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1
Baccelloni, Angelo, Andrea Giambarresi, and Marco Francesco Mazzù. "Effects on Consumers’ Subjective Understanding and Liking of Front-of-Pack Nutrition Labels: A Study on Slovenian and Dutch Consumers." Foods 10, no. 12 (December 1, 2021): 2958. http://dx.doi.org/10.3390/foods10122958.
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In the context of the ongoing debate on front-of-pack labels (FOPL), extant research highlights a lack of clear indications on which label is most effective in increasing consumers’ knowledge of food nutritional quality, and in favoring informed food choices. In this study, we have compared the effects of two different labels, one nutrient-specific label (i.e., NutrInform Battery) and one summary label (i.e., Nutri-Score), in terms of consumers’ “subjective understanding” and “liking”. Our work advances prior research on FOPL performance by focusing on two different countries—which have different socio-political contexts and which, from previous studies, present limited evidence on the topic—Slovenia, currently utilizing the Protective Food logo, and the Netherlands, who has recently adopted the Nutri-Score. The study also confirms, in line with previous research, a higher effectiveness of the nutrient-specific label, NutrInform Battery, on all analyzed dimensions in tested countries, when compared to the summary label, Nutri-Score.
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Galtier, Damien, Clémence Daclin, Laurence Perrin, and Ilaria Montagni. "Evaluating the impact of food labeling in a vocational school: an open prospective pilot study." World Nutrition 12, no. 2 (June 30, 2021): 5–20. http://dx.doi.org/10.26596/wn.20211225-20.
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Background: In October 2017, France adopted the Nutri-Score label as the official food label to display on industrial food packaging. School mass catering is recognized as a substantial contributor to individual diet.
Objective: Evaluating the impact of the food label Nutri-score on food choices of students at a school self-service restaurant and at home.
Methods: Longitudinal open prospective pilot study conducted in the self-service restaurant of a vocational school in France in 2019. After a survey among guests (T0), food products labeled with the Nutri-Score were presented to consumers on the menus at the entrance and directly on the food dishes at the counters (T1). The intervention was supplemented by a counseling service on healthy diet conducted by a nutritionist (T2).
Results: We observed a decrease in students’ consumption of sweet products (57%). Similarly, the self-service catering staff observed at the end of T1 a decrease in food leftovers categorized as less healthy. The implementation of the counseling service at T2 was significantly associated with a higher consumption of fruits and vegetables (P < .001), healthier eating habits at home (P < .001), more home cooking (P < .02), and an increased will to check for the presence of the Nutri-Score labels on supermarket food items (P < .001).
Conclusions: After the display of the Nutri-Score label, we observed an improvement in students’ diets. However, results were significant only when the Nutri-Score was associated with a counseling service.
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Fialon, Morgane, Manon Egnell, Zenobia Talati, Pilar Galan, Louise Dréano-Trécant, Mathilde Touvier, Simone Pettigrew, Serge Hercberg, and Chantal Julia. "Effectiveness of Different Front-of-Pack Nutrition Labels among Italian Consumers: Results from an Online Randomized Controlled Trial." Nutrients 12, no. 8 (July 31, 2020): 2307. http://dx.doi.org/10.3390/nu12082307.
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In Italy, discussions are currently ongoing to implement a front-of-pack nutrition label (FoPL) while a growing number of European countries are adopting the Nutri-Score. The effectiveness of the Nutri-Score among Italian consumers requires further investigation. This study compared five FoPLs among Italian participants (Health Star Rating system, multiple traffic lights, Nutri-Score, reference intakes, warning symbol) in terms of food choices and understanding of the labels by consumers. In 2019, 1032 Italian consumers completed an online survey in which they were asked to select one product they would likely purchase from a set of three foods with different nutrient profiles and then classify the products within the set according to their nutritional quality, first with no label and then with one of the five FoPLs on the pack. While no significant difference across labels was observed for food choices, the Nutri-Score demonstrated the highest overall performance in helping consumers to correctly rank the products according to their nutritional quality compared to the reference intakes (OR = 2.18 (1.50–3.17), p-value < 0.0001). Our results provide new insights on the effectiveness of the Nutri-Score, which would be a relevant tool to inform Italian consumers on the nutritional quality of food products.
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Falker, Gerrit-Milena. "Italien geht gegen Nutri-Score vor." Lebensmittel Zeitung 75, no. 5 (2023): 22. http://dx.doi.org/10.51202/0947-7527-2023-5-022-1.
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Im Streit um den Nutri-Score schafft Italien Fakten und verhängt erstmals Bußgelder gegen Unternehmen, die das Label aufbringen. Die Nutri-Score-Staaten drängen die EU-Kommission, das Vorgehen zu untersuchen.
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Finkelstein, Eric A., Felicia Jia Ler Ang, Brett Doble, Wei Han Melvin Wong, and Rob M. van Dam. "A Randomized Controlled Trial Evaluating the Relative Effectiveness of the Multiple Traffic Light and Nutri-Score Front of Package Nutrition Labels." Nutrients 11, no. 9 (September 17, 2019): 2236. http://dx.doi.org/10.3390/nu11092236.
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The objective of this trial was to test two promising front-of-pack nutrition labels, 1) the United Kingdom’s Multiple Traffic Lights (MTL) label and 2) France’s Nutri-Score (NS), relative to a no-label control. We hypothesized that both labels would improve diet quality but NS would be more effective due to its greater simplicity. We tested this hypothesis via an online grocery store using a 3 × 3 crossover (within-person) design with 154 participants. Outcomes assessed via within person regression models include a modified Alternative Healthy Eating Index (AHEI)-2010 (primary), average Nutri-Score, calories purchased, and singular measures of diet quality of purchase orders. Results show that both labels significantly improve modified AHEI scores relative to Control but neither is statistically superior using this measure. NS performed statistically better than MTL and Control based on average Nutri-Score, yet, unlike MTL it did not statistically reduce calories or sugar from beverages. This suggest that NS may be preferred if the goal is to improve overall diet quality but, because calories are clearly displayed on the label, MTL may perform better if the goal is to reduce total energy intake.
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Falker, Gerrit-Milena. "„Ähnlich gestalten wie den Nutri-Score“." Lebensmittel Zeitung 74, no. 5 (2022): 3. http://dx.doi.org/10.51202/0947-7527-2022-5-003-1.
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Die EU plant eine Nachhaltigkeitskennzeichnung für Lebensmittel, Frankreich ebenfalls, und auch in Deutschland preschen erste Unternehmen vor. Achim Spiller erklärt, warum er für ein staatliches Label hierzulande plädiert.
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Egnell, Manon, Isabelle Boutron, Sandrine Péneau, Pauline Ducrot, Mathilde Touvier, Pilar Galan, Léopold Fezeu, et al. "Impact of the Nutri-Score front-of-pack nutrition label on purchasing intentions of individuals with chronic diseases: results of a randomised trial." BMJ Open 12, no. 8 (August 2022): e058139. http://dx.doi.org/10.1136/bmjopen-2021-058139.
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ObjectiveTo our knowledge, the effect of front-of-pack nutrition labels such as the Nutri-Score on food purchases has never been assessed among individuals suffering from nutrition-related chronic diseases specifically, while dietary modifications are generally part of their care. This study aimed to investigate the effect of the Nutri-Score on the nutritional quality of purchasing intentions among adults suffering from a cardiometabolic disease, compared with no label and the Reference Intakes (RIs), a label already implemented by some food manufacturers in France.SettingSecondary prevention—mainland France.Participants2431 eligible participants were randomly assigned and 1180 participants (65.5% women, mean age 65.0±7.1 years) completed the shopping task and were included in the analyses.InterventionA three-arm randomised controlled trial using an experimental online supermarket was conducted in 2017. Participants with cardiometabolic diseases were invited to simulate food purchases with the Nutri-Score, the RIs or no label.Primary and secondary outcome measuresThe primary outcome was the nutritional quality of the shopping cart, estimated using the French-modified Food Standard Agency Nutrient Profiling System (FSAm-NPS), and secondary outcomes included the nutrient content of purchases.ResultsThe mean (SD) FSAm-NPS score was significantly lower in the Nutri-Score arm (1.29 (3.61) points), reflecting a higher overall nutritional quality of purchasing intentions, compared with the RIs (1.86 (3.23) points) and no label (1.92 (2.90) points) arms (p=0.01). Moreover, the Nutri-Score led to significantly lower content in calories and saturated fatty acids compared with the two other arms. These differences resulted from participants avoiding some packaged products (sweets, dairy and starches) and purchasing larger amounts of fresh fruit and meat.ConclusionsThe Nutri-Score exhibited a significant higher nutritional quality of purchasing intentions, encouraging healthier food choices among individuals suffering from cardiometabolic chronic diseases.Trial registration numberNCT02769455.
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Egnell, Manon, Isabelle Boutron, Sandrine Péneau, Pauline Ducrot, Mathilde Touvier, Pilar Galan, Camille Buscail, et al. "Randomised controlled trial in an experimental online supermarket testing the effects of front-of-pack nutrition labelling on food purchasing intentions in a low-income population." BMJ Open 11, no. 2 (February 2021): e041196. http://dx.doi.org/10.1136/bmjopen-2020-041196.
