While reformulation policies are commonly used to incentivise manufacturers to improve the nutrient profile of the foods and beverages they produce, only a few countries have implemented mandatory reformulation policies. This paper aimed to review evidence on the design, implementation challenges and effectiveness of mandatory reformulation policies and compare them to voluntary reformulation policies. The systematic search retrieved seventy-one studies including twelve on mandatory reformulation policies. Most mandatory reformulation policies were aimed at reducing trans-fatty acids or sodium in foods. Overall, mandatory reformulation policies were found to be more effective than voluntary ones in improving dietary intakes. Mandatory policies were implemented when voluntary policies either failed or were found to be insufficient to improve the composition of foods. Typical features of mandatory policies could also improve the design of voluntary policies. Examples include strict but attainable targets and a tight monitoring of compliance.

Building on the success of the Soft Drinks Industry Levy (SDIL), new tax proposals have been considered in the public health policy debate in the UK. To inform such debate, estimates of the potential impacts of alternative tax scenarios are of critical importance. Using a modelling approach, we studied the effects of two tax scenarios: (1) a hypothetical excise tax designed to tax food products included in the Sugar Reduction Programme (SRP), accounting for pack size to reduce the convenience of purchasing larger quantities at once; (2) an ad valorem tax targeting products based on the UK Nutrient Profile Model (NPM). Simulations of scenario 1 show a reduction in sugar purchased of up to 38 %, with the largest decreases observed for sweet confectionery with a tiered tax, similar in structure to the SDIL. Expected food reformulation in scenario 1 led to further decreases in sugar purchased for all categories. In scenario 2, under the assumption that the tax would not affect purchases of healthier products, a 20 % tax on less healthy products would reduce total sugar purchased by 4·3 % to 14·7 % and total energy by 4·7 % to 14·8 %. Despite some limitations and assumptions, our results suggest that new fiscal policy options hold a significant potential for improving diet quality beyond what has been achieved by the SDIL and SRP. An estimated increase in consumer expenditures in both scenarios suggests that attention needs to be paid to potentially regressive effects in the design of any new food taxes.

The UK government launched a two-component sugar-reduction programme in 2016, one component is the taxation of sugar-sweetened beverages, the Soft Drinks Industry Levy, and the second is a voluntary sugar reduction programme for products contributing most to children's sugar intakes. These policies provided incentives both for industry to change the products they sell and for people to change their food and beverage choices through a ' signalling ' effect that has raised awareness of excess sugar intakes in the population. In this study, we aimed to identify the relative contributions of the supply- and demand-side drivers of changes in the sugar density of food and beverages purchased in Great Britain. While we found that both supply- and demand-side drivers contributed to decreasing the sugar density of beverage purchases (reformulation led to a 19% reduction, product renewal 14%, and consumer switching between products 8%), for food products it was mostly supply-side drivers (reformulation and product renewal). Reformulation contributed consistently to a decrease in the sugar density of purchases across households, whereas changes in consumer choices were generally in the opposite direction, offsetting benefits of reformulation. We studied the social gradient of sugar density reduction for breakfast cereals, achieved mostly by reformulation, and found increased reductions in sugar purchased by households of lower socio-economic status. Conversely, there was no social gradient for soft drinks. We conclude that taxes and reformulation incentives are complementary and combining them in a programme to improve the nutritional quality of foods increases the probability of improvements in diet quality.

Taxation on food and non-alcoholic beverages are increasingly employed to promote healthier diets and combat the escalating rates of obesity and diet-related non-communicable diseases. While sugar-sweetened beverages have been the primary focus of such taxes, taxation of high-fat, salt, or sugar (HFSS) foods, and the impact of such taxes are less clear. We conducted a systematic literature review and assessment of the evidence gathered from 20 studies on the impacts of health taxes on HFSS foods around the world. We focused on impacts on sales and consumption of taxed foods, on health outcomes, and on possible unintended consequences (e.g., substitution towards unhealthier products, job losses, ripple effects on businesses, and potential economic burden on lower-income consumers). We found evidence of decreasing sales, or purchases, and intakes of taxed HFSS foods, especially when taxes were combined with subsidies on healthy foods. Higher tax rates were more effective in reducing purchases or consumption. Tax effects differed by income level, with the lowest-income groups being most responsive. In experimental studies, combining taxes and subsidies contributed to mitigating regressive financial impacts of taxes.

