Auteur : logonutriscore

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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.

¡Para que el Nutri-Score sea eficaz es necesario que se le añada a todos los alimentos! Para obligar a todos los industriales a ponerlo en sus envases, los consumidores pueden ejercer presión sobre la Comisión Europea para que sea obligatorio, firmando la petición de la Iniciativa Ciudadana Europea PRO-NUTRISCORE

Pr Serge Hercberg1,2, Dr Pilar Galan1, Dr Mathilde Touvier1, Manon Egnell1, Dr Chantal Julia1,2

1 Nutritional Epidemiology Research Team (EREN), U1153 Inserm/Inra/ Cnam/ Université Paris 13        
2   Department of Public Health, Hôpital Avicenne, AP-HP

Tras una batalla de varios años, el logotipo nutricional Nutri-Score  fue adoptado oficialmente en Francia en octubre 2017, y más recientemente por otros países (Bélgica, España).  Destinado a ser posicionado en la cara frontal de los envases de alimentos este logotipo nutricional tiene como finalidad informar a los consumidores, de manera sencilla y comprensible, de la calidad nutricional global de los alimentos y ayudarles a comparar los productos entre ellos para orientar sus selecciones hacia alimentos más saludables. El segundo objetivo de Nutri-Score es animar a los fabricantes a mejorar la calidad nutricional de sus alimentos a través reformulaciones y/o innovaciones para que se posicionen mejor sus productos en la escala de colores del Nutri-Score. El interés del Nutri-Score es el hecho que se basa en un expediente científico muy completo. Más de 35 trabajos publicados en revistas científicas internacionales han permitido validar su método de cálculo y su forma gráfica, demostrando así su eficacia y superioridad con respecto a los otros logotipos nutricionales existentes, sobre todo los propuestos por diversos grupos de presión.

Desarrllado por el Equipo de Investigación en Epidemiología Nutricional (inserm/inra/Cnam/Universidad París 13), un equipo de investigadores académicos independientes, Nutri-Score comprende 5 clases de calidad nutricional, que van del verde (asociado con la letra A) al naranja oscuro/rojo (asociado con la letra E). El algoritmo en el que se basa la NutriScore atribuye a cada alimento una puntuación única en función de su composición nutricional en elementos negativos (calorías, azúcares simples, ácidos grasos saturados y sodio) y positivos (fibras, porcentaje de frutas y hortalizas y proteínas).

No obstante, a la fecha de hoy, la aposición del Nutri-Score depende totalmente de la buena voluntad de los industriales que pueden negarse a colaborarlo en sus productos. En efecto, debido a una normativa europea (INCO) votada hace algunos años (y redactada en un contexto de presiones importantes de poderosos grupos de presión) los estados miembros no pueden obligar la aposición de un logotipo nutricional como Nutri-Score en los productos alimenticios. Por esta razón, si un cierto número de industriales y grandes distribuidores han aceptado hacerlo después de  la publicación oficial del decreto que anunció Nutri-Score como el único logotipo apoyado por los poderes públicos en Francia, decisión tomada posteriormente  por Bélgica y España, grandes multinacionales (entre otras, Coca-Cola, PepsiCo, Mars, Unilever, Mondelez, Ferrero o Kellogg’s ) siguen negándose a anadirlo en sus productos impidiendo a los consumidores de una verdadera transparencia sobre la calidad nutricional de sus productos. Coca-Cola incluso ha adoptado recientemente un sistema de tipo ‘semáforos tricolores múltiples’ sobre sus productos en Francia, intentando competir con Nutri-Score y provocando cada vez más confusión en los consumidores…

Probablemente hay una segunda idea detrás del rechazo de Nutri-Score por estas grandes multinacionales.  El portafolio de los alimentos de estas empresas contiene productos especialmente dulces, grasos o salados, por lo que se clasifican más bien en D o E en la escala de Nutri-Score. Se trata, entre otros, de bebidas azucaradas, barras a base de chocolate, dulces, galletas dulces, cereales del desayuno, helados o biscuits de aperitivo.  Por ejemplo, para los grupos Mars y Ferrero, 100 % de los alimentos de estas compañías se clasifican en D o E; 86 % de sus productos para Mondelez; 54 % para Coca-Cola; y 52 % para Unilever; 50 % para Kellogg’s y 46 % para Pepsico (https://theconversation.com/logo-nutritionnel-pourquoi-certains-industriels-font-de-la-resistance-87424).

Algunas de estas grandes empresas siguen intentando por todos los medios bloquear la adopción del Nutri-Score a nivel europeo. Los métodos utilizados utilizan diferentes estrategias que convergen para evitar una adopción generalizada de Nutri-Score en Europa. Para ello proponen logos alternativos, que, sin gran sorpresa, favorecen sus productos como es el caso del logo Evolved Nutrition Label, derivado de los semáforos tricolores inglés pero que, por una sutil manipulación (su cálculo por porción en lugar de por 100g), permite hacer «palidecer» los colores haciendo pasar el rojo al naranja, induciendo así a los consumidores a error sobre la composición nutricional real de los productos. Otras alternativas propuestas parecen muy poco comprensibles para los consumidores, como los círculos nutricionales propuestos por la asociación de los industriales alemanes BLL, los Aportes de Referencia (GDA o RI) apoyados por numerosos industriales, o incluso el sistema de baterías propuesto por el gobierno italiano (país donde el peso económico de grupos agroalimentarios con poder como Ferrero o los sectores de la charcutería y de los quesos italianos sigue siendo importante…). Además, el sistema italiano parece especialmente contra-intuitivo, representando el contenido de nutrientes a través del icono utilizado tradicionalmente para controlar la carga de un teléfono o de un aparato eléctrico, pero curiosamente utilizado en el logotipo italiano en sentido inverso (¡cuanto más «descargada» es la batería, mejor es la calidad nutricional del alimento!). Pero además de proponer alternativas que les favorecen (en la construcción o en la dificultad de interpretación de un sistema complejo), estas multinacionales se focalizan  enredando los mensajes y  multiplicando los logotipos para marginalizar Nutri-Score e impedir que sea aceptado oficialmente por un máximo de países europeos.


LAS ALTERNATIVAS PROPUESTAS AL NUTRI-SCORE POR DIFERENTES GRUPOS DE PRESION

        

La movilización de determinados políticos (parlamentarios nacionales, eurodiputados e incluso ministros) es también una estrategia clásica utilizada por estas grandes multinacionales para bloquear o retrasar la adopción del Nutri-score a nivel los estados miembros. Esto es lo que se ha visto recientemente en Alemania donde, según la organización Foodwatch que reveló correos internos del Ministerio Federal de Agricultura (https://www.foodwatch.org/de/pressemitteilungen/2019/interne-e-mails-zeigen-julia-kloeckner-verheimlicht-studie-zur-naehrwertkennzeichnung/?L), la Ministra de Agricultura (considerada por las asociaciones de consumidores como próxima a sectores de la industria) se negó a hacer público un primer informe científico que había encargado a un instituto de investigación sobre los logotipos nutricionales, considerando que era demasiado favorable al Nutri-Score (el segundo informe presentado públicamente por la ministra era mucho más matizado…).  Estas presiones políticas también se han manifestado recientemente, en vísperas de una reunión del Codex Alimentarius, a través de una declaración oficial del embajador de Italia a la OMS oponiéndose a un informe técnico de la OMS sobre los logotipos nutricionales, negando totalmente los trabajos científicos existentes para defender los productos alimenticios italianos (https://theconversation.com/etiquetage-nutritionnel-la-guerre-du-parmesan-et-du-prosciutto-116905)… Algunos meses antes, fue la embajadora de Italia en Bruselas la que intentó convencer al Ministerio de Sanidad belga para que renunciara a la adopción de Nutri-Score (https://www.eunews.it/2018/11/28/continua-la-battaglia-italiana-le-etichette-nutriscore-ora-si-combatte-belgio/112079).

Aunque 116 empresas (industriales y distribuidores) han aceptado hasta la fecha de hoy colocar el Nutri-Score en Francia, lo que representa entre el 20 % y el 25 % del mercado alimentario francés (véase la lista en el sitio web de Santé Publique France : https://www.santepubliquefrance.fr/Sante-publique-France/Nutri-Score) y si otros han hecho lo mismo en Bélgica, Alemania y España, está claro que las grandes multinacionales todavía no están dispuestas a unirse a este movimiento positivo y útil para los consumidores. Estas grandes multinacionales que se oponen a anadir el Nutri-Score representan varios centenares de marcas. Si analizamos las 10 empresas agroalimentarias más grandes del mundo, representan casi 500 marcas diferentes (472 en 2015 según OXFAM) lo que supone una gran parte de la oferta alimentaria puesta a disposición de los consumidores. De estas 10 multinacionales 8 se niegan a colocar el Nutri-Score en sus productos (sólo Danone y Nestlé han aceptado).

LAS 10 MAYORES EMPRESAS AGROALIMENTARIAS Y SUS DIFERENTES MARCAS

Image associée

Otras empresas industriales (aparte del Top 10) también siguen reacias a aplicar el Nutri-Score, es el caso de Lactalis, Ferrero, Aoste, Bel, Lesieur, Bigard, Harris, y muchas otras que fabrican productos muy difundidos en las estanterías de los supermercados. Esto supone una pérdida de información para los consumidores que no tienen acceso a una información sintética, sencilla e intuitiva para muchos productos presentes en las estanterías de los supermercados o en las tiendas de comestibles. Y esto pese a que el deseo de transparencia sobre la calidad nutricional de los alimentos sea una fuerte demanda de los consumidores que recurren cada vez más a aplicaciones móviles que ofrecen este tipo de información incluso para las marcas que no aplican el Nutri-Score.

Es cierto que la presión de los consumidores puede repercutir sobre las marcas que se niegan a mostrar el Nutri-Score evitando o boicoteando sus productos, basándose en la premisa que « ¡si no lo muestran, es porque tienen cosas que ocultar! ». Pero la mejor solución para los consumidores, que les permitiría en el contexto del momento de la compra, si lo desean, integrar la dimensión nutricional en sus hábitos de compra, sería obligar a todos los operadores económicos a colocar el Nutri-Score para que todos los productos vendidos contengan el etiquetado nutricional frontal. Razón por la cual,  la aposición del Nutri-Score debería ser obligatoria, lo cual requiere modificar el Reglamento europeo relativo a la información de los consumidores (INCO) adoptado en 2011 por el parlamento europeo y cuyas disposiciones principales entraron en vigor el 13 de diciembre de 2014. Este Reglamento, adoptado tras varios años de debate, impuso obligatorio un etiquetado que se materializó en un cuadro de cifras nutricionales en la parte posterior de los envases (que los estudios han demostrado que es poco utilizado por los consumidores, dada la complejidad de su presentación e interpretación) y, prohibió a los estados europeos añadir de forma obligatoria un sistema de información nutricional complementario en la cara frontal de los envases. Los grupos de presión de la industria gastaron 1000 millones de euros a escala europea en 2015 (cifra nunca desmentida por la industria agroalimentaria, cifra que hay que interpretarla comparándola a los 985.000 millones de euros recaudados por este sector) para impedir la introducción de un logotipo nutricional en la parte frontal de los envases.

Modificar un reglamento europeo mediante el procedimiento político clásico es, además del problema planteado sobre los fuertes grupos de presión que se oponen a ello, un proceso particularmente largo, complejo e incierto (teniendo en cuenta también que algunos estados próximos a sus sectores industriales agroalimentarios son capaces de bloquear el proceso…). Existe otro procedimiento para que la Comisión Europea (CE) revise el Reglamento que impide la obligatoriedad de la puntuación nutricional y es la iniciativa ciudadana europea (ICE), que es una innovación del Tratado de Lisboa, aplicada de forma efectiva en mayo de 2012 y que confiere un derecho de iniciativa política a una peticion de al menos un millón de ciudadanos de la Unión Europea reagrupando como mínimo un cuarto de los países miembros. La Comisión Europea puede verse obligada a redactar nuevas propuestas de actos jurídicos sobre la base de las peticiones de los ciudadanos.

Se trata de una oportunidad única para movilizar a la Comisión y permitir debatir el hecho de hacer obligatoria y exclusiva la aplicación del Nutri-Score en Europa. Sin embargo, es necesario que se reúnan las condiciones establecidas para presentar una iniciativa ciudadana europea y que la solicitud sea admisible y registrada por la CE. Así se ha hecho con la iniciativa ciudadana europea «PRO-NUTRISCORE», lanzada gracias a la iniciativa de siete asociaciones de consumidores miembros de la BEUC (Oficina Europea de Asociaciones de Consumidores): UFC-Que Choisir (Francia), Test-Achat (Bélgica), VZBV (Alemania), Consumentenbond (Holanda), OCU (España), Federajca Konsumentow (Polonia) y EKPIZO (Grecia).
Ha sido registrada el 8 de mayo de 2019 con el número ECI(2019)000008, su objetivo es pedir a la Comisión Europea para que imponga el etiquetado simplificado «Nutri-Score» en los productos alimenticios para garantizar una información nutricional de calidad a los consumidores europeos y proteger su salud. Con 3 finalidades:

  1. Simplificar la lectura y la comprensión del etiquetado nutricional: comprender el valor nutricional de un alimento con un solo vistazo frente a la diversidad de la oferta alimentaria;
  2. Influir sobre las problemáticas de salud pública incitando a los profesionales a mejorar la composición de sus productos;
  3. Unificar la información nutricional a nivel europeo imponiendo un etiquetado oficial único que permita acabar con la confusión de los consumidores europeos ante la multitud de logotipos existentes.  

