nu ien s
A icle
P e alence o Nu i ion and Heal h-Rela ed Claims on
P e-Packaged Foods: A Fi e-Coun y S udy in Eu ope
Sophie Hieke 1,*, Ne a Kuljanic 1, Igo P a s 2,3, K is a Mikla ec 2, Asha Kau 4,
Ke y A. B own 5, Be nade e M. Egan 5, Ka ja P ei e 6, Azucena G acia 7and Mike Rayne 4
1Eu opean Food In o ma ion Council, ue Paul-Emile Janson 6, 1000 B ussels, Belgium;
[email p o ec ed]
2Nu i ion Ins i u e, T žaška ces a 40, 1000 Ljubljana, Slo enia; igo [email p o ec ed] (I.P.);
[email p o ec ed] (K.M.)
3Bio echnical Facul y, Uni e si y o Ljubljana, Jamnika je a 101, 1000 Ljubljana, Slo enia
4B i ish Hea Founda ion Cen e on Popula ion App oaches o Non-Communicable Disease P e en ion,
Uni e si y o Ox o d, Ox o d OX3 7LF, UK; [email p o ec ed] (A.K.); [email p o ec ed] (M.R.)
5Food, Consume Beha iou and Heal h Resea ch Cen e, Uni e si y o Su ey, Guild o d GU2 7XH, UK;
ke y.b own@su ey.ac.uk (K.A.B.); m.egan@su ey.ac.uk (B.M.E.)
6Ins i u e o Consume and Beha iou al Resea ch, Saa land Uni e si y, 66123 Saa b ücken, Ge many;
[email p o ec ed]
7Ag i ood Resea ch and Technology Cen e o A agon, 50059 Za agoza, Spain; [email p o ec ed]
*Co espondence: [email p o ec ed]; Tel.: +32-2-506-8981
Recei ed: 11 Decembe 2015; Accep ed: 25 Feb ua y 2016; Published: 3 Ma ch 2016
Abs ac :
This s udy is pa o he esea ch unde aken in he EU unded p ojec CLYMBOL (“Role o
heal h- ela ed CLaims and sYMBOLs in consume beha iou ”). The i s phase o his p ojec
consis ed o mapping he p e alence o symbolic and non-symbolic nu i ion and heal h- ela ed
claims (NHC) on oods and non-alcoholic be e ages in i e Eu opean coun ies. P e-packaged oods
and d inks we e sampled based on a s anda dized sampling p o ocol, using s o e lis s o a s o e loo
plan. Da a collec ion ook place ac oss i e coun ies, in h ee ypes o s o es. A o al o 2034 oods
and d inks we e sampled and packaging in o ma ion was analyzed. A leas one claim was iden i ied
o 26% (95% CI (24.0%–27.9%)) o all oods and d inks sampled. Six pe cen o hese claims we e
symbolic. The majo i y o he claims we e nu i ion claims (64%), ollowed by heal h claims (29%)
and heal h- ela ed ing edien claims (6%). The mos common heal h claims we e nu ien and o he
unc ion claims (47% o all claims), ollowed by disease isk educ ion claims (5%). Eigh pe cen o
he heal h claims we e child en’s de elopmen and heal h claims bu hese we e only obse ed on
less han 1% (0.4%–1.1%) o he oods. The ca ego y o oods o speci ic die a y use had he highes
p opo ion o NHC (70% o oods ca ied a claim). The p e alence o symbolic and non-symbolic
NHC a ies ac oss Eu opean coun ies and be ween di e en ood ca ego ies. This s udy p o ides
baseline da a o policy make s and he ood indus y o moni o and e alua e he use o claims on
ood packaging.
Keywo ds: nu i ion claims; heal h claims; heal h symbols; ood supply; moni o ing
1. In oduc ion
1.1. Backg ound
The use o nu i ion and heal h- ela ed claims (NHC) on oods and non-alcoholic be e ages
(hence o h oods and d inks o jus oods) is egula ed in many de eloped coun ies. In he Eu opean
Union (EU), egula ions we e ha monized in 2006 by Regula ion (EC) 1924/2006 [
1
]. The Regula ion
applies o all nu i ion and heal h claims made on ood packaging. The gene al p inciple is ha NHC
Nu ien s 2016,8, 137; doi:10.3390/nu8030137 www.mdpi.com/jou nal/nu ien s
Nu ien s 2016,8, 137 2 o 16
should no be misleading and should be subs an ia ed by gene ally accep ed scien i ic da a [
1
,
2
]. Since
he EU Regis e o heal h claims made on ood en e ed in o o ce in Decembe 2012 [
3
], ood p oduce s
in he EU a e allowed o use only au ho ized heal h claims and ela ed gene al non-speci ic heal h
claims. One excep ion is claims ha a e s ill in he p ocess o scien i ic e alua ion, e.g., bo anicals [4].
