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The current food environment in The Netherlands is considered obesogenic. Eighty percent of the products in supermarkets are unhealthy. The Wheel of Five is the well-established, science-based Dutch food-based dietary guideline (FBDG) developed to stimulate healthier choices. In addition, simple directions on food packaging, such as front-of-package (FOP) health logos, could also be helpful. However, these tools should be in line with each other, in order not to confuse the consumer. To study this, we evaluated two FOP nutrient profiling systems (NPSs) for their alignment with the Wheel of Five: Choices five-level criteria and Nutri-Score. For this, a small but representative sample of 124 products was selected from the Dutch food composition database (NEVO). For these products, the scores for Choices and Nutri-Score were calculated using the published criteria, while compliance with the Wheel of Five was established by using the criteria from Netherlands Nutrition Center (NNC). The Wheel of Five food groups were used to categorize the products. Differences between the Wheel of Five and Choices are smaller than with Nutri-Score, concluding that Choices is more consistent with the Wheel of Five and might be an attractive alternation for a FOP health logo on the Dutch market.

Objective: Approximately 50 % of Dutch community-dwelling older adults does not meet protein recommendations. This study assesses the effect of replacing low protein foods with protein-rich alternatives on the protein intake of Dutch community-dwelling older adults. Design: The Dutch National Food Consumption Survey—Older Adults 2010–2012 (DNFCS-OA) was used for scenario modelling. Dietary intake was estimated based on two 24-h recalls. Commonly consumed products were replaced by comparable products rich in protein (scenario 1), foods enriched in protein (scenario 2) and a combination of both (scenario 3). Replacement scenarios were confined to participants whose dietary protein intake was < 1·0 g/kg BW/d (n 391). Habitual protein intake of all older adults was estimated, adjusting for effects of within-person variation in the 2-d intake data. Setting: A simulation study based on the DNFCS-OA. Participants: 727 Dutch community-dwelling older adults aged 70+. Results: Mean protein intake of the total population increased from 1·0 to 1·2 g/kg BW/d (scenarios 1 and 2) and to 1·3 g/kg BW/d (scenario 3). The percentage of participants with intakes of ≥ 1·0 g/kg BW/d increased from 47·1 % to 91·4 %, 90·2 % and 94·6 %, respectively, in scenarios 1, 2 and 3. The largest increases in protein intake were due to replacements in food groups: yoghurt, cream desserts and pudding, potatoes, vegetables and legumes and non-alcoholic beverages and milk in scenario 1 and bread; yoghurt, cream desserts and pudding and soups in scenario 2. Conclusions: This simulation model shows that replacing low protein foods with comparable alternatives rich in protein can increase the protein intake of Dutch community-dwelling older adults considerably. Results can be used as a basis for nutritional counselling.

An adequate protein intake is important for healthy ageing, yet nearly 50% of Dutch community-dwelling older adults do not meet protein recommendations. This study explores protein intake in relation to eight behavioral determinants (I-Change model) among Dutch community-dwelling older adults. Data were collected through an online questionnaire from October 2019–October 2020. Protein intake was assessed by the Protein Screener 55+, indicating a high/low chance of a low protein intake (

In 2008, the Choices International Foundation developed its logo criteria, identifying best-in-class food products. More advanced, global and graded nutrient profiling systems (NPSs) are needed to substantiate different national nutrition policies. The objective of this work was to extend Choices NPS to identify five levels of the healthiness of food products, so that the Choices NPS can also be used to support other nutrition policies, next to front-of-pack labelling. Based on the same principles as the previous logo criteria, four sets of threshold criteria were determined using a com-bination of compliance levels, calculated from a large international food group-specific database, the Choices logo criteria, and WHO-NPSs developed to restrict marketing to children. Validation consisted of a comparison with indicator foods from food-based dietary guidelines from various countries. Some thresholds were adjusted after the validation, e.g., because intermediate thresholds were too lenient. This resulted in a new international NPS that can be applied to different contexts and to support a variety of health policies, to prevent both undernutrition and obesity. It can effi-ciently evaluate mixed food products and represents a flexible tool, applicable in various settings and populations. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. CC BY 4.0Correspondence Address: Smorenburg, H.; Choices International Foundation Netherlands; email: herbert.smorenburg@choicesprogramme.org

About 20% of energy intake in the Netherlands is consumed out-of-home. Eating out-of-home is associated with higher energy intake and poorer nutrition. Menu labeling can be considered a promising instrument to improve dietary choices in the out-of-home sector. Effectiveness depends on the presentation format of the label and its attractiveness and usability to restaurant guests and restaurant owners. This exploratory study investigated which menu labeling format would be mostly appreciated by (a) (potential) restaurant guests (n386) and (b) the uninvestigated group of restaurant owners (n41) if menu labeling would be implemented in Dutch full-service restaurants. A cross-sectional survey design was used to investigate three distinct menu labeling formats: a simple health logo; (star) ranking and calorie information. Questionnaires were used as study tool. Ranking has been shown to be the most appreciated menu labeling format by both (potential) restaurant guests and owners. Statistical analysis showed that label preference of potential restaurant guests was significantly associated with age, possibly associated with level of education, and not associated with health consciousness. In summary, we found that ranking is the most appreciated menu label format according to both (potential) restaurant guests and restaurant owners, suggesting it to be a promising way to improve healthy eating out-of-home.

