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Kelly B, Ng SH, Carrad A, Pettigrew S. The Potential Effectiveness of Front-of-Pack Nutrition Labeling for Improving Population Diets. Annu Rev Nutr 2024; 44:405-440. [PMID: 38857543 DOI: 10.1146/annurev-nutr-011224-030917] [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] [Indexed: 06/12/2024]
Abstract
Nutrition labeling on the front of food packages can support more healthful purchase decisions and encourage favorable reformulation. This systematic literature review applied Cochrane methods to synthesize and appraise the evidence on the effectiveness of front-of-pack labeling (FOPL) on diet-related outcomes and food reformulation to inform policy recommendations. The search was conducted on 11 academic and gray literature databases, from inception to July 2022. Evidence was synthesized using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), vote counting, and meta-analyses, where appropriate. Overall, 221 articles were included in the review. The randomized controlled trial evidence suggested that, compared with when no FOPL was present, FOPL likely improved consumer understanding of the nutritional quality/content of foods (moderate certainty of evidence), and the healthfulness of food choices (moderate certainty) and purchases (moderate certainty). Interpretive FOPL had a greater effect on these outcomes compared with noninterpretive systems (moderate certainty). There was inconsistency in the best-performing interpretive FOPL system.
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Affiliation(s)
- Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia;
| | - See Hoe Ng
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia;
| | - Amy Carrad
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia;
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Stiletto A, Vecchio R, Cembalo L, Trestini S. The impact of nutri-score on consumers' preferences for geographical indications. Evidence from a non-hypothetical experiment. Appetite 2024; 199:107400. [PMID: 38735306 DOI: 10.1016/j.appet.2024.107400] [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: 01/09/2024] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/14/2024]
Abstract
The EU Farm to Fork strategy (F2F) promotes the compulsory adoption of a nutritional front of pack label to improve the diets of the citizens, supporting healthier food choices. In the public debate, Nutri-Score (NS) is the most favored candidate. Although being widely supported, oppositions on the political and producer levels are raised against the NS, due to the economic impact it could have on specific food sector, and specifically on Geographical Indications (GIs). Recent literature has stressed the need to explore it in more detail. The current study contributes to fill this gap by analyzing consumers' monetary preferences for GI products labelled with different NS levels. An incentivized non-hypothetical experiment was conducted on 188 Italian consumers. Different products representing different levels of NS were used. Specifically, a conventional pasta and the Pasta di Gragnano PGI (NS = A), a conventional flatbread (piadina) and the Piadina Romagnola PGI (NSC), and a conventional hard cheese and the Parmigiano Reggiano PDO (NS = D) were considered in the survey. Results reveal that the NS elicits favorable responses and unfavorable reactions in consumers' preferences, aligning with expectations for A and D scores, respectively. The perceived healthiness of the product significantly affects consumers' WTP, increasing it. Results stress the need to have effective communication strategies within the EU to reach the F2F goals. NS diminishes the premium in prices associated with GIs independently from its level, when considering those consumers who value more the GIs. However, the most well-known GIs does not suffer from this negative effect of the NS, as the positive value associated to the GI offset the negative effect of the NS.
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Affiliation(s)
- Alice Stiletto
- Department of Land, Environment, Agriculture, and Forestry, University of Padova, Viale dell'Università 16, Legnaro, Padova, Italy.
| | - Riccardo Vecchio
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 100, Portici, Naples, Italy.
| | - Luigi Cembalo
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 100, Portici, Naples, Italy.
| | - Samuele Trestini
- Department of Land, Environment, Agriculture, and Forestry, University of Padova, Viale dell'Università 16, Legnaro, Padova, Italy.
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Magriplis E, Marakis G, Panagiotakos DB, Samona A, Kotopoulou S, Kouretas D, Smiliotopoulos T, Chourdakis M, Zampelas A. The Relation between Consumer Perception and Objective Understanding of Front-of-Package Nutrition Labels (FOPNLs); Results from an Online Representative Survey. Nutrients 2024; 16:1751. [PMID: 38892684 PMCID: PMC11174983 DOI: 10.3390/nu16111751] [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: 04/19/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND This study investigates the efficacy of Front-of-Pack Nutrition Labels (FOPNLs) as a cost-effective tool for improving dietary choices among Greek consumers. The purpose of the study was to investigate Greek customers' preferences and comprehension of commonly used European FOPNL schemes. METHODS The Hellenic Food Authority and the Agricultural University of Athens performed a representative online survey in March 2022, titled "The Role of Nutritional Labelling in Public Perception and Food Procurement." Consumers responded to a questionnaire separated into two parts. Part one included (i) personal, sociodemographic information, and (ii) subjective opinions on the FOPNL schemes, and part two comprised (iii) an objective understanding of NutriScore and NutrInform Battery, using 15 different foods. Participants were randomly allocated to these groups, and general mixed models were used for analysis. RESULTS A total of 1389 adults completed the first part of the survey, and 74.8% completed the second part. The Multiple Traffic Lights scheme was the preferred FOPNL, chosen by 48.4% of respondents, compared to 19.7% for NutrInform Battery and 12.3% for NutriScore. However, the mean objective assessment score was highest for NutriScore (5.8 ± 2.3) compared to NutrInform Battery (5.4 ± 1.9). CONCLUSION The results highlight the necessity for comprehensive nutrition education programs by showing a considerable gap between subjective preferences and an objective understanding of nutrition labels.
