No abstract

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

Context and objective: When considering the health-related impact of foods, nutrient profile (content in salt, sugar, fibre, etc.) and (ultra-)processing are two complementary dimensions. The Nutri-Score, a summary graded front-of-pack label, already used in seven European countries, informs on the nutrient profile dimension, i.e. the one with the strongest evidence. Recently, mounting evidence linked ultra-processed food consumption to various adverse health outcomes, independently of their nutrient profile. To inform consumers about each of these two health-related dimensions of food (i.e., nutrient profile and ultra-processing), we aimed to test, in a randomised controlled trial, if a graphically modified version "Nutri-Score 2.0", including a black "ultra-processed" banner, would improve the capacity of consumers to rank products according to their nutrient profile but also to detect those ultra-processed, compared to a no-label situation. Methods: A total of 21,159 participants included in the NutriNet-Sante web-cohort were randomly assigned to a control arm (no front-of-pack label) or an experimental arm (Nutri-Score 2.0), and were presented an online interactive questionnaire with 3 sets of food products (8 cookies, 7 breakfast cereals, and 7 ready-to-eat meals) to rank according to their nutrient profile, and to identify ultra-processed foods. The primary outcome was the objective understanding of nutrient profile and ultra-processing, represented by a score of correct answers. Secondary outcomes were purchasing intentions and the healthiest-perceived product. Multinomial logistic regressions were performed. Results: The Nutri-Score 2.0 increased significantly the objective understanding of both the nutrient profile dimension of food products from 0.9% to 24.2% (OR = 29.0 (23.4 - 35.9), p<0.001), and the ultra-processing dimension from 4.4% to 77.7% (OR = 174.3 (151.4 - 200.5), p<0.001), compared with no front-of-pack label. The results followed similar trends for cookies, breakfast cereals, and ready-to-eat meals. The Nutri-Score 2.0 also had a positive impact on purchasing intentions and on the products perceived as the healthiest, guiding consumers towards a better nutrient profile and non-ultra-processed products. Conclusion: This randomised controlled trial demonstrates the interest of a front-of-pack label combining the Nutri-Score (informing on the nutrient profile dimension) with an additional graphic mention indicating when the food is ultra-processed, compared to a no-label situation. Our results show that participants were able to independently identify and understand these two complementary dimensions of foods. Keywords: Nutri-Score, randomised controlled trial, ultra-processed foods, nutrient profile, front-of-pack label Trial registration number:NCT05610930