Articles scientifiques et documents publiés relatifs au Nutri-Score

Scientific articles and papers published on the Nutri-Score

Validation du Nutri-Score

Validation of the nutrient profiling system underlying the computation of Nutri-Score

1) Julia C, Kesse-Guyot E, Touvier M, Méjean C, Fezeu L, et Hercberg S.
- Application of the British Food Standards Agency nutrient profiling system in a French food composition database
British Journal of Nutrition 112, no 10 (2014) : 1699 1705.

Abstract
Nutrient profiling systems are powerful tools for public health initiatives, as they aim at categorising foods according to their nutritional quality. The British Food Standards Agency (FSA) nutrient profiling system (FSA score) has been validated in a British food database, but the application of the model in other contexts has not yet been evaluated. The objective of the present study was to assess the application of the British FSA score in a French food composition database. Foods from the French NutriNet-Santé study food composition table were categorised according to their FSA score using the Office of Communication (OfCom) cut-off value (’healthier’ ≤ 4 for foods and ≤ 1 for beverages ; ’less healthy’ >4 for foods and >1 for beverages) and distribution cut-offs (quintiles for foods, quartiles for beverages). Foods were also categorised according to the food groups used for the French Programme National Nutrition Santé (PNNS) recommendations. Foods were weighted according to their relative consumption in a sample drawn from the NutriNet-Santé study (n 4225), representative of the French population. Classification of foods according to the OfCom cut-offs was consistent with food groups described in the PNNS : 97·8 % of fruit and vegetables, 90·4 % of cereals and potatoes and only 3·8 % of sugary snacks were considered as ’healthier’. Moreover, variability in the FSA score allowed for a discrimination between subcategories in the same food group, confirming the possibility of using the FSA score as a multiple category system, for example as a basis for front-of-pack nutrition labelling. Application of the FSA score in the French context would adequately complement current public health recommendations.

PMID : 25277084
DOI : 10.1017/S0007114514002761

2) Julia C, Touvier M, Méjean C, Ducrot P, Péneau S, Hercberg S, et Kesse-Guyot E.
- Development and Validation of an Individual Dietary Index Based on the British Food Standard Agency Nutrient Profiling System in a French Context
The Journal of nutrition 144, no 12 (2014) : 2009 17.

Abstract
BACKGROUND :
Nutrient profiling systems could be useful public health tools as a basis for front-of-package nutrition labeling, advertising regulations, or food taxes. However, their ability beyond characterization of foods to adequately characterize individual diets necessitates further investigation.
OBJECTIVES :
The objectives of this study were 1) to calculate a score at the individual level based on the British Food Standard Agency (FSA) food-level nutrient profiling system of each food consumed, and 2) to evaluate the validity of the resulting diet-quality score against food group consumption, nutrient intake, and sociodemographic and lifestyle variables.
METHODS :
A representative sample of the French population was selected from the NutriNet-Santé Study (n = 4225). Dietary data were collected through repeated 24-h dietary records. Sociodemographic and lifestyle data were self-reported. All foods consumed were characterized by their FSA nutrient profile, and the energy intake from each food consumed was used to compute FSA-derived aggregated scores at the individual level. A score of adherence to French nutritional recommendations [Programme National Nutrition Santé guideline score (PNNS-GS)] was computed as a comparison diet-quality score. Associations between food consumption, nutritional indicators, lifestyle and sociodemographic variables, and quartiles of aggregated scores were investigated using ANOVAs and linear regression models.
RESULTS :
Participants with more favorable scores consumed higher amounts of fruits [difference Δ = 156 g/d between quartile 1 (less favorable) and quartile 4 (most favorable), P < 0.001], vegetables (Δ = 85 g/d, P < 0.001), and fish, and lower amounts of snack foods (Δ = -72 g/d, P < 0.001 for sugary snacks) ; they also had higher vitamin and mineral intakes and lower intakes of saturated fat. Participants with more favorable scores also had a higher adherence to nutritional recommendations measured with the PNNS-GS (Δ = 2.13 points, P < 0.001). Women, older subjects, and higher-income subjects were more likely to have more favorable scores.
CONCLUSION :
Our results show adequate validity of the FSA nutrient profiling system to characterize individual diets in a French context. The NutriNet-Santé Study was registered in the European Clinical Trials Database (EudraCT) as 2013-000929-31.
© 2014 American Society for Nutrition.
KEYWORDS :
dietary behavior ; dietary score ; nutrient profiling system ; nutrition policy ; validation studies

PMID : 25411035
DOI : 10.3945/jn.114.199679

3) Julia C, Kesse-Guyot E, Ducrot P, Péneau S, Touvier M, Méjean C, et Hercberg S.
- Performance of a five category front-of-pack labelling system–the 5-colour nutrition label–to differentiate nutritional quality of breakfast cereals in France
BMC public health 15, no 1 (2015) : 179.

Abstract
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.

PMID : 25885583
PMCID : PMC4349460
DOI : 10.1186/s12889-015-1522-y

4) Julia C, Fezeu L, Ducrot P, Méjean C, Péneau S, Touvier M, Hercberg S, et Kesse-Guyot E.
- The Nutrient Profile of Foods Consumed Using the British Food Standards Agency Nutrient Profiling System Is Associated with Metabolic Syndrome in the SU. VI. MAX Cohort–3
The Journal of nutrition 145, no 10 (2015) : 2355 61.

Abstract
BACKGROUND :
Metabolic syndrome (MetS), comprising high waist circumference, blood pressure, glycemia, and triglycerides, and lower HDL cholesterol could in part be prevented by adequate nutrition. Nutrient profiling systems could be useful public health tools to help consumers make healthier food choices. An individual dietary index (DI) based on nutrient profiling of foods consumed could characterize dietary patterns in relation to the onset of MetS.
OBJECTIVE :
The objective of this study was to prospectively investigate the association between the Food Standards Agency (FSA) Nutrient Profiling System (NPS) DI and the onset of MetS in a middle-aged French cohort.
METHODS :
Participants from the SUpplémentation en VItamines et Minéraux AntioXydants cohort (SU.VI.MAX, n = 3741) were included in the present study. The FSA NPS DI was computed by using dietary data from 24 h records at inclusion. MetS was identified at baseline and at year 13 of follow-up with the use of self-reported medication, data from clinical investigations, and biological measurements. A prospective association between the FSA NPS DI (in quartiles and continuous) and the onset of MetS was investigated by using logistic regression.
RESULTS :
Poorer diets identified with the use of the FSA NPS DI were significantly associated with a higher risk of developing MetS (OR for poorer vs. healthier FSA NPS DI : 1.43 ; 95% CI : 1.08, 1.89 ; P-trend across quartiles = 0.02). The FSA NPS DI was significantly associated with the systolic blood pressure (SBP) and diastolic blood pressure (DBP) components of MetS (difference between healthier vs. poorer FSA NPS DI : 2.16 mm Hg for SBP and 1.5 mm Hg for DBP, P-trend across quartiles = 0.02).
CONCLUSION :
The FSA NPS DI was prospectively associated with the onset of MetS in a middle-aged French population. The application of NPSs in public health initiatives may help the population make healthier food choices, which might reduce the risk of developing MetS.
KEYWORDS :
a priori dietary score ; cohort study ; dietary patterns ; metabolic syndrome ; nutrient profiling system

PMID : 26290007
DOI :10.3945/jn.115.213629

5) Julia C, Ducrot P, Lassale C, Fezeu L, Méjean C, Péneau S, Touvier M, Hercberg S, et Kesse-Guyot E.
- Prospective associations between a dietary index based on the British Food Standard Agency nutrient profiling system and 13-year weight gain in the SU. VI. MAX cohort
Preventive medicine 81 (2015) : 189 94.