The benefits of increasing populations’ and individuals’ fibre intake on non-communicable disease risk have been known and promoted for decades in the UK and in the world. Public health campaigns, including dietary recommendations, called populations to increase their consumption of whole grains, fruits and vegetables, while manufacturers increased the fibre content of their products. In particular, the SACN report in 2015 highlighted the importance of fibres for the UK population. We analysed trends in fibre consumption for the whole population, by age group and gender using the UK National Diet and Nutrition Survey from 2008/09 to 2016/17. We investigated changes in total fibre intake and calculated the contribution to fibre intake and time trends from each food group. We compared the fibre content of food groups between 2008/09 and 2016/17. We found that fibre intake remained fairly stable. While the fibre content of some cereal-based products increased, it decreased for potato-based products. All age groups derived increasing fibre from pasta and other cereal-based products, and decreasing fibre from potato products. Adults, but not children or adolescents derived more fibre from vegetables. This resulted in an increase in fibre intake in adults, but not in children or adolescents.

Summary Food reformulation aimed at improving the nutritional properties of food products has long been viewed as a promising public health strategy to tackle poor nutrition and obesity. This paper presents a review of the empirical evidence (i.e., modelling studies were excluded) on the impact of food reformulation on food choices, nutrient intakes and health status, based on a systematic search of Medline, Embase, Global Health and sources of grey literature. Fifty‐nine studies (in 35 papers) were included in the review. Most studies examined food choices ( n = 27) and dietary intakes ( n = 26). The nutrients most frequently studied were sodium ( n = 32) and trans fatty acids (TFA, n = 13). Reformulated products were generally accepted and purchased by consumers, which led to improved nutrient intakes in 73% of studies. We also conducted two meta‐analyses showing, respectively, a −0.57 g/day (95%CI, −0.89 to −0.25) reduction in salt intake and an effect size for TFA intake reduction of −1.2 (95% CI, −1.79 to −0.61). Only six studies examined effects on health outcomes, with studies on TFA reformulation showing overall improvement in cardiovascular risk factors. For other nutrients, it remains unclear whether observed improvements in food choices or nutrient intakes may have led to an improvement in health outcomes.

Food reformulation policies aimed at reducing the risk of diet-related non-communicable diseases have been implemented in many countries. The degree of success of reformulation policies in changing the range of food options available to consumers has been a function of the design of these policies. Our objective was to review the different factors making the design and implementation of a food reformulation policy effective at improving populations' diets and health. In this narrative review, we present a logic model of the action of reformulation policies on consumer behaviour, dietary intake and population health. We set out how policy design could drive outcomes, and highlight the role for governments and public health agencies in promoting food reformulation that is effective in improving diet and health. The key drivers of success for reformulation policies include strong incentives, a tight implementation strategy, a focus on the overall nutritional quality of food products, rather than on individual nutrients, and effective monitoring and evaluation. Additionally, policies should mark the distinction between product reformulation and product differentiation, which have different nutrition and health outcomes.

Background Educational campaigns are often used to guide populations having a healthier diet. Current diets can be improved by limiting high sodium intakes, known to be the most important modifiable risk for high blood pressure. The UK launched a sodium reduction programme in 2005, consisting of educational campaigns and a reformulation strategy. The educational campaigns aimed at helping population make healthier choices towards manufactured foods, and reduce their use of table salt. The reformulation strategy gave manufacturers voluntary targets as an incentive to reduce the sodium content of their foods, and thus improve the composition of foods people can choose from. This study aims at analysing how changes in food composition and in consumer choice contributed to changes in the sodium density of foods consumed. Methods Using food diaries from the National Diet and Nutrition Survey in 2008/09 and 2016/17, we estimated the average quantity of food products eaten by the UK population. We calculated the sodium density of all foods (excluding drinks) consumed using year-specific nutrient information from the UK Nutrient Databank. Changes in sodium density between 2008/09 and 2016/17 were decomposed into changes in consumer choice and changes in food composition (reformulation of existing products and product renewal, i.e. the difference in sodium content between foods exiting and entering the market). Results The sodium density of solid foods was reduced by 15%. Reformulation resulted in a 13% decrease in sodium density. Categories contributing to most of the decrease were breads and meat and fish products. Product renewal led to a 3% decrease in the sodium density, mostly from the renewal of fruit- and vegetable-based products. In opposition to the effect of reformulation and product renewal, consumers switching between products led to a 1% increase in sodium density of solid foods consumed. This increase was the result of adverse choices in the sauces and condiment category (where consumers switched to products with higher sodium) and favourable choices in the meat and fish, and the grain-based products categories. Conclusion Overall, the reduction in the sodium density of foods consumed was driven by reformulation. Besides for sauces and condiments, consumers made favourable choices towards products with lower sodium content. However, the relative contribution of changes in composition and changes in behaviour differed by category. Attitudes and food preference by product category should be considered in the design of educational campaigns.

