Tassy Marie, van Dijk Ries, Eldridge Alison L, Mak Tsz Ning, Drewnowski Adam, Feskens Edith Jm
Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland.
Curr Dev Nutr. 2024 Dec 16;9(1):104530. doi: 10.1016/j.cdnut.2024.104530. eCollection 2025 Jan.
Micronutrient deficiencies, undernutrition, and overweight/obesity are prevalent in low- and middle-income countries (LMICs). Nutrient profiling models (NPMs), initially developed to help reduce the prevalence of diet-related chronic diseases in Western countries, could be one solution to promote nutrient-dense foods in LMICs. This study reviewed government-endorsed NPMs implemented in LMICs and assessed their key components in relation to country-specific nutritional challenges. The peer-reviewed and grey literature were systematically reviewed to identify government-endorsed NPMs implemented in LMICs to promote healthier choices among adults. Their key metrics, including scope, components, units, and validation method, were extracted. The prevalence of undernutrition; overweight/obesity; and iron, vitamin A, and iodine deficiencies were extracted from the Global Health Observatory and the Global Burden of Disease study. NPMs have been implemented in 16 LMICs to encourage healthier choices, mostly through front-of-pack labeling schemes. Warning Label schemes are used to strongly discourage the consumption of energy-dense products in countries where overnutrition affects most of the population, such as Latin American LMICs. A "Keyhole" front-of-pack labeling scheme was implemented only in North Macedonia. It limits sugar, fat, and salt while promoting fibers, fruits, vegetables, nuts, and legumes to prevent overnutrition and diet-related chronic diseases. "Choices" schemes that focus on positive messages have been implemented in Southeast Asia and Zambia where over- and undernutrition coexist. "Choices" criteria encourage the consumption of category-specific vitamins and minerals, in addition to advocating limiting certain nutrients. In LMICs, NPMs focus on discouraging the consumption of sugar, fat, and salt. Additionally, NPMs promote category-specific micronutrients in countries where undernutrition remains prevalent or food components associated with a reduced risk of diet-related chronic diseases, including whole grains and fibers, in countries where overnutrition is the main nutrition-related public health issue. This study was registered at PROSPERO as CRD42023468807.
微量营养素缺乏、营养不良以及超重/肥胖在低收入和中等收入国家（LMICs）普遍存在。营养成分剖析模型（NPMs）最初是为帮助减少西方国家与饮食相关的慢性病患病率而开发的，它可能是在低收入和中等收入国家推广营养丰富食品的一种解决方案。本研究回顾了在低收入和中等收入国家实施的政府认可的营养成分剖析模型，并评估了其与各国特定营养挑战相关的关键组成部分。对同行评审文献和灰色文献进行了系统回顾，以确定在低收入和中等收入国家实施的政府认可的营养成分剖析模型，以促进成年人做出更健康的选择。提取了它们的关键指标，包括范围、组成部分、单位和验证方法。营养不良、超重/肥胖以及铁、维生素A和碘缺乏的患病率是从全球卫生观测站和全球疾病负担研究中提取的。16个低收入和中等收入国家已实施营养成分剖析模型以鼓励做出更健康的选择，主要是通过包装正面标签计划。警示标签计划用于在营养过剩影响大多数人口的国家，如拉丁美洲的低收入和中等收入国家，强烈劝阻人们食用能量密集型产品。“锁孔”包装正面标签计划仅在北马其顿实施。它限制糖、脂肪和盐的含量，同时推广纤维、水果、蔬菜、坚果和豆类，以预防营养过剩和与饮食相关的慢性病。在营养过剩和营养不良并存的东南亚和赞比亚实施了侧重于积极信息的“选择”计划。“选择”标准除了提倡限制某些营养素外，还鼓励食用特定类别的维生素和矿物质。在低收入和中等收入国家，营养成分剖析模型侧重于劝阻人们食用糖、脂肪和盐。此外，在营养不良仍然普遍存在的国家，营养成分剖析模型推广特定类别的微量营养素；在营养过剩是主要的营养相关公共卫生问题的国家，推广与降低饮食相关慢性病风险相关的食物成分，包括全谷物和纤维。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42023468807。
