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Incorporating Added Sugar Improves the Performance of the Health Star Rating Front-of-Pack Labelling System in Australia.
Nutrients. 2017 Jul 05; 9(7)N

Abstract

BACKGROUND

The Health Star Rating (HSR) is an interpretive front-of-pack labelling system that rates the overall nutritional profile of packaged foods. The algorithm underpinning the HSR includes total sugar content as one of the components. This has been criticised because intrinsic sugars naturally present in dairy, fruits, and vegetables are treated the same as sugars added during food processing. We assessed whether the HSR could better discriminate between core and discretionary foods by including added sugar in the underlying algorithm.

METHODS

Nutrition information was extracted for 34,135 packaged foods available in The George Institute's Australian FoodSwitch database. Added sugar levels were imputed from food composition databases. Products were classified as 'core' or 'discretionary' based on the Australian Dietary Guidelines. The ability of each of the nutrients included in the HSR algorithm, as well as added sugar, to discriminate between core and discretionary foods was estimated using the area under the curve (AUC).

RESULTS

15,965 core and 18,350 discretionary foods were included. Of these, 8230 (52%) core foods and 15,947 (87%) discretionary foods contained added sugar. Median (Q1, Q3) HSRs were 4.0 (3.0, 4.5) for core foods and 2.0 (1.0, 3.0) for discretionary foods. Median added sugar contents (g/100 g) were 3.3 (1.5, 5.5) for core foods and 14.6 (1.8, 37.2) for discretionary foods. Of all the nutrients used in the current HSR algorithm, total sugar had the greatest individual capacity to discriminate between core and discretionary foods; AUC 0.692 (0.686; 0.697). Added sugar alone achieved an AUC of 0.777 (0.772; 0.782). A model with all nutrients in the current HSR algorithm had an AUC of 0.817 (0.812; 0.821), which increased to 0.871 (0.867; 0.874) with inclusion of added sugar.

CONCLUSION

The HSR nutrients discriminate well between core and discretionary packaged foods. However, discrimination was improved when added sugar was also included. These data argue for inclusion of added sugar in an updated HSR algorithm and declaration of added sugar as part of mandatory nutrient declarations.

Authors+Show Affiliations

The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, UK. sanne.peters@georgeinstitute.ox.ac.uk.Carolina Population Center, The University of North Carolina, Chapel Hill, NC 27516, USA. edunford@georgeinstitute.org.au. The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia. edunford@georgeinstitute.org.au.The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia. ajones@georgeinstitute.org.au. The Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia. ajones@georgeinstitute.org.au.National Institute for Health Innovation, University of Auckland, Auckland 1072, New Zealand. c.nimhurchu@auckland.ac.nz.The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia. mcrino@georgeinstitute.org.au. School of Public Health, Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia. mcrino@georgeinstitute.org.au.The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia. ftaylor@georgeinstitute.org.au.The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, UK. markw@georgeinstitute.org.au. The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia. markw@georgeinstitute.org.au. Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21218, USA. markw@georgeinstitute.org.au.The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia. bneal@georgeinstitute.org.au.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28678187

Citation

Peters, Sanne A E., et al. "Incorporating Added Sugar Improves the Performance of the Health Star Rating Front-of-Pack Labelling System in Australia." Nutrients, vol. 9, no. 7, 2017.
Peters SAE, Dunford E, Jones A, et al. Incorporating Added Sugar Improves the Performance of the Health Star Rating Front-of-Pack Labelling System in Australia. Nutrients. 2017;9(7).
Peters, S. A. E., Dunford, E., Jones, A., Ni Mhurchu, C., Crino, M., Taylor, F., Woodward, M., & Neal, B. (2017). Incorporating Added Sugar Improves the Performance of the Health Star Rating Front-of-Pack Labelling System in Australia. Nutrients, 9(7). https://doi.org/10.3390/nu9070701
Peters SAE, et al. Incorporating Added Sugar Improves the Performance of the Health Star Rating Front-of-Pack Labelling System in Australia. Nutrients. 2017 Jul 5;9(7) PubMed PMID: 28678187.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incorporating Added Sugar Improves the Performance of the Health Star Rating Front-of-Pack Labelling System in Australia. AU - Peters,Sanne A E, AU - Dunford,Elizabeth, AU - Jones,Alexandra, AU - Ni Mhurchu,Cliona, AU - Crino,Michelle, AU - Taylor,Fraser, AU - Woodward,Mark, AU - Neal,Bruce, Y1 - 2017/07/05/ PY - 2017/05/31/received PY - 2017/06/20/revised PY - 2017/06/30/accepted PY - 2017/7/6/entrez PY - 2017/7/6/pubmed PY - 2018/4/14/medline KW - Health Star Rating KW - food policy KW - front-of-pack labelling KW - nutrition labels KW - public health JF - Nutrients JO - Nutrients VL - 9 IS - 7 N2 - BACKGROUND: The Health Star Rating (HSR) is an interpretive front-of-pack labelling system that rates the overall nutritional profile of packaged foods. The algorithm underpinning the HSR includes total sugar content as one of the components. This has been criticised because intrinsic sugars naturally present in dairy, fruits, and vegetables are treated the same as sugars added during food processing. We assessed whether the HSR could better discriminate between core and discretionary foods by including added sugar in the underlying algorithm. METHODS: Nutrition information was extracted for 34,135 packaged foods available in The George Institute's Australian FoodSwitch database. Added sugar levels were imputed from food composition databases. Products were classified as 'core' or 'discretionary' based on the Australian Dietary Guidelines. The ability of each of the nutrients included in the HSR algorithm, as well as added sugar, to discriminate between core and discretionary foods was estimated using the area under the curve (AUC). RESULTS: 15,965 core and 18,350 discretionary foods were included. Of these, 8230 (52%) core foods and 15,947 (87%) discretionary foods contained added sugar. Median (Q1, Q3) HSRs were 4.0 (3.0, 4.5) for core foods and 2.0 (1.0, 3.0) for discretionary foods. Median added sugar contents (g/100 g) were 3.3 (1.5, 5.5) for core foods and 14.6 (1.8, 37.2) for discretionary foods. Of all the nutrients used in the current HSR algorithm, total sugar had the greatest individual capacity to discriminate between core and discretionary foods; AUC 0.692 (0.686; 0.697). Added sugar alone achieved an AUC of 0.777 (0.772; 0.782). A model with all nutrients in the current HSR algorithm had an AUC of 0.817 (0.812; 0.821), which increased to 0.871 (0.867; 0.874) with inclusion of added sugar. CONCLUSION: The HSR nutrients discriminate well between core and discretionary packaged foods. However, discrimination was improved when added sugar was also included. These data argue for inclusion of added sugar in an updated HSR algorithm and declaration of added sugar as part of mandatory nutrient declarations. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/28678187/Incorporating_Added_Sugar_Improves_the_Performance_of_the_Health_Star_Rating_Front_of_Pack_Labelling_System_in_Australia_ L2 - https://www.mdpi.com/resolver?pii=nu9070701 DB - PRIME DP - Unbound Medicine ER -