Objective understanding of the Nutri-score front-of-pack label by European consumers and its effect on food choices: an online experimental study

Abstract Background The effectiveness of Front-of-Pack nutrition Labels (FoPLs) may be influenced by national context. In light of the ongoing efforts to harmonize FoPLs across Europe, this study aimed to compare the effectiveness of five FoPLs (Health Star Rating system, Multiple Traffic Lights, Nutri-Score, Reference Intakes, Warning symbols) on consumer understanding and food choice in 12 European countries. Methods In 2018–2019, for three food categories, approximately 1000 participants per country were asked to select which food they would prefer to purchase between three products with distinct nutritional quality profiles, and then to rank the products by nutritional quality. Participants (N = 12,391 in total) completed these tasks first with no FoPL and then, after randomization to one of the five FoPLs, with a FoPL on the food packages. Associations between FoPLs and change in (i) nutritional quality of food choices and (ii) ability to correctly rank the products by nutritional quality were assessed with logistic regression models adjusted for sociodemographic and lifestyle characteristics of participants, conducted overall and by country. Findings Compared with the Reference Intakes, the Nutri-Score (OR = 3.23[2.75–3.81]; p < 0.0001), followed by the Multiple Traffic Lights (OR = 1.68[1.42–1.98]; p < 0.0001), was the most effective FoPL in helping consumers identify the foods’ nutritional quality, overall and in each of the 12 countries. Differences between FoPLs regarding food choice modifications were smaller, but the effect of the Nutri-Score seemed slightly higher in eliciting healthier food choices overall compared with the Reference Intakes, followed by the Warning symbols, the Multiple Traffic Lights and the Health Star Rating system. Interpretation In the context of FoPL harmonization in Europe, these findings from an online experiment provide insights into the Nutri-Score’s effectiveness on European consumers.

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Objective understanding of the front-of-pack nutrition label Nutri-Score by European consumers

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.902 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Egnell ◽

Z Talati ◽

P Galan ◽

V Andreeva ◽

S Vandevijvere ◽

...

Keyword(s):

Nutritional Quality ◽

Food Choices ◽

Nutrition Labels ◽

Logistic Regression Models ◽

Traffic Lights ◽

Nutrition Labelling ◽

Food Packages ◽

Objective Understanding ◽

Quality Of Food

Abstract Background The effectiveness of Front-of-Pack nutrition Labels (FoPL) may be influenced by national context. In light of the ongoing efforts to harmonize nutrition labelling across Europe, the study aimed to compare the effectiveness of five FoPLs (Health Star Rating system [HSR], Multiple Traffic Lights [MTL], Nutri-Score, Reference Intakes [RIs], Warning symbol) in 12 European consumers. Methods In 2018-2019, for three food categories, approximately 1,000 participants per country were asked to select which food they would prefer to purchase between three products with distinct nutritional quality, and then to rank the products nutritional quality. Participants completed these tasks first with no FoPL and then, after randomization to one of the five FoPLs, with a FoPL on food packages. Associations between FoPLs and change in (i) nutritional quality of food choices, and (ii) ability to correctly rank the products nutritional quality were assessed with multivariable logistic regression models. Results Compared with the RIs, the Nutri-Score (OR = 3·23[2·75-3·81]; p < 0.0001), followed by the MTL (OR = 1·68[1·42-1·98]; p < 0.0001), was the most effective FoPL in helping participants identify the foods nutritional quality, overall and in each of the 12 countries. Differences between FoPLs regarding food choice modifications were smaller, but the effect of the Nutri-Score was slightly higher in eliciting healthier food choices overall compared with the RIs, followed by the Warning symbol, MTL and HSR. Conclusions These findings from an online experiment provide insights on the Nutri-Score's effectiveness in multiple European countries in the context of FoPL harmonization in Europe. Key messages The comparison of the effectiveness of front-of-pack labels highlighted the relative performance of various types of labels, the Nutri-Score showing a higher performance than other schemes. The higher performance of the Nutri-Score was identified for objective understanding and to a lesser extent food choices.

