Search Results (148)

Ultra-processed foods (UPFs) are foods formulated through extensive industrial processing, with little or no natural food constituents, and include ingredients such as artificial colors, flavors, and other food additives to enhance shelf life and palatability. They are typically energy-dense and poor in essential nutrients, including products such as sugar-sweetened beverages, packaged snacks, processed meats, instant noodles and confectioneries. UPF intake has been associated with a wide range of metabolic and inflammatory diseases, especially obesity and adiposity. The transition to independent living and increased dietary autonomy among young adults, particularly university students, are associated with higher reliance on UPF. This narrative review aims to examine the global evidence on the association between UPF consumption and obesity and adiposity outcomes among young adults. Most reviewed studies demonstrated a consistent positive association between UPF consumption and increased obesity and adiposity risks among young adults. UPF consumption within this population is substantial, ranging between 25% and 50% of total energy intake (TEI). The association between UPF consumption and increased risk of obesity and adiposity can be explained through multiple biological and behavioral mechanisms, including high energy density and palatability, disruption of satiety signaling, gut microbiota alterations, and hormonal dysregulation. To reduce the long-term burden of obesity among young adults, public efforts should be directed to important health interventions, such as university awareness nutritional programs, front-of-pack labeling, and policy-level restrictions on UPF marketing. Full article

Background/Objectives: Multiple Traffic Light (MTL) front-of-pack (FOP) labels are being considered in Bahrain. We tested whether an adapted MTL label improves the nutritional quality of grocery purchases. Methods: In a two-arm randomized controlled intercept trial (January–May 2025), adults (≥21 years) responsible for household grocery shopping were recruited in high-footfall public venues and asked to complete a one-time shop on a tablet-based, purpose-built online grocery platform. The MTL label was adapted for Arabic reading direction and displayed per-serving nutrients and % recommended daily intake. Treatment effects were estimated using ordinary least squares regressions with robust standard errors and covariate adjustment. Results: Of 395 randomized participants, 360 were included in primary analyses (control n = 183; MTL n = 177). MTL exposure was not associated with a significant change in the primary outcome (basket weighted average MTL score per serving; β = 0.037; p = 0.64) or in per-serving calories and nutrients of concern (all p > 0.17). In the post-shop assessment, only 47.2% of participants correctly interpreted MTL labels, indicating modest objective label comprehension under the study conditions. Conclusions: These findings suggest that the impact of front-of-pack labels likely depends on both implementation features and consumer understanding, and that pairing labels with public communication and nutrition literacy initiatives may be necessary to maximize the effectiveness of labels in Bahrain and the wider Gulf region. Full article

Freshly prepared beverages are widely consumed in China, yet limited nutrition disclosure may hinder healthier choices. This study evaluated whether front-of-pack (FOP) nutrition labels combined with nutrition education improved stated purchase decisions and healthfulness evaluations for freshly prepared beverages beyond labels alone. Participants (n = 1100) were assigned to a combined intervention group (n = 551) or label-only group (n = 549) and completed six paired beverage tasks before and after intervention. Analyses used continuity-corrected McNemar tests, between-group net effects, transition analyses, and generalized estimating equations. For purchase decisions, healthier choices increased by 7.62–21.96 percentage points in the combined group versus 3.46–7.83 in the label-only group, with significant between-group net effects in five of six pairs after Holm correction. For healthfulness evaluations, improvements were 12.89–34.85 versus 6.19–9.29 percentage points, with significant between-group net effects in five of six pairs after Holm correction. Transition analyses showed larger shifts from non-healthier to healthier responses in the combined intervention group. Heterogeneity by sex and objective nutrition information literacy was significant only for healthfulness evaluations, with women and those with higher objective nutrition information literacy having additional benefit from the combined intervention. Therefore, adding nutrition education to FOP labels may promote healthier judgments and simulated choices for freshly prepared beverages. Full article

