Etudes sur la validation du format graphique du Nutri-Score en France

Perception et opinions

 Effectiveness of front-of-pack nutrition labels in French adults : results from the NutriNet-Sante cohort study
PloS one 10, no 10 (2015) : e0140898.
Ducrot P, Méjean C, Julia C, Kesse-Guyot E, Touvier M, Fezeu L, et al.

To date, no consensus has emerged on the most appropriate front-of-pack (FOP) nutrition label to help consumers in making informed choices. We aimed to compare the effectiveness of the label formats currently in use : nutrient-specific, graded and simple summary systems, in a large sample of adults.
The FOP label effectiveness was assessed by measuring the label acceptability and understanding among 13,578 participants of the NutriNet-Santé cohort study, representative of the French adult population. Participants were exposed to five conditions, including four FOP labels : Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), 5-Color Nutrition Label (5-CNL), Green Tick (Tick), and a "no label" condition. Acceptability was evaluated by several indicators : attractiveness, liking and perceived cognitive workload. Objective understanding was assessed by the percentage of correct answers when ranking three products according to their nutritional quality. Five different product categories were tested : prepared fish dishes, pizzas, dairy products, breakfast cereals, and appetizers. Differences among the label effectiveness were compared with chi-square tests.
The 5-CNL label was viewed as the easiest label to identify ans as the one requiring the lowest amount of effort and time to understand. GDA was considered as the least easy to identify and to understand, despite being the most attractive and liked label. All FOP labels were found to be effective in ranking products according to their nutritional quality compared with the "no label" situation, although they showed differing levels of effectiveness (p less than 0.0001). Globally, the 5-CNL performed best, followed by MTL, GDA and Tick labels.
The graded 5-CNL label was considered as easy to identify, simple and rapid to understand ; it performed well when comparing the products’ nutritional quality. Therefore, it is likely to present advantages in real shopping situations where choices are usaully made quickly.

PMID : 26509679
PMCID : PMC4624978
DOI : 10.1371/journal.pone.0140898

 Perception of different formats of front-of-pack nutrition labels according to sociodemographic, lifestyle and dietary factors in a French population : cross-sectional study among the NutriNet-Santé cohort participants
BMJ open 7, no 6 (2017) : e016108.
Julia C, Péneau S, Buscail C, Gonzalez R, Touvier M, Hercberg S, et al.

Four formats for a front-of-pack (FOP) nutrition label are currently considered in France : the Nutriscore (or 5-Colour Nutrition Label, developed by a public research team), the SENS (supported by retailers), Multiple Traffic Lights (MTL, currently used in UK) and a modified version of the Reference Intakes (mRIs, supported by industry). Our objective was to investigate the perception of these FOP labels, according to sociodemographic, lifestyle and dietary factors.
Cross-sectional study.
Web-based French cohort.
FOP labels perception.
Participants in the NutriNet-Santé cohort received a specific questionnaire on the perceptions of the four label formats identified. Sociodemographic, lifestyle and dietary data (three 24-hours dietary records) were collected through self-administered questionnaires. Mutually exclusive clusters of FOP labels perception were identified through a multiple correspondence analysis followed by a hierarchical clustering procedure. Sociodemographic, lifestyle and dietary factors associated with the clusters were explored using multivariable multinomial logistic regression. All analyses were weighted according to 2009 French census data.
Among the 21,702 participants in the study, the Nutriscore received the most important number of favourable responses on positive perception dimensions by participants, followed by MTL and SENS. The five identified clusters were characterised by marked preferences for Nutriscore (cluster 1, 43.2% of participants, crude n=9,399), MTL (cluster 2, 27.3%, crude n=6,163), SENS (cluster 3, 17.05%, crude n=3,546), mRIs (cluster 4, 7.31%, crude n=1,632) and none of the presented formats (cluster 5, 5.10%, crude n=965). The cluster 1 (Nutriscore) was associated with lower adherence to nutritional recommendations, while cluster 2 (MTL) was associated with younger age and higher level of education.
The Nutriscore appears to have a wide reach in the population and to appeal to subjects with lower adherence to nutritional recommendations.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
front-of-pack nutrition labels ; perception ; public health policy

PMID : 28619781
PMCID : PMC5726055
DOI : 10.1136/bmjopen-2017-016108

 Perception de différents systèmes d’information nutritionnelle actuellement proposés en France en fonction du statut pondéral
Obésité 12, no 1 (2017) : 5 15.
Julia C, Péneau S, Buscail C, Touvier M, Kesse-Guyot E, et al.

