Labeling of Nonalcoholic Beverages

CHAPTER 9

Labeling of Nonalcoholic Beverages Igor Pravst and Anita Kuˇsar Nutrition Institute, Ljubljana, Slovenia

Chapter Outline 9.1 Introduction 263 9.2 The European Union Regulations on the Provision of Food Information to Consumers 266 9.2.1 General Food Labeling 266 9.2.2 Front-of-Package Nutrition Labeling

9.3 Use of Nutrition and Health Claims

272

279

9.3.1 Nutrition Claims 280 9.3.2 Health Claims 283

9.4 The Use of Food Labeling to Support Monitoring of the Food Supply 9.5 Conclusion 300 Acknowledgments 302 References 302 Further Reading 307

287

9.1 Introduction The rising problem of obesity and diet-related noncommunicable diseases (NCDs) has focused the attention of policy-makers to establish a food environment that may influence consumer behavior toward making healthy food choices and have an impact on food manufacturers toward improving the healthiness of their food products (WHO, 2018). Food labeling is a possible tool to achieve improvements, which could result in health benefits (Campos et al., 2011; Rayner et al., 2013; Talati et al., 2016). Food labeling provides consumers with comprehensive information about the composition of food products to help them make informed choices while purchasing foodstuffs. In the European Union (EU), the quality and safety of foods, including food labeling, are the full responsibility of the producer (EC, 2002). Several elements of food labeling are mandatory on all prepacked foods (list of ingredients, name of the product, producer, etc.),

Trends in Non-alcoholic Beverages. DOI: https://doi.org/10.1016/B978-0-12-816938-4.00009-4 © 2020 Elsevier Inc. All rights reserved.

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264 Chapter 9 while some are voluntary. In certain cases (e.g., use of nutrition and health claims) the food operator can freely decide whether such information will be provided on the label, under the condition that such use is in line with both general food regulation, and specific regulation about particular type of voluntarily information. Food labels represent important information for consumers while making purchasing decisions. Some parts of food labeling are considered as particularly important for assuring food safety and guiding consumers in informed choices. Examples of these are a list of ingredients, presence of allergens, and nutrition declarations. Although labeling of nutrition information has been mandatory in the EU since 2016 (EC, 2011), it remains questionable whether such information is understood and correctly interpreted by consumers. Various tools were, therefore, developed to address this issue, for example, front-of-package (FOP) labeling of nutrition information (Hawley et al., 2012; Hersey et al., 2013; Maubach et al., 2014). If provided through a simple, easily viewable, and interpretable format, such labeling enables consumers to more easily and quickly access key information for an assessment of the nutrition composition and relative healthfulness of a specific product (Feunekes et al., 2008; Pomeranz, 2011). The objectives of FOP labeling of nutritional composition/quality of foods are not only to provide additional information to consumers, but also to encourage the industry to reformulate products. Some researchers argue that FOP nutrition labeling should be considered mainly as marketing, rather than a public-health strategy (Brownell and Koplan, 2011; Kanter et al., 2018). Indeed, food labels are commonly sources of various marketing claims, created by food producers to make specific products more attractive to consumers (Rayner et al., 2013). Therefore although such information can help consumers in making their food choices, it also has the potential to mislead consumers by highlighting positive nutrition composition or health impacts while ignoring undesirable characteristics, like high sugar, fat, or salt content. In order to enhance legal certainty and ensure rationality and consistency of enforcement rules on food labeling, harmonized legislation was prepared in the EU. The regulation (EU) No. 1169/2011 on the provision of food information to consumers (FIC regulation) was adopted in 2011 and has been in use from the end of 2014, with the exemption of provision of nutrition information, which was applied from 2016 (EC, 2011). The new regulation ensures certainty for consumers and other stakeholders and reduces the administrative burden in the EU. The regulation presented an upgrade of the Directive 2000/13/EC on the approximation of the laws of the EU member states relating to labeling, presentation, and advertising of foodstuffs (EC, 2000) and Directive 90/496/EEC on the content and presentation of nutrition information on prepacked foods (EC, 1990). The FIC regulation covers all types of food products, including nonalcoholic beverages. However, the overall labeling legislation is very complex because the information of food labels is affected by the variety of regulations and directives (Fig. 9.1). In many cases, national provisions and deviations also need to be considered.

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General food labeling Regulation EU No. 1169/2011 on the provision of food information to consumers

soft-drinks (specific national rules might apply)

juices, nectars Directive 2001/112/EC relating to fruit juices and certain similar products

mineral water Directive 2009/54/EC on the exploitation and marketing of natural mineral waters

Rules for specific types of foods

Food additives Regulation EC No. 1333/2008 on food additives

Adding vitamins, minerals, or other substances Regulation EC No. 1925/2006 on the addition of vitamins and minerals and of certain other substances to foods

Novel foods Regulation EU No. 2015/2283 of on novel foods; Regulation EU No 2017/2470 establishing the Union list of novel foods

Nutrition and health claims Regulation EC No. 1924/2006 on nutrition and health claims made on foods

Figure 9.1 Schematic presentation of the variety of rules affecting labeling of foodstuffs in the European Union (EU).

In addition to mandatory food labeling, voluntarily information on food labels is also subject to a variety of food laws. For example, the use of nutrition and health claims on foods is regulated very carefully, due to the potential impact of such information on consumers. In the EU rules on the use of nutrition and health claims on foods were adopted in 2006 by Regulation (EC) No 1924/2006 on nutrition and health claims made on foods (NHCR) (EC, 2006). The objective of the regulation is to ensure that any claim made on a food’s labeling, presentation, or advertising is clear, accurate, and based on scientific evidence. Considering this, only the use of authorized nutrition and health claims are allowed. The authorization process requires specific authorization by the European Commission (EC) through the comitology procedure, following the scientific assessment and verification of a claim by the European Food Safety Authority (EFSA). Food labeling has the potential to have both positive and negative effects on diets (Rayner et al., 2013). Monitoring different aspects of food labeling could help to identify priorities for future policy decisions, supporting healthier food choices. Several approaches for sampling the food supply and collecting and analyzing data have been developed to monitor the food supply.

266 Chapter 9

9.2 The European Union Regulations on the Provision of Food Information to Consumers 9.2.1 General Food Labeling The food business operator is responsible for the food information and shall ensure the presence and accuracy of the food information in accordance with the applicable food information law and requirements of relevant national provisions (EC, 2011). In the case of prepacked food, mandatory food information must appear either on the package or on the label attached thereto. Labels must not be easily removable to guarantee the availability or the accessibility of the mandatory food information to the consumer. According to the FIC regulation, the provided information must not be misleading, including: (1) as to the characteristics of the food and, in particular, as to its nature, identity, properties, composition, quantity, durability, country of origin or place of provenance, method of manufacture or production; (2) by attributing to the food effects or properties it does not possess; (3) by suggesting that the food possesses special characteristics when in fact all similar foods possess such characteristics, in particular by specifically emphasizing the presence or absence of certain ingredients and/or nutrients; and (4) by suggesting, by means of the appearance, description, or pictorial representations the presence of a particular food or ingredient, while in reality a component naturally present or an ingredient normally used in that food has been substituted with a different component or ingredient (EC, 2011). Prepacked foods must be labeled in accordance to general food-labeling requirements and any labeling provided must be accurate and not misleading. All the mandatory information must be indicated with words and numbers, but may additionally be expressed by means of pictograms or symbols (EC, 2011). In addition, the minimum font size for mandatory particulars is prescribed to benefit especially those consumers who have problems with reading small words, but could represent quite a challenge for food operators, especially in the case of small packages. The list of mandatory information on labeling includes: 1. The name of the food. 2. List of ingredients. 3. Any ingredient or processing aid known to cause allergies or intolerances used in the manufacture or preparation of a product and still present in the finished product, even if in an altered form. 4. The quantity of certain ingredients or categories of ingredients. 5. The net quantity of the product. 6. The date of minimum durability or the “use by” date. 7. Any special storage conditions and/or conditions of use. 8. The name or business name and address of the food business operator.

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9. The country of origin or place of provenance (in some cases). 10. Instructions for use where it would be difficult to make appropriate use of the food in the absence of such instructions. 11. With respect to beverages containing more than 1.2% by volume of alcohol, the actual alcoholic strength by volume. 12. A nutrition declaration. It should be noted that in the EU specific groups of foodstuffs are covered with additional regulations and rules. For example, there are special rules for fruit juices and similar products and for natural mineral waters. Specific provisions for fruit juices and similar products are established in Directive 2001/112/EC, which lays down common rules governing the composition, use of reserved descriptions, manufacturing specifications, and labeling of the products concerned (EC, 2001). The directive sets compositional and labeling requirements for fruit juice, fruit juice from concentrate, concentrated fruit juice, water-extracted fruit juice, dehydrated/powdered fruit juice, and fruit nectar. Each of these products must meet the compositional standards laid down in the legislation and may only be marketed under the product name or the designated name. These rules have been amended by Directive 2012/12/EU relating technical progress in fruit juice processing and the Codex Alimentarius standard for fruit juices and nectars. This amendment specified additional rules, for example, the prohibition of addition of sugars in fruit juice, fruit juice from concentrate, concentrated fruit juice, water-extracted fruit juice, and dehydrated/ powdered fruit juice. On the other hand, fruit nectars can be produced with, or without, the addition of sugar or honey. In addition, the amendment introduces a new category of juice; water-extracted fruit juice. The composition of the products (i.e., addition of sugar) therefore affect food labeling, because this define name of the product. Similarly, labeling of natural mineral waters is affected by specific rules, namely Directive 2009/54/EC (EC, 2009). This directive sets the rules governing the exploitation and placing on the market of waters extracted from the ground of member states and recognized by the responsible authority of the state concerned as natural mineral waters; and waters extracted from the ground of third countries, imported into the European Community and recognized as mineral waters by the responsible authority of an EU member state. The directive defines natural mineral water as microbiologically wholesome water, originating from an underground source, protected from all risk of pollution and emerging from a spring tapped at one or more natural or bore exits. It is clearly distinguished from ordinary drinking water by its nature (mineral content and trace elements) and by its original state. Only very limited treatments are permitted. The legislation covers the definition of natural mineral water, its exploitation, treatment, microbiological criteria, chemical contaminants, sales descriptions, labeling and packaging. It should be noted that labeling requirements for waters are further defined in Directive 2003/40/EC, which also establishes the list and concentration limits for the constituents of natural mineral waters (EC, 2003).

