LAUSR

We read with interest the article by Dunford and colleagues comparing the “healthiness” of packaged foods and beverages across 12 countries using nutrient profiling algorithms developed for Australia's interpretive front of pack nutrition labelling system, the Health Star Rating (HSR). Access to a nutritious, well‐balanced diet is an important determinant of health, and, with the rise in packaged food consumption in recent decades, monitoring the availability and nutritional quality of these products is timely. The objective of Dunford et al's paper was to use the HSR to examine the “healthiness” of national packaged food and beverage supplies. With the recommendations that the study's methodology be incorporated into an annual survey comparing countries' food supplies, it is important to consider the methodology used and whether the conclusions are warranted. The veracity of the HSR as the measure of healthiness is not questioned in the paper nor is it justified. As such, the conclusions of the paper rest on the assumption that the HSR is an accurate measure of the healthiness of different country's food supplies. While the authors posit that the HSR is “well suited to a comparative analysis of packaged foods and beverages available in different countries” we contend that the HSR provides a limited indication of the healthiness of foods for a number of reasons. Firstly, the HSR algorithm does not consider the full range of essential nutrients as it is based on just four so‐called “nutrients of concern” (“the densities of energy, sodium, total sugars and saturated fat), and some “positive nutrients” (“the densities of fruit and vegetable content, protein, fibre, and in some cases calcium”). This narrow view means that the algorithm is unable to take into account nutritional adequacy implications in its use. Second, it is a nutrition science truism that food and health relationships are predicated on more than the sum of the nutrients a food contains. This is because of synergies between nutrients in a food, and the interaction of nutrients with the food matrix. Yet, the HSR does not consider the combination of nutrients within a food matrix and the overall effect of the particular food on health. Using just isolated nutrients to assess a foods' healthiness is problematic. For example, recent analyses indicate a substantial number of foods associated with