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The 2018 Federal Menu Labeling regulations require restaurants and similar retail food establishments that are part of a chain with 20 or more locations to provide calorie and other nutrition information for standard menu items. In this study, we describe the sociodemographic correlates of prevalence of menu label use at Food-Away-From-Home (FAFH) establishments and estimate the association between menu label use and calorie intake. We use nationally representative data spanning the years 2007-2018 and multivariable logit regression and ordinary least squares regression models. For FAFH establishments, we find that female respondents have about 26% (95% CI = [1.14, 1.39]) higher odds of using menu labels. Respondents with high school degree have 51 percent higher odds (95% CI = [1.24, 1.85]), respondents with some college education have 107 percent higher odds (95% CI = [1.74, 2.47]) of seeing menu labels. Higher income is associated with 12% (95% CI = [1.08, 1.15]) greater odds of seeing menu labels. Hispanic respondents have 29% (95% CI = [0.62, 0.81]) lower odds of seeing and 79% (95% CI = [1.41, 2.29]) higher odds of using menu labels. Black respondents have 54% (95% CI = [1.35,1.75] higher odds of seeing menu labels at sit-down restaurants. Menu label users at fast-food restaurants reported consuming 202 kcal (95% CI = [-252,-153]) fewer total calories than nonusers and menu label users at sit-down restaurants reported using 181 kcal (95% CI = [-256,-106]) fewer total calories than nonusers. Our findings highlight the sociodemographic disparities in menu label use and provide baseline estimates for future studies evaluating the federal menu labeling regulation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Since May 2018, federal restaurant menu labeling regulations have required large U.S. chain restaurants to disclose calorie counts on menus. This study estimates the share of U.S. adults who notice calorie information on fast-food and sit-down restaurant menus and identifies the consumer characteristics that predict noticing calorie labels., Methods: Using a nationally representative sample of 5,185 U.S. adults aged 18 and older from the 2022 Health Information National Trends Survey (HINTS), linear regression models were estimated to predict the likelihood of noticing calorie labels the last time adults ordered food in a fast-food or sit-down restaurant. The 2022 HINTS data were publicly released in April 2023 and these public-use and de-identified data were analyzed in October 2023., Results: In 2022, about 1 in 2 U.S. adults (49.7%, 95% CI=47.6%, 51.8%) reported noticing calorie labels during their last restaurant visit. The likelihood of noticing calorie information was significantly lower among men, lower income households, unpartnered adults, residents of the Northeast Census Region, and residents of rural areas., Conclusions: Approximately half of U.S. adults reported seeing calorie labels when they last ordered food in a fast-food or sit-down restaurant in 2022. Sex, income, marital status, and residential location influenced the likelihood of noticing calorie counts posted on restaurant menus., (Published by Elsevier Inc.)

This paper presents an investigation of the factors influencing the decision to purchase processed food based on traffic-light labeling (TLL). To achieve this, we use data from the official National Survey of Health and Nutrition, which gathered information on 26,532 individuals aged between 19 and 59 between 2011 and 2013. Employing a probit regression to assess the likelihood of buying food based on TLL, we identify a positive association between income level and the probability of buying food based on TLL; indeed, our model suggests that a 1% increase in monthly income increases by 0.008 the probability of buying food based on TLL. We infer that people with higher levels of income are more aware of the benefits of TLL and healthy food habits. Our results also suggest that the probability of basing purchasing decisions on TLL is higher for overweight people compared to those of normal weight, that is, overweight people buy their processed food paying more attention to TLL compared to normal weight people., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective: To evaluate the trends in the healthiness of packaged food purchases of Australian consumers before and after the introduction of the Health Star Rating (HSR) nutrition labels., Design: Panel data analysis and difference-in-differences analysis., Setting: The Australian Government endorsed HSR nutrition labels for voluntary implementation on packaged foods in June 2014. We analyse the packaged food purchases of households across all major supermarkets before (January 2014 to June 2014) and after (June 2014-Dec 2018) the introduction of HSR., Participants: 6284 members of a panel of households across Australia reporting their grocery purchases to a market research company (Nielsen Homescan panel)., Results: The healthiness of household food purchases exhibited a U-shaped trend - decreasing from 2014 to 2017, and then increasing from 2018, corresponding to the time when a higher proportion of products were HSR-labelled. Households that purchased a higher proportion of HSR-labelled products had healthier household purchases overall. Further, the healthiness of households' category-specific food purchases was positively associated with the proportion of HSR-labelled products in categories where HSR was adopted, relative to control categories where HSR was not adopted., Conclusions: In Australia, once a substantial number of packaged food products adopted the voluntary HSR summary indicator, we observed an increasing trend in the healthiness of household food purchases. Widespread adoption of a nutrition summary indicator, such as HSR, on packaged food is likely to be beneficial for population health.

Objectives. To determine the extent to which reductions in sodium during the National Salt Reduction Initiative (NSRI) target-setting period (2009-2014) continued after 2014. Methods. We used the NSRI Packaged Food Database, which links products in the top 80% of US packaged food sales to nutrition information, to assess the proportion of products meeting the NSRI targets and the sales-weighted mean sodium density (mg/100 g) of 54 packaged food categories between 2009 and 2018. Results. There was an 8.5% sales-weighted mean reduction in sodium between 2009 and 2018. Most change occurred between 2009 and 2012, with little change in subsequent years. The proportion of packaged foods meeting the 2012 and 2014 targets increased 48% and 45%, respectively, from 2009 to 2012, with no additional improvements through 2018. Conclusions. Food manufacturers reduced sodium in the early years of the NSRI, but progress slowed after 2012. Public Health Implications. The US Food and Drug Administration just released 2.5-year voluntary sodium targets for packaged and restaurant food. Continued assessment of industry progress and further target setting by the Food and Drug Administration is crucial to reducing sodium in the food supply.

Background: Pictorial warnings on tobacco products are promising for motivating behavior change, but few studies have examined pictorial warnings for sugary drinks, especially in naturalistic environments. This study aimed to examine the impact of pictorial warnings on parents' purchases of sugary drinks for their children in a naturalistic store laboratory., Methods and Findings: Parents of children ages 2 to 12 (n = 325, 25% identifying as Black, 20% Hispanic) completed a shopping task in a naturalistic store laboratory in North Carolina. Participants were randomly assigned to a pictorial warnings arm (sugary drinks displayed pictorial health warnings about type 2 diabetes and heart damage) or a control arm (sugary drinks displayed a barcode label). Parents selected 1 beverage and 1 snack for their child, as well as 1 household good; one of these items was selected for them to purchase and take home. The primary outcome was whether parents purchased a sugary drink for their child. Secondary outcomes included reactions to the trial labels, attitudes toward sugary drinks, and intentions to serve their child sugary drinks. Pictorial warnings led to a 17-percentage point reduction in purchases of sugary drinks (95% CI for reduction: 7% to 27%), with 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm (p = 0.002). The impact of pictorial warnings on purchases did not differ by any of the 13 participant characteristics examined (e.g., race/ethnicity, income, education, and age of child). Pictorial warnings also led to lower calories (kcal), purchased from sugary drinks (82 kcal in the control arm versus 52 kcal in the pictorial warnings arm, p = 0.003). Moreover, pictorial warnings led to lower intentions to serve sugary drinks to their child, feeling more in control of healthy eating decisions, greater thinking about the harms of sugary drinks, stronger negative emotional reactions, greater anticipated social interactions, lower perceived healthfulness of sugary drinks for their child, and greater injunctive norms to limit sugary drinks for their child (all p < 0.05). There was no evidence of difference between trial arms on noticing of the labels, appeal of sugary drinks, perceived amount of added sugar in sugary drinks, risk perceptions, or perceived tastiness of sugary drinks (all p > 0.05)., Conclusions: Pictorial warnings reduced parents' purchases of sugary drinks for their children in this naturalistic trial. Warnings on sugary drinks are a promising policy approach to reduce sugary drink purchasing in the US., Trial Registration: The trial design, measures, power calculation, and analytic plan were registered before data collection at www.clinicaltrials.gov NCT04223687., Competing Interests: The authors have declared that no competing interests exist.

