ArticlePDF Available

C’est indéniable : il existe un biais de publication dans les études NutriScore. Au vu des éléments issus de parties opposées du spectre d'interprétation des études sur le Nutri-Score : la suggestion de l'existence d'un biais de publication ne peut être niée

Authors:
  • Dutch Dairy Association
  • Food Safety & Nutrition Consultancy

Abstract and Figures

-Contexte - Le logo Nutri-Score apposé sur la face avant des emballages alimentaires représente, actuellement, le système d’étiquetage de prédilection appliqué dans sept pays européens. Cependant, le Nutri-Score soulève toujours de nombreux débats scientifiques concernant sa validation et son efficacité. De plus, il existe également de vives discussions relatives à l’affiliation des auteurs et aux résultats d’études. - Méthodes - Nous avons récemment publié notre article intitulé : « Le Nutri-Score et les biais de publication » : une revue complète de la littérature sur la justification de l'efficacité du logo Nutri-Score sur la face avant des emballages (Peters & Verhagen, PharmaNutrition 27C (2024) 100380). Cet article a fait l’objet d’un commentaire rédigé par les développeurs du Nutri-Score : M. Touvier et al. 2024 « Rebuttal to the paper (« Réfutation de l’article ») publiée par S. Peters et H. Verhagen ». Nous fournissons, par la présente, un commentaire invité en réponse à l’article de réfutation, qui soutient en outre les biais de publication observés. - Résultats - Dans cette réponse à l’article de réfutation, nous réagissons principalement aux questions scientifiques soulevées dans cet article en donnant plus d’informations concernant notre conflit d’intérêt allégué et notre motivation pour rédiger l’article. De plus, nous tenons à remercier essentiellement les auteurs de l’article de réfutation d’avoir, peut-être ironiquement, mais essentiellement, confirmé notre analyse : il existe un biais de publication par rapport à l’affiliation. - Discussion - Dans l’ensemble, les données probantes disponibles sont clairement limitées et biaisées. C’est pourquoi, il convient de mener un plus grand nombre de travaux de recherche pour justifier ou réfuter l’efficacité du Nutri-Score.
Content may be subject to copyright.
Au vu des éléments issus de parties opposées du spectre d’interprétation des
études sur le Nutri-Score : la suggestion de l’existence d’un biais de publication ne
peut être niée
!
!
"#$%&'(!)$#$*+!1,*!$#!,'(+!-$*&'.$(!2,3,4,*
!
1 Nederlandse Zuivel Organisatie (NZO)/Dutch Dairy Association, Benoordenhoutseweg 46, 2596 BC La Haye, Pays-Bas
2 Food Safety & Nutrition Consultancy, 3703 EE Zeist, Pays-Bas
3 National Food Institute, Technical University of Denmark. Kemitorvet 201, 2800 Kgs. Lyngby, Danemark
4 Nutrition Innovation Centre for Food and Health (NICHE), University of Ulster, Coleraine BT52 1SA, R.-U.
!
* "#$$%&'#()*(+%!,!'%-%$&.(/#0(1!230405!6!7&(+#(&81-*(+9.:#-;*<10+#;!2=0>05!
!
/0+120!.*'%&341$!
!
RÉSUMÉ
Contexte!5!6$!78.8!91#*3:";8*$!'%%8+0!+1*!7'!<';$!'='(#!>$+!$2?'77'.$+!'732$(#'3*$+!
*$%*0+$(#$@!';#1$77$2$(#@!7$!+A+#B2$!>C0#341$#'.$!>$!%*0>37$;#38(!'%%73410!>'(+!+$%#!
%'A+!$1*8%0$(+D!E$%$(>'(#@!7$!91#*3:";8*$!+817B=$!#81F81*+!>$!(82?*$1G!>0?'#+!
+;3$(#3H41$+!;8(;$*('(#!+'!='73>'#38(!$#!+8(!$I3;';3#0D!J$!%71+@!37!$G3+#$!0.'7$2$(#!>$!
=3=$+!>3+;1++38(+!*$7'#3=$+!K!7C'I373'#38(!>$+!'1#$1*+!$#!'1G!*0+17#'#+!>C0#1>$+D!!
!
Méthodes!5!981+!'=8(+!*0;$22$(#!%1?730!(8#*$!'*#3;7$!3(#3#170!5!!L!6$!91#*3:";8*$!$#!7$+!
?3'3+!>$!%1?73;'#38(!M!5!!1($!*$=1$!;82%7B#$!>$!7'!73##0*'#1*$!+1*!7'!F1+#3H;'#38(!>$!
7N$I3;';3#0!>1!78.8!91#*3:";8*$!+1*!7'!<';$!'='(#!>$+!$2?'77'.$+!O)$#$*+!P!-$*&'.$(@!
)&'*2'91#*3#38(!QRE!OQSQTU!VSSWXSUD!E$#!'*#3;7$!'!<'3#!7C8?F$#!>C1(!;822$(#'3*$!*0>3.0!
%'*!7$+!>0=$78%%$1*+!>1!91#*3:";8*$!5!YD!Z81=3$*!$#!'7D!QSQT!L!/$?1##'7!#8!#&$!%'%$*!
OL!/0<1#'#38(!>$!7C'*#3;7$!MU!%1?730$!%'*!"D!)$#$*+!$#!,D!-$*&'.$(!MD!981+!<81*(3++8(+@!%'*!
7'!%*0+$(#$@!1(!;822$(#'3*$!3(=3#0!$(!*0%8(+$!K!7C'*#3;7$!>$!*0<1#'#38(@!413!+81#3$(#!$(!
81#*$!7$+!?3'3+!>$!%1?73;'#38(!8?+$*=0+D!!
!
Résultats!5!!
J'(+!;$##$!*0%8(+$!K!7C'*#3;7$!>$!*0<1#'#38(@!(81+!*0'.3++8(+!%*3(;3%'7$2$(#!'1G!
41$+#38(+!+;3$(#3H41$+!+817$=0$+!>'(+!;$#!'*#3;7$!$(!>8(('(#!%71+!>C3(<8*2'#38(+!
;8(;$*('(#!(8#*$!;8([3#!>C3(#0*\#!'770.10!$#!(8#*$!28#3='#38(!%81*!*0>3.$*!7C'*#3;7$D!J$!
%71+@!(81+!#$(8(+!K!*$2$*;3$*!$++$(#3$77$2$(#!7$+!'1#$1*+!>$!7C'*#3;7$!>$!*0<1#'#38(!
>C'=83*@!%$1#:\#*$!3*8(341$2$(#@!2'3+!$++$(#3$77$2$(#@!;8(H*20!(8#*$!'('7A+$!5!37!$G3+#$!
1(!?3'3+!>$!%1?73;'#38(!%'*!*'%%8*#!K!7C'I373'#38(D!
!
Discussion!5!J'(+!7C$(+$2?7$@!7$+!>8((0$+!%*8?'(#$+!>3+%8(3?7$+!+8(#!;7'3*$2$(#!
7323#0$+!$#!?3'3+0$+D!EC$+#!%81*4183@!37!;8(=3$(#!>$!2$($*!1(!%71+!.*'(>!(82?*$!>$!
#*'='1G!>$!*$;&$*;&$!%81*!F1+#3H$*!81!*0<1#$*!7C$I3;';3#0!>1!91#*3:";8*$D!
!
!
!!
!
!
]?*0=3'#38(+!5!^_)6!5!`#341$#'.$!(1#*3#38(($7!+1*!7$!>$='(#!>$+!$2?'77'.$+!O^*8(#:8<:
%';a!7'?$7U!b!^"]:9)"!"A+#B2$!>$!%*8H7'.$!>$+!(1#*32$(#+!>$!7C].$(;$!>$+!(8*2$+!
'732$(#'3*$+!O^88>!"#'(>'*>+!].$(;A!91#*3$(#!)*8H73(.!"A+#$2UD!
!
Mots-clés : Logo de la face avant des emballages ; FOPL ; Nutri-Score ; Biais de
publication ; Revue
!
!
Faits marquants
!
!
Nous avons récemment publié un article concernant la validation et l’efficacité du
Nutri-Score par rapport à l’affiliation des auteurs et aux résultats d’études et
avons découverts à ce sujet d’importants biais de publication.
La plupart des études qui soutiennent le Nutri-Score sont réalisées par les
développeurs du Nutri-Score.
Par ailleurs, la majorité des études qui sont réalisées indépendamment des
développeurs du Nutri-Score ont montré des résultats défavorables.
Il n’existe pas suffisamment de données probantes scientifiques pour soutenir
l’utilisation du Nutri-Score comme outil de santé publique efficace.
C’est pourquoi, il convient de mener des travaux de recherches supplémentaires
afin de justifier ou de réfuter l’efficacité du Nutri-Score.
De plus, les auteurs en lien avec les développeurs du Nutri-Score, peut-être
ironiquement, mais essentiellement, ont confirmé notre analyse : il existe un biais
de publication par rapport à l’affiliation.
!
1. Introduction
!
981+!'=8(+!*0;$22$(#!%1?730!(8#*$!'*#3;7$!3(#3#170!5!L!6$!91#*3:";8*$!$#!7$+!?3'3+!>$!
