TABLE 3.
Characteristics of the development of each included NP model (n = 78)1
| Country | State/province | Model number | Model name (reference) | Organization type | Organization name | Year of introduction or seminal publication | Model derived from other models identified as part of the review? [yes (indicated by model numbers) or no] | Model that served at least in part as the basis for the development of ≥1 other included model? [yes (indicated by model numbers) or no] |
|---|---|---|---|---|---|---|---|---|
| School food (n = 27) | ||||||||
| Australia | N/A | 93 | National Healthy School Canteens Project (15, 16) | Govt or intergovt, academic | Australian Government (Department of Health) and Flinders University (with support from Flinders Partners) | 2010 | 138 | No |
| Australia | New South Wales | 138 | Australia—Fresh Tastes @ School NSW Healthy School Canteens Strategy (17) | Govt or intergovt | NSW Department of Health and NSW Department of Education and Training | 2004 | No | 93; 140; 273; 290; 293; 367; 381 |
| Australia | Queensland | 290 | Smart Choices: healthy food and drink supply strategy for Queensland schools—nutrient criteria for the “Occasional” (red) food and drink category (18) | Govt or intergovt | Queensland Government (Education Queensland and Queensland Health) | 2004–2007 (revised 2016) | 138 | 273; 381 (therefore indirectly: 367) |
| Australia | South Australia | 293 | South Australia Right Bite for schools and preschools—nutrient criteria for the “Occasional” (red) category (19) | Govt or intergovt | Government of South Australia, Department for Education and Child Development | 2008 (revised 2015) | 138 | No |
| Australia | Victoria | 140 | Australia—State Government of Victoria—Go For Your Life healthy canteen kit—nutrient criteria for the “Occasionally” (red) food category (20) | Govt or intergovt | Office of Learning and Teaching, Department of Education and Training Victoria | 2006 | 138 | No |
| Canada | N/A | 393 | Canada—Provincial and Territorial nutrient criteria for foods and beverages in schools (2013) (21) | Govt or intergovt | Federal, Provincial, Territorial Group on Nutrition Working Group on Improving the Consistency of School Food and Beverage Criteria [working group included members from provincial/territorial government health departments and (federal) Health Canada] | 2013 | 131; 144; 180; 193; 200 (therefore indirectly: 282); 241; 259; 272 | No |
| Canada | Alberta | 131 | Alberta nutrition guidelines for children and youth (22) | Govt or intergovt | Government of Alberta (collaborative effort initiated by Alberta Health, Wellness Branch, Family and Population Health Division) | 2008 | No | 393 |
| Canada | British Columbia | 144 | Guidelines for food and beverage sales in BC schools (23) | Govt or intergovt | Government of BC (Ministry of Health, Population and Public Health Division and Ministry of Education) | 2005 (mandated for all public schools in 2008; revised 2010 and 2013) | No | 146; 393 |
| Canada | Manitoba | 193 | Guidelines for foods available in K to 12 schools in Manitoba (criteria for packaged foods) (24) | Govt or intergovt | Government of Manitoba | 2006 (revised 2014)2 | No | 393 |
| Canada | New Brunswick | 241 | New Brunswick healthier foods and nutrition in public schools (25, 26) | Govt or intergovt | Department of Education in partnership with the Department of Wellness, Culture and Sport | 2005 (revised 2008) | No | 393 |
| Canada | Nova Scotia | 180 | Food and beverage standards for Nova Scotia public schools (27) | Govt or intergovt | Nova Scotia Department of Education and Nova Scotia Department of Health Promotion and Protection | 2006 | No | 393 |
| Canada | Ontario | 259 | Ontario school food and beverage policy/program memorandum 150 (PPM 150) (28) | Govt or intergovt | Ontario Ministry of Education | 2010 (effective 2011) | No | 393 |