L’objectif de notre étude était d’analyser la perception de ces quatre formats de signalétiques nutritionnelles actuellement en compétition pour être en face avant des emballages parmi les participants de la cohorte NutriNet-Santé. La perception a été analysée dans l’ensemble de l’échantillon et selon le statut pondéral. Parmi les participants (N=21.648), le NutriScore était le format préféré (43,8%) suivi par les Traffic Light Multiples (24,9%), et le SENS (17,1%). Aucun logo n’était considéré comme culpabilisant pour 50.3% de la population. La perception était la même quel que soit le statut pondéral.
Our objective was to investigate the perception of four formats proposed as Front-of-pack nutrition labelling systems in France, among the participants in the NutriNet-santé study. Perception was investigated in the entire study population and according to weight status. Among participants (N=21,648), the NutriScore was the preferred format (43.8%), followed by Multiple Traffic Light (24.9%) and SENS (17.1%). No label was considered guilt-laden for 50.3% of the population. Perception was similar according to weight status.


 Nutri-Score and Nutrition Facts Panel through the Eyes of the Consumer : Correct Healthfulness Estimations Depend on Transparent Labels, Fixation Duration, and Product Equivocality
Nutrients 2021, 13(9), 2915
Saar Bossuyt, Kathleen Custers, José Tummers, Laura Verbeyst, Bert Oben

Research on front-of-pack labels (FOPLs) demonstrated that Nutri-Score is one of the most promising FOPLs regarding healthfulness estimation accuracy. Nevertheless, as consumers are exposed to both the Nutri-Score and the mandatory Nutrition Facts Panel (NFP) in the supermarket, it is key to understand if and how both labels interact. This study investigates the contribution of Nutri-Score and NFP regarding healthfulness estimation accuracy, whether this impact differs depending on the product, and what role visual attention plays. We set up an eye-tracking experiment in a controlled setting in which 398 participants rated the healthfulness of 20 products. The results confirmed the positive impact of the Nutri-Score on healthfulness estimation accuracy, though the impact was larger for equivocal (i.e., difficult to judge) products. Interestingly, NFP either had no effect (compared to a package without Nutri-Score or NFP) or a negative effect (compared to a package with Nutri-Score alone) on healthfulness estimation accuracy. Eye-tracking data corroborated that ‘cognitive overload’ issues could explain why consumers exposed to Nutri-Score alone outperformed those exposed to both Nutri-Score and NFP. This study offers food for thought for policymakers and the industry seeking to maximize the potential of the Nutri-Score.

 Objective understanding of front-of-package nutrition labels among nutritionally at-risk individuals
Nutrients 7, no 8 (2015) : 7106 25.
Ducrot P, Méjean C, Julia C, Kesse-Guyot E, Touvier M, Fezeu L, et al.

In the ongoing debate about front-of-package (FOP) nutrition labels, little data exist regarding nutritionally at-risk populations, although they are critical targets of prevention programs. This study aimed to compare the impact of FOP labels on the ability to rank products according to their nutritional quality among French adults potentially at risk of poor dietary quality (N = 14,230). Four labels were evaluated : Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), 5-Color Nutrition Label (5-CNL), Green Tick (Tick), along with a reference without label. Mixed models were used to assess how individual characteristics and FOP labels were associated with the ability to rank products. Older participants and those with a lower educational level, income, nutritional knowledge, and likelihood of reading nutrition facts were less skilled at ranking food products according to nutritional quality. Compared with individual characteristics, nutrition labels had an increased impact on food product ranking ability. Overall, 5-CNL corresponded to the highest rate of correct responses, followed by MTL, GDA, and Tick (p < 0.0001). The strongest impact of 5-CNL was observed among individuals with no nutritional knowledge (odds ratio (OR) : 20.24 ; 95% confidence interval (CI) : 13.19-31.06). Therefore, 5-CNL appeared to be effective at informing consumers, including those who are nutritionally at-risk, about the nutritional quality of food products.
food labeling ; front-of-package nutrition label ; objective understanding ; population at risk

