Serge Hercberg, Pilar Galan, Manon Egnell, Chantal Julia, Mathilde Touvier
Equipe de Recherche en Epidémiologie Nutritionnelle, Inserm/Inra/Cnam/ Université Paris 13
During interviews given to various media outlets and interventions on social networks, Mr Matteo Salvini accuses the front-of-pack nutrition label Nutri-Score of being the support of an operation secretly led by the European Union against the Mediterranean diet and products «made in Italy» (https://twitter.com/matteosalvinimi/status/1202197787347173376?s=20).
To support his “conspiracy” theory, Mr Salvini relies on inaccurate declarations and incorrect and truncated examples of application of the Nutri-Score. It shows how unfamiliar he is with the Nutri-Score and he tries to subvert it to serve interests that have nothing to do with science and public health. His pseudo-arguments have also been taken up by Lega MEPs who, under the impetus of Silvia Saldone, submitted a written question to the Commission on the «Nutri-Score system: risks for Italian-made products» (http://www.europarl.europa.eu/doceo/document/P-9-2019-004228_EN.html).
Italian scientists concerned with the health of the population reacted and published on December 13th a statement to restore the truth about the Nutri-Score and its interest in terms of public health (https://www.scienzainrete.it/articolo/nutri-score-perch%C3%A9-non-dobbiamo-averne-paura/2019-12-13).
In the same line the designers of the Nutri-Score wanted to respond to the various accusations of Mr Salvini.
Nutri-Score is a public health tool developed by independent scientists and not by “European technocrats”
The Nutri-Score is not a creation of «technocrats of the European Union» as Mr Salvini claims, but was developed by researchers specialized in Nutrition and Public Health at the Paris 13 University (France). They are academics and researchers from the French National Health and Medical Research Institute (INSERM), the French National Institute for Agronomic Research (INRA) and the National Conservatory of Arts and Crafts (CNAM), independent of any conflict of interest and working these many years on investigating the public health measures which could be implemented to improve the nutritional and health status of populations.
The implementation of a complementary interpretative nutritional information system on the front of food packages is recommended by national and international expert committees, including WHO, which has for several years considered this type of labels to be an effective measure to help consumers adopt healthier eating behaviours.
It is within this context that the Nutri-Score was developed. Intended to be displayed on the front of package of foods, it has a dual objective: 1) to help consumers at the point of purchase identify, at a glance, the overall nutritional quality of foods and help them compare products and guide their choices toward healthier products and improve their behaviours, 2) to encourage manufacturers to reformulate the nutritional composition of the foods they produce, to be better positioned on the Nutri-Score scale compared to their competitors, and eventually improve the overall nutritional quality of the food supply.
The Nutri-Score is based on an extremely solid scientific background (more than 40 studies published in international peer-reviewed journals) that have validated the algorithm underlying its computation (including cohort studies testing the associations with the risk or prevention of chronic diseases such as cancer, cardiovascular disease, obesity…, and mortality) and demonstrated its effectiveness in helping consumers making healthier choices (https://solidarites-sante.gouv.fr/prevention-en-sante/preserver-sa-sante/nutrition/article/articles-scientifiques-et-documents-publies-relatifs-au-nutri-score). Various studies have also highlighted its superiority over other existing labels or labels supported by various lobbies. Its colour-coded format (from green to red) coupled with letters (from A to E) makes it a simple, intuitive and understandable tool for consumers. Based on its effects on the nutritional quality of purchases, if the label was displayed on all foods of the market, the Nutri-Score would be associated, in France, to a reduction in mortality from nutrition-related chronic diseases by 3.4% using an internationally recognized simulation model (https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-019-0817-2).
Given the major public health issues related to nutrition (obesity, diabetes, cardiovascular disease, cancers, etc.), the Nutri-Score has been implemented by some European States on the basis of the scientific and public health elements that validate it, the support of public health agencies and learned societies and the demand from consumers who support it. It was adopted by France (October 2017), Belgium (April 2018), Spain (November 2018), Germany (September 2019) and Holland (November 2019). It is currently being discussed in many other European countries.
It should be noted that contrary to what Mr Salvini says, the Nutri-Score has never been supported by the European Commission, which, through its specific regulation on consumer information (INCO) voted in 2011 and implemented in 2014 (with effective pressure from lobbies) prohibit member-states from making a label (such as the Nutri-Score) mandatory on the front of food packages. The current EU regulation is blocking since it allows member-states to adopt the Nutri-Score (or any other label) only on a voluntary basis. It should be noted that European consumer associations have launched a European Citizens’ Initiative (pronutriscore.org) to force the European Commission to revise its INCO regulation to allow the Nutri-Score to become mandatory. It is therefore consumers, with the support of scientists and public health experts, and not the EU, who are now calling for the Nutri-Score to be rolled out throughout Europe and to become mandatory on all products.
