Effect of a modified Nutri-Score on the understanding of nutrient profile and ultra-processing

INTRODUCTION: When considering health-related impacts of foods, nutrient profile and processing are 2 complementary dimensions. Nutri-Score informs on the nutrient profile. Recently, mounting evidence linked ultra-processed food (UPF) consumption to various adverse health outcomes, independently of their nutrient profile. To inform consumers about each of these health-related dimensions of food, we tested, in a randomised controlled trial, if a graphically modified version “Nutri-Score 2.0”, including a black “ultra-processed” banner, would improve the capacity of consumers to rank products according to their nutrient profile, and to detect UPF, compared to a no-label situation. METHODS: 21,159 participants included in the NutriNet-Santé web-cohort were randomly assigned to a control arm (no front-of-pack label) or an experimental arm (Nutri-Score 2.0), and were presented an online questionnaire with 3 sets of food products (cookies, breakfast cereals, and ready-to-eat meals) to rank according to nutrient profile, and to identify UPF. The primary outcome was objective understanding of nutrient profile and ultra-processing, represented by a score of correct answers. Secondary outcomes were purchasing intentions and the healthiest-perceived product. Multinomial logistic regressions were performed. RESULTS: Nutri-Score 2.0 improved objective understanding of both nutrient profile of food products from 0.9% to 24.2% (OR = 29.0 (23.4-35.9), p < 0.001), and the ultra-processing dimension from 4.4% to 77.7% (OR = 174.3 (151.4-200.5), p < 0.001). Trends were similar for cookies, breakfast cereals, and ready-to-eat meals. The Nutri-Score 2.0 had a positive impact on purchasing intentions and on the products perceived as the healthiest. CONCLUSIONS: This randomised controlled trial demonstrates the interest of a front-of-pack label combining Nutri-Score (informing on nutrient profile) with an additional graphic mention indicating when the food is UPF, compared to a no-label situation. KEY MESSAGES: • This study suggests relevance for providing information on both nutrient profile and ultra-processing on front-of-pack labels. • Our results show that participants were able to independently identify and understand these two complementary dimensions of foods.