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1 Appendix 4. Overview of product group descriptions, criteria and rationales Development of international criteria for a front of package food labelling system: international Choices Programme 2 INTRODUCTION The detailed rationales below refer to the set of nutrient profiles that have been defined for the Choices programme in the paper: “Development of international criteria for a front of package food labelling system: international Choices Programme”. Table 1 and 2 show the overview of these nutrient profiles: including descriptions of the product groups and the specific criteria. Table 1. Overview of generic1 and product group specific criteria, including description of basic product groups2 Product group2 Overview Choices criteria3,4 Fresh or fresh frozen fruit, vegetables and legumes All types of fresh fruit, vegetables, and potatoes without additives, including freshly frozen and/or sliced fruit & vegetables. Pre-cut leek, pre-sliced melon, cucumber, broccoli, deep-frozen spinach (without added cream), raspberries. Processed fruit & vegetables All types of processed fruit & vegetables, with the exception of fruit juices and frozen or pre-sliced fruit & vegetables without further processing. E.g.: tinned tomatoes, tinned carrots, tinned kidney beans, deep-frozen spinach à la crème, deep-frozen vegetables, tomato juice, dried lentils, pickles, mixed vegetable juices, dried apricots or figs, pine on juice, fruit cocktail in own juice or syrup, apple sauce, candied dates, strawberry purée, olives, mixed fruit & vegetable purées or juices. Fruit Juices All kinds of fruit juices with a minimum of 98% own juice. Orange juice, apple juice, multi-fruit juice. All products without additives comply Water (plain) Includes natural (mineral) waters and other bottled waters, each of which may be non-carbonated or carbonated Potatoes (unprocessed) All unprocessed uncooked potatoes, without additives, including uncooked peeled, sliced and/or chilled potatoes. Potatoes (processed), pasta, noodles All kinds of potato products, pasta and similar grain products, used for a main dish. Boiled/ fried potatoes, mashed potato, (wholemeal) pasta. Rice All kinds of rice, used for a main dish. Boiled, dried unpolished rice, white rice, whole grain rice. Bread All kinds of bread or substitutes for bread with the exception of breakfast cereals. Wheat bread, wholemeal bread, crisp bread, croissants, rye bread, speciality rolls, crackers. SAFA: ≤ 1.1 g/100g TFA: ≤ 0.1 g/100g Sodium: ≤ 100mg/100g Added sugar: not added Fibre: ≥ 1.3 g/100kcal5 SAFA: ≤ 1.1 g/100g TFA: ≤ 0.1 g/100g Sodium: ≤ 100mg/100g Added sugar: not added Fibre: ≥ 0.75 g/100kcal5 Energy: ≤ 48 kcal/100mL Sodium: ≤ 20mg/100mL All products without additives comply SAFA: ≤ 1.1 g/100g TFA: ≤ 0.1 g/100g Sodium: ≤ 100mg/100g Added sugar: not added Fibre: ≥ 1.3 g/100kcal5 SAFA: ≤ 1.1 g/100g TFA: ≤ 0.1 g/100g Sodium: ≤ 100mg/100g Added sugar: not added Fibre: ≥ 0.7 g/100kcal5 SAFA: ≤ 1.1 g/100g TFA: ≤ 0.1 g/100g Sodium: ≤ 500mg/100g Added sugar: ≤ 13 en% 3 Product group2 Grains and cereal products All kinds of grains and cereal products (other than bread and breakfast cereal), flour, breadcrumbs, binding agents, pancake mixes. Breakfast cereal products All kinds of breakfast cereal products (muesli, cruesli, outs, cornflakes, rice crispies). Meat, poultry, eggs (unprocessed) All kinds of unprocessed meat, poultry and eggs (including deepfrozen meat without further processing). Beef, pork, turkey, egg. Processed meat, meat products and meat substitutes All kinds of processed meat/poultry, meat products and (vegetable) meat substitutes. Ready-to-eat meatballs, spiced or salted meat (fresh or deep-frozen), salami, smoke-dried beef, grilled ham, tempeh, tofu, dairy-based meat substitute, fungusbased meat substitute. Fresh or fresh frozen fish, shellfish and crustaceans All kinds of unprocessed fish, crustaceans and shellfish (including deep-frozen fish without further