The Nutri-Score is absolutely not opposed to the Mediterranean diet. On the contrary!
Among the arguments put forward by Mr Salvini and the Lega MPs, the « Nutri-Score would aim to destroy the Mediterranean diet ». Nonsense ! Obviously, the Nutri-Score is not a weapon against the Mediterranean diet which, in its original version, is a food model supported by all nutritionists (especially those who designed and developed the Nutri-Score) and included in the nutritional recommendations throughout most of Europe, from North to South. To support his theory, Mr Salvini highlights the fact that the Nutri-Score ranks Pecorino Romano, Gorgonzola, Prosciutto, San Daniele ham and olive oil in the less nutritionally favorable categories (i.e. D and E, according to him). With these examples, he asserts that the Nutri-Score aims to oppose the Mediterranean diet… This is totally absurd for several reasons:
a) The Mediterranean diet is not limited to eating Pecorino romano, Gorgonzola, Prosciutto or San Daniele ham… The Universal Piramide of Dieta Mediterranea (see figure) highlights that the Mediterranean diet is characterized by an abundant consumption of fruits, vegetables, pulses, cereals (especially whole-cereals), a moderate consumption of fish, a limited consumption of dairy products and a low consumption of meat, processed meat and sugary, fat and salty products; and favours olive oil among added fats without recommending its ad libitum consumption…
Therefore, the Mediterranean diet does not promote in any way, as Mr Salvini suggests, cheeses and deli meats (whether Italian or not!). They are not major pillars of the Mediterranean food pyramid. This is in total consistency with the classification provided by the Nutri-Score which classifies more favourably low-fat, -sweet and -salty foods or dishes rich in fiber, fruits and vegetables, legumes and nuts. When we compare the recommendations of the pyramid characterizing the Mediterranean diet and the Nutri-Score, we can note the good convergence.
b) If the majority of cheeses and processed meats (and not only Italian ones) are ranked D and sometimes E, this is explained by the fact that they contain significant amounts of saturated fats and salt and are also high in calories… But like all the products classified D or E with the Nutri-Score, cheeses and processed meats can be perfectly consumed as part of a balanced diet. Informing consumers about the reality of the nutritional quality of these traditional foods does not exclude their consumption but, they should be consumed in limited quantities/frequencies, which is fully consistent with the principles of the Mediterranean food model and with the significance of their ranking on the Nutri-Score scale.
c) However, pasta, risotto, polenta, multiple sauces and sughi and even some pizzas are rated A or B in the Nutri-Score system, and they also represent the richness of traditional Italian foods!d) Concerning olive oil, it is not red/E as stated by Mr Salvini! It is classified C, that correspond to the best score possible for added fats and even for vegetable oils! The public health recommendations in Italy and elsewhere do not suggest consuming olive oil without limits (it is a 100% fat product which is highly caloric like the others) but they encourage consumers to favour it over other vegetable oils and especially over animal fats. This is what the Nutri-Score contributes to, as jt classifies olive oil with the best possible score (C) for vegetable oils (with rapeseed oil and walnut oil) and therefore better ranked than soya, sunflower, corn oils (classified D), coconut or palm (classified E) and butter (classified E).
d) Concerning olive oil, it is not red/E as stated by Mr Salvini! It is classified C, that correspond to the best score possible for added fats and even for vegetable oils! The public health recommendations in Italy and elsewhere do not suggest consuming olive oil without limits (it is a 100% fat products that is caloric like the others) but they encourage consumers to favour it over other vegetable oils and especially over animal fats. This is what the Nutri-Score contributes to, as jt classifies olive oil with the best possible score (C) for vegetable oils (with rapeseed oil and walnut oil) and therefore better ranked than soya, sunflower, corn oils (classified D), coconut or palm (classified E) and butter (classified E).