PMID : 26305255
PMCID : PMC4555164
DOI : 10.3390/nu7085325

 Objective understanding of Nutri-Score Front-Of-Package nutrition label according to individual characteristics of subjects : Comparisons with other format labels
PloS one 13, no 8 (2018) : e0202095.
Egnell M, Ducrot P, Touvier M, Allès B, Hercberg S, Kesse-Guyot E, et al.

To improve nutritional status and prevent chronic nutrition-related diseases, international organizations have recommended the use of multiple strategies, including front-of-package nutrition labelling (FOPL). In France, the Nutri-Score has been selected by health authorities in March 2017. However, to be effective in purchasing situations, the label needs to be well understood, which may be influenced by label format and sociodemographic characteristics. This study aimed at investigating the objective understanding of the Nutri-Score compared to other label formats, and more particularly among specific at-risk populations.
The objective understanding of four FOPLs-namely Nutri-Score, Multiple Traffic Lights (MTL), the simplified nutrition labelling system (SENS), and modified Reference Intakes (mRIs)-was investigated in a sample from the NutriNet-Santé French cohort (n = 3,751). Logistic regression mixed models were computed to assess the association of the four FOPLs, compared to a "no label" situation, on the consumers’ ability to rank products according to their overall nutritional quality. Objective understanding was also investigated according to sociodemographic and lifestyle characteristics.
Compared to a "no label" situation, all FOPLs were significantly associated to an increase in consumers’ ability to classify the products correctly, with wide disparities in results according to formats. The best performance was observed for the Nutri-Score (OR = 20.33(17.68-23.37)), followed by SENS (OR = 9.57(8.50-10.77)), MTL (OR = 3.55(3.20-3.93)) and mRIs (OR = 1.53(1.39-1.69)). This ranking was similar among all sub-populations and the ORs associated to the Nutri-Score were over 10, whichever the sub-group considered. Women, younger people, non-smokers, individuals with higher educational level and those with children had a higher capacity to identify healthier products (all P≤0.05).
Nutri-Score, with a summarized graded and color-coded format, using semantic colours, is associated to a higher objective understanding than monochrome and nutrient-specific labels. Furthermore, though objective understanding may differ according to individual characteristics of subjects, the magnitude of effect of the Nutri-Score largely outweighed this effect, even in the at-risk populations.

PMID : 30138359
PMCID : PMC6107140
DOI : 10.1371/journal.pone.0202095

Impact sur les choix, les achats et les consommations

 Randomised controlled trial in an experimental online supermarket testing the effects of front-of-pack nutrition labelling on food purchasing intentions in a low-income population
Egnell M, Boutron I, Péneau S, Ducrot P, Touvier M, Galan P, Buscail C, Porcher R, Ravaud P, Hercberg S, Kesse-Guyot E, Julia C.
BMJ Open. 2021 Feb 8 ;11(2):e041196. doi : 10.1136/bmjopen-2020-041196.

 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.
Int J Behav Nutr Phys Act. 2021 Mar 17 ;18(1):38. doi : 10.1186/s12966-021-01108-9.

 Impact of the Front-of-Pack Label Nutri-Score on the Nutritional Quality of Food Choices in a Quasi-Experimental Trial in Catering
Julia, C. ; Arnault, N. ; Agaësse, C. ; Fialon, M. ; Deschasaux-Tanguy, M. ; Andreeva, V.A. ; Fezeu, L.K. ; Kesse-Guyot, E. ; Touvier, M. ; Galan, P. ; Hercberg, S.
Nutrients 2021, 13, 4530.