processing). Uncooked herring, cod (fresh or deep-frozen), fresh eel, lobster crab, mussel, shrimp. Overview Choices criteria3,4 Fibre: ≥ 1.3 g/100kcal5 SAFA: ≤ 1.1 g/100g TFA: ≤ 0.1 g/100g Sodium: ≤ 100mg/100g Added sugar: ≤ 2.5g/100g Fibre: ≥ 1.3 g/100kcal5 SAFA: ≤ 13 en% TFA: ≤ 0.1 g/100g Sodium: ≤ 500 mg/100g Added sugar: ≤ 20 g/100g Fibre: ≥ 1.3 g/100kcal5 SAFA: ≤ 1.1 g/100g or ≤ 13 en% TFA: ≤ 0.1 g/100g6 Sodium: ≤ 100 mg/100g Added sugar: not added SAFA: ≤ 1.1 g/100g or ≤ 13 en % TFA: ≤ 0.1 g/100g6 Sodium: ≤ 900 mg/100g Added sugar: ≤ 2.5g/100g SAFA: ≤ 1.1 g/100g or ≤ 30 % of total fat TFA: ≤ 0.1 g/100g Sodium: ≤ 100 mg/100g Added sugar: not added Processed fish or fish products All kinds of processed fish, processed crustaceans and processed shellfish. Cod parings, fried fillet of haddock, deep-fried octopus/ squid (cephalopod), pickled mussels, herring in tomato sauce, tinned sardines, tinned tuna, spiced or salted fish (fresh or deepfrozen). SAFA: ≤ 1.1 g/100g or ≤ 30 % of total fat TFA: ≤ 0.1 g/100g Sodium: ≤ 450 mg/100g Added sugar: not added Milk (-products) All kinds of milk and milk products. E.g.: low fat milk, buttermilk semi-skimmed milk, full-cream milk, low fat yoghurt, semiskimmed yoghurt, yoghurt drink, low fat custard, low fat fruit yoghurt, evaporated milk, coffee cream, cream (for culinary use), milk substitutes like soymilk. Cheese (-products) All kinds of cheese and cheese products. 20+ cheese, 30+ cheese, Edam, Brie 50+, 48+ Gouda cheese, blue cheese, gorgonzola, gruyère, soft herb cheese. SAFA: ≤ 1.4 g/100g TFA: ≤ 0.1 g/100g6 Sodium: ≤ 100 mg/100g Added sugar: ≤ 5 g/100g Oils, fats and fat containing spreads All fats and oils used as spreads on bread and/or the preparation of food. Oil (all types), low-fat margarine, margarine, butter, oil/fat products for roasting and frying (solid or liquid). SAFA: ≤ 30% of total fat TFA: ≤ 1.3 en%6 Sodium: ≤ 1.3 mg/kcal Added sugar: not added Main course All ready-to-cook meals that are intended to be eaten as main dish during lunch or dinner. Meals for steaming, ready-to-cook meals, pizza, mixes for main dishes, deep-frozen meals SAFA: ≤ 1.1 g/100g or ≤ 13 en% TFA: ≤ 0.1 g/100g or ≤ 1.3 en%6 Sodium: ≤ 2.2 mg/kcal Added sugar: ≤ 2.5g/100g or ≤ 13 en% Fibre: ≥ 1.25g/100kcal5 Energy: 400-700kcal/serving SAFA: ≤ 1.1 g/100g or ≤ 13 en% Filled sandwiches/rolls SAFA: ≤ 15 g/100g TFA: ≤ 0.1 g/100g6 Sodium: ≤ 900 mg/100g Added sugar: not added 4 Product group2 All ready-to-eat filled sandwiches/rolls Overview Choices criteria3,4 TFA: ≤ 0.1 g/100g or ≤ 1.3 en%6 Sodium: ≤ 1.9 mg/kcal Added sugar: ≤ 2.5g/100g or ≤ 13 en% Fibre: ≥ 0.8g/100kcal5 Energy: ≤ 350 kcal/serving National deviation example SAFA: ≤ 2 g/100g TFA: ≤ 0.1 g/100g6 Sodium: ≤ 400 mg/100g Added sugar: not added 1) Generic criteria are translated from population intake goals (1) as described in the paper: “Development of international criteria for a front of package food labelling system: international Choices Programme”. 2) Based on the product group classifications as used in food-based dietary guidelines in more than 20 countries Australia (2) Belgium (3), Caribbean (4), Canada (5), China (6), Denmark (7), Finland (8), France (9), Germany (10), Greece (11), Hungary (12), Malaysia (13), Mexico (14), Namibia (15), Netherlands (16), Philippines (17), Portugal (18), Singapore (19), Spain (20), Sweden (21), Turkey (22), UK (23), various countries (24, 25). 3) If possible the generic criteria were fixed per product group: either as en% or g/100g. However when this would lead to needless exclusion of low energy dense foods, both generic criteria (en% or g/100g) can be used. 4) Details on the rationales behind the product group specific criteria can be found below. 5) For each product group the fibre in a product has to come from ingredients products of the same product group. 