Abstract
Dietary practices are a key behavioral factor in chronic disease prevention; one strategy for improving such practices population-wise involves front-of-package labels (FoPL). This online randomized study, conducted in a quota-based sample of 1159 Polish adults (mean age = 40.9 ± 15.4 years), assessed the objective understanding of five FoPL: Health Star Rating, Multiple Traffic Lights, NutriScore, Reference Intakes (RI) and Warning Label. Objective understanding was evaluated by comparing results of two nutritional quality ranking tasks (without/with FoPL) using three food categories (breakfast cereals, cakes, pizza). Associations between FoPL exposure and objective understanding were assessed via multivariable ordinal logistic regression. Compared to RI and across food categories, significant improvement in objective understanding was seen for NutriScore (OR = 2.02; 95% CI: 1.41–2.91) and Warning Label (OR = 1.61; 95% CI: 1.12–2.32). In age-stratified analyses, significant improvement in objective understanding compared to RI emerged mainly among adults aged 18–30 years randomized to NutriScore (all food categories: OR = 3.88; 95% CI: 2.04–7.36; cakes: OR = 6.88; 95% CI: 3.05–15.51). Relative to RI, NutriScore was associated with some improvement in objective understanding of FoPL across and within food categories, especially among young adults. These findings contribute to the ongoing debate about an EU-wide FoPL model.
Highlights
The increase in life expectancy observed in Poland over the last few decades is a product of multiple factors, among which are somewhat decreasing smoking rates and some improvement in diet quality [1]
Across the three food categories, significant improvement in objective understanding of front-of-package labels (FoPL), measured by one’s ability to rank the products according to their nutritional value, was found in the group randomized to NutriScore and—to a lesser extent—in the group randomized to Warning Label
FoPL are increasingly being recognized as useful supplementary strategies in the fight against diet-related chronic diseases, and the European Commission intends to adopt a uniform FoPL model by the end of 2022 [8,48]
Summary
The increase in life expectancy observed in Poland over the last few decades is a product of multiple factors, among which are somewhat decreasing smoking rates and some improvement in diet quality (i.e., decreasing consumption of salt, animal fats and red meat; increasing consumption of fruit, vegetables and fish) [1]. In spite of awareness about the role of lifestyle behaviors in chronic disease risk [2], rates of obesity, smoking and alcohol use in Poland are higher than the respective European Union (EU) averages [3]. A report by the Organization for Economic Cooperation and Development (OECD) highlighted that, in Poland, diseases of the circulatory system accounted for a larger share of total mortality compared to the EU average (i.e., 45% versus 36% in 2016), that spending on prevention was relatively low and insufficient physical activity was prevalent [3]. Dietary practices are considered a crucial behavior-based factor in premature cardiovascular mortality prevention [5]
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