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The impact of the Nutri-Score front-of-pack nutrition label on purchasing intentions of unprocessed and processed foods: post-hoc analyses from three randomized controlled trials.
Egnell, M, Galan, P, Fialon, M, Touvier, M, Péneau, S, Kesse-Guyot, E, Hercberg, S, Julia, C
The international journal of behavioral nutrition and physical activity. 2021;18(1):38
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In order to prevent nutrition-related chronic diseases, Front-of-Pack nutrition Labels (FoPL) have been identified as efficient tools to encourage consumers towards healthier food choices and to promote food reformulation. The aim of this study was to investigate the impact of the Nutri-Score, compared to the current labelling situation in France (i.e., Reference Intakes (RIs) or no label), on food purchasing intentions. This study is a post-hoc analysis of three randomised controlled studies in three specific populations; students (N = 1866), low-income individuals (N = 336) and subjects suffering from cardiometabolic diseases (N = 1180). Results show that overall, participants (students, low-income individuals and subjects suffering from cardiometabolic diseases) simulating purchases with the Nutri-Score affixed on pre-packed foods were more likely to have higher proportions of unpacked products (especially unprocessed fruits and meat) in their shopping cart. Furthermore, Nutri-Score influenced the type of food purchased; less ultra-processed foods which have been found to be often of lower nutritional quality. Authors conclude that Nutri-Score may have a positive impact on food purchases which would discourage the purchase of pre-packed processed products.
Abstract
BACKGROUND The Nutri-Score summary graded front-of-pack nutrition label has been identified as an efficient tool to increase the nutritional quality of pre-packed food purchases. However, no study has been conducted to investigate the effect of the Nutri-Score on the shopping cart composition, considering the type of foods. The present paper aims to investigate the effect of the Nutri-Score on the type of food purchases, in terms of the relative contribution of unpacked and pre-packed foods, or the processing degree of foods. METHODS Between September 2016 and April 2017, three consecutive randomized controlled trials were conducted in three specific populations - students (N = 1866), low-income individuals (N = 336) and subjects suffering from cardiometabolic diseases (N = 1180) - to investigate the effect of the Nutri-Score on purchasing intentions compared to the Reference Intakes and no label. Using these combined data, the proportion of unpacked products in the shopping carts, as well as the distribution of products across food categories taking into account the degree of processing (NOVA classification) were assessed by trials arm. RESULTS The shopping carts of participants simulating purchases with the Nutri-Score affixed on pre-packed foods contained higher proportion of unpacked products - especially raw fruits and meats, i.e. with no FoPL -, compared to participants purchasing with no label (difference of 5.93 percentage points [3.88-7.99], p-value< 0.0001) or with the Reference Intakes (difference of 5.27[3.25-7.29], p-value< 0.0001). This higher proportion was partly explained by fewer purchases of pre-packed processed and ultra-processed products overall in the Nutri-Score group. CONCLUSIONS These findings provide new insights on the positive effect of the Nutri-Score, which appears to decrease purchases in processed products resulting in higher proportions of unprocessed and unpacked foods, in line with public health recommendations.
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Do nutrition labels influence healthier food choices? Analysis of label viewing behaviour and subsequent food purchases in a labelling intervention trial.
Ni Mhurchu, C, Eyles, H, Jiang, Y, Blakely, T
Appetite. 2018;121:360-365
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Nutrition labels provide point-of-purchase information on the nutritional content of pre-packaged foods. This study is a post-hoc exploratory analysis of recorded label information viewing behaviour and associated packaged food purchases of study participants over the four-week intervention period. For this study combined data from all three intervention groups carried out in a previous study were analysed. Participants who scanned at least one product label and/or purchased at least one packaged food or non-alcoholic beverage over the four-week study intervention period were included. Results show that label information was viewed for approximately one fifth of all purchased products. Shoppers were most likely to view labelling information for convenience foods, cereals, snack foods, breads, and oils. Authors conclude that nutrition labels may influence healthier food purchases by those consumers who choose to use them.
