The Impact Of The Nutri-Score Front-of-pack Nutrition Label On .
Egnell et al. International Journal of Behavioral Nutrition and Physical Activity(2021) EARCHOpen AccessThe impact of the Nutri-Score front-of-packnutrition label on purchasing intentions ofunprocessed and processed foods: posthoc analyses from three randomizedcontrolled trialsManon Egnell1* , Pilar Galan1, Morgane Fialon1, Mathilde Touvier1, Sandrine Péneau1, Emmanuelle Kesse-Guyot1,Serge Hercberg1,2 and Chantal Julia1,2AbstractBackground: The Nutri-Score summary graded front-of-pack nutrition label has been identified as an efficient toolto increase the nutritional quality of pre-packed food purchases. However, no study has been conducted toinvestigate the effect of the Nutri-Score on the shopping cart composition, considering the type of foods. Thepresent paper aims to investigate the effect of the Nutri-Score on the type of food purchases, in terms of therelative 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 wereconducted in three specific populations – students (N 1866), low-income individuals (N 336) and subjectssuffering from cardiometabolic diseases (N 1180) – to investigate the effect of the Nutri-Score on purchasingintentions compared to the Reference Intakes and no label. Using these combined data, the proportion ofunpacked products in the shopping carts, as well as the distribution of products across food categories taking intoaccount 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 foodscontained higher proportion of unpacked products – especially raw fruits and meats, i.e. with no FoPL –, comparedto participants purchasing with no label (difference of 5.93 percentage points [3.88–7.99], p-value 0.0001) or withthe Reference Intakes (difference of 5.27[3.25–7.29], p-value 0.0001). This higher proportion was partly explained byfewer purchases of pre-packed processed and ultra-processed products overall in the Nutri-Score group.(Continued on next page)* Correspondence: m.egnell@eren.smbh.univ-paris13.fr1Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam,Nutritional Epidemiology Research Team (EREN), Epidemiology and StatisticsResearch Center – University of Paris (CRESS), SMBH Paris 13, 74 rue MarcelCachin, F-93017 Bobigny Cedex, FranceFull list of author information is available at the end of the article The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver ) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.
Egnell et al. International Journal of Behavioral Nutrition and Physical Activity(2021) 18:38Page 2 of 12(Continued from previous page)Conclusions: These findings provide new insights on the positive effect of the Nutri-Score, which appears todecrease purchases in processed products resulting in higher proportions of unprocessed and unpacked foods, inline with public health recommendations.Keywords: Front-of-pack nutrition label, Purchasing behavior, Pre-packed foods, processed foodsIntroductionIn order to prevent nutrition-related chronic diseases,Front-of-Pack nutrition Labels (FoPL) have been identified as efficient tools to encourage consumers towardshealthier food choices [1–3] and to promote food reformulation [4, 5]. Multiple formats have been implemented worldwide, including purely informative orinterpretive schemes. In France, the Reference Intakes(RIs) have been implemented by some food manufacturers in 2006, providing numerical information on thenutritional content of foods. Currently, they co-exist onthe French market with the Nutri-Score, a summarygraded color-coded FoPL officially adopted in October2017 by the French public health authorities to be