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Pettigrew S, Jongenelis M, Maganja D, Hercberg S, Julia C. The Ability of Nutrition Warning Labels to Improve Understanding and Choice Outcomes Among Consumers Demonstrating Preferences for Unhealthy Foods. J Acad Nutr Diet 2024; 124:58-64.e1. [PMID: 37673335 DOI: 10.1016/j.jand.2023.08.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/04/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Given growing interest in warning labels as a form of front-of-pack nutrition label, it is important to better understand the mechanisms via which these labels may exert their effects, especially among those making suboptimal food choices. OBJECTIVE The study aim was to assess the extent to which consumers with the weakest outcomes for objective understanding and choice in no-label conditions were able to improve their understanding and choices after exposure to warning labels on food product options. DESIGN Post-hoc analyses of the cross-sectional FOP-ICE (Front-of-Pack International Comparative Experimental) study data generated from an online survey that included simulated food choice and nutritional quality ranking scenarios. PARTICIPANTS/SETTING Participants included 3,680 adults from the following 18 countries: Argentina, Australia, Belgium, Bulgaria, Canada, Denmark, France, Germany, Italy, Mexico, Netherlands, Poland, Portugal, Singapore, Spain, Switzerland, United Kingdom, and United States. INTERVENTION Survey respondents selected their preferred product options and ranked foods according to their healthiness before and after exposure to mock breakfast cereal, cake, and pizza products displaying warning labels. MAIN OUTCOME MEASURES Objective understanding and food choice were measured. STATISTICAL ANALYSES PERFORMED Within each product category, analyses were conducted on respondents who initially incorrectly identified the healthiest option and/or selected the unhealthiest option as their preferred choice. Significant differences between proportions selecting each understanding and choice response option were assessed using 2-sample z tests for proportions. RESULTS Salience of the warning labels was low; 46% reported noticing the labels while completing the survey. Just over one-third of those aware of the presence of warning labels were able to identify the least healthy option in the post-exposure condition. Approximately one-half reselected the least healthy option post exposure and just over one-fourth switched to the healthiest option. CONCLUSIONS The results indicated that warning labels can assist some consumers to improve their food quality assessments and choices. However, design improvements could enhance the salience and interpretability of this label format.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - Michelle Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Damian Maganja
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Serge Hercberg
- Sorbonne Paris Nord University, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center, Universite Paris Cite, Paris, France; Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Chantal Julia
- Sorbonne Paris Nord University, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center, Universite Paris Cite, Paris, France; Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
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Pan L, Xie C, Liu M. Development of nutrition label use scale for patients of coronary heart disease and examination of its reliability and validity. Front Psychol 2023; 14:1168951. [PMID: 37885741 PMCID: PMC10598845 DOI: 10.3389/fpsyg.2023.1168951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Background A proper evaluation on the intention of using nutrition label in patients with coronary heart disease (CHD) is crucial to design and formulate of behavior-based interventions. A valid and reliable instrument based on theoretical basis is needed to measure individual intention toward nutrition label use and identify underlying socio-cognitive factors. Object To develop and test validity and reliability of the theoretically based nutrition label use (NLU) scale and to promote the use of nutrition labels in CHD patients. Methods A questionnaire was developed based on the theory of planned behavior (TPB), empirical literatures, expert review and pilot tested. A total of 460 CHD patients in a hospital in Changsha were investigated using this questionnaire from April 2021 to August 2021. The items and dimensions in the scale were explored and confirmed using item-analysis, content validity, exploratory factor analytical (EFA), confirmatory factor analytical (CFA), internal consistency and split-half reliability tests. Results A total of 33 items with 4 structural factors were identified, including 10 items of attitude, 6 items of subjective norm, 12 items of perceived behavior control, and 5 items of intention. The total variance explained by the EFA model was 68.563%. The model was further tested with CFA. The measurement model fitted the data well (Ratio of chi-square minimum and degree of freedom (CMIN/DF) =1.743, goodness of fit index (GFI) =0.814, incremental fit index (IFI) =0.946, Tuker-Lewis index (TLI) =0.940, the comparative fit index (CFI) =0.945, the root mean square error of approximation (RMSEA) =0.057). The content validation index (CVI) of the scale was 0.82, and the CVI of the items ranged from 0.8 to 1.00. The reliability of the scale was 0.976 (p < 0 0.001) using Cronbach's alpha and 0.937 (p < 0.001) using the split-half coefficient. Conclusion The newly developed Nutrition Label Use Scale can serve as a valid and reliable tool to evaluate the nutrition label use of CHD patients.
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Affiliation(s)
- Lu Pan
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Caixia Xie
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mengjiao Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
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Graham DJ, Lucas-Thompson RG, Slejko G. The Role of Front-of-Package Nutrition Labels with and without Explanatory Videos on Parent and Child Food Choices. Nutrients 2023; 15:4082. [PMID: 37764865 PMCID: PMC10537255 DOI: 10.3390/nu15184082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/12/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this research was to determine whether parent/child pairs choosing products from a grocery aisle labeled with front-of-package (FOP) nutrition labels would make more healthful choices than pairs who viewed the same items without labels, and to determine the added value of viewing an explanatory video before choosing. In this experiment, 175 parent/child pairs chose USD 20 worth of packaged foods and beverages from a grocery aisle in a research laboratory and were randomly assigned to see products that either did or did not have 0-4-star FOP labels, with more stars indicating more healthful products. Among those participants with access to FOP labels, half were randomly assigned to view a 30 s video explaining the FOP labels before selecting foods. Participants who saw the explanatory video before selecting among products with FOP labels chose foods with significantly more stars than participants who saw the FOP-labeled products without the video; however, there was no significant difference in mean stars on selected products between the group that saw the videos and the control group that saw neither the video nor FOP labels. We conclude that explaining new FOP labels to consumers may be necessary for the labels to prompt more healthful choices.
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Affiliation(s)
- Dan J Graham
- Department of Psychology, College of Natural Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Rachel G Lucas-Thompson
- Department of Human Development and Family Studies, College of Health and Human Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Gina Slejko
- Department of Marketing, College of Business, Colorado State University, Fort Collins, CO 80523, USA
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Grummon AH, Gibson LA, Musicus AA, Stephens-Shields AJ, Hua SV, Roberto CA. Effects of 4 Interpretive Front-of-Package Labeling Systems on Hypothetical Beverage and Snack Selections: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2333515. [PMID: 37703015 PMCID: PMC10500374 DOI: 10.1001/jamanetworkopen.2023.33515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023] Open
Abstract
Importance Policymakers and researchers have proposed a variety of interpretative front-of-package food labeling systems, but it remains unclear which is most effective at encouraging people to choose healthier foods and beverages, including among people with less education. Objective To test the effects of 4 interpretative front-of-package food labeling systems on the healthfulness of beverage and snack selections, overall and by education level. Design, Setting, and Participants This randomized clinical trial of a national sample of US adults 18 years and older was conducted online from November 16 to December 3, 2022. Intervention Participants were randomized to view products with 1 of 5 food labeling systems, including control (calorie labels only) or 1 of 4 interpretative labeling systems: green ("choose often") labels added to healthy foods; single traffic light labels added to healthy, moderately healthy, and unhealthy foods; physical activity calorie equivalent labels added to all products; and nutrient warning labels added to products high in calories, sugar, saturated fat, or sodium. All conditions had calorie labels on all products. Main Outcomes and Measures Participants selected 1 of 16 beverages and 1 of 16 snacks that they wanted to hypothetically purchase. The primary outcomes were calories selected from beverages and from snacks. Secondary outcomes included label reactions and perceptions. Results A total of 7945 participants completed the experiment and were included in analyses (4078 [51%] female, 3779 [48%] male, and 88 [1%] nonbinary or another gender; mean [SD] age, 47.5 [17.9 years]). Compared with the control arm, exposure to the green (average differential effect [ADE], -34.2; 95% CI, -42.2 to -26.1), traffic light (ADE, -31.5; 95% CI, -39.5 to -23.4), physical activity (ADE, -39.0; 95% CI, -47.0 to -31.1), or nutrient warning labels (ADE, -28.2; 95% CI, -36.2 to -20.2) led participants to select fewer calories from beverages (all P < .001). Similarly, compared with the control label, exposure to the green (ADE, -12.7; 95% CI, -17.3 to -8.2), traffic light (ADE, -13.7; 95% CI, -18.2 to -9.1), physical activity (ADE, -18.5; 95% CI, -23.1 to -13.9), or nutrient warning labels (ADE, -14.2; 95% CI, -18.8 to -9.6) led participants to select fewer calories from snacks (all P < .001). These effects did not differ by education level. The green labels were rated as less stigmatizing than the other interpretative systems but otherwise generally received the least favorable label reactions and perceptions (eg, elicited less attention, were perceived as less trustworthy), while the nutrient warnings and physical activity labels received the most favorable ratings. Conclusions and Relevance In this randomized clinical trial of front-of-package food labeling systems, all 4 interpretative labeling systems reduced calories selected from beverages and from snacks compared with calorie labels, with no differences by education level. Trial Registration ClinicalTrials.gov Identifier: NCT05432271.