Abstract
BACKGROUND/OBJECTIVES :
The scoring of the nutritional quality of individual foods using nutrient profiling systems (NPS) has been suggested as a basis for public health preventive measures. Used for front-of-package labeling, such scoring would help consumers in making healthier food choices. An individual dietary score based on the Food Standards Agency NPS has been developed (FSA-NPS-DI), but its long term association with weight gain has not been investigated. Our objectives were to investigate long-term associations between the FSA-NPS DI and weight gain and overweight/obesity onset in a middle-aged French population.
SUBJECTS/METHODS :
Subjects included in the French SU.VI.MAX cohort with at least three dietary records at baseline and available anthropometric measurements at baseline and at a 13-year follow-up examination were included in the study. FSA-NPS DI at baseline was computed for each subject. Association between FSA-NPS DI and weight and BMI gain were investigated with ANCOVA and associations with overweight/obesity onset with logistic regression models.
RESULTS :
Higher baseline FSA-NPS DI (reflecting a poorer diet) was associated with higher weight and BMI gain (beta Q4 versus Q1=0.70 ; (95%CI 0.01 ; 1.38), P for trend=0.04). A 16% higher risk of obesity for a 1 point increase of FSA-NPS DI was observed only in men.
CONCLUSIONS :
Our results suggest that a shift in nutritional quality of the foods and beverages within an individual’s diet, as expressed by the FSA-NPS DI would be associated with lower weight gain in the long term. Using the FSA-NPS as a basis for food labeling might therefore contribute to tackle obesity.
Copyright © 2015. Published by Elsevier Inc.
KEYWORDS :
Cohort study ; Dietary score ; Nutrient profiling systems ; Obesity ; Weight gain

PMID : 26348449
DOI : 10.1016/j.ypmed.2015.08.022

6) Donnenfeld M, Julia C, Kesse-Guyot E, Méjean C, Ducrot P, Péneau S, Deschasaux M, Paule Latino-Martel, Fezeu L, et Hercberg S.
- Prospective association between cancer risk and an individual dietary index based on the British Food Standards Agency Nutrient Profiling System
British Journal of Nutrition 114, no 10 (2015) : 1702 10.

Abstract
The Food Standards Agency Nutrient Profiling System (FSA-NPS) constitutes the basis for the Five-Colour Nutrition Label suggested in France to be put on the front-of-pack of food products. At the individual level, a dietary index (FSA-NPS DI) has been derived and validated and corresponds to a weighted mean of all FSA-NPS scores of foods usually consumed by the individual, reflecting the nutritional quality of his/her diet. Our aim was to investigate the association between the FSA-NPS DI and cancer risk in a large cohort. This prospective study included 6435 participants to the SUpplémentation en VItamines et Minéraux AntioXydants cohort (1994-2007) who completed at least six 24 h dietary records during the first 2 years of follow-up. FSA-NPS DI was computed for each subject (higher values representing lower nutritional quality of the diet). After a median follow-up of 12·6 years, 453 incident cancers were diagnosed. Associations were characterised by multivariate Cox proportional hazards models. The FSA-NPS DI was directly associated with overall cancer risk (hazard ratio (HR)for a 1-point increment=1·08 (95 % CI 1·01, 1·15), P trend=0·02 ; HRQ5 v. Q1=1·34 (95 % CI 1·00, 1·81), P trend=0·03). This association tended to be more specifically observed in subjects with moderate energy intake (≤median, HRfor a 1-point increment=1·10 (95 % CI 1·01-1·20), P trend=0·03). No association was observed in subjects with higher energy intake (P trend=0·3). Results were not statistically significant for breast and prostate cancer risks. For the first time, this study investigated the prospective association between the FSA-NPS individual score and cancer risk. The results suggest that unhealthy food choices may be associated with a 34 % increase in overall cancer risk, supporting the public health relevance of developing front-of-pack nutrition labels based on this score.
KEYWORDS :
Cancer risk ; FSA-NPS DI Food Standards Agency Nutrient Profiling System Dietary Index ; Food Standards Agency Nutrient Profiling System ; HR hazard ratio ; Nutrient profiling systems ; Nutrition policy ; Prospective studies ; SU.VI.MAX SUpplémentation en VItamines et Minéraux AntioXydants

PMID : 26393396
DOI : 10.1017/S0007114515003384

7) Julia C, Ducrot P, Péneau S, Valérie Deschamps, Méjean C, Fezeu L, Touvier M, Hercberg S, et Kesse-Guyot E.
- Discriminating nutritional quality of foods using the 5-Color nutrition label in the French food market : consistency with nutritional recommendations
Nutrition journal 14, no 1 (2015) : 100.

Abstract
PURPOSE :
Our objectives were to assess the performance of the 5-Colour nutrition label (5-CNL) front-of-pack nutrition label based on the Food Standards Agency nutrient profiling system to discriminate nutritional quality of foods currently on the market in France and its consistency with French nutritional recommendations.
METHODS :
Nutritional composition of 7777 foods available on the French market collected from the web-based collaborative project Open Food Facts were retrieved. Distribution of products across the 5-CNL categories according to food groups, as arranged in supermarket shelves was assessed. Distribution of similar products from different brands in the 5-CNL categories was also assessed. Discriminating performance was considered as the number of color categories present in each food group. In the case of discrepancies between the category allocation and French nutritional recommendations, adaptations of the original score were proposed.
RESULTS :
Overall, the distribution of foodstuffs in the 5-CNL categories was consistent with French recommendations : 95.4% of ’Fruits and vegetables’, 72.5% of ’Cereals and potatoes’ were classified as ’Green’ or ’Yellow’ whereas 86.0% of ’Sugary snacks’ were classified as ’Pink’ or ’Red’. Adaptations to the original FSA score computation model were necessary for beverages, added fats and cheese in order to be consistent with French official nutritional recommendations.
CONCLUSION :
The 5-CNL label displays a high performance in discriminating nutritional quality of foods across food groups, within a food group and for similar products from different brands. Adaptations from the original model were necessary to maintain consistency with French recommendations and high performance of the system.

PMCID : PMC4587869
DOI : 10.1186/s12937-015-0090-4

8) Julia C, Méjean C, Péneau S, Camille Buscail, Benjamin Alles, Fezeu L, Touvier M, Hercberg S, et Kesse-Guyot E.
- The 5-CNL front-of-pack nutrition label appears an effective tool to achieve food substitutions towards healthier diets across dietary profiles
PloS one 11, no 6 (2016) : e0157545.

Abstract
BACKGROUND :
Front-of-pack (FOP) nutrition labels are considered helpful tools to help consumers making healthier food choices, thus improving their diet. In France, the implementation of a FOP nutrition label-the 5-Colour Nutrition Label (5-CNL)-is currently under consideration. Our objective was to investigate dietary profiles in a French adult population using the 5-CNL, and to assess its potential impact in improving the diet through substitution of foods.
METHODS AND FINDINGS :
Subjects included in the NutriNet-Santé cohort, who had completed three 24-h dietary records were included in this cross-sectional analysis. Mutually exclusive clusters of individuals were identified using the percentage of energy derived from foods of each of the 5-CNL colours as input variables. Three scenarios of substitution of foods for healthier alternative using the 5-CNL were tested. Food group and dietary intakes, socio-demographic and lifestyle data were compared across clusters using ANOVAs or Chi-square tests, as appropriate. We identified three mutually exclusive dietary profiles : ’Healthy’ (N = 28 095, 29.3% of the sample), with high consumption of fruit, vegetables, whole cereals and fish ; ’Western’ (N = 33 386, 34.8%) ; with high consumption of sweetened beverages, breakfast cereal, cheese, fatty and sugary foods ; ’Traditional’ (N = 34 461, 35.1%), with high consumption of potatoes, bread, meat and dairy desserts. Overall, substitutions strategies led to an increase in the number of subjects reaching the recommended intakes in energy, macro and micronutrients. Increases were particularly high in the ’Western’ pattern for lipids and saturates intakes : from 16.2% reaching the recommended amount for lipids (13.5% for saturates) to 60.6% and 85.7% respectively.
CONCLUSION :
The use of the 5-CNL as an indicator of food choice meaningfully characterizes clusters of dietary habits and appears as an effective tool to help improving the nutritional quality of the diet.

PMID : 27322033
PMCID : PMC4913953
DOI :10.1371/journal.pone.0157545

9) Julia C, Méjean C, Touvier M, Péneau S, Lassale C, Ducrot P, Hercberg S, et Kesse-Guyot E.
- Validation of the FSA nutrient profiling system dietary index in French adults—findings from SUVIMAX study
European journal of nutrition 55, no 5 (2016) : 1901 10.