applied on pre-packed foods – on a voluntary basis giventhe European regulation [6] – and then implemented inmultiple European countries, including Spain, Belgium,Netherlands, Luxembourg and Switzerland. FoPLs havebeen shown to improve the nutritional quality of foodpurchases [7–18]. Nevertheless, concerns have beenexpressed by experts on some potential disadvantages ofFoPLs [19]. The implementation of FoPLs on prepacked foods only may notably influence consumers’choices towards processed foods carrying a favourablelabel rather than unprocessed products such as freshfruits and vegetables which do not carry a label asunpacked [19] through a halo effect, while public healthrecommendations encourage the consumption of unprocessed foods [20]. However, to our knowledge no studyhas investigated the influence of the Nutri-Score andother FoPLs on the composition of food purchases, concerning the degree of processing of the products in theshopping cart. While the Nutri-Score calculation isbased on the nutritional quality of foods only withoutconsidering the processing dimension, it would be interesting to test the indirect impact of this FoPL on purchases in terms of food processing degree. The presentstudy aims to assess the effect of the Nutri-Score onfood purchasing intentions concerning the type food(unpacked versus pre-packed) and the processing degreeof the products in the shopping carts (i.e. unprocessed,processed or ultra-processed food products). For thispurpose, data from three randomized controlled trials,aiming to investigate the impact of the Nutri-Score,compared to the current labelling situation in France(i.e., Reference Intakes (RIs) or no label), on foodpurchasing intentions of, were used [21]. The effect wasinvestigated among populations at-risk of having lesshealthy diets (i.e. students, low-income population), orfor which an improvement of dietary intakes is part of atreatment strategy (i.e. individuals suffering from cardiometabolic diseases).Subjects and methodsBetween September 2016 and April 2017, three-arm parallel group randomized controlled trials (https://clinicaltrials.gov/ct2/show/NCT02769455) were conducted sequentially using an experimental online supermarket and including individuals engaged in groceryshopping. The design of the first trial among studentsand the recruitment have been described elsewhere [21].Briefly, the first trial included students from multipleFrench universities, aged between 18 and 25 years old.The second trial included active adults from the FrenchNutriNet-Santé cohort [22], aged between 30 and 50years old, and having a monthly income below 1200 per consumption unit (i.e. corresponding roughly to thesecond decile of income). The third trial focused on individuals over 50 years old within the NutriNet-Santécohort also, suffering from at least one nutrition-relatedcardiometabolic diseases (obesity, type 2 diabetes, dyslipidaemia, arterial hypertension, cardiovascular disease).The three trials were conducted following the sameprotocol as the trial on students and differed only on thetargeted population [21]. Participants were invited to fulfill an inclusion questionnaire to collect data on theeligibility criteria mentioned above, as well as information on various sociodemographic characteristics andnutrition-related behaviors. Eligible participants werethen randomly allocated to one of the three arms usinga random block method, and invited to simulate a shopping situation as if they were in their usual supermarket.For the three trials, the final sample size was calculatedconsidering an effect size of 0.2 (for the main outcome,the FSAm-NPS score of the shopping cart), a power of90% and a p-value of 0.02 considering the three-arm design, resulting in 1956 individuals, i.e. 652 participantsper arm (Supplemental Figure 1 in Additional file 1).To reach this final sample size while considering thenon-respondent rate, the number of participants validating their shopping cart was monitored.
