Improving the diets of European citizens is a public health concern, and the label must provide useful information for this purpose, also taking into account the nutritional profiles of foods on which EFSA has published a new scientific opinion. (1)
EFSA had already commented on nutrient profiles-introduced by reg. EC 1924/06 on nutrition and health claims-but the European Commission has not followed up on them, in the 13 years since the deadline for their adoption. (2)
The EU Farm to Fork strategy has taken up this theme, with a view to introducing Front-of-Pack Nutrition Labeling (FOPNL) useful for encouraging informed food choices consistent with the goals of promoting balanced diets. (3)
1) Nutritional profiles and balanced diets, EFSA’s study.
The classification of foods based on their nutritional profiles has been promoted by WHO(World Health Organization) for several purposes. Nutrition education, health-conscious product reformulation and synthetic nutrition labeling, (4) but also marketing restrictions.
The study conducted by EFSA on nutrient profiles considers the different nutrient profiling models (e.g.
NutriScore
) and relevant scientific literature (systematic scientific reviews and meta-analyses primarily). In addition to reviewing available data on the diet and nutritional intake of the European population, as well as the relevant authorities’ guidelines for a healthy and balanced diet.
2) Excess nutrients and non-nutrients in the diets of Europeans
2.1) Energy (kJ, kcal)
Excess energy (kcal, calories) intake through food leads to increased fat mass and the likelihood of developing overweight, obesity and related diseases(Non Communicable Diseases, NCDs. E.g., type 2 diabetes, cardiovascular disease, cancer).
Eurostat describes a prevalence of overweight in 50-75% in men and 35-65% in women (2016-2020 data). Obesity in turn ranges from 10 to 35 percent, up to 45 percent in children. In Italy, the situation is not among the best.
Defining a threshold value for energy intake was complex, even in EFSA’s opinion on nutrient profiles, due to a lack of data on physical activity and the complex regulatory mechanisms of energy balance, which vary significantly on an individual basis.
2.2) Total fats
Total fat is considered the main contributor to excess calories and should not exceed 35 percent of energy intake. Which should ideally be divided between fat (20-35%), carbohydrates (45-60%) and protein.
A balanced intake of lipids in the diet is, after all, important for preventing cardiovascular disease. To this end, preference of monounsaturated (e.g., oleic acid) and polyunsaturated (e.g., Omega-3, Omega-6) fatty acids is recommended.
2.3) Saturated fatty acids
Excess saturated fatty acids are responsible for the development of cardiovascular disease, also due to an accumulation of so-called bad cholesterol (LDL).
These fats are found in coconut and palm (fruit and/or seed) oils, cocoa butter, as well as animal fats (butter, lamb, beef and pork), each with their own specificities.
The European Authority (EFSA) has not identified a limit for these fats-unlike some member states, which have suggested a threshold of 8-10 percent of total energy in their guidelines-and recommends their lowest possible consumption.
2.4) Trans fatty acids
Transfatty acids(TFAs) promote the accumulation of LDL. A distinction is made between artificial TFAs, which are formed by partial hydrogenation, deodorization, and frying of oils (still found in some margarines and ultra-processed foods), and natural TFAs:
– natural TFAs are contained in milk and dairy products (from ruminants). The latter are attributed health properties, however, which EFSA does not consider sufficient. Their maximum intake is recommended within 1.2 percent of energy intake.
– Artificial TFAs, on the other hand, have already been subjected to a legal limit (<2% relative to total fat, as noted) and are not considered a cause for concern.
2.4) Sugars and salt (sodium)
Sugars (free and added) are prime suspects in contributing to the development of dental caries, as well as a number of diseases also associated with excess energy (calories) (e.g., obesity, overweight, noncommunicable diseases). In its recent opinion on the subject, EFSA therefore recommended minimizing their consumption. Several member states indicate that sugars should not exceed 5-10% of calories consumed.
Excess salt (sodium) is associated with increased blood pressure and increased risks of hypertension, cardiovascular and kidney disease, and premature mortality from all causes. Therefore, 5 g/day of table salt (2 g/day of sodium) should not be exceeded. However, this threshold is greatly exceeded in the average consumption of the European population, and is a cause for serious concern.
3) Nutrient and non-nutrient deficiencies in the diets of Europeans.
3.1) Protein
Protein is essential for the development and maintenance of muscle tissue. The biological value of proteins (digestibility and composition of essential amino acids) varies in different sources of animal and plant origin, with general advantage of the former. Combining different plant foods still allows the requirements to be met, as noted above.
Protein intake in the European population is considered by EFSA to be consistent or higher, on average, than the referenceintake (0.83 g protein/kg body weight), with values between 0.8 and 1.25 g/kg. Higher intakes are not considered in principle to provide additional benefit, under standard conditions, but the absence of evidence on undesirable effects does not allow thresholds to be set for protein.
3.2) Omega-3
EPA and DHA are the two Omega-3 essential fatty acids involved in the synthesis of eicosanoids (EPA), molecules that can intervene in the mitigation of inflammatory processes, coagulate blood and regulate blood pressure (vasodilator). In addition to forming cell membranes (DHA). They are mainly taken through the consumption of fish and seaweed or dietary supplements.
An adequate intake of combined EPA and DHA is defined at 250 mg/day and 100 mg/day of DHA for children between 6 months and 2 years. Excluding supplements, the average intake was calculated to be between 50-150 mg/day. In several member states, including Italy, fish (and thus EPA and DHA) consumption is considered to be below the minimum recommended value (100-500 g/week). To prevent cardiovascular disease, you need to increase your intake.
