Impact of Five Types of Front-of-Package Nutrition Labels on Consumer Behavior among Young Adults: A Systematic Review.

The World Health Organization (WHO) recommends that governments promote and implement front-of-package (FoP) nutrition labels to prevent noncommunicable diseases. Recently, additional research has focused on various views on FoP label creation. However, few review studies have examined how different FoP labels affect young consumer behavior. Therefore, this study thoroughly analyzed the evidence on how FoP labels in five categories affect young consumer purchasing intention and behavior. We searched for keywords in the Web of Science, Scopus, and EBSCO databases and screened study samples according to inclusion and exclusion criteria. Fourteen studies that matched the criteria were included in this review. We discovered that numerous studies support the efficacy of the "graded indicators" category labels, with the "color-coded" and "positive logos" categories trailing closely behind. The effectiveness of the "warning" FoP label category is mixed on consumers' healthy purchasing behavior and intention. The numerical FoP labels were most commonly used to indicate ineffectiveness. Future studies should investigate the effects of FoP labels on various subpopulations and conduct thorough evaluations of the design elements of FoP labels. Also, they should offer evidence-based recommendations, supported by both quantitative and qualitative data, for regions that have not yet implemented FoP labeling systems.

Assessing the Validity of Front-of-Pack Nutrition Labels for Evaluating the Healthiness of Mediterranean Food Choices: A Global Comparison.

In response to growing public health concerns, governments worldwide have implemented various nutrition labelling schemes to promote healthier eating habits. This study aimed to assess the consistency and effectiveness of these labels in an out-of-home context, specifically focusing on restaurant, hospitality, and institutional food service settings. In total, 178 different dishes from Spain were analysed using labels from the Mazocco method, the UK's traffic light system, the Health Star Rating (Australia), Nutri-Score (France), multiple traffic lights (Ecuador), and warning labels (Chile and Uruguay). The results demonstrated a generally low level of agreement among these labels (K < 0.40), indicating notable variability and a lack of consensus, which could hinder consumers' ability to make informed food choices in out-of-home settings. Nutri-Score classified the highest number of dishes as unhealthy (38%). This study underscores the need for an easy-to-understand labelling system tailored to each country's culinary and socio-cultural contexts to improve consumer decision-making in various dining environments. Future research should focus on developing and testing qualitative methods to more accurately gauge the nutritional quality of cooked dishes in diverse out-of-home settings, thereby enhancing public health outcomes. By addressing the specific needs of the home, restaurants, hospitality, and institutional food services, tailored labelling schemes could significantly improve consumers' ability to make healthier food choices.

Prepackaged foods healthiness ranking index: developing front-of-pack labeling to facilitate the assessment and validation of healthiness rankings of prepackaged foods in China.

BACKGROUND: The Medium and Long-Term Plan for the Prevention and Treatment of Chronic Diseases (2017-2025) in China has highlighted the importance of reducing fat, sodium, and sugar in foods. However, front-of-pack labeling, which enables consumers to assess the health levels of prepackaged foods, is lacking in China. In response to the Zhejiang Provincial Health Commission's request, we sought to develop a method for efficiently evaluating the health level of prepackaged foods. METHODS: Through a comprehensive literature review, we established a systematic framework: the Prepackaged Foods Healthiness Ranking Index (PHRI). We determined specific threshold values and grading criteria and conducted two rounds of Delphi survey to refine the index. Using a measurement dataset, we aimed to determine the optimal limit values for assessing the health level of prepackaged foods in real-world settings. RESULTS: After two rounds of Delphi surveys, the PHRI underwent multiple revisions until consensus among experts was reached. The final decision regarding the upper limit values set 30% Nutrient Reference Values as the limit for solid foods and 15% Nutrient Reference Values for liquid foods. The calculation of PHRI values was successfully implemented with the dataset, in accord with current nutrition awareness and real-world conditions. CONCLUSIONS: The PHRI provides a valuable tool for assessing the healthiness of prepackaged foods. This front-of-pack labeling system provides a convenient method for evaluating the nutritional quality of prepackaged foods. Ultimately, the PHRI has the potential to contribute to advancements in health policy, practice, and education in China.

[Labelling and composition of food, basic aspect in the update of the food composition tables]. / Etiquetado y composición de los alimentos, aspecto básico en la actualización de las tablas de composición de alimentos.

