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      Nutritional Content, Labelling and Marketing of Breakfast Cereals on the Belgian Market and Their Reformulation in Anticipation of the Implementation of the Nutri-Score Front-Of-Pack Labelling System

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          Abstract

          Objective: Breakfast cereals are frequently consumed in Belgium, especially among children. We investigated the nutritional content, labelling and marketing of breakfast cereals and the changes in nutrient content and reformulation in anticipation of the implementation of the Nutri-Score front-of-pack label. Design: Pictures were taken of cereal packages. The WHO-Europe nutrient profiling tool was used to classify cereals into ‘permitted’/‘not-permitted’ to be marketed to children, while the nutritional quality was assessed using Nutri-Score. The proportion of cereals with nutrition and health claims and/or promotional characters on the front-of-pack was compared between permitted and not-permitted cereals and between different Nutriscore categories using Chi-squared tests. The average nutrient contents per 100g were compared between 2017 and 2018 using paired t-tests. Setting: Belgium. Participants: All breakfast cereals in the major supermarkets ( n = 7) in 2017 and 2018. Results: Overall, 330 cereals were included. About 77.2% of cereals were not permitted to be marketed to children but, of those, 22.0% displayed promotional characters. More claims (68.9% of all claims) were found on ‘not-permitted’ compared with ‘permitted’ cereals, particularly nutrition claims. Most claims were displayed on cereals with the allocated Nutri-Score A (42.0%) and C (37.0%). A significant reformulation of cereals was found between 2017 and 2018, with reductions in total sugar (−5%) ( p < 0.001) and sodium (−20%) ( p = 0.002) and increases in fibre (+3%) ( p = 0.012) and proteins (+2%) ( p = 0.002). Conclusion: Breakfast cereals on the Belgian market are predominantly unhealthy and frequently carry claims and promotional characters. Minimal reformulation occurred over one year. Policy recommendations include restrictions on claims and marketing for not-permitted cereals.

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          Most cited references 31

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          Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

          In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.
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            A prospective study of breakfast consumption and weight gain among U.S. men.

            The aim was to investigate the association between breakfast consumption and long-term weight gain in an adult male population. We evaluated prospective data on 20,064 U.S men, 46 to 81 years of age, who participated in the Health Professionals Follow-up Study. Data on body weight, dietary factors, and lifestyle variables were obtained by validated questionnaires. We examined weight gain during 10 years of follow-up. Overall, 5,857 men had a weight gain of 5 kg or greater during 10 years of follow-up. Breakfast consumption was inversely associated with the risk of 5-kg weight gain after adjustment for age [hazard ratio (HR) = 0.77 (95% confidence interval [CI], 0.72 to 0.82)], and this association was independent of lifestyle and BMI at baseline [HR = 0.87 (95% CI, 0.82 to 0.93)]. Fiber and nutrient intakes partially explained the association between breakfast consumption and weight gain. The inverse association between breakfast consumption and weight gain was more pronounced in men with a baseline BMI of 25 kg/m(2) or lower [multivariate HR = 0.78 (95% CI, 0.70 to 0.87)] than in men who were overweight at baseline [HR = 0.92 (95% CI, 0.85 to 1.00)]. Furthermore, we observed that an increasing number of eating occasions in addition to three standard meals was associated with a higher risk of 5-kg weight gain [HR = 1.15 (95% CI, 1.06 to 1.25, for >or=2 vs. 0 additional eating occasions)]. These findings suggest that the consumption of breakfast may modestly contribute to the prevention of weight gain as compared with skipping breakfast in middle-aged and older men.
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              Breakfast Frequency and Development of Metabolic Risk

              OBJECTIVE The relation of breakfast intake frequency to metabolic health is not well studied. The aim of this study was to examine breakfast intake frequency with incidence of metabolic conditions. RESEARCH DESIGN AND METHODS We performed an analysis of 3,598 participants from the community-based Coronary Artery Risk Development in Young Adults (CARDIA) study who were free of diabetes in the year 7 examination when breakfast and dietary habits were assessed (1992–1993) and participated in at least one of the five subsequent follow-up examinations over 18 years. RESULTS Relative to those with infrequent breakfast consumption (0–3 days/week), participants who reported eating breakfast daily gained 1.9 kg less weight over 18 years (P = 0.001). In a Cox regression analysis, there was a stepwise decrease in risk across conditions in frequent breakfast consumers (4–6 days/week) and daily consumers. The results for incidence of abdominal obesity, obesity, metabolic syndrome, and hypertension remained significant after adjustment for baseline measures of adiposity (waist circumference or BMI) in daily breakfast consumers. Hazard ratios (HRs) and 95% CIs for daily breakfast consumption were as follows: abdominal obesity HR 0.78 (95% CI 0.66–0.91), obesity 0.80 (0.67–0.96), metabolic syndrome 0.82 (0.69–0.98), and hypertension 0.84 (0.72–0.99). For type 2 diabetes, the corresponding estimate was 0.81 (0.63–1.05), with a significant stepwise inverse association in black men and white men and women but no association in black women. There was no evidence of differential results for high versus low overall dietary quality. CONCLUSIONS Daily breakfast intake is strongly associated with reduced risk of a spectrum of metabolic conditions.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                25 March 2020
                April 2020
                : 12
                : 4
                Affiliations
                [1 ]Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050 Elsene, Belgium; marie.vermote@ 123456sciensano.be
                [2 ]Test Aankoop/ Test-Achat, Hollandstraat 13, 1060 Sint-Gillis, Belgium; stephanie.bonnewyn@ 123456test-achats.be
                [3 ]Clinical and Experimental Endocrinology, KU Leuven, 3000 Leuven, Belgium; christophe.matthys@ 123456uleuven.be
                Author notes
                [* ]Correspondence: stefanie.vandevijvere@ 123456sciensano.be ; Tel.: +32-2642-5754
                Article
                nutrients-12-00884
                10.3390/nu12040884
                7230794
                32218115
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

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