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Ewert B. Checkmating the Nutri-Score: Will Food Patriotism Prevent the Harmonization of Front-of-Pack Labeling Schemes within the EU? JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2024; 49:885-891. [PMID: 38567758 DOI: 10.1215/03616878-11259443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Front-of-pack labeling schemes are an effective but contested regulatory approach to nudge consumers toward healthy food choices. The Nutri-Score, being implemented by eight European countries, is one of the most elaborated and evidence-based examples. Therefore, the Nutri-Score has been deemed as the front-runner within the European Commission's attempt to harmonize front-of-pack labeling among European Union (EU) member states under its Farm-to-Fork strategy by the end of 2022. However, the endeavor is on the brink of failure because of massive resistance by Mediterranean member states and parts of the food industry capitalizing on patriotic narratives (e.g., "Made in Italy"). This article investigates the Nutri-Score saga from a political and commercial determinants of health lens. It argues that an EU-wide rollout of the label hinges on the specific interplay between political structures and stakeholder agency. As shown, the EU's weak decision-making power has been exploited by the No-Nutri-Score alliance.
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Tousen Y, Takebayashi J, Okada C, Suzuki M, Yasudomi A, Yoshita K, Ishimi Y, Takimoto H. Development of a Nutrient Profile Model for Dishes in Japan Version 1.0: A New Step towards Addressing Public Health Nutrition Challenges. Nutrients 2024; 16:3012. [PMID: 39275327 PMCID: PMC11397037 DOI: 10.3390/nu16173012] [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: 07/25/2024] [Revised: 08/24/2024] [Accepted: 08/28/2024] [Indexed: 09/16/2024] Open
Abstract
To address the rising incidence of non-communicable diseases (NCDs) and promote healthier eating habits, Japan requires a culturally tailored Nutrient Profile Model. This study aimed to develop a Nutrient Profile Model for Dishes in Japan version 1.0 (NPM-DJ (1.0)) that corresponds to the nutritional issues and food culture in Japan. The aim of the NPM-DJ (1.0) was to promote the health of the general population, and to prevent the increase in NCDs in Japan. The NPM-DJ (1.0) categorizes dishes into staples, sides, mains, mixed dishes, and mixed dishes with staples. The model evaluates dishes based on energy, saturated fats, sugars, and sodium as restricted nutrients, while considering protein, dietary fiber, and the weight of certain food groups as recommended nutrients. The distribution of the overall score for each dish category was analyzed and a rating algorithm was created. The baseline, modification points, and final scores were significantly lower for side dishes than for staple dishes. In contrast, the baseline points and final scores were significantly higher for mixed dishes with staple. The model effectively differentiated nutritional profiles across five dishes categories, which may promote healthier dish reformulation by food businesses operators and encourage consumers to select healthier dishes.