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Online Consumer Survey Comparing Different Front-of-Pack Labels in Greece

Nutrients ◽

10.3390/nu14010046 ◽

2021 ◽

Vol 14 (1) ◽

pp. 46

Author(s):

Lamprini Kontopoulou ◽

George Karpetas ◽

Εvangelos C. Fradelos ◽

Ioanna V. Papathanasiou ◽

Foteini Malli ◽

...

Keyword(s):

Nutritional Quality ◽

Online Survey ◽

Multinomial Logistic Regression ◽

Food Choices ◽

Nutrition Labeling ◽

Nutrition Labels ◽

Logistic Regression Models ◽

Traffic Lights ◽

Quality Of Food

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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Objective Understanding of Front-of-Package Nutrition Labels: An International Comparative Experimental Study across 12 Countries

Nutrients ◽

10.3390/nu10101542 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1542 ◽

Cited By ~ 58

Author(s):

Manon Egnell ◽

Zenobia Talati ◽

Serge Hercberg ◽

Simone Pettigrew ◽

Chantal Julia

Keyword(s):

Experimental Study ◽

Nutritional Quality ◽

Online Survey ◽

Rating System ◽

Label Free ◽

Free Products ◽

Nutrition Labels ◽

Traffic Lights ◽

Objective Understanding ◽

International Comparative

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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Consumers’ Responses to Front-of-Pack Nutrition Labelling: Results from a Sample from The Netherlands

Nutrients ◽

10.3390/nu11081817 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1817 ◽

Cited By ~ 13

Author(s):

Egnell ◽

Talati ◽

Gombaud ◽

Galan ◽

Hercberg ◽

...

Keyword(s):

The Netherlands ◽

Nutritional Quality ◽

Food Choices ◽

European Countries ◽

Star Rating ◽

Traffic Lights ◽

Nutrition Labelling ◽

Significant Difference ◽

Overall Performance ◽

Nutritional Profiles

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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Effectiveness of Different Front-of-Pack Nutrition Labels among Italian Consumers: Results from an Online Randomized Controlled Trial

Nutrients ◽

10.3390/nu12082307 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2307

Author(s):

Morgane Fialon ◽

Manon Egnell ◽

Zenobia Talati ◽

Pilar Galan ◽

Louise Dréano-Trécant ◽

...

Keyword(s):

Nutritional Quality ◽

Online Survey ◽

Controlled Trial ◽

Food Choices ◽

P Value ◽

Nutrition Labels ◽

Traffic Lights ◽

Significant Difference ◽

Nutrient Profiles

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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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 ◽

10.3390/nu13124335 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4335

Author(s):

Francisco Goiana-da-Silva ◽

David Cruz-e-Silva ◽

Catarina Nobre-da-Costa ◽

Alexandre Morais Nunes ◽

Morgane Fialon ◽

...

Keyword(s):

Nutritional Quality ◽

Food Choices ◽

P Value ◽

Portuguese Population ◽

Food Category ◽

Nutrition Labels ◽

Label Condition ◽

Promising Strategy ◽

Ranking Task

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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The nutritional quality of supermarket own brand chilled convenience foods: an Australian cross-sectional study reveals limitations of the Health Star Rating

Public Health Nutrition ◽

10.1017/s1368980020000051 ◽

2020 ◽

Vol 23 (12) ◽

pp. 2068-2077 ◽

Cited By ~ 1

Author(s):

Claire Elizabeth Pulker ◽

Heather Robertson Farquhar ◽

Christina Mary Pollard ◽

Jane Anne Scott

Keyword(s):