| Canada | PEI | 272 | PEI school nutrition policy (29) | Govt or intergovt | PEI Healthy Eating Alliance, Eastern School District | 2011 (superseded 2005 policy) | No | 393 |
| Canada | Saskatchewan | 200 | Healthy eating guidelines for Saskatchewan schools (Nourishing Minds) (30) | Govt or intergovt | Saskatchewan Ministry of Education in partnership with the Ministries of Health and Social Services | 2009 (revised 2012) | 282 (earlier version) | 393 |
| China | Hong Kong | 205 | Hong Kong nutritional criteria for snack classification (31) | Govt or intergovt | Department of Health | 2006 (revised 2009, 2010, 2014) | No | No |
| Costa Rica | N/A | 72 | Costa Rica school food regulations (32) | Govt or intergovt | Ministerio de Educación Pública and Ministry of Health | 2011 (effective 2012) | No | No |
| Czech Republic | N/A | 167 | Czech Republic draft decree for food sold and advertised in schools (33) | Govt or intergovt | Ministry of Education, Youth, and Physical Education and the Ministry of Health | 2016 | No | No |
| Greece | N/A | 59 | New School Canteen Standards (34) | Govt or intergovt | Greek Ministry of Health and Social Solidarity | 2006 | No | No |
| India | N/A | 211 | FSSAI draft guidelines for making available wholesome, nutritious, safe and hygienic food to schoolchildren in India (35) | Govt or intergovt | Central Advisory Committee of the FSSAI | 2015 | No | No |
| New Zealand | N/A | 70 | Food and beverage classification system nutrient criteria (Fuelled4life) (36) | Govt or intergovt, NGO | Ministry of Health, but managed by the New Zealand Heart Foundation | 2007 (revised 2013)3 | No | No |
| Scotland | N/A | 60 | Scotland nutritional requirements for food and drink in schools (37) | Govt or intergovt | Scottish Government | 2008 | No | No |
| Singapore | N/A | 76 | Healthy meals in schools program (Eating Healthily At The School Canteen) (38, 39) | Govt or intergovt | Health Promotion Board | 2009 (former version, Model School Tuckshop Programme, introduced in 2003) | 73 | No |
| United Kingdom (England) | N/A | 61 | England requirements for school food regulations (40, 41) | Govt or intergovt | Secretary of State for Education, England | 2007 (revised 2014; effective 2015) | No | No |
| United States | N/A | 325 | USDA smart snacks in school nutrition standards (also known as competitive food standards) (42) | Govt or intergovt | USDA | 2013 (effective 2014) | 80 | 163; 352 |
| United States | California | 352 | California's nutrition standards SB12 and SB965 (competitive food and beverage standards for schools) (43, 44) | Govt or intergovt | California Department of Education | 2005 | 325 (therefore indirectly: 80) | No |
| United States | Connecticut | 163 | Connecticut nutrition standards (45) | Govt or intergovt | Connecticut State Department of Education | 2006 (revised 2016)4 | 325 (therefore indirectly: 80) | No |
| United States | North Carolina | 248 | Eat Smart: North Carolina's recommended standards for all foods available in school (46) | Govt or intergovt | North Carolina Division of Public Health, North Carolina Department of Public Instruction, and the North Carolina Cooperative Extension Service | 2004 | 125 | No |
| Front-of-pack food labeling (n = 12) | ||||||||
| International | N/A | 53 | Choices (47, 48) | Foundation (private initiative) | Choices International Foundation5 | 2006 | No | No |
| Australia and New Zealand | N/A | 196 | Health Star Rating System (49, 50) | Govt or intergovt, commercial, NGO | Australian state and territory governments and New Zealand Government in collaboration with industry, public health, and consumer groups6 | 2014 | 20 (therefore indirectly: 5) | No |
| Chile | N/A | 156 | Chile “Black Octagonal Stop-Sign” warning labels (51) | Govt or intergovt | Ministry of Health (Ministerio de Salud) | 2012 (effective 2015) | No | No |