Egnell et al. International Journal of Behavioral Nutrition and Physical ActivityIn the experimental arm of the three trials, the NutriScore was affixed on the front of the package of all prepacked foods in the online supermarket – no label wasapplied on unpacked foods (e.g., fresh fruits and vegetables, butcher meat). Briefly, the Nutri-Score is a summary graded scale indicating the overall nutritionalquality of a food product, based on the United KingdomFood Standards Agency Nutrient Profiling System,adapted to the French context by the High Council forPublic Health (FSAm-NPS) [23]. Considering the nutritional content of food in unfavorable (energy, SaturatedFatty Acids (SFA), sugars, sodium) and favorable elements (proteins, fibers, fruits, vegetables, legumes andnuts), the FSAm-NPS score ranged from 15 points forproducts with higher nutritional quality to 40 pointsfor foods with lower nutritional quality. The Nutri-Scoreis then calculated using the FSAm-NPS score andexpressed through a graded scale between “A” in darkgreen for healthier products (e.g. fresh fruits, vegetables,whole-grain bread) and “E” in dark orange for unhealthier products (e.g. processed meat, butter, chocolate orcookies). In the three trials, two control arms were included: (i) no label, and (ii) the RIs affixed on the frontof pre-packed foods. The RIs label is a nutrient-specificFoPL providing the content in energy, fats, SFA, sugarsand sodium in gram per serving, as well as their percentage contribution to the guideline-based daily intakes[24]. The two schemes that were tested are displayed inSupplemental Figure 2 (Additional file 2).The experimental online supermarket was created toresemble existing online supermarket and allowed participants to simulate a purchasing situation, thoughwithout any payment. The supermarket included 751different foods and beverages, with raw and unpackedfresh products (N 56 foods) and pre-packed foods(N 695 foods). Selection of products was made in orderto reproduce the food offer available in online grocerystores. Information on the nutritional composition,ingredients list, and the price of the product was provided for all foods on the experimental supermarket,with in addition the FoPL on pre-packed foods in theNutri-Score and RIs arms. The products from the experimental online supermarket were classified in 36 foodcategories, including four categories containing foodswith various degrees of processing. Therefore, for thecategories of “fruits”, “vegetables”, “meat” and “fish”,products were categorized according to their degree ofprocessing, using the NOVA classification which isbased on the extent and purpose of industrial food processing [25]. The NOVA classification categorizes foodsinto four groups: the group 1 includes products with noor little processing, the group 2 gathers processed culinary ingredients (e.g., sugars, oils, butter), the group 3 includes processed products (i.e. foods containing usually(2021) 18:38Page 3 of 12two or three ingredients, and which have been transformed through various methods of preservation or cooking), and the group 4 contains ultra-processed foods, forwhich specific industrial processes were applied (i.e. hydrogenation, hydrolises, extruding, moulding, etc) or