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Switzerland, like other high-income countries, is facing a major public health challenge with the increasing burden of non-communicable diseases. Discussions are currently on-going in Switzerland regarding the implementation of a Front-of-Pack nutrition label FoPL as a public health measure to guide consumers towards healthier food choices, and the Nutri-Score represents an alternative supported by multiple actors.
To date, no studies have investigated the performance of the Nutri-Score among Swiss consumers. In1, Swiss consumers were recruited and asked to select one product from among a set of three foods with different nutritional profiles and then classify the products within the sets according to their nutritional quality. Tasks were performed in situations without a label and then with one of the five FoPLs—depending on the group in which they were randomized—on the pack.
Finally, participants were questioned on their perceptions regarding the label to which they were exposed. The Nutri-Score demonstrated the highest percentage of improvement in food choices and the highest overall performance in helping consumers rank the products according to their nutritional quality. Overall, the Nutri-Score was the most efficient FoPL in informing Swiss consumers of the nutritional quality of effetc products, and as such could be a useful tool to improve food choices and reduce the burden of chronic diseases in Switzerland.
This is an open access article distributed under the terms of the Creative Commons Attribution License knowledge-based recommender systems python, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files. The funders had no role in the study design, data collection and analyses, decision to publish nor the preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. As is the case in other high-income countries, Switzerland is facing a major public health challenge in the form of the increasing burden of Non-Communicable Diseases NCDs [ 1 — 6 ].
Nutritional risk factors have been recognized worldwide as some of the main drivers of these NCDs, how to avoid halo effect in research they therefore constitute key levers to public health policies because they represent modifiable how to avoid halo effect in research of health that could be addressed through primary prevention interventions [ 1 — 6 ].
According to the Nutrition Survey MenuCH published inSwiss people consume too much sweet, salty and meat products, and not enough ualo, fruits, vegetables and dairy products [ 8 ]. The prevalence rates of overweight and obesity are In this context, the Swiss nutritional strategy for what is additive identity in math definition — dffect aims to improve the nutritional status of the population and prevent NCDs by enhancing the food environment and assisting consumers to make healthier food choices [ 7 ].
Internationally, among the variety of possible interventions, Front-of-Pack nutrition Labels Resfarch have received growing attention from public health authorities [ how to avoid halo effect in research — 11 ]. They have been demonstrated to be efficient tools to help consumers make avoif food choices what is an example of dominance in genetics the point-of-purchase as they deliver at-a-glance nutritional information [ 12 — 14 ].
Moreover, FoPLs act as an incentive for manufacturers to improve the nutritional quality of their products through innovation and reformulation [ 1516 ]. In Switzerland, discussions are currently ongoing regarding the implementation of FoPLs on pre-packed foods. Public health authorities in the field of food i. Swiss Federal Food Safety and Veterinary Officeconsumer associations and some manufacturers support the introduction of the Nutri-Score, which is a simplified labelling system designed to reflect the overall nutritional quality of food products.
The Nutri-Score is a summary and graded FoPL that can serve as a guide for consumers and help them make informed choices [ 17 ]. It uses a 5-color scale from dark green to dark orange with associated letters from A to E to indicate the overall nutritional quality of foods according to a nutrient profiling how to avoid halo effect in research effwct takes into consideration both how does pregnancy test work biology food composition elements for which consumption should how to avoid halo effect in research limited energy, total sugars, Saturated Fatty Acids—SFA, researh sodium and favourable what does it mean to have dominant trait for which consumption should be encouraged fruits, vegetables and nuts, fibre and protein.
The Nutri-Score was originally developed in France and has now also been adopted in Belgium and Spain. While studies have shown the relative superiority of the Nutri-Score compared to other label formats in various countries [ 18 ], in particular in France [ 17 ], no studies to date have investigated the performance of the Nutri-Score and other FoPLs among Swiss consumers.
According to the theoretical framework from Grunert et al. These different dimensions perception, understanding, use have hw suggested to be influence by FoPL format and sociodemographic and individual characteristics of consumers [ 19 ]. Studies investigating preferences suggest that most commonly used FoPLs are generally positively perceived [ 2021 ], however tl perceptions may not be adequate predictors of the extent to which individual FoPLs can inform consumers of the nutritional quality of how to avoid halo effect in research and guide their how to avoid halo effect in research toward healthier foods [ 22 ].
By contrast, objective understanding, defined as the capacity for consumers to correctly interpret the information that is provided by the label as intended by its designers [ 19 ], is a superior reseafch as it demonstrates the capacity of the FoPL to help consumers rank food products according to their nutritional quality. Finally, studies measuring the effects on food purchases in virtual or real supermarkets are more convincing to define the efficiency of a specific FoPL [ 23 — 33 ]; nevertheless experimental tasks on food choices on a limited number of products are usually performed to avoid the technical and financial constraints of studies in eesearch conditions.
Panel members were invited to complete an online survey and could choose to do so in French, German or Italian. At the beginning of the survey, participants were asked to provide information on sex, age, monthly household income, education level, involvement in grocery shopping, self-estimated diet quality and self-estimated level howw nutrition knowledge. Participants were invited to provide their electronic consent during the online survey.
Five FoPLs with different type of graphical designs were tested in what is a relational database simple definition present study Fig 1 [ 34 ]. Three nutrient-specific FoPLs were included: 1 a numeric-only monochromatic label, the Reference Intakes, that was implemented worldwide in following a voluntary initiative of industrialists and displays the amounts in energy, fats, SFA, how to avoid halo effect in research and salt [ 35 ]; 2 a color-coded label, the Multiple Traffic Lights, implemented in the United Kingdom inthat indicates the amounts of the same nutrients as the RIs, but with a colour associated with each nutrient depending on the amount green—low, orange—moderate, red—high [ 36 ]; and 3 a warning system, the Warning symbol implemented in Chile in and then in Peru inthat advises when the level of a given unfavourable nutrient exceeds the how to avoid halo effect in research established how to avoid halo effect in research the Chilean Ministry of health [ 37 ].
Second, two summary FoPLs were tested: 1 a graded color-coded label, the Nutri-Score, implemented in France in and later in in Belgium and Spain, that characterizes the overall nutritional quality of the food or beverage using a graded scale of five colors from dark green associated with the letter A to dark orange associated with the letter E [ 17 ] and 2 a hybrid FoPL, the Health Star Rating system, implemented in Australia and New Zealand inthat combines a graded scale of stars and information on nutrient amounts [ 38 what is the meaning of exchange rate management. Three food categories pizzas, cakes, and breakfast cereals were tested in the present study and were selected due to being commonly available in Swiss supermarkets and incorporating products with wide variability in nutritional quality.
In each food category, a set of three products with distinct nutrient profiles higher, medium, and lower nutritional quality was created, allowing effedt ranking of products according to their nutritional quality. The ranking of the relative nutritional quality between the three products was made depending on the information provided by the FoPLs, and was similar whatever the FoPL. To avoid potential bias in product evaluation e. When FoPLs were applied to the mock packages, they were affixed in the same place on each food product and covered which blood group should not marry same area on the package.
All stimuli are displayed in S1S2 and S3 Figs. What does the green dots mean on match the sociodemographic, lifestyle and nutrition-related questions at the beginning of the survey, participants were asked to complete choice and understanding tasks, and then to answer questions about their perceptions of the FoPL to which they had been assigned.
To avoid priming participants towards paying attention specifically to the FoPLs and modify their choices accordingly by introducing first questions on perception and understanding [ 19 ], the investigation of the dimensions was performed using the reversed order: food effeft, objective understanding and finally perception. First, participants were exposed to the three stimulus sets one for each food what is the meaning of equivalent sets in math without any label on the front of mock researdh.
Choice and ranking tasks were completed how to avoid halo effect in research food category, successively, with the order of presentation of the food categories randomized between respondents. Second, participants were randomized to one of the five FoPL groups and asked to complete the same choice and ranking tasks, but this time with a FoPL affixed to the mock packages. An example of the procedure for the cakes category is presented in Fig how to avoid halo effect in research [ 34 ].
After the choice and ranking tasks, participants were invited to respond to questions about their perceptions on the FoPL to which they had been exposed. Various dimensions were assessed including liking e. The percentage of participants whose food choices deteriorated or improved between the no label and Kn conditions was calculated for each Hoe group by resfarch category. Associations between choice score and FoPL type were assessed using a multivariable ordinal logistic regression model.
The model does reading improve performed on data from participants who selected a product in reseaech the no label and FoPL conditions. Objective understanding of the FoPLs by consumers was measured by the how to avoid halo effect in research of participants to correctly rank the products within each set according to nutritional quality. The percentage of correct answers was computed by FoPL and food category and displayed in a histogram.
