Food and health: the label on the front of the packaging is n

Foods are not only characterized by their nutritional composition, but also by the degree of processing, which is crucial in determining the overall health potential of foods. Its indication on the labels would therefore help consumers to make an informed choice.

These are the results of an Italian study of Department of Epidemiology and Prevention at IRCCS Neuromed in Pozzilli in collaboration with the University of Insubria in Varese and Como, the University of Catania and the Mediterranea Cardiocentro in Naples. Posted in the British medical journal, who also devoted an editorial to this work, the study looked at which aspect of nutrition best defines mortality risk. Researchers followed more than 22,000 people participating in the Moli-sani study for 12 years, monitoring their state of health and relating it to dietary habits, taking into account both the nutritional composition of the diet and the degree of food processing.

“Our results – says Marialaure Bonaccio, epidemiologist from the Department of Epidemiology and Prevention of the IRCCS Neuromed de Pozzilli and first author of the study – confirm that the consumption of nutrient-poor or ultra-processed foods independently increases the risk of mortality, in particular from cardiovascular diseases. However, when we took into account both the overall nutritional composition of the diet and its degree of processing, it emerged that the latter aspect was essential in defining the risk of mortality. Indeed, more than 80% of foods classified as unhealthy by the Nutri-Score are also ultra-processed. This suggests that the increased mortality risk is not due directly (or exclusively) to the poor nutritional quality of certain products, but rather to the fact that these foods are mostly ultra-processed”.

“It is estimated that one in five deaths in the world is due to poor nutrition, for a total of 11 million deaths per year – recalls Augusto Di Castelnuovo, researcher at the Mediterraneo Cardiocentro in Naples – This is why improving dietary habits is at the top of the priority list of public health agencies and governments around the world.”

One proposal to help people make healthier food choices is to use a front-of-package labeling system for commercial products. Already used on a voluntary basis in some European countries, such as France and Spain, front-of-package labels are currently being considered by the European Commission to adopt a harmonized and mandatory nutrition labeling system in all member states. The Nutri-Score, developed in France, is given as a favorite. This system indicates the nutritional quality of a food (based, for example, on the content of fat, salt, fibre, etc.) by a scale of five colors (from dark green to dark orange) associated with letters, from A to E.

But nutritional composition isn’t the only factor to consider when looking at the diet-health relationship. The NOVA the classification, in particular, instead of evaluating a food on the basis of nutritional characteristics, rather looks at the extent to which this product has been transformed, mainly at the industrial level. NOVA specifically identifies so-called ultra-processed foods, i.e. foods made in part or in whole with substances not commonly used in cooking (hydrolyzed proteins, maltodextrins, hydrogenated fats, etc.) and which generally contain various additives, such as colorants, preservatives, antioxidants, anti-caking agents, flavor enhancers and sweeteners. This category includes the usual suspects: sugary and carbonated drinks, pre-packaged baked goods and spreads. But also seemingly innocent products should be considered ultra-processed. This is the case for rusks, certain breakfast cereals, crackers and fruit yoghurts.

According to the NOVA system, proposed a decade ago by a team of Brazilian researchers, a slice of unprocessed meat is healthier than a vegan hamburger, simply because the former has not undergone industrial manipulation and may not contain food additives, while the second is the result of an articulated industrial processing at the end of which the percentage of whole foods is negligible.

“The goal of helping people make healthier food choices is definitely a priority – comments Licia Iacoviello, director of the department and professor of hygiene at the University of Insubria in Varese and Como– However, the Nutri-Score, as well as other labeling systems, developed in Italy and other countries, only partially conveys the message aimed at improving food choices. While the letters and colors of the Nutri-Score can help to quickly compare products belonging to the same category, allowing you to choose the best from a nutritional point of view, they do not provide any indication of the degree of food processing. This is why we believe, in agreement with other researchers around the world, that each nutritional labeling system must be integrated with information regarding the level of processing”.

“For a truly effective prevention strategy, we will focus on foods that the Nutri-Score classifies as nutritionally healthy but are also highly processed – explains Giuseppe Grosso, associate professor at the University of Catania – This is the case, for example, of certain drinks which, although they have a reduced sugar content and are therefore nutritionally sufficient to obtain a letter B on the Nutri-Score, are in fact highly processed. Or even certain types of yoghurts and cold desserts that are low in fat despite containing a full list of food additives”.

“A common weakness of all front-of-package labeling systems is that they isolate a single food from the overall diet – says Giovanni de Gaetano, president of the IRCCS Neuromed in Pozzilli – To really improve nutrition, you have to go back to the old lesson of the Mediterranean diet, which is a way of life characterized by the careful choice of foods and the way they are combined and consumed. It’s not a shopping list, but it reflects a century-old history that risks disappearing if we consider food as atoms that do not communicate with each other. It should also be remembered that the diet of Mediterraneans is mainly based on fresh or minimally processed products. Therefore, an effective preventive strategy should also pay attention to industrial processing which, if excessive, poses a documented threat to our health.”


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