title: Impact of Different Front-of-Pack Nutrition Labels on Consumer Purchasing Intentions: A Randomized Controlled Trial.
abstract: BACKGROUND
  Despite growing evidence supporting the utility of front-of-pack nutrition labels in enabling consumer evaluation of food product healthiness, research on food choices is scarce. This study aims at comparing the impact of front-of-pack nutrition labels on consumers' purchasing intentions.
  
  
  METHODS
  Five-arm, open-label RCT.
  
  
  METHODS
  The study setting was a virtual web-based supermarket, with participants from the French NutriNet-Santé study. The eligibility requirement was grocery shopping involvement.
  
  
  METHODS
  The intervention was to simulate one shopping situation with front-of-pack nutrition labels affixed on food products (December 2014 to March 2015). Participants were randomly assigned to one of five exposure conditions using a central computer system: Guideline Daily Amounts, Multiple Traffic Lights, Five-Color Nutrition Label, Green Tick, or control (no front-of-pack exposure). Given the nature of the intervention, masking of participants was not performed.
  
  
  METHODS
  The primary outcome was the overall nutritional quality of the contents of the shopping cart, estimated using the United Kingdom Food Standards Agency nutrient profiling system. Secondary outcomes included energy and nutrient content of the shopping cart. Impact of the front-of-pack labels was also evaluated across sociodemographic subgroups based on age, educational level, income, and nutrition knowledge.
  
  
  RESULTS
  A total of 11,981 participants were included in the analyses (April 2015). The Five-Color Nutrition Label significantly led to the highest overall nutritional quality of the shopping cart, as reflected by lower Food Standards Agency scores (M=8.72; SD=2.75), followed by Multiple Traffic Lights (M=8.97; SD=2.68) and Green Tick (M=8.99; SD=2.71), compared with the control (M=9.34; SD=2.57) (p<0.0001). The Five-Color Nutrition Label was the only front-of-pack format that led to a lower content in lipids, saturated fatty acids, and sodium of the shopping cart (all p<0.05). The impact of the different front-of-pack labels was similar across sociodemographic subgroups.
  
  
  CONCLUSIONS
  The Five-Color Nutrition Label based on a color-coded and graded scale indicating overall nutritional quality is effective in promoting overall healthier food choices in all population subgroups.
  
  
  BACKGROUND
  This study is registered at www.clinicaltrials.gov NCT02385838.
authors.affiliation: Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Université Paris 13, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny Cedex, France. Electronic address: p.ducrot@eren.smbh.univ-paris13.fr.
authors.forename: Pauline
authors.initials: P
authors.lastname: Ducrot
authors.affiliation: Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Université Paris 13, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny Cedex, France; Département de Santé Publique, Hôpital Avicenne, Bobigny Cedex, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Julia
authors.affiliation: Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Université Paris 13, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny Cedex, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Méjean
authors.affiliation: Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Université Paris 13, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny Cedex, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Kesse-Guyot
authors.affiliation: Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Université Paris 13, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny Cedex, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Touvier
authors.affiliation: Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Université Paris 13, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny Cedex, France.
authors.forename: Léopold K
authors.initials: LK
authors.lastname: Fezeu
authors.affiliation: Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Université Paris 13, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny Cedex, France; Département de Santé Publique, Hôpital Avicenne, Bobigny Cedex, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Hercberg
authors.affiliation: Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Université Paris 13, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny Cedex, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Péneau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002755:Choice Behavior; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D005260:Female; D005515:Food Labeling / Q000379:methods*; D005518:Food Preferences; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009753:Nutritive Value; D055815:Young Adult