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

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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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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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 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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Assessing nutritional value of ready-to-eat breakfast cereals in the province of Quebec (Canada): a study from the Food Quality Observatory

Public Health Nutrition ◽

10.1017/s1368980021001361 ◽

2021 ◽

pp. 1-8

Author(s):

Julie Perron ◽

Sonia Pomerleau ◽

Pierre Gagnon ◽

Joséane Gilbert-Moreau ◽

Simone Lemieux ◽

...

Keyword(s):

Food Quality ◽

Food Supply ◽

Nutritional Quality ◽

Saturated Fat ◽

Nutritional Composition ◽

Breakfast Cereal ◽

Food Category ◽

Breakfast Cereals ◽

Sales Data

Abstract Objective: The Food Quality Observatory was created in the province of Quebec (Canada) in 2016. In this study, the Observatory aimed to generate a methodology to (1) test the use of sales data combined with nutrient values to characterise the nutritional composition of ready-to-eat (RTE) breakfast cereals offered and purchased in the province of Quebec (Canada) and (2) verify the extent to which a front-of-pack label based on the percentage of daily value (DV) for total sugar, as a strategy to improve the food supply, would be distributed in this food category. Design: Nutritional information were obtained by purchasing each RTE breakfast cereal available in the Greater Montreal area. Cereals were then classified according to their processing type. Setting: The nutritional values of 331 RTE breakfast cereals available in Quebec were merged with sales data covering the period between May 2016 and May 2017. A total of 306 products were successfully cross-referenced. Results: Granola and sweetened cereals were the most available (36·6 % and 19·6 %, respectively) and purchased (19·8 % and 40·9 % of sales, respectively). When compared with other types of cereals, granola cereals had a higher energy, fat, saturated fat, protein content and a lower Na content. A larger proportion of chocolate (65 %) and sweetened cereals (49 %) were above 15 % of the DV for sugar. Conclusions: This study showed that the methodology developed generates important data to monitor nutritional quality of the food supply and ultimately contribute to improve the nutritional quality of processed foods.

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A multipurpose tool to evaluate the nutritional quality of individual foods: Nutrimap®

Public Health Nutrition ◽

10.1017/s1368980007382505 ◽

2007 ◽

Vol 10 (7) ◽

pp. 690-700 ◽

Cited By ~ 22

Author(s):

E Labouze ◽

C Goffi ◽

L Moulay ◽

V Azaïs-Braesco

Keyword(s):

Public Health ◽

Nutritional Quality ◽

Nutritional Composition ◽

Consumer Information ◽

Food Category ◽

Health Authorities ◽

Public Health Authorities ◽

Nutritional Needs ◽

Health Objectives

AbstractBackground/objectivesWith obesity and nutrition-related diseases rising, public health authorities have recently insisted nutritional quality be included when advertising and labelling food. The concept of nutritional quality is, however, difficult to define. In this paper we present an innovative, science-based nutrient profiling system, Nutrimap®, which quantifies nutritional assets and weaknesses of foods.MethodsThe position of a food is defined according to its nutritional composition, food category, the consumer's nutritional needs, consumption data and major public health objectives for nutrition. Amounts of each of 15 relevant nutrients (in 100 kcal) are scored according to their ability to ‘rebalance’ or ‘unbalance’ the supply in the whole diet, compared with current recommendations and intakes. These scores are weighted differently in different food categories according to the measured relevance of the category to a nutrient's supply. Positive (assets) and negative (weaknesses) scores are totalled separately.ResultsNutrimap®provides an overall estimate of the nutritional quality of same-category foods, enabling easy comparisons as exemplified for cereals and fruit/vegetables. Results are consistent with major nutritional recommendations and match classifications provided by other systems. Simulations for breakfasts show that Nutrimap®can help design meals of controlled nutritional value.ConclusionsCombining objective scientific bases with pragmatic concerns, Nutrimap®appears to be effective in comparing food items. Decision-makers can set their own limits within the Nutrimap®-defined assets and weaknesses of foods and reach categorisations consistent with their objectives – from regulatory purposes to consumer information or support for designing meals (catering) or new products (food industry).

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Prospective associations between the nutritional quality of foods consumed (graded by the FSAm-NPS underlying the Nutri-Score) and mortality in Europe

Proceedings of The Nutrition Society ◽

10.1017/s0029665120000774 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Mélanie Deschasaux ◽

Inge Huybrechts ◽

Neil Murphy ◽

Chantal Julia ◽

Serge Hercberg ◽

...

