Search Results (143)

Background/Objectives: Poor dietary habits are a major contributor to non-communicable diseases (NCDs), the leading cause of mortality worldwide. To promote healthier eating, governments and stakeholders have implemented various nutrition policies, including front-of-pack nutrition labeling (FOPNL). The Choices International Foundation (Choices), through its criteria, supports these efforts through its standardized nutrient profiling system (NPS). Originally developed to underpin a positive FOPNL logo, in 2021, the criteria were expanded into a globally oriented five-level profiling system covering 23 basic and 10 discretionary food groups, addressing key nutrients such as trans-fatty acids, saturated fat, sodium, sugar, fiber, and energy. To ensure continued scientific relevance, the Choices criteria are periodically reviewed by an independent International Scientific Committee (ISC). Methods: This paper presents the 2025 revision of the Choices criteria, focusing on priority areas identified through stakeholder consultation and recent scientific developments. Results: Key updates include the introduction of nutrient-based equivalence criteria for plant-based alternatives to meat and dairy, based on protein and selected micronutrient thresholds. Non-sugar sweeteners (NSSs) were newly included as a factor that lowers a product’s health classification and makes it ineligible for a positive FOPNL. Additionally, the industrially produced trans-fatty acid (iTFA) criteria were revised and aligned with the latest World Health Organization (WHO) recommendations, improving both technical feasibility and policy coherence. While options for incorporating whole-grain and micronutrient criteria were explored, these were not included in the current revision. Conclusions: The 2025 update system enhances the scientific rigor, policy alignment, and global applicability of the Choices system. By providing a harmonized and evidence-based tool, it aims to support national policies that foster healthier food environments and, ultimately, improve public health outcomes worldwide. Full article

Background/Objectives: Obesity is a major global public health and economic challenge. Governments worldwide have implemented nutrition-focused policies such as sugar-sweetened beverage taxes, front-of-pack labeling, food assistance reforms, and school nutrition standards to improve diet quality and reduce obesity. Because large-scale randomized controlled trials are often infeasible and conventional epidemiologic methods overlook population heterogeneity and behavioral feedback, microsimulation modeling has become a key tool for evaluating long-term and distributional policy impacts. This scoping review examined the application of microsimulation to obesity-related nutrition policies, focusing on model structure, behavioral parameterization, and integration of economic and equity analyses. Methods: Following PRISMA guidelines (PROSPERO CRD42024599769), five databases were searched for peer-reviewed studies. Data were extracted on policy mechanisms, model design, parameterization, and equity analysis. Study quality was assessed using a customized 21-item checklist adapted from CHEERS and NIH tools. Results: Twenty-nine studies met the inclusion criteria, with most policy settings based in the United States. Most employed dynamic, stochastic, individual-level microsimulation models with diverse behavioral assumptions, obesity equations, and calibration approaches. While most studies stratified outcomes by socioeconomic or demographic group, only one used a formal quantitative equity metric. Conclusions: Microsimulation modeling provides valuable evidence on the long-term health, economic, and distributional impacts of nutrition policies. Future work should strengthen methodological transparency, standardize equity assessment, and expand application beyond high-income settings to improve the comparability, credibility, and policy relevance of simulation-based nutrition policy research. Full article

There is no clear consensus regarding which Front-of-Pack (FoP) label is more effective in promoting healthier food choices. This study explored consumers’ healthiness perception (HP) and willingness to buy (WTB) foods labelled with two different FoP labels: Nutri-Score (NS) and NutrInform Battery (NIB). The role of individual characteristics, such as sociodemographic variables, purchasing behaviors, orthorexia nervosa tendency, and cognitive abilities, in predicting consumers’ responses was also examined. Through an online survey, Italian consumers (n = 436; 71% female; average age: 38.9 ± 14.7) evaluated the HP and WTB of yoghurt and fruit jam, with three different nutritional qualities (high, medium, low) and labelled with both NS and NIB. The results showed significant differences between NS and NIB, with effects varying across product categories and nutritional profiles. Age, frequency of nutrition label reading, and role in buying decisions emerged as significant predictors of consumers’ responses, particularly for products with high nutritional quality. Conversely, orthorexia nervosa tendencies and cognitive abilities did not significantly predict differences in HP and WTB between FoP labels. These findings expand the understanding of the complexity involved in selecting an appropriate FoP labelling system and offer valuable insights to effectively guide healthier food choices while accommodating diverse consumers’ profiles. Full article

