Industry Levy (SDIL) (announced in March 2016; implemented in April 2018) aims to incentivise reformulation of soft drinks to reduce added sugar levels. The SDIL has been applauded as a policy success, and it has survived calls from parliamentarians for it to be repealed. We aimed to explore parliamentary reaction to the SDIL following its announcement until two years post-implementation in order to understand how health policy can become established and resilient to opposition., Design: Searches of Hansard for parliamentary debate transcripts that discussed the SDIL retrieved 186 transcripts, with 160 included after screening. Five stages of Applied Thematic Analysis were conducted: familiarisation and creation of initial codebooks; independent second coding; codebook finalisation through team consensus; final coding of the dataset to the complete codebook; and theme finalisation through team consensus., Setting: The United Kingdom Parliament., Participants: N/A., Results: Between the announcement (16/03/2016) - royal assent (26/04/2017), two themes were identified 1: SDIL welcomed cross-party 2: SDIL a good start but not enough. Between royal assent - implementation (5/04/2018), one theme was identified 3: The SDIL worked - what next? The final theme identified from implementation until 16/03/2020 was 4: Moving on from the SDIL ., Conclusions: After the announcement, the SDIL had cross-party support and was recognised to have encouraged reformulation prior to implementation. Lessons for governments indicate that the combination of cross-party support and a policy's documented success in achieving its aim can help cement the resilience of it to opposition and threats of repeal.

Objective: There are concerns that price promotions encourage unhealthy dietary choices. This review aims to answer the following research questions (RQ1) what is the prevalence of price promotions on foods in high-income settings, and (RQ2) are price promotions more likely to be found on unhealthy foods?, Design: Systematic review of articles published in English, in peer-review journals, after 1 January 2000., Setting: Included studies measured the prevalence of price promotions (i.e. percentage of foods carrying a price promotion out of the total number of foods available to purchase) in retail settings, in upper-mid to high-income countries., Participants: 'Price promotion' was defined as a consumer-facing temporary price reduction or discount available to all customers. The control group/comparator was the equivalent products without promotions. The primary outcome for this review was the prevalence of price promotions, and the secondary outcome was the difference between the proportions of price promotions on healthy and unhealthy foods., Results: Nine studies (239 344 observations) were included for the meta-analysis for RQ1, the prevalence of price promotions ranged from 6 % (95 % CI 2 %, 15 %) for energy-dense nutrient-poor foods to 15 % (95 % CI 9 %, 25 %) for cereals, grains, breads and other starchy carbohydrates. However, the I-squared statistic was 99 % suggesting a very high level of heterogeneity. Four studies were included for the analysis of RQ2, of which two supported the hypothesis that price promotions were more likely to be found on unhealthy foods., Conclusions: The prevalence of price promotions is very context specific, and any proposed regulations should be supported by studies conducted within the proposed setting(s).

Objective: The current paper describes methods of evaluating dietary habits of Sri Lankan adolescents based on the Diet Quality Index-International (DQI-I), which has been used in multiple international studies to describe dietary variety, moderation, adequacy and balance. The paper describes the method for calculating DQI-I scores and examines associations between DQI-I scores and dietary intake, and between DQI-I scores and sociodemographic factors., Design: The study followed a three-stage cluster randomised sampling method. Dietary intake was collected using a validated FFQ. Estimated micronutrient intakes and number of servings consumed were described according to DQI-I quartiles. DQI-I scores were tabulated according to sociodemographic characteristics. Multilevel modelling was used to examine associations between sociodemographic characteristics and DQI-I scores., Setting: Secondary schools in rural Sri Lanka.ParticipantsAdolescents (n 1300) aged 12-18 years attending secondary school in rural Sri Lanka., Results: DQI-I scores increased with consumption of fat (% energy), cholesterol (mg/d), energy (kJ/d), protein (% energy), Na (mg), dietary fibre (g), Fe (mg) and Ca (mg), but decreased according to percentage of energy coming from carbohydrates. DQI-I scores were significantly lower among females and students with lower levels of maternal education., Conclusions: Policies are needed to increase the availability and affordability of nutrient-rich foods such as fruits, vegetables and high-protein foods, particularly to students from lower socio-economic backgrounds. Significant differences in diet quality according to sex, socio-economic status and district suggest there is potential for targeted interventions that aim to increase access to affordable, nutrient-rich foods among these groups.