Abstract
PURPOSE :
Population-wide nutritional recommendations give guidance on food groups’ consumption, though a wide variability in nutritional quality within groups may subsist. Nutrient profiling systems may help capturing such variability. We aimed to apply and validate a dietary index based on the British Food Standards Agency nutrient profiling system (FSA-NPS DI) in French middle-aged adults.
METHODS :
Dietary data were collected through repeated 24-h dietary records in participants of the Supplémentation en Vitamines et Minéraux Antioxydants study (N = 5882). An aggregated dietary index at the individual level was computed using the FSA-NPS for each food consumed as well as compliance to the French nutritional guidelines using the Programme National Nutrition Santé-Guideline Score (PNNS-GS). Cross-sectional associations between FSA-NPS DI and nutrient intake, PNNS-GS, socio-demographic factors, lifestyle and nutritional biomarkers were computed using ANOVAs.
RESULTS :
The FSA-NPS DI was able to characterize the quality of the diets at the individual level in terms of nutrient intake and of adherence to nutritional recommendations : +37.6 % in beta-carotene intakes between subjects with a healthier diet versus subjects with a poorer diet, +42.8 % in vitamin C intakes ; +17 % in PNNS-GS, all P < 0.001. FSA-NPS-DI was also associated with nutritional status at the biological level : +21.4 % in beta-carotene levels between subjects with a healthier diet versus subjects with a poorer diet, +12.8 % in vitamin C levels, all P < 0.001.
CONCLUSIONS :
The FSA-NPS DI is a useful and validated tool to discriminate individuals according to the quality of the diet, accounting for nutritional quality within food groups. Taking into account nutritional quality of individual foods allows monitoring change in dietary patterns beyond food groups.
KEYWORDS :
Biomarkers ; Dietary index ; Nutrient profiling ; Nutritional recommendations

PMID : 26293977
DOI : 10.1007/s00394-015-1006-y

10) Adriouch S, Julia C, Kesse-Guyot E, Méjean C, Ducrot P, Péneau S, Donnenfeld Deschasaux M, Mehdi Menai, Hercberg S, Touvier M, Fezeu LK.
- Prospective association between a dietary quality index based on a nutrient profiling system and cardiovascular disease risk
European journal of preventive cardiology 23, no 15 (2016) : 1669-76.

Abstract
BACKGROUND :
Public health strategies are essential to guide consumers’ choices and produce a substantial population impact on cardiovascular disease risk prevention through nutrition. Our aim was to investigate the prospective association between the Food Standards Agency nutrient profiling system dietary index (FSA-NPS DI) and cardiovascular disease risk. The FSA-NPS has been proposed to serve as a basis for a five-colour nutrition label suggested in France to be put on the front of pack of food products.
METHODS AND RESULTS :
A total of 6515 participants to the SU.VI.MAX cohort (1994-2007), who completed at least six 24-hour dietary records during the first two years of the study, were followed for a median of 12.4 years (25th-75th percentiles : 11.0-12.6). Multivariable Cox proportional hazards models were used to characterise the associations between FSA-NPS DI (continuous and sex-specific quartiles) and the incidence of cardiovascular diseases. Interactions with individual characteristics were tested ; 181 major cardiovascular events were reported (59 myocardial infarctions, 43 strokes, 79 anginas). A higher FSA-NPS DI, characterising poorer food choices, was associated with an overall increase in cardiovascular disease risk (HRfor a 1-point increment = 1.14 (1.03-1.27) ; HRQ4vs.Q1 = 1.61 (1.05-2.47), Ptrend Q4-Q1 = 0.03). This association tended to be stronger in smokers (HRfor a 1-point increment = 1.39 (1.11-1.73) ; Pinteraction = 0.01) and those less physically active (HRfor a 1-point increment = 1.26 (1.08-1.46) ; Pinteraction = 0.04).
CONCLUSIONS :
Our results suggest that poorer food choices, as reflected by a higher FSA-NPS DI, may be associated with a significant increase in cardiovascular risk, especially in at-risk individuals (smokers and physically inactive persons). This score could be a useful tool for public health prevention strategies.
KEYWORDS :
Cardiovascular risk ; FSA-NPS ; nutrient profiling system ; nutrition policy ; prospective study

PMID : 27000099
DOI : 10.1177/2047487316640659

11) Adriouch S, Julia C, Kesse-Guyot E, Ducrot P, Péneau S, Méjean C, Assmann K, Deschasaux M, Hercberg S, et Touvier M. 
- Association between a dietary quality index based on the food standard agency nutrient profiling system and cardiovascular disease risk among French adults
International journal of cardiology 234 (2017) : 22 27.

Abstract
BACKGROUND :
In France, the implementation of a front-of-pack (FOP) nutrition label-the 5-Colour Nutrition Label (5-CNL) is currently under consideration as a strategic tool to allow consumers making healthier food choices. This FOP label is based on the British Food Standards Agency Nutrient Profiling System (FSA-NPS), reflecting the overall nutritional quality of foods. At the individual level, an energy-weighted mean of all FSA-NPS scores of foods usually consumed has been elaborated (FSA-NPS DI). Our objective was to investigate the prospective association between the FSA-NPS DI and cardiovascular disease (CVD) risk.
METHODS :
75,801 participants to the NutriNet-Santé cohort, who completed at least three 24h dietary records during the first 2y of the follow-up, were followed between 2009 and 2016. Multivariable Cox proportional hazards models were used to characterize the associations between FSA-NPS DI and the incidence of CVDs.
RESULTS :
509 major cardiovascular events were diagnosed (262 coronary heart diseases and 247 strokes). A higher FSA-NPS DI, characterizing lower dietary quality, was associated with increased CVD risk (HRfor a 1-point increment=1.08 (1.03-1.13) ; HRQ4vs.Q1=1.40 (1.06-1.84), Ptrend Q4-Q1=0.01). This association tended to be stronger in overweight subjects (HRfor a 1-point increment=1.12 (1.04-1.19) ; Pinteraction=0.003).
CONCLUSIONS :
These results suggest that lower dietary quality, as reflected by a higher FSA-NPS DI, may be associated with a significant increase in cardiovascular risk, especially in at-risk individuals (overweight population). They support the public health relevance of developing a front-of-pack nutrition label based on this score.
Copyright © 2017 Elsevier B.V. All rights reserved.
KEYWORDS :
Cardiovascular risk ; FSA-NPS ; Nutrient profiling system ; Nutrition policy ; Prospective study

PMID : 28258849
DOI : 10.1016/j.ijcard.2017.02.092

12) Deschasaux M, Julia C, Kesse-Guyot E, Lécuyer L, Adriouch S, Méjean C, Ducrot P, Péneau S, Latino-Martel P, et Fezeu L.
- Are self-reported unhealthy food choices associated with an increased risk of breast cancer ? Prospective cohort study using the British Food Standards Agency nutrient profiling system
BMJ open 7, no 6 (2017) : e013718.

Abstract
OBJECTIVES :
French authorities are considering the implementation of a simplified nutrition labelling system on food products to help consumers make healthier food choices. One of the most documented candidates (Five-Colour Nutrition Label/Nutri-score) is based on the British Food Standards Agency Nutrient Profiling System (FSA-NPS), a score calculated for each food/beverage using the 100 g amount of energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits and vegetables. To assess its potential public health relevance, studies were conducted on the association between the nutritional quality of the diet, measured at the individual level by an energy-weighted mean of all FSA-NPS scores of foods usually consumed (FSA-NPS dietary index (FSA-NPS DI)), and the risk of chronic diseases. The present study aimed at investigating the relationship between the FSA-NPS DI and breast cancer risk.
DESIGN :
Prospective study.
SETTING :
Population based, NutriNet-Santé cohort, France.
PARTICIPANTS :
46 864 women aged ≥35 years who completed ≥3 24-hour dietary records during their first 2 year of follow-up.
PRIMARY OUTCOME MEASURE :
Associations between FSA-NPS DI and breast cancer risk (555 incident breast cancers diagnosed between 2009 and 2015) were characterised by multivariable-adjusted Cox proportional hazard models.
RESULTS :
A higher FSA-NPS DI (lower nutritional quality of the diet) was associated with an increased breast cancer risk (HR1-point increment=1.06 (1.02-1.11), p=0.005 ; HRQ5vs.Q1=1.52 (1.11-2.08), p trend=0.002). Similar trends were observed in premenopausal and postmenopausal women (HR1-point increment=1.09 (1.01-1.18) and 1.05 (1.00-1.11), respectively).This study was based on an observational cohort using self-reported dietary data, thus residual confounding cannot be entirely ruled out. Finally, this holistic approach does not allow investigating which factors in the diet most specifically influence breast cancer risk.
CONCLUSIONS :
These results suggested that unhealthy food choices, as characterised by the FSA-NPS, may be associated with an increase in breast cancer risk, supporting the potential public health relevance of using this profiling system in the framework of public health nutritional measures.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PMID : 28600360
PMCID : PMC5577898
DOI : 10.1136/bmjopen-2016-013718

13) Egnell, M. ; Crosetto, P. ; d’Almeida, T. ; Kesse-Guyot, E. ; Touvier, M. ; Ruffieux, B. ; Hercberg, S. ; Muller, L. ; Julia, C.
- Modelling the impact of different front-of-package nutrition labels on mortality from non-communicable chronic disease
Int. J. Behav. Nutr. Phys. Act. 2019, 16, 56.