| Ecuador | N/A | 172 | Ecuador traffic light labeling system (52) | Govt or intergovt | Ministry of Public Health | 2014 | 41 | No |
| Finland | N/A | 27 | Heart symbol (53) | NGO, govt or intergovt | Finnish Heart Association and Finnish Diabetes Association, in active collaboration with the Finnish Food Safety Authority | 2000 | No | No |
| France | N/A | 178 | Five-Colour Nutrition Label (5-CNL/Nutri-Score) (54) | Govt or intergovt, academic | National Nutrition and Health Program (PNNS) of ANSES7 | 2013 | 5 | No |
| Singapore | N/A | 73 | Healthier choice symbol program (55) | Govt or intergovt | Health Promotion Board (Healthy Foods and Dining Department, Obesity Prevention Management Division) | 2009 | No | 75; 76 |
| Sweden, Denmark, Norway, Iceland | N/A | 11 | Keyhole (56) | Govt or intergovt | Swedish National Food Administration, Norwegian Directorate of Health and Norwegian Food Safety Authority, Danish Veterinary and Food Administration | 1989 in Sweden (revised 2005 and 2009); 2009 in Norway and Denmark; 2013 in Iceland (revised 2015) | No | 251 (therefore indirectly: 335; 334); 314 |
| United Arab Emirates | N/A | 314 | United Arab Emirates nutrition labeling model (Weqaya logo) (57, 58) | Govt or intergovt, academic, commercial | Abu Dhabi Quality and Conformity Council8 | 2015 | 11 | No |
| United Kingdom | N/A | 41 | Traffic light labeling (59) | Govt or intergovt | Food Standards Agency9 | 2007 (revised 2016) | No | 172 |
| United States | N/A | 1 | Fruits & veggies—More Matters (60) | NGO (nonprofit consumer education foundation), govt or intergovt | Produce for Better Health Foundation and US CDC | 2007 (former version, 5 A Day Program, introduced in 1991) | No | 291 |
| United States | Colorado | 291 | Smart Meal Seal nutrition criteria (61, 62) | Govt or intergovt, commercial | COPAN (program of the CDPHE) with food service/industry partners10 | 2007 (revised 2012) | 1; 133; 134; 135 | No |
| Restriction of marketing to children (n = 10) | ||||||||
| International | N/A | 334 | WHO nutrient profile model for the Western Pacific Regional Office (WHO-WPRO) (63) | Govt or intergovt | WHO Regional Office for the Western Pacific Region | 2015 (field tested); 2016 (published) | 335 (therefore indirectly: 62; 251 (also implies 5; 11)) | No |
| International | N/A | 335 | WHO Regional Office for Europe nutrient profile model (WHO-EURO) (64) | Govt or intergovt | WHO Regional Office for Europe in collaboration with Department of Nutrition for Health and Development at WHO headquarters | 2015 | 62; 251 (therefore indirectly: 5; 11) | 334 |
| International | N/A | 388 | PAHO nutrient profile model (WHO Regional Office for the Americas) (65) | Govt or intergovt | PAHO | 2016 | 123 | No |
| Denmark | N/A | 62 | Danish Code of responsible food marketing communication to children (66) | Commercial | Forum of Responsible Food Marketing Communication11 | 2008 (revised 2010) | No | 335 (therefore indirectly: 334) |
| Ireland | N/A | 220 | Ireland—broadcasting authority model for restricting the marketing of food and drink to children (67, 68) | Govt or intergovt | Broadcasting Authority of Ireland | Not specified (revised and effective 2013) | 5 | No |
| Mexico | N/A | 392 | Mexico—restriction on the promotion of high-caloric-density foods (69) | Govt or intergovt | Ministry of Health (Secretaria de Salud) | 2014 (effective 2015) | No | No |
| Norway | N/A | 251 | Norwegian Nutrient Profile model (70) | Govt or intergovt | Norwegian Directorate of Health12 | 2012 (revised 2013) | 5; 11 (were considered for the development of the present model) | 335 (therefore indirectly: 334) |
| Singapore | N/A | 287 | Singapore common nutrition criteria of the guidelines for food advertising to children (71) | Govt or intergovt | Nutrition Working Group established following discussions with Ministry of Health, HPB, and ASAS | 2013 (consultation); 2014 (published); effective 2015 | No | No |