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Affiliation(s)
- Yuko Tousen
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka Shinmachi, Settsu-shi, Osaka 566-0002, Japan
| | - Jun Takebayashi
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka Shinmachi, Settsu-shi, Osaka 566-0002, Japan
| | - Chika Okada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka Shinmachi, Settsu-shi, Osaka 566-0002, Japan
| | - Mariko Suzuki
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka Shinmachi, Settsu-shi, Osaka 566-0002, Japan
| | - Ai Yasudomi
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka Shinmachi, Settsu-shi, Osaka 566-0002, Japan
| | - Katsushi Yoshita
- Department of Nutrition, Osaka Metropolitan University Graduate School of Human Life and Ecology, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka 558-8585, Japan
| | - Yoshiko Ishimi
- Tokyo NODAI Research Institute, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-ku, Tokyo 156-8502, Japan
| | - Hidemi Takimoto
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka Shinmachi, Settsu-shi, Osaka 566-0002, Japan
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Deng Z, Wawro N, Freuer D, Peters A, Heier M, Meisinger C, Breuninger TA, Linseisen J. Differential association of dietary scores with the risk of type 2 diabetes by metabotype. Eur J Nutr 2024; 63:2137-2148. [PMID: 38714546 PMCID: PMC11377363 DOI: 10.1007/s00394-024-03411-0] [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: 12/18/2023] [Accepted: 04/22/2024] [Indexed: 05/10/2024]
Abstract
PURPOSE We aimed to examine the association between dietary patterns and type 2 diabetes mellitus (T2DM) while considering the potential effect modification by metabolic phenotypes (metabotypes). Additionally, we aimed to explore the association between dietary scores and prediabetes. METHODS A total of 1460 participants (11.8% with T2DM) from the cross-sectional population-based KORA FF4 study were included. Participants, classified into three metabotype subgroups, had both their FSAm-NPS dietary index (underpinning the Nutri-Score) and ultra-processed foods (UPF) intake (using NOVA classification) calculated. Glucose tolerance status was assessed via oral glucose tolerance tests (OGTT) in non-diabetic participants and was classified according to the American Diabetes Association criteria. Logistic regression models were used for both the overall and metabotype-stratified analyses of dietary scores' association with T2DM, and multinomial probit models for their association with prediabetes. RESULTS Participants who had a diet with a higher FSAm-NPS dietary index (i.e., a lower diet quality) or a greater percentage of UPF consumption showed a positive association with T2DM. Stratified analyses demonstrated a strengthened association between UPF consumption and T2DM specifically in the metabolically most unfavorable metabotype (Odds Ratio, OR 1.92; 95% Confidence Interval, CI 1.35, 2.73). A diet with a higher FSAm-NPS dietary index was also positively associated with prediabetes (OR 1.19; 95% CI 1.04, 1.35). CONCLUSION Our study suggests different associations between poorer diet quality and T2DM across individuals exhibiting diverse metabotypes, pointing to the option for stratified dietary interventions in diabetes prevention.
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Affiliation(s)
- Zhongyi Deng
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Ludwig- Maximilians University of Munich, Marchioninistr. 15, 81377, Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians University of Munich, Pettenkoferstr. 9A, 80336, Munich, Germany
- Chair of Epidemiology, Medical Faculty, University of Augsburg, University Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Nina Wawro
- Chair of Epidemiology, Medical Faculty, University of Augsburg, University Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
- Institute of Epidemiology, Helmholtz Munich (GmbH) - German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Dennis Freuer
- Chair of Epidemiology, Medical Faculty, University of Augsburg, University Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Annette Peters
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Ludwig- Maximilians University of Munich, Marchioninistr. 15, 81377, Munich, Germany
- Institute of Epidemiology, Helmholtz Munich (GmbH) - German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Munich (GmbH) - German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- KORA Study Centre, University Hospital Augsburg, Beim Glaspalast 1, 86153, Augsburg, Germany
| | - Christine Meisinger
- Chair of Epidemiology, Medical Faculty, University of Augsburg, University Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Taylor A Breuninger
- Chair of Epidemiology, Medical Faculty, University of Augsburg, University Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Jakob Linseisen
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Ludwig- Maximilians University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
- Pettenkofer School of Public Health, Ludwig-Maximilians University of Munich, Pettenkoferstr. 9A, 80336, Munich, Germany.
