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Coming from opposite parts of the spectrum of interpreting studies about Nutri-Score: Suggestion of publication bias cannot be denied

Authors:
Stephan Peters at Dutch Dairy Association
Stephan Peters
  • Dutch Dairy Association
Hans Verhagen at Food Safety & Nutrition Consultancy
Hans Verhagen
  • Food Safety & Nutrition Consultancy
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Abstract and Figures

The full article is available on request. - Background - The front-of-pack label Nutri-Score is currently proposed as the system of choice in seven EU countries. However, there is still much scientific debate about the validation and efficacy of Nutri-Score and there is much discussion about author affiliation and study outcome. - Methods - Recently we published our paper: Nutri-Score and publication bias: A complete literature review of the substantiation of the effectiveness of the front-of-pack logo Nutri-Score Peters & Verhagen, PharmaNutrition 27 C (2024) 100380. This paper received a commentary paper by the developers of Nutri-Score: M. Touvier et al. 2024 “Rebuttal to the paper published by S. Peters and H. Verhagen”. The rebuttal has also been published on the Nutri-Score blog https://nutriscore.blog/2024/02/19/rebuttal-of-the-claims-against-the-nutri-score-made-by-two-lobbyists-in-pharmanutrition-in-an-effort-to-discredit-academic-research/. We herewith provide an invited commentary to that rebuttal paper, which further supports the observed publication bias. - Results - In this response to the rebuttal, we primarily respond on the scientific issues raised in the rebuttal and explain more about our alleged conflict of interest and our motivation to write the paper. Moreover, we basically thank the authors of the rebuttal paper for, perhaps ironically but essentially, confirming our analysis: there is a publication bias versus affiliation. - Discussion - Overall, the available evidence is clearly limited and biased, and more research is needed to substantiate or disprove the effectiveness of Nutri-Score.
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Coming from opposite parts of the spectrum of interpreting studies about Nutri-
Score: suggestion of publication bias cannot be denied
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1 Nederlandse Zuivel Organisatie (NZO)/Dutch Dairy Association, Benoordenhoutseweg 46, 2596 BC The Hague, The Netherlands
2 Food Safet y & Nutrition Consultancy, 3703 EE Zeist, The Netherlands
3 National Food Institute, Technical University of Denmark. Kemitorvet 201, 2800 Kgs. Lyngby, Denmark
4 Nutrition Innovation Centre for Food and Health (NICHE), University of Ulster, Coleraine BT52 1SA, UK
* Correspondence: peters@nzo.nl (S.P.); fsnconsultancy@hotmail.com (H.V.)
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Graphical abstract
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ABSTRACT
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Key words: Front-of-pack logos; FOPL; Nutri-Score; Publication bias; Review
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Highlights
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• We published recently on the validation and efficacy of Nutri-Score versus author
affiliation and study outcome and found a large publication bias.
• The large majority of studies that support Nutri-Score are carried out by the
developers of Nutri-Score.
• The majority of studies that are carried out independently from the developers of
Nutri-Score showed unfavourable results.
• There is insufficient scientific evidence to support the use of Nutri-Score as an
effective public health tool.
• More research is needed to substantiate or disprove the effectiveness of Nutri-
Score.
• Authors that are connected to the developers of Nutri-Score, perhaps ironically
but essentially, confirm our analysis: there is a publication bias versus affiliation.
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1. Introduction
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2. Our conclusions compared with the conclusions of the rebuttal.
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Figure 1. Graphical abstract original article Publication bias and Nutri-Score: A complete literature review
of the substantiation of the e@ectiveness of the front-of-pack logo Nutri-Score [1].!
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Scientific substantiation of the e;ectiveness of Nutri-Score.
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Figure 2. Papers favourable versus not favourable in relation to a@iliation/conflict of interest according to
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conclude otherwise, coming from opposite parts of the spectrum of interpreting studies about Nutri-
Score, that there is at least a suggestion of publication bias from either direction, and, moreover, there is
essential agreement.
