Estimating the dietary and health impact of implementing front-of-pack nutrition labeling in Canada: A macrosimulation modeling study

Abstract

BackgroundFront-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy diets. Health Canada has recently published FOPL regulations that will require food and beverages that meet or exceed set thresholds for sodium, sugars, or saturated fat to display a ‘high in’ symbol on the front of the package. Although a promising measure, its potential impact on dietary intakes and health have not yet been estimated in Canada.ObjectiveThis study aims to estimate (1) the potential dietary impact of implementing a mandatory FOPL among Canadian adults; and (2) the number of diet-related non-communicable disease (NCD) deaths that could be averted or delayed due to these estimated dietary changes.MethodsBaseline and counterfactual usual intakes of sodium, total sugars, saturated fats, and calories were estimated among Canadian adults (n = 11,992) using both available days of 24 h recalls from the 2015 Canadian Community Health Survey-Nutrition. The National Cancer Institute method was used to estimate usual intakes, and adjusted for age, sex, misreporting status, weekend/weekday, and sequence of recall. Estimated counterfactual dietary intakes were modeled from reductions observed in experimental and observational studies that examined changes in sodium, sugars, saturated fat, and calorie content of food purchases in the presence of a ‘high in’ FOPL (four counterfactual scenarios). The Preventable Risk Integrated ModEl was used to estimate potential health impacts.ResultsEstimated mean dietary reductions were between 31 and 212 mg/day of sodium, 2.3 and 8.7 g/day of total sugars, 0.8 and 3.7 g/day of saturated fats, and 16 and 59 kcal/day of calories. Between 2,183 (95% UI 2,008–2,361) and 8,907 (95% UI 8,095–9,667) deaths due to diet-related NCDs, mostly from cardiovascular diseases (~70%), could potentially be averted or delayed by implementing a ‘high in’ FOPL in Canada. This estimation represents between 2.4 and 9.6% of the total number of diet-related NCD deaths in Canada.ConclusionResults suggest that implementing a FOPL could significantly reduce sodium, total sugar, and saturated fat intakes among Canadian adults and subsequently prevent or postpone a substantial number of diet-related NCD deaths in Canada. These results provide critical evidence to inform policy decisions related to implementing FOPL in Canada.

The estimated dietary and health impact of implementing the recently approved ‘high in’ front-of-package nutrition symbol in Canada: a food substitution scenario modeling study

“…Using PRIME, it was estimated that a considerable number of diet-related NCD deaths could be averted or delayed in Canada as a result of different degrees (%) of potential food substitution scenarios tested in this study. Similar to previous Canadians' estimates (33,34), most of the lives that could be saved are from CVDs in all counterfactual scenarios, followed by diabetes, cancers, liver disease, and chronic renal failure. Given that CVDs are the second leading cause of death in Canada (74), hypertension affects 23% of adults (75), 30% of the population have diabetes or pre-diabetes (76), and obesity and overweight affects 63% of adults (77), our estimates suggests that using FOPL to choose healthier food alternatives has the potential to decrease the burden of the most problematic diet-related NCDs affecting Canadians.…”

“…Previous Canadian studies explored the potential dietary and health impact of substituting foods labeled with at least one red-light label under the United Kingdom’s criteria for traffic light labelling (TLL), with a similar healthier alternative without any red-light label ( 32 , 33 ). A recent study estimated the potential dietary and health impact of implementing a FOPL in Canada by modeling consumers’ food purchase behavior changes observed in experimental and observational studies ( 34 ).…”

How Many Diet-Related Non-Communicable Disease Deaths Could Be Averted or Delayed If Canadians Reduced Their Consumption of Calories Derived from Free Sugars Intake? A Macrosimulation Modeling Study

“…To estimate the number of diet-related NCD deaths that could be averted or delayed in Canada, we used PRIME, which uses relative risks from robust meta-analyses, and which has been widely used in different countries [40], including Canada [41][42][43][44]. However, PRIME is a cross-sectional NCD scenario model, which means that the model does not incorporate the effect of time lag between the disease outcome and the exposure [40].…”

“…PRIME is a macrosimulation NCD scenario model that has been applied to study different scenarios of public health strategies, and it has been used in several country contexts [40], including in the Canadian population [41][42][43][44]. PRIME estimates the impact of changes in the distribution of behavioral risk factors at the population level on NCD mortality [40].…”

Evaluating the role of salt intake in achieving WHO NCD targets in the Eurasian Economic Union: A PRIME modeling study

“…Further interventional options include front-of-pack labelling (FOPL) of salt content on food products, disseminating knowledge to the public on the risks and benefits of salt intake, and carrying out salt reduction interventions at community-level settings, such as schools and workplaces. In a modelling study that examined the health impact of FOPL in Canada, it was estimated that up to 128 mg/day of sodium may be reduced following certain interventions, representing a significant reduction in sodium intake using nutritional awareness methods alone [49].…”