- Chair of Epidemiology, Medical Faculty, University of Augsburg, University Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
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Tacke F, Horn P, Wai-Sun Wong V, Ratziu V, Bugianesi E, Francque S, Zelber-Sagi S, Valenti L, Roden M, Schick F, Yki-Järvinen H, Gastaldelli A, Vettor R, Frühbeck G, Dicker D. EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol 2024; 81:492-542. [PMID: 38851997 DOI: 10.1016/j.jhep.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 06/10/2024]
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease (NAFLD), is defined as steatotic liver disease (SLD) in the presence of one or more cardiometabolic risk factor(s) and the absence of harmful alcohol intake. The spectrum of MASLD includes steatosis, metabolic dysfunction-associated steatohepatitis (MASH, previously NASH), fibrosis, cirrhosis and MASH-related hepatocellular carcinoma (HCC). This joint EASL-EASD-EASO guideline provides an update on definitions, prevention, screening, diagnosis and treatment for MASLD. Case-finding strategies for MASLD with liver fibrosis, using non-invasive tests, should be applied in individuals with cardiometabolic risk factors, abnormal liver enzymes, and/or radiological signs of hepatic steatosis, particularly in the presence of type 2 diabetes (T2D) or obesity with additional metabolic risk factor(s). A stepwise approach using blood-based scores (such as FIB-4) and, sequentially, imaging techniques (such as transient elastography) is suitable to rule-out/in advanced fibrosis, which is predictive of liver-related outcomes. In adults with MASLD, lifestyle modification - including weight loss, dietary changes, physical exercise and discouraging alcohol consumption - as well as optimal management of comorbidities - including use of incretin-based therapies (e.g. semaglutide, tirzepatide) for T2D or obesity, if indicated - is advised. Bariatric surgery is also an option in individuals with MASLD and obesity. If locally approved and dependent on the label, adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2) should be considered for a MASH-targeted treatment with resmetirom, which demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile. No MASH-targeted pharmacotherapy can currently be recommended for the cirrhotic stage. Management of MASH-related cirrhosis includes adaptations of metabolic drugs, nutritional counselling, surveillance for portal hypertension and HCC, as well as liver transplantation in decompensated cirrhosis.
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Montoye AHK, Molesky MJ, Vondrasek JD, Becker TB. Evidence-based food serving size labelling: Survey and laboratory analyses of consumer cooking spray usage. NUTR BULL 2024. [PMID: 39120004 DOI: 10.1111/nbu.12701] [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: 11/26/2023] [Revised: 07/02/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024]
Abstract
Nutrition label serving sizes are determined primarily based on typical consumption when such data are available. However, such data are not available for certain foods such as spray cooking oil (cooking spray). Our study assessed cooking spray use by the United States (US) adults compared to the 0.25-s serving size used on US-sold cooking spray labels. Adults (n = 1041, aged 33 ± 16.7 years) completed a 13-question survey on cooking spray use and perceptions. In the survey, participants reported using cooking spray for 1.9 ± 0.9 s per use, and 42.3%-43.1% of participants reported being more likely to purchase products if they were labelled calorie- or fat-free. Next, 30 adults (aged 29.7 ± 11.0 years) completed a laboratory-based study which assessed cooking spray durations for seven cookware items. Spray times ranged from 1.0 ± 0.5 (smallest pan) to 2.5 ± 1.3 s (largest baking sheet), with 100% of sprays (210/210) exceeding the 0.25-s US serving size. Our results suggest that cooking spray serving size should be increased to 1 s to better reflect actual consumption, and this would have the added benefit of aligning better with cooking spray serving sizes in other developed countries (0.5-1.0 s). A 1-s serving size would also preclude cooking spray advertised as calorie- or fat-free, allowing consumers to make more informed choices on the dietary implications of using cooking spray.