 A Randomized Controlled Trial Evaluating the Relative Effectiveness of the Multiple Traffic Light and Nutri-Score Front of Package Nutrition Labels
Nutrients. 2019 Sep ; 11(9) : 2236
Eric A. Finkelstein, Felicia Jia Ler Ang, Brett Doble, Wei Han Melvin Wong, and Rob M. van Dam

The objective of this trial was to test two promising front-of-pack nutrition labels, 1) the United Kingdom’s Multiple Traffic Lights (MTL) label and 2) France’s Nutri-Score (NS), relative to a no-label control. We hypothesized that both labels would improve diet quality but NS would be more effective due to its greater simplicity. We tested this hypothesis via an online grocery store using a 3 × 3 crossover (within-person) design with 154 participants. Outcomes assessed via within person regression models include a modified Alternative Healthy Eating Index (AHEI)-2010 (primary), average Nutri-Score, calories purchased, and singular measures of diet quality of purchase orders. Results show that both labels significantly improve modified AHEI scores relative to Control but neither is statistically superior using this measure. NS performed statistically better than MTL and Control based on average Nutri-Score, yet, unlike MTL it did not statistically reduce calories or sugar from beverages. This suggest that NS may be preferred if the goal is to improve overall diet quality but, because calories are clearly displayed on the label, MTL may perform better if the goal is to reduce total energy intake.

 The Influence of Front-of-Package Nutrition Labeling on Consumer Behavior and Product Reformulation
PubMed 2021 Aug 2
Christina A Roberto, Shu Wen Ng, Montserrat Ganderats-Fuentes, David Hammond, Simon Barquera, Alejandra Jauregui, Lindsey Smith Taillie

Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling systems. We provide a narrative review of (a) real-world evaluations of front-of-package nutrition labels that analyze objective sales data and (b) studies that objectively assess product reformulation in response to a front-of-package nutrition label implementation. We argue that there is sufficient scientific evidence to recommend that governments implement mandatory front-of-package nutrition labeling systems to improve population health. We also present a conceptual framework to describe front-of-package label influence and provide recommendations for the optimal label design, emphasizing that labeling systems should be highly visible and salient, be simple and easy to understand, leverage automatic associations, and integrate informational and emotional messaging. The existing research suggests that Guideline Daily Amount labels should be avoided and that the Health Star Rating and Nutri-Score systems are promising but that systems with warning labels like the one in Chile are likely to produce the largest public health benefits. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021.

 Randomised controlled trial in an experimental online supermarket testing the effects of front-of-pack nutrition labelling on food purchasing intentions in a low-income population
BMJ Journals
Manon Egnell, Isabelle Boutron, Sandrine Péneau, Pauline Ducrot, Mathilde Touvier, Pilar Galan, Camille Buscail, Raphaël Porcher, Philippe Ravaud, Serge Hercberg, Emmanuelle Kesse-Guyot, Chantal Julia

Background The Nutri-Score, a front-of-pack nutrition label, has been adopted in 2017 in France but its impact on low-income populations is unknown, and they are more at risk of having unhealthy diets. The present study assessed the effects of the Nutri-Score on the nutritional quality of purchasing intentions among low-income individuals, compared with the current French labelling situation : references intakes (RIs) and no label, using a three-arm parallel-group randomised controlled trial.
Methods Low-income active adults from the NutriNet-Santé cohort (household income below €1200/month) were asked to perform a shopping task in an experimental online supermarket after being randomised in one of the three conditions (Nutri-Score, RIs or no labelling). The main outcome was the overall nutritional quality of the virtual shopping cart, assessed with the French-modified Food Standards Agency Nutrient Profiling System (FSAm-NPS), and secondary outcomes were the nutrient content of the shopping carts. 524 subjects were randomised, and 336 included in the analys

 Nutritional and economic impact of five alternative front-of-pack nutritional labels : experimental evidence
European Review of Agricultural Economics, 21 August 2019
Crosetto P, Lacroix A, Muller L, Ruffieux B.

An incentivised laboratory framed field experiment with 691 subjects examined the impact of five front-of-pack labels (Multiple Traffic Lights ; Reference Intakes ; HealthStarRating ; NutriScore and Système d’Etiquetage Nutritionnel Simplifié) on food shopping within a catalogue of 290 products. Using difference-in-difference, we estimate the between-label variability of within-subject changes in the shopping’s Food and Standards Agency aggregated nutritional score. All labels improve the nutritional quality (−1.56 FSA points on average). NutriScore is the most effective (−2.65), followed by HealthStarRating (−1.86). Behaviourally, subjects react mostly to the extreme values of the labels and not to intermediate values. Nutritional gains are not correlated with higher expenditure.