El registro de esta iniciativa ciudadana europea es un primer éxito (muchas de ellas han sido rechazadas). Sin embargo, para que esta iniciativa se lleve a término, todavía hay  por reunir un millón de firmas en menos de un año repartidas en como mínimo 7países europeos y registradas en el sitio web de la Comisión Europea (www.pronutriscore.org).

No es una cosa sencilla: sólo cuatro de las 64 iniciativas ciudadanas propuestas a la Comisión Europea pudieron registrarse y recuperar más de un millón de firmas. Pero los ciudadanos/consumidores tienen, a través de esta ICE, la posibilidad de influenciar a la Comisión. Se trata de un elemento de democracia participativa en el funcionamiento de la Unión Europea que puede ser un medio para hacer avanzar la salud pública en beneficio de los consumidores pese a los grupos de presión que se oponen.

Al hacer clic en el enlace www.pronutriscore.org, cada ciudadano/consumidor se le dirige al portal securizado de la Comisión Europea para registrar su firma.  Los datos exigidos para firmar la petición (número de documento de identidad o de pasaporte) derivan de la normativa sobre la iniciativa ciudadana europea. Estos datos están alojados y securizados por la Comisión Europea y, evidentemente, no son objeto de ningún intercambio o transferencia.

Los investigadores en nutrición y salud pública solo pueden apoyar esta iniciativa de las asociaciones de consumidores, que constituye una oportunidad excepcional para que los ciudadanos puedan influenciar en la Comisión Europea para obtener los beneficios de esta medida en materia de salud pública y hace que prevalezca sobre la defensa de intereses económicos. Podríamos esperar que Nutri-Score se encuentre mañana en todos los productos alimenticios puestos a disposición de los consumidores permitiéndoles comparar, en un solo vistazo, la calidad nutricional de los alimentos y poder integrar esta dimensión en sus actos de compra. A través de esta simple medida, los consumidores tendrán  la posibilidad, en su vida cotidiana, de poder mejorar sus selecciones alimentarias y tender a aportes nutricionales más saludables, y al mismo tiempo acceder a una oferta alimentaria de mejor calidad nutricional. Esto es importante debido a los grandes retos de salud pública vinculados a la nutrición debido a su papel principal reconocido en el riesgo o la protección frente a enfermedades crónicas como las enfermedades cardiovasculares, ciertos cánceres, obesidad, diabetes… Esta transparencia nutricional, tan útil para la salud, es un derecho de los consumidores y una obligación de los que fabrican los alimentos o los distribuyen, que no deben de ninguna forma sustraerse a ella.
Por eso es necesario firmar esta petición ciudadana. Nosotros la firmamos y les invitamos a hacer lo mismo: www.pronutriscore.org

À la Une

Pour que le Nutri-Score soit efficace, il faut qu’il soit affiché sur tous les aliments ! Afin de contraindre tous les industriels à l’afficher, les consommateurs peuvent faire pression sur la commission Européenne pour le rendre obligatoire, en signant la pétition de l’Initiative Citoyenne Européenne PRO-NUTRISCORE !

Pr Serge Hercberg (1,2), Dr Pilar Galan (1), Dr Mathilde Touvier (1),
Manon Egnell (1),    Dr Chantal Julia (1,2)

(1) Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), U1153 Inserm/Inra/Cnam/Université Paris 13

(2) Département de Santé Publique, Hôpital Avicenne, AP-HP

Après une bataille de plusieurs années, le logo nutritionnel Nutri-Score a été adopté officiellement par la France en octobre 2017, et plus récemment par plusieurs autres pays européens (Belgique, Espagne). Destiné à être apposé sur la face avant des emballages des aliments, il a pour objectif d’informer les consommateurs, de façon simple et compréhensible, sur la qualité nutritionnelle globale des aliments et les aider à comparer les produits entre eux pour orienter leurs choix vers des aliments plus favorables à la santé. Le deuxième objectif du Nutri-Score est de pousser les fabricants à améliorer la qualité nutritionnelle de leurs aliments au travers de reformulations et/ou innovations dans le but d’être mieux positionnés sur l’échelle de couleurs du Nutri-Score .

L’intérêt du Nutri-Score est qu’il s’appuie sur un dossier scientifique très complet. Plus de 35 travaux publiés dans des revues scientifiques internationales ont permis de valider son mode de calcul et son format, et de démontrer ainsi son efficacité et sa supériorité par rapport aux autres logos existants, notamment ceux proposés par divers groupes de pression.

Conçu par l’Equipe de Recherche en Epidémiologie Nutritionnelle (Inserm/Inra/Cnam/Université Paris 13), une équipe de chercheurs académiques indépendants, Nutri-Score comprend 5 classes de qualité nutritionnelle,  allant du vert (associé à la lettre A) à l’orange foncé/rouge (associé à la lettre E). L’algorithme sous-tendant le NutriScore attribue à chaque produit alimentaire un score unique en fonction de sa composition nutritionnelle en éléments négatifs (calories, sucres simples, acides gras saturés et sodium) et positifs (fibres, pourcentage de fruits et légumes et protéines).

Cependant, aujourd’hui, l’apposition du Nutri-Score dépend totalement de la bonne volonté des industriels qui peuvent refuser de jouer le jeu de l’afficher sur leurs produits. En effet, du fait d’une réglementation européenne (INCO) votée il y a quelques années (et rédigée dans un contexte de pressions importante de puissants lobbys) les états-membres n’ont pas la possibilité de rendre obligatoire l’apposition d’un logo nutritionnel comme le Nutri-Score sur les produits alimentaires. De ce fait, si un certain nombre d’industriels et de grands distributeurs ont accepté de le faire, depuis la parution de l’arrêté l’officialisant comme le seul logo soutenu par les pouvoirs publics en France puis son adoption par la Belgique et L’Espagne, de grosses multinationales (entre autres Coca-Cola, PepsiCo, Mars, Unilever, Mondelez, Ferrero ou Kellogg’s) refusent toujours de l’afficher sur leurs produits et donc de fournir aux consommateurs une réelle transparence sur la qualité nutritionnelle de ces aliments. Coca-Cola a même récemment adopté un système de type ‘feux tricolores multiples’ sur ses produits en France, entrant alors en concurrence avec le Nutri-Score entraînant de plus en plus de confusion chez les consommateurs…
Ce n’est peut-être pas sans arrière-pensée que ces grandes multinationales refusent le Nutri-Score. Le portefeuille d’aliments de ces sociétés contient des produits particulièrement sucrés, gras ou salés, donc classés plutôt en D ou E sur l’échelle du Nutri-Score. Il s’agit, entre autres, de boissons sucrées, de barres chocolatées, de confiseries, de biscuits sucrés, de céréales du petit déjeuner, de glaces ou encore de biscuits apéritifs. Par exemple, pour les groupes Mars et Ferrero, 100 % des aliments de ces firmes sont classés en D ou E; pour Mondelez, c’est 86 % de leurs produits ; 54 % pour Coca-Cola ; 52 % pour Unilever ; 50 % pour Kellogg’s et 46 % pour PepsiCo (https://theconversation.com/logo-nutritionnel-pourquoi-certains-industriels-font-de-la-resistance-87424).

Certaines de ces grosses sociétés continuent par tous les moyens d’essayer de bloquer l’adoption du Nutri-Score au niveau européen. Les méthodes utilisées font appel à différentes stratégies qui convergent pour éviter une adoption généralisée du Nutri-Score en Europe. Cela passe par la proposition d‘alternatives de logos qui, sans grande suprise, avantagent leurs produits comme le logo Evolved Nutrition Label, dérivé des feux tricolores anglais mais qui, par une subtile manipulation (le calcul par portion plutôt qu’aux 100g), permet de faire « pâlir » les couleurs faisant passer le rouge en orange, induisant ainsi les consommateurs en erreur sur la composition nutritionnelle réelle des produits. D’autres alternatives proposées paraissent très peu compréhensibles pour les consommateurs comme les cercles nutritionnels proposé par l’association des industriels allemands BLL, les Apports de Référence (GDA ou RI) soutenus par de nombreux industriels, ou encore le système des batteries proposé par le gouvernement italien (pays où le poids économique de groupes agro-alimentaires puissants comme Ferrero ou les filières de la charcuterie et des fromages italiens reste important…). Le système italien semble d’ailleurs particulièrement contre-intuitif, représentant la teneur en nutriments au travers de l’icône traditionnellement utilisée pour surveiller la charge d’un téléphone ou d’un appareil électrique, mais curieusement utilisée dans le logo italien en sens inverse (plus la batterie est « déchargée », meilleure est la qualité nutritionnelle de l’aliment !). Mais outre le fait de proposer des alternatives qui leurs sont plus favorables (dans la construction ou dans la difficulté d’interprétation d’un système complexe), ces multinationales visent à brouiller les messages et à multiplier les logos pour marginaliser le Nutri-Score et empêcher qu’il soit retenu officiellement par un maximum de pays européens.

Si 116 entreprises (industriels et distributeurs) ont à ce jour accepté d’afficher le Nutri-Score en France, ce qui représente environ 20 à 25 % du marché alimentaire français (voir liste sur le site de Santé Publique France : https://www.santepubliquefrance.fr/Sante-publique-France/Nutri-Score) et si plusieurs autres ont fait de même en Belgique, en Allemagne et en Espagne, il apparait clairement que les grandes multinationales ne sont toujours pas prêtes à rejoindre ce mouvement positif utile aux consommateurs. Or ces grandes multinationales opposées à l’affichage du Nutri-Score représentent plusieurs centaines de marques. Si l‘on regarde les 10 plus grandes multinationales de l’agro-alimentaire dans le monde elles représentent près de 500 marques différentes (472 en 2015 selon OXFAM) soit une très grande partie de l’offre alimentaire mise à la disposition des consommateurs. Or parmi ces 10 multinationales 8 refusent d’afficher le Nutri-Score (seul Danone, et plus récemment Nestlé ont accepté).

LES 10 PLUS GROSSES SOCIETES AGRO-ALIMENTAIRES ET LEURS DIFFERENTES MARQUES

D’autres sociétés industrielles (en dehors du Top 10) sont également toujours réticentes à afficher le Nutri-Score : c’est le cas de Lactalis, Ferrero, Aoste, Bel, Lesieur, Bigard, Charal, Pasquier, Harris et de très nombreuses autres sociétés produisant des produits très largement répandus sur les rayons des supermarchés. Il s’agit donc d’une perte de chance pour les consommateurs qui n’ont pas accès à une information synthétique, simple et intuitive pour de très nombreux produits présents dans les rayons des supermarchés ou des magasins alimentaires. Or le souhait d’une transparence sur la qualité nutritionnelle des aliments est une demande forte des consommateurs, qui d’ailleurs, font de plus en plus appel à des applications mobiles proposant ce type d’information même pour les marques qui n’affichent pas le Nutri-Score.

Certes la pression des consommateurs peut se faire ressentir au niveau des marques qui refusent d’afficher le Nutri-Score en évitant ou boycottant leurs produits, sur le principe que « s’ils ne l’affichent pas, c’est qu’ils ont des choses à cacher ! ». Mais la meilleure solution, permettant aux consommateurs d’avoir un environnement d’achat leur permettant, s’ils le souhaitent, d’intégrer la dimension nutritionnelle dans leurs comportements d’achat, est d’obliger tous les opérateurs économiques concernés à afficher le Nutri-Score afin que tous les produits mis en vente soient étiquetés. Il faut donc pouvoir rendre obligatoire l’affichage du Nutri-Score, ce qui nécessite de modifier le règlement européen concernant l’information des consommateurs (INCO) adopté en 2011 par le parlement européen et dont l’essentiel de ses dispositions a pris effet le 13 décembre 2014 . Ce règlement, adopté après plusieurs années de discussions a rendu obligatoire un étiquetage qui se matérialise sous forme d’un tableau des valeurs nutritionnelles au dos des emballages (dont les études ont montré qu’il était peu utilisé par les consommateurs, compte-tenu de la complexité de sa présentation et de son interprétation), et d’autre part, interdit aux états européens de rendre obligatoire un système d’information nutritionnel complémentaire sur la face avant des emballages. Les lobbies de l’industrie ont d’ailleurs dépensé 1 milliard d’euros en 2015 pour empêcher la mise en place d’un logo en face avant des emballages à l’échelle européenne (chiffre jamais démenti par l’industrie agro-alimentaire qui est à rapprocher des quelques 985 milliards d’euros brassés par ce secteur).

Modifier un règlement européen par la procédure politique classique est, outre le problème posé par les puissants lobbys qui s’y opposent, un processus particulièrement long, complexe et incertain (compte-tenu également du fait que certains états proches de leurs secteurs industriels agro-alimentaires sont capables de bloquer le processus…).

