Ability of the front-of-pack nutrition label Nutri-Score to discriminate nutritional quality of food products in 7 European countries (Spain, Switzerland, Belgium, Italy, UK, the Netherlands and Sweden) and consistency with nutritional recommendations

Fabien Szabo de Edelenyi1, Manon Egnell1, Pilar Galan1, Serge Hercberg1,2, Chantal Julia1,2

1 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, F-93017 Bobigny, France.

2 Département de Santé Publique, Hôpital Avicenne (AP-HP), F-93017 Bobigny, France

This report describes the ability of the Front-of-Pack nutrition Label (FoPL), namely the Nutri-Score, to discriminate the nutritional quality of pre-packed food products available in the markets of 7 different European countries and its consistency with global nutritional recommendations. It complements specific analysis previously published in scientific peer-reviews journals using the same methodology concerning the French [1] and the German food markets [2].

Material and methods

Food composition table

Data was retrieved the 9th of July from the Open Food Facts project database, a collaborative web project gathering food composition data based on available back-of-pack labeling of products. Data is collected by volunteer contributors and includes information about ingredients and nutrition facts from food products purchased in stores, effectively using crowdsourcing to collect food composition data of the food supply. The collected data is available freely as an open data source and can be downloaded for research purposes.

As the items in the database are collected from stores, foods and beverages included are exclusively manufactured pre-packaged foods. As the single identifier for a given food is the barcode of the food, identical products sold with various packagings (in different amounts mainly) may appear multiple times in the database. The open Food Facts database contains data from national brands, store brands and discount brands, and is available around the world.

Depending on the number of contributors in a given country, the number of products in the database may vary.For this report, we selected only the 7 Europeans countries with more than 1000 products available (Spain, Switzerland, Belgium, Italy, United Kingdom, Netherlands and Sweden).

Food classification

Foods were categorized using a consumer’s point of view, grouping foods with similar use and distinct nutritional characteristics. Main food groups included ‘Products containing mainly fruits and vegetables’, ‘Cereals and potatoes’, ‘Meat, Fish and Eggs’, ‘Milk and dairy products’, ‘Fats and sauces’, ‘Composite foods’, ‘Sugary snacks’, ‘Salty snacks’ and ‘Beverages’. Within each food group, sub-groups were identified (e.g. in the ‘Cereals and potatoes’, subcategories included ‘Bread’, ‘Cereals’, ‘Legumes’, ‘Potatoes’ and ‘Breakfast cereals’). Each food was categorized in a single food group and sub-group. Herbs and spices, or special use products were excluded from the database, as they are not included in the perimeter of the Nutri-Score application. The number of products available in each group or sub-group varied depending on the country. To avoid misleading representation due to a small number of items, only food groups for which more than 20 foods were available were shown in the graphics. Foods with an incomplete nutritional composition for the Nutri-Score computation were excluded, as well as foods with missing group labelling.

Analyses

FSA score computation

The Nutri-Score relies on the computation of a nutrient profiling system, originally developed in the United Kingdom by the Food Standards Agency (FSA) for the regulation of advertising to children [3-5]. It was adapted for the purpose of nutritional labelling in France by the High Council for Public health, with the goal of ensuring a high degree of alignment between the scoring system and the French nutritional recommendations [6-7]. For each product, the FSA score modified by the Health Council of Public Health (FSAm-NSP) was computed taking into account nutrient content for 100 g. The FSAm-NSP score allocates positive points (0-10) for content in energy (KJ), total sugars (g), saturated fatty acids (g) and sodium (mg). Negative points (0-5) are allocated to content in fruits, vegetables and nuts (%), fibers (g) and proteins (g). Final score, calculated as a combination of the positive and the negative points, is based on a discrete continuous scale ranging theoretically from -15 (higher nutritional quality) to +40 points (lower nutritional quality). Specific thresholds to attribute points in the different components are used for generic foods, cheese, beverages and fats and oils. Then, cut-off are applied in order to obtain the corresponding Nutri-Score: A below -1 point (in dark green), B from 0 to 2 points (green), C from 3 to 10 points (yellow), D from 11 to 18 points (orange) and E from 19 points and over (dark orange). For beverages, the thresholds were adapted, as follow: A only applied to water, B up to 1 point (green), C from 2 to 5 (yellow), D from 6 to 9 (orange) and E from 10 points and over (dark orange).

Statistical analyses

The distribution of the overall FSAm-NSP score was computed in the different food groups, and displayed using a boxplot, highlighting the median, 25th and 75th percentiles of the distribution. Distribution of foods and beverages in the different categories of the Nutri-Score were computed. Ability of the FoPL to discriminate nutritional quality of foods and beverages was estimated by the number of available colors in each group and sub-groups. When three or more colors were available in a food group, the discriminating ability of the Nutri-Score was considered good, in a pragmatic approach.

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Results for Spain

For Spain, the OpenFoodFact table included 29 785 foods. From this list, 15982 products could not be affected to a specific food group and were deleted from the list. Then, 3639 products were removed because the nutritional informations necessary to the calculation of the NutriScore were missing. 11 products were deleted after additional quality controls. Finally, the OpenFoodFact table used for this document included 10 153 foods. The database contained 1132 products composed mainly of fruits and vegetables, 1919 bread and cereal products, 662 meat, fish and eggs products, 1544 milk and dairy, 809 fats and sauces, 586 composite dishes, 2137 sugary snacks, 667 salty snacks. Overall, the mean FSAm-NSP score was 7.5+/- 8.8 points.

The overall distribution of the FSAm-NSP score is represented in Figure 1.

Figure 1: Overall distribution of the FSAm-NSP score

The distribution of the Nutri-Score in the different food groups is represented in Figures 2, 3 and 4.

Figure 2: Distribution of the FSAm-NSP score for solid foods. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. *Products containing mainly fruits and vegetables

Figure 3: Distribution of the FSAm-NSP score for solid foods in subgroups containing more than 20 items.

Figure 4: Distribution of the FSAm-NSP score for beverages. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. By definition, only water is classified as A.

The distribution of the Nutri-Score within the different food groups is displayed in Table 1.