| South Korea | N/A | 44 | South Korea—guideline for energy-dense, nutrition-poor food for children (72, 73) | Govt or intergovt | Korea FDA | 2009 | No | No |
| United Kingdom | N/A | 5 | Ofcom model for regulating the marketing of food to children, final version (WXYfm) (74) | Govt or intergovt | Ofcom (broadcast regulator) and Department of Health (Food Standards Agency) | 2004–2005 (revision process started in October 2016) | No | 20 (therefore indirectly: 196; 394); 178; 220; 251 (therefore indirectly: 335; 334) |
| Regulation of claims (n = 7) | ||||||||
| Australia and New Zealand | N/A | 20 | FSANZ—nutrient profiling scoring criterion (75) | Govt or intergovt | FSANZ | 2007 | 5 | 196; 394 |
| France | N/A | 69 | The SAIN, LIM system (76) | Govt or intergovt | French Food Safety Agency (Agence Française de Sécurité Sanitaire des Aliments) | 2008 | 227; 253 | No |
| Singapore | N/A | 75 | Singapore—nutrient- specific diet-related health claims (77) | Govt or intergovt | Agri-Food and Veterinary Authority | 2010 | 73 | No |
| South Africa | N/A | 394 | South Africa NP model (FSANZ validated in South Africa) (78) | Govt or intergovt, academic, commercial | Centre of Excellence for Nutrition, North-West University, South Africa; FSANZ13 | 2013 | 20 (therefore indirectly: 5) | No |
| United States | N/A | 18 | US—requirements for foods carrying a health claim (79) | Govt or intergovt | US FDA | 1993 | No | No |
| United States | N/A | 35 | US—definition of a “healthy” food as an implied nutrient content claim (80) | Govt or intergovt | US FDA | 1993 (revision process started in September 2016) | No | No |
| United States | N/A | 319 | US—requirements for the “extra lean” and “lean” nutrient content claims (81) | Govt or intergovt | US FDA | Not specified | No | No |
| Health facilities (n = 5) | ||||||||
| Australia | Queensland | 381 | Queensland Health's A better choice – healthy food and drink supply strategy (2007)—nutrient criteria for the red category (82) | Govt or intergovt | Queensland Government (Queensland Health) | 2007 | 138; 290 | 367 |
| Australia | South Australia | 367 | Healthy food and drink choices for staff and visitors in South Australia health facilities—nutrient criteria for the red category (83) | Govt or intergovt | Government of South Australia, Department of Health | 2009 | 138; 381 (therefore indirectly: 290) | No |
| Canada | Nova Scotia | 160 | Colchester East Hants Health Authority food and beverage nutrient standards (84, 85) | Govt or intergovt | Colchester East Hants Health Authority, Nova Scotia (referred to as Nova Scotia Health Authority since April 2015) | 2013 | No | No |
| Scotland | N/A | 285 | Scotland nutritional standards for hospital food: Food in Hospitals (86, 87) | Govt or intergovt | Scottish Government | 2008 (revised 2016) | No | No |
| United States | North Carolina | 201 | Healthy food environments pricing incentives Nutrition Criteria (88–90) | NGO (nonprofit organization) | North Carolina Prevention Partners14 | 2007 (revised 2013) | No | No |
| Government facilities (n = 4) | ||||||||
| United Kingdom (England) | N/A | 174 | England government buying standards for food and catering services (91) | Govt or intergovt | Department for Environment, Food and Rural Affairs | 2014 (revised 2015) | No | No |
| United States | N/A | 364 | Food service guidelines for federal facilities (formerly Health and sustainability guidelines for federal concessions and vending operations; HHS/GSA guidelines) (92, 93) | Govt or intergovt | Health and Human Services General Services Administration collaborative team, Federal Health and Sustainability Team for Concessions and Vending | 2011 (revised 2017)15 | No | 256; 330; 376 |