Domestic demand for honey in Kenya consistently exceeds national production, resulting in periodic reliance on imports. Kenyan honey is typically branded and marketed according to its geographical origin, whereas information regarding botanical origin is rarely communicated. This study was undertaken in two phases: a systematic review of the literature on honey varieties in Kenya—with an emphasis on legislation, production, and processing—and an online survey assessing front-of-pack (FoP) labeling descriptions. Legislatively, Kenyan honey varieties are categorized based on (i) the bee species producing the honey (honeybee or stingless bee), (ii) the intended use (direct human consumption or industrial application), and (iii) the presence of added flavoring agents. The results from the FoP labeling survey indicated that all domestic honey samples (n = 24) failed to comply with labeling requirements, instead emphasizing descriptors such as “natural” and “pure.” Only 40% of imported honey brands (n = 10) declared the botanical origin and processing method. Mellisopalynological studies showed that honey produced in the Acacia woodlands of Baringo, West Pokot, and Kitui can legitimately be marketed as Acacia honey. In contrast, honey from the Eastern Mau forest can be characterized as monofloral Eucalyptus, Croton, Albizia, or Cordia spp. honeys, with numerous bifloral and multifloral combinations. Sisal and mangrove honeys were also identifiable in landscapes dominated by these plant species. The lack of legislative classification for Kenyan monofloral honeys appears to contribute to widespread non-compliance in industry labeling practices. Although Kenyan honey remains competitive, inadequate product differentiation and weak labeling hinder access to niche domestic and international markets. To strengthen competitiveness, Kenyan honey legislation should incorporate provisions for characterizing monofloral honey types, processing standards, and mellisopalynological authentication. Such measures will enhance producer awareness, promote adoption of good processing practices, strengthen compliance with trade regulations, and support the development of a robust national honey value chain. Full article

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: The majority of Australian children exceed the World Health Organization’s recommended dietary intake of free sugar, particularly through the consumption of sugar-sweetened beverages. Front-of-pack nutrition labels increase perceived risk and deter the consumption of sugar-sweetened beverages. However, past studies of young children have focused almost exclusively on a parent’s choice of beverage for children. This study investigated the influence of four label designs (text-based warning, tooth decay pictorial, teaspoons of sugar, and Health Star Rating) on the beverage choices of N = 1229 Australian children (aged 4–11 years) and their parents. Methods: In an online vending machine scenario, parent–child dyads were separately asked to select which beverage they would choose for themselves before and after being randomised to one label condition. The beverages displayed included 100% fruit juice, soft drink, soft drink with a non-nutritive sweetener, flavoured milk, plain milk and bottled water. Beverage healthiness was determined by a 1–10 rating based on a review by a panel of experts (10 dietitians and nutritionists). Results: Mixed-model ANOVAs showed that for parents, each label design performed comparably; however, for children, small but significant differences were seen in the effectiveness of different label designs, with the teaspoons of sugar label, text-based warning, and tooth decay pictorial found to be more impactful in promoting healthier drink choices than the Health Star Rating. Conclusions: These findings can inform public health advocacy efforts to improve food labelling and could be incorporated into educational resources to help children understand the nutritional profiles of different sugary drinks. Full article

Background: The health benefits associated with the consumption of nuts and seeds are well established, yet this food group is known to be the furthest from the recommended intake; therefore, actions aiming to increase nut intake are needed. The main front-of-pack communication device in Australia, the Health Star Rating (HSR), inadvertently penalises nuts with negative points associated with energy and saturated fat content. Methods: This study aims to suggest options to policy makers by (i) examining how the HSR rates a sample of 82 nuts, seeds and products containing them and (ii) testing three sets of moderate adjustments of the HSR algorithm on the sampled products: discounting the energy from nuts and seeds (S1), discounting the saturated fat from nuts and seeds (S2) and applying an adapted algorithm based on that for ‘oils and spreads’ for foods with ≥50% nuts and seeds (S3). Results: All three scenarios improved the Spearman correlation between the HSR score and the nut and seed content (−0.80, −0.75 and −0.71 for S1, S2 and S3, respectively) compared to the original HSR (−0.66). Products with more than 50% of their weight being nuts and seeds benefited much more from these adjustments than those below 50%. For all scenarios, but most clearly for S3, the products that had a lower HSR score than the original HSR (the healthier products) benefited more from the changes brought about by the adjusted algorithms than those of lower nutritional quality. The HSR of foods that contained no nuts or seeds remained unchanged. Conclusions: With minor changes to the HSR algorithm, nut and seed products could be brought into alignment with the current evidence, encouraging their regular inclusion in dietary patterns, which could help guide consumers at the supermarket shelf. Full article

