Guideline Daily Amounts Research Articles

Impact of nutrient warning labels on choice of ultra-processed food and drinks high in sugar, sodium, and saturated fat in Colombia: A randomized controlled trial.

ObjectiveThis study assessed nutrient warnings’ impact on product selection and identification of food products high in nutrients of concern in Colombia.MethodsIn an online experiment (October 2020), 8,061 Colombians were randomized to a nutrient warning, guideline daily amounts (GDA), Nutri-Score, or no-label condition. They viewed two fruit drinks labeled according to their condition, one high in sugar and one not, and completed selection tasks. Next, they assessed four products high in sugar, sodium, and/or saturated fat (“high in” product). Finally, they selected which label would most discourage them from consuming a “high in” product.ResultsThe nutrient warning performed better on most outcomes. Twenty percent of participants exposed to the nutrient warning would purchase the high-sugar fruit drink compared to GDA (24%, p<0.01), Nutri-Score (33%, p<0.001), and no label (29%, p<0.001). GDA performed slightly better than the nutrient warning in identifying the high-sugar fruit drink (91% vs 88%, p<0.001). The nutrient warning best helped participants correctly identify other “high in” products (75% vs. 23% no-label, 26% Nutri-Score, and 43% GDA, all p<0.001) and had the highest perceived message effectiveness (3.86 on 5-point scale vs. 2.97 GDA and 2.70 Nutri-Score, both p<0.001) and lowest likelihood of purchasing “high in” products (2.58 on 5-point scale vs. 3.23 GDA, 3.49 Nutri-Score, and 3.51 no label, all p<0.001). The nutrient warning most discouraged participants from wanting to consume “high in” products.ConclusionsNutrient warnings are a promising policy to help consumers identify and discourage consumption of products high in nutrients of concern.Trial registrationTrial Registration: NCT04567004.

Front-of-Package Label in Brazil: Comparison of Guideline Daily Amounts, Traffic-Light and Warning Systems

Front-of-Package Label in Brazil: Comparison of Guideline Daily Amounts, Traffic-Light and Warning Systems

Online Consumer Survey Comparing Different Front-of-Pack Labels in Greece.

According to the WHO, front-of-pack nutrition labeling provides simplified nutrition information in the form of symbols, colors or words that can help consumers understand the nutritional quality of food, thus leading them to healthier food choices. It is considered of the utmost importance to explore the knowledge and understanding of consumers about this form of nutrition labeling. The aim of this study was to investigate the understanding and perceptions of Greek consumers in response to five different front-of-pack nutrition labels (FoPLs): the Multiple Traffic Lights, Health Star Rating System, Guideline Daily Amounts, Warning Symbols and Nutri-Score. From April 2021 to June 2021, 1278 participants from Greece took part in an online survey where they were asked to rank three products according to their nutritional quality. The classification process was performed first without FoPLs and then with FoPLs. The ability to classify products according to their nutritional quality was evaluated with multinomial logistic regression models, and the Nutri-Score label presented greater improvements when compared to the GDA label for Greek consumers. The Nutri-Score seemed to better help the Greek consumers rank foods according to their nutritional value.

Impact of front-of-pack labels on the perceived healthfulness of a sweetened fruit drink: a randomised experiment in five countries.

Front-of-pack (FOP) nutrition labelling is a globally recommended strategy to encourage healthier food choices. We evaluated the effect of FOP labels on the perceived healthfulness of a sweetened fruit drink in an international sample of adult consumers. Six-arm randomised controlled experiment to examine the impact of FOP labels (no label control, Guideline Daily Amounts (GDA), Multiple Traffic Lights, the Health Star Ratings (HSR), Health Warning Labels, and 'High-in' Warning Labels (HIWL)) on the perceived healthfulness of the drink. Linear regression models by country examined healthfulness perceptions on FOP nutrition labels, testing for interactions by demographic characteristics. Online survey in 2018 among participants from Australia, Canada, Mexico, United Kingdom (UK) and United States. Adults (≥18 years, n 22 140). Compared with control, HIWL had the greatest impact in lowering perceived healthfulness (β from -0·62 to -1·71) across all countries. The HIWL and the HSR had a similar effect in Australia. Other labels were effective in decreasing the perceived healthfulness of the drink within some countries only, but to a lower extent. The GDA did not reduce perceived healthfulness in most countries. In the UK, the effect of HIWL differed by age group, with greater impact among older participants (> 40 years). There were no other variations across key demographic characteristics. HIWL, which communicates clear, non-quantitative messages about high levels of nutrients of concern, demonstrated the greatest efficacy to decrease the perceived healthfulness of a sweetened fruit drink across countries. This effect was similar across demographic characteristics.

