Twelve Country Comparison of Packaged Food and Beverages Using Health Star Rating System
Posted:
2019-09-10
The Health Star Rating (HSR) system was used to compare 394,815 packaged foods and beverages available in 12 countries (1). This study identified encouraging and concerning results. Encouraging for residents of Britain, Australia, Canada and the U.S is that these countries' packaged foods ranked the highest for their overall nutrient profiles, while the foods in India, Hong Kong, China and Chile ranked the lowest. The authors suggested that the differences between high and low-middle income countries may be due to the lack of food labelling in low-middle income countries or an inability to implement and enforce healthy food policies. As well, there could be a demand by consumers in high income countries for healthier foods and more actions from the food industry to produce healthier products. However, not all of the high ranking countries had consistent ratings across all nutrients. Perhaps the most concerning for Canadians was that packaged foods in the “US and Canada had the highest mean sodium content of all 12 countries examined”.
There are limits to nutrient profiling systems that should be kept in mind. No food rating system is perfect. The HSR is based on nutrients in the foods per 100 g or 100 mL, an evaluation method that rates some foods more or less favourably than systems that evaluate foods per 100 kilocalories or in usual serving sizes (2,3). In studies, nutrient profiling systems based on 100 kcal and serving sizes perform better than those based on 100 g, such as the HSR (4). For example, foods that are consumed in low quantities, such as cheese, are rated poorly by the HSR system for the saturated fat and sodium contents when assessed per 100 grams, while cheese is likely seldom consumed in 50-100 g servings (2,5). In contrast, foods that are consumed in large quantities, such as soup and juices, have their sodium and sugars contents assessed in unrealistically low serving sizes of 100 mL. The same problem happens with the desirable nutrients when assessed per 100 g, but in the opposite direction. Almonds are sometimes quoted as a source of calcium, as they have 247 mg/100 g (6). However, at 587 kcal/100 g, almonds may not be a very good source of calcium/day for many people. In comparison 1 and 2% milk and calcium-fortified soy beverages have 34 to 52 kcal/100 g and supply 234 to 374 mg of calcium per 100 kcal.
Another observation of the HSR is that it considers total sugars and does not discriminate between innate sugars versus added sugars, which lowers the ratings of some foods such as unsweetened fruit (7). Other factors that the HSR system does not consider are foods’ affordability (8), and the amount of processing the food has undergone (4).
While classifying foods by their nutrients does not address all aspects of a healthy diet, when used along with other interventions, nutrient profiling systems may help to improve the dietary intake of consumers (9). The authors of this study concluded that nutrient profiling systems are important for the development and monitoring of healthy food policies and products (1).
For information on the effects of food labelling systems, nutrition panels and menus on consumer behaviour see the PEN Food and Nutrition Labelling Knowledge Pathway.
References
- Dunford EK, Ni Mhurchu C, Huang L, Vandevijvere S, Swinburn B, Pravst I, et al. A comparison of the healthiness of packaged foods and beverages from 12 countries using the Health Star Rating nutrient profiling system, 2013-2018. Obes. Rev. 2019 Jul 22. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/31328385
- Dickie S, Woods JL, Lawrence M. Analysing the use of the Australian Health Star Rating system by level of food processing. Int J Behav Nutr Phys Act. 2018 Dec 13;15(1):128 Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/30545373
- Drewnowski A. Nutrient density: addressing the challenge of obesity. Br J Nutr. 2018 Aug;120(s1):S8-14. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/29081311
- Drewnowski A, Fulgoni VL 3rd. Nutrient density: principles and evaluation tools. Am J Clin Nutr. 2014 May;99(5 Suppl):1223S-8S. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/24646818
- Mhurchu CN, Eyles H, Choi YH. Effects of a voluntary front-of-pack nutrition labelling system on packaged food reformulation: the Health Star Rating System in New Zealand. Nutrient. 2017 Aug 22;9(8). Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/28829380
- Government of Canada. Canadian Nutrient File (CNF) – Search by Food. 2018 Feb 6. Available from: https://food-nutrition.canada.ca/cnf-fce/index-eng.jsp
- Menday H, Neal B, Wu JHY, Crino M, Baines S, Petersen KS. Use of added sugars instead of total sugars may improve the capacity of the Health Star Rating System to discriminate between core and discretionary foods. J Acad Nutr Diet. 2017 Dec;117(12):1921-30.e.11. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/29173348
- Cooper SL, Pelly FE, Lowe JB. Assessment of the construct validity of the Australian Health Star Rating: a nutrient profiling diagnostic accuracy study. Eur J Clin Nutr. 2017 Nov;71(11):1353-9. Abstract available from: https://www.ncbi.nlm.gov/pubmed/28294168
- World Health Organization. Nutrient Profiling. [cited 2019 Sep 3]. Available from: https://www.who.int/nutrition/topics/profiling/en/