somesubstances added (i.e., flavoring agents or food additivessuch as colors, emulsifiers, humectants, non-sugar sweeteners). In the present study, the four food categories forwhich products were classified according to the degree ofprocessing did not contain any foods from NOVA group2. Distribution showed an overall balanced distribution(33–33-34% split) across NOVA groups 1, 3 and 4 for fruitand vegetables (NOVA 1 fresh fruits and vegetables,NOVA 3 fruit purées, canned vegetables, NOVA 4 prepared fruit and vegetables with additives); a 17–29-54%split for fish (NOVA 1 fresh fish, NOVA 3 canned fish,NOVA 4 prepared fish or fish patties) and a 40–60% splitbetween NOVA 1 and 4 for meat (NOVA 1 fresh meatcuts, NOVA 4 processed meat).Main socio-demographic characteristics of participantscollected at inclusion were described according to eachof the studies performed (i.e. students, working adultswith low incomes, subjects with chronic diseases). Themean proportion of unpacked and pre-packed productsthat were purchased in each arm was calculated. Forpre-packed foods, products were distinguished accordingto their Nutri-Score class. Then, in each trial arm, thedistribution of foods across the different food categories,considering additionally the degree of processing(NOVA group) for the four categories mentioned above,was calculated and expressed with mean proportionsand standard deviations. The mean proportions werethen compared overall between arms using one-wayANOVA. Then, the two-by-two differences betweenarms were calculated and pairwise comparisons wereperformed using Tukey tests to consider multiple comparisons. Analyses were conducted on the overall samplewith an adjustment for the population, using the SASsoftware (version 9.4; SAS Institute, Inc). Tests weretwo-sided and a p-value below 0.05 was considered statistically significant.ResultsSocio-demographic characteristics of the samples arepresented in Table 1. Overall, the participants were predominantly female (up to 86.6% of participants for thestudy in working adults with low incomes) and with ahigh participation of highly educated participants – except notably in the study in low-income groups. Participants were the main grocery shopper for theirhouseholds and were asked to perform grocery shoppingonline. Notably, a large proportion of participants considered that they had intermediate to low nutritional
Egnell et al. International Journal of Behavioral Nutrition and Physical Activity(2021) 18:38Page 4 of 12Table 1 Socio-demographic characteristics of participants included in each study (N 3382 participants overall)StudentsWorking adultswith low incomesSubjects withchronic diseases18663361180Men497 (26.6)45 (13.4)407 (34.5)Women1369 (73.4)291 (86.6)773 (65.5)20.4 1.941.3 5.965.0 7.1Up to secondary education056 (16.7)0Secondary education077 (22.9)0Undergraduate1118 (59.9)138 (41.1)328 (27.8)Graduate studies736 (39.5)64 (19.0)852 (72.2)Others12 (0.6)00Missing data01 (0.3)0Always908 (48.7)223 (66.4)722 (61.2)Often531 (28.4)90 (26.8)342 (29.0)Sometimes427 (22.9)23 (6.8)116 (9.8)1286 (68.9)135 (40.2)821 (69.6)High141 (7.6)25 (7.4)98 (8.3)Intermediate765 (41.0)190 (56.6)675 (57.2)Low863 (46.2)110 (32.7)374 (31.7)No97 (5.2)11 (3.3)25 (2.1)Missing data008 (0.7)Always227 (12.2)51 (15.2)172 (14.6)Often662 (35.5)157 (46.7)607 (51.4)Sometimes751 (40.2)112 (33.3)358 (30.3)Never226 (12.1)16 (4.8)35 (3.0)Missing data008 (0.7)Total (N)Sex, n(%)Age, years, M (SD)Educational levelGrocery shopping frequency, n(%)Online grocery shopping, yes n(%)Perceived nutritional knowledge, n(%)Nutrition facts reading frequency, n(%)knowledge, and