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BackgroundThe Nutri-Score, a front-of-pack nutrition label, has been adopted in 2017 in France but its impact on low-income populations is unknown, and they are more at risk of having unhealthy diets. The present study assessed the effects of the Nutri-Score on the nutritional quality of purchasing intentions among low-income individuals, compared with the current French labelling situation: references intakes (RIs) and no label, using a three-arm parallel-group randomised controlled trial.MethodsLow-income active adults from the NutriNet-Santé cohort (household income below €1200/month) were asked to perform a shopping task in an experimental online supermarket after being randomised in one of the three conditions (Nutri-Score, RIs or no labelling). The main outcome was the overall nutritional quality of the virtual shopping cart, assessed with the French-modified Food Standards Agency Nutrient Profiling System (FSAm-NPS), and secondary outcomes were the nutrient content of the shopping carts. 524 subjects were randomised, and 336 included in the analyses.ResultsThe Nutri-Score resulted in the highest overall nutritional quality of the shopping cart, as reflected by a FSAm-NPS score (1.86 (SD 3.59) points) significantly lower (reflecting higher nutritional quality) than the RIs (3.21 (SD 4.14) points, p≤0.05) but not significantly lower than no label (2.60 (SD 3.09) points, p=0.3). The Nutri-Score also resulted into significantly lower contents in calories and saturated fatty acids in the shopping cart, compared with the RIs only (p≤0.05).ConclusionThe implementation of the front of pack nutrition label Nutri-Score, adopted in France and in different European countries, appears to have the potential to encourage purchasing intentions of foods from higher nutritional quality among low-income individuals, compared with the RIs label promoted by food manufacturers.Trial registration number:NCT02769455
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Dubois, Pierre, Paulo Albuquerque, Olivier Allais, Céline Bonnet, Patrice Bertail, Pierre Combris, Saadi Lahlou, Natalie Rigal, Bernard Ruffieux, and Pierre Chandon. "Effects of front-of-pack labels on the nutritional quality of supermarket food purchases: evidence from a large-scale randomized controlled trial." Journal of the Academy of Marketing Science 49, no. 1 (April 24, 2020): 119–38. http://dx.doi.org/10.1007/s11747-020-00723-5.
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AbstractTo examine whether four pre-selected front-of-pack nutrition labels improve food purchases in real-life grocery shopping settings, we put 1.9 million labels on 1266 food products in four categories in 60 supermarkets and analyzed the nutritional quality of 1,668,301 purchases using the FSA nutrient profiling score. Effect sizes were 17 times smaller on average than those found in comparable laboratory studies. The most effective nutrition label, Nutri-Score, increased the purchases of foods in the top third of their category nutrition-wise by 14%, but had no impact on the purchases of foods with medium, low, or unlabeled nutrition quality. Therefore, Nutri-Score only improved the nutritional quality of the basket of labeled foods purchased by 2.5% (−0.142 FSA points). Nutri-Score’s performance improved with the variance (but not the mean) of the nutritional quality of the category. In-store surveys suggest that Nutri-Score’s ability to attract attention and help shoppers rank products by nutritional quality may explain its performance.
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Ducrot, Pauline, Chantal Julia, and Anne-Juliette Serry. "Nutri-Score: Awareness, Perception and Self-Reported Impact on Food Choices among French Adolescents." Nutrients 14, no. 15 (July 29, 2022): 3119. http://dx.doi.org/10.3390/nu14153119.
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To date, no studies have evaluated the appropriation of the front-of-pack Nutri-Score labeling among adolescents, although they are both consumers and buyers of food products. Therefore, the objectives of the present study were (1) to assess Nutri-Score awareness, perception and self-reported impact on food choices in French adolescents and (2) to identify the determinants associated with higher Nutri-Score awareness and self-reported impact on food choices. A web-based survey was conducted in November 2021 among 1201 adolescents. Multivariate logistic models were used to evaluate the relationships between individual factors and Nutri-Score awareness and self-reported impact on food choices. Almost all the adolescents reported to know the Nutri-Score (97.0%) and more than 9 out of 10 considered this logo easy to understand and easy to identify on food packages. Finally, 54% self-reported that the label had already impacted their food choices. Girls (2.28 (1.09–4.77), p = 0.028) and the 15–17-year-olds (3.12 (1.32–7.35), p = 0.0094) were more likely to be aware of the label compared with their respective counterparts (i.e., boys and the 11–14-year-olds). Regarding the impact of food choices, the use of the Nutri-Score by the parents was the most determinant criterion (7.74 (5.74–10.42), p < 0.0001). Thus, promotion campaigns should target both adolescents and parents.
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Sarda, Barthélemy, Chantal Julia, Anne-Juliette Serry, and Pauline Ducrot. "Appropriation of the Front-of-Pack Nutrition Label Nutri-Score across the French Population: Evolution of Awareness, Support, and Purchasing Behaviors between 2018 and 2019." Nutrients 12, no. 9 (September 22, 2020): 2887. http://dx.doi.org/10.3390/nu12092887.
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Since the implementation of the Nutri-Score on a voluntary basis in 2017 in France, very few studies have evaluated how the label was recognized and used by consumers. The goal of this study was to assess the evolution of awareness, support, and perceived impact on purchasing behaviors of the Nutri-Score in France. Between April 2018 and May 2019, a total of 4006 participants were recruited across three successive waves and answered questions regarding awareness of the Nutri-Score, support of the measure, and change of behavior following the implementation of the Nutri-Score via an online survey. Descriptive analyses to assess the evolution over time were performed, as well as logistic regression models to evaluate associations between the different outcomes and individual characteristics. From April 2018 to May 2019, the awareness of the Nutri-Score increased considerably, reaching 81.5% in May 2019. Since April 2018, a steady proportion of participants—9 out of 10—showed strong support toward the measure and a similar proportion, 87.2%, declared being in favor of making the Nutri-Score mandatory. The impact on purchasing behaviors appeared promising given the limited implementation of the label, with 42.9% of the participants reporting they modified their purchasing behaviors thanks to the measure. Multivariate analyses showed that the impact on purchasing behaviors of the Nutri-Score was greater over time, on younger populations and on frequent labeling readers. Our results suggested that the labeling system was well received and used by all socioeconomic groups, including subgroups who are more likely to have a lower-quality diet.
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Mora-Plazas, Mercedes, Isabella Carolyn Aida Higgins, Luis Fernando Gomez, Marissa Hall, Maria Fernanda Parra, Maxime Bercholz, Nandita Murukutla, and Lindsey Smith Taillie. "Impact of nutrient warning labels on choice of ultra-processed food and drinks high in sugar, sodium, and saturated fat in Colombia: A randomized controlled trial." PLOS ONE 17, no. 2 (February 10, 2022): e0263324. http://dx.doi.org/10.1371/journal.pone.0263324.
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Objective This study assessed nutrient warnings’ impact on product selection and identification of food products high in nutrients of concern in Colombia. Methods In an online experiment (October 2020), 8,061 Colombians were randomized to a nutrient warning, guideline daily amounts (GDA), Nutri-Score, or no-label condition. They viewed two fruit drinks labeled according to their condition, one high in sugar and one not, and completed selection tasks. Next, they assessed four products high in sugar, sodium, and/or saturated fat (“high in” product). Finally, they selected which label would most discourage them from consuming a “high in” product. Results The nutrient warning performed better on most outcomes. Twenty percent of participants exposed to the nutrient warning would purchase the high-sugar fruit drink compared to GDA (24%, p<0.01), Nutri-Score (33%, p<0.001), and no label (29%, p<0.001). GDA performed slightly better than the nutrient warning in identifying the high-sugar fruit drink (91% vs 88%, p<0.001). The nutrient warning best helped participants correctly identify other “high in” products (75% vs. 23% no-label, 26% Nutri-Score, and 43% GDA, all p<0.001) and had the highest perceived message effectiveness (3.86 on 5-point scale vs. 2.97 GDA and 2.70 Nutri-Score, both p<0.001) and lowest likelihood of purchasing “high in” products (2.58 on 5-point scale vs. 3.23 GDA, 3.49 Nutri-Score, and 3.51 no label, all p<0.001). The nutrient warning most discouraged participants from wanting to consume “high in” products. Conclusions Nutrient warnings are a promising policy to help consumers identify and discourage consumption of products high in nutrients of concern. Trial registration Trial Registration: NCT04567004.
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Fialon, Morgane, Jordi Salas-Salvadó, Nancy Babio, Mathilde Touvier, Serge Hercberg, and Pilar Galan. "Is FOP Nutrition Label Nutri-Score Well Understood by Consumers When Comparing the Nutritional Quality of Added Fats, and Does It Negatively Impact the Image of Olive Oil?" Foods 10, no. 9 (September 17, 2021): 2209. http://dx.doi.org/10.3390/foods10092209.
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It has been suggested that the current ranking of olive oil by Nutri-Score (C) is not in line with its nutritional quality and could have a negative impact on the sales and consumption of olive oil, especially compared to other added fats with lower nutritional qualities One of the objectives of this study is to investigate consumers’ understanding of Nutri-Score when comparing the nutritional quality of added fats, and to test whether or not Nutri-Score has a negative impact on the image and the choice of olive oil in a sample of Spanish consumers. A cross-sectional study of 486 Spanish adults (mean age ± SD: 45.8 ± 14.0 years; 48.6% women) was conducted. Subjects were recruited through a web panel provider to participate in an online questionnaire. Almost 80% of participants declared that Nutri-Score was useful for recognizing the differences in nutritional quality between the eight added fats presented in the study; 89.1% rightly identified that olive oil was among the added fats with the best nutritional quality (vs. 4.1% for rapeseed oil (Nutri-Score C), and less than 3% for other added fats (Nutri-Score D or E)). When asked about which added fat they would buy more frequently, 86.2% of participants selected olive oil. Then, after being reminded that among added fats, the Nutri-Score C given to olive oil was the best grade, a majority of participants declared that they would keep consuming olive oil as much as before (71.4%). Finally, almost 78% of participants thought that Nutri-Score should be displayed on olive oil. In conclusion, the results of our study suggest that displaying Nutri-Score on olive oil was well accepted and understood by a large majority of participants who appeared to accept the current ranking of the Nutri-Score for olive oil (Nutri-Score C).
