Search Results (119)

Front-of-pack labels (FOPLs) have been identified as a potential key tool to enable consumers to make healthier and more sustainable food choices. The simplification of complex nutritional, environmental, and processing data into clear and immediate formats is an essential function of FOPLs, which facilitates a more efficient connection between detailed product information and real-world purchasing decisions. This review critically evaluates the three main categories of FOPL—nutritional (e.g., Nutri-Score), environmental (e.g., Eco-Score) and processing-based (e.g., NOVA)—and examines emerging efforts to weave these dimensions into unified labelling frameworks. A bibliometric analysis of 1803 publications from Scopus, Web of Science, and Google Scholar was conducted, using VOS viewer to identify co-occurrence networks and thematic clusters. A narrative synthesis of label design methods, regulatory steps and consumer impact research followed this. Despite the considerable maturation of individual FOPLs, their combined application remains ad hoc. Establishing harmonized, multidimensional criteria is therefore essential to ensure consistent labelling that informs consumers and promotes public health and sustainability goals. Full article

Background/Objectives: In 2020, the National Nutrition Committee in Saudi Arabia launched a nutrient profile model, aiming to support the classification of foods and beverages in line with successful international approaches. The objective of this study was to compare the existing Saudi Arabian nutrient profile model to other established models to help inform diet-related policies in the country. Methods: Packaged food and beverage data were obtained from Mintel’s Global New Products Database. Products were evaluated under the Saudi Arabian nutrient profile model, Nutri-Score and Chile’s high fat, salt, sugar (HFSS) model. Agreement among the three nutrient profile models was examined using Fleiss’ kappa statistic. Results: There were 6940 products used in analysis. All three models showed a low proportion of eligible/healthy products, with 26% for Chile’s HFSS model, 28% for Nutri-Score and 25% for the Saudi Arabian nutrient profile model. There was substantial agreement (86%; k = 0.74) among all three models examined, with the highest agreement between the Saudi Arabian nutrient profile model and the Nutri-Score model. Conclusions: All three demonstrated a sub-optimal level of overall healthiness in the Saudi Arabian packaged food and beverage supply, with <30% of products under all models considered “healthy”. Given the substantial agreement among all three nutrient profiling approaches examined, it is likely that Saudi Arabia could benefit from the use of a categorical approach to nutrient profiling such as the Nutri-Score model, which allows for a more scaled view on product healthiness compared to a binary approach. Full article

Background/Objectives: Autism Spectrum Disorder (ASD) is characterized by social communication challenges and repetitive behaviors. Children with ASD often exhibit selective eating habits that may result in nutritional deficiencies and exacerbate developmental issues. While food frequency questionnaires (FFQs) are effective for dietary assessment, the links between food preferences, ASD severity, and developmental outcomes remain underexplored, particularly in Bulgaria. This study examines these relationships using validated tools. Methods: The present report constitutes a pilot, hypothesis-generating substudy of the broader NutriLect project. This substudy involved 49 children aged 2–12 years diagnosed with ASD. Dietary patterns were evaluated with a modified FFQ, while ASD severity and developmental profiles were assessed using the Childhood Autism Rating Scale, Second Edition (CARS-2) and the Developmental Profile 3 (DP-3). Results: Among 49 ASD children (mean age = 6.89 ± 2.15 years; 86% boys), 73.4% consumed grains/potatoes daily. Only 34.7% met combined fruit and vegetable recommendations. Only 36.7% met the recommendation for daily milk or other dairy product consumption. Fish was consumed at least twice weekly by only 22,4%. Furthermore, children with more severe autism were approximately 9.4 times more likely to consume grains daily (χ² = 14.319, p = 0.006). Logistic regression analyses indicated that higher cognitive scores were strongly associated with lower grain (OR ≈ 0.044) and other dairy products consumption (OR ≈ 0.337), yet with greater fish intake (OR ≈ 3.317). In contrast, better communication skills corresponded to increased milk consumption (OR ≈ 5.76), and higher physical development scores predicted more frequent egg consumption (OR ≈ 4.40). Conclusions: The pronounced preference for grain and meat products, which are frequently ultra-processed, and avoidance of nutrient-dense foods in children with severe ASD symptoms underscore the need for tailored dietary interventions. These interventions must address sensory sensitivities, nutritional inadequacies, and the risks that selective nutrition can have on the nutritional status and development of the children. Full article