most reported reading the nutritionfacts table infrequently.For each trial arm, the numbers and proportions ofunpacked and pre-packed products from the differentclasses of Nutri-Score in the shopping carts are presented in Table 2. In the Nutri-Score arm, participantstended to purchase less food products in number, compared to the RIs and no label arms, and especially lesspre-packed products. Indeed, 4.27 pre-packed productson average were purchased in the Nutri-Score groupcompared to no label, and 5.82 compared to the RIs.In particular, the Nutri-Score application led to higherdecrease of less healthy foods classified from ‘C’ to ‘E’.Indeed, 1,99 product classified as ‘A’ or ‘B’ and 2,28products classified as ‘C’, ‘D’, or ‘E’ were purchased onaverage in the Nutri-Score group compared to no label,and 2,68 products classified as ‘A’ or ‘B’ and 3,14products classified as ‘C’, ‘D’, or ‘E’ were purchased onaverage in the Nutri-Score group compared to the RIs.The proportion of unpacked food products in the shopping carts was higher in the Nutri-Score group compared to no label (difference of 5.93 percentage points[3.88–7.99], p-value 0.0001) and the Reference Intakes(difference of 5.27 percentage points [3.25–7.29], pvalue 0.0001). No significant difference was observedbetween the Reference Intakes and no label.The distribution of foods across the different categoriesfor the overall sample – considering the processing degreefor some food categories – is described in Tables 3 and 4.In the Nutri-Score group, participants tended to purchaseless manufactured processed or ultra-processed products,especially cheeses, delicatessen, ultra-processed fish,
Nutri-Score B16.89 12.355.18 6.96Nutri-Score DbNutri-Score EbNo label27.69 17.7512.49 11.69Nutri-Score Cb28.36 17.545.95 9.4116.96 12.6312.10 10.579.85 9.0626.79 15.358.31 6.841.84 2.725.36 5.213.83 4.063.30 4.087.97 6.63ReferenceIntakes33.63 26.704.73 8.3313.56 12.3614.91 16.638.79 9.2124.39 17.076.18 5.461.18 1.983.66 4.453.05 3.422.56 3.946.03 6.14Nutri-Score 0.00010.002 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001P0.004 0.0001 0.0001 0.50 ( 0.87;-0.13) 1.37 ( 1.88;-0.86) 0.41 ( 0.64;-0.18)0.4 0.45 ( 1.28;0.37) 0.0001 0.00015.93 (3.88;7.99) 0.0001 3.33 ( 4.57;-2.10) 0.0001 1.87 ( 2.88;-0.86)2.43 (1.12;3.74)0.0003 2.71 ( 4.33;-1.08) 0.00010.01 0.46 ( 0.86;-0.07) 1.90 ( 2.64;-1.16) 0.0001 1.53 ( 2.22;-0.84)5.27 (3.25;7.29) 1.22 ( 2.03;-0.41) 3.40 ( 4.61;-2.18)2.81 (1.52;4.10) 1.06 ( 2.06;-0.07) 2.40 ( 4.00;-0.80) 2.13 ( 2.85;-1.4) 0.66 ( 0.89;-0.43) 1.70 ( 2.21;-1.19) 0.78 ( 1.14;-0.41) 0.74 ( 1.13;-0.35) 1.94 ( 2.62;-1.26) 0.00010.002 0.0001 0.00010.040.001 0.0001 0.0001 0.0001 0.0001 0.0001 0.0001PDifference [95%CI]Difference [95%CI]PNutri-Score vs Reference IntakesNutri-Score vs no label0.70.66 ( 1.38;2.70)0.77 ( 0.05;1.59)0.60.091.0 0.38 ( 1.69;0.92)0.06 ( 1.17;1.29)0.10.90.60.030.30.20.20.3P 0.81 ( 1.81;0.20) 0.30 ( 1.92;1.31)0.23 ( 0.51;0.96)0.25 (0.02;0.49)0.33 ( 0.18;0.84)0.28 ( 0.09;0.65)0.28 ( 0.12;0.67)0.41 ( 0.27;1.09)Difference[95%CI]Reference Intakes vs no labelPre-packed foods were categorized with the Nutri-Score. These products were the only foods from the experimental online supermarket carrying a Nutri-Score label given the European regulationbNutri-Score classifies products in 5 categories of overall nutritional quality between A healthier to E less healthycUnpacked foods included all food products from the experimental online supermarket, that were unpacked and therefore non-labeled given the European regulationValues correspond to mean standard deviationa10.65 12.16Unpacked foodsc27.09 16.66Nutri-Score Bb8.08 10.091.59 2.305.03 5.963.55 3.843.02 4.047.56 8.12No labelNutri-Score AbPre-packed foodsaProportionsNo labelUnpacked foodscNutri-Score EbNutri-Score DbNutri-Score CbbNutri-Score AbPre-packed foodsaNumber of productsType of productsTable 2 Numbers and proportions of unpacked and pre-packed labeled food products purchased in the three arms (N 3382 participants overall)Egnell et al. International Journal of Behavioral Nutrition and Physical Activity(2021) 18:38Page 5 of 12