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Affiliation(s)
| | - Monroe J Molesky
- Alma College, Alma, Michigan, USA
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Joseph D Vondrasek
- Alma College, Alma, Michigan, USA
- Univerisyt of Mississippi Medical Center, Florida State University, Tallahassee, Florida, USA
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EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Obes Facts 2024; 17:374-444. [PMID: 38852583 PMCID: PMC11299976 DOI: 10.1159/000539371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024] Open
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease (NAFLD), is defined as steatotic liver disease (SLD) in the presence of one or more cardiometabolic risk factor(s) and the absence of harmful alcohol intake. The spectrum of MASLD includes steatosis, metabolic dysfunction-associated steatohepatitis (MASH, previously NASH), fibrosis, cirrhosis and MASH-related hepatocellular carcinoma (HCC). This joint EASL-EASD-EASO guideline provides an update on definitions, prevention, screening, diagnosis and treatment for MASLD. Case-finding strategies for MASLD with liver fibrosis, using non-invasive tests, should be applied in individuals with cardiometabolic risk factors, abnormal liver enzymes, and/or radiological signs of hepatic steatosis, particularly in the presence of type 2 diabetes (T2D) or obesity with additional metabolic risk factor(s). A stepwise approach using blood-based scores (such as FIB-4) and, sequentially, imaging techniques (such as transient elastography) is suitable to rule-out/in advanced fibrosis, which is predictive of liver-related outcomes. In adults with MASLD, lifestyle modification - including weight loss, dietary changes, physical exercise and discouraging alcohol consumption - as well as optimal management of comorbidities - including use of incretin-based therapies (e.g. semaglutide, tirzepatide) for T2D or obesity, if indicated - is advised. Bariatric surgery is also an option in individuals with MASLD and obesity. If locally approved and dependent on the label, adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2) should be considered for a MASH-targeted treatment with resmetirom, which demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile. No MASH-targeted pharmacotherapy can currently be recommended for the cirrhotic stage. Management of MASH-related cirrhosis includes adaptations of metabolic drugs, nutritional counselling, surveillance for portal hypertension and HCC, as well as liver transplantation in decompensated cirrhosis.
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Rey-García J, Mérida DM, Donat-Vargas C, Sandoval-Insausti H, Rodríguez-Ayala M, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P. Less Favorable Nutri-Score Consumption Ratings Are Prospectively Associated with Abdominal Obesity in Older Adults. Nutrients 2024; 16:1020. [PMID: 38613053 PMCID: PMC11013145 DOI: 10.3390/nu16071020] [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: 02/05/2024] [Revised: 03/23/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Nutri-Score is a front-of-package (FOP) labeling designed to assist consumers in selecting healthier options at the point of purchase and ultimately enhance their health. This study aims to evaluate the association between the Nutri-Score system and incident abdominal obesity (AO) in community-dwelling older adults. A prospective cohort of 628 individuals aged ≥ 60 were recruited in Spain between 2008-2010 and were reexamined between 2015-2017. Dietary intake was evaluated utilizing a validated computerized dietary history. Food was categorized based on the Nutri-Score system into five levels from A (green, representing the best quality) to E (red, representing the poorest quality). A five-color Nutri-Score dietary index (5-CNS DI) in g/day/kg was calculated for each participant. AO was determined by a waist circumference (WC) of ≥102 cm for men and ≥88 cm for women. Logistic regression models were adjusted for the main potential confounders. During a mean six-year follow-up, 184 incident cases of AO occurred. The odds ratio (OR) and 95% confidence interval (CI) for AO, when comparing the highest and lowest quartiles of the 5-CNS DI, were 2.45 (1.17-5.14), with a p-value for trend of 0.035. In sensitivity analyses, the OR was 2.59 (1.22-5.52, p-trend: 0.032) after adjustment for WC at baseline, and 1.75 (0.74-4.18, p-trend: 0.316) after adjustment for ultra-processed food consumption. In conclusion, less favorable food-consumption ratings in the Nutri-Score are associated with incident AO in the elderly. These findings support the use of this FOP system to potentially improve metabolic health.
