Reformulation of snacks offered to children and adolescents at school kiosks: is this strategy enough or just the tip of the iceberg?

Several studies have reported high overweight and obesity incidence among schoolchildren and adolescents, who mostly consume packaged snacks with critical nutrients exceeding the criteria of international profiling systems during school breaks. Then, the objectives of this work were to reformulate a snack consumed by Argentinian schoolchildren and adolescents (aged 6-13 years) to decrease its critical nutrient contents and to determine if this product would still be accepted. Chocolate chip vanilla cookies were selected for reformulation considering each recommended cut-off point for critical nutrients, since a prohibition of products with warning octagons being offered at schools would come into effect in Argentina. These cookies received good acceptability scores (above 3 of 5 points) and would be consumed by 8 of 10 schoolchildren in a sample of 200 participants. These findings underscore the importance of legislation promoting awareness of healthier eating habits and increasing the availability of healthier food options in schools.

Analysis of health claims regarding creatine monohydrate present in commercial communications for a sample of European sports foods supplements.

OBJECTIVE: To analyse the information on health claims present in the labelling of creatine monohydrate (CM) products. DESIGN: A descriptive study of a selection of products marketed as CM, with health claims, and that met the inclusion/exclusion criteria, was conducted using the Amazon and Google Shopping websites. The adequacy and compliance of the health claims were evaluated with the European legislative requirements (European Food Safety Authority and European Commission). The results were discussed with scientific evidence criteria from the Academy of Nutrition and Dietetics, International Olympic Committee, and International Society of Sports Nutrition, as well as the systematic review carried out by Mielgo-Ayuso in 2019. SETTING: Health claims in the commercial communications of a sample of CM supplements, in relation to current legislation and scientific knowledge. PARTICIPANT: A total of 554 CM products were obtained. RESULTS: Of the total sample, only 167 met the inclusion/exclusion criteria. Of these, 30·5 % recommended a CM dose of 5·0-5·9 g/d, while 29·9 % recommended 3·0 to 3·9 g/d. As for the health claims, 'Enhances physical performance' appeared in 73·1 % of the supplements, in most cases referring to a dosage of 3·0 to 3·9 g/d for these products. The rest of the declarations were not adequate or needed to be modified. CONCLUSION: Only 25 % of the health claims complied with the criteria established by the scientific reference documents. Most of the declarations must be modified or eliminated, as they could be considered fraudulent and/or misleading for the consumer.

Labelling completeness and sodium content of packaged foods in India.

OBJECTIVE: To estimate the proportion of products meeting Indian government labelling regulations and to examine the Na levels in packaged foods sold in India. DESIGN: Nutritional composition data were collected from the labels of all packaged food products sold at Indian supermarkets in between 2012 and 2014. Proportions of products compliant with the Food Safety Standards Authority of India (FSSAI) regulations and labelled with Na content, and mean Na levels were calculated. Comparisons were made against 2010 data from Hyderabad and against the UK Department of Health (DoH) 2017 Na targets. SETTING: Eleven large chain retail stores in Delhi and Hyderabad, India. SUBJECTS: Packaged food products (n 5686) categorised into fourteen food groups, thirty-three food categories and ninety sub-categories. RESULTS: More packaged food products (43 v. 34 %; P<0·001) were compliant with FSSAI regulations but less (32 v. 38 %; P<0·001) reported Na values compared with 2010. Food groups with the highest Na content were sauces and spreads (2217 mg/100 g) and convenience foods (1344 mg/100 g). Mean Na content in 2014 was higher in four food groups compared with 2010 and lower in none (P<0·05). Only 27 % of foods in sub-categories for which there are UK DoH benchmarks had Na levels below the targets. CONCLUSIONS: Compliance with nutrient labelling in India is improving but remains low. Many packaged food products have high levels of Na and there is no evidence that Indian packaged foods are becoming less salty.

Impact of nutritional labelling on 10-d energy intake, appetite perceptions and attitudes towards food.

