Modeled Dietary Impact of Pizza Reformulations in US Children and Adolescents

Abstract

Background and ObjectiveApproximately 20% of US children and adolescents consume pizza on any given day; and pizza intake is associated with higher intakes of energy, sodium, and saturated fat. The reformulation of pizza products has yet to be evaluated as a viable option to improve diets of the US youth. This study modeled the effect on nutrient intakes of two potential pizza reformulation strategies based on the standards established by the Nestlé Nutritional Profiling System (NNPS).MethodsDietary intakes were retrieved from the first 24hr-recall of the National Health and Nutrition Examination Survey (NHANES) 2011–12, for 2655 participants aged 4–19 years. The composition of pizzas in the NHANES food database (n = 69) were compared against the NNPS standards for energy, total fat, saturated fat, sodium, added sugars, and protein. In a reformulation scenario, the nutrient content of pizzas was adjusted to the NNPS standards if these were not met. In a substitution scenario, pizzas that did not meet the standards were replaced by the closest pizza, based on nutrient content, that met all of the NNPS standards.ResultsPizzas consistent with all the NNPS standards (29% of all pizzas) were significantly lower in energy, saturated fat and sodium than pizzas that were not. Among pizza consumers, modeled intakes in the reformulation and substitution scenarios were lower in energy (-14 and -45kcal, respectively), saturated fat (-1.2 and -2.7g), and sodium (-143 and -153mg) compared to baseline.ConclusionsPotential industry wide reformulation of a single food category or intra-category food substitutions may positively impact dietary intakes of US children and adolescents. Further promotion and support of these complimentary strategies may facilitate the adoption and implementation of reformulation standards.

The impact of food reformulation on nutrient intakes and health, a systematic review of modelling studies

“…Overall, studies were heterogeneous in the way interventions and outcomes were modelled and reported, limiting between-study comparisons. As regards the type of nutrient reformulated, 20 studies focused exclusively on sodium reduction (60.6%) [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41], followed by 5 studies considering at least 2 different nutrients (15.1%) [8,[42][43][44][45], 5 studies addressing sugar (15.1%) [46][47][48][49][50] and 3 study addressing fat (9%) [11,51,52].…”

“…Target foods in the included studies were all processed foods (n = 9) [27,31,33,37,38,41,45,51,52], selected groups of nutrient-dense foods (n = 8) [11, 26, 34-36, 43, 44, 50], or single food products (n = 8) [23,24,42,[46][47][48][49]. Four studies provided estimates for more than one item [8,[28][29][30], whereas in 4 studies target foods were not specified since reformulation was modelled directly through its assumed effect on intake [22,25,32,39].…”

“…Four studies provided estimates for more than one item [8,[28][29][30], whereas in 4 studies target foods were not specified since reformulation was modelled directly through its assumed effect on intake [22,25,32,39]. Ten studies simply estimated changes in intake following reformulation (30.3%) [8,11,26,33,42,43,45,49,50,53], whereas other studies estimated effects on health outcomes (n = 12, 36.4%) [25, 31, 35, 37, 39-41, 44, 46-48, 51] or health related quality of life measures (n = 11, 33.3%) [22-24, 28-30, 32, 34, 36, 38, 52].…”

“…Ten studies used cohort Markov models [22, 23, 28-30, 32, 36-38], or individual level micro-simulations [31]. Finally, 13 records, accounting for almost 40% of the included studies, used mathematical-statistical models to estimate the potential change in intake by linking cross-sectional, individual-level consumption data to the nutrient-density of foods before and after reformulation [8,11,24,26,33,42,43,45,46,[48][49][50]53]. In the majority of this last group, time was not explicitly considered, since the analysis was limited to a re-assessment of past individual intakes after reformulating all or a specific set of products.…”

Nutrition-oriented reformulation of extruded cereals and associated environmental footprint: a case study

“…Studies looking at speci c food products, their process and/or nutritional properties, have rarely combined environmental and nutritional dimensions together. Indeed, studies tend to focus on improvement of the food production per se, highlighting alternative methods to reduce the environmental footprint of products (11)(12)(13)(14); or focusing on the evolution of the nutritional pro le of speci c food products, or group of food products, and their potential impact of nutritional intakes and health outcomes (8,(15)(16)(17). The question of whether such reformulations were compatible with a reduction of the environmental footprint of the food system has been rarely addressed, but the results are so far promising (18)(19)(20)(21).…”