    A B C D E Total
Fruits and
vegetables*
  663
(58.6%)
169
(14.9%)
263
(23.2%)
32
(2.8%)
5
(0.4%)
1132
  Vegetables*** 510
(78%)
72
(11%)
64
(9.8%)
8
(1.2%)
0
(0%)
654
  Dried fruits 13
(15.9%)
15
(18.3%)
52
(63.4%)
2
(2.4%)
0
(0%)
82
  Fruits** 134
(61.2%)
8
(3.7%)
61
(27.9%)
13
(5.9%)
3
(1.4%)
219
  Soups 6
(3.4%)
74
(41.8%)
86
(48.6%)
9
(5.1%)
2
(1.1%)
177
Cereals and
potatoes
  688
(35.9%)
311
(16.2%)
408
(21.3%)
435
(22.7%)
77
(4%)
1919
  Bread 91
(17.4%)
86
(16.5%)
173
(33.1%)
162
(31%)
10
(1.9%)
522
  Cereals 379
(51.4%)
112
(15.2%)
97
(13.1%)
110
(14.9%)
40
(5.4%)
738
  Legumes 140
(58.6%)
58
(24,3 %)
14
(5.9%)
20
(8.4%)
7
(2.9%)
239
  Potatoes 16
(44.4%)
4
(11.1%)
15
(41.7%)
1
(2.8%)
0
(0%)
36
  Breakfast
cereals
62
(16.1%)
51
(13.3%)
109
(28.4%)
142
(37%)
20
(5.2%)
384
Fish Meat,
Eggs
  43
(6.5%)
114
(17.2%)
171
(25.8%)
215
(32.5%)
119
(18%)
662
  Fish and
seafood
28
(8.2%)
91
(26.6%)
122
(35.7%)
97
(28.4%)
4
(1.2%)
342
  Meat 4
(6.9%)
5
(8.6%)
14
(24.1%)
23
(39.7%)
12
(20.7%)
58
  Processed meat 2
(0.8%)
8
(3.3%)
35
(14.4%)
95
(39.1%)
103
(42.4%)
243
  Eggs 9
(47.4%)
10
(52,6 %)
0
(0%)
0
(0%)
0
(0%)
19
Milk and
dairy
products
  242
(15.7%)
576
(373%)
272
(17.6%)
377
(244%)
77
(5%)
1544
  Plant-based
milk
substitutes
78
(26%)
198
(66%)
14
(4.7%)
8
(2.7%)
2
(0.7%)
300
  Milk and
yogurt
147
(22.9%)
353
(55.1%)
122
(19%)
16
(2.5%)
3
(0.5%)
641
  Cheese 12
(3.6%)
4
(1.2%)
47
(14%)
255
(76.1%)
17
(5.1%)
335
  Dairy desserts 4
(6.5%)
10
(16.1%)
37
(59.7%)
11
(17.7%)
0
(0%)
62
  Ice cream 1
(0.5%)
11
(5.3%)
52
(25.2%)
87
(42.2%)
55
(26.7%)
206
Fat and
sauces
  44
(5.4%)
33
(4.1%)
284
(35.1%)
342
(42.3%)
106
(13.1%)
809
  Dressings and
sauces
43(7%) 33
(5.4%)
262
(42.9%)
208
(34%)
65
(10.6%)
611
  Fats 1
(0.5%)
0
(0%)
22
(11.1%)
134
(67.7%)
41
(20.7%)
198
Salty
snacks
  10
(1.5%)
45
(6.7%)
211
(31.6%)
352
(52.8%)
49
(7.3%)
667
  Appetizers 2
(0.7%)
11
(3.8%)
74
(25.3%)
191
(65.2%)
15
(5.1%)
293
  Nuts 6
(3.8%)
5
(3.2%)
36
(22.9%)
82
(52.2%)
28
(17.8%)
157
  Salty and fatty
products
2
(0.9%)
29
(13.4%)
101
(46.5%)
79
(36.4%)
6
(2.8%)
217
Sugary
snacks
  52
(2.4%)
153
(7.2%)
293
(13.7%)
752
(35.2%)
887
(41.5%)
2137
  Biscuits and
cakes
16
(1.9%)
31
(3.7%)
115
(13.6%)
309
(36.5%)
375
(44.3%)
846
  Chocolate
products
1
(0.2%)
5
(1.1%)
25
(5.3%)
132
(27.7%)
313
(65.8%)
476
  Sweets 35
(4.4%)
117
(14.9%)
151
(19.2%)
293
(37.2%)
191
(24.3%)
787
  pastries 0
(0%)
0
(0%)
2
(7.1%)
18
(64.3%)
8
(28.6%)
28
Composite
foods
  117
(20%)
150
(25.6%)
224
(38.2%)
89
(15.2%)
6
(1%)
586
  One-dish
meals
115
(24.1%)
135
(28.2%)
189
(39.5%)
37
(7.7%)
2
(0.4%)
478
  Pizza pies and
quiches
0
(0%)
7
(10%)
23
(32.9%)
37
(52.9%)
3
(4.3%)
70
  Sandwiches 2
(5.3%)
8
(21.1%)
12
(31.6%)
15
(39.5%)
1
(2.6%)
38
Beverages   260
(37.3%)
82
(11.8%)
151
(21.7%)
73
(10.5%)
131
(18.8%)
697
  Waters 260
(100%)
0
(0%)
0
(0%)
0
(0%)
0
(0%)
260
  Teas and
herbal teas
and coffees
0
(0%)
1
(14.3%)
2
(28.6%)
2
(28.6%)
2
(28.6%)
7
  Fruit juices 0
(0%)
49
(24.1%)
119
(58.6%)
28
(13.8%)
7
(3.4%)
203
  Fruit nectars 0
(0%)
0
(0%)
8
(19.5%)
15
(36.6%)
18
(43.9%)
41
  Artificially
sweetened
beverages
0
(0%)
27
(29.3%)
21
(22.8%)
18
(19.6%)
26
(28.3%)
92
  Sweetened
beverages
0
(0%)
5
(5.3%)
1
(1.1%)
10
(10.6%)
78
(83%)
94
Sum   2119
(20.9%)
1633
(16.1%)
2277
(22.4%)
2667
(26.3%)
1457
(14.4%)
10
153

Table 1: Distribution of the Nutri-Score within the different food groups. ** Fruits based products ; *** Vegetables based products.

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Results for Switzerland

For Switzerland, the OpenFoodFact table included 34084 foods. From this list, 24468 products could not be affected to a specific food group and were deleted from the list. Then, 1105 products were removed because the nutritional informations necessary to the calculation of the NutriScore were missing. 18 products were deleted after additional quality controls. Finally, the OpenFoodFact table used for this document included 8493 foods. The database contained 588 products composed mainly of fruits and vegetables, 1303 bread and cereal products, 619 meat, fish and eggs products, 1358 milk and dairy, 731 fats and sauces, 630 composite dishes, 1972 sugary snacks, 427 salty snacks. Overall, the mean FSAm-NSP score was 9.2+/- 9.2 points.

The overall distribution of the FSAm-NSP score is represented in Figure 1.

Figure 1: Overall distribution of the FSAm-NSP score

The distribution of the Nutri-Score in the different food groups is represented in Figures 2, 3 and 4.

Figure 2: Distribution of the FSAm-NSP score for solid foods. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. *Products containing mainly fruits and vegetables »

Figure 3: Distribution of the FSAm-NSP score for solid foods in subgroups containing more than 20 items. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. ** Fruits based products ; *** Vegetables based products

Figure 4: Distribution of the FSAm-NSP score for beverages. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. By definition, only water is classified as A.

The distribution of the Nutri-Score within the different food groups is displayed in Table 1.

Table 1: Distribution of the Nutri-Score within the different food groups. ** Fruits based products ; *** Vegetables based products.