Abstract
BACKGROUND
Front-of-Package nutrition labels (FoPLs) are intended to help reduce the incidence of nutrition-related non-communicable diseases through an improvement in diet quality. FoPLs have been shown to improve the nutritional quality of purchases and have been associated with improved diet quality, which is in turn associated with reduced risk of non-communicable diseases. However, the potential impact of FoPLs on reducing mortality from chronic diseases has never been estimated.
METHODS
Data from a laboratory experimental economics test were used to investigate the effects of five different FoPLs (Nutri-Score, Health Star Rating system, Multiple Traffic lights, Reference intakes and SENS (Système d’Etiquetage Nutritionnel Simplifié)) on the nutritional quality of household purchases. The relative differences in nutrient content and composition of food purchases were then applied to dietary intakes using data from an observational study, thus yielding estimates for ‘reference’ and ‘labelled’ diets. A macro-simulation study using the PRIME model was then conducted to estimate the impact of the modification in dietary intake as a result of FoPL use on mortality from diet-related non-communicable diseases.
RESULTS
The use of FoPLs led to a substantial reduction in mortality from chronic diseases. Approximately 3.4% of all deaths from diet-related non-communicable diseases was estimated to be avoidable when the Nutri-Score FoPL was used. The remaining FoPLs likewise resulted in mortality reduction, although to a lesser extent : Health Star Rating system (2.8%), Reference Intakes (1.9%), Multiple Traffic Lights (1.6%), and SENS (1.1%).
CONCLUSIONS
FoPLs have the potential to help decrease mortality from diet-related non-communicable diseases, and the Nutri-Score appears to be the most efficient among the five formats tested.

Validation du format graphique

Validation of the graphic format

1) Ducrot P, Méjean C, Julia C, Kesse-Guyot E, Touvier M, Fezeu L, Hercberg S, et Péneau S.
- Effectiveness of front-of-pack nutrition labels in French adults : results from the NutriNet-Sante cohort study
PloS one 10, no 10 (2015) : e0140898.

Abstract
BACKGROUND :
To date, no consensus has emerged on the most appropriate front-of-pack (FOP) nutrition label to help consumers in making informed choices. We aimed to compare the effectiveness of the label formats currently in use : nutrient-specific, graded and simple summary systems, in a large sample of adults.
METHODS :
The FOP label effectiveness was assessed by measuring the label acceptability and understanding among 13,578 participants of the NutriNet-Santé cohort study, representative of the French adult population. Participants were exposed to five conditions, including four FOP labels : Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), 5-Color Nutrition Label (5-CNL), Green Tick (Tick), and a "no label" condition. Acceptability was evaluated by several indicators : attractiveness, liking and perceived cognitive workload. Objective understanding was assessed by the percentage of correct answers when ranking three products according to their nutritional quality. Five different product categories were tested : prepared fish dishes, pizzas, dairy products, breakfast cereals, and appetizers. Differences among the label effectiveness were compared with chi-square tests.
RESULTS :
The 5-CNL label was viewed as the easiest label to identify ans as the one requiring the lowest amount of effort and time to understand. GDA was considered as the least easy to identify and to understand, despite being the most attractive and liked label. All FOP labels were found to be effective in ranking products according to their nutritional quality compared with the "no label" situation, although they showed differing levels of effectiveness (p less than 0.0001). Globally, the 5-CNL performed best, followed by MTL, GDA and Tick labels.
CONCLUSION :
The graded 5-CNL label was considered as easy to identify, simple and rapid to understand ; it performed well when comparing the products’ nutritional quality. Therefore, it is likely to present advantages in real shopping situations where choices are usaully made quickly.

PMID : 26509679
PMCID : PMC4624978
DOI : 10.1371/journal.pone.0140898

2) Ducrot P, Méjean C, Julia C, Kesse-Guyot E, Touvier M, Léopold K Fezeu, Hercberg S, et Péneau S.
- Objective understanding of front-of-package nutrition labels among nutritionally at-risk individuals
Nutrients 7, no 8 (2015) : 7106 25.

Abstract
In the ongoing debate about front-of-package (FOP) nutrition labels, little data exist regarding nutritionally at-risk populations, although they are critical targets of prevention programs. This study aimed to compare the impact of FOP labels on the ability to rank products according to their nutritional quality among French adults potentially at risk of poor dietary quality (N = 14,230). Four labels were evaluated : Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), 5-Color Nutrition Label (5-CNL), Green Tick (Tick), along with a reference without label. Mixed models were used to assess how individual characteristics and FOP labels were associated with the ability to rank products. Older participants and those with a lower educational level, income, nutritional knowledge, and likelihood of reading nutrition facts were less skilled at ranking food products according to nutritional quality. Compared with individual characteristics, nutrition labels had an increased impact on food product ranking ability. Overall, 5-CNL corresponded to the highest rate of correct responses, followed by MTL, GDA, and Tick (p < 0.0001). The strongest impact of 5-CNL was observed among individuals with no nutritional knowledge (odds ratio (OR) : 20.24 ; 95% confidence interval (CI) : 13.19-31.06). Therefore, 5-CNL appeared to be effective at informing consumers, including those who are nutritionally at-risk, about the nutritional quality of food products.
KEYWORDS :
food labeling ; front-of-package nutrition label ; objective understanding ; population at risk

PMID : 26305255
PMCID : PMC4555164
DOI : 10.3390/nu7085325

3) Ducrot P, Julia C, Méjean C, Kesse-Guyot E, Touvier M, Fezeu L, Hercberg S, et Péneau S.
- Impact of different front-of-pack nutrition labels on consumer purchasing intentions : a randomized controlled trial
American journal of preventive medicine 50, no 5 (2016) : 627 36.

Abstract
INTRODUCTION :
Despite growing evidence supporting the utility of front-of-pack nutrition labels in enabling consumer evaluation of food product healthiness, research on food choices is scarce. This study aims at comparing the impact of front-of-pack nutrition labels on consumers’ purchasing intentions.
DESIGN :
Five-arm, open-label RCT.
SETTING/PARTICIPANTS :
The study setting was a virtual web-based supermarket, with participants from the French NutriNet-Santé study. The eligibility requirement was grocery shopping involvement.
INTERVENTION :
The intervention was to simulate one shopping situation with front-of-pack nutrition labels affixed on food products (December 2014 to March 2015). Participants were randomly assigned to one of five exposure conditions using a central computer system : Guideline Daily Amounts, Multiple Traffic Lights, Five-Color Nutrition Label, Green Tick, or control (no front-of-pack exposure). Given the nature of the intervention, masking of participants was not performed.
MAIN OUTCOME MEASURES :
The primary outcome was the overall nutritional quality of the contents of the shopping cart, estimated using the United Kingdom Food Standards Agency nutrient profiling system. Secondary outcomes included energy and nutrient content of the shopping cart. Impact of the front-of-pack labels was also evaluated across sociodemographic subgroups based on age, educational level, income, and nutrition knowledge.
RESULTS :
A total of 11,981 participants were included in the analyses (April 2015). The Five-Color Nutrition Label significantly led to the highest overall nutritional quality of the shopping cart, as reflected by lower Food Standards Agency scores (M=8.72 ; SD=2.75), followed by Multiple Traffic Lights (M=8.97 ; SD=2.68) and Green Tick (M=8.99 ; SD=2.71), compared with the control (M=9.34 ; SD=2.57) (p than less 0.0001). The Five-Color Nutrition Label was the only front-of-pack format that led to a lower content in lipids, saturated fatty acids, and sodium of the shopping cart (all p than less 0.05).
The impact of the different front-of-pack labels was similar across sociodemographic subgroups.
CONCLUSIONS :
The Five-Color Nutrition Label based on a color-coded and graded scale indicating overall nutritional quality is effective in promoting overall healthier food choices in all population subgroups.

