Prof. Tsugane presents "The main point of NPSs"

Prof. Shoichiro Tsugane, M.D., Ph.D

(International University of Health and Welfare Graduate School of Public Health)

Profile

Important features of NPSs
Use of NPSs
The need to design NPSs tailored to specific targets

Important features of NPSs

(i) Definition of an NPS

It is thought that adequate nutritional intake can help solve many of the health issues resulting from overeating, unbalanced diets and nutrient deficiencies. However, the nutritional components of foods are diverse and complex. It is therefore very difficult for consumers to correctly understand the nutritional content of foods. In addition, it is also difficult to combine foods appropriately in order to consume a balanced diet. This is the point where the Nutritional Profiling Systems (NPSs) come into focus.

The WHO defines “nutrient profiling” as “the science of classifying or ranking foods according to their nutritional composition for reasons related to preventing disease and promoting health”. ^*1 The WHO then refers to the system of utilizing “nutrition profiling” as a “nutrition profiling model”, with the word “model” added. On the other hand, the term “Nutritional Profiling System”, with the word “system” added, refers to the entire broader approach, including models’, and is also becoming more common.

*1 World Health Organization. Use of nutrient profile models for nutrition and health policies: meeting report on the use of nutrient profile models in the WHO European Region, September 2021. No. WHO/EURO: 2022-6201-45966-66383. World Health Organization. Regional Office for Europe, 2022.

(ii) Importance of scientific evidence in NPSs

NPSs are a method that categorizes or scores foods according to their nutritional composition based on scientific data. Around the world, a variety of NPSs have been developed and used for different applications. The World Health Organization (WHO) therefore recommends that NPSs be designed according to the dietary culture and health issues of the target population.

NPSs can be flexibly designed based on different ideas. It is therefore important for us to validate the NPSs we design to ensure they are scientifically reliable. There are three representative NPSs: the Nutri-Score used in Europe, the Health Star Rating (HSR) used in Australia and New Zealand, and the Food Compass developed at Tufts University in the USA. These NPSs have been scientifically validated, and several papers have reported that the consumption of foods rated as having high nutritional value by these NPSs have a more positive effect on health. ^*2

When designing an NPS, it is important to confirm its validity and improve it when necessary. With the accumulation of new scientific evidence related to the NPS and regular updates and improvements made to the NPS, its validity becomes robust and its reliability increases.

*2 Barrett, Eden M., et al. "Criterion validation of nutrient profiling systems: a systematic review and meta-analysis." The American Journal of Clinical Nutrition 119.1 (2024): 145-163.

This illustration shows a woman surrounded by many ingredients, including milk, bread, grilled fish and pineapple. She is trying to choose foodstuffs based on an NPS.

Use of Nutritional Profiling Systems

Two typical applications of NPSs are (i) providing nutritional information to the public (e.g. nutritional values on products) and (ii) use in product development.

(i) Providing nutritional information to the public

The WHO recommends a Front-Of-Pack Labelling (FOPL) approach, where the nutritional value of foods is displayed on the packaging in an easily understandable way. While discussions on the introduction of FOPL have only just begun in Japan, several countries have already taken the lead in implementing FOPL under the initiative of their governments. For example, in France, the NPS called Nutri-Score has been developed and is being used by the French government for the FOPL system (see figure below). The Nutri-Score ratings are calculated based on the nutritional composition, are classified from A (highest) to E (lowest), and a logo displayed on the packaging on the front of the product. Nutri-Score helps consumers to select products based on these logos, which in turn are based on nutritional value as determined by Nutri-Score. The results of the NPS are used as the basis for providing nutritional information in FOPL.

More detailed explanation

Examples of NPS applications

In several countries, nutritional profiling is used for a variety of purposes. For example, NPSs are used for FOPL by public institutions and as part of product development in food companies to determine restrictions on the sale of unhealthy foods to children, to provide a basis for the taxation of unhealthy foods, and to rate food companies based on their commitment to nutrition.

Inadequate nutritional intake, such as over- and under-nutrition, can lead to poor health, increased social security costs, and reduced labor productivity. It is hoped that food companies will use NPSs to provide foods with higher nutritional value so that people can consume more nutritional foods and therefore improve their health.

(ii) Usage in product development

The pleasure and satisfaction of eating well is a very important value of food. Nutritional value is also an important food value. The use of NPSs to scientifically assess the nutritional value of food products enables food companies to improve products by increasing their nutritional value or to develop new products with higher nutritional value. Several food companies have announced that they are using NPSs to assess the nutritional value of their products in order to offer healthier products.

The left illustration shows two personnel from a food company who evaluate the nutritional value of a food product using a computer. The right illustration shows two persons working on the improvement and development of a product based on the nutritional evaluation.