    A B C D E Total
Fruits and vegetables*   359
(61.1%)
89
(15.1%)
127
(21.6%)
12
(2%)
1
(0.2%)
588
  Vegetables*** 211
(77.9%)
36
(13.3%)
22
(8.1%)
1
(0.4%)
1
(0.4%)
271
  Dried
fruits
11
(11.7%)
28
(29.8%)
53
(56.4%)
2
(2.1%)
0
(0%)
94
  Fruits** 133
(76.4%)
5
(2.9%)
28
(16.1%)
8
(4.6%)
0
(0%)
174
  Soups 4
(8.2%)
20
(40.8%)
24
(49%)
1
(2%)
0
(0%)
49
Cereals
and
potatoes
  613
(47%)
234
(18%)
266
(20.4%)
159
(12.2%)
31
(2.4%)
1303
  Bread 74
(24.7%)
103
(34.3%)
84
(28%)
37
(12.3%)
2
(0.7%)
300
  Cereals 364
(64.7%)
66
(11.7%)
48
(8.5%)
62
(11%)
23
(4.1%)
563
  Legumes 60
(69%)
9
(10.3%)
5
(5.7%)
10
(11.5%)
3
(3.4%)
87
  Potatoes 34
(41%)
24
(28.9%)
24
(28.9%)
1
(1.2%)
0
(0%)
83
  Breakfast
cereals
81
(30%)
32
(11.9%)
105
(38.9%)
49
(18.1%)
3
(1.1%)
270
Fish Meat Eggs   71
(11.5%)
103
(16.6%)
127
(20.5%)
224
(36.2%)
94
(15.2%)
619
  Fish and
seafood
29
(13.1%)
73
(33%)
52
(23.5%)
66
(29.9%)
1
(0.5%)
221
  Meat 17
(9.8%)
23
(13.2%)
38
(21.8%)
80
(46%)
16
(9.2%)
174
  Processed meat 2
(1%)
5
(2.5%)
37
(18.8%)
76
(38.6%)
77
(39.1%)
197
  Eggs 23
(88.5%)
2
(7.7%)
0
(0%)
1
(3.8%)
0
(0%)
26
  Offals 0
(0%)
0
(0%)
0
(0%)
1
(100%)
0
(0%)
1
Milk and dairy
products
  155
(11.4%)
306
(22.5%)
338
(24.9%)
525
(38.7%)
34
(2.5%)
1358
  Plant-based
milk
substitutes
19
(22.9%)
43
(51.8%)
4
(4.8%)
17
(20.5%)
0
(0%)
83
  Milk and
yogurt
90
(17.2%)
215
(41%)
186
(35.5%)
33
(6.3%)
0
(0%)
524
  Cheese 34
(6.6%)
29
(5.6%)
75
(14.6%)
366
(71.1%)
11
(2.1%)
515
  Dairy
desserts
9
(9.7%)
13
(14%)
42
(45.2%)
26
(28%)
3
(3.2%)
93
  Ice cream 3
(2.1%)
6
(4.2%)
31(21.7%) 83
(58%)
20
(14%)
143
Fat and
sauces
  21
(2.9%)
45
(6.2%)
205
(28%)
347
(47.5%)
113
(15.5%)
731
  Dressings and
sauces
21
(3.9%)
45
(8.3%)
167
(30.8%)
237
(43.6%)
73
(13.4%)
543
  Fats 0
(0%)
0
(0%)
38
(20.2%)
110
(58.5%)
40
(21.3%)
188
Salty
snacks
  12
(2.8%)
21
(4.9%)
127
(29.7%)
206
(48.2%)
61
(14.3%)
427
  Appetizers 2
(0.9%)
12
5.4%)
64
(29%)
111
(50.2%)
32
(14.5%)
221
  Nuts 6
(6.1%)
6
(6.1%)
22
(22.4%)
50
(51%)
14
(14.3%)
98
  Salty and fatty
products
4
(3.7%)
3
(2.8%)
41
(38%)
45
(41.7%)
15
(13.9%)
108
Sugary
snacks
  17
(0.9%)
61
(3.1%)
166
(8.4%)
633
(32.1%)
1095
(55.5%)
1972
  Biscuits
and cakes
5
(0.6%)
4
(0.5%)
75
(9.2%)
288
(35.5%)
439
(54.1%)
811
  Chocolate
products
0
(0%)
0
(0%)
5
(1.1%)
61
(12.8%)
410
(86.1%)
476
  Sweets 12
(2%)
57
(9.7%)
65
(11.1%)
231
(39.4%)
222
(37.8%)
587
  pastries 0
(0%)
0
(0%)
21
(21.4%)
53
(54.1%)
24
(24.5%)
98
Composite
foods
  78
(12.4%)
179
(28.4%)
227
(36%)
123
(19.5%)
23
(3.7%)
630
  One-dish
meals
76
(16.1%)
157
(33.2%)
161
(34%)
65
(13.7%)
14
(3%)
473
  Pizza pies and quiches 0
(0%)
12
(10.9%)
56
(50.9%)
36
(32.7%)
6
(5.5%)
110
  Sandwiches 2
(4.3%)
10
(21.3%)
10
(21.3%)
22
(46.8%)
3
(6.4%)
47
Beverages   105
(12.1%)
70
(8.1%)
180
(20.8%)
183
(21.2%)
327
(37.8%)
865
  Waters 104
(100%)
0
(0%)
0
(0%)
0
(0%)
0
(0%)
104
  Teas and
herbal teas and
coffees
0
(0%)
5
(12.5%)
2
(5%)
12
(30%)
21
(52.5%)
40
  Fruit juices 1
(0.5%)
26
(12.6%)
144
(69.6%)
30
(14.5%)
6
(2.9%)
207
  Fruit nectars 0
(0%)
0
(0%)
0
(0%)
4
(13.3%)
26
(86.7%)
30
  Artificially sweetened
beverages
0
(0%)
37
(26.8%)
23
(16.7%)
63
(45.7%)
15
(10.9%)
138
  Sweetened
beverages
0
(0%)
2
(0.6%)
11
(3.2%)
74
(21.4%)
259
(74.9%)
346
Sum   1431
(16.8%)
1108
(13%)
1763
(20.8%)
2412
(28.4%)
1779
(20.9%)
8493
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Results for Belgium

For Belgium, the OpenFoodFact table included 30435 foods. From this list, 22415 products could not be affected to a specific food group and were deleted from the list. Then, 800 products were removed because the nutritional informations necessary to the calculation of the NutriScore were missing. 13 products were deleted after additional quality controls. Finally, the OpenFoodFact table used for this document included 7207 foods. The database contained 538 products composed mainly of fruits and vegetables, 892 bread and cereal products, 638 meat, fish and eggs products, 1209 milk and dairy, 676 fats and sauces, 553 composite dishes, 1485 sugary snacks, 417 salty snacks. Overall, the mean FSAm-NSP score was 9.3+/- 8.9 points.

The overall distribution of the FSAm-NSP score is represented in Figure 1.

Figure 1: Overall distribution of the FSAm-NSP score

The distribution of the Nutri-Score in the different food groups is represented in Figures 2, 3 and 4.

Figure 2: Distribution of the FSAm-NSP score for solid foods. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. *Products containing mainly fruits and vegetables

Figure 3: Distribution of the FSAm-NSP score for solid foods in subgroups containing more than 20 items. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. ** Fruits based products ; *** Vegetables based products

Figure 4: Distribution of the FSAm-NSP score for beverages. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. By definition, only water is classified as A.

The distribution of the Nutri-Score within the different food groups is displayed in Table 1.

Table 1: Distribution of the Nutri-Score within the different food groups. ** Fruits based products ; *** Vegetables based products.

