The Choices

1

• The Choices
• Nutrition Criteria
• Proposed
• Changes for Israel

2
Background on Choices in Israel

• Plans to launch at Q4 2009
• Specific dietary habits related to Mediterranean
  diet and Jewish diet
• Review of criteria began in August 2008
• Drafts and comments sent to Choices International
  foundation
• September 2008 (identification of foods to be
  adjusted)
• November 2008 (recommendations for food groups
  analysis of nutrients)
• January 2009 (recommendations for Cheese, Hummus
  (chickpeas), Meat, Milk)
• Meeting with Jaap Seidel January 2009 (agreement
  on kosher meet and 3 milk as a time leg)
• February 2009 Meeting report, agreement on next
  steps and process for adjusting criteria with CIF
• April 2009 Draft final review recommendations
  by Israeli scientific committee/
• Adjustment to the local situation in Israel is
  critical for launching Choices in Q4, 2009

3
Food product evaluation in Israel - Methodology

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

4
The Process for developing suggested adjustments
in the Choices criteria in Israel

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

5
What are the gaps?

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

6
Dairy Products in Israel

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

7
Salad Spreads

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

8
Proposal for Adjusting the Choices criteria to
Israel

• White Soft Cheese and Cottage Cheese

• Fundamental products in most Israelis' menu
• Commonly contain between 3-5 fat
• Consumed as a spread on bread or with a spoon in
  dairy meals.

• Hard cheese is not as common in Israel as it is
  in Europe and therefore white soft cheese is an
  important source of protein and calcium.

9
White Soft Cheese and Cottage Cheese in Israel

• Evaluation according to the Choices groups
• Milk products All products were disqualified
  due to high sodium levels,products containing
  more than 3 fat were also disqualified due to
  SAFA.
• Cheese products All products complied with the
  Choices criteria.
• Oils spreads All products were disqualified,
  most due to sodium and SAFA
• Unique Israeli food which do not fit in the
  current Choices criteria scheme
• It is necessary to create a new product subgroup.
  

Criteria Milk products Cheese products Oils spreads
Fat SAFA lt 1.4 g/100 g SAFA lt 15 g/100 g SAFA lt 30 of Total fat
Fat TFA lt 0.14 g/100 g TFA lt 0.14 g/100 g TFA lt 1.3en
Sodium lt 120 mg/100 g lt 900 mg/100 g lt 1.6 mg/Kcal
Added sugar lt 5 g/ 100 g Not added Not added
qualify 0 100 0
10
White Soft Cheese and Cottage Cheese in Israel

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

11
White Soft Cheese and Cottage Cheese review of
healthy symbols programs

• Other nutritional labeling programs in the world
  
• The food product group that was found to contain
  the most similar products was the "Fresh cheese"
  in the Swedish "Keyhole" program.
• The fat criterion Allows for 5 fat cheese to
  qualify.
• The sodium criterion gt Stricter than the
  choices cheese group(900mg/100g),
• Less strict than the choices milk group
  (120mg/100g)
• gt Not applicable in Israel - will cause
  disqualification of all cottage cheese (all
  products contain more than 370mg/100g)

Criteria Keyhole Fresh Cheese
Fat Total fatlt 5 g/100 g
Sodium 350 mg/100g
Added sugar Not added
12
White Soft Cheese and Cottage Cheese in Israel

• The proposal made by the Israeli scientific
  committee
• These products are to be included as a separate
  group.
• The benchmark for this group is to allow for
  400mg/100g sodium and 2g/100g SAFA.
• It is recommended to stiffen the sodium criterion
  in later stages of the implementation of the
  Choices program.

Criteria Israel Suggestion
Fat SAFA lt 2 g/100 g
Sodium lt 400 mg/100 g
qualify 38

• This will result in the qualifying of 38 of the
  products, all of the soft white cheese and
  cottage cheese containing up to 3 fat (including
  those manufactured by most manufactures).
• Viable suggestion, strict enough to stimulate
  innovation, will qualify sufficient number of
  products to ensure the consumption of beneficial
  nutrients.

13
White Soft Cheese and Cottage Cheese in Israel
Criteria Israel Suggestion
Fat SAFA lt 2 g/100 g
Sodium lt 400 mg/100 g
qualify 38
14
Proposal for Adjusting the Choices criteria to
Israel

• Vegetable oil based spreads (Hummus)

• Hummus is chick-peas spread/paste
• Hummus is fundamental in the diet of Israelis
  and other Mediterranean countries
• For some Israelis, hummus is not only a spread,
  but rather the main course of the meal (usually
  consumed with pita bread).

