WHO Guiding Principles and Framework Manual for the Development and Implementation of Nutrient Profile Models

Transcription

1 British Heart Foundation Health Promotion Research Group WHO Guiding Principles and Framework Manual for the Development and Implementation of Nutrient Profile Models Mike Rayner Second Project meeting, Washington DC, October 22 nd and 23 rd

2 Structure of the document Part 1: Guiding principles Part 2: Framework manual Module 1: Planning a np model Module 2: Adapting or developing a np model Module 3: Validation of np models Module 4: Evaluation of applications

3 Guiding principles Definitions and terms Distinction between models and applications Relationship of nutrient profile models to FBDGs Scope and limitations of nutrient profiling

4 Definitions Nutrient profiling is the science of classifying foods according to their nutritional composition for reasons related to disease prevention and health promotion

5 Terms: models and applications FSA/Ofcom model Points Energy (kj) 335 >335 >670 >3350 Sat fat (g) 1.0 >1.0 >2.0 >10.0 Total sugar (g) 4.5 >4.5 >9 >45.0 Sodium (mg) 90 >90 >180 >900 Protein (g)* 1.6 >1.6 >3.2 >8.0 Fibre (NSP) (g) 0.7 >0.7 >1.4 >3.5 Fruit, Veg & Nuts 40 >40 >60 >80 (g) Healthy/Intermediate food = 3 or less Healthy/Intermediate drink = 0 or less 5 For both food and drinks: scores are based on the content of nutrient in 100g. *If food scores 11 for protein, fibre and F&V then scores 0 for protein except if scores 5 for FV&N Less healthy food = 4 or more Less healthy drink = 1 or more FSA/Traffic light labelling model

6 Applications of nutrient profiling Public health interventions (social marketing) 1. Product Product reformulation 2. Promotion Front-of-pack (advertising) labelling 3. Place (availability) Place-based promotions 4. Price Government subsidies for vulnerable groups Public health regulation (of commercial marketing) Compositional standards Health and nutrition claim legislation Advertising regulation Standards for public provision (schools, hospitals) Health-related taxes

7 Relationship between Nutrient Profiling Healthiness of foods and FBDGs Healthiness of a diet Health

8 Scope and limitations It cannot solve all problems in relation to food and health Diets are determined by things other than nutrient quality It is concerned with nutrients not: Other substances in foods All concerns people have about foods (e.g. environmental sustainability, price)

9 Module 1: Planning a np model 1. Identify and describe nutrition related public health problems 2. Assess how these nutrition related public health problems are related to existing dietary patterns 3. Develop a list of key recommendations for foods and nutrients 4. Identify all possible interventions 5. Select interventions that require nutrient profiling 6. Convene project group

10 Module 2: Adapting or developing np model. Major decisions Whether the model is for one application or several Whether the model needs to classify foods by a single nutrient or by several nutrients The target population group Whether the model needs to define healthy or unhealthy foods or both Whether the model needs to help the population shift within or between food categories or both

11 Between or within categories or both? Healthier Less healthy

12 Healthy or unhealthy or both? Healthier Less healthy Advertising to children disallowed

13 Module 3: Validating a nutrient profile model Validity of a nutrient profile model = how well the underlying model classifies foods evaluation of applications supported by nutrient profile models

14 Different forms of validation Use of indicator foods to identify anomalous classifications Comparison with views of expert nutritionists Comparison with currently achieved healthy and unhealthy diets Comparison with theoretical diets Prediction of health outcomes models Comparison with validated nutrient profile

15 Validation of nutrient profiling Healthiness of foods Healthiness of a diet Health

16 Validation of nutrient profiling Construct validity testing Healthiness of foods Healthiness of a diet Health

17 Validation of nutrient profiling Predictive validity testing Healthiness of foods Healthiness of a diet Health

18 Other considerations feasibility Validity Assessment Relative importance Content Convergent Convergent Construct Indicator foods / scrutiny of model Comparison with opinions of expert nutritionists Comparison with other NP models Comparison with healthy diets Relative complexity Relative cost Predictive Prediction of biomarkers Predictive Prediction of health outcomes Adapted from: Townsend M. Where is the science? What will it take to show that nutrient profiling systems work? AJCN, 2010; 91: 1109S-115S

19 Module 4: Evaluation of applications Monitoring suitability of model for application e.g. assessing whether np model can be applied to all advertising Monitoring impact of application e.g. assessing changes advertising practice Evaluating the effectiveness of the application e.g. evaluating effects of advertising restrictions on children s diets.

20 British Heart Foundation Health Promotion Research Group Criteria for choosing a good model: regulating the promotion of foods to children Mike Rayner Second Project meeting, Washington DC, October 22 nd and 23 rd

21 A good np model Has been developed in a systematic (planned) and transparent way Has been validated (at least by reference to food based dietary guidelines) Details have been published so that it can be readily applied to a food/advert

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23 Possible models for regulating advertising of foods to children UK FSA/Ofcom model US Interagency Working Group model Etc.

24 Questions about a model before adapting it for your purposes Who has developed it and how has it been developed? Has if been validated and if so how? What is the target population group? Does the model helps the population shift within or between food categories or both? Does the model define healthy or unhealthy foods? How restrictive is the model?