Supplementary Material for: Use of the WHO Nutrient Profile Model for food marketing regulation in Germany: feasibility and public health implications

Introduction: Exposure to marketing for foods high in sugar, salt, and fat is considered a key risk factor for childhood obesity. To support efforts to limit such marketing, the World Health Organization Regional Office for Europe has developed a nutrient profile model (WHO NPM). Germany’s Federal Ministry of Food and Agriculture plans to use this model in proposed new food marketing legislation, but it has not yet been tested in Germany. The present study therefore assesses the feasibility and implications of implementing the WHO NPM in Germany. Methods: We applied the WHO NPM to a random sample of 660 food and beverage products across 22 product categories on the German market drawn from Open Food Facts, a publicly available product database. We calculated the share of products permitted for marketing to children based on the WHO NPM, both under current market conditions and for several hypothetical reformulation scenarios. We also assessed effects of adaptations to and practical challenges in applying the WHO NPM. Results: The median share of products permitted for marketing to children across the model’s 22 product categories was 20% (interquartile range (IQR) 3-59%) and increased to 38% (IQR 11-73%) with model adaptations for fruit juice and milk proposed by the German government. With targeted reformulation (assuming a 30% reduction in fat, sugar, sodium, and/or energy) the share of products permitted for marketing to children increased substantially (defined as a relative increase by at least 50%) in several product categories (including bread, processed meat, yogurt and cream, ready-made and convenience foods, and savoury plant-based foods), but changed less in the remaining categories. Practical challenges included the ascertainment of the trans-fatty acid content of products, among others. Conclusion: The application of the WHO NPM in Germany was found to be feasible. Its use in the proposed legislation on food marketing in Germany seems likely to serve its intended public health objective of limiting marketing in a targeted manner specifically for less healthy products. It seems plausible that it may incentivise reformulation in some product categories. Practical challenges could be addressed with appropriate adaptations and procedural provisions.

引言：高糖、高盐、高脂食品的营销暴露被认为是儿童肥胖的关键风险因素。为助力限制此类营销的工作，世界卫生组织欧洲区域办事处开发了一款营养成分概况模型（nutrient profile model, WHO NPM）。德国联邦食品与农业部计划在拟议的新食品营销立法中采用该模型，但该模型尚未在德国境内开展测试。因此本研究旨在评估在德国推行WHO NPM的可行性及其影响。
方法：我们从公开可用的产品数据库Open Food Facts中抽取了德国市场上22个产品类别的660种食品及饮料产品作为随机样本，并将WHO营养成分概况模型（WHO NPM）应用于该样本。我们基于WHO NPM，分别在当前市场环境以及多种假设的产品配方调整场景下，计算了允许面向儿童营销的产品占比。此外，我们还评估了应用该模型时所需的调整效果及实际面临的挑战。
结果：在该模型覆盖的22个产品类别中，允许面向儿童营销的产品占比中位数为20%（四分位距（interquartile range, IQR）为3%~59%）；若采用德国政府针对果汁与牛奶提出的模型调整方案，该占比将提升至38%（IQR为11%~73%）。通过针对性配方调整（假设脂肪、糖、钠和/或能量含量降低30%），多个产品类别（包括面包、加工肉制品、酸奶与奶油、即食食品与方便食品以及咸味植物基食品）中允许面向儿童营销的产品占比大幅提升（定义为相对增幅至少达到50%），但其余类别的占比变化较小。实际挑战包括产品反式脂肪酸含量的确定等。
结论：研究发现，在德国推行WHO NPM具备可行性。将其应用于德国拟议的食品营销立法中，或可实现其既定的公共卫生目标，即针对性地限制针对低健康品质产品的营销。该模型或可激励部分产品类别进行配方调整，这一推测具备合理性。实际面临的挑战可通过适当的调整方案与程序规定加以解决。