Dual front-of-pack (FoP) labelling (i.e., presence of both nutrition and sustainability labels) can guide consumers towards healthier and more sustainable food choices. Despite growing interest, evidence on behavioural outcomes remains limited. This study aimed to review existing literature to understand the effects of dual FoP labelling on consumer behaviour. We searched seven databases for experimental studies published until May 2024 that assessed dual front-of-pack labels as interventions. Eligible studies measured the following outcomes: objective understanding, purchase intention, food choice, and/or willingness to pay (WTP). Risk of bias was assessed using the RoB 2 tool. Seven studies examined five nutrition and five sustainability labels, with three reporting on purchase intention, three on food choice, and one on WTP. None of the studies assessed objective understanding. Risk of bias assessment rated five studies as high quality, one moderate, and one low. Five studies testing congruent dual labelling (positive nutrition & sustainability scores) using interpretive formats (e.g., warning labels, Nutri-Score, Eco-Score) reported favourable effects of dual labelling. Two studies assessing congruent text-based or certification labels showed unfavourable outcomes. Incongruent labelling (positive nutrition & negative sustainability, and vice versa) produced mixed results, suggesting conflicting information may confuse consumers. Understanding how consumers respond to combined nutrition and sustainability information is essential for transitioning to healthy and sustainable food systems. This review shows that dual labelling can influence choices, but its effectiveness depends on label format and message framing, highlighting the need for careful design to avoid unintended effects and support informed decision-making.

Does unmatching meat and plant-based meals change plant-based meal selection? An evaluation in an online hypothetical randomised trial.

Adolescents' food choice patterns at school: A data driven approach.

Healthy eating is a complex and often confusing topic, especially for young people. Conflicting advice, trends, and body ideals contribute to a stigmatising food environment in which social media influencers (SMIs) strongly shape perceptions of what counts as a 'healthy' diet. However, little is known about the specific food content that emerging adults encounter in their own social media feeds and how this influences their understanding of healthy eating. Guided by Source Credibility Theory and Expectancy-Value Theory, this study used a photo-voice approach combining content analysis and focus group discussions. Emerging adults collected 559 food-related images from their social media feeds, which were later used as discussion prompts. This multi-method design enabled an in-depth examination of the health-promoting food content shared by influencers, its alignment with dietary guidelines, and the features shaping perceived credibility. Results showed that 30% of analysed posts contradicted dietary guidelines, mainly by featuring too large portions of red meat. Most inaccurate content (78.3%) appeared in recipe posts and was almost exclusively shared by uncredentialed influencers (90.7%). Focus group discussions revealed that participants often overlooked subtle misinformation due to shortcomings in credibility evaluation. Many relied on perceived expertise, such as scientific language or a "healthy" appearance, rather than formal credentials, while others viewed recipe posts as harmless, underestimating their impact on perceptions of healthy eating. Overall, findings suggest that although influencer content can promote healthier food choices, improving digital literacy is crucial to help emerging adults recognise and critically assess misleading nutritional information.

Plant-based labels aim to promote plant-based choices by highlighting which products are plant-based. However, these labels are often applied selectively, leaving many more plant-based products unlabelled. We argue that this may unintentionally communicate that plant-based options are more 'niche' rather than the 'norm', and thereby hinder normalisation of plant-based consumption. Across two incentive-compatible experiments with representative Dutch samples in a simulated online supermarket, we examined how labelling interventions influence perceived availability of plant-based options, descriptive and injunctive social norms for choosing plant-based, and plant-based choices. In Study 1 (N=1474), we manipulated the number of plant-based products labelled as plant-based. We found that labelling the majority (≥60%) of plant-based products increased perceived availability of plant-based products. Study 2 (N=981) strengthened the label manipulation and compared two approaches: a positively framed "plant-based" label on all plant-based products versus a negatively framed 'contains animal-based ingredients' label on all non-plant-based products, hereby positioning those as 'exceptions'. The plant-based labels boosted perceived availability of plant-based foods, perceived descriptive norms and intention to choose plant-based products, while the 'contains animal-based ingredients' labels significantly increased plant-based choices. Together, these findings suggest that plant-based labels can shape perceptions beyond providing information on which products are plant-based by altering perceptions of availability and social norms. Future labelling strategies may increase their impact by normalising sustainable choices through effective labelling that highlights these options as the most visible and prevalent choice.