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Affiliation(s)
- Jimena Rey-García
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, 28034 Madrid, Spain;
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
| | - Diana María Mérida
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
| | - Carolina Donat-Vargas
- ISGlobal-Institut de Salut Global de Barcelona, 08036 Barcelona, Spain;
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | | | - Montserrat Rodríguez-Ayala
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
- Department of Microbiology and Parasitology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - José Ramón Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
- IMDEA-Food Institute, Campus de Excelencia Internacional (CEI)/Universidad Autónoma de Madrid (UAM) + Consejo Superior de Investigaciones Científicas (CSIC), 28049 Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
- IMDEA-Food Institute, Campus de Excelencia Internacional (CEI)/Universidad Autónoma de Madrid (UAM) + Consejo Superior de Investigaciones Científicas (CSIC), 28049 Madrid, Spain
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Sicilia M, López M, Palazón M. The combined effect of front-of-package labels and influencer recommendations on food choice decisions. Appetite 2023; 191:107074. [PMID: 37827199 DOI: 10.1016/j.appet.2023.107074] [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: 05/16/2023] [Revised: 09/20/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Abstract
Many governments have adopted front-of-pack nutrition labels (FOP labels) that give advice about how healthy a product is. An increasing number of digital food influencers are also informing consumers about the nutritional quality of products and promoting healthy consumption. In this context, the current study analyzes how both sources of information come together to affect purchase intention. Drawing on congruence theory, we propose that the influencer's recommendation reinforces the effect of the FOP label when there is congruence between the two; however, consumers clearly prefer to follow the recommendation of the influencer over the FOP label when the information sources are non-congruent. We develop a between-subjects experimental design in which the level of congruence between the two information sources is manipulated. The effect of the influencer on purchase intention is mediated by the credibility of the FOP label. A second study confirms the superiority of the influencer effect observed in the first study.
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Affiliation(s)
- María Sicilia
- Marketing Department, University of Murcia, Campus de Espinardo, 30100, Murcia, Spain.
| | - Manuela López
- Marketing Department, University of Murcia, Campus de Espinardo, 30100, Murcia, Spain.
| | - Mariola Palazón
- Marketing Department, University of Murcia, Campus de Espinardo, 30100, Murcia, Spain.
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9
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Rey-García J, Donat-Vargas C, Sandoval-Insausti H, Banegas JR, Dominguez LJ, Rodríguez-Artalejo F, Guallar-Castillón P. Less favourable food consumption ratings in the Five-Color Nutri-Score are associated with incident frailty in older adults. Age Ageing 2023; 52:afad142. [PMID: 37566560 DOI: 10.1093/ageing/afad142] [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: 11/11/2022] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The Nutri-Score front-of-package labelling classifies food products according to their nutritional quality, so healthier food choices are easier when shopping. This study prospectively assesses the association of a diet rated according to the Nutri-Score system and incident frailty in community-dwelling older adults. METHODS Cohort study with 1,875 individuals aged ≥60 recruited during 2008-2010 in Spain. At baseline, food consumption was assessed using a validated dietary history. Food was categorised into five Nutri-Score labels (A/green-best quality; B, C, D, E/red-worst quality) utilising an algorithm established in 2017 and currently in use. For each participant, a Five-Color Nutri-Score Dietary Index (5-CNS DI) in grams per day per kilogram was calculated. The 5-CNS DI sums up the grams per day of food consumed times their corresponding nutritional quality value (from A rated as 1 to E rated as 5) and divided by weight in kilograms. From baseline to December 2012, incident frailty was ascertained based on Fried's criteria. Statistical analyses were performed with logistic regression adjusted for main confounders. RESULTS After a mean follow-up of 3.5 years, 136 cases of frailty were identified. The multivariable-adjusted odds ratios (95% confidence interval) of incident frailty across increasing quartiles of the 5-CNS DI were 1, 1.51 (0.86-2.68), 1.56 (0.82-2.98) and 2.32 (1.12-4.79); P-trend = 0.033. The risk of frailty increased by 28% (3-58%) with a 10-unit increment in this dietary index. Similar results were found with the Nutri-Score algorithm modified in 2022. CONCLUSIONS consumption of a diet with less favourable Nutri-Score ratings doubles the risk of frailty among community-dwelling older adults.