    A B C D E Total
Fruits and
vegetables*
  324
(60.2%)
90
(16.7%)
111
(20.6%)
12
(2.2%)
1
(0.2%)
538
  Vegetables
***
207
(77.5%)
27(10.1%) 29(10.9%) 4(1.5%) 0(0%) 267
  Dried fruits 8(12.5%) 22(34.4%) 31(48.4%) 2(3.1%) 1(1.6%) 64
  Fruits** 107(74.8%) 17(11.9%) 13(9.1%) 6(4.2%) 0(0%) 143
  Soups 2(3.1%) 24(37.5%) 38(59.4%) 0(0%) 0(0%) 64
Cereals
and potatoes
  367(41.1%) 159(17.8%) 212(23.8%) 134(15%) 20(2.2%) 892
  Bread 44(23.5%) 50(26.7%) 62(33.2%) 25(13.4%) 6(3.2%) 187
  Cereals 195(59.3%) 58(17.6%) 33(10%) 36(10.9%) 7(2.1%) 329
  Legumes 50(68.5%) 5(6.8%) 9(12.3%) 7(9.6%) 2(2.7%) 73
  Potatoes 22(41.5%) 13(24.5%) 16(30.2%) 1(1.9%) 1(1.9%) 53
  Breakfast
cereals
56(22.4%) 33(13.2%) 92(36.8%) 65(26%) 4(1.6%) 250
Fish Meat Eggs   54(8.5%) 102(16%) 144(22.6%) 224(35.1%) 114(17.9%) 638
  Fish and
seafood
26(11.3%) 71(30.9%) 45(19.6%) 86(37.4%) 2(0.9%) 230
  Meat 18(12.5%) 21(14.6%) 50(34.7%) 47(32.6%) 8(5.6%) 144
  Processed meat 0(0%) 6(2.4%) 47(19%) 90(36.4%) 104(42.1%) 247
  Eggs 10(66.7%) 4(26.7%) 1(6.7%) 0(0%) 0(0%) 15
  Offals 0(0%) 0(0%) 1(50%) 1(50%) 0(0%) 2
Milk and dairy products   118(9.8%) 302(25%) 248(20.5%) 471(39%) 70(5.8%) 1209
  Plant-based milk substitutes 13(16.9%) 47(61%) 0(0%) 17(22.1%) 0(0%) 77
  Milk and
yogurt
81(18%) 216(48.1%) 117(26.1%) 34(7.6%) 1(0.2%) 449
  Cheese 9(1.9%) 10(2.1%) 67(14.3%) 348(74.4%) 34(7.3%) 468
  Dairy desserts 15(13.8%) 23(21.1%) 48(44%) 21(19.3%) 2(1.8%) 109
  Ice cream 0(0%) 6(5.7%) 16(15.1%) 51(48.1%) 33(31.1%) 106
Fat and sauces   6(0.9%) 17(2.5%) 148(21.9%) 335(49.6%) 170(25.1%) 676
  Dressings and sauces 6(1.3%) 15(3.1%) 102(21.3%) 229(47.9%) 126(26.4%) 478
  Fats 0(0%) 2(1%) 46(23.2%) 106(53.5%) 44(22.2%) 198
Salty snacks   6(1.4%) 20(4.8%) 119(28.5%) 224(53.7%) 48(11.5%) 417
  Appetizers 0(0%) 8(3.2%) 76(30.6%) 144(58.1%) 20(8.1%) 248
  Nuts 3(3.7%) 4(4.9%) 15(18.3%) 46(56.1%) 14(17.1%) 82
  Salty and fatty products 3(3.4%) 8(9.2%) 28(32.2%) 34(39.1%) 14(16.1%) 87
Sugary snacks   16(1.1%) 62(4.2%) 129(8.7%) 443(29.8%) 835(56.2%) 1485
  Biscuits and
cakes
3(0.5%) 9(1.4%) 42(6.6%) 168(26.4%) 415(65.1%) 637
  Chocolate products 0(0%) 4(1.3%) 4(1.3%) 56(17.8%) 250(79.6%) 314
  Sweets 12(2.4%) 48(9.7%) 80(16.2%) 197(39.8%) 158(31.9%) 495
  pastries 1(2.6%) 1(2.6%) 3(7.7%) 22(56.4%) 12(30.8%) 39
Composite
foods
  67(12.1%) 176(31.8%) 207(37.4%) 90(16.3%) 13(2.4%) 553
  One-dish
meals
65(14.4%) 160(35.4%) 167(36.9%) 50(11.1%) 10(2.2%) 452
  Pizza pies and quiches 0(0%) 10(15.6%) 23(35.9%) 28(43.8%) 3(4.7%) 64
  Sandwiches 2(5.4%) 6(16.2%) 17(45.9%) 12(32.4%) 0(0%) 37
Beverages   130(16.3%) 68(8.5%) 187(23.4%) 177(22.2%) 237(29.7%) 799
  Waters 130(100%) 0(0%) 0(0%) 0(0%) 0(0%) 130
  Teas and
herbal teas and coffees
0(0%) 0(0%) 0(0%) 24(50%) 24(50%) 48
  Fruit juices 0(0%) 16(8.6%) 140(74.9%) 26(13.9%) 5(2.7%) 187
  Fruit nectars 0(0%) 0(0%) 0(0%) 3(27.3%) 8(72.7%) 11
  Artificially
sweetened
beverages
0(0%) 45(29%) 36(23.2%) 65(41.9%) 9(5.8%) 155
  Sweetened
beverages
0(0%) 7(2.6%) 11(4.1%) 59(22%) 191(71.3%) 268
Sum   1088
(15.1%)
996
(13.8%)
1505
(20.9%)
2110
(29.3%)
1508
(20.9%)
7207
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Results for Italy

For Italy, the OpenFoodFact table included 6490 foods. From this list, 4326 products could not be affected to a specific food group and were deleted from the list. Then, 264 products were removed because the nutritional informations necessary to the calculation of the NutriScore were missing. 1 product was deleted after additional quality controls. Finally, the OpenFoodFact table used for this document included 1899 foods. The database contained 62 products composed mainly of fruits and vegetables, 367 bread and cereal products, 122 meat, fish and eggs products, 419 milk and dairy, 117 fats and sauces, 73 composite dishes, 519 sugary snacks, 85 salty snacks. Overall, the mean FSAm-NSP score was 8.8+/- 8.8 points.

The overall distribution of the FSAm-NSP score is represented in Figure 1.

Figure 1: Overall distribution of the FSAm-NSP score

The distribution of the Nutri-Score in the different food groups is represented in Figures 2, 3 and 4.

Figure 2: Distribution of the FSAm-NSP score for solid foods. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. *Products containing mainly fruits and vegetables

Figure 3: Distribution of the FSAm-NSP score for solid foods in subgroups containing more than 20 items. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. ** Fruits based products ; *** Vegetables based products

Figure 4: Distribution of the FSAm-NSP score for beverages. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. By definition, only water is classified as A.

The distribution of the Nutri-Score within the different food groups is displayed in Table 1.

Table 1: Distribution of the Nutri-Score within the different food groups. ** Fruits based products ; *** Vegetables based products.

