Front-of-package nutrition labeling as a driver for healthier food choices: Lessons learned and future perspectives

Exploring the Potential for Graphic Warning Labels to Reduce Intentions to Consume Energy Drinks

ISSUE ADDRESSED

Effective interventions to reduce energy drink (ED) consumption are needed. This study explored the effect of warning labels on intentions to reduce ED consumption, perceived label effectiveness and protection motivation theory (PMT) constructs.

METHODS

Australian ED consumers aged 18 to 39 years (N = 343) participated in an experimental online survey, randomly assigned to view one of three ED warning label conditions (weight gain, cardiac effects, no label-control). Intentions to reduce ED consumption, perceived effectiveness of labels and selected PMT constructs were assessed.

RESULTS

Participants reported moderate-high awareness of the health effects of consumption (62.68%) and advisory statements on EDs (69.39%), including daily consumption limits (48.40%). EDs were consumed frequently, with 56.26% regular (at least weekly) consumers and most commonly for functional benefits (e.g., alertness). ED warning labels did not have a statistically significant effect on intentions to reduce consumption. The cardiac label performed better than the weight gain label in 'grabbed attention' (72.97% vs. 55.66%, p = 0.008), with non-significant trends (p > 0.05, absolute differences ≥ 10%) suggesting it was stronger on some other perceived effectiveness measures. Supplementary analyses indicated females in the cardiac condition reported greater intentions to reduce ED consumption than females in the control condition (p = 0.042).

CONCLUSIONS

Graphic warning labels and labels warning of cardiac effects are worthy of further exploration as a potential intervention to reduce ED consumption. SO WHAT?: Future research should explore the motivations underlying ED consumption and further explore messages that will resonate with consumers.

Assessing the impact of a mandatory calorie labelling policy in out-of-home food outlets in England on consumer behaviour: a natural experimental study

BACKGROUND

Out-of-home (OOH) food tends to be energy-dense and nutrient-poor. In response, England implemented a mandatory calorie labelling policy in the OOH sector. We evaluated changes in consumer behaviours after the policy was implemented in April 2022.

METHODS

We employed a natural experimental design to assess pre-post changes in noticing and using nutrition information, and behaviours associated with menu labelling. We compared changes in England to comparator jurisdictions without similar policies. Data included four consecutive years (2019-2022) from the International Food Policy Study; participants were adults aged 18 years or older. Mixed effects logistic regression models assessed pre-post changes in binary outcomes, and mixed effects negative binomial regression assessed changes in frequency of OOH eating.

RESULTS

In England, noticing nutrition information increased from 16.0% (95% CI 15.6 to 16.4) in 2020 to 19.7% (95% CI 19.1 to 20.2) in 2021 and to 25.8% (95% CI 25.5 to 26.1) in 2022. This increase was 4.8% points (95% CI 2.5 to 7.1) higher in England versus the comparator group. Using nutrition information increased in England from 8.0% (95% CI 7.5 to 8.4) in 2020 to 11.8% (95% CI 10.9 to 12.6) in 2021 and to 13.5% (95% CI 13.1 to 13.9) in 2022. There was a 2.7% points (95% CI 2.0 to 3.4) greater increase in England versus the comparator group from 2020 to 2021. Ordering something different was the only behaviour associated with nutrition information that increased after implementation of the policy in England: from 12.6% (95% CI 12.4 to 12.7) in 2020 to 15.2% (95% CI 14.7 to 15.6) in 2021 and to 17.7% (95% CI 17.6 to 17.8) in 2022. There was a 2.8% points (95% CI 1.8 to 3.9) greater increase in England versus the comparator group from 2021 to 2022. Frequency of OOH eating did not change after policy implementation.

CONCLUSIONS

The introduction of mandatory calorie labelling in England led to increases in self-reported noticing and using, with the key behavioural impact on ordering something different. Additional strategies may be required to maximise the public health benefits of calorie labelling.

More than meets the eyes: How can healthiness perceptions and restraint shape the purchase intent of food with nutrition claims?