Background/Objective: Ultra-processed foods (UPFs) have become deeply embedded in global dietary patterns. However, their widespread consumption conceals the dual hidden risks of delayed physiological health effects and long-overlooked environmental externalities. Prior research has largely centered on health-driven dietary behaviors, with insufficient understanding of how perceptions of the environmental burden shape consumer choices, particularly in highly convenient, eating-out-dominated food environments. To address this gap, this study extends the theory of planned behavior (TPB) to examine how dual-risk perceptions influence intentions to reduce UPF consumption. Methods: Drawing on survey data from 362 Taiwanese consumers, this study analyzed the proposed theoretical model using structural equation modeling. Results: The findings show that (1) both health and environmental risk perceptions significantly and positively shape attitudes toward reducing UPF intake; (2) attitude, subjective norms, and perceived behavioral control (PBC) significantly increase reduction intentions, with subjective norms and attitude emerging as the strongest predictors; and (3) environmental awareness produces a counterintuitive diminishing marginal effect, negatively moderating the relationship between environmental burden perception and behavioral intention. Conclusions: These results extend the empirical foundation of the “green TPB” by demonstrating that the internalization of environmental costs complements traditional health motivations. The findings offer actionable implications for public health policy, including the implementation of front-of-pack warning labels and the use of the NOVA food classification system to advance sustainable diets. Full article

Background: The Glycemic Index (GI) serves as a critical indicator of carbohydrate quality linked to postprandial glycemic response. As “Low-GI” claims proliferate on front-of-pack labels, it remains unclear how consumers value this complex signal. This study quantifies willingness to pay (WTP) for Low-GI labeling and tests a “motivation–capability” mechanism, positing that health orientation motivates label use, while objective Low-GI knowledge facilitates targeted evaluation across nutritional contexts. Methods: A discrete choice experiment was conducted in China using plain yogurt (N = 910). Mixed logit models analyzed how the valuation of the Low-GI claim is moderated by carbohydrate context, health orientation, and objective knowledge. Results: Results indicate a significant average premium for Low-GI labeling, with health orientation acting as a consistent motivational amplifier. Objective knowledge functions as a critical moderator interacting with carbohydrate context, driving label valuation only in specific low- or high-carbohydrate profiles while triggering skepticism in regular carbohydrate ones. Conclusions: These findings suggest that the public health effectiveness of emerging physiological claims depends jointly on consumer motivation and label-specific literacy. Consequently, policy interventions should combine label standardization with targeted education, equipping consumers with the capability to decode the claim’s physiological meaning rather than relying on a generalized health halo. Full article

Background/Objectives: Poor dietary habits are a major contributor to non-communicable diseases (NCDs), the leading cause of mortality worldwide. To promote healthier eating, governments and stakeholders have implemented various nutrition policies, including front-of-pack nutrition labeling (FOPNL). The Choices International Foundation (Choices), through its criteria, supports these efforts through its standardized nutrient profiling system (NPS). Originally developed to underpin a positive FOPNL logo, in 2021, the criteria were expanded into a globally oriented five-level profiling system covering 23 basic and 10 discretionary food groups, addressing key nutrients such as trans-fatty acids, saturated fat, sodium, sugar, fiber, and energy. To ensure continued scientific relevance, the Choices criteria are periodically reviewed by an independent International Scientific Committee (ISC). Methods: This paper presents the 2025 revision of the Choices criteria, focusing on priority areas identified through stakeholder consultation and recent scientific developments. Results: Key updates include the introduction of nutrient-based equivalence criteria for plant-based alternatives to meat and dairy, based on protein and selected micronutrient thresholds. Non-sugar sweeteners (NSSs) were newly included as a factor that lowers a product’s health classification and makes it ineligible for a positive FOPNL. Additionally, the industrially produced trans-fatty acid (iTFA) criteria were revised and aligned with the latest World Health Organization (WHO) recommendations, improving both technical feasibility and policy coherence. While options for incorporating whole-grain and micronutrient criteria were explored, these were not included in the current revision. Conclusions: The 2025 update system enhances the scientific rigor, policy alignment, and global applicability of the Choices system. By providing a harmonized and evidence-based tool, it aims to support national policies that foster healthier food environments and, ultimately, improve public health outcomes worldwide. Full article