A labelling assessment study of Greek prepacked "quality label" cheeses was conducted with a view to provide an overview of the whole category. In total, 158 prepacked products belonging to 19 "quality label" cheeses were identified in the Greek market. Among them, Feta had the highest share followed by Kasseri, Graviera Kritis, Kefalograviera and Ladotyri Mitilinis with 81, 16, 15, 11 and 9 products found in the market, respectively. For the rest of the 14 cheeses, the share was limited, ranging from 1 to 4. All labelling indications, nutritional information, claims and other labelling data were recorded and analysed in relation to their compliance against European food law requirements. The results of the analysis showed that for only 6 of the 19 cheeses, all products fully complied with EU labelling legislation. Among the 14 mandatory labelling requirements, the lowest overall compliance was observed for allergens declaration (65%). The analysis of the nutritional data showed a remarkable variability between cheeses and products. Differences in the nutritional characteristics were more pronounced among soft, semi-hard, hard and whey cheese. The above data were entered into an archival database. Application of global harmonisation and standardisation guidelines and tools lead to the initialisation of a branded food composition database (BFCD), conceptualising a specialised database for "quality label" foods.

Plant-based meat (PBM) has been gaining popularity due to increasing concerns over health, animal welfare, and environmental issues linked to animal foods. This study aimed to compare the nutrient profile of PBM with equivalent meat products. We conducted a cross-sectional survey of 207 PBM and 226 meat products available from 14 retailers in the UK. We extracted data on energy density, total and saturated fat, protein, fiber, and salt per 100 g from product packaging and calculated the nutrient profile of each product. Compared to meat, PBM had significantly lower energy density, total fat, saturated fat, protein, and significantly higher fiber. Salt content was significantly higher in five out of six PBM categories. Based on the UK's Nutrient Profiling Model, 14% of PBM and 40% of meat products were classified as "less healthy" ( p < 0.001). When considering the UK's front-of-pack labelling criteria 20% of the PBM and 46% of meat products were considered high in either total fat, saturated fat, or salt ( p < 0.001). Nearly three quarters of PBM products did not meet the current UK salt targets. PBM products have a better nutrient profile compared to meat equivalents. However, more progress is needed to reduce salt in these products.

Introduction: Introduction: protein is an essential nutrient that can be obtained through different food sources. In recent years, a growing development in the food industry of dairy products with higher protein content has emerged in the national market. Métodos: the present work analyzed the nutritional information, protein content, and amino acid profile of high protein yogurts. Five main brands of high-protein yogurt (PY) were selected, as was a sample of regular yogurt (RY), and one of whey protein isolate (WP), which underwent a proximal analysis and amino acid profile by high-performance liquid chromatography (HPLC). Results: it was observed that the protein content of the analyzed YP ranged between 7.2 and 15.1 g/portion, representing 6.8 % to 11 % of total content, twice the content of YBAT (3,4 %). Regarding carbohydrates and fats, these were found to range between 6.25 and 13.5 g/serving and 0.9 and 5.3 g/serving, respectively. Leucine content of the PY varied between 0.6 and 1.5 g/portion, which was higher than RY (0.3 g/portion) and lower than WP (2.2 g/portion). The sum of essential amino acids was found to be between 3 and 6.9 g/portion in PY, 1.7 g/serving y 8.5 g/serving in WP. Conclusion: these results show that PYs are a good alternative to promote a correct protein intake, similar to proteins for sports use, so their recommendation could be useful to promote consumption in different populations according to their needs.

Context: Globally, the use of labels or signage targeting SSBs remains in its infancy and there is limited evidence available regarding its ability to decrease purchase and consumption of SSBs., Objective: This systematic review aimed to synthesize the evidence on the effect of sugar- or health-related sugar-sweetened beverage (SSB) warning labels or signage on knowledge, attitudes, and beliefs, and SSB purchase and consumption., Data Sources: Nine databases - Ovid Medline, Emerald Insight, Scopus, Informit, Business Source Complete, CINAHL, Global Health, PsychINFO, and SocIndex - were searched along with grey literature from inception to December 2019. The PRISMA guidelines were applied for reporting this systematic review., Study Selection: Studies examining the impact of front of pack (FOP) labels and/or point of sale (POS) signage highlighting added sugar content or its health risks were included., Data Extraction: Two authors independently extracted data on items, including study details, study design, population characteristics, intervention label details (type, duration, and settings), and outcomes measures. The Effective Public Health Practice Project tool was used to assess the study quality., Data Analysis: Findings were synthesized narratively., Results: Twenty-one studies published between 1992 and 2019 were included. Of these, 16 studies examined the impact of FOP labels and 5 studies examined the impact of POS signage. Both FOP labels and POS signage were associated with improved health knowledge, attitudes, and beliefs regarding SSBs and reduced SSB purchases. Warning labels with diet-related health consequences were found to be particularly effective. Overall quality of studies was assessed as mixed., Conclusion: Health- or sugar-related FOP labels and POS signage for SSBs are promising public health measures and may improve consumers' health behaviors toward reduced SSB purchase and consumption., (© The Author(s) 2020. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

To ensure the sustainable development of mountain livestock farming, the adequate remuneration of high-quality dairy products is fundamental. In this sense, communication strategies aimed at promoting mountain products and ensure better positioning and higher market prices are fundamental. The present research seeks to expand the literature regarding consumers' willingness to pay for mountain foods by using an online real auction experiment aimed at evaluating the premium price that consumers are willing to pay for summer over winter mountain cheese, depending on the information provided concerning the taste anticipation or animal welfare. The results showed an overall small premium price given to the higher quality summer cheese; this could be, partially, due to a generally low degree of consumer knowledge about mountain dairy farming. With reference to communication strategies, the results provide evidence about the effectiveness of the rational messages founded upon sensorial characteristics and the anticipated taste of cheese. In addition, this study explored that adding a logo had no main effect on the price premium participants were willing to pay. This may be due to the fact that logos and claims, having a lower information content, are more indicated to lead the choice of consumers with a higher level of awareness. In the conclusion section, policy and agribusiness implications of the findings are provided.

Nutrition and health claims (NHCs) are a powerful tool that influence consumers' final decision on the choice of food products. The purposes of this repeated cross-sectional study were to (i) assess the prevalence of pre-packaged food products containing nutrition and health claims among different food categories, (ii) to determine the type of NHCs labelled on the examined food products, and (iii) to evaluate the trend in the use of NHCs in comparison to the 2012 survey. The survey was conducted immediately before the full enforcement of the new national legislation on NHCs in 2020. It comprised 3141 pre-packaged food products from 10 product categories. In total, 21.2% of food products contained any claim (19.4% contained any nutrition claim; 8.2% contained any health claim). In comparison to the 2012 survey, we observed a rising trend in the presence of NHCs; the use of nutrition claims on food products increased three times and the use of health claims increased 1.3 times in the 2020 survey. Bearing in mind that NHCs are a powerful tool guiding consumers' food purchase decisions, NHCs should be supported by precise legislation and strict surveillance by the public health authorities.

We aimed to compare New Zealand private label (PL) and branded label (BL) packaged food products in relation to their current (2019) healthiness (sodium and sugar contents, and estimated Health Star Rating (HSR) score), display of the voluntary HSR nutrition label on the package, and price. Healthiness and HSR display of products were also explored over time (2015 to 2019). Data were obtained from Nutritrack, a brand-specific food composition database. Means and proportions were compared using Student t -tests and Pearson chi-square tests, respectively. Changes over time were assessed using linear regression and chi-square tests for trends (Mantel-Haenzel tests). Altogether, 4266 PL and 19,318 BL products across 21 food categories were included. Overall, PL products in 2019 had a significantly lower mean sodium content and price, a higher proportion of products with estimated HSR ≥ 3.5/5 (48.9% vs. 38.5%) and were more likely to display the HSR on the pack compared with BL products (92.4% vs. 17.2%, respectively). However, for most food categories, no significant difference was found in mean sodium or sugar content between PL and BL products. In the period 2015-2019, there were no consistent changes in estimated HSR score, sodium or sugar contents of PL or BL products, but there was an increase in the proportion of both PL and BL products displaying HSR labels. In most food categories, there were PL options available which were similar in nutritional composition, more likely to be labelled with the HSR, and lower in cost than their branded counterparts.

