Program in Health Services and Systems Research, Duke-NUS Medical School, Level 4, Singapore, 169857, Singapore.
Int J Behav Nutr Phys Act. 2023 Feb 15;20(1):18. doi: 10.1186/s12966-023-01422-4.
The epidemic of non-communicable diseases (NCDs) is a growing concern worldwide and Singapore is no exception to this global trend. As part of measures to address this concern, the Singapore government will implement a mandatory color-coded front-of-package (FOP) nutrition label for beverages, called Nutri-Grade (NG), which will complement the existing FOP label, Healthier Choice Symbol (HCS) logos, currently displayed on select food and beverage items. NG grades beverages on a four-point scale, A (healthiest) to D (least healthy), in terms of sugar and saturated fat levels. This study aimed to evaluate the effectiveness of the NG label on nutritional quality of pre-packaged beverages using a fully functional online grocery store.
We conducted a 2-arm crossover trial involving actual purchases with 138 participants randomly exposed to: 1) Control with HCS logos displayed on qualifying items; 2) Similar to Control except that all beverages displayed the NG label. The effects of the NG label were estimated using a linear mixed-effects model that addresses correlations between repeated measures and accommodates missing data.
We found that the NG label encouraged consumers to choose beverages with higher ratings. This led to a reduction in sugar from beverages purchased by 1.51 g [95% CI: - 2.68, - 0.34] per serving but was not effective at reducing saturated fat purchased (- 0.009 g [95% CI: - 0.22, 0.20]) per serving or improvements in overall diet quality, measured by the weighted (by the number of servings) average Nutri-Score value ranging from 1 to 5 (- 0.024 [95% CI: - 0.13, 0.08]).
Results suggest that the Nutri-Grade label is likely to reduce sugar purchased from beverages. However, to improve overall diet quality in Singapore, additional measures will be needed.
This trial was registered on ClinicalTrials.gov under the identifier: NCT05018026 on 24th August 2021.
非传染性疾病（NCDs）的流行是全球范围内日益关注的问题，新加坡也不例外。作为应对这一问题的措施之一，新加坡政府将对饮料实施强制性的彩色前端包装（FOP）营养标签，称为 Nutri-Grade（NG），该标签将补充现有的 FOP 标签、Healthier Choice Symbol（HCS）徽标，目前显示在选定的食品和饮料项目上。NG 根据糖和饱和脂肪含量将饮料分为 A（最健康）到 D（最不健康）四个等级。本研究旨在使用功能齐全的在线杂货店评估 NG 标签对预包装饮料营养质量的有效性。
我们进行了一项 2 臂交叉试验，涉及 138 名参与者的实际购买，他们随机暴露于以下两种情况：1）有 HCS 徽标显示在合格项目上的对照；2）类似于对照，只是所有饮料都显示 NG 标签。使用线性混合效应模型估计 NG 标签的效果，该模型解决了重复测量之间的相关性，并适应了缺失数据。
我们发现 NG 标签鼓励消费者选择评分较高的饮料。这导致每份量购买的饮料中的糖减少了 1.51g[95%CI：-2.68，-0.34]，但对每份量购买的饱和脂肪没有效果（-0.009g[95%CI：-0.22，0.20]），也没有改善整体饮食质量，通过加权（按份量数）平均 Nutri-Score 值来衡量，范围从 1 到 5（-0.024[95%CI：-0.13，0.08]）。
结果表明，Nutri-Grade 标签可能会减少从饮料中购买的糖量。然而，要改善新加坡的整体饮食质量，还需要采取其他措施。
本试验于 2021 年 8 月 24 日在 ClinicalTrials.gov 上以标识符 NCT05018026 注册。
