Comparative understanding and preference of Nutri-Score and NutrInform Battery in a sample of Spanish consumers

{"Background": "Front-of-pack nutrition labels (FoPLs) are recognized by the World Health Organization as a cost-effective policy tool to promote healthy diets. Within the European Union, multiple FoPL formats currently coexist, but the European Commission's Farm to Fork strategy (2020) announced plans to propose a single mandatory FoPL. Two prominent formats under debate are Nutri-Score, a summary graded color-coded interpretive label adopted by France and six other countries including Spain, and NutrInform Battery, a non-interpretive label adopted by Italy. While Nutri-Score has been validated by numerous studies, existing comparisons with NutrInform had only assessed subjective understanding (preference), not objective understanding (performance). This study aimed to fill that gap by comparing both dimensions in a representative sample of Spanish consumers.", "Methods": "A total of 1026 Spanish adults were recruited in 2021 through an ISO-accredited web panel, with quotas for sex (50% women), age, and educational level to ensure representativeness. Participants were randomly assigned to either the Nutri-Score group (n=486) or the NutrInform group (n=540). Both groups received an information note explaining their assigned label. Objective understanding was assessed through tasks requiring participants to identify the healthiest products in three food categories: breakfast products, breakfast cereals, and added fats. For each category, participants completed a one-product task (select the single healthiest product) and a three-product task (select the three healthiest products). Preference was measured through perceived helpfulness (subjective understanding) using a four-point Likert scale, and perception across four dimensions (ease of use, capacity to inform, trust, and liking) using 13 statements on a 1-9 scale summarized via principal component analysis. Finally, participants were shown both labels simultaneously and asked which they preferred. Multivariable ordinal logistic and logistic regression models were used, adjusted for sex, age, presence of children, nutrition knowledge, diet quality, and understanding of the information note.", "Key Results": "Nutri-Score significantly outperformed NutrInform on all objective understanding tasks. For the one-product task, 76% of Nutri-Score participants correctly identified the healthiest breakfast product vs. 29% for NutrInform; 76% vs. 33% for breakfast cereals; and 93% vs. 26% for added fats. For the three-product task, 82% of Nutri-Score participants correctly identified the three healthiest breakfast products vs. 10% for NutrInform; and 82% vs. 54% for breakfast cereals. The overall odds ratio for correctly identifying the healthiest product across all categories was 19.1 (95% CI: 14.2-25.7, P<0.0001) favoring Nutri-Score. For individual categories, odds ratios ranged from 5.54 (4.18-7.38) for breakfast cereals to 37.2 (24.9-57.6) for added fats. On preference measures, Nutri-Score was perceived as significantly more helpful for breakfast products (mean 1.32\u00b11.00 vs. 1.14\u00b11.02, P=0.0053) and breakfast cereals (1.33\u00b11.00 vs. 1.00\u00b11.03, P<0.0001), but not for added fats (1.06\u00b11.19 vs. 0.92\u00b11.09, P=0.066). Nutri-Score was rated significantly easier to use (0.32\u00b11.58 vs. -0.29\u00b11.66, P<0.0001) and more liked (0.080\u00b11.18 vs. -0.072\u00b11.17, P=0.039). No significant differences were found for capacity to inform (P=0.074) or trust (P=0.10). Being in the Nutri-Score group significantly increased the odds of preferring that label for ease of use (OR=2.18, 95% CI: 1.68-2.84, P<0.0001) and speed of use (OR=2.68, 95% CI: 2.06-3.50, P<0.0001). Notably, understanding of the information note was significantly lower for NutrInform (mean grade 2.86\u00b11.44 out of 7) than for Nutri-Score (3.91\u00b12.38, P<0.0001).", "Clinical Implications": "This study provides strong evidence that Nutri-Score is superior to NutrInform Battery in helping Spanish consumers correctly identify healthier food products across multiple categories, including added fats where olive oil\u2014a cornerstone of the Mediterranean diet\u2014was more frequently selected as the healthiest option with Nutri-Score (89%) than with NutrInform (57%). The findings highlight a critical disconnect between subjective and objective understanding: while a majority of NutrInform participants perceived the label as helpful, only a minority could correctly apply it in choice tasks. This underscores the importance of testing FoPLs on objective performance measures rather than relying solely on consumer preference. As the European Commission moves toward mandating a single FoPL, these results support the adoption of Nutri-Score as the more effective tool for guiding consumers toward healthier food choices. The study's limitations include potential familiarity bias (Nutri-Score was already present on some Spanish products) and the online questionnaire format, which may not fully replicate real-world purchasing conditions."}