6) Naturally occurring trans fat from meat or milk is excluded. Soft white cheese (Israel) Soft white spreadable cheeses with percentage moisture on a fatfree basis (MFFB) > 67%. Cottage cheese, white cheese spreads 5 Table 2. Overview of generic1 and product group specific criteria, including description of discretionairy product groups. Product group Overview Choices criteria2,3 Soups All kinds of soups and broths. Tinned soup, deep-frozen soup, soup in stand-up pouches, soup served by the catering industry SAFA: ≤ 1.1 g/100g TFA: ≤ 0.1 g/100g Sodium: ≤ 300 mg/100g Added sugar: ≤ 2.5g/100g Energy: ≤ 100 kcal/100g SAFA: ≤ 1.1 g/100g TFA: ≤ 0.1 g/100g Sodium: ≤ 450 mg/100g Added sugar: ≤ 2.5g/100g Energy: ≤ 100 kcal/100g SAFA: ≤ 1.1 g/100g TFA: ≤ 0.1 g/100g Sodium: ≤ 750 mg/100g Energy: ≤ 100 kcal/100g Meal sauces All sauces that constitute a substantial component of the meal (portion size > 35 g). E.g. Pasta sauce, béchamel sauce, vegetable sauce, meat sauce, fish sauce, cheese sauce, mustard sauce, gravy. Other sauces (on water basis) All sauces that constitute only a minor component of the meal (portion size < 35 g) without added emulsifying agent AND have a fat content < 10% w/w. E.g. Ketchup, soy sauce, chocolate sauce, fruit sauce, barbecue sauce. Other sauces (emulsions) All sauces that constitute only a minor component of the meal (portion size < 35 g) to which an emulsifying agent is added OR have a fat content ≥ 10% w/w. E.g. Mayonnaise, salad dressing, dip sauce, marinade, mustard, vinaigrette. SAFA: ≤ 1.1 g/100g & 30 % total fat TFA: ≤ 0.1 g/100g & 1.3 en% Sodium: ≤ 750 mg/100g Added sugar: ≤ 13 en% & 2.5g/100g Energy: ≤ 350 kcal/100g Snacks (including pastry, edible ice cream, sweet snacks and savoury snacks) All kinds of sweet, savoury, and sweet baked products intended to be eaten as a small snack between meals or as a minor component of a meal. E.g. Savoury products: potato crisps, popcorn; Sweet products: sweets, all types of chocolate, candy bars; Sweet baked products: biscuits, cookies, all types of cake and pastries. Ice cream: vanilla ice cream, sorbet, yoghurt ice, sorbet ice, milkshake. SAFA: ≤ 1.1 g/100g or ≤ 13 en% TFA: ≤ 0.1 g/100g or ≤ 1.3 en% Sodium: ≤ 400 mg/100g Added sugar: ≤ 20 g/100g Energy: ≤ 110 kcal/serving Beverages Liquid food products that are normally consumed from a cup, mug or glass (incl. products packed in portions in packaging, bottles, etc.), with the exception of dairy products and fruit juices. E.g. coffee, tea, (light) soft drinks, fruit drinks. Bread toppings incl. hummus like products All kinds of food product that are ment to be put on bread/toast and not fall under earlier mentioned product groups. E.G. jam, peanut butter, thunasalad, hummus, tahini SAFA: ≤ 1.1 g/100g TFA: ≤ 0.1 g/100g Sodium: ≤ 20 mg/100g Energy: ≤ 20 kcal/100mL SAFA: ≤ 13 en% TFA: ≤ 1.3 en% Sodium: ≤ 400 mg/100g Added sugar: ≤ 30 g/100g SAFA: ≤ 1.1 g/100g or ≤ 13 en% TFA: ≤ 0.1 g/100g or ≤ 1.3 en% Sodium: ≤ 100 mg/100g or ≤ 1.3 mg/kcal Added sugar: ≤ 2.5 g/100g or ≤ 13 en% 1) Generic criteria are translated from population intake goals (1) as described in the paper: “Development of international criteria for a front of package food labelling system: international Choices Programme”. 2) If possible the generic criteria were fixed per product group: either as en% or g/100g. However when this would lead to needless exclusion of low energy dense foods, both generic criteria (en% or g/100g) can be used. 3) Details on the rationales behind the product group specific criteria can be found below. All other products All kinds of food product that do not fall within any of the above mentioned product groups. E.g. baking product, seasonings, vinegar. 