268 Chapter 9 9.2.1.1 List of Ingredients The list of ingredients must include all the food’s ingredients in descending order of weight as recorded at the time of their use in the manufacture of the food (EC, 2008, 2011). The labeled composition must be average values based on the manufacturer’s analysis of the product. According to Annex VII of the FIC regulation, added water shall be listed in order of its weight in the finished product. The amount of water added as an ingredient in a food shall be calculated by deducting from the total amount of the finished product the total amount of the other ingredients used. This amount shall not be required to be taken into consideration if it does not exceed 5% by weight of the finished product. Ingredients used in concentrated or dehydrated form and reconstituted at the time of manufacture may be listed in order of weight as recorded before their concentration or dehydration. Fruit or vegetables, where none of which significantly predominates in terms of weight and are used in proportions that are likely to vary, or used in a mixture as ingredients of a food may be grouped together in the list of ingredients under the designation “fruit” or “vegetables” followed by the phrase “in varying proportions,” immediately followed by a list of the present fruit or vegetables. Also, ingredients constituting less than 2% of the finished product may be listed in a different order after the other ingredients. Food ingredients must be designated by their specific name. Some food ingredients may be labeled by the name of that category rather than the specific name of the food ingredient. For example, all types of sucrose can be designated as “sugar,” anhydrous dextrose or dextrose monohydrate as “dextrose,” glucose syrup and anhydrous glucose syrup as “glucose syrup,” all types of milk protein (caseins, caseinates, and whey proteins) and mixtures thereof as “milk proteins,” and starches (including starches modified by physical means or by enzymes) as “starch.” Under EU law, food operators must provide information about food additives used in the foods they produce (EC, 2008, 2011). Food additives need to be included in the list of ingredients on the packaging, either by name (as authorized) or/and E number. For each food additive, manufacturers need to specify their role in the food using the functional classes of the food additives as provided in the FIC regulation (Table 9.1). With regard to food composition, some additional particulars have to be included on the food label in case of some special ingredients such as sweeteners, caffeine, aspartame, and others. (Table 9.2). Table 9.1: Examples of categories of food additives commonly used in nonalcoholic beverages. Acid Acidity regulator Stabilizer Color Antioxidant

Sweetener Preservative Emulsifier Thickener

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Table 9.2: Examples, where food labeling must include one or more additional particulars. Food Type

Particulars

Foods Containing Sweeteners (EC, 2011) G

G

G

G

Foods containing a sweetener Foods containing both an added sugar or sugars and a sweetener Foods containing aspartame/aspartameacesulfame salt

Foods containing more than 10% added polyols

“With sweetener(s);” this statement shall accompany the name of the food. “With sugar(s) and sweetener(s);” this statement shall accompany the name of the food. “Contains aspartame (a source of phenylalanine)” shall appear on the label in cases where aspartame/aspartame-acesulfame salt is designated in the list of ingredients only by reference to the E number. “Contains a source of phenylalanine” shall appear on the label in cases where aspartame/aspartame-acesulfame salt is designated in the list of ingredients by its specific name. “Excessive consumption may produce laxative effects”.

Foods Containing Glycyrrhizinic Acid or Its Ammonium Salt (EC, 2011) G

G

Confectionery or beverages containing glycyrrhizinic acid or its ammonium salt due to the addition of the substance(s) as such or the liquorice plant Glycyrrhiza glabra, at a concentration of 100 mg/kg or 10 mg/L or above. Beverages containing glycyrrhizinic acid or its ammonium salt due to the addition of the substance(s) as such or the liquorice plant G. glabra at concentrations of 50 mg/L or above, or of 300 mg/L or above in the case of beverages containing more than 1.2% by volume of alcohol.

“Contains liquorice” shall be added immediately after the list of ingredients, unless the term “liquorice” is already included in the list of ingredients or in the name of the food. In the absence of a list of ingredients, the statement shall accompany the name of the food. “Contains liquorice—people suffering from hypertension should avoid excessive consumption” shall be added immediately after the list of ingredients. In the absence of a list of ingredients, the statement shall accompany the name of the food.

Beverages With High Caffeine Content (EC, 2011) Beverages (with the exception of those based on coffee, tea, or coffee or tea extracts where the name of the food includes the term “coffee” or “tea”), which: are intended for consumption without modification and contain caffeine, from whatever source, in a proportion in excess of 150 mg/L, or; are in concentrated or dried form and after reconstitution contain caffeine, from whatever source, in a proportion in excess of 150 mg/L G

G

“High caffeine content. Not recommended for children or pregnant or breast-feeding women” in the same field of vision as the name of the beverage, followed by a reference in brackets and in accordance with Article 13(1) of this regulation to the caffeine content expressed in mg per 100 mL.

Foods Containing One or More of the Following Food Colors (EC, 2008) G G G G G G

Sunset yellow (E 110) Quinoline yellow (E 104) Carmoisine (E 122) Allura red (E 129) Tartrazine (E 102) Ponceau 4R (E 124)

“Name or E number of the color(s);” may have an adverse effect on activity and attention in children.

270 Chapter 9 Certain substances or products causing allergies or intolerances shall be indicated in the list of ingredients, with a clear reference to the name of the substance or product as listed in Annex II of FIR Regulation (EC, 2011). This list includes 14 different substances or products causing allergies or intolerance, for example cereals containing gluten (wheat, rye, barley, oats, and products thereof, with exception of wheat-based glucose syrups including dextrose; wheat-based maltodextrins; glucose syrups based on barley; and cereals used for making alcoholic distillates including ethyl alcohol of agricultural origin); eggs and products thereof; milk and products thereof (except whey used for making alcoholic distillates including ethyl alcohol of agricultural origin, and lactitol), various nuts and products thereof (except for nuts used for making alcoholic distillates including ethyl alcohol of agricultural origin); sulfur dioxide and sulfites (at concentrations of more than 10 mg/kg or 10 mg/L in terms of the total SO2), etc. Ingredients present in the form of engineered nanomaterials must be clearly indicated in the list of ingredients. The names of such ingredients must be followed by the word “nano” in brackets. The indication of the quantity of an ingredient or category of ingredients used in the manufacture or preparation of a food shall be required where the ingredient or category of ingredients concerned: 1. Appears in the name of the food or is usually associated with that name by the consumer. 2. Is emphasized on the labeling in words, pictures or graphics. 3. Is essential to characterize a food and to distinguish it from products with which it might be confused because of its name or appearance Technical rules for indication of the quantity and exemptions for applying this are laid down in Annex VIII of FIC regulation (EC, 2011). Where indication of quantity of an ingredient is required, such information shall be expressed as a percentage, which shall correspond to the quantity of the ingredient or ingredients at the time of its/their use. This information shall appear either in or next to the name of the food or in the list of ingredients in connection with the ingredient in question. The quantity of ingredients used in concentrated or dehydrated form and reconstituted during manufacture may be indicated on the basis of their proportion by weight as recorded before their concentration or dehydration. In the case of concentrated or dehydrated foods which are intended to be reconstituted by the addition of water, the quantity of the ingredients may be indicated on the basis of their proportion by weight in the reconstituted product (EC, 2011). 9.2.1.2 Nutrition Declaration In the EU nutrition information is mandatory on all packaged foods and beverages as regulated by the FIC regulation (EC, 2011). The rules for presentation of nutrition information do not apply to natural mineral waters, for which specific regulations apply.

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Table 9.3: Presentation of nutrition declaration as defined in the food information to consumers Regulation (EC, 2011). Energy Fat of which saturates, monounsaturates, polyunsaturates Carbohydrate of which sugars polyols starch Fiber Protein Salt Vitamins and minerals

kJ/kcal g g

G G G

g g

G G G

g g g mg/µg—as defined in the FIC Regulation/Part A of Annex XIII

Also unprocessed products that comprise a single ingredient or category of ingredients herbal and fruit infusions, tea, decaffeinated tea, instant or soluble tea or tea extract, decaffeinated instant or soluble tea or tea extract, which do not contain other added ingredients than flavorings which do not modify the nutritional value of the tea are exempted from nutrition labeling. The presentation of nutrition declaration is defined by the FIC regulation (see Table 9.3). It is mandatory to include the energy value and amounts of fat, saturates, carbohydrate, sugars, protein, and salt. The content of the mandatory nutrition declaration may be supplemented on a voluntary basis with an indication of the amounts of monounsaturates, polyunsaturates, polyols, starch, fiber, and vitamins or minerals. The energy value and the amount of nutrients shall be expressed per 100 g or per 100 mL. The energy value and the amounts of nutrients may be expressed per portion and/or per consumption unit, easily recognizable by the consumer, provided that the portion or the unit used is quantified on the label and that the number of portions or units contained in the package is stated in addition to the form of expression per 100 g or per 100 mL. The information on the content of vitamins and minerals must also be expressed as a percentage of the reference values (EC, 2011). Daily reference intakes for vitamins and minerals are presented in Table 9.4. In addition, the labeling of vitamins and minerals is possible, only if they are present in the final product in “significant amounts.” For beverages “significant amounts” are defined as 7.5% of the nutrient reference values (NRV) supplied by 100 mL. Where the package of the beverage contains only a single portion or for products other than beverages, 15% of the nutrient reference values per portion is also considered as a “significant amount” of the nutrient.

272 Chapter 9 Table 9.4: Nutrient reference values (NRVs) for vitamins and minerals (EC, 2011). Vitamin

NRV

Mineral

NRV

Vitamin C Niacin Vitamin E Pantothenic acid Riboflavin Vitamin B6 Thiamin Vitamin A Folic acid Vitamin K Biotin Vitamin D Vitamin B12

80 mg 16 mg 12 mg 6 mg 1.4 mg 1.4 mg 1.1 mg 800 µg 200 µg 75 µg 50 µg 5 µg 2.5 µg

Potassium Calcium Chloride Phosphorus Magnesium Iron Zinc Fluoride Manganese Copper Iodine Selenium Molybdenum Chromium

2000 mg 800 mg 800 mg 700 mg 375 mg 14 mg 10 mg 3.5 mg 2 mg 1 mg 150 µg 55 µg 50 µg 40 µg

When nonalcoholic beverages or other foodstuff is enriched with nutrients or other substances, manufacturers also need to consider Regulation (EC) No. 1925/2006 on the addition of vitamins and minerals and of certain other substances to foods (EC, 2006). This regulation implemented in the community register on the addition of vitamins and minerals and of certain other substances to foods (EC, 2019) also contains a list of the vitamins and minerals which may be added to foods. For example, vitamin C may be added in the form of L-ascorbic acid, sodium-L-ascorbate, calcium-L-ascorbate, potassiumL-ascorbate, or L-ascorbyl 6-palmitate. The form of the added vitamin should be included into the list of ingredients, while in the nutrition declaration any form is represented as “Vitamin C.” When ingredients of food product are considered as novel food, Regulation EU 2015/2283 is also applicable (EC, 2015). It should be noted that during the authorization of novel foods, specific labeling requirements may be defined for food, to which novel foods are added. For example, chia seeds (Salvia hispanica) were authorized as a novel food and can also be used in beverages based on fruit juice and fruit juice blends (up to 15 g/450 mL for addition of whole, mashed, or ground chia seeds) (EC, 2017). The content of novel food should be labeled with the statement “Chia (S. hispanica) seeds” and a statement informing consumer that the daily intake of chia seeds is up to 15 g.

