Self-Reported Attention to Positive Versus Negative Nutrients During Breakfast Cereal Selection Is Associated With Healthier Food Choice.

Nutritional guidance sometimes prioritises avoiding certain 'negative' nutrients over seeking out 'positive' nutrients (i.e., nutrients recommended to "limit" or "increase" in dietary guidelines). This study evaluated the association between attention to positive or negative nutrients and the nutritional quality of ready-to-eat breakfast cereal choices. In an online survey, 962 adult US residents chose from 33 cereals displayed with nutritional information (i.e., energy, fat, sugar, sodium (negative), fibre, potassium, iron [positive]). After choosing, participants reported use of nutritional information. A "Guiding Stars" (GS) rating, which categorises foods based on their nutrient contents (not displayed to panellists during food choice), was used to categorise the healthfulness of cereals. Ordinal logistic regression was used to determine the relationship between attention to positive or negative nutrients and the GS rating of cereal choices. Each positive nutrient considered increased the odds of selecting a cereal with a higher GS rating 2.83 (95% confidence interval: 2.13, 3.80) times compared with someone considering no nutrients, which was significantly higher (p = 0.0015) than each additional negative nutrient considered (1.55 [1.33, 1.82]). For people considering only negative nutrients, the odds of selecting a cereal with a higher GS rating was 2.55 (1.89, 3.47) times that of someone considering no nutrients, but was 6.76 (3.72, 12.58) or 8.86 (6.09, 13.03) for people that considered only positive or both positive and negative nutrients. Thus, nutritional recommendations that highlight the importance of considering positive nutrients may be more effective at increasing the nutritional quality of food choices than messages focused on avoidance of negative nutrients.