Challenges and Opportunities for Food Reformulation. Prof. Eileen Gibney

Challenges and Opportunities for Food Reformulation Prof. Eileen Gibney

Outline What is food reformulation? scope, nutrients Opportunities Challenges Case studies PHE Calorie reduction scope and ambition for action Sodium reduction US Crème/FDII reformulation Moving forward effectively UPFD classification Working together

Food Reformulation what does this mean? Food reformulation initiatives aimed so far, at reducing salt, trans-fatty acids, saturated fatty acids, sugars and total energy. It must be measurable and achievable (EUFIC, 2010) Food reformulation is the reduction of salt and calories from sugar and saturated fat in processed foods. (RIVM, NL). Changing the nutrient content of a processed food product to either reduce the content of negative nutrients such as sodium, saturated fat, trans fat or energy (kilojoules) or to increase the content of beneficial nutrients such as dietary fibre, wholegrains, fruit, vegetables and unsaturated fats. The definition does not include the addition of vitamins, minerals or nutrients through fortification processes (Heart Foundation, AUS). From a health perspective, reformulation involves changing the nutrient content of a processed food product to either reduce the content of negative nutrients such as sodium, saturated fat, trans-fat, or to increase the content of beneficial nutrients such as dietary fibre, whole grains and unsaturated fats (Nutrition and Health Foundation, IRL). Reformulation refers to foods that have altered nutrition composition between two time points to reduce levels of energy, total fat, saturated fat, sodium and/or sugar (FDII/Crème Reformulation)

Reformulation. Around a long time WHO 2004 Governments could consider additional measures to encourage the reduction of the salt content of processed foods, the use of hydrogenated oils, and the sugar content of beverage and snacks WHO 2018.. Promote, through government leadership, product reformulation, improvements to the nutritional quality of the food supply,.

Promote, through government leadership, product reformulation, improvements to the nutritional quality of the food supply,

Reformulation opportunities. Consumer acceptance Health benefits

Consumer acceptance

Health Benefits

Challenges.. Measurable effects Food consumption data (detailed nutrient and food group across population) Food composition data (industry) Market / sales data Ingredient challenges Often not a simple ingredient substitution Cannot compromise sensory qualities Safety Transparency Available data industry and others. Consumer confidence

Challenges.. Many disciplines working together.

Nothing exists in isolation In reformulation.... how many food safety hurdles have I got and how high are they? Concept first introduced by Prof LEISTNER (1988) The answer determines product safety and shelf life!!... And reformulation strategy

Case studies

Reflections on the success of salt reformulation: Action across the food chain so that whole product categories were improved Salt taken out of most foods and not replaced or added back elsewhere. Targets set for levels of salt in a wide range of foods and refreshed on a regular basis Monitored effectively and consistently across all industry participants.

Reflections on the sugar reformulation programme: Sugar reduction is more complex than salt reduction. Developed 3 mechanisms for action portion size reduction, product reformulation to lower sugar levels in products setting guidelines for sugar levels per 100g of food and calorie or portion size taking account of naturally occurring sugars where appropriate

A major programme of re-formulation of processed foods The reduction and reformulation programme, and the calorie reduction work specifically, is a key intervention that can contribute to reducing the incidence of childhood obesity. Driven by many factors including: Increasing obesity - childhood Changing food environment Full programme - currently under development (specific guidelines 2019) Focus on foods / food groups consumed by children assume these will benefit adults too. Published baseline levels of calories in the food categories included in the programme for the year ending August 2017 Significant slant on portion size Joint PHE Industry activity

Sodium Reduction in US Households Packaged Food and Beverage Purchases, 2000 to 2014 Longitudinal study of US households in the 2000 to 2014 Nielsen Homescan Consumer Panel, a population-based sample of households that used barcode scanners to record all packaged foods purchased throughout the year. Time-varying brand- and product-specific nutrition information was used for 1,490,141 products. Sociodemographic-adjusted changes in mean sodium per capita (mg/d) and sodium content (mg/100 g), overall and for top food group sources of sodium, and the proportion of households that have total purchases with sodium density of 1.1mg/kcal or less.