The main goal of this study was to verify relationships between cognitive restraint, priorities in food choice, consumer perceptions, and engagement in slimming process, on willingness to buy foods with nutrition claims (NC). Online questionnaires were answered by 454 consumers over 18 years of age. Cognitive restraint, uncontrolled eating and emotional eating were measured by the Three-Factor Eating Questionnaire-R21. The Eating Motivation Survey was applied to evaluate food choice motives. Consumers' willingness to buy and perceived healthiness were assessed by structured scales. A structural equation model using partial least squares was used to evaluate the impact of different factors on willingness to buy foods with NC. Perceived healthiness impacted positively willingness to buy all foods with NC. Natural concerns had a positive impact on willingness to buy sugar-free chocolate, no sugar added paçoca (peanut sweet), high-protein yoghurt, high-fibre crackers, lactose-free milk and gluten-free bread. Cognitive restraint and engagement in a slimming process positively impacted willingness to buy sugar-free chocolate, high-protein yoghurt, gluten-free bread and light requeijão (Type of cream cheese). Yet, weight control concerns in food choices had a positive impact on willingness to buy light requeijão, high-protein yogurt, no sugar added paçoca and sugar-free chocolate. However, health concerns negatively impacted willingness to buy gluten-free bread, lactose-free milk and high-fibre crackers. The consequences of such perceptions and related factors on food choice and consumption are discussed. The present findings highlight the importance of extending the discussion on food labelling, as well as the careful regulation of the presence of NCs in ultra-processed foods.

Food packaging solutions in the post-per- and polyfluoroalkyl substances (PFAS) and microplastics era: A review of functions, materials, and bio-based alternatives

Food packaging (FP) is essential for preserving food quality, safety, and extending shelf-life. However, growing concerns about the environmental and health impacts of conventional packaging materials, particularly per- and polyfluoroalkyl substances (PFAS) and microplastics, are driving a major transformation in FP design. PFAS, synthetic compounds with dual hydro- and lipophobicity, have been widely employed in food packaging materials (FPMs) to impart desirable water and grease repellency. However, PFAS bioaccumulate in the human body and have been linked to multiple health effects, including immune system dysfunction, cancer, and developmental problems. The detection of microplastics in various FPMs has raised significant concerns regarding their potential migration into food and subsequent ingestion. This comprehensive review examines the current landscape of FPMs, their functions, and physicochemical properties to put into perspective why there is widespread use of PFAS and microplastics in FPMs. The review then addresses the challenges posed by PFAS and microplastics, emphasizing the urgent need for sustainable and bio-based alternatives. We highlight promising advancements in sustainable and renewable materials, including plant-derived polysaccharides, proteins, and waxes, as well as recycled and upcycled materials. The integration of these sustainable materials into active packaging systems is also examined, indicating innovations in oxygen scavengers, moisture absorbers, and antimicrobial packaging. The review concludes by identifying key research gaps and future directions, including the need for comprehensive life cycle assessments and strategies to improve scalability and cost-effectiveness. As the FP industry evolves, a holistic approach considering environmental impact, functionality, and consumer acceptance will be crucial in developing truly sustainable packaging solutions.

Impacts of sugar and sweetener warning labels on substitution between sugar- and non-sugar-sweetened beverages in a non-hypothetical selection task

BACKGROUND

Front-of-pack (FOP) warning labels have demonstrated effectiveness for reducing sugar-sweetened beverage (SSB) consumption and switching to water. However, an unintended consequence is that they may also increase switching to non-sugar-sweetened beverages (NSSBs). A non-hypothetical experimental study examined the effectiveness of combining sugar and sweetener FOP warning labels to reduce sugary drink consumption and prevent NSSB substitution. The study also examined potential integration with Australia and New Zealand's existing Health Star Rating (HSR) system to determine suitability for local context and other jurisdictions with interpretive labelling schemes already in place.