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Affiliation(s)
- Jimena Rey-García
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carolina Donat-Vargas
- ISGlobal-Institut de Salut Global de Barcelona, Barcelona, Spain
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Helena Sandoval-Insausti
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Ligia J Dominguez
- Faculty of Medicine and Surgery, Kore University of Enna, Enna, Italy
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
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McClinchy J, Dickinson A, Wills W. 'Feta is obviously very dangerous stuff looking at all those reds': Can nutrition labelling help people living with type 2 diabetes to self-manage their condition? J Hum Nutr Diet 2023; 36:1131-1143. [PMID: 36738128 DOI: 10.1111/jhn.13152] [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: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The consumption of a healthy balanced diet is the cornerstone of treatment for people living with type 2 diabetes (PLWT2DM). The United Kingdom recommends a standardised voluntary front-of-pack food labelling system which uses the green-amber-red colour coding to indicate the presence of nutrients in a food item. Research with PLWT2DM suggests that they may find it challenging to interpret the information on food labels. This paper draws from a larger study exploring nutrition information practices for PLWT2DM. The aim of this paper is to explore the experiences of using nutrition information found on food labels among PLWT2DM and their partners/carers. METHODS This study used a qualitative and mixed methods design, using a solicited 4-week unstructured diary followed by a qualitative interview with each participant. The theoretical framework drew on practice theory. Data were analysed using thematic analysis. RESULTS Nineteen PLWT2DM and one partner took part. Data consisted of 19 diaries and interviews. Almost all participants used food labels to help manage their condition; however, the colour-coding link with traffic lights appeared to overemphasise the need to avoid foods with red labels. Participants' beliefs about sugar influenced their food choices which in turn could impact on their nutritional intake. Highly developed mathematical skills were needed to interpret information about portion sizes. CONCLUSIONS Healthcare professionals and patient support groups should focus more on educating PLWT2DM about how to interpret food labels so that they are able to apply these to their own food choices. Future research and development of subsequent versions of the food labelling system should include PLWT2DM to ensure that labels are both clear and relevant to them.
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Affiliation(s)
- Jane McClinchy
- Nutrition and Dietetics, School of Life and Medical Sciences, University of Hertfordshire, Hatfield Herts, UK
| | - Angela Dickinson
- CRIPACC, School of Health and Social Work, University of Hertfordshire, Hatfield Herts, UK
| | - Wendy Wills
- CRIPACC, School of Health and Social Work, University of Hertfordshire, Hatfield Herts, UK
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11
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He J, Mazzù MF, Baccelloni A. A 20-Country Comparative Assessment of the Effectiveness of Nutri-Score vs. NutrInform Battery Front-of-Pack Nutritional Labels on Consumer Subjective Understanding and Liking. Nutrients 2023; 15:2852. [PMID: 37447177 DOI: 10.3390/nu15132852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The incidence of overweight and obesity has generated significant concerns among European consumers and institutions. As part of a set of measures undertaken, the European Union (EU) called for one harmonized mandatory front-of-pack nutritional label (FOPL) to improve consumer food nutritional knowledge and encourage healthier and more informed food choices. Different types of FOPLs, ranging from nutrient-specific labels-such as the NutrInform Battery-to summary labels-such as the Nutri-Score-have been developed and introduced in different markets, reporting different degrees of effectiveness in terms of understanding. The aim of this study is to provide actionable insights by analyzing a specific part of the complex consumers' decision-making process in food when aided by FOPLs. Adopting a between-subject experiment on a sample of 4560 respondents in 20 EU member countries, the study compares the consumer subjective understanding and liking of two labels currently under examination by the EU bodies, the NutrInform Battery and the Nutri-Score. At an aggregated level, the results show that NutrInform Battery is more effective than Nutri-Score in improving consumer subjective understanding and leads to a higher liking towards the label. A detailed by-country analysis highlights either a superiority or a parity of NutrInform Battery for subjective understanding and liking. Theoretically, this study, through a large panel of respondents, adds the fundamental perspective on subjective understanding, complementing the findings of extant research on objective understanding, and further clarifies the role of liking as a complementary element in the food decision-making process toward heathier and more informed food choices. This might be of significant relevance in providing additional evidence that can be used by policymakers in their attempt toward the selection of a uniform FOPL at EU level.