IntroductionConsumers demand healthy food products. While E-numbers are allowed in these products, many consumers have a negative perception. Food companies act on this and communicate on their package about removing E-numbers from their products or using less ‘chemical-sounding’ terms (clean label). Consequently, the question among food experts is how to deal with this perception and the real effects on health.The objective was to study the opinion of food experts about the causes and ways to reduce consumers’ distrust about E-numbers.MethodsThirteen food experts from universities, research institutes, Ministry of Health, Welfare and Sport, food industry organizations, media, The Netherlands Nutrition Centre, Dutch Consumers’ Association and two other non-governmental organizations (NGOs) were interviewed with a semi-structured topic list, based on a model of risk perception. Interviews were transcribed, coded by an open coding approach and analyzed.Results & discussionResults indicated that, according to food experts, this distrust of consumers arose from negative communication in the past and nowadays by the (social) media and in books. In this communication, the information source and the reliability of E-number information are important for consumers, according to food experts. Food experts suggested to reduce the distrust by avoiding negative claims on the label such as no/ reduced E-numbers, and to make collective appointments with all parties about a honest and transparent communication to consumers. Food companies need to explain clear and honest why they use E-numbers in food. The Netherlands Nutrition Centre and the Ministry of Health, Welfare and Sport were often mentioned as parties to undertake action, consumers had no confidence in the food industry, according to the experts.

Background: Over the last decade, different screening tools for malnutrition have been developed. Within these tools, a distinction can be made between tools that assess nutritional risk and tools that assess protein energy malnutrition. Insights in differences in characteristics of participants at risk and in differences in prevalence rates will aid in deciding which tool(s) to use in daily practice. Methods: Dutch community-dwelling older adults (n = 200, 78.2 +/- 6.9 years), not known to have specific nutrition problems, were recruited to participate in this cross-sectional study. SNAQ(65+) (low risk vs moderate/high risk) was used to assess risk of protein energy malnutrition and SCREEN II was used to assess nutrition risk (score

The primary goal of front of pack (FOP) labelling is to help consumers make healthier choices through communication. A secondary goal is to encourage producers to improve the nutritional composition of their products. Evidence has shown that (FOP) labelling can help consumers to make healthier food choices and has been an incentive for producers to improve product composition. As FOP labelling is seen as an important tool to improve food environments for public health purposes, the WHO supports initiatives of governments to implement an FOP labelling system. Based on the experiences of a wide range of countries over many years, possible success factors for such an FOP system have been defined, six of which are discussed in the present paper and used to evaluate the Dutch Choices Programme that was started in 2006. In the course of time a large number of producers joined the programme and the logo was recognised by more than 90 % of the consumers, but by 2016 the Dutch consumer organisation argued on the basis of their own research that a quarter of the consumers did not understand the colour coding of the logo and as a result the Dutch government decided to no longer support this logo and to introduce a nutrition app. The challenge that remains is to find a system that consumers understand well and that still encourages manufacturers of food to improve product composition. New technology-based data collecting initiatives might provide the right tools to develop such a system.

Over the last decade, different screening tools for malnutrition have been developed. Within these tools, a distinction can be made between tools that assess nutritional risk and tools that assess protein energy malnutrition. Insights in differences in characteristics of participants at risk and in differences in prevalence rates will aid in deciding which tool(s) to use in daily practice.Dutch community-dwelling older adults (n = 200, 78.2 ± 6.9 years), not known to have specific nutrition problems, were recruited to participate in this cross-sectional study. SNAQOf all participants 69.0% were at nutrition risk (SCREEN II), while 13.5% were at risk of protein energy malnutrition (SNAQSCREEN II and SNAQ

Food additives (E-numbers) are allowed in foods, but many consumers have a negative perception of them. The objective was to study the opinion of food experts about the causes and ways to reduce consumer distrust about E-numbers. Thirteen food experts from universities, research institutes, the government, food industry organisations, media, a nutrition information organisation, a consumer association and two other non-governmental organisations (NGOs) were interviewed with a semi-structured topic list, based on a model of risk perception. Interviews were transcribed, coded by an open-coding approach and analysed. Results indicated that, according to food experts, consumer distrust of E-numbers arose from negative communication by traditional media, social media and books. Food experts suggested that the information sources and the reliability of E-number information are important for consumers. Food experts also suggested reducing consumer distrust by avoiding negative label claims and making collective agreements with all parties about honest and transparent communication. According to interviewed food experts, food companies need to explain clearly and honestly why they use E-numbers in food. A nutrition information organisation and the government were often mentioned as appropriate parties to undertake action. The interviews suggested that consumers had no confidence in the food industry.