METHODS

Participants (N = 414) accessed an online convenience store app via an on-campus laptop to select one drink from an array of 10 beverages, on three occasions. Drink options included a variety of SSBs, 100% fruit juice, NSSBs, and water. Following an escalating exposure procedure, drinks were presented (1) without any additional labelling, (2) with warning labels added to sugary drinks or to both sugary drinks and NSSBs (according to allocated condition), then (3) with HSR icons added to all drinks. Participants were informed they would receive a complementary drink, based on their selections, following the completion of a brief questionnaire.

RESULTS

Baseline results indicated that SSBs and water were the most and least popular drink choices, respectively. Placing FOP warning labels on sugary drinks decreased selection of SSBs and increased NSSB and water choices. Water became the most popular individual drink choice in response to warnings on sugary drinks. Placing FOP warning labels on both sugary drinks and NSSBs successfully avoided an increase in NSSB choices, whilst also increasing water selections, but did not significantly decrease selection of SSBs until HSR ratings were added. The incorporation of HSR icons consolidated warning label effects on NSSB and water selection across both conditions.

CONCLUSIONS

Results demonstrate the potential of FOP sugar warning labels for addressing beverage consumption behaviours. The incorporation of sweetener warning labels may successfully avoid substitution towards NSSBs, whilst still promoting water choices, but may also dilute the impact of the sugary drinks warning labels. Warning labels were complementary to existing interpretive FOP labels.

Path2Green: introducing 12 green extraction principles and a novel metric for assessing sustainability in biomass valorization

We propose an innovative approach to address the pressing need for efficient and transparent evaluation techniques to assess extraction processes' sustainability. In response to society's growing demand for natural products and the consequent surge in biomass exploration, a critical imperative arises to ensure that these processes are genuinely environmentally friendly. Extracting natural compounds has traditionally been regarded as a benign activity rooted in ancient practices. However, contemporary extraction methods can also significantly harm the environment if not carefully managed. Recognizing this, we developed a novel metric, Path2Green, tailored specifically and rooted in 12 new principles of a green extraction process. Path2Green seeks to provide a comprehensive framework beyond conventional metrics, offering a nuanced understanding of the environmental impact of extraction activities from biomass collection/production until the end of the process. By integrating factors such as resource depletion, energy consumption, waste generation, and biodiversity preservation, Path2Green aims to offer a holistic assessment of sustainability of an extraction approach. The significance of Path2Green lies in its ability to distill complex environmental data into a simple, accessible metric. This facilitates informed decision-making for stakeholders across industries, enabling them to prioritize greener extraction practices. Moreover, by setting clear benchmarks and standards, Path2Green incentivizes innovation and drives continuous improvement in sustainability efforts, being a new user-friendly methodology.

Knowledge, Attitudes, and Practices Associated with the Selection of Sweetened Ultra-Processed Foods and Their Importance in Oral Health

BACKGROUND

Reading nutritional labelling helps consumers select healthier food, thereby benefitting their oral health. The purpose of this study was to describe the knowledge, attitudes, and practices (KAPs) of parents and carers of children and preteens, associated with reading nutritional labelling, selecting sweetened ultra-processed foods, and their impact on oral health.

MATERIALS AND METHODS

This was a descriptive cross-sectional study in which a validated questionnaire was administered to 298 parents and caregivers of children aged 1-12 years from different districts in Villavicencio, Colombia. Participants' scores, based on the number of correct answers, were used to classify their level of KAP as low, medium, or high. In addition, the frequency of responses, the KAP levels, and the median scores were analysed. Finally, associations were determined using the chi-square test.

RESULTS

Most participants reached a medium level in terms of knowledge (41.6%) and attitudes (49.3%) and a low level in terms of practices (43.3%). An association was found between participants' level of KAPs and their socioeconomic and educational level (p < 0.05).

CONCLUSIONS

The study findings reveal inadequate KAPs associated with nutritional labelling, adequate food selection, and the importance of oral health.