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3. Disagreement interpretation scientific studies
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show our deviant interpretation of studies when compared to the Besancon et al. paper.
Under the remarks- column in the supplementary material we explain the di;erences.
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!
4. Conflict of interest
W(!*$+%3(+$!#3!#&$!'55:+'#;3(+!;(!#&$!*$8:##'7!#3!3:*!'77$/$,!53(Y;5#!32!;(#$*$+#!'(,!3:*!
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.$*&'/$(!B'+!$=%73<$,!'#!#&$!9'#;3('7!W(+#;#:#$!23*!):87;5!-$'7#&!'(,!#&$!?(>;*3(=$(#!
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!
5. Conclusion
!
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!
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+5;$(#;D5!+#:,;$+!'(,!'(!;(,$%$(,$(#!$>'7:'#;3(!32!#&$!9:#*;4"53*$!;+!($$,$,A!
!
CRediT authorship contribution statement
"A)A0!K3(5$%#:'7;_'#;3(]!^'#'!5:*'#;3(]![3*='7!'('7<+;+]!S$#&3,373/<]!.'7;,'#;3(]!
.;+:'7;_'#;3(]!F37$+nV*;#;(/!4!3*;/;('7!,*'2#]!V*;#;(/!4!*$>;$B!H!$,;#;(/A!-A.A0!
K3(5$%#:'7;_'#;3(]!^'#'!5:*'#;3(]![3*='7!'('7<+;+]!S$#&3,373/<]!.'7;,'#;3(]!
.;+:'7;_'#;3(]!F37$+nV*;#;(/!4!3*;/;('7!,*'2#]!V*;#;(/!4!*$>;$B!H!$,;#;(/A!
!
!
Declaration of Competing Interest
"A)A!;+!$=%73<$,!'#!#&$!^:#5&!^';*<!G++35;'#;3(A!-A.A!;+!'(!;(,$%$(,$(#!53(+:7#'(#!'#!#&$!
[33,!"'2$#<!H!9:#*;#;3(!K3(+:7#'(5<!L1&$!9$#&$*7'(,+O!'(,!&37,+!%*32$++3*+&;%+!'#!#&$!
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W*$7'(,OA!9$;#&$*!':#&3*!&'+!'!%'+#!3*!5:**$(#!5377'83*'#;3(!B;#&!#&$!9:#*;4"53*$A!-A.A!;+!'!
=$=8$*!32!#&$!;(#$*('#;3('7!83'*,!32!#&$!K&3;5$+!W(#$*('#;3('7![3:(,'#;3(!+;(5$!IMIQA!
@(#;7!IMPcC!b3#&!"A)A!'(,!-A.A!B$*$!=$=8$*+!32!#&$!;(,$%$(,$(#!+5;$(#;D5!53==;##$$!;(!
#&$!9$#&$*7'(,+!+:%%3*#;(/!#&$!23*=$*!2*3(#4324%'56!73/3!T&$#!.;(6m$UA!1&$!':#&3*+!
,$57'*$!#&'#!#&$!*$+$'*5&!B'+!53(,:5#$,!;(!#&$!'8+$(5$!32!'(<!53==$*5;'7!3*!D('(5;'7!
*$7'#;3(+&;%+!#&'#!53:7,!8$!53(+#*:$,!'+!'!%3#$(#;'7!53(Y;5#!32!;(#$*$+#A!1&$!^:#5&!^';*<!
G++35;'#;3(!;+!;(>37>$,!;(!#&$!('#;3('7!,;+5:++;3(!;(!#&$!9$#&$*7'(,+!'83:#!2*3(#4324%'56!
73/3+!8<!+:8=;##;(/!;(%:#+!;(#3!%*3,:5#!*$23*=:7'#;3(+!'(,!2*3(#4324%'56!53(+:7#'#;3(+!
32!#&$!^:#5&!S;(;+#*<!32!-$'7#&C!V$72'*$!'(,!"%3*#A!
!
Data availability
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7;#$*'#:*$!#&*3:/&!):8S$,A!!
