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      Ability of the Nutri-Score front-of-pack nutrition label to discriminate the nutritional quality of foods in the German food market and consistency with nutritional recommendations

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          Abstract

          Background

          There is currently a societal debate in Germany concerning the interest to introduce a comprehensive and simplified nutritional information label on foods. Consumer associations and some manufacturers are supporting the Nutri-Score, a summary, graded, colours-coded front-of-pack label (FoPL) adopted by public health authorities in France, Belgium and Spain. The Nutri-Score is using a Nutrient Profiling System (NPS) to define five different categories of nutritional quality (from ‘Dark green’ associated with the letter A to ‘dark orange’ with an E). The ability of the Nutri-Score to discriminate nutritional quality of foods was demonstrated in the French context. The objectives of this study were to verify its ability to discriminate the nutritional quality of foods and beverages currently present on the market in Germany and its consistency with German Food-Based Dietary Guidelines (FBDG).

          Methods

          Nutritional composition of 8587 usual foods available on the German market collected from the web-based collaborative project Open Food Facts, were retrieved. Data were collected from 2012 to 2019, with regular updates each time a product is scanned again by a contributor. Distribution of products across the five Nutri-Score categories according to consumer-based food groups was assessed. The ability of the FoPL to discriminate the nutritional quality of foods and beverages was estimated by the number of available colours of the Nutri-Score in each food group and sub-groups.

          Results

          Overall, the classification of foods according to the Nutri-Score was consistent with German FBDG: foods which consumption is recommended were more favourably classified (e.g. 79.7% of products composed mainly of fruits and vegetables were classified as A or B) than foods which consumption should be limited (e.g. 93.4% of sugary snacks were classified as D or E).

          Moreover, we observed that the nutrient profiling system underpinning the Nutri-Score was able to display the variability in nutritional quality of foods within the same food groups, with good discriminating performance (at least three colours represented with the Nutri-Score).

          Conclusions

          The Nutri-Score label displays a high ability in discriminating nutritional quality of foods across food groups and within a food group in the German market. This element is a key step in the validation process of a front-of-pack label, so that the Nutri-Score is an efficient tool which could help German consumers to make healthier choices.

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          Development of a new front‐of‐pack nutrition label in France: the five‐colour Nutri‐Score

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            Where is the science? What will it take to show that nutrient profiling systems work?

            Nutrient profiling is defined as the science of ranking or categorizing foods on the basis of their nutritional composition. Validity is a general term meaning accuracy. Nutrient profiling systems in the United States have not undergone any systematic validation effort to assess their accuracy against a comparison measure or group of measures. Different types of validation studies should be conducted: content, face, convergent, criterion, and predictive. This article provides a conceptual framework for establishing the validity of nutrient profiling systems with the desired objective of assisting US consumers with food selection to improve diet quality. For a profiling system to work successfully in the American marketplace, it must function well with consumers from most or all cultural groups, from all racial groups, and with low-literate as well as highly literate people. Emphasis should be placed on conducting different types of validation studies and multiple studies with different subpopulation groups. The use of consistent standards to assess the accuracy and usefulness of multiple profiling systems is imperative to successfully identify a nutrient profiling intervention that will have the potential to lead to improved diet quality and eventually to an improved health status in US consumers.
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              Performance of a five category front-of-pack labelling system – the 5-colour nutrition label – to differentiate nutritional quality of breakfast cereals in France

              Background Breakfast cereals exhibit a wide variability in nutritional quality, and differences are not easily grasped by consumers. A simplified nutritional information system might contribute to help consumers make healthier food choices. A five-category colour label based on the Food Standards Agency Nutrient profiling system (FSA score) has been proposed in France to be implemented on the front-of-pack of foods (the five-colour nutrition label - 5-CNL). Objectives were to evaluate the ability of the 5-CNL to discriminate nutritional quality between types of breakfast cereals, within a category and in equivalent products, as well as its ability to change through product reformulation. Methods Nutritional information was collected through an Internet and supermarket research for N = 433 breakfast cereals (N = 380 complete data included in the analyses). Breakfast cereals were categorized according to common attributes in terms of processing and/or ingredients used. The FSA score and 5-CNL category allocation were computed for each cereal. Nutrient content and FSA score were compared across types of cereals. Distribution within the 5-CNL categories was assessed across types of cereals and for equivalent products. Impact of reformulation (reduction of 5 and 10% in simple sugar, saturated fat and sodium) on the 5-CNL category allocation was compared to original allocation with Bapkhar’s tests of homogeneity of marginal distribution. Results Variability in nutritional quality of breakfast cereals was high, as reflected by the FSA score (range −7- 22 for a theoretical range of −15-40) and the 5-CNL (all five categories represented). The 5-CNL allowed for discrimination across types of cereals, within categories of breakfast cereals and for equivalent products (at least 3 categories of the 5-CNL represented). Reformulation scenarios allowed for significant change in 5-CNL allocation: 5% reduction in sugar lead to a modification of the label for 4.21% of products while a reduction of 10% of sugar, saturated fat and sodium lead to a modification of the label for 19.2% of products. Conclusion The 5-CNL adequately discriminates between breakfast cereals. It would therefore be an adequate tool for consumer information on nutritional quality of foods in the French context. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1522-y) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                f.szabo@eren.smbh.univ-paris13.fr
                m.egnell@eren.smbh.univ-paris13.fr
                p.galan@eren.smbh.univ-paris13.fr
                n.pecollo@eren.smbh.univ-paris13.fr
                s.hercberg@eren.smbh.univ-paris13.fr
                +33 148388953 , +33 148388931 , julia@eren.smbh.univ-paris13.fr
                Journal
                Arch Public Health
                Arch Public Health
                Archives of Public Health
                BioMed Central (London )
                0778-7367
                2049-3258
                14 June 2019
                14 June 2019
                2019
                : 77
                : 28
                Affiliations
                [1 ]ISNI 0000 0004 0409 3988, GRID grid.464122.7, Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, ; Inserm (U1153), Inra(U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017 Bobigny, 74 rue Marcel Cachin, F-93017 Bobigny Cedex, France
                [2 ]ISNI 0000 0000 8715 2621, GRID grid.413780.9, Département de Santé Publique, , Hôpital Avicenne (AP-HP), ; F-93017 Bobigny, CJ SH France
                Author information
                http://orcid.org/0000-0002-8487-6557
                Article
                357
                10.1186/s13690-019-0357-x
                6567426
                30647917
                b77a3996-7404-44d4-88d4-eb3e59937fb1
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 15 February 2019
                : 23 May 2019
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Public health
                nutri-score, nutrient profiling system,nutritional quality,front-of-pack labelling,food-based dietary guidelines

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