The risk of undernutrition in older community-dwelling adults increases when they are no longer able to shop or cook themselves. Home-delivered products could then possibly prevent them from becoming undernourished. This single-blind randomised trial tested the effectiveness of home-delivered protein-rich ready-made meals and dairy products in reaching the recommended intake of 1·2 g protein/kg body weight (BW) per d and ≥25 g of protein per meal. Community-dwelling older adults (n 98; mean age 80·4 (sd 6·8) years) switched from self-prepared to home-delivered hot meals and dairy products for 28 d. The intervention group received ready-made meals and dairy products high in protein; the control group received products lower in protein. Dietary intake was measured at baseline, after 2 weeks (T1), and after 4 weeks (T2). Multilevel analyses (providing one combined outcome for T1 and T2) and logistic regressions were performed. Average baseline protein intake was 1·09 (se 0·05) g protein/kg BW per d in the intervention group and 0·99 (se 0·05) g protein/kg BW per d in the control group. During the trial, protein intake of the intervention group was 1·12 (se 0·05) g protein/kg BW per d compared with 0·87 (se 0·03) g protein/kg BW per d in the control group (between-group differences P < 0·05). More participants of the intervention group reached the threshold of ≥25 g protein at dinner compared with the control group (intervention T1: 84·8 %, T2: 88·4 % v. control T1: 42·9 %, T2: 40·5 %; P < 0·05), but not at breakfast and lunch. Our findings suggest that switching from self-prepared meals to ready-made meals carries the risk of a decreasing protein intake, unless extra attention is given to protein-rich choices.

Unhealthy diets contribute to an increased risk of non-communicable diseases, which are the leading causes of deaths worldwide. Nutrition policies such as front-of-pack labeling have been developed and implemented globally in different countries to stimulate healthier diets. The Choices Programme, including the International Choices criteria, is an established tool to support the implementation of such policies. The Choices criteria were developed to define the healthier choices per product group, taking saturated fatty acids, trans fatty acids, sodium, sugars, energy, and fiber into account. To keep these criteria updated, they are periodically revised by an independent international scientific committee. This paper explains the most important changes resulting from revisions between 2010 and 2016 and describes the process of the latest revision, resulting in the International Choices criteria version 2019. Revisions were based on national and international nutrition and dietary recommendations, large food composition databases, and stakeholders&rsquo, feedback. Other nutrient profiling systems served as benchmarks. The product group classification was adapted and new criteria were determined in order to enhance global applicability and form a credible, intuitively logical system for users. These newly developed criteria will serve as an international standard for healthier products and provide a guiding framework for food and nutrition policies.

Background/Objectives:Front-of-pack nutrition labels can help consumers to make healthier choices and stimulate healthier product development. This is the first modeling study to investigate the potential impact on cholesterol levels of consuming a diet consisting of products that comply with the criteria for a healthier choice logo.Subjects/Methods:National food consumption and food composition data were used to estimate the nutrient intake of the Dutch adult population (18-70 years) before and after replacing foods that did not comply with the Choices front-of-pack label criteria. Different scenarios were established. The difference in cholesterol levels in the Dutch population was assessed before and after replacement by means of equations from meta-analyses that calculate how blood lipids change when diet composition changes.Results:After replacing non-complying products with products, which comply with the label's criteria (maximum scenario), saturated fatty acids median intake reduced from 14.5 to 9.8 en%. Trans-fatty acids reduced from 0.95 to 0.57 en%. The average predicted changes in low-density lipoprotein and total cholesterol levels were 0.25 and 0.31 mmol/l, respectively. Because high-density lipoprotein (HDL) cholesterol levels reduced as well (0.05 mmol/l), overall, the result was a slightly positive change in the total cholesterol/HDL ratio (0.03).Conclusions:Our findings suggest that the consumption of foods complying with the criteria for a front-of-pack label could contribute moderately to cardiovascular risk reduction via influencing blood lipids. These findings were independent of other potential effects on related health outcomes. © 2012 Macmillan Publishers Limited. All rights reserved.

ObjectiveHealth logos are introduced to distinguish foods with ‘healthier’ nutrient composition from regular foods. In the present study, we evaluated the effects of changed food compositions according to health logo criteria on the intake of saturated fat, sugar and sodium in a Dutch population of young adults.DesignFoods in the Dutch food composition table were evaluated against nutrient criteria for logo eligibility. Three replacement scenarios were compared with the nutrient intake ‘as measured’ in the Dutch consumption survey. The foods not complying with health logo criteria were replaced either by ‘virtual’ foods exactly complying with the health logo criteria, with real 2007 market shares (scenario I) and 100 % market shares (scenario II), or by existing similar foods with a composition that already complied with the health logo criteria (scenario III).ResultsThe percentage reduction in nutrient intake with the current 2007 market shares of ‘health logo foods’ was −2·5 % for SFA, 0 % for sodium and −1 % for sugar. With a 100 % market share these reductions would be −10 % for SFA, −4 % for sodium and −6 % for sugar. This may lead to a reduction of −40 % for SFA, −23 % for sodium and −36 % for sugar in the most optimal replacement scenario.ConclusionsWith ‘health logo foods’, available in 2007 and current consumption patterns, small reductions can be achieved for SFA and sugar. For additional reductions, lowering the fat/sodium content of meat (products) towards health logo criteria and drinks without sugar towards limits far below health logo criteria would be the most effective reformulation strategy.