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PharmaNutrition IMINC!27C!PMMQRMC!,3;0PMAPMPdnmA%&'(:AIMINAPMMQRMA!
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... Interpretaties studies gunstige versus ongunstige uitkomst uitgesplitst naar auteurs die wel of niet zijn verbonden met de ontwikkelaars van Nutri-Score op basis van compleet literatuuronderzoek volgens Peters en Verhagen [8] en volgens de ontwikkelaars van Nutri-Score, Touvier et al. [9]. (9,10) ...
... We hebben een antwoord[10] gepubliceerd op de weerlegging door team Nutri-Score[3] en zijn tot de conclusie gekomen dat wanneer we de weerlegging door Touvier et al. en onze studie samen nemen, de eindconclusie door geen van beide partijen kan worden ontkend: Er is een duidelijke overeenstemming tussen voorstanders en critici over het bestaan van publicatiebias achter de studies over Nutri-Score (zie ook Figuur 2).Wij zijn daarom van mening dat de evaluatie van Nutri-Score moet worden uitgevoerd door een onafhankelijke instantie. We stellen voor dat de EFSA deze belangrijke taak uitvoert, omdat we vraagtekens zetten bij de huidige situatie waarin de wetenschappelijke ontwikkeling, de evaluatie van de wetenschappelijke ontwikkeling en het bijwerken van de fouten in het algoritme allemaal worden uitgevoerd door de ontwikkelaars van Nutri-Score. ...
Onafhankelijke evaluatie Nutri-Score hoogste tijd (Voeding Nu 2024 (4) pp 18-20).
Article
Full-text available
  • Jun 2024
Er is op dit moment onvoldoende wetenschappelijk bewijs om het gebruik van Nutri-Score als effectief instrument voor de volksgezondheid te benoemen. Daarnaast is er sprake van publicatiebias in het voordeel van Nutri-Score. Dat stellen Hans Verhagen en Stephan Peters. (Voeding Nu 2024, 4 pag 18-20.
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... We have published a reply [4] to the rebuttal by team Nutri-Score [3] and concluded that when taking together the rebuttal by Touvier et al. [3] and our study [2], the final conclusion cannot be denied by either party: There is a clear suggestion of publication bias behind the studies about Nutri-Score, coming from either direction. ...
... No data was used for the research described in the article other than publicly available literature through PubMed. Figure 1: Coming from opposite parts of the spectrum of interpreting studies about Nutri-Score: Suggestion of publication bias cannot be denied (reproduced from Peters&Verhagen 2024 [4]) ...
Nutri-Score and publication bias: it is time for an independent evaluation of the scientific substantiation of Nutri-Score. Rapid response BMJ Global Health
Article
Full-text available
  • Apr 2024
Nutri-Score and publication bias: it is time for an independent evaluation of the scientific substantiation of Nutri-Score. This is a rapid response in BMJ Global Health to the article: Besancon, S.; Beran, D.; Batal, M. A study is 21 times more likely to find unfavourable results about the nutrition label Nutri-Score if the authors declare a conflict of interest or the study is funded by the food industry. BMJ Glob Health 2023, 8, doi:10.1136/bmjgh-2023-011720.
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Conflicts of Interest in Nutrition: Categorical Thinking and the Stigma of Commercial Collaboration
Article
  • Jul 2024
There is a high level of concern about the possible influence of commercial organizations on food-related research and professional bodies, including regulatory and advisory panels. This has contributed to an increased emphasis on the declaration and management of conflicts of interest (CoI) in the reporting, evaluation, and application of research in nutrition science. However, common perceptions of CoI in nutrition, and procedures for declaring and managing these, often lack intellectual rigor and consistency. This commentary highlights 3 main issues related to CoI in nutrition, particularly the emphasis on industry-related CoI relative to other sources of conflict and bias. 1) Considerations of CoI in nutrition are largely limited to financial or collaborative links to the food industry, disregarding other important sources of influence such as intellectual allegiances or nonindustry financial and professional incentives. 2) Associations with industry incur ad hominem, often punitive stigmatization of individuals and their research, and inappropriate downgrading or exclusion of evidence. This disproportionately affects expertise in the food and agricultural sciences, in which commercial collaborations are widely encouraged. 3) These practices and related approaches to managing CoI are applied without due consideration of the nature of the conflicts and activities involved, the qualifications of individuals, or the availability of other, objective methods and guidance for assessing research quality and risks of bias. Overall, recognition of the nature and range of CoI in nutrition and approaches to their identification and management lack consistency and balance. A singular and strict focus specifically on industry-related CoI may paradoxically exacerbate rather than mitigate imbalance and bias in the field. This commentary outlines the underlying issues and the need for more comprehensive and nuanced approaches to the assessment, reporting, and management of CoI in nutrition.
