title: Front-of-pack symbols are not a reliable indicator of products with healthier nutrient profiles.
abstract: BACKGROUND
  Front-of-pack (FOP) nutrition rating systems and symbols are a form of nutrition marketing used on food labels worldwide. In the absence of standardized criteria for their use, it is unclear if FOP symbols are being used to promote products more nutritious than products without symbols.
  
  
  OBJECTIVE
  To compare the amount of calories, saturated fat, sodium, and sugar in products with FOP symbols, and different FOP symbol types, to products without symbols.
  
  
  METHODS
  The median calorie, saturated fat, sodium, and sugar content per reference amount of products with FOP symbols were compared to products without FOP symbols using data from the Food Label Information Program, a database of 10,487 Canadian packaged food labels. Ten food categories and 60 subcategories were analyzed. Nutrient content differences were compared using Wilcoxon rank-sum test; differences greater than 25% were deemed nutritionally relevant.
  
  
  RESULTS
  Products with FOP symbols were not uniformly lower in calories, saturated fat, sodium, and sugar per reference amount than products without these symbols in any food category and the majority of subcategories (59/60). None of the different FOP types examined were used to market products with overall better nutritional profiles than products without this type of marketing.
  
  
  CONCLUSIONS
  FOP symbols are being used to market foods that are no more nutritious than foods without this type of marketing. Because FOP symbols may influence consumer perceptions of products and their purchases, it may be a useful public health strategy to set minimum nutritional standards for products using FOP symbol marketing.
authors.affiliation: Department of Nutritional Sciences, University of Toronto, FitzGerald Building, 150 College Street, Toronto, ON M5S 3E2, Canada. Electronic address: teri.emrich@mail.utoronto.ca.
authors.forename: Teri E
authors.initials: TE
authors.lastname: Emrich
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
authors.forename: Ying
authors.initials: Y
authors.lastname: Qi
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Baltimore, MD 21205, USA.
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Cohen
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
authors.forename: Wendy Y
authors.initials: WY
authors.lastname: Lou
authors.affiliation: Department of Nutritional Sciences, University of Toronto, FitzGerald Building, 150 College Street, Toronto, ON M5S 3E2, Canada.
authors.forename: Mary L
authors.initials: ML
authors.lastname: L'Abbe
mesh_terms: D002170:Canada; D004032:Diet; D002149:Energy Intake; D005502:Food; D005504:Food Analysis; D019649:Food Industry; D005515:Food Labeling; D006801:Humans; D040541:Marketing; D009753:Nutritive Value
keywords: Food analysis; Food labelling; Food marketing; Food quality