Background/Objectives: Obesity is a major global public health and economic challenge. Governments worldwide have implemented nutrition-focused policies such as sugar-sweetened beverage taxes, front-of-pack labeling, food assistance reforms, and school nutrition standards to improve diet quality and reduce obesity. Because large-scale randomized controlled trials are often infeasible and conventional epidemiologic methods overlook population heterogeneity and behavioral feedback, microsimulation modeling has become a key tool for evaluating long-term and distributional policy impacts. This scoping review examined the application of microsimulation to obesity-related nutrition policies, focusing on model structure, behavioral parameterization, and integration of economic and equity analyses. Methods: Following PRISMA guidelines (PROSPERO CRD42024599769), five databases were searched for peer-reviewed studies. Data were extracted on policy mechanisms, model design, parameterization, and equity analysis. Study quality was assessed using a customized 21-item checklist adapted from CHEERS and NIH tools. Results: Twenty-nine studies met the inclusion criteria, with most policy settings based in the United States. Most employed dynamic, stochastic, individual-level microsimulation models with diverse behavioral assumptions, obesity equations, and calibration approaches. While most studies stratified outcomes by socioeconomic or demographic group, only one used a formal quantitative equity metric. Conclusions: Microsimulation modeling provides valuable evidence on the long-term health, economic, and distributional impacts of nutrition policies. Future work should strengthen methodological transparency, standardize equity assessment, and expand application beyond high-income settings to improve the comparability, credibility, and policy relevance of simulation-based nutrition policy research. Full article

There is no clear consensus regarding which Front-of-Pack (FoP) label is more effective in promoting healthier food choices. This study explored consumers’ healthiness perception (HP) and willingness to buy (WTB) foods labelled with two different FoP labels: Nutri-Score (NS) and NutrInform Battery (NIB). The role of individual characteristics, such as sociodemographic variables, purchasing behaviors, orthorexia nervosa tendency, and cognitive abilities, in predicting consumers’ responses was also examined. Through an online survey, Italian consumers (n = 436; 71% female; average age: 38.9 ± 14.7) evaluated the HP and WTB of yoghurt and fruit jam, with three different nutritional qualities (high, medium, low) and labelled with both NS and NIB. The results showed significant differences between NS and NIB, with effects varying across product categories and nutritional profiles. Age, frequency of nutrition label reading, and role in buying decisions emerged as significant predictors of consumers’ responses, particularly for products with high nutritional quality. Conversely, orthorexia nervosa tendencies and cognitive abilities did not significantly predict differences in HP and WTB between FoP labels. These findings expand the understanding of the complexity involved in selecting an appropriate FoP labelling system and offer valuable insights to effectively guide healthier food choices while accommodating diverse consumers’ profiles. Full article

Domestic demand for honey in Kenya consistently exceeds national production, resulting in periodic reliance on imports. Kenyan honey is typically branded and marketed according to its geographical origin, whereas information regarding botanical origin is rarely communicated. This study was undertaken in two phases: a systematic review of the literature on honey varieties in Kenya—with an emphasis on legislation, production, and processing—and an online survey assessing front-of-pack (FoP) labeling descriptions. Legislatively, Kenyan honey varieties are categorized based on (i) the bee species producing the honey (honeybee or stingless bee), (ii) the intended use (direct human consumption or industrial application), and (iii) the presence of added flavoring agents. The results from the FoP labeling survey indicated that all domestic honey samples (n = 24) failed to comply with labeling requirements, instead emphasizing descriptors such as “natural” and “pure.” Only 40% of imported honey brands (n = 10) declared the botanical origin and processing method. Mellisopalynological studies showed that honey produced in the Acacia woodlands of Baringo, West Pokot, and Kitui can legitimately be marketed as Acacia honey. In contrast, honey from the Eastern Mau forest can be characterized as monofloral Eucalyptus, Croton, Albizia, or Cordia spp. honeys, with numerous bifloral and multifloral combinations. Sisal and mangrove honeys were also identifiable in landscapes dominated by these plant species. The lack of legislative classification for Kenyan monofloral honeys appears to contribute to widespread non-compliance in industry labeling practices. Although Kenyan honey remains competitive, inadequate product differentiation and weak labeling hinder access to niche domestic and international markets. To strengthen competitiveness, Kenyan honey legislation should incorporate provisions for characterizing monofloral honey types, processing standards, and mellisopalynological authentication. Such measures will enhance producer awareness, promote adoption of good processing practices, strengthen compliance with trade regulations, and support the development of a robust national honey value chain. Full article