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Affiliation(s)
- Anna H. Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Department of Health Policy, Stanford University School of Medicine, Stanford, California
| | - Laura A. Gibson
- Department of Medical Ethics and Healthy Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Aviva A. Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Now with Center for Science in the Public Interest, Washington, DC
| | - Alisa J. Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sophia V. Hua
- Department of Medical Ethics and Healthy Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christina A. Roberto
- Department of Medical Ethics and Healthy Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Stiletto A, Cei L, Trestini S. A Little Bird Told Me… Nutri-Score Panoramas from a Flight over Europe, Connecting Science and Society. Nutrients 2023; 15:3367. [PMID: 37571304 PMCID: PMC10421117 DOI: 10.3390/nu15153367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Within the Farm to Fork Strategy, the European Commission ask for a unified Front Of Pack nutritional label for food to be used at the European level. The scientific debate identified the Nutri-Score (NS) as the most promising candidate, but within the political discussion, some Member States brought to attention several issues related to its introduction. This misalignment led to a postponement of the final decision. With the aim to shed some light on the current stances and contribute to the forthcoming debate, the objective of the present work is to understand to what extent scientific research addresses the issues raised by the general public. We applied a structural topic model to tweets from four European countries (France, Germany, Italy, Spain) and to abstracts of scientific papers, all dealing with the NS topic. Different aspects of the NS debate are discussed in different countries, but scientific research, while addressing some of them (e.g., the comparison between NS and other labels), disregards others (e.g., relations between NS and traditional products). It is advisable, therefore, to widen the scope of NS research to properly address the concerns of European society and to provide policymakers with robust evidence to support their decisions.
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Affiliation(s)
| | | | - Samuele Trestini
- Department of Land, Environment, Agriculture and Forestry, University of Padova, 35020 Legnaro, Italy; (A.S.); (L.C.)
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A Diet Profiling Algorithm (DPA) to Rank Diet Quality Suitable to Implement in Digital Tools—A Test Study in a Cohort of Lactating Women. Nutrients 2023; 15:nu15061337. [PMID: 36986066 PMCID: PMC10051632 DOI: 10.3390/nu15061337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
Although nutrient profiling systems can empower consumers towards healthier food choices, there is still a need to assess diet quality to obtain an overall perspective. The purpose of this study was to develop a diet profiling algorithm (DPA) to evaluate nutritional diet quality, which gives a final score from 1 to 3 with an associated color (green-yellow-orange). It ranks the total carbohydrate/total fiber ratio, and energy from saturated fats and sodium as potentially negative inputs, while fiber and protein are assumed as positive items. Then, the total fat/total carbohydrate ratio is calculated to evaluate the macronutrient distribution, as well as a food group analysis. To test the DPA performance, diets of a lactating women cohort were analyzed, and a correlation analysis between DPA and breast milk leptin levels was performed. Diets classified as low quality showed a higher intake of negative inputs, along with higher energy and fat intakes. This was reflected in body mass index (BMI) and food groups, indicating that women with the worst scores tended to choose tastier and less satiating foods. In conclusion, the DPA was developed and tested in a sample population. This tool can be easily implemented in digital nutrition platforms, contributing to real-time dietary follow-up of patients and progress monitoring, leading to further dietary adjustment.
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Nutri-Score: Its Benefits and Limitations in Children's Feeding. J Pediatr Gastroenterol Nutr 2023; 76:e46-e60. [PMID: 36399776 DOI: 10.1097/mpg.0000000000003657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Reducing the burden of noncommunicable diseases (NCDs) is one of the top priorities of public health policies worldwide. One of the recognized means of achieving this objective is to improve the diet quality. The Nutri-Score (N-S) is a [five-color-A, B, C, D, E letters] front-of-pack labeling logo intended to help consumers quickly identify the healthier prepackaged foods within a food category. Available studies have shown that the N-S is an efficient tool to achieve this aim in terms of consumers' awareness, perception, understanding, and purchasing and that its use may help to reduce the prevalence of NCDs. The N-S is currently implemented on a voluntary basis in 7 European countries and a discussion is underway within the European Commission to achieve a harmonized mandatory label. However, no study on the putative impact of the N-S on children's dietary patterns and health is available. The N-S is not applicable to infants' and young children's formulas and to specific baby foods, the compositions of which are already laid down in European Union regulations. The N-S does not replace age-appropriate dietary guidelines. As children consume an increasing number of adult type and processed foods, the relevance of the N-S for children should be evaluated considering the children's high specific requirements, especially in younger children. This is especially necessary for fitting fat and iron requirements, whereas protein-rich foods should be better framed. Moreover, efforts should be made to inform on how to use the N-S and in education on healthy diets.
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Hafner E, Pravst I. Comparison of Nutri-Score and Health Star Rating Nutrient Profiling Models Using Large Branded Foods Composition Database and Sales Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3980. [PMID: 36900987 PMCID: PMC10002453 DOI: 10.3390/ijerph20053980] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Front-of-package nutrition labelling (FOPNL) is known as an effective tool that can encourage healthier food choices and food reformulation. A very interesting type of FOPNL is grading schemes. Our objective was to compare two market-implemented grading schemes-European Nutri-Score (NS) and Australian Health Star Rating (HSR), using large Slovenian branded foods database. NS and HSR were used for profiling 17,226 pre-packed foods and drinks, available in Slovenian food supply dataset (2020). Alignment between models was evaluated with agreement (% of agreement and Cohen's Kappa) and correlation (Spearman rho). The 12-month nationwide sales-data were used for sale-weighing, to address market-share differences. Study results indicated that both models have good discriminatory ability between products based on their nutritional composition. NS and HSR ranked 22% and 33% of Slovenian food supply as healthy, respectively. Agreement between NS and HSR was strong (70%, κ = 0.62) with a very strong correlation (rho = 0.87). Observed profiling models were most aligned within food categories Beverages and Bread and bakery products, while less aligned for Dairy and imitates and Edible oils and emulsions. Notable disagreements were particularly observed in subcategories of Cheese and processed cheeses (8%, κ = 0.01, rho = 0.38) and Cooking oils (27%, κ = 0.11, rho = 0.40). Further analysis showed that the main differences in Cooking oils were due to olive oil and walnut oil, which are favoured by NS and grapeseed, flaxseed and sunflower oil that are favoured by HSR. For Cheeses and cheese products, we observed that HSR graded products across the whole scale, with majority (63%) being classified as healthy (≥3.5 *), while NS mostly graded lower scores. Sale-weighting analyses showed that offer in the food supply does not always reflect the sales. Sale-weighting increased overall agreement between profiles from 70% to 81%, with notable differences between food categories. In conclusion, NS and HSR were shown as highly compliant FOPNLs with few divergences in some subcategories. Even these models do not always grade products equally high, very similar ranking trends were observed. However, the observed differences highlight the challenges of FOPNL ranking schemes, which are tailored to address somewhat different public health priorities in different countries. International harmonization can support further development of grading type nutrient profiling models for the use in FOPNL, and make those acceptable for more stake-holders, which will be crucial for their successful regulatory implementation.
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Affiliation(s)
- Edvina Hafner
- Nutrition Institute, Tržaška Cesta 40, SI-1000 Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
| | - Igor Pravst
- Nutrition Institute, Tržaška Cesta 40, SI-1000 Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
- VIST—Faculty of Applied Sciences, Gerbičeva Cesta 51A, SI-1000 Ljubljana, Slovenia
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Pettigrew S, Jongenelis MI, Talati Z, Dana LM, Hercberg S, Julia C. The ability of five different front-of-pack labels to assist Australian consumers to identify healthy versus unhealthy foods. Aust N Z J Public Health 2023; 47:100017. [PMID: 36641957 DOI: 10.1016/j.anzjph.2022.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the relative ability of different interpretive front-of-pack food labels to alert consumers to both healthier and unhealthier options to inform their food choices. METHODS One thousand Australians completed an online experiment where they rated the nutritional quality of sets of fictional products pre- and post-randomisation to one of five front-of-pack labels: Health Star Rating, Multiple Traffic Lights, Nutri-Score, Reference Intakes and Warning Label. Two sample z-tests were used to assess the ability of each label to facilitate the correct identification of the least and most healthy product options. RESULTS The Nutri-Score was superior in assisting respondents to identify both the healthiest and unhealthiest options. The Health Star Rating ranked second for both outcomes, followed by the Multiple Traffic Lights. CONCLUSIONS Results reinforce the role of interpretive front-of-pack labels in assisting consumers to understand the nutritional quality of food products and suggest spectrum labels may provide superior utility in assisting consumers to identify both the most and least nutritious products from among available product options. IMPLICATIONS FOR PUBLIC HEALTH The strongest performance of a highly interpretive front-of-pack label (Nutri-Score) featuring colour in a summary indicator suggests potential strategies for enhancing the performance of the Health Star Rating.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Australia.
| | - Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Zenobia Talati
- School of Population Health, Curtin University, Western Australia, Australia
| | - Liyuwork M Dana
- School of Population Health, Curtin University, Western Australia, Australia
| | - Serge Hercberg
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris-Cité (CRESS), Bobigny, France; Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Chantal Julia
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris-Cité (CRESS), Bobigny, France; Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
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Grummon AH, Musicus AA, Moran AJ, Salvia MG, Rimm EB. Consumer Reactions to Positive and Negative Front-of-Package Food Labels. Am J Prev Med 2023; 64:86-95. [PMID: 36207203 PMCID: PMC10166580 DOI: 10.1016/j.amepre.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The National Academy of Medicine recommends that the U.S. adopt an interpretative front-of-package food labeling system, but uncertainty remains about how this system should be designed. This study examined reactions to front-of-package food labeling systems that use positive labels to identify healthier foods, negative labels to identify unhealthier foods, or both. METHODS In August 2021, U.S. adults (N=3,051) completed an online randomized experiment. Participants were randomly assigned to 1 of 4 labeling conditions: control (calorie), positive, negative, or both positive and negative labels. Labels were adapted from designs for a 'healthy' label drafted by the Food and Drug Administration and displayed on the front of product packaging. Participants selected products to purchase, identified healthier products, and reported reactions to the labels. Analyses, conducted in 2022, examined the healthfulness of participants' selections using the Ofcom Nutrient Profiling Model score (0-100, higher scores indicate being healthier). RESULTS Participants exposed to only positive labels, only negative labels, or both positive and negative labels had healthier selections than participants in the control arm (differences vs control=1.13 [2%], 2.34 [4%] vs 3.19 [5%], respectively; all p<0.01). The both-positive-and-negative-labels arm outperformed the only-negative-labels (p=0.03) and only-positive-labels (p<0.001) arms. The only-negative-labels arm outperformed the only-positive-labels arm (p=0.005). All the 3 interpretative labeling systems also led to improvements in the identification of healthier products and beneficial psychological reactions (e.g., attention, thinking about health effects; all p<0.05). CONCLUSIONS Front-of-package food labeling systems that use both positive and negative labels could encourage healthier purchases and improve understanding more than systems using only positive or only negative labels.