Nutrition classification schemes for plant-based meat analogues: Drivers to assess nutritional quality and identity profile

Changes in dietary patterns promoted by the emergence of alternative food systems are becoming increasingly common. The decrease in the consumption of animal-derived products promoted exponential growth in plant-based product demand and, consequently, the availability of several meat analogues for this consumer market. Plant-based meat analogues (PBMAs) were developed to mimic the physical and sensory characteristics of meats and their derivatives. Therefore, the composition of these products has been studied in some countries as an attempt to evaluate their nutritional quality in comparison with that of traditional meat products. The main aim of this study was to employ different Nutrition Classification Schemes (NCSs) to assess the nutritional quality of plant-based meat and to discuss the application of one or more NCSs in defining the identity and quality profile of these foods. Five NCSs were used: three nutrient-based (Nutri-Score; Nutrient Profiling Model (NPM) from Brazil; NPM from PAHO); one food-based (NOVA classification); and one hybrid (Plant-Based Nutrient Profile Model). The nutritional composition and ingredients were collected from labels of 349 PBMAs; 117 were classified as burgers, and 182 products employed soy as the main protein ingredient. The use of different NCSs is strategic for PBMAs' nutritional quality evaluation, and the Nutri-Score was able to show the effectiveness of differentiating products as having poor nutritional quality. In this way, the employment of NPM from Brazil is recommended as a driver for PBMAs choices, especially due to the excellent agreement between the Nutri-Score and NPM from Brazil for burgers.

Warning labels for sugar-sweetened beverages and fruit juice: evaluation of 27 different labels on health effects, sugar content, energy and exercise equivalency

OBJECTIVES

Front-of-pack warning labels may reduce consumption of sugar-sweetened beverages, potentially mitigating negative health outcomes. Comparisons between different warning label types to inform future research and policy directions are lacking. This study compared 27 warning labels across six message types for their potential to reduce sugar-sweetened beverage consumption.

DESIGN AND METHODS

A national sample of regular soda (n = 2578) and juice (n = 1048) consumers aged 14-60 years participated in an online survey. Participants evaluated randomly allocated labels; one from each of six warning label sets (health-graphic, sugar-pictogram, sugar-text, exercise equivalents, health-text, energy information) on four measures of perceived effectiveness (PE: overall effectiveness, discourage from drinking, emotional response, persuasive potential). Participants could also provide open comments. A general linear model compared differences in mean scores across label sets for each measure of PE.

RESULTS

PE ratings differed significantly between label sets. Labels clearly quantifying sugar content (sugar-teaspoons) received consistently high PE ratings, whereas 'high in sugar' labels did not. Health-graphic labels were rated highly across all PE measures except persuasive potential. Exercise labels only rated highly on persuasive potential. Health-text results were mixed, and energy labels were consistently low.

CONCLUSIONS

Simple, factual labels were easily interpreted and perceived as most effective. Labels quantifying sugar content were consistently high performers and should be advanced into policy to help decrease overconsumption of sugar-sweetened beverages.

The Double Burden of Malnutrition is Associated with Continued Breastfeeding and Early Consumption of Ultra-Processed Drinks in Socially Vulnerable Brazilian Children

This study aimed to assess the association between the double burden of malnutrition (DBM) with continued breastfeeding and the early introduction of ultra-processed drinks in children living in situations of social vulnerability. This cross-sectional population-based study was carried out in a capital city in the Northeast of Brazil, which included 561 children. It was observed that introducing soft drinks into the child's diet during the first year of life was directly associated with DBM but indirectly with continuous breastfeeding for 12 or more months. These results indicate paths that can be followed to reverse the current scenario.

Evaluation of the Nutritional Quality of Chinese Processed Meat Products: Comparison of Two Nutrient Profile Models

Processed meat products are one of the most consumed pre-packaged foods in China. They are also group-1 carcinogens, whose consumption has proved to be positively associated with the risk of noncommunicable diseases (NCDs). The purpose of this study is to analyze the nutrient content on the food label of processed meat products based on the China Standardized Database for the Composition of Pre-packaged Food and the National Open Database of the UK and France. The Chilean front-of-pack warning label (FOPWL) and the Chinese Healthier Choice Logo were used to compare the nutrient content of processed meat products from the three countries. It was found that cured meat products have the highest median energy (483 kcal/100 g), total fat content (38.7 g/100 g), and sodium content (2076 mg/100 g) and dried meat products have the highest median protein content (30.2 g/100 g) and carbohydrate content (38.2 g/100 g). In addition, there were significant differences in energy content and contents of total fat, protein, and carbohydrate across different products of the three countries (p < 0.001). A large number of processed meat products currently collected did not meet the criteria of the Chilean FOPWL and the Chinese Healthier Choice Logo. This study provided information on the healthiness of Chinese processed meat products and provided data for improving food formulations for different categories of processed meat products.