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Hummus spreads in Israel

• What is Hummus? Ingredients 16 cooked hummus
  (chick-peas), vegetable oil, water, tahini,
  salt, lemon acid, spices, preservative
• The sodium level is usually above 350 mg / 100 g
• Wide range of SAFA and sodium levels

17
Hummus spreads in Israel

• Evaluation according to the Choices groups
• Processed vegetable All products were
  disqualified due to sodium and SAFA levels
• Oils spreads A majority of the products (65)
  comply. The main reason for disqualification
  sodium (91), SAFA (18).
• All other products A majority of the products
  (58) comply. The main reason for
  disqualification sodium (77), SAFA (31).
• In the last two food groups the products that
  contain less added fat were disqualified due to
• the fact that the sodium criterion is based on
  units of mg/Kcal.
• Unique Israeli food which do not fit in the
  current Choices criteria scheme

Criteria Processed fruit vegetable Oils spreads All other products
Fat SAFA lt 1.4 g/100 g SAFA lt 30 of Total fat SAFA lt 13en (1.4 g/100 g)
Fat TFA lt 0.14 g/100 g TFA lt 1.3en TFA lt 1.3en (0.14 g/100 g)
Sodium lt 120 mg/100 g lt 1.6 mg/Kcal lt 1.6 mg/Kcal(120mg/100 g)
Added sugar Not added Not added lt 13en(3.25g/100 g)
Dietary fibre lt 1.3 g/100 kcal  
qualify 0 65 58
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Hummus spreads in Israel

• The proposal made by the Israeli scientific
  committee
• The criteria for the hummus subgroup will be
  based on the "all other products" group gtThis
  group Includes salad spreads gtThe SAFA criterion
  is stricter than that in the oils spreads
  group.
• The best products which contain less fat, less
  sodium and less energy (hummus light) do not
  qualify when evaluated according to the present
  sodium criterion (1.6 mg/Kcal).gt The sodium
  criterion should be set specifically for the
  hummus subgroup

Criteria All other products
Fat SAFA lt 13en (1.4 g/100 g)
Fat TFA lt 1.3en (0.14 g/100 g)
Sodium 400 mg/100g
Added sugar lt 13en(3.25g/100 g)
qualify 26

• These products are to be evaluated according to
  the all others food group, but with a change
  of the sodium reference and consider sodium as
  amount per 100g (400 mg/100g) instead of mg per
  Kcal ( this will result in 26 of the products
  qualifying )
• This allows for the best Hummus products in the
  market only to qualify while relying on the
  current Choices system, without the need to
  develop a unique food group for this product
  category.

19
Hummus spreads in Israel
Criteria light hummus, Achla (Strauss) plain hummus (Zabar)
Energy 209 kcal 335 kcal
Fat SAFA 1.7 g (7.3en) SAFA 4.5 g (12en)
Sodium 353 mg (1.68 mg/kcal) 435 mg (1.3 mg/kcal)
Qualify?(1.6 mg/kcal) no yes
Qualify? (400 mg/100g) yes no
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Hummus spreads in Israel
Criteria All other products (Hummus)
Fat SAFA lt 13en (1.4 g/100 g)
Fat TFA lt 1.3en (0.14 g/100 g)
Sodium 400 mg/100g
Added sugar lt 13en(3.25g/100 g)
qualify 26
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Proposal for adjusting the Choices criteria to
Israel

• Breakfast cereals

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

22
Granola Cereals Market in Israel

• Granola segment is 7 of the cereal market.
• Granola Penetration rate 30
• Cereals (without Granola) Penetration rate- 86
  (April Mat 2009)
• Its seems that every one who buys Cereals buys
  also Granola.

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Breakfast cereals in Israel

• Sodium content vary from as low as 0.5 to as
  high as 730 mg/100g.
• Most products contain 200 - 500 mg/100g.
• Sugar content varies widely from as low as 1 to
  as high as 50 g/100g.
• The products targeted for children contain more
  sugar.gt more than 22 g/100g.gt average 33 g/100g
  (19 g/100g for adults products).