The need to design NPSs tailored to specific targets

Nutrition-related health issues are largely dependent on over- and under-nutrition, as well as improper nutrient balance of diets. Nutritional issues vary from region to region, as over- and under-nutrition are strongly influenced by food culture and other factors. In addition, different life stages - children, adults, and the older populations - have different health issues that need to be addressed. Other factors such as race and economic status also affect nutrition-related health issues. In order to use NPSs to effectively address nutrition-related health issues, we need to design NPSs that are appropriate for the target population.

This illustration shows, from left to right, a child, an adult and an older adult eating from different menus.

More detailed explanation

Differences in NPS needs between Japan and Western countries
The people living in the United States, where dairy consumption is relatively high, tend to be calcium sufficient ^{*3 *4}, whereas people in Japan tend to be calcium deficient. ^*5 There are also characteristic health issues related to food culture, such as excessive saturated fatty acids intake in the US, and excessive salt intake in Japan. While the Japanese diet is considered healthy, there are also issues such as excessive salt intake, and regional issues of excess or deficiency of individual nutrients vary. WHO guidelines for the development of NPSs recommend that NPSs should be designed that address regional health issues and consider dietary guidelines in each region. ^*6

Obesity and ischemic heart disease are major nutrition-related health issues in Western countries. As a result, NPSs developed in Western countries often identify energy and sugars, which contribute to obesity, and saturated fatty acids, which are thought to increase the risk of ischemic heart disease, as “nutrients to limit intake”. This is a very sensible approach in terms of adapting to the health issues of the target population in the Western countries. In Japan, excessive intake of energy, sugar and saturated fatty acids also needs to be considered in order to prevent obesity and ischemic heart disease. However, Japan has the lowest percentage of obesity among the G7 countries, and the health issues caused by being underweight (health issues and early death due to nutrient deficiencies and lowered immunity) are more significant, especially in the older population. Furthermore, mortality from ischemic heart disease in Japan is among the lowest causes of death among the G7 countries, while mortality from stroke is among the highest. Thirteen global cohort studies examining the association between saturated fatty acids intake and stroke risk have shown that the risk of stroke decreases with increasing saturated fatty acids intake (particularly pronounced in five Asian studies). ^*7

In Japan, it has been suggested that the increased intake of saturated fatty acids due to the westernization of the diet may be related to the consistent post-war downward trend in stroke mortality rates since the 1950s. ^*8 Among the Japanese, who consume relatively high amounts of unsaturated fatty acids from seafood and other sources, which are expected to be effective in preventing ischemic heart disease, it is assumed that the proportion of people who consume too little saturated fatty acids and are at increased health risk is higher than the proportion of people who consume too much and are at increased health risk. Therefore, limiting saturated fatty acids intake uniformly might increase health risks such as stroke.

It is hoped that further scientific validation of individual nutrients tailored to the target population and applied to the design of NPSs will contribute to the development of NPSs with high scientific validity, leading to an increase in healthy life expectancy.
- *3Liu, Junxiu, et al. "Trends in food sources and diet quality among US children and adults, 2003-2018." JAMA Network Open 4.4 (2021): e215262-e215262.
- *4Higgins, Kelly A., et al. "Adequacy of total usual micronutrient intakes among pregnant women in the United States by level of dairy consumption, NHANES 2003–2016." Nutrition and Health 28.4 (2022): 621-631.
- *5Saito, Aki, et al. "The association between milk and dairy products consumption and nutrient intake adequacy among Japanese adults: analysis of the 2016 National Health and Nutrition Survey." Nutrients 11.10 (2019): 2361.
- *6World Health Organization. Nutrient profiling: report of a WHO/IASO technical meeting, London, United Kingdom 4‐6 October 2010, World Health Organization, 2011.
- *7Kang, Zhou-Qing, Ying Yang, and Bo Xiao. "Dietary saturated fat intake and risk of stroke: systematic review and dose–response meta-analysis of prospective cohort studies." Nutrition, Metabolism and Cardiovascular Diseases 30.2 (2020): 179-189.
- *8Tsugane, Shoichiro. "Why has Japan become the world’s most long-lived country: insights from a food and nutrition perspective." European Journal of Clinical Nutrition 75.6 (2021): 921-928.

Supervising editor’s profile

Prof. Shoichiro Tsugane, M.D., Ph.D

International University of Health and Welfare Graduate School of Public Health

Graduated from the School of Medicine, Keio University in 1981 and studied public health at the Graduate School of Medicine at Keio University. After working as an assistant at Keio's School of Medicine, he joined the National Cancer Centre in 1986 and served as Director of the Center for Public Health Sciences. He then worked at the National Institute of Health and Nutrition from 2021 as Executive Director and Director of the National Institute of Health and Nutrition, before assuming his current position in 2023.