Experimental study of front-of-package nutrition labels’ efficacy on perceived healthfulness of sugar-sweetened beverages among youth in six countries

Front-of-package (FOP) nutrition labels have been proposed as a strategy to help limit sugar-sweetened beverage (SSB) consumption among youth. However, few studies have examined the efficacy of FOP labels in youth across different countries. A between-group experiment was conducted to examine the impact of FOP labels (no-label control, Health Star Rating, ‘High in’ Octagon, Guideline Daily Amount (GDA), Traffic Light, or Nutri-Score) on perceived healthfulness of an SSB. The study was conducted online in November-December 2019 with 10,762 children aged 10–17 from six countries: Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. A binary logistic regression model tested the impacts of FOP label condition, country, and sociodemographic characteristics on participants’ likelihood of perceiving the SSB to be Unhealthy. Compared to the control condition, participants in each of the five FOP label conditions were significantly more likely to perceive the SSB as Unhealthy (p < 0.002). The ‘High in’ Octagon label had the greatest impact on perceived healthfulness across five out of six countries, whereas the GDA and Nutri-Score labels demonstrated the lowest impact across all six countries. The impact of FOP labels was consistent across sex, age, race/ethnicity, and perceived income adequacy. FOP labels can significantly reduce the perceived healthfulness of SSBs among youth across multiple countries. The current study adds to the evidence that ‘high in’ labels, which use intuitive symbols such as the octagon ‘stop sign’, are the most efficacious labels for helping consumers identify foods high in nutrients of concern, including SSBs.

The Influence of Front-of-Package Nutrition Labeling on Consumer Behavior and Product Reformulation.

Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling systems. We provide a narrative review of (a) real-world evaluations of front-of-package nutrition labels that analyze objective sales data and (b) studies that objectively assess product reformulation in response to a front-of-package nutrition label implementation. We argue that there is sufficient scientific evidence to recommend that governments implement mandatory front-of-package nutrition labeling systems to improvepopulation health. We also present a conceptual framework to describe front-of-package label influence and provide recommendations for the optimal label design, emphasizing that labeling systems should be highly visible and salient, be simple and easy to understand, leverage automatic associations, and integrate informational and emotional messaging. The existing research suggests that Guideline Daily Amount labels should be avoided and that the Health Star Rating and Nutri-Score systems are promising but that systems with warning labels like the one in Chile are likely to produce the largest public health benefits.

Synergy effect of nutritional labelling on purchase intention of sugar-sweetened beverages

PurposeThe purpose of this study is to investigate how combined nutrition labelling influences consumer attitudes, subjective norms, perceived behavioural control and purchase intention for sugar-sweetened beverages (SSBs).Design/methodology/approachThis study adopted a mixed method research, quasi-experimental design with 406 valid Taiwanese samples to evaluate the possible effects of combined nutrition labelling on SSB purchase intention; two focus group interviews with four nutritional experts and 12 students were conducted to explain how and why consumers perceived different types of combined nutritional labels.FindingsCombined labels including sugar type/gram with the guideline daily amounts and traffic light display were perceived by consumers as high-quality and reliable, which improved consumer attitude and SSB purchase intention. Consumers perceived the traffic light display and warning claim as a sugar over-consumption message, which reduced SSB purchase intention through subject norms.Practical implicationsGovernments should be aware that concrete nutritional information (NIP) leads to the worst SSB consumption. Moreover, the authors suggest that policymakers emphasise the effectiveness of warning claims on SSB products with “sufficient” sugar information to trigger consumers' concern, remind SSB manufacturers of their moral obligation to consumers.Originality/valueThis study identified that the combined effects of nutritional attributes and parts of meanings might be enhanced, eliminated or even separated from their original meaning. Although the label messages were delivered simultaneously, the consumer's psychological perceptions proved to be more complicated than a single attribute and sequentially affected consumer attitudes, subject norms and SSB purchase intention.