NHC as well as hei symbolic ep esen a ions (examples o heal h symbols would be he Du ch
Choices logo, he No dic Keyhole and he Finnish Hea Symbol) may help consume s iden i y oods
ha a e heal hie op ions, bu li le is known abou how such claims a e used by consume s in
eal-wo ld shopping si ua ions. The pan-Eu opean esea ch p ojec “Role o heal h- ela ed CLaims
and sYMBOLs in consume beha iou ” (CLYMBOL) has se ou o de e mine how nu i ion and
heal h- ela ed claims and symbols, in hei con ex , can a ec consume unde s anding, pu chase and
consump ion pa e ns ( o an o e iew o he p ojec see [5]).
As a s a ing poin o he p ojec , he su ey epo ed he e aimed o unde s and wha nu i ion
and heal h- ela ed claims and symbols consume s a e exposed o, i.e., on which ood ca ego ies such
claims and symbols a e mos common, which ypes o claims and symbols a e used and o which
nu ien s and heal h ela ionships hey e e . While some s udies on he p e alence o NHC ha e been
conduc ed in coun ies whe e such claims a e ela i ely well egula ed, pa icula ly in he US [
6
,
7
],
Canada [
8
,
9
], Aus alia [
10
–
13
] and New Zealand [
14
], s udies on he Eu opean ma ke a e sca ce and
o da e no c oss-coun y p e alence s udy o Eu ope exis s.
In 2009, as pa o he EU- unded p ojec FLABEL [
15
], a s udy in es iga ed he p e alence o
nu i ion in o ma ion, including heal h claims, o i e ood ca ego ies ac oss all EU Membe S a es
plus Tu key [
16
]. Signi ican coun y- o-coun y di e ences we e epo ed ega ding he p e alence o
nu i ion and heal h claims. Howe e , he s udy did no analyze he di e en ypes o claims ound.
Mo e in-dep h analyses a e a ailable o he UK [
17
], I eland [
18
] and Slo enia [
19
]. Howe e , all o
hese su eys we e comple ed be o e he EU Regis e o heal h claims came in o e ec in 2012. Some
o he s udies a e also a ailable in which he au ho s selec i ely ocused on speci ic ood ca ego ies,
o example dai y oods [
20
] and b eak as ce eals [
21
]. Las ly, he p e alence o nu i ion and heal h
claims was also ecen ly in es iga ed in Se bia, a candida e coun y o EU membe ship [22].
While moni o ing he ood supply is an impo an public heal h issue, he numbe o oods
a ailable and he di e si y o e ail en i onmen s make his challenging. A global ini ia i e ha
add esses he ha moniza ion o such da a collec ion is he INFORMAS ini ia i e (In e na ional Ne wo k
o Food and Obesi y/Non-Communicable Diseases Resea ch, Moni o ing and Ac ion Suppo ).
This ne wo k has p oposed a s ep-wise app oach o su eying ood labeling depending on esou ces,
s anda dized me hods o he sampling o e ail ou le s and oods and p io i ies o he labeling and
ela ed in o ma ion o be collec ed [
22
]. While he selec ion o all oods wi hin all ood ca ego ies
migh be conside ed ideal [
22
], a huge olume o da a is gene a ed when s udies a emp o be en i ely
comp ehensi e [
19
]. The e o e, a sampling app oach o he selec ion o oods is needed pa icula ly
o s udies in es iga ing di e en coun ies. The p esen s udy desc ibes a no el app oach on how o
sample a selec numbe o oods ac oss a ious coun ies, using he ood ca ego iza ion scheme [
23
] ha
has been adop ed by he Global Food Moni o ing G oup o u u e moni o ing o he ood supply [
24
].
1.2. Resea ch Ques ions
The aim o his s udy was o in es iga e he p e alence o nu i ion and heal h claims as ound
on oods and d inks ac oss i e di e en Eu opean coun ies. The ollowing esea ch ques ions
we e iden i ied:
‚
Wha p opo ion o p e-packaged oods and d inks a ailable in-s o e in he i e coun ies ca y NHC?
‚Wha p opo ion o hese claims is symbolic?
‚Wha ypes o NHC can be ound on p e-packaged oods and d inks?
Nu ien s 2016,8, 137 3 o 16
‚To which nu ien s o o he ood componen s do NHC e e ?
‚To which heal h- ela ionships do heal h claims e e ?
‚Which ypes o oods and d inks ca y NHC?