Intervention: This study examined whether the impacts of sugar taxes and front-of-pack (FOP) nutrition labels differ across socio-demographic subgroups., Research Question: What are the main and moderating effects of individual-level characteristics on the nutrient content of participants' purchases in response to varying taxation levels and FOP labels?, Methods: Data from an experimental marketplace were analyzed. A sample of 3584 Canadians aged 13 years and older received $5 to purchase an item from a selection of 20 beverages and 20 snack foods. Participants were shown products with one of five FOP labels and completed eight within-subject purchasing tasks with different tax conditions. Linear mixed models were used to estimate the main and moderating effects of 11 individual-level variables on the sugars, sodium, saturated fats, and calorie content of participants' purchases., Results: Participants who were younger, male, and more frequent consumers of sugary drinks purchased products containing more sugars, sodium, saturated fats, and calories. Sex and age moderated the relationship between tax condition and sugars or calories purchased: female participants were more responsive than males to a tax that included fruit juice, and younger participants were more responsive to all sugar tax conditions than older participants. Reported thirst and education level also moderated the relationship between tax condition and calories purchased. No individual-level characteristics moderated the effects of FOP labels., Conclusion: A small proportion (7 of 176) of the moderating effects tested in this study were significant. Sugar taxes and FOP labelling policies may therefore produce similar effects across key socio-demographic groups.

Excessive free-sugar intake has become highly prevalent in numerous countries, and Portugal is not the exception. One product category that contributes to the daily intake of free sugars is breakfast cereals. In the current work, we identified 289 exemplars from two major retailers in Portugal and collected information on their nutritional profile (e.g., sugar, salt, fiber per 100 g), price, packaging features, type of food claims present (e.g., statements about the composition, sensory features, the origin of the product), and ingredients list. Overall, the sugar content of breakfast cereals was high ( Mean = 19.9 g), and less than 10% of the products complied with the current national guidelines (i.e., 5 g of sugar per 100 g of product). Sugar (or other sugar sources) was listed in the top three ingredients for over 85% of the products. On average, each product included about four claims ( Mean = 3.9), and sugar content was lower when the claims were related to the product composition. Critically, the sugar content was particularly high for children-oriented products ( Mean = 26.4 g). Correlation analysis showed that breakfast cereals with higher sugar content also were cheaper and had lower quantities of fiber, proteins, and salt. Our findings suggest the need to implement strategies to reduce sugar in this product category (e.g., incentivize manufacturers to reformulate products). Also, our results may inform strategies aimed at promoting consumers' awareness about the sugar content in breakfast cereals and other processed foods, facilitating healthier decision-making.

Little is known about the healthfulness and cost of gluten-free (GF) foods, relative to non-GF alternatives, in Canada. This study compared the extent of processing, nutritional composition and prices of Canadian products with and without GF claims. Data were sourced from the University of Toronto Food Label Information Program (FLIP) 2013 ( n = 15,285) and 2017 ( n = 17,337) databases. Logistic regression models examined the association of NOVA processing category with GF claims. Calorie/nutrient contents per 100 g (or mL) were compared between GF and non-GF products. Generalized linear models compared adjusted mean prices per 100 g (or mL) of products with and without GF claims. The prevalence of GF claims increased from 7.1% in 2013 to 15.0% in 2017. GF claims appeared on 17.0% of ultra-processed foods, which were more likely to bear GF claims products than less-processed categories. Median calories and sodium were significantly higher in GF products; no significant differences were observed for saturated fat or sugars. Compared to non-GF products, adjusted mean prices of GF products were higher for 10 food categories, lower for six categories and not significantly different for six categories. Overall, GF claims are becoming increasingly prevalent in Canada; however, they are often less healthful and more expensive than non-GF alternatives, disadvantaging consumers following GF diets.

The package label is an important factor to be evaluated, for constituting the first contact of the product with the consumer, which may exert influence on the purchase intention. Thus, this study identified and evaluated the importance of front label attributes of a new functional beverage made from cashew nut added with mango juice on consumers' purchase intention; it also evaluated the influence of consumers' attitudinal issues regarding functional foods on the importance of these attributes to the attitude of buying the beverage. Focus group methodology was used to assess which front label attributes of the product are important in the choosing process. The combination of attributes and their levels was used to develop 18 labels, which were analyzed by consumers in relation to their buying intention. The results were analyzed by conjoint and cluster analysis. The most relevant qualitative information on the purchase intention process of the cashew nut beverage highlighted by the focus groups were the illustration, the nutritional information (0% lactose and 0% cholesterol), and the term "prebiotic" with its functional claim. According to the conjoint analysis, the illustration was the attribute with more influence on the consumers' purchase intention concerning this product, revealing the consumers' preference for the image of the cashew nut standing alone on the label. Nutritional information and the term prebiotic and its functional claim had a positive impact, but were considered of low importance. Regarding the attitudinal factors involving functional foods there was no significant difference among the three groups of consumers.

Background: Fruit drinks are the most commonly consumed sugar-sweetened beverage among young children. Fruit drinks carry many nutrition-related claims on the front of package (FOP). Nutrition-related claims affect individuals' perceptions of the healthfulness of products and purchase intentions, often creating a "health halo" effect., Objective: The aims of this study were to describe the prevalence of FOP nutrition-related claims on fruit drinks purchased by households with young children and to examine the association between claims and the nutritional profile of fruit drinks., Design: The sample included 2059 fruit drinks purchased by households with children 0 to 5 years old participating in Nielsen Homescan in 2017. FOP labels were obtained from 2 databases that contain bar code-level information on all printed material on product labels. A codebook was used to code for presence of FOP nutrition-related claims. The coded claims data were linked by bar code with Nutrition Facts label data. Claim type prevalence was calculated, and the association between claim types and median calories and total grams of sugar per 100 mL was analyzed using Wilcoxon rank-sum tests. The percentages of products containing noncaloric sweeteners (NCSs) with and without each claim type were also calculated and compared., Results: Almost all (97%) fruit drinks sampled had at least 1 nutrition-related FOP claim. Implied natural claims such as "natural flavors" were the most common (55% of products), followed by claims about the presence of juice or nectar (49%). Claims about vitamin C (33%), sugar (29%), and calories (23%) were also common. Fruit drinks with vitamin C, juice or nectar, fruit or fruit flavor, and overt natural claims were higher in calories and sugar and less likely to contain NCSs compared with products without these claims. Fruit drinks with calorie, sugar, NCS, implied natural, and other claims were lower in calories and sugar and more likely to contain NCSs compared with products without these claims., Conclusions: Claims are prevalent on fruit drinks purchased by households with young children. This is concerning given prior research demonstrating that claims can mislead consumers. Regulatory actions such as requiring a warning or disclosure on drinks that contain added sugars or NCSs should be considered., (Copyright © 2021 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

In this work, we examined knowledge about sugars and guidelines for its consumption and explored the relationship between knowledge and measures related to nutritional information processing as well as sugar consumption. Specifically, we asked participants ( n = 1010 Portuguese) to categorize a set of ingredients (e.g., glucose, aspartame) regarding their composition (i.e., intrinsic vs. added/free sugars) and origin (e.g., natural vs. artificial) and if they were aware of the WHO guidelines for sugar intake. Overall, despite using information about sugar frequently and considering attending to such information as very important to stay healthy, most participants were unaware of the WHO guidelines and revealed difficulties in the categorization task. Women, participants with a higher level of education, and those with children in the household reported higher use of sugar content information present in nutritional labels, higher perceived knowledge of nutritional guidelines, and higher hit rates in categorizing sugar sources. Almost one-fourth of the population exceeds the daily limit recommended by the WHO. Therefore, characterizing the knowledge of a Portuguese sample regarding sugar sources and sugar intake guidelines is particularly relevant, and our results emphasize the need to implement effective strategies to reduce sugar intake.