%1?73;'#38(!M!5!1($!*$=1$!;82%7B#$!>$!7'!73##0*'#1*$!+1*!7'!F1+#3H;'#38(!>$!7N$I3;';3#0!>1!
78.8!91#*3:";8*$!+1*!7'!<';$!'='(#!>$+!$2?'77'.$+!!O)$#$*+!P!-$*&'.$(@!)&'*2'91#*3#38(!
QRE!OQSQTU!VSSWXSUD!E$#!'*#3;7$!'!<'3#!7C8?F$#!>C1(!;822$(#'3*$!*0>3.0!%'*!7$+!
>0=$78%%$1*+!>1!91#*3:";8*$!5!YD!Z81=3$*!$#!'7D!QSQT!L!/$?1##'7!#8!#&$!%'%$*!OL!/0<1#'#38(!
>$!7C'*#3;7$!MU!%1?730$!%'*!"D!)$#$*+!$#!,D!-$*&'.$(!MD!981+!<81*(3++8(+@!%'*!7'!%*0+$(#$@!
1(!;822$(#'3*$!3(=3#0!$(!*0%8(+$!K!7C'*#3;7$!>$!*0<1#'#38(@!413!+81#3$(#!$(!81#*$!7$+!?3'3+!
>$!%1?73;'#38(!8?+$*=0+D!!
!!
J'(+!;$##$!*0%8(+$!K!7C'*#3;7$!>$!*0<1#'#38(@!(81+!*0'.3++8(+!%*3(;3%'7$2$(#!'1G!
41$+#38(+!+;3$(#3H41$+!+817$=0$+!>'(+!;$#!'*#3;7$!$(!>8(('(#!%71+!>C3(<8*2'#38(+!
;8(;$*('(#!(8#*$!;8([3#!>C3(#0*\#!'770.10!$#!(8#*$!28#3='#38(!%81*!*0>3.$*!7C'*#3;7$D!J$!
%71+@!(81+!#$(8(+!K!*$2$*;3$*!$++$(#3$77$2$(#!7$+!'1#$1*+!>$!7C'*#3;7$!>$!*0<1#'#38(!
>C'=83*@!%$1#:\#*$!3*8(341$2$(#@!2'3+!$++$(#3$77$2$(#@!;8(H*20!(8#*$!'('7A+$!5!37!$G3+#$!
1(!?3'3+!>$!%1?73;'#38(!%'*!*'%%8*#!K!7C'I373'#38(D!
!
J'(+!7'!*0%8(+$!H.1*'(#!;3:>$++81+@!(81+!'?8*>$*8(+!7$+!'+%$;#+!+13='(#+!5!
!
Q 98+!;8(;71+38(+!.0(0*'7$+@!*$;81%'(#!#*B+!0#*83#$2$(#!7$+!;8(;71+38(+!023+$+!
%'*!7$+!>0=$78%%$1*+!>1!91#*3:";8*$!
W 6$+!>3=$*.$(;$+!$(!2'#3B*$!>C3(#$*%*0#'#38(!>$+!0#1>$+!+;3$(#3H41$+!
T 6$!L!E8([3#!>C3(#0*\#!M!
2. Nos conclusions comparées à celles de l’article de réfutation.
!
981+!'=8(+!#$(#0!>$!*0'73+$*!1($!*$=1$!$G&'1+#3=$!>$!7C$(+$2?7$!>$!7'!73##0*'#1*$!
+;3$(#3H41$!+1*!7$!91#*3:";8*$!41$!(81+!'=8(+!%1!#*81=$*!'H(!>C'('7A+$*!7$+!>8((0$+!
%*8?'(#$+!%*0+$(#0$+!$(!<'=$1*!>$!7'!='73>3#0!$#!>$!7C$I3;';3#0!>1!91#*3:";8*$!%'*!
*'%%8*#!'1G!0=$(#1$7+!?3'3+!>$!%1?73;'#38(D!98+!8?+$*='#38(+!+8(#!*0+120$+!>'(+!7$!
*0+120!.*'%&341$!>$!7C'*#3;7$!>C8*3.3($!%'*1$!>'(+!)&'*2'91#*3#38(!O^3.1*$!VUD!
!
!
?<@8$%!A0!BC&8;C!@$*':<D8%!)%!1E*$-<+1%!)E#$<@<(%!F!G%!H8-$<I3+#$%!%-!1%&!J<*<&!)%!'8J1<+*-<#(!,!8(%!$%K8%!
+#;'1L-%!)%!1*!1<--C$*-8$%!&8$!1*!M8&-<N+*-<#(!)%!1O%P<+*+<-C!)8!1#@#!H8-$<I3+#$%!&8$!1*!7*+%!*K*(-!)%&!
%;J*11*@%&QARD!
!
c1+#3H;'#38(!+;3$(#3H41$!>$!7C$I3;';3#0!>1!91#*3:";8*$D!
!
d(!;$!413!;8(;$*($!7'!F1+#3H;'#38(!+;3$(#3H41$!>$!7C$I3;';3#0!>1!91#*3:";8*$@!(81+!(81+!
';;8*>8(+!K!>3*$!41C1(!$I$#!?0(0H41$!>$+!';&'#+!$(!+1%$*2'*;&0!+1*!7C'7.8*3#&2$!>$!
;'7;17!O^"]:9)"U!>1!91#*3:";8*$!%$1#!0=$(#1$77$2$(#!'=83*!1(!$I$#!%8+3#3<!+1*!7'!+'(#0D!
E$%$(>'(#@!+3!8(!;8(+3>B*$!7'!%$*#3($(;$!+1*!7C0;&$77$!>$!='73>'#38(@!K!%'*#3*@!>C1($!%'*#@!
>C1(!$I$#!#&08*341$!K@!>C'1#*$!%'*#@!1(!$I$#!$(!=3$!*0$77$!>'(+!1(!+1%$*2'*;&0!*0$7@!7$+!
>8((0$+!%*8?'(#$+!*$7'#3=$+!K!7C$I3;';3#0!>1!91#*3:";8*$!>323(1$(#!>C1(!$I$#!#&08*341$!
%*82$##$1*!K!'1;1($!>8((0$!%*8?'(#$!>'(+!1(!+1%$*2'*;&0!*0$7!QARD!981+!'=8(+!>0FK!
'?8*>0!;$!+1F$#!>'(+!1(!%*0;0>$(#!'*#3;7$!eQfD!6C'*#3;7$!>$!*0<1#'#38(@!'3(+3!41$!7$+!'1#*$+!
*0%8(+$+!*0>3.0$+!%'*!7$+!>0=$78%%$1*+!>1!91#*3:";8*$!(C8(#!F'2'3+!;8(#$+#0!;$##$!
;8(;71+38(!<8(>'2$(#'7$D!
!
6$+!?3'3+!>$!%1?73;'#38(!
!
981+!'=8(+!0.'7$2$(#!>028(#*0!41C37!$G3+#$!>$+!?3'3+!>$!%1?73;'#38(!>'(+!7$+!>8((0$+!
+;3$(#3H41$+!;8(;$*('(#!7$!91#*3:";8*$D!E$##$!%*$23B*$!'770.'#38(!'!0#0!<8*2170$!78*+!
>$!7C'*#3;7$!*0>3.0!%'*!g$+'(;8(!$#!'7D!eWf!'141$7!(81+!<'3+8(+!*0<0*$(;$!>'(+!(8#*$!
'*#3;7$!eVfD!Z81#!;822$!(8#*$!'*#3;7$@!;$713!0;*3#!%'*!g$+'(;8(!$#!'7D!%*0+$(#$@!
0.'7$2$(#@!>$+!7';1($+!$#!>$+!&A%8#&B+$+D!Z81#$<83+@!;8(#*'3*$2$(#!K!g$+'(;8(!$#!'7D!
eWf@!(81+!'=8(+!$++'A0!>C0#'?73*!1($!*$=1$!%71+!$G&'1+#3=$!>$!#81+!7$+!'*#3;7$+!41$!(81+!
'=8(+!#*81=0+!>'(+!)1?Y$>!$#!>$!;$1G!2$(#38((0+!>'(+!7'!>8;12$(#'#38(!
+1%%702$(#'3*$!>$!g$+'(;8(!$#!'7D!h!>$+!H(+!>$!#*'(+%'*$(;$!#8#'7$@!=81+!%81=$i!
*$#*81=$*!#81+!;$+!0702$(#+!>'(+!7'!>8;12$(#'#38(!+1%%702$(#'3*$!*$7'#3=$!K!(8#*$!
'*#3;7$D!981+!'=8(+!'.*'(>3!7$!#'?7$'1!;8(j1!%'*!g$+'(;8(!$#!'7D!$(!A!'F81#'(#!%71+!>$!
;878(($+!'H(!>C3771+#*$*!7'!%$*#3($(;$!>$+!0#1>$+!%'*!*'%%8*#!K!7'!='73>'#38(!>1!91#*3:
";8*$@!'1G!20#&8>878.3$+!$#@!>'(+!7$!?1#!>C'##$3(>*$!1($!#*'(+%'*$(;$!#8#'7$@!(81+!