2. Me hods and Ma e ials
Labeling da a we e collec ed om p e-packaged oods and d inks sampled in i e EU coun ies:
he UK, he Ne he lands, Ge many, Slo enia and Spain. The selec ion o coun ies aimed a a
geog aphical sp ead ac oss Eu ope. Th ee ypes o s o es we e selec ed in each coun y (wi h a
o al o 15 s o es o e all), wi h he aim o co e ing a ange o di e en e ail ou le s, in o de o
map consume exposu e o ood and d ink p oduc s ac oss a a ie y o shopping places: a la ge
supe ma ke /na ional e aile , a discoun e and a neighbo hood s o e. Di e ences in he pene a ion
o a ious ood labeling in o ma ion in di e en e ail ou le s we e epo ed ecen ly [
19
], con i ming
he a ionale o he app oach used in his s udy. S o es we e selec ed based on he accessibili y o hei
ne wo k wi hin he espec i e coun y, as well as compa able s o e cha ac e is ics (e.g., s o e size).
A ood o d ink (hence o h only e e ed o as “ ood”) was de ined as a single i em a ailable o sale
in he selec ed s o e. This de ini ion mean ha he same ood in di e en sized packaging could be
included in he su ey, on he basis ha he packaging o he same ood in di e en sized packages
may ca y di e en heal h- ela ed claims. Wi hin-coun y, exac duplica es, howe e , we e emo ed
om he da abase.
Only p e-packaged oods we e conside ed. The EU Regula ion on he p o ision o ood
in o ma ion o consume s (EC) 1169/2011 de ines a p e-packaged oods u as “any single i em
o p esen a ion as such o he ul ima e consume and o mass ca e e s, consis ing o a oods u and
he packaging in o which i was pu be o e being o e ed o sale, whe he such packaging encloses he
oods u comple ely o only pa ially, bu in any case in such a way ha he con en s canno be al e ed
wi hou opening o changing he packaging” [25].
2.1. Da a Collec ion
In each o he i e coun ies, app oxima ely 400 oods we e sampled i.e., pu chased using a
andomized sampling app oach. A powe calcula ion was conduc ed o es ima e he sample size
equi ed. An assumed 50% p e alence a e o NHC was selec ed in o de o ensu e an adequa e
sample size, o he de ec ion o NHC p e alence wi h 5% p ecision. The sample size needed o
an es ima ion o p e alence is a maximum when he measu ed p e alence is 50%. Hence, a e
adjus men o a ini e popula ion and assuming a p e alence a e o 50% o NHC, 400 oods o each
coun y would p oduce con idence in e als o
˘
5%, su icien o dis inguishing a 10% di e ence in
p e alence be ween coun ies.
In each o he i e coun ies app oxima ely 250 oods we e sampled om he supe ma ke /
na ional e aile , 75 oods we e sampled om he discoun e and 75 om he neighbo hood s o e.
De ails o he whole sample a e p o ided in Table 1.
Table 1. Sample o e iew (sampling me hod and numbe o oods).
UK Ne he lands Ge many Slo enia Spain To al
La ge supe ma ke /
na ional e aile
loo plan, n= 248
s o e lis , n= 252 s o e lis , n= 248 s o e lis , n= 260 s o e lis , n= 251 1259 (62%)
Discoun e loo plan, n= 75 s o e lis , n= 81 s o e lis , n= 76 s o e lis , n= 78 s o e lis , n= 78 388 (19%)
Neighbo hood s o e loo plan, n= 75 s o e lis , n= 83 loo plan, n= 75 s o e lis , n= 78 s o e lis , n= 76 387 (19%)
To al no o oods 398 (20%) 416 (20%) 399 (20%) 416 (20%) 405 (20%)
2034 (100%)
Foods we e sampled om e ail ou le s in wo ways: ei he using a s o e/s ock lis o ailing ha a loo plan.
Nu ien s 2016,8, 137 4 o 16
Re aile ’s s o e/s ock lis s we e con e ed o Mic oso Excel sp eadshee s, i no al eady in ha
o ma . The ollowing ypes o p oduc we e hen excluded: (a) non- ood i ems; (b) ood supplemen s;
(c) alcoholic d inks; and (d) unpackaged oods. The emaining oods we e assigned an ID numbe and
he app op ia ely sized sample andomly selec ed using he RAND unc ion in Excel. The sample o
oods was hen pu chased.
Fo ou o he s o es, a s o e/s ock lis could no be ob ained. In hese cases a loo plan was
c ea ed which mapped he layou o he s o e (including he loca ion o p omo ional s ands o o he
non-aisle displays). Each sec ion/aisle was hen assigned a numbe and he numbe o oods in each
sec ion/aisle was es ima ed using a ally coun e . The o al numbe o oods in he s o e was hen
es ima ed and each ood loca ion assigned an ID numbe . Again, an app op ia ely sized lis o ood
loca ions was andomly gene a ed using he RAND unc ion in Excel. The esea che s hen e u ned
o he s o e and pu chased he oods using he lis o loca ions.
Exclusion o p oduc s also occu ed pos sampling. Pos -sampling exclusion occu ed o
unpackaged p oduc s selec ed inad e en ly. Foods we e selec ed and pu chased in he same ime
ame (July–Augus 2013) o all coun ies. Fo pe ishable oods, he packaging was emo ed.