6 PRODUCT GROUP SPECIFIC CRITERIA: DETAILED RATIONALES Rationale All products comply: Fresh or fresh frozen fruit, vegetables and legumes, unprocessed potatoes; water Fruit, vegetables, legumes and potatoes are carriers of essential nutrients. Consumption should be stimulated. The same is the case for plain water. Thus the main rationale is alignment with recommendation to consume more fresh fruit and vegetables and drink plain water. Rationales SAFA criteria: Fish, fish products, fats and oils and emulsion-based sauces (30% total fat) These are products high in fat. Applying the generic SAFA criterion (13 en%) would imply that none of these products would qualify for a Choices stamp. Because the quality of fat is more relevant than the SAFA quantity, the SAFA criterion for these products is expressed as percentage of total fat, rather than percentage of energy. This way consumption of unsaturated fatty acids is stimulated. In summary: the main rationale is alignment with recommendation to consume sufficient unsaturated fatty acids. Milk products (1.4g/100g): With the current generic insignificancy level for SAFA (1.1 g/100g) semi-skimmed milk does not comply. International legislation (26) and seasonal influences determine the fat content of the milk. Semi-skimmed milk consumption is important for intake of calcium, protein and B vitamins. Therefore it has been agreed to keep the SAFA criterion for milk products at 1.4g/100g. In summary: the main rationale is alignment with recommendation to consume semi-skimmed milk. Cheese (15g/100g): The percentage of cheeses for the combined European test database that comply with the generic criteria is zero (see Appendix 3a. Detailed characteristics per product group). The discriminating nutrients are sodium and saturated fat. Saturated fat content is determined by the content of milk (milk fat consists of 2/3 SAFA), which is a legally required ingredient in cheese (26, 27). The criterion of 15g SAFA/100g allows reduced-fat cheese to comply. Thus the main rationale is to allow healthier choices within the product group cheese. White soft cheese, Israel (2g/100g): Data from Israel indicated that these products are an important source of essential nutrients (such as calcium and B-vitamins) in the Israeli diet (See Appendix 1. Israeli Case study). 7 There was not enough data available that indicate this is also the case for other parts of the world, especially Europe. Therefore it was decided that this criterion would (for now) be applied to Israel only. Thus the main rationale is alignment with recommendation to consume dairy products. Rationales sodium criteria Water (plain) and beverages (20mg/100mL): All plain waters comply with the criteria. Mineral waters can be high in sodium levels. To ensure that sodium content does not increase above undesirable levels the 20mg/100mL is used as sodium criterion, which is the European directive (28). Thus the main rationale is alignment with recommendation to limit intake of salt. Bread and breakfast cereal products (500mg/100g): Few breads and breakfast cereals comply with the generic sodium criteria according to the combined European test database (see Appendix 3a. Detailed characteristics per product group). Therefore, a product group specific criterion for sodium was set for bread, based on the sodium benchmarks from available food standards (29, 30). The same cut-off was also used for breakfast cereal products. In summary: the main rationale is to stimulate innovation to lower the salt content in these product groups. Processed meat (900mg/100g) & processed fish (450mg/100g): The percentage of processed meat and fish (products) complying with the generic criteria is relatively low (see Appendix 3a. Detailed characteristics per product group). A product group specific criterion for processed meat was set based on available food standards (31, 32). Processed fish contain less salt therefore the cut-off was set at 50% of the processed meat criterion. Thus the main rationale is to stimulate innovation to lower the salt content in these product groups. Cheese (900mg/100g): As mentioned above the discriminating nutrients in cheese are sodium and saturated fat. Sodium is needed for the cheese making process and for conservation (33). The lower the fat level, the more sodium is needed. The proposed level of 900 mg/100g was seen as a realistic target. Thus the main rationale is to stimulate innovation to lower the salt content in this product group. White soft cheese, Israel (400mg/100g): Data from Israel indicated that these products are an important source of essential nutrients (such as calcium and B-vitamins) in the Israeli diet (See Appendix 1. Israeli case study). 