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Kontopoulou, Lamprini, George Karpetas, Εvangelos C. Fradelos, Ioanna V. Papathanasiou, Foteini Malli, Dimitrios Papagiannis, Dimitrios Mantzaris, Morgane Fialon, Chantal Julia, and Konstantinos I. Gourgoulianis. "Online Consumer Survey Comparing Different Front-of-Pack Labels in Greece." Nutrients 14, no. 1 (December 23, 2021): 46. http://dx.doi.org/10.3390/nu14010046.
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According to the WHO, front-of-pack nutrition labeling provides simplified nutrition information in the form of symbols, colors or words that can help consumers understand the nutritional quality of food, thus leading them to healthier food choices. It is considered of the utmost importance to explore the knowledge and understanding of consumers about this form of nutrition labeling. The aim of this study was to investigate the understanding and perceptions of Greek consumers in response to five different front-of-pack nutrition labels (FoPLs): the Multiple Traffic Lights, Health Star Rating System, Guideline Daily Amounts, Warning Symbols and Nutri-Score. From April 2021 to June 2021, 1278 participants from Greece took part in an online survey where they were asked to rank three products according to their nutritional quality. The classification process was performed first without FoPLs and then with FoPLs. The ability to classify products according to their nutritional quality was evaluated with multinomial logistic regression models, and the Nutri-Score label presented greater improvements when compared to the GDA label for Greek consumers. The Nutri-Score seemed to better help the Greek consumers rank foods according to their nutritional value.
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Talati, Zenobia, Manon Egnell, Serge Hercberg, Chantal Julia, and Simone Pettigrew. "Consumers’ Perceptions of Five Front-of-Package Nutrition Labels: An Experimental Study Across 12 Countries." Nutrients 11, no. 8 (August 16, 2019): 1934. http://dx.doi.org/10.3390/nu11081934.
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Consumers’ perceptions of five front-of-pack nutrition label formats (health star rating (HSR), multiple traffic lights (MTL), Nutri-Score, reference intakes (RI) and warning label) were assessed across 12 countries (Argentina, Australia, Bulgaria, Canada, Denmark, France, Germany, Mexico, Singapore, Spain, the UK and the USA). Perceptions assessed included liking, trust, comprehensibility, salience and desire for the label to be mandatory. A sample of 12,015 respondents completed an online survey in which they rated one of the five (randomly allocated) front-of-pack labels (FoPLs) along the perception dimensions described above. Respondents viewing the MTL provided the most favourable ratings. Perceptions of the other FoPLs were mixed or neutral. No meaningful or consistent patterns were observed in the interactions between country and FoPL type, indicating that culture was not a strong predictor of general perceptions. The overall ranking of the FoPLs differed somewhat from previous research assessing their objective performance in terms of enhancing understanding of product healthiness, in which the Nutri-Score was the clear front-runner. Respondents showed a strong preference for mandatory labelling, regardless of label condition, which is consistent with past research showing that the application of labels across all products leads to healthier choices.
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Dréano-Trécant, Louise, Manon Egnell, Serge Hercberg, Pilar Galan, Juliette Soudon, Morgane Fialon, Mathilde Touvier, Emmanuelle Kesse-Guyot, and Chantal Julia. "Performance of the Front-of-Pack Nutrition Label Nutri-Score to Discriminate the Nutritional Quality of Foods Products: A Comparative Study across 8 European Countries." Nutrients 12, no. 5 (May 2, 2020): 1303. http://dx.doi.org/10.3390/nu12051303.
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In Europe, discussions are currently ongoing to harmonize front-of-pack nutritional labelling, while some countries have adopted or are considering implementing the Nutri-Score. However, its adaptability to multiple nutritional contexts in Europe requires further investigation. This study aimed to evaluate the applicability of the Nutri-Score in various European countries, regarding its ability to discriminate the nutritional quality of foods and its consistency with national dietary recommendations. The European Food Information Resource (EUROFIR) nutritional composition databases from eight European countries (Finland, France, Norway, Poland, Portugal, Slovakia, Sweden, and Switzerland) were used. The distribution of foods across the Nutri-Score classes within food groups was assessed, as well as the discriminating performance of the label, and the adequacy of nutritional recommendations. The Nutri-Score demonstrated high discriminating ability for all food groups, with similar trends in the eight countries, and consistency with nutritional recommendations. For instance, fruit and vegetable products were mainly classified in the two healthiest Nutri-Score categories, while sugar and animal fat products were mainly classified in the two less healthy categories of the Nutri-Score. Our results support the fact that the Nutri-Score would be a relevant tool to discriminate the nutritional quality of products within and across relevant food groups in different European countries, with consistency with nutritional recommendations.
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Egnell, Manon, Emmanuelle Kesse-Guyot, Pilar Galan, Mathilde Touvier, Mike Rayner, Jo Jewell, João Breda, Serge Hercberg, and Chantal Julia. "Impact of Front-of-Pack Nutrition Labels on Portion Size Selection: An Experimental Study in a French Cohort." Nutrients 10, no. 9 (September 8, 2018): 1268. http://dx.doi.org/10.3390/nu10091268.
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In the European Union (EU) three coloured graded Front-of-Pack labels (FoPLs), two endorsed by governments (Nutri-Score and Multiple Traffic Lights (MTL)) and one designed by industry (Evolved Nutrition Label (ENL)) are currently being discussed. This study aimed to investigate the impact of these FoPLs on portion size selection, specifically for less healthy products. In 2018, participants from the French NutriNet-Santé cohort study (N = 25,772) were exposed through a web-based self-administered questionnaire to products from three food categories (sweet biscuits, cheeses, and sweet spreads), with or without FoPLs, and were invited to select the portion they would consume (in size and number). Kruskall-Wallis tests, and mixed ordinal logistic regression models, were used to investigate the effects of FoPLs on portion size selection. Compared to no label, Nutri-Score consistently lowered portion sizes (OR = 0.76 (0.74–0.76)), followed by MTL (OR = 0.83 (0.82–0.84)). For ENL, the effects differed depending on the food group: It lowered portion size selection for cheeses (OR = 0.84 (0.83–0.87)), and increased it for spreads (OR = 1.19 (1.15–1.22)). Nutri-Score followed by MTL appear efficient tools to encourage consumers to decrease their portion size for less healthy products, while ENL appears to have inconsistent effects depending on the food category.
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Fialon, Morgane, Mauro Serafini, Pilar Galan, Emmanuelle Kesse-Guyot, Mathilde Touvier, Mélanie Deschasaux-Tanguy, Barthélémy Sarda, Serge Hercberg, Lydiane Nabec, and Chantal Julia. "Nutri-Score and NutrInform Battery: Effects on Performance and Preference in Italian Consumers." Nutrients 14, no. 17 (August 26, 2022): 3511. http://dx.doi.org/10.3390/nu14173511.
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In May 2020, the European Commission announced a proposal for a mandatory front-of-pack label (FoPL) for all European Union (EU) countries. Indeed, FoPLs have been recognized by several public institutions as a cost-effective measure to guide consumers toward nutritionally favorable food products. The aim of this study was to compare the performance and consumer preference of two FoPLs currently proposed or implemented in EU countries, the interpretive format Nutri-Score and the non-interpretive format NutrInform Battery, among Italian consumers. The experimental study was conducted in 2021 on a representative sample of 1064 Italian adults (mean age = 46.5 ± 14.1 years; 48% men). Participants were randomized to either Nutri-Score or NutrInform and had to fill out an online questionnaire testing their objective understanding of the FoPL on three food categories (breakfast products, breakfast cereals and added fats) as well as purchase intention, subjective understanding and perception. Multivariable logistic regressions and t-tests were used to analyze the answers. In terms of the capacity of participants to identify the most nutritionally favorable products, Nutri-Score outperformed NutrInform in all food categories, with the highest odds ratio being observed for added fats (OR = 21.7 [15.3–31.1], p < 0.0001). Overall, with Nutri-Score, Italian participants were more likely to intend to purchase nutritionally favorable products than with NutrInform (OR = 5.29 [4.02–6.97], p < 0.0001). Focusing on olive oil, participants of the Nutri-Score group had higher purchase intention of olive oil compared to those in the NutrInform group (OR = 1.92 [1.42–2.60], p < 0.0001) after manipulating the label. The interpretive format Nutri-Score appears to be a more efficient tool than NutrInform for orienting Italian consumers towards more nutritionally favorable food choices.
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Egnell, Talati, Gombaud, Galan, Hercberg, Pettigrew, and Julia. "Consumers’ Responses to Front-of-Pack Nutrition Labelling: Results from a Sample from The Netherlands." Nutrients 11, no. 8 (August 6, 2019): 1817. http://dx.doi.org/10.3390/nu11081817.
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Front-of-pack labels (FoPLs) are efficient tools for helping consumers identify healthier food products. Although discussions on nutritional labelling are currently ongoing in Europe, few studies have compared the effectiveness of FoPLs in European countries, including the Netherlands. This study aimed to compare five FoPLs among Dutch participants (the Health Star Rating (HSR) system, Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), and Warning symbols) in terms of perception and understanding of the labels and food choices. In 2019, 1032 Dutch consumers were recruited and asked to select one product from among a set of three foods with different nutritional profiles, and then rank the products within the sets according to their nutritional quality. These tasks were performed with no label and then with one of the five FoPLs on the package, depending on the randomization arm. Finally, participants were questioned on their perceptions regarding the label to which they were exposed. Regarding perceptions, all FoPLs were favorably perceived but with only marginal differences between FoPLs. While no significant difference across labels was observed for food choices, the Nutri-Score demonstrated the highest overall performance in helping consumers rank the products according to their nutritional quality.