An assessment of nutrition information on front of pack labels and healthiness of foods in the United Kingdom retail market

BackgroundFront of pack nutrition labelling is part of United Kingdom government’s programme of activities aiming to tackle diet-related diseases. There are several front of pack labelling formats available and they differ in the information they deliver. This study assessed the frequency of usage of front of pack food labelling systems on food products in the United Kingdom grocery market. It also measured the healthiness of some foods in the online market by categorising them according to their nutrient contents.MethodsFive hundred food products in five categories [(1) cereals and cereal products, (2) dairy products, (3) beverages, (4) packaged meats and meat products, and (5) pre-packaged fruits and vegetables] from three main United Kingdom retail websites were investigated. A simple random sampling method was used for product selection according to the categories on the retailers’ websites. The healthiness of foods was also assessed by categorising them into ‘healthier’, ‘moderately healthy’ and ‘least healthy’ based on fat, saturated fat, salt and sugar contents.ResultsThe total number of label types assessed comprises 19.6% of Guideline Daily Amounts or Reference Intakes and 43.8% had a combination of Traffic Light and Reference Intakes (hybrid label). Slightly over a quarter (27.4%) of products included nutritional information in a grid or table, 3.4% of the foods had two of any of the following: Health Logo, Reference Intakes and Traffic Light labels, and 5.8% did not have any Reference Intakes, Traffic Light, Health Logo or Hybrid label. Most of the foods assessed were manufactured in the United Kingdom with only 30.8% imported from 32 countries across four continents.ConclusionsTraffic Light and Guideline Daily Amounts were the most used front of pack labelling formats on the assessed food product. A higher number of assessed products belonged to the “moderately healthy” and “healthier” categories than the “least healthy”. The imported foods that were found in the United Kingdom retail market showed that food choices could be made from the diverse food types.

Understanding and use of the front-of-pack Guideline Daily Amounts nutritional labeling of industrialized food and beverages in Mexico.

Evaluate the use, subjective and objective under-standing of the GDA frontal labeling to assist the population towards making healthy decisions regarding the products they consume. The use of nu-tritional information contained in products ́ packages (GDA, nutritional information table, and list of ingredients), as well as the subjective and objective comprehension of the GDA. A total of 43 157 people were interviewed. Amid the labels, the nutritional table was read more frequently (11.1%). 24.6% (IC95%: 23.9-25.3) and 41.2% (IC95%: 40.4-42.1) of the interviewees classified products correctly as not healthy and high in sodium, respectively. These outcomes were smaller between the elderly, lower socioeconomic levels, lower educational levels, and rural areas. The results show that the GDA labeling is not useful to support the vulnerable population to make healthy decisions.

Impact of different front-of-pack nutrition labels on online food choices

Front-of-pack nutrition labels (FOP-NL) are efficient tools for increasing consumers' awareness of the nutritional quality of food products, prompting healthier food choices. The main goal of this study was to evaluate the impact of four FOP-NL schemes - Traffic Light label (TL), Guideline Daily Amounts (%GDA), Nutri-Score (NS) and Health Star Rating (HSR) - on consumers' selection of food products according to perceived nutritional quality. A cross-sectional open-label crossover randomized controlled study was carried out among Portuguese consumers. A web-based questionnaire was used to assess participants' a) preferences regarding FOP-NLs and b) capacity to select healthy products in a food selection task using the information from FOP-NL schemes. When performing the selection task, participants had the option to indicate that they could not decide simply based on the presented FOP-NL (requiring more information). Overall, 357 adults participated in the study. Regarding consumers' preferences, TL received the most favorable responses, while NS received the fewest. All FOP-NLs performed better than the no-nutritional label control condition in the food selection task. The highest proportion of correct choices was obtained for TL (72.3%), followed by HSR (70.9%), %GDA (70.0%) and NS (62.2%), though no significant differences were found among FOP-NLs. Percentages of respondents indicating not being able to answer due to lack of information affected the proportion of correct choices, with 10.3% for TL, 12.9% for %GDA, 14.6% for HSR, and 25.8% for NS, indicating they were unable to choose without additional information. Although no particular FOP-NL system stood out as the most significantly effective, TL was the most preferred by Portuguese adults. Long-term real-world evidence is necessary to assess the impact of FOP-NL systems on individuals’ food choices.