8 There was not enough data available that indicate this is also the case for other parts of the world. Therefore it was decided that this criterion would (for now) be applied to Israel only. Thus the main rationale is to stimulate innovation to lower the salt content in this product group. Main course (2.2mg/kcal) & filled sandwiches (1.9mg/kcal): When applying the generic criterion for sodium (1.3 mg/kcal) few main courses would comply (see Appendix 3a. Detailed characteristics per product group). Thus the proposed sodium criterion was set at 2.2 mg/kcal for main course, which is the median sodium level in the product group of main courses in the combined European test database. For filled sandwiches, the sodium criterion was determined by the weighted average of the criteria for bread and toppings assuming that a sandwich consists of 60% bread and 40% topping. Average energy densities were assumed to be 2 kcal/g for bread and 2.5 kcal/g for bread toppings. The calculation of the criteria is as follows: 60% x Sodium criterion bread (500mg/100g = 2.4mg/kcal) + 40% x Sodium criterion bread toppings (400mg/100g = 1.6mg/kcal) = 1.9 mg/kcal This still resulted in few complying products for both groups; however experiences in the Netherlands show that these are not too strict to motivate producers to innovate. There are examples on the Dutch market that fulfil the criteria. This illustrates that the combined European test database is of limited value for these product groups. In summary: the main rationale is to stimulate innovation to lower the salt content in these product groups. Soups (300mg/100g), meal sauces (450mg/100g) & sauces water/emulsion based (750mg/100g): Applying the generic sodium criteria to these products, which are relatively salty, would result in very few products that can comply. Thus, to stimulate innovation of products that remain acceptable for consumers regarding sodium levels, a product group specific sodium criterion was set at levels based on various food standards (29, 30, 34). In summary: the main rationale is to stimulate innovation to lower the salt content in these product groups. Snacks & bread toppings (400mg/100g): Sodium criterion for snacks was set in such a way that around 5% of the savoury snacks would comply (Appendix 3a. Detailed characteristics per product group). This same level was applied to the product group bread toppings. Thus the main rationale is to stimulate innovation to lower the salt content in these product groups. 9 Rationales added sugar criteria No added sugar: fruit juices; processed potatoes, pasta, noodles; rice; unprocessed meat, poultry; unprocessed & processed fish; cheese (products); oils and fats: To prevent any unnecessary addition of sugar, there is no added sugar allowed in all product groups mentioned above. Thus the main rationale is alignment with recommendations to limit intakes of added sugar. Breakfast cereals (20g/100g): Breakfast cereals are commonly consumed across the globe. Sugar is a very common ingredient and levels are relatively high, especially in products targeted to children (35, 36). In summary: the main rationale is to stimulate innovation to lower the added sugar content in this product group. Milk products (5g/100g): Gradually lowering added sugar without the use of artificial sweeteners is challenging. Current developments show that innovation in dairy products in the Netherlands, a country that is working with the criteria for 3 years cannot go below 5 g added sugar per 100g, without use of sweeteners because of taste. In summary: the main rationale is to stimulate innovation to lower the added sugar content in this product group. Snacks (20 g/100g): A sugar criterion was needed in order to prevent that high sugar-containing sweets would qualify for a