Une autre procédure existe pour amener la Commission Européenne (CE) à revoir le règlement empêchant que le Nutri-Score soit rendu obligatoire : l’initiative citoyenne européenne (ICE), qui est une innovation du traité de Lisbonne, mise en place de façon effective en mai 2012 et donnant un droit d’initiative politique à un rassemblement d’au moins un million de citoyens de l’Union européenne, venant d’au moins un quart des pays membres. La Commission européenne peut ainsi être amenée à rédiger de nouvelles propositions d’actes juridiques sur la base des demandes des citoyens. Il s’agit là d’une opportunité unique pour faire bouger la Commission et permettre de rediscuter le fait de rendre obligatoire et de façon exclusive l’application du Nutri-Score en Europe. Encore fallait-il que les conditions fixées pour déposer une initiative citoyenne européenne soient réunies et que la demande soit recevable et enregistrée par la CE. C’est chose faite avec l’initiative citoyenne européenne intitulée « PRO-NUTRISCORE », lancée à l’initiative de 7 associations de consommateurs membres du BEUC (Bureau Européen des Associations de Consommateurs): UFC-Que Choisir (France), Test-Achat (Belgique), VZBV (Allemagne), Consumentenbond (Pays-Bas), OCU (Espagne), Federajca Konsumentow (Pologne) et EKPIZO (Grèce).

Enregistrée le 8 mai 2019, sous le numéro ECI(2019)000008, son objet est de demander à la Commission Européenne d’imposer l’étiquetage simplifié « Nutri-Score » sur les produits alimentaires, pour garantir une information nutritionnelle de qualité aux consommateurs européens et protéger leur santé avec 3 finalités :

1. Simplifier la lecture et la compréhension de l’étiquetage nutritionnel : comprendre l’intérêt nutritionnel d’un aliment en un coup d’œil face à la diversité de l’offre alimentaire ;
2. Agir sur les problématiques de santé publique en incitant les professionnels à améliorer la composition de leurs produits ;
3. Harmoniser l’information nutritionnelle au niveau européen en imposant un étiquetage officiel unique, permettant de mettre fin à la confusion des consommateurs européens face à la myriade de logos existants.

L’enregistrement de cette initiative citoyenne européenne est un premier succès (elles sont nombreuses à être rejetée). Mais il reste pour que cette initiative aille à son terme à rassembler, en moins d’une année, un million de signatures réparties dans au moins 7 pays européens et enregistrées sur le site de la Commission européenne : http://www.pronutriscore.org

Ce n’est pas une chose simple : seules 4 initiatives citoyennes sur 64 proposées à la Commission européenne ont pu être enregistrées et récupérer plus d’1 million de signatures. Mais les citoyens/consommateurs ont au travers de cette ICE la possibilité de se faire entendre auprès de la Commission. Il s’agit d’un élément de démocratie participative dans le fonctionnement de l’Union européenne qui peut être un moyen permettant de faire avancer la santé publique au bénéfice des consommateurs malgré les lobbys qui s’y opposent. En cliquant sur le lien http://www.pronutriscore.org, chaque citoyen/consommateur est dirigé sur le serveur sécurisé de la Commission Européenne pour enregistrer sa signature. Les données exigées pour signer la pétition (numéro de carte d’identité ou de passeport) découlent de la réglementation sur l’initiative citoyenne européenne. Elles sont hébergées par la Commission européenne dans un espace sécurisé et ne font, bien évidemment, l’objet d’aucun échange ou transfert.

Les chercheurs en Nutrition et Santé Publique ne peuvent que soutenir cette initiative des associations de consommateurs qui est une opportunité exceptionnelle pour les citoyens de peser sur la Commission européenne afin que les bénéfices de la mesure en termes de santé publique soient pris en compte et l’emportent sur la défense d’intérêts économiques. Et l’on peut donc espérer que le Nutri-Score se retrouve demain sur tous les produits alimentaires mis à la disposition des consommateurs leur permettant de pouvoir comparer, d’un seul coup d’œil, la qualité nutritionnelle des aliments et pouvoir intégrer cette dimension dans leur actes d’achat.

Par cette mesure simple, les consommateurs auront dans leur vie quotidienne la possibilité d’améliorer leurs choix alimentaires et tendre vers des apports nutritionnels plus favorables à la santé tout en ayant accès à une offre alimentaire de meilleure qualité nutritionnelle. Ceci est important compte tenu des grands enjeux de santé publique liés à la nutrition et notamment son rôle majeur reconnu dans le risque ou la protection vis-à-vis de maladies chroniques telles que les maladies cardio-vasculaires, certains cancers, obésité, diabète… Cette transparence nutritionnelle si utile à la santé est un droit des consommateurs et un devoir de ceux qui fabriquent les aliments ou qui les distribuent, qui ne doivent d’aucune façon pouvoir s’y soustraire. C’est pour cela qu’il faut signer cette pétition citoyenne. Nous la signons et vous invitons à faire de même : http://www.pronutriscore.org

    To be really effective, Nutri-Score must be displayed on all foods packaging ! In order to ensure all food companies display the label, consumers have the opportunity to pressure the European Commission to change the regulation and make it mandatory, by signing the petition for the PRO-NUTRISCORE European Citizen’s Initiative!

    Pr Serge Hercberg1,2, Dr Pilar Galan1, Dr Mathilde Touvier1, Manon Egnell1, Dr Chantal Julia1,2

    1 Nutritional Epidemiology Research Team (EREN), U1153 Inserm/Inra/ Cnam/ Université Paris 13        
    2   Department of Public Health, Hôpital Avicenne, AP-HP

    After a multi-year battle, the nutrition label Nutri-Score was officially adopted by public health authorities in France in October 2017, and more recently in several other European countries (Belgium and Spain). Displayed on the front-of-pack, this label aims to inform consumers, at a glance, about the overall nutritional quality of foods and encourage towards healthier choices at the point of purchase by helping consumers to compare the nutritional quality of foods. The second objective of the Nutri-Score label is to motivate manufacturers to improve nutritional quality of their food through reformulations and/or innovations to be better positioned on the Nutri-Score color scale. Nutri-Score is supported by a comprehensive scientific background. Indeed, more than 35 studies were published during the last years in international peer-reviewed scientific journals validating both the underlying algorithm of the Nutri-Score and its graphical design, and thus demonstrating its effectiveness and superiority compared to other existing labels, including those proposed by various economic operators.

    Today, however, the uptake of the Nutri-Score entirely depends on the goodwill of manufacturers who can refuse to ensure a complete transparency of the nutritional quality of their products. Indeed, due to a specific European regulation (Regulation (EU) No 1169/2011 on the provision of food information to consumers) voted a few years ago (and drafted in a context of very strong pressures from powerful lobbies), member-states cannot make a front-of-pack nutrition label such as Nutri-Score compulsory in their country. Hence, even if many agro-alimentary firms and major retailers have agreed to apply the label on their products since its official adoption by the French government (and then in Belgium and Spain), large multinational food companies (e.g. Coca-Cola, Pepsico, Mars, Unilever, Mondelez, Ferrero and Kellogg’s) are still refusing to display the Nutri-Score label. Coca-Cola has even recently adopted a labelling system of multiple traffic lights on its products in France, entering into competition with Nutri-Score and potentially leading to confusion among consumers…

    Rejecting Nutri-Score may not be entirely without an afterthought. The food portfolio of these companies contains a large numbers of sweet, fat or salty products, thus classified in D or E on the Nutri-Score scale, including soft drinks, chocolate bars, confectionery, sweet biscuits, breakfast cereals, ice cream, and appetizers. For example, for Mars and Ferrero, 100% of their products are classified in D or E; for Mondelez, it is 86% of their products; 54% for Coca-Cola; 52% for Unilever; 50% for Kellogg’s and 46% for PepsiCo (https://theconversation.com/logo-nutritionnel-pourquoi-certains-industriels-font-de-la-resistance-87424).

    Some of these large companies continue by all possible avenues to block the adoption of Nutri-Score at the European level, through different convergent strategies. These strategies include the proposals of alternatives to the Nutri-Score which, unsurprisingly, tend to favor their products. This is the case for example of the Evolved Nutrition Label (derived from the British Multiple Traffic Light) which, by a subtle manipulation of the original label (setting thresholds per serving rather than for 100 g/100ml), change the colors characterizing the nutrient contents of products, switch red signs into amber, and mislead the consumers on the actual nutritional quality of products. Other firms have proposed alternatives which appear very difficult for consumers to understand, such as the nutritional circles proposed by the association of German food manufacturers BLL, the Reference Intakes (GDA or RI) supported by many industrialists, or the battery system proposed by the Italian government (a country where the economic weight of powerful agro-food groups such as Ferrero or the processed meat and cheeses sectors is very important…). The Italian system appears to be even counter-intuitive, representing the nutrient content of foods through the icon traditionally used to monitor the load of electrical device, but curiously used in the Italian label in the opposite direction (the more the battery is «unloaded», the better the nutrient content of the food!). In addition to these alternatives that appear more favorable to them, big food companies aim to blur the message and to multiply labels, thus marginalizing Nutri-Score and preventing it from being officially adopted by many European countries.

    Finally, among the strategies put in place to discredit Nutri-Score and try to delay its deployment in Europe, are conveyed many fake-news on social networks, sometimes picked up by media outlets and by politicians opposed to Nutri-Score …          

    The mobilization of some politicians (national parliamentarians, MEPs and even ministers) is also a classic strategy used by these large food companies to block or delay the adoption of Nutri-Score at the level of member states. This has recently been seen in Germany, where the FoodWatch organization revealed internal emails from the Federal Ministry of Agriculture (https://www.foodwatch.org/de/pressemitteilungen/2019/interne-e-mails-zeigen-julia-kloeckner-verheimlicht-studie-zur-naehrwertkennzeichnung/?L) in which the Minister of Agriculture (considered by consumer associations to be close to industry) refused to publish a scientific report commissioned from a research institute, considering that it was too much in favor of the Nutri-Score (the second report presented publicly by the Minister being much more nuanced…). This political lobbying has also been shown recently, on the eve of a Codex Alimentarius meeting, through an official statement from the WHO Italian Ambassador opposing a WHO technical report on nutrition labels, totally denying published scientific works, just to defend Italian food products (https://theconversation.com/etiquetage-nutritionnel-la-guerre-du-parmesan-et-du-prosciutto-116905)… A few months earlier, it was the Italian ambassador in Brussels who tried to convince the Belgian Minister of Health to renounce to adopt Nutri-Score.

    While 116 companies (manufacturers and retailers) have, to date, agreed to display Nutri-Score on their products in France, which represents roughly 20-25% of the French food market (see list on the website of Santé Publique France: https://www.santepubliquefrance.fr/Sante-publique-France/Nutri-Score), and if others have done the same in Belgium, Germany, Holland, Luxembourg and Spain, major multinationals food firms are still not ready to join this positive position. These large food companies opposed to Nutri-Score represent several hundred brands. The top 10 of the largest multinationals food companies in the world represent nearly 500 different brands (472 in 2015 according to OXFAM) which correspond to a very large part of the food supply available to European consumers. Of these 10 big companies, 8 refuse to display the Nutri-Score (only Danone and more recently Nestlé accepted).

    Top 10 world’s largest food and beverage Companies (including their brands)

    Other food companies (outside of the Top 10) are also still reluctant to display Nutri-Score on their products such as Lactalis, Ferrero, Aoste, Bel, Lesieur, Bigard, Charal, Pasquier, Harris, and many other companies producing foods which are widely present in supermarkets. The refusal by companies to display Nutri-Score on their products represents a serious loss of opportunity for consumers to have access to a synthetic, simple and intuitive information for all products present in supermarkets or food stores. However, the desire for transparency on the nutritional quality of food is a strong demand from consumers, who are increasingly using mobile applications that offer this type of information even for brands which refused to display Nutri-Score on their packaging.

    Consumers may pressure brands refusing to display Nutri-Score by avoiding or boycotting their products on the principle that “If they don’t display it, they have something to hide!” However the best solution for consumers in order to have a favorable purchasing environment allowing them to integrate the nutritional dimension into their purchasing behaviour, would be for all manufacturers and retailers to label their products . So making compulsory the display of Nutri-Score on foods appears necessary; and for that, amending the European regulation on consumer information (No 1169/2011) adopted in 2011 by the European Parliament which took effect on December 13th, 2014 would be required. This regulation adopted after several years of discussions, made the nutritional declaration mandatory as a table presenting, on the back of pack, the nutrient content of the food (studies have shown that it is rarely used by consumers, given the complexity of its presentation and interpretation) ; and, on the other hand, it also prohibits European states from the possibility of making mandatory an additional nutritional information system in the form of a front of pack label. Industry lobbies spent €1 billion in 2015 to prevent the introduction of a front-of-pack label at the European level (a figure never denied by the agro-food industry, and which is to be related to the 985 billion euros stirred by this sector).

    Amending a European regulation through the traditional political procedure, besides being subject to the actions of the powerful lobbies who oppose it, is a particularly long, complex and uncertain process.