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Wychodząc z przeciwnych stron spektrum interpretacji badań dotyczących Nutri- Score: nie można zaprzeczyć sugestii stronniczości publikacji
Article
Full-text available
  • Apr 2024
To jest tłumaczenie [22] Peters, S.; Verhagen, H. Pochodzący z przeciwnych stron spektrum interpretacji badań dotyczących Nutri-Score: Nie można odmówić sugestii stronniczości publikacji. PharmaNutrition. - Kontekst - Etykieta Nutri-Score umieszczona na przodzie opakowania jest obecnie proponowana jako system z wyboru w siedmiu krajach UE. Jednakże nadal toczy się szeroka debata naukowa na temat walidacji i skuteczności Nutri-Score, a także na temat przynależności autora i wyników badań. - Metody - Niedawno opublikowaliśmy nasz artykuł: Nutri-Score i błąd publikacji: pełny przegląd literatury dotyczący uzasadnienia skuteczności logo Nutri-Score Peters & Verhagen, PharmaNutrition 27C (2024) 100380. Artykuł ten otrzymał artykuł z komentarzem twórców Nutri-Score: M. Touvier et al. 2024 „Odparcie artykułu opublikowanego przez S. Petersa i H. Verhagena”. Niniejszym przedstawiamy zaproszony komentarz do tego obalającego artykułu, który dodatkowo potwierdza zaobserwowaną stronniczość publikacji. - Wyniki - W tej odpowiedzi na obalenie odpowiadamy przede wszystkim na kwestie naukowe poruszone w odrzuceniu i wyjaśniamy więcej na temat naszego rzekomego konfliktu interesów oraz naszej motywacji do napisania artykułu. Co więcej, w zasadzie dziękujemy autorom artykułu obalającego tę tezę za – być może ironicznie, ale zasadniczo – potwierdzenie naszej analizy: istnieje stronniczość publikacji w stosunku do afiliacji. - Dyskusja - Ogólnie rzecz biorąc, dostępne dowody są wyraźnie ograniczone i stronnicze i potrzebne są dalsze badania, aby potwierdzić lub obalić skuteczność Nutri-Score. Kwestionujemy obecną sytuację, że rozwój naukowy, ocena rozwoju naukowego i aktualizacja błędów w algorytmie powinna być prowadzona tylko przez jedną grupę. Jak stwierdzono w artykule w PharmaNutrition, zalecamy, aby przed wprowadzeniem Nutri-Score do Europy, został on oceniony przez niezależny organ naukowy ds. żywności, taki jak m.in. EFSA.