Background: Calorie labeling is mandated in restaurant chains with ≥20 locations nationwide, but the effect of labeling on the nutritional quality of purchased meals in fast-food settings is unclear, especially for adolescents and children., Objective: To estimate the effect of calorie menu labeling on the nutrient content and composition of fast-food meal purchases in McDonald's restaurants vs control restaurants., Design: From 2010 to 2014, customers were sampled during repeated visits to McDonald's restaurants, which voluntarily labeled menus with calorie information in 2012, and 5 control fast-food restaurant chains that had not labeled their menus over the study period., Participants/setting: Restaurant receipts and questionnaires were collected from 2883 adults, 2131 adolescents, and 433 children in 4 New England cities., Main Outcome Measures: Saturated fat, sugar, sodium, and fiber content of purchased meals, as well as nutrient densities (ie, nutrient content adjusted for total calories), were calculated after linking purchases to nutrition data from restaurant websites., Statistical Analyses: Difference-in-differences analyses and linear mixed models were used to examine whether calorie labeling in McDonald's was associated with changes in nutrient content and nutrient density of purchased meals separately in adults, adolescents, and children., Results: After implementation of calorie labeling at McDonald's, adult meals contained on average 4.0% fewer calories from sugar (95% confidence interval: -7.5 to -0.5), but 1.8% more calories from saturated fat (95% confidence interval: 0.7 to 2.9) compared with control chains. The fiber content of children's purchased meals was lower at McDonald's after calorie labeling (change = -1.4 g, 95% confidence interval: -2.5 to -0.3). Calorie labeling was not associated with changes in nutrient quality of adolescent meals., Conclusions: Calorie labeling at McDonald's was associated with a possibly small positive change in the nutritional quality of meals in adults but not in adolescents or children. Efforts are needed to improve the nutritional quality of restaurant meals., (Copyright © 2020 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Vietnam is experiencing a diet and nutrition transition. Increasing consumption of food and beverages with added sugars is a significant public health concern. Policies and interventions, such as mandatory nutrition labelling, are being considered to improve consumers' awareness and understanding of diet and health implications of added sugars in food and beverages. The effectiveness of various policy approaches relies on an improved understanding of the interrelationships between urban Vietnamese consumers' health concerns, nutrition label use, and intake of sugars. We empirically disentangle these relationships for urban Vietnamese households using novel intra-household data covering 4047 adults and 737 adolescents from 1590 households in Hanoi and Ho Chi Minh City. The data are from comprehensive household surveys and 24-hour food diaries. Simultaneous equation regression models are estimated using three-stage least squares (3SLS) to account for possible endogeneity. Nutrition label use is significantly associated with a lower share of calories from foods and beverages with added sugars. These findings suggest that nutrition labelling programs may be an effective policy mechanism to reduce the negative health implications of increasing availability and consumption of food and beverages with added sugars in urban Vietnam.

This study evaluated orders of adult menu items designated as healthier at the Silver Diner, a regional full-service restaurant chain serving over 4 million customers annually. This restaurant implemented a healthier children's menu in April 2012. Orders of adult menu items were abstracted from before (September 2011-March 2012; PRE; n = 1,801,647) and after (September 2012-March 2013; POST; n = 1,793,582) the healthier children's menu was introduced. Entrées, appetizers, and sides listed as healthier options on the menu were coded as healthier. PRE to POST changes in the percentage of orders of healthier items, soda, and dessert were evaluated using McNemar tests of paired proportions. Orders of healthier entrées, appetizers, and sides on the adult menu increased PRE to POST (8.9% to 10.4%, 25.5% to 27.5%, and 7.3% to 9.3%, respectively), and soda and dessert orders decreased (23.2% to 21.7% and 29.0% to 28.3%, respectively). All shifts were statistically significant ( p < 0.0001). Our findings demonstrate improvements in orders of healthier adult menu options during the same time frame as a healthy children's menu change. Future research can help elucidate mechanisms to inform future health promotion efforts in restaurants in ways that have the potential to impact both adults and children.

Nutrition and health claims should be truthful and not misleading. We aimed to determine the use of nutrition and health claims in packaged foods sold in Mongolia and examine their credibility. A cross-sectional study examined the label information of 1723 products sold in marketplaces in Ulaanbaatar, Mongolia. The claim data were analysed descriptively. In the absence of national regulations, the credibility of the nutrition claims was examined by using the Codex Alimentarius guidelines, while the credibility of the health claims was assessed by using the European Union (EU) Regulations (EC) No 1924/2006. Nutritional quality of products bearing claims was determined by nutrient profiling. Approximately 10% ( n = 175) of products carried at least one health claim and 9% ( n = 149) carried nutrition claims. The credibility of nutrition and health claims was very low. One-third of nutrition claims (33.7%, n = 97) were deemed credible, by having complete and accurate information on the content of the claimed nutrient/s. Only a few claims would be permitted in the EU countries by complying with the EU regulations. Approximately half of the products with nutrition claims and 40% of products with health claims were classified as less healthy products. The majority of nutrition and health claims on food products sold in Mongolia were judged as non-credible, and many of these claims were on unhealthy products. Rigorous and clear regulations are needed to prevent negative impacts of claims on food choices and consumption, and nutrition transition in Mongolia.

Background: To reduce diet-related chronic disease, policymakers have proposed requiring health warnings on sugar-sweetened beverages (SSBs). Health warnings reduced purchases of these products by 22% in our recent randomized controlled trial, but the mechanisms remain unclear., Purpose: We sought to identify the psychological mechanisms that explain why SSB health warnings affect purchase behavior., Methods: In 2018, we recruited 400 adult SSB consumers to complete a shopping task in a naturalistic convenience store laboratory in North Carolina, USA. We randomly assigned participants to either a health warning arm (all SSBs in the store displayed a text health warning) or to a control arm (SSBs displayed a control label). Participants selected items to purchase with cash., Results: Compared to control labels, health warnings elicited more attention, negative affect, anticipated social interactions, and thinking about harms (range of ds = 0.63-1.34; all p < .001). Health warnings also led to higher injunctive norms about limiting SSB consumption (d = 0.27, p = .008). Except for attention, all of these constructs mediated the effect of health warnings on SSB purchases (all p < .05). In contrast, health warnings did not influence other attitudes or beliefs about SSBs or SSB consumption (e.g., healthfulness, outcome expectations, and response efficacy)., Conclusions: Health warnings on sugar-sweetened beverages affected purchase behavior by eliciting negative emotions, increasing anticipated social interactions, keeping SSBs' harms at top of mind, and shifting norms about beverage consumption. Results are consistent with recent studies of why tobacco warnings influence quitting behavior, pointing toward a general framework for understanding how health warnings affect behavior., Clinical Trials Registration: NCT #03511937., (© Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The paper aims to identify selected predictors of food label use to extend our knowledge about consumer behavior related to food purchases. Two types of information were examined: front-of-package (FOP) and back-of-package (BOP), and two contexts of reading labels were distinguished: during shopping and at home. Various types of potential predictors were tested, including demographic (e.g., age, gender, household size, place of living), socioeconomic (e.g., education, professional activity, income), behavioral (e.g., purchasing certain types of products), and psychographic (e.g., importance attached to various types of information) criteria. The survey was conducted with the use of the CAWI (Computer-Assisted Web Interviews) methodology in a sample of 1051 Polish consumers. Quota sampling was applied based on sex, age, education, place of living (urban vs. rural), and region. Descriptive statistics, t -tests, ANOVAs, Pearson correlation coefficients, and multiple and retrograde step regressions were applied. In retrograde step regression models, only one predictor (self-rated knowledge about nutrition healthiness) turned out to be significant for all four measures of label reading. The remaining predictors were specific to selected measures of reading labels. The importance of the information about the content of fat and that about the health effects of consuming a food product were significant predictors of three types of food label use. This study confirms the necessity to investigate reading labels in fine-grained models, adapted to different types of labels and different contexts of reading. Our results show that demographic or socioeconomic variables are not significant predictors of reading food labels for a large group of Polish consumers.

School environments are an optimal setting to promote healthy student diets, yet it is unclear what role state and district policies play in shaping school contexts. This study examined how state and district policies are associated with school-reported practices for promoting student participation in school lunch programs. School nutrition manager data were obtained from the School Nutrition and Meal Cost Study's (SNMCS) sample of 1210 schools in 46 states and the District of Columbia (DC) during school year 2014-2015. Relevant state laws and district policies were compiled and coded. Multivariable logistic and Poisson regressions, controlling for school characteristics, examined the relationship between state/district laws/policies and school practices. Compared to schools in districts or states with no policies/laws, respectively, schools were more likely to provide nutritional information on school meals (AOR = 2.59, 95% CI = 1.33, 5.05) in districts with strong policies, and to promote school meals at school events (AOR = 1.93, CI = 1.07, 3.46) in states with strong laws. Schools in states with any laws related to strategies to increase participation in school meals were more likely to seek student involvement in menu planning (AOR = 2.02, CI = 1.24, 3.31) and vegetable offerings (AOR = 2.00, CI = 1.23, 3.24). The findings support the association of laws/policies with school practices.

