The Choices Nutrition Criteria Proposed Changes for Israel

The Choices Nutrition Criteria: Proposed Changes for Israel

Background on Choices in Israel • • Plans to launch at Q 4 2009 Specific dietary habits related to Mediterranean diet and Jewish diet Review of criteria began in August 2008 Drafts and comments sent to Choices International foundation: – September 2008 (identification of foods to be adjusted) – November 2008 (recommendations for food groups+ analysis of nutrients) – January 2009 (recommendations for Cheese, Hummus (chickpeas), Meat, Milk) – Meeting with Jaap Seidel January 2009 (agreement on kosher meet and 3 % milk as a time leg) – February 2009 – Meeting report, agreement on next steps and process for adjusting criteria with CIF – April 2009 – Draft final review recommendations by Israeli scientific committee/ Adjustment to the local situation in Israel is critical for launching Choices in Q 4, 2009 Choices International Foundation

Food product evaluation in Israel - Methodology • • Analysis of Choices Criteria against Israeli dietary patterns for most products available on the Israeli market: Review and analysis of choices food groups using Israeli National Nutrition Survey (Mabat 2003) and israeli food data base (Tsameret) Missing data collected from food packaging or from laboratory tests, Thorough analysis of the food content, consumption patterns, technological production, compatibility to Choices and other nutritional labeling programs. - Examination of the need for adjusting Choices criteria to consumption patterns in Israel. - Suggested solutions for the adjustment of the criteria, according to the choices methodology Choices International Foundation

The Process for developing suggested adjustments in the Choices criteria in Israel • • • Identifying missing : 1. food groups 2. product groups 3. gaps Review of nutrient content, role in the diet Consultation with IMOH on consumption patters and MOH policy Position paper from IMOH 4 meetings of Israeli Choices Scientific Committee Presenting issues to Prof Jaap Seidel by the Israeli committee during his visit in January 2009 • Proposing criteria for specific groups in Israel, using Choices criteria development system and principles • Decision by national committee on criteria for specific food groups Choices International Foundation

What are the gaps? Choices criteria reflect patterns of Western/Northern European diet The Israeli Manu reflect some differences : • Jewish Tradition: Kosher cuisine (separating meat from cheeses in the same meal, koshering of foods). • Local Dietary patterns: – White Cheeses, Milk and the major role of low fat dairy foods in the diet – Salad spreads (hummus- chickpeas) – Breakfast Cereals – Kosher (e. g. , salt in meat) – Rice Choices International Foundation

Dairy Products in Israel • Dairy products : – Choices “cheese food group” contains cheese not highly recommended and not as prevalent in Mediterranean diet (hard cheese high in salt and SAFA) – Choices does not cover white soft cheese such as fresh cream cheese and cottage cheese, labane – all are main source of dairy foods in Israel (most are low fat (3 -9% fat), and substantially lower in sodium levels then cheese (900 in Cheese against 350 -400 in soft cheese) – White soft Cheese are central to daily menu of all Israelis, they are eaten at least once a day in dinner or even twice breakfast and dinner in an average amount of 100 -200 gr a day. Choices International Foundation

Salad Spreads • Current Choices criteria do not allow for appropriate food group for basic salad spreads typical in Israeli (and Mediterranean diet) such as – Hummus (Chick Peas) salad spread – Tahinni (sesame spread) – Eggplant salads (babaganoush) Current criteria either allow for too many products or for no products at all. Choices International Foundation

Proposal for Adjusting the Choices criteria to Israel White Soft Cheese and Cottage Cheese • Fundamental products in most Israelis' menu • Commonly contain between 3 -5% fat • Consumed as a spread on bread or with a spoon in dairy meals. ü Hard cheese is not as common in Israel as it is in Europe and therefore white soft cheese is an important source of protein and calcium. Choices International Foundation