Introduction: Food and beverage composition tables are a crucial element for determining nutrient intakes from the dietary records of foods and beverages. Knowing their composition and how they are updated is an essential mechanism for reliably providing real data on these intakes, otherwise it could be the case that current food and beverage consumption would be reflected in nutrient conversion with information on ingredient composition and nutritional value from 5, 10, 15 or 20 years ago, with the resulting deviations in the interpretations, especially in macronutrients, from the existing reality.

Introducción: Las tablas de composición de alimentos y bebidas son un elemento crucial para poder determinar las ingestas de nutrientes a partir de los registros dietéticos de alimentos y bebidas y conocer su composición y sus vías de actualización. Son mecanismos imprescindibles para poder dar con fiabilidad datos reales de dichas ingestas; si no, podría darse el caso de que se reflejaran sobre el consumo de alimentos y bebidas actuales una conversión a nutrientes con información de composición de ingredientes y valor nutricional de hace 5, 10, 15 o 20 años, con las consiguientes desviaciones sobre las interpretaciones, sobre todo en macronutrientes, sobre la realidad existente.

Effects of environmental impact labels on the sustainability of food purchases: A randomised controlled trial in an experimental online supermarket.

Providing consumers with product-specific environmental impact information for food products (ecolabels) may promote more sustainable purchasing, needed to meet global environmental targets. This UK study (N = 1051 participants) investigated the effectiveness of different ecolabels using an experimental online supermarket platform, comparing three labels against control (no label). Significant reductions were found in the environmental impact score (EIS) for all labels compared to control (labels presented: values for four environmental indicators [-3.9 percentiles, 95%CIs: -5.3, -2.6]; a composite score [taking values from A to E; -3.9, 95%CIs: -5.2,-2.5]; or both together [-3.2, 95%CIs: -4.5, -1.9]). Providing ecolabels is a promising intervention to promote the selection of more sustainable products.

Potential impact of alcohol calorie labelling on the attitudes and drinking behaviour of hazardous and low-risk drinkers in England: a national survey.

OBJECTIVES: We investigated the hypothetical impact of mandatory alcohol calorie labelling, comparing non-drinkers, low-risk and hazardous drinkers in terms of attitudes, knowledge about calorie content and hypothetical behaviour changes should labelling be introduced. DESIGN: Cross-sectional national telephone survey. SETTING: Community-dwelling adults in England between November 2022 and January 2023. PARTICIPANTS: Data were collected from 4683 adults >18 years, of whom 24.7% were non-drinkers; 77.6% of alcohol drinkers were categorised as low-risk and 22.4% as hazardous drinkers according to the Alcohol Use Disorders Identification Test questionnaire. PRIMARY OUTCOME MEASURES: Attitudes to alcohol calorie labelling in shops and supermarkets and in hospitality venues, knowledge of the calorie content of alcoholic beverages (beer, wine, cider and spirits) and changes in drinking practices if calorie labelling was introduced. RESULTS: Comparisons were made between non-drinkers, low-risk drinkers and hazardous drinkers, with analyses adjusted for age, gender, ethnicity, socioeconomic status and education. Attitudes to calorie labelling were generally positive, but were less favourable among alcohol drinkers than non-drinkers. Hazardous drinkers were more accurate in their estimations of the calorie content of wine, cider and spirits than non-drinkers (p<0.0001). Overall, 46.4% of drinkers indicated that they would change their drinking patterns if calorie labelling was introduced, and this response was more common among hazardous than low-risk drinkers (OR=1.43, 95% CI 1.199 to 1.699), adjusting for age, gender, ethnicity, socioeconomic status and education. Compared with low-risk drinkers, hazardous drinkers stated that they would be more likely to drink fewer alcoholic beverages, to drink alcohol less often, to choose lower calorie drinks and to do more exercise (adjusted OR 1.27, 1.009 to 1.606). CONCLUSIONS: A sizeable proportion of hazardous drinkers indicated that they would change their consumption practices if mandatory calorie labelling was introduced. Promoting more positive attitudes to calorie labelling might lead to stronger intentions to reduce consumption. Mandatory calorie labelling of alcoholic beverages may make a modest contribution to energy intake and the maintenance of health weight, particularly among heavier drinkers.

