Evaluating Nutrient-Based Indices against Food- and Diet-Based Indices to Assess the Health Potential of Foods: How Does the Australian Health Star Rating System Perform after Five Years?

Abstract

Nutrient-based indices are commonly used to assess the health potential of individual foods for nutrition policy actions. This study aimed to evaluate the nutrient profile-informed Australian Health Star Rating (HSR), against NOVA and an index informed by the Australian Dietary Guidelines (ADGs), to determine the extent of alignment. All products displaying an HSR label in the Australian marketplace between June 2014 and June 2019 were extracted from the Mintel Global New Product Database, and classified into one of four NOVA categories, and either as an ADG five food group (FFG) food or discretionary food. Of 4451 products analysed, 76.5% were ultra-processed (UP) and 43% were discretionary. The median HSR of non-UP foods (4) was significantly higher than UP foods (3.5) (p < 0.01), and the median HSR of FFG foods (4) was significantly higher than discretionary foods (2.5) (p < 0.01). However, 73% of UP foods, and 52.8% of discretionary foods displayed an HSR ≥ 2.5. Results indicate the currently implemented HSR system is inadvertently providing a ‘health halo’ for almost ¾ of UP foods and ½ of discretionary foods displaying an HSR. Future research should investigate whether the HSR scheme can be reformed to avoid misalignment with food-and diet-based indices.

Energy Density of New Food Products Targeted to Children

“…Differences in the database dates used, target sample and/or the product sample size could explain these differing proportions of foods displaying an HSR. Bakery and Snacks categories were the most prevalent products displaying an HSR, as also found by Lawrence et al and Dickie et al [37,38]. The food categories in this study that did not have any products displaying an HSR were mostly discretionary foods, for example, Chocolate Confectionary and Sugar and Gum Confectionery.…”

“…An HSR was displayed on 18.2% of products examined in this study. This result is higher than that obtained in a study by Lawrence et al, who found that 10.5% of new products (using Mintel's GNPD) released between 27th June 2014 and 27th June 2017 displayed an HSR, and a study by Dickie et al using the same database but for the time period 6 June 2014-30 June 2019, who found an HSR on 17.6% of products [37,38]. Differences in the database dates used, target sample and/or the product sample size could explain these differing proportions of foods displaying an HSR.…”

“…If the HSR was classifying foods correctly on the basis of ED, then we would expect a much lower percentage of high ED foods displaying a high HSR. This further adds to the body of literature, demonstrating the shortcomings of the HSR system [23,37,38,[40][41][42][43], and shows that it does not consistently discriminate between levels of ED, especially when considering high ED foods. The median ED of products with a high HSR was 1507 kJ/100 g, well above the cut-off (950 kJ/100 g), signifying the beginning of the high ED range [31].…”

Ultra‐processed foods and the nutrition transition: Global, regional and national trends, food systems transformations and political economy drivers

“…Nutrient‐centric approaches can also stimulate the production and promotion of UPFs. For example, between 2014 and 2019, the Australian nutrient‐based Health Star Rating (HSR) system approved between 73% and 77% of UPFs using the system to display a ‘pass mark’ of 2.5 stars or more (out of a possible 5) on labels 196,197 . Food‐based dietary guidelines (FBDGs) adopted in most countries are a foundation for nutrition policy and guidance 193,198 .…”

“…For example, between 2014 and 2019, the Australian nutrient-based Health Star Rating (HSR) system approved between 73% and 77% of UPFs using the system to display a 'pass mark' of 2.5 stars or more (out of a possible 5) on labels. 196,197 Foodbased dietary guidelines (FBDGs) adopted in most countries are a foundation for nutrition policy and guidance. 193,198 Yet, a large majority of FBDGs adopt a nutrient-centric approach, recommending to limit foods high in certain risk nutrients or 'energy-dense and nutrient-poor' foods.…”