European Journal of Nutrition (v.46, #2)

Foreword (3-3).

Nutritional characterisation of foods: Science-based approach to nutrient profiling by Inge Tetens; Regina Oberdörfer; Carina Madsen; Jan de Vries (4-14).
The background of the workshop was the proposed EU legislation to regulate nutrition and health claims for foods in Europe. This regulation will require the development of a science-based nutrient profiling system in order to determine which foods or categories of foods will be permitted to make nutrition or health claims. Nutrient profiling can also be used to categorize foods, based on an assessment of their nutrient composition according to scientific principles. Today, various nutrient profiling schemes are available to classify foods based on their nutritional characteristics.The aim of the workshop was to discuss the work developed by ILSI Europe’s expert group and to explore wider scientific aspects of nutrient profiling, including their relative effectiveness, strengths and weaknesses. In particular, the focus of the workshop was on scientific approaches to the development of nutrient profiles for the purpose of regulating nutrition and health claims. The 76 workshop participants were scientists from European academic institutions, research institutes, food standards agencies, food industry and other interested parties, all of whom contributed their thinking on this topic.The workshop reached a degree of agreement on several central points. Most participants favored a food category approach rather than an ‘across the board’ system for nutrient profiling. Most also felt that nutrient profiling schemes should focus on disqualifying nutrients, while taking into due account relevant qualifying nutrients. Levels of each nutrient should be clearly defined for all food categories to be profiled. Reference amounts selected for further considerations were: (1) per 100 g/100 ml, (2) legislated reference amounts, and (3) per 100 kcal. The majority of workshop participants agreed that nutrient profiling schemes should allow for a two-step decision process; step (1) identify which nutrients to take into account, and step (2) define the thresholds for these nutrients. All participants agreed that an objective validation should be conducted before implementation of nutrient profiling. This would include determination of sensitivity and specificity using “indicator foods” selected on their potential to affect major health issues. The management of any adopted system needs to allow it to be dynamic over time and revise the system when new scientific knowledge emerges.The majority of participants favored a food category approach rather than an ‘across the board’ system. Further work is required to identify the final list of qualifying and disqualifying nutrients for any food category that may be identified and for the selection of optimal reference amounts. It is essential that key stakeholders continue to communicate and work together on the complex issues of nutrient profiling.
Keywords: nutrient profiling; health claims; food category; across the board; validation

Nutrient profiling schemes: overview and comparative analysis by Marcella Garsetti; Jan de Vries; Maurice Smith; Amélie Amosse; Nathalie Rolf-Pedersen (15-28).
Nutrient profiling is a discipline aimed at classifying foods based on their nutritional composition. So far, several profiling schemes have been proposed for varied purposes world-wide. Primary aim to inventory the main profiling schemes that have been developed so far (both applied and not) and to summarise their main aspects. Secondary aim to critically review a selection of them, to test their “performance” and to evaluate their strengths and weaknesses. Scientific and popular search engines were used for identifying profiling schemes. Schemes were described concisely by providing details on four main “Building Blocks” or factors: (1) Food category declination: category-wise or “across the board”; (2) Reference amount: 100 g, 100 kcal; serving; (3) Cut-off use: thresholds or scores; (4) Nutrients Selection: balance between positive and negative nutrients and number of them. The “performance” analysis was done by testing how the selected schemes classify a sample of food. Profiling schemes display considerable variation based on the underlying approach, format and content. Moreover, the rationale of the schemes largely varies and seems to be inspired by either nutrient recommendations or regulations figures. When tested for “performance”, the five selected schemes classify in the same way foods having either a very “positive” or a very “negative” nutrient profile, whereas they give inconsistent results for food products with intermediate characteristics. Strengths and weaknesses analysis shows the difficulty of finding schemes combining qualities such as simplicity, scientific relevance, ability to cope with changes in nutrient recommendations. Current proposed profiling schemes exhibit a wide range of differences both in terms of approaches and “performance”. Nutrition scientists have now the challenge to develop the “ideal scheme” that, in our view, will have to be strict enough to ensure consumer protection but also flexible enough to encourage food industry innovation and to promote a “healthy” competitive market.
Keywords: nutrient profiling; health claim; nutritional quality; food classification; profiling schemes