The purpose of this study was to investigate the impact of nutritional labelling on energy intake, appetite perceptions and attitudes towards food. During a 10-d period, seventy normal-weight (BMI<25 kg/m2) and seventy-one obese women (BMI≥30 kg/m2) were given three meals per d under ad libitum conditions. Participants were randomly assigned to one of three experimental labelling groups in which the only difference was the label posted on lunch meal entrée: (1) low-fat label, (2) energy label (energy content of the entrée and average daily needs) and (3) no label (control). Average energy intake was calculated by weighing all foods before v. after daily consumption. Hunger and fullness perceptions were rated on visual analogue scales immediately before and after each meal. Satiety efficiency was assessed through the calculation of the satiety quotient (SQ). The appreciation and perceived healthiness of the lunch entrées were rated on eight-point Likert scales. There was no difference in energy intake, SQ and attitudes towards food between the three labelling groups. Fasting hunger perception was higher in the low-fat label group compared with the two others groups (P=0·0037). No interactions between labelling groups and BMI categories were observed. In conclusion, although labelling does not seem to influence energy intake, a low-fat label may increase women's fasting hunger perceptions compared with an energy label or no label.

Making food labels social: The impact of colour of nutritional labels and injunctive norms on perceptions and choice of snack foods.

Recent studies report that using green labels to denote healthier foods, and red to denote less healthy foods increases consumption of green- and decreases consumption of red-labelled foods. Other symbols (e.g. emoticons conveying normative approval and disapproval) could also be used to signal the healthiness and/or acceptability of consuming such products. The present study tested the combined effects of using emoticons and colours on labels amongst a nationally representative sample of the UK population (n = 955). In a 3 (emoticon expression: smiling vs. frowning vs. no emoticon) × 3 (colour label: green vs. red vs. white) ×2 (food option: chocolate bar vs. cereal bar) between-subjects experiment, participants rated the level of desirability, healthiness, tastiness, and calorific content of a snack bar they had been randomised to view. At the end they were further randomised to view one of nine possible combinations of colour and emoticon labels and asked to choose between a chocolate and a cereal bar. Regardless of label, participants rated the chocolate as tastier and more desirable when compared to the cereal bar, and the cereal bar as healthier than the chocolate bar. A series of interactions revealed that a frowning emoticon on a white background decreased perceptions of healthiness and tastiness of the cereal bar, but not the chocolate bar. In the explicit choice task selection was unaffected by label. Overall nutritional labels had limited effects on perceptions and no effects on choice of snack foods. Emoticon labels yielded stronger effects on perceptions of taste and healthiness of snacks than colour labels. Frowning emoticons may be more potent than smiling emoticons at influencing the perceived healthiness and tastiness of foods carrying health halos.

The impact of nutritional labels and socioeconomic status on energy intake. An experimental field study.

There is some evidence for paradoxical effects of nutritional labelling on energy intake particularly amongst restrained eaters and those with a higher body mass index (BMI) resulting in greater consumption of energy from foods with a positive health message (e.g. "low-fat") compared with the same foods, unlabelled. This study aimed to investigate, in a UK general population sample, the likelihood of paradoxical effects of nutritional labelling on energy intake. Participants (n = 287) attended a London cinema and were offered a large tub of salted or toffee popcorn. Participants were randomised to receive their selected flavour with one of three labels: a green low-fat label, a red high-fat label or no label. Participants watched two film clips while completing measures of demographic characteristics, emotional state and taste of the popcorn. Following the experiment, popcorn consumption was measured. There were no main effects of nutritional labelling on consumption. Contrary to predictions neither BMI nor weight concern moderated the effect of label on consumption. There was a three-way interaction between low-fat label, weight concern and socioeconomic status (SES) such that weight-concerned participants of higher SES who saw a low-fat label consumed more than weight unconcerned participants of similar SES (t = -2.7, P = .04). By contrast, weight-concerned participants of lower SES seeing either type of label, consumed less than those seeing no label (t = -2.04, P = .04). Nutritional labelling may have different effects in different socioeconomic groups. Further studies are required to understand fully the possible contribution of food labelling to health inequalities.

Innovative salt replacement for green Spanish-style olives using potassium, calcium, and magnesium chlorides during packaging.

This work aimed to enhance green Spanish-style Manzanilla table olives by replacing salt with K, Ca, and Mg chlorides in innovative packaging, utilising Response Surface Methodology (RSM). Both the added replacers and naturally occurring minerals were considered. RSM allowed the development of predictive models for K, Ca, Mg, and Mn (initially present) in olive flesh and their contributions to Reference Daily Intakes (RDI) based on the added salts. The sodium content in the new products decreased from 1.4 g/100 g flesh to 0.68 g/100 g flesh, while K, Ca, and Mg concentrations could increase up to 0.50, 0.45 and 0.15 g/100 g flesh, respectively. Added salt contributions to RDI could reach 25, 60, and 44 % for K, Ca, and Mg. Minimal differences between analytical data-derived minerals and predicted values were minimal, suggesting reliable model performance for nutrition labelling. Results assist the industry in creating nutritionally enhanced table olive products.