Background: In response to criticism and limitations of the Nutri-Score Nutrient Profiling Model (NS-NPM), the algorithm was updated in 2023. However, its impact on beverage classification remains partially assessed. Objective: This study aimed to compare the nutritional profiles of beverages marketed in Spain using the original and updated NS-NPM algorithms. Methods: Nutritional data for 3432 beverages in the “Drink Base” database were analyzed using both the 2015 (original) and 2023 (updated) NS-NPM versions. Results: The 2023 update showed significant changes compared to the 2015 version. Updated scores particularly increased for artificially sweetened beverages (+190.3%), milkshakes (+98.9%), nut-based beverages (+343.9%), cereal-based beverages (+651.3%), and the mix of plant-based beverages (+733%), leading to a less healthy classification. Conversely, scores decreased for fruit juices (−12.7%) and alcohol-substitute beverages (−8.2%), while legume-based beverages maintained their classification with minimal score variation (−1.4%), raising questions about the treatment of free sugars. The remaining beverage categories experienced score changes that did not alter their classification. Conclusions: The 2023 NS-NPM algorithm improves beverage classification by refining the differentiation of sugar-sweetened and artificially sweetened beverages, improving consumer guidance. While it increases discrimination, challenges remain in the classification of plant-based beverages and fruit juices. These findings highlight Nutri-Score’s impact on industry reformulation and its potential as a public health tool to promote healthier beverage choices. This study provides novel evidence on how the updated Nutri-Score algorithm may influence consumer perception and food policy in the Spanish context. Full article

Introduction: Malnutrition is a critical issue among cancer patients, leading to adverse clinical outcomes, including increased treatment toxicity, reduced physical function, and decreased survival. Nutritional screening is essential to identify patients at risk and provide timely interventions. Objectives: This study aimed to assess the effectiveness of various nutritional screening tools in identifying the risk of malnutrition and obesity in Mexican cancer outpatients. Methods: A cross-sectional study was conducted with 396 adult cancer outpatients at a public hospital in Mexico. Nutritional risk was evaluated using NRS-2002, MUST, MST, NUTRISCORE, and PG-SGA, while malnutrition was assessed using GLIM criteria and PG-SGA. Anthropometric and demographic data were collected. Sensitivity, specificity, and kappa coefficients were calculated to determine the performance of the screening tools. Results: Nutritional risk was identified in 22.7–26.5% of patients, with the highest agreement observed between MUST and PG-SGA (k = 0.64). Malnutrition prevalence was higher using GLIM criteria (37.4%) compared to PG-SGA (25.8%, p < 0.001). Overweight and obesity affected 37.1% and 23.5% of patients, respectively. Low BMI and reduced HGS were strongly associated with nutritional risk and malnutrition (p < 0.001). Conclusions: MUST and PG-SGA are reliable tools for nutritional screening in cancer outpatients, while GLIM criteria detect a higher prevalence of malnutrition than PG-SGA. The high rates of overweight and obesity highlight the complex nutritional challenges in this population, emphasizing the need for tailored nutritional assessments and interventions. Full article

Among plant-based analogs, fish and seafood analogs (PBFSAs) represent a growing sector. This study analyzed the nutritional quality of PBFSAs in Italy and compared it to their animal-based counterparts. Nutritional declarations, ingredient lists, and claims were collected from PBFSA food labeling. Nutri-Scores of PBSFAs and animal-based counterparts were also determined as nutritional quality indicators. Fifty-one products were collected, with most attributed to tuna, salmon, and cod categories (n = 18, 12, and 14, respectively). Results showed large heterogeneity in nutritional quality, with cod products having higher energy (217 (201–257) kcal/100 g), protein (10.5 (7.9–13.0) g/100 g), and carbohydrate (19.4 (14.2–26.0) g/100 g) levels, while tuna and salmon products had a higher fat content (15.0 (10.0–19.7) and 13.5 (5.0–17.0) g/100 g, respectively). Products with fiber or fat nutrition claims did not necessarily indicate higher fiber or lower fat content, while products with a protein claim had a higher protein content. Most animal-based counterparts, except cod and sturgeon caviar, received an “A” Nutri-Score, and often scored better than the PBSFA due to lower salt content. In conclusion, PBFSAs on the market should not be considered animal product analogs regarding nutritional quality, but drawing definitive conclusions is challenging due to the limited number and high variability of the products. However, these findings provide insights that may improve PBFSA nutritional quality, such as decreasing salt and sugar content, for people trying to incorporate such foods into their diet. Full article

