Theoretical Reductions in Discretionary Choices Intake via Moderation, Substitution, and Reformulation Dietary Strategies Show Improvements in Nutritional Profile: A Simulation Study in Australian 2- to 18-Year-Olds.

BACKGROUND: Excessive consumption of discretionary choices (nutrient-poor foods and beverages) negatively impacts on children's diet quality and increases the risk of obesity and related chronic conditions. Dietary guidelines are complex, and simple messages based on effective dietary strategies are needed to improve population compliance with dietary guidelines.

OBJECTIVE: This study aimed to quantify the theoretical nutritional impact of dietary strategies targeting a reduction in discretionary choice intake in Australian children aged 2 to 18 years.

DESIGN: This study was a computer simulation dietary modeling design.

PARTICIPANTS/SETTING: Participants were Australian children aged 2 to 18 years (n=2,812, population weighted N=4,770,094) from the National Nutrition and Physical Activity Survey 2011-2012.

INTERVENTION: Simulations were performed on 24-hour recall dietary intake data to model theoretical impact on nutrient profile of moderating (50% reduction), substituting (replacing 50% of discretionary choices for core foods), and reformulating (reducing target nutrients within products) mean population intake of all discretionary choices.

MAIN OUTCOME MEASURES: The main outcome measures were absolute and percentage change in nutrient profile (energy, saturated fat, added sugars, sodium).

STATISTICAL ANALYSES PERFORMED: Simulations were performed using percent adjustment calculations and "What If" analyses. Sensitivity analyses were performed adjusting parameter uncertainties.

RESULTS: Moderation (energy -4.8% to -19.3%, saturated fat -10.2% to -24.5%, added sugars -24.3% to -43.1%, sodium -6.4% to -20.3%) and substitution (energy -9.4% to -15.4%, saturated fat -7.6% to -22.5%, added sugars -39.2% to -42.7%, sodium -10.8% to -19.0%) scenarios saw the greatest reductions across energy and target nutrients, with substitution scenarios modeling a smaller impact on protein, fiber, and micronutrients compared with the moderation strategy. The reformulation scenarios showed less theoretical reductions in energy intake (-1.1% to -12.8%), despite the differences in saturated fat (-27.5%), added sugars (-25.5%), and sodium (-9.1%), between the primary scenarios compared with base case.

CONCLUSIONS: Dietary strategies to reduce discretionary choices (moderation) or replace them with core (healthy) food group choices (substitution) show good theoretical improvements in energy intake and nutritional profile. Multinutrient reformulation approaches achieve reductions in saturated fat, added sugar, and sodium. To reduce population discretionary choices intake, the dietary strategies can inform policy and food industry and consumer education action.