Estimating the impact of reformulation by 14 FDII members on the Irish population Analysis divided into two parts: (1) calculating the levels of nutrients sold via reformulated products, at baseline and postreformulation, and (2) calculating daily nutrient intakes of Irish subpopulations, at baseline and post-reformulation. Using data National Food Consumption Survey (IUNA data) Industry food composition data (2005, 2012) Market share / purchase data (2005, 2012)

Salt reduction programme (2004-2018) Food category Number of samples Period of testing Categories with Na reduced % REDUCTION in sodium levels Soups products 429 05-17 3/4 12-33 Ready meals 283 04-14 3/5 26-32 Cooking sauces 259 04-14 4/5 36-71 Snacks 531 05-14 1/7 45 Processed meats 834 05-14 3/4 11-15 Breads 729 05-14 5/6 17-42 Breakfast cereals 687 05-14 6/7 39-63

Moving forward effectively

We need to talk about NOVA. NOVA food classification ultra-processed food and drink (UPFD) Suggested link between UPFD consumption and metabolic health Call for reformulation based on NOVA food classification system However; evidence to date is mixed

NOVA Food Classification System NOVA is the food group classification system that categorises foods according to the extent and purpose of food processing, rather than in terms of nutrients. 4 NOVA food groups: Unprocessed/minimally processed foods (e.g. whole fruit/veg, whole cuts of meat, fish, nuts/seeds ) Processed culinary ingredients (e.g. salt, sugar, oil ) Processed foods (e.g. salted/cured meats, canned fruits/veg, salted/sugared nuts/seeds, cheese ) Ultra-processed foods (e.g. chocolate, crisps, breakfast cereals, fizzy drinks, mass produced packaged breads/cakes/pastries, reconstituted meat/poultry/fish products (i.e chicken nuggets), powdered instant sauce, pre-prepared dishes etc )

NOVA classification system Flawed and inconsistent Implied that classification is based on the complexity of food processing, however. foods with added sugar are deemed as PF or UPFD regardless of processing methods or technology used. Subjective classification system (significant variation from publication to publication, and within the system (3 or 4 categories)).

Analysis of NANS data Data from Irish National Adult Nutrition Survey 2008-2012 1,500 participants (740 men, 760 women) aged 18-90y Dietary assessment 4-day semi-weighed food records Sociodemographic characteristics, smoking levels and attitude towards health assessed via questionnaire Anthropometric measurements, blood and urine samples for nutrition status, cardiometabolic risk markers and sodium intake. Food and drink items were classified into one of the four NOVA food groups, using published guidelines Determined NOVA food group contribution to nutrient intake

Results 60 50 40 30 20 10 0 Unprocessed / Culinary Ingredients Processed Ultra procesed Minimally processed % food consumed Gibney et al (unpublished)

Table 1. Percentage contribution to energy and macronutrients from NOVA food groups 1-4 total population Food Groups 1 2 3 4 μ ± SD % μ ± SD % μ ± SD % μ ± SD % Energy (kj) 2724 ± 1229 33.4 236 ± 392 2.8 1347 ± 1082 15.4 4123 ± 1925 48.4 Protein (g) 42.02 ± 20.29 49.9 0.03 ± 0.09 0.0 14.27 ± 9.98 16.9 26.99 ± 14.13 33.1 CHO (g) 68.97 ± 37.46 31.1 6.81 ± 13.43 2.9 22.97 ± 24.26 9.9 129.54 ± 62.44 56.1 Sugars (g) 32.58 ± 21.22 37.8 6.80 ± 13.43 6.9 4.85 ± 7.79 5.7 46.08 ± 31.87 49.6 Fat (g) 24.01 ± 13.64 33.1 3.38 ± 7.89 4.0 8.60 ± 7.45 11.3 39.71 ± 21.71 51.6 SFA (g) 9.59 ± 6.05 33.4 2.05 ± 5.12 5.6 3.75 ± 3.65 12.5 14.36 ± 8.09 48.6 MUFA (g) 8.71 ± 5.33 33.1 0.96 ± 2.14 3.3 2.99 ± 2.69 11.0 15.00 ± 9.01 52.6 PUFA (g) 3.71 ± 3.17 29.6 0.17 ± 0.46 1.5 1.34 ± 1.40 10.6 8.07 ± 5.47 58.4 Fibre (g) 7.93 ± 5.24 40.8 0.00 ± 0.04 0.0 2.37 ± 2.87 11.8 8.82 ± 5.02 47.4 Data is presented as mean intake (μ) ± standard deviation (SD) and the percentage (%) value. Abbreviations: CHO, carbohydrates, MUFA, monounsaturated fatty acids, PUFA, polyunsaturated fatty acids, SFA, saturated fatty acids Gibney et al (unpublished)