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Affiliation(s)
- Emmanuella Magriplis
- Laboratory of Dietetics & Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece; (S.K.); (T.S.); (A.Z.)
| | - Georgios Marakis
- Hellenic Food Authority, Leoforos Kifissias 124 & Iatridou 2, 11526 Athens, Greece; (G.M.); (A.S.)
| | - Demosthenes B. Panagiotakos
- Department of Nutrition & Dietetics, School of Health Sciences & Education, Harokopio University, 17776 Athens, Greece;
| | - Aspasia Samona
- Hellenic Food Authority, Leoforos Kifissias 124 & Iatridou 2, 11526 Athens, Greece; (G.M.); (A.S.)
| | - Sotiria Kotopoulou
- Laboratory of Dietetics & Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece; (S.K.); (T.S.); (A.Z.)
- Hellenic Food Authority, Leoforos Kifissias 124 & Iatridou 2, 11526 Athens, Greece; (G.M.); (A.S.)
| | - Dimitris Kouretas
- Department of Biochemistry-Biotechnology, University of Thessaly, 41334 Larisa, Greece;
| | - Theodoros Smiliotopoulos
- Laboratory of Dietetics & Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece; (S.K.); (T.S.); (A.Z.)
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Antonis Zampelas
- Laboratory of Dietetics & Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece; (S.K.); (T.S.); (A.Z.)
- Hellenic Food Authority, Leoforos Kifissias 124 & Iatridou 2, 11526 Athens, Greece; (G.M.); (A.S.)
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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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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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Srour B, Hercberg S, Galan P, Monteiro CA, Szabo de Edelenyi F, Bourhis L, Fialon M, Sarda B, Druesne-Pecollo N, Esseddik Y, Deschasaux-Tanguy M, Julia C, Touvier M. Effect of a new graphically modified Nutri-Score on the objective understanding of foods' nutrient profile and ultraprocessing: a randomised controlled trial. BMJ Nutr Prev Health 2023; 6:108-118. [PMID: 37484539 PMCID: PMC10359533 DOI: 10.1136/bmjnph-2022-000599] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/18/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction When considering health-related impacts of foods, nutrient profile and (ultra)processing are two complementary dimensions. The Nutri-Score informs on the nutrient profile dimension. Recently, mounting evidence linked ultraprocessed food consumption to various adverse health outcomes, independently of their nutrient profile. To inform consumers about each of these health-related dimensions of food, we tested, in a randomised controlled trial, if a graphically modified version 'Nutri-Score V.2.0', including a black 'ultraprocessed' banner, would improve the capacity of consumers to rank products according to their nutrient profile and to detect those ultra-processed, compared with a no-label situation. Methods 21 159 participants included in the NutriNet-Santé web-cohort were randomly assigned to a control arm (no front-of-pack label) or an experimental arm (Nutri-Score 2.0) and were presented an online questionnaire with three sets of food products (cookies, breakfast cereals and ready-to-eat meals) to rank according to nutrient profile and to identify ultraprocessed foods. The primary outcome was objective understanding of nutrient profile and ultraprocessing, represented by a score of correct answers. Secondary outcomes were purchasing intentions and the healthiest-perceived product. Multinomial logistic regressions were performed. Results The Nutri-Score V.2.0 increased the objective understanding of both the nutrient profile dimension (OR highest vs lowest score category=29.0 (23.4-35.9), p<0.001) and the ultraprocessing dimension (OR=174.3 (151.4-200.5), p<0.001). Trends were similar for cookies, breakfast cereals and ready-to-eat meals. The Nutri-Score V.2.0 had a positive effect on purchasing intentions and on the products perceived as the healthiest. Conclusion This randomised controlled trial demonstrates the interest of a front-of-pack label combining the Nutri-Score (informing on the nutrient profile dimension) with an additional graphic mention, indicating when the food is ultraprocessed, compared with a no-label situation. Our results show that a combined label enabled participants to independently understand these two complementary dimensions of foods. Trial registration number NCT05610930.
