Influence of ultra-processed food in the diet of South Indian young adults: an explanatory mixed method study.

PURPOSE: To determine the contribution of ultra-processed foods (UPFs) to overall macronutrient intake and their association with anthropometric measurements, and to explore the perceptions regarding UPF consumption among young adults in Puducherry, India. METHODS: This study included 630 participants from three colleges selected using multistage cluster sampling. Following the demonstration of portion estimation, dietary data from previous day were collected using a Google Form-based tool. The participant's anthropometric measures were taken. Food items were classified into NOVA groups and intake analysis was performed using DietSoft software. The participants with low and high consumption were identified and focus group discussions were conducted in each group using criterion sampling. RESULTS: Of all the participants, 178 (28.3%) were overweight or obese. UPF contributed 9.3% of total energy intake and 2.8% protein, 9.9% fat, and 9.9% carbohydrates. The most consumed UPFs were biscuits, wafers (25%), and potato chips(16.2%). No significant association was found between anthropometric measures and UPF consumption. Qualitative findings revealed four major themes, further explained using the socio-ecological framework. CONCLUSION: UPF consumption in the region was lower than that reported in other global and Indian studies. While our study did not find a significant association between UPF consumption and anthropometric measures, there is a concerning shift from traditional diets to increased UPF reliance, driven by convenience and commercial factors. Addressing this is crucial for healthier choices and combating non-communicable diseases during this pivotal life stage.

Evidence on consumers' perceptions, understanding and uses of the Nutri-Score to improve communication about its update: a qualitative study with shopping observations in France.

BACKGROUND: The Nutri-Score is a front-of-pack nutrition label widely used in several European countries to improve the overall quality of consumers' diets. In the view of the upcoming update of the Nutri-Score algorithm, this study evaluates consumers' perceptions, understanding and uses of this label as well as their expectations or criticisms and opinions regarding the algorithm update. METHODS: Two complementary qualitative approaches were used in 2023. Six focus group discussions with a total of 51 participants as well as 20 individual shopping observations with real purchase conditions followed by in-depth interviews were conducted among French adults. The sessions were recorded, transcribed and then analysed using a thematic approach. RESULTS: Participants were familiar with the Nutri-Score but used it for food purchasing in a secondary way due to other more important criteria such as price or habits. They were aware that the label aimed to help them choose healthier products and to protect consumers. However, the lack of awareness about some aspects of the label such as the entity responsible for it or the calculation method of the score created a sense of mistrust about the Nutri-Score. Nevertheless, consumers did not report hearing criticism about the label in the media. Finally, they considered the updating of the label to be relevant. CONCLUSIONS: Participants had a rather positive image of the Nutri-Score and its forthcoming update. Notwithstanding, to improve consumers' trust in the label, this study recommends launching an information campaign to explain its calculation method and reassure them that the Nutri-Score is a government-endorsed scheme as part of the national public health nutrition policy.

Investigation of the 1-week effect of traffic light nutrition labeling on diet selection among Japanese university students: a randomized controlled trial.

BACKGROUND: The method of displaying nutrition information labels on the front of food packaging (FOP: Front of Pack) has been implemented worldwide to prevent lifestyle-related diseases. This study aimed to investigate whether the use of the UK's Traffic Light Food (TLF) label, known as the FOP label, influences the dietary choices of Japanese youth and promotes healthy dietary choices. METHODS: Diet selection was performed for one week each during the baseline and intervention periods. During the intervention period, TLF labels were displayed on meal images of the intervention group. Participants chose what they would like to have for dinner of the day from 15 images. Each meal was scored based on the color of the nutrition label, and a comparison between groups was made to determine whether TLF labeling influenced meal selection for dinner. The psychological stress caused by the presence or absence of nutrition labels and nutritional components when choosing meals was also evaluated. RESULTS: A total of 69 participants were randomly assigned to two groups. Dietary choice scores indicated that the TLF-labeled group made significantly healthier dietary choices than the unlabeled group. Additionally, the TLF-labeled group showed a significant increase in the percentage of people conscious of nutritional components when choosing meals. Furthermore, a significant increase in the number of people conscious of protein, a nutritional ingredient not indicated on the TLF label, was observed. During the test period, no difference in psychological stress caused by the presence and absence of the TLF labels was observed. CONCLUSIONS: The use of TLF labels also encouraged healthy dietary choices among Japanese university students. The use of FOP nutrition labels should be considered in Japan to prevent lifestyle-related diseases through healthy dietary choices. TRIAL REGISTRATION: UMIN Clinical Trials Registry Number: UMIN000047268. Registered March 23, 2022.