PMID : 26699246
DOI : 10.1016/j.amepre.2015.10.020

4) Julia, C, S Péneau, Buscail C, Touvier M, Kesse-Guyot E, et Hercberg S.
- Perception de différents systèmes d’information nutritionnelle actuellement proposés en France en fonction du statut pondéral
Obésité 12, no 1 (2017) : 5 15.

Résumé
L’objectif de notre étude était d’analyser la perception de ces quatre formats de signalétiques nutritionnelles actuellement en compétition pour être en face avant des emballages parmi les participants de la cohorte NutriNet-Santé. La perception a été analysée dans l’ensemble de l’échantillon et selon le statut pondéral. Parmi les participants (N=21.648), le NutriScore était le format préféré (43,8%) suivi par les Traffic Light Multiples (24,9%), et le SENS (17,1%). Aucun logo n’était considéré comme culpabilisant pour 50.3% de la population. La perception était la même quel que soit le statut pondéral.
Abstract
Our objective was to investigate the perception of four formats proposed as Front-of-pack nutrition labelling systems in France, among the participants in the NutriNet-santé study. Perception was investigated in the entire study population and according to weight status. Among participants (N=21,648), the NutriScore was the preferred format (43.8%), followed by Multiple Traffic Light (24.9%) and SENS (17.1%). No label was considered guilt-laden for 50.3% of the population. Perception was similar according to weight status.

5) Julia C, Péneau S, Camille Buscail, Rebeca Gonzalez, Touvier M, Hercberg S, Kesse-Guyot E.
- Perception of different formats of front-of-pack nutrition labels according to sociodemographic, lifestyle and dietary factors in a French population : cross-sectional study among the NutriNet-Santé cohort participants
BMJ open 7, no 6 (2017) : e016108.

Abstract
OBJECTIVE :
Four formats for a front-of-pack (FOP) nutrition label are currently considered in France : the Nutriscore (or 5-Colour Nutrition Label, developed by a public research team), the SENS (supported by retailers), Multiple Traffic Lights (MTL, currently used in UK) and a modified version of the Reference Intakes (mRIs, supported by industry). Our objective was to investigate the perception of these FOP labels, according to sociodemographic, lifestyle and dietary factors.
DESIGN :
Cross-sectional study.
SETTING :
Web-based French cohort.
MAIN OUTCOME MEASURE :
FOP labels perception.
PARTICIPANTS :
Participants in the NutriNet-Santé cohort received a specific questionnaire on the perceptions of the four label formats identified. Sociodemographic, lifestyle and dietary data (three 24-hours dietary records) were collected through self-administered questionnaires. Mutually exclusive clusters of FOP labels perception were identified through a multiple correspondence analysis followed by a hierarchical clustering procedure. Sociodemographic, lifestyle and dietary factors associated with the clusters were explored using multivariable multinomial logistic regression. All analyses were weighted according to 2009 French census data.
RESULTS :
Among the 21,702 participants in the study, the Nutriscore received the most important number of favourable responses on positive perception dimensions by participants, followed by MTL and SENS. The five identified clusters were characterised by marked preferences for Nutriscore (cluster 1, 43.2% of participants, crude n=9,399), MTL (cluster 2, 27.3%, crude n=6,163), SENS (cluster 3, 17.05%, crude n=3,546), mRIs (cluster 4, 7.31%, crude n=1,632) and none of the presented formats (cluster 5, 5.10%, crude n=965). The cluster 1 (Nutriscore) was associated with lower adherence to nutritional recommendations, while cluster 2 (MTL) was associated with younger age and higher level of education.
CONCLUSION :
The Nutriscore appears to have a wide reach in the population and to appeal to subjects with lower adherence to nutritional recommendations.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
KEYWORDS :
front-of-pack nutrition labels ; perception ; public health policy

PMID : 28619781
PMCID : PMC5726055
DOI : 10.1136/bmjopen-2017-016108

6) Egnell M, Ducrot P, Touvier M, Allès S, Hercberg S, Kesse-Guyot E, et Julia C.
- Objective understanding of Nutri-Score Front-Of-Package nutrition label according to individual characteristics of subjects : Comparisons with other format labels
PloS one 13, no 8 (2018) : e0202095.

Abstract
BACKGROUND :
To improve nutritional status and prevent chronic nutrition-related diseases, international organizations have recommended the use of multiple strategies, including front-of-package nutrition labelling (FOPL). In France, the Nutri-Score has been selected by health authorities in March 2017. However, to be effective in purchasing situations, the label needs to be well understood, which may be influenced by label format and sociodemographic characteristics. This study aimed at investigating the objective understanding of the Nutri-Score compared to other label formats, and more particularly among specific at-risk populations.
METHODS :
The objective understanding of four FOPLs-namely Nutri-Score, Multiple Traffic Lights (MTL), the simplified nutrition labelling system (SENS), and modified Reference Intakes (mRIs)-was investigated in a sample from the NutriNet-Santé French cohort (n = 3,751). Logistic regression mixed models were computed to assess the association of the four FOPLs, compared to a "no label" situation, on the consumers’ ability to rank products according to their overall nutritional quality. Objective understanding was also investigated according to sociodemographic and lifestyle characteristics.
RESULTS :
Compared to a "no label" situation, all FOPLs were significantly associated to an increase in consumers’ ability to classify the products correctly, with wide disparities in results according to formats. The best performance was observed for the Nutri-Score (OR = 20.33(17.68-23.37)), followed by SENS (OR = 9.57(8.50-10.77)), MTL (OR = 3.55(3.20-3.93)) and mRIs (OR = 1.53(1.39-1.69)). This ranking was similar among all sub-populations and the ORs associated to the Nutri-Score were over 10, whichever the sub-group considered. Women, younger people, non-smokers, individuals with higher educational level and those with children had a higher capacity to identify healthier products (all P≤0.05).
CONCLUSION :
Nutri-Score, with a summarized graded and color-coded format, using semantic colours, is associated to a higher objective understanding than monochrome and nutrient-specific labels. Furthermore, though objective understanding may differ according to individual characteristics of subjects, the magnitude of effect of the Nutri-Score largely outweighed this effect, even in the at-risk populations.

PMID : 30138359
PMCID : PMC6107140
DOI : 10.1371/journal.pone.0202095

7) Egnell M, Kesse-Guyot E, Galan P, Touvier M, Rayner M, Jewell J, Breda J, Hercberg S, et Julia C.
- Impact of Front-of-Pack Nutrition Labels on Portion Size Selection : An Experimental Study in a French Cohort
Nutrients 10, no 9 (2018) : 1268.

Abstract
In the European Union (EU) three coloured graded Front-of-Pack labels (FoPLs), two endorsed by governments (Nutri-Score and Multiple Traffic Lights (MTL)) and one designed by industry (Evolved Nutrition Label (ENL)) are currently being discussed. This study aimed to investigate the impact of these FoPLs on portion size selection, specifically for less healthy products. In 2018, participants from the French NutriNet-Santé cohort study (N = 25,772) were exposed through a web-based self-administered questionnaire to products from three food categories (sweet biscuits, cheeses, and sweet spreads), with or without FoPLs, and were invited to select the portion they would consume (in size and number). Kruskall-Wallis tests, and mixed ordinal logistic regression models, were used to investigate the effects of FoPLs on portion size selection. Compared to no label, Nutri-Score consistently lowered portion sizes (OR = 0.76 (0.74⁻0.76)), followed by MTL (OR = 0.83 (0.82⁻0.84)). For ENL, the effects differed depending on the food group : It lowered portion size selection for cheeses (OR = 0.84 (0.83⁻0.87)), and increased it for spreads (OR = 1.19 (1.15⁻1.22)). Nutri-Score followed by MTL appear efficient tools to encourage consumers to decrease their portion size for less healthy products, while ENL appears to have inconsistent effects depending on the food category.
KEYWORDS :
Front-of-Pack nutrition label ; food products ; portion size

PMID : 30205548
PMCID : PMC6165438
DOI : 10.3390/nu10091268

8) Julia, C, O Blanchet, C Méjean, S Péneau, P Ducrot, B Allès, LK Fezeu, et al.
- Impact of the Front-of-Pack 5-Colour Nutrition Label (5-CNL) on the Nutritional Quality of Purchases : An Experimental Study
Int J Behav Nutr Phys Act 13 (2016) : 101.