Background: Canada's food supply is abundant in less healthy products, increasing Canadians' risk of obesity and non-communicable diseases. Food companies strongly influence the food supply; however, no studies have examined differences in the healthfulness of products offered by various companies in Canada. This study aimed to compare the nutritional quality of products offered by the top packaged food and beverage companies in Canada., Methods: Twenty-two top packaged food and beverage manufacturing companies were selected, representing > 50% of the Canadian market share in 2018. Nutritional information for products (n = 8277) was sourced from the University of Toronto Food Label Information Program 2017 database. Descriptive analyses examined the nutritional quality of products based on: 1) the Health Star Rating (HSR) system; 2) calories, sodium, saturated fat and total sugars per 100 g (or mL) and per reference amounts (RAs) defined by Health Canada; and 3) "high in" thresholds for sodium, saturated fat and total sugars proposed by Health Canada for pending front-of-package labelling regulations. Kruskal-Wallis tests compared HSRs of products between companies., Results: Mean HSRs of companies' total product offerings ranged from 1.9 to 3.6 (out of 5.0). Differences in HSRs of products between companies were significant overall and for 19 of 22 food categories (P < 0.05), particularly for fats/oils and beverages. Calories, sodium, saturated fat and total sugars contents varied widely between companies for several food categories, and depending on whether they were examined per 100 g (or mL) or RA. Additionally, 66.4% of all products exceeded ≥1 of Health Canada's "high in" thresholds for sodium (31.7%), saturated fat (28.3%) and/or sugars (28.4%). The proportion of products offered by a company that exceeded at least one of these thresholds ranged from 38.5 to 97.5%., Conclusions: The nutritional quality of products offered by leading packaged food and beverage manufacturers in Canada differs significantly overall and by food category, with many products considered less healthy according to multiple nutrient profiling methods. Variation within food categories illustrates the need and potential for companies to improve the healthfulness of their products. Identifying companies that offer less healthy products compared with others in Canada may help prompt reformulation.

Background: Non-communicable diseases, such as obesity, diabetes, and hypertension, can be prevented and treated through a balanced nutrient-rich diet. Nutrition labels have been recognized as crucial to preventing obesity and non-communicable diseases through a healthier diet., Objective: Our aim was to examine the association between nutrition label use and chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension) among an adult Mexican population., Design: This was a cross-sectional study that used data from the Mexican National Health and Nutrition Survey of 2016 (ENSANUT MC 2016)., Participants/setting: The participants were 5,013 adults aged 20 to 70 years old. Older adults (>70 years), illiterate participants, pregnant women, and participants with implausible blood pressure data were excluded from the sample. The survey was conducted from May to August 2016 in the participants' households., Main Outcome Measures: We measured chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension)., Statistical Analyses Performed: Pearson χ 2 test was used to examine the associations among the use of nutrition labels and sociodemographic characteristics and chronic conditions. Multiple logistic regression was used to determine the association between nutrition label use and chronic conditions adjusting for the effect of confounding variables like sex, age, body mass index, education level, marital status, ethnicity, residence area, region, and socioeconomic status., Results: From the total sample, 40.9% (95% CI 38.4% to 43.8%) reported using nutrition labeling. Respondents with overweight or obesity were less likely to use nutrition labels (odds ratio 0.74; P<0.05). Participants who self-reported diabetes had significantly lower odds of nutrition label use than participants who did not report to have diabetes (odds ratio 0.66; P<0.05). Participants having 3 chronic conditions had lower odds of nutrition label use (odds ratio 0.34; P<0.01) relative to having zero chronic conditions., Conclusions: This study suggests an association between nutrition label use and chronic conditions (obesity and diabetes). These findings demonstrate that people with obesity, diabetes, and a combination of chronic conditions were less likely to use nutrition labels than people without these conditions., (Copyright © 2020 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the associations among eating behaviour traits, food label use and diet quality and to evaluate if the association between eating behaviour traits and diet quality is mediated by food label use., Design: Eating behaviour traits were assessed using the Three-Factor Eating Questionnaire (TFEQ), the Restraint Scale and the Intuitive Eating Scale, whereas food label use was measured with the Label Reading Survey. Diet quality (Canadian Healthy Eating Index) was assessed with an FFQ., Setting: Cross-sectional study., Participants: Adults (n 385; mean (sd): BMI = 26·0 (4·9) kg/m2, age = 41·1 (15·0) years) involved in two previous experimental studies., Results: When controlling for potential covariates, general food label use (β = 1·18 (se 0·26), P < 0·0001) was the main determinant of diet quality, explaining 6·7 % of its variance. General food label use partly mediated the association between TFEQ-cognitive restraint and diet quality; the indirect effect (βindirect (se); 95 % CI) was stronger in men (0·32 (0·10); 0·15, 0·55) than women (0·16 (0·05); 0·08, 0·27). General food label use also partly mediated the negative association between unconditional permission to eat and diet quality; the indirect effect (βindirect (se); 95 % CI) was also stronger in men (-1·88 (0·55); -3·11, -0·96) than women (-1·03 (0·33); -1·81, -0·49)., Conclusions: General food label use was the main determinant of diet quality and partly mediated the association between eating behaviour traits and diet quality. The stronger mediating effect observed in men suggests they rely more on food labelling when attempting to restrained themselves, which translates into better diet quality.

Introduction: Large chain restaurants reduced calories in their newly-introduced menu items from 2012 to 2015. The objective of this study was to provide updated calorie trends through 2018 and examine trends in the macronutrient composition of menu items across this time period., Methods and Findings: Data were obtained from the MenuStat project and include 66 of the 100 largest revenue generating U.S. chain restaurants (N = 28,238 items) that had data available in all years from 2012 to 2018. Generalized linear models were used to examine per-item calorie and nutrient changes (saturated fat, trans fat, unsaturated fat, sugar, non-sugar carbohydrates, protein, sodium) among (1) items on the menu in all years (common items) and (2) newly introduced items (2013-2018). Overall, there were no significant changes in calories or nutrients among common items from 2012 to 2018. Among all newly introduced items, calories (-120 kcals, -25%, p = 0.01; p-for-trend = 0.02), saturated fat (-3.4g, -41%, p<0.01, p-for-trend = 0.06), unsaturated fat (-4.5g, -37%, p = 0.02; p-for-trend = 0.04), non-sugar carbohydrates (-10.3g, -40%, p = 0.02, p-for-trend = 0.69), and protein (-4.3g, -25%, p = 0.04, p-for-trend = 0.02) declined., Conclusion: Newly introduced menu items in large chain restaurants have continued to decline in calories through 2018, which may help to reduce calorie intake. Other changes in macronutrient content were sporadic and not clearly toward improved dietary quality., Competing Interests: Caroline Dunn owns stock over a value of $5,000 in Beyond Meat, Inc. The other authors have declared that no competing interests exist. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Food consumed outside of the home is often high in energy and population level interventions that reduce energy intake of people from both lower and higher socioeconomic position (SEP) are needed. There is a lack of evidence on the effectiveness and SEP equity of structural-based (e.g. increasing availability of lower energy options) and information provision (e.g. menu energy labelling) interventions on food choice., Methods: Across two online experiments, participants of lower and higher SEP made meal choices in a novel virtual fast-food restaurant. To be eligible to take part, participants were required to be UK residents, aged 18 or above, fluent in English, have access to a computer with an internet connection and have no dietary restrictions. Participants were randomized to one of four conditions in a 2 × 2 between-subjects design: menu energy labelling present vs. absent and increased availability of lower energy options (75% of menu options lower energy) vs. baseline availability (25% of menu options lower energy). Participants also completed measures of executive function and food choice motives., Results: The analysis of pooled data from both studies (n = 1743) showed that increasing the availability of lower energy options resulted in participants ordering meals with significantly less energy on average (- 71 kcal, p <  0.001, partial η 2  = 0.024) and this effect was observed irrespective of participant SEP. Menu labelling had no significant effect on energy ordered (- 18 kcal, p = 0.116, partial η 2  = 0.001) in participants from both higher and lower SEP. Furthermore, we found no evidence that executive function or food choice motives moderated the effect of increasing lower energy menu options or energy labelling on total energy ordered., Conclusions: In a virtual fast-food environment, energy labelling was ineffective in reducing total energy ordered for both higher and lower SEP participants. Increasing the availability of lower energy options had an equitable effect, reducing total energy ordered in participants from higher and lower SEP., Trial Registration: Study protocols and analysis plans were pre-registered on the Open Science Framework (https://osf.io/ajcr6/).