2.54 2.390.66 1.090.17 0.632.52 3.87Ultra-processed fruitsRaw vegetables1.68 1.492.53 2.130.22 0.622.33 2.57Seeds and dried fruits1.05 1.600.47 0.980.56 1.340.37 0.850.38 1.320.08 0.32DelicatessenRaw fishProcessed fishUltra-processed fishSeafood products0.20 0.580.36 0.871.01 1.540.32 0.790.20 0.70Cream dessertsBread and pastriesBreakfast cereals0.74 1.550.41 1.010.02 0.16Composite dishes,pizzas and sandwichesSavoury aperitif productsSaladesSalty productsIce creams0.38 0.780.22 0.63Pie dough0.04 0.311.69 1.610.03 0.250.31 0.900.64 1.640.15 0.460.25 0.600.75 1.190.34 0.790.13 0.490.93 1.680.66 1.340.09 0.360.26 0.700.25 0.620.37 0.870.30 0.700.87 1.331.53 2.100.86 1.462.41 3.451.73 1.970.18 0.710.28 0.700.46 0.800.55 1.141.48 1.800.16 0.490.24 0.580.80.20.00020.040.040.0002 0.00010.60.0002 0.0001 0.00010.0030.0070.0006 0.0001 0.00010.0090.09 0.0001 0.0001 0.00010.2 0.00010.0010.08 0.00010.40.003 0.19 ( 0.29;-0.08) 0.12 ( 0.19;-0.05) 0.12 ( 0.21;-0.02) 51.35% 48% 46.15%33.33%0.01 ( 0.02;0.03) 0.10 ( 0.20;0.00) 0.05 ( 0.11;0.00) 33.33% 32.26% 0.06 ( 0.13;0.01) 28% 0.10 ( 0.27;0.06) 0.26 ( 0.4;-0.12) 34.67% 15.63% 0.09 ( 0.15;-0.03) 0.01 ( 0.10;0.07) 69.23% 5.88% 0.15 ( 0.29;0.00) 0.3 ( 0.49;-0.11) 22.73% 32.26%0.01 ( 0.03;0.05) 0.17 ( 0.25;-0.08) 56.67%11.11% 0.07 ( 0.31;0.17) 0.55 ( 0.73;-0.36) 63.95% 0.18 ( 0.32;-0.03) 0.59 ( 0.93;-0.26) 24.48% 4.58% 0.60 ( 0.82;-0.38) 34.68% 20.69% 0.13 ( 0.21;-0.05) 0.04 ( 0.11;0.02) 46.43% 22.22% 0.08 ( 0.21;0.04) 0.10 ( 0.21;0.01) 1.04 ( 1.31;-0.76) 70.27% 14.55% 0.01 ( 0.07;0.04) 6.25% 21.74%0.08 (0.03;0.13) 0.05 ( 0.22;0.13)33.33% 2.96%Difference[95%CI]0.59%0.01 ( 0.16;0.19) 0.17 ( 0.27;-0.07) 0.01 ( 0.03;0.01) 54.84% 33.33% 0.17 ( 0.33;-0.01) 0.05 ( 0.11;0.00) 0.13 ( 0.19;-0.06) 0.34 ( 0.48;-0.20)0.60.00010.030.060.0001 0.00010.00070.5 0.09 ( 0.15;-0.03) 0.0001 0.00010.020.020.040.0008 0.00010.060.08 0.0001 0.0001 0.00010.2 0.00010.00070.08 0.00010.30.31.0P-value 0.04 ( 0.12;0.05) 0.49 ( 0.68;-0.31)0.06 26.56% 33.33% 52% 45.33% 11.76% 69.23% 52.69% 0.28 ( 0.43;-0.14) 0.04 ( 0.08;0.00) 44.44% 43.94% 0.11 ( 0.2;-0.01) 0.07 ( 0.14;0.00) 0.15 ( 0.25;-0.05) 0.17 ( 0.25;-0.08) 0.14 ( 0.28;0.00) 0.21 ( 0.45;0.03) 0.43 ( 0.62;-0.25) 0.93 ( 1.26;-0.60) 0.80 ( 1.02;-0.59) 0.04 ( 0.10;0.02) 0.19 ( 0.27;-0.11) 0.17 ( 0.27;-0.06) 0.11 ( 0.24;0.01) 1.06 ( 1.33;-0.79) 0.03 ( 0.09;0.02)0.03 ( 0.02;0.09) 42.31% 28% 40.54% 56.67% 16.09% 13.73% 51.16% 38.17% 46.24% 22.22% 64.29% 36.96% 20% 71.62% 18.75%12.5%Difference[95%CI]Nutri-Score vs Reference IntakesRelativedifference0.70.20.080.07 0.00010.90.0010.00060.040.80.020.00040.0001 0.00010.0090.8 0.0001 0.0001 0.00010.30.00070.070.2 %5.26%0%13.38%14.74%38.46% 2.7% 15.63% 7.69%0% 3.96%8.05% % 3.57%0.02 ( 0.01;0.04)0.08 ( 0.02;0.17)0.07 ( 0.09;0.23)0.00 ( 0.06;0.05)0.06 ( 0.01;0.13)0.08 ( 0.06;0.22)0.02 ( 0.06;0.10)0.00 ( 0.06;0.06)0.19 (0.00;0.38)0.14 (0.00;0.28)0.05 (0.01;0.09) 0.01 ( 0.11;0.09) 0.05 ( 0.12;0.02) 0.04 ( 0.14;0.07)0.00 ( 0.08;0.09) 0.04 ( 0.18;0.11)0.14 ( 0.10;0.38) 0.11 ( 0.30;0.08)0.33 (0.00;0.66)0.20 ( 0.02;0.42)0.00 ( 0.07;0.06)0.06 ( 0.02;0.14)0.07 ( 0.04;0.17)0.03 ( 0.10;0.16)0.02 ( 0.25;0.30)0.02 ( 0.04;0.07)0.05 ( 0.01;0.10) 0.06 ( 0.24;0.11)Difference[95%CI]Reference Intakes vs no 0.90.70.10.8P-value(2021) 18:380.48 1.120.81 1.721.09 1.500.38 0.890.22 0.651.42 2.070.81 1.411.23 2.05Confectionery andspreads0.95 1.680.13 0.430.37 0.850.32 0.720.52 0.980.47 0.901.01 1.461.74 2.58Sweet biscuitsSugary products1.60 2.741.30 1.801.41 2.38Raw meat3.33 3.530.46 0.923.00 3.18Ultra-processed meatMeat and fishCheesesMilk products and eggsStarches0.22 0.590.41 0.86Legumes0.63 1.130.63 1.600.56 1.29Processed vegetablesUltra-processed vegetables0.19 0.510.21 0.551.74 2.240.16 0.52Raw fruitsProcessed fruitsP-valueNutri-Score vs no Number of productsNo labelFruits, vegetables, legumes and nutsFood categoryTable 3 Number of food products in the different categories by trial arm in the overall sample (N 3382 participants overall)Egnell et al. International Journal of Behavioral Nutrition and Physical ActivityPage 6 of 12
1.79 3.300.65 1.600.39 1.170.68 0.98WatersFruits juicesSyrups and sweetenedbeveragesTea, hot chocolateand coffeaBeverages0.90 1.36Fats and oils0.22 0.580.87 1.060.46 1.260.65 1.171.84 3.220.97 1.161.21 1.990.19 0.821.16 2.030.15 0.500.55 0.950.33 0.900.58 1.011.58 3.130.73 1.090.80 1.570.03 0.00010.030.30.1 0.0001 0.0001 0.22 ( 0.54;0.10) 0.08 ( 0.20;0.05) 0.06 ( 0.17;0.05) 0.13 ( 0.23;-0.04) 13.29% 18.18% 23.64% 0.17 ( 0.29;-0.05) 23.29% 12.07% 0.05 ( 0.11;0.02) 0.36 ( 0.54;-0.18) 26.67% 45% 0.05 ( 0.08;-0.01)0.0007 66.67%0.11 0.380.10 0.430.06 0.29Difference[95%CI]P-valueNutri-Score vs no Number of productsNo labelSauces and condimentsVegetable soupsSoupsFood category0.0040.40.30.30.003 0.00010.20.01P-value 58.18% 39.39% 12.07% 16.46% 32.88% 51.25% 46.67% 83.33%Relativedifference 0.33 ( 0.42;-0.23) 0.13 ( 0.24;-0.02) 0.07 ( 0.20;0.05) 0.27 ( 0.58;0.05) 0.24 ( 0.35;-0.13) 0.41 ( 0.59;-0.23) 0.07 ( 0.13;-0.01) 0.06 ( 0.09;-0.02)Difference[95%CI]Nutri-Score vs Reference Intakes 0.00010.020.40.1 0.0001 0.00010.030.001P-valueTable 3 Number of food products in the different categories by trial arm in the overall sample (N 3382 participants overall) %0.19 (0.09;0.29)0.07 ( 0.04;0.18)0.00 ( 0.13;0.12)0.05 ( 0.27;0.37)0.07 ( 0.04;0.19)0.05 ( 0.13;0.23)0.02 ( 0.04;0.09)0.01 ( 0.03;0.05)Difference[95%CI]Reference Intakes vs no labelRelativedifference 0.00010.41.00.90.20.70.70.8P-valueEgnell et al. International Journal of Behavioral Nutrition and Physical Activity(2021) 18:38Page 7 of 12
1.42 3.120.56 1.819.44 9.319.23 9.661.88 3.431.99 5.141.26 3.060.65 2.328.37 7.65Raw vegetablesaProcessed vegetablesaUltra-processed vegetablesaLegumesSeeds and dried fruits1.65 4.471.84 4.16DelicatessenRaw fisha0.27 1.83Seafood products3.56 5.721.11 2.570.53 1.80Bread and pastriesBreakfast cerealsIce creams0.51 1.881.30 3.953.51 4.661.11 3.850.56 1.690.53 1.611.26 4.45Pie doughCream desserts3.80 4.533.22 7.053.57 5.16Sweet biscuits3.49 8.330.37 1.871.03 2.580.81 1.961.60 4.141.38 2.773.23 4.595.33 6.22Confectionery and spreadsSugary products1.06 3.93Processed fishUltra-processed fisha1.84 7.383.91 6.34a5.16 6.513.81 5.844.60 5.84Ultra-processed meata11.74 10.091.94 3.389.06 8.820.53 1.6111.37 10.99Raw meataMeat and fishCheesesMilk products and eggsStarches1.87 3.160.54 1.68Ultra-processed fruitsa0.64 1.890.49 1.55Processed fruitsa6.25 6.966.52 6.62Raw fruitsa0.46 1.710.99 2.483.42 6.702.07 7.030.33 1.323.07 5.872.25 4.330.38 2.060.77 2.130.76 1.961.59 4.670.97 2.574.66 10.028.35 12.53.07 5.149.37 10.246.80 7.300.46 1.740.91 2.721.75 3.661.82 3.667.18 10.990.56 1.891.96 7.8912.72 19.190.70.060.8 0.00010.00040.002 0.00010.30.04 0.00010.4 0.0001 0.0001 0.0001 0.0001 0.0001 0.00010.08 