A new reference method for the validation of the nutrient profiling schemes using dietary surveys by Jean-Luc Volatier; Anja Biltoft-Jensen; Stefaan De Henauw; Michael J. Gibney; Inge Huybrechts; Sinéad N. McCarthy; Jennifer L. O’Neill; Caroline Quinio; Aida Turrini; Inge Tetens (29-36).
Nutrient profiles of foods are increasingly used as the scientific basis of nutritional labeling, health claims, or nutritional education. Nutrient profiling schemes are based on sets of rules, scores, or thresholds applied to the nutritional composition of foods. However, there is a lack of scientific validation of nutritional profiling schemes. To develop a reference method using existing dietary surveys, to define a set of indicator foods that are positively or negatively associated with a “healthy diet.” Such indicator foods can be used both for establishing relevant nutrient profiles and for the validation of existing or future nutrient profiling schemes. The proposed validation method is based on food and nutrient intakes of adults participating in national dietary surveys in five EU countries: Belgium (n = 2,507), Denmark (n = 3,151), France (n = 1,474), Ireland (n = 1,379), and Italy (n = 1,513). The characterization of indicator foods is divided in two steps. First, “healthy diets” of individuals are identified in the five national dietary surveys by comparison to the Eurodiet reference intakes. Second, indicator foods associated positively or negatively to the “healthy diets” are determined. With a P-value of 10−3 for the test of comparison of food intakes between the “most healthy eaters” and the “less healthy eaters,” it was possible to identify 294 indicator foods out of 1,669 foods tested in the five countries. In all the countries except Italy, there were more indicator foods positively associated than indicator foods negatively associated with the “healthy diet.” The food categories of these indicator foods were in good agreement with Food Based Dietary Guidelines like the USDA dietary guideline for Americans. A new reference method for the validation of profiling schemes was developed based on dietary intake data from using dietary surveys in five European countries. Only a minority of foods consumed in these dietary surveys could be used as indicator foods of healthy or unhealthy diets in order to subsequently test nutritional profiling schemes. Further work is needed to build a list of indicator foods that could be considered as a “gold standard.”
Keywords: nutrition and health claims; nutrient profiles; validation

Comparison of different nutrient profiling schemes to a new reference method using dietary surveys by Caroline Quinio; Anja Biltoft-Jensen; Stefaan De Henauw; Michael J. Gibney; Inge Huybrechts; Sinéad N. McCarthy; Jennifer L. O’Neill; Inge Tetens; Aida Turrini; Jean-Luc Volatier (37-46).
A new EU regulation on nutrition and health claims made on foods has entered into force in January 2007. The regulation provides for the use of nutrient profiles to determine which foods may bear claims but does not specify what the profiles should be or how they should be developed. Several nutrient profiling schemes have already been established. Therefore, it is necessary to develop approaches to test if the existing profiling schemes could fulfil the new regulation needs. The aim of the present study is to investigate how reference “indicator foods” derived from national dietary surveys in five different countries, are classified according to three existing nutrient profiling schemes: The UK Food Standards Agency (FSA) model, The Dutch Tripartite classification model and the US FDA model used for regulating health claims. “Indicator foods” that have been shown to be positively or negatively associated with healthy diets in adults in five EU countries were classified according to each of the three profiling schemes. The performance and effectiveness of each profiling scheme in correctly classifying the “indicator foods” were assessed using sensitivity and specificity ratios. The sensitivity and the specificity ratios of the three profiling schemes tested were relatively good. There were only small differences of performance between the three systems. A significant negative correlation between sensitivity and specificity was observed. The level of concordance between the classification of the “indicator foods” that have been selected because of being positively or negatively associated with a healthy diet and the classification by each of the three profiling methods tested was quite good. However, further improvement of the “indicator foods” approach is needed if it is to serve as a “gold standard”.
Keywords: nutrition and health claims; nutrient profiling schemes; evaluation; sensitivity; specificity