Do calorie labels change energy purchased in a simulated online food delivery platform? A multi-arm randomised controlled trial.

BACKGROUND: As rates of obesity and overweight continue to increase in the UK, calorie labels have been introduced on menus as a policy option to provide information to consumers on the energy content of foods and to enable informed choices. This study tested whether the addition of calorie labels to items in a simulated food delivery platform may reduce the energy content of items selected. METHODS: UK adults (n = 8,780) who used food delivery platforms were asked to use the simulated platform as they would in real life to order a meal for themselves. Participants were randomly allocated to a control condition (no calorie labels) or to one of seven intervention groups: (1) large size calorie labels adjacent to the price (LP), (2) large size label adjacent to the product name (LN), (3) small label adjacent to price (SP), (4) small label adjacent to product name (SN), (5) LP with a calorie label switch-off filter (LP + Off), (6) LP with a switch-on filter (LP + On), or, (7) LP with a summary label of the total basket energy content (LP + Sum). Regression analysis assessed the impact of calorie labels on energy content of foods selected compared to the control condition. RESULTS: The mean energy selected in the control condition was 1408 kcal (95%CI: 93, 2719). There was a statistically significant reduction in mean energy selected in five of the seven intervention trial arms (LN labels (-60 kcal, 95%CI: -111, -6), SN (-73, 95%CI: -125, -19), LP + Off (-110, 95%CI: -161, -57), LP + On (-109, 95%CI: -159, -57), LP + Sum (-85 kcal, 95%CI: -137, -30). There was no evidence the other two conditions (LP (-33, 95%CI: -88, 24) and SP (-52, 95%CI: -105, 2)) differed from control. There was no evidence of an effect of any intervention when the analysis was restricted to participants who were overweight or obese. CONCLUSION: Adding calorie labels to food items in a simulated online food delivery platform reduced the energy content of foods selected in five out of seven labelling scenarios. This study provides useful information to inform the implementation of these labels in a food delivery platform context.

Food and beverage manufacturing and retailing company policies and commitments to improve the healthfulness of Canadian food environments.

BACKGROUND: Food and beverage companies play a central role in shaping the healthfulness of food environments. METHODS: The BIA-Obesity tool was used to evaluate and benchmark the specificity, comprehensiveness and transparency of the food environment-related policies and commitments of leading food and beverage manufacturing and retailing companies in Canada. Policies and commitments related to the healthfulness of food environments within 6 action areas were assessed: 1) corporate nutrition strategy; 2) product (re)formulation; 3) nutrition information and labelling; 4) product and brand promotion; 5) product accessibility; and 6) disclosure of relationships with external organizations. Data were collected from publicly available sources, and companies were invited to supplement and validate information collected by the research team. Each company was then assigned a score out of 100 for each action area, and an overall BIA-Obesity score out of 100. RESULTS: Overall BIA-Obesity scores for manufacturers ranged from 18 to 75 out of 100 (median = 49), while scores for retailers ranged from 21 to 25 (median = 22). Scores were highest within the product (re)formulation (median = 60) followed by the corporate nutrition strategy (median = 59) domain for manufacturers, while retailers performed best within the corporate nutrition strategy (median = 53), followed by the disclosure of relationships with external organizations (median = 47) domain. Companies within both sectors performed worst within the product accessibility domain (medians = 8 and 0 for manufacturers and retailers, respectively). CONCLUSIONS: This study highlights important limitations to self-regulatory approaches of the food and beverage industry to improve the healthfulness of food environments. Although some companies had specific, comprehensive, and transparent policies and commitments to address the healthfulness of food environments in Canada, most fell short of recommended best-practice. Additional mandatory government policies and regulations may be warranted to effectively transform Canadian food environments to promote healthier diets and prevent related non-communicable diseases.

Mismanagement and poor transparency in the European processed seafood supply revealed by DNA metabarcoding.