9.2.2 Front-of-Package Nutrition Labeling Stakeholders such as policy-makers, health organizations, food industries, and consumer associations have advocated for nutrition labeling as part of a comprehensive response to the

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global epidemic of obesity and diet-related NCDs (Campos et al., 2011; Kanter et al., 2018; WHO, 2018). Nutrition labeling could represent an efficient tool to provide information to consumers when informing them about healthier food choices (Hieke and Taylor, 2012; Kasapila and Shaarani, 2014; WHO, 2018). This is especially important in the case of complex food products where the composition of products within the same category can vary in content of risk nutrients such as sugars, fats, and salt and the content of beneficial components such as fiber, protein, vitamins, minerals, and others (Hoefkens et al., 2011; WHO, 2018). Although labeling of nutrition information in the EU has been mandatory since 2016 (EC, 2011), such information is sometimes difficult to understand without further interpretation (Campos et al., 2011; Grunert et al., 2010). The FIC regulation allows voluntary repetition of some elements of the mandatory nutrition declaration that are of key importance for public health. The nutrition information can be repeated in the principal field of vision, in accordance with legislative rules, allowed for the energy value or the energy value together with the amounts of fat, saturates, sugars, and salt. In addition, the FIC regulation allows provision of nutrition information by other forms of expression such as using graphic forms or symbols in addition to words or numbers provided that these requirements are met: 1. They are based on sound and scientifically valid consumer research and do not mislead the consumer as referred. 2. Their development is the result of consultation with a wide range of stakeholder groups. 3. They aim to facilitate consumer understanding of the contribution or importance of the food to the energy and nutrient content of a diet. 4. They are supported by scientifically valid evidence of understanding of such forms of expression or presentation by the average consumer. 5. In the case of other forms of expression, they are based either on the harmonized reference intakes or, in their absence, on generally accepted scientific advice on intake of energy or nutrients. 6. They are objective and nondiscriminatory. 7. Their application does not create obstacles to the free movement of goods on the EU marketplace. EU member states may recommend to food business operators the use of one or more additional forms of expression or presentation of the nutrition declaration. Such provision of nutrition information by other forms of expression and/or presented using graphic forms or symbols is considered as FOP nutrition labeling. FOP labeling with interpretative information about nutrient content—explained with words, symbols, and colors—have been found to be more easily understood and more correctly interpreted by consumers (Hersey et al., 2013; Savoie et al., 2013). Such

274 Chapter 9 labeling can help consumers make quick decisions based on the nutritional composition or relative healthfulness of a product provided through its simple, easily viewable, and interpretable format (Feunekes et al., 2008; Pomeranz, 2011). FOP nutrition schemes vary in presentation (e.g., shape, color, and size), type of public-health nutrition message (proscriptive, prescriptive, or both), and nutrient focus (e.g., focus on “critical nutrients” or the inclusion of both positive and negative nutrients). The most common “critical nutrients” that have been included in FOP nutrition labeling schemes are sodium, fats (saturates, trans), and total sugars. Some, but not all, of the FOP nutrition schemes also include certain nutrient-rich components, such as fiber, whole grains, protein, vegetables, and/or fruits. Governments and nongovernmental organizations are involved in the development and implementation of different FOP nutrition labeling schemes. Common policy objectives of FOP nutrition labeling are to provide additional information to consumers to inform healthier food choices and to encourage the industry to reformulate products toward healthier options (Kanter et al., 2018) (Fig. 9.2). The FOP nutrition labeling as a policy measure to improve diet and health was proposed also by the WHO in 2004 and further it is promoted as part of a comprehensive policy response to the global epidemic of obesity and diet-related NCDs (Kanter et al., 2018). There are no specific widely accepted international recommendations regarding the format, content, or criteria of FOP nutrition labeling, which presents a challenge for the implementation of FOP schemes around the world. However, it should be noted that proposals for new work concerning a global standard for FOP interpretive nutrition labeling was accepted by a joint WHO/FAO Food standards program, namely the Codex committee on food labeling (FAO, 2006). Various FOP nutrition labeling schemes have been implemented around the world (Kanter et al., 2018; WHO, 2018). In general, these can be divided into: 1. An interpretive nutrition rating system which provides nutrition information as guidance rather than specific facts like the star-based system, nutriscore, traffic-light symbols, and health logos. 2. A reductive system that shows information only, with no specific judgment, opinion, or recommendation like the case of the guideline daily amount (GDA) system. 3. An evaluative/summary indicator system which combines several criteria to establish one indication of the healthiness of a product and shows judgment, opinion, or recommendation with no specific information like star-based systems and health logos (e.g., keyhole logo, choices program logo). 4. A nutrient-specific system which provides nutrition information for a set of nutrients like traffic-light symbols and warnings or “high in” symbols (Table 9.5).

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Figure 9.2 Timeline of front-of-package nutrition labeling globally. Replicated from Kanter R., Vanderlee L., Vandevijvere S., 2018. Front-of-package nutrition labelling policy: global progress and future directions. Public Health Nutr. 21 (8), 1399 1408 with permission from the publisher.

Table 9.5: Examples of characteristics of front-of-package (FOP) nutrition labeling schemes introduced around the world. Scheme

Covered Nutrients and Implementation Ingredients

Limits

Units

Voluntarily

Saturated fat, total sugar, sodium fiber

Nutrient criteria for 25 different food groups

100 g/mL

Netherlands Voluntarily Belgium Poland Czech Republic Mexico

Saturated fat, trans-fatty acids, added sugar, sodium, energy, fiber

National criteria based on international choices criteria; nine basic and six non basic product groups with nutrient criteria

100 g/mL or per serving (for energy)

Slovenia

Voluntarily

Total fat, saturated fat, sugar, and salt nutrients that are subject to nutrition or health claims by EC legislation

Basic nutrient criteria for foods/beverages; additional criteria for specific food groups. Symbol used together with authorized nutrition/health claims

100 g/mL

Singapore

Voluntarily

% Limits Total fat, saturated fat, trans fat, Nutrient criteria for over 60 subcategories of foods and beverages. At least 20% or 25% sodium, total sugar, calcium. more or less of the nutrient/ingredient needed. Fiber, wholegrain

Thailand

Voluntarily

Sodium, total sugar, energy, total Beverages, sauces and condiments, dairy products, ready meals, instant food and fat, saturated fat, protein, snacks. Point system in six categories. Calcium, and iron Fiber

Region

Examples of Logos Keyhole Sweden Denmark Iceland Lithuania Choices Program

Protective Food (PF) Symbol

Singapore Healthier Choices

Thailand Healthier Choices 100 g/mL and per serving

Brunei Healthier Choices Brunei

Voluntarily

Total fat, saturated fat, sodium, sugar, calcium. Fiber

Nutrient criteria exist for over 60 subcategories 100 g/mL of foods and beverages

Energy, fat, saturated fat, total sugar, salt

100 g/mL Fat (low: # 3.0 g/100 g; medium: .3.0 g to # 17.5 g/100 g; high: .17.5 g/100 g) Saturated fat (low: # 1.5 g/100 g; medium: .1.5 g to # 5.0 g/100 g; high: .5.0 g/100 g) total sugar (low: # 5.0 g/100 g; medium: .5.0 g to # 22.5 g /100 g; high: .22.5 g/100 g) salt (low: # 0.3 g/100 g; medium: .0.3 g to # 1.5 g/100 g; high: .1.5 g/100 g)

Examples of Traffic Lights UK Traffic Lights: Red/Amber/Green for Each Critical Nutrient UK

Voluntarily

Ecuador Traffic Lights: Red/Amber/Green for Each Critical Nutrient Ecuador

Mandatory

Fats, sugar, salt

Total fat (low: # 3 g/100 g or 1.5 g/100 mL; medium: .3 and ,20 g/100 g or .1.5 and ,10 g/100 mL; high ($20 g/100 g or $ 10 g/100 mL) Total sugars (low: # 5 g/100 g or 2.5 g/100 mL; medium: .5 and ,15 g/100 g or .2.5 and ,7.5 g/100 g; high ($15 g/100 g or $ 7.5 g/100 mL) Sodium (low: # 120 mg/ 100 g/mL; medium: .120 and ,600 mg/ 100 g/mL; high ($600 mg/100 g/mL)

100 g/mL

Examples of Summary Systems Nutriscore: A, B, C, D, E According to Healthiness With A the Most Healthy France

Voluntarily

Energy, saturated fat, total sugar, Calculations of points for each of the nutrients 100 g/mL of concern and ingredients sodium, proteins. Fiber, fruits, and vegetables

(Continued)

Table 9.5: (Continued) Scheme

Region

Covered Nutrients and Implementation Ingredients

Limits

Units

Health Star Ratings (HSR): From 1/2 Star (Least Healthy) to 5 Stars (Most Healthy) Australia, New Zealand

Voluntarily

Energy, saturated fat, sodium, Calculations of points for each of the nutrients 100 g/mL total sugar, protein. Fiber, fruits of concern and ingredients and vegetables, nuts and legumes

Mandatory (in the past)

Salt

Examples of Warning Systems Salt Warning Symbol Finland

Was specified by food group; including all food groups that make a substantial contribution to salt intake in Finland, for example, when $ 1.1% for bread, $ 2.0% for sausages, $ 2.2% for cold meat cuts, $ 2.0% for fish products, $ 1.4% for cheese, $ 1.2% for ready meals and $ 1.4% for breakfast cereals or crisp bread

% Limits

Chile Warning Label: Black Warning Label for Each Critical Ingredient Chile

Mandatory

Energy, saturated fat, sodium, total sugar

Current (not final) limits: calories (275/100 g or 70/100 mL); saturated fat (4 g/100 g or 3 g/100 mL); total sugar (10 g/100 g or 5 g/100 mL);sodium (400 mg/100 g or 100 mg/100 mL)

100 g/mL

Mandatory

N7A

Including five categories of snack food

N/A

Thailand Warning Labels for Snacks Text “Should consume in Thailand small amounts and exercise for better health”

Source: Adapted from Kanter R., Vanderlee L., Vandevijvere S., 2018. Front-of-package nutrition labelling policy: global progress and future directions. Public Health Nutr. 21 (8), 1399 1408 with additional information.