Keyword(s):

Cardiovascular Diseases ◽

Mortality Risk ◽

Nutritional Quality ◽

Respiratory Diseases ◽

Food Products ◽

Food Choices ◽

Competing Events ◽

Quality Of Food ◽

Related Mortality

AbstractIn 2017, 11 million deaths related to non-communicable diseases (NCDs) were attributable to dietary risk factors (GBD, 2019). Helping consumers make healthier food choices hence appears as one key strategy to prevent NCDs-related mortality. To this end, political authorities are considering implementing a simple label to reflect the nutritional quality of food products. The five-colour Nutri-Score label, derived from the Nutrient Profiling System of the British Food Standards Agency (FSAm-NPS), has been chosen by several countries in Europe (France, Belgium, Spain). Yet, its implementation is still voluntary per EU labelling regulation. Scientific evidence is therefore needed regarding the relevance of the FSAm-NPS at the European level. Following on our results showing an increased risk of cancer related to the consumption of foods with a high FSAm-NPS score in the EPIC cohort, our objective is now to focus on NCDs-related mortality. Our prospective analyses included 501,594 adults from the EPIC cohort (1992–2015, median follow-up: 17.2 years). Mortality events occurring < 2 years after recruitment were excluded, leaving 50,743 death events (main causes: cancer, n = 21,971; cerebro/cardiovascular diseases, n = 12,407; respiratory diseases, n = 2,796). Usual food intakes were assessed with standardized country-specific diet assessment methods. The FSAm-NPS was calculated for each food/beverage using their 100-g content in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. The individual FSAm-NPS Dietary Index (DI) is obtained as an energy-weighted mean of the FSAm-NPS scores of all food items usually consumed by a participant. Cox proportional hazards models adjusted for confounding factors, including personal history of cancer, cardiovascular diseases and diabetes were computed. Fine and Gray models were also tested to take into account competing events for cause-specific mortality analyses. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the diet, was associated with a higher mortality risk overall (HRQ5vs.Q1 = 1.06 [95%CI: 1.02–1.09], P-trend < 0.001) and by cancer (HRQ5vs.Q1 = 1.06 [1.01–1.11], P-trend = 0.003) and respiratory diseases (HRQ5vs.Q1 = 1.33 [1.16–1.52], P-trend < 0.001), with similar results in competing events analyses. Associations with cerebro-/cardiovascular diseases mortality were weaker (HRQ5vs.Q1 = 1.05 [0.98,1.11], P-trend = 0.04) and no longer statistically significant in competing events analyses. In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality of the foods consumed) was associated with a higher mortality risk, supporting the relevance of the FSAm-NPS to grade the nutritional quality of food products for public health applications (e.g, Nutri-Score) aiming to guide the consumers towards healthier food choices.

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Low-cost foods: how do they compare with their brand name equivalents? A French study

Public Health Nutrition ◽

10.1017/s1368980008003157 ◽

2009 ◽

Vol 12 (6) ◽

pp. 808-815 ◽

Cited By ~ 28

Author(s):

Nicole Darmon ◽

France Caillavet ◽

Caroline Joly ◽

Matthieu Maillot ◽

Adam Drewnowski

Keyword(s):

Nutritional Quality ◽

Low Cost ◽

Quality Score ◽

Food Category ◽

Nutrition Labelling ◽

French Study ◽

Total Fat ◽

Food Budget ◽

The Relationship

AbstractObjectiveConsumers are increasingly relying on low-cost foods, although it is not clear if the nutritional quality of these foods is fully maintained. The aim of the present work was to analyse the relationship between cost and quality within a given food category.Design and settingThe relationship was analysed between nutritional quality and cost for 220 food products belonging to seventeen different categories, controlling for package type and package size. Given that a summary of nutrient information was not available on the product label, a novel ingredient quality score was developed based on listed product ingredients.ResultsWithin a given category, the lowest-priced foods were not different from the equivalent branded products in terms of overall energy or total fat content. Nevertheless, a positive relationship, small but significant, was observed between the price and the ingredient quality score. On average, the branded products cost 2·5 times more than the low-cost products, for an equivalent energy and lipid content, and had a slightly higher (1·3 times) ingredient quality score.ConclusionsMore studies are necessary to evaluate the nutritional quality of low-cost foods. This evaluation would be facilitated if nutrition labelling was mandatory. Yet in view of the present results, it does not seem to be justified to divert consumers, especially the poorest, from low-cost foods because this may have an adverse effect on the nutritional quality of their diet, by reducing further the fraction of their food budget spent on fresh fruit and vegetables.

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Marketing foods to children and adolescents: licensed characters and other promotions on packaged foods in the supermarket

Public Health Nutrition ◽

10.1017/s1368980009991339 ◽

2009 ◽

Vol 13 (3) ◽

pp. 409-417 ◽

Cited By ~ 110

Author(s):

Jennifer L Harris ◽

Marlene B Schwartz ◽

Kelly D Brownell

Keyword(s):

