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HSR fibre reformulations - any benefits?

Are HSR driven changes to fibre content likely to improve health?

Authors: Anna Worthington, Student,* Cliona Ni Mhurchu, Professor*, Helen Eyles, Senior Research Fellow* *National Institute for Health Innovation, University of Auckland

Introduction

The Health Star Rating (HSR) system (Figure 1) provides an incentive to industry to reformulate their products to increase the star rating and appeal to consumers (1). Dietary fibre, one of the nutrients in the HSR score, is known to have a positive relationship with health through improved bowel motions, reduction in blood cholesterol, and/ or modulation of blood glucose(2). However, there is a perception that functional fibre ingredients added to processed foods are not as beneficial for health as naturally occurring dietary fibres.

The New Zealand Government adopted the HSR nutrition labelling system in 2014. The HSR is a voluntary, front-of-pack nutrition label currently displayed on 21% of packaged food and beverage products sold in major New Zealand supermarkets (3). The star rating for a food is calculated based on the balance of positive food components (fruit, vegetable, nut and legume contents, dietary fibre and protein) and adverse nutrients (energy, saturated fat, sodium, and total sugars) it contains. HSR scores range from one half to five stars, with five being the healthiest.

Methodology

In our study we used Nutritrack(4), a New Zealand database of packaged supermarket products, to identify foods where the fibre content had increased following adoption of the HSR. We also examined which fibre ingredients were added or increased, and completed a review of the evidence to investigate whether the most commonly added fibre ingredients are likely to be health promoting.

Nutritrack data are collected annually from four major supermarkets in Auckland by trained fieldworkers and are estimated to account for ~75% of packaged food products purchased by New Zealand households (4, 5). In 2015, 39 of 14,415 products available in the database that year (0.27%) displayed the HSR nutrition label, and in 2016, 807 of 15,358 products displayed the HSR (5.25%)(4). Of the 807 products that displayed the HSR label in 2016, 431 were also available in 2014 prior to the introduction of HSR, had been reformulated in some way, and could be examined to determine whether this reformulation was due to a change in the amount of fibre.

Of 431 reformulated products, 148 (40%) reported an actual (n=74) or assumed (n=74) increase in fibre content between 2014 and 2016 (Figure 2). Of the 74 with a reported increase in fibre on the Nutrition Information Panel, 21 (28%) had new fibre ingredients added, 13 (18%) had increased in the amount of an existing fibre ingredient, and 11 (15%) had both. For the remaining 29 products it was not possible to tell which fibre ingredients changed, or by how much. Across all 148 reformulated products, the most commonly added ‘new’ fibre ingredients were oat fibre (n=5), wholegrain oat flour (n=7), and inulin (n=5), while cereals/wholegrains were by far the most common ‘existing’ ingredients to be increased (n=14). Breakfast cereals were the food group to which wheat bran, oat fibre, and wholegrain oat flour were most commonly added, and cereal bars were the food group to which inulin was most commonly added (Table 1).

We reviewed existing literature reviews on the health effects of the most commonly added or increased fibre ingredients i.e. wheat bran, inulin and ‘oats’. The question for each was “What effects does consumption of this fibre ingredient have on human health?”. Fourteen to 20 reviews from Medline, Scopus, Google Scholar and Food Science Technology Abstracts met the inclusion/exclusion criteria for each of the three ingredients i.e. reviews were included if the majority of included studies investigated the ingredient of interest and the review had a population health focus.

Overall, the literature indicated that all three fibre ingredients were likely to be health promoting, albeit via different mechanisms.

Wheat Bran

Eleven reviews supported the relationship between wheat bran and improved bowel function(7-17), while ten reviews reported that wheat bran consumption can reduce risk of colon cancer in humans (8, 10, 12, 14, 18-21). The effect wheat bran has on cholesterol was inconclusive with four reviews agreeing wheat bran lowers cholesterol(8, 10, 12, 14), and three disagreeing (7, 9, 22).

Inulin

Twelve reviews reported that inulin acts as a prebiotic (23-34), which in turn has been associated with suppression of activity of harmful bacteria (n=8 reviews)(25-29, 31, 33, 34), improved bowel health (n=7 reviews)(24, 26-29, 31, 33), and increased absorption of calcium(n=6 reviews)(24, 26-28, 33, 35). Inulin also lowers blood cholesterol levels (n=5 reviews)(24-27, 36). However, the relationship of inulin with immune markers (n=6 studies, 4 positive(23, 26, 27, 30) and 2 inconclusive (24, 29)) and cancer(n=3 studies, all inconclusive), was inconclusive overall (28, 29, 31). Further, the evidence indicates that inulin may cause abdominal discomfort and flatulence in some individuals (n=4 reviews) (24, 26-28, 36).

Oats

Eleven reviews reported that oats, like inulin, are associated with lower blood cholesterol levels(37-46), which in turn may reduce the risk of cardiovascular disease (38, 40, 42, 45, 47). The majority of reviews that reported on the relationship between oats and cancer in humans were inconclusive (37-39, 47, 48), although a number reported that oats exhibit antioxidant properties (n=6)(37-40, 43, 45).

Conclusions

In summary, early indications are that the HSR labelling system may be promoting an increase in the fibre content of some New Zealand packaged foods, and the most commonly added fibre ingredients are likely to provide beneficial health effects. However, specific health effects depend on the type of fibre and care must be taken when generalising the results of the reviews to specific food products. This is because several factors can alter the extent to which a fibre ingredient can provide a health benefit for an individual (10), including the cultivar and source of fibre, the amount consumed (36), an individual’s microbiota, and the overall dietary food pattern (25).

The HSR labelling system has also been in place for a relatively short time, and this analysis included a comparison of products only available in 2014 and 2016. Therefore, it would be beneficial to repeat the analysis when a larger number of years and products with the HSR label are available.

Partial list of References

A full list of references is available from Dr Helen Eyles: h.eyles@auckland. ac.nz

1. Vyth EL, Steenhuis IHM, Roodenburg AJC, Brug J, Seidell JC. Front-of-pack Nutrition label stimulates healthier product development: A quantitative analysis. International Journal of Behavioral Nutrition and Physical Activity. 2010;7:65.

2. Ni Mhurchu C. Effects of interpretive nutrition labels on food reformulation: the Health Star Rating system. Oral presentation at Tackling diet-related disease in New Zealand - the need, the evidence, the priorities. 2018; The University of Otago, Wellington. Accessed 24/09/18. Available: https://www.otago.ac.nz/ wellington/otago694619.pdf.

3. National Health and Medical Research Council, Australian Government Department of Health and Ageing, New Zealand Ministry of Health. Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. Canberra: National Health and Medical Research Council; 2006.

4. Ministry for Primary Industries. Health Star Rating. Monitoring implementation at Year Two. Accessed 24/08/18. Available: https://www.mpi. govt.nz/dmsdocument/17635/loggedIn. 2017.

5. Eyles H, Neal B, Jiang Y, Ni Mhurchu C. Estimating population food and nutrient exposure: a comparison of store survey data with household panel food purchases. The British Journal of Nutrition. 2016 May 28;115(10):1835-42.

6. Australia New Zealand Food Standards Code – Standard 1.2.8 – Nutrition information requirements [Internet] [updated 2017 Apr 13; cited 23/09/18]. Available from: https://www.legislation.gov.au/Details/F2017C00311

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