Nutritional Quality ◽

Cross Sectional Study ◽

Food Groups ◽

Cross Sectional ◽

Nutrition Labels ◽

Star Rating ◽

Photographic Images ◽

Corporate Social

AbstractObjective:To assess the nutritional quality of Australian supermarket own brand chilled convenience foods (SOBCCF), for example, ready meals, pizza, pies and desserts.Design:Cross-sectional.Setting:Two large supermarkets (Coles and Woolworths) in Perth, Western Australia were audited in February 2017.Participants:Data were extracted from photographic images of 291 SOBCCF, including front-of-pack information (i.e. product name, description and nutrition labels including Health Star Rating (HSR)) and back-of-pack information (i.e. nutrition information panel and ingredients list). SOBCCF were classified as healthy or unhealthy consistent with principles of the Australian Guide to Healthy Eating (AGTHE), NOVA classification of level of food processing and HSR score.Results:Fifty-four percentage of SOBCCF were classified as unhealthy according to AGTHE principles, 94 % were ultra-processed foods using NOVA and 81 % scored a HSR of ≥2·5, implying that they were a healthy choice. Some convenience food groups comprised more healthy choices overall including prepared vegetables, salad kits and bowls, soups and vegetarian food. A significantly larger proportion of SOBCCF from Coles were classified as unhealthy compared with Woolworths (70 v. 44 %, P < 0·05) using the AGTHE.Conclusions:The findings suggest there is potential for Australian supermarkets to improve the nutritional quality of their SOBCCF and highlights the differences between supermarkets in applying their corporate social responsibility policies. Policies to assist consumers to select healthier foods should address difficulties in identifying healthy convenience foods. The findings reveal misclassification of unhealthy SOBCCF as healthy by the HSR suggesting that its algorithm should be reformed to align with recommendations of the AGTHE.

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The Impact of the Australasian ‘Health Star Rating’, Front-of-Pack Nutritional Label, on Consumer Choice: A Longitudinal Study

Nutrients ◽

10.3390/nu10070906 ◽

2018 ◽

Vol 10 (7) ◽

pp. 906 ◽

Cited By ~ 8

Author(s):

Robert Hamlin ◽

Lisa McNeill

Keyword(s):

Time Series ◽

New Zealand ◽

Consumer Choice ◽

Experimental Methodology ◽

Rating System ◽

Nutrition Labels ◽

Star Rating ◽

Nutritional Label ◽

The Impact ◽

Retail Food

Front-of-pack (FoP) nutrition labels are a widely deployed tool in public good marketing. This article reports on a field experimental test of the impact of one of these systems, the Australasian Health Star Rating system (HSR), on consumer choice in the breakfast cereals category in New Zealand. This study forms part of a time-series replication stream of research on this topic. The research applied a 2 × 2 factorial design with multiple replications to retail food consumers exiting from supermarkets in New Zealand. The first part of the time series, undertaken shortly after the HSR’s initiation in 2014, indicated that the HSR was ineffective. Between 2014 and 2016, commercial brands in the category within New Zealand massively promoted the HSR as a basis for consumer choice. The research presented in this article forms part of the second part of the series, undertaken in 2016, using an identical experimental methodology to the 2014 study. The results indicate that the HSR may be beginning to influence consumer choice as it was predicted to, but the impact of the system is still small, and statistically sub-significant, relative to other consumer decision inputs presented on the package.

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Effects on Consumers’ Subjective Understanding and Liking of Front-of-Pack Nutrition Labels: A Study on Slovenian and Dutch Consumers

Foods ◽

10.3390/foods10122958 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2958

Author(s):

Angelo Baccelloni ◽

Andrea Giambarresi ◽

Marco Francesco Mazzù

Keyword(s):

The Netherlands ◽

Nutritional Quality ◽

Food Choices ◽

Limited Evidence ◽

Ongoing Debate ◽

Nutrition Labels ◽

Protective Food ◽

Specific Label

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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Impact of Front-of-Pack Nutrition Labels on Portion Size Selection: An Experimental Study in a French Cohort

Nutrients ◽

10.3390/nu10091268 ◽

2018 ◽

Vol 10 (9) ◽

pp. 1268 ◽

Cited By ~ 9

Author(s):

Manon Egnell ◽

Emmanuelle Kesse-Guyot ◽

Pilar Galan ◽

Mathilde Touvier ◽

Mike Rayner ◽

...

Keyword(s):

Food Group ◽

Portion Size ◽

The European Union ◽

Food Category ◽

Web Based ◽

Nutrition Labels ◽

Logistic Regression Models ◽

Traffic Lights ◽

Size Selection ◽

The Impact

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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