Nutrition labeling encompasses nutrient declaration, supplemental nutrient information such as interpretative nutrition information on the principal display panel or front-of-pack labeling, and nutrition-related claims used to promote the nutritional properties of packaged foods. These types of labeling are inter-related. In many countries, nutrient declaration is mandatory for most packaged foods and used to inform consumers at the point of purchase to help them make more informed food choices. Supplemental nutrition information on the principal display panel is designed to assist consumers in the interpretation of nutrition information. The use of nutrition-related claims should be regulated to have consistency in what is allowed and avoid claims from being false or misleading. Nutrition labeling should be based on public health priorities and be designed to enable consumers to compare products and judge if a product is high or low in a declared nutrient in the context of the daily diet. Supplemental nutrition labeling can have various purposes and research is needed to validate that it is effective for the intended purpose with the target audience. The presence of standardized nutrition labeling on packaged foods enables the development of education strategies for consumer use of the information. Education is a key component for labeling strategies to be effective., (© 2020 S. Karger AG, Basel.)

It is of great value to study consumer demand for safe foods in promoting the development of a safe food market system and the reduction of food safety risks, as well as foodborne diseases in China. This paper takes traceable pork as an example and constructs food safety information attributes with ex ante quality verification and ex post traceability. Interactions between safety information attributes and the consumer's response to cost-driven price changes were investigated for 345 consumers in Wuxi City, Jiangsu Province, China, using a menu-based choice (MBC) experiment and multivariate probit (MVP) model as analysis tools. The results suggest that food safety information attributes are important to consumers, as the consumers preferred pork quality inspection attributes to pre-incident quality assurance functions. Therefore, it is beneficial to include pork quality inspection attributes in the traceable pork attribute systems during the initial construction of traceable pork markets in China. Attribute price was an important factor that affected consumers' choice of information attributes. When customization cannot be achieved, a profile composed of elastic pork quality inspection attribute and supply chain-internal traceability attribute would be the most preferred traceable pork product in the market based on the need of building a fully functional traceable food system and reducing food safety risks. In addition, there was a strong substitution relationship between different information attributes, and there was heterogeneity in consumers' choice of information attributes. Therefore, the government should support manufacturers in producing multi-level safe food to meet diverse consumer demand., Competing Interests: The authors declare no conflicts of interest.

Regular breakfast consumption has the potential to prevent the prevalence of NCDs and to improve the nutritional profile of diets. Given consumers' interest in improving their diets, food suppliers are interested in introducing new cereal products making different health claims to capture consumers' attention. The purpose of this study is threefold: first, it aims to understand whether UK food suppliers are working to increase the availability of breakfast cereals with healthy and nutritious attributes; second, it explores which companies are leading the launch of these products; and third, it assesses to what extent health and nutrition claims made by breakfast cereals have an impact on their market success. The study employs an assembled database combining data from Mintel Global New Products Database (GNPD) and Kantar Worldpanel Dataset (KWDS) for the UK. A hazard-based duration model was used to analyse the success of the new products launched in the UK market in 2011 following them up to 2015. Our results reveal that UK suppliers broadened the number of breakfast cereals on offer in the period 2000 to 2018, with a particular focus on multigrain cereals, porridge and granola. Health and nutrition claims were added to 27% of these products. Although consumers welcome healthy alternatives such as muesli, the impact of positional claims on the success of newly developed breakfast cereals is claim-specific. No clear pattern regarding the impact of health and nutrition claims is identified. However, other elements such as celiac-friendly ingredients and UK origin do have a positive impact on the success of breakfast cereals.

We assessed the prevalence of front-of-package (FoP) claims in the Brazilian packaged food supply and examined whether foods with claims were more likely to be high in critical nutrients. Using data from a random 30% subsample of 11,434 foods and beverages collected in the five largest food retailers in Brazil in 2017 ( n = 3491), we classified claims into nutrition, health, and environment. We examined whether foods with claims were more likely to be high in critical nutrients using 95% confidence intervals. Claims were found in 41.2% of the products. Nutrition claims were the most prevalent (28.5%), followed by health (22.1%), and environment-related claims (5.2%). More than 85% of the breakfast cereals, granola bars, and nectars contained claims, which were found in 51% of the dairy beverages. Foods with nutrition claims were more likely to be high in critical nutrients (65.3%; 95% CI 62.3, 68.2% vs. 54.1% 95% CI 52.1, 56.0). Products with health (52.9%; 95% CI 49.3, 56.4% vs. 58.5%; 95% CI 56.6, 60.3) and environment-related claims (33.5%; 95% CI 27.0, 40.8% vs. 58.6%; 95% CI 56.9, 60.2%) were less likely to be high in critical nutrients. FoP claims are prevalent in Brazil, and nutrition claims are more likely to have a poorer nutritional profile. Policymakers should consider restricting the presence of claims on unhealthy products.

Point-of-sale nutrition information has been adopted by numerous grocery stores to respond to the demand for easy-to-understand nutrition labeling by consumers. Although there is conflicting evidence regarding the effectiveness of providing nutrition information, previous research indicates simplified shelf nutrition labels may lead to healthier choices. However, these studies have not examined how different consumer segments respond to these labels, nor the differential impacts across foods. Using household purchase data from a store that voluntarily adopted the (now defunct) NuVal shelf nutrition labels (a 1-100 numeric score derived from a nutrition-profiling algorithm), we assess NuVal impacts across different consumers and foods. NuVal scores potentially influence not only purchase quantity but also likelihood of buying. Thus, the effect of NuVal was measured by estimating a two-part model and predicting consumers' unconditional purchase responses. We found evidence of heterogeneous impacts of NuVal across consumers and foods. High-income households and households with children shifted their yogurt and frozen dinner purchases to more healthful items. In contrast, households with children and households headed by heads with college education slightly shifted their canned soup purchases to less healthful options. Our findings suggest that specific foods and consumer segments are influenced by simplified shelf nutrition information and further research is necessary to better understand its effect on consumer dietary quality., (Copyright © 2019 Elsevier B.V. All rights reserved.)

As a result of increased consumer awareness, demand for healthier food products is increasing day by day. Consumers seek healthier versions of food products which they relate to reduced presence of unhealthy components or increased presence of healthy ones. As a result, the food industry has not only increased the variety of products available but also uses nutritional claims to signal the presence of more substances. As an average consumer at the supermarket devotes just a few seconds to selecting each product, they are only able or willing to process that information that immediately attracts their attention or that is felt to be more important to them. This paper analyses how consumers rank different nutritional claims for two processed cereal products. Five claims were chosen to reflect the current market landscape of availability, and that relates to both "healthy" (i.e., fiber) and "unhealthy" (i.e., fat) substances. We use a direct ranking preference method with data from a survey conducted with consumers in a Spanish region in 2017. Results show that the ranking of claims differs between the two products (biscuits and pastries) and across consumers. However, consumers prefer those that show reduced presence of unhealthy substances above those that highlight the presence of healthy ones. Therefore, policy to maximize the impact of nutritional labelling should be product-specific., Competing Interests: The authors declare no conflict of interest.

Background: A significant proportion of the Canadian diet comes from foods purchased in restaurant settings. In an effort to promote healthy eating, the province of British Columbia (BC) implemented the Informed Dining Program (IDP), a voluntary, industry supported information program in 2012, while the province of Ontario implemented mandatory calorie labelling on menus in 2017. The study examined differences in awareness and the self-reported influence of nutrition information on food choices in restaurants with voluntary nutrition information, calorie labelling on menus, and no nutrition information program., Methods: Exit surveys were conducted outside of nine chain restaurants in Toronto, Ontario and Vancouver, British Columbia (Canada) in 2012, 2015, and 2017 with varying nutrition information programs implemented. Logistic regression analyses compared self-reported noticing and influence of nutrition information in restaurants with: 1) the IDP which provided nutrition information upon request, 2) calorie labelling on menus, and 3) control restaurants with no specific nutrition information program in place, adjusted for year, city and socio-demographic characteristics. Awareness and knowledge of the IDP were also examined., Results: There were no significant differences in noticing and self-reported influence of nutrition information on food choices between restaurants with the IDP and restaurants with no program. Participants were more likely to notice nutrition information in restaurants when calorie information was provided on menus (57%) compared to in restaurants with the IDP (22%, AOR = 6.20, 95%CI 3.51-10.94, p < 0.001) or restaurants with no nutrition information program (20%, AOR = 7.44, 95%CI 4.21-13.13, p < 0.001). Participants in restaurants with menu labelling were also more likely to report that nutrition information influenced their food purchase (38%) compared to restaurants with the IDP (12%, AOR = 4.43, 95%CI 2.36-8.30, p < 0.001) and restaurants with no nutrition information program (12%, AOR = 5.29, 95%CI 2.81-9.95, p < 0.001). Fewer than 1 in 5 participants who visited an IDP restaurant had heard of the IDP across all data collection years in both cities., Conclusions: There was no evidence that voluntary programs which provide nutrition information upon request were effective. Providing calorie information on menus increased the likelihood that consumers noticed and that their food choices were influenced by nutrition information in restaurant settings.