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Affiliation(s)
- Bernard Srour
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
| | - Serge Hercberg
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
- Département de Santé Publique, Hôpital Avicenne, F-93017, Bobigny Cedex, France, Bobigny, France
| | - Pilar Galan
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
| | - Carlos Augusto Monteiro
- Department of Nutrition, School of Public Health, University of Sao Paulo, São Paulo, Brazil
| | - Fabien Szabo de Edelenyi
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
| | - Laurent Bourhis
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
| | - Morgane Fialon
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
| | - Barthélémy Sarda
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
| | - Nathalie Druesne-Pecollo
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
| | - Younes Esseddik
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
| | - Mélanie Deschasaux-Tanguy
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
| | - Chantal Julia
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
- Département de Santé Publique, Hôpital Avicenne, F-93017, Bobigny Cedex, France, Bobigny, France
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), F-93017 Bobigny, France
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Batista MF, de Carvalho-Ferreira JP, Thimoteo da Cunha D, De Rosso VV. Front-of-package nutrition labeling as a driver for healthier food choices: Lessons learned and future perspectives. Compr Rev Food Sci Food Saf 2023; 22:535-586. [PMID: 36514235 DOI: 10.1111/1541-4337.13085] [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: 04/30/2022] [Revised: 10/13/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022]
Abstract
This work aims to provide a comprehensive overview of the use of front-of-package nutritional labeling (FOPL), identify and characterize the major existing FOPL systems, examine the impact of FOPL systems on consumer behavior, and discuss future perspectives. The searched databases were PubMed, Scopus, and Web of Science, and papers in English, Portuguese, Spanish, and French were considered. The integrative review method was used, comprising 68 papers. The FOPL system from more than 47 countries from North America, South America, Africa, Europe, Australia, and Asia was included in this study. The two main ways to characterize FOPL are the level of interpretation and the type of information provided. Interpretive schemes (such as warning labels, multiple traffic lights, and Nutri-Score) appear to lead to better consumer understanding and support healthier food purchases. However, due to the differences among the results and the specificity of the contexts in which they are used, it is impossible to define one FOPL interpretation scheme superior to the others. Some potential factors that influence the effectiveness of FOPL on consumer attitudes have been identified, such as food taste, as a major intrinsic factor. Extrinsic factors, such as price, food category, cultural diversity, politics, and economics, were also relevant. The lack of availability of similar alternatives, lack of understanding of the importance of FOPL, and lower levels of income and education were also some cognitive and social aspects impairing FOPL effectiveness. Prospects for the United States, Europe, Brazil, Colombia, and Argentina were discussed.
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Affiliation(s)
- Mariana Frazão Batista
- Graduate Program in Nutrition, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Nutrition and Food Service Research Center, Federal University of São Paulo (UNIFESP), Santos, Brazil
| | - Joana Pereira de Carvalho-Ferreira
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Santos, Brazil.,School of Applied Sciences, State University of Campinas (UNICAMP), Limeira, Brazil
| | | | - Veridiana Vera De Rosso
- Nutrition and Food Service Research Center, Federal University of São Paulo (UNIFESP), Santos, Brazil
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Nutritional Assessment of Ready-to-Eat Salads in German Supermarkets: Comparison of the nutriRECIPE-Index and the Nutri-Score. Foods 2022; 11:foods11244011. [PMID: 36553751 PMCID: PMC9777885 DOI: 10.3390/foods11244011] [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: 10/12/2022] [Revised: 11/17/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
Globally, an unbalanced diet causes more deaths than any other factor. Due to a lack of knowledge, it is difficult for consumers to select healthy foods at the point of sale. Although different front-of-pack labeling schemes exist, their informative value is limited due to small sets of considered parameters and lacking information on ingredient composition. We developed and evalauated a manufacture-independent approach to quantify ingredient composition of 294 ready-to eat salads (distinguished into 73 subgroups) as test set. Nutritional quality was assessed by the nutriRECIPE-Index and compared to the Nutri-Score. The nutriRECIPE-Index comprises the calculation of energy-adjusted nutrient density of 16 desirable and three undesirable nutrients, which are weighted according to their degree of supply in the population. We show that the nutriRECIPE-Index has stronger discriminatory power compared to the Nutri-Score and discriminates as well or even better in 63 out of the 73 subgroups. This was evident in groups where seemingly similar products were compared, e.g., potato salads (Nutri-Score: C only, nutriRECIPE-Index: B, C and D). Moreover, the nutriRECIPE-Index is adjustable to any target population's specific needs and supply situation, such as seniors, and children. Hence, a more sophisticated distinction between single food products is possible using the nutriRECIPE-Index.
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Fialon M, Nabec L, Julia C. Legitimacy of Front-of-Pack Nutrition Labels: Controversy Over the Deployment of the Nutri-Score in Italy. Int J Health Policy Manag 2022; 11:2574-2587. [PMID: 35219283 PMCID: PMC9818094 DOI: 10.34172/ijhpm.2022.6127] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 01/12/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Front-of-pack nutrition labels (FoPLs) aim at increasing transparency and consumers' awareness of the nutritional composition of pre-packed food products in order to improve the nutritional quality of their food choices. Nevertheless, the legitimacy of the Nutri-Score - the FoPL officially adopted in France and several other European countries - is subject to both technical and political controversy, particularly in Italy. In this study, we investigated how and by whom the legitimacy of the Nutri-Score, recognized by several institutional authorities, could be deconstructed within a specific system of norms, values and beliefs among Italian stakeholders. METHODS A netnography completed with qualitative interviews with eight Italian and French nutrition and public health experts were carried out to highlight the dimensions (pragmatic, normative and cognitive) in which the Nutri-Score's legitimacy is being challenged among the stakeholders involved in FoPLs' implementation in Italy. The degree of influence and the position of these stakeholders on the debate around the Nutri-Score were assessed through the Stakeholder Theory (SHT), using their respective level of power, legitimacy and urgency. Furthermore, we compared the Italian and the French contexts on the issue. RESULTS The direct implication of political parties and media outlets in framing the Italian debate around Nutri-Score as well as the high influence of corporate unions, led to a different political outcome than in France. Results also show that the deconstruction of the legitimacy of the Nutri-Score in Italy pertained mainly to its pragmatic dimension according to the Italian public health experts. Nevertheless, its two other dimensions (normative and cognitive) are also questioned by high-influence stakeholders. CONCLUSION Due to the limited mobilization of scientific expertise over the issue, the debate in Italy stayed centered around the "attack" of the Nutri-Score to the Italian way of life, mixing up concepts such as Made in Italy products and the Mediterranean diet.