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Peters, Stephan, and Hans Verhagen. "An Evaluation of the Nutri-Score System along the Reasoning for Scientific Substantiation of Health Claims in the EU—A Narrative Review." Foods 11, no. 16 (August 12, 2022): 2426. http://dx.doi.org/10.3390/foods11162426.
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In this narrative review, the scientific evidence in support of the front-of-pack label (FOPL) Nutri-Score system is evaluated along with the reasoning for scientific substantiation of health claims in the EU. A health claim could be phrased as ‘Nutri-Score as an FOPL system results in an increased purchase of healthier foods by consumers’. Peer-reviewed scientific literature as found in Pubmed under search terms ”NutriScore” and “Nutri-Score” that investigate the effects of the Nutri-Score on food purchases were evaluated. In total, eight papers were identified. Only three studies were conducted in real-life settings, and five were on online purchases. In the EU, health claims are evaluated by the European Food Safety Authority (EFSA). Considering the three basic questions that EFSA uses to evaluate scientific substantiation of health claims, it appears that the (i) food/constituent (the Nutri-Score system) is sufficiently defined/characterised, and (ii) the evidence is sufficient to appraise the system as ‘beneficial to human health’. However, the scientific evidence for a (iii) cause-and-effect relationship is contradictory and limited. In conclusion, based on the EFSA approach for substantiation of health claims, there is insufficient evidence to support a health claim based on the Nutri-Score system, since a cause-and-effect relationship could not be established.
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Julia, Chantal, Nathalie Arnault, Cédric Agaësse, Morgane Fialon, Mélanie Deschasaux-Tanguy, Valentina A. Andreeva, Léopold K. Fezeu, et al. "Impact of the Front-of-Pack Label Nutri-Score on the Nutritional Quality of Food Choices in a Quasi-Experimental Trial in Catering." Nutrients 13, no. 12 (December 17, 2021): 4530. http://dx.doi.org/10.3390/nu13124530.
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The front-of-pack labelling Nutri-Score has recently been implemented as a policy measure to improve the healthiness of food choices. The aim of this study was to investigate the impact of the Nutri-Score label in catering. A quasi-experimental trial was conducted in France between 16 December 2019 and 13 March 2020 in two staff restaurants (one intervention and one control site) from the same company. After a control period of seven weeks, the Nutri-Score label was affixed on all proposed products in the intervention site. Overall effects of the intervention were investigated using a difference in difference approach with generalised linear models. Over the 13 weeks of the study, 2063 participants who frequented the restaurant cafeteria at least once were included (1268 and 795 in the intervention and control site, respectively), representing 36,114 meals. Overall, the intervention led to a significant improvement in the nutritional quality of meals (p = 0.008) and a significant reduction in the intake of calories, sugars and saturated fat (p < 0.0001). Mixed effects models showed a qualitative improvement of food choices initially, and an adaptation of the quantities consumed over time, suggesting for the first time longer-term effects of the label on dietary behaviour.
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Stiletto, Alice, and Samuele Trestini. "Is it really a piece of cake to label Geographical Indications with the Nutri-Score? Consumers’ behaviour and policy implications." PLOS ONE 17, no. 11 (November 17, 2022): e0277048. http://dx.doi.org/10.1371/journal.pone.0277048.
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To improve the dietary habits of the population, the EU, within the Farm to Fork strategy (F2F), is strongly supporting the Nutri-Score (NS) Front Of Pack (FOP) label. Under the NS system, Geographical Indications (GIs) are generally scored as “unhealthy” food, given the predominance of products of animal origin among GIs which are, notoriously, high-fat products. This study aims to determine the impact of the NS label on consumers’ preferences for two Protected Designation of Origin (PDO) cheeses, in comparison with generic ones. A Discrete Choice Experiment (DCE) was conducted on 600 Italian consumers through the estimation of a Random Parameter Logit model. Results highlighted that Italian consumers are generally not familiar with the NS and perceive it as a positive characteristic of the product, even if it is signalling an unhealthy choice (D score). However, consumers aware of the Nutri-Score meaning are willing to pay less to buy a product considered “unhealthy” according to this system. Furthermore, we found that consumers who already knew the NS system have homogeneous behaviours in rejecting the product, independently of the association with a PDO certification. This result has important implications on the agri-food sector. If the Nutri-Score becomes mandatory in the EU, consumers might refuse many GIs due to their negative Nutri-Score values. However, the quality of these products is recognized and protected worldwide. In this vein, the GI policy could be questioned by the F2F strategy: both of them aims to reduce information asymmetry producing, at the same time, contrasting results. Within the Geographical Indication policy, the PDO and PGI goods are protected for their quality attributes, which are strictly linked to their geographical origin of the products and traditional know-how. However, the EU adoption of the Nutri-Score could damage these products, reducing their perceived quality/value.
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Hoge, Axelle, Mathilde Labeye, Anne-Françoise Donneau, Halehsadat Zahraei Nekoee, Eddy Husson, and Michèle Guillaume. "Health Literacy and Its Associations with Understanding and Perception of Front-of-Package Nutrition Labels among Higher Education Students." International Journal of Environmental Research and Public Health 19, no. 14 (July 19, 2022): 8751. http://dx.doi.org/10.3390/ijerph19148751.
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(1) Background: Nutrition labels on the front of food packages have increasingly become the focus of research. However, too few studies have placed special emphasis on nutritionally at-risk subpopulations, such as young adults or those with low literacy/numeracy skills. The present study aimed to assess both the perception and objective understanding of three front-of-package labeling (FOPL) formats currently in use on the Belgian market, i.e., the Nutri-Score, Reference Intakes, and Multiple Traffic Lights, among students of varying health literacy (HL) levels. (2) Methods: A web-based survey was carried out among 2295 students of tertiary education in the province of Liège, Belgium. The questionnaire included questions related to general characteristics, objective understanding, and perception in response to the assigned FOPL format and level of HL. (3) Results: With respect to objective understanding, the Nutri-Score outperformed all other labels across all HL levels, and it was similarly understood in students of varying HL levels. Several students’ characteristics appeared to be associated with each cluster of perception, with the Nutri-Score cluster having the highest percentages of disadvantaged students, i.e., those with inadequate HL, from non-university institutions, with low self-estimated nutrition knowledge, and with low self-estimated diet quality. (4) Conclusion: Overall, the findings supported the Nutri-Score as particularly effective in guiding students in their food choices. Of particular importance is the fact that the summarized and graded color-coded nutritional label would be a useful strategy for those disadvantaged by limited HL.
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De las Heras-Delgado, Sara, Adoración de las Nieves Alías-Guerrero, Esther Cendra-Duarte, Jordi Salas-Salvadó, Elisenda Vilchez, Esther Roger, Pablo Hernández-Alonso, and Nancy Babio. "Assessment of price and nutritional quality of gluten-free products versus their analogues with gluten through the algorithm of the nutri-score front-of-package labeling system." Food & Function 12, no. 10 (2021): 4424–33. http://dx.doi.org/10.1039/d0fo02630a.
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Shin, Soye, Rob M. van Dam, and Eric A. Finkelstein. "The Effect of Dynamic Food Labels with Real-Time Feedback on Diet Quality: Results from a Randomized Controlled Trial." Nutrients 12, no. 7 (July 20, 2020): 2158. http://dx.doi.org/10.3390/nu12072158.
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The rising prevalence of non-communicable diseases has brought attention to the importance of consuming a healthy diet. One strategy to improve diet quality is through front-of-pack (FOP) nutrition labels. Taking advantage of an online grocery store, we allowed consumers to choose the FOP labels they preferred, and combined this information with real-time feedback on the overall nutritional quality of the shopping basket. We hypothesized that these dynamic food labels with real-time feedback (DFLF) would improve nutritional quality of food purchases. This trial followed a two-arm (no-label control and DFLF) crossover design with 125 participants exposed to each condition once in random order via an online grocery store. A first difference regression model allowed for estimating the unbiased effect of the DFLF on diet quality, measured by the weighted average Nutri-Score (ranging 1 to 5) per serving (primary) and changes in select nutrients and calories. The mean weighted Nutri-Score was 0.4 (12.6%) higher in the DFLF arm (CI: [0.2, 0.6]) relative to the control. The DFLF also decreased the amount of sugar per serving by 0.9 g (CI: [−1.7, −0.0]) and total sugar per shop by 169.5 g (CI: [−284.5, −54.5]). The DFLF features significantly improved nutrition quality relative to no labelling, as measured by average Nutri-Score values. These results shed light on the considerable potential of the online shopping environment to improve diet quality through customization and real time feedback.
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Valenzuela, Aranza, Leandro Zambrano, Rocío Velásquez, Catalina Groff, Tania Apablaza, Cecilia Riffo, Sandra Moldenhauer, Pamela Brisso, and Marcell Leonario-Rodriguez. "Discrepancy between Food Classification Systems: Evaluation of Nutri-Score, NOVA Classification and Chilean Front-of-Package Food Warning Labels." International Journal of Environmental Research and Public Health 19, no. 22 (November 8, 2022): 14631. http://dx.doi.org/10.3390/ijerph192214631.