Background: To help consumers make healthier choices, the US Food and Drug Administration (FDA) has been charged with developing a front-of-package label (FOPL) to appear on US packaged foods and beverages. One option being explored is the use of “high-in” FOPLs for added sugar, sodium, and saturated fat using a threshold of ≥20% of the recommended daily value (%DV) per portion/serving size to define “high-in”. While research has addressed what FOPL designs are most effective at visually communicating “high-in”, less attention has been paid to the nutrient profile model (NPM) used to decide which products should receive these labels. In addition, several established regional NPMs already exist that identify products that are high in nutrients of concern, but it is unclear how these compare to the FDA’s %DV approach. Methods: We used a dataset of 51,809 US products from Mintel’s Global New Products Database to examine how the FDA’s current definition of “high-in” compares to three established regional NPMs: the Canadian NPM, the Pan American Health Organization (PAHO) NPM, and Chile’s NPM. Results: Overall agreement between the four NPMs was 51% for foods and 72% for beverages, with highest agreement in categories such as sweetened sodas (87%), and lowest agreement in categories such as bread (14%) and salty snacks (29%). The Canadian NPM showed the highest agreement to the FDA “high-in” criteria while the Chilean and PAHO models had lower agreement. For many food categories, the FDA’s definition of “high-in” would require the fewest products to carry a “high-in” label. This issue was particularly pronounced in categories that tend to be served in small portions (e.g., salty snacks, bars), but disappeared or reversed for categories that are served in larger portions (e.g., frozen and non-frozen main dishes). Conclusions: The NPM chosen has important policy implications for an FOPL system’s ability to identify unhealthy foods and incentivize companies to reformulate products. Based on these results, the FDA should consider using a stronger NPM similar to those used elsewhere in the Americas region when deciding the final thresholds for “high-in” for US packaged foods and beverages. Full article

The Smart Choice logo (SCL), as an encouraging form of front-of-package nutrition labeling (FOPNL), helps consumers to choose low-oil, -salt, and -sugar mooncakes during the Mid-Autumn Festival. It is widely acknowledged that nutrition knowledge contributes to nutrition label use, but there has been little research on whether it helps enhance consumers’ willingness to pay (WTP). Our study aims to fill this gap by investigating 630 randomly selected Chinese adults from Jilin, Inner Mongolia, Shaanxi, Shandong, Henan, Sichuan, and Guangdong. The semi-double-bounded dichotomous choice contingent value method was selected to measure their WTP for pre-packed mooncakes with the SCL at 20 different premium levels, ranging from 0% to 95% of the price per unit. It was found that the respondents’ WTP decreased by 0.7% as the premium level increased by 1%, and the WTP of people from South China, those who were obese, and those with a high income was not sensitive to changes in premium. Nutrition knowledge played a negative moderating role, and the probability of the premium levels affecting WTP decreased by 1.0% for each 1 point increase in the nutrition knowledge level. These findings highlight the potential implications associated with SCL promotion and differentiated mooncake pricing, as well as the supply of healthier Chinese holiday foods. 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

Background: Front-of-package labeling (FOPL) is shown to support healthier consumer choices. Many countries have adopted different FOPL systems. Objective: This study explored perceptions and understanding of three FOPLs and identified features that could enhance their effectiveness in Kenya. Methods: A qualitative study was conducted across four Kenyan counties—Nairobi, Mombasa, Garissa, and Kisumu. Data from 12 focus group discussions with 137 adults of diverse socio-demographic backgrounds were analysed. Participants evaluated three FOPLs: Red and Green (RG) Octagon, Red and Green Octagon with icons and text (RGI), and Black Octagon Warning Label (WL). The FGDs assessed visibility and memorability, comprehension, potential effectiveness, and cultural relevance of each label. NVivo version 14.0 was used for thematic analysis. Results: Kenyan consumers had mixed perceptions of the proposed FOPLs. The black Octagon WL was found to be the most visible and memorable due to its bright colours. Although the RG and RGI symbols were visually engaging, some participants reported confusion with the colour meanings. The WL was also more readily understood due to its text. Overall, WL was preferred for its potential to influence purchasing decisions, while all three FOPLs were considered culturally suitable. Conclusions: The Black Octagon Warning Label was the most visible and comprehensible of the three FOPLs and shows promise in influencing consumer behaviour in Kenya. While RG and RGI symbols are appealing, their colour scheme could reduce their effectiveness. Educating consumers on FOPLs could enhance their impact in reducing unhealthy food purchases. Full article

