TABLE 1.
Description of purpose and scoring criteria of each nutrition classification scheme studied1
| Conceptual basis | NCS | Description | Scoring criteria |
|---|---|---|---|
| Nutrient-based | Chilean NPM (2019 limits) | Developed for the Chilean Food Act and applied to FOPLs, the regulation of food products sold in schools, and restrictions to advertising targeting children. Came into effect in 2016 (8) | Foods are subject to regulation when they exceed thresholds for “risk” nutrients; e.g., for FOPL regulation the product would receive a “high in” warning label. Energy, added sugar, added sodium, and added saturated fat are assessed |
| Nutri-Score | Designed specifically for FOPL and first implemented by the French government in 2017 (5). Foods score a rating on a scale from A to E, with A indicating a “healthier” product, and E an “unhealthier” product | Scoring depends on the food category. An algorithm balances the quantity of beneficial and risk nutrients. Risk nutrients assessed are energy, total sugar, sodium, and saturated fat. Beneficial components assessed are fiber, protein, and fruit, vegetable, nut, and legume content | |
| HSR | Designed specifically for FOPL and implemented in Australia and New Zealand in 2014 (6). Foods score a rating on a scale from 0.5 stars to 5 stars, in half-star increments, more stars indicating a “healthier” product | Scoring depends on the food category. An algorithm balances the quantity of beneficial and risk nutrients. Risk nutrients assessed are energy, total sugar, sodium, and saturated fat. Beneficial components assessed are fiber, protein, and fruit, vegetable, nut, and legume content | |
| Nutrient- and food-based | WHO-Euro NPM | Published in 2015 and specifically designed for the purpose of restricting the marketing of foods to children in the European region (16) | Uses a binary approach, wherein foods exceeding upper thresholds for certain nutrients, depending on the food category, are not permitted for marketing. Assesses energy, total sugar, added or free sugars, nonsugar sweeteners, sodium, total fat, and saturated fat |
| PAHO NPM | Developed in 2016 to be used in the design of all forms of regulation on food and nonalcoholic beverages in PAHO member states (17) | Processed (group 3) and ultraprocessed foods (group 4, using NOVA) that are in excess of free sugars, nonnutritive sweeteners, salt, total fat, saturated fat, and trans fatty acids are classified as “unhealthy” | |
| Food-based | NOVA | First published in 2009 and incorporated into dietary guidelines of Brazil, Uruguay, Ecuador, Peru, Israel, and Malaysia (13), and applied to procurement guidelines for the Brazilian Ministry of Health and its entities (32) | Classifies foods into 4 groups based on the nature, extent, and purpose of industrial processing (13). Ultraprocessed foods (group 4) are identified by the presence of certain processed food substances or cosmetic additives |
| Dietary-based | ADGs (2013) | The ADGs are a tool to inform policy in Australia (31) | A binary classification of the ADGs identifies foods as either discretionary, for which the ADGs advise limited consumption, or recommended nutritious “five food group” foods |
1
ADGs, Australian Dietary Guidelines; FOPL, front-of-pack labeling; HSR, Health Star Rating; NCS, nutrition classification scheme; NPM, nutrient profile model, PAHO, Pan American Health Organization; WHO-Euro, World Health Organization European Division.