 Réponses des consommateurs à trois systèmes d’étiquetage nutritionnel face avant
Cahiers de Nutrition et de Diététique Vol 51 - N° 3 P. 124-131 - juin 2016 16/06/16
Crosetto P, Muller L, Ruffieux B.

In an experimental store, we study the behavioral responses of consumers food purchasing and their impact on the nutritional quality of shopping carts for three different front-of-pack nutritional labeling systems, i.e. the Reference Intakes, the multiple Traffic Lights and the new French system 5C. We use an experimental economics framework for observing the change for each participant between a cart done without label and a cart done with one of the three systems. By then comparing cohorts, we measure their relative effectiveness. All three systems improve the nutritional quality, but at a lesser or greater extent. 5C and Traffic lights have a significantly greater nutritional impact than the Reference Intakes.

Doi : 10.1016/j.cnd.2016.04.002

 Modification des achats alimentaires en réponse à cinq logos nutritionnels
Cahiers de Nutrition et de Diététique Vol 52 - N° 3 P. 129-133 - juin 2017
Crosetto P, Lacroix A, Muller L, Ruffieux B.

In a controlled and reproducible experimental food store of 290 products, we studied the purchases of 691 participants to observe reactions to five simplified nutritional graphic labeling systems (NutriCouleurs, NutriMark, NutriRepère, NutriScore and SENS). Participants are randomly assigned to one of the five treatments where one of the systems is set up on all store products. The impact on nutritional quality is measured in terms of reduction of “FSA points”. Each of the systems generates a significant improvement in the FSA indicator, with an average gain of −1.54 point FSA. NutriScore is significantly more effective than the others, reducing average FSA score by −2.65 points, NutriMark is 2nd (−1.86), NutriCouleurs 3rd (−1.40), Sens 4th (−1.02), NutriRepère 5th (−0.81).
Le texte complet de cet article est disponible en PDF.
Mots clés : Évaluation de politique publique, Politique nutritionnelle, Étiquetage nutritionnel, Comportement d’achat des consommateurs, France
Keywords : Public policy assessment, Nutrition policy, Nutrition labeling, Consumer buying behavior, France

Doi : 10.1016/j.cnd.2017.04.002

 Impact of different front-of-pack nutrition labels on consumer purchasing intentions : a randomized controlled trial
American journal of preventive medicine 50, no 5 (2016) : 627 36.
Ducrot P, Julia C, Méjean C, Kesse-Guyot E, Touvier M, Fezeu LK, et al.

Despite growing evidence supporting the utility of front-of-pack nutrition labels in enabling consumer evaluation of food product healthiness, research on food choices is scarce. This study aims at comparing the impact of front-of-pack nutrition labels on consumers’ purchasing intentions.
Five-arm, open-label RCT.
The study setting was a virtual web-based supermarket, with participants from the French NutriNet-Santé study. The eligibility requirement was grocery shopping involvement.
The intervention was to simulate one shopping situation with front-of-pack nutrition labels affixed on food products (December 2014 to March 2015). Participants were randomly assigned to one of five exposure conditions using a central computer system : Guideline Daily Amounts, Multiple Traffic Lights, Five-Color Nutrition Label, Green Tick, or control (no front-of-pack exposure). Given the nature of the intervention, masking of participants was not performed.
The primary outcome was the overall nutritional quality of the contents of the shopping cart, estimated using the United Kingdom Food Standards Agency nutrient profiling system. Secondary outcomes included energy and nutrient content of the shopping cart. Impact of the front-of-pack labels was also evaluated across sociodemographic subgroups based on age, educational level, income, and nutrition knowledge.
A total of 11,981 participants were included in the analyses (April 2015). The Five-Color Nutrition Label significantly led to the highest overall nutritional quality of the shopping cart, as reflected by lower Food Standards Agency scores (M=8.72 ; SD=2.75), followed by Multiple Traffic Lights (M=8.97 ; SD=2.68) and Green Tick (M=8.99 ; SD=2.71), compared with the control (M=9.34 ; SD=2.57) (p than less 0.0001). The Five-Color Nutrition Label was the only front-of-pack format that led to a lower content in lipids, saturated fatty acids, and sodium of the shopping cart (all p than less 0.05).
The impact of the different front-of-pack labels was similar across sociodemographic subgroups.
The Five-Color Nutrition Label based on a color-coded and graded scale indicating overall nutritional quality is effective in promoting overall healthier food choices in all population subgroups.