Background
Front-of-pack (FOP) nutrition labelling has received growing attention from public health authorities, as a tool to promote healthier diets in the population. Recently, the French Health law introduced the principle of implementing a FOP nutrition labelling system. A scientific proposal has put forward the 5-Colour Nutrition Label (5-CNL), a five-category colour-coded summary system supported by research suggesting that it is well perceived and understood in the population. Our objective was to investigate the impact of the 5-CNL on the nutritional quality of purchases in experimental supermarkets.
Methods
Participants (n = 901) were recruited using quota sampling between September and December 2015 and evenly distributed in three experimental conditions : 1) control situation ; 2) Application of the 5-CNL on all food products in three specific sections : breakfast cereals, sweet biscuits and appetizers ; 3) introduction of the 5-CNL accompanied by consumer information on use and understanding of the label. Main outcome was the nutritional quality of the shopping cart in the three sections combined, measured using the United Kingdom Food Standards Agency nutrient profiling system (FSA score).
Results
Significantly higher mean nutritional quality of the purchased items per section were observed for the sweet biscuits category in the intervention combining the label + communication (overall FSA score 21.01 vs. 20.23, P = 0.02). No significant effects were observed for the general mean over the three sections combined or other food categories. The results observed on purchase may be related to the high level of recall, self-reported and objective understanding of the label that were observed in the intervention groups as they are pre-requisites for use of a label in purchasing situations.
Conclusion
These results suggest that the 5-CNL FOP nutrition label may have a limited impact on purchases, leading to healthier food choices in some food categories such as sweet biscuits.
Trial registration
The trial was registered on Clinicaltrials.gov under the number NCT02546505.

PMID : 27645372
PMCID : PMC5028942
DOI : 10.1186/s12966-016-0416-4

9) Crosetto Paolo, Lacroix Anne, Muller Laurent, Ruffieux Bernard
- Modification des achats alimentaires en réponse à cinq logos nutritionnels
Cahiers de Nutrition et de Diététique Vol 52 - N° 3 P. 129-133 - juin 2017

In a controlled and reproducible experimental food store of 290 products, we studied the purchases of 691 participants to observe reactions to five simplified nutritional graphic labeling systems (NutriCouleurs, NutriMark, NutriRepère, NutriScore and SENS). Participants are randomly assigned to one of the five treatments where one of the systems is set up on all store products. The impact on nutritional quality is measured in terms of reduction of “FSA points”. Each of the systems generates a significant improvement in the FSA indicator, with an average gain of −1.54 point FSA. NutriScore is significantly more effective than the others, reducing average FSA score by −2.65 points, NutriMark is 2nd (−1.86), NutriCouleurs 3rd (−1.40), Sens 4th (−1.02), NutriRepère 5th (−0.81).
Le texte complet de cet article est disponible en PDF.
Mots clés : Évaluation de politique publique, Politique nutritionnelle, Étiquetage nutritionnel, Comportement d’achat des consommateurs, France
Keywords : Public policy assessment, Nutrition policy, Nutrition labeling, Consumer buying behavior, France

Doi : 10.1016/j.cnd.2017.04.002

10) Paolo Crosetto, Laurent Muller, Bernard Ruffieux.
- Réponses des consommateurs à trois systèmes d’étiquetage nutritionnel face avant
Cahiers de Nutrition et de Diététique Vol 51 - N° 3 P. 124-131 - juin 2016 16/06/16

In an experimental store, we study the behavioral responses of consumers food purchasing and their impact on the nutritional quality of shopping carts for three different front-of-pack nutritional labeling systems, i.e. the Reference Intakes, the multiple Traffic Lights and the new French system 5C. We use an experimental economics framework for observing the change for each participant between a cart done without label and a cart done with one of the three systems. By then comparing cohorts, we measure their relative effectiveness. All three systems improve the nutritional quality, but at a lesser or greater extent. 5C and Traffic lights have a significantly greater nutritional impact than the Reference Intakes.

Doi : 10.1016/j.cnd.2016.04.002


11) Comité Scientifique de l’étude d’expérimentation.
- Evaluation ex ante de systèmes d’étiquetage nutritionnel graphique simplifié
Rapport final du comité scientifique.


12) Egnell M, Boutron I, Péneau S, Ducrot P, Touvier M, Galan P, Buscail C, Porcher R, Ravaud P, Hercberg S, Kesse-Guyot E, Julia C.
Front-of-Pack Labeling and the Nutritional Quality of Students’ Food Purchases : A 3-Arm Randomized Controlled Trial
Am J Publ Health 20 juin 2019

Abstract
Objectives : To assess the effects of the Nutri-Score label (relative to the Reference Intakes label or no label) on the nutritional quality of students’ food purchases. Methods. A 3-arm randomized controlled trial was conducted in France in 2017 ; 2907 participants were randomized into 1 of the 3 study arms (Nutri-Score, Reference Intakes, no label) and invited to purchase groceries from an experimental Web-based supermarket. The main outcome was the overall nutritional quality of purchases, measured according to a modified version of the Food Standards Agency Nutrient Profiling System (FSAm-NPS/HCSP) score. Results. The mean (±SD) FSAm-NPS/HCSP score was lower in the Nutri-Score group (2.02 ±3.56) than in the Reference Intakes group (2.69 ±3.44), reflecting higher nutritional quality ; however, there was no significant difference between the Nutri-Score and no-label (2.45 ±3.28) groups or between the Reference Intakes and no-label groups. Shopping cart content was lower in calories and saturated fatty acids and higher in fruits and vegetables in the Nutri-Score arm than in the other arms.
Conclusions ; The Nutri-Score label appeared to improve the nutritional composition of students’ food purchases relative to the Reference Intakes label or no label.

PMID : 31219721
DOI : 10.2105/AJPH.2019.305115

Articles généraux

Reviews on Nutri-Score

Julia C et Hercberg S
- Development of a new front-of-pack nutrition label in France : the five-colour Nutri-Score
Public Health Panorama 3, no 4 (2017) : 712 25.

Abstract
Background : The French Government recently announced the implementation of a novel Front-of-Pack (FOP) nutrition label at national level. The selected system, the Nutri-Score, is a five coloured label developed by the Nutritional Epidemiology Research Team (EREN), an academic public research unit, and has been the object of scientific research for validation purposes.
Methods : The objective of the present narrative review is to examine the existing literature on the development, validation and testing of the Nutri-Score. Elements of the validity of the nutrient profiling system underlying the label as well as the format of the label were investigated.
Results : Scientific evidence suggests that the Food Standards Agency nutrient profiling system (FSA score) underlying the Nutri-Score FOP label can adequately characterize the nutritional quality of foods, and that an individual score based on the weighted mean of the FSA score of the foods consumed (the FSA-NPS dietary index, FSA-NPS DI) can adequately summarize the nutritional quality of the diet. Moreover, the FSA-NPS DI is associated with chronic diseases onset. Finally, the format of the Nutri-Score (and its former version, the 5-Colour Nutrition Label, 5-CNL) appears to be well-perceived and understood. The Nutri-Score was associated with a higher nutritional quality of purchases in experimental and large scale trials.
Conclusion : Altogether, these elements provide evidence-based support for the implementation of the Nutri-Score in France. The research steps undertaken to examine the effects of the Nutri-Score could be used in other settings to help policymakers considering the implementation of FOP labels as a public health nutrition measure.

Julia C et Hercberg S
- Nutri-Score : Effectiveness of the Nutrition Label introduced in France
Ernhahrung Umschau 64, no 12 (2017) : M685 91.

