Objective Understanding of Front-of-Package Nutrition Labels: An International Comparative Experimental Study across 12 Countries

TLDR

Front‑of‑package labels are effective tools for raising consumer awareness of nutritional quality and promoting healthier choices, yet their design may influence effectiveness and cross‑cultural comparisons are scarce. This study evaluated consumers’ ability to interpret five FoPL systems—Health Star Rating, Multiple Traffic Lights, Nutri‑Score, Reference Intakes, and Warning symbol—across 12 countries. Approximately 1,000 participants per country completed an online survey ranking three sets of unlabeled products, then were randomly assigned to one FoPL and re‑ranked the same products, with changes analyzed by ordinal logistic regression. Nutri‑Score consistently outperformed the other labels in all countries and food categories, followed by Multiple Traffic Lights, Health Star Rating, Warning symbol, and Reference Intakes.

Abstract

Front-of-Package labels (FoPLs) are efficient tools for increasing consumers’ awareness of foods’ nutritional quality and encouraging healthier choices. A label’s design is likely to influence its effectiveness; however, few studies have compared the ability of different FoPLs to facilitate a consumer understanding of foods’ nutritional quality, especially across sociocultural contexts. This study aimed to assess consumers’ ability to understand five FoPLs [Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), and Warning symbol] in 12 different countries. In 2018, approximately 1000 participants per country were recruited and asked to rank three sets of label-free products (one set of three pizzas, one set of three cakes, and one set of three breakfast cereals) according to their nutritional quality, via an online survey. Participants were subsequently randomised to one of five FoPL conditions and were again asked to rank the same sets of products, this time with a FoPL displayed on pack. Changes in a participants’ ability to correctly rank products across the two tasks were assessed by FoPL using ordinal logistic regression. In all 12 countries and for all three food categories, the Nutri-Score performed best, followed by the MTL, HSR, Warning symbol, and RIs.