In spite of the existence of extensive recommendations to the public, poor dietary and lifestyle habits are still aggravating mortality and morbidity in a host of nutrition affected diseases. Lifestyle modification that encompasses healthier eating and exercise patterns remains a global challenge. New initiatives and partnerships amongst health authorities, non-governmental organisations and food manufacturers are emerging to address this. At this satellite workshop, the need to pass from theoretical recommendations to more practical tools for helping the general public by offering healthier food choices was expressed. Development of systems for nutritional evaluation of food products was discussed by reviewing the main concepts developed around nutrition profiling and dietary guidelines. For instance, the Naturally Nutrient Rich score, based on nutrient density of foods, was presented. Another example is Unilever's Nutrition Enhancement Programme, whereby food products are compared to nutritional benchmarks derived from international guidelines. Being linked to a health indicator, such a system can also inform consumers and help them in making nutritionally sound food choices. Ultimately, the health improvements due to favourable changes in nutrient composition can be felt on a population-wide level, as illustrated by examples where countries have achieved target changes in eating patterns.

The increasing consumer interest in health and the food industry's responsibility to make “the healthy choice the easy choice” have been incorporated into Unilever's Vitality Mission. This involves improvement of the nutritional quality of our food and beverage products and ensuring responsible communication to consumers. Food composition databases play a central role in guaranteeing a sound nutritional basis for our product composition and nutrition communication. Optimal nutrition composition of foods can be determined based on the comparison of current dietary intakes with dietary guidelines and nutrient recommendations. This comparison can be made not only in terms of minimum amounts of healthy nutrients, but also in terms of maximum levels of less healthy nutrients. Unilever has initiated a process of evaluating and optimising its entire food and beverage product portfolio in terms of trans fatty acids, saturated fatty acids, sugar and sodium. Food composition databases were used extensively for the development of the benchmarks that are being used in this evaluation. An example of food composition databases being used to substantiate communication is the Knorr Vie shot claim that this product provides 50% of one's daily fruit and vegetable needs. To support this claim, analytical data for Knorr Vie were compared with calculated nutrient data based on the industrial recipes using food composition databases from four different countries. As a result of increasing consumer interest in health, communication to consumers on the dietary role and potential health benefits of food and beverage products is essential. Ideally, validated ingredient data from suppliers, together with analytical data, form the basis of nutritional labelling. This will enable the consumer to make a healthy choice. Food composition databases are also used in consumer communication materials such as dietary assessment tools in interactive web sites. There is a need for good quality data on nutrient content from various countries for product innovations.

Food composition data have extensively been used in the Choices International Programme: they formed the basis of both criteria development and nutrient intake modeling. Criteria were developed for key nutrients linked to non communicable diseases by an independent scientific committee. The criteria can be used for the logo assignment on food products, in order to stimulate producers to improve their products and to stimulate consumers to purchase these products. Insights in steps of development of the criteria for the Choices program illustrates the importance of food composition data in this process. Modeling studies with the criteria for the Dutch Choices program showed an improved nutrient intake profile if consumers would choose products fulfilling the criteria of the Dutch logo as part of their diets. The role and availability of food composition databases in the development of the criteria and the modeling studies is discussed.

INTRODUCTION: The Choices Programme is an internationally applicable nutrient profiling system with nutrition criteria for trans fatty acids (TFA), saturated fatty acids, sodium, added sugar and for some product groups energy and fibre. These criteria determine whether foods are eligible to carry a "healthier option" stamp. In this paper a nutrient intake modelling method is described to evaluate these nutritional criteria by investigating the potential effect on nutrient intakes.METHODS: Data were combined from the 2003 Dutch food consumption survey in young adults (aged 19-30) and the Dutch food composition table into the Monte Carlo Risk Assessment model. Three scenarios were calculated: the "actual intakes" (scenario 1) were compared to scenario 2, where all foods that did not comply were replaced by similar foods that did comply with the Choices criteria. Scenario 3 was the same as scenario 2 adjusted for the difference in energy density between the original and replacement food. Additional scenarios were calculated where snacks were not or partially replaced and stratified analyses for gender, age, Body Mass Index (BMI) and education.RESULTS: Calculated intake distributions showed that median energy intake was reduced by 16% by replacing normally consumed foods with Choices compliant foods. Intakes of nutrients with a maximal intake limit were also reduced (ranging from -23% for sodium and -62% for TFA). Effects on intakes of beneficial nutrients varied from an unintentional reduction in fat soluble vitamin intakes (-15 to -28%) to an increase of 28% for fibre and 17% calcium. Stratified analyses in this homogeneous study population showed only small differences across gender, age, BMI and education.CONCLUSIONS: This intake modelling method showed that with consumption of Choices compliant foods, nutrient intakes shift towards population intake goals for the nutrients for which nutrition criteria were defined, while effects on beneficial nutrients were diverse.

