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Nutrients 2017, 9(12), 1284; doi:10.3390/nu9121284

Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases—A Randomised Controlled Trial

1
The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia
2
The Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
3
Royal Prince Alfred Hospital, University of New South Wales, Sydney, NSW 2050, Australia
4
Department of Epidemiology and Biostatistics, Imperial College London, London SW7 2AZ, UK
5
Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
6
National Heart Foundation of Australia, Melbourne, VIC 3000, Australia
7
Bupa, Brisbane, QLD 4001, Australia
8
National Institute for Health Innovation, University of Auckland, Auckland 1010, New Zealand
9
School of Psychology and Speech Pathology, Curtin University, Bentley, WA 6102, Australia
10
School of Health and Social Development, Deakin University, Melbourne, VIC 3008, Australia
*
Author to whom correspondence should be addressed.
Received: 11 October 2017 / Revised: 10 November 2017 / Accepted: 19 November 2017 / Published: 24 November 2017
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Abstract

Background: Front-of-pack nutrition labelling may support healthier packaged food purchases. Australia has adopted a novel Health Star Rating (HSR) system, but the legitimacy of this choice is unknown. Objective: To define the effects of different formats of front-of-pack labelling on the healthiness of food purchases and consumer perceptions. Design: Individuals were assigned at random to access one of four different formats of nutrition labelling—HSR, multiple traffic light labels (MTL), daily intake guides (DIG), recommendations/warnings (WARN)—or control (the nutrition information panel, NIP). Participants accessed nutrition information by using a smartphone application to scan the bar-codes of packaged foods, while shopping. The primary outcome was healthiness defined by the mean transformed nutrient profile score of packaged foods that were purchased over four weeks. Results: The 1578 participants, mean age 38 years, 84% female recorded purchases of 148,727 evaluable food items. The mean healthiness of the purchases in the HSR group was non-inferior to MTL, DIG, or WARN (all p < 0.001 at 2% non-inferiority margin). When compared to the NIP control, there was no difference in the mean healthiness of purchases for HSR, MTL, or DIG (all p > 0.07), but WARN resulted in healthier packaged food purchases (mean difference 0.87; 95% confidence interval 0.03 to 1.72; p = 0.04). HSR was perceived by participants as more useful than DIG, and easier to understand than MTL or DIG (all p < 0.05). Participants also reported the HSR to be easier to understand, and the HSR and MTL to be more useful, than NIP (all p < 0.03). Conclusions: These real-world data align with experimental findings and provide support for the policy choice of HSR. Recommendation/warning labels warrant further exploration, as they may be a stronger driver of healthy food purchases. View Full-Text
Keywords: food labelling; food industry; food purchases; policy; randomised trial food labelling; food industry; food purchases; policy; randomised trial
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Neal, B.; Crino, M.; Dunford, E.; Gao, A.; Greenland, R.; Li, N.; Ngai, J.; Ni Mhurchu, C.; Pettigrew, S.; Sacks, G.; Webster, J.; Wu, J.H.Y. Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases—A Randomised Controlled Trial. Nutrients 2017, 9, 1284.

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