The combined effect of front-of-package labels and influencer recommendations on food choice decisions

Many governments have adopted front-of-pack nutrition labels (FOP labels) that give advice about how healthy a product is. An increasing number of digital food influencers are also informing consumers about the nutritional quality of products and promoting healthy consumption. In this context, the current study analyzes how both sources of information come together to affect purchase intention. Drawing on congruence theory, we propose that the influencer's recommendation reinforces the effect of the FOP label when there is congruence between the two; however, consumers clearly prefer to follow the recommendation of the influencer over the FOP label when the information sources are non-congruent. We develop a between-subjects experimental design in which the level of congruence between the two information sources is manipulated. The effect of the influencer on purchase intention is mediated by the credibility of the FOP label. A second study confirms the superiority of the influencer effect observed in the first study.

Evaluating front-of-pack voluntary well-being messaging for milk powders targeting Chinese older adults: A hedonic price model

This study examines the price structure of milk powders targeting Chinese older adults, with special emphasis on the assessment of front-of-pack (FOP) voluntary well-being messaging (VWM), using a hedonic price model. Data of 456 sets of product prices and attributes were collected from official stores at online shops, TMALL.com and JD.com, in China. Prices were recorded 10 d before, during, and 10 d after a major online promotion event (November 11, 2021). A hedonic price model was employed to decompose explicit market prices into individual product attributes implicit prices, including essential attributes, such as milk source, brand origin, package material, and nutritional composition, and nonessential attributes conveyed by FOP VWM, regarding nutrition, ingredients, health, sensory qualities, and certification. Results showed that above and beyond essential attributes, nonessential attributes conveyed by FOP VWM were significantly associated with price. Specifically, significant price premiums were associated with dietary fiber claims (+12.7%), no added sugar (+19.0%) and potential health benefits (+19.3%), as nutrition-, ingredient-, and health-related FOP VWM respectively. However, nutrition claims regarding calcium and fat were negatively associated with price (-21.2% and -8.0%, respectively, when they were presented). Additionally, nutrition claims for protein and vitamin D, introducing farm environment, referring to imported ingredients, declaring specific ingredients added, describing sensory characterizes and providing certificates on FOP were not significantly associated with price in this market. These findings provide manufacturers with information to better differentiate their products by producing and advertising attributes most valued by consumers.

Do Brazilian consumers intend to use food labels to make healthy food choices? An assessment before the front-of-package labelling policy

Front-of-package labelling is a measure that can facilitate consumption of healthier foods. This study examined the predictors of consumers' intentions to use food labelling to make healthy food choices and prevent non-communicable diseases before the implementation of the front-of-package labelling policy in Brazil. An extended theory of planned behaviour incorporating knowledge and food literacy served as the theoretical foundation. First, experts (n = 6) and the target population (n = 30) validated the questionnaire, and the validation data were analysed using content validity coefficients (CVC). An online questionnaire was administered to 783 participants, and data were collected between May and October 2022. Partial least squares structural equation modelling (PLS-SEM) was used to test the prediction hypothesis. The questionnaire showed adequate content validity, with all indicators of CVC ≥ 0.75. In the PLS-SEM attitudes (p < 0.001), subjective norms (p < 0.001), knowledge (p < 0.001), and food literacy (p < 0.001) positively predicted the intention to use food labels to make healthy food choices, confirming the main hypothesis. Also, Food literacy and knowledge predicted all constructs of the theory of planned behaviour (p < 0.001). The results highlight the importance of providing nutritional knowledge and food literacy, developing nutritional skills and abilities to encourage consumers to make healthy food choices, and to strengthen other policies such as front-of-package labelling.