Understanding How Consumers Categorise Health Related Claims on Foods: A Consumer-Derived Typology of Health-Related Claims

Does exposure necessarily lead to misbelief? A meta-analysis of susceptibility to health misinformation

A meta-analysis was conducted to quantify the overall effect of health misinformation exposure on shaping misbelief. Aggregation of results from 28 individual randomized controlled trial studies (n = 8752) reveals a positive but small average effect, d = 0.28. Moderation analyses suggest that adults who are younger and female tend to develop higher misbelief if exposed to health misinformation. Furthermore, media platform, message falsity, and misbelief measurements also contribute to the exposure effect. These findings offer nuanced but crucial insights into existing misinformation literature, and development of more effective strategies to mitigate the adverse impacts of health misinformation.

Smoothies Marketed in Spain: Are They Complying with Labeling Legislation?

There is no legal definition of a smoothie, so the European legislation applicable to its labeling is that of fruit juice. The smoothie market has grown in recent years, as it can include a wide variety of ingredients: fruits, fruit purees, honey, milk and vegetable milks, vegetables, herbs, cereals, cereal flours, seaweed, and crushed ice. In this study, 57 smoothies were reviewed. All of them were purchased in supermarkets and classified into eight types according to the main ingredients. Fifteen legal statements/items were reviewed on the pack labels: eleven mandatory and three optional. Moreover, nutrition labels, nutritional claims, images, marks, and other symbols were also reviewed. Only 22.8% of the samples complied with EU and Spanish labeling legislation. More incorrectness was related to the name of the food and the fruits included as main ingredients; other errors related to the allergy/intolerance statements, and some nutritional claims concerning vitamin C were also detected to a lesser extent. General advice is provided for consumers to interpret smoothie labels correctly. Lawmakers should amend legislation to accept the term "smoothie" as a legal name.

Persuasive packaging? The impact of packaging color and claims on young consumers' perceptions of product healthiness, sustainability and tastiness

Following the increasing importance of healthiness and sustainability for many consumers, manufacturers increasingly try to give products a healthier or eco-friendlier image, for instance through packaging design. We conducted two experiments to investigate how visual (i.e., colors) and textual (i.e., claims) packaging elements shape perceptions of product healthiness, sustainability and tastiness. Additionally, the studies investigated whether these packaging elements impact the likelihood that these products are selected in a choice task. Study 1 (N = 202) had a mixed design, with packaging color (warm versus cool) and a nutrition claim (present versus absent) as within-subjects manipulations. Young consumers chose between four beverages, and subsequently evaluated these beverages. Study 2 (N = 211) had a similar design and procedure, but focused on the impact of an ecological claim on the evaluation of snacks. In line with our hypotheses, cool packaging colors (i.e., green and blue) increased perceptions that food and drinks were healthy and sustainable. However, in Study 1, cool packaging colors also resulted in lower tastiness expectations, and a lower likelihood that the product was selected. We also found that a simple nutrition/ecological claim made products seem overall healthier and more sustainable. Additionally, contrary to many previous studies, we did not find that these claims affected taste expectations. Our studies highlight the importance of package design as a factor that can influence perceptions of food and drink products.

Nature of the evidence base and strengths, challenges and recommendations in the area of nutrition and health claims: a position paper from the Academy of Nutrition Sciences

The regulation of health claims for foods by the Nutrition and Health Claims Regulation is intended, primarily, to protect consumers from unscrupulous claims by ensuring claims are accurate and substantiated with high quality scientific evidence. In this position paper, the Academy of Nutrition Sciences uniquely recognises the strengths of the transparent, rigorous scientific assessment by independent scientists of the evidence underpinning claims in Europe, an approach now independently adopted in UK. Further strengths are the separation of risk assessment from risk management, and the extensive guidance for those submitting claims. Nevertheless, four main challenges in assessing the scientific evidence and context remain: (i) defining a healthy population, (ii) undertaking efficacy trials for foods, (iii) developing clearly defined biomarkers for some trial outcomes and (iv) ensuring the composition of a food bearing a health claim is consistent with generally accepted nutrition principles. Although the Regulation aims to protect the consumer from harm, we identify some challenges from consumer research: (i) making the wording of some health claims more easily understood and (ii) understanding the implications of the misperceptions around products bearing nutrition or health claims. Recommendations are made to overcome these challenges. Further, the Academy recommends that a dialogue is developed with the relevant national bodies about Article 12(c) in the Regulation. This should further clarify the GB Guidance to avoid the current non-level playing field between health professionals and untrained ‘influencers’ who are not covered by this Article about the communication of authorised claims within commercial communications.