Salient nutrition labels shift peoples' attention to healthy foods and exert more influence on their choices

Nutrition labels are the most commonly used tools to promote healthy choices. Research has shown that color-coded traffic light (TL) labels are more effective than purely numerical Guideline Daily Amount (GDA) labels at promoting healthy eating. While these effects of TL labels on food choice are hypothesized to rely on attention, how this occurs remains unknown. Based on previous eye-tracking research we hypothesized that TL labels compared to GDA labels will attract more attention, will induce shifts in attention allocation to healthy food items, and will increase the influence of attention to the labels on food choice. To test our hypotheses, we conducted an eye-tracking experiment where participants chose between healthy and unhealthy food items accompanied either by TL or GDA labels. We found that TL labels biased choices towards healthier items because their presence caused participants to allocate more attention to healthy items and less to unhealthy items. Moreover, our data indicated that TL labels were more likely to be looked at, and had a larger effect on choice, despite attracting less dwell time. These results reveal that TL labels increase healthy food choice, relative to GDA labels, by shifting attention and the effects of attention on choice.

Impact of front-of-pack nutrition labels on consumer purchasing intentions: a randomized experiment in low- and middle-income Mexican adults

BackgroundFront-of-pack (FOP) nutrition labeling is a cost-effective strategy to help consumers make informed and healthier food choices. We aimed to investigate the effect of the FOP labels used in the Latin American region on consumers’ shopping intentions when prompted to make their choices with specific nutrients-to-limit in mind among low- and middle-income Mexican adults (> 18 y).MethodsIn this experimental study of an online simulated shopping situation participants (n = 2194) were randomly assigned to one of three labeling conditions: Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), or red Warning Labels (WL). Participants were required to view a video explaining how to correctly interpret the assigned label. Primary outcomes were the overall nutritional quality (estimated using the Nutrient Profiling Scoring Criterion [NPSC] and NPSC baseline score) and mean energy and nutrient content of purchases. Secondary outcomes included shopping time variables. We also evaluated the impact of the labels across food categories (ready-made foods, dairy beverages, non-dairy beverages, salty snacks, and breakfast cereals) and sociodemographic subgroups.ResultsThe MTL and the WL led to a better overall nutritional quality of the shopping cart compared to the GDA (p < 0.05). According to the NPSC score, the WL led to a better nutritional quality across breakfast cereals and salty snacks compared to the GDA (p < 0.05); a similar effect was observed for the MTL among non-dairy beverages (p < 0.05). The MTL and the WL required shorter shopping times compared to GDA (p < 0.05). Across all labeling conditions, the nutritional quality of the shopping cart tended to be lower among those with low income, education and nutrition knowledge levels.ConclusionWL and MTL may foster healthier food choices in a faster way among low- and middle-income groups in Mexico. To produce an equitable impact among consumers of all socioeconomic strata, efforts beyond simply the inclusion of a communication campaign on how to use and interpret FOP labels will be required.Trial registrationclinicaltrials.gov. NCT04308408 Retrospectively registered March 16, 2020.

Consumers\u2019 food choices, understanding and perceptions in response to different front-of-pack nutrition labelling systems in Belgium: results from an online experimental study