White Soft Cheese and Cottage Cheese in Israel Evaluation according to the Choices groups: – Milk products: All products were disqualified due to high sodium levels, products containing more than 3% fat were also disqualified due to SAFA. – Cheese products: All products complied with the Choices criteria. – Oils & spreads: All products were disqualified, most due to sodium and SAFA Milk products Cheese products Oils & spreads SAFA < 1. 4 g/100 g SAFA < 15 g/100 g SAFA < 30% of Total fat Fat TFA < 0. 14 g/100 g TFA < 1. 3%en Sodium < 120 mg/100 g < 900 mg/100 g < 1. 6 mg/Kcal Added sugar < 5 g/ 100 g Not added % qualify 0 100 0 Criteria Unique Israeli food which do not fit in the current Choices criteria scheme ü It is necessary to create a new product subgroup. Choices International Foundation

White Soft Cheese and Cottage Cheese in Israel • Sodium levels - White soft cheese: 130 - 340 mg /100 g • Sodium levels - Cottage cheese: 370 - 430 mg /100 g • Cottage cheese contains 100 -150 mg/100 g more sodium due to the manufacturing techniques (the process which gives cottage cheese its unique texture involves the use of sodium). ü In order for cottage cheese to qualify, the sodium criterion should be set to about 400 mg/100 g Choices International Foundation

White Soft Cheese and Cottage Cheese – review of healthy symbols programs Other nutritional labeling programs in the world: – The food product group that was found to contain the most similar products was the "Fresh cheese" in the Swedish "Keyhole" program. Criteria Keyhole – Fresh Cheese Total fat< 5 g/100 g Fat – The fat criterion: Allows for 5% fat cheese to qualify. – The sodium criterion: > Stricter than the choices cheese group(900 mg/100 g), Less strict than the choices milk group (120 mg/100 g) > Not applicable in Israel - will cause disqualification of all cottage cheese (all products contain more than 370 mg/100 g) Choices International Foundation Sodium 350 mg/100 g Added sugar Not added

White Soft Cheese and Cottage Cheese in Israel The proposal made by the Israeli scientific committee: Israel Suggestion Fat – These products are to be included as a separate group. – The benchmark for this group is to allow for 400 mg/100 g sodium and 2 g/100 g SAFA. ü It is recommended to stiffen the sodium criterion in later stages of the implementation of the Choices program. Criteria SAFA < 2 g/100 g Sodium < 400 mg/100 g %qualify 38 - This will result in the qualifying of 38% of the products, all of the soft white cheese and cottage cheese containing up to 3% fat (including those manufactured by most manufactures). - Viable suggestion, strict enough to stimulate innovation, will qualify sufficient number of products to ensure the consumption of beneficial nutrients. Choices International Foundation

White Soft Cheese and Cottage Cheese in Israel Criteria Fat SAFA < 2 g/100 g Sodium < 400 mg/100 g %qualify Choices International Foundation Israel Suggestion 38

Proposal for Adjusting the Choices criteria to Israel Vegetable oil based spreads (Hummus) • Hummus is chick-peas spread/paste • Hummus is fundamental in the diet of Israelis and other Mediterranean countries • For some Israelis, hummus is not only a spread, but rather the main course of the meal (usually consumed with pita bread). Choices International Foundation

Choices International Foundation

Hummus spreads in Israel What is Hummus? Ingredients: 16% cooked hummus (chickpeas), vegetable oil, water, tahini, salt, lemon acid, spices, preservative • The sodium level is usually above 350 mg / 100 g • Wide range of SAFA and sodium levels Choices International Foundation

Hummus spreads in Israel Evaluation according to the Choices groups: – Processed vegetable: All products were disqualified due to sodium and SAFA levels – Oils & spreads: A majority of the products (65%) comply. The main reason for disqualification: sodium (91%), SAFA (18%). – “All other products”: A majority of the products (58%) comply. The main reason for disqualification: sodium (77%), SAFA (31%). ü In the last two food groups the products that contain less added fat were disqualified due to the fact that the sodium criterion is based on units of mg/Kcal. Criteria Processed fruit & vegetable SAFA < 1. 4 g/100 g Fat TFA < 0. 14 g/100 g Oils & spreads SAFA < 30% of Total fat All other products SAFA < 13%en (1. 4 g/100 g) TFA < 1. 3%en (0. 14 g/100 g) TFA < 1. 3%en Sodium < 120 mg/100 g < 1. 6 mg/Kcal (120 mg/100 g) Added sugar Not added < 13%en (3. 25 g/100 g) Dietary fibre < 1. 3 g/100 kcal % qualify 0 65 58 Unique Israeli food which do not fit in the current Choices criteria scheme Choices International Foundation