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Affiliation(s)
- Anna H Grummon
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alyssa J Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Meg G Salvia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Pettigrew S, Jongenelis MI, Hercberg S, Julia C. Front-of-pack nutrition labels: an equitable public health intervention. Eur J Clin Nutr 2023; 77:135-137. [PMID: 36085363 PMCID: PMC9876787 DOI: 10.1038/s41430-022-01205-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 01/29/2023]
Abstract
It is important for nutrition interventions to be equitable to ensure they do not widen socioeconomic health-based inequalities. The role of front-of-pack nutrition labels is to provide accessible and easily understood information on product packages, and it is essential that such labels assist those who are least able to access and interpret other forms of nutrition information. This secondary analysis of the FOP-ICE food labelling study involving 18 countries (N = 18,393) assessed whether five different front-of-pack labels varied in effectiveness according to income status. The two outcome variables were objective understanding of products' nutritional quality and product choice. While there were substantial differences in the ability of individual labels to improve understanding, for each label and across all labels combined there were no significant differences in changes in both outcome variables by income category. The results provide evidence that interpretive front-of-pack nutrition labels are an equitable and useful nutrition intervention.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
| | - Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Serge Hercberg
- Sorbonne Paris Nord University, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center- Université Paris Cité, Bobigny, France
- Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Chantal Julia
- Sorbonne Paris Nord University, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center- Université Paris Cité, Bobigny, France
- Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
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Godden E, Thornton L, Avramova Y, Dens N. High hopes for front-of-pack (FOP) nutrition labels? A conjoint analysis on the trade-offs between a FOP label, nutrition claims, brand and price for different consumer segments. Appetite 2023; 180:106356. [PMID: 36309232 DOI: 10.1016/j.appet.2022.106356] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 12/15/2022]
Abstract
An increasing number of studies investigate the effect of front-of-pack (FOP) nutrition labels on consumer choice without considering differences in consumer preferences for product attributes. This study used a choice-based conjoint analysis to test consumers' preferences for four product attributes (5 levels of a FOP nutrition label, absence/presence of a nutrition claim, brand (unfamiliar, private label or premium) and 5 levels of price) when they coexist (n = 1156). As the consumer preferences showed distinct patterns (multimodality), consumers were subsequently clustered based on how a FOP nutrition label (Nutri-Score) influenced their food choices. Three consumer segments were identified, each valuing the Nutri-Score label differently. The label effectively seems to nudge one segment toward healthier choices (n = 456), while in contrast, another segment is unexpectedly steered toward unhealthier food choices by the label (n = 343). The third segment is only consistently nudged by the FOP label's extremes (n = 357). The segments also differ in their preferences for other product attributes (brand and price), health involvement, and self-reported understanding and use of the Nutri-Score, but not in the measured socio-demographic variables (age, sex, education, social class), dieting or smoking habits. In summary, consumers vary in their food label preferences, and studies that pool consumers may fail to capture these nuances, leading to biased results. This study shows that FOP labels do not steer all consumers toward healthier choices and may even have adverse effects for some. This suggests combining different policies and marketing strategies to reach all consumer segments.
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Affiliation(s)
- Elke Godden
- Faculty of Business and Economics, Department of Marketing, University of Antwerp, Belgium, Prinsstraat 13, 2000, Antwerp, Belgium.
| | - Lukar Thornton
- Faculty of Business and Economics, Department of Marketing, University of Antwerp, Belgium, Prinsstraat 13, 2000, Antwerp, Belgium.
| | - Yana Avramova
- Faculty of Business and Economics, Department of Marketing, University of Antwerp, Belgium, Prinsstraat 13, 2000, Antwerp, Belgium.
| | - Nathalie Dens
- Faculty of Business and Economics, Department of Marketing, University of Antwerp, Belgium, Prinsstraat 13, 2000, Antwerp, Belgium.
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13
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Are Front-of-Pack Nutrition Labels Influencing Food Choices and Purchases, Diet Quality, and Modeled Health Outcomes? A Narrative Review of Four Systems. Nutrients 2023; 15:nu15010205. [PMID: 36615862 PMCID: PMC9824714 DOI: 10.3390/nu15010205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Front-of-Pack Nutrition labels (FOPNLs) aim to improve consumers' food purchases and prompt product reformulation by the food and beverage industry. Despite their widespread use, the effectiveness of FOPNL in achieving these goals is still a matter of debate. This review has gathered 65 original studies exploring the performances of four widely used FOPNLs (Multiple Traffic Light, Warning signs, Nutri-Score and Health Star Rating). Although FOPNLs have been associated with healthier food purchases, the magnitude of improvements was small and dependent on study settings. Any associated health effects were modeled rather than observed. None of the four FOPNLs clearly outperformed the other ones on any outcome. Few studies dealt with the impact of FOPNL on product reformulation. Some of those studies, but not all, found small reductions in energy, sodium, sugar and saturated fat content of foods in some food categories. Although global trends point to a small favorable effect of FOPNL, this conclusion is subject to caution since the evidence is inconsistent and comes from a wide variety of contexts and study designs. There remain numerous research gaps, notably with regard to the optimal characteristics of FOPNLs, the durability of FOPNL effects on consumer behaviors, and any possible unexpected consequences.
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14
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Effects of Digitalized Front-of-Package Food Labels on Healthy Food-Related Behavior: A Systematic Review. Behav Sci (Basel) 2022; 12:bs12100363. [DOI: 10.3390/bs12100363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Front-of-package (FOP) food labels may impact healthy food-related behavior. However, such labels may be presented using new technology and they may impact behavior differently than physical labels. This systematic review investigated the effects of physical and digitalized labels on healthy food-related behavior. This review used four search engines to collect articles that investigated the effects of food labels on the purchase, consumption, hypothetical choice, and self-reports of healthy foods. General findings, types of labels, or whether the articles used physical versus digitalized static, interactive, or technology-enabled labels were synthesized. The dependent variables were categorized according to whether they were under full, partial, or no control of the independent variables. The risk of bias was measured by the RoB 2 tool and adapted Joanna Briggs Institute Checklist. The search strategy identified 285 records and 30 articles were included. While digitalized static and physical labels did not differ in their effects on healthy food-related behavior, technology-enabled labels were more predictive of healthy food-related behavior than interactive labels.
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15
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Uncovering the Effect of European Policy-Making Initiatives in Addressing Nutrition-Related Issues: A Systematic Literature Review and Bibliometric Analysis on Front-of-Pack Labels. Nutrients 2022; 14:nu14163423. [PMID: 36014929 PMCID: PMC9414449 DOI: 10.3390/nu14163423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 12/19/2022] Open
Abstract
The last decades have been marked by the introduction of front-of-pack labels (FoPL) as an institutional corrective action against obesity and nutrition-related illnesses. However, FoPL-related policy-making initiatives issued by the European Union evolved over time and led to a diversity of labels with different effects on consumers’ decisions. As a result, the extant literature adapted to the regulative scenario over the years and investigated the effects of the labels, creating consensus on some topics while being fragmented on others. Similarly, policy-makers adapted some regulations to the evidence supported by the research. With the aim to systematize the overall structure and evolution of the literature on FoPL, investigate the presence of a consensus on specific topics through a co-citation analysis, and examine the evolution of the consensus and co-citation networks over the years and potential research gaps, we report the results of bibliometric and co-citation analyses and a systematic literature review involving 170 papers and a selection of 49 articles published in the last months, for a total of 219 articles, analysed according to three timespans (Period 1 (1989–2011); Period 2 (2012–2016) and Period 3 (2017–2022)). Our findings highlight the interplay of policy development and FoPL research, the presence of few self-reinforcing and well-established co-citation networks based on validated evidence in the literature and the presence of alternative emerging theories that offer different and valid perspectives overlooked by mainstream co-citation research networks.