    A B C D E Total
Fruits and
vegetables*
  44(71%) 9(14.5%) 9(14.5%) 0(0%) 0(0%) 62
  Vegetables*** 32(94.1%) 1(2.9%) 1(2.9%) 0(0%) 0(0%) 34
  Dried fruits 1(12.5%) 4(50%) 3(37.5%) 0(0%) 0(0%) 8
  Fruits** 10(66.7%) 0(0%) 5(33.3%) 0(0%) 0(0%) 15
  Soups 1(20%) 4(80%) 0(0%) 0(0%) 0(0%) 5
Cereals and
potatoes
  187(51%) 47(12.8%) 56(15.3%) 68(18.5%) 9(2.5%) 367
  Bread 10(14.5%) 9(13%) 17(24.6%) 30(43.5%) 3(4.3%) 69
  Cereals 140(76.1%) 22(12%) 11(6%) 8(4.3%) 3(1.6%) 184
  Legumes 14(87.5%) 1(6.2%) 0(0%) 1(6.2%) 0(0%) 16
  Potatoes 5(45.5%) 4(36.4%) 2(18.2%) 0(0%) 0(0%) 11
  Breakfast
cereals
18(20.7%) 11(12.6%) 26(29.9%) 29(33.3%) 3(3.4%) 87
Fish Meat Eggs   3(2.5%) 26(21.3%) 31(25.4%) 56(45.9%) 6(4.9%) 122
  Fish and
seafood
3(7%) 11(25.6%) 5(11.6%) 24(55.8%) 0(0%) 43
  Meat 0(0%) 2(9.5%) 8(38.1%) 10(47.6%) 1(4.8%) 21
  Processed
meat
0(0%) 3(6.2%) 18(37.5%) 22(45.8%) 5(10.4%) 48
  Eggs 0(0%) 10(100%) 0(0%) 0(0%) 0(0%) 10
Milk and dairy products   56(13.4%) 137(32.7%) 119(28.4%) 92(22%) 15(3.6%) 419
  Plant-based
milk
substitutes
12(22.6%) 37(69.8%) 4(7.5%) 0(0%) 0(0%) 53
  Milk and
yogurt
43(20.8%) 96(46.4%) 67(32.4%) 1(0.5%) 0(0%) 207
  Cheese 1(0.8%) 4(3.2%) 41(32.8%) 72(57.6%) 7(5.6%) 125
  Dairy desserts 0(0%) 0(0%) 1(50%) 1(50%) 0(0%) 2
  Ice cream 0(0%) 0(0%) 6(18.8%) 18(56.2%) 8(25%) 32
Fat and sauces   2(1.7%) 12(10.3%) 12(10.3%) 59(50.4%) 32(27.4%) 117
  Dressings and sauces 2(3.1%) 11(17.2%) 10(15.6%) 21(32.8%) 20(31.2%) 64
  Fats 0(0%) 1(1.9%) 2(3.8%) 38(71.7%) 12(22.6%) 53
Salty snacks   4(4.7%) 1(1.2%) 27(31.8%) 46(54.1%) 7(8.2%) 85
  Appetizers 2(2.9%) 1(1.4%) 20(29%) 39(56.5%) 7(10.1%) 69
  Nuts 2(33.3%) 0(0%) 2(33.3%) 2(33.3%) 0(0%) 6
  Salty and fatty products 0(0%) 0(0%) 5(50%) 5(50%) 0(0%) 10
Sugary snacks   6(1.2%) 9(1.7%) 87(16.8%) 189(36.4%) 228(43.9%) 519
  Biscuits and
cakes
3(1.1%) 3(1.1%) 55(20.7%) 103(38.7%) 102(38.3%) 266
  Chocolate
products
0(0%) 0(0%) 0(0%) 20(23.3%) 66(76.7%) 86
  Sweets 3(2%) 6(4%) 30(20.1%) 60(40.3%) 50(33.6%) 149
  pastries 0(0%) 0(0%) 2(11.1%) 6(33.3%) 10(55.6%) 18
Composite
foods
  6(8.2%) 13(17.8%) 25(34.2%) 26(35.6%) 3(4.1%) 73
  One-dish
meals
3(8.6%) 10(28.6%) 11(31.4%) 11(31.4%) 0(0%) 35
  Pizza pies and quiches 1(2.8%) 3(8.3%) 14(38.9%) 15(41.7%) 3(8.3%) 36
  Sandwiches 2(100%) 0(0%) 0(0%) 0(0%) 0(0%) 2
Beverages   17(12.6%) 7(5.2%) 32(23.7%) 18(13.3%) 61(45.2%) 135
  Waters 17(100%) 0(0%) 0(0%) 0(0%) 0(0%) 17
  Teas and
herbal teas and coffees
0(0%) 1(100%) 0(0%) 0(0%) 0(0%) 1
  Fruit juices 0(0%) 4(10%) 28(70%) 6(15%) 2(5%) 40
  Fruit nectars 0(0%) 0(0%) 0(0%) 1(4%) 24(96%) 25
  Artificially
sweetened
beverages
0(0%) 2(15.4%) 3(23.1%) 8(61.5%) 0(0%) 13
  Sweetened
beverages
0(0%) 0(0%) 1(2.6%) 3(7.7%) 35(89.7%) 39
Sum   325(17.1%) 261(13.7%) 398(21%) 554(29.2%) 361(19%) 1899
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Results for United-Kingdom

For United-Kingdom, the OpenFoodFact table included 11924 foods. From this list, 8051 products could not be affected to a specific food group and were deleted from the list. Then, 811 products were removed because the nutritional informations necessary to the calculation of the NutriScore were missing. 4 products were deleted after additional quality controls. Finally, the OpenFoodFact table used for this document included 3058 foods. The database contained 186 products composed mainly of fruits and vegetables, 346 bread and cereal products, 285 meat, fish and eggs products, 421 milk and dairy, 311 fats and sauces, 271 composite dishes, 805 sugary snacks, 198 salty snacks. Overall, the mean FSAm-NSP score was 8.9+/- 9.2 points.

The overall distribution of the FSAm-NSP score is represented in Figure 1.

Figure 1: Overall distribution of the FSAm-NSP score

The distribution of the Nutri-Score in the different food groups is represented in Figures 2, 3 and 4.

Figure 2: Distribution of the FSAm-NSP score for solid foods. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. *Products containing mainly fruits and vegetables

Figure 3: Distribution of the FSAm-NSP score for solid foods in subgroups containing more than 20 items. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. ** Fruits based products ; *** Vegetables based products

Figure 4: Distribution of the FSAm-NSP score for beverages. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. By definition, only water is classified as A.

The distribution of the Nutri-Score within the different food groups is displayed in Table 1.

Table 1: Distribution of the Nutri-Score within the different food groups. ** Fruits based products ; *** Vegetables based products.