    But another procedure exists to push the European Commission (EC) to review its regulation, through the European Citizen’s Initiative (ECI). This innovation of the Lisbon Treaty, implemented in May 2012 gives citizens an opportunity to urge the EC to draft new proposals for legislation on the basis of citizens’ requests, provided they gather at least one million EU signatures from at least one quarter of the member countries.

    This is a unique opportunity to get the Commission’s attention and to make Nutri-Score mandatory in Europe.

    Submitting a European citizens’ initiative requires specific conditions and the application needs to be admissible and registered by the EC.

    This is now the case with the European citizens’ initiative entitled «PRO-NUTRISCORE», launched at the initiative of 7 consumer associations members of BEUC (European Bureau of Consumer Associations): UFC-Que Choisir (France), Test-Achat (Belgium), VZBV (Germany), Consumentenbond (Netherlands), OCU (Spain), Federajca Konsumentow (Poland) and EKPIZO (Greece).

    Registered May 8th 2019, under the number ECI(2019)000008, its purpose is to ask the European Commission to impose the label «Nutri-Score» on food products, to ensure a real quality of  nutritional information provided to european consumers and to protect their health with three objectives:

    1. Make nutritional labelling easier to read and understand, so that the nutritional value of a food can be understood at a glance in the face of the diversity of food supply;
    2. Take action on public health issues by encouraging professionals to improve the composition of their products;        
    3. Harmonise nutritional information at European level by imposing a single official labelling system, thereby putting an end to the confusion experienced by European consumers when faced by the plethora of existing logos.

    The registration of this European citizens’ initiative is a first success (many are usually rejected). But there is still a big challenge for this initiative to be completed, in less than a year, with one million signatures distributed in at least 7 European countries and registered on the European Commission’s website: http://www.pronutriscore.org

    It is not a simple matter: only 4 out of 64 citizens’ initiatives proposed to the European Commission have been able to get registered and to collect more than 1 million signatures. But citizens/consumers have a real opportunity through this ICE to be heard by the Commission. It is an element of participatory democracy in the functioning of the European Union which can be a means of advancing public health for the benefit of consumers and despite the lobbies that oppose it.

    By clicking on the link http://www.pronutriscore.org, each citizen/consumer is directed to the secure server of the European Commission to register their signature. The data required to sign the petition (identity card or passport number) depends on each country and derives from the regulation on the European Citizens’ Initiative. Data are hosted by the European Commission in a secure space and are obviously not the subject of any exchange or transfer.

    Researchers in the fields of Nutrition and Public Health strongly support this initiative of consumer associations. This is an exceptional opportunity for citizens to weigh on the European Commission so that the benefits of this public health measure are taken into account and take precedence over purely economic interests. We can therefore hope that the Nutri-Score will be, in a near future, on all food products available to consumers in Europe, allowing them to integrate the nutritional dimension into their purchasing acts. By this simple measure, consumers will have the opportunity in their daily lives to improve their food choices and move towards healthier nutritional intakes while having access to a better nutritional quality of food supply. This is important given the major public health issues related to nutrition and in particular its recognized major role in the risk or protection against chronic diseases such as cardiovascular diseases, cancers, obesity, diabetes, etc. This nutritional transparency, which is so useful for health, has to be considered as a right of consumers and a duty of those who manufacture or distribute foods, who must in no way be able to avoid it.         

    For all these reasons, we need to sign this citizen petition. We are signing it and inviting you to do the same: http://www.pronutriscore.org

    The Italian government is trying to undermine a WHO report on FOP Nutrition labelling for obvious reasons: typical Italian products don’t come out well!

    Julia C1,2, Hercberg S1,2, Egnell M1, Galan P1, Jones A3, L’Abbé M4, Rayner M5 
     1 Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, U1153 Inserm, Inra, Cnam, Université Paris 13, F-93017 Bobigny, France. 
     2 Département de Santé Publique, Hôpital Avicenne (AP-HP), F-93017 Bobigny, France.
     3  George Institute for Global Health, UNSW, Newtown, Australia  
     4 Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
     5 Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
      

    This week the Italian government issued a press release1 strongly criticizing an unpublished World Health Organization (WHO) report – the “WHO Guiding Principles and Framework Manual for Front-of-Pack Labelling for Promoting Healthy Diets”.

    As its name suggests, the report provides advice to countries developing front-of-pack nutrition labelling (FOPL) policies to promote healthy diets. These simple, interpretive labels aim to make nutrition information easier to understand and use for consumers. They are part of the suite of measures recommended by WHO to prevent the growing global burden of non-communicable diseases. More than 30 government-supported FOPL are already operating worldwide using a variety of approaches. They include France’s voluntary Nutri-Score and Australia’s Health Star Rating, as well as mandatory ‘high in’ style warning labels now adopted in Chile, Peru and Israel.

    On their face, the Italian Ambassador’s objections related to the use of nutrient profiling to evaluate the nutritional quality of foods, rejecting the concept as being politically motivated rather than rooted in science. His real motivations, however, were hinted in the findings he used in support:  specifically a UK study that found one year after traffic-lights were introduced voluntarily there was “ a dramatic decrease in the sale of all the most typical Italian quality foods: a clear demonstration that systems based on nutrient profiles do not lead to healthier choices and penalize Italian traditional foods”.

    While perhaps not surprising, these arguments are concerning for scientists and public health experts working in this field. Since concerns over nutrient profiling were raised a number of years ago, a significant body of scientific work has been developed to solidify the evidence-base underpinning its use in public health policy. A seminal article by Townsend et al. in 20112 (appropriately titled ‘Where is the science? What will it take to show that nutrient profiling systems work?’) provides a theoretical framework for scholars validating nutrient profiling systems to ensure they reflect not only the nutritional quality of foods, but also promote healthier diets. More importantly, the most robust form of validation available links the nutrient profile with health outcomes. This has now been investigated in numerous recent studies, particularly for the nutrient profiling system underpinning the Nutri-Score3. These studies have contributed significantly to WHO’s work in this area, and its recommendations to countries deciding to implement public health policies.

    What is the Italian ambassador referring to when he speaks about the quality of typical Italian foods (we can suppose parmesan, prosciutto, salami, coppa, gorgonzola, olive oil, Parma ham… and may be Nutella)? The quality of foods could include a variety of dimensions, from the quality of individual ingredients, their cultural roots, their sensory properties, or their nutritional value to name a few. Nutrient profiling, by definition, only addresses one of these dimensions – namely nutrition – and does not aim at qualifying the all these other qualities. Nutrient profiling relies on decades of scientific studies on the associations between foods, nutrients and health, as well as dietary patterns that combine food choices and health. The nutritional quality of foods (and finally of the diet) is undoubtedly the main dimension to take into consideration from a public health viewpoint.

    Though the nutritional quality of individual foods may not affect the overall balance of a person’s diet, depending on the amount and frequency of consumption – all foods may participate in a healthy diet – a higher consumption of less healthy foods is indeed associated with a less healthy diet overall, and in the end to a poorer health. This has been demonstrated by numerous epidemiological, clinical and biological studies during the last decades.

    Food-based dietary guidelines are the first step in educating consumers on the appropriate frequency and amount of foods that correspond to a healthy diet. But alone, they are often insufficient to guide consumers through the vast array of foods present in the food supply. Consumers struggle to translate this guidance into their day-to-day dietary behaviour and to discriminate between products based on their relative healthfulness. Food policies based on nutrient profiling, such as front-of-pack labelling, aim to close this gap by building upon food-based dietary guidelines with tools to be used in stores.

    While the use of nutrient profiling to qualify the nutritional quality of foods is only recent, tools to qualify the other dimensions of quality have long been present: protected designation of origin, traditional foods, organic label, etc.

    So why this disregard for a new tool, that covers the major dimension of the quality of foods, one that pertains to health?

    Perhaps because some of those foods judged ‘quality’ by other dimensions to not fare so well with these new measures of nutritional quality. Typical Italian processed meat (Prosciutto, Parma ham, Salami,…) and cheeses (parmesan, gorgonzola), similar to traditional equivalents in other countries are high in saturated fats, salt and energy. While they may be part of a healthy diet, they should not be overconsumed. Alerting consumers to the nutritional composition of traditional foods does not undermine their inclusion in a given food culture. Labelling their nutritional quality simply allows consumers to think about the frequency and amount of the food they consume.

    As the full reasons provided by Italy suggest, industries behind these products are primarily motivated by profits, and determined to halt any action that may affect them. These concerns should not be used as argument against evidence-based policies to promote healthier diets.

    Beyond the reasoning used by the Italian ambassador, perhaps more concerning is the timing of such a press release. An international meeting of Codex – a joint program of FAO and WHO that develops international food standards – is scheduled for next week in Ottawa. On the agenda is guidance on front-of-pack labelling. While the science now demonstrates that nutrient profiling is far from a matter of politics, action by the Italian government to criticize WHO’s work and garner support for its own Codex position is clearly a political move.

    1.           WHO – Press release on the draft document “WHO guiding principles and framework manual for front-of-pack labelling for promoting healthy diets”. (2019). (https://italiarappginevra.esteri.it/rappginevra/en/ambasciata/news/dall-ambasciata/oms-comunicato-stampa-sul-documento.html)

    2.           Townsend, M. S. Where is the science? What will it take to show that nutrient profiling systems work? Am. J. Clin. Nutr. 91, 1109S-1115S (2010).

    3.           Julia, C. & Hercberg, S. Development of a new front-of-pack nutrition label in France: the five-colour Nutri-Score. Public Health Panor. 3, 712–725 (2017).

    Read also in The Conversation Front-of-pack nutrition labels: ‘The parmesan and prosciutto war’ https://theconversation.com/front-of-pack-nutrition-labels-the-parmesan-and-prosciutto-war-11696

    Incomprensiones y fake-news sobre Nutri-Score. ¿Cómo tratar de desestabilizar una herramienta de salud pública que molesta?

    Serge Hercberg1,2, Pilar Galan1, Manon Egnell1, Chantal Julia1,2

    1 Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d’Epidémiologie et Biostatistiques Sorbonne Paris Cité (CRESS), 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

    Desde hace algunos meses circulan en las redes sociales, en diversos medios de comunicación y a veces incluso en el discurso de personalidades políticas de primer rango, cierto número  de comentarios negativas y de informaciones engañosas sobre Nutri-Score, el logotipo de información nutricional destinado a ser colocado en la cara frontal de los envases de alimentos adoptado oficialmente en Francia en 2017, y más recientemente en Bélgica y España. Este fenómeno se ha acentuado especialmente en las últimas semanas, probablemente en relación con el debate que existe actualmente en varios países europeos en torno a la elección de su logotipo nutricional, y de las discusiones que están llevándose a cabo en las instancias de la Comunidad Europea en Bruselas.

    En este marco de agitación, se multiplican las maniobras destinadas a desacreditar el Nutri-score para evitar su adopción a pesar que es el logotipo elogiado por múltiples asociaciones de consumidores en Europa. A pesar de basarse en un convincente expediente científico con  más de una treintena de publicaciones internacionales que validan, por una parte, su algoritmo subyacente y su formato gráfico y que demuestran, por otra parte, su eficacia y superioridad con respecto a otros logotipos sobre varias dimensiones del comportamiento de los consumidores, Nutri-score es rechazado con fuerza por algunos grupos de presión (asociación de los industriales agroalimentarios FEVIA en Bélgica, BLL en Alemania, Coldiretti en Italia…).

    Aunque algunos industriales y distribuidores en Francia, Bélgica, España, pero también en Alemania, Austria, Portugal, Suiza, Eslovenia,… han optado por aplicar en sus productos el Nutri-Score, todavía persisten fuertes oposiciones de algunas grandes multinacionales agroalimentarias que no desean utilizar Nutri-Score. Estas multinacionales han desarrollado estrategias para intentar torpedearlo, proponiendo, por ejemplo, alternativas de logotipos desarrollados que ellas mismas y que les son más favorables (ENL a nivel europeo, círculos del BLL en Alemania,…). En este sentido, las informaciones engañosas («fake news») que circulan sobre Nutri-score hacen el juego, sin duda, a estas multinacionales que desean desacreditarlo. Son también secundadas por todo tipo de «gurús» o de simples internautas que no expresan una visión de salud pública respaldada por un trabajo científico sino simples opiniones personales que, a través de algunos ejemplos desmesurados, intentan desacreditar el conjunto del sistema.

    La información engañosa sobre  Nutri-Score que circula actualmente en las redes sociales y en algunos medios de comunicación no tiene nada que ver con las críticas legítimas que forman parte del debate científico útil (en particular sobre los límites del sistema) tanto en sus objetivos como en su forma. Las fake news se caracterizan por el hecho de que la información que transmiten es engañosa y sólo intentan crear confusión. A menudo se limitan a la yuxtaposición de elementos que pueden ser legítimos para alguno de ellos, pero la teatralización  puede contribuir a una confusión o a esparcir la duda entre aquellas personnes sin capacidad de interpretación o sin suficientemente conocimientos sobre  Nutri-Score, sus objetivos y a su forma de cálculo y utilización.