Impact of food swap recommendations on dietary choices in an online supermarket: A randomized controlled trial.

One novel strategy to shift food choices in digital shopping environments is to automatically recommend healthier alternatives when an unhealthy choice is made. However, this raises the question which alternative products to recommend. This study assesses 1) whether healthier food swap recommendations are effective, even though the unhealthy choice was made in the presence of visible FOP nutrition labels, and 2) how the similarity of the alternatives influences the acceptance of food swap recommendations. Based on a pre-test, similarity of the recommendation was operationalized in terms of animal-based versus plant-based options. A randomized controlled trial (healthy food swap recommendation conditions: none, similar animal-based, dissimilar plant-based, or mixed animal- and plant-based) with 428 Dutch participants was conducted in a simulated online supermarket. Additional healthier food swap recommendations improved the nutritional quality of the final basket compared to only providing Nutri-Score nutrition labels (-1.7 mean FSA score, p < .001, medium Cohen's d = -0.48). Compared to the dissimilar condition, acceptance of an alternative was more likely in the mixed (odds-ratio = 2.78, p = .015) and in the similar condition (odds-ratio = 2.24, p = .048), but the nutritional quality of the final basket did not differ between treatment conditions. Individuals in treatment conditions who did not receive any recommendation (i.e. only made healthy choices) had higher Nutri-Score familiarity and general health interest than individuals who received recommendations. This suggests that for individuals with higher knowledge and motivation FOP nutrition labels were sufficient, whereas for individuals with lower knowledge and motivation additional food swap recommendations can improve dietary choices. Food swap recommendations may act as meaningful reminders by disrupting the automatic choice process and triggering individuals to rethink their (unhealthy) choice.

The influence of visual elements in Chinese food labels on consumers' visual perception: insights from an eye-tracking study.

To investigate the impact of four visual elements, namely text, colour, image, and shape, on the visual perception of Chinese consumers when observing nutrition labels, as well as to enhance their attention towards nutritional information, this study examines the visual effects of nutrition labels incorporating these elements through eye movement experiments, questionnaire surveys, subjective evaluations, and other research methods. The aim is to determine the optimal design solution. The results revealed that participants displayed the highest level of attention towards the round x image group, followed by the colour group. Thus, exceptional image design and a suitable colour scheme can significantly enhance consumers' attention during browsing. This study offers valuable references and guidance for the redesign of food nutrition labels, while also presenting research insights for the application of visual perception in other domains.

How does the updated Nutri-Score discriminate and classify the nutritional quality of foods in a Norwegian setting?