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16
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Pettigrew S, Coyle D, McKenzie B, Vu D, Lim SC, Berasi K, Poowanasatien A, Suya I, Kowal P. A review of front-of-pack nutrition labelling in Southeast Asia: Industry interference, lessons learned, and future directions. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 3:100017. [PMID: 37384259 PMCID: PMC10305914 DOI: 10.1016/j.lansea.2022.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Front-of-pack nutrition labelling is an evidence-based nutrition intervention that is recommended by the World Health Organization and other health agencies as an effective non-communicable disease prevention strategy. To date, the types of front-of-pack labels that have been identified as being most effective have yet to be implemented in Southeast Asia. This has been partly attributed to extensive industry interference in nutrition policy development and implementation. This paper outlines the current state of food labelling policy in the region, describes observed industry interference tactics, and provides recommendations for how governments in Southeast Asia can address this interference to deliver best-practice nutrition labelling to improve diets at the population level. The experiences of four focal countries - Malaysia, Thailand, the Philippines, and Viet Nam - are highlighted to provide insights into the range of industry tactics that are serving to prevent optimal food labelling policies from being developed and implemented. Funding This research was supported by the United Kingdom Global Better Health Programme, which is managed by the United Kingdom Foreign, Commonwealth and Development Office and supported by PricewaterhouseCoopers in Southeast Asia.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, 1 King St Newtown NSW 2042, Sydney, Australia
| | - Daisy Coyle
- The George Institute for Global Health, University of New South Wales, 1 King St Newtown NSW 2042, Sydney, Australia
| | - Briar McKenzie
- The George Institute for Global Health, University of New South Wales, 1 King St Newtown NSW 2042, Sydney, Australia
| | - Duong Vu
- Alive & Thrive Southeast Asia, FHI 360, 7F, Opera Business Center, 60 Ly Thai To Street, Hanoi, Vietnam
| | - Shiang Cheng Lim
- RTI International Malaysia, Unit 5.2 & 5.3, Level 5, Nucleus Tower, Jalan PJU 7/6, Mutiara Damansara Petaling Jaya, Selangor, 47820, Malaysia
| | - Kyra Berasi
- Global Health Advocacy Incubator, 1400 I (Eye) Street NW, Suite 1200, Washington, DC 20005, USA
| | - Amphika Poowanasatien
- FHI360, Asia Pacific Regional Office, 19th Floor, Tower 3, Sindhorn Building, 130-132 Wireless Road, Kwaeng Lumpini, Khet Phatumwan, Bangkok 10330 Thailand
| | - Inthira Suya
- FHI360, Asia Pacific Regional Office, 19th Floor, Tower 3, Sindhorn Building, 130-132 Wireless Road, Kwaeng Lumpini, Khet Phatumwan, Bangkok 10330 Thailand
| | - Paul Kowal
- Better Health Programme Southeast Asia, 7 Straits View, Marina One, Singapore, 018936
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17
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Pettigrew S, Jongenelis M, Jones A, Hercberg S, Julia C. An 18-country analysis of the effectiveness of five front-of-pack nutrition labels. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2022.104691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Braesco V, Ros E, Govindji A, Bianchi C, Becqueriaux L, Quick B. A Slight Adjustment of the Nutri-Score Nutrient Profiling System Could Help to Better Reflect the European Dietary Guidelines Regarding Nuts. Nutrients 2022; 14:nu14132668. [PMID: 35807847 PMCID: PMC9268614 DOI: 10.3390/nu14132668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 02/01/2023] Open
Abstract
The consumption of nuts remains low among European populations despite widespread inclusion as a recommended food group across European dietary guidelines. Front-of-Pack nutrition labelling systems are designed to support consumers make healthier choices and to stimulate product improvement, thus representing a pivotal opportunity to reduce the gap between intakes and recommendations. This study examined how the Nutri-Score algorithm treats nuts and nut-containing products and tested whether slight adjustments could better recognise and motivate nut inclusion in foods and diets. The nutritional score (ScN) and corresponding Nutri-Score letter of 68 nuts and nut-containing products were calculated, using the initial algorithm and slight adjustments, where nut weight was doubled (S1), saturated fats (S2) or energy (S3) from nuts were discounted, or saturated fats were replaced by the saturated fats/lipid ratio (S4). The correlation between the nuts’ content and the ScN was moderate for the initial algorithm (R2 = 0.34) and S1 (R2 = 0.36), but improved for S2, S3 and S4 (R2 = 0.54, 0.55 and 0.52, respectively). Four plain nuts, initially labelled as “B” or “C” obtained a Nutri-Score “A” with S2, S3 and S4. Slight adjustments could better align the Nutri-Score with food-based dietary guidelines, reassure consumers on healthfulness of nuts and nut-containing products, whilst incentivising the inclusion of nuts in diverse foods.
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Affiliation(s)
- Véronique Braesco
- VAB-Nutrition, 63100 Clermont-Ferrand, France;
- Correspondence: ; Tel.: +33-473614414
| | - Emilio Ros
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d’Investigacions Biomediques August Pi Sunyer, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | | | - Lise Becqueriaux
- General Mills, Bell Institute of Health and Nutrition, Minneapolis, MN 55427, USA; (L.B.); (B.Q.)
| | - Belinda Quick
- General Mills, Bell Institute of Health and Nutrition, Minneapolis, MN 55427, USA; (L.B.); (B.Q.)
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19
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Carruba MO, Caretto A, De Lorenzo A, Fatati G, Ghiselli A, Lucchin L, Maffeis C, Malavazos A, Malfi G, Riva E, Ruocco C, Santini F, Silano M, Valerio A, Vania A, Nisoli E. Front-of-pack (FOP) labelling systems to improve the quality of nutrition information to prevent obesity: NutrInform Battery vs Nutri-Score. Eat Weight Disord 2022; 27:1575-1584. [PMID: 34664216 PMCID: PMC9123065 DOI: 10.1007/s40519-021-01316-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 12/31/2022] Open
Abstract
Many systems for classifying food products to adequately predict lower all-cause morbidity and mortality have been proposed as front-of-pack (FOP) nutritional labels. Although the efforts and advances that these systems represent for public health must be appreciated, as scientists involved in nutrition research and belonging to diverse Italian nutrition scientific societies, we would like to draw stakeholders' attention to the fact that some FOP labels risk being not correctly informative to consumers' awareness of nutritional food quality. The European Commission has explicitly called for such a nutrition information system to be part of the European "strategy on nutrition, overweight and obesity-related issues" to "facilitate consumer understanding of the contribution or importance of the food to the energy and nutrient content of a diet". Some European countries have adopted the popular French proposal Nutri-Score. However, many critical limits and inadequacies have been identified in this system. As an alternative, we endorse a new enriched informative label-the NutrInform Battery-promoted by the Italian Ministry of Health and deeply studied by the Center for Study and Research on Obesity, Milan University. Therefore, the present position paper limits comparing these two FOP nutritional labels, focusing on the evidence suggesting that the NutrInform Battery can help consumers better than the Nutri-Score system to understand nutritional information, potentially improving dietary choices. LEVEL OF EVIDENCE: II. Evidence was obtained from well-designed controlled trials without randomization.
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Affiliation(s)
- Michele O Carruba
- Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Milan, Italy.
| | - Antonio Caretto
- Endocrinology, Metabolic Diseases and Clinical Nutrition, Hospital of Brindisi, Brindisi, Italy
| | - Antonino De Lorenzo
- Division of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | | | | | | | - Claudio Maffeis
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alexis Malavazos
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giuseppe Malfi
- Department of Dietetics and Clinical Nutrition, San Giovanni Battista Hospital, Turin, Italy
| | - Enrica Riva
- Italian Society of Paediatric Nutrition, Milan, Italy
| | - Chiara Ruocco
- Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Milan, Italy
| | - Ferruccio Santini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Marco Silano
- Unità Operativa Alimentazione, Nutrizione e Salute, Dipartimento Sicurezza Alimentare, Nutrizione e Sanità Pubblica Veterinaria, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandra Valerio
- Department of Molecular and Translational Medicine, Brescia University, Brescia, Italy
| | - Andrea Vania
- Department of Paediatrics and Paediatric Neuropsychiatry, La Sapienza" University of Rome, Rome, Italy
| | - Enzo Nisoli
- Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Milan, Italy.
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20
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Aguenaou H, Babio N, Deschasaux-Tanguy M, Galan P, Hercberg S, Julia C, Jones A, Karpetas G, Kelly B, Kesse-Guyot E, Kontopoulou L, Labonté ME, Ni Mhurchu C, Pravst I, Pettigrew S, Riboli E, Salas-Salvadó J, Srour B, Touvier M, Vandevijvere S. Comment on Muzzioli et al. Are Front-of-Pack Labels a Health Policy Tool? Nutrients 2022, 14, 771. Nutrients 2022; 14:nu14102165. [PMID: 35631306 PMCID: PMC9145939 DOI: 10.3390/nu14102165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/27/2022] [Indexed: 02/06/2023] Open
Abstract
As scientists working and publishing in the field of front-of-pack nutrition labelling (FOPNL) for many years, we have read with interest and concern the narrative review regarding their effectiveness by Muzzioli et al. [...].
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Affiliation(s)
- Hassan Aguenaou
- Joint Research Unit in Nutrition and Food, RDC-Nutrition AFRA/IAEA, Ibn Tofail University-CNESTEN, Rabat, Kenitra 14000, Morocco;
| | - Nancy Babio
- Departament de Bioquimica i Biotecnologia, Unitat de Nutrició Humana. (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain; (N.B.); (J.S.-S.)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28014 Madrid, Spain
| | - Mélanie Deschasaux-Tanguy
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
| | - Pilar Galan
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
| | - Serge Hercberg
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
- Public Health Department, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
| | - Chantal Julia
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
- Public Health Department, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
- Correspondence:
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia; (A.J.); (S.P.)
| | - Georgios Karpetas
- Laboratory Teaching Staff, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece;
| | - Bridget Kelly
- Early Start, School of Health & Society, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Emmanuelle Kesse-Guyot
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
| | - Lamprini Kontopoulou
- Laboratory Teaching Staff, Nursing Department, University of Thessaly, 41500 Larissa, Greece;
| | - Marie-Eve Labonté
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Québec City, QC G1V 0A6, Canada;
- School of Nutrition, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, The University of Auckland, Auckland 1142, New Zealand;
| | - Igor Pravst
- Nutrition and Public Health Research Group, Nutrition Institute, Trzaska Cesta 40, 1000 Ljubljana, Slovenia;
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia; (A.J.); (S.P.)