In the global processed seafood industry, disparate actors play different roles along the supply chain, creating multiple opportunities for mistakes, malpractice, and fraud. As a consequence, consumers may be exposed to non-authentic products, which hinder informed purchasing decisions and broader efforts to improve trade transparency and sustainability. Here, we characterised the taxonomic composition of 62 processed seafood products in Italian, British and Albanian retailers, purposefully obtained from different supply routes, using multiple DNA metabarcoding markers. By combining molecular results with metadata reported on labels, we revealed patterns of mislabelling in 24 products (39%) across sampling regions, denoting lack of transparency of processed seafood products based on resources sourced from either Europe or globally. We show that the accuracy of label claims and the mis-represented and underestimated levels of traded biodiversity are largely determined by the management of raw material by global processors. Our study shows that DNA metabarcoding is a powerful and novel authentication tool that is mature for application at different stages of the seafood supply chain to protect consumers and improve the sustainable management of fish stocks.

Use of Interactive Food Labels to Increase Confidence in Preparing Produce among College Students.

College students may have limited access to produce and may lack confidence in preparing it, but cooking videos can show how to make healthy dishes. The Cognitive Theory of Multimedia Learning suggests that learning is enhanced when visual and auditory information is presented considering cognitive load (e.g., highlighting important concepts, eliminating extraneous information, and keeping the video brief and conversational). The purpose of this project was to pilot test a food label for produce grown at an urban university and assess whether student confidence in preparing produce improved after using the label and QR code to view a recipe video developed using principles from the Cognitive Theory of Multimedia Learning. The video showed a student preparing a salad with ingredients available on campus. Students indicated the label was helpful and reported greater perceived confidence in preparing lettuce after viewing the label and video (mean confidence of 5.60 ± 1.40 before vs. 6.14 ± 0.89 after, p = 0.016, n = 28). Keeping the video short and providing ingredients and amounts onscreen as text were cited as helpful. Thus, a brief cooking video and interactive label may improve confidence in preparing produce available on campus. Future work should determine whether the label impacts produce consumption and if it varies depending on the type of produce used.

Research Quality of Clinical Trials Reported for Foods with Function Claims in Japan, 2023-2024: Evaluation Based on a Revised Tool to Assess Risk of Bias in Randomized Trials.

BACKGROUND: The Foods with Function Claim was introduced in Japan in April 2015 to make more products available that are labeled with health functions. A product's functionality of function claims must be explained by the scientific evidence presented in clinical trials (CTs) or systematic reviews, but the quality of recent CTs is unclear. The purpose of this study was to evaluate the risk of bias (RoB) using "a revised tool to assess risk (RoB 2)" published in 2018 for notifications based on all recent CTs published on the Consumer Affairs Agency website. METHODS: A total of 38 submitted papers based on CTs that were published on the Consumer Affairs Agency website during the period from 1 January 2023 to 30 June 2024 were eligible. The RoB 2 tool provides a framework for considering the risk of bias in the findings of any type of randomized trial. This tool with five domains was used to evaluate the quality of research methods. RESULTS: Eligible CTs were assessed as "low risk" (11%, n = 4), "medium risk" (13%, n = 5), and "high risk" (76%, n = 29). A number of highly biased papers were published. Bias occurred in all five domains, especially "bias in selection of the reported result (Domain 5)", which was the most serious ("high risk"; 75%). For elements correlated with RoB, there was no significant difference (p = 0.785) in the RoB 2 score between for-profit and academic research in the author's affiliated organization. There was no significant difference (p = 0.498) in the RoB score between the published year categories of 2000-2019 and 2020-2024, and no significant difference (p = 0.643) in the RoB score between English and Japanese language publications. CONCLUSION: Overall, the quality of the latest CTs submitted after 2023 was very low, occurring in all five domains, and was most serious for "bias in selection of the reported result (Domain 5)".

An Evaluation of the Nutritional and Promotional Profile of Commercial Foods for Infants and Toddlers in the United States.

Despite growing concerns over the increasing popularity and health impact of commercial foods for infants and toddlers, no nutrition or promotional guidelines currently exist for the United States. In 2022, the WHO Regional Office for Europe published a nutrient and promotion profile model (NPPM) to provide guidance and regulation for commercially produced infant and toddler foods. This study assessed the nutritional and promotional profile of infant and toddler foods (6-36 months of age) collected from the top 10 grocery chains in 2023. Products were assessed against the WHO NPPM nutritional and promotional requirements. The type and number of claims across packaging type were also assessed. Of the 651 products examined, 60% failed to meet the nutritional requirements of the NPPM, and 0% met the promotional requirements. Almost 100% of products had at least 1 claim on-pack that was prohibited under the NPPM, with some products displaying up to 11 prohibited claims. Snack-size packages had the lowest compliance with nutrient requirements. These findings highlight that urgent work is needed to improve the nutritional quality of commercially produced infant and toddler foods in the United States. The high use of prohibited claims also suggests the need to regulate the type and number of claims allowed on-pack.