BACKGROUND: The Nutri-Score is a candidate for the harmonized mandatory front-of-pack nutrition label enabling consumers in the European Union to make healthier food choices. Nutri-Score classifies foods (including beverages) from A (high nutritional quality) to E (low nutritional quality) based on the foods' qualifying and disqualifying components. We aimed to evaluate the updated Nutri-Score for foods (2022) and beverages (2023) in a Norwegian setting by exploring its ability to discriminate the nutritional quality of foods within categories. Additionally, we assessed Nutri-Scores' ability to classify foods in accordance with the Norwegian food-based dietary guidelines (FBDGs). METHODS: The updated Nutri-Score was calculated for 1,782 foods in a Norwegian food database. The discriminatory ability of the updated Nutri-Score was considered by exploring the distribution of Nutri-Score within categories of foods using boxplots and frequency tables, and by examining which qualifying and disqualifying components that contributed most to the Nutri-Score class. Accordance with the Norwegian FBDGs was assessed by exploring Nutri-Score for foods specifically mentioned in the guidelines. RESULTS: Overall, the updated Nutri-Score seemed to discriminate the nutritional quality of foods within categories, in a Norwegian setting. The foods' content of salt and the beverages' content of sugar were components contributing the most to Nutri-Scores' discriminatory ability. Furthermore, in most cases the updated Nutri-Score classified foods in accordance with the Norwegian FBDGs. However, there were minor inconsistencies in how Nutri-Score classified certain foods, such as the inabilities to discriminate between full-fat and low-fat/leaner cheeses, cremes and processed meats (sausages), and between whole grain and refined pasta/rice. CONCLUSIONS: We observed an overall acceptable discriminatory performance of the updated Nutri-Score in a Norwegian setting and in most cases the updated Nutri-Score classified foods in accordance with the Norwegian FBDGs. However, minor inconsistencies were observed. Together with the FBDGs, the updated Nutri-Score could be a useful tool in guiding consumers towards healthier food choices in Norway, but consumer evaluations are warranted to fully assess the performance of the updated Nutri-Score in a Norwegian context.

Advantages of graphical nutrition facts label: faster attention capture and improved healthiness judgement.

Consumers have to rely on the traditional back-of-package nutrition facts label (NFL) to obtain nutrition information in many countries. However, traditional NFLs have been criticised for their poor visualisation and low efficiency. This study redesigned back-of-package NFLs integrated with bar graphs (black or coloured) to visually indicate nutrient reference values (NRVs). Two eye movement studies were performed to evaluate the ergonomic advantages of the graphical NFLs. Our findings suggested that the newly designed NFLs led to faster and better healthiness evaluation performance. The newly designed graphical labels led to a shorter time to first fixation duration and offered a higher percentage of fixation time in the nutrient reference values region compared with that observed using traditional text labels. Nowadays, many chronic diseases are associated with poor eating habits, therefore, the importance of visualisation design to nudge healthier food choices could be paid more attention to by policymakers and food manufacturers.Practitioner summary: To improve the ergonomic design of traditional nutrition facts panel (NFL), this study assessed a newly designed graphical NFL. The results showed that graphical NFL captured consumers' attention faster and improved their healthiness judgement. Moreover, a brief nutrition education can improve consumers' attention and understanding of nutrition information.

Correlates of Self-Reported and Functional Understanding of Nutrition Labels across 5 Countries in the 2018 International Food Policy Study.

BACKGROUND: Nutrition labels on prepackaged foods are an important source of nutrition information; however, differences in comprehension of varying label formats can limit their use and effectiveness. OBJECTIVES: This study examined levels and correlates of consumers' self-reported understanding of Nutrition Facts tables (NFts) and front-of-package (FOP) labels, as well as functional NFt understanding. METHODS: Adults (≥18 y) in Australia (n = 3901), Canada (n = 4107), Mexico (n = 4012), the United Kingdom (n = 5121), and the United States (n = 4445) completed online surveys in November/December 2018. Descriptive statistics summarized sample profiles by country. Linear regression models examined the association between label understanding (self-reported NFt and FOP, functional NFt) and consumer dietary behaviors, functional nutrition knowledge, and sociodemographic characteristics. NFt understanding was measured in all countries, with FOP labeling assessed only in Mexico, Australia, and the United Kingdom. RESULTS: Self-reported and functional NFt understanding was significantly higher in the United States and Canada (P < 0.0001). In adjusted analyses, functional NFt understanding was significantly higher among women compared to men (P < 0.0001); respondents from the "majority" ethnic group in their respective countries compared with minority ethnic groups (P < 0.0001); those with higher education levels (P < 0.0001) and functional nutrition knowledge compared with their lower education and nutrition knowledge counterparts (P < 0.0001), respectively; and those making efforts to consume less sodium, sugar, or fat compared with those not reporting dietary efforts (P < 0.0001). Self-reported FOP label understanding was significantly higher for interpretive labeling systems in Australia (health star ratings) and the United Kingdom (traffic lights) compared with Mexico's Guideline Daily Amounts (GDAs) (P < 0.0001). CONCLUSIONS: Nutrition labels requiring greater numeracy skills (i.e., NFts, GDAs) were more difficult for consumers to understand than interpretive FOP labels (i.e., traffic lights). Differences in NFt and FOP label understanding by income adequacy and education suggest potential disparities in labeling policy effects among vulnerable subgroups.

