Commentary: Think healthy foods holistically when it comes to Nutri-Grade

SINGAPORE: Have you been paying attention to the Nutri-Grade of your kopi, bubble tea or canned drinks? Consumers may soon see more of these colour-coded labels to help them watch their sodium and saturated fat intake.
But could more labels lead to greater confusion on healthier eating? What will be considered healthy or unhealthy?
The Ministry of Health (MOH) and Health Promotion Board (HPB) recently announced they will extend the mandatory nutrition labelling from sugar and saturated fat in beverages to sodium and saturated fat in salt, sauces, seasonings, instant noodles and cooking oil.
Surveys by MOH and HPB released last year found that nine in 10 Singapore residents exceeded the daily recommended intake of less than 2,000mg of salt, while the prevalence of high blood pressure has nearly doubled since 2010.
Nutri-Grade labelling is a part of a larger effort to help consumers understand what goes into their food and what is good for their bodies.
When the Nutri-Grade ratings were first introduced for beverages, there was some confusion when the labelling went against common perceptions and habits.
Many consumers were puzzled when fruit juice and full cream milk received poorer grades than artificially sweetened soft drinks. It raised questions about the beverages people grew up with and thought were healthy in terms of other nutrients like vitamins and minerals.
In this aspect, the proposed sodium and saturated fat labelling may also surprise some consumers as hidden sodium and saturated fat will be then disclosed, sending an alarming message. For example, many are aware that instant noodles are often high in sodium, but they may not realise that a single serving can contain as much as the recommended limit of sodium of 2000mg a day.
Oils, such as palm oil, may receive a poorer rating due to the high saturated fat content, despite being better for high temperature cooking such as deep frying due to its high smoke point. The ability to withstand higher temperatures means carcinogenic compounds are less likely to be formed.
Sauces and seasonings, on the other hand, tend to be culturally significant – from soy sauce and oyster sauce to curry made with coconut milk. Food producers will likely offer low sodium and saturated fat alternatives to remain competitive and meet consumer demand on these products.  
Consumers are more likely to avoid consuming too much salt or saturated fat if they were to religiously abide by the Nutri-Grade labelling. The labels are meant to make it easier to make informed decisions, especially at a glance when buying groceries.
However, we must realise that nutrition is a far more complex and multi-faceted subject, and the binary descriptors of “healthy” and “unhealthy” start to lose their meaning. One often overlooked aspect is the nutrient-nutrient interaction in food.
For example, a sauce with high sodium content may receive a low Nutri-Grade score. However, if it contains a proportional amount of potassium – which helps excrete sodium out of the body and lower blood pressure – the negative impact to health could be less severe.
Similarly, a food product high in saturated fat would be given a lower rating. However, if it is formulated with a significant amount of dietary fibre, the actual amount of fat absorbed by the body could be significantly reduced.
The authorities could consider incorporating additional components into the Nutri-Grade system, such as dietary fibre or energy content, over time to reflect a more holistic picture of nutritional value. But there needs to be a fine balance between providing a fuller view and making it easy to understand.
Making food choices based on a single nutrient, be it sugar, sodium or saturated fat, can be useful for people who tend to overconsume these or who are at risk for chronic diseases. But doing this alone does not make a healthy diet.
A study by the Duke-NUS Medical School found that Nutri-Grade sugar levels were effective in increasing consumers’ purchases of beverages rated A or B. Despite being perceived as healthier, there was no significant impact on the participants’ diet quality.
We must move away from thinking of “healthy” and “unhealthy” food based on a single nutrient. The overall nutritional impact of a food product cannot be overlooked.
We can rethink what a nutritious diet – where every nutrient has a part to play – truly entails. Take potato chips for example, eating the whole bag and nothing else, is unhealthy, but eating a handful alongside a nutritious meal is not as unhealthy.
So how can we help consumers make informed choices without adding to the confusion?
By explaining clear and concisely what the Nutri-Grade is trying to tell us – how products in the same category compare, specifically in terms of the nutrients that we tend to overconsume and contribute to ill health.
Many of us are already familiar with the Healthier Choice Symbol (HCS), though perhaps not that there are 41 labels with different taglines covering nutrients other than sugar, sodium and saturated fat. HCS is voluntary and covers a wider range of food products than Nutri-Grade. HCS items are supposed to fall into Nutri-Grade A or B categories and public perception may then confuse them as the same. Hence, there is a need to establish more distinct roles for each guideline to minimise confusion.
We should also help people think critically and rationally on the food they eat as a whole, beyond just food labels.
This starts from young. Healthy eating and an active lifestyle are already being taught in primary schools’ physical education curriculum. The recently concluded Health and Food Science Competition for secondary schools, co-organised by the Singapore Science Centre and Republic Polytechnic was a useful platform in helping students to appreciate and apply healthy eating concepts.
But healthy eating habits are ultimately reinforced at home. Besides the health authorities, consumer organisations and healthcare institutions can also play their part, to educate different demographics of the population they serve.
A greater, concerted effort by all stakeholders – government, industry and research institutions – should work harder to develop alternatives that will help to reduce sugar, sodium and saturated fat content in a range of food items. A complete ecosystem needs to be in place if we want to move the needle on healthier diets and tackling chronic diseases.
Dr Heng Kiang Soon is a nutrition scientist and lecturer at the School of Applied Science, Republic Polytechnic.