'=8(+!'F81#0!>$+!*$2'*41$+!78*+41$!(81+!(C0#38(+!%'+!>C';;8*>!'=$;!7$+!=$*>3;#+!+1*!7$!
;'*';#B*$!<'=8*'?7$!>$+!0#1>$+!'=$;!g$+'(;8(!$#!'7D!981+!+822$+!*'=3+!41$!7$+!
'1#$1*+!>$!7C'*#3;7$!>$!*0<1#'#38(!+$!+83$(#!'%%1A0+!+1*!(8#*$!>8;12$(#'#38(!
+1%%702$(#'3*$D!
!
g3$(!$(#$(>1@!;822$!;$7'!$+#!<*041$22$(#!7$!;'+!$(!+;3$(;$@!37!$G3+#$!>$+!>3I0*$(;$+!
>C3(#$*%*0#'#38(!>$+!0#1>$+!%'*23!7$+!+;3$(#3H41$+D!J'(+!7'!*1?*341$!QD!J3=$*.$(;$!
>C3(#$*%*0#'#38(!>$+!0#1>$+!+;3$(#3H41$+!H.1*'(#!;3:>$++81+@!(81+!(81+!'##';&$*8(+!K!
$G%7341$*!7$+!>3I0*$(;$+!>C3(#$*%*0#'#38(!$(#*$!(8#*$!%83(#!>$!=1$!$#!;$713!>$+!
>0=$78%%$1*+!>1!91#*3:";8*$!413!8(#!*0>3.0!7C'*#3;7$!>$!*0<1#'#38(D!981+!;8(+3>0*8(+!41$!
;$#!'*#3;7$!'%%8*#$!+1I3+'22$(#!>C$G%73;'#38(+!;8(;$*('(#!7$+!>3I0*$(#$+!
3(#$*%*0#'#38(+!%8++3?7$+D!
!
)'*!;8(+041$(#@!$(!;8(+3>0*'(#!(8#*$!*0+120!*$7'#3<!'1G!?3'3+!>$!%1?73;'#38(!$#!7$!
*0+120!>$!7C'*#3;7$!>$!*0<1#'#38(@!(81+!($!;8(+#'#8(+!%'+!>$!>3I0*$(;$!+3.(3H;'#3=$!
$(#*$!7$+!>$1GD!J'(+!7'!H.1*$!Q@!(8#*$!*0+120!$#!7$!*0+120!'2$(>0!>$!7C'*#3;7$!>$!
*0<1#'#38(!0#'?73!%'*!7$+!>0=$78%%$1*+!>1!91#*3:";8*$!%$1=$(#!\#*$!;8(+17#0+!;3:;8(#*$D!
)'*!'377$1*+@!37!$+#!<*'%%'(#!>$!;8(+#'#$*!41$!7$+!>$1G!H.1*$+!+8(#!41'+32$(#!'73.(0$+!
7C1($!+1*!7C'1#*$D!EC$+#!%81*4183@!(81+!*$2$*;38(+!7$+!'1#$1*+!>$!7C'*#3;7$!>$!*0<1#'#38(!
>C'=83*@!%$1#:\#*$!3*8(341$2$(#@!2'3+!$++$(#3$77$2$(#@!;8(H*20!(8#*$!'('7A+$D!
!
!
?<@8$%!S0!T$-<+1%&!7*K#$*J1%&!K%$&8&!*$-<+1%&!)C7*K#$*J1%&!+#(+%$(*(-!1E*P<1<*-<#(U1%!+#(V<-!)E<(-C$W-!&%1#(!
4%-% $&!2X!@*8+:%5!%-!>%$:*@% (! %-!1 E*$-<+1%!)%!$C78-*-<#(!2X!)$#<-%5!)%!Y#8K<%$!%-!*10!G*!&<;<1<-8)%!%&-!
7$*''*(-%!,!(#-$%!+#(+18&<#(!(%!'%8-!W-$%!D8%!1*!&8<K*(-%Z!%(!'$%(*(-!+#;;%!'#<(-!)%!)C'*$-!)%&!'*$-<%&!
#''#&C%&!)8!&'%+-$%!)E<(-%$'$C-*-<#(!)%&!C-8)%&!$%1*-<K%&!*8!H8-$<I3+#$%!,!<1!%[<&-%!*8!;#<(&!8(%!
CK%(-8*1<-C!)%!J<*<&!)%!'8J1<+*-<#(!)*(&!1%&!)%8[!&%(&0!\%!'18&Z!<1!%[<&-%!8(!*++#$)!%&&%(-<%10!
!
3. Divergence d’interprétation des études scientifiques
!
J'(+!;$##$!+$;#38(@!(81+!(81+!'##';&$*8(+!K!*0%8(>*$!'1G!'*#3;7$+!2$(#38((0+!>'(+!7'!
*0<1#'#38(D!
!
d(!;$!413!;8(;$*($!7'!>3=$*.$(;$!+1*!7C3(;71+38(!$#!7C0='71'#38(!>$+!'*#3;7$+!>'(+!7'!
*0<1#'#38(!+$!#$*23('(#!%'*!1($!;8(;71+38(!<'=8*'?7$!!81!>0<'=8*'?7$!@!(81+!
+81&'3#$*38(+!<'3*$!%'*#!>$!(8+!28#3='#38(+D!E8(#*'3*$2$(#!K!;$!413!'!0#0!0;*3#!>'(+!
7C'*#3;7$!>$!*0<1#'#38(@!413!'!$G'23(0!7'!<8*217'#38(!413!'!0#0!1#373+0$!>'(+!7$+!
;8(;71+38(+!81!78*+!>$+!*01(38(+!>$!>3+;1++38(+@!(81+!'=8(+!'%%*8<8(>3!(8+!
*$;&$*;&$+!>'(+!7$+!%1?73;'#38(+!>C8*3.3($@!;D:K:>D!0.'7$2$(#!>'(+!7$+!+$;#38(+!>0>30$+!
'1G!20#&8>878.3$+!$#!'1G!*0+17#'#+D!
!
J3=$*.$(;$!;8(;$*('(#!7C3(;71+38(!>C'*#3;7$+!%$*#3($(#+!$(!<'=$1*!>$!7'!='73>'#38(D!
!
6C'*#3;7$!*0>3.0!%'*!g'#3+#'!$#!'7D!eTf!(C'!%'+!0#0!3(;71+!;822$!'*#3;7$!%$*#3($(#!%81*!7'!
='73>'#38(!>1!91#*3:";8*$@!;'*!37!;82%'*'3#!$(#*$!$1G!>3I0*$(#+!78.8+!'%%8+0+!+1*!7'!<';$!
'='(#!>C$2?'77'.$+!$#!7'!;8(;71+38(!3(>341'3#!41$!7$+!78.8+!'%%8+0+!+1*!7'!<';$!'='(#!
>$+!$2?'77'.$+!$(#*'k('3#!>$+!';&'#+!'732$(#'3*$+!%71+!+'3(+@!2'3+!(C3(>341'3#!%'+!+3!1(!
^_)6!0#'3#!%71+!$I3;';$!41C1(!'1#*$D!EC$+#!%81*4183@!(8#*$!'%%*0;3'#38(!0#'3#!($1#*$D!
981+!(C'=8(+!>8(;!%'+!3(;71+!;$#!'*#3;7$!>'(+!(8#*$!0='71'#38(!H('7$@!;'*!7$!91#*3:";8*$!
($!<'3+'3#!%'+!$G%73;3#$2$(#!7C8?F$#!>$!7C0#1>$D!
!
6C'*#3;7$!*0>3.0!%'*!g8++1A#!$#!'7D!elf!(C'!%'+!0#0!3(;71+!>'(+!(8#*$!#'?7$'1!>$!='73>'#38(@!
;'*!7$+!$G%0*3$(;$+!8;17828#*3;$+!+8(#@!>C'%*B+!(8#*$!%83(#!>$!=1$@!%$*#3($(#$+!%81*!7'!
*$;8(('3++'(;$!>1!78.8!+1*!7'!<';$!'='(#!>$+!$2?'77'.$+!$(!#'(#!41$!#$7!%'*!7$!
;8(+822'#$1*@!2'3+!($!%*0+$(#$(#!'1;1(!73$(!>$!;'1+'73#0!'=$;!7$+!';&'#+!
'732$(#'3*$+D!981+!(C'=8(+@!;$%$(>'(#@!%'+!3(;71+!7'!%'*#3$!>0>30$!K!7'!='73>'#38(!>$!7'!
*$;8(('3++'(;$!$#!>$!7C'%%*0;3'#38(!>$!7C32'.$!>1!78.8!713:2\2$D!981+!(81+!+822$+!
;8(;$(#*0+!+1*!7'!%$*#3($(;$!>$!7'!='73>'#38(!%81*!7$+!';&'#+!'732$(#'3*$+D!
!
6C'*#3;7$!*0>3.0!%'*!d.($77!$#!'7D!mno+1*!7$!*p7$!>1!91#*3:";8*$!$#!7'!#'377$!>$+!%8*#38(+!!(C'!