Pho og aphs we e aken o all sides o packages ca ying a leas one claim.
Two pilo s udies we e ca ied ou : one in Ge many a a la ge supe ma ke and he o he in he
UK a a neighbo hood s o e. Feedback om he pilo s esul ed only in mino changes o he inal
p o ocol o da a collec ion.
2.2. Da a Ex ac ion
Labeling da a we e aken om packaging and en e ed in o a da abase. All NHC we e iden i ied
and cha ac e is ics o he claims we e eco ded, i.e., whe he he claim was wo ded, pic o ial o a
combina ion (bo h wo ded and pic o ial) and whe he i quali ied as a symbolic claim. Wo ded
claims we e eco ded e ba im and ansla ed in o English. Pic o ial claims (o claims which we e a
combina ion o wo ds and pic u e(s)) we e b ie ly desc ibed. The ype o heal h symbol was no ed.
O he labeling and ood composi ion da a we e also collec ed (e.g., whe he he package had
on -o -pack nu i ion labeling and in o ma ion abou nu ien con en om he nu ien decla a ion).
Addi ional cha ac e is ics o he NHC eco ded included hei posi ion on pack and he numbe
o imes hey appea ed on one packe . Fo heal h claims, i was also no ed whe he i was a speci ic
heal h claim, meaning whe he a speci ied nu ien , o he subs ance o heal h- ela ed ing edien was
s a ed o ha e a speci ic heal h e ec , o a non-speci ic heal h claim.
2.3. Analysis
Once iden i ied, claims we e classi ied in o nu i ion claims (including nu ien con en claims and
nu ien compa a i e claim), heal h- ela ed ing edien claims and heal h claims (including educ ion
o disease isk claims, nu ien and o he unc ion claims, gene al heal h claims and child en’s
de elopmen and heal h claims).
All claims we e ca ego ized as being ei he symbolic o non-symbolic. A symbolic claim was
de ined as a heal h- ela ed claim (whe he a nu i ion, heal h- ela ed ing edien o heal h claim) ha
was pic o ial o combined wo ds and pic u es and o which he c i e ia o use o he symbol ha e
been published. An example o a symbolic gene al heal h claim is he Du ch “Choices” logo [
26
].
An example o a symbolic nu ien and o he unc ion claims is he “Too h iendly” logo [
27
]. See
Figu e 1.
Nu ien s 2016,8, 137 5 o 16
Nu ien s 2016,8,1375o 17

Allclaimswe eca ego izedasbeingei he symbolico non‐symbolic.Asymbolicclaimwas
de inedasaheal h‐ ela edclaim(whe he anu i ion,heal h‐ ela eding edien o heal hclaim) ha 
waspic o ialo combinedwo dsandpic u esand o which hec i e ia o useo  hesymbolha e
beenpublished.Anexampleo asymbolicgene alheal hclaimis heDu ch“Choices”logo[26].An
exampleo asymbolicnu ien ando he  unc ionclaimsis he“Too h iendly”logo[27].
Symbolicgene al
heal hclaim
Symbolicnu ien and
o he  unc ionclaim
Du chchoiceslogoToo h iendlylogo
Figu e1.Exampleso symbolicclaims.
Colo ‐codednu i ionlabels(e.g., a icligh o %GDAlabeling)didno quali yasasymbolic
claimbecause heyp esen nu i ionalin o ma ionbu dono sugges aheal h ela ionship[28].All
NHCde ini ionsa econsis en wi hEURegula ion:
1. Anu i ionclaimwasde inedas“anyclaimwhichs a es,sugges so implies ha a oodhas
pa icula bene icialnu i ionalp ope iesdue o(a) heene gy(calo i ic alue)i (i)p o ides;
(ii)p o idesa a educedo inc eased a e;o (iii)doesno p o ide;and/o (b) henu ien so 
o he subs ancesi (i)con ains;(ii)con ainsin educedo inc easedp opo ions;o (iii)doesno 
con ain”[1].
2. Nu i ionclaimswe eclassi iedasei he anu ien con en claimwheni “desc ibes hele elo 
anu ien con ainedina ood(o i sene gy alue)”(e.g.,“highin ib e”and“low a ”)o a
nu ien compa a i eclaim“wheni compa es hecomposi iono  he oodinques ionwi h he
composi iono o he  oods”(e.g.,“highe in ib e”and“ educedsuga ”)[1].
3. Aheal h‐ ela eding edien claimwasde inedasaclaimcommunica ing hep esenceo an
ing edien (s)whichisno anu ien o o he subs anceasde inedin heEURegula ion[1]bu 
whichimpliesheal hbene i s.Inmos cases, heseclaims ela ed o hecon en o ing edien s
ha a econside edasaheal hy(e.g.,“Con ainsoneo you  i eaday”)o a leas aheal hie 
al e na i e(e.g.,“Swee enedonlywi hb ownsuga ”).