Mapping ultra-processed foods (UPFs) in India: a formative research study.

BACKGROUND: Increased consumption of ultra-processed foods (UPFs) which have additives such as artificial colours, flavours and are usually high in salt, sugar, fats and specific preservatives, are associated with diet-related non-communicable diseases (NCDs). In India, there are no standard criteria for identifying UPFs using a classification system based on extent and purpose of industrial processing. Scientific literature on dietary intake of foods among Indian consumers classifies foods as unhealthy based on presence of excessive amounts of specific nutrients which makes it difficult to distinguish UPFs from other commercially available processed foods. METHODS: A literature review followed by an online grocery retailer scan for food label reading was conducted to map the types of UPFs in Indian food market and scrutinize their ingredient list for the presence of ultra-processed ingredients. All UPFs identified were randomly listed and then grouped into categories, followed by saliency analysis to understand preferred UPFs by consumers. Indian UPF categories were then finalized to inform a UPF screener. RESULTS: A lack of application of a uniform definition for UPFs in India was observed; hence descriptors such as junk-foods, fast-foods, ready-to-eat foods, instant-foods, processed-foods, packaged-foods, high-fat-sugar-and-salt foods were used for denoting UPFs. After initial scanning of such foods reported in literature based on standard definition of UPFs, an online grocery retailer scan of food labels for 375 brands (atleast 3 brands for each food item) confirmed 81 food items as UPFs. A range of packaged traditional recipes were also found to have UPF ingredients. Twenty three categories of UPFs were then developed and subjected to saliency analysis. Breads, chips and sugar-sweetened beverages (e.g. sodas and cold-drinks) were the most preferred UPFs while frozen ready-to-eat/cook foods (e.g. chicken nuggets and frozen kebabs) were least preferred. CONCLUSION: India needs to systematically apply a food classification system and define Indian food categories based on the level of industrial processing. Mapping of UPFs is the first step towards development of a quick screener that would generate UPF consumption data to inform clear policy guidelines and regulations around UPFs and address their impact on NCDs.

Clean labelling sodium nitrite at pilot scale: In-situ reduction of nitrate from plant sources and its effects on the overall quality and safety of restructured cooked ham.

Growing health and environmental concerns have increased demand for all-natural products, with a focus on clean labelling. Sodium nitrite is the most widely used additive in the meat industry because it imparts the typical cured flavour and colour to meat products and, most importantly, their microbiological safety. However, due to health concerns, the European Commission is proposing revised regulations to reduce nitrate and nitrite levels in meat products. As a result, the meat industry is actively seeking alternatives. This study explored the production of four cooked hams utilising nitrate-rich vegetable sources combined with two different nitrate-reducing commercial food cultures, alongside a control ham prepared with sodium nitrite (150 ppm). Microbiological, physico-chemical (pH, water activity, nitrate and nitrite concentration, lipid profile, lipid oxidation) and sensory (texture and colour profile) characterisation of the products was carried out. Challenge tests for Listeria monocytogenes, Clostridium sporogenes and Clostridium perfringens have been performed to assess the growth of pathogens, if present in the products. Results revealed comparable microbiological and physico-chemical profiles across ham formulations, with minor differences observed in colour parameters for sample C. The sensory analysis showed that for the pilot ham formulations A and D, there were no significant differences in consumer perception compared to the control ham. In the challenge tests, L. monocytogenes levels were similar in both control and tested hams. There were no significant differences in C. sporogenes and C. perfringens counts at any temperature or between test and control samples. These results indicate that this technology has a potential future in the cured meat sector, as regulators mandate the reduction of added synthetic chemicals and consumers seek healthier and more natural ingredients in their daily diets.

Current Regulatory Issues for the Use of Probiotics.