    En la mayoría de los casos, las fake news ponen de relieve, exagerándolo, un solo ejemplo del sistema, sacandolo de su contexto, y utilizándolo para desacreditar el conjunto. Circulan en forma de mensajes o soportes iconográficos y en la mayoría de casos a través de una imagen «comunicativa» presentada pseudocientífica. La misma imagen suele ir acompañada de comentarios despectivos e incluso injuriosos. Las fake-news suelen ser disponibles o retransmitidas por emisores «anónimos» o por particulares que se apoyan en la misma información (a menudo la misma imagen) dando su opinión personal (en algunos casos, y probablemente,  ellos mismos engañados por la información o insuficientemente conocedores para reconocer la fake news). Lo espectacular es que estas desinformaciones salen de las redes sociales y son consideradas como elementos científicos por algunos medios de comunicación (a veces importantes) y por todos aquellos que tienen interés en utilizarlas (grupos de presión, científicos con vínculos de interés con operadores económicos, personalidades políticas e incluso ministros…).

    De hecho, el lanzamiento de una falsa información sobre Nutri-Score y el hecho de que sea canalizada por diferentes emisores implican diferentes mecanismos:

    1. el desconocimiento o la denegación de lo que se puede esperar del Nutri-Score (o de cualquier otro logotipo nutricional). Por consiguiente, no integran obviamente, ya sea de forma voluntaria o no, el principio, el objetivo, las restricciones y el ámbito de acción de un logotipo nutricional, ni el conjunto de datos científicos que validan su algoritmo de cálculo o su formato gráfico,
    • la repetición de ejemplos de comparaciones del Nutri-score que se refieren siempre a los mismos alimentos (en número muy limitado), asociandolos y escenificadolos  para dar la impresión de que Nutri-Score clasificaría de forma absurda la calidad nutricional o el valor sanitario de los alimentos y, por lo tanto, induciría a error a los consumidores… Es nteresante observar que los ejemplos utilizados se basan siempre en los mismos alimentos de marca (menos de quince alimentos de marca, sabiendo que en total hay más de 200.000 para los que es posible el calculo del Nutri-Score) buscando a impactar  su reputacion en la población (alimentos tradicionales considerados favorables a la salud, alimentos industriales considerados desfavorables,…) y utilizando una comparación binaria (bien o mal clasificados). Interesante de destacar que los detractores no evocan jamas el hecho de que Nutri-Score no plantee ningún problema para el  99 % de los alimentos y !éstos no son el blanco de sus ataques!

    A continuación se presentan diferentes fake-news aparecidas en las redes sociales durante los últimos meses y para las cuales explicamos su falta de seriedad. Por razones de homogéneidad hemos traducido todas las citaciones que circulan en las redes sociales o en la prensa españolas, inglésas, flamencas, italianas o francesas.

    1. Ejemplo de fake-news basado en una verdadera incomprensión de la finalidad de los logotipos nutricionales

    «Nutri-Score no tiene ningún interés y es engañoso para el consumidor, la prueba: ¡Algunos alimentos ultratransformados que contienen aditivos o pesticidas están bien clasificados!»

    Este tipo de críticas se refieren al hecho de que Nutri-Score no integra los aditivos, el grado de transformación o los pesticidas. Esta elección está plenamente asumida tanto Nutri-Score como para todos los otros logotipos nutricionales existentes (para más detalles consultar el artículo en The Conversation: https://theconversation.com/le-nutriscore-mesure-la-qualite-nutritionnelle-des-aliments-et-cest-deja-beaucoup-99234),  y está ligada a la imposibilidad, basándose en los conocimientos científicos actuales, de desarrollar un indicador sintético que cubriría el conjunto de estas dimensiones. Nutri-Score es un sistema de información nutricional  que ha demostrado su gran utilidad para ayudar a los consumidores a orientar sus elecciones hacia alimentos de mejor calidad nutricional pero  de ninguna manera tiene la pretensión de ser un sistema informativo sobre la dimensión “salud “  global de los alimentos cubriendo, además de la dimensión nutricional,  las dimensiones sanitarias y medioambientales.

    Sintetizar el conjunto de dimensiones salud de los alimentos a través de un indicador único y fiable que podria predecir el riesgo para la salud, es el sueño de todo actor de Nutrición de Salud Pública en beneficio de los consumidores. Pero no es por casualidad o  incompetencia, si ningún equipo de investigación o estructura de salud pública en el mundo, o comité de expertos independientes nacionales o internacionales, ni la OMS han podido diseñar tal indicador sintético. Esto puede explicarse por dos tipos de razones:
    1)  Los niveles de conocimientos y el grado de certitud  de sus relaciones con la salud difieren según la dimensión de los alimentos que se considere.  La acumulación de numerosos trabajos epidemiológicos, clínicos y experimentales permite considerar que existen para ciertos elementos nutricionales (nutrientes/ alimentos) un nivel de evidencia documentada y sólida sobre sus consecuencias sobre el riesgo de enfermedad crónicas que va de “probable” a “convincente” en las clasificaciones internacionales. Para otras dimensiones y sobre todo las referentes  a los numerosos aditivos, compuestos neo-formados o contaminantes (pesticidas, antibióticos, perturbadores endocrinianos) existen ciertas hipótesis sobre la salud, pero con niveles de prueba muy distintos (particularmente en los estudios realizados en el hombre).

    2) Una razón que deriva de la precedente, es la imposibilidad hoy de sospesar la contribución relativa de cada una de las dimensiones de un alimento sobre su riesgo sobre la salud, para poder concluir en una nota sintética que sería idealmente predictible del nivel de riesgo global. Ciertas aplicaciones on line lo proponen, pero no poseen una base científica valida. Las cuestiones metodológicas  son numerosas y todavía no solucionadas: magnitud precisa del riesgo atribuible a cada una de las dimensiones, a cada uno de los componentes potencialmente incriminados, efecto coctel potencial… De hecho, calcular un índice único para caracterizar la calidad sanitaria global de un alimento que podria desembocar a un juicio, en lo absoluto (excelente, bueno, mediocre…) no tiene bases científicas suficientemente sólidas y se haría utilizando un carácter bastante arbitrario.

    3) Por último, en lo que respecta a los aditivos y los pesticidas, en caso de que se demuestre un riesgo para la salud, la respuesta que debe aportarse, desde el punto de vista de la salud pública, no es tanto la información del consumidor a través de un logotipo, si no el retiro del elemento en cuestión de la cadena alimentaria según un principio de gestión del riesgo sanitario. Por cierto, este es el caso del controvertido aditivo E171, cuyo retiro ya ha sido anunciado por las autoridades francesas.

    Todo esto  no impide, en el marco de una política nutricional de salud pública eficaz, recomendar a la población de elijir alimentos  con el mejor Nutri-Score posible, sin o con la menor lista de aditivos (en la lista de ingredientes) y de privilegiar los alimentos sin transformacion y, si es posible Bio (con un logotipo certificado).

    1. Un ejemplo de fake-news  basado en  falsas contradicciones sobre  la capacidad del Nutri-Score a clasificar los alimentos en función de sus calidades nutricionales

    «¡El nutri-Score es falso, la prueba es que las patatas fritas que no son buenas para la salud son mejor clasificadas que las sardinas que contienen muchas cosas buenas; o el aceite de oliva es menos bien clasificado que la Coca-Cola Zero… ! »

    No hay que olvidar que la finalidad de un logotipo nutricional, como el Nutri-Score, no es de clasificar los alimentos en « alimentos sanos » o « alimentos no sanos » en valor absoluto, como lo haría un etiquetado binario (bien vs mal). Tal finalidad atribuida a un logotipo nutricional sería totalmente discutible ya que esta característica depende de la cantidad de alimento consumida y de la frecuencia de su consumo, pero igualmente del equilibrio alimentario global de las personas (el equilibrio nutricional no se obtiene gracias al consumo en una toma alimentaria, ni en una comida o en un solo día…). Es evidente que estas nociones complexas no pueden ser resumidas por un logotipo nutricional atribuido a un producto específico de una marca dada…

    No, la finalidad del Nutri-Score es aportar a los consumidores una información en valor relativo, que va a permitirles con una ojeada, comparar la calidad nutricional de los alimentos lo cual es importante para orientar sus elecciones en el momento de la compra. Pero esta comparación sólo tiene sentido si es pertinente cuando se trata de comparar  alimentos que el consumidor compra en la vida real (en el momento del acto de compra o de su consumo). De hecho, Nutri-Score no inventa nada y no tiene plenos poderes para aportar al alimento un  valor salud aboluto, Nutri-Score solo sintetiza los elementos sobre la composición nutricional  presentes en la cara posterior de los envases.

    Y al contrario,  las fake-news tratarán de desviar el interés del Nutri-Score destacando pseudo-contradicciones a partir de comparaciones que no tienen sentido real

    Esta es una de las imágenes que más a menudo circulan por las redes sociales, ampliamente difundidas por los internautas, algunos medios de comunicación, grupos de presión y políticos.

    FAKE NEWS

    El principio de esta imagen (citada muchas veces) es intentar caricaturizar Nutri-Score sugiriendo que determinadas categorías de productos industriales serían clasificadas como «buenas para la salud» («healthy foods») y mejor clasificadas que los alimentos «tradicionales» que serían considerados «no favorables para la salud» («unhealthy foods»).

    Nutri-Score permite comparar la calidad nutricional de los alimentos, pero siempre que estas comparaciones sean pertinentes y útiles para los consumidores a la hora de orientar sus decisiones.

    Una vez más, conviene recordar que Nutri-Score permite comparar la calidad nutricional:


    1) de alimentos pertenecientes a la misma  categoría,  por ejemplo en el caso de la familia de cereales de desayuno,  comparar los copos de avena  versus cereales con chocolate versus cereales  con chocolate y rellenos, o comparar las galletas secas vs galletas con confituras vs galletas chocolatadas, o las lasañas con carne vs las de salmón vslas de espinacas, o también los distintos platos preparados  a base de pasta, o las distintas pizzas entre ellas, o los distintos tipos de bebidas (agua, zumos de frutas, bebidas a base de frutas, sodas,…). En cada una de las categorías  Nutri-Score puede ir de A a E, lo cual aporta una información útil al consumidor para sus elecciones.

    2) de un mismo tipo de alimento propuesto por marcas distintas (por ejemplo: comparar cereales de desayuno chacolatados y rellenos de una cierta marca  con el producto «equivalente» de otra marca o galletas chacolatadas de distintas marcas). En estas situaciones también Nutri-Score puede ir de A a E entre alimentos de la misma apelación pero de marcas distintas. Una vez más, Nutri-Score puede variar de A a E, información útil para ayudar a los consumidores a distinguir los alimentos de mejor calidad nutricional,

    3) de alimentos pertenecientes a familias diferentes, pero a condición que  tenga una pertinencia  real respecto  a su ocasión de consumo o uso (y que a menudo están colocados cerca en las  estanterías de los  supermercados): yogures comparados a postres lácteos,  cereales del desayuno comparados a galletas, bollería industrial, o panes industriales, etc.

    ¿Pero qué sentido tiene comparar,  como lo hacen las  fake news, las patatas fritas al roquefort, los cereales del desayuno a las sardinas en aceite o a la Coca Cola Zero? ¿Los consumidores se plantean realmente la cuestión de esta manera en el momento de la compra o del consumo de alimentos? Es muy poco probable que el consumidor prevea a priori consumir sardinas para su desayuno o condimentar su ensalada con Coca-Cola o refrescarse con aceite de oliva… Lo que el consumidor necesita es poder comparar la calidad nutricional de los alimentos que tienen una pertinencia a ser substituidos en su consumo.  Si desea escoger los componentes de su desayuno, es importante que pueda comparar los alimentos de diferentes categorías pero consumidos en esta ocasión, como por ejemplo pan de molde, bollería industrial, cereales de desayuno o galletas.  Y evidentement acceder de forma transparente a la calidad nutricional  en las grandes categorías de alimentos en función de las marcas, para para poder así comparar diferentes cereales del desayuno entre ellos, o las diferentes bollerías industriales o los panes de molde en función de las marcas…

    En este contexto, Nutri-Score funciona perfectamente, como lo demuestran los ejemplos que se presentan a continuación.

    Por ejemplo: diferentes alimentos pertenecientes a categorías distintas pero consumidos en el desayuno

    En este ejemplo, que sólo incluye algunos de los múltiples alimentos concernidos, cuando se comparan varias categorías de alimentos entre ellas, se comprende con una sola ojeada sobre las opciones para el desayuno que algunos alimentos son más favorables que otros: los panes integrales o ciertos copos de avena  se clasifican mejor que las galletas o bollerías industriales. Además, dependiendo del tipo de pan (integral o no), el tipo de galletas o de cereales del desayuno, existen variaciones importantes de calidad nutricional. Por ejemplo, dentro de la categoría de cereales de desayuno, existe una gran variabilidad en la calidad nutricional, el Nutri-Score puede ir de A a E según el tipo de cereal de desayuno (lo mismo ocurre con cereales de la misma apelación pero de marcas distintas):

    Lo mismo se aplica a la variabilidad de la calidad nutricional de las cremas de postre. Sin logotipo nutricional los consumidores tendrían dificultades en evaluarlas, pero con la visualización del Nutri-Score, que puede ir de A a E según los productos, las diferencias son muy evidentes:

    Este  tipo de fake-news, al comparar alimentos que no tienen razón de ser comparados entre sí,  intenta dar la impresión de que Nutri-Score no es coherente en términos de clasificación nutricional de los alimentos, omitiendo al  mismo tiempo el interés principal del  Nutri-Score para el consumidor, es decir, comparar alimentos en las condiciones pertinentes. El otro elemento de engaño subyacente en la fake-news es el hecho de jugar con estereotipos en términos de creencia o de percepción de los alimentos.