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Background: Currently, there are different food classification systems in order to inform the population of the best alternatives for consumption, considering all the diseases associated with the consumption of products of low nutritional quality. Reports indicate that these forms of labelling warnings correspond to a laudable strategy for populations that do not have the knowledge to discriminate between the wide range of products offered by the food industry. However, recent publications indicate that there may be inconsistencies between the different classification guidelines, and the guidelines that nations should adopt in their food guides are still a matter of debate. In view of this, the present study aimed to evaluate the quantitative and qualitative differences that exist between the NOVA, Nutri-Score and Chilean Front-of-package (FoP) food warning label according to the Chilean basic food basket list. Method: An analytical study was carried out to classify a list of 736 foods according to three different systems, evaluating the distributions according to their methods of classifying the products. Quantitative differences were contrasted for each system, as well as between them, together with an analysis of the dimensions of each system. Results: According to the Nutri-Score classification, the most frequent category was A with 27% (high nutritional quality), followed by D with 22% (low nutritional quality) of the total. On the other hand, the NOVA classification showed that the most frequent categorization was ultra-processed food (NOVA 4) with 54%, followed by unprocessed (NOVA 1) with 19%. Regarding the FoP warning labels, 57% of the foods were categorized as free warning labels, followed by the category of foods with 3 warning labels (23%). Regarding the results of the principal component analysis, the Nutri-Score and FoP warning labels present a degree of similarity in their classification guidelines, being different than the dimension pointed out by NOVA. Conclusion: The present work managed to demonstrate that there are quantitative and qualitative differences between the classification and recommendation guidelines of the Nutri-Score, NOVA and FoP warning labels, finding concrete discrepancies between them.
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Mora-García, Claudio, Luisa Tobar, and Jeremy Young. "The Effect of Randomly Providing Nutri-Score Information on Actual Purchases in Colombia." Nutrients 11, no. 3 (February 26, 2019): 491. http://dx.doi.org/10.3390/nu11030491.
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Recently, front-of-package (FOP) food labeling systems have captured the attention of researchers and policy makers. Several Latin American governments are currently considering employing different FOP labeling systems. However, there is much need for more research-based evidence in these countries. In this paper, we study whether food-purchasing decisions and the nutritional qualities of those purchases are influenced by randomly informing some customers and not others about an FOP label known as Nutri-Score. We also separate the information effect from the effect of being aware of the system. We combined a randomized field intervention in a university cafeteria in Bogotá, Colombia with data from an after-purchase survey and receipts. We found that randomly providing information on Nutri-Score increased total expenditure by $0.18. Additional spending on healthier items was 21% or $0.26 higher, with no change for less healthy items. Expenditure estimates were higher among customers who were aware of the system’s existence. Customers in the study were also 10% more likely to buy a healthier item than control customers were, and the concentration of protein in their purchases was greater. Information on the Nutri-Score system increased the store’s sales. This potential financial incentive may facilitate the implementation of Nutri-Score.
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Andreeva, Valentina A., Manon Egnell, Pilar Galan, Gilles Feron, Serge Hercberg, and Chantal Julia. "Association of the Dietary Index Underpinning the Nutri-Score Label with Oral Health: Preliminary Evidence from a Large, Population-Based Sample." Nutrients 11, no. 9 (August 23, 2019): 1998. http://dx.doi.org/10.3390/nu11091998.
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The 2017 implementation in France of the front-of-package nutrition label known as ‘Nutri-Score’ was intended as a public health strategy to help individuals make healthier food choices at the point of purchase and thus help reduce chronic disease on the population level. Nutri-Score and the associated individual-level dietary index are based on the British Food Standards Agency Nutrient Profiling System (FSAm-NPS-DI). Prior research has shed light on the relation between the dietary index and various physical health outcomes, yet no studies have explored the link with oral health. We analyzed the cross-sectional association of the dietary index with oral health in a population-based sample of 33,231 adults from the French NutriNet-Santé cohort. Oral health (main dependent variable) was assessed in 2016 with the General Oral Health Assessment Index; FSAm-NPS-DI (main independent variable) was calculated using ≥3 non-consecutive 24-h dietary records, following established methodology; lower scores corresponded to better diet quality. Age-specific associations were explored via multivariable linear regression. Fully-adjusted models showed modest yet significant associations between the dietary index and oral health in younger (18–59 years) and older (60+ years) participants, with the strength of the model being more pronounced in the former compared with the latter age group (F value: 28.5 versus 6.3, both p < 0.0001). Higher diet quality was associated with a somewhat lower risk of oral health problems. Albeit preliminary, the findings support the relevance of dietary indices underpinning nutrition labels such as the Nutri-Score. Future research is needed to confirm the associations.
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Éliás, Anna Júlia. "Cikkismertetés: A Nutri-Score tápértékjelölési rendszer közérthetősége és hatása az élelmiszer-választásra." Egészségfejlesztés 62, no. 2 (May 4, 2021): 80–82. http://dx.doi.org/10.24365/ef.v62i2.5905.
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Az élelmiszerek csomagolásának elülső oldalán alkalmazott tápértékjelölés (front-of-pack label) a lakosság táplálkozási szokásait javító potenciális eszköz. Jelenleg többféle, önkéntesen használt tápértékjelölési rendszer is megtalálható a piacokon. Mivel az Európai Unión belüli rend-szerek egységesítésről folyamatos egyeztetés zajlik, ezért fontos, hogy a tagországokban is megvizsgálják azok relatív közérthetőségét (a termékek tápérték szerinti helyes besorolásának képessége), valamint hatékonyságát (az egészségesebb tápanyag-összetételű élelmi-szer választása) a fogyasztók körében. Jelen tanulmány öt jelölési rendszer alkalmazhatóságát mérte fel a tápérték szerinti besorolási képesség és az élelmiszer-választás befolyásolása szempontjából a fogyasztók körében.
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Katsouri, Evangelia, Emmanuella Magriplis, Antonis Zampelas, Eleftherios H. Drosinos, and George-John Nychas. "Dietary Intake Assessment of Pre-Packed Graviera Cheese in Greece and Nutritional Characterization Using the Nutri-Score Front of Pack Label Scheme." Nutrients 13, no. 2 (January 20, 2021): 295. http://dx.doi.org/10.3390/nu13020295.
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Gravieras are ‘gruyere’ type hard cheeses with a variety of different products and the second highest consumption in Greece. In this study, we present a dietary intake assessment and a nutritional characterization of pre-packed graviera products sold in the Greek market using Nutri-Score Front of Pack Label (FoPL). The nutrient contents of 92 pre-packed graviera products were combined with daily individual consumption data extracted from the Hellenic National Nutrition Health Survey (n = 93), attempting to evaluate the contribution of graviera’s consumption to the Greek diet. The analysis of nutrients’ intake as a Reference Intake (RI) percentage ranked saturated fat first on the nutrients’ intake list, with RI percentage ranging from 36.1 to 109.2% for the 95th percentile of consumption. The respective % RI for energy, total fat, carbohydrates, sugars, proteins and salt ranged from 12.7–20.7%, 21.6–50.4%, 0–3.1%, 0–6.1%, 37–57.1% and 6.3–42%. Nutri-Score classified 1% of the products to C—light orange class, 62% to D—orange and 37% to E—dark orange, while no products were classified to A—dark green or B—green classes. The comparison between the Nutri-Score classification and the nutrients’ intake assessment, also separately conducted within the classes, showed a higher salt intake after the consumption of products classified as D—orange and E—dark orange.
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Hoteit, Maha, Nour Yazbeck, Ayoub Al-Jawaldeh, Cecile Obeid, Heba Abdul Fattah, Marwa Ghader, and Hala Mohsen. "Assessment of the knowledge, attitudes and practices of Lebanese shoppers towards food labeling: The first steps in the Nutri-score roadmap." F1000Research 11 (May 5, 2022): 84. http://dx.doi.org/10.12688/f1000research.75703.2.
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Background: Food labeling is a fundamental educational tool for advocating for public awareness. It emphasizes knowledge of the nutrient content of food and thus directs the choice towards the healthiest food products. This cross-sectional survey aimed to assess the knowledge, attitudes, and practices (KAP) regarding nutrition label use in Lebanon through a valid questionnaire. Methods: Overall, 768 participants (mean age: 30.8 ±12, males: 60.2%) were recruited randomly between February and May 2020. We used word of mouth and social media to recruit our sample population. Results: Social media was the most accessed tool to attain nutrition information by responders (39.8%). More than half the participants expressed positive attitudes to check information related to sugars (66.4%), vitamins (64.9%), total fats (61.7%), proteins (59.1%), and calories (58.7%) on the food label. Expiry date, price, and brand name were the top three considerations while reading food labels. About half (46.5%) reported to “always” look at the food label. Responders reported reading labels related primarily to sugars (44.3%), calories (38.8%), and total fats (36.8%). The optimal total KAP score was 46; our findings revealed a mean KAP score of 14.46 ±7 (31.4%). When categorizing the KAP scores, 15% had high scores, and 85% scored low. Spearman’s coefficients showed positive correlations between knowledge-attitude, knowledge-practice, and attitude-practice scores, with p<0.001. The regression analysis revealed that gender, age, BMI, residency area, educational level, university degree, health and diet statuses, and activity level were significant predictors of the KAP score. Being on a diet had the highest odds (OR=3.107, CI=1.904-5.072, p<0.001). Conclusion: The low awareness of food labels leads Lebanese people to choose unhealthy food options. A planned educational program is recommended to ease the interpretation of these labels.
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Hoteit, Maha, Nour Yazbeck, Ayoub Al-Jawaldeh, Cecile Obeid, Heba Abdul Fattah, Marwa Ghader, and Hala Mohsen. "Assessment of the knowledge, attitudes and practices of Lebanese shoppers towards food labeling: The first steps in the Nutri-score roadmap." F1000Research 11 (January 24, 2022): 84. http://dx.doi.org/10.12688/f1000research.75703.1.