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The Updated Algorithm of Front-of-Pack Label Nutri-Score Is Not in Line with Dutch Food-Based Dietary Guidelines: Results of Calculations with Dutch Food Composition Database
Conference Paper
Full-text available
  • Feb 2024
Background and objectives: The front-of-pack label Nutri-Score has met a lot of scientific opposition. In the Netherlands, these were major concerns that Nutri-Score was not in line with the Dutch food-based dietary guidelines. In 2022, the algorithm behind the Nutri-Score was updated with the intention to bring it more in line with the general European food-based dietary guidelines. Methods: In this study, the renewed 2022 algorithm for solid foods is applied to the Dutch Food Composition Database (NEVO) to calculate the Nutri-Score values. Subsequently, the Nutri-Score values of all-solid foods were compared to the Dutch food-based dietary guidelines (the Wheel of Five). The foods that are included in the Wheel of Five are considered as “healthy”, i.e., would qualify for labels A or B, while the foods that receive labels C/D/E are considered “unhealthy”. Results: In total, 1980 solid foods were selected from NEVO. Despite the intended outcome, 19% of the unhealthy (non-Wheel of Five) products still received a Nutri-Score A or B. In addition, 25% of the healthy products in the Wheel of Five were scored as “unhealthy’, i.e., Nutri-Scores C/D/E. So grossly, circa one quarter of the foods will be wrongly labelled if the new algorithm is applied. Discussion: If the Nutri-Score is applied with the updated algorithm, this will mean that an average supermarket in the Netherlands will contain thousands of products with an inappropriate score. These results confirm the worries of the >200 Dutch food scientists and the associations of dietitians, life style coaches and weight councilors that the Nutri-Score will confuse Dutch consumers upon introduction. In their request to the Dutch Ministry of Health, they suggest to first bring the Nutri-Score essentially in line with our Wheel of Five before introducing the Nutri-Score system in the Netherlands. The full details of this work can be found at doi 10.13140/RG.2.2.23262.31043.
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Publication bias and Nutri-Score: A complete literature review of the substantiation of the effectiveness of the front-of-pack logo Nutri-Score
Article
Full-text available
  • Feb 2024
Background The front-of-pack label Nutri-Score is currently proposed as the system of choice in seven EU countries. However, there is still much scientific debate about the validation and efficacy of Nutri-Score and there is much discussion about author affiliation and study outcome. Methods To address these issues, we conducted a complete PubMed search on Nutri-Score which resulted in n=180 results and selected all papers that address the relevance of the evidence for the validation of Nutri-Score (n=104). Results Our main observations are that the large majority of studies that support the Nutri-Score are carried out by the developers of Nutri-Score. In contrast, the majority (61%) of studies that are carried out independently from the developers of Nutri-Score showed unfavourable results. A second observation is that even though the theoretical effect of Nutri-Score is validated on a multi-nutrient algorithm (FSA-NPS), there is no real-life evidence of any beneficial effects of Nutri-Score on this algorithm in a complete supermarket range. In conclusion, there is insufficient scientific evidence to support the use of Nutri-Score as an effective public health tool. Discussion Overall, the available evidence is limited and biased, and more research is needed to substantiate or disprove the effectiveness of Nutri-Score.
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The updated algorithm of front-of-pack label Nutri-Score is not in line with Dutch food-based dietary guidelines. Results of calculations with Dutch food composition database
Poster
Full-text available
  • Nov 2023
Introduction In the Netherlands the Front-of-pack (FOPL) Nutri-Score has received a lot of opposition (by approximately 180 food scientists in 2019), because Nutri-Score was not sufficiently in line with Dutch food-based dietary guidelines (FBDGs). In 2022 an updated algorithm has been published with an attempt to bring Nutri-Score more in line with European food-based dietary guidelines. In this study the updated algorithm is compared to the Dutch FBDGs which is called The Wheel of Five. Method The renewed 2022 algorithm for solid foods is applied to the Dutch Food Composition Database (NEVO) to calculate the Nutri-Score values for all foods. The Nutri-Score values were compared to the Dutch food-based dietary guidelines. Foods that are included in the Wheel of Five are considered as “healthy”, i.e. would qualify for labels A or B, and foods that receive labels C/D/E are considered “unhealthy”. Results Figure 1 shows the distribution of all solid foods according to their Nutri-Scores and their place in the Dutch food-based dietary guidelines. In total, 1980 solid foods were selected from NEVO. 19% of unhealthy foods still received a ‘healthy’ Nutri-Score A or B. In addition, 25% of healthy foods scored “unhealthy’ Nutri-Scores C-D-E. Table 1 show examples of foods groups with a large misalignment with the Wheel of Five. These are e.g. fish, cheese, nuts and seeds and cereal products Conclusion In general, the updated 2022 algorithm of Nutri-Score has got a 19% error in evaluating healthy foods as unhealthy and a 25% error in evaluating unhealthy foods as healthy according to their Nutri-Scores for all food groups. Food groups with the largest mismatch are cheese, solid milk products, fish and potatoes and tubers. Controverse After publication of the updated algorithm again more than 200 Dutch food scientists and, in addition, two dietician associations have sent a letter to the Dutch Ministry of Health with a request to not introduce Nutri-Score in the Netherlands and wait for further adjustment of the algorithm until it is sufficiently in line with the Dutch FBDGs to prevent confusion among consumers. Nevertheless, the Ministry has decided to ignore this request and introduce the Nutri-Score as voluntary label as of 2024.