Ultra-processed, pre-packaged foods are becoming a growing part of our diet, while displacing whole and minimally processed foods. This results in an increased intake of free sugar, salt, and saturated fats, that have a profoundly negative effect on health. We aimed to assess the trend in free sugar content in pre-packaged foods in Slovenia and evaluate the efficacy of industry self-regulations designed to combat the excess consumption of free sugar. A nation-wide data collection of the Slovenian food supply was performed in 2015 and repeated in 2017. In 2017, 54.5% of all products ( n = 21,115) contained free sugars (median: 0.26 g free sugar/100 g). Soft drinks became the main free sugar source among pre-packaged goods (28% of all free sugar sold on the market) in place of chocolates and sweets, of which relative share decreased by 4.4%. In the categories with the highest free sugar share, market-leading brands were often sweeter than the average free sugar value of the category. This indicates that changes in on-shelf availability towards a greater number of healthier, less sweet products are not necessarily reflected in healthier consumers' choices. Relying solely on voluntary industrial commitments to reduce free sugar consumption will likely not be sufficient to considerably improve public health. While some further improvements might be expected over the longer term, voluntarily commitments are more successful in increasing the availability of healthier alternatives, rather than improving the nutritional composition of the market-leading products. Additional activities are, therefore, needed to stimulate reformulation of the existing market-leading foods and drinks, and to stimulate the consumption of healthier alternatives.

Background: Poor diet is a leading driver of obesity and morbidity. One possible contributor is increased consumption of foods from out of home establishments, which tend to be high in energy density and portion size. A number of out of home establishments voluntarily provide consumers with nutritional information through menu labelling. The aim of this study was to determine whether there are differences in the energy and nutritional content of menu items served by popular UK restaurants with versus without voluntary menu labelling., Methods and Findings: We identified the 100 most popular UK restaurant chains by sales and searched their websites for energy and nutritional information on items served in March-April 2018. We established whether or not restaurants provided voluntary menu labelling by telephoning head offices, visiting outlets and sourcing up-to-date copies of menus. We used linear regression to compare the energy content of menu items served by restaurants with versus without menu labelling, adjusting for clustering at the restaurant level. Of 100 restaurants, 42 provided some form of energy and nutritional information online. Of these, 13 (31%) voluntarily provided menu labelling. A total of 10,782 menu items were identified, of which total energy and nutritional information was available for 9605 (89%). Items from restaurants with menu labelling had 45% less fat (beta coefficient 0.55; 95% CI 0.32 to 0.96) and 60% less salt (beta coefficient 0.40; 95% CI 0.18 to 0.92). The data were cross-sectional, so the direction of causation could not be determined., Conclusion: Menu labelling is associated with serving items with less fat and salt in popular UK chain restaurants. Mandatory menu labelling may encourage reformulation of items served by restaurants. This could lead to public health benefits., Competing Interests: The authors have declared that no competing interests exist.

For those diagnosed with cancer, lifestyle factors including diet can be more important than ever. However, lack of nutrition-related knowledge can pose a significant barrier to healthy eating. Food labels guide consumers in selecting appropriate portion sizes-that is, caloric content-and ensuring adequate intake of nutrients. Data from the 2013-2014 HINTS were used to examine (a) differences in food label use and food label literacy between respondents ever had a cancer diagnosis and those never had a diagnosis; (b) sociodemographic correlates and health-related correlates of food label use and literacy, in a context of cancer diagnosis; and (c) potential association between food label use/literacy and each of two dietary choices, eating vegetables and fruits and limiting intake of sugary drinks, again, in a context of cancer diagnosis. Data was analyzed via SPSS version 24.0, and cross tabulations using Pearson's Chi-square test and logistic regressions. Income, gender and non-participation in support groups were associated with food label literacy (p<.05). Confidence to take care of self was associated with food label use (p<.05). Relationships were observed between using food labels and curtailing soda intake (b = -.368, p<.05), eating relatively more fruits (b = .558, p<.05), and eating relatively more vegetables (b = .558, p<.05). The overall models predicting consumption of soda [x2 (2) = 13.70, p = .001, Nagelkerke R-square = .059], of fruits [x2 (2) = 33.87, p < .001, Nagelkerke R-square = .136], and of vegetables [x2 (2) = 36.08, p < .001, Nagelkerke R-square = .144] was statistically significant. Implications for research and practice can be found in results linking food label use to better quality diets. They include the usefulness of nutrition education interventions targeting lower-income men with cancer diagnoses; one lesson should be the use of food labels.

In May 2016, labeling of certain nonintact mechanically tenderized beef (MTB) products was mandated in the United States. MTB products should be handled differently by the consumer because pathogens can be transferred from the exterior to the interior of the meat during the tenderization process. Without labeling, it is difficult to visually distinguish between some intact beef and MTB products, which is a concern because MTB products require higher internal cooking temperatures for safety. An exploratory study was conducted to understand consumer understanding of MTB products and consumer responses to the new label. Thirteen focus groups were convened in rural and urban settings across Virginia and North Carolina between December 2015 and May 2016. Sessions were audiorecorded, transcribed verbatim, and analyzed through constant-comparison thematic analysis. Although MTB products were commonly bought, prepared, and consumed, consumer awareness of MTB products and the MTB process was limited. Generally, the label confused participants, and they did not understand the message. Specifically, terminology such as "blade tenderized" and "mechanically tenderized" were preferred over the term "needle tenderized" on labels. Once explained, many individuals wanted more information and better messaging. Through a multiprong approach, other messaging methods (e.g., in stores, through technology, and with certifications) were highly valued by consumers and may result in increased message clarity. Ultimately, the intrinsic and extrinsic properties of the beef rather than the MTB product continued to be the primary guide for purchasing and preparation. This study is the first to be conducted regarding American perceptions of MTB products. An understanding of consumer awareness of MTB products and labels is needed to develop targeted risk messaging communication tools.