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9.3 Use of Nutrition and Health Claims Health-related information on food labels may play a crucial role in informing consumers and influence their purchase decisions (Kaur et al., 2017; Loebnitz et al., 2015; Pothoulaki and Chryssochoidis, 2009). However, consumer acceptance is far from unconditional and depends on beliefs about foods being viewed as a marketing stunt, as well as on familiarity and perceptions related to the perceived fit of ingredients and carrier or base products (Kaur et al., 2017; Verbeke, 2010). Several studies show that consumers might have a preference to food products with different health statements compared to food products without such labeling (Bitzios et al., 2011; Miklavec et al., 2015, 2016). Indeed, consumers’ attitudes to the use of nutrition information or claims on food labels have been studied extensively in recent years (Bitzios et al., 2011; Hoefkens et al., 2011; Kaur et al., 2017; Miklavec et al., 2016; Pothoulaki and Chryssochoidis, 2009; Pravst and Kusˇar, 2015; Verbeke, 2010). The frequency of different claims varies among food categories; usually the prevalence of nutrition claims is reported as much higher in comparison with health claims (Hieke et al., 2016; Kaur et al., 2015, 2016; Legault et al., 2004; Pravst and Kuˇsar, 2015). International study of the prevalence of claims in European Union across food categories was performed within the CLYMBOL project (Hieke et al., 2016). A high prevalence of nutrition claims (above 20%) was found in “cereal and cereal products,” “dairy products,” and “beverages.” In addition, health claims were mostly found on “edible oils and oil emulsions,” “fish and fish products” (both 26%), “beverages” (17%), “cereal and cereal products,” “sugars, honey, and related products” (both 16%), and “dairy products” (13%). The remaining food categories had less than 10% of foods carrying health claims. When promoting the particular food due to its nutrition or health beneficial effects, the use of nutrition and health claims in the labeling and advertising of foods is carefully regulated in many countries. Although there are international recommendations for regulation in this area, the regulation of the use of claims in different countries is quite different (de Boer and Bast, 2015). The WHO and FAO (of the United Nations) established Codex Alimentarius in 1963 to provide a global reference food code for consumers, food producers or processors, national food control agencies, and the international food trade (FAO, 2006). The code has impacted on the protection of public health and on the international food trade (FAO, 2017). Codex Alimentarius standards, codes of practice, guidelines, and recommendations were compiled by the Codex Alimentarius Commission (CAC) (Aggett et al., 2012; Grossklaus, 2009). The first Codex guidelines on nutrition were adopted in 1997, and revised as the guidelines for use of nutrition and health claims in 2004 (last amended in 2013) (CAC, 2013). The Codex guidelines, for example, define “nutrient function claims” (the physiological role of the nutrient for growth, development, and

280 Chapter 9 normal functions of the body); “other function claims” (specific beneficial effects of consuming a food (constituent), within the context of the overall diet, for the body’s normal functions or biological activities. Such claims relate to a positive contribution to health (or an improvement in function or to modifying or preserving health), and “reduction of disease risk (RDR) claims” relating to the consumption of a food (constituent), within the context of the overall diet, to the reduced risk of developing a disease or health-related condition; risk reduction means significantly altering a major risk factor(s) for a disease or health-related condition. The guidelines specifically mention that diseases have multiple risk factors and altering one of these risk factors may, or may not, have a beneficial effect, therefore the presentation of RDR claims must ensure that consumers do not interpret them as prevention claims. In the EU harmonized use of claims was assured with Regulation (EC) No 1924/2006 on NHCR (EC, 2006) with a somewhat different definition of claims. The regulation applies to all nutrition and health claims made in commercial communications, including trademarks and other brand names which could be nutrition or health claims. The general principle is that claims should be substantiated by generally accepted scientific data, nonmisleading and preapproved on the EU level. Additionally, claims shall not give rise to doubt about the safety of other foods or encourage excessive consumption of a food. Considering that nonalcoholic beverages are also heavily marketed (Kelly et al., 2019; Korosec and Pravst, 2016), it should be also mentioned that the rules for the use of nutrition and health claims are also applicable to any kind of advertising or other types of promotion (EC, 2006).

9.3.1 Nutrition Claims The regulation defines a “nutrition claim” as any claim stating, suggesting, or implying that a food has beneficial nutritional properties due to its calorific value or composition with respect to the presence or absence of specific nutrients or other substances. Nutrition claims are only permitted if they are listed in the Annex of Regulation (EC) No 1924/2006 and provided in accordance with the set conditions of use (EC, 2006). In practice, we can distinguish two general types of nutrition claims, namely nutrient content claims that refer to the amount of a nutrient in a product (e.g., contains calcium); and “nutrient comparative claims” that compare the nutrient levels between two or more products (e.g., “reduced sodium”). Nutrient content claims are very well-defined and four different comparative claims are also listed in the regulation [i.e., increased (name of the nutrient); reduced (name of the nutrient); energy reduced; light], together with conditions of use. The difference in the quantity of a nutrient and/or the energy value shall be stated and the comparison shall

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relate to the same quantity of food. The difference in the content of the nutrient should be relevant, for most nutrients at least for 30%. The use of comparative claims is further explained in the guidance on the implementation of Regulation No. 1924/2006 on NHCR. The guidance explains that the claims “as much as” or any claim having the same meaning are not considered to be comparative claims, because the regulation specifies that a comparative claim should indicate the difference in the quantity of a nutrient or the energy value. Furthermore, the claim “as much as” is not in the Annex of the NHCR and is consequently not allowed. Same applies for the claim “super light.” It should be noted that a comparison may only be made between foods of the same category, taking into consideration a range of foods in that category. Also, comparative nutrition claims shall compare the composition of the food in question with a range of foods of the same category, which do not have a composition which allows them to bear a claim, including foods of other brands. The guidance also explains that products being compared should belonging to a group of foods that are similar in terms of nutritional content. Certain comparisons could be misleading and are, therefore, not allowed. For example, although 100% fruit juices are produced from certain fruits, a comparative claim comparing juice with the fruit is not allowed. The NHCR specifies that a range of foods of the same category should be taken into account, including foods of other brands, for the comparison. This is to avoid a situation where a comparison with a single product may mislead the consumer because the single product may not be representative of that category of products. For example, a food manufacturer could take as a reference product a food which has a higher energy content than the average product in that food category. The “light” version could have 30% less energy of such reference product, but the comparison could be misleading as the latter would not be representative of the products of that category on the market. The guidance explains that a specific branded product may be used as a term for comparison, if it is representative of the products of its category. Examples of authorized nutrition claims and the conditions applying to them are listed in Table 9.6. Any claim considered to have the same meaning for consumers as a nutrition claim included on the list is subject to the same conditions of use, as defined for the authorized claim. It should be noted that a claim that a food contains a nutrient or another substance (for which certain conditions are not specified in regulation), or any claim likely to have the same meaning for the consumer, may only be made where the nutrient or other substance is contained in the final product in a significant quantity that will produce the nutritional or physiological effect claimed as established by generally accepted scientific evidence. The substance must also be in a bioavailable form.

282 Chapter 9 Table 9.6: Nutrition claims and the conditions for their use in the Europeon Union. Nutrition Claim

Conditions of Use

Low energy Energy-reduced

Less than 170 kJ/100 g for solids or 80 kJ/100 mL for liquids The energy value reduced by at least 3%, with an indication of the characteristic(s) which make(s) the food reduced in its total energy value Less than 4 kcal (17 kJ)/100 mL Less than 3 g of fat /100 g for solids and less than 1.5 g of fat/100 mL for liquids Less than 0.5 g fat/100 g or 100 mL Less than 1.5 g/100 g for solids or 0.75 g/100 mL for liquids; sum of saturated fatty acids and trans-fatty acids must not provide more than 10% of energy Less than 0.1 g of saturated fat and trans-fatty acids per 100 g or 100 mL Less than 5 g of sugars per 100 g for solids or 2.5 g of sugars per 100 mL for liquids Less than 0.5 g of sugars per 100 g or 100 mL The product does not contain any added mono- or disaccharides or any other food used for its sweetening properties. If sugars are naturally present in the food, the following indication should also appear on the label: “contains naturally occurring sugars” Less than 0.12 g of sodium or the equivalent value for salt per 100 g or per 100 mL; for water, other than natural mineral water falling within the scope of Directive 80/777/EEC this value should not exceed 2 mg of sodium per 100 mL Less than 0.04 g of sodium or the equivalent value for salt, per 100 g or per 100 mL. This claim shall not be used for natural mineral water and other water Less than 0.005 g of sodium, or the equivalent value for salt, per 100 g The product does not contain any added sodium/salt or any other ingredient containing added sodium/salt and the product contains no more than 0.12 g sodium, or the equivalent value for salt, per 100 g or 100 mL At least 3 g of fiber per 100 g or at least 1.5 g of fiber per 100 kcal At least 6 g of fiber per 100 g or at least 3 g of fiber per 100 kcal At least 12% of the energy value of the food is provided by protein At least 20% of the energy value of the food is provided by protein A significant amounta of vitamins or minerals

Energy-free Low-fat Fat-free Low saturated-fat Saturated fat-free Low sugars Sugar-free With no added sugars

Low sodium/salt

Very-low sodium/salt Sodium-free or salt free No added sodium/salt

Source of fiber High fiber Source of protein High protein Source of vitamins and/ or minerals High in vitamins or minerals Source of omega-3 fatty acids

At least twice the amount of “source of vitamins or minerals”

At least 0.3 g alpha-linolenic acid per 100 g and per 100 kcal, or at least 40 mg of the sum of eicosapentaenoic acid and docosahexaenoic acid per 100 g and per 100 kcal High omega-3 fatty acids At least 0.6 g alpha-linolenic acid per 100 g and per 100 kcal, or at least 80 mg of the sum of eicosapentaenoic acid and docosahexaenoic acid per 100 g and per 100 kcal High monounsaturated At least 45% of the fatty acids present in the product derive from fat monounsaturated fat under the condition that monounsaturated fat provides more than 20% of energy of the product High polyunsaturated fat At least 45% of the fatty acids present in the product derive from polyunsaturated fat under the condition that polyunsaturated fat provides more than 20% of energy of the product (Continued)

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Table 9.6: (Continued) Nutrition Claim

Conditions of Use

High unsaturated fat

At least 70% of the fatty acids present in the product derive from unsaturated fat under the condition that unsaturated fat provides more than 20% of energy of the product A claim that a food contains a nutrient or another substance for which specific conditions are not laid down in this regulation may only be made where the product complies with all the applicable provisions of this regulation A claim stating that the content in one or more nutrients, other than vitamins and minerals, has been increased, may only be made where the product meets the conditions for the claim ‘source of’ and the increase in content is at least 30% compared to a similar product A claim stating that the content in one or more nutrients has been reduced, and any claim likely to have the same meaning for the consumer, may only be made where the reduction in content is at least 30% compared to a similar product, except for micronutrients, where a 10% difference in the reference values as set in Directive 90/496/EEC shall be acceptable, and for sodium, or the equivalent value for salt, where a 25% difference shall be acceptableThe claim “reduced saturated fat” and any claim likely to have the same meaning for the consumer, may only be made: 1. if the sum of saturated fatty acids and of trans-fatty acids in the product bearing the claim is at least 30% less than the sum of saturated fatty acids and of trans-fatty acids in a similar product 2. if the content in trans-fatty acids in the product bearing the claim is equal to or less than in a similar product The claim “reduced sugars” and any claim likely to have the same meaning for the consumer may only be made if the amount of energy of the product bearing the claim is equal to or less than the amount of energy in a similar product Shall follow the same conditions as those set for the term “reduced”; the claim shall also be accompanied by an indication of the characteristic(s) which make (s) the food “light” A food naturally meets the condition(s) laid down for the use of a nutritional claim, the term “naturally/natural” may be used as a prefix to the claim

Contains (name of the nutrient) Increased (name of the nutrient)

Reduced (name of the nutrient)

Light

Naturally/natural

a A significant amount of vitamin or mineral: a 15% of the nutrient reference intake of products other than beverages (including beverages packed in a single portion) and 7.5% of beverages supplied by 100 g or 100 mL as specified in the Annex XIII of the EU Regulation on the provision of food information to consumers (EC, 2011).