%'+!0#0!3(;71+!>'(+!(8#*$!0='71'#38(!78*+!>C1($!0#'%$!>$!='73>'#38(@!;'*!(81+!(81+!
+822$+!;8(;$(#*0+!+1*!7N'%%73;'#38(!';#1$77$!>1!91#*3:";8*$@!;D:K:>D!7$!;'7;17!>1!91#*3:
";8*$!*$%8+$!+1*!7C'7.8*3#&2$!>1!+A+#B2$!^"]:9)"!$#!>83#!\#*$!1#373+0!%81*!;82%'*$*!
>$+!%*8>13#+!$(#*$!$1G!'1!+$3(!>C1(!.*81%$!>$!%*8>13#+@!2'3+!($!>83#!%'+!+C'%%7341$*!'1!
;&83G!>$!7'!#'377$!>$+!%8*#38(+D!
!
6C'*#3;7$!*0>3.0!%'*!^3'78(!$#!'7D!eRf5!981+!'=8(+!0='710!;$##$!0#1>$!'=$;!1(!*0+17#'#!
<'=8*'?7$D!981+!*$;8(('3++8(+!'=83*!;8223+!1($!$**$1*!K!;$!+1F$#!$#!41$!;$#!'*#3;7$!
'1*'3#!>q!\#*$!3(;71+!>'(+!(8#*$!0='71'#38(@!0#'(#!>8((0!41C37!A!'!1($!;82%'*'3+8(!'=$;!
1(!.*81%$!+'(+!78.8D!r(!'1#*$!'*#3;7$!*0>3.0!%'*!^3'78(!$#!'7D!eXf!(C'!%'+!0#0!3(;71+!>'(+!
(8#*$!0='71'#38(@!;'*!37!;82%'*'3#!7C0#341$##$!91#*n(<8*2!'1!91#*3:";8*$!+'(+!0#1>3$*!1(!
.*81%$!+'(+!78.8D!!
!
6C'*#3;7$!*0>3.0!%'*!cs*;a$(?$;a!$#!'7D!etf!(C$+#!%'+!%$*#3($(#!%81*!7'!='73>'#38(!>1!91#*3:
";8*$@!;'*!37!(C0#1>3$!%'+!7C$I$#!>1!91#*3:";8*$!+1*!>$+!';&'#+!%71+!+'3(+@!2'3+!+1*!>$+!
$I$#+!>$!L!&'78!M!+1*!7'!+'(#0D!
!
J3=$*.$(;$!*$7'#3=$!K!7'!;7'++3H;'#38(!>$+!'=3+!L!<'=8*'?7$+!M!81!L!>0<'=8*'?7$+!M!>$!(8#*$!
'*#3;7$!=$*+1+!7C'*#3;7$!>$!*0<1#'#38(D!J'(+!7'!>8;12$(#'#38(!+1%%702$(#'3*$!>$!(8#*$!
'*#3;7$!>C8*3.3($!eVf@!7$+!7$##*$+!$(!*81.$!3(>341$(#!(8#*$!3(#$*%*0#'#38(!>0=3'(#$!>$+!
0#1>$+!%'*!*'%%8*#!K!;$77$!>$!7C'*#3;7$!>$!g$+'(;8(!$#!'7D!J'(+!7'!>8;12$(#'#38(!
+1%%702$(#'3*$@!(81+!$G%73418(+!7$+!>3I0*$(;$+!+81+!7'!;878(($!>$+!*$2'*41$+D!
!
6C0#1>$!>$!J1?83+!$#!'7D!eVSf!'!28(#*0!1(!70.$*!$I$#!+#'#3+#341$2$(#!+3.(3H;'#3<!>1!91#*3:
";8*$!+1*!7'!41'73#0!(1#*3#38(($77$!>$+!';&'#+!'732$(#'3*$+!>$+!T!.*81%$+!>$!%*8>13#+D!
981+!7C'=8(+!;7'++0!;822$!L!9$1#*$!M@!;'*!7C$I$#!($!+C07$='3#!41CK!Q@l!u!$#!41$!(81+!
;8(+3>0*8(+!41C1(!$I$#!$+#!;73(341$2$(#!+3.(3H;'#3<!>B+!78*+!41C37!$+#!+1%0*3$1*!K!l!uD!
d(!81#*$@!7$+!'1#$1*+!;8(H*2$(#!41$!L!!Y'7.*0!7$+!;8(#*p7$+!$#!7$!.*'(>!(82?*$!
>C8?+$*='#38(+@!7$1*!32%';#!+1*!7'!41'73#0!(1#*3#38(($77$!>1!%'(3$*!>$!;81*+$+!>$!
%*8>13#+!0#341$#0+!(C0#'3#!%'+!+#'#3+#341$2$(#!+3.(3H;'#3<!'1!(3=$'1!>$+!l!u!>$!7'!
;8(+822'#38(!MD!
!
E8(;$*('(#!7$+!'*#3;7$+!>$!d.($77!$#!'7D!mno!%'*1+!$(!QSVt!!$#!QSQV!!@!(81+!($!+822$+!%'+!
>C';;8*>!'=$;!7$!%83(#!>$!=1$!>$+!'1#$1*+!O'I3730+!'1G!>0=$78%%$1*+!>1!91#*3:";8*$U!
+$78(!7$41$7!;$+!0#1>$+!>83=$(#!\#*$!3(#$*%*0#0$+!;822$!0#'(#!<'=8*'?7$+D!6$+!'1#$1*+!
8(#!;8(;71!41$!7$!91#*3:";8*$!'I3;&$!>$!2$377$1*+!*0+17#'#+!41$!7C0#341$##$!L!]%%8*#+!>$!
*0<0*$(;$!MD!981+!'=8(+@!#81#$<83+@!;&$*;&0!K!+'=83*!+3!7$!91#*3:";8*$!8?#$('3#!>$!
2$377$1*+!*0+17#'#+!41$!7$+!%*8>13#+!+'(+!0#341$##$!>'(+!7$!;'>*$!>1!+A+#B2$!^"]:9)"D!
6$+!'1#$1*+!8(#!28(#*0!41$!;$!(C0#'3#!%'+!7$!;'+D!n7+!8(#!2$(#38((0!;$!*0+17#'#!>'(+!
7C'*#3;7$@!2'3+!($!7C8(#!%'+!3(>3410!>'(+!7'!;8(;71+38(D!`#'(#!>8((0!41$!7$!91#*3:";8*$!
(C'I3;&$!%'+!>$!2$377$1*+!*0+17#'#+!41$!7$!.*81%$!>$!%*8>13#+!+'(+!0#341$##$@!37!;8(=3$(#!
>$!;8(;71*$!41$!7$!91#*3:";8*$!(C'!$1!'1;1(!$I$#D!EC$+#!%81*4183@!7$+!*0+17#'#+!>$!
7C0#1>$!0#'3$(#!>0<'=8*'?7$+D!
!
)'*!'377$1*+@!(81+!'=8(+!$1!>$+!>3I3;17#0+!>C3(#$*%*0#'#38(!'=$;!7C0#1>$!eVWf!>$!
^3(a$7+#$3(!$#!'7D!eVWf@!;'*!7$!*0+17#'#!>$!7C0#1>$!($!*$%*0+$(#'3#!%'+!1(!$I$#!+1*!7$!
+A+#B2$!^"]:9)"@!2'3+!+1*!7'!28A$(($!>$+!91#*3:";8*$+D!d(!*'3+8(!>$!7'!>3I0*$(;$!
>C$I$#!>'(+!;$##$!0#1>$!+1*!7C0#341$##$!217#3:1+'.$!$#!7$!91#*3:";8*$@!(81+!'=8(+!8%#0!
%81*!1(!$I$#!'*?3#*'3*$!($1#*$D!
!
6$+!'1#$1*+!>$!7C'*#3;7$!*0>3.0!%'*!^1;&+!$#!'7D!eVTf!8(#!;&83+3!1(!$I$#!>$!%!mS@VS!;822$!
+#'#3+#341$2$(#!+3.(3H;'#3<@!'78*+!41$!(81+!'=8(+!*$+%$;#0!7'!='7$1*!+;3$(#3H41$!
;81*'(#$!%!m!S@SlD!
!
c173'!$#!'7D!eVlf!8(#!0#1>30!7C$I3;';3#0!>3+;*323('#83*$!$#!7'!;8(<8*23#0!'1G!
*$;822'(>'#38(+!(1#*3#38(($77$+!$(!#$*2$+!>C'732$(#+!>1!91#*3:";8*$!$(!QSVl!$#!8(#!
;8(;71!K!1(!*0+17#'#!%8+3#3<D!E$%$(>'(#@!$(!QSQQ!7C'7.8*3#&2$!'!0#0!23+!K!F81*!$(!*'3+8(!
>$!7C'F1+#$2$(#!>1!91#*3:";8*$!'H(!>$!7$!2$##*$!$(!;8(<8*23#0!'=$;!7$+!
*$;822'(>'#38(+!(1#*3#38(($77$+!$(!#$*2$+!>C'732$(#+D!6$!E823#0!>C'F1+#$2$(#!0#'3#!