Table 2. Percentage contribution to micronutrient from NOVA food groups 1-4 total population Food Groups 1 2 3 4 μ ± SD % μ ± SD % μ ± SD % μ ± SD % Calcium (mg/10 MJ) 473 ± 289 42.0 1 ± 2. 0.2 185 ± 160 17.5 418 ± 189 40.4 Iron (mg/10 MJ) 4.71 ± 2.68 33.2 0.03 ± 0.05 0.2 2.37 ± 2.04 16.5 7.43 ± 4.60 50.1 Sodium (mg/10 MJ) 525 ± 354 18.2 32.± 80 1.1 758 ± 508 24.7 1683 ± 649 56.0 Vitamin A (mcg/10 MJ) 948 ± 1341 65.5 44 ± 105 4.3 79 ± 245 7.2 223 ± 206 23.0 Vitamin D (mcg/10 MJ) 2.00 ± 2.49 48.4 0.04 ± 0.09 1.5 0.47 ± 1.42 11.1 1.51 ± 1.71 39.0 Vitamin E (mcg/10 MJ) 4.02 ± 2.91 35.7 0.13 ± 0.38 1.4 0.61 ± 0.88 5.6 6.59 ± 4.17 57.3 Vitamin B6 (mg/10 MJ) 1.52 ± 0.69 49.3 0.00 ± 0.00 0.0 0.41 ± 0.38 13.3 1.30 ± 1.26 37.4 Total Folate (mcg/10 MJ) 174 ± 100 46.0 0.02 ± 0.19 0.0 51 ± 59 13.9 158 ± 118 40.2 Folic Acid (mcg/10 MJ) 18.85 ± 62.04 11.5 0.00 ± 0.00 0.0 0.000 ± 0.000 0.0 81.06 ± 103.61 88.5 Vitamin B12 (mcg/10 MJ) 3.60 ± 5.08 58.9 0.01 ± 0.03 0.3 0.67 ± 1.12 11.8 1.47 ± 1.53 29.0 Vitamin C (mg/10 MJ) 77.49 ± 62.32 75.3 0.00 ± 0.03 0.0 1.37 ± 7.16 1.4 19.44 ± 26.45 23.3 Data is presented as mean intake (μ) ± standard deviation (SD) and the percentage (%) value. Gibney et al (unpublished)

