title: Modeled Dietary Impact of Pizza Reformulations in US Children and Adolescents.
abstract: OBJECTIVE
  Approximately 20% of US children and adolescents consume pizza on any given day; and pizza intake is associated with higher intakes of energy, sodium, and saturated fat. The reformulation of pizza products has yet to be evaluated as a viable option to improve diets of the US youth. This study modeled the effect on nutrient intakes of two potential pizza reformulation strategies based on the standards established by the Nestlé Nutritional Profiling System (NNPS).
  
  
  METHODS
  Dietary intakes were retrieved from the first 24hr-recall of the National Health and Nutrition Examination Survey (NHANES) 2011-12, for 2655 participants aged 4-19 years. The composition of pizzas in the NHANES food database (n = 69) were compared against the NNPS standards for energy, total fat, saturated fat, sodium, added sugars, and protein. In a reformulation scenario, the nutrient content of pizzas was adjusted to the NNPS standards if these were not met. In a substitution scenario, pizzas that did not meet the standards were replaced by the closest pizza, based on nutrient content, that met all of the NNPS standards.
  
  
  RESULTS
  Pizzas consistent with all the NNPS standards (29% of all pizzas) were significantly lower in energy, saturated fat and sodium than pizzas that were not. Among pizza consumers, modeled intakes in the reformulation and substitution scenarios were lower in energy (-14 and -45kcal, respectively), saturated fat (-1.2 and -2.7g), and sodium (-143 and -153mg) compared to baseline.
  
  
  CONCLUSIONS
  Potential industry wide reformulation of a single food category or intra-category food substitutions may positively impact dietary intakes of US children and adolescents. Further promotion and support of these complimentary strategies may facilitate the adoption and implementation of reformulation standards.
authors.affiliation: Public Health Nutrition, Nestlé Research Center, Lausanne, Switzerland.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Masset
authors.affiliation: Public Health Nutrition, Nestlé Research Center, Lausanne, Switzerland.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Mathias
authors.affiliation: Public Health Nutrition, Nestlé Research Center, Lausanne, Switzerland.
authors.forename: Antonis
authors.initials: A
authors.lastname: Vlassopoulos
authors.affiliation: Public Health Nutrition, Nestlé Research Center, Lausanne, Switzerland.|Department of Human Nutrition, Wageningen University and Research Center, Wageningen, The Netherlands.
authors.forename: Famke
authors.initials: F
authors.lastname: Mölenberg
authors.affiliation: Public Health Nutrition, Nestlé Research Center, Lausanne, Switzerland.
authors.forename: Undine
authors.initials: U
authors.lastname: Lehmann
authors.affiliation: Institute of Food and Health, University College Dublin, Dublin, Ireland.|School of Biomedical Sciences, University of Ulster, Coleraine, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: Gibney
authors.affiliation: Center for Public Health Nutrition, University of Washington, Seattle, Washington, United States of America.
authors.forename: Adam
authors.initials: A
authors.lastname: Drewnowski
mesh_terms: D000293:Adolescent; D002648:Child; D004032:Diet / Q000592:standards*; D002149:Energy Intake; D005227:Fatty Acids / Q000032:analysis*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D009749:Nutrition Surveys; D009753:Nutritive Value; D012982:Sodium, Dietary / Q000032:analysis*
chemical_list: D005227:Fatty Acids; D012982:Sodium, Dietary