The triad of fibre, sodium and saturated fat as decisive factors of a healthy diet: A cross-sectional study on nutrient profile and nutritional quality of processed foods

Öz

The present study aimed to monitor the amounts of fibre, sodium and saturated fat in Turkey's food supply and determine the number of processed foods with labelling information for these components. Additionally, this study aimed to determine the nutritional quality of the foods based on declared labelling information. This was a cross-sectional study of 2676 products from January-April 2023. Products with partial and complete nutrient declarations were expressed as numbers and percentages. Fibre, sodium, and saturated fat amounts were expressed as median, interquartile range, and range. The nutritional quality of the food products was assessed using a Health Star Rating system. The information about labels for fibre, sodium, and saturated fat was 61.4%, 23.1%, and 97.1%, respectively. The median fibre, sodium, and saturated fat in all food products were 1.60 g, 76 mg, and 2.30 g/100 g, respectively. The food categories with the least fibre content were "milk and dairy products" and "non-alcoholic beverages." Conversely, the highest sodium and saturated fat content categories were "sauces and broths" and "snack foods," respectively. Based on the declared composition of food products, the median Health Star Rating score was 2.0, with 70.9% considered less healthy. Although Turkey has made progress in line with global developments, more effort is needed to improve the composition of certain processed foods.

Anahtar Kelimeler

• Fiber
• Sodium
• saturated fat
• Nutritional quality
• Processed foods

References

1. Ahuja, J.K.C., Pehrsson, P.R., Cogswell, M. (2017). A comparison of concentrations of sodium and related nutrients (potassium, total dietary fiber, total and saturated fat, and total sugar) in private-label and national brands of popular, sodium-contributing, commercially packaged foods in the United States. Journal of the Academy of Nutrition and Dietetics, 117(5), 770-777.e717. https://doi.org/10.1016/j.jand.2016.12.001
2. Arcand, J., Blanco-Metzler, A., Benavides Aguilar, K., L'Abbe, M.R., Legetic, B. (2019). Sodium levels in packaged foods sold in 14 Latin American and Caribbean countries: a food label analysis. Nutrients, 11(2), 369. https://doi.org/10.3390/nu11020369
3. Bayram, H.M., Ozturkcan, A. (2021). Nutrition quality of the Turkey packaged foods and beverages: a comparison of two nutrient profile models. Journal of Food Products Marketing, 27(5), 255-265. https://doi.org/10.1080/10454446.2021.1980755
4. Chen, X., Zhang, Z., Yang, H., Qiu, P., Wang, H., Wang, F., . . . Nie, J. (2020). Consumption of ultra-processed foods and health outcomes: a systematic review of epidemiological studies. Nutrition Journal, 19(1), 86. https://doi.org/10.1186/s12937-020-00604-1
5. Crino, M., Sacks, G., Dunford, E., Trieu, K., Webster, J., Vandevijvere, S., . . . Neal, B. (2018). Measuring the healthiness of the packaged food supply in Australia. Nutrients, 10(6), 702. https://doi.org/10.3390/nu10060702
6. Dicken, S.J., Batterham, R.L. (2021). The role of diet quality in mediating the association between ultra-processed food intake, obesity and health-related outcomes: a review of prospective cohort studies. Nutrients, 14(1), 23. https://doi.org/10.3390/nu14010023
7. Dickie, S., Woods, J.L., Baker, P., Elizabeth, L., Lawrence, M.A. (2020). Evaluating nutrient-based indices against food- and diet-based indices to assess the health potential of foods: how does the australian health star rating system perform after five years? Nutrients, 12(5), 1463. https://doi.org/10.3390/nu12051463
8. Dietary Guidelines for Turkey (2022). Dietary Guidelines for Turkey, 2022. Ankara: Ministry of Health Publication No: 1031. Republic of Turkey Ministry of Health and The General Directorate of Primary Health Care. https://hsgm.saglik.gov.tr/depo/birimler/saglikli-beslenme-ve-hareketli-hayat-db/Dokumanlar/Rehberler/Turkiye_Beslenme_Rehber_TUBER_2022_min.pdf (accessed 16.08.2024)