3.3) Dietary fibers
Dietary fiber includes all nondigestible carbohydrates and similar components (e.g., lignin). Fruits and vegetables are rich in fiber, and it is advisable to consume them (when possible) whole and in their skins, so as to limit the loss of valuable fibers such as beta-glucans or pectins. They are very important to promote proper intestinal transit of food and stimulate and development of the microbiota (i.e., eubiosis). Several cardiovascular diseases and type 2 diabetes can be reduced with it.
25 g/day of fiber is the recommended amount so that physiological and preventive functions for health are best carried out. Current fiber intakes in European adults are lower (minimum 15.7 g/day), and their increased consumption needs to be promoted to ensure good health and longevity, in line with WHO recommendations.
3.4) Minerals
Potassium is an essential element for normal cellular functions such as intra- and extracellular water transfer and contributes to the membrane potential for nerve and muscle activity. Adequate intakes are 3,500 mg/day for adults (lower values are associated with a higher risk of heart attacks), with values dropping as low as 750 mg/day for children, depending on age. Tubers and starchy roots, along with grains, fruits, and vegetables are the main contributors of this mineral in the EU, but intakes are generally (not always) below the minimum value, and intake should be increased.
Iodine is a key mineral in the regulation of thyroid hormones. Its deficiency can lead to reduced thyroid function and fertility, as well as increase infant mortality and reduce mental capacity in children. Adults should take 150 mg/day, 200 mg/day pregnant women. For children, 70-150 mg/day. To limit shortages, several member states have mandated or suggested the addition of iodine in salt. Only some subgroups reported iodine deficiencies.
Iron is needed for oxygen and electron transport, energy metabolism, and other benefits already seen. Its deficiency leads to anemia and psycho-motor problems in children and adults. Average iron intakes are set at 6-8/day, depending on age. Except for 7-11-month-old children, all population groups have excess iron intake. Deficiencies have been observed in infants (> 4 months) born to iron-deficient women. Apart from these cases, iron supplements are not recommended.
3.5) Vitamins
Vitamin D and calcium are considered as a pair, as intake of the vitamin promotes mineral absorption. A deficiency of them leads to bone mass problems and osteopenia. The elderly should be careful to take suitable amounts to limit the risks of falls and fractures. Adequate vitamin D intake is 10 and 15 mg/day for children aged 7-11 months and other categories, respectively. For calcium, 750-860 mg/day is recommended for adults, 390-680 for children and 960 mg/day for adolescents. Children, expectant mothers and infants, the elderly, those with poor sun exposure and dark skin should take vitamin D supplements.
Folate is important for DNA and RNA synthesis, muscle growth, and amino acid metabolism. Essential for the proper development of the fetus during pregnancy. Optimal amounts are considered 80 micrograms of folate equivalents/day for infants between 7-11 months, 120-330 for children, adolescents and adults, up to 500-600 for lactating and expectant mothers, respectively. Data on recruitment are insufficient, and it has not been possible to determine strategies to be adopted in this regard.
4) Choice of nutrients and non-nutrients for nutritional profiling
Intakes of saturated fat, sodium and free/added sugars, along with fiber, could be included in nutritional profiling models. Given both their relevance to health and their respective excesses and deficiencies in the diets of European consumers.
Energy value may also come into consideration, given its impact on obesity and overweight. Total sugars can be a reference for added/free sugars, which are the most variable fraction. Essential nutrients (e.g., Omega-3) and micronutrients (vitamins and minerals) could also be considered.
5) Interim Conclusions
EFSA’s scientific opinion on nutrient profiles was worthwhile to take stock of the status quo and review both intake levels in the European population and optimal intakes when data are available. But the lack of data on some categories turned out to be a serious obstacle to drafting a useful opinion for the purposes.
A responsible decision is now awaited from the European Commission on the adoption of mandatory and effective Front-of-Pack Nutrition Labeling (FOPNL), as the NutriScore system has been widely shown to be. And the effective implementation of nutrition profiles, to mitigate the harm to public health–of minors especially–caused by junk food marketing.
Dario Dongo and Andrea Adelmo Della Penna
Notes
(1) EFSA NDA Panel (2022). Scientific advice related to nutrient profiling for the development of harmonized mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. EFSA Journal 20(4):7259, https://doi.org/10.2903/j.efsa.2022.7259
(2) Dario Dongo. Nutrition profiles, 10 years of absconding in Brussels. GIFT (Great Italian Food Trade). 19.1.19, https://www.greatitalianfoodtrade.it/etichette/profili-nutrizionali-10-anni-di-latitanza-a-bruxelles
(3) Dario Dongo. Reform reg. EU 1169/11, public consultation. GIFT (Great Italian Food Trade). 16.1.22, https://www.greatitalianfoodtrade.it/etichette/riforma-reg-ue-1169-11-consultazione-pubblica
(4) Dario Dongo, Andrea Adelmo Della Penna. How to solve the nutritional conundrum? News on the label front, review and outlook. GIFT (Great Italian Food Trade). 12/29/20, https://www.greatitalianfoodtrade.it/etichette/come-risolvere-l-enigma-nutrizionale-notizie-sul-fronte-etichetta-rassegna-e-prospettive
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
Graduated in Food Technologies and Biotechnologies, qualified food technologist, he follows the research and development area. With particular regard to European research projects (in Horizon 2020, PRIMA) where the FARE division of WIISE Srl, a benefit company, participates.