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Comparison of Nutri-Score and Health Star Rating Nutrient Profiling Models Using Large Branded Foods Composition Database and Sales Data
Article
Full-text available
Front-of-package nutrition labelling (FOPNL) is known as an effective tool that can encourage healthier food choices and food reformulation. A very interesting type of FOPNL is grading schemes. Our objective was to compare two market-implemented grading schemes—European Nutri-Score (NS) and Australian Health Star Rating (HSR), using large Slovenian branded foods database. NS and HSR were used for profiling 17,226 pre-packed foods and drinks, available in Slovenian food supply dataset (2020). Alignment between models was evaluated with agreement (% of agreement and Cohen’s Kappa) and correlation (Spearman rho). The 12-month nationwide sales-data were used for sale-weighing, to address market-share differences. Study results indicated that both models have good discriminatory ability between products based on their nutritional composition. NS and HSR ranked 22% and 33% of Slovenian food supply as healthy, respectively. Agreement between NS and HSR was strong (70%, κ = 0.62) with a very strong correlation (rho = 0.87). Observed profiling models were most aligned within food categories Beverages and Bread and bakery products, while less aligned for Dairy and imitates and Edible oils and emulsions. Notable disagreements were particularly observed in subcategories of Cheese and processed cheeses (8%, κ = 0.01, rho = 0.38) and Cooking oils (27%, κ = 0.11, rho = 0.40). Further analysis showed that the main differences in Cooking oils were due to olive oil and walnut oil, which are favoured by NS and grapeseed, flaxseed and sunflower oil that are favoured by HSR. For Cheeses and cheese products, we observed that HSR graded products across the whole scale, with majority (63%) being classified as healthy (≥3.5 *), while NS mostly graded lower scores. Sale-weighting analyses showed that offer in the food supply does not always reflect the sales. Sale-weighting increased overall agreement between profiles from 70% to 81%, with notable differences between food categories. In conclusion, NS and HSR were shown as highly compliant FOPNLs with few divergences in some subcategories. Even these models do not always grade products equally high, very similar ranking trends were observed. However, the observed differences highlight the challenges of FOPNL ranking schemes, which are tailored to address somewhat different public health priorities in different countries. International harmonization can support further development of grading type nutrient profiling models for the use in FOPNL, and make those acceptable for more stake-holders, which will be crucial for their successful regulatory implementation.