4. Aheal hclaimwasde inedas“anyclaim ha s a es,sugges so implies ha a ela ionshipexis s
be weena oodca ego y,a oodo oneo i scons i uen sandheal h”[1].
5. Agene alheal hclaim(co e edbyA icle10(3)o  heEURegula ion[1])wasde inedasaclaim
e e ing obene i s o gene alheal ho well‐being.A ypicalexampleo suchaclaimis“Good
o you heal h”o “Heal hie choice(wi hin hisp oduc g oup)”.
6. Anu ien ando he  unc ionclaim(asco e edbyA icle13o  heEURegula ion[1])was
de inedasaheal hclaim ha desc ibeso  e e s ooneo  he ollowing:(a) he oleo anu ien 
o o he subs anceing ow h,de elopmen and he unc ionso  hebody;(b)psychologicaland
beha io al unc ions;o (c)slimmingo weigh ‐con olo a educ ionin hesenseo hunge o 
aninc easein hesenseo sa ie yo a educ iono  hea ailableene gy om hedie .Typical
exampleso suchaclaima e“Calciumbuildss ong ee h”and“Fib ehelpsmain ainaheal hy
diges i esys em”.
7. A educ iono disease iskclaim(co e edbyA icle14.1(a)o  heEURegula ion[1])was
de inedasaclaimcommunica ing ha  heconsump iono a oodca ego y,a oodo oneo i s
cons i uen ssigni ican ly educesa isk ac o in hede elopmen o ahumandisease.Typical
exampleso suchaclaima e“Plan s e ols educebloodcholes e ol.Highcholes e olisa isk
Figu e 1. Examples o symbolic claims.
Colo -coded nu i ion labels (e.g., a ic ligh o % GDA labeling) did no quali y as a symbolic
claim because hey p esen nu i ional in o ma ion bu do no sugges a heal h ela ionship [
28
].
All NHC de ini ions a e consis en wi h EU Regula ion:
1.
A nu i ion claim was de ined as “any claim which s a es, sugges s o implies ha a ood has
pa icula bene icial nu i ional p ope ies due o (a) he ene gy (calo i ic alue) i (i) p o ides;
(ii) p o ides a a educed o inc eased a e; o (iii) does no p o ide; and/o (b) he nu ien s o
o he subs ances i (i) con ains; (ii) con ains in educed o inc eased p opo ions; o (iii) does no
con ain” [1].
2.
Nu i ion claims we e classi ied as ei he a nu ien con en claim when i “desc ibes he le el
o a nu ien con ained in a ood (o i s ene gy alue)” (e.g., “high in ib e” and “low a ”) o a
nu ien compa a i e claim “when i compa es he composi ion o he ood in ques ion wi h he
composi ion o o he oods” (e.g., “highe in ib e” and “ educed suga ”) [1].
3.
A heal h- ela ed ing edien claim was de ined as a claim communica ing he p esence o an
ing edien (s) which is no a nu ien o o he subs ance as de ined in he EU Regula ion [
1
] bu
which implies heal h bene i s. In mos cases, hese claims ela ed o he con en o ing edien s
ha a e conside ed as a heal hy (e.g., “Con ains one o you i e a day”) o a leas a heal hie
al e na i e (e.g., “Swee ened only wi h b own suga ”).
4.
A heal h claim was de ined as “any claim ha s a es, sugges s o implies ha a ela ionship exis s
be ween a ood ca ego y, a ood o one o i s cons i uen s and heal h” [1].
5.
A gene al heal h claim (co e ed by A icle 10(3) o he EU Regula ion [
1
]) was de ined as a claim
e e ing o bene i s o gene al heal h o well-being. A ypical example o such a claim is “Good
o you heal h” o “Heal hie choice (wi hin his p oduc g oup)”.
6.
A nu ien and o he unc ion claim (as co e ed by A icle 13 o he EU Regula ion [
1
]) was
de ined as a heal h claim ha desc ibes o e e s o one o he ollowing: (a) he ole o a nu ien
o o he subs ance in g ow h, de elopmen and he unc ions o he body; (b) psychological and
beha io al unc ions; o (c) slimming o weigh -con ol o a educ ion in he sense o hunge o
an inc ease in he sense o sa ie y o a educ ion o he a ailable ene gy om he die . Typical
examples o such a claim a e “Calcium builds s ong ee h” and “Fib e helps main ain a heal hy
diges i e sys em”.
7.