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK;
| | - Jordi Salas-Salvadó
- Departament de Bioquimica i Biotecnologia, Unitat de Nutrició Humana. (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain; (N.B.); (J.S.-S.)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28014 Madrid, Spain
| | - Bernard Srour
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
| | - Mathilde Touvier
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
| | - Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Service of Lifestyle and Chronic Diseases, 1050 Brussels, Belgium;
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21
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Fuchs KL, Lian J, Michels L, Mayer S, Toniato E, Tiefenbeck V. Effects of Digital Food Labels on Healthy Food Choices in Online Grocery Shopping. Nutrients 2022; 14:nu14102044. [PMID: 35631185 PMCID: PMC9146588 DOI: 10.3390/nu14102044] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 02/01/2023] Open
Abstract
In order to induce the shift in consumer behavior necessary for the mitigation of diet-related diseases, front-of-package labels (FoPL) such as the Nutri-Score that support consumers in their efforts to identify nutritionally valuable products during grocery shopping have been found to be effective; however, they remain non-compulsory in most regions. Counter-intuitively, a similar stream of research on digital web-based FoPL does not yet exist, even though such digital labels hold several advantages over physical labels. Digital FoPL can provide scalable and personalized interventions, are easier to implement than physical labels, and are especially timely due to the recent increase in online grocery shopping. The goal of this study was to demonstrate the technical feasibility and intervention potential of novel, scalable, and passively triggered health behavior interventions distributed via easy-to-install web browser extensions designed to support healthy food choices via the inclusion of digital FoPL in online supermarkets. To that end, we developed a Chrome web browser extension for a real online supermarket and evaluated the effect of this digital food label intervention (i.e., display of the Nutri-Score next to visible products) on the nutritional quality of individuals’ weekly grocery shopping in a randomized controlled laboratory trial (N = 135). Compared to the control group, individuals exposed to the intervention chose products with a higher nutritional quality (e.g., 8% higher healthy trolley index (HETI), 3.3% less sugar, 7.5% less saturated fat). In particular, users with low food literacy seemed to benefit from the digital FoPL (e.g., 11% higher HETI, 10.5% less sugar, 5.5% less saturated fat). Furthermore, participants exposed to the food label advocated its introduction more strongly than the control group (p = 0.081). Consumers worldwide could easily install such applications to display digital food labels on their end devices, and would thus not have to wait for stakeholders in the food industry to eventually reach consensus on mandatory food label introduction.
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Affiliation(s)
- Klaus L. Fuchs
- ETH AI Center, ETH Zurich, 8092 Zurich, Switzerland;
- Correspondence: ; Tel.: +41-78-858-7037
| | - Jie Lian
- Institute of Computer Science (ICS-HSG), University of St. Gallen, 9000 St. Gallen, Switzerland; (J.L.); (S.M.)
| | - Leonard Michels
- Institute of Information Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (L.M.); (V.T.)
| | - Simon Mayer
- Institute of Computer Science (ICS-HSG), University of St. Gallen, 9000 St. Gallen, Switzerland; (J.L.); (S.M.)
| | | | - Verena Tiefenbeck
- Institute of Information Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (L.M.); (V.T.)
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22
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Dörnyei KR, Bauer AS, Krauter V, Herbes C. (Not) Communicating the Environmental Friendliness of Food Packaging to Consumers-An Attribute- and Cue-Based Concept and Its Application. Foods 2022; 11:foods11091371. [PMID: 35564094 PMCID: PMC9104930 DOI: 10.3390/foods11091371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/22/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023] Open
Abstract
While consumer understanding of and preferences for environmentally friendly packaging options have been well investigated, little is known about the environmentally friendly packaging attributes communicated to consumers by suppliers via packaging cues. We thus propose a literature-based attribute-cue matrix as a tool for analyzing packaging solutions. Using a 2021 snapshot of the wafer market in nine European countries, we demonstrate the tool's utility by analyzing the cues found that signal environmentally friendly packaging attributes. While the literature suggests that environmentally friendly packaging is increasingly used by manufacturers, our analysis of 164 wafer packages shows that communication is very limited except for information related to recyclability and disposal. This is frequently communicated via labels (e.g., recycling codes, Green Dot) and structural cues that implicitly signal reduced material use (e.g., less headspace and few packaging levels). Our attribute-cue matrix enables researchers, companies, and policymakers to analyze and improve packaging solutions across countries and product categories. Our finding that environmentally friendly packaging attributes are not being communicated to consumers underscores a pressing need for better communication strategies. Both direct on-pack and implicit communication should help consumers choose more environmentally friendly packaging. Governments are encouraged to apply our tool to identify communication gaps and adopt labeling regulations where needed.
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Affiliation(s)
- Krisztina Rita Dörnyei
- Institute of Marketing, Corvinus University of Budapest, 8 Fovam ter, 1093 Budapest, Hungary;
| | - Anna-Sophia Bauer
- Packaging and Resource Management, Department Applied Life Sciences, FH Campus Wien, University of Applied Sciences, Helmut-Qualtinger-Gasse 2/2/3, 1030 Vienna, Austria;
| | - Victoria Krauter
- Packaging and Resource Management, Department Applied Life Sciences, FH Campus Wien, University of Applied Sciences, Helmut-Qualtinger-Gasse 2/2/3, 1030 Vienna, Austria;
- Correspondence: ; Tel.: +43-1-606-68-77-3592
| | - Carsten Herbes
- Institute for International Research on Sustainable Management and Renewable Energy, Nuertingen Geislingen University, Neckarsteige 6-10, 72622 Nuertingen, Germany;
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23
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Ramírez AS, Garibay KK, Payán DD, Campos Gática V, Merino Salmeron Y. News coverage of Mexico's front-of-package food label policy. BMJ Glob Health 2022; 7:bmjgh-2022-008803. [PMID: 35550339 PMCID: PMC9109016 DOI: 10.1136/bmjgh-2022-008803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives To examine news coverage of Mexico’s front-of-package food labelling policy. Methods We used Lexis Nexis to identify newspaper articles that mention the proposed law in four Mexican newspapers representing politically centre-left and centre-right perspectives. We coded for type and valence of arguments, sources and research evidence cited. Results We identified N=361 relevant articles. Coverage of the front-of-package food label policy was primarily news (vs editorial/opinion). While most were neutral in tone, left-leaning newspapers had slightly more positive overall coverage compared with right-leaning newspapers, indicated by publishing more stories in favour of the policy, fewer in opposition, more propolicy arguments and more frequent inclusion of perspectives by government officials and public health advocates. Despite some evidence of bias, there was a general lack of credible opposition to the policy and mention of opponents across newspapers. Conclusions and policy implications The relative absence of food and beverage industry stakeholders in news coverage of the food label policy is unexpected given their documented involvement in prior food policy debates. We discuss possible reasons for their conspicuous absence and lessons for public health advocates around the globe.
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Affiliation(s)
- A Susana Ramírez
- Department of Public Health, University of California Merced, Merced, California, USA
| | - Kesia K Garibay
- Department of Public Health, University of California Merced, Merced, California, USA
| | - Denise Diaz Payán
- Department of Health, Society, and Behavior, University of California Irvine, Irvine, CA, USA
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24
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Morrow G, Swire‐Thompson B, Polny JM, Kopec M, Wihbey JP. The emerging science of content labeling: Contextualizing social media content moderation. J Assoc Inf Sci Technol 2022. [DOI: 10.1002/asi.24637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Garrett Morrow
- Northeastern University Ethics Institute Boston Massachusetts USA
| | | | | | - Matthew Kopec
- Northeastern University Ethics Institute Boston Massachusetts USA
| | - John P. Wihbey
- Northeastern University College of Arts Media and Design School of Journalism and Media Innovation Boston Massachusetts USA
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25
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Andreeva VA, Egnell M, Stoś K, Przygoda B, Talati Z, Touvier M, Galan P, Hercberg S, Pettigrew S, Julia C. Polish Consumers' Understanding of Different Front-of-Package Food Labels: A Randomized Experiment. Foods 2022; 11:foods11010134. [PMID: 35010260 PMCID: PMC8750026 DOI: 10.3390/foods11010134] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/27/2021] [Accepted: 01/01/2022] [Indexed: 02/08/2023] Open
Abstract
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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Affiliation(s)
- Valentina A. Andreeva
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University/INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center, University of Paris (CRESS), 93017 Bobigny, France; (M.E.); (M.T.); (P.G.); (S.H.); (C.J.)