health stamp and to assure that daily intake of added sugar could not exceed maximal daily recommendations (< 25 en%) as set by the US Institute of Medicine (37). Calculation of maximal sugar levels for snacks (applying 20 g/100g): Per 100g, a snack may contain 20 g sugar. For an average 45 g snack, this will be 9 g sugar 3 times a day a sweet snack x 9 g sugar 27 g sugar from snacks Sugar from the rest of the diet (applying the generic added sugar criterion: <13 en%): Total energy intake (2000 kcal – 330kcal (snacks) = 1670 kcal) of which 13 en% of added sugar (generic criterion): 54.3 g sugar Maximal daily energy intake from added sugar in diet according to Choices: 27 g + 54.3 g = 81.3 g (x 4 kcal) = 325.2 kcal = 16.3% of total daily energy (2000kcal), which is below the IOM upper limit (25 %energy) (37) In summary: the main rationale is alignment with recommendations to limit intakes of added sugar. 10 Bread toppings, sandwich fillings, including hummus like products (30g/100g): For this heterogeneous product group there was a need to define criteria as g/100g, in order not to stimulate innovation by addition of energy. The added sugar criterion was set at 30g/100g to allow a few low sugar marmalades to comply. Thus the main rationale is to stimulate innovation to lower the added sugar content in this product group. Rationales fibre criteria There are generic fibre criteria for the following product groups: processed fruit and vegetables; processed potatoes, pasta and noodles; bread; grains and cereal products; breakfast cereal products. All these product groups are important sources of fibre. Fibre must come from ingredients that are already present in the food: To assure inclusion of cell wall polysaccharides of vegetables, fruit and whole grains, the health effects of which have been clearly established, and exclusion of synthetic, isolated or purified oligosaccharides with diverse, and in some cases unique, physiological effects (38, 39). Product group specific fibre criteria have been set for fruit juice, rice and main course. For the other groups the generic fibre criterion will be applied. Fruit juice (0.75g/100kcal): Fruit contains 1.75 times more energy when compared to vegetables. This is based on median values of fresh fruit and vegetables in the combined European test database (see Appendix 3a. Detailed characteristics per product group). This can be explained by higher intrinsic sugar levels in fruits. Generic criterion for fibre is 1.3 g/100 kcal for processed fruit and vegetables. Fibre criterion for fruit juices is set at 0.75 g/100kcal, which is 1.3 (g/100kcal) divided by 1.75. Thus the main rationale is alignment with recommendation to increase fibre intake. Rice (0.7g/100kcal): The generic fibre criterion 1.3g/100kcal is too strict for rice. Based on the indicator foods in the European test database, it was decided to set the fibre criterion at 0.7 g/100kcal, so that brown rice would comply (Appendix 3b. Indicator foods). Thus the main rationale is to allow choice within the product group “ rice”. Filled sandwiches (0.8g/100kcal): For filled sandwiches, the fibre criterion was determined by the weighted average of the criteria for bread and toppings assuming that a sandwich consists of 60% bread and 40% topping. Average energy densities were assumed to be 2 kcal/g for bread and 2.5 kcal/g for bread toppings. The calculation of the criterion is as follows: 11 60% x Fibre criterion bread (1.3 g/100kcal) = 0. 