Adults average
Children's average
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Breakfast cereals in Israel

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

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Breakfast cereals in Israel
Criteria Choices -Grains Cereal Products Choices - Bread Choices - Snacks
Fat SAFA lt 1.4 g/100 g SAFA lt 1.4 g/100 g SAFA lt 13en
Fat TFA lt 0.14 g/100 g TFA lt 0.14 g/100 g TFA lt 1.3en
Sodium lt 120 mg/100 g lt 500 mg/100 g lt 400 mg/100 g
Added sugar lt 3.25 g/100 g lt 13en lt 20 g/100 g
Dietary fibre lt 1.3 g/100 kcal lt 1.3 g/100 kcal  
Energy     lt 110 kcal/ portion
qualify 0 6 4

• Evaluation according to the Choices groups
• Grain group All products were disqualified. The
  main reason for disqualification sodium and
  sugar (94)
• Bread group Only 6 qualified.The main reason
  for disqualification sugar (94)
• Snacks group Only 3 qualified.The main reason
  for disqualification energy (78) and sugar
  (77)
• none of the products targeted at children
  qualified.
• Common Israeli food which does not fit in the
  current Choices criteria scheme
• It is necessary to create a new product subgroup.
  

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Breakfast Cereals
Criteria Choices -Grains Cereal Products Choices - Bread Keyhole - Cereals "Smart-Choices" - Cereals Heart Symbol- Cereals
Fat SAFA lt 1.4 g/100 g SAFA lt 1.4 g/100 g Total Fat lt 7 g/100 g SAFA lt 10en Total Fat lt 5 g/100 g
Fat TFA lt 0.14 g/100 g TFA lt 0.14 g/100 g    
Sodium lt 120 mg/100 g lt 500 mg/100 g lt 500 mg/100 g lt 240 mg/ portion (30g), lt 800 mg/100 g lt 400 mg/100 g
Added sugar lt 3.25 g/100 g lt 13en 13 g/100 g lt 12 g/ portion (30g), lt 40 g/100 g 16 g/100 g
Dietary fibre gt 1.3 g/100 kcal gt 1.3 g/100 kcal gt 1.9 g/100 kcal gt10 DV  gt 6 g/100 g

• Other nutritional labeling programs in the world
  
• Two programs were reviewed, the American Smart
  choices and the Swedish Keyhole
• Regarding sugar and sodium
• the American program ("Smart-Choices) is the
  less strict of the two.
• The breakfast cereal groups in both programs are
  less strict than the Choices grains food group.
• Sodium and sugar criteria, which were the main
  reason for disqualification of products, should
  be modified.
• These modified criteria can be based on the bread
  product group, which are similar to the grains
  group criteria in the fat and fiber criteria but
  are less strict in the sodium criterion.

Recently, another program was reviewed, the
Finish Heart symbol. This program also sets
more lenient sugar criterion with regards to the
current choices criterion.
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Breakfast Cereals

• Other nutritional labeling programs in the world
  
• In order to asses the possible sugar criterion,
  the products were evaluated according to the
  Choices bread products criteria while sugar
  levels were taken from other programs-
  "Keyhole" cereals group (13 g/100g) sugar
  criterion only 9 of the products qualify (no
  children product).- Smart Choices" cereals
  group (40 g/100g) criterion 24 of the products
  qualified (including some products targeted at
  children). only 7 were disqualified due to
  sugar levels.
• A practical sugar criterion can be set somewhere
  in-between the two programs (Keyhole and
  Smart-Choice) in order to stimulate industry to
  reduce sugar levels especially in cereals
  targeted at children.

Criteria Choices Bread Keyhole Sugar criteria Choices Bread Smart Choices Sugar criteria
Fat SAFA lt 1.4 g/100 g SAFA lt 1.4 g/100 g
Fat TFA lt 0.14 g/100 g TFA lt 0.14 g/100 g
Sodium lt 500 mg/100 g lt 500 mg/100 g
Added sugar lt 13 g/100 g lt 40 g/100 g
Dietary fibre gt 1.3 g/100 kcal gt 1.3 g/100 kcal
qualify 8 25
qualify (adults products) 15 39
qualify (childrens products) 0 10
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Breakfast cereals in Israel

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

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Breakfast cereals in Israel

• Israels suggestions
• These suggestions are based on the bread
  products criteria but with a modified sugar
  criterion
• Option 1 - 18 g/100g sugarqualification of 14
  of the products (none of the children's
  products).
• Option 2 - less strict sugar criterion (22
  g/100g) qualification of 18 of the total
  products, including only one children's
  product,and 32 of the adult's products.
• Option 3 - midrange between the "Keyhole" and
  the "Smart Choices" sugar criterion (28 g/100g)
  qualification of 20 of the total products,
  including only one children's product, and 37
  of the adult's products.
• The only children's product which qualified
  (Shugi protein, Uniliver) contains artificial
  sweeteners, which is needed in order to meet the
  demand from such a product (sweet).

