An Evaluation of the Nutri-Score System along the Reasoning for Scientific Substantiation of Health Claims in the EU—A Narrative Review
“the Commission shall […] establish specific nutrient profiles, including exemptions, which food or certain categories of food must comply with in order to bear nutrition or health claims and the conditions for the use of nutrition or health claims for foods or categories of foods with respect to the nutrient profiles”.
2. Materials and Methods
3. Results and Discussion
- The food/constituent is characterised;
- The claimed effect is ‘beneficial to human health’ (i.e., the context in which a food constituent should be characterised in relation to the claimed effect);
- A cause-and-effect relationship is established (i.e., there must be sufficient scientific evidence for the health claim).
3.1. The ‘Food/Constituent’ Is Defined/Characterised
3.2. The Claimed Effect Is ‘Beneficial to Human Health’
- Consumption of foods with higher FSA-NPS scores is associated with an increased risk of mortality from cancer and cardiocirculatory, gastrointestinal, and respiratory diseases .
- Consumption of foods with a higher FSA-NPS score is associated with poorer oral health .
- Consumption of foods with a higher FSA-NPS score is associated with greater asthmatic airway symptoms .
3.3. A Cause-and-Effect Relationship Is Established
|Year of Publication||Country||Authors Affiliated w Nutri-Score||Study Description||Results||Notes||Effect on FSA-NPS||Reference|
|2019||CO||no||Randomised field trial in a university cafeteria, with randomly provided information on the Nutri-Score. n= 484 participants.||Using the Nutri-Score led to more protein, more calories and more expenditures (on healthy items only) in purchases. Purchases of ‘unhealthy’ products did not decrease.||Customers were 10% more likely to buy a healthier item than controls. Information on the Nutri-Score system increased the store’s sales.||Not investigated||Mora-Garcia et al., 2019 |
|2019||SG||no||RCT investigating the effect of the Nutri-Score compared to the UK’s multiple traffic light system (MTL) and no label in online grocery store. n = 154 participants in a 3 × 3 crossover (within-person) design.||The Nutri-Score and MTL performed significantly better vs. no-label controls. NS performed statistically better than MTL and control-based on average Nutri-Score. MTL (but not the Nutri-Score) statistically reduced calories or sugar from beverages.||Thorough study with crossover design.||Not investigated||Finkelstein et al., 2019 |
|2021||BE||no||A difference-in-difference analysis of a natural experiment in 43 supermarkets of a major retailer in Belgium versus 14 control stores, studying the impact of shelf tags with the Nutri-Score on consumer purchases.||The proportion of Nutri-Score B and C product sales was more favourable in intervention than control stores and less favourable for Nutri-Score D product sales.|
A positive impact was found for 17/58 food categories (vegetable, fruit and dairy products, and confectionery), a negative impact for 16/58 categories (bread and bakery products).
|The impact on consumer purchases was mixed as difference–in-differences found were favourable for Nutri-Score B and C products and unfavourable for Nutri-Score D products.|
Shelf labelling on its own is unlikely to significantly influence consumer behaviour.
|Not investigated||Vandevijvere and Berger 2021 |
|2020||FR||no||RCT investigating four FOPLs (SENS, Nutri-Score, Nutri Repère, Nutri-Couleurs) to improve the nutritional quality of food purchases in real-life grocery shopping|
|The Nutri-Score increased purchases of foods in the top-third of their category by 14% nutrition-wise, but had no impact on purchases of foods with medium, low or unlabelled|
|The Nutri-Score improved the nutritional quality of labelled foods purchased by only 2.5% in the FSA-NPS score. Effect sizes were 17 times smaller on average than those found in comparable laboratory studies.||Yes, but based on four product groups only||Dubois et al., 2020 |
|2019||FR||yes||Three RTCs in students (n = 1866), low-income individuals (n = 336), and cardiovascular patients (n = 1180) investigating the effect of the Nutri-Score on overall nutritional quality of purchases in an online supermarket compared to the RIs and no label.||Shopping cart contents were lower in calories and saturated fatty acids and higher in fruits and vegetables in the Nutri-Score arm than in the other arms.||No significant difference between the Nutri-Score and no-label groups or between RIs and no-label groups.||Yes, but no significant effect of Nutri-score versus no label||Egnell et al., 2019 |
|2021||FR||yes||Three RTCs in students (n = 1866), low-income individuals (n = 336), and cardiovascular patients (n = 1180) investigating the effect of the Nutri-Score on purchasing intentions in an online supermarket compared to RIs and no label.||Shopping carts of participants simulating purchases with the Nutri-Score affixed to pre-packaged foods contained a higher proportion of unpacked products—especially raw fruits and meats, i.e., with no FoPL—comparedto participants purchasing with no label or withRIs.||This is a sequel paper to the one above (#17). It is a post-hoc analysis, viz. analyses that were not originally planned.“The Nutri-Score appears to decrease purchases in processed products resulting in higher proportions of unprocessed and unpacked foods, in line with public health recommendations.”||Not investigated||Egnell et al., 2021 |
|2021||FR||yes||RCT investigating the effect of the Nutri-Scorecompared to RIs and no label. Participants (n = 336) went on a simulated grocery shopping at an experimental online supermarket.||The Nutri-Score performed significantly better versus RIs (overall nutritional quality of the shopping cart, and lower caloric and saturated fatty acids content), but not versus no label.||This is one of the three arms in the study mentioned above published as a separate paper.||Yes, but no significant effect of Nutri-score versus no label||Egnell et al., 2021 |
|2021||NL||no||Investigate the effect of the Nutri-Score on (n = 192) consumer attitudes, taste perception, and purchase intention in an online environment by comparing the Nutri-Score’s efficacy on three different snacks labelled with Nutri-Score A, B, and C.||No effects of the Nutri-Score were observed on attitudes, taste perception, or purchase intention.||This study is similar to those conducted by the Nutri-Score’s developers.||Not investigated||Folkvord and Pabian 2021 |
Data Availability Statement
Conflicts of Interest
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Peters, S.; Verhagen, H. An Evaluation of the Nutri-Score System along the Reasoning for Scientific Substantiation of Health Claims in the EU—A Narrative Review. Foods 2022, 11, 2426. https://doi.org/10.3390/foods11162426
Peters S, Verhagen H. An Evaluation of the Nutri-Score System along the Reasoning for Scientific Substantiation of Health Claims in the EU—A Narrative Review. Foods. 2022; 11(16):2426. https://doi.org/10.3390/foods11162426Chicago/Turabian Style
Peters, Stephan, and Hans Verhagen. 2022. "An Evaluation of the Nutri-Score System along the Reasoning for Scientific Substantiation of Health Claims in the EU—A Narrative Review" Foods 11, no. 16: 2426. https://doi.org/10.3390/foods11162426