Consumers' Attitudes and Purchase Intention for a Vitamin-Enriched Extra Virgin Olive Oil

This study aims to examine Italian consumer preferences for extra virgin olive oil (EVOO) enriched with vitamins and to analyze the key drivers that affect consumer choices for this product. Specifically, we assessed consumers' intention to purchase the enriched product compared to the conventional one. The methodology adopted inferential and multivariate statistical techniques: (1) exploratory factor analysis (EFA), (2) ordinary least squares regression (OLS) and (3) non-hierarchical clustering. This study appears to be the first research project related to exploring consumers' interest in an extra virgin olive oil enhanced with vitamins, thereby providing preliminary indications. The main results represent a significant starting point for the development of new marketing strategies for the food industry.

Use of Branded Food Composition Databases for the Exploitation of Food Fortification Practices: A Case Study on Vitamin D in the Slovenian Food Supply

Vitamin D deficiency is a worldwide public health concern, which can be addressed with voluntary or mandatory food fortification. The aim of this study was to determine if branded food composition databases can be used to investigate voluntary fortification practices. A case study was conducted using two nationally representative cross-sectional datasets of branded foods in Slovenia, collected in 2017 and 2020, and yearly sales data. Using food labeling data we investigated prevalence of fortification and average vitamin D content, while nutrient profiling was used to investigate overall nutritional quality of the foods. In both datasets, the highest prevalence of vitamin D fortification was observed in meal replacements (78% in 2017; 100% in 2020) and in margarine, corresponding to high market share. Other food categories commonly fortified with vitamin D are breakfast cereals (5% in 2017; 6% in 2020), yogurts and their imitates (5% in 2017; 4% in 2020), and baby foods (18% in both years). The highest declared average content of vitamin D was observed in margarine and foods for specific dietary use (7-8 μg/100g), followed by breakfast cereals (4 μg/100g), while the average content in other foods was below 2 μg/100g. Only minor differences were observed between 2017 and 2020. Major food-category differences were also observed in comparison of the overall nutritional quality of the fortified foods; higher overall nutritional quality was only observed in fortified margarine. Our study showed that branded food composition databases are extremely useful resources for the investigation and monitoring of fortification practices, particularly if sales data can also be used. In the absence of mandatory or recommended fortification in Slovenia, very few manufacturers decide to add vitamin D, and even when this is the case, such products are commonly niche foods with lower market shares. We observed exceptions in imported foods, which can be subject to fortification policies introduced in other countries.

Nutrition and Health Claims Spectra of Pre-Packaged Foods on Serbian Supermarket Shelves: A Repeated Cross-Sectional Study

Nutrition and health claims (NHCs) are a powerful tool that influence consumers' final decision on the choice of food products. The purposes of this repeated cross-sectional study were to (i) assess the prevalence of pre-packaged food products containing nutrition and health claims among different food categories, (ii) to determine the type of NHCs labelled on the examined food products, and (iii) to evaluate the trend in the use of NHCs in comparison to the 2012 survey. The survey was conducted immediately before the full enforcement of the new national legislation on NHCs in 2020. It comprised 3141 pre-packaged food products from 10 product categories. In total, 21.2% of food products contained any claim (19.4% contained any nutrition claim; 8.2% contained any health claim). In comparison to the 2012 survey, we observed a rising trend in the presence of NHCs; the use of nutrition claims on food products increased three times and the use of health claims increased 1.3 times in the 2020 survey. Bearing in mind that NHCs are a powerful tool guiding consumers' food purchase decisions, NHCs should be supported by precise legislation and strict surveillance by the public health authorities.

Heart Images on Food Labels: A Health Claim or Not?