To mimic the impaired iron status seen in children with chronic vitamin A deficiency, an attempt was made to produce rats with different, but more or less constant vitamin A status. Dams were fed different levels of vitamin A (1200, 450, 150 or 75 RE/kg feed) throughout pregnancy and lactation and their pups received the same diets. Blood parameters of vitamin A and iron status were measured throughout the study in the female pups until they were aged 41 weeks. At the end of the experiment blood and organs were collected for determination of vitamin A and iron status. In this rat model, different degrees of vitamin A deficiency were associated with almost constant plasma retinol concentrations. Vitamin A deficiency produced increases in spleen and tibia iron, and reductions in plasma iron, total iron-binding capacity and mean corpuscular hemoglobin concentration.

This review evaluates the methodological quality of current front-of-pack labeling research and discusses future research challenges. Peer-reviewed articles were identified using a computerized search of the databases PubMed and Web of Science (ISI) from 1990 to February 2011; reference lists from key published articles were used as well. The quality of the 31 included studies was assessed. The results showed that the methodological quality of published front-of-pack labeling research is generally low to mediocre; objective observational data-based consumer studies were of higher quality than consumer studies relying on self-reports. Experimental studies that included a control group were lacking. The review further revealed a lack of a validated methodology to measure the use of front-of-pack labels and the effects of these labels in real-life settings. In conclusion, few methodologically sound front-of-pack labeling studies are presently available. The highest methodological quality and the greatest public health relevance are achieved by measuring the health effects of front-of-pack labels using biomarkers in a longitudinal, randomized, controlled design in a real-life setting. © 2012 International Life Sciences Institute.

BACKGROUND: A global push to reduce the amount of saturated and trans-fatty acids, added salt and sugar in processed food, and to enhance fruit, vegetable and whole grain intake, while limiting energy intake, exists for most populations.OBJECTIVES: To redesign the International Choices Program (note: this is unrelated to the US Smart Choices Program), initially Netherlands focused, by an international board of scientists to create a generic, global front-of-pack nutrition logo system that helps consumers make healthier food choices and stimulates product reformulation.METHODS: The Programme is a product-group-specific-nutrient-profiling approach with a distinction between basic and discretionary foods. The basic product groups are main contributors of essential and beneficial nutrients, and are based on food-based dietary guidelines from more than 20 countries across the globe. Generic criteria are derived from international nutrient recommendations for trans-fatty acids, saturated fatty acids, sodium, added sugar, fibre and energy, and evaluated against food composition data from 12 countries across Europe and market reality (actual foods on the market). Selected debates such as the source of fibre are also presented.RESULTS: Generic criteria and a decision framework were developed to further define food categories, so as to meet the unique country- and region-specific dietary needs. The result is a complete set of criteria that is evaluated on a regular basis to ensure its alignment with international dietary patterns, new scientific insights and current developments within the food market.CONCLUSIONS: These guidelines are currently used in a number of countries across the globe, and are being evaluated for effectiveness. Completed studies have demonstrated an increase in consumer awareness, a positive effect on product innovation and a potential impact on nutrient intakes.

This study investigated the effectiveness of labeling foods with the Choices nutrition logo on influencing cafeteria menu selection and the behavioral determinants of menu choices in work site cafeterias in the Netherlands. A cluster randomized controlled trial was conducted. Intervention cafeterias (n=13), where the Choices logo was used to promote healthier eating for a 3-week period, were compared with control cafeterias (n=12), which offered the same menu without the logo. Sales data were collected daily for 9 weeks, from March to May 2009. In addition, employees from one intervention and one control company completed an online questionnaire at baseline and after the intervention (n=368) in which the behavioral determinants of food choice (ie, attitude, self-efficacy, and intention) and logo use were measured. Generalized estimating equation analyses, χ 2 tests, t tests and linear regression analyses were performed. No nutritionally meaningful intervention effects were found in the sales of sandwiches, soups, snacks, fruit, and salads. Also, no significant differences in behavioral determinants were found. "Intention to eat healthier" and "paying attention to product information" were positively associated with self-reported consumption of foods with the Choices logo at lunch. The intervention did not have a significant effect on employees' lunchtime food choices. Labeling healthy choices might be useful for health-conscious employees in the volitional phase of behavior change. Further research should focus on the possible health benefits of menu reformulation in the catering sector.