Consumption of foods with the Keyhole front-of-pack nutrition label: potential impact on energy and nutrient intakes of Swedish adolescents.

OBJECTIVE: The Keyhole is an internationally recognised front-of-pack nutrition label, guiding consumers to healthier food options. It indicates products in accordance with specific criteria for dietary fats, sugars, fibres, salt and wholegrains. The objective of this study was to simulate the potential impact of the Keyhole on adolescents' energy and nutrient intakes by modelling a shift from reported food intakes to foods meeting the Keyhole criteria. DESIGN: Self-reported dietary intake data were derived from a cross-sectional survey. Multiple replacement scenarios were calculated, where foods meeting the Keyhole criteria replaced reported non-compliant foods with varying proportions of replacement. SETTING: Dietary survey 'Riksmaten Adolescents 2016-2017' in schools across Sweden. PARTICIPANTS: A nationally representative sample of 3099 adolescents in school years 5, 8 and 11 (55 % girls). RESULTS: Overall, replacement with foods meeting the Keyhole criteria led to more adolescents meeting nutrition recommendations. Largest median intake improvements were seen for wholegrains (+196 %), SFA (-13 %), PUFA (+17 %) and fibres (+15 %). Smallest improvements were seen for free sugars (-3 %) and salt (-2 %), partly explained by the ineligibility of main food sources of free sugars for the Keyhole, and non-inclusion of ready meals that are often high in salt. Most micronutrient intakes were stable or improved. Unintentional effects included decreases in vitamin A, MUFA and energy intakes. Largest potential improvements in fat and fibre sources were observed in the youngest age group. CONCLUSIONS: A shift to Keyhole alternatives for everyday foods would improve adolescents' nutrient intakes, even with smaller exchanges.

Analysis of stakeholders' responses to the food warning labels regulation in Mexico.

BACKGROUND: In Mexico, the inclusion of a front-of-pack label in the Official Mexican Standard 051 (NOM-051 for its Spanish acronym) has been widely discussed for years by different stakeholder groups. In 2019, the NOM-051 modification project was proposed, which included front-of-pack warning labels. To be modified, it underwent a public consultation period where stakeholders sent their comments to be reviewed and considered. The purpose of this study was to analyse the stakeholders' perspectives during the public consultation of the NOM-051 modification project. METHODS: To assess perspectives, the 795 comments available on the National Commission for Regulatory Improvement website were analysed. Identity, expectations and demands were identified from each comment using content analysis in NVivo. In addition, frequencies and percentages were obtained. RESULTS: Fifty-six percent of the comments were opposed to the NOM-051 modification project. Industry and business interest nongovernmental organizations were against it; they considered that their revenues and profits would be affected. Public interest nongovernmental organizations, academia and health professionals were in favour, stating that the changes proposed are fundamental to informing consumers and improving food choices, and an essential factor in reducing the prevalence of overweight and obesity. Stakeholders in favour expected that eating habits would improve, and demanded that the front-of-pack warning label suggested in the modification proposal be maintained. CONCLUSIONS: The comments opposed to the NOM-051 modification project were consistent with the literature, indicating that food industry stakeholders use all possible arguments to interfere in public health policies. The main issues used by the food industry to discredit the NOM-051 modification project coincide with those used in other countries to stop public health policies and with those used by the tobacco industry to avoid market regulations. On the other hand, those in favour looked after the interests of the Mexican population.

Examination of the nutritional composition of alternative beef burgers available in the United States.