AbstractIn an effort to promote population health, governments and businesses are promoting food reformulation initiatives. In most instances, these initiatives have focused on reducing the amount of individual nutrients such as trans-fatty acids (TFA) or sodium, and generally they have been successful at doing so. However, the impact of single-nutrient reformulation on the broader nutrient profile of foods, and on the overall quality of people's diet, remains unclear. We have undertaken a systematic review of evidence of the impact of single-nutrient reformulation on the overall nutrient profile of foods, covering both peer-reviewed studies and grey literature. The outcome of interest was the nutrient composition of the reformulated food or food category. Only 17 studies reported the effect of initiatives on reformulated products’ nutrient profile (44 studies reported on only the targeted nutrient). Results are heterogeneous. Six studies investigated the impact of TFA reduction initiatives, showing different impacts on the reformulated products’ fat profile, with saturated fats (SFA) decreasing in parallel in some studies, but increasing in others. Similarly, when sodium was reduced, sugar, SFA and calories changed in different directions in different studies. Six studies assessed the effect of mandatory calorie labelling in restaurants, two leading to a reduction in energy intake, one to an increase in sugar and a decrease in unsaturated fatty acids, suggesting a worsened nutrient profile. Of the companies participating in England's sugar reformulation initiative, only 13% also reduced total energy. Results highlight the limited research on the effect of reformulation strategies on the overall nutrient composition of foods. Only 28% of the studies that analyse the impact of policies incentivising single nutrient reformulation report the effect on the foods’ complete nutrient profile after reformulation. Over a third of the studies show that reducing the targeted nutrient comes at a cost – namely other nutrients may be increased. To produce the desire health impact, reformulation policies must incentivise improvements of the overall nutrient profile of products.

Abstract Background The UK salt reduction programme started in 2005, consisting of education campaigns and a reformulation strategy. This programme is often cited as an example of a successful public health programme, and used as a model for other programmes. This study aims at assessing how the programme succeeded in reducing sodium intakes, and whether success was even across socioeconomic (SES) groups. Methods Food intakes for the UK adult population were derived from food diaries in the UK National Diet and Nutrition Survey for 2008/09 (Y1) and 2016/17 (Y9). Year-specific sodium densities of foods were used to calculate the quantity-weighted average sodium density of all food and beverage consumed by the population. Using a decomposition approach (Griffith et al., Economica, 2017), changes in sodium density were attributed to either changes in food composition (change in sodium density), or changes in behaviour (type and quantity of food products consumed), stratifying by SES. Results The programme was linked to a 16% decrease in sodium intakes between Y1 and Y9, while sodium density decreased by 15%. This decrease was largely driven by reformulation (-12mg/100g), while changes in food choices had a smaller impact (-2mg/100g). This finding was consistent across SES groups, whether stratified by education or income, with no significant differences between SES groups in behavioural responses to the programme (changes in food choices). Conclusions Changing people's food environment, through reformulation to reduce the sodium density of foods, had a larger impact on sodium intakes in the UK population than efforts to change food choices, and produced consistent impacts across SES groups. Key messages Reformulation led to a consistent reduction of the sodium density of food consumed across SES. There was no evidence of adverse equity impact from changes in behaviour.