- Correspondence: ; Tel.: +33-1-4838-9030
| | - Manon Egnell
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University/INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center, University of Paris (CRESS), 93017 Bobigny, France; (M.E.); (M.T.); (P.G.); (S.H.); (C.J.)
| | - Katarzyna Stoś
- National Institute of Public Health NIH-National Research Institute, 00-791 Warsaw, Poland; (K.S.); (B.P.)
| | - Beata Przygoda
- National Institute of Public Health NIH-National Research Institute, 00-791 Warsaw, Poland; (K.S.); (B.P.)
| | - Zenobia Talati
- Western Australian Cancer Prevention Research Unit, School of Population Health, Curtin University, Bentley 6102, Australia;
| | - Mathilde Touvier
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University/INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center, University of Paris (CRESS), 93017 Bobigny, France; (M.E.); (M.T.); (P.G.); (S.H.); (C.J.)
| | - Pilar Galan
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University/INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center, University of Paris (CRESS), 93017 Bobigny, France; (M.E.); (M.T.); (P.G.); (S.H.); (C.J.)
| | - Serge Hercberg
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University/INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center, University of Paris (CRESS), 93017 Bobigny, France; (M.E.); (M.T.); (P.G.); (S.H.); (C.J.)
- Department of Public Health, AP-HP Paris Seine-Saint-Denis Hospital System, 93017 Bobigny, France
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney 2042, Australia;
| | - Chantal Julia
- Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University/INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center, University of Paris (CRESS), 93017 Bobigny, France; (M.E.); (M.T.); (P.G.); (S.H.); (C.J.)
- Department of Public Health, AP-HP Paris Seine-Saint-Denis Hospital System, 93017 Bobigny, France
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26
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The effect of health prompts on product consideration, attention to information, and choice in large, online product assortments: The case of fiber. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2021.104329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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27
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Hock K, Acton RB, Jáuregui A, Vanderlee L, White CM, Hammond D. Experimental study of front-of-package nutrition labels' efficacy on perceived healthfulness of sugar-sweetened beverages among youth in six countries. Prev Med Rep 2021; 24:101577. [PMID: 34976639 PMCID: PMC8683942 DOI: 10.1016/j.pmedr.2021.101577] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 10/25/2022] Open
Abstract
Front-of-package (FOP) nutrition labels have been proposed as a strategy to help limit sugar-sweetened beverage (SSB) consumption among youth. However, few studies have examined the efficacy of FOP labels in youth across different countries. A between-group experiment was conducted to examine the impact of FOP labels (no-label control, Health Star Rating, 'High in' Octagon, Guideline Daily Amount (GDA), Traffic Light, or Nutri-Score) on perceived healthfulness of an SSB. The study was conducted online in November-December 2019 with 10,762 children aged 10-17 from six countries: Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. A binary logistic regression model tested the impacts of FOP label condition, country, and sociodemographic characteristics on participants' likelihood of perceiving the SSB to be Unhealthy. Compared to the control condition, participants in each of the five FOP label conditions were significantly more likely to perceive the SSB as Unhealthy (p < 0.002). The 'High in' Octagon label had the greatest impact on perceived healthfulness across five out of six countries, whereas the GDA and Nutri-Score labels demonstrated the lowest impact across all six countries. The impact of FOP labels was consistent across sex, age, race/ethnicity, and perceived income adequacy. FOP labels can significantly reduce the perceived healthfulness of SSBs among youth across multiple countries. The current study adds to the evidence that 'high in' labels, which use intuitive symbols such as the octagon 'stop sign', are the most efficacious labels for helping consumers identify foods high in nutrients of concern, including SSBs.
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Affiliation(s)
- Karen Hock
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Rachel B. Acton
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Alejandra Jáuregui
- Centre for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, MOR 62100, Mexico
| | - Lana Vanderlee
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada
| | - Christine M. White
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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28
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Pérez-Escamilla R, Vilar-Compte M, Rhodes E, Sarmiento OL, Corvalan C, Sturke R, Vorkoper S. [Implementación de políticas de prevención y control de la obesidad infantil en Estados Unidos y Latinoamérica: lecciones para la investigación y la práctica transfronterizas]. Obes Rev 2021; 22 Suppl 5:e13347. [PMID: 34708536 DOI: 10.1111/obr.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, EE. UU
| | - Mireya Vilar-Compte
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Ciudad de México, México
| | - Elizabeth Rhodes
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, EE. UU.,Yale School of Medicine, New Haven, Connecticut, EE. UU
| | - Olga L Sarmiento
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Camila Corvalan
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, EE. UU
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, EE. UU
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29
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Mazzù MF, Romani S, Baccelloni A, Lavini L. Introducing the Front-Of-Pack Acceptance Model: the role of usefulness and ease of use in European consumers' acceptance of Front-Of-Pack Labels. Int J Food Sci Nutr 2021; 73:378-395. [PMID: 34583617 DOI: 10.1080/09637486.2021.1980866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In recent years, increasing attention to the utilisation of Front-Of-Pack Labels (FOPLs) as a tool to prompt individuals towards healthier food choices has been observed both in regulatory bodies and academic research. However, few theoretical models have been used to understand their role in consumer decision-making, as well as the antecedents that induce individuals to accept the information provided by the label, and to benchmark FOPL performance in different markets.Through a sequence of two studies conducted in Italy, France and the UK on 2812 primary grocery shoppers, we developed a new theoretical framework, the Front-Of-Pack Acceptance Model, applicable both in contexts in which FOPL are present, and in which they should be introduced. Our findings suggest a structural link between the usefulness and ease of use of the labels and the way consumers form their attitudes and intentions towards buying healthier products.
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Affiliation(s)
| | - Simona Romani
- Department of Business and Management, LUISS "Guido Carli" University, Rome, Italy
| | - Angelo Baccelloni
- Department of Business and Management, LUISS "Guido Carli" University, Rome, Italy
| | - Ludovico Lavini
- Department of Business and Management, LUISS "Guido Carli" University, Rome, Italy
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30
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van den Akker K, Bartelet D, Brouwer L, Luijpers S, Nap T, Havermans R. The impact of the nutri-score on food choice: A choice experiment in a Dutch supermarket. Appetite 2021; 168:105664. [PMID: 34453996 DOI: 10.1016/j.appet.2021.105664] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/04/2021] [Accepted: 08/22/2021] [Indexed: 01/27/2023]
Abstract
Front-of-package (FOP) nutrition labels are placed on products to help consumers make healthy food choices. A lab-in-field experiment was conducted to test the effectiveness of two FOP labels in promoting healthy food choices among Dutch consumers, and to examine whether dieters and health conscious shoppers are more likely to use the FOP labels. In addition, it was examined whether the placement of relatively "good" FOP label scores on products might inadvertently lead to increases in serving sizes. Participants (N = 300) consisted of Dutch consumers shopping for groceries in a local supermarket. They were randomly assigned to one of three conditions (Nutri-score, Multiple Traffic Light (MTL) label, or no label control condition), presented with six different (labeled) cereals, and asked to make a choice. Next, participants were shown a product with a relatively good label score and selected their desired serving size. The results show that the Nutri-score promotes choice of the healthiest cereal. Dieting behaviour and health conscious shopping did not moderate this effect, and the labels did not affect serving size selection. Overall, the study provides evidence for the Nutri-score to promote healthy food choices among Dutch consumers.
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Affiliation(s)
- Karolien van den Akker
- CentERdata, Tilburg University, Intermezzo Building, Professor de Moorplein 524-525, P.O. Box 90153, 5037 DR, Tilburg, the Netherlands.
| | - Dimona Bartelet
- Laboratory of Behavioural Gastronomy, Centre for Healthy Eating and Food Innovation, Maastricht University Campus Venlo, the Netherlands
| | - Lotte Brouwer
- CentERdata, Tilburg University, Intermezzo Building, Professor de Moorplein 524-525, P.O. Box 90153, 5037 DR, Tilburg, the Netherlands
| | - Syrah Luijpers
- CentERdata, Tilburg University, Intermezzo Building, Professor de Moorplein 524-525, P.O. Box 90153, 5037 DR, Tilburg, the Netherlands
| | - Tobias Nap
- CentERdata, Tilburg University, Intermezzo Building, Professor de Moorplein 524-525, P.O. Box 90153, 5037 DR, Tilburg, the Netherlands
| | - Remco Havermans
- Laboratory of Behavioural Gastronomy, Centre for Healthy Eating and Food Innovation, Maastricht University Campus Venlo, the Netherlands
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31
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Hafner E, Pravst I. Evaluation of the Ability of Nutri-Score to Discriminate the Nutritional Quality of Prepacked Foods Using a Sale-Weighting Approach. Foods 2021; 10:foods10081689. [PMID: 34441467 PMCID: PMC8392670 DOI: 10.3390/foods10081689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/23/2022] Open
Abstract
The implementation of mandatory front-of-pack nutrition labelling is currently being discussed in the European Union (EU). The Nutri-Score (NS) was developed in France to empower consumers to make informed and healthier food choices. Based on strong evidence of its efficacy in supporting healthy choices, it has already been implemented for voluntary use in some EU member states, making it relevant to developing a harmonised EU scheme. This study aimed to evaluate the NS’s discriminating ability on products available in the food supply and compare it with Slovenian national nutritional recommendations based on an adapted WHO Europe (WHOE) profile. The innovative approach of the study is that we used sale-weighting to address the public health importance of available foods, with consideration of market share. We profiled 15,822 products available in the Slovenian food supply in 2017. The NS had a high ability to discriminate food products based on nutritional composition. Products that are generally encouraged in dietary recommendations (fruits, vegetables, cereals) had, in most cases, better NS grades than less favourable products (confectionery, snack foods, added fats), which is also in line with the national nutrition policy programme. The discriminating ability of the model was also shown within food (sub)categories (e.g., plain and flavoured yoghurt). Sale-weighting showed that offerings do not always reflect sales. Major differences between offerings and sales were observed for beverages, dairy, fruits/vegetables, and edible oils/emulsions. Additionally, sale-weighted distribution tended towards less favourable nutritional composition, particularly in categories with overall smaller offerings of products with favourable composition. The NS showed moderate agreement with the WHOE profile (κ = 0.57); differences were particularly observed in flavoured yoghurts, juices, cooking oils, and cheeses. Modelling the operation of the NS with representative real-life food samples provided insight valuable for developing and implementing harmonised mandatory front-of-pack nutrition labelling in Europe.