Background: Front-of-pack-labels (FOPLs) on packaged foods provide essential information to help consumers make informed dietary choices. However, evidence on their effectiveness, particularly in low- and middle-income countries like Kenya, is limited. Objective: This study assessed the effectiveness of three FOPLs in helping consumers identify nutrients of concern in packaged food products and influencing their purchase intention in Kenya. Methods: A total of 2198 shoppers from supermarkets in Nairobi, Mombasa, Kisumu, and Garissa were randomized into three groups: Red and Green Octagon label (RG), Red and Green Octagon with icons (RGI), and Black Octagon Warning label (WL). In the control phase, participants were shown unlabeled images of packaged foods, followed by questions. In the experimental phase, the same images were presented with one assigned FOPL, and participants responded again to the same set of questions. Differences in correct identification of nutrients of concern and changes in purchase intention were analyzed using frequency tables and Chi-Square tests, while modified Poisson regression assessed FOPL effectiveness. Results: FOPLs significantly improved correct nutrient identification and reduced the intention to purchase unhealthy foods, with the WL proving most effective. Conclusions: These findings highlight the potential of FOPLs, particularly the WL, as an effective regulatory tool for promoting healthier food choices in Kenya. 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

This study evaluated the healthiness of meat products (n = 62) and their plant-based (PB) counterparts (n = 62) available in the UK market. Back-of-pack (BoP) and front-of-pack (FoP) nutrition label information, nutrition and health claims, and nutrient profiling model scores were compared. BoP labels revealed that meat products had higher protein, fat, and saturated fat content (p = 0.029), whilst PB alternatives were higher in dietary fibre and carbohydrates (p < 0.001). Red colour coding (FoP) for fat and saturated fat (‘high’) was more prominent in meat products (23 and 35%, respectively), and the red meat category had the most products with high fat and saturated fat content. Only 15% of meat products made nutrition claims compared to 40% of PB alternatives, and none included health claims. Most red meat PB alternatives made a nutrition claim, all related to the protein content (34%). The nutrient profiling model indicated that 74% of the PB alternatives were ‘healthy’ compared to 60% of the meat products. No association was found between the product type (meat/PB) and healthiness, except for the red meat products, which showed a significant negative association (p = 0.005), suggesting that these products corresponded to less healthy options. Therefore, PB alternatives can be considered as healthier substitutes for meat products. Full article

Background/Objectives: Low quality diets are a risk factor for non-communicable diseases; therefore, improving diet quality is a public health and policy priority in the UK and elsewhere. Reformulating food/beverage products to make them healthier may be an effective approach. Evidence suggests that fiscal interventions, notably taxes/levies on soft drinks, can lead to reformulation but the evidence for voluntary or mandated non-fiscal interventions is less clear. We aimed to review and synthesise contemporary evidence to determine whether non-fiscal policies/interventions result in the reformulation of food/beverage products Methods: In April 2023, we systematically searched ten international academic and nine grey literature databases. We included real-world study designs, all nutrients, in- and out-of-home sectors, and studies published from 2013, to ensure policy relevancy. We excluded modelling studies. Using the Synthesis Without Meta-Analysis method we conducted vote counting of studies based on the direction of effect and narrative synthesis by intervention type. Risk of bias was assessed using a tool developed by the EPPI-Centre and quality was assessed using GRADE. Results: We included 77 real-world studies from 19 countries, reporting 100 non-fiscal policies/interventions. Most commonly, these were reduction targets (n = 44), front-of-pack labels (n = 23), and advertising standards (n = 9). Most interventions were voluntary (n = 67), compared to mandatory (n = 33), and focused on the in-home sector (n = 63). The vote counting results showed non-fiscal policies/interventions overall led to improvements in reformulation in 60/63 studies with a valid direction of effect (95%, 95% CI 0.869, 0.984, p < 0.001). Mandatory implementations were more successful than voluntary implementations with 15/15 showing an improvement (100%, 95% CI 0.796, 1], p < 0.001), compared 40/43 showing an improvement (93%, 95% CI 0.814, 0.976, p < 0.001). Most of the studies were of low quality, due to the observational nature of the studies. Sodium was the most commonly targeted nutrient (n = 56) and was found to be reformulated in most studies. Causation is difficult to establish from real-world studies, but evidence suggests that regulatory and multi-component strategies may be effective at driving reformulation. Conclusions: Non-fiscal policies/interventions can play an important role in driving reformulation, alongside fiscal measures. This work was funded by the National Institute for Health and Care Research PRP-PRU-02-15-Healthy Weight and registered on Open Science Framework. Full article