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IntroductionReformulation of the food supply has been identified as one of the way to tackle food related chronic diseases (along with others e.g. nutrition education or promotion of physical activity). Several food producers use nutrient profiling systems to guide their reformulation strategy. An example is the Nestlé Nutritional Profiling System (NNPS), a category‐specific system, whose outcome is dichotomous to distinguish more nutritious options within food categories.The objective of this study was to assess the proportion of products meeting the NNPS standards in the food supply, and their respective frequency of consumption.MethodsFood intakes of US adults (aged 18y+) were retrieved from the first 24h recall of the National Health and Nutrition Examination Survey 2011–12. All consumed food and beverage products amenable for reformulation were assessed against the NNPS. The proportion of products compliant with the system was evaluated (i) as available in the food supply (i.e. among the food composition dataset, FNDDS 2011–12), and (ii) weighted by frequency of consumptions. The foods were then grouped using the USDA Major Commodity groups. The analysis was further stratified by Income‐to‐Poverty Ratio.ResultsAmong the 4110 food items consumed by the study population, 3111 could be assessed against the NNPS. The proportion of products meeting the NNPS standards in the food supply was 39.2%; whereas it was 49.6% when weighted by consumption. Within food groups, the consumption of more nutritious options (i.e. compliant with NNPS) did not appear to be associated with their availability (Figure). In dairy products, grain‐based products, sweets and beverages, and processed fruits, more nutritious options were more likely to be consumed. The opposite was observed in the other food groups. Further, there was a positive association between Income‐to‐Poverty Ratio and the consumption of more nutritious sweets and beverages and eggs products. The opposite was observed for legumes and processed fruits.ConclusionReformulation of the food supply can be an effective way to enhance consumers' intakes only if the resulting products are actually consumed. This study showed that for each major food group, products meeting the NNPS standards existed and were consumed, but with a great heterogeneity between groups. For some groups there was a selection towards products with a better nutrient profile, meaning that the reformulation of these categories may be more easily accepted by consumers. For categories in which consumption of foods with a better profile was low, more efforts should be put on the sensory characteristics of reformulated products.Support or Funding InformationThis study was funded by Nestec SA.

Background: Food reformulation has been identified as a strategy to improve nutritional intakes; however, little is known about the potential impact of industry-wide reformulations.Objective: The aim of the study was to model the dietary impact of food and beverage reformulation following the Nestlé Nutritional Profiling System (NNPS) standards for children, adolescents, and adults in the United States and France.Design: Dietary intakes of individuals aged ≥4 y were retrieved from nationally representative surveys: the US NHANES 2011-2012 (n = 7456) and the French Individual and National Survey on Food Consumption (n = 3330). The composition of all foods and beverages consumed were compared with the NNPS standards for energy, total and saturated fats, sodium, added sugars, protein, fiber, and calcium. Two scenarios were modeled. In the first, the nutrient content of foods and beverages was adjusted to the NNPS standards if they were not met. In the second, products not meeting the standards were replaced by the most nutritionally similar alternative meeting the standards from the same category. Dietary intakes were assessed against local nutrient recommendations, and analyses were stratified by body mass index and socioeconomic status.Results: Scenarios 1 and 2 showed reductions in US adults' mean daily energy (-88 and -225 kcal, respectively), saturated fats (-4.2, -6.9 g), sodium (-406, -324 mg), and added sugars (-29.4, -35.8 g). Similar trends were observed for US youth and in France. The effects on fiber and calcium were limited. In the United States, the social gradient of added sugars intake was attenuated in both scenarios compared with the baseline values.Conclusions: Potential industry-wide reformulation of the food supply could lead to higher compliance with recommendations in both the United States and France, and across all socioeconomic groups. NNPS standards seemed to be especially effective for nutrients consumed in excess.

Nutrient profiling ranks foods based on their nutrient composition, with applications in multiple aspects of food policy. We tested the capacity of a category-specific model developed for product reformulation to improve the average nutrient content of foods, using five national food composition datasets (UK, US, China, Brazil, France). Products (n = 7183) were split into 35 categories based on the Nestlé Nutritional Profiling Systems (NNPS) and were then classified as NNPS ‘Pass’ if all nutrient targets were met (energy (E), total fat (TF), saturated fat (SFA), sodium (Na), added sugars (AS), protein, calcium). In a modelling scenario, all NNPS Fail products were ‘reformulated’ to meet NNPS standards. Overall, a third (36%) of all products achieved the NNPS standard/pass (inter-country and inter-category range: 32%–40%; 5%–72%, respectively), with most products requiring reformulation in two or more nutrients. The most common nutrients to require reformulation were SFA (22%–44%) and TF (23%–42%). Modelled compliance with NNPS standards could reduce the average content of SFA, Na and AS (10%, 8% and 6%, respectively) at the food supply level. Despite the good potential to stimulate reformulation across the five countries, the study highlights the need for better data quality and granularity of food composition databases.