INTRODUCTION: Nutrient profiling is defined as the science of categorising foods based on their nutrient composition. The Choices Programme is a nutrient profile system with criteria that determine whether foods are eligible to carry a "healthier option" stamp. The Daily Menu Method which has been developed to evaluate these criteria is described here. This method simulates the change in calculated nutrient intakes which would be the result of consumers changing their diets in favour of food products that comply with the criteria.METHODS: Average intakes of energy, trans fatty acids (TFA), saturated fatty acids (SAFA), sodium, added sugar and fibre were derived from dietary intake studies and food consumption surveys of 7 countries: The Netherlands, Greece, Spain, the USA, Israel, China and South Africa. For each of the key nutrients, these average intakes were translated into three Typical Daily Menus per country. Average intakes based on these three menus were compared with average intakes from three Choices Daily Menus. To compose the Choices Menus, foods from the Typical Menus that did not comply with the Choices criteria were replaced with foods that did comply and are available on the market.RESULTS: Comparison of intakes from the Choices Menus with the survey data showed that calculated intakes of energy, SAFA, TFA, sodium and added sugar were reduced. Fibre intakes were increased. The size of the effect differed per country.CONCLUSION: The Daily Menu Method is a useful means to predict the potential effects of nutrient profiles such as the Choices criteria, on daily nutrient intakes. The method can be applied internationally and confirms that the criteria of the Choices Programme are in line with the aim of the programme: to improve nutrient intakes in the direction of the recommendations.

A high intake of olive oil has been proposed as an explanation for the low incidence of coronary heart disease in Mediterranean countries, but it is unclear whether olive oil offers specific benefits beyond a low content of saturated fat. Some types of extra virgin olive oil are rich in non-polar phenols, which might be taken up by plasma LDL particles and protect these from becoming atherogenic by oxidative modification. In a pilot study we found that consumption of 47 g fortified olive oil containing 31 mg phenols significantly increased the lag time of LDL oxidation from 112 +/- 5 min before to 130 +/- 7 min 2 h after the meal. However, this study was not controlled, and in the current study we therefore investigated whether olive oil phenols increase the lag time of LDL oxidation in postprandial samples when compared with a control group. Twelve healthy men and women consumed four different olive oil supplements with a meal on four separate occasions: one similar to the supplement in the pilot study (positive control); one containing mainly non-polar olive oil phenols; one containing mainly polar olive oil phenols; and one without phenols (placebo). Lag time significantly increased 2 h after the meals with the positive control (8 +/- 2 min), the polar phenols (8 +/- 2 min), and the placebo (8 +/- 2 min), but not after the non-polar phenols (-0.4 +/- 3 min). Increases were not statistically different between supplements. These results indicate that the lag time of LDL-oxidation is increased after consumption of a meal. This increase is probably due to non-specific meal or time effects and not to phenols from olives or olive oil. Furthermore, these findings stress the need for adequate controlled studies to avoid misinterpretations of the data.

Phenols present in olive oil may contribute to the health effects of the Mediterranean lifestyle. Olive oil antioxidants increase the resistance of low-density lipoproteins (LDL) against oxidation in vitro, but human intervention studies have failed to demonstrate similar consistent effects. To better mimic the in vivo situation, plasma was incubated with either individual olive oil phenols or olive oil extracts with different phenolic compositions, and LDL was subsequently isolated and challenged for its resistance to oxidation. The results show that the ortho-dihydroxy phenols (hydroxytyrosol and oleuropein-aglycone) are more efficient than their mono-hydroxy counterparts (tyrosol and ligstroside-aglycone) in increasing the resistance of LDL to oxidation. However, the concentration of antioxidants required to inhibit LDL oxidation when added to whole plasma was substantially higher as compared to previous data where antioxidants are directly added to isolated LDL. In conclusion, this study supports the hypothesis that extra virgin olive oil phenols protect LDL in plasma against oxidation. The explanation that in vitro studies show protective effects in contrast to the lack of effect in the majority of human studies may be that the dose of the phenols and thus their plasma concentration in humans was too low to influence ex vivo LDL oxidizability. Further studies are required to gain a better understanding of the potential health benefits that extra virgin olive oil may provide.