Energy labelling of alcoholic drinks: An important or inconsequential obesity policy?

Alcohol is calorie dense, but unlike food products, alcoholic drinks tend to be exempt from nutritional labelling laws that require energy content information to be displayed on packaging or at point of purchase. This review provides a perspective on the likely efficacy of alcoholic drink energy labelling as a public health policy to reduce obesity and discusses key questions to be addressed by future research. First, the contribution that alcohol makes to population level daily energy intake and obesity is outlined. Next, consumer need for alcohol energy labelling and the potential impacts on both consumer and industry behavior are discussed. Pathways and mechanisms by which energy labelling of alcoholic drinks could reduce obesity are considered, as well as possible unintended consequences of alcoholic drink energy labelling. Would widespread energy labelling of alcoholic drinks reduce obesity? The unclear effect that alcohol has on population level obesity, the modest contribution calories from alcohol make to daily energy intake and limited impact nutritional labelling policies tend to have on behavior, suggest alcohol energy labelling may have limited impact on population obesity prevalence as a standalone policy. However, there are a number of questions that will need to be answered by future research to make definitive conclusions on the potential for alcohol energy labelling policies to reduce obesity.

Information displayed on Brazilian food bar labels points to the need to reformulate the current food labelling legislation.

This article compares information on the labels of Brazilian food bars with National Health Surveillance Agency legislation. Twenty-six brands of food bars were identified, comprising 50 commercial lines and 153 flavors. The marketing appeal to consumers on the front of pack labeling appeared in many ways to identify these products with a healthy and sustainable lifestyle. However, mandatory information was hard to see, both on the packaging and online, making it difficult for consumer to access. Most of the information on labels followed current legislation, but nutritional irregularities were identified since most bars were ultra-processed and one had incorrect information on the label. The claim that these foods are healthy reinforces the need to reformulate nutrition labeling in Brazil to facilitate identification of nutritional quality/value of foods as part of healthy and sustainable diets.

Key Stakeholder Perspectives on Introducing a Front-of-Pack Labelling Scheme on Packaged Foods in China: A Qualitative Study.

Front-of-pack (FoP) labelling on foods is recommended by the World Health Organization (WHO) to address the growing global burden of diet-related noncommunicable diseases (NCDs), but this policy has not yet been implemented in China. The aim of this study was to ascertain key stakeholders' views on barriers and facilitators to developing a feasible and acceptable FoP labelling policy in the Chinese context. Semistructured interviews were used to elicit opinions from diverse representatives in roles of FoP labelling policy influence. Participants were identified by purposive and snowball sampling. The Consolidated Framework for Implementation Research (CFIR) was adopted to facilitate data collection and analysis. Themes and subthemes were generated using deductive and inductive approaches. Thirty participants were interviewed. The major barriers were the absence of national contextual analysis, perceived complexity of the process of policy development, disagreement on a preferred FoP labelling format, cost for the food industry, low priority compared to food safety policies, lack of existing regulatory framework or authorised nutrient profiling system, limited knowledge of FoP labelling, and the lack of planning and engagement with stakeholders. Facilitators included existing prerequisites, experiences and lessons from the pilot, policy coherence with Healthy China 2030, and support from external agents (e.g., WHO). Further efforts are required to develop and collate evidence to demonstrate the scientific, legal, and political feasibility of introducing effective FoP labelling.

Sodium Content and Labelling of Packaged Foods and Beverages in Nigeria: A Cross-Sectional Study.