PMID : 26699246
DOI : 10.1016/j.amepre.2015.10.020

 Impact of the Front-of-Pack 5-Colour Nutrition Label (5-CNL) on the Nutritional Quality of Purchases : An Experimental Study
Int J Behav Nutr Phys Act 13 (2016) : 101.
Julia C, Blanchet O, Méjean C, Péneau S, Ducrot P, Allès B, et al.

Front-of-pack (FOP) nutrition labelling has received growing attention from public health authorities, as a tool to promote healthier diets in the population. Recently, the French Health law introduced the principle of implementing a FOP nutrition labelling system. A scientific proposal has put forward the 5-Colour Nutrition Label (5-CNL), a five-category colour-coded summary system supported by research suggesting that it is well perceived and understood in the population. Our objective was to investigate the impact of the 5-CNL on the nutritional quality of purchases in experimental supermarkets.
Participants (n = 901) were recruited using quota sampling between September and December 2015 and evenly distributed in three experimental conditions : 1) control situation ; 2) Application of the 5-CNL on all food products in three specific sections : breakfast cereals, sweet biscuits and appetizers ; 3) introduction of the 5-CNL accompanied by consumer information on use and understanding of the label. Main outcome was the nutritional quality of the shopping cart in the three sections combined, measured using the United Kingdom Food Standards Agency nutrient profiling system (FSA score).
Significantly higher mean nutritional quality of the purchased items per section were observed for the sweet biscuits category in the intervention combining the label + communication (overall FSA score 21.01 vs. 20.23, P = 0.02). No significant effects were observed for the general mean over the three sections combined or other food categories. The results observed on purchase may be related to the high level of recall, self-reported and objective understanding of the label that were observed in the intervention groups as they are pre-requisites for use of a label in purchasing situations.
These results suggest that the 5-CNL FOP nutrition label may have a limited impact on purchases, leading to healthier food choices in some food categories such as sweet biscuits.
Trial registration
The trial was registered on under the number NCT02546505.

PMID : 27645372
PMCID : PMC5028942
DOI : 10.1186/s12966-016-0416-4

 Effects of front-of-pack labels on the nutritional quality of supermarket food purchases : evidence from a large-scale randomized controlled trial
Journal of the Academy of Marketing Science (2020)
Dubois P, Albuquerque P, Allais O, Bonnet C, Bertail P, Combris P, et al.

To examine whether four pre-selected front-of-pack nutrition labels improve food purchases in real-life grocery shopping settings, we put 1.9 million labels on 1266 food products in four categories in 60 supermarkets and analyzed the nutritional quality of 1,668,301 purchases using the FSA nutrient profiling score. Effect sizes were 17 times smaller on average than those found in comparable laboratory studies. The most effective nutrition label, Nutri-Score, increased the purchases of foods in the top third of their category nutrition-wise by 14%, but had no impact on the purchases of foods with medium, low, or unlabeled nutrition quality. Therefore, Nutri-Score only improved the nutritional quality of the basket of labeled foods purchased by 2.5% (−0.142 FSA points). Nutri-Score’s performance improved with the variance (but not the mean) of the nutritional quality of the category. In-store surveys suggest that Nutri-Score’s ability to attract attention and help shoppers rank products by nutritional quality may explain its performance.
Nutrition, Labelling, Supermarket, RCT, Food, Field experiment, Policy

- Evaluation ex ante de systèmes d’étiquetage nutritionnel graphique simplifié
Rapport final du comité scientifique. Paris, Ministère des Affaires sociales et de la Santé. [Internet]. Mars 2017
Comité Scientifique de l’étude d’expérimentation.