Health claims on food labels are used by food manufacturers to inform consumers about the health effects of a product, and such claims can have notable effects on consumer preferences. According to regulatory definitions, health claims can be either worded or presented as images, but it is not clear under which conditions an image on a food label should be considered a health claim. This question has important practical implications, as the use of health claims is strictly regulated. The objective of this study was to determine how commonly images of the heart are used on food labels, and to investigate consumers’ perceptions of products labelled with heart images, using different degrees of health relationships. Both a food supply study (N = 10,573 foods) and experiments with consumers (N = 1000) were performed in Slovenia. The use of heart imagery on food products was very common (9%). The consumer study was conducted using a web panel. Structure of the study population was comparable with Slovenian adult population (18–65 years), according to gender and age. The questionnaire was split into conjoint analysis with constructed elements, a choice-based task with real-life elements and a consumers’ association task. The experiments showed that a heart image as part of the brand name itself—without an additional (worded) health claim—did not cause most consumers to relate it to health. However, consumers tended to strongly relate an image of the heart as part of a brand with health benefits, where the image was accompanied by a worded health claim or if the heart image was designed specifically to imply health benefits. We can conclude that the use of heart images was very common on food products, but references to health were less common. Without a health-related context, heart images could not be considered as a health claim.

Consumers' Implicit and Explicit Recall, Understanding and Perceptions of Products with Nutrition-Related Messages: An Online Survey

This study aimed to assess consumers' implicit and explicit recall, understanding and perceptions of products with a nutrition claim and a symbol depicting 'health,' and to determine whether these perceptions differed among Nutrition Facts table (NFt) users vs. nonusers. In an online survey, participants (n = 1997) were randomized to one of eight conditions in a 2 × 2 × 2 factorial design, consisting of a label with a claim (present/absent) a heart-shaped symbol depicting 'health' (present/absent) for a healthier or less healthy soup. Participants were shown a label for 10 s and asked whether they recalled seeing a claim. If participants answered yes, they were then asked to describe their response using open-ended questions. Participants also rated the product's perceived nutritional quality and purchase intentions using seven-point Likert scales. In the claim condition, most participants (75%) were able to recall the presence of a claim, while 12% incorrectly mentioned the presence of a claim when there was none. Claims likely attracted consumers' attention and increased perceived nutritional quality, although with limited influence among NFt users (23%). The symbol depicting 'health' did not enhance perceived nutritional quality or purchase intentions. Although most participants (77%) made their decisions implicitly using the front of labels, those who used the NFt had a better understanding of the nutritional quality of products.

The Role of Individual Knowledge in Functional Olive Oil Preferences: Does Self-Coherence Lead to Different Health Attributes Perception?

This study examined whether health cues influence the choices of olive oil consumers with different degrees of knowledge about the nutritional properties of olive oil. To this end, a direct survey on the consumption of healthy extra-virgin olive oil was implemented by examining the stated preferences of a sample of consumers. Two econometric analyses were carried out to identify the drivers of the consumption of olive oil with high polyphenol content. The logistic model was chosen as the most suitable method to answer the research questions. The results revealed a general consensus among consumers regarding the beneficial properties of olive oil consumption. Moreover, the findings show that different degrees of individual knowledge act as distinctive drivers in influencing the health perception of olive oil consumers. Finally, this study verified that, even for healthy foods, consumers’ choices are strongly dependent on their own self-coherence. As a consequence, consumers’ knowledge or beliefs that orientate their attitudes are influenced by different motivations and attributes.

Nutrition Claims Frequency and Compliance in a Food Sample of the Spanish Market: The BADALI Study

Nutrition claims (NCs) have been shown to affect customers' perceptions and behaviour. In Europe, they are regulated by Regulation (EC) No 1924/2006. The aim of this work was to analyse the prevalence and compliance of NCs according to this regulation in Spain. For this purpose, we used the BADALI database, which included 3197 foods present in the Spanish market. Our results show that 36.1% of all foods carried NCs, at a rate of 3.3 NCs/food. The prevalence was very heterogeneous among food groups. Nuts and seeds, legumes and non-alcoholic beverages were the groups with the highest prevalence. Micronutrients, fat, fibre and sugars were the nutrients most referred to in NCs. Overall, the compliance was low, with 49.2% NCs correct. Fibre and proteins were the nutrients with most correct NCs. Vegetables and non-alcoholic beverages were the food groups with the highest proportion of correct NCs. The main reason for incorrect NCs was because the amount of the nutrient was not stated in the label. The results of our study reveal that the aim of the European Commission to ensure a high level of protection for consumers regarding NCs has not been fulfilled. Therefore, we consider it crucial that European institutions invest in guaranteeing regulation compliance.