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IntroductionThe sugar intake of the US population is above the WHO recommendation, with soft drinks and sugary foods as the main contributors of such intake. Lower socio‐economic classes (SEC) tend to have higher sugar intake than higher SEC. Different incentives are being discussed to limit this intake, like taxation, reformulation, or labelling of added sugars. Reformulation is a possible strategy to improve dietary intakes, without having to change consumers' eating habits.The objective of this study was to assess the potential impact of industry wide reformulation on added sugars intake, from solid and liquid sources, and across SEC.MethodsFoods and beverages consumed by 5076 US adults aged 18+ years were retrieved from the National Health and Nutrition Examination Survey 2011–12, and assessed against the Nestlé Nutritional Profiling System (NNPS) standards. NNPS classifies products in a dichotomous Pass/Fail, based on whether they meet all criteria for energy, total and saturated fats, sodium, added sugars, protein, fiber and calcium. In a modelling scenario, all Fail products were substituted with the Pass item having the closest nutrition composition using the Euclidean distance. Actual added sugars intakes (baseline) were compared to the modeled intakes (substitution scenario). Added sugars intakes from solid and liquid sources were studied separately. The study was stratified by SEC, using the income‐to‐poverty ratio (IPR). Linear regressions were performed to assess social gradients of added sugars intake (actual and modeled).ResultsThe average daily intake of added sugars was 77.6 g/d (SE:1.7) for US adults at baseline, with solid and liquid sources contributing similarly (38.7;1.0 and 38.9;1.4 g/d, respectively). Added sugars intake was negatively associated with IPR (1st quintile 89.4g; /d, 5th 70.8g/d, p‐trend<0.001, Figure). This social gradient was explained by intake from liquid sources.The substitution scenario led to a mean daily intake of 41.7;0.9g/d for the whole population. The modeled reduction in added sugar intakes was mainly explained by reduced intakes from liquid sources (−29.5 g/d vs −6.4 for solid sources). This resulted in an overall attenuation of the added sugars intake social gradient (1st IPR quintile 45.9g/d, 5th 41.3g/d, p‐trend= 0.025, Figure).ConclusionIndustry‐wide reformulations could lead to a 46% reduction in the US adults' added sugars intake, mainly through the reformulation of liquid sources. Moreover, the modeling suggests that reformulations are likely to reduce the social gradient in added sugars intakes. Nevertheless, reformulation efforts need to be combined with other initiatives promoting healthier dietary choices and adequate serving sizes.Support or Funding InformationThis study was founded by Nestec SA

BackgroundReformulation of foods and beverages may help to improve the US population dietary intakes. Food nutrient profiling can be used to define reformulation standards for manufacturers.ObjectiveThis study assessed the association between the consumption of foods passing the Nestlé reformulation standards and the HEI‐2010 and its components.MethodsDietary intakes of 5076 participants aged 18+ years were derived from the first 24hr‐recall of the NHANES 2011–12 survey. All foods declared to be consumed were tested against the criteria of the Nestlé Nutritional Profiling System (NNPS) using the RACC serving size, with three outcomes: Pass (i.e. all criteria were met), Fail, and ‘Out‐of‐scope’ for reformulation (e.g. pure frozen fruit). The consumption of Pass, Fail, and Out‐of‐scope foods and beverages was assessed as percentage of total energy, excluding alcoholic drinks. The HEI‐2010 and its components was calculated using the USDA FPED 2011–12 files, and associations with the consumption of NNPS Pass/Fail/Out‐of‐scope products were estimated.ResultsThe adult population of the NHANES 2011–12 derived 34.0% (95% CI 33.0;35.0) of its energy from NNPS Pass products, 53.9% (52.6;55.2) from NNPS Fail products, and 12.1% (11.3;12.8) from out‐of‐scope products. The average HEI‐2010 was 51.5 (50.5;52.5). Consumption of both NNPS Pass and Out‐of‐scope products was positively associated with the HEI‐2010; consumption of NNPS Fail products was negatively associated with the HEI‐2010 (Figure). In all cases, trends were highly significant. Consumption of NNPS Pass products was positively associated with the total fruit, whole grains, and empty calories components of the HEI‐2010; and negatively with the dairy, fatty acids, seafood and plant proteins, and whole fruit components. Associations were reversed for the consumption of NNPS Fail foods, which was also negatively associated with the sodium, refined grains, and total vegetables components.ConclusionIn US adults, the consumption of manufactured foods accounted for the majority of energy intake. Greater consumptions of non‐processed or minimally processed foods was positively associated with the HEI‐2010. Nonetheless, setting manufacturing standards could be a strategy to increase diet quality as highlighted by the positive association between NNPS Pass products and the HEI‐2010. Further research ought to explore whether higher consumption of foods meeting specific reformulation guidelines would encourage a higher nutritional adequacy beyond compliance with food based dietary guidelines.Support or Funding InformationThis study was funded by Nestec SA.