A educ ion o disease isk claim (co e ed by A icle 14.1(a) o he EU Regula ion [
1
]) was de ined
as a claim communica ing ha he consump ion o a ood ca ego y, a ood o one o i s cons i uen s
signi ican ly educes a isk ac o in he de elopmen o a human disease. Typical examples
o such a claim a e “Plan s e ols educe blood choles e ol. High choles e ol is a isk ac o in
he de elopmen o co ona y hea disease” and “Reduces he isk ac o o de elopmen o
den al ca ies”.

Nu ien s 2016,8, 137 6 o 16
8.
A child en’s de elopmen and heal h claim (co e ed by A icle 14.1(b) o he EU Regula ion [
1
])
was de ined as a heal h claim whe e child en’s de elopmen and/o heal h was speci ically
men ioned. Typical examples o such a claim a e “Calcium is needed o no mal g ow h and
de elopmen o bones in child en” and “Fo you baby’s sa e and balanced die ”. Claims whe e
child en we e no speci ically men ioned, e en i hese claims we e ound on oods in ended
solely o use by child en, we e no conside ed child en’s de elopmen and heal h claims.
Claims such as “na u al”, “o ganic” and “halal” we e no conside ed NHCs on he basis ha hey
e e o he me hod o he p oduc ion a he han he con en . Simila ly, in o ma ion on he p esence
o addi i es, p ese a i es, la o ings, e c. was no conside ed a heal h- ela ed claim. Alle gy ad ice
(e.g., “con ains nu s”) was no conside ed o be an NHC no we e e e ences o he p esence o a ood
o ood g oup in he p oduc whe e he e was no clea ela ionship o i s heal h bene i s, e.g., e e ences
o milk con en . Claims ela ing o he endo semen o a heal h- ela ed o ganiza ion we e also no
included, e.g., “[P oduc ] suppo ed by he [heal h associa ion]”.
3. Resul s
Whe e con idence in e als a e p o ided in ables, hey will no be epo ed in he ex . Resul s
a e discussed by coun y, claim ype and p oduc ca ego y.
3.1. Wha P opo ion o P e-Packaged Foods and D inks A ailable In-S o e in he Fi e Coun ies Ca y NHC?
Twen y-six pe cen o oods ca ied a leas one nu i ion, heal h- ela ed ing edien o heal h claim
(including symbolic e sions o such claims) (Table 2). The e we e almos wice as many oods ca ying
nu i ion claims as he e we e oods ca ying heal h claims (21% and 11% espec i ely). Jus 4% o
oods ca ied a heal h- ela ed ing edien claim. Gene al heal h claims appea ed on 7% o he oods.
Only 5% o oods ca ied a nu ien and o he unc ion claim. Jus 0.6% o oods ca ied a educ ion o
disease isk claim and 0.7% o oods ca ied child en’s de elopmen and heal h claims. P oduc s could
ca y mo e han one claim.
Thi y pe cen o oods sampled in he UK ca ied a nu i ion claim, ollowed by Spain (23%),
Slo enia (19%), he Ne he lands (17%) and Ge many (16%). The e was less a ia ion ac oss coun ies
in he numbe o oods ca ying heal h claims; he highes p e alence was obse ed in he Ne he lands
(14%) and he lowes in Spain (7%). The oods sampled in he Ne he lands had mo e ins ances o
gene al heal h claims (12%), compa ed o 4%–6% o he emaining coun ies. The highes p opo ion
o oods ca ying a nu ien and o he unc ion claim was ound in Slo enia (9%), ollowed by he UK
(7%), Ge many (5%), Spain and he Ne he lands (bo h 3%). O e all, he p e alence o educ ion o
disease isk claims was e y low ac oss all coun ies; i was highes in he UK (1%) and lowes in he
Ne he lands (0.2%). Simila ly, he p e alence o child en’s de elopmen and heal h claims anged
om 0% (in he Ne he lands) o 1.3% (in Ge many).
Foods ca ying claims end o ca y mul iple claims; he a e age numbe o NHC pe p oduc
ca ying any claim ac oss he i e coun ies was 2.6 (Table 3). The highes numbe o claims seen on
a p oduc was 17, obse ed on wo baby ood p oduc s in Spain and Ge many. The mean numbe
o nu i ion claims pe p oduc ca ying any claim was sligh ly highe han he mean numbe o
heal h claims (2.0 and 1.9, espec i ely). A K uskal-Wallis es was used o de e mine i he e we e any
signi ican coun y di e ences in he numbe o nu i ion claims, heal h claims o any claims (NHC)
o oods ha ca y such claims. The e was a signi ican coun y di e ence in he numbe o heal h
claims, bu he coun y di e ences in he numbe o nu i ion claims o NHC claims o e all we e no
s a is ically signi ican . The highes numbe o heal h claims obse ed on a single p oduc was 15,
ound on a baby ood, and o nu i ion claims, 13 claims ound on a con ec ione y p oduc , bo h
in Ge many.