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Affiliation(s)
- Morgane Fialon
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University/INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center, University of Paris (CRESS), Paris, France
| | - Lydiane Nabec
- Centre de Recherche Réseaux, Innovation, Territoire et Mondialisation (RITM), Université Paris-Saclay, Paris, France
| | - Chantal Julia
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University/INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center, University of Paris (CRESS), Paris, France
- Public Health Department, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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10
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Is it really a piece of cake to label Geographical Indications with the Nutri-Score? Consumers’ behaviour and policy implications. PLoS One 2022; 17:e0277048. [PMCID: PMC9671382 DOI: 10.1371/journal.pone.0277048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022] Open
Abstract
To improve the dietary habits of the population, the EU, within the Farm to Fork strategy (F2F), is strongly supporting the Nutri-Score (NS) Front Of Pack (FOP) label. Under the NS system, Geographical Indications (GIs) are generally scored as “unhealthy” food, given the predominance of products of animal origin among GIs which are, notoriously, high-fat products. This study aims to determine the impact of the NS label on consumers’ preferences for two Protected Designation of Origin (PDO) cheeses, in comparison with generic ones. A Discrete Choice Experiment (DCE) was conducted on 600 Italian consumers through the estimation of a Random Parameter Logit model. Results highlighted that Italian consumers are generally not familiar with the NS and perceive it as a positive characteristic of the product, even if it is signalling an unhealthy choice (D score). However, consumers aware of the Nutri-Score meaning are willing to pay less to buy a product considered “unhealthy” according to this system. Furthermore, we found that consumers who already knew the NS system have homogeneous behaviours in rejecting the product, independently of the association with a PDO certification. This result has important implications on the agri-food sector. If the Nutri-Score becomes mandatory in the EU, consumers might refuse many GIs due to their negative Nutri-Score values. However, the quality of these products is recognized and protected worldwide. In this vein, the GI policy could be questioned by the F2F strategy: both of them aims to reduce information asymmetry producing, at the same time, contrasting results. Within the Geographical Indication policy, the PDO and PGI goods are protected for their quality attributes, which are strictly linked to their geographical origin of the products and traditional know-how. However, the EU adoption of the Nutri-Score could damage these products, reducing their perceived quality/value.
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Bolhuis D, Mosca AC, Pellegrini N. Consumer Awareness of the Degree of Industrial Food Processing and the Association with Healthiness-A Pilot Study. Nutrients 2022; 14:4438. [PMID: 36297121 PMCID: PMC9610034 DOI: 10.3390/nu14204438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Consumption of ultraprocessed foods (UPFs) has been associated with lower diet quality, obesity, and adverse health effects. Not much is known about how consumers evaluate the degree of processing of a food product and how they relate this to healthiness. An online questionnaire was completed by a total of 277 Dutch, 204 Italian, and 181 Brazilian consumers. Consumers were aged 18-65 year, mean 38 ± 13 year, 31% were males, and 71% were highly educated. Pictures of several common food products were evaluated on the degree of industrial processing and healthiness. Thirteen food categories were included, each including one minimally processed food (MPF), one High NS_UPF (Nutri-Score A or B), and one Low NS_UPF (Nutri-Score D or E). Lastly, knowledge and attitude about UPFs were assessed. Ultraprocessing was perceived as unhealthy by the majority of consumers (Dutch, Italian: 55%; Brazilian: 75%) and contributed to weight gain according to: 38% Dutch, 51% Italian, and 70% Brazilian consumers. Low NS_UPFs were correctly rated toward "processed" and "not healthy" in all countries. High NS_UPF were rated as processed but showed large variations in healthiness scores. In conclusion, consumers rated UPFs relatively low in healthiness compared with MPFs with similar Nutri-Scores within the same food category. These preliminary findings suggest that consumers incorporate, to some extent, the degree of industrial processing while assessing the healthiness of food products.
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Affiliation(s)
- Dieuwerke Bolhuis
- Food Quality and Design, Wageningen University and Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands
| | | | - Nicoletta Pellegrini
- Food Quality and Design, Wageningen University and Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands
- Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, 3310 Udine, Italy
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12
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Do Individuals Use Nutrition Labels on Food Packages to Make Healthy Choices? Testing the Dual-Process Model in Two Laboratory-Based Experiments. Nutrients 2022; 14:nu14183732. [PMID: 36145108 PMCID: PMC9505394 DOI: 10.3390/nu14183732] [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: 06/25/2022] [Revised: 08/09/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Nutrition labels on food packages are designed to assist consumers in making healthy decisions. Based on the model of a dual-process system, the current study examined how people might be affected by nutrition labels and consuming contexts when making choices about healthy foods. Using four types of nutrition labels (i.e., the NuVal label, 5-Color nutrition label, traffic light label, and daily value label), participants were instructed to choose the healthier foods with or without time constraints in two experiments. In Experiment 1, participants were presented with pairs of foods accompanied by the same type of nutrition labels to measure the efficiency of their health evaluation. In Experiment 2, two types of labels with inconsistent nutritional information were presented to participants simultaneously to measure their preference regarding the nutrition labels. Findings of the current study support the notion that the traffic light label is advantageous in terms of both the efficiency of, and preferences regarding, nutrition judgment, especially with time constraints. When there was only one type of nutrition label, participants made decisions fastest and most accurately when observing the NuVal label, regardless of time constraints. Overall, the reliable interactions between the time constraints and patterns of nutrition labels have theoretical implications for the appeal-based heuristics and rational-based processing when making health-related food decisions.