Ordering plant-based meat dishes helps the hospitality industry progress toward net zero, yet most guests order traditional meat dishes because they are unfamiliar with meat alternatives. We test whether watching a video about the manufacturing process of plant-based meat alters simulated restaurant orders. Grounded in perceived risk theory, exploratory consumer behaviour literature, and hierarchy-of-effects models, we examine three theoretical mechanisms that could explain why the video alters food choices: reduced perceived risk, increased curiosity, or increased attention to the plant-based meat dish. Results from a survey experiment ( n = 484) and an eye-tracking study ( n = 45) show that the video increases simulated ordering of the plant-based meat dish by increasing curiosity, rather than lowering perceived risk or directing attention. Identifying curiosity as the key mechanism represents the main theoretical contribution of this research. The findings also offer restaurants a practical approach to help lower food-related greenhouse gas emissions. • Plant-based meat manufacturing video triples simulated ordering. • Curiosity – not risk reduction – drives simulated choice of plant-based meat dishes. • Eye-tracking shows video does not increase menu attention to plant-based option. • Curiosity-provoking videos offer scalable interventions for sustainable dining.

Children's evaluations of deceptive packaged foods within a conceptual model of food choice.

Anorexia Nervosa (AN) is a severe psychiatric disorder marked by excessive restriction and automatic avoidance of fat and high-caloric foods, driven by fear of weight gain and guided by negative encoding of some foods that are essential for health. These impairments seem to reflect a conflict between willingness-to-eat and fear of negative outcomes, leading to maladaptive decisions prioritizing hypocaloric foods. We developed an experimental paradigm to investigate the link between these cognitive disturbances by monitoring gaze during three tasks evaluating the health, taste, and preference values of three food categories: hypocaloric, hypercaloric, and intermediate calorie foods. We evaluated the reject rate and quantity wanted of each food item to compose their meal. To consider different patients profiles, we applied this protocol to 67 subjects across two subtypes: AN-Restrictive (n = 37), and AN-Binge-Purge (n = 30) and 37 healthy controls. Both AN subtypes showed lower hedonic ratings for high-calorie foods and strong correlations between taste and health perceptions (absent in controls), though AN-BP provided lower overall health ratings than AN-R. Eye-tracking revealed subtype-specific patterns: AN-BP exhibited reduced gaze on food images and increased non-stimulus area fixation during preference evaluations, while AN-R showed greater fixation on food names during willingness-to-eat decisions. Furthermore, presentation context modulated food selection in both patient groups: intermediate foods were preferentially chosen over hypercaloric alternatives but rejected in favor of hypocaloric options, demonstrating that choices are relative rather than absolute. By shedding light on mechanisms of food restriction and avoidance, this study holds promise for refining therapeutic strategies; contextual manipulation of food choices may offer intervention potential with intermediate-calorie foods potentially serving as a bridge during nutritional rehabilitation.

ABSTRACT Background: While associations between individual nutrients and cognitive performance are well documented, the joint influence of healthy and unhealthy food group combinations on cognition remains poorly understood. This study examined whether the balance between healthy and unhealthy food group intake is associated with cognitive performance in youth, using a multivariate, pattern-based analytical approach. Methods: This cross-sectional study included 1,296 Chilean children and adolescents (10–14 years; 50% girls). Cognitive performance was assessed using eight standardized neurocognitive tasks, and dietary intake was evaluated using the Global Food Quality Index. Linear regression models were used to explore associations between individual food groups and cognitive outcomes, with correction for multiple testing. Canonical correlation analysis (CCA) was applied to identify multivariate modes of covariation between food group intake patterns and cognitive performance. Sex-stratified analyses were exploratory. Results: The CCA identified a significant mode of covariation in the full sample (rc = 0.25, p = .027). Cross-loadings indicated that a dietary configuration characterized by higher consumption of legumes and fish, together with lower intake of pastries, soft drinks, and fried foods, was associated with greater performance across most cognitive tasks (7 of 8), including fluid intelligence and processing speed, except for reverse memory span. No robust multivariate patterns were observed in sex-stratified analyses. Conclusion: The balance between healthy and unhealthy food group intake, rather than isolated food choices, is associated with cognitive performance in children and adolescents. Considering overall dietary configurations may provide a more informative framework for understanding diet–cognition relationships during this critical developmental period.