0.00010.40.8 0.00010.9 0.0001 0.0001P-value0.4 0.00010.06 0.25 ( 0.67;0.17) 1.08 ( 1.53;-0.63) 0.29 ( 0.59;0.00)0.0050.80.60.7 0.14 ( 0.70;0.43) 0.11 ( 0.41;0.19) 0.07 ( 0.25;0.11)0.001 0.21 ( 0.36;-0.05)0.81 (0.28;1.33)0.0010.06 0.98 ( 1.65;-0.31) 0.51 ( 1.02;0.01)0.4 0.0001 0.68 ( 1.01;-0.34)0.11 ( 0.08;0.30)0.050.75 (0.02;1.48) 0.0001 0.0001 1.53 ( 2.09;-0.98)3.19 (2.31;4.06) 0.0001 0.0001 1.56 ( 2.36;-0.77) 1.99 ( 3.03;-0.95)0.020.060.3 0.24 ( 0.65;0.16) 0.35 ( 0.64;-0.06)0.9 0.05 ( 0.40;0.29) 0.19 ( 0.39;0.00)0.9 0.0001 2.05 ( 3.04;-1.07) 0.0001 0.00010.03 ( 0.15;0.20)1.47 (0.99;1.94)6.20 (4.98;7.43)P-valueDifference[95%CI]Nutri-ScoreNo labelReferenceIntakesNutri-Score vs no labelProportions in percentageFruits, vegetables, legumes and nutsFood category 0.05 ( 0.22;0.13) 0.31 ( 0.61;-0.01) 0.10 ( 0.65;0.46)0.96 (0.44;1.48) 0.23 ( 0.39;-0.08) 0.73 ( 1.24;-0.22) 1.24 ( 1.90;-0.58)0.01 ( 0.18;0.20) 0.26 ( 0.55;0.03) 0.05 ( 0.49;0.39) 0.01 ( 0.43;0.40) 0.4 ( 0.73;-0.07)1.43 (0.71;2.14)3.02 (2.16;3.88) 0.75 ( 1.29;-0.20) 2.37 ( 3.39;-1.35) 2.64 ( 3.43;-1.86) 0.11 ( 0.30;0.08) 0.52 ( 0.80;-0.23) 0.12 ( 0.52;0.27) 0.11 ( 0.45;0.23) 1.88 ( 2.84;-0.91)0.03 ( 0.14;0.20)1.31 (0.85;1.78)6.47 (5.27;7.68)Difference[95%CI]0.80.050.9 0.00010.00080.002 0.00011.00.071.01.00.01 0.0001 0.00010.004 0.0001 0.00010.3 0.00010.80.8 0.00010.9 0.0001 0.0001P-valueNutri-Score vs Reference IntakesTable 4 Proportions of food products in the different categories by trial arm in the overall sample (N 3382 participants overall)1.00.06 ( 0.28;0.40) 0.02 ( 0.2;0.15)0.20 ( 0.10;0.50)1.00.40.90.8 0.04 ( 0.6;0.52)0.90.03 ( 0.12;0.18)0.50.70.41.0 0.00010.5 0.15 ( 0.68;0.37)0.22 ( 0.29;0.74)0.27 ( 0.4;0.93)0.10 ( 0.09;0.29) 0.03 ( 0.32;0.26) 1.03 ( 1.47;-0.58) 0.24 ( 0.66;0.18)0.10.06 0.27 ( 0.61;0.06)0.8 0.68 ( 1.40;0.04)0.0030.70.0080.70.30.71.00.17 ( 0.70;1.04) 0.79 ( 1.34;-0.23)0.38 ( 0.65;1.41)1.08 (0.29;1.87) 0.08 ( 0.28;0.11)0.17 ( 0.13;0.46) 0.12 ( 0.52;0.28)0.9 0.01 ( 0.18;0.16) 0.18 ( 1.15;0.8)0.80.9P-value0.15 ( 0.32;0.63) 0.27 ( 1.49;0.95)Difference[95%CI]Reference Intakes vs no labelEgnell et al. International Journal of Behavioral
In the experimental arm of the three trials, the Nutri-Score was affixed on the front of the package of all pre-packed foods in the online supermarket - no label was applied on unpacked foods (e.g., fresh fruits and vegeta-bles, butcher meat). Briefly, the Nutri-Score is a sum-mary graded scale indicating the overall nutritional
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
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Dr. Sunita Bharatwal** Dr. Pawan Garga*** Abstract Customer satisfaction is derived from thè functionalities and values, a product or Service can provide. The current study aims to segregate thè dimensions of ordine Service quality and gather insights on its impact on web shopping. The trends of purchases have
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- Nutri-Score: No deterioration of the nutritional quality of the shopping cart in any subgroup -Nutri-Score : Spontaneous understanding -Nutri score 92% ; -MTL 29% - 0,312 - 0,229 - 0,051 Proxy of less affluent consumers Higher impact in subjects buying less expensive products Experimental economy Test in experimental economy 5 .
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7. Four options for the name of the label were tested: "Nutri-Grade", "Nutri-Mark", "Health Grade", and "Health Mark". 8. The majority of participants preferred the name "Health Grade", followed by "Nutri-Grade". Participants who preferred "Health" over "Nutri" in the name felt the term "Health" was