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13
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Nutri-Score and NutrInform Battery: Effects on Performance and Preference in Italian Consumers. Nutrients 2022; 14:nu14173511. [PMID: 36079769 PMCID: PMC9459720 DOI: 10.3390/nu14173511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
In May 2020, the European Commission announced a proposal for a mandatory front-of-pack label (FoPL) for all European Union (EU) countries. Indeed, FoPLs have been recognized by several public institutions as a cost-effective measure to guide consumers toward nutritionally favorable food products. The aim of this study was to compare the performance and consumer preference of two FoPLs currently proposed or implemented in EU countries, the interpretive format Nutri-Score and the non-interpretive format NutrInform Battery, among Italian consumers. The experimental study was conducted in 2021 on a representative sample of 1064 Italian adults (mean age = 46.5 ± 14.1 years; 48% men). Participants were randomized to either Nutri-Score or NutrInform and had to fill out an online questionnaire testing their objective understanding of the FoPL on three food categories (breakfast products, breakfast cereals and added fats) as well as purchase intention, subjective understanding and perception. Multivariable logistic regressions and t-tests were used to analyze the answers. In terms of the capacity of participants to identify the most nutritionally favorable products, Nutri-Score outperformed NutrInform in all food categories, with the highest odds ratio being observed for added fats (OR = 21.7 [15.3−31.1], p < 0.0001). Overall, with Nutri-Score, Italian participants were more likely to intend to purchase nutritionally favorable products than with NutrInform (OR = 5.29 [4.02−6.97], p < 0.0001). Focusing on olive oil, participants of the Nutri-Score group had higher purchase intention of olive oil compared to those in the NutrInform group (OR = 1.92 [1.42−2.60], p < 0.0001) after manipulating the label. The interpretive format Nutri-Score appears to be a more efficient tool than NutrInform for orienting Italian consumers towards more nutritionally favorable food choices.
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14
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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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15
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Jürkenbeck K, Mehlhose C, Zühlsdorf A. The influence of the Nutri-Score on the perceived healthiness of foods labelled with a nutrition claim of sugar. PLoS One 2022; 17:e0272220. [PMID: 35976882 PMCID: PMC9385015 DOI: 10.1371/journal.pone.0272220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
High sugar intake in humans is associated with the development of overweight and other diet-related diseases. The World Health Organization and other health organizations recommend limiting the sugar intake to 10% of the total energy intake. There have been different approaches of front-of-pack labelling to reduce the amount of sugar in food products. Companies use nutrition claims to advertise the sugar content (e.g., without added sugar, 30% less sugar). Such nutrition claims can lead to false assumptions about the healthiness of foods and can lead to health-halo effects. Nutrition claims make products appear healthier than they really are, the aspect advertised in the nutrition claim is transferred to the entire food product. As a result, food products can be perceived as healthy even though they are not. Recently, the Nutri-Score was introduced in an increasing number of countries throughout Europe to provide consumers with an overview of the overall nutritional quality of a product. This study analyzes if the Nutri-Score can help to prevent health-halo effects caused by nutrition claims on sugar. Therefore, an online survey consisting of a split-sample design with more than 1,000 respondents was assessed. The results show that, depending on the initial perceived healthiness of a product, the Nutri-Score is able to prevent health-halo effects caused by claims on sugar. Making the Nutri-Score mandatory when using nutrition claims would be one possible way to reduce misperceptions about unhealthy food and reduce health-halo effects caused by claims on sugar.
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Affiliation(s)
- Kristin Jürkenbeck
- Department of Agricultural Economics and Rural Development, Marketing of Food and Agricultural Products, University of Goettingen, Goettingen, Germany
| | - Clara Mehlhose
- Department of Agricultural Economics and Rural Development, Marketing of Food and Agricultural Products, University of Goettingen, Goettingen, Germany
| | - Anke Zühlsdorf
- Department of Agricultural Economics and Rural Development, Marketing of Food and Agricultural Products, University of Goettingen, Goettingen, Germany
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16
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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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17
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Are Front-of-Pack Labels a Health Policy Tool? Nutrients 2022; 14:nu14040771. [PMID: 35215421 PMCID: PMC8879020 DOI: 10.3390/nu14040771] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
To stem the increasing incidence of non-communicable diseases (NCDs) and obesity, front-of-pack labels (FOPLs) have been developed since 1989. Whereas several countries have already adopted one voluntarily, the European Community wants to harmonize an FOPL system that will be mandatory for all member states. The purpose of this narrative review is to describe what could be achieved or not by FOPLs, and to discuss if there is enough evidence to establish whether such labels are effective in modifying purchasing behavior, in directing individual dietary patterns towards a healthy and sustainable diet, and in reformulating food products by the food industry. Non-directive FOPLs, which are still under study, appear to be informative and well-accepted by consumers even if they require a cognitive effort. Conversely, directive FOPLs are supported by several studies, but they are mostly conducted in simulated scenarios and/or performed as retrospective studies. Nevertheless, directive FOPLs are rated as an intuitive tool, and they have demonstrated a high capacity to help consumers rank food products as more or less healthy. In conclusion, directive and non-directive FOPLs convey different messages. No FOPL individually can be considered exhaustive in relation to all the objectives outlined in this narrative review, and therefore, the development of a model synthesizing both messages is advisable. Many questions remain open, such as the possibility of reformulating pre-packaged products, how to deal with traditional products, and the impact on the incidence of NCDs and obesity. In the light of the complexity of factors that condition consumption choices and health, none of the current FOPLs can be considered a health policy tool on its own. The possibility of development remains open, but as the state of the art, these tools do not seem to be able to achieve all the European Community goals together. We can speculate that they could meet these goals only if they are integrated into a multi-tiered, structured health policy intervention.