Front-of-pack labels (FOPLs) have been identified as a potential key tool to enable consumers to make healthier and more sustainable food choices. The simplification of complex nutritional, environmental, and processing data into clear and immediate formats is an essential function of FOPLs, which facilitates a more efficient connection between detailed product information and real-world purchasing decisions. This review critically evaluates the three main categories of FOPL—nutritional (e.g., Nutri-Score), environmental (e.g., Eco-Score) and processing-based (e.g., NOVA)—and examines emerging efforts to weave these dimensions into unified labelling frameworks. A bibliometric analysis of 1803 publications from Scopus, Web of Science, and Google Scholar was conducted, using VOS viewer to identify co-occurrence networks and thematic clusters. A narrative synthesis of label design methods, regulatory steps and consumer impact research followed this. Despite the considerable maturation of individual FOPLs, their combined application remains ad hoc. Establishing harmonized, multidimensional criteria is therefore essential to ensure consistent labelling that informs consumers and promotes public health and sustainability goals. Full article

Background: The majority of Australian children exceed the World Health Organization’s recommended dietary intake of free sugar, particularly through the consumption of sugar-sweetened beverages. Front-of-pack nutrition labels increase perceived risk and deter the consumption of sugar-sweetened beverages. However, past studies of young children have focused almost exclusively on a parent’s choice of beverage for children. This study investigated the influence of four label designs (text-based warning, tooth decay pictorial, teaspoons of sugar, and Health Star Rating) on the beverage choices of N = 1229 Australian children (aged 4–11 years) and their parents. Methods: In an online vending machine scenario, parent–child dyads were separately asked to select which beverage they would choose for themselves before and after being randomised to one label condition. The beverages displayed included 100% fruit juice, soft drink, soft drink with a non-nutritive sweetener, flavoured milk, plain milk and bottled water. Beverage healthiness was determined by a 1–10 rating based on a review by a panel of experts (10 dietitians and nutritionists). Results: Mixed-model ANOVAs showed that for parents, each label design performed comparably; however, for children, small but significant differences were seen in the effectiveness of different label designs, with the teaspoons of sugar label, text-based warning, and tooth decay pictorial found to be more impactful in promoting healthier drink choices than the Health Star Rating. Conclusions: These findings can inform public health advocacy efforts to improve food labelling and could be incorporated into educational resources to help children understand the nutritional profiles of different sugary drinks. Full article

Background: The health benefits associated with the consumption of nuts and seeds are well established, yet this food group is known to be the furthest from the recommended intake; therefore, actions aiming to increase nut intake are needed. The main front-of-pack communication device in Australia, the Health Star Rating (HSR), inadvertently penalises nuts with negative points associated with energy and saturated fat content. Methods: This study aims to suggest options to policy makers by (i) examining how the HSR rates a sample of 82 nuts, seeds and products containing them and (ii) testing three sets of moderate adjustments of the HSR algorithm on the sampled products: discounting the energy from nuts and seeds (S1), discounting the saturated fat from nuts and seeds (S2) and applying an adapted algorithm based on that for ‘oils and spreads’ for foods with ≥50% nuts and seeds (S3). Results: All three scenarios improved the Spearman correlation between the HSR score and the nut and seed content (−0.80, −0.75 and −0.71 for S1, S2 and S3, respectively) compared to the original HSR (−0.66). Products with more than 50% of their weight being nuts and seeds benefited much more from these adjustments than those below 50%. For all scenarios, but most clearly for S3, the products that had a lower HSR score than the original HSR (the healthier products) benefited more from the changes brought about by the adjusted algorithms than those of lower nutritional quality. The HSR of foods that contained no nuts or seeds remained unchanged. Conclusions: With minor changes to the HSR algorithm, nut and seed products could be brought into alignment with the current evidence, encouraging their regular inclusion in dietary patterns, which could help guide consumers at the supermarket shelf. Full article