Nu ien s 2016,8, 137 7 o 16
Table 2. P e alence o nu i ion claims, heal h claims, and symbols in i e Eu opean coun ies.
Coun y Claim Type No. o Claims . . . o Which A e Symbolic No. o Foods wi h a Claim % o Foods wi h Claim (95% CIs)
All Coun ies
N = 2034 Foods
Nu i ion claim 865 1 423 20.8% (19.0%–22.5%)
Nu ien con en claim 797 1399 19.6% (17.8%–21.3%)
Nu ien compa a i e claims 68 049 2.4% (1.7%–3.1%)
Heal h- ela ed ing edien claim 105 6 72 3.5% (2.7%–4.3%)
Heal h claim 392 74 222 10.9% (9.6%–12.3%)
Gene al heal h claim 153 64 137 6.7% (5.6%–7.8%)
Nu ien and o he unc ion claim 185 9 106 5.2% (4.2%–6.2%)
Reduc ion o disease isk claim 21 1 12 0.6% (0.2%–0.09%)
Child en’s de elopmen & heal h claims 33 0 15 0.7% (0.4%–1.1%)
Any ype o claim (NHC) 1362 81 528 26.0% (24.0%–27.9%)
UK N = 398 oods
Nu i ion claim 247 0 118 29.6 (25.1%–34.1%)
Heal h- ela ed ing edien claim 65 3 40 10.1% (7.1%–13.0%)
Heal h claim 85 2 44 11.1% (8.0%–14.1%)
Gene al heal h claim 30 0 23 5.8% (3.5%–8.1%)
Nu ien and o he unc ion claim 38 2 26 6.5% (4.1%–9.0%)
Reduc ion o disease isk claim 10 0 4 1.0% (0.0%–0.2%)
Child en’s de elopmen & heal h claims 7 0 4 1.0% (0.0%–2.0%)
Any ype o claim (NHC) 397 5 140 35.2% (30.4%–40.0%)
Ne he -lands N = 416 oods
Nu i ion claim 154 0 70 16.8% (13.2%–20.4%)
Heal h- ela ed ing edien claim 12 0 12 2.9% (1.3%–4.5%)
Heal h claim 73 50 60 14.4% (8.9%–15.2%)
Gene al heal h claim 52 49 50 12.0% (8.9%–15.2%)
Nu ien and o he unc ion claim 19 1 12 2.9% (1.3%–4.5%)
Reduc ion o disease isk claim 2 0 1 0.2% (0.0%–0.1%)
Child en’s de elopmen & heal h claims 0 0 0 0.0%
Any ype o claim (NHC) 239 50 103 24.8% (20.6%–29.0%)
Ge many N = 399 oods
Nu i ion claim 123 0 64 16.0% (12.4%–19.7%)
Heal h- ela ed ing edien claim 19 1 13 3.3% (1.5%–5.0%)
Heal h claim 82 0 37 9.3% (6.4%–12.1%)
Gene al heal h claim 29 0 23 5.8% (3.5%–8.1%)
Nu ien and o he unc ion claim 45 0 20 5.0% (2.9%–3.2%)
Reduc ion o disease isk claim 1 0 1 0.3% (–0.2%–0.7%)
Child en’s de elopmen & heal h claims 7 0 5 1.3% (0.1%–0.2%)
Nu ien s 2016,8, 137 8 o 16
Table 2. Con .
Coun y Claim Type No. o Claims . . . o Which A e Symbolic No. o Foods wi h a Claim % o Foods wi h Claim (95% CIs)
Slo enia N = 416 oods
Nu i ion claim 144 0 78 18.8% (15.0%–22.5%)
Heal h- ela ed ing edien claim 3 1 2 0.5% (–0.2%–1.1%)
Heal h claim 88 7 52 12.5% (0.9%–15.7%)
Gene al heal h claim 24 1 23 5.5% (3.3%–7.7%)
Nu ien and o he unc ion claim 58 6 36 8.7% (5.9%–11.4%)
Reduc ion o disease isk claim 4 0 3 0.7% (–0.1%–1.5%)
Child en’s de elopmen & heal h claims 2 0 1 0.2% (–0.2%–0.7%)
Any ype o claim (NHC) 235 8 103 24.8% (20.6%–28.9%)
Spain N = 405
Nu i ion claim 196 1 93 23.0% (18.8%–27.1%)
Heal h- ela ed ing edien claim 6 1 5 1.2% (0.2%–2.3%)
Heal h claim 64 15 29 7.2% (4.6%–9.7%)
Gene al heal h claim 18 14 18 4.4% (2.4%–6.5%)
Nu ien and o he unc ion claim 25 0 12 3.0% (1.3%–4.6%)
Reduc ion o disease isk claim 4 1 3 0.7% (–0.1%–1.6%)
Child en’s de elopmen & heal h claims 17 0 5 1.2% (0.2%–2.3%)
Any ype o claim (NHC) 266 17 100 24.7% (20.5%–28.9%)
Bold is o main claims we looked a and he o al claims. I alic is o he sub-ca ego ies o all hese claims. Regula on size was only used o he desc ip ion o he coun ies o he le .