 Front-of-Pack Labeling and the Nutritional Quality of Students’ Food Purchases : A 3-Arm Randomized Controlled Trial
Am J Publ Health 20 juin 2019
Egnell M, Boutron I, Péneau S, Ducrot P, Touvier M, Galan P, et al.

Objectives : To assess the effects of the Nutri-Score label (relative to the Reference Intakes label or no label) on the nutritional quality of students’ food purchases. Methods. A 3-arm randomized controlled trial was conducted in France in 2017 ; 2907 participants were randomized into 1 of the 3 study arms (Nutri-Score, Reference Intakes, no label) and invited to purchase groceries from an experimental Web-based supermarket. The main outcome was the overall nutritional quality of purchases, measured according to a modified version of the Food Standards Agency Nutrient Profiling System (FSAm-NPS/HCSP) score. Results. The mean (±SD) FSAm-NPS/HCSP score was lower in the Nutri-Score group (2.02 ±3.56) than in the Reference Intakes group (2.69 ±3.44), reflecting higher nutritional quality ; however, there was no significant difference between the Nutri-Score and no-label (2.45 ±3.28) groups or between the Reference Intakes and no-label groups. Shopping cart content was lower in calories and saturated fatty acids and higher in fruits and vegetables in the Nutri-Score arm than in the other arms.
Conclusions ; The Nutri-Score label appeared to improve the nutritional composition of students’ food purchases relative to the Reference Intakes label or no label.

PMID : 31219721
DOI : 10.2105/AJPH.2019.305115

 Impact of Front-of-Pack Nutrition Labels on Portion Size Selection : An Experimental Study in a French Cohort
Nutrients 10, no 9 (2018) : 1268.
Egnell M, Kesse-Guyot E, Galan P, Touvier M, Rayner M, Jewell J, et al.

In the European Union (EU) three coloured graded Front-of-Pack labels (FoPLs), two endorsed by governments (Nutri-Score and Multiple Traffic Lights (MTL)) and one designed by industry (Evolved Nutrition Label (ENL)) are currently being discussed. This study aimed to investigate the impact of these FoPLs on portion size selection, specifically for less healthy products. In 2018, participants from the French NutriNet-Santé cohort study (N = 25,772) were exposed through a web-based self-administered questionnaire to products from three food categories (sweet biscuits, cheeses, and sweet spreads), with or without FoPLs, and were invited to select the portion they would consume (in size and number). Kruskall-Wallis tests, and mixed ordinal logistic regression models, were used to investigate the effects of FoPLs on portion size selection. Compared to no label, Nutri-Score consistently lowered portion sizes (OR = 0.76 (0.74⁻0.76)), followed by MTL (OR = 0.83 (0.82⁻0.84)). For ENL, the effects differed depending on the food group : It lowered portion size selection for cheeses (OR = 0.84 (0.83⁻0.87)), and increased it for spreads (OR = 1.19 (1.15⁻1.22)). Nutri-Score followed by MTL appear efficient tools to encourage consumers to decrease their portion size for less healthy products, while ENL appears to have inconsistent effects depending on the food category.
Front-of-Pack nutrition label ; food products ; portion size

PMID : 30205548
PMCID : PMC6165438
DOI : 10.3390/nu10091268

 Appropriation of the Front-of-Pack Nutrition Label Nutri-Score across the French Population : Evolution of Awareness, Support, and Purchasing Behaviors between 2018 and 2019
Nutrients. 22 sept 2020 ;12(9).
Sarda B, Julia C, Serry A-J, Ducrot P.