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Affiliation(s)
- Edvina Hafner
- Nutrition Institute, Tržaška Cesta 40, SI-1000 Ljubljana, Slovenia;
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
| | - Igor Pravst
- Nutrition Institute, Tržaška Cesta 40, SI-1000 Ljubljana, Slovenia;
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
- VIST–Higher School of Applied Sciences, Gerbičeva Cesta 51A, SI-1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-59-068-871
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32
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Pérez-Escamilla R, Vilar-Compte M, Rhodes E, Sarmiento OL, Corvalan C, Sturke R, Vorkoper S. Implementation of childhood obesity prevention and control policies in the United States and Latin America: Lessons for cross-border research and practice. Obes Rev 2021; 22 Suppl 3:e13247. [PMID: 33951275 PMCID: PMC8365637 DOI: 10.1111/obr.13247] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
Progress has been made in the development and widespread implementation of effective interventions to address childhood obesity, yet important challenges remain. To understand how the United States and Latin American countries achieved success in implementing obesity policies and programs (PAPs) and identify improvement opportunities using implementation science principles. We identified three comparative case studies: (1) front-of-food package labeling (Mexico and Chile); (2) Open Streets/play streets (Colombia and the United States); and (3) the Baby-Friendly Hospital Initiative (Brazil and the United States). Information from multiple sources (e.g., scientific and gray literature and key informant interviews) was synthesized to describe barriers, facilitators, and progress of PAPs across RE-AIM framework dimensions. Evidence-based advocacy along with political will and evidence of scalability and impact were key for successful launch and implementation of all PAPs. Diverse adaptations of PAP design and implementation had to be done across contexts. Stronger process and impact monitoring and evaluation systems that track equity indicators are needed to maximize the population benefits of these PAPs. Implementation science offers an important contribution toward addressing knowledge gaps, enhancing obesity policy dialogue, and producing transferable lessons across the Americas and, therefore, should be used for research and evaluation during PAP development and throughout the implementation and maintenance phases.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Mireya Vilar-Compte
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Mexico City, Mexico
| | - Elizabeth Rhodes
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Camila Corvalan
- Institute of Nutrition, Universidad de Chile, Santiago, Chile
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
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The role of colour and summary indicators in influencing front-of-pack food label effectiveness across seven countries. Public Health Nutr 2020; 24:3566-3570. [PMID: 33317658 DOI: 10.1017/s1368980020004966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Many countries are considering the implementation of front-of-pack nutrition labels as a strategy to address high and increasing levels of overweight and obesity. A growing body of work demonstrates the superiority of labels that use colour and/or provide a summary indicator of product healthiness to enhance comprehension. However, previous studies have been confounded in determining the relative effectiveness of these two attributes by comparing labels that also differ in other ways. The present study tested labels that varied only on use of colour and/or reliance on a summary indicator across an international sample to provide unique insights into the relative importance of these attributes. DESIGN Participants were randomised to see one of four variations of the Health Star Rating label that differed on the basis of use of colour and sole provision of a summary indicator. SETTING Australia, Canada, China, India, New Zealand, the UK and the USA. PARTICIPANTS Adults (n 7545) in seven countries were exposed to online choice tasks requiring them to select a preferred breakfast cereal and then nominate the healthiest cereal. RESULTS Overall, the coloured versions, and particularly the one with just a summary indicator, outperformed the monochrome version that included nutrient-specific information. However, there were some differences by country, with results from Canada and China indicating superior outcomes for monochrome labels and those providing nutrient-specific information. CONCLUSIONS The results highlight the importance of colour, but suggest that the introduction of front-of-pack nutrition labels should be preceded by country-specific formative testing to identify potential differences in outcomes.
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34
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Zhang J, Zhai L, Osewe M, Liu A. Analysis of Factors Influencing Food Nutritional Labels Use in Nanjing, China. Foods 2020; 9:foods9121796. [PMID: 33287197 PMCID: PMC7761705 DOI: 10.3390/foods9121796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022] Open
Abstract
A correct use of food nutrition la bels benefits consumers in pursuing balanced diets. As a result, we conducted interviews in Nanjing, China and randomly sampled 427 respondents. Further, we used both descriptive statistics and binary logistic regression to assess their perception of food nutrition label use. The results indicated that the current situation is not ideal in Nanjing. Only 7.26% of respondents use labeling consistently. Data on purchasing experience, comprehension, nutritional value, work sector, chronic disease, diet awareness, nutritional knowledge, and age were statistically significant. Conversely, taste and primary shopper categories negatively influenced food nutrition label use. In light of the above results, we propose policy recommendations to promote consumers' use of food nutrition labels. These are also beneficial in improving diet and relieving chronic diseases.
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Affiliation(s)
- Jing Zhang
- College of Economics & Management, Nanjing Agricultural University, Nanjing 210014, China; (J.Z.); (L.Z.); (M.O.)
| | - Liangliang Zhai
- College of Economics & Management, Nanjing Agricultural University, Nanjing 210014, China; (J.Z.); (L.Z.); (M.O.)
| | - Maurice Osewe
- College of Economics & Management, Nanjing Agricultural University, Nanjing 210014, China; (J.Z.); (L.Z.); (M.O.)
| | - Aijun Liu
- College of Economics & Management, Nanjing Agricultural University, Nanjing 210014, China; (J.Z.); (L.Z.); (M.O.)
- China Center for Food Security Studies, Nanjing Agricultural University, Nanjing 210014, China
- Correspondence:
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35
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Dixon H, Scully M, Gascoyne C, Wakefield M. Can counter-advertising diminish persuasive effects of conventional and pseudo-healthy unhealthy food product advertising on parents?: an experimental study. BMC Public Health 2020; 20:1781. [PMID: 33238936 PMCID: PMC7687848 DOI: 10.1186/s12889-020-09881-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/11/2020] [Indexed: 12/03/2022] Open
Abstract
Background To help address rising rates of obesity in children, evidence is needed concerning impacts of common forms of marketing for unhealthy child-oriented food products and the efficacy of educational interventions in counteracting any detrimental impacts of such marketing. This study aims to explore parents’ responses to advertising for unhealthy children’s food products that employ different types of persuasive appeals and test whether a counter-advertising intervention exposing industry motives and marketing strategies can bolster parents’ resistance to influence by unhealthy product advertising. Methods N = 1613 Australian parents were randomly assigned to view online either a: (A) non-food ad (control); (B) conventional confectionery ad (highlighting sensory benefits of the product); (C) pseudo-healthy confectionery ad (promoting sensory benefits and health attributes of the product); (D) conventional confectionery ad + counter-ad (employing inoculation-style messaging and narrative communication elements); (E) pseudo-healthy confectionery ad + counter-ad. Parents then viewed various snacks, including those promoted in the food ads and counter-ad. Parents nominated their preferred product, then rated the products. Results Exposure to the conventional confectionery ad increased parents’ preference for the advertised product, enhanced perceptions of the product’s healthiness and reduced sugar content and boosted brand attitude. Exposure to the pseudo-healthy confectionery ad increased parents’ preference for the advertised product, and enhanced perceptions of healthiness, fibre content and lower sugar content. The counter-ad diminished, but did not eliminate, product ad effects on parents’ purchasing preference, product perceptions and brand attitudes. The counter-ad also prompted parents to perceive processed foods as less healthy, higher in sugar and lower in fibre and may have increased support for advertising regulation. Conclusions Exposure to unhealthy product advertising promoted favourable perceptions of products and increased preferences for advertised products among parents. Counter-advertising interventions may bolster parents’ resistance to persuasion by unhealthy product advertising and empower parents to more accurately evaluate advertised food products. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09881-1.
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Affiliation(s)
- Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia. .,Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Maree Scully
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Claudia Gascoyne
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia
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Egnell M, Talati Z, Galan P, Andreeva VA, Vandevijvere S, Gombaud M, Dréano-Trécant L, Hercberg S, Pettigrew S, Julia C. Objective understanding of the Nutri-score front-of-pack label by European consumers and its effect on food choices: an online experimental study. Int J Behav Nutr Phys Act 2020; 17:146. [PMID: 33213459 PMCID: PMC7678195 DOI: 10.1186/s12966-020-01053-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023] Open
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-020-01053-z.