    La imagen de las patatas fritas (a menudo asociada a la de los fast-foods) está percibida en la opinión popular más bien como negativa desde el punto de vista nutricional,  mientras que la de los alimentos «tradicionales» como el roquefort, el jamón Serrano o las sardinas (asi como el salmón ahumado) gozan de una percepción bastante favorable. Sin embargo, basta mirar la etiqueta del alimento para darse cuenta de la realidad de la composición nutricional. Es totalmente normal que el roquefort o el jamón Serrano sean clasificados según su contenido en grasas saturadas y sal. Del mismo modo que el salmón ahumado está clasificado como D, ampliamente comentado como una crítica al Nutri-Score, es «normal» teniendo en cuenta su riqueza en sal (2,5 a 3,5 g de sal por 100g), a diferencia del salmón fresco que es clasificado A, y esto nunca es comentado en los mensajes que acusan la clasificación por Nutri-Score del salmón ahumado.

    Una vez mas,  existen también grandes diferencias de calidad nutricional al interior de las categorías de alimentos (diferentes quesos, diferentes jamones,…) o para un mismo alimento según la preparación y la marca. Si el roquefort sigue clasificado en E (contiene entre 3 y 4 g de sal/100g y es rico en ácidos grasos saturados), la mayoría de quesos se clasifican en D y algunos en C (por ejemplo, mozzarella). Incluso para los jamones equivalentes, por ejemplo el jamón Serrano puede ser E o D, y otros tipos de jamón se clasifican en D o C.

    En el caso de las sardinas, ampliamente utilizadas para poner en tela de Nutri-Score (a través siempre de la misma imagen), si algunas marcas se clasifican realmente en D, otras sardinas en lata pueden ir de A a D según su composición nutricional, por lo que no es justo dar a entender que las sardinas son sistemáticamente clasificadas por Nutri-Score en D…

    Problemas especificos de las patatas fritas

    Las reflexiones hechas en las fake news sobre las patatas fritas implican a la vez lo irracional (la imagen negativa de las patatas fritas ligada a los fast-foods) y la incomprensión de cómo se establece un logotipo nutricional y cuál debe ser su papel

    Dehecho, por definición, Nutri-Score (como todos los demás logotipos nutricionales) solo es una traducción de los valores nutricionales declarados en la parte posterior del envase del alimento y que se refieren al alimento tal como es vendido. Se le pide al fabricante transparencia sobre el producto que comercializa, pero no puede tomarse en cuenta y/o anticipar la variabilidad de los modos de preparación, de utilización o de consumo de su producto.


    Respecto al Nutri-Score, sólo los alimentos que requieren una reconstitución específica, según una receta estandarizada (puré en copos, preparaciones en polvo para pasteles), benefician del Nutri-Score calculado a partir de la receta estandarizada.

    En cambio, en el caso preciso  de las patatas fritas congeladas se pueden utilizar varios métodos de cocción, y el uso de una receta estandardizada sería reductrice respecto a las formas de consumo por la población. La cocción al horno de las patatas pre cocinadas congeladas (generalmente clasificadas como B por Nutri-Score) no tiene ningún impacto en su composición nutricional y el Nutri-Score no cambia después de la cocción (continua siendo B). Por el contrario, las patatas congeladas (no pre cocinadas) clasificadas con mayor frecuencia en A por Nutri-Score (son simplemente patatas peladas y cortadas), la información sobre el modo de cocción se da en los envases recomendando una cocción en una olla a presion. En estas condiciones, Nutri-Score pasará, según los aceites de cocción (más o menos ricos en ácidos grasos saturados) a B o a C como máximo. El añadido de sal después de la cocción también puede afectar la clasificación, pero es algo que no puede preverse logicamente en el momento de la compra del producto.

    Estos elementos muestran a la vez el interés de Nutri-Score que permite informar a los consumidores de la realidad de la composición nutricional y luchar contra ciertos estereotipos o ideas preconcebidas: por ejemplo, en el caso de las patatas fritas, ampliamente utilizadas en las fake news, pese a su composición nutricional bastante favorable para las destinadas a ser cocinadas al horno  e incluso las congeladas cocinadas en freidoras siguen siendo correctas desde el punto de vista nutricional (clasificadas C como máximo).

    No obstante, es necesario, en el caso exclusivo de alimentos que no pueden consumirse tal como se compran (como las patatas fritas congeladas sin pre cocinar) y para los cuales se especifica en el envase un método de cocción específico y detallado que pueda impactar el Nutri-Score, que el fabricante informe a los consumidores de la modificación inducida en el cálculo del Nutri-Score aportando 1) el Nutri-Score del producto tal como es vendido (correspondiente a los elementos que figuran en el etiquetado nutricional) y 2) una anotación sobre la puntuación final, dando la letra del Nutri-Score obtenida por el producto después de la cocción según el método recomendado en el envase (en el caso de las patatas fritas, la modificación conduce a un salto a la clase superior del Nutri-Score después de su cocción  a la freidora).

    En resumen

    Queda claro, contrariamente a lo que transmiten las fake news, que Nutri-Score permite diferenciar, finamente y fácilmente con un simple vistazo, la calidad nutricional de los alimentos y comparar los alimentos entre sí, para ayudar a los consumidores a elegir, eventualmente, una alternativa más favorable desde el punto de vista nutricional, ya sea en otra categoríade alimentos que corresponda al uso que se desea hacer del alimento, ya sea dentro de la misma categoría, eligiendo un mejor Nutri-Score o la marca que proponga el alimento el mejor clasificado.

    Es también fundamental recordar una regla importante del Nutri-Score, que nunca aparece en las fake news: el hecho de ser clasificado D y E un alimento no significa que no deba consumirse en absoluto. En una alimentación equilibrada, el consumidor informado sabrá, si no desea elegir una alternativa de mejor calidad nutricional y desea mantener su elección para un producto D o E, que es mejor que lo consuma en cantidades más pequeñas y/o con menos frecuencia.

    El problema de la clasificación de los alimentos puesta en entredicho, como la comparación entre el aceite de oliva y la Coca-Cola Zero, ¿es específico al Nutri-Score? ¿Cómo los clasifican los otros logotipos?

    Debido a que todos los logotipos nutricionales se basan en los datos correspondientes a su composición nutricional, todos los logotipos de color, como el Traffic Light en el Reino Unido o el ENL apoyado por algunas multinacionales,  basándose en su composición en grasas saturadas y grasas totales, describen para el aceite de oliva dos «rojos», y  4 «verdes en la Coca-Cola Zero. Del mismo modo, en el caso de las advertencias sanitarias sostenidas en América Latina, Canadá o Israel, la Coca-Cola Zero no da ninguna advertencia. Así pues, cualquiera que sea el sistema, el aceite de oliva está menos bien clasificado por su contenido en calorías, grasas totales y grasas saturadas. Pero curiosamente si esta crítica es permanente  para Nutri-Score, nadia se ha preocupado por este problema del Traffic Light Traffic Lights Multiples inglés que también  clasifica  el aceite de oliva peor que la Coca-Cola Zero y que no ha supuesto problema a los consumidores de las cadenas de distribución que lo utilizan ya desde varios años  (España, Portugal, Reino Unido.

    1. Fake news sobre el hecho de que el nutri-Score es adaptado para Francia y no para otros países europeos

    « El nutri-score es franco-francés y no es adaptado para otros países de Europa. Las adaptaciones hechas en su cálculo se hicieron para complacer a su sector quesero»

    Otra « fake-news » que circula en Internet es el hecho que Francia habría hecho una excepción especifica en el cálculo del algoritmo para los quesos con la finalidad de !mejorar la imagen de los quesos que hacen parte de su patrimonio culinario! Esto es totalmente falso. De hecho, Nutri-Score fue objeto de mínimas adaptaciones durante su desarrollo en 2015-2016 que no modificaban los elementos implicados en el cálculo de su puntuación de base (el que permite atribuir los distintos colores del Nutri-Score) al conjunto de alimentos. Los elementos “negativos” del cálculo son los que figuran en la declaración nutricional obligatoria a  nivel europeo y son citados en el etiquetado obligatorio que se encuentra en la parte posterior del envase (calorías, lípidos totales, grasas saturadas, sodio que por cierto son los únicos disponibles para todos los alimentos). Las mínimas adaptaciones de la forma de cálculo fueron realizadas para los quesos, las materias grasas y las bebidas.

    Ello se debe a que, tras el análisis de 2015 de estas tres categorías (se trata de categorías y no de alimentos específicos) por la Agencia Francesa de Seguridad Sanitaria de los Alimentos (ANSES)  se consideró que planteaban problemas específicos fáciles a soluciona (sin poner en tela de juicio la selección de los nutrientes  que entran en el cálculo del algoritmo):

    1. En el caso de los quesos, debido a su elevado contenido en ácidos grasos saturados y al hecho que el contenido de proteínas (reflejo del contenido de calcio y hierro en el algoritmo de cálculo del Nutri-Score) no se contabilizaba en el cálculo del Nuti-Score,  todos los quesos eran clasificados en E. Pero como los quesos son una fuente importante de calcio, se consideró que el algoritmo era incoherente, ya que no tomaba correctamente en cuenta la contribución del queso a los aportes de calcio. Del mismo modo, no permitía distinguirlos según las diferencias en los niveles de sal y/o grasas. Con la modificación, la gran mayoría de los quesos se clasifican en D (lo que es coherente con las recomendaciones nutricionales que tienen por objeto no animar a un consumo excesivo de quesos), yendo de C (para los quesos frescos poco salados) a E (para los quesos curados salados).
    2. Todas las materias grasas añadidas se posicionaban en la misma categoría del Nutri-Score, era evidente que había que discriminar  entre las grasas de origen animal, más ricas en grasas saturadas, (mantequilla) y las grasas vegetales, menos ricas en este tipo de grasas (aceites y margarinas) en coherencia con las recomendaciones nutricionales a la población. La modificación aportada al algoritmo permitió discriminar los dos grupos ya que las materias grasas de origen animal son todas E (con el aceite de palma), a diferencia de los aceites y margarinas vegetales.
    3. En el caso de las bebidas la modificación al algoritmo original fue por el hecho que las bebidas tienen una densidad distinta a los alimentos sólidos y contienen principalmente azúcar,  pero sobre todo para que el agua sea la única bebida clasificada como A (y evitar que las bebidas con edulcorantes sean clasificadas como el agua y que los jugos de frutas sean clasificados mejor que el agua). La adaptación se realizó principalmente para que el agua sea la única bebida clasificada como A (y para evitar que las bebidas edulcoradas sean clasificadas al mismo nivel que el agua, teniendo en cuenta los compuestos incluidos en el cálculo).
    • ¿Qué conclusiones pueden sacarse de estos problemas de comparación de alimentos tratados por las fake news

    Aunque, como ya se ha mencionado, la comparación (no justificada) de las clasificaciones nutricionales de determinados alimentos no es adecuada y parece una crítica irrelevante en términos de realidad práctica (como la de Coca-Cola Zero y el aceite de oliva ), y sese a que Nutri-Score funciona perfectamente bien para la inmensa mayoría de alimentos, las clasificaciones nutricionales del aceite de oliva y de la Coca Zero por el Nutri-Score (ligadas al cálculo de su algoritmo de base) plantea verdaderas cuestiones en términos de salud pública de las que son plenamente conscientes los científicos que han trabajan en el diseño del logotipo desde su creación. Aunque no son de la misma naturaleza que las fake news, algunos elementos relativos al posicionamiento de unos pocos alimentos en relación con las recomendaciones de salud pública requieren una reacción a corto o medio plazo:

    – En el caso del aceite de oliva, no es tanto una comparación irrelevante con otros alimentos (que no tienen nada que ver en términos de utilizacion) lo que plantea un problema, sino más bien el hecho de que el aceite de oliva (en la categoría D) es, aunque mejor clasificado que las grasas animales (clasificadas como E) o los aceites muy ricos en ácidos grasos saturados (coco, palma, …) menos bien  clasificado que el aceite de colza (que se clasifica como C). Teniendo en cuenta que las recomendaciones nutricionales de salud pública en casi todos los países europeos tienden a privilegiar las grasas vegetales más que las de origen animale (lo cual fue ya tomado en cuenta al origen del Nutri-Score), pero también recomiendan privilegiar, y particularmente en función de la cultura  alimentaria,  los aceites de oliva, de colza y de nueces (lo cual no es actualmente el caso ya que el aceite de oliva y el aceite de nuez están peor clasificados que el aceite de colza).