Background: The European Commission has called for a harmonised front-of-package nutritional label (FOPNL) system in the European region. The Keyhole is a widely adopted positive FOPNL used in several Nordic countries. The Nutri-Score is a five-level graded FOPNL, more recently introduced in Western Europe. Both FOPNLs are supported by intrinsically different nutrient profiling systems (NPSs). A third NPS is the Choices NPS, which originally supported a positive FOPNL similar to the Keyhole and has been expanded into a five-level NPS. Objectives: The main objective of this study was to investigate the overall alignment between both the Choices and Nutri-Score multi-level NPSs and the Keyhole NPS. Furthermore, food group-based alignment was analysed to understand the main sources of misalignment. Methods: In this study, we extracted 1064 food/drink items from the food and beverage database of the Swedish Food Administration. All products were assessed according to all three NPSs, and alignment was assessed, using the Keyhole NPS as a recommendation-based reference. Two definitions of alignment were examined—healthier (more lenient, i.e., two highest grades) and healthiest (stricter, i.e., only the highest grade). Results: The overall alignment between the Choices and Keyhole NPSs was similar to that between the Nutri-Score and Keyhole NPSs (89% and 85% alignment under the healthiest definition, i.e., stricter). However, two food groups showed poor alignment between the Nutri-Score NPS and the Keyhole NPS (~60%). Under the healthier (more lenient) definition, the alignment for both the Choices and Nutri-Score systems with the Keyhole system was lower (86% and 79%). Conclusions: The alignments and misalignments between the Choices/Nutri-Score systems and the Keyhole system prompt important considerations for future developments of FOPNL systems for the Nordic countries. Extending the Keyhole NPS to include a multi-level criterion could potentially help consumers identify healthier choices, even for less nutritious foods. Full article

Due to the beneficial composition of wine pomace, it has found several applications in the food industry, mostly in the form of flour or extracts. This study suggests the use of grape skin separated from the pomace as a functional ingredient for fruit bars based on the hypothesis that grape skin can contribute to fruit bar antioxidant potential. Fruit bars were produced with dried figs/dates, grape skin, and cocoa/hazelnut mix in different proportions (48–70%, 30–50%, and 0–2%, respectively). The addition of grape skin proved beneficial for the total polyphenolic content (TPC) and antioxidant capacity. Furthermore, consumers appeared to like the newly developed functional product, and the addition of up to 30% grape skin did not have an adverse effect of sensory properties. The bars were graded A based on the NutriScore value and were microbiologically compliant to food safety regulations. These results demonstrate the possibility of grape skin use in the development of a functional fruit bar product, which can be beneficial not only from chemical and sensory point of view, but also economically feasible and environmentally friendly. Full article

To promote sustainable food choices, it is essential to provide easily understandable information that integrates health, environmental impacts and planetary boundaries. For this purpose, the Planet Health Conformity Index (PHC) was developed and tested. Current labels, such as the Nutri-Score for health and the Eco-Score for environmental impacts, provide separate information, which may result in consumers receiving conflicting messages. The PHC combines these dimensions into a single label, aligning with consumer demand for clearer guidance and fostering sustainable food consumption and development. Methods: The PHC assesses 18 nutrients and five environmental impacts—Global Warming Potential (GWP), cropland use, freshwater use, nitrogen application (N-min) and phosphorus application (P-min)—within the framework of planetary boundaries. Six different algorithm designs, varying in capping and weighting, were tested on 125 food products from the German market. The analysis compared mass-, energy- and multi-nutrient-based functional units. Results: Under mass- and energy-based units, many products meet planetary boundaries. However, incorporating nutrient profiles often leads to exceeding these boundaries (exceedance rate PHC: GWP: 38% of products transgressed the boundary, cropland use: 41%, freshwater use: 27%, N-min: 34%, P-min: 71%). Accordingly, the PHC contextualizes nutritional strengths and weaknesses environmentally. Moreover, it disaggregates the Planetary Health Diet (PHD) at the nutrient level, facilitating adaptation to individual nutritional needs. Conclusions: Traditional food Life Cycle Assessments should include nutrients in the functional unit and consider planetary boundaries to enable more accurate food comparisons. The PHC presented here takes these aspects into account. In addition, its dual-factor approach, integrating health and environmental metrics, ensures broad applicability. Thus, the PHC Index can be applied not only to single food items but also to recipes, dishes, menus and entire diets. Full article