BackgroundFront-of-pack nutrition labels (FoPLs) are increasingly implemented by governments internationally to support consumers to make healthier food choices. Although the Nutri-Score FOPL has officially been implemented in Belgium since April 2019, no study has been conducted before its implementation to compare the effectiveness of different FOPLs.MethodsThe aim of this study was to compare food choices, objective understanding and perceptions of Belgian consumers in response to five different FOPLs, currently implemented in different countries internationally, namely the Health Star Ratings (HSR), the Multiple Traffic Lights (MTL), Nutri-Score, Guideline Daily Amounts (GDA), and Warning symbols. During the summer 2019, 1007 Belgian consumers were recruited and randomized to one of the five different FOPLs. Through an online questionnaire they were asked to choose one of three different foods within each of three categories (pizzas, cakes, breakfast cereals), as well as rank those same three foods according to nutritional quality, in the condition without as well as with FOPL. In addition, various questions were asked on their perceptions in relation to the FOPL they were exposed to.ResultsPerceptions of consumers were favorable for all FOPLs with no significant differences between the different FOPLs. There were no significant differences in food choices among the different FOPLs, but Nutri-Score performed best for ranking food products according to nutritional quality.ConclusionsWhile there were no significant differences among different FOPLs for food choices and perceptions, the Nutri-Score was the most effective FOPL in informing Belgian consumers of the nutritional quality of food products.

The intuitive use of contextual information in decisions made with verbal and numerical quantifiers

Verbal and numerical formats (e.g., verbal: “low fat,” or numerical: “20% fat”) are used interchangeably to communicate nutritional information. However, prior research implies that verbal quantifiers are processed more intuitively than numerical ones. We tested this hypothesis in two pre-registered experiments measuring four indicators of processing style: (a) response time, (b) decision performance, (c) reliance on irrelevant contextual information, which we inferred from participants’ decision patterns, and (d) the level of interference from a concurrent memory task. Participants imagined they had consumed a given amount of a nutrient (represented in a pie chart) and decided whether a new quantity (either verbal or numerical) could be eaten within their guideline daily amount (GDA). The experiments used a mixed design varying format (verbal or numerical), concurrent memory load (no load, easy, and hard load in Experiment 1; no load and hard load in Experiment 2), nutrient (fat and minerals), quantity (low, medium, and high in Experiment 1; low and high in Experiment 2), and the assigned correct response for a trial (within and exceeding limits). Participants were faster and made fewer correct decisions with verbal quantifiers, and they relied more on contextual information (i.e., the identity of the nutrient involved). However, memory load did not impair decisions with verbal or numerical quantifiers. Altogether, these results suggest that verbal quantifiers are processed intuitively, slightly more so than numerical quantifiers, but that numerical quantifiers do not require much analytical processing to reach simple decisions.

Red for "Stop": "Traffic-Light" Nutrition Labels Decrease Unhealthy Food Choices by Increasing Activity and Connectivity in the Frontal Lobe.

Food labels comprise a national health-intervention policy that informs consumers of food-product nutritional value. Previous evidence has indicated that, compared to a purely numeric guideline-daily-amount label, a traffic-light-inspired, color-coded label more effectively conveys the nutritional level and increases the selection of healthier products. Therefore, we used functional magnetic resonance imaging to assess the mechanism whereby traffic-light and guideline-daily-amount labels influence food-related decision-making. Forty-four female dieters (age, mean = 20.0, standard deviation = 1.45 years) were recruited to participate in a food-choice task; healthy or unhealthy food options were presented with color-coded traffic-light or purely numeric guideline-daily-amount labels, and the participants were asked to state their preference. We found that, compared with the guideline-daily-amount label, a salient, red traffic-light label potentially reduced unhealthy food-related decision-making and activated the superior medial frontal gyrus and the supplementary motor area, which are implicated in the execution of responses and motor inhibition. For the same stimulus contrast, we also found increased activation in the anterior cingulate cortex, which is associated with salient information monitoring. Finally, we found stronger functional connectivity between the anterior cingulate cortex and inhibitory regions (inferior and middle frontal gyri) under red-traffic-light than under guideline-daily-amount label conditions. These results suggest that traffic-light-inspired labels may be a more effective means of public-policy intervention than are numeric labels conveying guideline daily amounts.