Introduction Product reformulation has been a key strategy to address high sodium intakes in many countries, the US FDA has proposed category specific sodium reduction targets per 100g. At the same time the update of Recommended Amounts Customarily Consumed (RACCs) highlights that Americans are now eating larger portions than they used to which in turn impacts their sodium and sugar intakes. Literature to date is inconclusive on whether nutrient reduction targets for reformulation are best set per 100g or per serving (RACCs). Objective To assess the capacity of reformulation targets per serving to successfully drive sugar and sodium reductions in the US food supply, and the impact of the RACCs update on such capacity. Methods Foods commonly consumed in the USA were identified using the FNDDS 2011–12 food composition dataset (n=7,618). The Nestlé Nutritional Profiling System (NNPS) was used to classify products as in‐ or out‐of‐scope for reformulation and then split them in 35 products categories each with category specific nutrient targets for energy, total fat, saturated fat, sodium, added sugar, protein, calcium and fiber. The NNPS has a dichotomous Pass/Fail outcome based on whether all nutrient targets are met or not. In a modelling scenario all NNPS Fail products were ‘reformulated’ to meet the NNPS standards. For categories with an updated RACCs the system performance was measured by comparing pass rates with the current versus the updated RACC. Results A total of 3,111 products (40.8% of the total) were identified as in scope for reformulation. Sodium carriers such as complete meals, side dishes, meat and fish entrees, sandwiches, hors d'oeuvres, mini mixed dishes and other small meals made up 37.8% of all products in scope, with an additional 15.6% coming from sugar carriers such as beverages, cakes, cookies, desserts and ice creams. Overall, 38% of all products met all nutrient targets (NNPS Pass) with most products failing multiple nutrients rather than just one (55%). 28% and 14% of products failed the sodium and added sugars targets, respectively. If all products were reformulated in order to achieve the NNPS targets there would be on average an 8% reduction in sodium content and a 14% reduction in added sugars. The RACC update impacted 500 products in the database. Overall as shown in Tables 1 & 2 , increases in the RACCs were linked with increases in the reformulation intensity both in absolute and relative sodium and sugar reductions and vice versa. Discussion The NNPS has good capacity to drive sodium and added sugars reductions by setting targets that are feasible and likely to be within the margin of organoleptic acceptance (~10% reductions). Setting reformulation targets per serving is a relevant public health approach as it allows to address simultaneously issues in the nutrient compositions of foods as well as their consumption pattern. A serving size approach would put priority in the reformulation of products consumed in large servings. Support or Funding Information This study was funded by Nestec SA Proposed RACC updates in the impacted categories and average changes in sodium content and reformulation intensity of the relevant categories Sodium (mg/serving) Meeting Sodium targets ( %) Potential Sodium reduction (%) Potential Sodium reduction (mg/serving) NEW RACCs categories OLD RACC NEW RACC OLD RACC NEW RACC OLD RACC NEW RACC OLD RACC NEW RACC OLD RACC NEW RACC Bagels, toaster pastries, muffins (excluding English muffins) (n=48) 55g 110g 231.6 463.2 71% 60% 20% 56% 49.5 246.6 Carbonated and noncarbonated