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Epidemiology

Assessment of the construct validity of the Australian Health Star Rating: a nutrient profiling diagnostic accuracy study

European Journal of Clinical Nutrition volume 71, pages 1353–1359 (2017)Cite this article

Subjects

Abstract

Background/Objectives:

Nutrient profiling models classify the healthiness of foods based on their nutritional composition and provide the science that underlies nutrition signposting schemes. The two objectives were to examine the construct validity of the Health Star Rating (HSR) system by determining its diagnostic accuracy and to detect the optimal HSR cutoff points to define healthiness in packaged dairy foods. We hypothesised that ultra-processed dairy, defined by NOVA, would have less stars (less healthy) and non-ultra-processed dairy would have more stars (more healthy).

Subjects/Methods:

The diagnostic accuracy of the HSR system used for 621 dairy foods for sale in an Australian regional supermarket was investigated. The healthiness of packaged dairy was measured using the NOVA food classification system.

Results:

The dairy beverages model was found to discriminate between healthy and less healthy dairy beverages as classified by NOVA (AUC: 0.653; 95% CI: 0.556–0.750; P=0.005). A receiver operating characteristic curve analysis for dairy beverages demonstrated that the optimal cutoff point corresponded to a rating of four stars. There was no discrimination power when using the HSR for predicting the health value of yoghurt and other dairy, or cheeses.

Conclusions:

At the optimal cutoff point of four stars the HSR has a high sensitivity but a low specificity to correctly classify healthy packaged dairy beverages, as defined by NOVA. We provide evidence to support the construct validity of the HSR model for dairy beverages, but not for the models used for yoghurts and other dairy products, or cheeses.

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Acknowledgements

We thank Dr Judith Maher for her assistance with classifying Australian dairy foods using the NOVA system. We also thank Professor Richard Burns for reviewing the final manuscript.

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Authors and Affiliations

  1. School of Health and Sport Sciences, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Queensland, Australia

    S L Cooper, F E Pelly & J B Lowe

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  1. S L Cooper
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Correspondence to S L Cooper.

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Cooper, S., Pelly, F. & Lowe, J. Assessment of the construct validity of the Australian Health Star Rating: a nutrient profiling diagnostic accuracy study. Eur J Clin Nutr 71, 1353–1359 (2017). https://doi.org/10.1038/ejcn.2017.23

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