9.3.2 Health Claims 9.3.2.1 Health Claims Approval Process, Scientific Substantiation, and Current Challenges The regulation requires the authorization of all health claims by the EC through the comitology procedure, following the scientific assessment and verification of a claim by the EFSA (Pravst, 2010). All health claims on the EU market prior to 2006 were included in the evaluation process. Lists of general function claims then on the market were provided by EU member states

284 Chapter 9 and included in a consolidated list of over 4000 general function claims that entered the EFSA’s evaluation process. The evaluation of many claims was finalized in 2011; after 340 EFSA scientific opinions were published, the EU a list of permitted health claims was introduced with the Commission Regulation (EU) No. 432/2012 (EU, 2012). Scientific advice was provided for 2758 general function health claims, about 20% of which were favorable (Pravst, 2012a,b). While some claims were withdrawn, about 1500 claims on so-called “botanicals” have been placed “on hold” by the EC (EU, 2012) pending further consideration of how to proceed with these as a part of the European Commission’s Regulatory Fitness and Performance program (REFIT) (EC, 2018). On the other hand, all (1) general function health claims based on new evidence, (2) claims referring to children’s development and health, and (3) reduction of disease risk claims need to be submitted directly by companies. In cases where a health claim substantiation is based on (unpublished) proprietary data and if a claim cannot be substantiated without such proprietary data, the applicant can request 5 years of protection of such data (Pravst, 2012a,b). The authorization of new health claims was found to be challenging. Recommendations for successful substantiation of new health claims in the EU were prepared (Pravst et al., 2018) within the EC-funded REDICLAIM project (Raats et al., 2015). It should be also noted that the NHCR provided the requirement that folds labeled with health nutrition claims should meet minimal nutritional criteria. This was to avoid the situation where producers would be making claims about beneficial aspects of their products while “hiding” their nonbeneficial properties (e.g., use of claims on foods high in energy, sugar, saturated fat, and sodium). The idea was to define such nutritional criteria similarly as it was done in Australia and New Zealand (FSANZ, 2017) where a nutrientprofile model was implemented. However, this part of the legislation has not been implemented yet (Cappuccio and Pravst, 2011) even though the scientific criteria were prepared by the EFSA back in 2008 (EFSA, 2008). Several studies show many claims are often displayed on the labels of foods and beverages of lower nutritional quality and may mislead consumers by highlighting certain beneficial nutrients or components while minimizing information on nutrients of public-health concern (Kaur et al., 2016; Rayner et al., 2013; Talati et al., 2017). This (nonimplemented) part of NHCR is now part of the EC’s REFIT program (EC, 2018) and the EC is currently seeking to evaluate whether nutrient profiling is necessary. An official report on this topic will provide a point-ofdeparture for future policies in the EU. 9.3.2.2 The Use of Health Claims Regulation EC 1924/2006 (NHCR) defines a “health claim” as any claim which states, suggests, or implies that a relationship exists between a food category, a food, or one of its constituents and health. All health claims should be authorized and included in the list of authorized claims (EC, 2006). Information about the quantity of the food and pattern of

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consumption required to obtain the claimed beneficial effect should be included in the label and reasonably expected to be consumed in context of a varied and balanced diet. The claim must be specific, based on generally accepted scientific data, and well-understood by the average consumer. Reference to general, nonspecific benefits of the nutrient or food for overall good health or health-related well-being may only be made if accompanied by a specific health claim. All authorized health claims are listed in a public Community Register of nutrition and health claims made on food which includes the wordings of claims and the conditions applying to them, together with any restrictions. Basically, the regulation distinguishes three categories of health claims (Table 9.7). General function claims describe the role of a food in body functions, including the sense of hunger or satiety and not Table 9.7: Categorization and examples of nutrition and health claims in the European Union. Reference to the NHCR

Claim Type

Art. 8

Nutrition claims

Art 13

Art. 14 (1)a

Art. 14(1)b

Art. 10(3) Art. 1(3)

Definition

Claims referring to particular beneficial nutritional properties of the food Function claims: Claims referring: to (1) the role of a nutrient or other substance in a. Based on growth, development and the generally functions of the body; (2) accepted psychological and behavioral scientific evidence, or functions; or (3) slimming or weight control or a reduction in b. Based on the sense of hunger or an increase new in the sense of satiety, or to the evidence reduction of the available energy from the diet Reduction of Claims that state, suggest, or disease risk claim imply that the consumption of a food (constituent/category) significantly reduces a risk factor in the development of a human disease No specific definition in the Children’s development and regulation health claims References to general, nonspecific General benefits of the nutrient or food for nonspecific overall good health or healthhealth claim related well-being. Such claims can also include trademarks and brand names. Such claims may only be made, if accompanied by an authorized specific health claim

Examples of Wording Source of calcium

Calcium is needed for the maintenance of normal bones

Calcium helps to reduce the loss of bone mineral in postmenopausal women. Lowbone mineral density is a risk factor for osteoporotic bone fractures Calcium is needed for normal growth and development of bone in children Bone health

286 Chapter 9 referring to children, while disease risk reduction claims state that the consumption of a food or food constituent significantly reduces a risk factor in the development of a human disease. The regulation also mentions claims referring to children’s development and health, for which no further definition is given. 9.3.2.3 Labeling Requirements When Health Claims Are Used When health claims are used, other pieces of compulsory information must be provided on the labeling: • • • •

Nutrition information (also in cases where nutrition declaration would not be mandatory by law, for example, on very small sized packaging). Statement indicating the importance of a varied and balanced diet and a healthy lifestyle. The quantity and pattern of consumption required to obtain the claimed beneficial effect. Where appropriate, a statement addressed to persons who should avoid using the food and an appropriate warning for products that are likely to present a health risk if consumed in excess. Manufacturers should be aware of their responsibilities under the general food laws and comply with the fundamental requirements to market food which is safe and not harmful to health and utilize such statements on their own recognizance (EC, 2013).

Beside the use of specific, authorized health claims, the NHCR also allows the use of easy, attractive statements which refer to the general, nonspecific benefits of a product for overall good health or health-related well-being, without an authorization procedure. While the use of such statements could be helpful to consumers as these would convey more consumerfriendly messages, such statements could be easily misunderstood, possibly leading people to imagine different health benefits than actually exist (EC, 2013). For this reason such statements should be accompanied by permitted health claims. A specific health claim must be made next to or following such a general statement. The specific claims should bear some relevance to the general reference. To avoid misleading consumers, the manufacturer has a responsibility to demonstrate the link between the reference to the general, nonspecific benefits of the food and the specific, accompanying, and authorized permitted health claim. 9.3.2.4 The List of Authorized Functional Health Claims The EFSA’s opinions related to the evaluation of health claims were reviewed in 2011 (Pravst, 2012a,b), yet not all scientifically substantiated claims have been authorized by the EC. Authorization may be legitimately withheld if health claims do not comply with other general and specific requirements of the NHCR, even in the case of a favorable scientific assessment (EU, 2012). Indeed, in the process of authorizing health claims some claims

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were not included on the list of authorized health claims for public-health reasons. For example, in the evaluation of a health claim on the effect of sodium on the maintenance of normal muscle function a cause-and-effect relationship has been established. However, the use of such a claim would convey a conflicting and confusing message to consumers because it would encourage the consumption of a nutrient for which, based on generally accepted scientific advice, authorities are informing consumers that their intake should be reduced. Therefore such a claim would be ambiguous or misleading. In some other cases, public-health risks were avoided by establishing proper conditions of use (Cappuccio and Pravst, 2011; EU, 2012), while for others there are still some unresolved issues (Pravst, 2011; Ritz et al., 2012). Table 9.8 presents examples of authorized function health claims in the EU, which can be used on foods and drinks.

9.4 The Use of Food Labeling to Support Monitoring of the Food Supply The rising burden of obesity and diet-related NCDs has focused attention on the food environment that might influence consumer behavior toward the selection of healthy food choices and/or influence food manufacturers toward improving the nutritional composition of their food products (Cohen, 2009; Heinrich et al., 2005; WHO, 2018). Food labeling is an area where improvements have potential health benefits. People who read the nutrition information on food labels tend to have a healthier diet; however, some consumers find the information difficult to understand or interpret (Campos et al., 2011). Besides this, pointing out health-related characteristics by using nutrition and health claims is also considered as an advantageous strategy for food companies and is a widely used practice (Steinhauser and Hamm, 2018; Talati et al., 2016). Food products carrying nutrition claims are more likely to be chosen than an identical product without such labeling, at least in some population groups (Al-Ani et al., 2016; Miklavec et al., 2016). With unhealthy foods becoming more and more prevalent and affordable, the responsibility for food choices is moving away from the consumers (Heinrich et al., 2005; Walls et al., 2009). Rather than educating consumers how to make healthier choices, we should recast the environment with healthier options to be far more accessible, available, and desirable than unhealthy alternatives. Interventions that go beyond individuals’ knowledge and freedom to choose are needed (Cobiac et al., 2010; Heinrich et al., 2005; Kanter et al., 2018). Changing the composition of processed foods (food reformulation) is currently considered as major means to help reduce the prevalence of diet-related diseases (Lehmann et al., 2017; van Raaij, 2008; WHO, 2018). Main food reformulation initiatives are aimed at reducing salt, saturated fatty acids, trans-fatty acids, sugars, and total energy. The food industry holds great potential for driving consumers to adopt healthy food choices as (re)formulation of foods can improve the nutritional quality of these foods (Lehmann et al., 2017; WHO, 2018).

