What is "healthy" food? A cross-sectional evaluation of foods and beverages consumed by United States adults that satisfy the United States Food and Drug Administration's updated "healthy" claim criteria

Abstract

Background: The Food and Drug Administration (FDA) recently updated criteria for the "healthy" claim displayed on foods and beverages in the United States. However, it is unknown how updated criteria compare with existing methods for evaluating the healthfulness of foods and beverages.

Objectives: To evaluate correlation between "healthy" criteria and 3 nutrient profiling models used to evaluate food and beverage healthfulness, and with Nova food processing classification. Exploratory analyses compare the nutritional profile of "healthy" items and items not meeting "healthy" criteria.

Methods: In this cross-sectional analysis, we identified individual "healthy" items reported in the 2017-2018 National Health and Nutrition Examination Survey. We used descriptive statistics to characterize "healthy" items across food categories, nutrient profiling models (Food Compass 2.0, Nutri-Score, and Health Star Rating), and Nova. We used point-biserial correlation to evaluate correlation between FDA criteria and nutrient profiling models, and rank point-biserial correlation to evaluate correlation with Nova. We used t-tests to compare nutrient content of "healthy" items and items not meeting "healthy" criteria across food categories and Nova categories.

Results: Overall, 14.9% of items qualified for the "healthy" claim. Although the majority of fruits (60.9%), vegetables (59.6%), and nuts and seeds (68.8%) qualified, few meat, poultry, and eggs (3.0%), grains (4.8%), or savory snacks and desserts (1.3%) met criteria. Criteria were moderately correlated with Food Compass 2.0 (r = 0.56), Nutri-Score (r = 0.46), Health Star Rating (r = 0.41), and Nova (0.49). "Healthy" items were lower in saturated fat and sodium and higher in fiber and vitamin C across nearly all food categories and Nova categories.

Conclusions: Findings suggest few foods met "healthy" criteria. Moderate correlations between "healthy" criteria, Nova, and validated nutrient profiling models provide evidence of convergent validity, yet underscore the challenge of classifying foods by healthfulness, and highlight uncertainty about whether discrepancies reflect real differences in model performance and food healthfulness.

Keywords: Nova; food labeling regulation; food policy; food quality; nutrient profiling; nutrition labeling.