Front-of-pack warning labels are preferred by parents with low education level in four Latin American countries

Background: Overweight and obesity rates in Latin America are much higher than the global prevalence. Front-of-pack (FOP) nutrition label systems are gaining momentum in Latin America and being implemented as a strategy to tackle obesity among children and adults. This study investigates the usage and preference of three FOP nutrition labels among Argentinian, Chilean, Costa Rican, and Mexican adult parents.&#x0D; Methods: From March to May 2016, a questionnaire was administered to 966 parents of elementary school aged children in Argentina (89), Chile (304), Costa Rica (258) and Mexico (315). Guideline Daily Amounts (GDA), traffic light (TL), and warning label FOP systems were compared and analyzed. Statistical analysis was conducted using frequencies and proportions. Median differences tests, ANOVAs and logistic regression models were performed. A thematic analysis of qualitative data was conducted using a deductive process.&#x0D; Results: Parents with low education levels and poor health conditions (i.e., overweight) preferred the FOP warning labels over the GDA and TL systems. The GDA FOP nutrition labels were preferred by parents with higher education levels. Overall, the TL system was preferred with no significant differences across countries.&#x0D; Conclusion: FOP warning labels are preferred by parents with vulnerable conditions (i.e., low education levels and overweight) across four Latin American countries. An easily understandable, readable and acceptable label may facilitate usage by vulnerable groups to make healthy food purchases. These results have important policy implications by providing evidence to government policymakers to enact legislation to implement or enhance existing FOP nutrition label policies as a viable strategy to reduce obesity risk.

Front-of-pack nutritional labels: Understanding by low- and middle-income Mexican consumers.

Front-of-pack labeling is a cost-effective strategy to decrease population consumption of sodium, sugar, saturated fat, total fat, and trans-fatty acids, considered critical nutrients for chronic disease. Our main objective was to explore the subjective understanding of labels that are currently used internationally among low- and middle-income Mexican consumers. We performed two phases of 10 focus groups with adolescents (13-15 y), young adults (21-23 y), mothers of children 3-12 y, fathers of children 3-12 y and older adults (55-70 y). Seven FOPL were evaluated: Guideline Daily Amounts, Multiple Traffic Light, Chilean Warning labels, Warning labels in Red, 5-Color Nutrition Label, Health Star Rating, and Healthy Choice label. Data was analyzed with a triangulation of researchers using a content analysis, based on three codes: 1) awareness and use of the Guideline Daily Amounts, 2) acceptability, and 3) subjective understanding of labels. Most participants were aware of the Guideline Daily Amounts, however they rarely used it because interpreting the information displayed on the label was too complicated. Health Star Rating, Warning labels, Multiple Traffic Light and the Healthy Choice logo labels were the most understandable, however the acceptability of the The Healthy Choice logo decreased as it did not provide information on specific ingredients. The Warning labels was the only label able to warn about critical nutrients that could represent a health risk. The Warning labels in red was more accepted compared to Warning labels in black. Results show that directive and semi-directive labels, such as Warning labels, Health Star Rating or Multiple Traffic Light, may be better at helping population of low- and middle income make healthier food choices, than non-directive FOPL such as the Guideline Daily Amounts implemented in México. The study results highlight the potential of Warning labels to support decreases in the consumption of critical ingredients in low- and middle-income Mexican consumers.

Understanding and use of food labeling systems among Whites and Latinos in the United States and among Mexicans: Results from the International Food Policy Study, 2017

BackgroundObesity and chronic diseases could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating. This study evaluated adult consumer understanding and use of nutrition labeling systems in the US and Mexico, the most obese countries in the world.MethodsAdults from online consumer panels in the US (Whites n = 2959; Latinos n = 667) and in Mexico (n = 3533) were shown five food labeling systems: 1. Nutrition Facts Table (NFT) that shows nutrients of concern per serving; 2. Guideline Daily Amounts (GDA) that shows levels of nutrients of concern; 3. Multiple Traffic-Light (MTL) that color codes each GDA nutrient (green = healthy; yellow = moderately unhealthy; red = unhealthy); 4. Health Star Rating System (HSR) that rates foods on a single dimension of healthiness; 5. Warning Label (WL) with a stop sign for nutrients present in unhealthy levels. Participants rated each label on understanding (“easy”/“very easy to understand” vs “difficult”/“very difficult to understand”), and, for NFTs and GDAs, frequency of use (“sometimes”/“often” vs “never”). Mixed logistic models regressed understanding and frequency of use on indicators of labeling systems (NFT = ref), testing for interactions by ethnicity (US Latinos, US Whites, Mexicans), while controlling for sociodemographic and obesity-related factors.ResultsCompared to the NFT, participants reported greater understanding of the WL (OR = 4.8; 95% CI = 4.4–5.3) and lower understanding of the HSR (OR = 0.34, 95% CI = 0.31–0.37) and the MTL (OR = 0.56, 95% CI = 0.52–0.61), with similar patterns across ethnic subgroups. Participants used GDAs less often than NFTs (OR = 0.48; 95%CI = 0.41–0.55), with the greatest difference among US Whites (OR = 0.10; 95%CI = 0.07–0.14).ConclusionsUnderstanding and use of the GDA was similar to that of the NFT. Whites, Latinos, and Mexicans consistently reported the best understanding for WLs, a FOPL that highlights unhealthfulness of a product. Therefore, a FOPL summary indicator, such as WLs, may be more effective in both the US and Mexico for guiding consumers towards informed food choices.