Increased consumption of unhealthy processed foods, particularly those high in sodium, is a major risk factor for cardiovascular diseases. The nutrition information on packaged foods can help guide consumers toward products with less sodium and support government actions to improve the healthiness of the food supply. The aims of this study were to estimate the proportion of packaged foods displaying nutrition information for sodium and other nutrients specified by Nigerian nutrition labelling regulations and to determine the amount of sodium in packaged foods sold in Nigeria using data from the nutritional information panel. Data were collected from November 2020 to March 2021 from in-store surveys conducted in supermarkets in three states. A total of 7039 products were collected. Overall, 91.5% (n = 6439) provided only partial nutrition information, 7.0% (n = 495) provided no nutritional information, and only 1.5% (n = 105) displayed a nutrient declaration that included all nutrients specified by 2019 Nigerian regulations. Some form of sodium content information was displayed for 86% of all products (n = 6032), of which around 45% (n = 2689) expressed this as 'salt' and 59% (n = 3559) expressed this as 'sodium', while a small number of food products had both 'salt' and 'sodium' content (3.6%). Provision of sodium or salt information on the label varied between food categories, ranging from 50% (vitamins and supplements, n = 2/4) to 96% (convenience foods, n = 44/46). Food categories with the highest median sodium content were 'meat and meat alternatives' (904 mg/100 g), 'sauces, dressings, spreads, and dips' (560 mg/100 g), and 'snack foods' (536 mg/100 g), although wide variation was often observed within categories. These findings highlight considerable potential to improve the availability and consistency of nutrition information on packaged products in Nigeria and to introduce further policies to reduce the amount of sodium in the Nigerian food supply.

Secondary Outcomes of a Front-of-Pack-Labelling Randomised Controlled Experiment in a Representative British Sample: Understanding, Ranking Speed and Perceptions.

Front-of-pack labels (FOPLs) provide simplified nutritional information that aims to inform consumer choice and encourage reformulation. We conducted an online randomised controlled experiment on a representative British sample to test the effectiveness of FOPLs across a range of outcomes. The primary outcomes have been published; here, we present the secondary outcomes: the ability to rank the healthiest product and the time to complete the rankings by comparing the FOPL groups and a no-label control, as well as a descriptive analysis of the perceptions. Participants from the NatCen panel were randomised to one of five experimental groups (Multiple Traffic Lights; Nutri-Score; Warning Label; Positive Choice tick; no-label control). Six food/drink categories were selected (pizza, drinks, cakes, crisps, yoghurts, breakfast cereals), and three products were created with varying healthiness. The participants (analytic sample = 4530) were asked to rank the products in order of healthiness twice (baseline: no label; follow-up: experimental group label). Compared to the control, the probability of correctly ranking the healthiest product at follow-up was significantly greater for the N-S, MTL and WL across all products. The time to correctly complete the ranking was fastest for the N-S, PC and no-label control. The descriptive analysis showed that the FOPLs were perceived favourably, and especially N-S and MTL. The findings were supportive of the primary analyses, with those results suggesting that N-S performed the best, and then MTL.

Guideline Daily Amounts Versus Nutri-Score Labeling: Perceptions of Greek Consumers About Front-of-Pack Label.

Nutrition information is becoming more urgent than ever so that consumers can make informed choices when buying food. This study aimed to investigate consumers' perceptions and behavior of the front-of-pack label (FOPL), between two specific labeling systems, the Nutri-Score and the Guideline Daily Amounts (GDA). This is a post hoc analysis of data from a previous, more extensive cross-sectional study conducted from April 2021 to June 2021. A total of 510 participants were included in the study, of whom 49.6% were women. Participants' perceptions were assessed in nine questions on a five-point Likert scale (1=strongly disagree, 5=strongly agree). Multivariate variance analysis (MANOVA) was performed to test the effects of the label GDA vs. Nutri-Score on the overall positive and negative perceptions. We found that the Nutri-Score label was significantly more understandable (p=0.003), clear, visible, and preferable (p<0.001) than the GDA label, which required more time to be understood. The findings indicate that the interpretive label, Nutri-Score, was superior to the non-interpretive label GDA, in terms of consumers' perception, more visibility, less time-consuming, and reliability. The FOPL can improve the ability of consumers in Greece to understand the healthfulness of food products.

Performance and discriminatory capacity of Nutri-Score in branded foods in Greece.