| United States | Massachusetts | 232 | Massachusetts state agency food standards (94) | Govt or intergovt | Nutrition and Physical Activity Obesity Initiative, Bureau of Community Health Access and Promotion, Massachusetts Department of Public Health | 2009 (revised 2012) | No | No |
| United States | Washington | 330 | Washington State healthy nutrition guidelines (95) | Govt or intergovt | Washington State Department of Health | 2014 | 364 (in part) | No |
| Vending machines (n = 4) | ||||||||
| Canada | British Columbia | 146 | Healthier choices in vending machines in BC public buildings policy (96) | Govt or intergovt | Government of BC (Ministry of Health, Population and Public Health Division) | 2006 (revised 2014) | 144 | No |
| United Kingdom (Wales) | N/A | 329 | Wales—health-promoting vending guidance (hospitals) (97) | Govt or intergovt | Department of Health and Health Improvement Division of the Welsh Government | 2008 | No | No |
| United States | N/A | 341 | Nemours Health and Prevention Services (Delaware's public health department) “Go, Slow, and Whoa” model (guide to healthier vending and concessions) (98, 99) | NGO (nonprofit foundation) | Nemours Health and Prevention Services16 | 2010 | No | 169 |
| United States | Iowa | 256 | Nutrition Environment Measurement Survey-Vending (NEMS-V) traffic light system (100, 101) | Govt or intergovt, academic, NGO (nonprofit foundation) | Iowa State University Extension and Outreach, Iowa Department of Public Health, and Wellmark Foundation | 2012 | 364 (when it was previously called Health and sustainability guidelines for federal concessions and vending operations) | No |
| Recreational facilities (n = 3) | ||||||||
| Australia | Queensland | 273 | Queensland—red criteria of the Food for Sport guidelines (102, 103) | Govt or intergovt | Department of National Parks, Sport and Racing, Queensland Government | Not specified (Queensland Government websites updated 2010 and 2011) | 138; 290 | No |
| United States | N/A | 376 | US National Park Service healthy food choice standards and sustainable food choice guidelines for front country operations (104) | Govt or intergovt | US National Park Service | 2012 (revised 2013) | 364 | No |
| United States | Delaware | 169 | Delaware State Parks healthy eating initiative—“Munch Better at Delaware State Parks” (105, 106) | NGO (nonprofit foundation), govt or intergovt | Nemours Health and Prevention Services, Delaware Division of Parks and Recreation, and Delaware Health and Social Services’ Division of Public Health | 2010 | 341 | No |
| Food assistance programs (n = 2) | ||||||||
| United States | N/A | 81 | Minimum requirements and specifications for food items allowed in the WIC food packages (supplemental foods) (107, 108) | Govt or intergovt | USDA, Food and Nutrition Service | 1980 (interim rule 2007; final rule 2014) | No | 318 |
| United States | Georgia | 318 | US—Georgia WIC approved food list—criteria to evaluate an eligible food item (109, 110) | Govt or intergovt | Georgia Department of Public Health, Georgia WIC- Program, Special Supplemental Nutrition Program for WIC | Not specified (criteria to evaluate an eligible food item updated 2015; WIC- approved foods list revised 2016) | 81 | No |
| Food systems/ surveillance (n = 2) | ||||||||
| International | N/A | 254 | Nutrient value score (111, 112) | Govt or intergovt | UN World Food Program | 2013 | No | No |
| Canada | N/A | 195 | Health Canada Surveillance Tool tier system (113) | Govt or intergovt | Health Canada | 2014 | No | No |
| Consumer education (n = 1) | ||||||||
| Canada | Alberta | 351 | Alberta nutrition guidelines for adults (114) | Govt or intergovt | Government of Alberta | 2012 | No | No |
| Taxation (n = 1) | ||||||||
| Hungary | N/A | 371 | Hungarian public health tax (tax on food products containing unhealthy levels of sugar, salt, and other ingredients) (115–117) | Govt or intergovt | Hungarian Government | 2011 (revised 5 times between 2011 and 2015) | No | No |
