Do nutrition labels influence healthier food choices? Analysis of label viewing behaviour and subsequent food purchases in a labelling intervention trial

Role of Front-of-Package Gluten-Free Product Labeling in a Pair-Matched Study in Women with and without Celiac Disease on a Gluten-Free Diet

Gluten-free (GF) product labeling is one of the most important determinants of food product choices by patients with celiac disease, due to the need for following a GF diet. The aim of this study was to assess the role of front-of-package GF product labeling in pair-matched celiac and non-celiac women on a GF diet in a choice experiment (CE). In subgroups of celiac (n = 77) and non-celiac pair-matched respondents on a GF diet, but with no gluten-related diseases diagnosed (n = 77), the influence of front-of package labeling of GF bread on the choice of products was assessed. The labeling assessed in a CE included for all the products crossed grain logotype and additional logotypes of European Union (EU) organic production, “dairy-free” product, wheat starch-free product, quality and vegan product, as well as additional “gluten-free” written information. It was stated that the frequency of selection of products with “gluten-free” written information did not differ between subgroups of celiac and non-celiac respondents, as well as in subgroups stratified by age, body mass index (BMI), place of residence, and economic status. The frequency of selection of products with “vegan” logotype was higher for non-celiac respondents than for celiac ones (p = 0.0011). The frequency of selection of a product with additional logotypes was influenced by BMI and place of residence, but not by age and economic status of assessed women.

Reading the Nutritional Information on Food Labels Among Teachers with and without Hypertension in Brazil

BACKGROUND

To examine the associations among nutritional label use, medically diagnosed hypertension, and sociodemographic factors among teachers.

METHODS

A cross-sectional study of elementary and secondary school teachers in Londrina, Paraná, Brazil, was conducted. Data regarding sociodemographic variables, hypertension diagnosis, and the reading of nutritional information on food/beverage labels were collected in 2012-2013. Associations were analyzed using Chi-square test or Fisher's exact test, and multivariate binary logistic regression models were used to adjust for possible confounders; odds ratios (ORs), 95% confidence intervals (CIs), and adjusted P values were calculated.

RESULTS

Of the 978 teachers interviewed, 15% were diagnosed with hypertension, and 62.5% read nutritional information in the 12 months prior to the survey (41% frequently or always). No differences were found between teachers with and without hypertension with regard to frequent reading (frequently/always) of nutritional labels. The frequent use of nutritional labels was significantly associated with female sex (OR = 1.39; 95% CI = 1.04-1.85) and the highest monthly family income level (OR = 1.82; 95% CI = 1.07-3.11). Teachers with hypertension reported checking for sodium more frequently than those without (adjusted P value = 0.040). Medical advice (adjusted P value <0.001) and choosing healthier foods (adjusted P value = 0.002) were the major reasons for reading labels provided by teachers with and without hypertension, respectively.

CONCLUSIONS

Checking for sodium values on nutritional labels was significantly higher among teachers with hypertension, which most likely results from medical advice, and was the major reported reason for reading these labels.

Delay discounting and its association with food purchasing considerations and food availability in the home in south-east Alabama, USA

Objective

Certain factors, such as food quality, label content and grocery characteristics, may be considered when purchasing foods. Food availability in the home has been shown to influence dietary behaviours, also associated with delay discounting (DD). The present study sought to characterize the relationships between DD, food purchasing considerations and healthfulness of foods in the home.

Design

A cross-sectional, online survey of adults (n 477) was conducted with the following measures: DD, consideration of food quality (nutrition, taste) and grocery characteristics (price, ease of preparation, shelf-life) while shopping, use of food labels and food availability in the home. DD was assessed by the area under the delay discounting curve (AUC) using a binary choice task. Greater AUC reflects lower DD. Structural equation modelling was used to allow AUC to simultaneously predict purchasing considerations and foods in the home.

Setting

Online survey.

Participants

Adult employees in south-east Alabama, USA.

Results

DD was negatively associated with food label use and emphasis on food quality when shopping (P<0·001). In the final model, DD was associated with availability of healthful foods in the home and emphasis on food quality and grocery characteristics. About 33 % of the variance in shopping behaviours, 5 % in food label use, 7 % in availability of healthful foods and 4 % in availability of unhealthful foods was explained by DD.

Conclusions

Individuals with lower DD appear to be more thoughtful in making food purchasing decisions and have healthful foods available in the home more frequently than individuals with higher DD.

