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Bar graph showing the median sugar content (g) of selected food items grouped by major food categories. Data taken from USDA National Nutrient Database released in 2014. Dairy: regular vs low calorie (P=0.011) vs non fat (P=0.036); meat, fish and poultry: regular vs low calorie (P=0.080) vs non fat (P=0.043); baked goods: regular vs low calorie (P=0.0180); fats, oils and salad dressings: regular vs low calorie (P=0.091) vs non fat (P=0.0180).
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Obesity remains a significant public health concern. One of the primary messages from providers and health-care organizations is to eat healthier foods with lower fat. Many in the lay press, however, have suggested that lower fat versions of foods contain more sugar. To our knowledge, a systematic comparison of the sugar content in food with lower...
Citations
... Moreover, consumers may overlook potentially negative attributes (e.g., high sugar) due to the presence of positive claims (e.g., "with calcium" (Hastak & Mazis, 2011;Wellard et al., 2015). For example, a systematic comparison of thousands of products has shown that products labeled as "reduced calories", "light", and "low fat" present higher sugar content than their "regular" counterparts (Nguyen et al., 2016). Claims about sugar may refer to the quantity (e.g., a "low sugar" food must contain up to 5gr of sugar per 100 gr of product) or the quality (e.g., "with coconut sugar") of this nutrient. ...
... Research has not yet investigated this important aspect of biased food evaluations (see Table 1). Importantly, 'low fat' foods with high sugar content are not uncommon as food manufacturers sometimes compensate the fat reduction with added sugar to keep the food's tastiness (Jahn et al., 2018;Nguyen et al., 2016). For example, a cake mix with a '97% fat free' claim was awarded the 2020 Bad Taste Food Award for its excessive sugar content of 55% (Consumer NZ, 2020). ...
... Table 1 summarizes these research findings and classifies them according to the inference mechanism being a direct transfer (e.g., from a 'healthy' claim to perceived healthiness), an overgeneralization to a general healthiness assessment (e.g., from a 'low fat' claim to perceived healthiness) or to a specific, closely associated nutrient (e.g., from a 'low fat' claim to perceived number of calories). This is problematic because many 'low fat' products contain more sugar than the regular product (Nguyen et al., 2016). When choosing a 'low fat' product over the regular option, consumers could thus consume a product higher in sugar when they expect it to be lower in sugar. ...
Truthful yet misleading: Consumer response to 'low fat' food with high sugar content. Food Quality and Preference, forthcoming. 2 Marketers use nutrition claims to communicate potentially beneficial nutritional properties of their products. Claims may only be used if a product has a specific nutrient profile. A downside of nutrition claims is that consumers tend to overgeneralize their meaning, perceiving a product as healthier than it is. This becomes particularly problematic when claims emphasize low amounts of one nutrient while the product contains high amounts of other, typically unhealthy, unmentioned nutrients-a phenomenon which has received little attention in extant literature. This research examines how consumers perceive food with 'low fat' claims in terms of sugar content, and how consumers respond when front-of-package (FOP) nutrition information reveals the high amounts of sugar for that product. The empirical part comprises three different experiments with consumers from the United States (total N = 760). Data were analyzed using ANCOVA to evaluate interaction effects and regression-based mediation analysis to assess the underlying mechanism. Results indicate biased consumer expectations regarding sugar content for products with 'low fat' claims. The presence of FOP nutrition labels reveals such claim-induced expectation gaps with nuanced changes in nutrient evaluation and purchase intention. This research provides important implications for consumer food choice. Marketers would be better off avoiding the use of misleading nutrition claims as a food marketing tool to avoid detrimental effects to their consumers and business performance. For public policy implications, this study demonstrates that reductive FOP nutrition labels are effective in mitigating the harm induced by potentially misleading nutrition claims.
... of marketing tool to gain competitive advantage, as the presence of such claims influence purchase intentions (Hawkes, 2004;Roe et al., 1999). As such, less healthy foods are sometimes portrayed as healthy (Nguyen et al., 2016;Colby et al., 2010). Moreover, even when consumers are reading food labels to differentiate healthy and unhealthy food choices, they do not understand the food label terminology or the Nutrition Information Panel (NIP) on the food labels (Cowbum & Stockley, 2005). ...