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Affiliation(s)
- Manon Egnell
- Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre -University of Paris (CRESS), Bobigny, 93000, France.
| | - Zenobia Talati
- School of Psychology, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Pilar Galan
- Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre -University of Paris (CRESS), Bobigny, 93000, France
| | - Valentina A Andreeva
- Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre -University of Paris (CRESS), Bobigny, 93000, France
| | - Stefanie Vandevijvere
- Scientific Institute of Public Health (Sciensano), J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Marion Gombaud
- Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre -University of Paris (CRESS), Bobigny, 93000, France
| | - Louise Dréano-Trécant
- Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre -University of Paris (CRESS), Bobigny, 93000, France
| | - Serge Hercberg
- Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre -University of Paris (CRESS), Bobigny, 93000, France.,Department of Public Health, Hôpitaux Universitaires Paris Seine-Saint-Denis (AP-HP), Bobigny, 93000, France
| | - Simone Pettigrew
- The George Institute for Global Health, Newtown NSW, Sydney, 2042, Australia
| | - Chantal Julia
- Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre -University of Paris (CRESS), Bobigny, 93000, France.,Department of Public Health, Hôpitaux Universitaires Paris Seine-Saint-Denis (AP-HP), Bobigny, 93000, France
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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 2020; 12:nu12092887. [PMID: 32971744 PMCID: PMC7551644 DOI: 10.3390/nu12092887] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/18/2022] Open
Abstract
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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Fialon M, Egnell M, Talati Z, Galan P, Dréano-Trécant L, Touvier M, Pettigrew S, Hercberg S, Julia C. Effectiveness of Different Front-of-Pack Nutrition Labels among Italian Consumers: Results from an Online Randomized Controlled Trial. Nutrients 2020; 12:nu12082307. [PMID: 32752021 PMCID: PMC7468990 DOI: 10.3390/nu12082307] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
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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Affiliation(s)
- Morgane Fialon
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), 93000 Bobigny, France; (M.E.); (P.G.); (L.D.-T.); (M.T.); (S.H.); (C.J.)
- Correspondence: ; Tel.: +33-1483-876-38
| | - Manon Egnell
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), 93000 Bobigny, France; (M.E.); (P.G.); (L.D.-T.); (M.T.); (S.H.); (C.J.)
| | - Zenobia Talati
- School of Psychology, Curtin University, Kent St, Bentley, WA 6102, Australia;
| | - Pilar Galan
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), 93000 Bobigny, France; (M.E.); (P.G.); (L.D.-T.); (M.T.); (S.H.); (C.J.)
| | - Louise Dréano-Trécant
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), 93000 Bobigny, France; (M.E.); (P.G.); (L.D.-T.); (M.T.); (S.H.); (C.J.)
| | - Mathilde Touvier
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), 93000 Bobigny, France; (M.E.); (P.G.); (L.D.-T.); (M.T.); (S.H.); (C.J.)
| | - Simone Pettigrew
- The George Institute for Global Health, Newtown, Sydney 2042, Australia;
| | - Serge Hercberg
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), 93000 Bobigny, France; (M.E.); (P.G.); (L.D.-T.); (M.T.); (S.H.); (C.J.)
- Public Health department, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
| | - Chantal Julia
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), 93000 Bobigny, France; (M.E.); (P.G.); (L.D.-T.); (M.T.); (S.H.); (C.J.)
- Public Health department, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
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An Experimental Comparison of the Impact of 'Warning' and 'Health Star Rating' FoP Labels on Adolescents' Choice of Breakfast Cereals in New Zealand. Nutrients 2020; 12:nu12061545. [PMID: 32466408 PMCID: PMC7352816 DOI: 10.3390/nu12061545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
This research investigated the performance of the red, octagonal Vienna Convention traffic ‘STOP’ sign as a front of pack (FoP) warning nutritional label. While the Vienna Convention traffic light system is an established FoP label, the potential of the ‘STOP’ sign in the role has not been investigated. The performance of the ‘STOP’ label was compared with that of a single star (low nutritional value) Australasian Health Star Rating (HSR) label using a fractionally replicated Latin square design. The labels were presented on choice diads of cold breakfast cereal packets. The sample of 240 adolescents aged 16–18 was drawn from a secondary school in the South Island of New Zealand. A large and significant main effect was observed at the p < 0.01 level for the difference between the ’STOP’ sign and the control condition (no nutritional FoP label), and at p < 0.05 for the difference between the HSR and the ‘STOP’ label. There was no significant difference between the HSR FoP and the control condition. A significant non-additivity (interaction) (p < 0.01) was also observed via the fractional replication. The results indicate that the Vienna Convention ‘STOP’ sign is worthy of further research with regard to its potential as an FoP nutritional label.
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Gustafson CR, Zeballos E. The effect of presenting relative calorie information on calories ordered. Appetite 2020; 153:104727. [PMID: 32387531 DOI: 10.1016/j.appet.2020.104727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/19/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
In this research, we tested the effect of a novel method of presenting calorie information-highlighting relative differences in calories among ingredients. We conducted an online hypothetical food choice experiment where 633 participants selected the ingredients for a sandwich from five categories: meat/protein, cheese, spread/dressing, bread, and vegetables. Each participant was randomly assigned to one of four calorie information conditions: 1) a condition in which no information about calories was provided, 2) a condition in which calorie information was provided for each ingredient, 3) a condition in which calorie information was presented relative to the highest calorie item, and 4) a condition in which calorie information was presented relative to the lowest calorie item. Participants in the high- and low-calorie reference conditions ordered between 32 and 36 fewer calories per sandwich than participants in the no-calorie information control condition (p ≤ 0.04). Calories ordered by participants in the per-item calorie condition were not significantly different than the control. Presenting relative calorie or other nutritional information to make health-related trade-offs more salient may guide consumers to make healthier choices.
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Affiliation(s)
- Christopher R Gustafson
- Department of Agricultural Economics, University of Nebraska-Lincoln, 314A Filley Hall, Lincoln, NE, 68583, USA.
| | - Eliana Zeballos
- USDA Economic Research Service, Food Economic Division, Washington, D.C, USA.
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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 2020; 12:nu12051303. [PMID: 32370277 PMCID: PMC7284849 DOI: 10.3390/nu12051303] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 01/18/2023] Open
Abstract
Abstract: 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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42
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Prevention of Childhood Obesity: A Position Paper of the Global Federation of International Societies of Paediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN). J Pediatr Gastroenterol Nutr 2020; 70:702-710. [PMID: 32205768 DOI: 10.1097/mpg.0000000000002708] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Global childhood obesity increased more than 8-fold over 40 years, inducing a very large personal, societal, and economic burden. Effects of available treatments are less than satisfactory; therefore, effective prevention is of high priority. In this narrative review, we explore preventive opportunities. The available evidence indicates large benefits of improving nutrition and lifestyle during early life, such as promoting breast-feeding and improving the quality of infant and early childhood feeding. Promoting healthy eating patterns and limiting sugar-containing beverage consumption from early childhood onwards are of great benefit. Regular physical activity and limited sedentary lifestyle and screen time alone have limited effects but are valuable elements in effective multicomponent strategies. The home environment is important, particularly for young children, and can be improved by educating and empowering families. School- and community-based interventions can be effective, such as installing water fountains, improving cafeteria menus, and facilitating regular physical activity. Reducing obesogenic risk factors through societal standards is essential for effective prevention and limiting socioeconomic disparity; these may comprise food, drink, and physical activity standards for day cares and schools, general food quality standards, front-of-pack food labeling, taxation of unhealthy foods, restriction of food advertisements to children, and others. Effective prevention of childhood obesity is not achieved by single interventions but by integrated multicomponent approaches involving multiple stakeholders that address children, families, and societal standards. Pediatricians and their organizations should be proactive in supporting and empowering families to support their children's health, and in promoting societal measures that protect children.
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Labonté ME, Emrich TE, Scarborough P, Rayner M, L’Abbé MR. Traffic light labelling could prevent mortality from noncommunicable diseases in Canada: A scenario modelling study. PLoS One 2019; 14:e0226975. [PMID: 31881069 PMCID: PMC6934336 DOI: 10.1371/journal.pone.0226975] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022] Open
Abstract
Background Traffic-light labelling (TLL) is a promising front-of-pack system to help consumers make informed dietary choices. It has been shown that adopting TLL in Canada, through an optimistic scenario of avoiding, if possible, foods with red traffic lights, could effectively reduce Canadians’ intakes of energy, total fat, saturated fat, and sodium by 5%, 13%, 14% and 6%, respectively. However, the potential health impact of adopting TLL has not been determined in the North American context. Objective This study modelled the potential impact of adopting TLL on mortality from noncommunicable diseases (NCDs) in Canada, due to the previously predicted improved nutrient intakes. Methods Investigators used data from adults (n = 19,915) in the 2004 nationally representative Canadian Community Health Survey (CCHS)-Cycle 2.2. Nutrient amounts in foods consumed by CCHS respondents were profiled using the 2013 United Kingdom’s TLL criteria. Whenever possible, foods assigned at least one red light (non-compliant foods) were replaced with similar, but compliant, foods identified from a Canadian brand-specific food database. Respondents’ nutrient intakes were calculated under the original CCHS scenario and the counterfactual TLL scenario, and entered in the Preventable Risk Integrated ModEl (PRIME) to estimate the health impact of adopting TLL. The primary outcome was the number of deaths attributable to diet-related NCDs that could be averted or delayed based on the TLL scenario compared with the baseline scenario. Results PRIME estimated that 11,715 deaths (95% CI 10,500–12,865) per year due to diet-related NCDs, among which 72% are specifically related to cardiovascular diseases, could be prevented if Canadians avoided foods labelled with red traffic lights. The reduction in energy intakes would by itself save 10,490 deaths (9,312–11,592; 90%). Conclusions This study, although depicting an idealistic scenario, suggests that TLL (if used to avoid red lights when possible) could be an effective population-wide intervention to improve NCD outcomes in Canada.
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Affiliation(s)
- Marie-Eve Labonté
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Teri E. Emrich
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Scarborough
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Mike Rayner
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Mary R. L’Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- * E-mail:
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