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Use of Added Sugars Instead of Total Sugars May Improve the Capacity of the Health Star Rating System to Discriminate between Core and Discretionary Foods.
J Acad Nutr Diet. 2017 Dec; 117(12):1921-1930.e11.JA

Abstract

BACKGROUND

The Australian Government has introduced a voluntary front-of-package labeling system that includes total sugar in the calculation.

OBJECTIVE

Our aim was to determine the effect of substituting added sugars for total sugars when calculating Health Star Ratings (HSR) and identify whether use of added sugars improves the capacity to distinguish between core and discretionary food products.

DESIGN

This study included packaged food and beverage products available in Australian supermarkets (n=3,610). The product categories included in the analyses were breakfast cereals (n=513), fruit (n=571), milk (n=309), non-alcoholic beverages (n=1,040), vegetables (n=787), and yogurt (n=390). Added sugar values were estimated for each product using a validated method. HSRs were then estimated for every product according to the established method using total sugar, and then by substituting added sugar for total sugar. The scoring system was not modified when added sugar was used in place of total sugar in the HSR calculation. Products were classified as core or discretionary based on the Australian Dietary Guidelines. To investigate whether use of added sugar in the HSR algorithm improved the distinction between core and discretionary products as defined by the Australian Dietary Guidelines, the proportion of core products that received an HSR of ≥3.5 stars and the proportion of discretionary products that received an HSR of <3.5 stars, for algorithms based upon total vs added sugars were determined.

RESULTS

There were 2,263 core and 1,347 discretionary foods; 1,684 of 3,610 (47%) products contained added sugar (median 8.4 g/100 g, interquartile range=5.0 to 12.2 g). When the HSR was calculated with added sugar instead of total sugar, an additional 166 (7.3%) core products received an HSR of ≥3.5 stars and 103 (7.6%) discretionary products received a rating of ≥3.5 stars. The odds of correctly identifying a product as core vs discretionary were increased by 61% (odds ratio 1.61, 95% CI 1.26 to 2.06; P<0.001) when the algorithm was based on added compared to total sugars.

CONCLUSIONS

In the six product categories examined, substitution of added sugars for total sugars better aligned the HSR with the Australian Dietary Guidelines. Future work is required to investigate the impact in other product categories.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29173348

Citation

Menday, Hannah, et al. "Use of Added Sugars Instead of Total Sugars May Improve the Capacity of the Health Star Rating System to Discriminate Between Core and Discretionary Foods." Journal of the Academy of Nutrition and Dietetics, vol. 117, no. 12, 2017, pp. 1921-1930.e11.
Menday H, Neal B, Wu JHY, et al. Use of Added Sugars Instead of Total Sugars May Improve the Capacity of the Health Star Rating System to Discriminate between Core and Discretionary Foods. J Acad Nutr Diet. 2017;117(12):1921-1930.e11.
Menday, H., Neal, B., Wu, J. H. Y., Crino, M., Baines, S., & Petersen, K. S. (2017). Use of Added Sugars Instead of Total Sugars May Improve the Capacity of the Health Star Rating System to Discriminate between Core and Discretionary Foods. Journal of the Academy of Nutrition and Dietetics, 117(12), 1921-e11. https://doi.org/10.1016/j.jand.2017.08.013
Menday H, et al. Use of Added Sugars Instead of Total Sugars May Improve the Capacity of the Health Star Rating System to Discriminate Between Core and Discretionary Foods. J Acad Nutr Diet. 2017;117(12):1921-1930.e11. PubMed PMID: 29173348.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of Added Sugars Instead of Total Sugars May Improve the Capacity of the Health Star Rating System to Discriminate between Core and Discretionary Foods. AU - Menday,Hannah, AU - Neal,Bruce, AU - Wu,Jason H Y, AU - Crino,Michelle, AU - Baines,Surinder, AU - Petersen,Kristina S, PY - 2017/03/21/received PY - 2017/08/10/accepted PY - 2017/11/28/entrez PY - 2017/11/28/pubmed PY - 2017/12/15/medline KW - Added sugar KW - Food label KW - Front-of-pack label KW - Health Star Rating KW - Nutrition Information Panel SP - 1921 EP - 1930.e11 JF - Journal of the Academy of Nutrition and Dietetics JO - J Acad Nutr Diet VL - 117 IS - 12 N2 - BACKGROUND: The Australian Government has introduced a voluntary front-of-package labeling system that includes total sugar in the calculation. OBJECTIVE: Our aim was to determine the effect of substituting added sugars for total sugars when calculating Health Star Ratings (HSR) and identify whether use of added sugars improves the capacity to distinguish between core and discretionary food products. DESIGN: This study included packaged food and beverage products available in Australian supermarkets (n=3,610). The product categories included in the analyses were breakfast cereals (n=513), fruit (n=571), milk (n=309), non-alcoholic beverages (n=1,040), vegetables (n=787), and yogurt (n=390). Added sugar values were estimated for each product using a validated method. HSRs were then estimated for every product according to the established method using total sugar, and then by substituting added sugar for total sugar. The scoring system was not modified when added sugar was used in place of total sugar in the HSR calculation. Products were classified as core or discretionary based on the Australian Dietary Guidelines. To investigate whether use of added sugar in the HSR algorithm improved the distinction between core and discretionary products as defined by the Australian Dietary Guidelines, the proportion of core products that received an HSR of ≥3.5 stars and the proportion of discretionary products that received an HSR of <3.5 stars, for algorithms based upon total vs added sugars were determined. RESULTS: There were 2,263 core and 1,347 discretionary foods; 1,684 of 3,610 (47%) products contained added sugar (median 8.4 g/100 g, interquartile range=5.0 to 12.2 g). When the HSR was calculated with added sugar instead of total sugar, an additional 166 (7.3%) core products received an HSR of ≥3.5 stars and 103 (7.6%) discretionary products received a rating of ≥3.5 stars. The odds of correctly identifying a product as core vs discretionary were increased by 61% (odds ratio 1.61, 95% CI 1.26 to 2.06; P<0.001) when the algorithm was based on added compared to total sugars. CONCLUSIONS: In the six product categories examined, substitution of added sugars for total sugars better aligned the HSR with the Australian Dietary Guidelines. Future work is required to investigate the impact in other product categories. SN - 2212-2672 UR - https://www.unboundmedicine.com/medline/citation/29173348/Use_of_Added_Sugars_Instead_of_Total_Sugars_May_Improve_the_Capacity_of_the_Health_Star_Rating_System_to_Discriminate_between_Core_and_Discretionary_Foods_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2212-2672(17)31243-1 DB - PRIME DP - Unbound Medicine ER -