Bean consumption can reduce chronic disease risk and improve diet quality; however, bean consumption among North Americans is low. Since health claims and other information sources could increase bean consumption, their exploration is warranted, particularly among older adults, a population well positioned to benefit. The purpose of this study was to explore bean consumption among older adults (≥65 years old) in relation to health claims and other information sources. A mixed-methods explanatory sequential study design utilizing a between strategy data collection approach was used. Community-dwelling older adults (n = 250; 76.0% female) completed a validated researcher-administered questionnaire to explore bean consumption, awareness and reading of health claims, the likelihood of health claims influencing bean consumption, and current and preferred sources of nutrition and/or health information regarding beans. The questionnaire was followed up with 10 semi-structured focus groups (n = 46; 76.1% female). Awareness of nutrient content, nutrient function, therapeutic and disease risk reduction claims was reported by 94.4%, 64.0%, 79.6% and 77.2% of participants, respectively. Among those aware, these health claims were read by 91.5%, 85.6%, 87.9% and 88.6% of participants, respectively. The prevalence of bean consumption was 51.2% and participants (46.8%) most frequently indicated that all health claims would equally increase their likelihood of bean consumption. Participants (72.0%) reported that they would like more information about the nutrition and/or health properties of beans, with their most common preferred sources including food labels (54.8%), brochures (51.2%) and the internet (47.2%). This research advances the literature on how health claims relate to eating behaviour and can inform regulatory and food industry scientists about consumer perception to bean health claims, and healthcare professionals about preferred information sources for their clients., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: The nutrient profile of combination meals in large chain restaurants is not well understood., Methods: Combination meals from 34 U.S. fast food and fast casual restaurants (lunch/dinner, n=1,113; breakfast, n=366) were identified from online menus in 2017-2018 and corresponding nutrition information for each menu item was obtained from a restaurant nutrition database (MenuStat). Three options for each combination meal were analyzed: (1) default (as advertised on menu), (2) minimum (low-calorie option), and (3) maximum (high-calorie option). In 2018, meal nutrient composition was compared with the Healthier Restaurant Meal Guidelines, and linear models examined to what extent each meal component (entrée, side, beverage) drove differences in nutrients across meal options., Results: There was substantial variation across the default, minimum, and maximum options of lunch/dinner combination meals for calories (default,: 1,193 kilocalories;, minimum,: 767 kilocalories;, maximum,: 1,685 kilocalories), saturated fat (14 g, 11 g, 19 g), sodium (2,110 mg, 1,783 mg, 2,823 mg), and sugar (68 g, 10 g, 117 g). Most default meals exceeded the Healthier Restaurant Meal Guidelines for calories (97%) and sodium (99%); fewer exceeded the standards for saturated fat (50%) and total sugar (6%). Comparing the maximum and default lunch/dinner combination meals, beverages were the largest driver of differences in calories (178 kilocalories, 36% of difference) and sugar (46 g, 93% of difference), and entrées were the largest driver of differences in saturated fat (3 g, 59% of difference) and sodium (371 g, 52% of difference). Results were similar for breakfast meals., Conclusions: Combination meals offered by large U.S. chain restaurants are high in calories, sodium, saturated fat, and sugar, with most default meals exceeding recommended limits for calories and sodium., (Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The consumption of non-carbonated sugar-sweetened beverages (NCSSBs) has many adverse health effects. However, the sugar and energy content in NCSSBs sold in China remain unknown. We aimed to investigate the sugar and energy content of NCSSBs in China and how these contents were labelled., Methods: A cross-sectional survey was conducted in 15 supermarkets in Haidian District, Beijing from July to October 2017. The product packaging and nutrient information panels of NCSSBs were recorded to obtain type of products (local/imported), serving size, nutrient contents of carbohydrate, sugar and energy. For those NCSSBs without sugar content information, we used carbohydrate content as a replacement., Results: A total of 463 NCSSBs met the inclusion criteria and were included in our analysis. The median of sugar content and energy content was 9.6 [interquartile range (IQR): 7.1-11.3] g/100 ml and 176 (IQR: 121-201) kJ/100 ml. The median of sugar contents in juice drinks, tea-based beverages, sports drinks and energy drinks were 10.4, 8.5, 5.0 and 7.4 g/100 ml. Imported products had higher sugar and energy content than local products. There were 95.2% products of NCSSBs receiving a 'red'(high) label for sugars per portion according to the UK criteria, and 81.6% products exceeding the daily free sugar intake recommendation from the World Health Organization (25 g). There were 82 (17.7%) products with sugar content on the nutrition labels and 60.2% of them were imported products., Conclusions: NCSSBs had high sugar and energy content, and few of them provided sugar content information on their nutrition labels especially in local products. Measures including developing better regulation of labelling, reducing sugar content and restricting the serving size are needed for reducing sugar intakes in China.

This review aims to summarize and synthesize studies reporting on changes in sodium levels in packaged food products, restaurant foods, and hospital or school meals, as a result of salt reduction interventions. Studies were extracted from those published in the Science of Salt Weekly between June 2013 and February 2018. Twenty-four studies were identified: 17 assessed the changes in packaged foods, four in restaurant foods, two in hospital or school meals, and one in both packaged and restaurant foods. Three types of interventions were evaluated as part of the studies: voluntary reductions (including targets), labeling, and interventions in institutional settings. Decreases in sodium were observed in all studies (n = 8) that included the same packaged foods matched at two time points, and in the studies carried out in hospitals and schools. However, there was little to no change in mean sodium levels in restaurant foods. The pooled analysis of change in sodium levels in packaged foods showed a decrease in sodium in unmatched food products (-36 mg/100 g, 95% CI -51 to -20 mg/100 g) and in five food categories-breakfast cereals, breads, processed meats, crisps and snacks, and soups. Twenty-two of the 24 studies were from high-income countries, limiting the applicability of the findings to lower resource settings., (©2019 Wiley Periodicals, Inc.)

Background: Front-of-Package nutrition labels (FoPLs) are intended to help reduce the incidence of nutrition-related non-communicable diseases through an improvement in diet quality. FoPLs have been shown to improve the nutritional quality of purchases and have been associated with improved diet quality, which is in turn associated with reduced risk of non-communicable diseases. However, the potential impact of FoPLs on reducing mortality from chronic diseases has never been estimated., Methods: Data from a laboratory experimental economics test were used to investigate the effects of five different FoPLs (Nutri-Score, Health Star Rating system, Multiple Traffic lights, Reference intakes and SENS (Système d'Etiquetage Nutritionnel Simplifié)) on the nutritional quality of household purchases. The relative differences in nutrient content and composition of food purchases were then applied to dietary intakes using data from an observational study, thus yielding estimates for 'reference' and 'labelled' diets. A macro-simulation study using the PRIME model was then conducted to estimate the impact of the modification in dietary intake as a result of FoPL use on mortality from diet-related non-communicable diseases., Results: The use of FoPLs led to a substantial reduction in mortality from chronic diseases. Approximately 3.4% of all deaths from diet-related non-communicable diseases was estimated to be avoidable when the Nutri-Score FoPL was used. The remaining FoPLs likewise resulted in mortality reduction, although to a lesser extent: Health Star Rating system (2.8%), Reference Intakes (1.9%), Multiple Traffic Lights (1.6%), and SENS (1.1%)., Conclusions: FoPLs have the potential to help decrease mortality from diet-related non-communicable diseases, and the Nutri-Score appears to be the most efficient among the five formats tested.

Poor diet, resulting from high intake of ultra-processed packaged foods, is increasingly recognised as a key contributing factor to ill health. Food labels provide information on the nutritional content of packaged foods to consumers, which may influence consumption of nutrients such as energy, fat, saturated fat, trans-fats, sodium and added sugars. This review aims to summarise the current evidence for the association between use of food labels and dietary intake. The systematic search was conducted in August 2017 using six databases, with 6325 results. Twenty-six studies were included, including cross-sectional studies (n = 20), a cohort study (n = 1) and randomised controlled trials (n = 5). Studies were assessed using the American Dietetic Association Quality Criteria Checklist. Results were inconsistent in reporting a relationship between diet and food label use but indicated that reading the nutrition facts label is associated with healthier diets, measured by food frequency questionnaires and 24 h recalls. However, there is insufficient research on the association between dietary consumption and use of ingredients lists, serving size information and front-of-pack labels. Using health-related claims may be associated with poor diets, however evidence is inconclusive. Apart from health-related claims, using food labels is associated with healthier diets and should continue to be promoted through policies and education programs. Further research in this area is warranted to provide additional information on the impact of ingredients lists, serving sizes, front-of-pack labels and health-related claims on dietary intake., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Eating out is now common and food served out of the home is often of low nutritional quality. Kilocalorie (kcal) labelling of food and drink products sold in restaurant chains in the US is now mandatory, although in store kcal labelling practices among major UK restaurant and takeaway chains have not been examined., Methods: During August 2018, we contacted, visited the website and/or retail outlets of major eating out and takeaway food chains in the UK, including full-service and fast-food restaurants, cafes and coffee shops, some of which had previously made a voluntary pledge to provide kcal labelling. We examined the proportion of chains providing kcal information to customers at point of choice in store and the extent to which kcal information provision adhered to labelling recommendations. We also examined the proportion of chains that did not have point of choice kcal labelling but were able to provide kcal information on request. The study protocol was pre-registered on the Open Science Framework., Results: Of the 104 eligible chains, only a small minority (18 chains, 17%) provided in store kcal labelling. Of those that did, provision of kcal information tended not to adhere to recommended labelling practices. Of the 16 eligible chains that had previously committed to a voluntary public health pledge to provide point of choice kcal labelling, labelling did not meet recommendations and 4 (25%) did not provide kcal labelling. Of the 86 chains that did not provide kcal labelling in store, kcal information was available on request from 43 (50%) chains., Conclusions: It is rare for eating out and takeaway chains in the UK to provide point of choice kcal labelling and when labelling is provided it does not adhere to recommended labelling practices. Chains that previously volunteered to provide kcal labelling as part of an industry and public health partnership do so inadequately. Voluntary policies have not resulted in adequate kcal labelling in the UK eating out of home sector.