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Background: Food labeling is a fundamental educational tool for advocating for public awareness. It emphasizes knowledge of the nutrient content of food and thus directs the choice towards the healthiest food products. This cross-sectional survey aimed to assess the knowledge, attitudes, and practices (KAP) regarding nutrition label use in Lebanon through a valid questionnaire. Methods: Overall, 768 participants (mean age: 30.8 ±12, males: 60.2%) were recruited randomly between February and May 2020. We used word of mouth and social media to recruit our sample population. Results: Social media was the most accessed tool to attain nutrition information by responders (39.8%). More than half the participants expressed positive attitudes to check information related to sugars (66.4%), vitamins (64.9%), total fats (61.7%), proteins (59.1%), and calories (58.7%) on the food label. Expiry date, price, and brand name were the top three considerations while reading food labels. About half (46.5%) reported to “always” look at the food label. Responders reported reading labels related primarily to sugars (44.3%), calories (38.8%), and total fats (36.8%). The optimal total KAP score was 46; our findings revealed a mean KAP score of 14.46 ±7 (31.4%). When categorizing the KAP scores, 15% had high scores, and 85% scored low. Spearman’s coefficients showed positive correlations between knowledge-attitude, knowledge-practice, and attitude-practice scores, with p<0.001. The regression analysis revealed that gender, age, BMI, residency area, educational level, university degree, health and diet statuses, and activity level were significant predictors of the KAP score. Being on a diet had the highest odds (OR=3.107, CI=1.904-5.072, p<0.001). Conclusion: The low awareness of food labels leads Lebanese people to choose unhealthy food options. A planned educational program is recommended to ease the interpretation of these labels.
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Kühne, Swen J., Ester Reijnen, Gracinda Granja, and Rachel S. Hansen. "Labels Affect Food Choices, but in What Ways?" Nutrients 14, no. 15 (August 5, 2022): 3204. http://dx.doi.org/10.3390/nu14153204.
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To reduce obesity and thus promote healthy food choices, front-of-pack (FOP) labels have been introduced. Though FOP labels help identify healthy foods, their impact on actual food choices is rather small. A newly developed so-called swipe task was used to investigate whether the type of label used (summary vs. nutrient-specific) had differential effects on different operationalizations of the “healthier choice” measure (e.g., calories and sugar). After learning about the product offerings of a small online store, observers (N = 354) could, by means of a swipe gesture, purchase the products they needed for a weekend with six people. Observers were randomly assigned to one of five conditions, two summary label conditions (Nutri-Score and HFL), two nutrient (sugar)-specific label conditions (manga and comic), or a control condition without a label. Unexpectedly, more products (+7.3 products)—albeit mostly healthy ones—and thus more calories (+1732 kcal) were purchased in the label conditions than in the control condition. Furthermore, the tested labels had different effects with respect to the different operationalizations (e.g., manga reduced sugar purchase). We argue that the additional green-labeled healthy products purchased (in label conditions) “compensate” for the purchase of red-labeled unhealthy products (see averaging bias and licensing effect).
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De Temmerman, Joyce, Eva Heeremans, Hendrik Slabbinck, and Iris Vermeir. "The impact of the Nutri-Score nutrition label on perceived healthiness and purchase intentions." Appetite 157 (February 2021): 104995. http://dx.doi.org/10.1016/j.appet.2020.104995.
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Egnell, Manon, Zenobia Talati, Serge Hercberg, Simone Pettigrew, and Chantal Julia. "Objective Understanding of Front-of-Package Nutrition Labels: An International Comparative Experimental Study across 12 Countries." Nutrients 10, no. 10 (October 18, 2018): 1542. http://dx.doi.org/10.3390/nu10101542.
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Front-of-Package labels (FoPLs) are efficient tools for increasing consumers’ awareness of foods’ nutritional quality and encouraging healthier choices. A label’s design is likely to influence its effectiveness; however, few studies have compared the ability of different FoPLs to facilitate a consumer understanding of foods’ nutritional quality, especially across sociocultural contexts. This study aimed to assess consumers’ ability to understand five FoPLs [Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), and Warning symbol] in 12 different countries. In 2018, approximately 1000 participants per country were recruited and asked to rank three sets of label-free products (one set of three pizzas, one set of three cakes, and one set of three breakfast cereals) according to their nutritional quality, via an online survey. Participants were subsequently randomised to one of five FoPL conditions and were again asked to rank the same sets of products, this time with a FoPL displayed on pack. Changes in a participants’ ability to correctly rank products across the two tasks were assessed by FoPL using ordinal logistic regression. In all 12 countries and for all three food categories, the Nutri-Score performed best, followed by the MTL, HSR, Warning symbol, and RIs.
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Poon, Theresa, Marie-Ève Labonté, Christine Mulligan, Mavra Ahmed, Kacie M. Dickinson, and Mary R. L’Abbé. "Comparison of nutrient profiling models for assessing the nutritional quality of foods: a validation study." British Journal of Nutrition 120, no. 5 (July 17, 2018): 567–82. http://dx.doi.org/10.1017/s0007114518001575.
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AbstractNutrient profiling (NP) is a method for evaluating the healthfulness of foods. Although many NP models exist, most have not been validated. This study aimed to examine the content and construct/convergent validity of five models from different regions: Australia/New Zealand (FSANZ), France (Nutri-Score), Canada (HCST), Europe (EURO) and Americas (PAHO). Using data from the 2013 UofT Food Label Information Program (n15342 foods/beverages), construct/convergent validity was assessed by comparing the classifications of foods determined by each model to a previously validated model, which served as the reference (Ofcom). The parameters assessed included associations (Cochran–Armitage trend test), agreement (κ statistic) and discordant classifications (McNemar’s test). Analyses were conducted across all foods and by food category. On the basis of the nutrients/components considered by each model, all models exhibited moderate content validity. Although positive associations were observed between each model and Ofcom (all Ptrend<0·001), agreement with Ofcom was ‘near perfect’ for FSANZ (κ=0·89) and Nutri-Score (κ=0·83), ‘moderate’ for EURO (κ=0·54) and ‘fair’ for PAHO (κ=0·28) and HCST (κ=0·26). There were discordant classifications with Ofcom for 5·3 % (FSANZ), 8·3 % (Nutri-Score), 22·0 % (EURO), 33·4 % (PAHO) and 37·0 % (HCST) of foods (all P<0·001). Construct/convergent validity was confirmed between FSANZ and Nutri-Score v. Ofcom, and to a lesser extent between EURO v. Ofcom. Numerous incongruencies with Ofcom were identified for HCST and PAHO, which highlights the importance of examining classifications across food categories, the level at which differences between models become apparent. These results may be informative for regulators seeking to adapt and validate existing models for use in country-specific applications.
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Andreeva, Valentina A., Manon Egnell, Mathilde Touvier, Pilar Galan, Chantal Julia, and Serge Hercberg. "International evidence for the effectiveness of the front-of-package nutrition label called Nutri-Score." Central European Journal of Public Health 29, no. 1 (March 31, 2021): 76–79. http://dx.doi.org/10.21101/cejph.a6239.
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Pigeyre, M., L. Genser, and J. Dargent. "Le Nutri-Score supérieur au logo Evolved Nutrition Label (ENL) proposé par quelques grosses multinationales." Obésité 13, no. 3 (September 2018): 145. http://dx.doi.org/10.3166/obe-2018-0033.
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Goiana-da-Silva, Francisco, David Cruz-e-Silva, Catarina Nobre-da-Costa, Alexandre Morais Nunes, Morgane Fialon, Manon Egnell, Pilar Galan, et al. "Nutri-Score: The Most Efficient Front-of-Pack Nutrition Label to Inform Portuguese Consumers on the Nutritional Quality of Foods and Help Them Identify Healthier Options in Purchasing Situations." Nutrients 13, no. 12 (November 30, 2021): 4335. http://dx.doi.org/10.3390/nu13124335.
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Several studies have identified Front-of-Pack Nutrition Labels (FoPLs) as a promising strategy to improve the nutritional quality of consumers’ food choices and encourage manufacturers to offer healthier products. This study aims to fill the evidence gap regarding the most effective FoPL among the Portuguese population. In total, 1059 Portuguese participants were recruited through a web panel provider and asked to declare their intended food choices and to rank three sets of products (pizza, cakes and breakfast cereals) according to their nutritional quality, first in the absence of any labelling, and then with a FoPL displayed on-pack (five FoPLs tested). Finally, participants were asked to answer nine statements related to perceptions of FoPLs. Results showed that participants improved their food choices, depending on the FoPL and the food category. All FoPLs led to a higher percentage of correct responses on the ranking task compared to the no label condition. The Nutri-Score was among the FoPLs producing the greatest improvement across all food categories compared to the reference intakes (OR = 6.45 [4.43–9.39], p-value < 0.0001) and facilitating the highest percentage to correctly rank products according to nutritional quality. This study suggests that, among the available options, Nutri-Score is the most efficient FoPL to inform Portuguese consumers of the nutritional quality of foods and help them identify healthier options in mock purchasing situations.
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Vermote, Marie, Stephanie Bonnewyn, Christophe Matthys, and Stefanie Vandevijvere. "Nutritional Content, Labelling and Marketing of Breakfast Cereals on the Belgian Market and Their Reformulation in Anticipation of the Implementation of the Nutri-Score Front-Of-Pack Labelling System." Nutrients 12, no. 4 (March 25, 2020): 884. http://dx.doi.org/10.3390/nu12040884.