288 Chapter 9 Table 9.8: A selection of function health claims authorized in the European Union. Ingredient

Wording

Conditionsa

Immune System and Oxidative Stress Copper, folate, iron, selenium, Contributes to the normal function of the immune system vitamin A, vitamin B12, vitamin B6, vitamin C, vitamin D, and zinc Vitamin C Contributes to maintain the normal function of the immune system during and after intense physical exercise Copper, manganese, Contributes to the protection of cells riboflavin, selenium, vitamin from oxidative stress C, vitamin E, and zinc

200 mg; special conditions apply

Brain, Psychological, and Neurological Functions Biotin, copper, iodine, magnesium, niacin, potassium, riboflavin, thiamine, vitamin B12, vitamin B6, and vitamin C Biotin, folate, magnesium, niacin, thiamine, vitamin B12, vitamin B6, and vitamin C Iodine, iron, and zinc Pantothenic acid DHA Carbohydrates

Calcium Folate, iron, magnesium, niacin, pantothenic acid, riboflavin, vitamin B12, vitamin B6, and vitamin C

Contributes to normal functioning of the nervous system

Contributes to normal psychological function Contributes to normal cognitive function Contributes to normal mental performance Contributes to maintenance of normal 40 mg; special conditions apply brain function Contributes to maintenance of normal At least 20 g of carbohydrates, brain function excluding polyols, per quantified portion and complies with the nutrition claim low sugars or with no added sugars; special conditions apply Contributes to normal neurotransmission Contributes to the reduction of tiredness and fatigue

Bone, Teeth, and Calcium Levels Calcium Magnesium, phosphorus, and vitamin D Manganese, protein, vitamin K, and zinc

Is needed for the maintenance of normal bones and teeth Contributes to the maintenance of normal bones and teeth Contributes to the maintenance of normal bones (Continued)

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Table 9.8: (Continued) Ingredient

Wording

Contributes to normal collagen formation for the normal function of bones and teeth Fluoride Contributes to the maintenance of tooth mineralization Vitamin D Contributes to normal absorption/ utilization of calcium and phosphorus Vitamin D Contributes to normal blood calcium levels Nonfermentable carbohydrates Consumption of foods/drinks containing nonfermentable carbohydrates instead of fermentable carbohydrates contributes to the maintenance of tooth mineralization

Conditionsa

Vitamin C

Fermentable carbohydrates should be replaced in foods or drinks by nonfermentable carbohydrates; special conditions apply

Collagen, Connective Tissue, and Mucous Membranes Vitamin C

Copper Manganese Biotin, niacin, riboflavin, and vitamin A

Contributes to normal collagen formation for the normal function of blood vessels, bones, teeth, cartilage, gums, and skin Contributes to maintenance of normal connective tissues Contributes to the normal formation of connective tissue Contributes to the maintenance of normal mucous membranes

Skin, Hair, and Nails Biotin, selenium, and zinc Selenium, zinc Biotin, iodine, niacin, riboflavin, vitamin A, and zinc Vitamin C

Copper

Contributes to the maintenance of normal hair Contributes to the maintenance of normal nails Contributes to the maintenance of normal skin Contributes to normal collagen formation for the normal function of skin Contributes to normal hair and skin pigmentation

Muscle Mass and Function Calcium, magnesium, potassium, and vitamin D Protein Protein

Contributes to (the maintenance of) normal muscle function Contributes to a growth in muscle mass Contributes to the maintenance of muscle mass (Continued)

290 Chapter 9 Table 9.8: (Continued) Ingredient

Wording

Conditionsa

Carbohydrates

Contribute to the recovery of normal muscle function (contraction) after highly intensive and/or long-lasting physical exercise leading to muscle fatigue and the depletion of glycogen stores in skeletal muscle

Carbohydrates from all sources, excluding polyols, at a total intake of 4 g per kg body weight; special conditions apply

Cell Specialization and Division, Cell Membranes, and DNA Synthesis Vitamin A, calcium Calcium, folate, iron, magnesium, vitamin B12, vitamin D, and zinc Phosphorus Zinc

Has a role in the process of cell specialization Has a role in the process of cell division

Contributes to normal function of cell membranes Contributes to normal DNA synthesis

Digestion Chloride

Calcium Dried plums of “prune” cultivars (Prunus domestica L.) Sugar beet fiber

Lactitol

Contributes to normal digestion by production of hydrochloric acid in the stomach Contributes to the normal function of digestive enzymes Contribute to normal bowel function

A daily intake of 100 g of dried plums Contributes to an increase in fecal bulk For food which is high in that fiber as referred to in the claim high fiber Contributes to normal bowel function by 10 g of lactitol in a single daily increasing stool frequency quantified portion; special conditions apply

Vision and Metabolism of Vitamin A DHA, riboflavin, vitamin A, and zinc Zinc

Contributes to the maintenance of normal vision Contributes to normal metabolism of vitamin A

DHA 40 mg; special conditions apply

Blood, Oxygen transport, and Iron Absorption and Metabolism Calcium, vitamin K Riboflavin

Contributes to normal blood clotting Contributes to the maintenance of normal red blood cells Folate Contributes to normal blood formation Iron, vitamin B12, and vitamin Contributes to normal red blood cell B6 formation Iron Contributes to normal formation of hemoglobin (Continued)

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Table 9.8: (Continued) Ingredient

Wording

Iron

Contributes to normal oxygen transport in the body Contributes to the normal metabolism of iron Contributes to normal iron metabolism Contributes to normal iron transport in the body Increases iron absorption

Riboflavin Vitamin A Copper Vitamin C

Conditionsa

Blood Pressure Potassium DHA/EPA

Contributes to the maintenance of normal blood pressure

3 g; special conditions apply

Blood Cholesterol or Triglyceride Levels Beta glucansb, chitosan, Contributes to the maintenance of normal blood cholesterol levels glucomannan, guar gum, hydroxypropyl methylcellulose, and pectins Plant sterols/stanols Monascus purpureus (red yeast rice) DHA/EPA Contributes to the maintenance of normal blood glucose levels

1 10 g; special conditions apply

0.8 g; special conditions apply 10 mg of monacolin K; special conditions apply 2g

Blood Glucose Levels Chromium Alpha-cyclodextrin

Contributes to the maintenance of normal blood glucose levels Consumption of alpha-cyclodextrin as part of a starch-containing meal contributes to the reduction of the blood glucose rise after that meal

Fructose

Consumption of foods containing fructose leads to a lower blood glucose rise compared to foods containing sucrose or glucose

Nondigestible carbohydrates

Consumption of foods/drinks Containing nondigestible carbohydrates instead of sugars induces a lower blood glucose rise after their consumption compared to sugar-containing foods/ drinks

At least 5 g of alphacyclodextrin per 50 g of starch in a quantified portion as part of the meal; special conditions apply Glucose and/or sucrose should be replaced by fructose in sugar-sweetened foods or drinks so that the reduction in content of glucose and/or sucrose, in these foods or drinks, is at least 30% Sugars should be replaced in foods or drinks by nondigestible carbohydrates; special conditions apply

(Continued)

292 Chapter 9 Table 9.8: (Continued) Ingredient

Wording

Conditionsa

Contributes to the normal function of the heart Contributes to the maintenance of normal blood triglyceride levels

EPA 1 DHA: 250 mg

Contributes to the maintenance of normal liver function

82.5 mg

Heart DHA and EPA, Thiamine DHA/EPA

2 g of DHA and EPA; special conditions apply

Liver Choline Thyroid Gland Iodine, selenium

Contributes to the normal thyroid function

Hormonal Activity/Synthesis Iodine Vitamin B6 Pantothenic acid

Zinc

Contributes to the normal production of thyroid hormones Contributes to the regulation of hormonal activity Contributes to normal synthesis and metabolism of steroid hormones, vitamin D, and some neurotransmitters Contributes to the maintenance of normal testosterone levels in the blood

Fertility, Reproduction, and Pregnancy Zinc Selenium Folate

Contributes to normal fertility and reproduction Contributes to normal spermatogenesis Contributes to maternal tissue growth during pregnancy

Performance Creatine

Creatine

Increases physical performance in successive bursts of short-term, highintensity exercise Enhance the effect of resistance training on muscle strength in adults over the age of 55

3 g; special conditions apply

3 g; special conditions apply

Macronutrients and Energy-Yielding Metabolism Contributes to normal energy-yielding Biotin, calcium, copper, metabolism iodine, iron, magnesium, manganese, niacin, pantothenic acid, phosphorus, riboflavin, thiamine, vitamin B12, vitamin B6, vitamin C Biotin, chromium, and zinc Contributes to normal macronutrient metabolism (Continued)

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Table 9.8: (Continued) Conditionsa

Ingredient

Wording

Choline Vitamin B6

Contributes to normal Contributes to normal glycogen metabolism Contributes to normal Contributes to normal fatty acids

Magnesium, zinc Zinc

lipid metabolism protein and protein synthesis metabolism of

Amino Acids and Homocysteine Metabolism/Synthesis Molybdenum Folate Vitamin B6 Betaine, choline, folate, vitamin B12, and vitamin B6

Contributes metabolism Contributes synthesis Contributes Contributes metabolism

to normal sulfur amino acid to normal amino acid to normal cysteine synthesis to normal homocysteine

Betaine: 500 mgc

Electrolyte Balance and Acid-Base Metabolism Zinc Magnesium

Contributes to normal acid base metabolism Contributes to electrolyte balance

Other Claims Activated charcoal Melatonin Melatonin Lactase enzyme Meal replacement for weight control

Meal replacement for weight control a

Contributes to reducing excessive flatulence after eating Contributes to the alleviation of subjective feelings of jet lag Contributes to the reduction of time taken to fall asleep Improves lactose digestion in individuals who have difficulty digesting lactose Substituting one daily meal of an energyrestricted diet with a meal replacement contributes to the maintenance of weight after weight loss Substituting two daily meals of an energy-restricted diet with meal replacements contributes to weight loss

1 gd 0.5 mge 1 mgf 4500 FCC units Special conditions about energy value and nutrition composition apply Special conditions about energy value and nutrition composition apply

Common conditions regarding the use of health claims are that the product contains a significant amount of a nutrient (eligible for the nutrition claim “source of”), except where different conditions are noted. b Beta-glucans from barley or oats. c A daily intake in excess of 4 g may significantly increase blood cholesterol levels. d The beneficial effect is obtained when 1 g of activated charcoal is consumed at least 30 min before and 1 g shortly after a meal. e The beneficial effect is obtained when 0.5 mg of melatonin is taken close to bedtime on the first day of travel and on the following few days after arrival at the destination. f The beneficial effect is obtained with an intake of 1 mg of melatonin close to bedtime.