Alternative meat products provide help to reduce the consumption of meat; however, consumers are concerned with the nutritional quality of the novel and traditional plant-based burgers. The objective is to analyse the nutritional profile of commercially available burgers in the U.S. in the categories of beef, imitation, and veggie. We generated a database of burger products by investigating Mintel and company websites, which resulted in the inclusion of imitation (n = 28), veggie (n = 89), and conventional beef (n = 41) burgers. We analysed the nutritional composition (serving size, kcal, macro and micronutrients, vitamins, and minerals) across the three burger types. Beef burgers provided significantly more calories, fat (total fat, saturated fat, trans fat, and cholesterol), and protein while providing less sodium and fibre compared to alternative burgers. As consumers begin to make conscious decisions to reduce meat consumption, either for health or sustainability reasons, they need to be aware that these products are not nutritionally equivalent.

The influence of front-of-pack nutritional labels on eating and purchasing behaviors: a narrative review of the literature.

BACKGROUND: Front-of-Pack Nutritional Labels are considered a useful tool to help consumers orient themselves in their food choices and direct their behavior toward a healthier diet. FOPNL development and use are part of a framework that includes cognitive, biological, hedonic and cultural aspects, able to affect consumers' eating and purchasing behavior. AIM: Given the complexity of the matter, the aim of this narrative review is to analyze the combination of different factors that drive food choices and eating behaviors and to highlight some aspects that are not fully studied. METHODS: The authors conducted the research using a top-down approach at first, followed by a bottom-up approach; starting with general considerations about the purchasing process, gradually narrowing the discussion to a specific sub-population, and finally extending the discussion back to more general reasonings about the direction to adopt in future, or at least to evaluate, for effective communication. RESULTS: Biases and attitudes toward food products were found to regularly interfere with buying behavior patterns, making it impossible to standardize an average consumer. This reflects in current research, increasing the complexity of the topic. All determinants influencing food choices are often assessed individually rather than in a synergistic and multidimensional context, while the purchasing scenario is characterized by multiple stimuli to which the consumer is subjected. FOPNLs' impact on perceived healthiness has been studied in different conditions, but some population subgroups have not been sufficiently represented. In particular, the effect of FOPNLs on consumers suffering from eating disorders is understudied and needs further attention. Furthermore, some approaches can be compared to "negative nutrition" or "loss-framed communication", putting nutrients out of context, emphasizing losses more than gains and risking promoting negative feelings in consumers. CONCLUSION: Due to the heterogeneity of studies, evidence on what works best in driving people to adopt lasting lifestyle changes is still mixed. Science communicators and policymakers should consider the possibility that a multi-component approach incorporating nutrition information and education may be a key strategy to promote consumers' self-consciousness and to support them in their cognitive efforts toward a healthy and sustainable diet. LEVEL OF EVIDENCE: Level V, narrative review.

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.

BACKGROUND: The Nutri-Score summary graded front-of-pack nutrition label has been identified as an efficient tool to increase the nutritional quality of pre-packed food purchases. However, no study has been conducted to investigate the effect of the Nutri-Score on the shopping cart composition, considering the type of foods. The present paper aims to investigate the effect of the Nutri-Score on the type of food purchases, in terms of the relative contribution of unpacked and pre-packed foods, or the processing degree of foods. METHODS: Between September 2016 and April 2017, three consecutive randomized controlled trials were conducted in three specific populations - students (N = 1866), low-income individuals (N = 336) and subjects suffering from cardiometabolic diseases (N = 1180) - to investigate the effect of the Nutri-Score on purchasing intentions compared to the Reference Intakes and no label. Using these combined data, the proportion of unpacked products in the shopping carts, as well as the distribution of products across food categories taking into account the degree of processing (NOVA classification) were assessed by trials arm. RESULTS: The shopping carts of participants simulating purchases with the Nutri-Score affixed on pre-packed foods contained higher proportion of unpacked products - especially raw fruits and meats, i.e. with no FoPL -, compared to participants purchasing with no label (difference of 5.93 percentage points [3.88-7.99], p-value< 0.0001) or with the Reference Intakes (difference of 5.27[3.25-7.29], p-value< 0.0001). This higher proportion was partly explained by fewer purchases of pre-packed processed and ultra-processed products overall in the Nutri-Score group. CONCLUSIONS: These findings provide new insights on the positive effect of the Nutri-Score, which appears to decrease purchases in processed products resulting in higher proportions of unprocessed and unpacked foods, in line with public health recommendations.