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Objective: Breakfast cereals are frequently consumed in Belgium, especially among children. We investigated the nutritional content, labelling and marketing of breakfast cereals and the changes in nutrient content and reformulation in anticipation of the implementation of the Nutri-Score front-of-pack label. Design: Pictures were taken of cereal packages. The WHO-Europe nutrient profiling tool was used to classify cereals into ‘permitted’/‘not-permitted’ to be marketed to children, while the nutritional quality was assessed using Nutri-Score. The proportion of cereals with nutrition and health claims and/or promotional characters on the front-of-pack was compared between permitted and not-permitted cereals and between different Nutriscore categories using Chi-squared tests. The average nutrient contents per 100g were compared between 2017 and 2018 using paired t-tests. Setting: Belgium. Participants: All breakfast cereals in the major supermarkets (n = 7) in 2017 and 2018. Results: Overall, 330 cereals were included. About 77.2% of cereals were not permitted to be marketed to children but, of those, 22.0% displayed promotional characters. More claims (68.9% of all claims) were found on ‘not-permitted’ compared with ‘permitted’ cereals, particularly nutrition claims. Most claims were displayed on cereals with the allocated Nutri-Score A (42.0%) and C (37.0%). A significant reformulation of cereals was found between 2017 and 2018, with reductions in total sugar (−5%) (p < 0.001) and sodium (−20%) (p = 0.002) and increases in fibre (+3%) (p = 0.012) and proteins (+2%) (p = 0.002). Conclusion: Breakfast cereals on the Belgian market are predominantly unhealthy and frequently carry claims and promotional characters. Minimal reformulation occurred over one year. Policy recommendations include restrictions on claims and marketing for not-permitted cereals.
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Packer, Jessica, Simon J. Russell, Deborah Ridout, Anne Conolly, Curtis Jessop, Russell M. Viner, and Helen Croker. "Secondary Outcomes of a Front-of-Pack-Labelling Randomised Controlled Experiment in a Representative British Sample: Understanding, Ranking Speed and Perceptions." Nutrients 14, no. 11 (May 24, 2022): 2188. http://dx.doi.org/10.3390/nu14112188.
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Front-of-pack labels (FOPLs) provide simplified nutritional information that aims to inform consumer choice and encourage reformulation. We conducted an online randomised controlled experiment on a representative British sample to test the effectiveness of FOPLs across a range of outcomes. The primary outcomes have been published; here, we present the secondary outcomes: the ability to rank the healthiest product and the time to complete the rankings by comparing the FOPL groups and a no-label control, as well as a descriptive analysis of the perceptions. Participants from the NatCen panel were randomised to one of five experimental groups (Multiple Traffic Lights; Nutri-Score; Warning Label; Positive Choice tick; no-label control). Six food/drink categories were selected (pizza, drinks, cakes, crisps, yoghurts, breakfast cereals), and three products were created with varying healthiness. The participants (analytic sample = 4530) were asked to rank the products in order of healthiness twice (baseline: no label; follow-up: experimental group label). Compared to the control, the probability of correctly ranking the healthiest product at follow-up was significantly greater for the N-S, MTL and WL across all products. The time to correctly complete the ranking was fastest for the N-S, PC and no-label control. The descriptive analysis showed that the FOPLs were perceived favourably, and especially N-S and MTL. The findings were supportive of the primary analyses, with those results suggesting that N-S performed the best, and then MTL.
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Egnell, Manon, Pauline Ducrot, Mathilde Touvier, Benjamin Allès, Serge Hercberg, Emmanuelle Kesse-Guyot, and Chantal Julia. "Objective understanding of Nutri-Score Front-Of-Package nutrition label according to individual characteristics of subjects: Comparisons with other format labels." PLOS ONE 13, no. 8 (August 23, 2018): e0202095. http://dx.doi.org/10.1371/journal.pone.0202095.
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Hallez, Lotte, Yara Qutteina, Filip Boen, and Tim Smits. "The ABC’s of Ecological and Nutrition Labels. The Impact of Label Theme and Complexity on the Environmental Footprint of Online Grocery Choices." Sustainability 13, no. 5 (February 25, 2021): 2474. http://dx.doi.org/10.3390/su13052474.
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Current food production and consumption patterns pose serious threats to our global environment. The goal of the current research is to investigate whether the presence of specific informational cues, i.e., ecological labels and nutrition labels, can improve the environmental impact of food choices. Two online experiments were carried out in which young adults were asked to select products in a grocery shop setting, and to indicate quantities (in grams) for a hypothetical one-person meal. In the first experiment (N = 142), we varied the theme (sustainability vs. nutrition vs. control) of the labels alongside the products. The labels displayed a summarized product score (i.e., the products’ actual nutri-score), but this was either presented as the nutritional score or as the ecological score of that product. In the second experiment (N = 250), we again varied this label theme as well as the level of complexity, namely interpretative (i.e., simple) vs. reductive (i.e., detailed). While the results of the first experiment revealed no impact of the labels, the results of the second experiment suggest that labels with a sustainability theme can influence young adults to compose a more sustainable meal with less meat, and with a lower carbon and blue water footprint. The labels’ level of complexity did not impact the different eating outcomes. In conclusion, while these results point to the potential use of labels with a sustainability theme, it is important to note that the results did not consistently replicate across studies and analyses and should therefore be interpreted with caution. A possible explanation for the effect of eco-themed labels might be that they trigger pro-environmental objectives during decision-making, and prime people to consider the sustainability of their food choices.
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Millar, Seán R., Pilar Navarro, Janas M. Harrington, Ivan J. Perry, and Catherine M. Phillips. "Associations between the Nutrient Profiling System Underlying the Nutri-Score Nutrition Label and Biomarkers of Chronic Low-Grade Inflammation: A Cross-Sectional Analysis of a Middle- to Older-Aged Population." Nutrients 14, no. 15 (July 29, 2022): 3122. http://dx.doi.org/10.3390/nu14153122.
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Low-grade systemic inflammation is associated with a range of conditions. Diet may modulate inflammation and public health strategies are needed to guide consumers’ dietary choices and help prevent diet-related disease. The Food Standards Agency nutrient profiling system (FSAm-NPS) constitutes the basis of the five-colour front-of-pack Nutri-Score labelling system. No study to date has examined FSAm-NPS dietary index associations with biomarkers of inflammation. Therefore, our objective was to test relationships between the FSAm-NPS and a range of inflammatory biomarkers in a cross-sectional sample of 2006 men and women aged 46–73 years. Individual participant FSAm-NPS scores were derived from food frequency questionnaires. Pro-inflammatory cytokine, adipocytokine, acute-phase response protein, coagulation factor and white blood cell count concentrations were determined. Correlation and linear regression analyses were used to examine FSAm-NPS relationships with biomarker levels. In crude and adjusted analyses, higher FSAm-NPS scores, reflecting poorer nutritional quality, were consistently and positively associated with biomarkers. In fully adjusted models, significant associations with concentrations of complement component 3, c-reactive protein, interleukin 6, tumour necrosis factor alpha, resistin, white blood cell count, neutrophils, eosinophils and the neutrophil-to-lymphocyte ratio persisted. These results suggest that dietary quality, determined by Nutri-Score rating, is associated with inflammatory biomarkers related to health.
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Folkvord, Frans, Niki Bergmans, and Sara Pabian. "The effect of the nutri-score label on consumer’s attitudes, taste perception and purchase intention: An experimental pilot study." Food Quality and Preference 94 (December 2021): 104303. http://dx.doi.org/10.1016/j.foodqual.2021.104303.
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Ahmed, Mavra, Kacie Dickinson, Laura Vergeer, Christine Mulligan, Beatriz Franco-Arellano, Chantal Julia, and Mary L'Abbé. "Evaluating the Consistency of the French Nutri-Score Front-of-Pack Scoring System with Canadian Dietary Guidelines." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1711. http://dx.doi.org/10.1093/cdn/nzaa064_001.
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Abstract Objectives Nutrient profiling (NP) models, underpinning front-of-pack (FOP) labelling, can guide consumers towards healthier food choices and should be aligned with food-based dietary guidelines. In France, [the FSAm/HCSP NP model], underpinning the Nutri-Score (NS) FOP, ranks foods on both nutrients-to-limit (saturated fat, sodium, sugar) and nutrients-to-encourage (e.g., protein, fibre, fruits, vegetables, legumes and nuts) and was found to adequately align with dietary recommendations in Europe. However, investigations on the comparable ranking of foods by the FSAm/HCSP NP model with the new Canadian dietary guidelines is lacking. The objective was to assess the ability of the NS to discriminate the nutritional quality of foods and beverages in the Canadian food supply and their consistency with nutritional recommendations according to the Canada's 2019 Food Guidelines (CFG). Methods Using the University of Toronto Food Label Information Program 2017 database (n = 17,360), the nutritional scores for prepackaged foods and beverages were derived using the NS. These scores correspond to five grades of nutritional quality, ranging from green (A; highest quality) to red (E; lowest quality). Scores were assessed as binary where A/B were considered ‘in alignment’ with CFG recommendations while C/D/E were considered ‘not in alignment’. Results The NS system classified 21% of products as A, ranging from 99% of legumes to 0.45% of the sugars/sweets. The NS was able to discriminate the nutritional quality of foods within the same food groups (based on display of three grades represented within the Nutri-Score). Overall, there was 73% agreement between NS and CFG, ranging from 48% for combination dishes to 95% for eggs/egg substitute categories. The classification of foods according to the NS was consistent with the CFG; foods for which consumption is recommended were more favourably classified (e.g., 76% of vegetables were classified as A or B) than foods for which consumption should be limited (e.g., 79% of snacks were classified as C/D/E). Conclusions The NS FOP system is an effective tool to discriminate products across and within food categories. The classification of different food groups in the NS displayed a high consistency with the new Canadian dietary guidelines. Funding Sources Sanofi-Pasteur University of Toronto Université Paris-Descartes Collaborative Grant.