%*0+3>0!%'*!7$!J*!!c173'D!981+!'=8(+!;8(+3>0*0!7$!*0+17#'#!;822$!0#'(#!>0<'=8*'?7$@!;'*!
7C'7.8*3#&2$!#$+#0!>'(+!;$##$!0#1>$!'!>q!\#*$!'F1+#0!17#0*3$1*$2$(#D!
!
6$+!>$1G!0#1>$+!eVv@VRf!>$!,'<($*!$#!'7D!8(#!0#0!;7'++0$+!;822$!0#'(#!>0<'=8*'?7$+@!;'*!
7C'('7A+$!%*0+$(#0$!>'(+!7$+!'*#3;7$+!'!28(#*0!41$!7C'7.8*3#&2$!#*'(+=$*+'7!($!>8(($!%'+!
1($!?8(($!*0%'*#3#38(!$(#*$!7$+!>3I0*$(#+!91#*3:";8*$+!>$+!>3I0*$(#+!.*81%$+!>$!
%*8>13#+@!%D!$GD!A'81*#+!'*82'#3+0+@!<*82'.$+@!F1+!>$!<*13#+!$#!&137$+!>$!;13++8(D!E$##$!
'('7A+$!'!0#0!*0'73+0$!'='(#!7'!23+$!K!F81*!>$!7C'7.8*3#&2$D!
!
6C0#1>$ !eVXf!>$!"&*$+#&'!$#!'7D!'!0#0!;7'++0$!;822$!>0<'=8*'?7$@!;'*!L!1($!;8(;71+38(!
>0H(3#3=$!;8(;$*('(#!7$+!$I$#+!>1!^_)6!+1*!7$+!';&'#+!$#!7'!;8(+822'#38(!*0$7+!M!($!
%$1#!%'+!\#*$!0#'?73$D!E$#!'*.12$(#!$+#!;8(<8*2$!'1G!0702$(#+!2$(#38((0+!78*+!>$!
(8#*$!%*0;0>$(#!'*#3;7$!eQfD!
!
6C'*#3;7$!*0>3.0!%'*!Z$*!g8*.!$#!'7D!eVtf!'!0='710!7'!;8(<8*23#0!>1!91#*3:";8*$!'=$;!7$+!
*$;822'(>'#38(+!(1#*3#38(($77$+!$(!#$*2$+!>C'732$(#+!(0$*7'(>'3+$+!$#!'!3>$(#3H0!>$+!
7';1($+D!6C'7.8*3#&2$!>1!91#*3:";8*$!'!0#0!23+!K!F81*!17#0*3$1*$2$(#!$(!<8(;#38(!>$!;$+!
7';1($+!O%'*23!>C'1#*$+!0#1>$+!+3237'3*$+UD!
!
6C0#1>$!*0'73+0$!%'*!-'(>$=3F=$*$!$#!g$*.$*!eQSf!$+#!7'!+$17$!41$!(81+!;8(('3++8(+!>'(+!
7'41$77$!7$!91#*3:";8*$!'!0#0!'%%73410!K!1($!.'22$!;82%7B#$!>$!+1%$*2'*;&0D!6$!
91#*3:";8*$!'!0#0!'%%73410!$(!(83*!$#!?7'(;!+1*!7$+!0#341$##$+!>$+!*'A8(+D!6C$I$#!+1*!7$+!
';&'#+!0#'3#!23#3.0!$#!32%*0=3+3?7$D!
!
4. 6$!Conflit d’intérêt
d(!*0%8(+$!'1G!';;1+'#38(+!'='(;0$+!>'(+!7'!*0<1#'#38(!;8(;$*('(#!(8#*$!;8([3#!
>C3(#0*\#!'770.10!$#!(8#*$!32%73;'#38(!>'(+!7$+!>0?'#+!*$7'#3<+!'1G!78.8+!'%%8+0+!+1*!7'!
<';$!'='(#!>$+!$2?'77'.$+@!(81+!+81&'3#$*38(+!>0;7'*$*!;$!413!+13#!5!!
!
6'!28#3='#38(!$#!7C32%73;'#38(!>'(+!7$+!>0?'#+!*$7'#3<+!'1G!78.8+!'%%8+0+!+1*!7$+!>$='(#!
>$+!$2?'77'.$+!$#@!%'*!;8(+041$(#@!7$!91#*3:";8*$@!#*81=$!+8(!8*3.3($!>'(+!7$!<'3#!41$!
(8(!+$17$2$(#!7$!)*!!-$*&'.$(@!2'3+!'1++3!7$!J*!"#$%&'(!)$#$*+!0#'3$(#!2$2?*$+!>1!
E823#0!+;3$(#3H41$!3(>0%$(>'(#!$#!+81#$('3$(#!7C'(;3$(!78.8!'%%8+0!+1*!7'!<';$!'='(#!
>$+!$2?'77'.$+!'1G!)'A+:g'+!5!L!,$#!-3(aF$!M!O;&83G!>$!78.8!>$+!)'A+:g'+UD!)$(>'(#!
;$##$!%0*38>$@!7$!)*!,'(+!-$*&'.$(!0#'3#!$(!%8+#$!K!7Cn(+#3#1#!('#38('7!(0$*7'(>'3+!>$!7'!
+'(#0!%1?7341$!$#!>$!7C$(=3*8(($2$(#!O9'#38('7!n(+#3#1#$!<8*!)1?73;!,$'7#&!'(>!#&$!
d(=3*8(2$(#!:!/n-YUD!n7!0#'3#@!K!;$##$!0%841$@!0.'7$2$(#!2$2?*$!>1!%'($7!9J]!>$!
7C]1#8*3#0!$1*8%0$(($!>$!+0;1*3#0!>$+!'732$(#+!OZ&$!d1*8%$'(!^88>!"'<$#A!]1#&8*3#A!:!
d^"]UD!6$!J*!"#$%&'(!)$#$*+@!41'(#!K!713@!8;;1%'3#!1(!%8+#$!>$!/$+%8(+'?7$!>$!
*$;&$*;&$!$(!+;3$(;$!(1#*3#38(($77$!'1!E$(#*$!(0$*7'(>'3+!>$!7'!(1#*3#38(D!6$!E$(#*$!
(0$*7'(>'3+!>$!7'!(1#*3#38(!$+#!7C]1#8*3#0!(0$*7'(>'3+$!3(>0%$(>'(#$!>$+!'732$(#+!413@!
%'*23!>C'1#*$+@!0>3;#$(#!7$+!*$;822'(>'#38(+!(1#*3#38(($77$+!$(!#$*2$+!>C'732$(#+!'1G!
)'A+:g'+D!)$(>'(#!;$##$!%0*38>$@!37+!8(#!>8(;!#*'='3770!#81+!>$1G!>'(+!>$+!8*.'(3+2$+!
3(>0%$(>'(#+!413!(C'='3$(#!'1;1(!73$(!'=$;!7$!+$;#$1*!3(>1+#*3$7D!98#*$!&3+#83*$!
;8221($!;8(;$*('(#!7$+!78.8+!+1*!7$!>$='(#!>$+!$2?'77'.$+!'!>8(;!0#0!7$!<$*!>$!7'(;$!
%81*!%'*#3;3%$*!'1G!>0?'#+!+1*!7C3(#*8>1;#38(!>1!91#*3:";8*$!'1G!)'A+:g'+D!93!-$*&'.$(!
(3!)$#$*+!($!<8(#!%*$++38(!;8(#*$!7$!91#*3:";8*$D!Z81#$<83+@!37+!+8(#!>$+!<$*=$(#+!
>0<$(+$1*+!>$+!>8((0$+!+;3$(#3H41$+!H'?7$+D!
!
6C'++8;3'#38(!7'3#3B*$!(0$*7'(>'3+$@!9$>$*7'(>+$!w13=$7!_*.'(3+'#3$@!(C'!'1;1(!L!8?F$;#3<!
>$!78??A3(.!M!;8(#*$!7$!91#*3:";8*$!;822$!7$!7'3++$!$(#$(>*$!7C'*#3;7$!>$!*0<1#'#38(!$#!
;822$!'*.12$(#!1#373+0!%'*!7$+!>0=$78%%$1*+!>1!91#*3:";8*$!%81*!+C8%%8+$*!'1G!
;8(;71+38(+!>$!(8+!'*#3;7$+D!E$##$!'++8;3'#38(!'!#81F81*+!0#0!$(!';;8*>!'=$;!7C'=3+!>$!7'!
%71%'*#!>$+!+;3$(#3H41$+!(0$*7'(>'3+!+%0;3'73+0+!>'(+!7$+!%*8>13#+!'732$(#'3*$+@!7$+!
>$1G!'++8;3'#38(+!(0$*7'(>'3+$+!>$!(1#*3#38((3+#$+!$#!7C'++8;3'#38(!(0$*7'(>'3+$!>$!
;8(+$377$*+!$(!2'#3B*$!>$!%83>+!+$78(!7$41$7!7$!91#*3:";8*$!($!>83#!%'+!\#*$!7'(;0!'1G!