    Se están llevando a cabo intercambios entre investigadores en Francia y en Europa para permitir que Nutri-Score pueda corregir esta anomalía, valorizando los aceites de oliva y de nuez en la atribución de los puntos positivos en el cálculo de su algoritmo de base (pero sin modificarlo). Los aceites de oliva y de nuez se clasificarían en C como el aceite de colza y formarían parte de los tres aceites mejor clasificados… Un decreto modificativo al del 31 de octubre de 2017 aportaría  la coherencia necesaria entre las recomendaciones nutricionales francesas (publicadas por Health Publique France en enero de 2019) y con las europeas y mundiales y la clasificación de los aceites por Nuitri-Score.

    – En el caso de los edulcorantes, está previsto que este punto se vuelva a debatir en la evaluación que se realizará en 2021 en el marco de la discusión con los diferentes estados que participarán en el proceso. Posibles limitaciones que podrían identificarse para su uso o posibles avances en la construcción del algoritmo relacionados con la evolución de los conocimientos científicos y/o la situación jurídica en Europa (tomas en consideración los azúcares libres,…) también serán discutidos en el momento de su evaluación.

    Por último, hay que recordar claramente que el Nutri-Score, como todos los logotipos nutricionales en la cara anterior de los envases de los alimentos, es sólo uno de los elementos de una política nutricional de salud pública. Debe beneficiar de un acompañamiento pedagógico (acciones de información, comunicación y educación al público en general y a los profesionales de la salud, trabajadores sociales, de la educación,…) en cuanto a su utilización, su significado, su interés y sus límites. Se inscribe en complementariedad con las demás medidas de salud pública y, en particular, con todas las acciones de comunicación sobre las recomendaciones genéricas de consumo en términos de grupos alimentarios y, en particular, el consumo de productos no transformados  y de productos agrícolas que utilicen el menor número posible de pesticidas (alimentos orgánicos).

    CONCLUSION

    En guisa de conclusión,  es legítimo que haya debate en torno al Nutri-Score y que cada uno haga oír su voz y se pueda expresar sus preguntas (científicos, consumidores, industriales, periodistas, especialistas o profanos,…) pero es importante que el debate sea constructivo y honesto. Nutri-Score, tanto en su construcción como en su validación, se apoya en bases científicas muy sólidas (con más de 30 publicaciones científicas en revistas internacionales a comité de lectura) que han demostrado su eficacia y superioridad con respecto a todos los demás logotipos nutricionales (que no tienen un historial científico tan convincente).                                                                                    

    A través de críticas focalizadas y desproporcionadas que niegan los múltiples intereses del Nutri-Score, el juego de los lobbys sólo pretende impedir el despliegue del Nutri-Score en Europa…  para mantener el statu quo, que sigue siendo poco convincente y poco útil para el consumidor.

    Misunderstandings and fake news about Nutri-Score. How to try to destabilize a disturbing public health tool…?

    Serge Hercberg1,2, Pilar Galan1, Manon Egnell1, Chantal Julia1,2

    1 Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d’Epidémiologie et Biostatistiques Sorbonne Paris Cité (CRESS), 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

    Over the past few months, a number of negative opinions and misleading information about the front-of-pack nutrition label Nutri-Score (adopted by France in 2017, and more recently by Belgium and Spain) have been circulating on social networks, in various media and sometimes even in the words of leading political figures. This phenomenon has been particularly marked in recent weeks, probably in connection with the current highly publicized debates in several European countries currently considering implementing a FOP nutrition label, and in view of of the discussions taking place in the European Community bodies in Brussels.

    In this bubbling period, the tactics intended to destroy the credibility of Nutri-Score in order to avoid its adoption in European countries appear to be multiplying…  Disregarding a convincing scientific record of more than 30 international publications validating its underlying algorithm and its graphical design and demonstrating its efficiency and superiority over other FOP labels on several dimensions of consumer behaviour, and despite its large support by multiple European consumer associations Nutri-Score is still stongly rejected by certain agro-industry lobbys (association of food manufacturers FEVIA in Belgium, BLL in Germany, Coldiretti in Italy, etc.).

    Although some manufacturers and distributors in France, Belgium, Spain, but also in Germany, Austria, Portugal, Switzerland, Slovenia, etc. have chosen to display the Nutri-Score on their products, very strong oppositions of some large multinational agri-business companies who refuse the idea of using the Nutri-Score persists. They have established strategies to torpedo Nutri-Score, for example, by proposing alternative labels they developed themselves and appear more favourable to them : ENL at the European level, BLL circles in Germany, …. To that end, the false news («fake news») targeting the Nutri-Score play into the hands of these big international food companies who want to discredit it. Fake news also originate or are relayed by all kinds of influencers or Internet users who do not disseminate evidence-based information but rather their own personal opinions that, through a few details blown up out of all proportion, aim is to destroy the credibility of the whole system.

    The misinformation about Nutri-Score currently circulating on social networks and in some media are clearly different from the legitimate criticism that is part of a useful scientific debate (particularly on the limitations of the system), both in their objectives and in their form. False news is characterised by the fact that the information it conveys is misleading, and only seeks toraise confusion. They are often limited to the juxtaposition of examples that may each taken alone be right but which staging may contribute to sow doubt among those who do not have sufficient knowledge about the Nutri-Score,  and in particular how it is calculated and used.

    Fake news therefore highlights a single example– and often enough a peculiar one – , taken out of any context, using it to discredit the whole system. They then circulate in the same form (message or visual document), usually through a powerful image presented in a pseudo-scientific form. The same image is often accompanied by contemptuous or even insulting comments. Fake news are often put online or relayed by « anonymous » users or by individuals who rely on the same information (often the same image) to give their personal opinion (in some cases probably deceived themselves by the information or insufficiently informed to recognize the fake news). What is spectacular is that this misinformation ends up being taken up as scientific elements by some media (even well established ones)  and by all those who have an interest in using it (lobbies, scientists with links of interest with economic operators, political personalities, even ministers, etc.).

    The launch of false information about the Nutri-Score and the fact that it is relayed by different issuers imply different mechanisms:

    1. the uptake of examples of comparisons of the Nutri-Score on a very limited number of foods, always the same, which are displayed together and staged in order to give the impression that the Nutri-ScoreScore would classify absurdly the nutritional quality or the health value of foods, and therefore mislead consumers… It is interesting to note that the examples used are always based on the same brand name foods (less than 15 brand foods, while more than 200,000 products may be used tocalculate the Nutri-Score) and which are intended to impress people using their popular perception (traditional foods deemed to be healthy, industrial foods deemed to be unhealthy, etc.) and by binary comparison (well or badly classified). At no time are the detractors reporting that Nutri-Score does not pose a problem for more than 99.9% of other foods !
    2. The lack of knowledge or the denial of what can be expected from Nutri-Score (or any other front-of-pack nutrition label). Thus, either voluntarily or not, they clearly do not incorporatethe the principle, the objective, the constraints and the scope of action of a nutritional logo, neither the set of scientific data pertaining to the validation of its computational algorithm or its graphic format.


    Below are presented various fake news that have appeared in recent months on social networks and for which we explain their lack of seriousness. For reasons of homogeneity we have translated into English the verbatims circulating in Spanish, English, Flemish, Italian or in French in social networks or in the press

    1.  Example of fake news based on a real misunderstanding of the purpose of Nutri-Score

     “Nutri-Score has no interest and is misleading to the consumer, the proof is that some ultra-processed foods containing additives or pesticides are well classified with Nutri-Score !”

    This kind of criticism relates to the fact that Nutri-Score does not include additives, degree of processing, or pesticides. This choice is fully assumed for Nutri-Score as for all other FOP nutritional label (for more details see article in The Conversation: https://theconversation.com/le-nutriscore-mesure-la-qualite-nutritionnelle-des-aliments-et-cest-deja-beaucoup-99234), and is linked to the impossibility, given current scientific knowledge, of developing a synthetic indicator covering all the different health dimensions of foods. Nutri-Score refers to a nutritional information system, which has been shown to be very useful in helping consumers to be aware of the nutritional quality of foods and to direct their choices towards foods of higher nutritional quality. But under no circumstances does Nutri-Score claim to be an information system on the global ‘health’ dimension of food covering, in addition to the nutritional dimension, the health and environmental dimensions.

    To summarize the overall health dimensions of food through a single and reliable indicator, which would be able to predict overall health risk would be, obviously, the dream of any public health nutrition actor in the interest of consumers.  But it is not by chance and certainly not by incompetence, if no international research team or public health structure in the world, or any committee of independent national or international experts, nor has the WHO, been able to develop such a synthetic indicator. This can be explained by several reasons:

    1) First, the level of evidence concerning the links with health differs according the dimension considered for food. The accumulation of numerous epidemiological, clinical and experimental studies providefor certain nutritional components (nutrients/foods) a documented and robust level of evidence of their impact on chronic disease risk ranging from “probable” to “convincing” in international classifications.For the other dimensions, in particular those referring to numerous additives, neoformed compounds or contaminants (pesticides, antibiotics, endocrine disruptors, etc.), while some hypotheses of their impact on health have been raised, their underlying  levels of evidence differ greatly (especially in terms of human studies).

    2) As a result of the above, it is currently impossible to weight the relative contribution of each dimension of a food, to provide a synthetic score that would ideally be predictive of an overall health risk level. Some apps may offer it, but they have no valid and robust scientific basis. The methodological questions are numerous and still unresolved: precise measurement of the risk attributable to each of the dimensions, to each of the various components potentially incriminated, potential cocktail effect, etc. In fact, calculating a single index to characterize the overall health quality of a food, which could ultimately lead to an absolute judgement is not based on sufficiently solid scientific bases and is therefore rather arbitrary.

    Finally, with regard to additives and pesticides, where there is a sufficient body of evidence for a health risk, the answer from a public health point of view is not the information of the consumer through a logo, but the removal of the element in question from the food chain, according to a health risk management principle. This is the case today for the controversial additive E171, for which a withdrawal has been announced very recently by the French authorities.

    However complex this issue may be, this does not preclude, as part of an effective public health nutrition policy, to recommend, as it is done in the food-based dietary guidelines available for the general population to choose foods with the best Nutri-Score, without or with the shortest list of additives (in the list of ingredients) and to prefer unprocessed foods and, if possible, organic (with a certifying logo).

    2. An example of fake news based on pseudo contradictions in the ability of Nutri-Score to classify foods according to their nutritional qualities

     “Nutri-Score is false, the proof: fries that are not good for health are better ranked than sardines that contain lots of good components; or olive oil is less well ranked than Coca-Cola zero…!”.
     

    We have to keep in mind that the purpose of a FOP nutrition label such as Nutri-Score is not to classify foods as “healthy” or “unhealthy”, in absolute terms, as a binary nutritional logo would do (good vs. bad).  Such a purpose for a nutritional logo remains totally questionable since this property is linked to the amount of food consumed and the frequency of its consumption, but also to the overall dietary balance of individuals (a nutritional balance is not achieved on the consumption of a single food item, nor on a meal or even on a day…). These complex concepts cannot, of course, be summarized by a nutritional logo attributed to a specific product of a given brand…

    The real purpose of Nutri-Score is to provide consumers with information, in relative terms, that allows them, at a glance, to compare easily the nutritional quality of food, which is already a very important point to guide their choices at the time of the act of purchase. But this comparison between foods is of interest only if it is relevant, especially if it concerns foods which the consumer needs to compare in real life situations (at the time of his act of purchase or his consumption). Moreover, by definition, the Nutri-Score does not invent anything. It simply reproduces in a synthetic form the elements of nutritional composition that appear on the mandatory nutritional declaration at the back of the package.

    And on the contrary, fake news will try to divert the interest of the Nutri-Score by highlighting pseudo-contradictions based on non relevant comparisons of specific foods… For instance, here is one of the pictures that circulates most often on social networks that are widely promoted by Internet users, certain media, lobbyes and politicians.

    Fake news

    The principle of this picture (shared many times in the social networks) is to caricature the Nutri-Score suggesting that certain categories of industrial products would be classified as « healthy foods » and better ranked than “traditional” foods that would be considered “unhealthy” (“Unhealthy foods”).

    Nutri-Score makes it possible to compare the nutritional quality of foods, but on condition that these comparisons are relevant and useful to consumers to guide their choices. Here again it is worth remembering that Nutri-Score makes it possible to compare nutritional quality:

    1) of foods belonging to the same category, for example in the family of breakfast cereals comparing mueslis versus chocolate cereals, versus chocolate and filled cereals; compare dry cookies vs. fruit cookies vs. chocolate cookies; or meat lasagna, salmon lasagna, spinach lasagna; or different pasta dishes; different types of pizzas; or different types of beverages (water, fruit juices, fruit drinks, sodas, etc. ). In each of these categories the Nutri-Score will vary from A to E, which provides useful information for consumers for their choices

    2) of the same type of food proposed by different brands (e.g., comparing chocolate and filled cereal from one brand to its “equivalent” from another brand or chocolate cookies from different brands). Here again, Nutri-Score can vary from A to E, which is also a useful information to help consumers to discriminate similar foods according to their nutritional quality,

    3) of foods belonging to different families provided there is a real relevance in their conditions of use or consumption (and which are often close in supermarket shelves): yogurts versus dessert creams; breakfast cereals versus biscuits, bread or industrial pastries…

    But what is the meaning, as the fake news does, to compare French fries to Roquefort, breakfast cereals to sardines or olive oil to Coca Cola Zero? Does the question really arise in this way for consumers at the time of their act of purchase or their food consumption? It is very unlikely that a consumer would consider eating sardines for breakfast, seasoning his salad with Coca-Cola or refreshing himself with olive oil… In reality, the consumer needs to be able to compare the nutritional quality of foods that have relevance to substitute in their consumption. If he wants to choose the elements of his breakfast, it is important that he should be able to compare foods of different categories but which are traditionally consumed on this occasion, for example bread, pastries, breakfast cereals or cookies. And of course he needs to have access to transparency on the nutritional quality within the categories or according to brands, in order to be able to compare different breakfast cereals between them, or the various industrial pastries or the breads depending on the brands…

    In this context, the Nutri-Score works perfectly as shown in the examples below.