    A B C D E Total
Fruits and
vegetables*
  136(73.1%) 19(10.2%) 26(14%) 5(2.7%) 0(0%) 186
  Vegetables*** 96(91.4%) 6(5.7%) 3(2.9%) 0(0%) 0(0%) 105
  Dried fruits 2(10.5%) 6(31.6%) 11(57.9%) 0(0%) 0(0%) 19
  Fruits** 37(69.8%) 1(1.9%) 10(18.9%) 5(9.4%) 0(0%) 53
  Soups 1(11.1%) 6(66.7%) 2(22.2%) 0(0%) 0(0%) 9
Cereals and
potatoes
  163(47.1%) 69(19.9%) 66(19.1%) 40(11.6%) 8(2.3%) 346
  Bread 31(47.7%) 20(30.8%) 11(16.9%) 3(4.6%) 0(0%) 65
  Cereals 78(56.1%) 33(23.7%) 16(11.5%) 7(5%) 5(3.6%) 139
  Legumes 13(32.5%) 1(2.5%) 9(22.5%) 15(37.5%) 2(5%) 40
  Potatoes 7(46.7%) 5(33.3%) 3(20%) 0(0%) 0(0%) 15
  Breakfast
cereals
34(39.1%) 10(11.5%) 27(31%) 15(17.2%) 1(1.1%) 87
Fish Meat
Eggs
  57(20%) 67(23.5%) 51(17.9%) 80(28.1%) 30(10.5%) 285
  Fish and
seafood
18(21.2%) 31(36.5%) 18(21.2%) 18(21.2%) 0(0%) 85
  Meat 22(20.8%) 28(26.4%) 15(14.2%) 33(31.1%) 8(7.5%) 106
  Processed meat 0(0%) 6(8.6%) 15(21.4%) 27(38.6%) 22(31.4%) 70
  Eggs 17(85%) 2(10%) 1(5%) 0(0%) 0(0%) 20
  Offals 0(0%) 0(0%) 2(50%) 2(50%) 0(0%) 4
Milk and dairy products   67(15.9%) 108(25.7%) 95(22.6%) 139(33%) 12(2.9%) 421
  Plant-based
milk
substitutes
5(19.2%) 10(38.5%) 1(3.8%) 10(38.5%) 0(0%) 26
  Milk and
yogurt
55(22.4%) 94(38.2%) 75(30.5%) 21(8.5%) 1(0.4%) 246
  Cheese 7(6.5%) 0(0%) 7(6.5%) 90(84.1%) 3(2.8%) 107
  Dairy desserts 0(0%) 4(20%) 10(50%) 5(25%) 1(5%) 20
  Ice cream 0(0%) 0(0%) 2(9.1%) 13(59.1%) 7(31.8%) 22
Fat and sauces   3(1%) 16(5.1%) 106(34.1%) 143(46%) 43(13.8%) 311
  Dressings and sauces 3(1.3%) 14(6%) 101(43%) 101(43%) 16(6.8%) 235
  Fats 0(0%) 2(2.6%) 5(6.6%) 42(55.3%) 27(35.5%) 76
Salty snacks   9(4.5%) 17(8.6%) 75(37.9%) 83(41.9%) 14(7.1%) 198
  Appetizers 3(2.6%) 7(6.1%) 37(32.5%) 55(48.2%) 12(10.5%) 114
  Nuts 1(2.8%) 2(5.6%) 17(47.2%) 16(44.4%) 0(0%) 36
  Salty and fatty products 5(10.4%) 8(16.7%) 21(43.8%) 12(25%) 2(4.2%) 48
Sugary snacks   6(0.7%) 14(1.7%) 57(7.1%) 329(40.9%) 399(49.6%) 805
  Biscuits and
cakes
3(0.8%) 2(0.5%) 22(5.8%) 148(38.7%) 207(54.2%) 382
  Chocolate
products
0(0%) 0(0%) 0(0%) 37(22%) 131(78%) 168
  Sweets 3(1.3%) 12(5.1%) 32(13.5%) 130(54.9%) 60(25.3%) 237
  pastries 0(0%) 0(0%) 3(16.7%) 14(77.8%) 1(5.6%) 18
Composite
foods
  88(32.5%) 84(31%) 54(19.9%) 38(14%) 7(2.6%) 271
  One-dish
meals
75(38.5%) 63(32.3%) 40(20.5%) 17(8.7%) 0(0%) 195
  Pizza pies and quiches 0(0%) 7(17.9%) 10(25.6%) 16(41%) 6(15.4%) 39
  Sandwiches 13(35.1%) 14(37.8%) 4(10.8%) 5(13.5%) 1(2.7%) 37
Beverages   40(17%) 23(9.8%) 66(28.1%) 47(20%) 59(25.1%) 235
  Waters 40(100%) 0(0%) 0(0%) 0(0%) 0(0%) 40
  Teas and
herbal teas and coffees
0(0%) 1(16.7%) 0(0%) 4(66.7%) 1(16.7%) 6
  Fruit juices 0(0%) 7(10.9%) 42(65.6%) 12(18.8%) 3(4.7%) 64
  Fruit nectars 0(0%) 0(0%) 1(50%) 0(0%) 1(50%) 2
  Artificially
sweetened
beverages
0(0%) 12(19.4%) 22(35.5%) 20(32.3%) 8(12.9%) 62
  Sweetened
beverages
0(0%) 3(4.9%) 1(1.6%) 11(18%) 46(75.4%) 61
Sum   569(18.6%) 417(13.6%) 596(19.5%) 904(29.6%) 572(18.7%) 3058
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Results for the Netherlands

For the Netherlands, the OpenFoodFact table included 5134 foods. From this list, 3810 products could not be affected to a specific food group and were deleted from the list. Then, 128 products were removed because the nutritional informations necessary to the calculation of the NutriScore were missing. 2 products were deleted after additional quality controls. Finally, the OpenFoodFact table used for this document included 1194 foods. The database contained 69 products composed mainly of fruits and vegetables, 231 bread and cereal products, 46 meat, fish and eggs products, 209 milk and dairy, 105 fats and sauces, 62 composite dishes, 288 sugary snacks, 84 salty snacks. Overall, the mean FSAm-NSP score was 8.5+/- 9.5 points.

The overall distribution of the FSAm-NSP score is represented in Figure 1.

Figure 1: Overall distribution of the FSAm-NSP score

The distribution of the Nutri-Score in the different food groups is represented in Figures 2, 3 and 4.

Figure 2: Distribution of the FSAm-NSP score for solid foods. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. *Products containing mainly fruits and vegetables

Figure 3: Distribution of the FSAm-NSP score for solid foods in subgroups containing more than 20 items. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. ** Fruits based products ; *** Vegetables based products

Figure 4: Distribution of the FSAm-NSP score for beverages. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. By definition, only water is classified as A..

The distribution of the Nutri-Score within the different food groups is displayed in Table 1.

Table 1: Distribution of the Nutri-Score within the different food groups. ** Fruits based products ; *** Vegetables based products.