)'A+:g'+!F1+41CK!7'!*0+871#38(!>$+!41$+#38(+!;*3#341$+!K!;$!+1F$#D!h!;$!F81*@!37!(C'!
#81F81*+!%'+!0#0!3(#*8>13#!'1G!)'A+:g'+@!2'7.*0!1($!23+$!K!F81*!*0;$(#$!>$!7C'7.8*3#&2$!
$I$;#10$!%'*!$(=3*8(!QSS!+;3$(#3H41$+!+%0;3'73+0$+!>'(+!7$!>82'3($!>$+!%*8>13#+!
'732$(#'3*$+!5!O$(!(0$*7'(>'3+@!QSQQU!
&##%+5xx=8$>3(.+F1(.7$DH7$+Dy8*>%*$++D;82xQSQQxVQxQSQQVQVVz8%*8$%:''(:='(:
883F$(:(1#*3+;8*$:''(:#$:%'++$(:=88*'<.''(>:3(=8$*3(.z>$<D%><!!
!
,07'+@!(8+!'*#3;7$+!+8(#!41'73H0+!%'*!7$+!>0=$78%%$1*+!>1!91#*3:";8*$!+1*!7$1*!?78.!$#!
>'(+!7$1*+!%1?73;'#38(+!+1*!7$+!*0+$'1G!+8;3'1G!>CL!'*#3;7$+!>$!78??A3(.!>0<$(>'(#!7$+!
3(#0*\#+!0;8(82341$+!'1!>0#*32$(#!>$!7'!+'(#0!%1?7341$!M!$#!(81+!+822$+!%*0+$(#0+!
;822$!>$+!L!78??A3+#$+!MD!981+!(C'=8(+@!;$%$(>'(#@!F'2'3+!$1!7C8;;'+38(!>$!(81+!
>0<$(>*$!<';$!K!;$+!<'1++$+!'770.'#38(+D!981+!$+%0*8(+!'3(+3!41$!;$##$!*0%8(+$@!'3(+3!
41$!(8+!'*#3;7$+!%$*2$##*8(#!>$!<'3*$!#81#$!7'!7123B*$!K!;$!+1F$#!$#!41C1($!'*.12$(#'#38(!
+;3$(#3H41$!H'?7$!7C$2%8*#$!+1*!7C'I373'#38(!$#!7$!;8(#$G#$D!68*+41C37!$+#!41$+#38(!
>N0#341$#'.$!+1*!7'!<';$!'='(#!>$+!$2?'77'.$+!$#!(8#*$!#*'='37!*$7'#3<!'1!91#*3:";8*$@!(81+!
+822$+!>$+!+;3$(#3H41$+!$(.'.0+!413!<8(#!%*$++38(!%81*!8?#$(3*!1(!0#341$#'.$!%*0;3+!
'%%8+0!+1*!7'!<';$!'='(#!>$+!$2?'77'.$+D!
!
6N]++8;3'#38(!7'3#3B*$!(0$*7'(>'3+$!'!H('(;0!7$!73?*$!';;B+!>'(+!)&'*2'91#*3#38(D!981+!
+822$+!*$;8(('3++'(#+!>1!+81#3$(!41$!(81+!'=8(+!*$j1!K!;$!+1F$#D!
!
E822$!7$!28(#*$!(8+!'*#3;7$+!eV@Q@QVf@!(81+!+822$+!;*3#341$+!K!7C0.'*>!>$!7'!
F1+#3H;'#38(!+;3$(#3H41$!';#1$77$!+81+:F';$(#$!'1!91#*3:";8*$D!981+!($!;8(;718(+!%'+!
$(!>0<'=$1*!81!($!>3+;*0>3#8(+!%'+!7$!91#*3:";8*$@!2'3+!(81+!'=8(+!%81*!8?F$#!>$!
28(#*$*!7'!(0;$++3#0!>C'20738*$*!7'!F1+#3H;'#38(!+;3$(#3H41$!>'(+!7'41$77$!37!2'(41$!
>$1G!'*.12$(#+!$++$(#3$7+D!d(!%*$23$*!73$1@!37!(C$G3+#$!'1;1($!>8((0$!%*8?'(#$!*$7'#3=$!
K!7C$I3;';3#0!>1!91#*3:";8*$!$(!=3$!*0$77$!eV@Qf!$#@!$(!+$;8(>!73$1@!7$!91#*3:";8*$!%*0+$(#$!
1(!;8(#*'+#$!#*8%!32%8*#'(#!%'*!*'%%8*#!'1G!*$;822'(>'#38(+!(1#*3#38(($77$+!$(!#$*2$+!
>C'732$(#+!eQVfD!J$!%71+@!;822$!3(>3410!>'(+!7C'*#3;7$!%'*1!>'(+!)&'*2'91#*3#38(@!(81+!
*$;822'(>8(+!>8(;!41$!7$!91#*3:";8*$@!'='(#!+8(!7'(;$2$(#!$(!d1*8%$@!<'++$!7C8?F$#!
>C1($!0='71'#38(!%'*!1($!'1#8*3#0!+;3$(#3H41$!3(>0%$(>'(#$!$(!2'#3B*$!>C'732$(#+!
;822$!7Cd^"]D!!
!
981+!*$2$##8(+!$(!41$+#38(!7'!+3#1'#38(!';#1$77$!+$78(!7'41$77$!7$!>0=$78%%$2$(#!
+;3$(#3H41$@!7C0='71'#38(!>1!>0=$78%%$2$(#!+;3$(#3H41$!$#!7'!23+$!K!F81*!>$+!$**$1*+!
%*0+$(#$+!>'(+!7C'7.8*3#&2$!>83=$(#!\#*$!2$(0+!%'*!1(!+$17!.*81%$!>C$G%$*#+D!!
!
5. Conclusion
!
E822$!7C3(>341$!(8#*$!'*#3;7$!%'*1!>'(+!)&'*2'91#*3#38(@@!7$+!%1?73;'#38(+!*0'73+0$+!
%'*!7$+!>0=$78%%$1*+!>1!91#*3:";8*$!+8(#!%*$+41$!#81#$+!<'=8*'?7$+!'1!91#*3:+;8*$!OlQ!
'*#3;7$+!+1*!lvU@!$#!>'(+!7'!*0<1#'#38(!VSS!u!>$!7$1*+!'*#3;7$+!+8(#!$(!<'=$1*!>$!;$!78.8D!
68*+41$!7C8(!;8(+3>B*$!7$+!+;3$(#3H41$+!413!8(#!0='710!7$!91#*3:";8*$!$#!413!+8(#!
3(>0%$(>'(#+!81!413!($!+8(#!%'+!'I3730+!'1G!>0=$78%%$1*+!>1!91#*3:";8*$@!7'!*0%'*#3#38(!
>$+!*0+17#'#+!L!<'=8*'?7$+!M!81!L!>0<'=8*'?7$+!M!$+#!>C$(=3*8(!lSxlS@!;$!413!+$!*'%%*8;&$!
7$!%71+!>$+!;'7;17+!>$!%*8?'?373#0D!!
!
d(!;8(;71+38(@!'1!=1!>$+!0702$(#+!3++1+!>$!%'*#3$+!8%%8+0$+!>1!+%$;#*$!
>C3(#$*%*0#'#38(!>$+!0#1>$+!+1*!7$!91#*3:";8*$!5!7'!+1..$+#38(!>$!7C$G3+#$(;$!>C1(!?3'3+!>$!
%1?73;'#38(!($!%$1#!\#*$!(30$D!EC$+#!%81*4183@!$(!;8(;71+38(!H('7$!+1*!7C$I3;';3#0!>1!
91#*3:";8*$@!>$+!0#1>$+!+;3$(#3H41$+!+1%%702$(#'3*$+!$#!#8#'7$2$(#!3(>0%$(>'(#$+@!
'3(+3!41C1($!0='71'#38(!3(>0%$(>'(#$!+1*!7$!91#*3:";8*$!+8(#!(0;$++'3*$+D!
!
Déclaration de contribution des auteurs CRediT
"D!)D!5!;8(;$%#1'73+'#38(!b!;1*'#38(!>$+!>8((0$+!b!'('7A+$!<8*2$77$!b!20#&8>878.3$!b!
='73>'#38(!b!=3+1'73+'#38(!b!*p7$+x*0>';#38(!:!=$*+38(!3(3#3'7$!b!*0>';#38(!:!*0=3+38(!$#!
0>3#38(D!,D!-D!5!;8(;$%#1'73+'#38(!b!;1*'#38(!>$+!>8((0$+!b!'('7A+$!<8*2$77$!b!
20#&8>878.3$!b!='73>'#38(!b!=3+1'73+'#38(!b!*p7$+x*0>';#38(!:!=$*+38(!3(3#3'7$!b!*0>';#38(!:!
*0=3+38(!$#!0>3#38(D!
!
!
Déclaration des intérêts concurrents
"D!)D!8;;1%$!1(!%8+#$!'1!+$3(!>$!7C]++8;3'#38(!7'3#3B*$!(0$*7'(>'3+$@!9$>$*7'(>+$!w13=$7!