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18
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Stuber JM, Lakerveld J, Kievitsbosch LW, Mackenbach JD, Beulens JWJ. Nudging customers towards healthier food and beverage purchases in a real-life online supermarket: a multi-arm randomized controlled trial. BMC Med 2022; 20:10. [PMID: 35034635 PMCID: PMC8762859 DOI: 10.1186/s12916-021-02205-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/03/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Nudging is increasingly used to promote healthy food choices in supermarkets. Ordering groceries online is gaining in popularity and nudging seems efficacious there as well, but is never comprehensively tested in real-life. We evaluated the real-life effectiveness of nudging in an online supermarket on healthy food purchases. METHODS We conducted a multi-arm, parallel-group, individually randomized controlled trial in an online supermarket. During 1 month, all customers were randomized to (1) control condition, (2) information nudges, (3) position nudges, and (4) information and position nudges combined. Allocation was concealed and customers were not blinded, but unaware of the intervention. Mean differences between the control condition and the intervention arms in the total percentage of healthy purchases were assessed with a linear mixed model. We tested for effect modification by area-level deprivation. RESULTS Based on sales data from 11,775 shoppers, no overall significant effects were detected. Yet, effects were modified by area-level deprivation (pArm 2 < 0.001). Among shoppers from deprived areas, those allocated to information nudges purchased a 2.4% (95%CI 0.8, 4.0) higher percentage of healthy products compared to controls. No significant differences were observed for position (- 1.3%; 95%CI - 2.8, 0.3) and combined nudges (- 0.1%; 95%CI - 1.7, 1.5). Shoppers from non-deprived areas exposed to information nudges (- 1.6%; 95%CI - 3.2, - 0.1) and the combined nudges (- 2.1%; 95%CI - 3.6, - 0.6), but not position nudges (- 0.9%; 95%CI - 2.4, 0.7), purchased a lower percentage of healthy products. CONCLUSION Information nudges in an online supermarket can increase healthy product purchases, but only for those living in deprived areas. The adverse effects found on purchasing behaviors for those from non-deprived areas call for further research. Further research should also focus on real-life effects of online healthy food nudging as part of a broader nutrition intervention strategy, and on the equitability of the online nudging intervention within populations. TRIAL REGISTRATION Retrospectively registered in the ISRCTN registry at May 21, 2021 ( ISRCTN10491616 ).
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Affiliation(s)
- Josine M Stuber
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
- Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Loes W Kievitsbosch
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Joreintje D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, Netherlands
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19
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Ricco M, Ranzieri S, Balzarini F, Vezzosi L, Marchesi F, Valente M, Peruzzi S. Understanding of the Nutri-Score front-of-pack label by Italian Medical Professionals and its effect on food choices: a web-based study on knowledge, attitudes and practices. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022042. [PMID: 35546029 PMCID: PMC9171852 DOI: 10.23750/abm.v93i2.11191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM A growing number of European Countries have adopted front-of-pack nutrition labels (FPNL) in order to assist costumers' alimentary choices, and particularly Nutri-Score. While its acceptance in Italy has been slowed by ongoing debates, we assessed corresponding knowledge, attitudes and practices of a sample of Italian Medical Professionals (MP). METHODS A total of 153 MP participated into an internet-based survey by completing a structured questionnaire. While 43.1% reported any knowledge of Nutri-Score, the overall understanding of its conceptual issues was quite low (50.8% after percentual normalization of the knowledge score). Only half of participants acknowledge some usefulness of FPNL, and their acceptance as a guide for nutritional choices was seemingly low (36.6%), being more likely in MP participants from Northern regions (Odds Ratio 9.610, 95% confidence intervals 2.667-34.637), living with children < 14 year or age (3.658, 1.463-9.145), and perceiving some usefulness in FPNL (3.595, 1.381-9.356). In turn, having any knowledge of Nutri-Score and being of male gender were negative effects. CONCLUSIONS Nutri-Score is a useful instrument in guiding consumers' alimentary choices, but the actual understanding of its rationale by participants MP was insufficient. Specifically aimed interventions should be tailored in order to cope with a significant share of MP reporting false beliefs and misunderstanding.