Since the implementation of the Nutri-Score on a voluntary basis in 2017 in France, very few studies have evaluated how the label was recognized and used by consumers. The goal of this study was to assess the evolution of awareness, support, and perceived impact on purchasing behaviors of the Nutri-Score in France. Between April 2018 and May 2019, a total of 4006 participants were recruited across three successive waves and answered questions regarding awareness of the Nutri-Score, support of the measure, and change of behavior following the implementation of the Nutri-Score via an online survey. Descriptive analyses to assess the evolution over time were performed, as well as logistic regression models to evaluate associations between the different outcomes and individual characteristics. From April 2018 to May 2019, the awareness of the Nutri-Score increased considerably, reaching 81.5% in May 2019. Since April 2018, a steady proportion of participants—9 out of 10—showed strong support toward the measure and a similar proportion, 87.2%, declared being in favor of making the Nutri-Score mandatory. The impact on purchasing behaviors appeared promising given the limited implementation of the label, with 42.9% of the participants reporting they modified their purchasing behaviors thanks to the measure. Multivariate analyses showed that the impact on purchasing behaviors of the Nutri-Score was greater over time, on younger populations and on frequent labeling readers. Our results suggested that the labeling system was well received and used by all socioeconomic groups, including subgroups who are more likely to have a lower-quality diet. View Full-Text

 Impact of a front-of-pack nutritional traffic-light label on the nutritional quality and the hedonic value of mid-afternoon snacks chosen by mother-child dyads Appetite. 01 2019 ;143:104425.
Poquet D, Ginon E, Goubel B, Chabanet C, Marette S, Issanchou S, et al.

The aim of this study was to assess the impact of a nutritional traffic-light label, the Nutri-Score, on snack choices in mother-child dyads and to assess a potential hedonic cost associated with a change in favour of healthier choices. French mothers and children (n = 95 ; children’s age : 7–11 years) who participated were asked to choose, for themselves and for the other dyad member, a snack composed of one beverage and two food items selected among several products with different nutritional quality. In the first step, the products were presented without any information. In the second step, the products were labelled with the Nutri-Score. Mothers and children were asked to rate their liking for all proposed products before being informed of their nutritional quality. The nutritional quality, the hedonic score, and the estimated budget of the selected snacks were compared before and after labelling. As hypothesized, the Nutri-Score label led to a significant increase in the nutritional quality of the chosen snacks. The budget for the chosen snacks was unchanged or decreased after the nutritional labelling was applied. Children and mothers had significantly lower liking for the snacks after nutritional labelling than before nutritional labelling, suggesting a hedonic cost associated with a change in favour of healthier snack choices. This raises the question of the sustainability of the behavioural change induced by the Nutri-Score label.

Effet sur la santé

 Modelling the impact of different front-of-package nutrition labels on mortality from non-communicable chronic disease
Int. J. Behav. Nutr. Phys. Act. 2019, 16, 56.
Egnell M, Crosetto P, d’Almeida T, Kesse-Guyot E, Touvier M, Ruffieux B, et al.

Front-of-Package nutrition labels (FoPLs) are intended to help reduce the incidence of nutrition-related non-communicable diseases through an improvement in diet quality. FoPLs have been shown to improve the nutritional quality of purchases and have been associated with improved diet quality, which is in turn associated with reduced risk of non-communicable diseases. However, the potential impact of FoPLs on reducing mortality from chronic diseases has never been estimated.
Data from a laboratory experimental economics test were used to investigate the effects of five different FoPLs (Nutri-Score, Health Star Rating system, Multiple Traffic lights, Reference intakes and SENS (Système d’Etiquetage Nutritionnel Simplifié)) on the nutritional quality of household purchases. The relative differences in nutrient content and composition of food purchases were then applied to dietary intakes using data from an observational study, thus yielding estimates for ‘reference’ and ‘labelled’ diets. A macro-simulation study using the PRIME model was then conducted to estimate the impact of the modification in dietary intake as a result of FoPL use on mortality from diet-related non-communicable diseases.
The use of FoPLs led to a substantial reduction in mortality from chronic diseases. Approximately 3.4% of all deaths from diet-related non-communicable diseases was estimated to be avoidable when the Nutri-Score FoPL was used. The remaining FoPLs likewise resulted in mortality reduction, although to a lesser extent : Health Star Rating system (2.8%), Reference Intakes (1.9%), Multiple Traffic Lights (1.6%), and SENS (1.1%).
FoPLs have the potential to help decrease mortality from diet-related non-communicable diseases, and the Nutri-Score appears to be the most efficient among the five formats tested.