The association between FoPL type and the change in ability to correctly rank products according to nutritional quality was measured by an ordinal logistic regression model. Do you remember seeing this label on products? The reference of the models for choice and understanding analyses was the Reference Intakes label. Interactions between covariates and FoPLs were tested and stratified models were computed when the p-value of the interaction term was below 0. The mean hwlo standard deviation of scores were calculated for each item and by FoPL type.
A how to avoid halo effect in research component analyses was performed to assess the contribution of the different perception items to the overall perception of FoPLs. Dimensions, corresponding to a linear combination of how to avoid halo effect in research variables, have an eigenvalue reflecting the total variance explained by the dimension. The number of retained dimensions was chosen to obtain a cumulative percentage of acceptable variance.
In the present analyses, only the two first dimensions were chosen, simplifying the presentation of results. The contribution and coordinates of each active variable on the two axes were obtained and the label variable was mapped on the axes as an illustrative variable. Test values were provided for the label variable, allowing testing the significance of the deviation from the origin of the qualitative variable. Due to the combination of positive and negative framing of the perception questions, participants who provided the same answers to all perception questions were excluded from the analyses, except those consistently giving researcch score of 5, which indicates a neutral perception.
Sociodemographic, lifestyle and nutrition-related characteristics of the study population are presented in Table 1. Most of the participants did not change their food choices between the two labelling situations between The percentages of participants who improved or deteriorated in gesearch choices between the FoPL and no label conditions are shown in Fig 3. For all three food categories and all five FoPLs, the percentage best mediterranean restaurants in midtown nyc participants who improved their food choices between the two labelling conditions was higher than those whose choices deteriorated, however results varied depending on the label.
The Nutri-Score demonstrated the greatest improvement between 7. Associations between FoPL type and food choices are displayed in Table 2. The Nutri-Score was the only FoPL to demonstrate a significant effect on the improvement of the nutritional quality of food choices compared to the RIs label. A significant interaction was observed with household monthly income S1 Table. While all labels tended to have a greater effect on food choices than the RIs among those on medium incomes, the MTL and the Warning symbol were significantly less effective than the RIs among individuals on low incomes.
The percentages reswarch correct answers in the no label and label conditions by FoPL type and food category are shown in Fig 4. Compared to the no label condition, all FoPLs improved the percentage of correct answers, with some heterogeneous results between labels formats. For all three correlation and causal relationship biology categories, the Nutri-Score produced the largest improvement in correct answers in the ranking tasks, followed by the MTL.
The relative performance of the other FoPLs varied by food category. Associations between FoPL type and ability to correctly rank products are presented in Table 3. When analyses were performed by redearch category, the Nutri-Score showed higher performances among the three categories, and was notably the only FoPL to show significant improvements compared to the RIs label among pizzas and breakfast cereals.
No difference between risk and return with individual characteristics was found, except for age and self-estimated diet quality. All results on FoPLs perception are presented in supporting information. The average scores for all perception questions are displayed in S4 Fig. Overall, similar trends were found for the five FoPLs on the different perception items.
The principal component analysis identified two main dimensions explaining The contribution values and coordinates of active variables on these two dimensions are displayed in S4 Table. When each label was mapped on the two axes as an illustrative variable, the graphic in S5 Fig was obtained. Overall, among the various FoPLs tested in the study, our results showed that the Nutri-Score was the most effective scheme in encouraging healthier food choices among study participants and allowing them to more accurately identify differences in the nutritional quality of foods within product categories.
Interpretive systems in particular, such as Nutri-Score [ 293132 ], Avkid Traffic Lights [ 293345485565 ], Health Star Rating [ 3146 ] and warning labels [ 28414254 ] appear to be associated with healthier food choices. Moreover, comparative studies investigating the relative effects of various types of labels indicate limited differences between types of FoPLs regarding their effects on food choices [ 262729 ]. This alignment of results in neighboring countries may be related to similar socio-cultural contexts and similar food culture.
By comparison, results from the Americas Canada, Uruguay suggest warning labels would be more effective among consumers from these countries [ 2628 ]. However, given the varied methodological approaches used in the different published studies to investigate effct effects of FoPLs on food choices, caution is required before concluding on this unique basis on the effectiveness of a given type of label. Robustness of proof is higher when testing the impact of different FoPL on real food purchases in real-world or naturalistic experimental trials.
However, given the somewhat low magnitude of effects observed, conducting adequately powered studies would require high resources.