This study examines if the demographic characteristics influencing the usage of food labels and the extent to which Singaporeans read, understand and interpret food labels. Results suggest that food label reading prevalence in Singapore is high, with fat calories and sugar being read more often than other types of food label items. Healthier Choice Symbol is the most read label format in Singapore. Females are more likely to read food labels. The study also shows that, while Singaporeans positively perceived their ability to read food labels accurately, there are gaps in their perceived ability and the actual correct understanding and interpretation of food labels. The research concludes with suggestions for bridging the perceptional gaps and improving the existing food label formats.
... Possible mechanisms elucidated include alteration in lipophilic vitamins A and D delivery to sebaceous gland, alterations in lipid oxidation pathways, lack of essential linoleic and α-linolenic acid, ratio of omega-6 to omega-3 fatty acids where proin ammatory omega 6 fatty acids are thought to induce acne vulgaris 22 . Moreover, saturated fats including trans-fats and de cient ω-3 polyunsaturated fatty acids (PUFAs) which change the proportion of monounsaturated fatty acids in sebum triglycerides can cause acne 23 .These ndings are the basis for studies that revealed that non-Western diets correlated with the absence of acne 22 .Low-fat foods were also corelated to acne formation which maybe because of their high sugar content 24 . ...
Background
Acne vulgaris affects millions of adults. Despite extensive research, its etiology pertaining to food remains elusive.
Objective
To assess the correlation between dietary intake and acne through a case-control survey of 300 respondents aged 15–25 years living in Pakistan.
Method
150 acne patients and 150 age- and ethnicity-matched controls were subjected to a questionnaire. Using SPSS-22, cases and controls were separated and univariate analysis was done using chi-square test. p value < 0.05 was considered statistically significant. Adjusted odds ratio was used to assess the strength of association with 95% confidence interval.
Results
Most of the respondents were females (91.3%). Most(48.7%) acne patients were aged 20–25 years .Acne severity was mild in 50%, moderate in 34%, severe in 14% and very severe in 2%.Frequent low-fat foods (p < 0.001)(OR = 3.22),fat intake(p = 0.03)(OR = 1.629),sweet snacks i.e. biscuits and candies etc. (p = 0.013) (OR = 1.9254), soft drinks(p = 0.045)(OR = 1.9091),butter(p < 0.001) (OR = 1.8185),dairy products(p = 0.043)(OR = 0.624),salty foods(p = 0.011)(OR = 1.961),chocolate (p = 0.028)(OR = 1.669), were associated with increased acne risk. No association was found in terms of fried foods, desserts, fruit juices, raw fruit intake, fast foods, vegetables, cheese, soy product, salt intake and corn. Increased butter and chocolate consumption were linked to more severe forms of acne (p = 0.049 and p = 0.005 respectively). Most respondents (n = 218) thought they had healthy eating habits showing that they were not educated on dietary aspect of acne treatment.
Conclusions
Participants without acne had healthier eating habits. Dietary awareness is critical for convincing adolescents to reduce acne. Further studies must be conducted to develop a causative relationship between different dietary components and acne.
... Nguyen et al. [27] 2016 United States of America ...
... Nguyen et al. [27] used the Friedman and post-hoc Wilcoxon signed-rank test to determine if 'healthier' versions of common foods contained more sugar. By comparing fat-free, low-fat, and regular versions of the same food, it was found that the amount of sugar was higher for fat-free and low-fat versions as compared to the regular versions, despite having a lower caloric content. ...
... Associating nutrients with known food characteristics was a common aim among the included studies. These characteristics could be physical such as colour or part of a plant [29,30], conceptual such as the cold-and hot-nature assignment in traditional Chinese medicine [25,37], or they could be existing food labels such as 'fat-free' and 'low-fat' [27]. Establishing the relationship between the composition and characteristic with statistical analysis provides strong evidence to support dietary recommendations and guidelines. ...