Nutrition label processing in the past 10 years: Contributions from eye tracking approach.

Healthy eating plays a critical role in preventing diet-related chronic diseases. To promote healthy eating, nutrition labels have been mandated to certain foods in many countries. To test how different designs of nutrition labels affect consumer behavior, eye tracking technique has been increasingly used to overcome the limitations of subjective report which are susceptible to different biases and a poor indicator of nutrition label use in reality. In this review, we reviewed 45 eye-tracking studies on nutrition label processing. Besides a summary of eye tracking methodology, we found three emerged topics from these studies: attention capture, nutrition label comprehension and food choice. Overall, updated designs of nutrition labels improve attention capture and nutrition label comprehension, but it does not necessarily lead to healthier food choices. The discrepancy between attention capture and food choice also indicate potential limitation in promoting healthy food choice via the indirect attention route (exposure - attention - nutrition label processing - food choice). Instead, actual food choice may be a consequence of a direct heuristic route and modulated by person-, product- and context-related factors. These findings can not only guide future studies, but also have implications on making nutrition label policy and improving human health in eastern developing countries.

A randomized controlled trial testing the effects of a positive front-of-pack label with or without a physical activity equivalent label on food purchases.

BACKGROUND: Positive front-of-pack (FOP) labels, including Singapore's Healthier Choice Symbol (HCS), target a subset of healthier products whose consumption is to be encouraged. However, this may inadvertently lead to excess caloric intake, which could be addressed by including an additional label identifying calories per serving. We test this hypothesis by adding a Physical Activity Equivalent (PAE) label, an indicator of calorie content, to all products available in an on-line grocery store. METHODS: We conducted a randomized controlled trial using a 3 arm within-subject crossover design in adult Singapore residents recruited online. Participants shopped once in each condition in an experimental online grocery store in random order: 1) no FOP label (Control); 2) Select products displaying HCS labels (HCS-only); 3) Condition 2 with additional information displaying PAEs per serving on every product (HCS+PAE). 117 participants were recruited and data from 317 shops were analyzed. We used first-differenced regressions to assess the impact of the conditions on calories per serving (primary) and on other measures of diet quality. RESULTS: The HCS-only condition led to a statistically significant five-percentage point increase in the proportion of HCS products purchased (95% CI, 1%: 9%). However, neither the HCS-only (3.45; 95% CI, -12.52: 19.43) nor HCS + PAE (8.14; 95% CI, -5.25: 21.54) condition led to a change in the number of calories per serving purchased or changes in other measures of diet quality. CONCLUSIONS: Positive labels, like the HCS, are likely to increase purchases of labelled products. However, these changes may not lead to improvements in diet quality or calorie intake. Combining positive labels with additional PAE information does not appear to address this concern.

A Cluster-Randomized Controlled Trial to Evaluate a Community-Based Healthy Eating and Nutrition Label Interpretation Intervention Among Latinx Immigrant Mothers and Their Daughters.

We evaluated outcomes from a healthy eating/nutrition label interpretation intervention among Latinx immigrant mothers and their daughters, aged 9-12 years, in Alabama. Between May 2013-October 2017, this cluster randomized controlled trial assigned 299 mother-daughter dyads to either a healthy eating (intervention) or HPV vaccination (control) study arm. Participants attended four group sessions delivered in Spanish by Lay Health Educators covering portion sizes, healthy eating/cooking strategies, and nutrition label reading/interpretation. An individual session in participants' homes reviewed pantries and developed healthy eating plans. Identical interviewer-administered surveys were completed at baseline and 7-month follow-up by both study arms. Retention rate at follow-up was 93.4% in intervention arm (92.6% in control arm). Positive changes in healthy eating behaviors and proficiency in nutrition label interpretation were assessed. Adjusting for marital status, employment status, and health insurance coverage status, when compared to controls, mothers in the intervention arm had greater odds of increasing daily fruit and vegetable consumption (OR 3.66, 95% CI 2.14-6.27, p < 0.001), decreasing weekly fried food intake (OR 4.3, 95% CI 2.3-8.04, p < 0.001), decreasing daily sweetened beverages (OR 2.07, 95% CI 1.22-3.52, p < 0.01), increasing frequency of reading nutrition labels (OR 12.58, 95% CI 6.81-23.22, p < 0.001), and correctly interpreting nutrition labels (OR 4.45, 95% CI 2.64-7.48, p < 0.001). Significant positive changes in targeted behaviors were not observed among daughters. A community-based, culturally relevant intervention that includes nutrition label interpretation can positively influence eating habits among Latinx immigrant mothers.