Objective: To prioritise policy actions for government to improve the food environment and contribute to reduced obesity and related diseases., Design: Cross-sectional study applying the Food Environment Policy Index (Food EPI) in two stages. First, the evidence on all relevant policies was compiled, through an Internet search of government documents, and reviewed for accuracy and completeness by government officials. Second, independent experts were brought together to identify critical gaps and prioritise actions to fill those gaps, through a two-stage rating process., Setting: England., Subjects: A total of seventy-three independent experts from forty-one organisations were involved in the exercise., Results: The top priority policy actions for government identified were: (i) control the advertising of unhealthy foods to children; (ii) implement the levy on sugary drinks; (iii) reduce the sugar, fat and salt content in processed foods (leading to an energy reduction); (iv) monitor school and nursery food standards; (v) prioritise health and the environment in the 25-year Food and Farming Plan; (vi) adopt a national food action plan; (vii) monitor the food environment; (viii) apply buying standards to all public institutions; (ix) strengthen planning laws to discourage less healthy food offers; and (x) evaluate food-related programmes and policies., Conclusions: Applying the Food EPI resulted in agreement on the ten priority actions required to improve the food environment. The Food EPI has proved to be a useful tool in developing consensus for action to address the obesity epidemic among a broad group of experts in a complex legislative environment.

Objective: The present study aimed to measure the prevalence of different types of health and nutrition claims on foods and non-alcoholic beverages in a UK sample and to assess the nutritional quality of such products carrying health or nutrition claims., Design: A survey of health and nutrition claims on food packaging using a newly defined taxonomy of claims and internationally agreed definitions of claim types., Setting: A national UK food retailer: Tesco., Subjects: Three hundred and eighty-two products randomly sampled from those available through the retailer's website., Results: Of the products, 32 % (95 % CI 28, 37 %) carried either a health or nutrition claim; 15 % (95 % CI 11, 18 %) of products carried at least one health claim and 29 % (95 % CI 25, 34 %) carried at least one nutrition claim. When adjusted for product category, products carrying health claims tended to be lower in total fat and saturated fat than those that did not, but there was no significant difference in sugar or sodium levels. Products carrying health claims had slightly higher fibre levels than products without. Results were similar for comparisons between products that carry nutrition claims and those that do not., Conclusions: Health and nutrition claims appear frequently on food and beverage products in the UK. The nutrient profile of products carrying claims is marginally healthier than for similar products without claims, suggesting that claims may have some but limited informational value. The implication of these findings for guiding policy is unclear; future research should investigate the 'clinical relevance' of these differences in nutritional quality.

Objective: Obesity levels are rising in almost all parts of the world, including the UK. School food offers children in Great Britain between 25 % and 33 % of their total daily energy, with vending typically offering products high in fat, salt or sugar. Government legislation of 2007 to improve the quality of school food now restricts what English schools can vend. In assessing the effect of this legislation on the quality of English secondary-school vending provision, the response of schools to these effects is explored through qualitative data., Design: A longitudinal postal and visit-based inventory survey of schools collected vending data during the academic year 2006-2007 (pre-legislation), 2007-2008 and 2008-2009 (both post-legislation). Interviews with school staff explored issues of compliance. Product categorisation and analysis were carried out by product type, nutrient profiling and by categories of foods allowed or prohibited by the legislation., Setting: English secondary schools., Subjects: A representative sample of 279 schools including sixty-two researcher-visited inventory schools participated in the research., Results: School vending seems to have moved towards compliance with the new standards - now drinks vending predominates and is largely compliant, whereas food vending is significantly reduced and is mostly non-compliant. Sixth form vending takes a disproportionate share of non-compliance. Vending has declined overall, as some schools now perceive food vending as uneconomic. Schools adopting a 'whole-school' approach appeared the most successful in implementing the new standards., Conclusions: Government legislation has achieved significant change towards improving the quality of English school vending, with the unintended consequence of reducing provision.

Objective: To assess the validity of nutrient profiling Model WXYfm - developed for the purpose of regulating the promotion of 'less healthy' foods to children. The model ranks foods according to their healthiness and categorises foods into 'healthier' and 'less healthy' foods., Design: Convergent and discriminant validity was tested by comparing the way Model WXYfm categorises foods with the way the UK's national food guide - the Balance of Good Health (BGH) - categorises foods. Construct validity was assessed by testing a hypothesis relating the constructs of 'healthiness' of foods (as measured by Model WXYfm) and the 'healthiness' of diets (measured using the Diet Quality Index) and assessing whether this hypothesis was confirmed or refuted by using data on the dietary patterns of subjects (n = 1117) of the National Diet and Nutrition Survey of adults carried out in Great Britain in 2000-01., Results: Model WXYfm showed good convergent and discriminant validity: the level of agreement between the way the model categorises foods and the way the BGH categorises foods was good (kappa = 0.69). Model WXYfm also showed good construct validity: the energy intake from 'less healthy' foods amongst subjects with the least healthy diets was nearly twice the energy intake from 'less healthy' foods amongst the subjects with the healthiest diets., Conclusions: Model WXYfm demonstrated good validity in categorising foods in a way that is related to the healthiness of diets both recommended and achieved. The methods for assessing the validity of a nutrient profile model used in this paper have not, to our knowledge, been used before.