Adolescence is a critical period for the development of dietary patterns that significantly impact long-term health. This study explores the perspectives of adolescent girls, their parents, and educational staff regarding the factors shaping dietary behaviors in female school students. A qualitative content analysis was conducted between February and August 2024 in various regions of Khuzestan, Iran. Data were collected through semistructured interviews guided by social cognitive theory (SCT) and analyzed via a directed content analysis approach. The study took place in school and home environments in Khuzestan, Iran. Twenty-eight participants, including 17 female school students (aged 13-17 years), 8 parents, and 3 health educational stakeholders, were interviewed for 28-55min (average: 40min). The analysis identified 208 thematic codes categorized into six main categories and 15 subcategories. The key categories include (1) self-efficacy, which addresses challenges in nutrition management during stress and positive eating habits; (2) outcome expectations, which highlight the role of physical consequences and social approval/disapproval in food choices; (3) environmental factors, which reflect the influence of physical and social contexts; (4) self-regulation, which emphasizes goal-setting and self-monitoring; (5) knowledge, which reveals gaps in general and specialized nutritional understanding; and (6) attitudes, which highlight various perceptions of local foods. The dietary behaviors of female school students are shaped by a dynamic interplay of individual, social, and environmental factors. Promoting healthy eating requires a multifaceted approach, incorporating education, environmental adjustments, and social support to create sustainable changes.

Recent increases in food prices in Egypt have raised concerns about their impact on dietary patterns and household food security (FS), particularly among economically vulnerable groups, forcing families to reduce dietary diversity and nutrient intake. This may indirectly contribute to an increased risk of malnutrition and chronic diseases. To identify changes in food consumption behavior (food choices and dietary patterns) among Egyptian households following food inflation and determine the levels and predictors of food insecurity (FI). An online cross-sectional survey of 723 Egyptian households from June to December 2024. Data was collected using a pretested structured questionnaire targeting household heads. The tool assessed sociodemographic characteristics, food consumption changes, and FS status. Most participants reported increased food expenditure (58.2%) with dietary shift toward cheaper carbohydrate-rich staple foods (55.2%). Reduced consumption of animal protein and dairy products was also observed. Overall, 64.6% of households experienced FI: 15.8% mild, 27.5% moderate, and 20.3% severe levels. Significant predictors of FI included female respondents (OR = 2.425, P< .001), maternal unemployment [odds ratio (OR) = 1.597, P= .018], low household income (OR = 1.774, P= .001), maternal financial responsibility (OR = 3.432, P< .001), the presence of a family member with chronic disease (OR = 1.748, P= .002), and a current smoking father (OR = 1.711, P= .004). Increased food prices lead to changes in food consumption patterns with shifts toward less nutritionally valuable foods and deprive most households of FS. Therefore, there is an urgent need for national nutrition health education programs to help households optimize the use of limited household budgets to achieve a balanced diet.

This study evaluated the association between diet quality and socio-demographic factors, anthropometric measures, food choices, and consumption of processed foods in a low-income Brazilian manufacturing worker population, addressing gaps in evidence from low- and middle-income countries (LMICs). A cross-sectional study was conducted with 921 workers from 33 industries in Rio Grande do Norte, Brazil, selected via stratified proportional and multi-stage sampling. Diet quality was assessed using the Diet Quality Index-International (DQI-I), which evaluates variety, adequacy, moderation, and balance. Dietary intake was measured via 24-hour recalls, and foods were classified by processing level (NOVA system). Socio-demographic, anthropometric, and food choice data (using the Food Choice Questionnaire) were collected. Associations were analyzed using multilevel linear regression. Higher diet quality was associated with being male (p = 0.001). Among women, diet quality improved with age (p = 0.018) and participation in a food assistance program (p < 0.001), whereas those variables showed no association among men. Prioritizing natural food content predicted higher DQI-I scores in both sexes (p < 0.05), while weight control was significant only for women (p = 0.034). Unprocessed food intake showed a positive association (p < 0.001) with diet quality, whereas ultra-processed food consumption was inversely associated (p < 0.001), most notably with diet variety and adequacy in both sexes, and with moderation in women. Food choices also influence diet quality, with people who value health benefits, natural content, weight control, and familiar products being more likely to consume diets with better variety and adequacy. No significant associations were found between diet quality and anthropometric measures. Socio-demographic factors, food choices, and levels of food processing significantly influence diet quality in this low-income Brazilian population. Public health strategies targeting reductions in ultra-processed food consumption and supporting food assistance programs may improve dietary patterns, particularly among women. These findings highlight the need for context-specific interventions to address nutrition transitions in LMICs.

