The nutritional quality of gluten-free vs. non-gluten-free pre-packaged foods and beverages sold in Hong Kong

Introduction: The consumption of gluten-free foods has continued to increase in recent years. Given their higher intake amongst individuals both with or without a medically diagnosed gluten allergy or sensitivity, it is important to understand how the nutritional quality of these foods compares against non-gluten-free foods. As such, we aimed to compare the nutritional quality of gluten-free and non-gluten-free pre-packaged foods sold in Hong Kong.Methods: Data from 18,292 pre-packaged food and beverage items in the 2019 FoodSwitch Hong Kong database were used. These products were categorized as (1) "declared gluten-free"; (2) "gluten-free by ingredient or naturally gluten-free" and (3) "non-gluten-free" according to information presented on the package. One way ANOVA was used to compare the differences in the Australian Health Star Rating (HSR), energy, protein, fibre, total fat, saturated fat, trans-fat, carbohydrates, sugars and sodium content between products in different gluten categories, overall and by major food category (e.g., bread and bakery products) and region of origin (e.g., America, Europe).Results: Products declared gluten-free (mean +/- SD: 2.9 +/- 1.3; n = 7%) had statistically significantly higher HSR than those gluten-free by ingredient or naturally gluten-free (2.7 +/- 1.4; n = 51.9%) and non-gluten-free (2.2 +/- 1.4; n = 41.2%) (all pairwise comparisons p < 0.001). Overall, non-gluten-free products have higher energy, protein, saturated fat, trans-fat, free sugar and sodium, and less fibre compared with products in the other two gluten categories. Similar differences were observed across major food groups and by region of origin.Conclusions: Non-gluten-free products sold in Hong Kong were generally less healthy than gluten-free products (regardless of presence of gluten-free declaration). Consumers should be better educated on how to identify gluten-free foods given many gluten-free foods do not declare this information on the label.