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Affiliation(s)
- Jun He
- Department of Business and Management, Luiss University, 00197 Rome, Italy
| | | | - Angelo Baccelloni
- Department of Business Administration, Frank J. Guarini School of Business, John Cabot University, 00165 Rome, Italy
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12
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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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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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Włodarek D, Dobrowolski H. Fantastic Foods and Where to Find Them-Advantages and Disadvantages of Nutri-Score in the Search for Healthier Food. Nutrients 2022; 14:nu14224843. [PMID: 36432529 PMCID: PMC9694186 DOI: 10.3390/nu14224843] [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: 10/21/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
The composition and quality of food rations and the intake of nutrients with the diet are undoubtedly reflected in our health. In order to help the consumer choose the right food product, food manufacturers use front-of-pack labels, which are designed to convey concise information about the nutritional value of the product. Such labels include the Nutri-Score system. In this paper, we have critically analyzed this system. As the available data indicate, this system does not take into account a number of factors that affect the quality of a food product, including the size of the package, the contents of vitamins, minerals, and other selected health-promoting ingredients, the degree of processing, or the fatty acid profile of the product, and it discriminates against regional products, organic products, and juices and nectars. This system, although intuitive and created with good intentions, still has quite a few flaws that must be addressed before it can be considered to correctly indicate the nutritional value of food products.
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Affiliation(s)
- Dariusz Włodarek
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW), 159c Nowoursynowska Str., 02-776 Warsaw, Poland
- Correspondence:
| | - Hubert Dobrowolski
- Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW), 159c Nowoursynowska Str., 02-776 Warsaw, Poland
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15
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Isabel Sonntag W, Lemken D, Spiller A, Schulze M. Welcome to the (label) jungle? Analyzing how consumers deal with intra-sustainability label trade-offs on food. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2022.104746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Bonaccio M, Di Castelnuovo A, Ruggiero E, Costanzo S, Grosso G, De Curtis A, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Joint association of food nutritional profile by Nutri-Score front-of-pack label and ultra-processed food intake with mortality: Moli-sani prospective cohort study. BMJ 2022; 378:e070688. [PMID: 36450651 PMCID: PMC9430377 DOI: 10.1136/bmj-2022-070688] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To jointly analyse two food dimensions, the Food Standards Agency Nutrient Profiling System (FSAm-NPS), used to derive the Nutri-Score front-of-pack label, and the NOVA classification in relation to mortality. DESIGN Prospective cohort study. SETTING Moli-sani Study, Italy 2005-10. PARTICIPANTS 22 895 participants (mean age 55 (SD 12) years; 48% men). MAIN OUTCOMES MEASURES Associations between dietary exposures and mortality risk, assessed using multivariable cause specific Cox proportional hazard models controlled for known risk factors. RESULTS A total of 2205 deaths occurred during 272 960 person years of follow-up. In the highest quarter of the FSAm-NPS index compared with the lowest quarter, multivariable adjusted hazard ratios for all cause and cardiovascular mortality were 1.19 (95% confidence interval 1.04 to 1.35; absolute risk difference 4.3%, 95% confidence interval 1.4% to 7.2%) and 1.32 (1.06 to 1.64; 2.6%, 0.3% to 4.9%), respectively. The hazard ratios were 1.19 (1.05 to 1.36; absolute risk difference 9.7%, 5.0% to 14.3%) and 1.27 (1.02 to 1.58; 5.0%, 1.2% to 8.8%), respectively, for all cause and cardiovascular mortality when the two extreme categories of ultra-processed food intake were compared. When these two indices were analysed jointly, the magnitude of the association of the FSAm-NPS dietary index with all cause and cardiovascular mortality was attenuated by 22.3% and 15.4%, respectively, whereas mortality risks associated with high ultra-processed food intake were not altered. CONCLUSIONS Adults with the lowest quality diet, as measured using the FSAm-NPS dietary index (underpinning the Nutri-Score), and the highest ultra-processed food consumption (NOVA classification) were at the highest risk for all cause and cardiovascular mortality. A significant proportion of the higher mortality risk associated with an elevated intake of nutrient poor foods was explained by a high degree of food processing. In contrast, the relation between a high ultra-processed food intake and mortality was not explained by the poor quality of these foods.