Evidence-based knowledge of the relationship between foods and nutrients is needed
to inform dietary-based guidelines and policy. Proper and tailored statistical methods to analyse food composition databases (FCDBs) could assist in this regard. This review aims to collate the existing literature that used any statistical method to analyse FCDBs, to identify key trends and
research gaps. The search strategy yielded 4238 references from electronic databases of which
24 fulfilled our inclusion criteria. Information on the objectives, statistical methods, and results was
extracted. Statistical methods were mostly applied to group similar food items (37.5%). Other aims
and objectives included determining associations between the nutrient content and known food
characteristics (25.0%), determining nutrient co-occurrence (20.8%), evaluating nutrient changes over
time (16.7%), and addressing the accuracy and completeness of databases (16.7%). Standard statistical
tests (33.3%) were the most utilised followed by clustering (29.1%), other methods (16.7%), regression
methods (12.5%), and dimension reduction techniques (8.3%). Nutrient data has unique characteristics
such as correlated components, natural groupings, and a compositional nature. Statistical methods
used for analysis need to account for this data structure. Our summary of the literature provides a
reference for researchers looking to expand into this area.
... Moreover, another study examined the effect of a lowfat vegan diet on insulin resistance and found a reduction in insulin resistance with a diet high in polyunsaturated fatty acids, particularly α-linolenic and linoleic acids (32). Our results may have a confounding effect where participants following the low-fat diet had high-sugar consumption as lowfat products are higher in sugar content than regular food products (33). ...
Background
Diabetes mellitus type 2 (T2DM) is one of the most common diseases worldwide. Unhealthy dietary habits may lead to T2DM, which is also influenced by the extent of education and knowledge of appropriate diets for this disease.
Aim
This study aims to highlight the possible association between following different types of diet (low-fat diet, low-calorie diet, low-salt diet, and more than one diet) and glycemic control among Qatari and long-term resident patients with T2DM.
Methods
This study is secondary data analysis. Qatar Biobank (QBB) data on 2448 T2DM patients aged 18–60 years were obtained. The first group included participants with HbA1C <7%, while the second included those with HbA1c ≥ 7%.
Results
The results of the association of glycemic control with different diets followed by patients with type 2 diabetes were adjusted in four models. In the 4th model (adjusted for gender, age, sociodemographic, anthropometric, dietary habits, comorbidities, and medications), results showed that poor patients with poor glycemic control have higher odds [OR 1.90; CI (1–3.63)] of following a low-salt diet. The same observation was found in the low-fat diet [OR 1.73; CI (1.06-3.07)]. However, patients following more than one diet showed lower odds of having poor glycemic control for about 32% [OR.69; CI (0.48–0.98)].
Conclusion
Diet and lifestyle are vital factors that can affect HbA1C levels. The findings of this secondary analysis showed that better glycemic control of the patients was observed in patients following more than diet from the studied diets.
... There is some evidence that foods adapted to be 'healthy' in one respect are less helpful in others, to make the food more palatable. Thus Nguyen et al (2016) found foods marketed as low fat had more sugar in them, although the overall energy content was lower. Further, there is a risk that foods marketed as low fat will lead to people believing them to be healthy and eating more (Geyskens et al, 2007). ...
Maintaining a healthy weight is a concern for a large proportion of adults in the UK, with obesity rates having almost doubled between 1993 and 2011. With overweight and obesity linked to several diseases and health conditions, nurses are often tasked with raising the subject with their clients/patients and advising on lifestyle modifications. This article examines ways to identify whether a person needs to lose weight and establishing targets. It then reviews the evidence base for different approaches to weight management currently available and the advice nurses can provide.
... low and moderate) objective sugar content were also perceived as having more fat and calories and as being tastier. It is noteworthy that consumers related sugar and fat content, given that previous research has suggested that these nutrients are not associated (e.g., a sample of breakfast cereals, Prada, Saraiva, Viegas, et al., 2021) or its relationship is negative (e.g., low or non-fat products often contain more sugar than their regular versions, Nguyen et al., 2016). At the same time, products with high levels of sugar were also deemed the least healthy. ...
In Portugal, about one-fourth of the adult population exceeds the recommended daily amount of free sugars intake. This excessive consumption may be due to a lack of awareness of the sugar content of commonly available processed products. In two studies, we explored this assumption by asking participants (convenient samples) to evaluate the sugar content of breakfast cereals based on the front-of-packaging images and analyzed the correspondence between subjective and objective sugar content. In Study 1 (n = 90), all the exemplars were high in sugar, whereas in Study 2 (n = 85), exemplars contained low, moderate, or high sugar content.
