Herbert Smorenburg

Background/Objectives: Poor dietary habits are a major contributor to non-communicable diseases (NCDs), the leading cause of mortality worldwide. To promote healthier eating, governments and stakeholders have implemented various nutrition policies, including front-of-pack nutrition labeling (FOPNL). The Choices International Foundation (Choices), through its criteria, supports these efforts through its standardized nutrient profiling system (NPS). Originally developed to underpin a positive FOPNL logo, in 2021, the criteria were expanded into a globally oriented five-level profiling system covering 23 basic and 10 discretionary food groups, addressing key nutrients such as trans-fatty acids, saturated fat, sodium, sugar, fiber, and energy. To ensure continued scientific relevance, the Choices criteria are periodically reviewed by an independent International Scientific Committee (ISC). Methods: This paper presents the 2025 revision of the Choices criteria, focusing on priority areas identified through stakeholder consultation and recent scientific developments. Results: Key updates include the introduction of nutrient-based equivalence criteria for plant-based alternatives to meat and dairy, based on protein and selected micronutrient thresholds. Non-sugar sweeteners (NSSs) were newly included as a factor that lowers a product’s health classification and makes it ineligible for a positive FOPNL. Additionally, the industrially produced trans-fatty acid (iTFA) criteria were revised and aligned with the latest World Health Organization (WHO) recommendations, improving both technical feasibility and policy coherence. While options for incorporating whole-grain and micronutrient criteria were explored, these were not included in the current revision. Conclusions: The 2025 update system enhances the scientific rigor, policy alignment, and global applicability of the Choices system. By providing a harmonized and evidence-based tool, it aims to support national policies that foster healthier food environments and, ultimately, improve public health outcomes worldwide.

Background: The European Commission has called for a harmonised front-of-package nutritional label (FOPNL) system in the European region. The Keyhole is a widely adopted positive FOPNL used in several Nordic countries. The Nutri-Score is a five-level graded FOPNL, more recently introduced in Western Europe. Both FOPNLs are supported by intrinsically different nutrient profiling systems (NPSs). A third NPS is the Choices NPS, which originally supported a positive FOPNL similar to the Keyhole and has been expanded into a five-level NPS. Objectives: The main objective of this study was to investigate the overall alignment between both the Choices and Nutri-Score multi-level NPSs and the Keyhole NPS. Furthermore, food group-based alignment was analysed to understand the main sources of misalignment. Methods: In this study, we extracted 1064 food/drink items from the food and beverage database of the Swedish Food Administration. All products were assessed according to all three NPSs, and alignment was assessed, using the Keyhole NPS as a recommendation-based reference. Two definitions of alignment were examined—healthier (more lenient, i.e., two highest grades) and healthiest (stricter, i.e., only the highest grade). Results: The overall alignment between the Choices and Keyhole NPSs was similar to that between the Nutri-Score and Keyhole NPSs (89% and 85% alignment under the healthiest definition, i.e., stricter). However, two food groups showed poor alignment between the Nutri-Score NPS and the Keyhole NPS (~60%). Under the healthier (more lenient) definition, the alignment for both the Choices and Nutri-Score systems with the Keyhole system was lower (86% and 79%). Conclusions: The alignments and misalignments between the Choices/Nutri-Score systems and the Keyhole system prompt important considerations for future developments of FOPNL systems for the Nordic countries. Extending the Keyhole NPS to include a multi-level criterion could potentially help consumers identify healthier choices, even for less nutritious foods.

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.

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 combination 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 efficiently evaluate mixed food products and represents a flexible tool, applicable in various settings and populations.