Background: The harmonization of front-of-pack nutritional declaration is in the heart of food and nutrition policy discussions in Europe. The Nutri-Score system has been proposed by many countries as a potential candidate but its suitability for use across Europe is still under consideration. The current study aimed to evaluate the performance and discriminatory capacity of Nutri-Score in Greece and to test its alignment with the national food-based dietary guidelines. Materials and methods: Data on the energy, saturated fat, total sugars, sodium, protein, and fiber content per 100°g or ml were extracted for all foods available (n = 4,002) in the Greek branded food composition database HelTH. Each food content in fruits, vegetables, pulses, nuts and oils was manually estimated from the ingredients list. The Nutri-Score algorithm was used both as a continuous (FSAm-NPS Score) and a categorical variable [Grades (A)-(E)]. Results: The average FSAm-NPS Score in Greece was 8.52 ± 9.4. More than half of the solid foods (53.8%) were graded from (A) to (C), while most beverages (59.2%) were graded (E). More than 50% of food categories were populated with foods in all Nutri-Score grades, indicative of a good discriminatory capacity. The system scores favorably vegetables, pulses, and low-fat dairy products and unfavourablly sweets and processed meats showing in this way good alignment with the national guidelines. Eggs and seafood scored preferably compared to meat products. Animal fats received less favorable scores and so did cereal products that were highly processed. Discussion: Nutri-Score showed good capacity to inform consumers toward better food choices in line with the national guidelines. It showed a potential to guide consumers and manufacturers toward less energy dense and more nutrient dense options and highlighted areas of improvement in the food supply.

Online Consumer Survey Comparing Different Front-of-Pack Labels in Greece.

According to the WHO, front-of-pack nutrition labeling provides simplified nutrition information in the form of symbols, colors or words that can help consumers understand the nutritional quality of food, thus leading them to healthier food choices. It is considered of the utmost importance to explore the knowledge and understanding of consumers about this form of nutrition labeling. The aim of this study was to investigate the understanding and perceptions of Greek consumers in response to five different front-of-pack nutrition labels (FoPLs): the Multiple Traffic Lights, Health Star Rating System, Guideline Daily Amounts, Warning Symbols and Nutri-Score. From April 2021 to June 2021, 1278 participants from Greece took part in an online survey where they were asked to rank three products according to their nutritional quality. The classification process was performed first without FoPLs and then with FoPLs. The ability to classify products according to their nutritional quality was evaluated with multinomial logistic regression models, and the Nutri-Score label presented greater improvements when compared to the GDA label for Greek consumers. The Nutri-Score seemed to better help the Greek consumers rank foods according to their nutritional value.

Evaluation of Nutri-Score in Relation to Dietary Guidelines and Food Reformulation in The Netherlands.

An unhealthy dietary pattern is an important risk factor for non-communicable diseases. Front-of-Pack nutritional labels such as Nutri-Score can be used to improve food choices. In addition, products can be improved through reformulation. The current study investigates to what extent Nutri-Score aligns with the Dutch Health Council dietary guidelines and whether it can be used as an incentive for reformulation. Nutri-Score calculations were based on the Dutch Branded Food database (2018). The potential shift in Nutri-Score was calculated with product improvement scenarios. The Nutri-Score classification is in line with these dietary guidelines: increase the consumption of fruit and vegetables, pulses, and unsalted nuts. It is, however, less in line with the recommendations to limit (dairy) drinks with added sugar, reduce the consumption of red meat and replace refined cereal products with whole-grain products. The scenario analyses indicated that a reduction in sodium, saturated fat or sugars resulted in a more favourable Nutri-Score in a large variety of food groups. However, the percentage of products with an improved Nutri-Score varied greatly between the different food groups. Alterations to the algorithm may strengthen Nutri-Score in order to help consumers with their food choices.

Assessing the Effectiveness of Front of Pack Labels: Findings from an Online Randomised-Controlled Experiment in a Representative British Sample.

Front of pack food labels (FOPLs) provide accessible nutritional information to guide consumer choice. Using an online experiment with a large representative British sample, we aimed to examine whether FOPLs improve participants' ability to identify the healthiness of foods and drinks. The primary aim was to compare ability to rank between FOPL groups and a no label control. Adults (≥18 years), recruited from the NatCen panel, were randomised to one of five experimental groups (Multiple Traffic Light, MTL; Nutri-Score, N-S; Warning Label, WL; Positive Choice tick, PC; no label control). Stratification variables were year of recruitment to panel, sex, age, government office region, and household income. Packaging images were created for three versions, varying in healthiness, of six food and drink products (pizza, drinks, cakes, crisps, yoghurts, breakfast cereals). Participants were asked to rank the three product images in order of healthiness. Ranking was completed on a single occasion and comprised a baseline measure (with no FOPL), and a follow-up measure including the FOPL as per each participant's experimental group. The primary outcome was the ability to accurately rank product healthiness (all products ranked correctly vs. any incorrect). In 2020, 4504 participants had complete data and were included in the analysis. The probability of correct ranking at follow-up, and improving between baseline and follow-up, was significantly greater across all products for the N-S, MTL and WL groups, compared to control. This was seen for only some of the products for the PC group. The largest effects were seen for N-S, followed by MTL. These analyses were adjusted for stratification variables, ethnicity, education, household composition, food shopping responsibility, and current FOPL use. Exploratory analyses showed a tendency for participants with higher compared to lower education to rank products more accurately. Conclusions: All FOPLs were effective at improving participants' ability to correctly rank products according to healthiness in this large representative British sample, with the largest effects seen for N-S, followed by MTL.