Hummus spreads in Israel The proposal made by the Israeli scientific committee: – The criteria for the hummus subgroup will be based on the "all other products" group: >This group Includes salad spreads >The SAFA criterion is stricter than that in the “oils & spreads” group. Criteria All other products SAFA < 13%en (1. 4 g/100 g) TFA < 1. 3%en (0. 14 g/100 g) Fat Sodium 400 mg/100 g – The best products which contain less fat, less sodium and less energy Added < 13%en (hummus light) do not qualify when evaluated according to the present sugar (3. 25 g/100 g) sodium criterion (1. 6 mg/Kcal). % qualify 26 > The sodium criterion should be set specifically for the hummus subgroup – These products are to be evaluated according to the “all others” food group, but with a change of the sodium reference and consider sodium as amount per 100 g (400 mg/100 g) instead of mg per Kcal ( this will result in 26% of the products qualifying ) –This allows for the best Hummus products in the market only to qualify while relying on the current Choices system, without the need to develop a unique food group for this product category. Choices International Foundation

Hummus spreads in Israel Criteria light hummus, Achla (Strauss) plain hummus (Zabar) Energy 209 kcal 335 kcal Fat SAFA = 1. 7 g (7. 3%en) SAFA = 4. 5 g (12%en) Sodium 353 mg (1. 68 mg/kcal) 435 mg (1. 3 mg/kcal) Qualify? (1. 6 mg/kcal) no yes Qualify? (400 mg/100 g) yes no Choices International Foundation

Hummus spreads in Israel Criteria All other products (Hummus) SAFA < 13%en (1. 4 g/100 g) TFA < 1. 3%en (0. 14 g/100 g) Fat Sodium Added sugar < 13%en (3. 25 g/100 g) % qualify Choices International Foundation 400 mg/100 g 26

Proposal for adjusting the Choices criteria to Israel Breakfast cereals • Breakfast cereals are very common products in Israel and are consumed by both adults and children. • In 9 out of 10 households cereal is consumed for breakfast on a daily basis. • 80 products have been analyzed, from the main producers : Unilever, Nestle, Kellog’s, Monday, Shufersol (PL), Quaker, Marmolight • Of the products reviewed divided 50% adults and 50% are children cereals. • These represent almost all products with available nutrition information Choices International Foundation

Granola & Cereals Market in Israel • Granola segment is 7% of the cereal market. • Granola Penetration rate – 30% • Cereals (without Granola) Penetration rate- 86% (April Mat 2009) • It’s seems that every one who buys Cereals buys also Granola. Choices International Foundation

Breakfast cereals in Israel • Sodium content vary from as low as 0. 5 to as high as 730 mg/100 g. • Most products contain 200 - 500 mg/100 g. • Sugar content varies widely from as low as 1 to as high as 50 g/100 g. • The products targeted for children contain more sugar. > more than 22 g/100 g. > average 33 g/100 g (19 g/100 g for adults’ products). Adults’ average Children's average Choices International Foundation

Breakfast cereals in Israel Sugar - technological importance • Sugar has a technological importance in the manufacturing of breakfast cereals. • The sugar assists in acquiring the typical texture of breakfast cereals. manufacturing by extrusion requires 7 -10 g/100 g sugar (not including the sugar coating) in order to achieve crunchiness and prevent softening in milk. • The coating syrup used for the external sweetening also contains sugar (mostly common in children's products). The external coating adds 12 to 40 additional grams of sugar per 100 gram product. The demand for children's products is to be sweeter and therefore they contain high levels of sugar. Choices International Foundation