294 Chapter 9 Food labeling has the potential to have positive and negative effects on diets (Rayner et al., 2013). While on one hand this can affect consumer decisions, food labeling as a public type of information service can also encourage food manufactures to improve the nutritional composition of foods. Nutrition declarations can, on the other hand, provide information to competitive food manufacturers, giving them insights into the availability of competitive products. This can further stimulate reformulation of food products, particularly when such information is exposed systematically on a large scale. With the development of informatics, this can be notably affected with availability of tools, which offer comparison of similar foods. An example of such a tool is FoodSwitch, a smartphone application launched by the Food Policy Group at The George Institute for Global Health (Australia) designed to jointly support the individual and environmental approaches to the prevention of diet-related ill health (Dunford and Neal, 2017). The app was originally developed to support consumers in healthy food choices and was first launched in Australia and New Zealand, followed by some other countries in the European region and the United Kingdom. In practice, consumers can use the app to scan the barcode of a food product, which is then rated (and compared with competitive products) based on its nutritional composition. In practice, food labeling is used as a major resource of the data for such tools. Furthermore, food labels can be used as a source of data for monitoring the changes in the food supply and achieving reformulation targets. Such information can provide very valuable data for policy-makers, health professionals, and the food industry to drive changes in the nutrient composition of processed foods. The Global Food Monitoring Initiative should be mentioned in respect to harmonization of the protocols for the data collection (Dunford et al., 2012). The goal of the project was to standardize the collection of nutrient composition data for processed foods in different countries with the objective of improving the nutritional composition of the world’s processed-food supply. Also, International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) should to be mentioned here. This is a global network of publicinterest organizations and researchers that aims to monitor, benchmark, and support public and private sector actions to increase healthy food environments and reduce obesity and NCDs and their related inequalities. The INFORMAS food-labeling protocol was published to support monitoring of the supply of prepacked foods (INFORMAS, 2019). The protocol includes a taxonomy of the elements of health-related food labeling. A step-wise approach has been also developed for independently assessing the nature and extent of health-related food labeling in different countries and over a certain time period. The approach was used in a recent study of the comparative healthiness of packaged food and beverages from 12 countries (, Dunford et al., 2018). The study compared the overall healthiness of packaged foods and beverages between selected countries using the health star rating (HSR) nutrient profiling system. The sample included data collected from branded food composition databases for Australia, Canada, Chile, China, India, Hong

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Kong, Mexico, New Zealand, Slovenia, South Africa, the United Kingdom, and the United States; considerable variability in the healthiness of packaged food and beverages available in the various countries was observed. Interestingly, packaged foods were, on average, less healthy in middle-income countries such as China and India, compared with higher-income countries. Another international comparison specifically addressed nutritional composition of beverages, marketed in the United Kingdom, New Zealand, Australia, and Canada (Chepulis et al., 2018). The objective of the study was to compare the nutritional content, serving size, and taxation potential of supermarket beverages from these four Western countries. A crosssectional analysis was done on 4157 beverages (fruit juices, fruit-based drinks, carbonated soda, waters, and sports/energy drinks), marketed in supermarkets. The highest percentage of beverages with added sugar (52%) was reported for New Zealand, while the United Kingdom had the lowest (9%). Differences in energy, carbohydrate, and sugar content were observed among the countries and within certain categories, with UK products generally having the lowest energy and sugar content. Up to half of all products across categories/countries exceeded the US FDA’s reference single-serving sizes, with fruit juices contributing the greatest number. The authors reported substantial differences between countries in the mean energy, serving size, and proportion of products eligible for fiscal sugar taxation. A series of other studies were also conducted where food-labeling data was used for assessment of the food supply. For example, within the abovementioned EC-funded CLYMBOL project, the nutritional quality of foods carrying health-related claims in Germany, The Netherlands, Spain, Slovenia, and the United Kingdom was investigated (Kaur et al., 2016). A cross-sectional study was conducted on 2034 foods, randomly sampled from three food store types (a supermarket, neighborhood store, and discount store). Authors compared the nutritional quality of prepackaged foods carrying healthrelated claims with foods that do not carry health-related claims; Food Standards Australia New Zealand’s Nutrient Profiling Scoring Criterion (FSANZ-NPSC) was used for nutrient profiling. The study showed that foods carrying nutrition or health claims had, on average, lower levels of energy, protein, total sugars, saturated fat, and sodium and higher levels of fiber. From a whole sample about a quarter of the foods passed the FSANZ-NPSC, while somewhat better nutritional quality was observed within foods labeled with nutrition or health claims. Unfortunately, the sample of foods was not large enough for analyses of specific food categories such as, for example, nonalcoholic beverages. Another study was conducted in Spain with the aim to draw an updated map of the nutrition facts in the different categories of nonalcoholic beverages in the market based on the information declared on the labels of these products (Iglesias et al., 2016). The database included 211 beverages classified in seven groups with energy/carbohydrate content per 100 mL ranging from 0 55 kcal/0 13 g for soft drinks; 2 60 kcal/0 14.5 g for energy

296 Chapter 9 drinks; 24 31 kcal/5.8 7.5 g for sports drinks; 1 32 kcal/0 7.3 g for drinks containing mineral salts in their composition; 14 69 kcal/2.6 17 g for fruit juice, nectar, and grape musts; 43 78 kcal/6.1 14.4 g for vegetable drinks; and 33 88 kcal/3.6 14 g for dairy drinks. The researchers concluded that the nonalcoholic beverage market is a dynamic, growing, and highly innovative one, allowing consumers to choose according to their preferences, needs, or level of physical activity at any moment of the day. Investigation on the composition of nonalcoholic beverages in the market could serve as a starting point for evaluating the growing offers of reformulated and new beverages. Furthermore, this approach allows periodical updates and could be a tool for dietary intake estimates in line with the reality of the market. In the United Kingdom, Kaur et al. (2015), used food-labeling data to investigate how many foods and nonalcoholic beverages carry health and nutrition claims, and whether those are healthier than foods not labeled with such claims. The study was done on randomly sampled products from those available through the retailer’s website. About 33% carried either a health or nutrition claim and 15% carried at least one health claim. When adjusted for product category, products carrying health claims tended to be lower in total and saturated fats than those that did not, but there was no significant difference in sugar or sodium levels. Interestingly, beverages were noted as the food category with the secondmost frequent use of nutrition and health claims (28%). Higher penetration of claims was observed only on milk and dairy products (31%). Also in Europe, a series of studies were conducted in Slovenia. First, the Slovenia food supply was investigated in 2011 to explore health-related labeling information (Pravst and Kuˇsar, 2015). Food-labeling data were collected from 6342 prepacked foods available in four different food stores. Consumers’ exposure was calculated as the percentage of available food products with particular food information in the food category. In addition, 12-month sales data were used to calculate sales-weighted exposure as a percentage of sold-food products with certain food information in the food category. The consumers’ in-store and sales-weighted exposure to nutrition claims was 37% and 45%, respectively. Exposure to health claims was much lower (13% in store, 11% when sales-weighted). In the category of fruit juices almost all products were labeled with a nutrition declaration (95%) and high penetration was also observed for soft drinks and waters (63%). Beverages were commonly labeled with vitamin nutrition claims, such as energy drinks (95%), isotonic and sport drinks (55%), fruit juices (31%), and nectars (27%). On the other hand, observing specific function health claims, the highest penetration was observed for isotonic and sport drinks (45%), while for fruit juices and smoothies 9.2% penetration and 7.6% penetration for soft drinks and water were observed. The fact that nutrition and/or health claims were found on about half the volume of the prepacked food market is a clear indication that this area must be carefully investigated for the role of health-related claims and health-related symbols on consumer behavior.

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Another cross-sectional study was conducted in Slovenia using data for 2015. The study investigated total and free-sugar content for 10,674 prepackaged food items available from major Slovenian food stores (Zupaniˇc et al., 2018a). Among the soft drinks, consumers were least likely to buy products containing extremely high free sugar levels ( . 15 g of free sugar per 100 g), although products with very low free sugar (0 5 g/100 g) were also bought less frequently. Market-leading drinks contained approximately 10 15 g of free sugars. Using year-round sales data provided by retailers, the investigation showed that chocolates, sweets, and soft drinks alone accounted for more than 50% of all free-sugar products sold on the Slovenian market. The same dataset was also used for the evaluation of overall nutritional quality of foods labeled with claims, using two nutrient-profile models, namely the FSANZNPSC and European World Health Organization Regional office for Europe model (WHOE) (Pivk Kupiroviˇc et al., 2019). The study showed that a considerable proportion of foods labeled with any type of health-related claim was found to have poor-nutritional quality. About 68% of the foods labeled with health-related claims passed the FSANZ criterion (75% when considering sales data) and 33% passed the WHOE model (56% when considering sales data). Looking at beverages only, the medium total sugar level was 5.8 g (per 100 mL) on products labeled with claim(s) and 7.6 g on beverages not labeled with claims (average for all beverages was 7.0 g/100 mL). About 23% of all soft drinks passed the FSANZ criterion, while in the sample of soft drinks labeled with nutrition or health claims this ratio was 47%. Several other studies were also conducted in Slovenia to investigate food supply using food-labeling data (Pravst et al., 2017; Zmitek and Pravst, 2016; Zupaniˇc et al., 2018b), but are less relevant for the category of nonalcoholic beverages and therefore not reviewed here in detail. However, Miklavec et al., investigated the use of FOP symbols as a tool to promote healthier food choices in Slovenia (Miklavec et al., 2016). The Protective Food (PF) symbol is wellrecognized by Slovenian consumers and used on notable proportion of foods in some food categories. The study conducted through an online questionnaire by 1050 adults showed that the majority of consumers were familiar with the PF symbol. Interesting research using food-labeling data was also done outside Europe. In Canada, an assessment of sugar in Canadian prepacked foods was performed in 2016 (Bernstein et al., 2016). The objectives of the study were: (1) the systematic calculation of free-sugar content; (2) a comprehensive assessment of total sugar and free-sugar levels; and (3) sweetener and free-sugar ingredient use. The University of Toronto’s Food Label Information Program database from 2013 (n 5 15,342) was used; free sugar accounted for 64% of total sugar content; eight of 17 food groups had 75% of the total sugar derived from free sugar; free sugar contributed 20% of calories overall in prepacked foods and beverages, with the highest at 70% in beverages. It is interesting to note another Canadian study which investigated the effects of food-labeling elements on consumers. Acton et al., explored the influence of three summary indicator FOP nutrition labels on consumer perceptions of the healthiness of different beverage products (Acton et al., 2018). A total of 675 respondents