beverages, wine coolers, water, coffee or tea, flavored and sweetened (n=172) 240 mL 360 mL 41.4 62.1 91% 81% 38% 38% 81.8 102.6 Yogurt (n=21) 225 170 176.9 117.9 86% 100% 30% 0% 100.8 0 Ice cream, ice milk, frozen yoghurt, sherbet: all types, bulk and novelties (n=104) 1/2 cup 160 mL 73.8 98.5 92% 85% 29% 29% 67.8 74.8 Frozen flavored and sweetened ice and pops, frozen fruit juices : all types, bulk and novelties (n=12) 85 mL 17.2 26.9 100% 100% 0% 0% 0 0 Appetizers, hors d'oeuvres, mini mixed dishes, e.g., mini bagel pizzas, breaded mozzarella sticks, egg rolls, dumplings, pot stickers, wontons, mini quesadillas, mini quiches, mini sandwiches, mini pizza rolls, potato skins (n=100) 140g or 55g if sauce added, 1 cup if measurable with cup 85 (or 35 for products with gravy of sauce) 701.7 426.1 53% 86% 27% 16% 310.5 143.5 all other candies [chocolates] (n=39) 40g 30g 56.7 42.6 95% 100% 11% 0% 15.6 0 Proposed RACC updates in the impacted categories and average changes in sugar content and reformulation intensity of the relevant categories Added sugars (g/serving) Meeting Sugar targets (%) Potential Sugar reduction (%) Potential Sugar reduction (g/serving) NEW RACCs categories OLD RACC NEW RACC OLD RACC NEW RACC OLD RACC NEW RACC OLD RACC NEW RACC OLD RACC NEW RACC Bagels, toaster pastries, muffins (excluding English muffins) (n=48) 55g 110g 5.5 9.3 88% 73% 17% 47% 2.7 12.4 Carbonated and noncarbonated beverages, wine coolers, water, coffee or tea, flavored and sweetened (n=172) 240 mL 360 mL 10.3 15.4 67% 57% 43% 53% 14.3 22.3 Yogurt (n=21) 225 170 13.7 9.2 48% 62% 45% 26% 11.4 4.9 Ice cream, ice milk, frozen yoghurt, sherbet: all types, bulk and novelties (n=104) 1/2 cup 160 mL 73.8 98.5 47% 34% 22% 37% 3.9 8.1 Frozen flavored and sweetened ice and pops, frozen fruit juices : all types, bulk and novelties (n=12) 85 mL 12.9 20.2 50% 17% 24% 41% 5.9 11.6 Appetizers, hors d'oeuvres, mini mixed dishes, e.g., mini bagel pizzas, breaded mozzarella sticks, egg rolls, dumplings, pot stickers, wontons, mini quesadillas, mini quiches, mini sandwiches, mini pizza rolls, potato skins (n=100) 140g or 55g if sauce added, 1 cup if measurable with cup 85 (or 35 for products with gravy of sauce) 1.9 1.2 94% 98% 34% 59% 8.5 10.9 all other candies [chocolates] (n=39) 40g 30g 18.3 13.7 3% 33% 30% 15% 5.9 2.4

In the European Union, multiple claims regarding sugar content are defined to help the consumer identifying beneficial nutritional properties of foods (e.g. “Low in sugar”, “no added sugars”, “sugars-free”). However, previous studies showed that foods having a claim do not always have a better nutrient profile that foods without. The objective of this study was to analyse the sugar content of soft drinks across Europe, stratifying by the presence of a sugar claim, using a branded food composition database. The labelled sugar content of soft drinks launched from 2014 to 2016 in nine European countries was obtained from the Mintel Global New Products Database. Products having any kind of claim regarding (added) sugars (Low in/No/Reduced) were compared with products without claims in the whole zone studied, using t-test. Patterns between countries were assessed with an ANOVA. Sugar content in products with and without claims varied between countries (p < 0·01). Overall, products with a claim had a significantly lower mean sugar content than products without (3·2 and 8·3 g/100mL respectively, p-value < 0·0001). However, different patterns were observed inside countries, with overlapping inter-quartiles ranges between the two groups of products (Figure).