9. Elleuch, M., Bedigian, D., Roiseux, O., Besbes, S., Blecker, C., Attia, H. (2011). Dietary fibre and fibre-rich by-products of food processing: characterisation, technological functionality and commercial applications: a review. Food Chemistry, 124(2), 411-421. https://doi.org/10.1016/j.foodchem.2010.06.077
10. Erdem, Y., Akpolat, T., Derici, Ü., Şengül, Ş., Ertürk, Ş., Ulusoy, Ş., . . . Arıcı, M. (2017). Dietary sources of high sodium intake in Turkey: SALTURK II. Nutrients, 9(9), 933. https://doi.org/10.3390/nu9090933
11. Esposito, K., Maiorino, M.I., Bellastella, G., Chiodini, P., Panagiotakos, D., Giugliano, D. (2015). A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open, 5(8), e008222. https://doi.org/10.1136/bmjopen-2015-008222 The European Food Information Council (2017). Processed food: What is the purpose of food processing? https://www.eufic.org/en/food-production/article/processed-food-qa (accessed 31.08.2023).
12. Food Standards Agency (2016). Guide to creating a front of pack (FoP) nutrition label for pre-packed products sold through retail outlets. https://www.food.gov.uk/sites/default/files/media/document/fop-guidance_0.pdf (accessed 19. 09.2023).
13. Franco-Arellano, B., Labonté, M., Bernstein, J.T., L'Abbé, M.R. (2018). Examining the nutritional quality of Canadian packaged foods and beverages with and without nutrition claims. Nutrients, 10(7), 832. https://doi.org/10.3390/nu10070832
14. Ghodsian, B., Madden, A.M. (2018). Evaluating the ≤10:1 wholegrain criterion in identifying nutrient quality and health implications of UK breads and breakfast cereals. Public Health Nutrition, 21(6), 1186-1193. https://doi.org/10.1017/s1368980017003718
15. Grimes, C.A., Campbell, K.J., Riddell, L.J., Nowson, C.A. (2011). Sources of sodium in Australian children's diets and the effect of the application of sodium targets to food products to reduce sodium intake. British Journal of Nutrition, 105(3), 468-477. https://doi.org/10.1017/S0007114510003673
16. Guasch-Ferré, M., Babio, N., Martínez-González, M.A., Corella, D., Ros, E., Martín-Peláez, S., . . . Salas-Salvadó, J. (2015). Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease. The American Journal of Clinical Nutrition, 102(6), 1563-1573. https://doi.org/10.3945/ajcn.115.116046
17. Karimi, R., Azizi, M.H., Ghasemlou, M., Vaziri, M. (2015). Application of inulin in cheese as prebiotic, fat replacer and texturizer: a review. Carbohydrate Polymers, 119, 85-100. https://doi.org/10.1016/j.carbpol.2014.11.029 Lowery, C.M., Mora-Plazas, M., Gómez, L.F., Popkin, B., Taillie, L.S. (2020). Reformulation of packaged foods and beverages in the Colombian food supply. Nutrients, 12(11), 3260. https://doi.org/10.3390/nu12113260
18. Lustig, R.H. (2020). Ultraprocessed food: addictive, toxic, and ready for regulation. Nutrients, 12(11), 3401. https://doi.org/10.3390/nu12113401
19. Republic of Turkey Ministry of Health (2013). Chronic Diseases and Risk Factors Survey in Turkey. Ankara: Ministry of Health Publication No: 909. Republic of Turkey Ministry of Health Turkish Public Health Institution, Chronic Diseases, Elderly Health, and Disabled Department. https://ekutuphane.saglik.gov.tr/Ekutuphane/kitaplar/khrfai.pdf (accessed 16.08.2024)
20. Republic of Turkey Ministry of Health (2016). Turkey Reduction of Excess Salt Consumption Programme. Ankara: Public Health Institution of Turkey Department of Obesity, Diabetes and Metabolic Diseases. http://beslenme.gov.tr/content/files/Tuz/t_rkiye_a_r_ tuz_t_ketiminin_azalt_lmas_program_2017-2021.pdf (accessed 16.08.2024)