    A B C D E Total
Fruits and
vegetables*
  44(63.8%) 12(17.4%) 12(17.4%) 1(1.4%) 0(0%) 69
  Vegetables*** 26(81.2%) 6(18.8%) 0(0%) 0(0%) 0(0%) 32
  Dried fruits 0(0%) 3(33.3%) 6(66.7%) 0(0%) 0(0%) 9
  Fruits** 18(81.8%) 1(4.5%) 2(9.1%) 1(4.5%) 0(0%) 22
  Soups 0(0%) 2(33.3%) 4(66.7%) 0(0%) 0(0%) 6
Cereals and
potatoes
  126(54.5%) 29(12.6%) 33(14.3%) 41(17.7%) 2(0.9%) 231
  Bread 13(35.1%) 10(27%) 6(16.2%) 7(18.9%) 1(2.7%) 37
  Cereals 69(70.4%) 9(9.2%) 11(11.2%) 9(9.2%) 0(0%) 98
  Legumes 28(53.8%) 2(3.8%) 3(5.8%) 19(36.5%) 0(0%) 52
  Potatoes 0(0%) 1(50%) 1(50%) 0(0%) 0(0%) 2
  Breakfast
cereals
16(38.1%) 7(16.7%) 12(28.6%) 6(14.3%) 1(2.4%) 42
Fish Meat Eggs   3(6.5%) 9(19.6%) 10(21.7%) 11(23.9%) 13(28.3%) 46
  Fish and
seafood
1(4.3%) 9(39.1%) 9(39.1%) 4(17.4%) 0(0%) 23
  Meat 1(16.7%) 0(0%) 1(16.7%) 4(66.7%) 0(0%) 6
  Processed meat 0(0%) 0(0%) 0(0%) 3(18.8%) 13(81.2%) 16
  Eggs 1(100%) 0(0%) 0(0%) 0(0%) 0(0%) 1
Milk and dairy products   47(22.5%) 79(37.8%) 20(9.6%) 48(23%) 15(7.2%) 209
  Plant-based
milk
substitutes
16(29.6%) 33(61.1%) 0(0%) 5(9.3%) 0(0%) 54
  Milk and
yogurt
27(31.8%) 40(47.1%) 11(12.9%) 6(7.1%) 1(1.2%) 85
  Cheese 3(6.5%) 4(8.7%) 6(13%) 29(63%) 4(8.7%) 46
  Dairy desserts 1(33.3%) 0(0%) 2(66.7%) 0(0%) 0(0%) 3
  Ice cream 0(0%) 2(9.5%) 1(4.8%) 8(38.1%) 10(47.6%) 21
Fat and sauces   7(6.7%) 4(3.8%) 26(24.8%) 57(54.3%) 11(10.5%) 105
  Dressings and sauces 4(6.3%) 3(4.8%) 19(30.2%) 31(49.2%) 6(9.5%) 63
  Fats 3(7.1%) 1(2.4%) 7(16.7%) 26(61.9%) 5(11.9%) 42
Salty snacks   2(2.4%) 1(1.2%) 36(42.9%) 39(46.4%) 6(7.1%) 84
  Appetizers 1(2.5%) 0(0%) 16(40%) 20(50%) 3(7.5%) 40
  Nuts 1(4.8%) 1(4.8%) 6(28.6%) 11(52.4%) 2(9.5%) 21
  Salty and fatty products 0(0%) 0(0%) 14(60.9%) 8(34.8%) 1(4.3%) 23
Sugary snacks   4(1.4%) 8(2.8%) 22(7.6%) 88(30.6%) 166(57.6%) 288
  Biscuits and
cakes
1(1%) 2(1.9%) 12(11.4%) 31(29.5%) 59(56.2%) 105
  Chocolate
products
0(0%) 0(0%) 1(1%) 14(14%) 85(85%) 100
  Sweets 3(3.7%) 6(7.4%) 9(11.1%) 41(50.6%) 22(27.2%) 81
  pastries 0(0%) 0(0%) 0(0%) 2(100%) 0(0%) 2
Composite
foods
  7(11.3%) 12(19.4%) 29(46.8%) 12(19.4%) 2(3.2%) 62
  One-dish
meals
6(13.3%) 10(22.2%) 20(44.4%) 7(15.6%) 2(4.4%) 45
  Pizza pies and quiches 0(0%) 0(0%) 7(63.6%) 4(36.4%) 0(0%) 11
  Sandwiches 1(16.7%) 2(33.3%) 2(33.3%) 1(16.7%) 0(0%) 6
Beverages   18(18%) 7(7%) 25(25%) 26(26%) 24(24%) 100
  Waters 18(100%) 0(0%) 0(0%) 0(0%) 0(0%) 18
  Teas and
herbal teas and coffees
0(0%) 0(0%) 1(8.3%) 9(75%) 2(16.7%) 12
  Fruit juices 0(0%) 5(20%) 16(64%) 3(12%) 1(4%) 25
  Fruit nectars 0(0%) 0(0%) 0(0%) 0(0%) 1(100%) 1
  Artificially
sweetened
beverages
0(0%) 2(22.2%) 3(33.3%) 4(44.4%) 0(0%) 9
  Sweetened
beverages
0(0%) 0(0%) 5(14.3%) 10(28.6%) 20(57.1%) 35
Sum   258
(21.6%)
161
(13.5%)
213
(17.8%)
323
(27.1%)
239
(20%)
1194
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Results for Sweden

For Sweden, the OpenFoodFact table included 2073 foods. From this list, 912 products could not be affected to a specific food group and were deleted from the list. Then, 93 products were removed because the nutritional informations necessary to the calculation of the NutriScore were missing. Finally, the OpenFoodFact table used for this document included 1068 foods. The database contained 47 products composed mainly of fruits and vegetables, 121 bread and cereal products, 82 meat, fish and eggs products, 202 milk and dairy, 95 fats and sauces, 203 composite dishes, 151 sugary snacks, 90 salty snacks. Overall, the mean FSAm-NSP score was 8.3+/- 9 points.

The overall distribution of the FSAm-NSP score is represented in Figure 1.

Figure 1: Overall distribution of the FSAm-NSP score

The distribution of the Nutri-Score in the different food groups is represented in Figures 2, 3 and 4.

Figure 2: Distribution of the FSAm-NSP score for solid foods. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. *Products containing mainly fruits and vegetables

Figure 3: Distribution of the FSAm-NSP score for solid foods in subgroups containing more than 20 items. Vertical lines represent the cut-offs of the 5-category Nutriscore. The boundary of the box nearest to the left indicates the 25th percentile, the line within the box marks the median, and the boundary of the box furthest from the left indicates the 75th percentile. Whiskers (error bars) left and right of the box indicate the lower limit (25th percentile – 1.5 * (Inter-quartile range) and the upper limit (75th percentile + 1.5 * (Inter-quartile range)). The circles are individual outlier points. ** Fruits based products ; *** Vegetables based products

The distribution of the Nutri-Score within the different food groups is displayed in Table 1.

Table 1: Distribution of the Nutri-Score within the different food groups. ** Fruits based products ; *** Vegetables based products.