298 Chapter 9 in southwestern Ontario aged 16 and over viewed images of soda, unflavored milk, and chocolate milk displaying one of four FOP label conditions (no FOP label, numeric rating, HSR, or simplified traffic light [STL]), and rated the products’ healthiness. Participants also indicated their preference for summary indicators versus nutrient-specific FOP labels. Consumers in the HSR and STL conditions, for example, were more likely to correctly perceive a chocolate milk beverage as “moderately healthy.” Most respondents (93%) indicated that they would like to see a health rating or nutrient-specific information on the front of food products. Results of this study suggest that the influence of FOP labels may vary based on the nutritional quality of food products and may have the greatest influence on consumer perceptions of “nutritionally ambiguous” foods. Another Canadian study was conducted to investigate whether foods and beverages carrying claims (nutrient content claims, health claims, and FOP symbols) had more favorable nutritional profiles than those without claims (Franco-Arellano et al., 2018). This study also examined differences in the global nutritional quality using FSANZ-NPSC where products bearing nutrition claims were compared with those without (n 5 15,184). About 63% of beverages carrying nutrition claims were found to be ineligible to carry claims based on the FSANZ-NPSC, in comparison to 72% of beverages without claims. Products with nutrition claims had fewer calories, less saturated fat, sodium, and sugar, and higher content of protein and fiber than comparable products without nutrition claims. In conclusion, nearly half of foods and beverages carrying nutrition claims in Canada did not meet the FSANZNPSC threshold, although Canadian products carrying nutrition claims have an overall “healthier” profile than their counterparts without such claims. Ni Mhurchu et al. (2016), investigated nutrient profiles of prepackaged foods and nonalcoholic beverages available in Australian and New Zealand supermarkets. They also investigated products’ eligibility to carry health claims and the relationship between nutrientprofile score and nutritional content. Nutritional composition data were collected in major supermarkets in 2012 and FSANZ-NPSC was used for nutrient profiling. About 45% of foods were eligible to carry health claims based on NPSC thresholds; 47% in Australia and 41% in New Zealand. The sample also contained 1040 beverages and 53% of the products passed the NPSC criteria. It should be also noted that Australia and New Zealand are countries with well-developed FOP labeling systems; several studies investigated different FOP labeling systems and how such systems affect consumers. For example, Yang et al., compared three different currently used or proposed FOP nutrition labeling systems using a range of prepackaged beverage products (Yang et al., 2016). The traffic-light system (TLS), % daily intake label, and the HSR systems were applied in accordance with established criteria and standards on 31 nonalcoholic, prepackaged beverages representing eight subcategories. Results showed considerable differences between labeling system ratings for the same products. The TLS had similar labeling when comparing soft drinks and fruit juice and sodium content was marked as low for all tested products. Percentage daily intake

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reflected similar results for regular soft drinks and fruit juices; however, in terms of energy, liquid breakfasts ranked highest followed by energy drinks, fruit juices, and soft drinks. The HSR showed the fruit juice category to be healthier than other beverages. Therefore the HSR system was concluded to be more suitable to label beverages based on better utility, applicability, and ease of identifying healthier beverage choices; however, this system would benefit from further refinement. Labeling simplicity, health representativeness, marketplace utility, and consumer comprehensiveness are important considerations for future labeling development. In another study, Billich et al. (2018), investigated whether FOP labels with a graphic warning, text warning, sugar information (with the number of teaspoons of added sugar), or HSR reduced intended choice of a sugar-sweetened beverage (SSB). An online choice experiment was conducted on 994 participants (young adults). Compared to the control group who were not exposed to a label, graphic warning, text warning, sugar information, or HSR labels all significantly reduced selection of a SSB in the choice scenario. The magnitude of effect was greatest for the graphic warning label. It was concluded that FOP labels, particularly those with graphic warnings, have the potential to reduce intended SSB purchases. Labels that also identify healthier alternatives may influence consumers to substitute SSBs with healthier drinks. The effects of the FOP nutrition labels on the reformulation was also investigated. Ni Mhurchu et al., evaluated the use of voluntary interpretive FOP labeling system using HSR in New Zealand (Ni Mhurchu et al., 2017). Annual surveys of packaged food and beverage labeling and composition were undertaken in supermarkets before and after the adoption of the HSR system, namely in 2014 16. In 2016 2 years after adoption of the voluntary system, 5.3% of packaged food and beverage products surveyed displayed HSR labels. Nonalcoholic beverages displaying HSR labels had significantly a lower mean of total-sugar contents than non HSR products. Reformulation of HSR-labeled products was greater than that of non HSR-labeled products over the same period, for example, energy reduction in HSR products was greater than in non HSR products (1.5% vs 0.4%). The authors concluded that the voluntary HSR labeling system was driving healthier reformulation of some products, and that greater uptake across the full food supply should improve population diets. In Argentina and Costa Rica, Tiscornia et al. (2017), also used food-labeling data to investigate food supply, focusing on the sugar content in nonalcoholic beverages. Sugar data were collected from 13 categories of nonalcoholic beverages available in supermarkets in 2012 and 2013, using 200 mL as a standard serving. Mean sugar levels were calculated. In both countries the majority of the beverages were sugar-sweetened (77.6%). The majority of them (56%) had sugar contents that were over 20% of the daily intake recommended by the WHO. The categories with the highest sugar content in Costa Rica were nectars (24.7 g/200 mL), fruit juices (22.5 g/200 mL), and regular soft drinks (22.5 g/ 200 mL). In Argentina the categories were regular soft drinks (20.9 g/200 mL), fruit juices (18.5 g/200 mL), and soy-based drinks (14.9 g/200 mL).

300 Chapter 9 Pongutta et al. (2018), investigated the nutritional quality of ready-to-eat packaged food products in Thailand. In 2015 they collected food-labeling data on 7205 ready-to-eat packaged foods from the biggest store of each of the 12 major retailers using INFORMAS protocols. The Thai Nutrient Profile Model was used to classify food products according to their nutritional quality as “healthier” or “less healthy.” The penetration of nutrition facts panel, a GDA label and health-related claims was 79%, 35%, and 21%, respectively. Out of 4689 products that could be classified according to the Thai Nutrient Profile Model, only 432 products (9%) were classified as healthier. The sample also contained 1728 sugary beverages, where penetration of nutrition and health claims was 23 and 8%, respectively, and the mean total sugar level was 6.1 g/100 g. About 900 of those could be evaluated using the nutrient profile and only 16% passed the Thai model as healthier. In China Huang et al. (2016), investigated the completeness of nutrient declarations and the average nutritional composition of prepackaged foods. This cross-sectional study was conducted on foods sampled in Beijing in 2013 after the implementation of mandatory nutrient declaration on prepackaged foods. The average nutritional composition of 14 different major food groups was calculated. Data for 11,489 products were included in the evaluation of nutrient declarations and data for 10,048 in the summary analysis of average nutritional composition. The content of sugar, which is not required by the Chinese regulation, was reported very infrequently (11%). Also in the category of nonalcoholic beverages, only 19% were labeled with total-sugar content. On those, very high and variable mean sugar levels were reported (20 6 22 g/100 g).

9.5 Conclusion Creating supportive environments that help consumers make healthy choices is an important underlying principle in promoting public health. Over the past decade the regulation of food labeling, including nutrition and health claims, has been one of the top food-related themes discussed in Europe. Regulations covering these topics are urgent to achieve a higher level of consumer protection and to guarantee their right to information. The food industry is dealing with challenges in the area of both general food labeling and specific areas of labeling, such as use of nutrition and health claims. General labeling was particularly affected by the regulation (EU) No. 1169/2011 on the provision of food information to consumers (EC, 2011). The main key changes in the area of general food labeling included mandatory presentation of nutrition declaration, highlighting allergens on the list of ingredients of prepacked foods, ensuring better legibility, and the mandatory labeling of the origin of some unprocessed meats. The use of nutritional and health claims was harmonized in 2006 with regulation (EC) 1924/2006 (EC, 2006), but a number of implementing acts was accepted later on.

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Food packing offers an opportunity for the identification foods that suit consumers’ individual dietary needs and to encourage healthier food choices. To achieve this, nutrition labeling can present key information; however, the efficiency of this is considerably affected by a variety of factors. Indeed, nutrition declarations as mandatory information on food labels in the EU since 2016 presented a major step forward. However, while some consumers use the nutrition label, many consumers pay little attention to them because the labels can be challenging to understand and interpret. Simplified FOP nutrition labels can address this issue by providing consumers with easier assessment of the nutritional quality and healthfulness of a product. FOP labeling should provide a simple and visible summary of the product’s nutritional quality. Under EU regulations, FOP labeling is not compulsory, but it has been implemented through some national government policies to influence public health by giving consumers informed choices for healthier food purchase decisions which will improve their overall diet and health. At the industry level, FOP labeling can motivate food manufacturers to either reformulate existing products or develop new ones in order to provide healthier options that can carry more favorable nutrition label. The use of nutrition and health claims also enable the promotion foodstuffs with better nutritional composition. Products promoted with such claims may be perceived by consumers as having nutrition and health advantages in comparison to other foods. With nutrition claims the food manufacturer gives consumers information regarding the amount of nutrients, or whether the nutrient content is high or low in comparison with other products on the market. Furthermore, health claims have the potential of communicating certain health effects. Most authorized health claims relate to nutrients and their function in the body and are based on scientific, nutritional knowledge. When interpreting health-related information consumers have to rely on the available information and their knowledge. Since everyday food choices tend to be low-involvement, fast, habitual decisions, the situation where claims mask the overall nutritional status of a food product containing high content of adverse nutrients (salt, fats, sugars, etc.) can mislead consumers when trying to make healthy choices in the context of a balanced diet. The health claim legislation in the EU provided an introduction of nutrient profiles, meaning that only products with favorable nutritional quality would be allowed to carry health claims. However, nutrient profiles have not yet been established. The decision whether nutrient profiles will be implemented will be taken on the basis of the European Commission’s Regulatory Fitness and Performance program (EC, 2018). Nevertheless, to assure nonmisleading information on food labels, food manufacturers should be encouraged to use nutrition and health claims only on foods and drinks with favorable nutritional compositions. Providing nutrition and health-related information on food labels represents an opportunity to improve consumers’ choices toward healthier foods, but the crucial factor in this aspect could be consumers’ motivation. A major challenge is to find ways to reach unmotivated consumers.

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Acknowledgments This research was financially supported by the research program “Nutrition and Public Health” (P3-0395) funded by Slovenian Research Agency, and research project “Sugars in human nutrition: availability in foods, dietary intakes and health effects” (L3-9290) funded by Slovenian Research Agency and Ministry of Health of Republic of Slovenia. The funding organizations had no role in writing this chapter.

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Further Reading Australia New Zealand, 2017. Food Standards Code: Schedule 5—Nutrient profiling scoring method. Berryman, P. (Ed.), 2015. Advances in Food and Beverage Labelling. Woodhead Publishing Series in Food Science, Technology and Nutrition. Woodhead Publishing, ISBN 9781782420859, https://doi.org/10.1016/ B978-1-78242-085-9.50016-7. FAO/WHO, 2019. Codex Alimentarious Commission: proposal for new work concerning a global standard for front of pack interpretive nutrition labelling. Available from: ,http://www.fao.org/fao-who-codexalimentarius/ sh-proxy/en/?lnk 5 1&url 5 https%253A%252F%252Fworkspace.fao.org%252Fsites%252Fcodex% 252FMeetings%252FCX-714-43%252FCRD%252Ffl43_CRD17x.pdf.. WHO, 2019. Global strategy on diet, physical activity and health. Available from: ,https://www.who.int/ dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf..