A Randomized Controlled Trial Evaluating the Relative Effectiveness of the Multiple Traffic Light and Nutri-Score Front of Package Nutrition Labels

Abstract

The objective of this trial was to test two promising front-of-pack nutrition labels, 1) the United Kingdom's Multiple Traffic Lights (MTL) label and 2) France's Nutri-Score (NS), relative to a no-label control. We hypothesized that both labels would improve diet quality but NS would be more effective due to its greater simplicity. We tested this hypothesis via an online grocery store using a 3 × 3 crossover (within-person) design with 154 participants. Outcomes assessed via within person regression models include a modified Alternative Healthy Eating Index (AHEI)-2010 (primary), average Nutri-Score, calories purchased, and singular measures of diet quality of purchase orders. Results show that both labels significantly improve modified AHEI scores relative to Control but neither is statistically superior using this measure. NS performed statistically better than MTL and Control based on average Nutri-Score, yet, unlike MTL it did not statistically reduce calories or sugar from beverages. This suggest that NS may be preferred if the goal is to improve overall diet quality but, because calories are clearly displayed on the label, MTL may perform better if the goal is to reduce total energy intake.

Keywords: 5-color nutritional label; diet; diet quality; food Intake; front-of-pack labeling; multiple traffic lights; nutri-score; nutrition labeling; online grocery store.

Figure 1

Front-of-pack labels under consideration in Singapore.

Figure 2

Example of the storefront with a sample of the Multiple Traffic Light and Nutri-Score labels on the same product as it appears in each condition.

Figure 3

CONSORT flow diagram for participant recruitment and randomization.