Background:Childhood obesity has become a growing UK and first world problem. Obesity is reaching epidemic levels, particularly in some lower socio-economic populations and ethnic minority groups where it is over 30%. The cause is multifactorial but is underpinned by a rise in the availability of unhealthy, highly processed convenience foods, and decreased activity levels. We sought to understand what food was available in the surgical out-patient setting of a dedicated regional Children’s Hospital in the UK and the nutritional messages we are giving patients.Hypothesis:The hospital provides balanced food and drink choices to promote healthy living.Methods:Researchers determined where food and drinks could be purchased within the Hospital’s surgical out-patient settings. All vending machines and shops were included, with photographs taken to identify all available food and drink. The nutritional information of each product was recorded from manufacturer data available online or on packaging. Data was analysed and compared to the UK Government’s recommended daily intake (RDI) guidelines for food and drink. The Australian Health Star rating system was also used to give each product a “healthiness score”.Results:Food and drink were available from a branded coffee shop, a national newsagent and 6 vending machines. In the vending machines, 39% of foods were chocolate, 37% crisps, 13% biscuits/baked goods, and 11% sweets. 72% had a health star rating of 1.5 or less stars out of 5. None had a health star rating of 4 or more stars out of 5. The average food contained >57% carbohydrate of which >33% was sugars. In shops 52% of the items were cakes, chocolate or sweets and only 2.5% were fruit. 55% of products had a health star rating of 1.5 or less, with only 8% achieving 4 stars or more. 41% of food items and 46% of drinks contained more than the RDI of sugar for a 10-year-old.Conclusion:Optimising peri-operative nutrition has been shown to improve immunity, reduce inflammation, and optimise healing time and recovery following surgery. The majority of food and drinks available in the surgical out-patients were highly processed and contained large quantities of free sugars. Allowing patient choice in relation to food and drink purchases is important but this should be a balanced healthy choice. Heath care settings have a duty to promote health living, but it appears we are currently sending patients mixed messages.

The brain is wired to drive behavior towards foods that are high in sugar and fat. Yet, individuals with anorexia nervosa (AN) prefer low-sugar and low-fat foods to the point of starvation and even death. Here, we aimed to understand how alterations in decision-making processes and associated neural activity contribute to the pattern of maladaptive food-related decisions observed in AN. We combined decision-making tasks with computational modeling of behavior and fMRI to examine food-specific and general (nonfood)-related decisions in female individuals with AN and healthy controls (HC). Results from this pre-registered study suggest that patients with AN, like HC, employ a decision-making process that relies on sampling and evaluating evidence, regardless of the type of decision. However, neural activity patterns differed between groups when deliberating about what to eat: food choice-related activation among HC was localized to the hippocampus, whereas individuals with AN engaged both the hippocampus and the striatum, regions apparently serving as sources of evidence in the decision process. These findings suggest that the maladaptive reversal of food preferences in AN may be attributable to reliance on different inputs to the process that leads to restrictive food choice, rather than a maladaptive decision process per se Significance Statement Disordered eating often involves maladaptive choices about what to eat. The present research shows that the decision-making process unfolds similarly in healthy individuals and patients with anorexia nervosa but the brain regions that support deliberation about what to eat differ. Together, the findings suggest that the inputs to the decision process, rather than the decision process per se should be a point of focus in the search for novel treatments of eating disorders.

Food literacy is important for understanding the factors that determine food choices, eating behaviors, and diet quality. However, few studies have examined the relationship between food literacy, diet quality, and food consumption. The present study aimed to examine this relationship in an adult population. This cross-sectional study included 639 adults (50.2% female; age range: 19-65 years) at Ondokuz Mayıs University in Samsun, Türkiye. Participants completed the Short Form of Food Literacy (SFLQ). Anthropometric measurements and 24-h food recall were recorded. Diet quality was assessed using the Healthy Eating Index (HEI)-2015. Total scores for vegetables and seafood and plant proteins (HEI-2015 components) were higher in the adequate-excellent food literacy group (2.9±2.25 vs 2.5±1.85, p=0.041 and 12.8±12.51 vs 11.0±10.58, p= 0.040). Conversely, the refined grain scores were higher in the inadequate-limited food literacy group (3.6±5.77 vs 4.5±5.67, p=0.041). In the regression model, the SFLQ score was positively associated with HEI-2015 scores (β=0.364, p=0.026) and total vegetable consumption (β=0.029, p=0.015). For each 1-point increase in the SFLQ score, the HEI-2015 score increased by 0.364 points on average (β = 0.364, p=0.026). Furthermore, SFLQ scores were negatively associated with refined grain scores (β= -0.107, p=0.001) and added sugar scores (β= -0.021, p=0.042). Food literacy is an important factor associated with diet quality. Enhancing nutrition knowledge, skills, and attitudes in adults may contribute to healthier eating behaviors.