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Affiliation(s)
- Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077 Pozzilli (IS), Italy
| | | | - Emilia Ruggiero
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077 Pozzilli (IS), Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077 Pozzilli (IS), Italy
| | - Giuseppe Grosso
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077 Pozzilli (IS), Italy
| | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077 Pozzilli (IS), Italy
| | | | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077 Pozzilli (IS), Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077 Pozzilli (IS), Italy
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, 21100 Varese-Como, Italy
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17
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Mazzù MF, Baccelloni A, Finistauri P. 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; 14:3423. [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] [MESH Headings] [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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Affiliation(s)
| | - Angelo Baccelloni
- Department of Communication and Social Research, Sapienza University, Via Salaria 113, 00198 Rome, Italy
| | - Piera Finistauri
- Department of Business and Management, Luiss University, Viale Romania 32, 00197 Rome, Italy
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18
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Furuta C, Jinzu H, Cao L, Drewnowski A, Okabe Y. Nutrient Profiling of Japanese Dishes: The Development of a Novel Ajinomoto Group Nutrient Profiling System. Front Nutr 2022; 9:912148. [PMID: 35967784 PMCID: PMC9372512 DOI: 10.3389/fnut.2022.912148] [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: 04/04/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Government agencies and private companies have supported the development of nutrient profiling (NP) systems to facilitate the selection of nutrient-dense foods by consumers, promote nutritious food development, and limit excessive advertising of products with low nutritional value. While most NP models were developed to assess individual foods, the Ajinomoto Group Nutrient Profiling System (ANPS) was developed to assess the overall nutritional value of cooked dishes that are culturally specific to Japan. Based on the national dietary recommendations and nutritional surveys, target values were created for 13 dish categories, while considering the combinations of meal units. For the ANPS, the four evaluating elements were protein and vegetables, which should be encouraged, and sodium and saturated fatty acids, which should be limited. The ANPS algorithm for dishes was the sum of the scores of individual elements, with a maximum of 10 points per serving. The sum of scores was then multiplied by 2.5 to convert to the 100-point scale. Convergent validity was tested using the nutrient-rich food index (NRF) score of 6.3. In total, 1,089 popular Japanese dishes were evaluated using the ANPS, and the median score of ANPS was 70.0 points (interquartile range, 55–78.8), and the average score was 67.7 (standard deviation, 16.5) points. Since salt intake is a major health risk in Japan, this tool was designed to evaluate sodium content with high sensitivity, and low-salt dishes significantly improved sodium and ANPS scores compared with regular dishes. The Pearson’s correlation coefficient between the total score of NRF 6.3 and ANPS in 1,089 dishes was r = 0.452 (p < 0.0001). This newly developed ANPS could be used to evaluate culture-specific cooked dishes per serving size. It can determine the nutritional values of dishes, with a high sensitivity to sodium content, a major Japanese nutritional issue. Further research is needed to determine the accuracy and usefulness of the ANPS as a system that would lead to changes in eating behavior nationwide.
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Affiliation(s)
- Chie Furuta
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Hiroko Jinzu
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Lili Cao
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Adam Drewnowski
- Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, WA, United States
| | - Yuki Okabe
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kawasaki, Japan
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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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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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