Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore.
Public Health Authority, Riyadh 11176, Saudi Arabia.
Nutrients. 2023 Jun 27;15(13):2904. doi: 10.3390/nu15132904.
One common strategy for governments to tackle the non-communicable disease (NCD) epidemic is front-of-package (FOP) nutrition labeling. The Kingdom of Saudi Arabia (KSA) is considering implementing a new FOP label that is based on either France's Nutri-Score (NS), which labels all foods (A = healthiest to E = least healthy) based on overall nutritional quality, or the Chilean warning label (WL) approach, which identifies foods to avoid based on select nutritional characteristics. Using a fully functional online grocery store, this study aimed to test these two promising FOP strategies by randomizing 656 KSA adults into one of the three versions of the store to complete a hypothetical grocery shop: no-label (control), NS, and WL. The NS was modified with a sugar percentage tag given that reducing sugar consumption is one of KSA's public health goals. We found that both modified NS labels and Chilean warning labels positively influenced food and beverage choices among KSA participants, but there were differential effects across the two labels. Relative to the control, NS improved the overall diet quality of the shopping baskets, measured by the weighted (by the number of servings) average NS point (ranging from 0, least healthy, to 55, healthiest), by 2.5 points [95% CI: 1.7, 3.4; < 0.001], whereas results for WL were not statistically significant (0.6 points [95% CI: -0.2,1.5]). With respect to each nutritional attribute, we found that NS reduced sugar intake per serving, whereas WL was effective at decreasing energy and saturated fat intake per serving from food and beverages purchased. Our results suggest that the NS approach that identifies the healthiness of all foods using a holistic approach appears preferable if the purpose of the label is to improve overall diet quality as opposed to addressing select nutrients to avoid.
一种政府应对非传染性疾病（NCD）流行的常见策略是使用包装正面（FOP）营养标签。沙特阿拉伯王国（KSA）正在考虑实施一种新的 FOP 标签，该标签基于法国的 Nutri-Score（NS）或智利的警告标签（WL）。NS 标签根据整体营养质量对所有食品（A 表示最健康，E 表示最不健康）进行分类，而 WL 标签则根据特定营养特性确定要避免的食品。本研究使用功能齐全的在线杂货店，通过将 656 名沙特成年人随机分配到商店的三个版本之一来测试这两种有前途的 FOP 策略，以完成假设的杂货店购物：无标签（对照）、NS 和 WL。NS 标签经过修改，增加了糖含量百分比标签，因为减少糖摄入量是沙特阿拉伯公共卫生目标之一。我们发现，经过修改的 NS 标签和智利警告标签都对沙特参与者的食品和饮料选择产生了积极影响，但两种标签的影响存在差异。与对照相比，NS 提高了购物篮的整体饮食质量，用加权（按份数计算）平均 NS 点（范围从 0，最不健康，到 55，最健康）来衡量，提高了 2.5 分[95%CI：1.7，3.4；<0.001]，而 WL 的结果则没有统计学意义（0.6 分[95%CI：-0.2，1.5]）。就每个营养属性而言，我们发现 NS 降低了每份食物的糖摄入量，而 WL 则有效降低了购买的食品和饮料中每份的能量和饱和脂肪摄入量。我们的结果表明，如果标签的目的是提高整体饮食质量，而不是针对特定的营养素来避免，那么使用整体方法来识别所有食品健康程度的 NS 方法似乎更可取。