_*.'(3+'#3$D!,D!-D!3(#$*=3$(#!$(!41'73#0!>$!;8(+$377$*!3(>0%$(>'(#!'1!+$3(!>$!7'!^88>!
"'<$#A!P!91#*3#38(!E8(+17#'(;A!O)'A+:g'+U!$#!>0#3$(#!1($!;&'3*$!K!7Cr(3=$*+3#0!#$;&(341$!
>1!J'($2'*a!OJ'($2'*aU!$#!K!7Cr(3=$*+3#0!>Cr7+#$*!On*7'(>$!>1!98*>UD!]1;1(!>$+!'1#$1*+!
(C'!;877'?8*0!81!($!;877'?8*$!'=$;!7$+!>0=$78%%$1*+!>1!91#*3:";8*$D!,D!-D!$+#!2$2?*$!
>1!E8(+$37!3(#$*('#38('7!>$!7'!E&83;$+!n(#$*('#38('7!^81(>'#38(!>$%13+!QSQWD!"D!%D!$#!,D!
-D!0#'3$(#@!F1+41CK!QSVl@!#81+!>$1G!2$2?*$+!>1!E823#0!+;3$(#3H41$!3(>0%$(>'(#!'1G!
)'A+:g'+!+81#$('(#!7C'(;3$(!78.8!+1*!7$!>$='(#!>$+!$2?'77'.$+!L!,$#!-3(aF$!MD!6$+!
'1#$1*+!>0;7'*$(#!41$!7$+!#*'='1G!>$!*$;&$*;&$!8(#!0#0!2$(0+!$(!7C'?+$(;$!>$!#81#$!
*$7'#38(!;822$*;3'7$!81!H('(;3B*$!413!'1*'3#!%1!\#*$!%$*j1$!;822$!1(!;8([3#!>C3(#0*\#!
%8#$(#3$7D!6C'++8;3'#38(!7'3#3B*$!(0$*7'(>'3+$!%'*#3;3%$!'1!>0?'#!('#38('7!413!+$!#3$(#!'1!
)'A+:g'+!+1*!7$+!78.8+!'%%8+0+!+1*!7$+!<';$+!'='(#!>$+!$2?'77'.$+!$(!;8(#*3?1'(#!K!7'!
*$<8*217'#38(!>$+!%*8>13#+!$#!'1G!;8(;$*#'#38(+!*$7'#3=$+!K!7C0#341$#'.$!'%%8+0!+1*!7'!
<';$!'='(#!>$+!$2?'77'.$+!>1!23(3+#B*$!(0$*7'(>'3+!>$!7'!"'(#0@!>1!g3$(:\#*$!$#!>$+!
"%8*#+D!
!
Disponibilité des données
]1;1($!>8((0$!(C'!0#0!$G%783#0$!K!>$+!H(+!>$!*$;&$*;&$!>0;*3#$+!>'(+!7$!%*0+$(#!'*#3;7$!
'1#*$!41$!7'!73##0*'#1*$!';;$++3?7$!'1!%1?73;!=3'!)1?Y$>D!!
!
!
/0<0*$(;$+!
!
eVf!)$#$*+@!"Db!-$*&'.$(@!,D!)1?73;'#38(!?3'+!'(>!91#*3:";8*$5!]!;82%7$#$!73#$*'#1*$!
*$=3$y!8<!#&$!+1?+#'(#3'#38(!8<!#&$!$I$;#3=$($++!8<!#&$!<*8(#:8<:%';a!78.8!91#*3:";8*$D!
)&'*2'91#*3#38(!QSQT@!QR@!VSSWXS@!>835VSDVSVvxFD%&'(1DQSQTDVSSWXSD!
eQf!)$#$*+@!"Db!-$*&'.$(@!,D!](!d='71'#38(!8<!#&$!91#*3:";8*$!"A+#$2!'78(.!#&$!/$'+8(3(.!
<8*!";3$(#3H;!"1?+#'(#3'#38(!8<!,$'7#&!E7'32+!3(!#&$!dr{]!9'**'#3=$!/$=3$yD!^88>+!
QSQQ@!VV@!QTQvD!
eWf!g$+'(;8(@!"Db!g$*'(@!JDb!g'#'7@!YD!]!+#1>A!3+!QV!#32$+!28*$!73a$7A!#8!H(>!1(<'=81*'?7$!
*$+17#+!'?81#!#&$!(1#*3#38(!7'?$7!91#*3:";8*$!3<!#&$!'1#&8*+!>$;7'*$!'!;8([3;#!8<!3(#$*$+#!
8*!#&$!+#1>A!3+!<1(>$>!?A!#&$!<88>!3(>1+#*AD!gYc!|78?!,$'7#&!QSQW@!X@!
>835VSDVVWvx?2F.&:QSQW:SVVRQSD!
eTf!g'#3+#'@!YD^Db!>$!E'*='7&8:^$**$3*'@!cD)Db!Z&328#$8!>'!E1(&'@!JDb!J$!/8++8@!-D-D!^*8(#:
8<:%';a'.$!(1#*3#38(!7'?$73(.!'+!'!>*3=$*!<8*!&$'7#&3$*!<88>!;&83;$+5!6$++8(+!7$'*($>!'(>!
<1#1*$!%$*+%$;#3=$+D!E82%*!/$=!^88>!";3!^88>!"'<!QSQW@!QQ@!lWl:lXv@!
>835VSDVVVVxVlTV:TWWRDVWSXlD!
elf!g8++1A#@!"Db!E1+#$*+@!}Db!Z122$*+@!cDb!-$*?$A+#@!6Db!_?$(@!gD!91#*3:";8*$!'(>!91#*3#38(!
^';#+!)'($7!#&*81.&!#&$!dA$+!8<!#&$!E8(+12$*5!E8**$;#!,$'7#&<17($++!d+#32'#38(+!
J$%$(>!8(!Z*'(+%'*$(#!6'?$7+@!^3G'#38(!J1*'#38(@!'(>!)*8>1;#!d413=8;'73#AD!91#*3$(#+!
QSQV@!VW@!>835VSDWWtSx(1VWStQtVlD!
evf!d.($77@!YDb!}$++$:|1A8#@!dDb!|'7'(@!)Db!Z81=3$*@!YDb!/'A($*@!YDb!c$y$77@!cDb!g*$>'@!cDb!
,$*;?$*.@!"Db!c173'@!ED!n2%';#!8<!^*8(#:8<:)';a!91#*3#38(!6'?$7+!8(!)8*#38(!"3i$!
"$7$;#38(5!](!dG%$*32$(#'7!"#1>A!3(!'!^*$(;&!E8&8*#D!91#*3$(#+!QSVX@!VS@!
>835VSDWWtSx(1VSStVQvXD!
eRf!^3'78(@!YDb!d.($77@!YDb!Z'7'#3@!wDb!|'7'(@!)Db!J*$'(8:Z*$;'(#@!6Db!Z81=3$*@!YDb!)$##3.*$y@!
"Db!,$*;?$*.@!"Db!c173'@!ED!dI$;#3=$($++!8<!J3I$*$(#!^*8(#:8<:)';a!91#*3#38(!6'?$7+!
'28(.!n#'73'(!E8(+12$*+5!/$+17#+!<*82!'(!_(73($!/'(>823i$>!E8(#*877$>!Z*3'7D!
91#*3$(#+!QSQS@!VQ@!>835VSDWWtSx(1VQSXQWSRD!
eXf!^3'78(@!YDb!g'?38@!9Db!"'7'+:"'7='>~@!cDb!|'7'(@!)Db!}$++$:|1A8#@!dDb!Z81=3$*@!YDb!
J$+;&'+'1G:Z'(.1A@!YDb!"'*>'@!gDb!,$*;?$*.@!"Db!}&81*A@!9Db!$#!'7D!E82%'*'#3=$!
1(>$*+#'(>3(.!'(>!%*$<$*$(;$!8<!91#*3:";8*$!'(>!91#*n(<8*2!g'##$*A!3(!'!+'2%7$!8<!
"%'(3+&!;8(+12$*+D!d1*!c!)1?73;!,$'7#&!QSQW@!WW@!QtW:QtX@!
>835VSDVStWx$1*%1?x;a'>SSQD!
etf!cs*a$(?$;a@!}Db!Y$&7&8+$@!EDb!ws&7+>8*<@!]D!Z&$!3([1$(;$!8<!#&$!91#*3:";8*$!8(!#&$!
%$*;$3=$>!&$'7#&3($++!8<!<88>+!7'?$77$>!y3#&!'!(1#*3#38(!;7'32!8<!+1.'*D!)68"!_($!QSQQ@!
VR@!$SQRQQQS@!>835VSDVWRVxF81*('7D%8($DSQRQQQSD!
eVSf!J1g83+@!)D@!]7?141$*41$!)D@!E&'(>8(@!)D!dI$;#+!8<!<*8(#:8<:%';a!7'?$7+!8(!#&$!
(1#*3#38('7!41'73#A!8<!+1%$*2'*a$#!<88>!%1*;&'+$+5!$=3>$(;$!<*82!'!7'*.$:+;'7$!