How do different warning signs compare with the guideline daily amount and traffic-light system?

Nutritional warnings are rapidly gaining relevance, particularly in the region of the Americas, as a front-of-package nutrition labelling scheme that facilitate the identification of products with high content of nutrients associated with non-communicable diseases (NCDs). Several graphic designs are being developed as countries discuss the implementation of nutritional warnings, which makes it necessary to develop research to evaluate their efficacy. In this context, the aim of the present work was to compare the efficacy of a series of nutritional warnings that are being considered by Brazilian national authorities for the country with two of the most studied schemes: the guidelines daily amounts (GDA) and the traffic light system. Two studies were conducted. In the first one, visual search was conducted with 62 participants to evaluate the time needed by them to identify the schemes on food labels and to identify whether a product had high nutrient content. In the second study, an online survey with 1932 participants was used to evaluate their ability to use FOP nutrition labelling schemes to correctly identify the most healthful product in a set, as well as high nutrient content in a product. In addition, the influence of FOP nutrition labelling schemes on perceived healthfulness was evaluated. Finally, consumers’ perception of the schemes was gathered using an open-ended question. Results confirmed the advantages of nutritional warnings compared to the GDA and the traffic-light system to facilitate the identification of products with high content of nutrients associated with NCDs. In addition, the use of familiar signs frequently used to convey a ‘warning message’ outperformed other unfamiliar signs in terms of their ability to facilitate the interpretation of nutrition information. Regarding colour, black signs tended to required significantly less time to be detected when included on colour food labels compared to red signs.

Packaged food consumption and understanding of front-of-pack labels in urban Thailand

ObjectivesWe assessed the use of current guideline daily amount (GDA) label and consumers' ability to read GDA, compared with GDA-plus labels (green colour–coded GDA [GGDA], GDA label with text [GDAT] and green colour–coded GDA label with text [GGDAT]) in Thailand. Study designThis is a cross-sectional study. MethodsWe interviewed individuals at 23 major supermarkets across the country in March 2015. We used a mixed multivariate logistic regression model to identify factors associated with the ability to make healthier choices when reading front-of-pack (FoP) labels. ResultsOf 1364 participants, only 11% claimed to read the GDA label every time; those who did not read the main reason was that it was not understandable or attractive. In total, 65%, 62%, 61% and 39% were able to read GDAT, GGDAT, GGDA and GDA labels, respectively. When reading GGDA, GDAT and GGDAT labels, participants were 2.91 (95% confidence interval [CI]: 2.45, 3.45), 3.59 (95% CI: 3.01, 4.28) and 3.13 (95% CI: 2.63, 3.72) times more likely to choose healthier food choices compared with having read an ordinary GDA label. Participants who were exposed to food selection guidelines were more likely to make healthier food choices when reading FoP labels with different odds depending on sources of information. Participants who recognized the link between diet and non-communicable diseases were 1.21 (95% CI: 1.02, 1.44) times more likely to choose healthier food choices. No sociodemographic characteristics were significantly statistically associated with the ability to choose healthier food choices when adjusted for diet-related knowledge and FoP formats. ConclusionsUse and understanding of GDA are still low, mainly because GDA is incomprehensible and unattractive. Interpretive FoP formats tend to be more understandable and need less complementary public campaigns compared with non-interpretive formats.