The chapter provides an overview of the current regulatory challenges surrounding the use of probiotics. It explores the global regulatory landscape, noting the need for uniform regulations across various regions. It emphasizes that these inconsistencies pose challenges for consumers, healthcare professionals, and industry stakeholders. Furthermore, the chapter highlights the ongoing efforts at the Codex Alimentarius to establish harmonized probiotic guidelines. The chapter also discusses labeling regulations, stressing the need for more accurate and comprehensive information on probiotic products to aid in evidence-based decision-making. Finally, it addresses safety concerns, particularly for vulnerable populations like children, and calls for a multi-layered approach to safety assessments. The chapter concludes by advocating harmonizing regulations and guidelines to facilitate probiotics' safer and more effective use.

An ecological reorientation of the Codex Alimentarius Commission could help transform food systems.

The Codex Alimentarius Commission (Codex) has a substantial influence over the structure and operation of food systems by setting international standards that affect the composition, structure and labelling of food. Despite the dual mandates of Codex to protect public health and ensure fair practices in food trade, food systems are increasingly unhealthy and unsustainable. An ecological reorientation of the decision-making elements that influence how Codex sets food standards-particularly mandates, governance and risk assessment-could help transform food systems towards the UN Sustainable Development Goals.

Food Resource Management and Healthy Eating Focus Associates with Diet Quality and Health Behaviors in Low-Income Adults.

Nutrition education and food resource management (FRM) can assist food-insecure individuals in acquiring healthy and affordable food. We aimed to assess the relationships between FRM skills and healthy eating focus with diet quality and health-related behaviors in low-income adults during the COVID-19 pandemic. This cross-sectional study was conducted using an online survey of 276 low-income adults living in a low-food-access community in Northeast Connecticut. Through analysis of covariance, adults who usually or always had a meal plan, considered reading nutrition labels important, made a grocery list, were concerned about their food healthiness, and rated their diet quality as very good/excellent reported higher diet quality (frequency-based and liking-based scores) (p < 0.05 for all). Individuals who considered reading food labels very important and reported having a good diet reported less frequent pandemic-related unhealthy behaviors (consumption of candy and snack chips, soda or sugary drinks, weight gain, smoking) (p < 0.001). Furthermore, higher-frequency-based diet quality was associated with lower risk of overweight or obesity (OR: 0.37; 95% CI: 0.18, 0.76; p-trend < 0.01). Thus, FRM skills and healthy eating focus were associated with higher diet quality and healthier self-reported changes in diet, weight, and smoking behaviors during the pandemic.

Health Claims for Sports Drinks-Analytical Assessmentaccording to European Food Safety Authority's Scientific Opinion.

In Europe, sports food supplements (SSFs) are subject to specific laws and regulations. Up to 70% of athletes are highly influenced by the information on the label or the advertisement of the SSF, which often does not correspond to the scientific evidence, such as health claims. The aim is to analyze such claims relating to sports drinks (SDs) in commercial messages. To this end, an observational and cross-sectional study was conducted based on the analysis of the content and degree of adequacy of the health claims indicated on the labelling or technical data sheet of the SDs with those established by the European legislation in force according to the European Food Safety Authority (EFSA). The SSFs were searched for via Amazon and Google Shopping. A total of 114 health claims were evaluated. No claim fully conformed with the recommendations. A total of 14 claims (n = 13 products) almost conformed to the recommendations; they were "Maintain endurance level in exercises requiring prolonged endurance", "Improve water absorption during physical exercise", and "Improved physical performance during high intensity, high duration physical exercise in trained adults", representing 12.3% of the total (n = 114). The vast majority of the claims identified indicated an unproven cause-effect and should be modified or eliminated, which amounts to food fraud towards the consumer.

Becoming Healthier without Paying More? Experimental Evidence from the Impact of Multiple Traffic Lights on Chinese College Students.

The prevalence of overweight and obesity among Chinese residents has become a pressing public health concern. The UK Multiple Traffic Light labeling system, known for its user-friendly design, has demonstrated success in promoting healthier food choices. This paper presents novel findings from a randomized controlled experiment assessing the impact of traffic light labeling on Chinese consumers' food choices. Results indicate that the label significantly reduces the intake of calories, fat, carbohydrates, and sodium without increasing the economic costs of food choices. This study contributes empirical evidence to the effectiveness of traffic light labeling in China, with implications for the country's approach to front-of-pack nutrition labeling.