Abstract
France recently decided to implement a newly developed 5 colour Front-of-Pack (FOP) nutrition labelling, “Nutri-Score” to orient consumers towards healthier food choices at the point of purchase and as an incentive for manufacturers to reformulate their products towards healthier compositions. Results of validation studies suggest that the Food Standards Agency nutrient profiling system (FSA-NPS) underlying the Nutri-Score can adequately characterize the nutritional quality of foods, and that an individual score (FSA-NPS dietary index, FSA-NPS DI) based on the FSA score of the foods consumed can adequately summarize the nutritional quality of the diet. Moreover, the FSA-NPS DI is associated with chronic diseases onset. The format of the Nutri-Score appears well-perceived and understood. Finally, the Nutri-Score was associated with a higher nutritional quality of purchases in experimental and large scale trials. Altogether, these elements tend to corroborate the Nutri-Score as an efficient tool in public health nutrition.

Études spécifiques pays-régions

FOP Label/Nutri-Score : countries and regions

ESPAGNE/ SPAIN

Galan P, Gonzalez R, Julia C, Hercberg S, Varela-Moreiras G, Aranceta-Bartrina J, Pérez-Rodrigo C et Serra-Majem L.
- El logotipo nutricional NutriScore en los envases de los alimentos puede ser una herramienta útil para los consumidores españoles.
Rev Esp Nutr Comunitaria 23, no 2 (2017).

Abstract
Spain as other industrialized countries face a major public health challenge in the form of the increasing burden of chronic diseases, fuelled by the rising prevalence of obesity. Nutritional risk factors have been recognized as some of the main drivers of obesity and chronic diseases in the Western world. They are key levers to public health policies as they represent modifiable determinants of health that could be addressed through primary prevention interventions. In this context, France recently announced the implementation of a novel Front-of-Pack (FOP) nutrition labelling at national level to help consumers making healthier choice at the point of purchase and to incent manufacturers to improve the nutritional quality of foods they produce. The selected system, the NutriScore, five couloured label has been the object of scientific research for validation purposes. The objective of the present narrative review is to examine the existing literature on the development, validation and testing of the NutriScore. Elements of the validity of the nutrient profiling system underlying the label as well as the format of the label were investigated. Scientific evidence suggests that the nutrient profiling system underlying the Nutriscore FOP label can adequately characterize the nutritional quality of foods and may be associated at individual level with chronic diseases onset. Finally, the format of the NutriScore (and its former version, the 5-Colour Nutrition Label, 5-CNL) appears as a well-perceived and understood label. The NutriScore was associated with a higher nutritional quality of purchases in experimental and large scale trials. Altogether, these elements tend to corroborate the NutriScore as an efficient tool in public health nutrition for Spain.
Key words : Nutriscore ; Front-of-pack labelling ; nutritional quality of foods ; information ; prevention.

Galan P, Egnell M, Salas-Salvadó J, Babio N, Pettigrew S, Hercberg S, Julia C
- Comprension de differentes etiquetados frontales en población española : Resultados deun estudio comparativo
Endocrinología, Diabetes y Nutrición

Abstract
Background and objectives :Increased prevalence of obesity and its comorbidities has shown the need to implement social policies to help curb this trend. Nutritional risk factors are recognized as key drivers of obesity and other chronic diseases in Spain and in other Western countries. Front-of-package labels (FoPLs) are efficient tools to help consumers make healthier choices. To be useful in purchasing situations, consumers need to understand the information provided by FoPLs. The study objective was to assess objective understanding by consumers of five types of FoPLs, i.e. Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), and Warning symbol in Spain.
Methods : In 2018, 1,000 Spanish participants were recruited and requested to rank three sets of label-free products (one set of three pizzas, one set of three cakes, and one set of three breakfast cereals) according to their nutritional quality in an on-line survey. Participants were then randomized to one of the five types of FoPLs, and were requested to rank the same sets of products again, this time with a given FoPL displayed on the package. Changes in ability to correctly rank products according to FoPLs were compared between both tasks using ordinal logistic regression.
Results :For all three food categories, Nutri-Score performed significantly better, followed by MTL, the Warning symbol, HSR and RIs.
Conclusions :Nutri-Score emerged as the most efficient FoPL in conveying information on the nutritional quality of foods among Spanish consumers.
Key words : Food labeling ; Spanish consumer behavior ; Nutrition policy.

DOI : 10.1016/j.endinu.2019.03.013

ALLEMAGNE/ GERMANY

Szabo de Edelenyi F, Egnell M, Galan P, Druesne-Pecollo N, Hercberg S, Julia C (2019)
- 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
Archives of Public Helth

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).
Method : 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.
Result : 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.
Keywords : NButri-Score, Nutrient profiling system, Nutritional quality, Front-of-pack labelling, Food-based dietary guidelines.

DOI 10.1186/s13690-019-0357-x

Egnell M, talati Z, Pettigrew S, Galan P, Hercberg S, Julia C (2019)
- Comparison of front-of-pack labels to help German consumers understand the nutritional quality of food products. Colour-coded labels outperform all other systems
Ernhahrung Umschau 66(5) : 76-84

Abstract
Front-of-Package labels (FoPLs) provide simplified nutritional information to consumers to help them make healthier food choices. Investigating consu-mers’ understanding of this information is of major importance. This study compared consumers’ objective understanding of five FoPLs (Health Star Rating System [HSR], Multiple Traffic Lights [MTL], Nutri-Score, Reference Intakes [RIs], warning symbol). In 2018, 1,000 German participants were en-rolled in an online survey and asked to rank three sets of products according to their nutritional quality, first in the absence of any labelling, and then with an FoPL displayed on-pack (randomized). Change in ability to correctly rank products was assessed using ordinal logistic regression. For all food catego-ries, the Nutri-Score performed best, followed by the MTL, warning Symbol, HSR and RIs. The Nutri-Score emerged as the most effective FoPL in conveying information on the nutritional quality of foods for German consumers.

PORTUGAL

GOIANA-DA-SILVA F, CRUZ-E-SILVA D, GREGÓRIO MJ, NUNES AM, CALHAU C, HERCBERG C, RITO A, BENTO A, CRUZ D, ALMEIDA F, DARZI A, ARAÚJO F
- Nutri-Score : A Public Health Tool to Improve Eating Habits in Portugal
Acta Med Port 2019 Mar ;32(3):175-178


MAROC/ MOROCCO

Aguenaou H, Julia C, El Hajjab , Galan P, El Berri H, Brahimi M, Belkhadir J, Heikel J et Hercberg S.
- Le logo nutritionnel Nutri-Score : un outil au service du consommateur marocain.
Revue Marocaine des Sciences Agronomiques et Vétérinaires 6, no 3 (2018).


ETUDES EUROPEENNES / EUROPEAN STUDIES

Deschasaux M, Huybrechts I, Murphy N, Julia C, Hercberg S, Srour B, Kesse-Guyot E, Latino-Martel P, Biessy C, Casagrande C et al.
- Nutritional quality of food as represented by the FSAm-NPS nutrient profiling system underlying the Nutri-Score label and cancer risk in Europe : Results from the EPIC prospective cohort study.
PLoS medicine 15, no 9 (2018) : e1002651.

Abstract
BACKGROUND :
Helping consumers make healthier food choices is a key issue for the prevention of cancer and other diseases. In many countries, political authorities are considering the implementation of a simplified labelling system to reflect the nutritional quality of food products. The Nutri-Score, a five-colour nutrition label, is derived from the Nutrient Profiling System of the British Food Standards Agency (modified version) (FSAm-NPS). How the consumption of foods with high/low FSAm-NPS relates to cancer risk has been studied in national/regional cohorts but has not been characterized in diverse European populations.
METHODS AND FINDINGS :
This prospective analysis included 471,495 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC, 1992-2014, median follow-up : 15.3 y), among whom there were 49,794 incident cancer cases (main locations : breast, n = 12,063 ; prostate, n = 6,745 ; colon-rectum, n = 5,806). Usual food intakes were assessed with standardized country-specific diet assessment methods. The FSAm-NPS was calculated for each food/beverage using their 100-g content in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. The FSAm-NPS scores of all food items usually consumed by a participant were averaged to obtain the individual FSAm-NPS Dietary Index (DI) scores. Multi-adjusted Cox proportional hazards models were computed. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the food consumed, was associated with a higher risk of total cancer (HRQ5 versus Q1 = 1.07 ; 95% CI 1.03-1.10, P-trend < 0.001). Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI scores were 81.4 and 69.5 cases/10,000 person-years, respectively. Higher FSAm-NPS DI scores were specifically associated with higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women (all P < 0.05). The main study limitation is that it was based on an observational cohort using self-reported dietary data obtained through a single baseline food frequency questionnaire ; thus, exposure misclassification and residual confounding cannot be ruled out.
CONCLUSIONS :
In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of cancer. This supports the relevance of the FSAm-NPS as underlying nutrient profiling system for front-of-pack nutrition labels, as well as for other public health nutritional measures.