Background: To improve consumers’ diet, policy measures such as food reformulation strategies and front-of-pack nutritional labels (FOPNLs) are implemented, aiming to guide consumers’ food choice and to stimulate an improvement in food composition by manufacturers. The FOPNL Nutri-Score has been implemented in several European countries. Changes in food compositions in relation to the Nutri-Score over time have been limitedly studied. This study evaluates food compositions in Europe over time, and if changes in compositions of the food supply could have potentially resulted in changes in Nutri-Score classifications of foods. Materials and Methods: Food composition data were available from EUREMO, from which bread products, breakfast cereals, hot sauces, and processed potato products from Austria, Belgium, Finland, Italy, and the United Kingdom from 2019 to 2021 were selected (n = 2260). Of these countries, only Belgium had implemented the Nutri-Score in 2019. Distributions of food compositions and Nutri-Score classifications were calculated and changes in median salt, sugar, and saturated fatty acids content were plotted by food group, country and year. Distribution of the final sum of Nutri-Score points was plotted by nutrient, food group, country and year. Results: Overall, more favourable Nutri-Score classifications (i.e., towards Nutri-Score classification A) were observed in most of the selected food groups and countries over the years, due to the influence of specific nutrients such as salt in breakfast cereals (lower median of 0.1–0.4 g/100 g) and processed potato products (lower median of 0.1–1.2 g/100 g); and sugar in processed potato products (lower median of 0.1–1.9 g/100 g) and bread products (lower median of 0.7–2.2 g/100 g). For nutrient contents in other food groups, no consistent changes were observed. Conclusions: Changes in the compositions of the food supply resulted in favourable changes in Nutri-Score classifications, suggesting a potential for food reformulation. Monitoring after the actual implementation of Nutri-Score is recommended. Full article

To provide a systematic and quantitative summary of dietary factors and rheumatoid arthritis (RA) risk. A systematic review and meta-analysis included prospective cohort studies from 2000 to 2024 reporting relative risks (RRs) with 95% confidence intervals (CIs) for RA incidence relating to 32 different dietary exposures. Linear and non-linear dose–response analyses were conducted. Thirty studies were included, involving 2,986,747 participants with 9,677 RA cases. Linear dose–response analysis suggested that each 2-unit per week increase in total alcohol intake was linked to 4% risk reduction (RR (95%-CI), heterogeneity (I²), NutriGrade score: 0.96 (0.94, 0.98), 58%, moderate certainty), and beer consumption was associated with a 10% reduction per 2 units/week increase (0.90 (0.84, 0.97), 0%, very low certainty). Each 2-unit/week increase in total alcohol intake was associated with a 3% decrease in seropositive RA risk (0.97 (0.96, 0.99), 28%, moderate certainty). Increased intakes of fruit (per 80 g/day) and cereals (per 30 g/day) were associated with 5% (0.95 (0.92, 0.99), 57%, moderate certainty) and 3% (0.97 (0.96, 0.99), 20%, moderate certainty) reduced risk, respectively. Conversely, tea consumption showed a 4% increased risk per additional cup/day (1.04 (1.02, 1.05), 0%, moderate certainty). Non-linear associations were observed for total coffee, vegetables, oily fish, and vitamin D supplementation. Data on dietary patterns and specific micronutrients were limited. The findings suggest that moderate alcohol consumption and a higher intake of fruits, oily fish, and cereals are associated with a reduced risk of RA, while tea and coffee may be linked to an increased risk. Optimising dietary intake of certain food components may reduce RA risk, despite moderate-quality evidence. Full article

