Effect of a new graphically modified Nutri-Score on the objective understanding of foods’ nutrient profile and ultra-processing – a randomised controlled trial

Abstract Context and objective When considering the health-related impact of foods, nutrient profile (content in salt, sugar, fibre, etc.) and (ultra-)processing are two complementary dimensions. The Nutri-Score, a summary graded front-of-pack label, already used in seven European countries, informs on the nutrient profile dimension, i.e. the one with the strongest evidence. Recently, mounting evidence linked ultra-processed food consumption to various adverse health outcomes, independently of their nutrient profile. To inform consumers about each of these two health-related dimensions of food (i.e., nutrient profile and ultra-processing), we aimed to test, 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 but also to detect those ultra-processed, compared to a no-label situation. Methods A total of 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 interactive questionnaire with 3 sets of food products (8 cookies, 7 breakfast cereals, and 7 ready-to-eat meals) to rank according to their nutrient profile, and to identify ultra-processed foods. The primary outcome was the 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 The Nutri-Score 2.0 increased significantly the objective understanding of both the nutrient profile dimension 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), compared with no front-of-pack label. The results followed similar trends for cookies, breakfast cereals, and ready-to-eat meals. The Nutri-Score 2.0 also had a positive impact on purchasing intentions and on the products perceived as the healthiest, guiding consumers towards a better nutrient profile and non-ultra-processed products. Conclusion This randomised controlled trial demonstrates the interest of a front-of-pack label combining the Nutri-Score (informing on the nutrient profile dimension) with an additional graphic mention indicating when the food is ultra-processed, compared to a no-label situation. Our results show that participants were able to independently identify and understand these two complementary dimensions of foods. Trial registration number NCT05610930