PMID : 30226842
PMCID : PMC6143197
DOI : 10.1371/journal.pmed.1002651

Fabien Szabo de Edelenyi, Manon Egnell, Pilar Galan, Serge Hercberg, Chantal Julia
- Rapport Technique de l’Equipe de Recherche en Epidémiologie Nutritionnelle - Ability of the front-of-pack nutrition label Nutri-Score to discriminate nutritional quality of food products in 7 European countries (Spain, Switzerland, Belgium, Italy, UK, Netherlands and Sweden) and consistency with nutritional recommendations
EREN, U1153 Inserm/Inra/Cnam/Université Paris 13

ABSTRACT :
This report describes the ability of the Front-of-Pack nutrition Label (FoPL), namely the Nutri-Score, to discriminate the nutritional quality of pre-packed food products available in the markets of 7 different European countries (Spain, Switzerland, Belgium, Italy, UK, Netherlands and Sweden) and its consistency with global nutritional recommendations. It complements specific analysis previously published in scientific peer-reviews journals using the same methodology concerning the French and the German food markets.

INTERNATIONAL

Egnell M, Talati Z, Hercberg S, Pettigrew S, et Julia C.
- Objective Understanding of Front-of-Package Nutrition Labels : An International Comparative Experimental Study across 12 Countries
Nutrients 10, no 10 (2018) : 1542.

Abstract
Front-of-Package labels (FoPLs) are efficient tools for increasing consumers’ awareness of foods’ nutritional quality and encouraging healthier choices. A label’s design is likely to influence its effectiveness ; however, few studies have compared the ability of different FoPLs to facilitate a consumer understanding of foods’ nutritional quality, especially across sociocultural contexts. This study aimed to assess consumers’ ability to understand five FoPLs [Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), and Warning symbol] in 12 different countries. In 2018, approximately 1000 participants per country were recruited and asked to rank three sets of label-free products (one set of three pizzas, one set of three cakes, and one set of three breakfast cereals) according to their nutritional quality, via an online survey. Participants were subsequently randomised to one of five FoPL conditions and were again asked to rank the same sets of products, this time with a FoPL displayed on pack. Changes in a participants’ ability to correctly rank products across the two tasks were assessed by FoPL using ordinal logistic regression. In all 12 countries and for all three food categories, the Nutri-Score performed best, followed by the MTL, HSR, Warning symbol, and RIs.
KEYWORDS :
comprehension ; international comparison ; nutritional labelling

PMID : 30340388
PMCID : PMC6213801
DOI : 10.3390/nu10101542

Études sur lobbying et Nutri-Score

Lobbying focused on the Nutri-Score

Julia C et Hercberg S.
- Research and lobbying conflicting on the issue of a front-of-pack nutrition labelling in France.
Archives of Public Health 74, no 1 (2016) : 51.

Abstract
Front-of-pack nutrition labelling has been highlighted as a promising strategy to help consumers making healthier food choices at the point of purchase. In France, a simplified front-of-pack nutrition labelling system was proposed in 2014, the 5-Colour Nutrition Label (5-CNL). It is supported by studies evaluating the various dimensions of the validation of both its underlying classification algorithm and its format. Opposed by agro-industry and retailers, multiples lobbying strategies have been deployed to stop or at least delay the implementation of the 5-CNL. Various alternative nutrition labels were proposed, and a full-scale trial was successfully argued for. This paper retraces the various steps of the opposition between public health and agro-industry lobbies on the topic of front-of-pack nutrition labelling in France.
KEYWORDS :
Agro-industry ; Front-of-pack nutrition labels ; Lobbies ; Public health policies

PMID : 27933143
PMCID : PMC5125039
DOI : 10.1186/s13690-016-0162-8

Julia C et Hercberg S.
- La bataille de l’étiquetage nutritionnel.
Rev Prat 66, no 9 (2016) : 943 48.

PMID : 30512355


Julia C, Charpak Y, Rusch E, Lecomte F, Lombrail P et Hercberg S.
- Promoting public health in nutrition : Nutri-Score and the tug of war between public health and the food industry
The European Journal of Public Health 28, no 3 (2018) : 396 97.

PMID:29554256
DOI : 10.1093/eurpub/cky037


Mialon M, Julia C et Hercberg S.
- The policy dystopia model adapted to the food industry : the example of the Nutri-Score saga in France.
World Nutrition 9, no 2 (2018) : 109 20.

Abstract
In October 2017 in France, the government recognized the Nutri-Score front-of-pack labelling system as the only official system to be used on food products. As of July 2018, a total of 70 companies had implemented it voluntarily. There is ample evidence to support its use, and multiple expected benefits in terms of public health. We present here an essay discussing about the Nutri-Score saga. A policy dystopia model, from the literature on tobacco industry tactics, was adapted to classify the corporate political activity of the food industry during the development and implementation of the Nutri-Score. We conclude that, despite public commitments made by some industry actors to implement this system, the food industry is still strongly trying to influence policy and public opinion in the country. There are and will be many hurdles along the way, with food industry members trying to influence regulation at the European level, and building alliances with the media, among others, in France. Hopefully, public health objectives will prevail over commercial interests, in France and abroad.

Julia C et Hercberg S.
- Big Food’s Opposition to the French Nutri-Score Front-of-Pack Labeling Warrants a Global Reaction
American Journal of Public Health, 2018.

PMID : 29412720
DOI : 10.2105/AJPH.2017.304284


Julia C, Etilé F et Hercberg S.
- Front-of-pack Nutri-Score labelling in France : an evidence-based policy
The Lancet Public Health 3, no 4 (2018) : e164.

PMID : 29483002
DOI : 10.1016/S2468-2667(18)30009-4


Études marketing

Marketing studies

Mérigot P & Nabec L (2016)
- Les effets d’alerte et de promotion des logos nutritionnels sur la face-avant des produits agroalimentaires.
Décision Marketing 83, 29-48.


Nabec L (2016)
- Améliorer les comportements alimentaires avec l’étiquetage nutritionnel : vers un agenda de recherche au service du Bien-être des consommateurs.
Recherche et Applications en Marketing (French Edition) 32, 76-104


Nabec L, Mérigot P & Julia C (2017)
- Les logos nutritionnels sont-ils légitimes ? Analyse de l’effet de leur format selon l’expertise nutritionnelle des consommateurs.
In 33è Colloque International de l’Association Française du Marketing.


Prises de positions

Position papers

Articles publiés dans « The Conversation »

3 juillet 2018
- Le NutriScore mesure la qualité nutritionnelle des aliments, et c’est déjà beaucoup
Julia C, Touvier M, Hercberg S
Peut-on reprocher au logo NutriScore de ne pas prendre en compte la présence de substances chimiques dans l’alimentation ? Non, car il est conçu pour évaluer seulement la qualité nutritionnelle.


27 mars 2017
- Le NutriScore, un étiquetage nutritionnel pour les aliments enfin reconnu par tous, ou presque…
Julia C, Hercberg S
Des codes couleurs simples vont permettre aux consommateurs de repérer les produits alimentaires les plus sains dans les supermarchés. Sauf que les fabricants font de la résistance.


1 décembre 2017
- Logo nutritionnel : pourquoi certains industriels font de la résistance
Hercberg S, Julia C
Les consommateurs peuvent connaître la qualité des aliments d’un point de vue nutritionnel grâce au NutriScore. Une pétition dénonce les tentatives de plusieurs fabricants pour contrer ce logo.


Rapports institutionnels

Institutionnal reports

- Rapport du Bureau européen des unions de consommateurs : Front-of-pack Nutritional labelling : BEUC Position (2019)

- Rapport du Parlement Europeen Policy Department for Citizens’ Rights and Constitutional Affairs (2019) : Food Labelling for Consumers EU Law, Regulation and Policy Options