Health Claims Notification Panorama Studies on Food Labels - Scope Review Protocol
Creators: name: Fernandes, Ana Carolina
name: Chaddad, Maria Cecília Cury
name: Kraemer, Mariana
name: Da Costa Proenca, Rossana Pacheco
name: Uggioni, Paula Lazzarin
name: Fogolari, Natalia
name: Greyce Luci Bernardo
Publisher: name: OSF Registries
Year: 2024
Subjects: subject: Public Health
subject: Nutrition
subject: Medicine and Health Sciences
subject: Life Sciences
subject: Food Science
subject: Foods with health claims
subject: foods with function claims;
subject: health related claim
subject: nutrient function claim
subject: other function claim

description: The Codex Alimentarius, a joint program of the Food and Agriculture Organization (FAO) and the World Health Organization (WHO), defines food labels as the presence of any tag, brand, mark, pictorial, or other descriptive matter, written, printed, stencilled, marked, embossed or impressed on, or attached to, a container of food (FAO/WHO, 2016; FAO/WHO, 2018). On the other hand, the information present on these labels, referred to as food labeling, encompasses any written, printed or graphic matter that is present on the label, accompanies the food, or is displayed near the food (FAO/ WHO, 2018).
 In food labeling, among the optional items, the presence of health claims is permitted (FAO/WHO, 2009; 2018). Although the General Standard for the Labelling of Prepackaged Foods (FAO/WHO, 2018), the most comprehensive document of the Codex Alimentarius regarding food labeling, does not mention health claims in its text, it is understood that these can be optionally included as long as they do not conflict with mandatory requirements. This option is described within the scope of the Guidelines for the Use of Nutrition and Health Claims, which encompasses the use of health claims as part of food labeling (FAO/WHO, 2009).
Health claims are defined by the Codex Alimentarius as any representation that states, suggests, or implies that a relationship exists between a food or a constituent of that food and health (FAO/WHO, 2009). The Codex Alimentarius categorizes them into three groups: (i) nutrient function claims: describe the physiological role of the nutrient in growth, development and normal functions of the body; (ii) other function claims: refer to specific beneficial effects of consuming foods or their constituents, within the context of the total diet, on the normal functions or biological activities of the body, promoting a positive contribution to health or to the improvement of a function, or to the modification or preservation of health; e (iii) reduction of disease risk claims: relate the consumption of a food or food constituent, in the context of the total diet, to the reduced risk of developing a disease or health-related condition (FAO/WHO, 2009). 
Based on the guidelines proposed by the Codex Alimentarius, each country or economic bloc, such as the European Union (EU), develops its own legislation. In a review study, 26 distinct regulations for health claims worldwide were identified (Boer; Bast, 2015). Although the regulations had different nomenclatures and concepts for classifying claims, the authors noted that it was possible to fit them into the three groups proposed by the Codex Alimentarius for most jurisdictions. However, jurisdictions were identified that did not allow some of the three groups of health claims or did not include them in the legislation. Three of them did not allow the presence of "other function claims," and two did not specify them in the legislation. Eight did not allow the presence of "reduction of disease risk claims," and one did not specify them in the legislation. Additionally, two of the jurisdictions classified nutrient function claims as nutrition claims (Boer; Bast, 2015).
It is important to highlight the importance of discussing the different classifications, concepts, and nomenclatures of health claims, as studies demonstrate their influence on purchasing and/or consumption behavior. In a systematic review study with meta-analysis, it was identified that foods with health claims are more likely to be purchased or consumed compared to identical products without claims (Kaur; Scarborough; Rayner, 2017). A strong influence of health claims was observed on the choices and/or purchasing behavior of protein-rich foods (animal or vegetable) and fruits, vegetables, and greens, with moderate effects for foods high in fat and/or sugar and dairy products (Kaur; Scarborough; Rayner, 2017).
Given the potential increase in consumption and/or purchase of foods with health claims, it is crucial to identify the prevalence of foods available for sale containing such claims on labels, to which food groups these claims are linked, what types of health claims are being used on food labels, and what textual information accompanies them. As proposed by Kasapila and Shaarani (2013), monitoring the use of these claims can aid in improving regulations regarding their application, as findings from studies with this aim can be valuable in formulating evidence-based policies and strategies for nutrition.
Prevalence studies that provide a panorama of the presence of health claims on food labels enable the aforementioned monitoring. These prevalence studies involve the collection and analysis of data from all foods available for sale at the time the research is conducted and allow for a less biased analysis by not targeting specific food groups. As observed, there are differences in the classifications, concepts, and nomenclatures of health claims according to jurisdiction. These differences can influence study results, leading to underestimation or overestimation of the percentage of foods with health claim notifications, as well as difficulties in comparing studies.
Based on the above, a preliminary search was conducted in the Cochrane, Scopus, and JBI Evidence Synthesis databases, and no literature reviews were found that aimed to analyze panorama studies on the prevalence of health claim notifications on food labels. In this context, this scoping review will aim to investigate how health claims notifications are conceptualized, identified, and analyzed in scientific studies on food label panorama.