Animal and in vitro studies suggest that olive oil phenols are effective antioxidants. The most abundant phenols in olive oil are the nonpolar oleuropein- and ligstroside-aglycones and the polar hydroxytyrosol and tyrosol. The aim of this study was to gain more insight into the metabolism of those phenols in humans. We measured their absorption in eight healthy ileostomy subjects. We also measured urinary excretion in the ileostomy subjects and in 12 volunteers with a colon. Subjects consumed three different supplements containing 100 mg of olive oil phenols on separate days in random order. Ileostomy subjects consumed a supplement with mainly nonpolar phenols, one with mainly polar phenols and one with the parent compound oleuropein-glycoside. Subjects with a colon consumed a supplement without phenols (placebo) instead of the supplement with oleuropein-glycoside. Ileostomy effluent and urine were collected for 24 h after supplement intake. Tyrosol and hydroxytyrosol concentrations were low (< 4 mol/100 mol of intake) in the ileostomy effluent, and no aglycones were detected. We estimated that the apparent absorption of phenols was at least 55–66% of the ingested dose. Absorption was confirmed by the excretion of tyrosol and hydroxytyrosol in urine. In ileostomy subjects, 12 mol/100 mol and in subjects with a colon, 6 mol/100 mol of the phenols from the nonpolar supplement were recovered in urine as tyrosol or hydroxytyrosol. In both subject groups, 5–6 mol/100 mol of the phenols was recovered from the polar supplement. When ileostomy subjects were given oleuropein-glycoside, 16 mol/100 mol was recovered in 24-h urine, mainly in the form of hydroxytyrosol. Thus, humans absorb a large part of ingested olive oil phenols and absorbed olive oil phenols are extensively modified in the body. -------------------------------------------------------------------------------- KEY WORDS: … phenols … olive oil … absorption … ileostomy … humans

Background Fat-soluble vitamin E and carotenoids are regarded as being protective against chronic diseases. Little is known about the effect of dietary fat on the bioavailability of these compounds. Objective The objective of this study was to assess the effect of the amount of dietary fat on plasma concentrations of vitamin E and carotenoids after supplementation with these compounds. Design During two 7-d periods, 4 groups of 14-15 volunteers received daily, with a low-fat hot meal, 1 of 4 different supplements: vitamin E (50 mg), alpha- plus beta-carotene (8 mg), lutein esters (8 mg lutein), or placebo. The supplements were provided in a low- or high-fat spread supplied in random sequence during either of the 2 experimental periods. Results As anticipated, plasma concentrations of vitamin E, alpha- and beta-carotene, and lutein were significantly higher in the supplemented groups than in the placebo group. The amount of dietary fat consumed with the hot meal (3 or 36 g) did not affect the increases in plasma concentrations of vitamin E (20% increase with the low-fat spread and 23% increase with the high-fat spread) or alpha- and beta-carotene (315% and 139% with the low-fat spread and 226% and 108% with the high-fat spread). The plasma lutein response was higher when lutein esters were consumed with the high-fat spread (207% increase) than with the low-fat spread (88% increase). Conclusion Optimal uptake of vitamin E and alpha- and beta-carotene requires a limited amount of fat whereas the amount of fat required for optimal intestinal uptake of lutein esters is higher. 2000;71:-93.

This article focuses on the opportunities and challenges Dutch Small and Medium sized Enterprises (SMEs) in the food and beverage industry are facing with respect to innovation in food and health. An online questionnaire was developed to give an overview on attitudes and activities of SMEs with respect to innovation; their interest in trends, among which were health and wellbeing; and their view on logos as a possible way of communication. The questionnaire was held May 2011 with a response of n = 110. Results show that innovation is important for SMEs: over 80% of the SMEs are innovating in products and over 60% in processes. The most appealing trends are: Health and wellbeing, ‘Puur en Eerlijk’ (Note 1) and sustainability. Of the SMEs 70-80% indicate to have a current, and 85% a future interest in these trends. Furthermore 43% used the health logo on part of their product portfolio. Logos that communicate health and sustainability are most popular; 23% of the SMEs indicated not to be interested in the use of logos in general. In conclusion, the identified opportunities for innovation in food and health are: a large willingness to innovate and the increasing interest in the already appealing trend of nutrition and health. There is a moderate interest in (health) logos. Challenges are time, costs, knowledge on innovation in general and lack of specific knowledge on nutrition and health, and unclarities around use and added value (informative and increasing sales) of logos. Also, taste is considered as important as health and cannot be compromised.

Studies with anaemic children and pregnant women from areas where vitamin A deficiency is endemic have shown a beneficial effect on Fe status of supplemental vitamin A in addition to Fe supplementation. This suggests a relationship between vitamin Aand Fe status, which we attempted to mimic in rats with anaemia and chronic vitaminA deficiency. Male rats were fed on Fe-adequate diets (35 mg Fe/kg)containing different levels of vitamin A (1200,450,150,75 and 0 retinol equivalents (RE)/kg feed) until they were 5 weeks old. These diets wereidentical to the diets fed to their mothers. Then the young male rats were transferred to diets containing the same levels of vitamin A but no added Fe. After another 2 weeks the rats wererepleted with Fe (35 mg/kg feed) without or with vitamin A to a level of 1200 RE/kg feed. Increased vitamin A intake by the groups previously fed on diets with either 0 or 75 RE/kg produced a reduction in blood haemoglobin concentration, packed cell volume and erythrocyte count. In the group which had been fed on the diet without vitamin A, supplemental vitamin A raised mean cell volume, plasma Fe concentration and total Fe-binding capacity. Vitamin A supplementation during the period of Fe repletion produceda decrease in splenic and tibia Fe concentration, the effect being greater with increasing seventy of previous vitamin A deficiency. The paradoxical effect of supplemental vitamin A on haemoglobin, packed cell volume and erythrocyte count can be explained by a decrease in the degree of haemwoncentration. Thus, the positive effect of supplemental vitamin A seen in humans is also observed with rats under controlled experimental conditions. We speculate that supplemental vitamin A during Fe repletion contributes to optimum erythropoiesis and Fe mobilization when baseline vitamin A status is impaired

