Bulgarian consumers’ objective understanding of front-of-package nutrition labels: a comparative, randomized 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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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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Polish Consumers’ Understanding of Different Front-of-Package Food Labels: A Randomized Experiment

Foods ◽

10.3390/foods11010134 ◽

2022 ◽

Vol 11 (1) ◽

pp. 134

Author(s):

Valentina A. Andreeva ◽

Manon Egnell ◽

Katarzyna Stoś ◽

Beata Przygoda ◽

Zenobia Talati ◽

...

Keyword(s):

Randomized Study ◽

Food Labels ◽

Warning Label ◽

Ongoing Debate ◽

Dietary Practices ◽

Traffic Lights ◽

Behavioral Factor ◽

Objective Understanding ◽

Ranking Tasks ◽

Quality Ranking

Dietary practices are a key behavioral factor in chronic disease prevention; one strategy for improving such practices population-wise involves front-of-package labels (FoPL). This online randomized study, conducted in a quota-based sample of 1159 Polish adults (mean age = 40.9 ± 15.4 years), assessed the objective understanding of five FoPL: Health Star Rating, Multiple Traffic Lights, NutriScore, Reference Intakes (RI) and Warning Label. Objective understanding was evaluated by comparing results of two nutritional quality ranking tasks (without/with FoPL) using three food categories (breakfast cereals, cakes, pizza). Associations between FoPL exposure and objective understanding were assessed via multivariable ordinal logistic regression. Compared to RI and across food categories, significant improvement in objective understanding was seen for NutriScore (OR = 2.02; 95% CI: 1.41–2.91) and Warning Label (OR = 1.61; 95% CI: 1.12–2.32). In age-stratified analyses, significant improvement in objective understanding compared to RI emerged mainly among adults aged 18–30 years randomized to NutriScore (all food categories: OR = 3.88; 95% CI: 2.04–7.36; cakes: OR = 6.88; 95% CI: 3.05–15.51). Relative to RI, NutriScore was associated with some improvement in objective understanding of FoPL across and within food categories, especially among young adults. These findings contribute to the ongoing debate about an EU-wide FoPL model.

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