    For example: different foods belonging to different categories but usually  eaten at breakfast.

    In this example, which includes only a few of the many foods concerned, it is clear at a glance that when comparing several categories of food, among the options for breakfast, some are more favourable than others: whole breads or some mueslis are better classified than cookies or pastries. In addition, depending on the type of bread (complete or not), the type of biscuits or breakfast cereals, there may be significant variations in nutritional quality. For example within the breakfast cereal category, there is a very high variability in nutritional quality with Nutri-Score ranging from A to E depending on the type of cereal (the same applies to equivalent breakfast  cereals but with different brands):

    This type of fake news gives the feeling that the Nutri-Score is not consistent in terms of nutritional classification of foods only by comparing foods that have no reason to be compared with each other while omitting the main interest of the Nutri-Score for the consumer, namely, comparing foods under relevant conditions. The other element of deception underlying the fake news is based on playing with stereotypes in terms of food belief or perception.

    The image of French fries (often linked to fast-foods) is, in the popular belief, rather perceived as unfavorable from a nutritional point of view, while that of “traditional” foods such as Roquefort, Serrano ham or sardines (just like smoked salmon) have a rather favourable perception. Yet it is enough to look at the nutritional declaration on the back of pack of these foods to realize the reality of the nutritional composition. It is quite normal that Roquefort or Serrano ham should be classified E, given their very high content in saturated fats and salt. In the same way that smoked salmon is classified as D, which is widely used as a critique of Nutri-Score, is quite « normal » given its salt high content (2.5 to 3.5 g of salt per 100 g), unlike fresh salmon, which is classified as A, which is never indicated in the fake news mocking the classification of smoked salmon by Nutri-Score.

    Again, there are very large differences in nutritional quality within the food categories (different cheeses, different hams, etc.) or for the same food depending on the preparation and brand. If Roquefort is classified in E (it contains a high quanity of salt and saturated fats), the majority of cheeses are classified in D and some in C (for example mozzarella). Even for ham, for example Serrano ham can be E or D (depending on the brand), and other types of ham are classified in D or C.

    For sardines, widely used in fake news to question the interest of Nutri-Score (always through the same image of the same brand), if some brands are actually classified in D, other canned sardines will go from A to D according to their nutritional composition. So we can see that is not honest to suggest that sardines are systematically classified in D by the Nutri-Score…

    Specific problems with French fries

    Remarks made in the fake news about French fries imply both irrational perception of this type of food (negative image linked to fast-food) and there, again, on the misunderstanding of how a nutritional logo is established and what its role can be. Indeed, by definition, the Nutri-Score (like all other FOP nutrition labels) is, in fact, only a translation of the declared nutritional values present on  the back of the package, which refers to foods as sold. The manufacturer is required to be transparent about the nutritional composition of foods which are placed on the market, but the latter cannot take into account and/or anticipate the variability of the methods of preparation, use or consumption for its product. For Nutri-Score, only foods that require a specific reconstitution, according to a standardized recipe (mashed potatoes flakes, dry preparations for cakes),  have to give a Nutri-Score calculated on the basis of the standardized recipe.

    However, for frozen French fries several cooking methods are possible. Cooking in the oven frozen pre-cooked fries (usually classified B by Nutri-Score) has no impact on the nutritional composition, so the Nutri-Score is not modified in this case after cooking (it remains B). On the other hand, for frozen French fries (not pre-cooked) usually classified A by Nutri-Score (they are simply peeled and cut potatoes), the cooking method information given on the packaging recommends using a fryer. Under these conditions, the Nutri-Score will change, depending on the cooking oils (more or less rich in saturated fatty acids) from A to B or maximum to C. The subsequent addition of salt may also affect the note, but cannot reasonably be anticipated upon purchase of the product. These elements show both the interest of Nutri-Score, which helps to inform consumers on the reality of nutritional composition and to combat certain stereotypes or misconceptions: in the example of French fries widely used in fake news, those pre-cooked have rather a favourable nutritional composition and even those not pre-cooked remain nutritionally correct even using a fryer (classified B or maximum C). However, it appears necessary in the case of foods that cannot be consumed as purchased (such as frozen, uncooked fries), and only for those which a specific and detailed method of cooking is given on the packaging that could impact the Nutri-Score, that the manufacturer alerts consumers to the modification induced on the Nutri-Score by giving 1) the Nutri-Score of the product as sold (classical use of Nutri-Score using the elements that are on the nutritional declaration) and 2) a statement on the final score (presenting  the final letter) of the Nutri-Score obtained by the product after cooking according to the recommended mode indicated on the package (for French fries the modification leads to a higher class of Nutri-Score after passing in deep fryer).

    Finally,

    It is clear, contrary to what fake news conveys, that Nutri-Score makes it possible to distinguish easily, at a glance, the nutritional quality of foods and to compare foods with each other, to help consumers to choose a more nutritionally favourable alternative either in another category corresponding to the intended use of the food, either in the same category by choosing a better Nutri-Score or the brand offering the best-ranked food.

    It is also essential to remind a major rule of Nutri-Score, which never appears in fake news: the fact of being classified D and E for a food does not mean that it should not be consumed at all. In the context of a balanced diet, it can be integrated but the informed consumer will know, if he does not wish to choose an alternative of better nutritional quality and wishes to maintain his choice for a product D and E, it is better to consume it in smaller quantities and/or less frequently.

    Is the classification issued of the specific foods displayed in the fake news, such as the comparison between olive oil and zero Coca-Cola, specific to Nutri-Score? How do the other logos classify them?

    As all FOP nutrition labels are based on the data corresponding to their nutritional composition, all colour-coded logos such as the Traffic Light in the United Kingdom or the ENL supported by certain international food companies, describe two “red” messages for olive oil based on its saturated and total fat composition, whereas zero Coca-Cola has 4 “green”. Similarly, in the case of health warnings endorded in Chile, Canada or Israel, Coca-Cola zero displays no warnings. So whatever the system, olive oil is less well-classified than Coca Cola Zero given its content in calories, total fats and saturated fats. But curiously if this criticism is raised  strongly for Nutri-Score, no one was ever offended by this classification for the British Traffic Lights Multiples and this did not pose any problems for consumers of the retailers that already use for many years this type of logo (in United Kingdom, Spain or Portugal) and also place with their  system, olive oil worse than Coca-Cola zero.

    4.  Fake news about the fact that the Nutri-Score would be appropriate to France and not to other European countries

    « The Nutri-Score is purely French and not adapted to other European countries. As a matter of fact, the adjustments made in his calculation were made to please his cheese sector»

    Another fake news circulating on the internet is the fact that France made a specific exception on the calculation of the algorithm for cheeses in order to improve the image of French cheeses that are part of its culinary heritage! This is of course totally wrong. In fact, during its development in 2015-2016, the Nutri-Score underwent marginal adjustments that did not change the elements  taken into account for the calculation of the final score which allows to assign the different colors of the Nutri-Score to foods. The « negative » elements of the calculation are those which are included in the mandatory nutritional declaration at European level and which are mentioned in the mandatory labelling on the back of the packaging (calories, total fat, saturated fat, sodium, which are otherwise the only elements available for all foods). Minor adjustments to the method of calculation were realized by the French High Council for Public Health for cheeses, added fats and beverages.This comes from the fact that after the analysis in 2015 of the French Food Safety Agency (ANSES) these 3 categories (these are indeed categories no specific foods) have been recognised as raising specific problems that were easy to solve (without calling into question the choice of nutrients used in the calculation of the algorithm):

    1. For cheeses, because of their high saturated fatty acid composition, the protein content (used as a proxy to reflect the calcium and iron content of foods in the Nutri-Score calculation algorithm) was not integrated in the calculation of the score underlying the Nutri-Score. So all cheeses were ranked in E. Yet, cheese is an important source of calcium. As a result, it was considered that the algorithm presented an inconsistency, since it did not take into account the contribution of cheese to calcium intakes. Similarly,the initial calculation did not permit to distinguish differences in salt and/or fat content. With the change, the vast majority of cheeses (French or not) are classified in D (which is consistent with the nutritional recommendations that aim not to push to overly high cheese consumption), going further from C (for low-salt fresh cheeses) to E (for salted ripened cheeses).

    2. All the added fats were classified in the same Nutri-Score category, but it was clear that it is relevant to discriminate between animal fats richer in saturated fatty acids (such as butter) and vegetable fats less rich in saturated fats (oil, margarines), consistent with food-based dietary guidelines for the general population. The modification made to the algorithm permits to discriminate between the two groups since animal fats are all in E (with palm and coco oil), unlike vegetable oils and vegetable margarines which are better classified (in D or C).

    3. For beverages the change made to the original algorithm was related to the fact that beverages have a different density from solid products, and that most contain mainly sugar. Adaptation was carried out mainly to ensure that water was the only drink classified as A (and to prevent sweetened drinks from being classified at the same level as water, given the components taken into account in the calculation).

    5.  What lessons can be learned from these food comparison problems conveyed by fake news

    Even if, as previously mentioned, the (not justified) comparison of nutritional scores of certain foods is not adapted and appears as an irrelevant criticism in terms of practical reality (like comparisons between Coca-Cola Zero and olive oil ), and although Nutri-Score works perfectly for the very large majority of foods, the nutritional positioning of a limited number of foods  in the Nutri-Score scale (related to the calculation of its basic algorithm) nevertheless raises real issues  in terms of public health which the scientists working in the design of the system since its inception are fully aware of. Even if they are not of the same nature as those raised by fake news, some elements concerning the positioning of some rare foods with regard to public health recommendations require a short or medium-term reaction:

    – For olive oil, it is not so much an irrelevant comparison with other foods(which have nothing to do in term of use)  which is a real problem, but even if olive oil (classified D) is, of course, better placed than animal fats (classified E) or very rich oils in saturated fatty acids (coconut, palm, etc.), it is less well classified than rapeseed oils (which are classified in C).However, the nutritional recommendations of public health in almost all European countries aim at favouring vegetable fats rather than animal fats (which is covered by the initial form of Nutri-Score), but also recommend that olive, rapeseed and walnut oils be preferred among vegetable oils (which is not the case, as olive oil and walnut oil are less well-classified than rapeseed oil).

    Discussions are underway with various researchers in France and Europe to correct this anomaly of the Nutri-Score, by valuing olive and nut oils in thepositive points of the algorithm (but without modifying it). Olive and nut oils would then classified in C as rapeseed oils and would be among the three best-classified oils … An amending decree of the decree of 31 October 2017, would give the necessary consistency between the French nutritional recommendations (published by Santé Publique France in January 2019) but also European and global and the ranking of oils in the Nutri Score.

    – For sweeteners, it is expected that this issue will be discussed again during the review of Nutri-Score plan to be done at European level in 2021 and in the context of the discussion with the various states that will be engaged in the process. Possible loopholes that could be identified in the use of Nutri-Score or possible progress in the construction of the algorithm related to the evolution of scientific knowledge and/or the legal situation in Europe (taking into account free sugars for instance, etc.) will also be discussed for the future at the time of the review.

    Moreover, it should also be clearly pointed out that Nutri-Score, like all FOP nutrition labels, is only one of the elements of a public health nutritional policy. It must benefit from educational support (information, communication and education for the general public, health professionals, social workers, education, etc.) as regards its use, its meaning, its interest and its limits. It is complementary to other public health measures and in particular all communication actions on generic consumption recommendations in terms of unprocessed food and products containing as few pesticides as possible (organic foods).

    CONCLUSION                                                                                     

    Finally, a debate around the Nutri-Score is legitimate and it is important for everyone to be able to make their voice heard and to be able to ask questions (scientists, consumers, industrialists, journalists, specialists or laypersons, etc.), but it is important that the debate remain constructive and honest. The Nutri-Score, both in its construction and its validation, is based on a very solid scientific basis (with more than 30 scientific publications in international peer-reviewed journals) demonstrating its effectiveness and superiority over all other FOP nutrition labels (which do not have such a compelling scientific record).

    Through focused and disproportionate criticisms denying the multiple interests of Nutri-Score, the lobbies’ strategy aims only to prevent the deployment of Nutri-Score in Europe…  to maintain the status quo, which remains unconvincing and of little use to the consumer.