The Nutri-Score algorithm: Evaluation of its validation process.

The Nutri-Score front-of-pack label, which classifies the nutritional quality of products in one of 5 classes (A to E), is one of the main candidates for standardized front-of-pack labeling in the EU. The algorithm underpinning the Nutri-Score label is derived from the Food Standard Agency (FSA) nutrient profile model, originally a binary model developed to regulate the marketing of foods to children in the UK. This review describes the development and validation process of the Nutri-Score algorithm. While the Nutri-Score label is one of the most studied front-of-pack labels in the EU, its validity and applicability in the European context is still undetermined. For several European countries, content validity (i.e., ability to rank foods according to healthfulness) has been evaluated. Studies showed Nutri-Score's ability to classify foods across the board of the total food supply, but did not show the actual healthfulness of products within different classes. Convergent validity (i.e., ability to categorize products in a similar way as other systems such as dietary guidelines) was assessed with the French dietary guidelines; further adaptations of the Nutri-Score algorithm seem needed to ensure alignment with food-based dietary guidelines across the EU. Predictive validity (i.e., ability to predict disease risk when applied to population dietary data) could be re-assessed after adaptations are made to the algorithm. Currently, seven countries have implemented or aim to implement Nutri-Score. These countries appointed an international scientific committee to evaluate Nutri-Score, its underlying algorithm and its applicability in a European context. With this review, we hope to contribute to the scientific and political discussions with respect to nutrition labeling in the EU.

Making sense of adolescent-targeted social media food marketing: A qualitative study of expert views on key definitions, priorities and challenges.

Traditional food marketing stimulates adolescents' consumption of energy-dense, nutrient-poor foods. These dietary behaviours may track into adulthood and lead to weight gain, obesity and related non-communicable diseases. While social media use in adolescents has proliferated, little is known about the content of food marketing within these platforms, and how this impacts adolescents' dietary behaviours. This paper aimed to obtain expert insights on factors involved in the association between social media food marketing (SMFM) and adolescent dietary behaviours, and to explore their views on key priorities, challenges and strategies for future SMFM research and policies. One-on-one semi-structured interviews (n = 17) were conducted with experts from Western Europe, Australia and North America, in the fields of public health (policy), nutrition science, social media marketing, adolescent medicine, clinical psychology, behavioural sciences, communication, food industry, social influencing, and social marketing. The experts' collective responses identified that the line between food content posted by social media users and food companies is blurred. Adolescents' processing of SMFM may be mostly implicit, involving social comparison, emotional engagement, and attaching symbolic meanings to foods. Mediating factors and adolescent-specific and SMFM-specific moderating factors potentially influencing adolescents' response to SMFM were summarized in a Social Ecological model. Experts agreed that there is limited scientific evidence on adolescent-targeted SMFM and there are no strict regulations in place to protect adolescents from unhealthy SMFM, while adolescents are active social media users who are cognitively vulnerable to implicit marketing tactics. Adolescent-targeted SMFM should be controlled by encouraging healthy food marketing or limiting junk food marketing. Also, prioritizing both quantitative research on SMFM exposure and its impact, and qualitative research to obtain adolescents' perspectives, is crucial to advocate for regulatory changes regarding adolescent-targeted SMFM content.

The influence of a front-of-pack nutrition label on product reformulation: A ten-year evaluation of the Dutch Choices programme.

Front-of-pack (FoP) labels are regarded as helpful tools to stimulate healthier product reformulation as they are based on nutrient criteria that products should comply with in order to obtain the label. Some FoP labelling programs revise criteria periodically. This is the first study investigating the impact of criteria revisions on product compositions over time. Nutrient contents of 4,343 products, including 27 basic and non-basic product (sub) categories with the Dutch Choices Logo were analysed between 2006 and 2016. The number of labelled products increased over time. Sodium and trans-fat contents reduced significantly in 10 and 11 product categories, respectively. Energy, saturated fat and added sugar decreased significantly whilst fibre increased in 4-6 product categories. Overall, labelled products had healthier compositions and more favourable trends in nutrient content compared with products generally on the Dutch market. The results of this study suggest an important role for FoP labels in product reformulation.

Differences and Similarities between Front-of-Pack Nutrition Labels in Europe: A Comparison of Functional and Visual Aspects.

Many different front-of-pack (FOP) nutrition labels have been introduced worldwide. To continue the debate on the most effective FOP labels for increased consumer health, full comprehension of their visual and functional features is relevant. This paper compares and provides an overview of all FOP labels currently in practice or in preparation in Europe, by means of the visually oriented Funnel Model. The Funnel Models were completed in collaboration with the respective FOP labelling initiatives. In total, six positive FOP labels, two mixed FOP labels and one negative FOP label were compared. There are multiple similarities and differences between the FOP labels, with each FOP label being characterised by a unique set of criteria and methodological approach. This Funnel Model comparison provides the knowledge to ultimately find more common ground for all stakeholders involved in the FOP labelling debate. Importantly, implementation and evaluation activities carried out by FOP labelling organisations are crucial success factors for FOP labels in practice. We conclude that more attention should be paid to methodological differences between FOP labels and recommend that the current comparison is expanded to a global level and periodically updated, as the variety of FOP labels in the global marketplace is changing constantly.