21. Republic of Turkey Ministry of Health (2021). Salt Reduction and Protocol Implementation Guide for the Food and Beverage Industry. Ankara: Ministry of Health Publication No: 1202. Republic of Turkey Ministry of Health and The General Directorate of Primary Health Care. https://hsgm.saglik.gov.tr/depo/birimler/saglikli-beslenme-ve-hareketli-hayat-db/Dokumanlar/Rehberler/tuz_azaltma_rehberi_20_10_2021.pdf (accessed 16.08.2024).
22. Mozaffarian, R.S., Lee, R.M., Kennedy, M.A., Ludwig, D.S., Mozaffarian, D., Gortmaker, S.L. (2013). Identifying whole grain foods: a comparison of different approaches for selecting more healthful whole grain products. Public Health Nutrition, 16(12), 2255-2264. https://doi.org/10.1017/s1368980012005447
23. Ni Mhurchu, C., Capelin, C., Dunford, E.K., Webster, J.L., Neal, B.C., Jebb, S.A. (2011). Sodium content of processed foods in the United Kingdom: analysis of 44,000 foods purchased by 21,000 households. The American Journal of Clinical Nutrition, 93(3), 594-600. https://doi.org/10.3945/ajcn.110.004481
24. Nourishing-Database (2022). Nourishing database. London: World Cancer Research Fund International. https://policydatabase.wcrf.org (accessed 09.09.2023).
25. O'Mahony, S., O'Donovan, C.B., Collins, N., Burke, K., Doyle, G., Gibney, E.R. (2023). Reformulation of processed yogurt and breakfast cereals over time: a scoping review. International Journal of Environmental Research and Public Health, 20(4), 3322. https://doi.org/10.3390/ijerph20043322
26. Petrus, R.R., do Amaral Sobral, P.J., Tadini, C.C., Gonçalves, C.B. (2021). The NOVA classification system: a critical perspective in food science. Trends in Food Science and Technology, 116, 603-608. https://doi.org/10.1016/j.tifs.2021.08.010
27. Rogers, M.A., Amer, H. (2022). Food as we knew it: food processing as an evolutionary discourse. Trends in Food Science and Technology, 128, 68-74. https://doi.org/10.1016/j.tifs.2022.07.015
28. Rosato, V., Temple, N.J., La Vecchia, C., Castellan, G., Tavani, A., Guercio, V. (2019). Mediterranean diet and cardiovascular disease: a systematic review and meta-analysis of observational studies. European Journal of Nutrition, 58(1), 173-191. https://doi.org/10.1007/s00394-017-1582-0 Schönenberger, K.A., Pestoni, G., Huwiler, V.V., Reber, E., Stanga, Z., Faeh, D. (2023). Inverse and dose-dependent association between fiber intake and ultra-processed food consumption in the general population of Switzerland. Clinical Nutrition ESPEN, 54, 481. https://doi.org/10.1016/j.clnesp.2022.09.075 Srour, B., Fezeu, L.K., Kesse-Guyot, E., Allès, B., Méjean, C., Andrianasolo, R.M., . . . Touvier, M. (2019). Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). British Medical Journal, 365, l1451. https://doi.org/10.1136/bmj.l1451
29. Turkish Food Codex (2017). Turkish Food Codex. Regulation on Food Labelling and Informing Consumers. https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=23282&MevzuatTur=7&MevzuatTertip=5 (accessed 10.09.2023).
30. Turkish Statistical Institute (2024). Death and Cause of Death Statistics, 2023. https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2023-53709] (accessed 16.08.2024).
31. Webster, J.L., Dunford, E.K., Neal, B.C. (2010). A systematic survey of the sodium contents of processed foods12. The American Journal of Clinical Nutrition, 91(2), 413-420. https://doi.org/10.3945/ajcn.2009.28688
32. World Health Organization (‎2015)‎. Regional Office for Europe. European Food and Nutrition Action Plan 2015–2020. Denmark, Copenhagen: World Health Organization. Regional Office for Europe. https://iris.who.int/bitstream/handle/10665/329405/9789289051231-eng.pdf?sequence=1 (accessed 16.08.2024)