Obesity represents a growing public health challenge globally, with rising prevalence among university students. Its causes extend beyond diet and exercise, encompassing socioeconomic background, and family education and migration history. This study examined obesity among German university students using data from the 2016 Studitemps survey, which included over 9,960 participants and mirrors key characteristics of national statistics and the largest social study of German students “Sozialerhebung 2016”. Logistic regression results indicate that with each additional year, the associated chance of obesity increases. Students whose parents hold university degrees had significantly lower associated chances of obesity—nearly half—compared to those whose parents had not attained any university entry-level qualification (OR = 0.536). Furthermore, living alone or with a partner, as opposed to in shared accommodation, was associated with higher odds of obesity (OR = 1.878), as was frequent use of food delivery services (OR = 1.498). Student income showed no association with obesity in either the regression or descriptive analyses; however, students with obesity appeared more reliant on student loans. Public and university initiatives should focus on at-risk groups by improving access to shared accommodations, promoting healthier food choices to reduce reliance on delivery services, and addressing cultural challenges faced by students from lower-education households. In conclusion, this study highlights the complex interplay of socio-demographic and lifestyle factors in obesity among university students.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-026-57347-y.

Millions of people relocate each year, yet little is known about how relocation shapes dietary behavior. Drawing on social identity threat and dysplacement frameworks, this research examines how perceived involuntariness shapes food choices across the processing continuum. Three studies provide complementary evidence linking perceived involuntariness to social identity threat and dietary vulnerability. A survey of recently relocated adults finds that perceived involuntariness is associated with greater interpersonal social identity threat. A laboratory experiment suggests that social identity threat is associated with increased preferences for ultra-processed foods. Analysis of large-scale survey data from international migrants suggests that discrimination, a theoretically related source of social identity-relevant threat, is associated with reduced fresh food consumption through emotional distress. Together, the findings suggest that relocation experiences perceived as forced may be associated with greater reliance on ultra-processed foods and reduced fresh food engagement, with implications for health marketing interventions targeting mobile and displaced populations.

The physiological processes of sensorineural hearing in the cochlea have high energy demands. As energy is provided mainly by mitochondria housed in cochlear cells, mitochondrial dysfunction can possibly lead to sensorineural hearing loss (SNHL). Consequently, hearing benefits can potentially be derived if measures that can potentially enhance mitochondrial health are implemented. Unhealthy lifestyle practices have led to an increased risk of developing systemic oxidative stress and chronic inflammation. These, in turn, may result in persistent mitochondrial dysfunction in the body. Together, they could possibly lead to the development of SNHL and other non-communicable chronic diseases (NCDs). Factors such as micro-nutrient deficiencies, obstructive sleep apnea, and gut dysfunction could result in mitochondrial dysfunction. On the other hand, mitochondrial function could be enhanced by interventions such as better food choices and hormetic strategies like intermittent fasting. Conventional treatments of SNHL focus on steroid therapy in acute loss and hearing rehabilitation with hearing devices in chronic loss. By integrating personalized healthy lifestyle strategies, it is postulated that the chances of hearing recovery in acute SNHL could be enhanced in some patients. In chronic SNHL, they could help to prevent/slow down its progression and possibly also the progression of concomitant NCDs. Further research is warranted to substantiate these postulations.

Ethical eating: food choices that make a difference.

Background Although shared understanding between consumers and experts, and within experts themselves, is essential for healthier food choices, no existing method systematically prioritizes foods based on the magnitude of health education gaps. Objective To develop and apply a quantitative belief-mapping methodology to identify commonly consumed foods that warrant prioritization for research and nutrition communication. Methods Based on survey data and a meta-nutrition profiling system that represents transparent and harmonized expert healthfulness ratings, consumer misalignment and misperception relative to experts, as well as expert-only uncertainty, were quantified across 20 commonly consumed carbohydrate-rich foods. Foods were then ranked by jointly considering misalignment, expert uncertainty, and national consumption prevalence. Results Among the 20 foods evaluated, 85% received a consumer-to-expert Alignment Grade of C or D, and 75% received an Uncertain expert-only healthfulness classification. Among consumers, the most negatively misperceived foods—those rated less healthy by consumers than by experts—included all surveyed potato based foods (French fries, chips, and baked potatoes) and unbuttered, air-popped popcorn. In contrast, honey was the most positively misperceived food, being rated as healthier by consumers than by experts. Most foods (70%) exhibited a mixture of negative and positive misperception (≥15/85%). When misalignment, expert uncertainty, and high U.S. consumption were considered jointly, white rice, white bread, corn tortilla, and fruit juice with vitamin C emerged as priority foods for future research and nutrition education. Conclusions Substantial consumer–expert misalignment and expert uncertainty were observed across commonly consumed carbohydrate-containing foods. This scalable belief-mapping methodology prioritizes foods for future nutrition research, communication efforts, and policy.