Effect of front-of-package nutrition labeling on food purchases: a systematic review.

OBJECTIVES: This study systematically reviewed evidence from interventions on the effect of front-of-package (FOP) nutrition labeling on food purchases. STUDY DESIGN: The study design used in this study is a systematic review. METHODS: Keyword search was performed in PubMed, Web of Science, Scopus, and Cochrane Library. RESULTS: Fifteen studies (10 randomized controlled trials, four pre-post studies, and one case-control study) met the eligibility criteria and were included in the review. Five studies were conducted in a controlled setting through the establishment of an online virtual supermarket or physical laboratory food store solely for the intervention. In contrast, the remaining ten studies were conducted in a naturalistic setting where people commonly purchase foods (e.g., supermarket, grocery store, school/hospital cafeteria, or vending machine). FOP labels assessed included traffic lights, health star rating, daily intake guides, health warnings, and high sugar symbol labels. Compared with the control, FOP labels were effective for helping participants make healthier food purchase decisions in five of the 12 studies that assessed traffic lights labels, in one of the two studies that assessed health warning labels, and in one study that assessed high sugar symbol labels. Three assessed health star ratings and one assessed daily intake guide labels, but none revealed an effect on food purchases compared with the control. CONCLUSIONS: Findings on the effectiveness of FOP nutrition labels in 'nudging' consumers toward healthier food purchases remain mixed and inconclusive. Future studies should examine other types of FOP labels beside the traffic lights labels and explore the different effects by consumer affordability, population subgroup, and shopping environment.

Objective understanding of the Nutri-score front-of-pack label by European consumers and its effect on food choices: an online experimental study.

BACKGROUND: The effectiveness of Front-of-Pack nutrition Labels (FoPLs) may be influenced by national context. In light of the ongoing efforts to harmonize FoPLs across Europe, this study aimed to compare the effectiveness of five FoPLs (Health Star Rating system, Multiple Traffic Lights, Nutri-Score, Reference Intakes, Warning symbols) on consumer understanding and food choice in 12 European countries. METHODS: In 2018-2019, for three food categories, approximately 1000 participants per country were asked to select which food they would prefer to purchase between three products with distinct nutritional quality profiles, and then to rank the products by nutritional quality. Participants (N = 12,391 in total) completed these tasks first with no FoPL and then, after randomization to one of the five FoPLs, with a FoPL on the food packages. Associations between FoPLs and change in (i) nutritional quality of food choices and (ii) ability to correctly rank the products by nutritional quality were assessed with logistic regression models adjusted for sociodemographic and lifestyle characteristics of participants, conducted overall and by country. FINDINGS: Compared with the Reference Intakes, the Nutri-Score (OR = 3.23[2.75-3.81]; p < 0.0001), followed by the Multiple Traffic Lights (OR = 1.68[1.42-1.98]; p < 0.0001), was the most effective FoPL in helping consumers identify the foods' nutritional quality, overall and in each of the 12 countries. Differences between FoPLs regarding food choice modifications were smaller, but the effect of the Nutri-Score seemed slightly higher in eliciting healthier food choices overall compared with the Reference Intakes, followed by the Warning symbols, the Multiple Traffic Lights and the Health Star Rating system. INTERPRETATION: In the context of FoPL harmonization in Europe, these findings from an online experiment provide insights into the Nutri-Score's effectiveness on European consumers.

