(P28-002-25) Evaluating the Dietary and Healthcare Implications of Non-Compliance With Health Canada’s Front-of-Package Nutrition Labelling Policy

Objectives: Front-of-package (FOP) nutrition labeling policies are effective regulatory tools to mitigate excess consumption of nutrients of public health concern, saturated fat, sugar and sodium (SFSS). Health Canada’s FOP policy mandates “High-In” symbols when foods surpass a set threshold. The U.S. FDA recently proposed a similar policy to combat chronic diseases. However, the benefits of these policies remain unclear. This study aims to estimate the impact of non-compliance with Health Canada's FOP policy on diet quality and 5-year all-cause hospital occupancy risk at the national level.

Methods: Data from CCHS-Nutrition 2004 linked with individual-level health administrative databases (2004-2014) were analyzed. Dietary intake from repeated 24-hr recalls were used to measure compliance, defined as the usual proportion of energy consumed from ‘High-In’ labeled foods with (FOP-ECI ) and without (FOP-ECI_SENS) policy-exempt foods. The number of high-in labels (_mCAN-FOP DI) and a reference dietary pattern (DASH) were also used in sensitivity tests. Weighted multivariable zero-inflated negative binomial models estimated relative risk of hospital bed-days across compliance group quintiles.

Results: Of 2839 unique foods reported by Canadian adults ( >20), 33% required ≥ 1 FOP symbol. FOP-ECI showed high, moderate and low agreement with _mCAN-FOP DI (k=0.83), FOP-ECI_SENS (k=0.48), and DASH (k=0.13), respectively. Individuals in the low compliance group (Q5) compared to those compliant (Q5) for FOP-ECI, had lower fruit, vegetable intake, and higher energy consumed from SFSS and fast food. Those in the low compliance group, compared to high, for FOP-ECI had 52% higher risk of hospital bed-days (RR:1.52; 90%CI: 1.50-2.19); sex-stratified analyses and FOP-ECI_SENS models did not reach statistical significance.

Conclusions: Non-compliance with FOP policy was associated with lower diet quality, underscoring its critical role to promote healthier diet patterns at the national level. While hospital occupancy was negatively associated with FOP compliance in Canada, sensitivity analyses indicated the need for future larger studies to confirm results. This evidence provides a new line of inquiry to support implementation of FOP labels in other jurisdictions (e.g. U.S.) to improve population healthcare outcomes.

Funding Sources: Canadian Institute of Health Research