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Affiliation(s)
- Matteo Ricco
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza negli ambienti di Lavoro (SPSAL), Reggio Emilia, Italy
| | - Silvia Ranzieri
- University of Parma, Department of Medicine and Surgery, School of Occupational Medicine, Parma, Italy
| | | | - Luigi Vezzosi
- Agenzia di Tutela della Salute (ATS) di Bergamo, Dipartimento P.A.A.P.S.S., Servizio Autorizzazione e Accreditamento, Bergamo, Italy
| | - Federico Marchesi
- University of Parma, Department of Medicine and Surgery, Division of General Surgery, Parma, Italy
| | - Marina Valente
- University of Parma, Department of Medicine and Surgery, Division of General Surgery, Parma, Italy
| | - Simona Peruzzi
- AUSL–IRCCS di Reggio Emilia, Laboratorio Analisi Chimico Cliniche e Microbiologiche, Ospedale Civile di Guastalla, Guastalla (RE), Italy
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20
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Online Consumer Survey Comparing Different Front-of-Pack Labels in Greece. Nutrients 2021; 14:nu14010046. [PMID: 35010921 PMCID: PMC8746628 DOI: 10.3390/nu14010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022] Open
Abstract
According to the WHO, front-of-pack nutrition labeling provides simplified nutrition information in the form of symbols, colors or words that can help consumers understand the nutritional quality of food, thus leading them to healthier food choices. It is considered of the utmost importance to explore the knowledge and understanding of consumers about this form of nutrition labeling. The aim of this study was to investigate the understanding and perceptions of Greek consumers in response to five different front-of-pack nutrition labels (FoPLs): the Multiple Traffic Lights, Health Star Rating System, Guideline Daily Amounts, Warning Symbols and Nutri-Score. From April 2021 to June 2021, 1278 participants from Greece took part in an online survey where they were asked to rank three products according to their nutritional quality. The classification process was performed first without FoPLs and then with FoPLs. The ability to classify products according to their nutritional quality was evaluated with multinomial logistic regression models, and the Nutri-Score label presented greater improvements when compared to the GDA label for Greek consumers. The Nutri-Score seemed to better help the Greek consumers rank foods according to their nutritional value.
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21
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Nutri-Score: The Most Efficient Front-of-Pack Nutrition Label to Inform Portuguese Consumers on the Nutritional Quality of Foods and Help Them Identify Healthier Options in Purchasing Situations. Nutrients 2021; 13:nu13124335. [PMID: 34959887 PMCID: PMC8705821 DOI: 10.3390/nu13124335] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Several studies have identified Front-of-Pack Nutrition Labels (FoPLs) as a promising strategy to improve the nutritional quality of consumers’ food choices and encourage manufacturers to offer healthier products. This study aims to fill the evidence gap regarding the most effective FoPL among the Portuguese population. In total, 1059 Portuguese participants were recruited through a web panel provider and asked to declare their intended food choices and to rank three sets of products (pizza, cakes and breakfast cereals) according to their nutritional quality, first in the absence of any labelling, and then with a FoPL displayed on-pack (five FoPLs tested). Finally, participants were asked to answer nine statements related to perceptions of FoPLs. Results showed that participants improved their food choices, depending on the FoPL and the food category. All FoPLs led to a higher percentage of correct responses on the ranking task compared to the no label condition. The Nutri-Score was among the FoPLs producing the greatest improvement across all food categories compared to the reference intakes (OR = 6.45 [4.43–9.39], p-value < 0.0001) and facilitating the highest percentage to correctly rank products according to nutritional quality. This study suggests that, among the available options, Nutri-Score is the most efficient FoPL to inform Portuguese consumers of the nutritional quality of foods and help them identify healthier options in mock purchasing situations.
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22
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Chio AI, Davies T, Wu JHY, Louie JCY. Prevalence of missing nutrition label and ingredients list information on e‐shops of major chain supermarkets in Hong Kong. NUTR BULL 2021. [DOI: 10.1111/nbu.12530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Amy I. Chio
- School of Biological Sciences The University of Hong Kong Pokfulam, Hong Kong
| | - Tazman Davies
- Food Policy Division The George Institute for Global Health Camperdown NSW Australia
| | - Jason H. Y. Wu
- Food Policy Division The George Institute for Global Health Camperdown NSW Australia
| | - Jimmy Chun Yu Louie
- School of Biological Sciences The University of Hong Kong Pokfulam, Hong Kong
- Food Policy Division The George Institute for Global Health Camperdown NSW Australia
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23
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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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24
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Bossuyt S, Custers K, Tummers J, Verbeyst L, Oben B. Nutri-Score and Nutrition Facts Panel through the Eyes of the Consumer: Correct Healthfulness Estimations Depend on Transparent Labels, Fixation Duration, and Product Equivocality. Nutrients 2021; 13:nu13092915. [PMID: 34578792 PMCID: PMC8467654 DOI: 10.3390/nu13092915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022] Open
Abstract
Research on front-of-pack labels (FOPLs) demonstrated that Nutri-Score is one of the most promising FOPLs regarding healthfulness estimation accuracy. Nevertheless, as consumers are exposed to both the Nutri-Score and the mandatory Nutrition Facts Panel (NFP) in the supermarket, it is key to understand if and how both labels interact. This study investigates the contribution of Nutri-Score and NFP regarding healthfulness estimation accuracy, whether this impact differs depending on the product, and what role visual attention plays. We set up an eye-tracking experiment in a controlled setting in which 398 participants rated the healthfulness of 20 products. The results confirmed the positive impact of the Nutri-Score on healthfulness estimation accuracy, though the impact was larger for equivocal (i.e., difficult to judge) products. Interestingly, NFP either had no effect (compared to a package without Nutri-Score or NFP) or a negative effect (compared to a package with Nutri-Score alone) on healthfulness estimation accuracy. Eye-tracking data corroborated that ‘cognitive overload’ issues could explain why consumers exposed to Nutri-Score alone outperformed those exposed to both Nutri-Score and NFP. This study offers food for thought for policymakers and the industry seeking to maximize the potential of the Nutri-Score.
