Nutritional content, labelling and marketing of breakfast cereals on the Belgian market and their reformulation in anticipation of the implementation of the nutri-score front-of-pack labelling system

Objective: Breakfast cereals are frequently consumed in Belgium, especially among children. We investigated the nutritional content, labelling and marketing of breakfast cereals and the changes in nutrient content and reformulation in anticipation of the implementation of the Nutri-Score front-of-pack label. Design: Pictures were taken of cereal packages. The WHO-Europe nutrient profiling tool was used to classify cereals into ‘permitted’/‘not-permitted’ to be marketed to children, while the nutritional quality was assessed using Nutri-Score. The proportion of cereals with nutrition and health claims and/or promotional characters on the front-of-pack was compared between permitted and not-permitted cereals and between different Nutriscore categories using Chi-squared tests. The average nutrient contents per 100g were compared between 2017 and 2018 using paired t-tests. Setting: Belgium. Participants: All breakfast cereals in the major supermarkets (n = 7) in 2017 and 2018. Results: Overall, 330 cereals were included. About 77.2% of cereals were not permitted to be marketed to children but, of those, 22.0% displayed promotional characters. More claims (68.9% of all claims) were found on ‘not-permitted’ compared with ‘permitted’ cereals, particularly nutrition claims. Most claims were displayed on cereals with the allocated Nutri-Score A (42.0%) and C (37.0%). A significant reformulation of cereals was found between 2017 and 2018, with reductions in total sugar (−5%) (p < 0.001) and sodium (−20%) (p = 0.002) and increases in fibre (+3%) (p = 0.012) and proteins (+2%) (p = 0.002). Conclusion: Breakfast cereals on the Belgian market are predominantly unhealthy and frequently carry claims and promotional characters. Minimal reformulation occurred over one year. Policy recommendations include restrictions on claims and marketing for not-permitted cereals

Improving selection of markers in nutrition research: evaluation of the criteria proposed by the ILSI Europe Marker Validation Initiative

The conduct of high-quality nutrition research requires the selection of appropriate markers as outcomes, for example as indicators of food or nutrient intake, nutritional status, health status or disease risk. Such selection requires detailed knowledge of the markers, and consideration of the factors that may influence their measurement, other than the effects of nutritional change. A framework to guide selection of markers within nutrition research studies would be a valuable tool for researchers. A multidisciplinary Expert Group set out to test criteria designed to aid the evaluation of candidate markers for their usefulness in nutrition research and subsequently to develop a scoring system for markers. The proposed criteria were tested using thirteen markers selected from a broad range of nutrition research fields. The result of this testing was a modified list of criteria and a template for evaluating a potential marker against the criteria. Subsequently, a semi-quantitative system for scoring a marker and an associated template were developed. This system will enable the evaluation and comparison of different candidate markers within the same field of nutrition research in order to identify their relative usefulness. The ranking criteria of proven, strong, medium or low are likely to vary according to research setting, research field and the type of tool used to assess the marker and therefore the considerations for scoring need to be determined in a setting-, field- and tool-specific manner. A database of such markers, their interpretation and range of possible values would be valuable to nutrition researchers