8 g/100kcal. No fibre criterion was set for toppings. Thus the main rationale is alignment with recommendation to increase fibre intake. Rationales energy criteria Energy criteria have been established for two product groups within the basic product groups, namely the “main courses” and “filled sandwiches”, as these are major contributors to the daily energy intake. Also for fruit juice an energy criterion has been set, as there is a concern that fruit juices also contribute substantially to energy intakes. Furthermore, energy criteria have been set for all products in the non-basic product groups. These foods do not substantially contribute to the supply of essential nutrients, but as they are eaten frequently they are important suppliers of energy. Table 3. Overview of recommendations for daily energy intake, main courses and snacks Target group Daily energy recommendation1 Recommended Recommended energy from main energy from courses2 snacks2 Elderly 1800 kcal/d 486 kcal/serve 108 kcal/serve Adult women 2000 kcal/d 540 kcal/serve 120 kcal/serve Adult men 2500 kcal/d 675 kcal/serve 150 kcal/serve Children 2-12 1546 kcal/day 1 Based on references (40,41) 2 Based on calculation shown in Figure 1 95 kcal/serve Energy criterion: Energy criterion: 400-700 kcal/serve 110 kcal/serve Main courses (400-700kcal/serve), sandwiches (350kcal/serve) and snacks (110kcal/serve): The energy criteria are based on recommended energy intakes (see Table 3). Since 10% is recommended to come from beverages (42), this leaves 90% of the total daily energy recommendation for meals and snacks. The remaining energy is allocated as follows, based on certain assumptions about meal patterns: Breakfast (20%) Lunch (30%), Dinner (30%), 3x Snack (20%), see Figure 1. For main courses the energy criterion was set at 400-700 kcal/meal. The lower level (400 kcal) is to assure sufficient energy intake for vulnerable groups (elderly). The higher level (700 kcal) is to control for too high energy intake. For 12 sandwiches the energy criterion was set at 350 kcal as that is half of maximal total energy for lunch/dinner. For snacks the average energy recommendation for adults (women, 120kcal/serving) and children (95kcal/serving) was calculated (rounded: 110 kcal/serving). In summary the main rationale is alignment with recommendation for energy intake. 2,000 kcal/day Recommended energy intake for women < 200 kcal/day Day’s beverage intake (10 en%) Remaining energy1,800 kcal/day Breakfast (20% en%) Lunch (30 en%) Dinner (30 en%) 540 kcal/serving 3x Snack (20 en%) 120 kcal/serving Figure 1. Overview of recommended energy intake during the day: basis for energy criteria (as calculated for adult women) Fruit juices (48kcal/100mL): Pure (100%) fruit juice contributes to fruit intake. However there is evidence that fruit juice consumption contributes to high energy intake, weight gain and diabetes (43, 44). Therefore, while initially there was no differentiation between fruits and fruit juices, there now is a new focus on limiting fruit juice intake. Because sugar levels are determined by Codex and EU fruit directive (45, 46) there is little room to innovate. Therefore an energy criterion has been set at 48kcal/100mL to exclude the fruit juices that are high in energy.This level is similar to the 3rd quartile of the European test database for fruit juices (Appendix 3a. Detailed characteristics per product group). Thus the main rationale is alignment with recommendation to limit energy intake from fruit juices. Soups (100kcal/100g), sauces (100 or 350 kcal/100g): It was decided that non-basic product groups should be minimized in their contribution to daily energy intake. Therefore energy criteria were set for all non-basic product groups. For the soups and sauces this was based on the following: Energy density is correlated with water 13 content (47). For products with high water content (>50% w/w) it was decided to use 100kcal/100g as criteria. While for products with low water content (<50% w/w) this is 350kcal/100g). See Table 4. Thus the main rationale is alignment with recommendation to limit energy intake from soups and sauces. Table 4. Overview of water content and energy criteria in non-basic product groups Average water content1 Energy criteria (% w/w) [kcal/100g] Soups > 50 100 Meal sauces > 50 100 Sauces emulsions < 50 350 Sauces non-emulsions >50 100 Non-basic product group Snacks 110 Beverages 20 1Based on references (48, 49). Beverages (20 kcal/100mL): There are clear concerns that any higher kcal beverage will adversely