Nu ien s 2016,8, 137 9 o 16
Table 3. Numbe o claims pe p oduc .
Mean Numbe o
Nu i ion Claims 1
Highes Numbe o
Nu i ion Claims
on a Single P oduc
Mean Numbe
o Heal h
Claims 1
Highes Numbe o
Heal h Claims on a
Single P oduc
Mean
Numbe o
Any Claim 1
Highes Numbe o
Any Claims on a
Single P oduc
All coun ies 2.0 13 1.9 15 2.6 17
UK 2.1 11 1.9 5 2.8 15
Ne he lands 2.2 8 1.2 6 2.3 9
Ge many 1.9 13 2.2 15 2.7 17
Slo enia 1.8 8 1.7 5 2.3 11
Spain 2.1 12 2.2 11 2.7 17
p alue 0.94 <0.01 0.52
NOTE: pe p oduc ca ying a claim.
3.2. Wha P opo ion o These Claims is Symbolic?
Subs an ial di e ences we e obse ed in he p e alence o symbolic claims be ween he coun ies
(Table 2). The highes p e alence was ound in he Ne he lands (12%, (9%–14%)), ollowed by Spain
(4%, (2%–6%)), Slo enia (2%, (1.0%–3.0%)), he UK (1%, (0%–2%)), and Ge many (0.3%, (0%–1%)).
Almos all o he gene al heal h claims in he Ne he lands we e symbolic— he majo i y o which
comp ised o he Choices logo. Spain had a simila ly high le el o symbolic gene al heal h claims,
including logos o heal h o ganiza ions such as he Spanish Associa ion o Pedia icians. Howe e ,
i should be no ed ha in gene al he p e alence o symbolic claims was qui e low; al oge he only
3.88% (3%–5%) o oods we e labeled wi h a symbolic claim.
3.3. Wha Types o NHC Can Be Found on P e-Packaged Food and D inks?
64% o he claims we e nu i ion claims o which 92% (90%–94%) we e classi ied as nu ien
con en claims and jus 8% (6%–10%) we e nu ien compa a i e claims (Table 2). Heal h claims
accoun ed o 29% (26%–31%) o he claims eco ded. O hese, almos hal (47%, (42%–52%)) we e
nu ien and o he unc ion claims, 39% (34%–44%) we e gene al heal h claims, 8% (6%–11%) we e
child en’s de elopmen and heal h claims and he emaining 5% (3%–8%) we e educ ion o isk claims.
The emaining claims ell in o he ca ego y o heal h- ela ed ing edien claims (8%, (6%–9%)).
The p opo ion o nu i ion claims was highes in Spain (74% o all claims we e nu i ion claims),
ollowed by he Ne he lands (64%), he UK (62%), Slo enia (61%), and Ge many (55%). The p opo ion
o heal h claims showed sligh ly less a ia ion ac oss he i e coun ies: i was highes in Slo enia and
Ge many (bo h 37%), ollowed by he Ne he lands (31%), Spain (24%) and he UK (21%).
Only 14% (12%–15%) o he NHC we e nu ien and o he unc ion heal h claims. The highes
p opo ion was ound in Slo enia (25%, (19%–30%)) and lowes in he Ne he lands (8%, (5%–11%)).
Spain had he highes p opo ion o child en’s de elopmen and heal h claims (6%, (3%–9%)) while
none we e ound on oods sampled in he Ne he lands. The UK had he highes p opo ion o disease
isk claims (3%, (1%–4%)) whe eas Ge many had he lowes (only one such claim was ound, ou o a
o al o 224 claims iden i ied) (Table 2).
3.4. To Which Nu ien s o O he Food Componen s Do NHC Re e ?
Mo e han one hi d o he nu i ion claims e e ed o i amins and/o mine als (e.g., “En iched
wi h impo an i amins and mine als”) (Table 4). Mo e speci ically, 22% e e ed o i amins, o which
i amin C was he mos common i amin e e enced (e.g., “High in i amin C”) and 13% o mine als,
o which calcium was he mos common mine al (e.g., “A sou ce o calcium”). Almos a qua e o
nu i ion claims (24%) e e ed o he a con en o a ood in some way, 12% o he suga con en and
9% o ibe .
Nu ien s 2016,8, 137 16 o 16
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©
2016 by he au ho s; licensee MDPI, Basel, Swi ze land. This a icle is an open access
a icle dis ibu ed unde he e ms and condi ions o he C ea i e Commons by A ibu ion
(CC-BY) license (h p://c ea i ecommons.o g/licenses/by/4.0/).