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Andrianasolo, Roland M., Chantal Julia, Raphaëlle Varraso, Manon Egnell, Mathilde Touvier, Emmanuelle Kesse-Guyot, Serge Hercberg, and Pilar Galan. "Association between an individual dietary index based on the British Food Standard Agency Nutrient Profiling System and asthma symptoms." British Journal of Nutrition 122, no. 1 (June 19, 2019): 63–70. http://dx.doi.org/10.1017/s0007114519000655.
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AbstractThe role of diet in asthma is still debated. In France, a front-of-pack (FOP) nutrition label based on a modified Food Standards Agency Nutrient Profiling System/High Council for Public Health (FSAm-NPS/HCSP) has recently been implemented to help consumers to make healthier food choices during purchase. At the individual level, the FSAm-NPS dietary index (DI) has been shown to reflect the nutritional quality of the diet. The aim of the present study was to investigate the association between the FSAm-NPS DI and the asthma symptom score. In total, 34 323 participants (25 823 women and 8500 men) from the NutriNet-Santé cohort were included. The overall nutritional quality of the diet was assessed using the FSAm-NPS DI. Increasing FSAm-NPS DI reflects decreasing overall diet quality. Asthma was defined by the asthma symptom score (sum of five questions). Negative binomial regression was used to evaluate the association between the FSA-NPS DI and the asthma symptom score. Overall, mean participant’s age was 54 ± 14 years, and about 27 % reported at least one asthma symptom. We observed a significant positive association between less healthy diet, as expressed by higher FSAm-NPS DI, and the asthma symptom score. The adjusted OR were 1·27 (95 % CI 1·17, 1·38) among women and 1·31 (95 % CI 1·13, 1·53) among men. Unhealthy food choices, as reflected by a higher FSAm-NPS DI, were associated with greater asthma symptoms. These results reinforce the relevance of public health approach to orient consumers towards healthier food choices by using a clear and easy-to-understand FOP nutrition label based on the FSAm-NPS, such as the Nutri-Score.
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Packer, Jessica, Simon J. Russell, Deborah Ridout, Steven Hope, Anne Conolly, Curtis Jessop, Oliver J. Robinson, Sandro T. Stoffel, Russell M. Viner, and Helen Croker. "Assessing the Effectiveness of Front of Pack Labels: Findings from an Online Randomised-Controlled Experiment in a Representative British Sample." Nutrients 13, no. 3 (March 10, 2021): 900. http://dx.doi.org/10.3390/nu13030900.
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Front of pack food labels (FOPLs) provide accessible nutritional information to guide consumer choice. Using an online experiment with a large representative British sample, we aimed to examine whether FOPLs improve participants’ ability to identify the healthiness of foods and drinks. The primary aim was to compare ability to rank between FOPL groups and a no label control. Adults (≥18 years), recruited from the NatCen panel, were randomised to one of five experimental groups (Multiple Traffic Light, MTL; Nutri-Score, N-S; Warning Label, WL; Positive Choice tick, PC; no label control). Stratification variables were year of recruitment to panel, sex, age, government office region, and household income. Packaging images were created for three versions, varying in healthiness, of six food and drink products (pizza, drinks, cakes, crisps, yoghurts, breakfast cereals). Participants were asked to rank the three product images in order of healthiness. Ranking was completed on a single occasion and comprised a baseline measure (with no FOPL), and a follow-up measure including the FOPL as per each participant’s experimental group. The primary outcome was the ability to accurately rank product healthiness (all products ranked correctly vs. any incorrect). In 2020, 4504 participants had complete data and were included in the analysis. The probability of correct ranking at follow-up, and improving between baseline and follow-up, was significantly greater across all products for the N-S, MTL and WL groups, compared to control. This was seen for only some of the products for the PC group. The largest effects were seen for N-S, followed by MTL. These analyses were adjusted for stratification variables, ethnicity, education, household composition, food shopping responsibility, and current FOPL use. Exploratory analyses showed a tendency for participants with higher compared to lower education to rank products more accurately. Conclusions: All FOPLs were effective at improving participants’ ability to correctly rank products according to healthiness in this large representative British sample, with the largest effects seen for N-S, followed by MTL.
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Castronuovo, Luciana, Maria Victoria Tiscornia, Leila Guarnieri, Enrique Martins, Fabio S. Gomes, and Lorena Allemandi. "Efficacy of different front-of-package labeling systems in changing purchase intention and product healthfulness perception for food products in Argentina." Revista Panamericana de Salud Pública 46 (September 26, 2022): 1. http://dx.doi.org/10.26633/rpsp.2022.137.
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Objectives. To identify the front-of-package scheme—Multiple Traffic Light (MTL), Nutri-Score (NS), and black octagon Warning System (WS)—most effective in reducing purchase intention and perceived product healthfulness of drinking yogurts, cookies and cheese spreads, and to assess the joint influence of nutrient claims on the effects. Methods. Randomized-controlled experiment. A within-subjects factorial design was used to evaluate the influence of three independent factors on perceived product healthfulness and purchase intention. A total of 704 adults in Argentina were shown three mock-up products and asked to indicate which product they would buy choosing between pairs of products from different categories and to rate product healthfulness on a 7-point Likert scale. Results. The WS was the most effective in reducing purchase intention in drinking yogurts (OR:0.16, 95%CI: 0.09;0.28), cookies (OR:0.10, 95%CI: 0.05;0.18) and cheese spreads (OR:0.10, 95%CI: 0.05;0.18), and the perception of healthfulness (WS Mean score 3,63 vs No label 4,24, p<0.001), regardless of the participants’ gender, age, and level of education. NS was inefficacious in reducing product healthfulness perception, while MTL had significantly increased how healthful the product was perceived (p<0.001). Nutrient claims increased purchase intention and perception of healthfulness, thus reducing the effectiveness of front-of-package labels (p<0.001). Conclusions. In line with growing evidence, our findings support that WS perform better than NS and MTL in reducing purchase intention and healthfulness perception of products with excessive amounts of critical nutrients associated with the greatest burden of diseases. Front-of-package WS are expected to facilitate the population in Argentina to make healthier decisions.
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Song, Jing, Mhairi K. Brown, Monique Tan, Graham A. MacGregor, Jacqui Webster, Norm R. C. Campbell, Kathy Trieu, Cliona Ni Mhurchu, Laura K. Cobb, and Feng J. He. "Impact of color-coded and warning nutrition labelling schemes: A systematic review and network meta-analysis." PLOS Medicine 18, no. 10 (October 5, 2021): e1003765. http://dx.doi.org/10.1371/journal.pmed.1003765.
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Background Suboptimal diets are a leading risk factor for death and disability. Nutrition labelling is a potential method to encourage consumers to improve dietary behaviour. This systematic review and network meta-analysis (NMA) summarises evidence on the impact of colour-coded interpretive labels and warning labels on changing consumers’ purchasing behaviour. Methods and findings We conducted a literature review of peer-reviewed articles published between 1 January 1990 and 24 May 2021 in PubMed, Embase via Ovid, Cochrane Central Register of Controlled Trials, and SCOPUS. Randomised controlled trials (RCTs) and quasi-experimental studies were included for the primary outcomes (measures of changes in consumers’ purchasing and consuming behaviour). A frequentist NMA method was applied to pool the results. A total of 156 studies (including 101 RCTs and 55 non-RCTs) nested in 138 articles were incorporated into the systematic review, of which 134 studies in 120 articles were eligible for meta-analysis. We found that the traffic light labelling system (TLS), nutrient warning (NW), and health warning (HW) were associated with an increased probability of selecting more healthful products (odds ratios [ORs] and 95% confidence intervals [CIs]: TLS, 1.5 [1.2, 1.87]; NW, 3.61 [2.82, 4.63]; HW, 1.65 [1.32, 2.06]). Nutri-Score (NS) and warning labels appeared effective in reducing consumers’ probability of selecting less healthful products (NS, 0.66 [0.53, 0.82]; NW,0.65 [0.54, 0.77]; HW,0.64 [0.53, 0.76]). NS and NW were associated with an increased overall healthfulness (healthfulness ratings of products purchased using models such as FSAm-NPS/HCSP) by 7.9% and 26%, respectively. TLS, NS, and NW were associated with a reduced energy (total energy: TLS, −6.5%; NS, −6%; NW, −12.9%; energy per 100 g/ml: TLS, −3%; NS, −3.5%; NW, −3.8%), sodium (total sodium/salt: TLS, −6.4%; sodium/salt per 100 g/ml: NS: −7.8%), fat (total fat: NS, −15.7%; fat per 100 g/ml: TLS: −2.6%; NS: −3.2%), and total saturated fat (TLS, −12.9%; NS: −17.1%; NW: −16.3%) content of purchases. The impact of TLS, NS, and NW on purchasing behaviour could be explained by improved understanding of the nutrition information, which further elicits negative perception towards unhealthful products or positive attitudes towards healthful foods. Comparisons across label types suggested that colour-coded labels performed better in nudging consumers towards the purchase of more healthful products (NS versus NW: 1.51 [1.08, 2.11]), while warning labels have the advantage in discouraging unhealthful purchasing behaviour (NW versus TLS: 0.81 [0.67, 0.98]; HW versus TLS: 0.8 [0.63, 1]). Study limitations included high heterogeneity and inconsistency in the comparisons across different label types, limited number of real-world studies (95% were laboratory studies), and lack of long-term impact assessments. Conclusions Our systematic review provided comprehensive evidence for the impact of colour-coded labels and warnings in nudging consumers’ purchasing behaviour towards more healthful products and the underlying psychological mechanism of behavioural change. Each type of label had different attributes, which should be taken into consideration when making front-of-package nutrition labelling (FOPL) policies according to local contexts. Our study supported mandatory front-of-pack labelling policies in directing consumers’ choice and encouraging the food industry to reformulate their products. Protocol registry PROSPERO (CRD42020161877).