Criteria Suggestion 1 Suggestion 2 Suggestion 3
Fat SAFA lt 1.4 g/100 g SAFA lt 1.4 g/100 g SAFA lt 1.4 g/100 g
Fat TFA lt 0.14 g/100 g TFA lt 0.14 g/100 g TFA lt 0.14 g/100 g
Sodium lt 480 mg/100 g lt 500 mg/100 g lt 500 mg/100 g
Added sugar lt 18 g/100 g lt 22 g/100 g lt 28 g/100 g
Dietary fibre gt 1.3 g/100 kcal gt 1.3 g/100 kcal gt 1.3 g/100 kcal
qualify 14 18 20
qualify (adults products) 27 32 37
qualify (childrens products) 0 3 3

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Breakfast cereals in Israel

• Israels suggestion- the principles
• Setting the criteria should be done so that
  products for all consumer populations will be
  represented (children adults).
• It is recommended to maintain all breakfast
  cereals as one category.
• A need for educating consumers to consume less
  sweet products, and purchase improved products,
  therefore avoiding criteria that will result in
  usage of sugar substitutes, which keep sweetness
  high and is not perceived as acceptable by
  parents.

Criteria Suggestion 1 Suggestion 2 Suggestion 3
Sodium lt 480 mg/100 g lt 500 mg/100 g lt 500 mg/100 g
Added sugar lt 18 g/100 g lt 22 g/100 g lt 28 g/100 g
qualify 14 18 20
qualify (adults products) 27 32 37
qualify (childrens products) 0 3 3

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Breakfast cereals in Israel

• Israels recommended suggestions
• Options 2 and 3 seem to be the practical options.
  gt The criteria in these options are challenging
  (only 1 product targeted at children qualified)
• Option 2 - a great challenge for manufacturers
  since current sugar levels are much higher. gt
  low acceptance of products with different taste
  due to decreasing sugar levels or adding
  artificial sweeteners.
• Option 3 less strict. gt it may allow gradual
  shift to the development of better children's
  breakfast cereals.

Criteria Suggestion 1 Suggestion 2 Suggestion 3
Sodium lt 480 mg/100 g lt 500 mg/100 g lt 500 mg/100 g
Added sugar lt 18 g/100 g lt 22 g/100 g lt 28 g/100 g
qualify 14 18 20
qualify (adults products) 27 32 37
qualify (childrens products) 0 3 3

• It is suggested that as a first step, a
  challenging criterion will be set, but without
  forcing manufacturers to use artificial
  sweeteners suggestion 3 (28g/ 100g sugar). gt
  The goal is that in the future this criterion
  will be lowered to 22 g/100g sugar

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Breakfast cereals in Israel

Criteria Israel Suggestion
Fat SAFA lt 1.4 g/100 g
Fat TFA lt 0.14 g/100 g
Sodium lt 500 mg/100 g
Added sugar lt 28 g/100 g
Dietary fibre gt 1.3 g/100 kcal
qualify 20

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Breakfast cereals in Israel

• Appendix - Assessment of the added sugar daily
  intake according to the suggested criteria
• In order to check the compliance of the criteria
  suggested to the recommended nutritional intake
  there is a need to evaluate their influence on
  the total daily intake of added sugar.
• When evaluating according to even the most
  lenient suggested criteria it was found that the
  maximal daily energy intake from added sugar was
  less than the upper limit (lt 25 en) as set by
  the US Institute of Medicine.
• Calculation of maximal sugar levels for snacks
  (applying product specific sugar criterion 20
  g/100g)
• Per 100g, a snack may contain 20 g sugar. For a
  45 g snack, this will be 9 g sugar
• 3 times a day a sweet snack x 9 g sugar 27 g
  sugar from snacks
• Calculation of maximal sugar levels for breakfast
  cereals (applying product specific sugar
  criterion 28 g/100g)
• Per 100g, cereals may contain 28 g sugar. For a
  30 g serve, this will be 8.4 g sugar
• Sugar from the rest of the diet (applying the
  generic added sugar criterion lt13 en)
• Total energy intake (2000 kcal 330kcal
  (snacks) 33.6kcal (cereals) 1600 kcal of
  which 13 en of added sugar (generic criterion)
  52 g sugar
• Maximal daily energy intake from added sugar in
  diet
• 27 g 8.4 g 52 g 87.4 g (x 4 kcal) 349.6
  kcal
• 17.5 of total daily energy (2000kcal), which
  is below the IOM upper limit (25 energy)

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