title: Performance of a five category front-of-pack labelling system - the 5-colour nutrition label - to differentiate nutritional quality of breakfast cereals in France.
abstract: BACKGROUND
  Breakfast cereals exhibit a wide variability in nutritional quality, and differences are not easily grasped by consumers. A simplified nutritional information system might contribute to help consumers make healthier food choices. A five-category colour label based on the Food Standards Agency Nutrient profiling system (FSA score) has been proposed in France to be implemented on the front-of-pack of foods (the five-colour nutrition label - 5-CNL). Objectives were to evaluate the ability of the 5-CNL to discriminate nutritional quality between types of breakfast cereals, within a category and in equivalent products, as well as its ability to change through product reformulation.
  
  
  METHODS
  Nutritional information was collected through an Internet and supermarket research for N = 433 breakfast cereals (N = 380 complete data included in the analyses). Breakfast cereals were categorized according to common attributes in terms of processing and/or ingredients used. The FSA score and 5-CNL category allocation were computed for each cereal. Nutrient content and FSA score were compared across types of cereals. Distribution within the 5-CNL categories was assessed across types of cereals and for equivalent products. Impact of reformulation (reduction of 5 and 10% in simple sugar, saturated fat and sodium) on the 5-CNL category allocation was compared to original allocation with Bapkhar's tests of homogeneity of marginal distribution.
  
  
  RESULTS
  Variability in nutritional quality of breakfast cereals was high, as reflected by the FSA score (range -7- 22 for a theoretical range of -15-40) and the 5-CNL (all five categories represented). The 5-CNL allowed for discrimination across types of cereals, within categories of breakfast cereals and for equivalent products (at least 3 categories of the 5-CNL represented). Reformulation scenarios allowed for significant change in 5-CNL allocation: 5% reduction in sugar lead to a modification of the label for 4.21% of products while a reduction of 10% of sugar, saturated fat and sodium lead to a modification of the label for 19.2% of products.
  
  
  CONCLUSIONS
  The 5-CNL adequately discriminates between breakfast cereals. It would therefore be an adequate tool for consumer information on nutritional quality of foods in the French context.
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra(U1125), Cnam, COMUE Sorbonne Paris Cité, 93017, Bobigny, France. c.julia@uren.smbh.univ-paris13.fr.|Hôpital Avicenne (AP-HP), Département de Santé Publique, 93017, Bobigny, France. c.julia@uren.smbh.univ-paris13.fr.
authors.forename: Chantal
authors.initials: C
authors.lastname: Julia
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra(U1125), Cnam, COMUE Sorbonne Paris Cité, 93017, Bobigny, France. e.kesse@uren.smbh.univ-paris13.fr.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Kesse-Guyot
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra(U1125), Cnam, COMUE Sorbonne Paris Cité, 93017, Bobigny, France. p.ducrot@uren.smbh.univ-paris13.fr.
authors.forename: Pauline
authors.initials: P
authors.lastname: Ducrot
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra(U1125), Cnam, COMUE Sorbonne Paris Cité, 93017, Bobigny, France. s.peneau@uren.smbh.univ-paris13.fr.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Péneau
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra(U1125), Cnam, COMUE Sorbonne Paris Cité, 93017, Bobigny, France. m.touvier@uren.smbh.univ-paris13.fr.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Touvier
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra(U1125), Cnam, COMUE Sorbonne Paris Cité, 93017, Bobigny, France. c.mejean@uren.smbh.univ-paris13.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Méjean
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra(U1125), Cnam, COMUE Sorbonne Paris Cité, 93017, Bobigny, France. s.hercberg@uren.smbh.univ-paris13.fr.|Hôpital Avicenne (AP-HP), Département de Santé Publique, 93017, Bobigny, France. s.hercberg@uren.smbh.univ-paris13.fr.
authors.forename: Serge
authors.initials: S
authors.lastname: Hercberg
mesh_terms: D062408:Breakfast; D002755:Choice Behavior; D003116:Color; D002523:Edible Grain; D005515:Food Labeling / Q000706:statistics & numerical data*; D005602:France; D006801:Humans; D009753:Nutritive Value