1ANSES, Agence Nationale de Sécurité Sanitaire de l'Alimentation, de l'Environnement et du Travail; ASAS, Advertising Standards Authority of Singapore; BC, British Columbia; CDPHE, Colorado Department of Public Health and Environment; COPAN, Colorado Physical Activity and Nutrition Program; FSANZ, Food Standards Australia New Zealand; FSSAI, Food Safety and Standards Authority of India; Govt/govt, government; GSA, General Services Administration; HHS, Health and Human Services; HPB, Health Promotion Board; intergovt, intergovernmental; LIM, limited nutrients; N/A, not applicable; NGO, nongovernmental organization; NP, nutrient profile; NSW, New South Wales; Ofcom, Office of Communications; PAHO, Pan American Health Organization; PEI, Prince Edward Island; PNNS, Programme National Nutrition Santé; SAIN, Nutrient Adequacy Score for Individual foods; WHO-EURO, WHO-Europe; WHO-WPRO, WHO Western Pacific Region; WIC, Women, Infants and Children.
2Data from the 2014 version were extracted.
3Nutritional criteria from the September 2013 version were extracted. This information was e-mailed to one of the authors by the New Zealand Heart Foundation in February 2016. The New Zealand Heart Foundation also indicated that the criteria were due for review in 2016.
4Data from the 2016 version were extracted.
5Although the model was developed by a foundation, the initiative was initially triggered by a governmental request to the food industry in the Netherlands as indicated by Roodenburg et al. (47).
6Including Australian Beverages Council, Australian Chronic Disease Prevention Alliance, Australian Food and Grocery Council, Australian Industry Group, Australian Medical Association, Australian National Retail Association, CHOICE, Obesity Policy Coalition, and Public Health Association of Australia.
7The model specifically proposed by Serge Hercberg (professor at the University Paris-XIII and director of the PPNS) as per a request by the Minister of Social Affairs and Health (Ministre des Affaires Sociales et de la Santé) in June 2013.
8The working Group consists of members from Abu Dhabi Quality and Conformity Council, Health Authority Abu Dhabi, Abu Dhabi Food Control Authority, Emirates Authority For Standardization and Metrology, United Arab Emirates University, Abu Dhabi University, AGTHIA Company, Al FOAH Company, and AbuDhabi Farmers Service Centre.
9The responsibility for the policy was transferred to the Department of Health as of October 2010. Also, it is stressed that the updated 2016 guidance document was developed by the Department of Health, the Food Standards Agency, and devolved administrations in Scotland, Northern Ireland, and Wales in collaboration with the British Retail Consortium.
10COPAN partnered with the Colorado Restaurant Association and owners of large and small restaurants to help shape and define the Smart Meal Seal program.
11The model is endorsed by the Danish government as indicated in the reference document of the WHO Regional Office for Europe nutrient profile model (no. 335).
12The working group consisted of the Norwegian Directorate of Health, Consumer Ombudsman, Food Safety Authority, Ministry of Children and Equality, Ministry of Health and Care Services, and Secretariat: Ministry of Health and Care Services.
13The original model (no. 20) was developed by government. Stakeholders for the present model no. 394 included government (Department of Health, South Africa, Directorate: Food Control; FSANZ), the food industry, and academia (North-West University).
14According to the USDA webpage, the present program is part of the Supplemental Nutrition Assistance Program (SNAP)-Ed Strategies & Interventions Toolkit. The model therefore appears to be endorsed by the government.
15Data from the 2011 version were extracted.
16The model was developed by a foundation but is endorsed or used by Delaware State Parks (refer to model no. 169).