[Survey on the behavior and attitude of nutrition labels by Chengdu fast food and light meal takeaway merchants].

OBJECTIVE: Learn about the view, cognition, willingness and attitude of the employees of Chengdu fast food takeaway business on nutrition labels and their attitude towards labeling nutrition labels on takeaway meals. METHODS: Using a multi-stage random sampling method, five districts were randomly selected in Chengdu City, Sichuan Province, and two streets were randomly selected in each of the selected districts, and the questionnaire was administered on a one-to-one basis. RESULTS: A total of 834 chefs and caterers were surveyed in the fast food, simple meals category of takeaway businesses. The rate of viewing the nutrition labels on pre-packaged food by chefs and catering staff in takeaway businesses was 48. 07%, and the viewing rate was increasing with the improvement of education(χ~2=15. 379, P=0. 001). The mastery rate of nutrition label knowledge was 15. 08%, which was different for different ages(χ~2=6. 072, P=0. 048). The mastery rate of men(18. 72%) was higher than that of women(9. 91%)(χ~2=12. 193, P<0. 001), and that of chefs(18. 01%) was higher than that of catering staff(12. 88%)(χ~2=4. 172, P=0. 041). The nutritional label understanding intention of the subjects was 28. 10%, and the difference of willingness to know about nutrition label-related knowledge was statistically significant in different age groups(χ~2=6. 183, P=0. 045). The respondents' viewing of nutrition labels was associated with willingness to understand, with a Person coefficient of contingency of 0. 104. The proportion of supporting nutrition labels on takeaway meals was 56. 69%. There were statistically significant differences in attitudes towards nutrition labels on takeaway food packages among respondents of different age groups, gender, education, working years and whether they were chain stores(χ~2=21. 445, 8. 675, 14. 684, 12. 198, 25. 852, P<0. 05). CONCLUSION: The take-out industry chefs and catering staff have insufficient review rate and mastery of nutrition labels, and their willingness to understand nutrition labels is not high.

[Effect evaluation of health education intervention on nutrition label for community residents in Shanghai].

OBJECTIVE: To understand the knowledge, attitude and practice(KAP) of nutrition label for community residents in Shanghai and the effects of health education interventions, and to explore the factors affecting the knowledge, attitude and practice(KAP), and to provide theoretical bases for relevant policies. METHODS: Using stratified random sampling to randomly select at least 20 residents before and after the intervention in each community in Shanghai. A baseline survey was carried out in early March 2016. The survey included basic information and the knowledge、attitude and practice of nutrition label. Using a combination of online and offline method such as issuing posters, folding pages, conducting lectures on knowledge, tweeting on WeChat public accounts, etc. , for a 4-month intervention, and an assessment survey was conducted in June. The same questionnaire was used before and after the intervention. RESULTS: The awareness rate of nutrition labels among community residents in Shanghai increased from 63. 0% before the intervention to 87. 4% after the intervention. The proportion of those who felt it necessary to label nutrition labels increased from 77. 7% before the intervention to 88. 3%. When purchasing prepackaged food, the proportion of people who often read nutrition labels increased from 32. 2% before intervention to 51. 8%, and the above differences were statistically significant(P<0. 05). After the intervention, the mastery of nutrition labeling knowledge, attitudes and behaviors of men were positively changed(P<0. 05). After the intervention, residents in the suburban areas have significantly improved their knowledge, attitudes and behaviors related to nutrition labeling(P<0. 05). The improvement effects of residents in the suburbs was lower than that in the other two types of areas(P<0. 05). Logistic regression analysis showed that intervention, female, high education, living in the central city, knowing the nutrition label, and thinking that it is necessary to label the nutrition label are the protective factors of looking at the nutrition label when buying foods. CONCLUSION: Health education can effectively improve the awareness rate of prepackaged food nutrition labels, relevant attitudes and behavior changes of residents in Shanghai communities. After intervention, the knowledge and behavior of nutrition labels in Shanghai communities are at a high level. Men, low-education low-income and residents in remote areas are the key population for future health education related to nutrition labels.