Breakfast cereals in Israel Choices Grains & Cereal Products Choices - Bread Choices Snacks SAFA < 1. 4 g/100 g SAFA < 13%en Fat TFA < 0. 14 g/100 g TFA < 1. 3%en Sodium < 120 mg/100 g < 500 mg/100 g < 400 mg/100 g Added sugar < 3. 25 g/100 g < 13%en < 20 g/100 g Dietary fibre < 1. 3 g/100 kcal Evaluation according to the Choices groups: – Grain group: All products were disqualified. The main reason for disqualification: sodium and sugar (94%) – Bread group: Only 6% qualified. The main reason for disqualification: sugar (94%) – Snacks group: Only 3% qualified. The main reason for disqualification: energy (78%) and sugar (77%) – none of the products targeted at children qualified. Criteria Energy % qualify < 110 kcal/ portion 0 6 Common Israeli food which does not fit in the current Choices criteria scheme ü It is necessary to create a new product subgroup. Choices International Foundation 4

Breakfast Cereals Fat Sodium Choices - Bread SAFA < 1. 4 g/100 g Total Fat < 7 g/100 g SAFA < 10%en TFA < 0. 14 g/100 g < 400 mg/100 g < 500 mg/100 g < 240 mg/ portion (30 g), < 800 mg/100 g 16 g/100 g > 6 g/100 g < 120 mg/100 g < 500 mg/100 g "Smart-Choices" Cereals Heart Symbol- Keyhole Cereals SAFA < 1. 4 g/100 g Criteria Choices -Grains & Cereal Products Cereals Total Fat < 5 g/100 g Added sugar < 3. 25 g/100 g < 13%en 13 g/100 g < 12 g/ portion (30 g), < 40 g/100 g Dietary fibre > 1. 3 g/100 kcal > 1. 9 g/100 kcal >10% DV Other nutritional labeling programs in the world: Two programs were reviewed, the American “Smart choices” and the Swedish “Keyhole”: Regarding sugar and sodium: Recently, another program was reviewed, the Finish “Heart • the American program ("Smart-Choices“) is the less strict of the two. symbol”. This program also sets more lenient sugar criterion • The breakfast cereal groups in both programs are less strict than the Choices grains food group. with regards to the current choices criterion. • • Sodium and sugar criteria, which were the main reason for disqualification of products, should be modified. These modified criteria can be based on the bread product group, which are similar to the grains group criteria in the fat and fiber criteria but are less strict in the sodium criterion. Choices International Foundation

Breakfast Cereals Other nutritional labeling programs in the world: • • In order to asses the possible sugar criterion, the products were evaluated according to the Choices bread products criteria while sugar levels were taken from other programs: - "Keyhole" cereals group (13 g/100 g) sugar criterion: only 9% of the products qualify (no children product). - “Smart Choices" cereals group (40 g/100 g) criterion: 24% of the products qualified (including some products targeted at children). only 7% were disqualified due to sugar levels. A practical sugar criterion can be set somewhere inbetween the two programs (Keyhole and Smart-Choice) in order to stimulate industry to reduce sugar levels especially in cereals targeted at children. Choices International Foundation Choices Bread + Keyhole Sugar criteria Choices Bread + “Smart Choices” Sugar criteria SAFA < 1. 4 g/100 g Fat TFA < 0. 14 g/100 g Sodium < 500 mg/100 g Added sugar < 13 g/100 g < 40 g/100 g Dietary fibre > 1. 3 g/100 kcal %qualify 8 25 %qualify (adults’ products) 15 39 %qualify (children’s products) 0 10 Criteria

Breakfast cereals in Israel Conclusions: • Sugar and salt have an important taste and technological role in breakfast cereal and are the most important yet complicated target for stimulation of product improvement and product development. • As regards children targeted products, sugar is the most challenging nutrient to target. • Currently, the bread criterion for sugar is too remote from market situation in breakfast cereals (none of the products targeted at children qualified) • We suspect that in Israel there is a unique situation where sugar levels in a selected number of breakfast cereals targeted at children are lower then elsewhere, and are limited to one manufacturer's products only (Unilever). Choices International Foundation