Front-of-pack labeling (FOPL) may represent an important instrument for the food industry in the promotion of food product reformulation. The present cross-sectional study used salt reduction in packaged breads as a case study, aiming to investigate whether two different types of FOPL (i.e., Nutri-Score (NS) and NutrInform battery (NIB)) can capture food reformulation and thus be effective tools for encouraging reformulation. The Nutri-Score and NIB were calculated by consulting the nutritional declarations and ingredient lists of 527 packaged breads currently sold in Italy before and after applying three different theoretical reformulation strategies: (i) a 25% salt decrease from the current median salt content in bread; (ii) a reduction of up to 0.825 g/100 g of salt, corresponding to the sodium benchmark of 330 mg/100 g set by the World Health Organization (WHO); and (iii) the minimum salt reduction needed to improve the NS by one grade. The results show that only ~44% of breads had improved NSs when the sodium was lowered to reach the WHO benchmark or when salt was reduced by 25%, whereas large variability was observed in the minimum salt reduction needed to improve the NS. Regarding the NIB, the battery for salt improved when both strategies of reformulation were applied. FOPL is not always effective in capturing food reformulation in terms of salt reduction, possibly discouraging the efforts of food companies to improve the nutritional quality of foods. Full article

Background/Objectives: Reducing visceral fat is a critical factor in preventing obesity-related health complications. In this study, we evaluated the effectiveness of our previously reported novel dietary intervention program, “Optimized Nutri-Dense Meals”, designed according to the Dietary Reference Intakes (DRIs) in Japan in reducing visceral fat. Method: This open-label, randomized controlled trial included 100 Japanese males with obesity or overweight. In total, 50 participants were assigned to a control group that continued their usual diets, and the other 50 consumed test meals twice per week for four weeks (test group). Result: The primary outcome, visceral fat area, significantly decreased in the test group compared to that in the control group (−7.5 cm², confidence interval [CI]: −14.3 to −0.6). In addition, we measured the changes in gut flora and work productivity. The abundance of Bifidobacterium (+1.5%, CI: 0.3–2.7) and Christensenellaceae (+0.4%, CI: 0.01–0.8) increased significantly in the test group compared with those in the control group. Work Limitation Questionnaire Japanese version scores representing presenteeism also significantly increased in the test group (+1.2 points, CI: 0.2–2.3) compared with the control group. Conclusions: These findings suggest that dietary interventions based on Japanese DRIs can effectively decrease visceral fat and improve health outcomes over the short term without the need for a complete dietary overhaul. Full article

In response to growing public health concerns, governments worldwide have implemented various nutrition labelling schemes to promote healthier eating habits. This study aimed to assess the consistency and effectiveness of these labels in an out-of-home context, specifically focusing on restaurant, hospitality, and institutional food service settings. In total, 178 different dishes from Spain were analysed using labels from the Mazocco method, the UK’s traffic light system, the Health Star Rating (Australia), Nutri-Score (France), multiple traffic lights (Ecuador), and warning labels (Chile and Uruguay). The results demonstrated a generally low level of agreement among these labels (K < 0.40), indicating notable variability and a lack of consensus, which could hinder consumers’ ability to make informed food choices in out-of-home settings. Nutri-Score classified the highest number of dishes as unhealthy (38%). This study underscores the need for an easy-to-understand labelling system tailored to each country’s culinary and socio-cultural contexts to improve consumer decision-making in various dining environments. Future research should focus on developing and testing qualitative methods to more accurately gauge the nutritional quality of cooked dishes in diverse out-of-home settings, thereby enhancing public health outcomes. By addressing the specific needs of the home, restaurants, hospitality, and institutional food services, tailored labelling schemes could significantly improve consumers’ ability to make healthier food choices. Full article

Objective: Analyse the breakfast cereal market to help to help healthcare professionals to guide parents in choosing healthy products for their children. Study design: Observational study of the breakfast cereals available in the biggest supermarkets, discount stores and organic chains in France, Belgium and Luxembourg. Methods: An analysis of nutritional qualities using three indicators: Nutri-Score (initial and modified version), WHO Europe nutrient profile model, and Nova. Results: 645 products were listed; 559 excluding duplicates. A total of 28.8% are marketed to children and make up the group of “children’s” cereals, 62.1% of cereals are Muesli, Oats and other cereal flakes (MOCF), and 54.9% are “organic”. The study shows that “children’s” cereals have a poorer nutritional profile: a higher proportion of Nutri-Score D, higher sugar content, lower fibre content, less conformity with the WHO Europe nutrient profile model and a higher proportion ofultra-processed. On the other hand, MOCF and “organic” products generally have a better nutritional profile: less sugar, more fibre, more Nutri-Score A, less Nutri-Score D and fewer ultra-processed products. Conclusions: Parents should therefore opt for cereals that do not bear any reference to children on the packaging. Full article