Rats with severe vitamin A deficiency were supplemented with vitamin A for 3 days; control rats were not supplemented. Vitamin A supplementation produced an increase in plasma retinol levels, but iron metabolism as assessed by hematological variables, plasma iron concentration, total iron-binding capacity and organ iron content was not affected. The high plasma concentrations of alanine aminotransferase (ALAT) and aspartate aminotransferase (ASAT) in the control rats, indicative of liver damage, were normalized by vitamin A supplementation. Differential counts of bone marrow cells revealed that vitamin A supplementation increased myelopoiesis relative to erythropoiesis. We conclude that vitamin A supplementation for 3 days to rats with severe vitamin A deficiency corrects liver damage, influences blood cell synthesis, but does not affect iron status.

In order to induce a range of vitamin A-deficient states in young growing rats and to study the effect of vitamin A deficiency on Fe status, we designed the following two-generation experiment. Dams were fed on diets with one of five vitamin A levels from 2 weeks before and throughout pregnancy and lactation. The pups received the same diets as their mothers both before and after weaning. The five dietary levels of vitamin A were 1200, 450, 150, 75 and 0 retinol equivalents/kg feed. Vitamin A intake did not affect reproduction outcome, nor were body and liver weights of the pups affected when they were 3·5 weeks old. Male pups with normal vitamin A status had higher plasma retinol levels than female pups. Vitamin A status of the offspring was affected from 3·5 weeks onwards. Body and liver weights were decreased in the male pups given the lowest dietary vitamin A levels from week 6·5 onwards but not in the female pups. Fe status was marginally affected. Haemoglobin levels were increased and total Fe-binding capacity was decreased in the groups given no dietary vitamin A at week 9·5. Splenic Fe was increased only in the male pups given the lowest levels of dietary vitamin A. However, as a whole, Fe status was only mildly affected and subject to considerable variation. We conclude that the two-generation rat model described here is not suitable for studying effects of vitamin A deficiency on Fe metabolism.

To compare the changes in Fe metabolism during the development of vitamin A and Fe deficiencies, rats were given either a control diet with sufficient Fe (35 mg added Fe/kg feed) and retinol (1200 retinol equivalents/kg feed), a diet without added vitamin A or a diet with sufficient vitamin A but only 3.5 mg added Fe/kg feed. During a period of 10 weeks, indicators of vitamin A and Fe status were monitored. Neither vitamin A nor Fe deficiency produced clinical signs. Fe deficiency induced an immediate fall in blood haemoglobin concentration. Vitamin A deficiency produced a mild anaemia as the first change in Fe metabolism, pointing to unpaired erythropoiesis. This effect was followed by a rise in Fe absorption and an increased amount of Fe in the spleen. By the end of the study, blood haemoglobin, packed cell volume, plasma Fe and Fe content in kidney and femur had increased above control levels, while total Fe-binding capacity had decreased. We speculate that the initial anaemia was masked later by haemoconcentration. The decrease in Fe mobilization, shown by lower total Fe-binding capacity, and the increase in Fe absorption may have caused the observed continuous rise in tissue Fe concentration in rats with vitamin A deficiency. In the rats with Fe deficiency, low tissue Fe levels coincided with high Fe absorption and high total Fe-binding capacity. Thus, changes in Fe metabolism with vitamin A deficiency differed from those with Fe deficiency.

Background In addition to helping consumers make healthier food choices, front-of-pack nutrition labels could encourage companies to reformulate existing products and develop new ones with a healthier product composition. This is the largest study to date to investigate the effect of a nutrition logo on the development of healthier products by food manufacturers. Methods A total of 47 food manufacturers joining the Choices Foundation in the Netherlands (response: 39.5%) indicated whether their Choices products were newly developed, reformulated or already complied with the Choices criteria and provided nutrient composition data for their products (n = 821; 23.5% of the available Choices products in August 2009). Results Most products carrying the logo as a result of reformulation and new product development were soups and snacks. Sodium reduction was the most common change found in processed meats, sandwiches, soups and sandwich fillings. Dietary fiber was significantly increased in most newly developed Choices product groups; for example, in fruit juices, processed meats, dairy products, sandwiches and soups. Saturated fatty acids (SAFA) and added sugar were significantly decreased both in reformulated and newly developed dairy products. Caloric content was significantly decreased only in reformulated dairy products, sandwich fillings and in some newly developed snacks. Conclusions The results indicate that the Choices logo has motivated food manufacturers to reformulate existing products and develop new products with a healthier product composition, especially where sodium and dietary fiber are concerned.