Breakfast cereals in Israel’s suggestions: • • • These suggestions are based on the bread products criteria but with a modified sugar criterion Option 1 - 18 g/100 g sugar: qualification of 14% of the products (none of the “children's products”). Option 2 - less strict sugar criterion (22 g/100 g): qualification of 18% of the total products, including only one children's product, and 32% of the adult's products. Option 3 - midrange between the "Keyhole" and the "Smart Choices" sugar criterion (28 g/100 g): qualification of 20% of the total products, including only one children's product, and 37% of the adult's products. The only children's product which qualified (Shugi protein, Uniliver) contains artificial sweeteners, which is needed in order to meet the demand from such a product (sweet). Suggestion 1 Suggestion 2 Suggestion 3 SAFA < 1. 4 g/100 g Fat TFA < 0. 14 g/100 g Sodium < 480 mg/100 g < 500 mg/100 g Added sugar < 18 g/100 g < 22 g/100 g < 28 g/100 g Dietary fibre > 1. 3 g/100 kcal %qualify 14 18 20 %qualify (adults’ products) 27 32 37 %qualify (children’s products) 0 3 3 Criteria Choices International Foundation

Breakfast cereals in Israel’s suggestion- the principles: • • • Criteria Suggestion 1 Suggestion 2 Suggestion 3 Sodium < 480 mg/100 g < 500 mg/100 g Added sugar < 18 g/100 g < 22 g/100 g < 28 g/100 g %qualify 14 18 20 %qualify (adults’ products) 27 32 37 %qualify (children’s products) 0 3 3 Setting the criteria should be done so that products for all consumer populations will be represented (children & adults). It is recommended to maintain all breakfast cereals as one category. A need for educating consumers to consume less sweet products, and purchase improved products, therefore avoiding criteria that will result in usage of sugar substitutes, which keep sweetness high and is not perceived as acceptable by parents. Choices International Foundation

Breakfast cereals in Israel’s recommended suggestions : Options 2 and 3 seem to be the practical options. > The criteria in these options are challenging (only 1 product targeted at children qualified) • • Option 2 - a great challenge for manufacturers since current sugar levels are much higher. > low acceptance of products with different taste due to decreasing sugar levels or adding artificial sweeteners. Option 3 – less strict. > it may allow gradual shift to the development of better children's breakfast cereals. • Criteria Suggestion 1 Suggestion 2 Suggestion 3 Sodium < 480 mg/100 g < 500 mg/100 g Added sugar < 18 g/100 g < 22 g/100 g < 28 g/100 g %qualify 14 18 20 %qualify (adults’ products) 27 32 37 %qualify (children’s products) 0 3 3 It is suggested that as a first step, a challenging criterion will be set, but without forcing manufacturers to use artificial sweeteners – suggestion 3 (28 g/ 100 g sugar). > The goal is that in the future this criterion will be lowered to 22 g/100 g sugar Choices International Foundation

Breakfast cereals in Israel Criteria Israel Suggestion SAFA < 1. 4 g/100 g Fat Sodium < 500 mg/100 g Added sugar < 28 g/100 g Dietary fibre > 1. 3 g/100 kcal %qualify Choices International Foundation TFA < 0. 14 g/100 g 20

Breakfast cereals in Israel Appendix - Assessment of the added sugar daily intake according to the suggested criteria: • • • In order to check the compliance of the criteria suggested to the recommended nutritional intake there is a need to evaluate their influence on the total daily intake of added sugar. When evaluating according to even the most lenient suggested criteria it was found that the maximal daily energy intake from added sugar was less than the upper limit (< 25 en%) as set by the US Institute of Medicine. • • Calculation of maximal sugar levels for snacks (applying product specific sugar criterion: 20 g/100 g): • Per 100 g, a snack may contain 20 g sugar. For a 45 g snack, this will be 9 g sugar • 3 times a day a sweet snack x 9 g sugar = 27 g sugar from snacks Calculation of maximal sugar levels for breakfast cereals (applying product specific sugar criterion: 28 g/100 g): • Per 100 g, cereals may contain 28 g sugar. For a 30 g serve, this will be 8. 4 g sugar Sugar from the rest of the diet (applying the generic added sugar criterion: <13 en%): • Total energy intake (2000 kcal – 330 kcal (snacks) – 33. 6 kcal (cereals) = 1600 kcal of which 13 en% of added sugar (generic criterion): 52 g sugar Maximal daily energy intake from added sugar in diet: • 27 g + 8. 4 g + 52 g= 87. 4 g (x 4 kcal) = 349. 6 kcal • • = 17. 5% of total daily energy (2000 kcal), which is below the IOM upper limit (25 %energy) Choices International Foundation

Choices International Foundation