Background: To help consumers make healthier choices, the US Food and Drug Administration (FDA) has been charged with developing a front-of-package label (FOPL) to appear on US packaged foods and beverages. One option being explored is the use of “high-in” FOPLs for added sugar, sodium, and saturated fat using a threshold of ≥20% of the recommended daily value (%DV) per portion/serving size to define “high-in”. While research has addressed what FOPL designs are most effective at visually communicating “high-in”, less attention has been paid to the nutrient profile model (NPM) used to decide which products should receive these labels. In addition, several established regional NPMs already exist that identify products that are high in nutrients of concern, but it is unclear how these compare to the FDA’s %DV approach. Methods: We used a dataset of 51,809 US products from Mintel’s Global New Products Database to examine how the FDA’s current definition of “high-in” compares to three established regional NPMs: the Canadian NPM, the Pan American Health Organization (PAHO) NPM, and Chile’s NPM. Results: Overall agreement between the four NPMs was 51% for foods and 72% for beverages, with highest agreement in categories such as sweetened sodas (87%), and lowest agreement in categories such as bread (14%) and salty snacks (29%). The Canadian NPM showed the highest agreement to the FDA “high-in” criteria while the Chilean and PAHO models had lower agreement. For many food categories, the FDA’s definition of “high-in” would require the fewest products to carry a “high-in” label. This issue was particularly pronounced in categories that tend to be served in small portions (e.g., salty snacks, bars), but disappeared or reversed for categories that are served in larger portions (e.g., frozen and non-frozen main dishes). Conclusions: The NPM chosen has important policy implications for an FOPL system’s ability to identify unhealthy foods and incentivize companies to reformulate products. Based on these results, the FDA should consider using a stronger NPM similar to those used elsewhere in the Americas region when deciding the final thresholds for “high-in” for US packaged foods and beverages. Full article

The Smart Choice logo (SCL), as an encouraging form of front-of-package nutrition labeling (FOPNL), helps consumers to choose low-oil, -salt, and -sugar mooncakes during the Mid-Autumn Festival. It is widely acknowledged that nutrition knowledge contributes to nutrition label use, but there has been little research on whether it helps enhance consumers’ willingness to pay (WTP). Our study aims to fill this gap by investigating 630 randomly selected Chinese adults from Jilin, Inner Mongolia, Shaanxi, Shandong, Henan, Sichuan, and Guangdong. The semi-double-bounded dichotomous choice contingent value method was selected to measure their WTP for pre-packed mooncakes with the SCL at 20 different premium levels, ranging from 0% to 95% of the price per unit. It was found that the respondents’ WTP decreased by 0.7% as the premium level increased by 1%, and the WTP of people from South China, those who were obese, and those with a high income was not sensitive to changes in premium. Nutrition knowledge played a negative moderating role, and the probability of the premium levels affecting WTP decreased by 1.0% for each 1 point increase in the nutrition knowledge level. These findings highlight the potential implications associated with SCL promotion and differentiated mooncake pricing, as well as the supply of healthier Chinese holiday foods. Full article

Background: To improve consumers’ diet, policy measures such as food reformulation strategies and front-of-pack nutritional labels (FOPNLs) are implemented, aiming to guide consumers’ food choice and to stimulate an improvement in food composition by manufacturers. The FOPNL Nutri-Score has been implemented in several European countries. Changes in food compositions in relation to the Nutri-Score over time have been limitedly studied. This study evaluates food compositions in Europe over time, and if changes in compositions of the food supply could have potentially resulted in changes in Nutri-Score classifications of foods. Materials and Methods: Food composition data were available from EUREMO, from which bread products, breakfast cereals, hot sauces, and processed potato products from Austria, Belgium, Finland, Italy, and the United Kingdom from 2019 to 2021 were selected (n = 2260). Of these countries, only Belgium had implemented the Nutri-Score in 2019. Distributions of food compositions and Nutri-Score classifications were calculated and changes in median salt, sugar, and saturated fatty acids content were plotted by food group, country and year. Distribution of the final sum of Nutri-Score points was plotted by nutrient, food group, country and year. Results: Overall, more favourable Nutri-Score classifications (i.e., towards Nutri-Score classification A) were observed in most of the selected food groups and countries over the years, due to the influence of specific nutrients such as salt in breakfast cereals (lower median of 0.1–0.4 g/100 g) and processed potato products (lower median of 0.1–1.2 g/100 g); and sugar in processed potato products (lower median of 0.1–1.9 g/100 g) and bread products (lower median of 0.7–2.2 g/100 g). For nutrient contents in other food groups, no consistent changes were observed. Conclusions: Changes in the compositions of the food supply resulted in favourable changes in Nutri-Score classifications, suggesting a potential for food reformulation. Monitoring after the actual implementation of Nutri-Score is recommended. Full article