Impact of warning labels on sugar-sweetened beverages on parental selection: An online experimental study

Sugar-sweetened beverages (SSBs) are one of the largest added sugar sources to diets in the UK and USA, particularly among young people. Warning labels, including calorie information labels, could reduce SSB consumption but uncertainty surrounds the labels that are most effective. This study assessed the impact of labels containing (a) each of two image-based warnings and (b) calorie information, singly and together, on SSB selection by parents of 11-16-year-olds living in the UK. Using a 3 (disease image, sugar content image, no image) × 2 (calorie information, no calorie information) between-subjects experimental design, 2002 participants were randomised to see beverages with one of six labels and selected one for their child to consume. The primary outcome was the proportion of participants selecting an SSB. Data were collected in December 2017. Logistic regressions showed SSB selection was lower when labels contained an image-based warning (35%), compared to not having any label (49%) or just calorie information (43.5%). The disease image lowered selection more than the sugar image (32% vs 40.5%). Providing calorie information with the disease image had no additional impact on selection (33%) but enhanced the impact of the sugar image (36%). Image-based warning labels discourage SSB selection by parents for their children. Images depicting health consequences of excess sugar consumption have larger effects than those depicting sugar content. Calorie information does not add to the effect of the former but does to that of the latter. Field studies are needed to assess the impact of SSB warning labels in real-life settings.

Personal Involvement Moderates Message Framing Effects on Food Safety Education among Medical University Students in Chongqing, China

OBJECTIVE

This study explored whether the efficacy of food safety education interventions can be increased by message framing among medical university students, and demonstrated the role of personal involvement within the message recipient in moderating framed effects.

METHODS

A cross-sectional study of food safety message framing was conducted among medical university students (randomly selected 1353 participants). An online self-administered questionnaire was used to collect information. Wilcoxon rank-sum test and Ordered multivariate logistic regression were utilised in the data analyses.

RESULTS

The present study showed significant differences in acceptance between the gain- and loss-framed groups (p < 0.001). Participants with higher personal involvement had higher acceptance than those with low personal involvement in gain- and loss-framed message models (p < 0.001). The acceptance of participants who were concerned about their health condition was higher than those who were neutral regarding their health condition (p < 0.001) and participants who suffered a food safety incident had higher acceptance than those who did not (p < 0.05).

CONCLUSIONS

This study portrayed the selection preference of message framing on food safety education among medical university students in southwest China. Participants exposed to loss-framed messages had higher message acceptance than those exposed to gain-framed messages. Personal involvement may affect the food safety message framing. Public health advocates and professionals can use framed messages as a strategy to enhance intervention efficacy in the process of food safety education.

Nutrition Labelling Use and Higher Adherence to Mediterranean Diet: Results from the DiSA-UMH Study

The aim of this study was to identify determinants of the nutrition labelling (NL) use and explore its association with the adherence to Mediterranean Diet (MD) in Spanish health university students. We performed a cross-sectional analysis of the baseline data from 1026 university students aged 17-35 years enrolled in the DiSA-UMH (Dieta, Salud y Antropometría-Universidad Miguel Hernández) cohort study. Students were asked about their NL use by the following question: "Do you usually read the nutrition labelling of packaged foods?" (No, Yes). Dietary intake was assessed using a validated food frequency questionnaire and the adherence to MD was measured by relative Mediterranean Diet score (rMED). Socio-demographic, lifestyle, and anthropometric variables were also collected. Multiple logistic regression models were applied for the analysis. Fifty-eight percent of the students were NL users and were most likely to be women (Odds Ratio (OR): 1.38; 95% Confidence Interval (CI): 1.01-1.89), be older (OR per year: 1.08; 95% CI: 1.03-1.13), be physically active/very active (OR: 1.68; 95% CI: 1.17-2.41), and spend less time watching television (OR per hour: 0.84; 95% CI: 0.74-0.95). After adjusting for potential confounding factors, our findings suggested that those university students who had higher adherence to MD used NL greatly (OR per 2 points increase: 1.30; 95% CI: 1.18-1.43) and had a larger consumption of fish (OR per 100 g/day: 1.94; 95 CI: 1.38-2.71), vegetables (OR per 100 g/day: 1.15; CI 95%: 1.08-1.12), and fruits (OR per 100 g/day: 1.22; 1.11-1.34) and a smaller intake of meats (OR per 100 g/day: 0.76; 95% CI: 0.58-0.99). Our approach contributes to exploring the role of NL use as a suitable tool to make healthier food choices from a different wider perspective based on dietary patterns such as MD, which can also indicate an overall healthy lifestyle. Given the lack of research in Mediterranean areas, further studies focused on exploring the potential role of NL in promoting healthy dietary habits are required.