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Randomized Controlled Trial
. 2017 Nov 24;9(12):1284.
doi: 10.3390/nu9121284.

Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases-A Randomised Controlled Trial

Bruce Neal  1   2   3   4 , Michelle Crino  1 , Elizabeth Dunford  1   5 , Annie Gao  1 , Rohan Greenland  6 , Nicole Li  1 , Judith Ngai  7 , Cliona Ni Mhurchu  8 , Simone Pettigrew  9 , Gary Sacks  10 , Jacqui Webster  1 , Jason HY Wu  1
Affiliations
Randomized Controlled Trial

Effects of Different Types of Front-of-Pack Labelling Information on the Healthiness of Food Purchases-A Randomised Controlled Trial

Bruce Neal et al. Nutrients. .

Abstract

Background: Front-of-pack nutrition labelling may support healthier packaged food purchases. Australia has adopted a novel Health Star Rating (HSR) system, but the legitimacy of this choice is unknown.

Objective: To define the effects of different formats of front-of-pack labelling on the healthiness of food purchases and consumer perceptions.

Design: Individuals were assigned at random to access one of four different formats of nutrition labelling-HSR, multiple traffic light labels (MTL), daily intake guides (DIG), recommendations/warnings (WARN)-or control (the nutrition information panel, NIP). Participants accessed nutrition information by using a smartphone application to scan the bar-codes of packaged foods, while shopping. The primary outcome was healthiness defined by the mean transformed nutrient profile score of packaged foods that were purchased over four weeks.

Results: The 1578 participants, mean age 38 years, 84% female recorded purchases of 148,727 evaluable food items. The mean healthiness of the purchases in the HSR group was non-inferior to MTL, DIG, or WARN (all p < 0.001 at 2% non-inferiority margin). When compared to the NIP control, there was no difference in the mean healthiness of purchases for HSR, MTL, or DIG (all p > 0.07), but WARN resulted in healthier packaged food purchases (mean difference 0.87; 95% confidence interval 0.03 to 1.72; p = 0.04). HSR was perceived by participants as more useful than DIG, and easier to understand than MTL or DIG (all p < 0.05). Participants also reported the HSR to be easier to understand, and the HSR and MTL to be more useful, than NIP (all p < 0.03).

Conclusions: These real-world data align with experimental findings and provide support for the policy choice of HSR. Recommendation/warning labels warrant further exploration, as they may be a stronger driver of healthy food purchases.

Keywords: food industry; food labelling; food purchases; policy; randomised trial.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Label formats investigated.
Figure 2
Figure 2
CONSORT diagram. Health Star Rating (HSR), Multiple Traffic Lights (MTL), Daily Intake Guide (DIG), Recommendations/warnings (WARN), and Nutrition Information Panel (NIP).
Figure 3
Figure 3
Fixed effects meta-analysis of the effects of health star ratings and multiple traffic lights compared to control on healthiness of food purchases in the current trial and a sister trial done in New Zealand (mean differences and 95% confidence interval). ES = Effect size; 95% CI = 95% confidence interval; HSR = Health Star Rating; MTL = Multiple Traffic Light; NIP = Nutrition Information Panel; NZ = New Zealand; AUS = Australia. I-squared statistic indicates between trial differences in contributing trial results beyond chance and p-value is result for test of heterogeneity of trial results.
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