*'(>823i$>!;8(#*877$>!#*3'7D!c81*('7!8<!#&$!];'>$2A!8<!Y'*a$#3(.!";3$(;$!QSQV@!Tt@!VVt:
VWXD!
eVVf!d.($77@!YDb!g81#*8(@!nDb!)0($'1@!"Db!J1;*8#@!)Db!Z81=3$*@!YDb!|'7'(@!)Db!g1+;'37@!EDb!
)8*;&$*@!/Db!/'='1>@!)Db!,$*;?$*.@!"Db!$#!'7D!^*8(#:8<:)';a!6'?$73(.!'(>!#&$!91#*3#38('7!
•1'73#A!8<!"#1>$(#+N!^88>!)1*;&'+$+5!]!W:]*2!/'(>823i$>!E8(#*877$>!Z*3'7D!]2!c!)1?73;!
,$'7#&!QSVt@!VSt@!VVQQ:VVQt@!>835VSDQVSlx]c),DQSVtDWSlVVlD!
eVQf!d.($77@!YDb!g81#*8(@!nDb!)0($'1@!"Db!J1;*8#@!)Db!Z81=3$*@!YDb!|'7'(@!)Db!g1+;'37@!EDb!
)8*;&$*@!/Db!/'='1>@!)Db!,$*;?$*.@!"Db!$#!'7D!/'(>823+$>!;8(#*877$>!#*3'7!3(!'(!
$G%$*32$(#'7!8(73($!+1%$*2'*a$#!#$+#3(.!#&$!$I$;#+!8<!<*8(#:8<:%';a!(1#*3#38(!7'?$773(.!
8(!<88>!%1*;&'+3(.!3(#$(#38(+!3(!'!78y:3(;82$!%8%17'#38(D!gYc!_%$(!QSQV@!VV@!
$STVVtv@!>835VSDVVWvx?2F8%$(:QSQS:STVVtvD!
eVWf!^3(a$7+#$3(@!dD]Db!](.@!^DcD6Db!J8?7$@!gDb!€8(.@!€D,DYDb!='(!J'2@!/DYD!]!/'(>823i$>!
E8(#*877$>!Z*3'7!d='71'#3(.!#&$!/$7'#3=$!dI$;#3=$($++!8<!#&$!Y17#3%7$!Z*'I3;!63.&#!'(>!
91#*3:";8*$!^*8(#!8<!)';a'.$!91#*3#38(!6'?$7+D!91#*3$(#+!QSVt@!VV@!
>835VSDWWtSx(1VVStQQWvD!
eVTf!^1;&+@!}D6Db!63'(@!cDb!Y3;&$7+@!6Db!Y'A$*@!"Db!Z8(3'#8@!dDb!Z3$<$(?$;a@!-D!dI$;#+!8<!
J3.3#'7!^88>!6'?$7+!8(!,$'7#&A!^88>!E&83;$+!3(!_(73($!|*8;$*A!"&8%%3(.D!91#*3$(#+!
QSQQ@!VT@!>835VSDWWtSx(1VTVSQSTTD!
eVlf!c173'@!EDb!J1;*8#@!)Db!)0($'1@!"Db!J$+;&'2%+@!-Db!Y0F$'(@!EDb!^0i$1@!6Db!Z81=3$*@!YDb!
,$*;?$*.@!"Db!}$++$:|1A8#@!dD!J3+;*323('#3(.!(1#*3#38('7!41'73#A!8<!<88>+!1+3(.!#&$!l:
E878*!(1#*3#38(!7'?$7!3(!#&$!^*$(;&!<88>!2'*a$#5!;8(+3+#$(;A!y3#&!(1#*3#38('7!
*$;822$(>'#38(+D!91#*!c!QSVl@!VT@!VSS@!>835VSDVVXvx+VQtWR:SVl:SStS:TD!
eVvf!,'<($*@!dDb!)*'=+#@!nD!d='71'#38(!8<!#&$!]?373#A!8<!91#*3:";8*$!#8!J3+;*323('#$!#&$!
91#*3#38('7!•1'73#A!8<!)*$%';a$>!^88>+!r+3(.!'!"'7$:€$3.&#3(.!]%%*8';&D!^88>+!QSQV@!
VS@!>835VSDWWtSx<88>+VSSXVvXtD!
eVRf!,'<($*@!dDb!)*'=+#@!nD!E82%'*3+8(!8<!91#*3:";8*$!'(>!,$'7#&!"#'*!/'#3(.!91#*3$(#!
)*8H73(.!Y8>$7+!r+3(.!6'*.$!g*'(>$>!^88>+!E82%8+3#38(!J'#'?'+$!'(>!"'7$+!J'#'D!n(#!
c!d(=3*8(!/$+!)1?73;!,$'7#&!QSQW@!QS@!>835VSDWWtSx3F$*%&QSSlWtXSD!
eVXf!"&*$+#&'@!]Db!E177$*#8(@!}Db!€&3#$@!}DYDb!Y'A+@!cDb!"$(>'77@!YD!n2%';#!8<!<*8(#:8<:%';a!
(1#*3#38(!7'?$773(.!3(!;8(+12$*!1(>$*+#'(>3(.!'(>!1+$!';*8++!+8;38:$;8(823;!+#'#1+5!]!
+A+#$2'#3;!*$=3$yD!]%%$#3#$!QSQW@!VXR@!VSvlXR@!>835VSDVSVvxFD'%%$#DQSQWDVSvlXRD!
eVtf!Z$*!g8*.@!"Db!"#$$(?$*.$(@!dDb!Y37>$*@!nDdDcDb!Z$22$@!dD,DYD!d='71'#38(!8<!91#*3:";8*$!
3(!/$7'#38(!#8!J3$#'*A!|13>$73($+!'(>!^88>!/$<8*217'#38(!3(!Z&$!9$#&$*7'(>+D!91#*3$(#+!
QSQV@!VW@!>835VSDWWtSx(1VWVQTlWvD!
eQSf!-'(>$=3F=$*$@!"Db!g$*.$*@!9D!Z&$!32%';#!8<!+&$7<!#'.+!y3#&!91#*3:";8*$!8(!;8(+12$*!
%1*;&'+$+5!'!>3I$*$(;$:3(:>3I$*$(;$!'('7A+3+!8<!'!('#1*'7!$G%$*32$(#!3(!+1%$*2'*a$#+!
8<!'!2'F8*!*$#'37$*!3(!g$7.312D!n(#!c!g$&'=!91#*!)&A+!];#!QSQV@!VX@!VlS@!
>835VSDVVXvx+VQtvv:SQV:SVQSR:RD!
eQVf!|$**3#+$(@!cDb!-$*&'.$(@!,Db!)$#$*+@!"D!Z&$!r%>'#$>!]7.8*3#&2!8<!^*8(#:8<:)';a!6'?$7!
91#*3:";8*$!n+!98#!3(!63($!y3#&!J1#;&!^88>:g'+$>!J3$#'*A!|13>$73($+5!/$+17#+!8<!
E'7;17'#38(+!y3#&!J1#;&!^88>!E82%8+3#38(!J'#'?'+$D!)*8;$$>3(.+!QSQW@!tV@!WQX@!
>835VSDWWtSx%*8;$$>3(.+QSQWStVWQvD!
!
ResearchGate has not been able to resolve any citations for this publication.
Conference Paper
Full-text available
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.
Article
Full-text available
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.
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.
Article
Full-text available
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.
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.
Article
Full-text available
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.
Article
Full-text available
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.
Article
Full-text available
In order to induce the shift in consumer behavior necessary for the mitigation of diet-related diseases, front-of-package labels (FoPL) such as the Nutri-Score that support consumers in their efforts to identify nutritionally valuable products during grocery shopping have been found to be effective; however, they remain non-compulsory in most regions. Counter-intuitively, a similar stream of research on digital web-based FoPL does not yet exist, even though such digital labels hold several advantages over physical labels. Digital FoPL can provide scalable and personalized interventions, are easier to implement than physical labels, and are especially timely due to the recent increase in online grocery shopping. The goal of this study was to demonstrate the technical feasibility and intervention potential of novel, scalable, and passively triggered health behavior interventions distributed via easy-to-install web browser extensions designed to support healthy food choices via the inclusion of digital FoPL in online supermarkets. To that end, we developed a Chrome web browser extension for a real online supermarket and evaluated the effect of this digital food label intervention (i.e., display of the Nutri-Score next to visible products) on the nutritional quality of individuals’ weekly grocery shopping in a randomized controlled laboratory trial (N = 135). Compared to the control group, individuals exposed to the intervention chose products with a higher nutritional quality (e.g., 8% higher healthy trolley index (HETI), 3.3% less sugar, 7.5% less saturated fat). In particular, users with low food literacy seemed to benefit from the digital FoPL (e.g., 11% higher HETI, 10.5% less sugar, 5.5% less saturated fat). Furthermore, participants exposed to the food label advocated its introduction more strongly than the control group (p = 0.081). Consumers worldwide could easily install such applications to display digital food labels on their end devices, and would thus not have to wait for stakeholders in the food industry to eventually reach consensus on mandatory food label introduction.
Article
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.