affect energy intake, weight gain and related health problems (50, 51). Beverages should not contribute more than 10% to daily energy intake (42; see Figure 1). However people would not stop drinking energy containing drinks. Therefore reformulation should be stimulated into the healthier direction. Currently, regular energy containing drinks contain 10-12 g/100g of sugar (=40-48 kcal/100g). As a first step, but without forcing manufacturers to use artificial sweeteners, was set at 20 kcal/100g or 100mL. This represents 5 g of sugar. The intention is that this will be further lowered. With the use of sweeteners, lower levels of energy in beverages can be reached. There is however a considerable number of consumers who do not consume sweeteners (52, 53) and there are possible concerns about the effects of excessive sweetness on long-term habituation to sugar and sweet foods (54, 55). Therefore it was decided to also aim for a less sweet taste. When consumers are getting used to this, it will also benefit sugar 14 levels in other product groups, such as milk products. As the energy in beverages mainly comes from sugar, it was decided that there is no additional need for a sugar criterion for this group. The percentage of complying products is 36%. This is relatively high. These, however are exclusively coffee, tea, flavoured water and light beverages. The changes from the original Netherlands-based criteria All insignificancy levels are changed to 5% of the WHO recommendations for total daily diet/100g The recommendation for sodium was 2400mg/d, this is now 2000mg/d, aligned with WHO recommendations (Joint Consultation FAO/WHO, 2003). There is an agreed procedure for addition of new product groups, or change of criteria. New product groups have been defined: water, rice, breakfast cereals, bread toppings & (only for Israel) white soft cheese. The Israeli case is included as an example of a national adaptation of criteria. For existing product groups, specific criteria have been added for fruit juices (energy) and revised for fish products (SAFA), main dishes (fibre), soups (sodium) & beverages (energy). Fibre only counts when it comes from ingredients that are already naturally present in the food. . 15 OTHER Online Supplementary Material to the paper: “Development of international criteria for a front of package food labelling system: international Choices Programme” Appendix 1. Israeli case study This document gives an overview of the discussion points raised by the Israeli Scientific Committee that were brought as input to the meeting of the International Scientific Committee. This is an example of how local dietary habits and food composition are brought into the discussion. Appendix 2. Development of a test database on food composition This document describes how the test database on food composition was prepared: Foods needed to be classified according to the Choices product group classification. In addition, assumptions needed to be made for serving sizes for snacks and for missing data (TFA and added sugar). Appendix 3a. Detailed characteristics per product group In an introductory file an overview of the test database is given. The other files contain keynutrient content and data descriptions for all products groups. Appendix 3b. Indicator foods This file contains indicator foods on separate worksheets for all product groups. Indicator foods are typical foods that comply or do not comply with the criteria. Both data source and discriminatory nutrients (for which these foods do not comply) are given. 16 REFERENCES 1. Joint Consultation FAO/WHO. Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint FAO/WHO Expert Consultation. FAO/WHO. WHO Technical Report Series 916. 2003. Geneva, World Health Organisation. 2. National Health and Medical Research Council; Dietary Guidelines for all Australians. http://www.nhmrc.gov.au/publications/synopses/dietsyn.htm last accessed October 2009 (Australia) 3. 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