Abstract
BACKGROUND There are few objective data on how nutrition labels are used in real-world shopping situations, or how they affect dietary choices and patterns. DESIGN The Starlight study was a four-week randomised, controlled trial of the effects of three different types of nutrition labels on consumer food purchases: Traffic Light Labels, Health Star Rating labels, or Nutrition Information Panels (control). Smartphone technology allowed participants to scan barcodes of packaged foods and receive randomly allocated labels on their phone screen, and to record their food purchases. The study app therefore provided objectively recorded data on label viewing behaviour and food purchases over a four-week period. A post-hoc analysis of trial data was undertaken to assess frequency of label use, label use by food group, and association between label use and the healthiness of packaged food products purchased. RESULTS Over the four-week intervention, study participants (n = 1255) viewed nutrition labels for and/or purchased 66,915 barcoded packaged products. Labels were viewed for 23% of all purchased products, with decreasing frequency over time. Shoppers were most likely to view labels for convenience foods, cereals, snack foods, bread and bakery products, and oils. They were least likely to view labels for sugar and honey products, eggs, fish, fruit and vegetables, and meat. Products for which participants viewed the label and subsequently purchased the product during the same shopping episode were significantly healthier than products where labels were viewed but the product was not subsequently purchased: mean difference in nutrient profile score -0.90 (95% CI -1.54 to -0.26). CONCLUSIONS In a secondary analysis of a nutrition labelling intervention trial, there was a significant association between label use and the healthiness of products purchased. Nutrition label use may therefore lead to healthier food purchases.
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Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases-A Randomised Controlled Trial.
Neal, B, Crino, M, Dunford, E, Gao, A, Greenland, R, Li, N, Ngai, J, Ni Mhurchu, C, Pettigrew, S, Sacks, G, et al
Nutrients. 2017;9(12)
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Nutrition labelling on the front of packaged food is a policy tool to help promote healthier food choices. Current research on the effectiveness of package labelling food-purchasing behaviour is both limited and mixed in results. The aim of this large-scale randomised trial was to compare Australia's new Health Star Rating (HSR) with five other front-of-pack labelling schemes with a focus on usability and impact on food choices. The 1578 participants were randomised to one of six experimental groups or the control group and food purchases were tracked by a smartphone application for four weeks. This study demonstrated that the HSR system was as good as other front-of-pack labelling schemes in many outcomes, and superior in terms of usefulness, however there was no evidence to show HSR improved food purchasing behaviour. Based on these results, the authors conclude that various package labelling systems are effective and HSR is one they would recommend.
Abstract
BACKGROUND Front-of-pack nutrition labelling may support healthier packaged food purchases. Australia has adopted a novel Health Star Rating (HSR) system, but the legitimacy of this choice is unknown. OBJECTIVE To define the effects of different formats of front-of-pack labelling on the healthiness of food purchases and consumer perceptions. DESIGN Individuals were assigned at random to access one of four different formats of nutrition labelling-HSR, multiple traffic light labels (MTL), daily intake guides (DIG), recommendations/warnings (WARN)-or control (the nutrition information panel, NIP). Participants accessed nutrition information by using a smartphone application to scan the bar-codes of packaged foods, while shopping. The primary outcome was healthiness defined by the mean transformed nutrient profile score of packaged foods that were purchased over four weeks. RESULTS The 1578 participants, mean age 38 years, 84% female recorded purchases of 148,727 evaluable food items. The mean healthiness of the purchases in the HSR group was non-inferior to MTL, DIG, or WARN (all p < 0.001 at 2% non-inferiority margin). When compared to the NIP control, there was no difference in the mean healthiness of purchases for HSR, MTL, or DIG (all p > 0.07), but WARN resulted in healthier packaged food purchases (mean difference 0.87; 95% confidence interval 0.03 to 1.72; p = 0.04). HSR was perceived by participants as more useful than DIG, and easier to understand than MTL or DIG (all p < 0.05). Participants also reported the HSR to be easier to understand, and the HSR and MTL to be more useful, than NIP (all p < 0.03). CONCLUSIONS These real-world data align with experimental findings and provide support for the policy choice of HSR. Recommendation/warning labels warrant further exploration, as they may be a stronger driver of healthy food purchases.