Predicting Old-age Mortality Using Principal Component Analysis: Results from a National Panel Survey in Korea

Background and Objectives: This study aimed to group diseases classified by the International Classification of Diseases using principal component analysis, and discuss a systematic approach to reducing the preventable death rate from a perspective of public health. Materials and Methods: Using a 10-year follow-up analysis of the Korean Longitudinal Study of Aging (KLoSA) data, this study obtained de-identified data including participants’ data of community-dwelling individuals aged ≥45 years from 2006 to 2016. Participants were randomly selected using a multistage, stratified probability sampling based on geographical area and housing type. We excluded 37 participants with missing information at baseline and included 10,217 study participants. This study used the principal component analysis to extract comorbidity patterns, and chi-square test and Cox proportional hazards models for analyzing the association between the factors of interest. Results: Principal component 1 (diabetes, heart disease, and hypertension) was associated with an increased hazard ratio (HR) of 1.079 (95% confidence interval (CI) 1.031–1.129, p = 0.001). Principal component 3 (psychiatric and cerebrovascular diseases) was related to an increased HR of 1.134 (95% CI 1.094–1.175, p < 0.0001). Moreover, principal component 4 was associated with a high HR of 1.172 (95% CI 1.130–1.215, p < 0.0001). However, among participants aged between 45 and 64 years, principal component 4 showed a meaningfully increased HR of 1.262 (95% CI 1.184–1.346, p < 0.001). In this study, among the four principal components, three were statistically associated with increased mortality. Conclusions: The principal component analysis for predicting mortality may become a useful tool, and artificial intelligence (AI) will improve a value-based healthcare strategy, along with developing a clinical decision support model.

Changes in nutrition content and health claims post-implementation of regulation in Australia

OBJECTIVE

To determine whether there were changes in the prevalence or healthiness of products carrying claims post-implementation of Standard 1.2.7: Nutrition, Health and Related Claims in the Australia New Zealand Food Standards Code.

DESIGN

Observational survey of claims on food packages in three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products to determine their eligibility to carry health claims under Standard 1.2.7. The Standard came into effect in 2013. The proportion of products carrying claims and the proportion of those not meeting the nutrient profiling criteria were calculated. A comparative analysis was conducted to determine changes between 2011 and 2016.

SETTING

Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in 2011 and 2016.

PARTICIPANTS

All claims on all available products in 2016 (n 1737). Nutrition composition and ingredients were collected from the packaging.

RESULTS

Overall in 2016, 76 % of products carried claims and there were 7367 claims identified in the three food categories. Of products in 2016 with health claims, 34 % did not meet nutrient profiling criteria. These may breach Standard 1.2.7. Comparison of 2011-2016 showed a significant increase in the number of products carrying claims (66 v. 76 %, P < 0·001).

CONCLUSIONS

The proportion of products carrying claims that do not meet nutrient profiling and consumers' tendency to infer health benefits from nutrition content claims warrants the regulation of all claims using the nutrient profiling. This will ensure consumers are not misled by claims on unhealthy food products.

Do Consumers Care about Nutrition and Health Claims? Some Evidence from Italy

This study investigates Italian consumer knowledge and use of nutrition and health claims (NHCs). Six specific claims are examined on the basis of a web survey carried out on a sample of 504 consumers. Our results show that there is little attention to NHCs and their use is not widespread; objective knowledge of the selected claims is fairly scant, generating misinterpretation and confusion about their real meaning. K-means cluster analysis allowed us to identify three segments of consumers, characterized by different levels in attention and use frequency of NHCs, with a specific profile in terms of motivation and nutritional knowledge. Our results suggest the advisability of policy interventions and communication efforts which target the three segments with a view to achieving greater attention to NHCs. In conclusion, to boost knowledge concerning the actual meaning of the claims and their relation with a healthy diet, especially to reach non-users, information should be provided both simply and clearly, avoiding the use of complex scientific terminology.