The Nutri-Score does not classify foods as « healthy » or « unhealthy » but helps to compare the nutritional quality in relative value of foods that have relevance to be compared
Comparing olive oil to Coca Cola Light makes no sense. The question does not arise in this way for consumers at the point of purchase or food consumption! Indeed, it is very unlikely that consumers would consider seasoning their salad with Coca-Cola or refreshing themselves with olive oil… In reality, consumers need to be able to compare the nutritional quality of foods that are relevant to be substituted in their consumption, use or purchasing conditions. If they want to choose a bottle of oil they will easily see on supermarket shelves thanks to the display of the Nutri-Score, that olive oil is the best ranked compared to other oils. They will also see that water is the only beverage classified in A and that regular soft drinks are classified in E…
It should be kept in mind that the objective a front-of-pack nutrition label such as the Nutri-Score is not to classify, as Mr Salvini thinks, foods as “healthy food” or “unhealthy food”, in absolute value, as a binary logo would do (good vs bad). Such a purpose for a nutritional label would remain totally questionable because healthiness is linked to the amount of foods consumed and the frequency of its consumption, but also to the overall food balance of individuals (the nutritional balance is not achieved through the consumption of a limited food intake, or even over a meal or over a day… ). These complex concepts cannot, of course, be summarized by a nutritional label attributed to a specific brand product… No, the objective of the Nutri-Score is to provide information to consumers, in relative value, that allows them, at a glance, to compare the nutritional quality of foods. This is already very important to guide their choices at the time of purchases. But the comparison of nutritional quality of foods is of interest only if it is relevant, especially if it concerns foods which the consumer is confronted with comparing in real life (at the time of his act of purchase or consumption). Furthermore, by definition, the Nutri-Score does not invent anything, it only reproduces in synthetic form the elements of the nutritional composition which appear on the table of nutrition values present on the back of the packaging.
Here again it is important to remind that the Nutri-Score allows to compare nutritional quality:
- of foods belonging to the same category, for example in the breakfast cereal family, comparing mueslis versus chocolate cereals versus chocolate and filled cereals; compare dry cookies versus fruit cookies versus chocolate cookies; or meat lasagna, salmon lasagna, spinach lasagna; or different pasta dishes; different types of pizzas; or different types of drinks (water, fruit juice, fruit drinks, sodas, etc. ). In each of these categories, the Nutri-Scores can vary from A to E, which provides useful information for consumers during their choices,
- of the same type of foods from different brands (e.g., comparing chocolate and filled cereal from one brand to its “equivalent” of another brand or chocolate cookies from different brands). Again, the Nutri-Scores can vary from A to E, which is also useful information to help consumers recognize foods of better nutritional quality,
- of foods belonging to different families provided that there is a real relevance in their conditions of use or consumption (and which are often close in supermarket shelves) : yogurts compared to desserts; breakfast cereals compared to cookies, bread or pastries…
In this context, as many scientific studies have demonstrated, the Nutri-Score works perfectly well and is in line with the traditional model of the Mediterranean diet towards which the recommendations in most countries tend. It should be noted that Spain, a typical Mediterranean country, and France (which also has a Mediterranean gastronomic culture in the south), which make public health recommendations aiming to promote the Mediterranean diet, have adopted the Nutri-Score!
The Nutri-Score: a public health tool developed in the interest of consumers even if it goes against the commercial interests of some industrial groups
In fact, the Nutri-Score disturbs large multinational food companies and lobbies that refuse to adopt it and continue to fight its implementation at the international level. If Nestlé has finally complied with consumer demand (after several years of fighting) the big foods companies like Ferrero, Cocacola, Pepsico, Mars, Mondelez, Unilever, Kellogg’s… still reject it.
Italian cheeses are not classified worse by the Nutri-Score than other cheeses from European countries, whether French, Spanish, Dutch , German, Greek or Swiss: Roquefort is classified E, Bleu d’Auvergne E, Gouda E, Manchego D or E, Mimolette E, Brie de Meaux D, Emmental D, Conté D, Saint-Nectaire D, Camembert D, Fêta D or E, … Note that among the rare traditional cheeses classified C (the best score for cheese), we find the famous Italian cheeses Mozzarela, Burrata and Ricotta… Similarly Italian processed meats are not specifically targeted: if San Daniele ham ranks D, this is also the case for the French Bayonne ham or the Spanish Serrano ham, etc. As for salami, it finds itself at the same level as the rosette of Lyon, the Spanish chorizo and all the others sausages in Europe…
So it is clear that the Nutri-Score does not aim to penalize the products «made in Italy», nor «made in France» (the manufacturers of Foie gras, Roquefort, butter, or sausages of Strasbourg could also feel penalized) or « made in Spain » (with Serrano ham, manchego or chorizo, etc.). It only aims to provide transparency on the nutritional quality of foods and help consumers to guide their choices (without ever saying that a product should not be consumed but that it should be placed as part of a balanced diet…). It is totally incorrect to suggest that the Nutri-Score was developed to harm “made in Italy” products (or “made anywhere else”!) or would be a construction of Europe to attack traditional Italian products ! No, the Nutri-Score is only “made in Public Health”!
In his arguments, Mr Salvini defends the interests of certain Italian industrial groups but is never concerned about the health of Italian consumers… The Nutri-Score has been developed for the benefit of consumers and responds to their demand, even if it goes against some economic interests.
1] Mr Matteo Salvini is former Vice-president of the Council of Italian Ministers (June 2018 – September 2019); Senator since January 2018; Federal Secretary of the Lega since December 2013