Children And Adolescents ◽

Nutritional Quality ◽

Third Party ◽

Food Marketing ◽

Food Category ◽

Media Companies ◽

Packaged Foods ◽

Marketing To Children ◽

Nutrition Standards

AbstractObjectiveTo analyse cross-promotions targeted to children and adolescents on packaging in the supermarket.DesignOn three occasions from 2006 to 2008, researchers purchased all foods in a large supermarket that included a cross-promotion on the package. A total of 397 products were categorized by promotional partner, food category, targeted age group, promotion type, product nutrition, and company policies on marketing to children.ResultsThe number of products with youth-oriented cross-promotions increased by 78 % during the period examined. Overall, 71 % of cross-promotions involved third-party licensed characters and 57 % appealed primarily to children under 12 years of age; however, the use of other forms of promotions increased from 5 % of the total in 2006 to 53 % in 2008, and promotions targeting pre-school and general audiences increased from 23 % to 54 % of the total. Only 18 % of products met accepted nutrition standards for foods sold to youth, and nutritional quality declined during the period examined. Food manufacturers with policies limiting marketing to children represented 65 % of all youth-oriented cross-promotions, their use of cross-promotions increased significantly, and the nutritional quality of their products did not improve. Some media companies did reduce the use of their properties on food promotions.ConclusionsOverall, the supermarket environment worsened due to an increase in cross-promotions targeted to children and adolescents and a decline in the nutritional quality of these products. This analysis failed to find improvements in food marketing to youth and highlights the need to expand current industry self-regulatory pledges.

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Nutritional quality of foods and beverages on child-care centre menus in Mexico

Public Health Nutrition ◽

10.1017/s1368980012004387 ◽

2012 ◽

Vol 16 (11) ◽

pp. 2014-2022 ◽

Cited By ~ 11

Author(s):

Sara E Benjamin Neelon ◽

Hortensia Reyes-Morales ◽

Jess Haines ◽

Matthew W Gillman ◽

Elsie M Taveras

Keyword(s):

Child Care ◽

Nutritional Quality ◽

Energy Content ◽

High Energy ◽

Whole Grains ◽

Nutrition Intervention ◽

Food Groups ◽

Child Care Centre ◽

Food Category

AbstractObjectiveThe purpose of the present study was to assess the nutritional quality of foods and beverages listed on menus serving children in government-sponsored child-care centres throughout Mexico.DesignFor this cross-sectional menu assessment, we compared (i) food groups and portion sizes of foods and beverages on the menus with MyPlate recommendations and (ii) macronutrients, sugar and fibre with Daily Reference Intake standards.SettingMenus reflected foods and beverages served to children attending one of 142 government-sponsored child-care centres throughout Mexico.SubjectsThere were fifty-four distinct menus for children aged 4–6 months, 7–9 months, 10–12 months, 13–23 months, 24–47 months and 48–72 months.ResultsMenus included a variety of foods meeting minimum MyPlate recommendations for each food category except whole grains for children aged 48–72 months. Menus listed excessive amounts of high-energy beverages, including full-fat milk, fruit juice and sugar-sweetened beverages for children of all ages. The mean daily energy content of menu items yielded an average of 2·76 MJ for infants, 4·77 MJ for children aged 13–23 months, 5·36 MJ for children aged 24–47 months and 5·87 MJ for children aged 48–72 months. Foods and beverages on menus provided sufficient grams of carbohydrate and fat, but excessive protein.ConclusionsMenus provided a variety of foods but excessive energy. Whole grains were limited, and high-energy beverages were prevalent. Both may be appropriate targets for nutrition intervention. Future studies should move beyond menus and assess what children actually consume in child care.

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Are campus food environments healthy? A novel perspective for qualitatively evaluating the nutritional quality of food sold at foodservice facilities at a Brazilian university

Perspectives in Public Health ◽

10.1177/1757913916636414 ◽

2016 ◽

Vol 137 (2) ◽

pp. 122-135 ◽

Cited By ~ 9

Author(s):

Isadora Santos Pulz ◽

Paula Andréa Martins ◽

Charles Feldman ◽

Marcela Boro Veiros

Keyword(s):

Food Environment ◽

Nutritional Quality ◽

Food Choices ◽

Healthy Food ◽

Food Environments ◽

Cross Sectional ◽

Food Ingredients ◽

Nutrition Environment ◽

Food And Beverage

Aims: The purpose of this novel study was to evaluate the food environment at a Brazilian university, encompassing 6 restaurants and 13 snack bars. The investigation uniquely analyses the food environment (barriers, facilitators, type of foods and prices). This was a food-based analysis of the nutritional quality of the products sold on campus. Methods: A cross-sectional descriptive design was used, applying the classic Nutrition Environment Measures Survey–Restaurants (NEMS-R) adapted for Brazil and an original methodology to evaluate and classify qualitatively the nutritional quality and characteristics of the food. A census of all campus food environments was applied. Results: The main results show most food and beverage products were made with processed ingredients and had a lower nutritional quality and price when compared with similar products made on premises, that is, processed iced tea compared with fresh tea ( p < .001), fried refined flour salgados compared with baked wholegrain flour salgados ( p < .001) and refined flour biscuits compared with those made with whole grains ( p = .028). Only 16% of the outlets provided food ingredients or nutritional information of products available. Conclusion: The overall options for healthy food choices and good nutritional quality on campus were mostly limited by the availability and higher prices of products. These findings could be used to develop new policy perspectives for the offering of healthy food items and to facilitate better food choices among students in a healthier food environment.

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