Flexner Nadia, Zaltz Daniel, Greenthal Eva, Musicus Aviva A, Ahmed Mavra, L'Abbe Mary R
Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Global Health Advocacy Incubator, Washington, District of Columbia, United States of America.
PLoS One. 2025 Feb 24;20(2):e0312638. doi: 10.1371/journal.pone.0312638. eCollection 2025.
Recognized as a cost-effective policy to promote healthier diets, mandatory front-of-package labeling (FOPL) identifying foods high in sodium, sugar, and saturated fat has been adopted and implemented in ten countries, and is currently under consideration in several others including the US. However, its potential impact on dietary intake and health have not yet been estimated in the US context.
To estimate (1) the potential dietary impact of implementing mandatory nutrient-specific 'high in' FOPL among US adults; and (2) the number of diet related non-communicable disease (NCD) deaths that could be averted or delayed due to estimated dietary changes.
Baseline and counterfactual dietary intakes of sodium, sugars, saturated fats, and calories were estimated among US adults (n = 7,572) using both available days of 24h recall data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). The National Cancer Institute method was used to estimate usual intakes and distributions, adjusting for age, sex, misreporting status, weekend/weekday, and sequence of recall. To estimate counterfactual dietary intakes, we modeled two reduction scenarios observed in experimental and observational studies that examined changes in sodium, sugars, saturated fat and calorie content of food and beverage purchases due to nutrient-specific 'high in' FOPL. This study used the Preventable Risk Integrated ModEl (PRIME) to estimate potential health impacts.
Estimated mean dietary reductions of 156 mg and 259 mg/day of sodium, 10.1 g and 7.2 g/day of sugars, 1.08 g and 4.49 g/day of saturated fats, and 38 kcal and 57 kcal/day of calories were observed under the two policy scenarios tested. Between 96,926 (95% UI 89,011-105,284) and 137,261 (95% UI 125,534-148,719) diet related NCD deaths, primarily from cardiovascular diseases (74%), could potentially be averted or delayed by implementing mandatory nutrient-specific FOPL in the US. Overall, more lives would be saved in males than females.
Findings suggest that implementing mandatory nutrient-specific 'high in' FOPL in the US could significantly reduce sodium and total sugar intakes among US adults, resulting in a substantial number of NCD related deaths that could be averted or delayed. Our results can inform current food policy developments in the US regarding the adoption and implementation of FOPL regulations.
作为一项促进更健康饮食的具有成本效益的政策，强制实施包装正面标签（FOPL）以标识高钠、高糖和高饱和脂肪食品，已在10个国家采用并实施，目前包括美国在内的其他几个国家也在考虑采用。然而，在美国背景下，其对饮食摄入和健康的潜在影响尚未得到评估。
（1）估计在美国成年人中实施强制性特定营养素“高含量”FOPL对饮食的潜在影响；（2）估计由于饮食变化可能避免或推迟的与饮食相关的非传染性疾病（NCD）死亡人数。
利用2017 - 2020年国家健康与营养检查调查（NHANES）中24小时回忆数据的可用天数，估计美国成年人（n = 7572）的钠、糖、饱和脂肪和卡路里的基线和反事实饮食摄入量。采用美国国立癌症研究所的方法估计通常摄入量和分布情况，并根据年龄、性别、误报状况、周末/工作日以及回忆顺序进行调整。为了估计反事实饮食摄入量，我们模拟了在实验和观察性研究中观察到的两种减少情景，这些研究考察了由于特定营养素“高含量”FOPL导致的食品和饮料购买中钠、糖、饱和脂肪和卡路里含量的变化。本研究使用可预防风险综合模型（PRIME）来估计潜在的健康影响。
在测试的两种政策情景下，估计钠的日均饮食摄入量分别减少156毫克和259毫克，糖分别减少10.1克和7.2克，饱和脂肪分别减少1.08克和4.49克，卡路里分别减少38千卡和57千卡。在美国实施强制性特定营养素FOPL可能避免或推迟96,926例（95% UI 89,011 - 105,284）至137,261例（95% UI 125,534 - 148,719）与饮食相关的NCD死亡，主要是心血管疾病死亡（74%）。总体而言，男性挽救的生命比女性更多。
研究结果表明，在美国实施强制性特定营养素“高含量”FOPL可显著降低美国成年人的钠和总糖摄入量，从而避免或推迟大量与NCD相关的死亡。我们的结果可为美国当前关于采用和实施FOPL法规的食品政策发展提供参考。