Table 5. Anthropometric measures stratified by percentage energy intake for food groups 1 and 4 Food Group 1 4 1 vs 4 Quartile 1 Quartile 2 Quartile 3 Quartile 4 P Quartile 1 Quartile 2 Quartile 3 Quartile 4 P P Energy kj % 18.67 ± 0.38 a 28.72 ± 0.32 b 36.26 ± 0.33 c 47.81 ± 0.39 d 0.000 30.43 ± 0.47 a 44.17 ± 0.31 b 53.20 ± 0.36 c 64.44 ± 0.44 d 0.000 0.000 BMI (kg/m 2 ) 27.34 ± 0.37 26.78 ± 0.31 27.10 ± 0.32 26.07 ± 0.38 0.072 27.19 ± 0.40 26.87 ± 0.27 26.53 ± 0.31 26.94 ± 0.38 0.626 0.352 Waist Circumference (cm) 92.86 ± 0.99 a 91.55 ± 0.84 ab 92.18 ± 0.86 ab 88.42 ± 1.02 b 0.013 92.67 ± 1.09 90.93 ± 0.72 90.13 ± 0.84 92.23 ± 1.02 0.295 0.268 Waist to hip ratio 0.89 ± 0.01 0.88 ± 0.01 0.88 ± 0.01 0.87 ± 0.01 0.158 0.88 ± 0.01 0.88 ± 0.00 0.88 ± 0.00 0.89 ± 0.01 0.681 0.653 Body fat % 29.58 ± 0.56 28.93 ±.47 29.31 ± 0.48 27.87 ± 0.57 0.097 29.48 ± 0.61 29.42 ± 0.41 28.28 ± 0.48 28.73 ± 0.58 0.204 0.299 Fat mass (kg) 23.68 ± 0.77 22.69± 0.65 23.52 ± 0.67 21.21 ± 0.79 0.078 23.38 ± 0.85 23.28 ± 0.56 21.86 ± 0.66 23.04 ± 0.80 0.358 0.186 Fat free mass (kg) 54.76 ± 0.50 53.96 ± 0.42 54.99 ± 0.44 53.90 ± 0.51 0.224 54.57 ± 0.55 54.53 ± 0.36 53.93 ± 0.43 54.82 ± 0.52 0.594 0.647 SBP (mmhg) 125.63 ± 1.20 123.07 ± 1.01 124.17 ± 1.04 124.81 ± 1.23 0.440 124.12 ± 1.31 ab 126.94 ± 0.87 a 123.65 ± 1.02 ab 122.37 ± 1.23 b 0.012 0.264 DBP (mmhg) 79.24 ± 0.84 77.67 ± 0.71 77.41 ± 0.73 77.19 ± 0.87 0.236 77.92 ± 0.93 ab 79.58 ± 0.61 a 77.24 ± 0.72 ab 76.63 ± 0.87 b 0.013 0.408 Data is presented as mean ± standard error for the values adjusted for covariates (gender, age, education). P<0.05 indicated statistical significance. P value presented is for adjusted values for the multivariate ANCOVA corrected for covariates. Different superscript letters within the same row of the table indicate significantly different values (p<0.05). Abbreviations: BMI, body mass index, DBP, diastolic blood pressure, SBP, systolic blood pressure. Gibney et al (unpublished)

Key findings UPFD contribute to energy, fat, sodium.. UPFD contribute to micronutrient intake Folate. Ca, Fe UPFD highest in younger individuals (52.3% daily energy) Limited effects seen on anthropometric variables within food groups no link to markers of health/disease Same findings when analysis is conducted using weight contribution Gibney et al (unpublished)

NOVA and reformulation Calls to change FBDG to reduce UPFD consumption and use NOVA to drive reformulation No doubt that UPFD food group contributes to target nutrients. Significant evidence that processed foods can contribute positively to nutrient intakes. Need to focus on nutrients not processing.

Reformulation cannot be at NOVA food group level to be effective

Moving forward effectively Industry and government partnership work effectively together Government & industry working together. Sensible approach to reformulation Evidence driven Measurable and effective Achievable

5 Steps to better food.. Support business that work with nutritious foods e.g. create business parks for producers of nutritious foods, with lower rents and taxes and cheaper electricity and water supplies? Create demand for healthy foods e.g. take the lead to build consumer demand for healthy foods public health campaigns. Lawrence Haddad Winner of 2018 World Food Prize Create models to emulate e.g. governments and businesses need evaluated examples of things they can do together that work seek examples in other sectors. Name and fame.. or shame e.g. develop scorings / rankings Foster public-private partnerships

Taste must not be sacrificed at the altar of reformulation (Ronan Gormley UCD). Thank You eileen.gibney@ucd.ie