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Comparative understanding and preference of Nutri-Score and NutrInform Battery in a sample of Spanish consumers
Article
Full-text available
  • Jan 2023
  • EUR J PUBLIC HEALTH
Background: Interpretive front-of-pack labels (FoPLs) are supported by World Health Organization as an important policy tool to promote healthy diets. At present, various FoPLs formats co-exist in the European Union (EU). However, as part of the Farm to Fork strategy published in 2020, the European Commission stated that it would propose a single mandatory FoPL. The aim of this study was to analyze Spanish consumers' preference and objective understanding of Nutri-Score and NutrInform, two FoPLs that are currently the subject of debate in the EU. Methods: In a representative sample of 1026 Spanish adults (50% women, mean age ± SD = 46 ± 14 years), objective understanding was assessed by asking participants to identify the healthiest food products in three food categories (breakfast products, breakfast cereals and added fats). The preference dimensions were tested by asking participants about the perceived helpfulness of the FoPL in discriminating the nutritional quality of food products (subjective understanding) and their overall assessment of the FoPL's ease of use, informativeness, trust and liking (perception). Results: In terms of objective understanding, Nutri-Score was significantly associated with an increase in consumers' ability to identify healthier food products across all food categories compared with NutrInform [OR (odds ratio) = 19.1 [14.2-25.7], P < 0.0001]. On the preference dimension, Nutri-Score was perceived as significantly easier to use and was more liked than NutrInform (standardized principal component analysis dimension, respectively, 0.32 ± 1.58 vs. -0.29 ± 1.66, P < 0.0001 and 0.080 ± 1.18 vs. -0.072 ± 1.17, P = 0.039). Conclusions: This study provides new evidence to support Nutri-Score in comparison with NutrInform in Spanish consumers, on both objective understanding and preference aspects.
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Front‐of‐package nutrition labeling as a driver for healthier food choices: Lessons learned and future perspectives
Article
Full-text available
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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The influence of the Nutri-Score on the perceived healthiness of foods labelled with a nutrition claim of sugar
Article
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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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An Evaluation of the Nutri-Score System along the Reasoning for Scientific Substantiation of Health Claims in the EU—A Narrative Review
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  • Aug 2022
In this narrative review, the scientific evidence in support of the front-of-pack label (FOPL) Nutri-Score system is evaluated along with the reasoning for scientific substantiation of health claims in the EU. A health claim could be phrased as ‘Nutri-Score as an FOPL system results in an increased purchase of healthier foods by consumers’. Peer-reviewed scientific literature as found in Pubmed under search terms ”NutriScore” and “Nutri-Score” that investigate the effects of the Nutri-Score on food purchases were evaluated. In total, eight papers were identified. Only three studies were conducted in real-life settings, and five were on online purchases. In the EU, health claims are evaluated by the European Food Safety Authority (EFSA). Considering the three basic questions that EFSA uses to evaluate scientific substantiation of health claims, it appears that the (i) food/constituent (the Nutri-Score system) is sufficiently defined/characterised, and (ii) the evidence is sufficient to appraise the system as ‘beneficial to human health’. However, the scientific evidence for a (iii) cause- and-effect relationship is contradictory and limited. In conclusion, based on the EFSA approach for substantiation of health claims, there is insufficient evidence to support a health claim based on the Nutri-Score system, since a cause-and-effect relationship could not be established.
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Impact of front-of-pack nutrition labelling in consumer understanding and use across socio-economic status: A systematic review
Article
  • May 2023
  • APPETITE
An unhealthy diet is a leading contributor to the increasing burden of overweight and obesity. Front-of-pack labelling (FOPL) is being recognized as a policy strategy to promote healthier choices yet there is limited evaluation of FOPL to suggest if it is effective for all population subgroups. This systematic review aimed to assess the impact of FOPL on consumer understanding and usage across socio-economic gradients. Six electronic databases were searched through a systematic search process using key terms for FOPL and socioeconomic status (SES) from 2011 to March 2022 to include studies evaluating the effectiveness of FOPL. A narrative synthesis was conducted and the results were assessed according to the effects of FOPL on consumer awareness, understanding, and usage across SES. The review included 36 articles. In general, people of all SES groups were aware of and more likely to pay attention towards FOPL than the nutrition information panel provided on the back of the package. However, the understanding and usage were relatively poor, particularly in low SES groups. While studies conducted in low SES populations suggest FOPL increased the purchase intention of healthy products, the stratified analysis across SES showed less beneficial effects in low SES individuals. The findings suggest simplified and easy-to-understand FOPLs such as Nutri-score and traffic light labelling are likely to be effective for all populations including low SES groups. Overall, the review suggests FOPLs are more visible than the nutrition information panel and may guide healthier food choices for people of all SES backgrounds. It is unclear whether FOPL influences actual purchasing and food intake as there are insufficient studies comparing the effects among higher and lower SES populations.
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