Study 1 revealed that participants accurately perceived all exemplars as containing high sugar. Study 2 showed that participants were able to distinguish between different levels of sugar content, which impacted how they evaluated the products in other dimensions. Specifically, besides being rated as having more sugar, products with objective high (vs. moderate or low) sugar content were perceived as tastier, as having more fat and calories, but also as less healthful. Notably, participants who perceived the exemplars as containing more sugar also reported using nutritional information more often and consuming these products less frequently.
These findings suggest that awareness of products' sugar content may not be sufficient to address the problem of excessive sugar intake. Intervention should also focus on building up consumers' knowledge about sugar intake guidelines and its negative health outcomes.
... Research dealing with the Front-Of-Package (FOP) labelling illustrates that a macronutrient-related claim such as Low Fat can successfully lead a consumer to perceive that product as a "healthy choice", ignoring the impact of other nutrients (Fernan, Schuldt, & Niederdeppe, 2018). For example, low-fat or fat-reduced products, to maintain palatability, are generally high in sugar and carbohydrate (Nguyen, Lin, & Heidenreich, 2016); therefore, the Health Halo Effect attached with low-fat labelled products can indirectly increase the consumption of sugar and carbohydrates. Similarly, a low-calorie label can lead to increased consumption without considering the quality/type of the calorie, which is the prime factor in defining a product's healthiness. ...
Considering the ever-rising enormous global burden of NCDs and Obesity, the time has come to clear the Public Health message: physical activity may not influence the Obesity risk, nor it can be used as a weapon to counterbalance the consumption of sugar and carbohydrates. This article is not against the Public Health physical activity guidelines and does not discourage people from exercising. This article discusses that although exercising of prudent to prevent and manage several metabolic conditions, it may not effectively induce fat loss. This article highlights how the calorie’s quality plays a vital role than the quantity, and physical activity is not a compensatory tool. It is time to sabotage and reverse the years of Public Health damage caused by the commercial food industry's longstanding strategies to disseminate an unscientific and deceptive notion of "emphasising physical activity over diet."
... These misperceptions are particularly concerning for nutritionally poor products (Miklavec et al., 2015). For example, a systematic comparison of thousands of products has shown that products labeled as "reduced calories", "light", "low fat" present higher sugar content than their "regular" versions (Nguyen et al., 2016). ...
... Food claims have the potential to inform healthier choices and improve the consumers' diet (Cowburn & Stockley, 2005). However, these claims may also mislead consumers (Fernan et al., 2018;Thorndike et al., 2012), increasing the perception that a food is healthier than it really is (Nguyen et al., 2016;Wills et al., 2012). Research examining the impact of claims specifically related to sugar on food perception is still scarce (cf. ...
Food packaging usually includes multiple cues, including claims about nutrients that may modulate how the consumer perceives (and behaves towards) the product. In the current work, we systematically examined how different types of claims about sugar influenced the perception of food product categories (i.e., yogurts, ice creams, cookies, and breakfast cereals). In two experiments (combined n = 406), participants were asked to evaluate the perceived healthfulness, caloric value, and expected taste of products with (vs. without) sugar-related claims. Specifically, the claims were on the sugar content (“0% sugar”, “sugar-free”, “no added sugars”, “low sugar” - Experiment 1) or on the type of sugars or sweeteners of natural origin (“sucrose”, “cane sugar”, “honey” and “stevia” - Experiment 2).
Experiment 1 revealed that all products with sugar-related claims were rated as healthier, less caloric, and less tasty than the regular alternatives. Still, products with the “low sugar” claim were perceived as the least healthy, most caloric, and tastiest. In Experiment 2, we observed that products with “stevia” claim were rated as healthier, less caloric, and less tasty than regular products. In both experiments, the frequency of consumption of products with sugar-related claims was positively associated with the general perception of these products, the influence of nutritional information on consumption decisions, attention to sugar intake, and interest in nutrition.
Overall, our results show that sugar-related claims may influence consumer's perceptions about food products, but the direction of that influence depends on the type of claim and evaluative dimension.