    A B C D E Total
Fruits and
vegetables*
  23(48.9%) 7(14.9%) 17(36.2%) 0(0%) 0(0%) 47
  Vegetables*** 20(66.7%) 2(6.7%) 8(26.7%) 0(0%) 0(0%) 30
  Dried fruits 0(0%) 3(60%) 2(40%) 0(0%) 0(0%) 5
  Fruits** 2(33.3%) 0(0%) 4(66.7%) 0(0%) 0(0%) 6
  Soups 1(16.7%) 2(33.3%) 3(50%) 0(0%) 0(0%) 6
Cereals and
potatoes
  56(46.3%) 28(23.1%) 12(9.9%) 16(13.2%) 9(7.4%) 121
  Bread 14(45.2%) 9(29%) 4(12.9%) 4(12.9%) 0(0%) 31
  Cereals 27(49.1%) 10(18.2%) 3(5.5%) 7(12.7%) 8(14.5%) 55
  Legumes 4(44.4%) 1(11.1%) 1(11.1%) 3(33.3%) 0(0%) 9
  Potatoes 4(57.1%) 2(28.6%) 1(14.3%) 0(0%) 0(0%) 7
  Breakfast
cereals
7(36.8%) 6(31.6%) 3(15.8%) 2(10.5%) 1(5.3%) 19
Fish Meat Eggs   17(20.7%) 16(19.5%) 15(18.3%) 22(26.8%) 12(14.6%) 82
  Fish and
seafood
7(25%) 11(39.3%) 6(21.4%) 4(14.3%) 0(0%) 28
  Meat 3(9.4%) 5(15.6%) 9(28.1%) 8(25%) 7(21.9%) 32
  Processed meat 0(0%) 0(0%) 0(0%) 10(66.7%) 5(33.3%) 15
  Eggs 7(100%) 0(0%) 0(0%) 0(0%) 0(0%) 7
Milk and dairy products   61(30.2%) 34(16.8%) 36(17.8%) 57(28.2%) 14(6.9%) 202
  Plant-based
milk
substitutes
0(0%) 1(50%) 0(0%) 1(50%) 0(0%) 2
  Milk and
yogurt
43(50.6%) 20(23.5%) 13(15.3%) 9(10.6%) 0(0%) 85
  Cheese 14(17.9%) 12(15.4%) 15(19.2%) 30(38.5%) 7(9%) 78
  Dairy desserts 3(37.5%) 0(0%) 4(50%) 1(12.5%) 0(0%) 8
  Ice cream 1(3.4%) 1(3.4%) 4(13.8%) 16(55.2%) 7(24.1%) 29
Fat and sauces   1(1.1%) 3(3.2%) 21(22.1%) 54(56.8%) 16(16.8%) 95
  Dressings and sauces 1(1.3%) 3(3.8%) 20(25.3%) 43(54.4%) 12(15.2%) 79
  Fats 0(0%) 0(0%) 1(6.2%) 11(68.8%) 4(25%) 16
Salty snacks   4(4.4%) 2(2.2%) 12(13.3%) 66(73.3%) 6(6.7%) 90
  Appetizers 3(4.6%) 0(0%) 6(9.2%) 53(81.5%) 3(4.6%) 65
  Nuts 0(0%) 1(6.7%) 5(33.3%) 7(46.7%) 2(13.3%) 15
  Salty and fatty products 1(10%) 1(10%) 1(10%) 6(60%) 1(10%) 10
Sugary snacks   3(2%) 6(4%) 3(2%) 43(28.5%) 96(63.6%) 151
  Biscuits and
cakes
1(2.2%) 0(0%) 0(0%) 11(23.9%) 34(73.9%) 46
  Chocolate
products
0(0%) 0(0%) 0(0%) 8(13.3%) 52(86.7%) 60
  Sweets 2(4.4%) 6(13.3%) 3(6.7%) 24(53.3%) 10(22.2%) 45
Composite
foods
  22(10.8%) 56(27.6%) 103(50.7%) 22(10.8%) 0(0%) 203
  One-dish
meals
21(13.7%) 50(32.7%) 72(47.1%) 10(6.5%) 0(0%) 153
  Pizza pies and quiches 1(2.1%) 6(12.8%) 29(61.7%) 11(23.4%) 0(0%) 47
  Sandwiches 0(0%) 0(0%) 2(66.7%) 1(33.3%) 0(0%) 3
Beverages   7(9.1%) 10(13%) 11(14.3%) 8(10.4%) 41(53.2%) 77
  Waters 7(100%) 0(0%) 0(0%) 0(0%) 0(0%) 7
  Teas and
herbal teas and coffees
0(0%) 0(0%) 0(0%) 0(0%) 1(100%) 1
  Fruit juices 0(0%) 4(28.6%) 8(57.1%) 1(7.1%) 1(7.1%) 14
  Fruit nectars 0(0%) 0(0%) 0(0%) 0(0%) 1(100%) 1
  Artificially
sweetened
beverages
0(0%) 5(45.5%) 3(27.3%) 3(27.3%) 0(0%) 11
  Sweetened
beverages
0(0%) 1(2.3%) 0(0%) 4(9.3%) 38(88.4%) 43
Sum   194
(18.2%)
162
(15.2%)
230
(21.5%)
288
(27%)
194
(18.2%)
1068
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Conclusion

Overall, the distribution of the FSAm-NSP score displayed a high variability in the 7 countries, confirming its validity for use in the 5-category label Nutri-Score in different sociocultural contexts. Moreover, the distribution in the FSAm-NSP score showed a high consistency between the classification and dietary recommendations: overall, products composed mainly of fruits and vegetables, bread and cereals scored consistently more favorably than sugary or salty snacks. Composite dishes displayed a very large distribution, highlighting the variability of the products in this specific category.

The classification of the different food groups in the Nutri-Score displayed a high consistency with nutritional recommendations: the majority of products containing mainly fruits and vegetables were classified as A or B , while a majority of sugary snacks were classified as D or E. This variability was also displayed within food groups: in the bread and cereals group, legumes + pasta and rice were consistently better classified than breakfast cereals; in dairy, milk and yogurt were better classified than cheese.

Finally, in beverages, while a majority of fruit juices were classified as C, soft drinks were classified as E, consistently with nutritional recommendations (onlu water is in A).

Overall, the discriminating power of the Nutri-Score (number of categories in the Nutri-Score available for each food group) was high, as foods were classified in more than 3 categories of the Nutri-Score, both for food groups and for subgroups of foods.

Therefore, overall, the Nutri-Score displays a high consistency with nutritional recommendations, and allows consumers to graps the very high variability in the nutritional composition of foods. The discriminating power of the Nutri-Score can be used to help consumers making healthier choices at the point of purchases, by displaying with at-a-glance labelling the nutritional quality of products.

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References

  1. Julia C, Ducrot P, Peneau S et al. Discriminating nutritional quality of foods using the 5-Color nutrition label in the French food market: consistency with nutritional recommendations. Nutr J. 2015;14:100.
  2. Szabo de Edelenyi F, Egnell M, Galan P, Druesne-Pecollo N, Hercberg S and Julia C. Ability of the Nutri-Score front-of-pack nutrition label to discriminate the nutritional quality of foods in the German food market and consistency with nutritional recommendations. Arch Public Health. 2019;77:28.
  3. Rayner M, Scarborough P, Stockley L, and Boxer A. Nutrient profiles: development of Final model. Final Report . Available from: https://www.researchgate.net/publication/266447771_Nutrient_profiles_Development_of_Final_Model_Final_Report.
  4. Rayner M, Scarborough P, and Stockley L. Nutrient profiles: Applicability of Currently Proposed Model for Uses in Relation to Promotion of Foods in Children Aged 5-10 and Adults. [Internet]. Available from: https://www.researchgate.net/publication/267952402_Nutrient_profiles_Applicability_of_currently_proposed_model_for_uses_in_relation_to_promotion_of_food_to_children_aged_5-10_and_adults.
  5. Rayner M, Scarborough P, and Lobstein T. The UK Ofcom Nutrient Profiling Model – Defining ‘healthy’ and ‘unhealthy’ food and drinks for TV advertising to children. [Internet] Available from: https://www.ndph.ox.ac.uk/cpnp/files/about/uk-ofcom-nutrient-profile-model.pdf.
  6. ANSES. Evaluation de la faisabilité du calcul d’un score nutritionnel tel qu’élaboré par Rayner et al. Rapport d’appui scientifique et technique.ANSES :Maison Alfort. Available from: https://www.anses.fr/fr/system/files/DER2014sa0099Ra.pdf.
  7. Haut Conseil de la Santé Publique. Avis relatif à l’information sur la qualité nutritionnelle des produits alimentaires. Paris :HCSP. Availablefrom: http://www.hcsp.fr/Explore.cgi/avisrapportsdomaine?clefr=519.

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