Peters Sanne A E, Dunford Elizabeth, Jones Alexandra, Ni Mhurchu Cliona, Crino Michelle, Taylor Fraser, Woodward Mark, Neal Bruce
The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, UK.
Carolina Population Center, The University of North Carolina, Chapel Hill, NC 27516, USA.
Nutrients. 2017 Jul 5;9(7):701. doi: 10.3390/nu9070701.
The Health Star Rating (HSR) is an interpretive front-of-pack labelling system that rates the overall nutritional profile of packaged foods. The algorithm underpinning the HSR includes total sugar content as one of the components. This has been criticised because intrinsic sugars naturally present in dairy, fruits, and vegetables are treated the same as sugars added during food processing. We assessed whether the HSR could better discriminate between core and discretionary foods by including added sugar in the underlying algorithm.
Nutrition information was extracted for 34,135 packaged foods available in The George Institute's Australian FoodSwitch database. Added sugar levels were imputed from food composition databases. Products were classified as 'core' or 'discretionary' based on the Australian Dietary Guidelines. The ability of each of the nutrients included in the HSR algorithm, as well as added sugar, to discriminate between core and discretionary foods was estimated using the area under the curve (AUC).
15,965 core and 18,350 discretionary foods were included. Of these, 8230 (52%) core foods and 15,947 (87%) discretionary foods contained added sugar. Median (Q1, Q3) HSRs were 4.0 (3.0, 4.5) for core foods and 2.0 (1.0, 3.0) for discretionary foods. Median added sugar contents (g/100 g) were 3.3 (1.5, 5.5) for core foods and 14.6 (1.8, 37.2) for discretionary foods. Of all the nutrients used in the current HSR algorithm, total sugar had the greatest individual capacity to discriminate between core and discretionary foods; AUC 0.692 (0.686; 0.697). Added sugar alone achieved an AUC of 0.777 (0.772; 0.782). A model with all nutrients in the current HSR algorithm had an AUC of 0.817 (0.812; 0.821), which increased to 0.871 (0.867; 0.874) with inclusion of added sugar.
The HSR nutrients discriminate well between core and discretionary packaged foods. However, discrimination was improved when added sugar was also included. These data argue for inclusion of added sugar in an updated HSR algorithm and declaration of added sugar as part of mandatory nutrient declarations.
健康星级评定（HSR）是一种包装食品正面的解释性标签系统，用于对包装食品的整体营养状况进行评级。支撑HSR的算法将总糖含量作为其中一个组成部分。这受到了批评，因为乳制品、水果和蔬菜中天然存在的内在糖与食品加工过程中添加的糖被同等对待。我们评估了HSR是否可以通过在基础算法中纳入添加糖，更好地区分核心食品和 discretionary 食品。
从乔治研究所的澳大利亚食品转换数据库中提取了34135种包装食品的营养信息。添加糖水平根据食品成分数据库估算。根据澳大利亚膳食指南将产品分类为“核心”或“ discretionary”。使用曲线下面积（AUC）估计HSR算法中包含的每种营养素以及添加糖区分核心食品和 discretionary 食品的能力。
纳入了15965种核心食品和18350种 discretionary 食品。其中，8230种（52%）核心食品和15947种（87%）discretionary 食品含有添加糖。核心食品的HSR中位数（四分位间距）为4.0（3.0，4.5），discretionary 食品为2.0（1.