Performance of the Front-of-Pack Nutrition Label Nutri-Score to Discriminate the Nutritional Quality of Foods Products: A Comparative Study across 8 European Countries.

Abstract: In Europe, discussions are currently ongoing to harmonize front-of-pack nutritional labelling, while some countries have adopted or are considering implementing the Nutri-Score. However, its adaptability to multiple nutritional contexts in Europe requires further investigation. This study aimed to evaluate the applicability of the Nutri-Score in various European countries, regarding its ability to discriminate the nutritional quality of foods and its consistency with national dietary recommendations. The European Food Information Resource (EUROFIR) nutritional composition databases from eight European countries (Finland, France, Norway, Poland, Portugal, Slovakia, Sweden, and Switzerland) were used. The distribution of foods across the Nutri-Score classes within food groups was assessed, as well as the discriminating performance of the label, and the adequacy of nutritional recommendations. The Nutri-Score demonstrated high discriminating ability for all food groups, with similar trends in the eight countries, and consistency with nutritional recommendations. For instance, fruit and vegetable products were mainly classified in the two healthiest Nutri-Score categories, while sugar and animal fat products were mainly classified in the two less healthy categories of the Nutri-Score. Our results support the fact that the Nutri-Score would be a relevant tool to discriminate the nutritional quality of products within and across relevant food groups in different European countries, with consistency with nutritional recommendations.

Consumers' Responses to Front-of-Pack Nutrition Labelling: Results from a Sample from The Netherlands.

Front-of-pack labels (FoPLs) are efficient tools for helping consumers identify healthier food products. Although discussions on nutritional labelling are currently ongoing in Europe, few studies have compared the effectiveness of FoPLs in European countries, including the Netherlands. This study aimed to compare five FoPLs among Dutch participants (the Health Star Rating (HSR) system, Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), and Warning symbols) in terms of perception and understanding of the labels and food choices. In 2019, 1032 Dutch consumers were recruited and asked to select one product from among a set of three foods with different nutritional profiles, and then rank the products within the sets according to their nutritional quality. These tasks were performed with no label and then with one of the five FoPLs on the package, depending on the randomization arm. Finally, participants were questioned on their perceptions regarding the label to which they were exposed. Regarding perceptions, all FoPLs were favorably perceived but with only marginal differences between FoPLs. While no significant difference across labels was observed for food choices, the Nutri-Score demonstrated the highest overall performance in helping consumers rank the products according to their nutritional quality.

Objective Understanding of Front-of-Package Nutrition Labels: An International Comparative Experimental Study across 12 Countries.

Front-of-Package labels (FoPLs) are efficient tools for increasing consumers' awareness of foods' nutritional quality and encouraging healthier choices. A label's design is likely to influence its effectiveness; however, few studies have compared the ability of different FoPLs to facilitate a consumer understanding of foods' nutritional quality, especially across sociocultural contexts. This study aimed to assess consumers' ability to understand five FoPLs [Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), and Warning symbol] in 12 different countries. In 2018, approximately 1000 participants per country were recruited and asked to rank three sets of label-free products (one set of three pizzas, one set of three cakes, and one set of three breakfast cereals) according to their nutritional quality, via an online survey. Participants were subsequently randomised to one of five FoPL conditions and were again asked to rank the same sets of products, this time with a FoPL displayed on pack. Changes in a participants' ability to correctly rank products across the two tasks were assessed by FoPL using ordinal logistic regression. In all 12 countries and for all three food categories, the Nutri-Score performed best, followed by the MTL, HSR, Warning symbol, and RIs.