Abstract
Food reformulation aimed at improving the nutritional properties of food products has long been viewed as a promising public health strategy to tackle poor nutrition and obesity. This paper presents a review of the empirical evidence (i.e., modelling studies were excluded) on the impact of food reformulation on food choices, nutrient intakes and health status, based on a systematic search of Medline, Embase, Global Health and sources of grey literature. Fifty-nine studies (in 35 papers) were included in the review. Most studies examined food choices (n = 27) and dietary intakes (n = 26). The nutrients most frequently studied were sodium (n = 32) and trans fatty acids (TFA, n = 13). Reformulated products were generally accepted and purchased by consumers, which led to improved nutrient intakes in 73% of studies. We also conducted two meta-analyses showing, respectively, a −0.57 g/day (95%CI, -0.89 to -0.25) reduction in salt intake and an effect size for TFA intake reduction of -1.2 (95% CI, -1.79 to -0.61). Only six studies examined effects on health outcomes, with studies on TFA reformulation showing overall improvement in cardiovascular risk factors. For other nutrients, it remains unclear whether observed improvements in food choices or nutrient intakes may have led to an improvement in health outcomes.
Generated Summary
This systematic review and meta-analysis evaluates the impact of food reformulation on individuals’ behavior, nutrient intakes, and health status. It examines the effects of food reformulation strategies on consumer choices, dietary intakes, and health outcomes, using a systematic search of Medline, Embase, Global Health, and gray literature sources. The review included 59 studies (in 35 papers) focusing on how food reformulation impacts consumer choices, nutrient intakes, and health outcomes. Most studies focused on food choices (n = 27) and dietary intakes (n = 26), with sodium (n = 32) and trans fatty acids (TFA, n = 13) being the most frequently studied nutrients. The meta-analysis was performed to assess the effects of reformulation on sodium and TFA intakes, revealing significant reductions in both. The study aimed to provide a comprehensive overview of how food reformulation affects consumer behavior, nutrient intake, and health outcomes, focusing on the role of food reformulation in improving dietary intakes and health outcomes.
Key Findings & Statistics
- The review analyzed 59 studies (in 35 papers).
- The majority of studies examined food choices (n = 27) and dietary intakes (n = 26).
- The nutrients most frequently studied were sodium (n = 32) and trans fatty acids (TFA, n = 13).
- Reformulated products were generally accepted and purchased by consumers, leading to improved nutrient intakes in 73% of the studies.
- A meta-analysis showed a -0.57 g/day (95%CI, -0.89 to -0.25) reduction in salt intake.
- The effect size for TFA intake reduction was -1.2 (95% CI, -1.79 to -0.61).
- Six studies examined effects on health outcomes, with studies on TFA reformulation showing overall improvement in cardiovascular risk factors.
- Among the 59 studies, only three were conducted in upper-middle-income countries.
- The majority of studies were conducted in high-income countries.
- Three of the 32 initiatives were mandatory (i.e., bans on the use of TFA).
- In the studies that measured the purchased salt by households, there was a reduction of -1.04 g/day (95% CI, -1.11 to -0.97).
- In the studies that measured salt intake using 24-h urinary excretion, there was a reduction of -0.47 g/day (95% CI, -1.13 to 0.18).
- The reduction in TFA intakes was estimated at -1.20 (95% CI, -0.79 to -0.61).
- The percentage reduction of TFA in reformulated products was substantially larger than that of reductions in total energy, or sugar.
- The effect was stronger when studies with the least risk of bias (NOS score >2) were selected.
- The morbidity or mortality from cardiovascular diseases was reduced in four of the five studies that evaluated the effect of TFA bans in packaged foods or restaurant foods, where mortality was reduced by between 4.3%-6.2%.
Other Important Findings
- Reformulated food products were accepted and consumed by the population, which led to an improved composition of the population purchases.
- The extent to which foods were reformulated also depends on the food category.
- Studies not isolating the effect of reformulation reported on an effect that can be the result of reformulation, and other strategies (in the case of multiple-component interventions, or by other uncontrolled inputs such as a change in advertising).
- The combination of a complete removal of TFA from the food supply in some countries, in addition to the strong correlation between TFA intake and health, created the conditions for a measurable impact on health.
- The health impact of diets is not mediated solely through one nutrient which may explain the difficulty to observe any health impact of the reformulation of single nutrients.
- The absence of effect was often explained by a small proportion of products reformulated, or a too slow pace.
Limitations Noted in the Document
- There is not equal representation of reformulation on all nutrients, meaning that evidence on reformulation of TFA and sodium are overrepresented.
- Some studies relied on labelled nutrient content in foods to measure changes, which can produce a biased measure, as nutrition labels allow for a margin of error between labelled content and actual content.
- The effect of reformulation alone was teased out only on a small proportion of studies (n = 18).
- Pooled estimates were different by measurement method used.
- Population-based monitoring is generally not sensitive enough to link reformulation to health outcomes.
Conclusion
Food reformulation has the potential to improve people’s diet and health. Changes in the nutrient composition of food products translate into changes in the balance of nutrients from food purchased by consumers. The evidence shows that a reduction in sodium or TFA content in foods results in a change in the intakes of those nutrients, and reductions of TFA in foods tend to be associated with decreased mortality from cardiovascular diseases at a population level. However, many reformulation initiatives lack a robust evaluation of their impacts on food choices, dietary intakes, and health. The success of reformulation as a public health strategy depends on the breadth of products reformulated and the extent to which they are reformulated. The studies indicated that when food products were reformulated, those products were purchased, resulting in an improved composition of the population purchases. It was difficult to isolate the effect of reformulation, as many studies were part of larger initiatives including other components such as labeling or public health campaigns. Although reformulation may be helpful in changing the consumption of some nutrients, it is not enough to tackle obesity as a global issue, especially for children. Given the challenges involved in changing behaviors and food choices, reformulation can provide the means to improve dietary intakes and health by changing the environment in which people make their food choices.