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Affiliation(s)
- Saar Bossuyt
- Smart Organizations, UCLL University of Applied Sciences, Geldenaaksebaan 335, 3001 Leuven, Belgium; (S.B.); (J.T.)
| | - Kathleen Custers
- Smart Organizations, UCLL University of Applied Sciences, Geldenaaksebaan 335, 3001 Leuven, Belgium; (S.B.); (J.T.)
- Correspondence:
| | - José Tummers
- Smart Organizations, UCLL University of Applied Sciences, Geldenaaksebaan 335, 3001 Leuven, Belgium; (S.B.); (J.T.)
| | - Laura Verbeyst
- Health Innovation, UCLL University of Applied Sciences, Herestraat 49, 3000 Leuven, Belgium;
| | - Bert Oben
- Faculty of Arts, University of Leuven, Blijde Inkomststraat 21, 3000 Leuven, Belgium;
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Gibson‐Moore H, Spiro A. Evolution not revolution – what might the future hold for front‐of‐pack nutrition labelling in the UK?: A British Nutrition Foundation roundtable. NUTR BULL 2021. [DOI: 10.1111/nbu.12517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Measuring the Effect of Blockchain Extrinsic Cues on Consumers' Perceived Flavor and Healthiness: A Cross-Country Analysis. Foods 2021; 10:foods10061413. [PMID: 34207107 PMCID: PMC8235256 DOI: 10.3390/foods10061413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Many studies in the related literature have proven that the perception of flavor and healthiness can be affected by both the product’s intrinsic and extrinsic cues. Package designs, brands, colors, labels and other visual elements exert and influence consumers’ expectations and guide them toward food decisions. With the increasing initiatives promoted within Europe in support of the adoption of blockchain technology in supply chains and agri-food contexts, in the coming years, packages will be used with additional product information certified with the technology itself. Cueing packages with blockchain-certified information could affect consumers in their overall flavor and health perceptions, similarly to that previously demonstrated with other extrinsic cues. In the present study, we analyzed a sample of 310 primary grocery shoppers from Germany, Italy and the UK, demonstrating the effectiveness of technology-certified information on the package of animal milk in influencing consumers’ flavor and health perceptions and exploring the differences and similarities across the three countries and milk categories.
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Mazzù MF, Romani S, Baccelloni A, Gambicorti A. A cross-country experimental study on consumers' subjective understanding and liking on front-of-pack nutrition labels. Int J Food Sci Nutr 2021; 72:833-847. [PMID: 33657942 DOI: 10.1080/09637486.2021.1873918] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Different Front-of-Pack (FOP) nutritional labels have been implemented in order to increase consumers' awareness of food nutritional quality and encourage healthier choices. However, few studies have analysed the effects of FOPLs on consumers' subjective understanding and liking across different socio-cultural contexts. This study tests the effect that the new enriched informative label NutrInform Battery and the summary label Nutri-Score have on subjective comprehension and liking across 2776 respondents of seven European countries (France, Germany, Greece, Italy, Portugal, Romania and Spain). Main effects regarding socio-demographic differences are also explored according to extant literature and highlighting significant effects of education and income. This study therefore extends the current research on subjective understanding and liking with a cross-country analysis. Findings suggest that NutrInform Battery can help consumers in understanding information in a relevant way, obtaining the highest performance across countries and showing limited impact of socio-cultural differences.
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Affiliation(s)
| | - Simona Romani
- Department of Business and Management, Luiss University, Rome, Italy
| | - Angelo Baccelloni
- Department of Business and Management, Luiss University, Rome, Italy
| | - Antea Gambicorti
- Department of Business and Management, Luiss University, Rome, Italy
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Enriquez JP, Archila-Godinez JC. Social and cultural influences on food choices: A review. Crit Rev Food Sci Nutr 2021; 62:3698-3704. [PMID: 33427479 DOI: 10.1080/10408398.2020.1870434] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Human food choices (FC) influence food production systems. Agriculture is responsible for feeding the entire population, and somehow generates different types of environmental degradation. Consumers play a decisive role in consumption trends because FC has shaped habits and behaviors. Food is an expression of people's identity, values, and lifestyle. The objective of this article is to analyze the factors that influence FC and to consider intervention strategies used to work on improving behaviors and FC. The influence of socio-cultural aspects, such as cultural capital, social stratifications, and the inequalities could possibly trigger consumers' FC. The effects of different factors such as foodscapes, social environments, tastes, and even nutritional information, have generated that, the consumer chooses a product under pressure or makes an uninformed choice that generally is unhealthy. Restricting food accessibility generates a reactive but non-aware action, so it is necessary to work creating a sustainable food culture, with the first step of consumers being self-aware of their current FC.
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Affiliation(s)
- Jean Pierre Enriquez
- Master Program in Sustainable Tropical Agriculture, Graduate Department, Zamorano University, Tegucigalpa, Honduras
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