Front-of-pack nutritional label Nutri-Score and food-based dietary guidelines: complementarity and synergic objectives

Chantal Julia, Manon Egnell, Pilar Galan, Morgane Fialon, Mathilde Touvier, Serge Hercberg

Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center – University of Paris (CRESS), Bobigny, France

Public Health Department, Paris-Seine-Saint-Denis University Hospitals (AP-HP), Bobigny, France

Nutritional risk factors, and especially unhealthy diet, are considered as some of the main drivers of non-communicable diseases in Europe, including obesity, cardiovascular diseases, diabetes and some types of cancers. In order to tackle the growing burden of these chronic diseases, government-led strategies have been developed worldwide to improve the diet and the nutritional status of populations through the implementation of multifaceted nutritional policies. For several decades, Food-Based Dietary Guidelines (FBDG) have been disseminated in a large number of countries providing populations with guidance on optimal food groups’ consumption and dietary behaviors. More recently, Front-of-Pack nutrition Labels (FoPLs) have become prominent around the world and considered as effective tools to make consumers aware of the nutritional quality of foods. More specifically, interpretative FoPLs, providing an evaluation of the nutritional content of foods have been recommended by the World Health Organization.
Among the various interpretative schemes that have been developed, Nutri-Score was originally developed in France and has now also been officially adopted in Belgium, Spain, Germany, Switzerland, the Netherlands and Luxembourg. The Nutri-Score is a summary, graded, five colors-coded FoPL indicating the overall nutritional quality of foods according to a nutrient profiling system that takes into consideration both unfavourable food composition elements for which consumption should be limited (energy, total sugars, Saturated Fatty Acids – SFA, and sodium) and favourable elements for which consumption should be encouraged (fibres, protein, fruits, vegetables, legumes, nuts and olive, rapeseed and nuts oils).

Questions have been raised on whether FoPLs and notably the Nutri-Score perfectly align with dietary guidelines. Even if alignment appears reasonable overall and may be improved on some specific points, 100 % alignment is unlikely to be possible as with any other systems. Indeed, FBDGs and FoPLs schemes represent expressions of two different kinds of nutritional information and the principles of development of each of them differ in a number of ways. To understand the respective role of FBDGs and FoPLs such as Nutri-Score as well as the complementarity and the synergy between these two public health tools, it is necessary to take into consideration the differences in their objectives and to discuss how they could be coordinated.

What are the objectives of food-based dietary guidelines ?

Food-based dietary guidelines provide the overarching framework for a healthy diet, which is the result of the consumption of a combination of foods, in both quantity and quality. FBDG provide consumers practical guidance about what is considered as a healthy diet giving general information about consumption of broadly defined food groups (fruits and vegetable, pulses, nuts, dairy products, meat, added fats, sugary products, …) in order to help consumers identifying what are the food groups for which consumption should be encouraged or limited. For some of these food groups, a recommended quantitative frequency of consumption is provided (e.g. at least 5 fruit and vegetables a day, fish twice a week, one handful a day of non-salted nuts), while qualitative advice may be given for others (such as  limiting salt, sugar or fat, favour wholegrain cereals, and vegetal fats vs animal fats…). Finally, recent food-based dietary guidelines recommend unprocessed foods, promoting home-made meals.

What are the objectives of FoPL such as the Nutri-Score?

Nutri-Score FoPL has two main objectives: to encourage consumers to make healthier choices at the point of purchase and influence industry to reformulate their food products towards less salty, sugary or fatty products. To help consumer’s choices, Nutri-Score aims to provide information, in relative terms, allowing them, to compare easily the nutritional quality of food, which is a very important point to guide their choices at the time of purchase. Nutri-Score does not invent anything. It simply summarizes in a synthetic and easily understandable form the elements of nutritional composition that appear on the mandatory nutritional declaration on the back of the packaging.

The goal of Nutri-Score is to make possible for consumers to compare the nutritional quality of foods. However, this comparison between foods is only of interest, if it concerns foods the consumer needs to compare in real-life situations during purchases). Here again it should be remembered that the Nutri-Score allows for a comparison of the nutritional quality of:

1) foods belonging to the same category, for example in breakfast cereals, comparing mueslis vs chocolate cereals, vs chocolate and filled cereals; or in biscuits, comparing fruit cookies vs. chocolate cookies; or meat lasagna vs. salmon lasagna vs. spinach lasagna; or different pasta dishes; different types of pizzas; or different types of beverages (water, fruit juices, fruit drinks, sodas, etc),

2) the same food item proposed by different brands (e.g., comparing chocolate-filled cereal from one brand to its “equivalent” from another brand or chocolate cookies from different brands),

3) foods belonging to different categories provided that they are used or consumed in similar ways (and which are often close in supermarket shelves): yogurts vs dessert creams; breakfast cereals vs biscuits, bread or pastries…

Complementarity between FBDG and FoPL taking into consideration their respective specificies

FBDG aim to drive consumers toward a healthy diet. While we may identify a diet as healthy or unhealthy, by its association with various health outcomes, such as cancer, cardiovascular disease or type 2 diabetes, the same cannot be said for individual specific foods. Indeed, no food is detrimental or toxic per se, just as none is a universal panacea, and only their combination within diets may define healthy or unhealthy. However contrary to FBDG that refer to the overall diet, FoPLs rate specific foods. This contention is the main reason Nutri-Score does not classify foods as “healthy” or “unhealthy” in absolute terms.  Such a purpose for a nutritional FoPL would even be questionable since absolute healthiness depends on the amount of food consumed and the frequency of its consumption, but also on 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 be summarized by a nutritional label calculated for a specific product of a given brand…

Moreover, even for food groups that are recommended within FBDGs, a large variability in composition exists, even more so when considering the available range of industrial foods, e.g. fish may be purchased as raw, canned, smoked, patty, breaded, minced – all of them would fall under the definition of fish under FBDGs. For instance, salmon (or other fatty fish), depending on its form of sale may contain no salt (if it is fresh) or up to 3 to 4g of salt per 100g if it is smoked (corresponding to 1/2 to 2/3 of the daily recommended amount for salt). The Nutri-Score provides additional information: fresh salmon ranks A, canned salmon ranks B and smoked salmon D (Figure 1). This detail is particularly useful for consumers given that the recommendation “eat salmon, or herring or sardines” that may be disseminated in dietary-guidelines does not indicate the potential nutritional differences of various forms of the same food. Therefore, the Nutri-Score is truly complementary to the FBDG because it can help consumers adjusting the quantity and frequency of consumption of different types of salmon product in an easy way.

0.1 g salt/100g 1,2 g salt/100g 3 g salt/100g

Figure 1. The ranking of different types of fish with the Nutri-Score

Even for foods for which consumption should be limited according to dietary guidelines (e.g. crisps or sugary desserts or pizzas), there is a high variability in nutritional composition in terms of salt, saturated, fats, sugar or calories, fibers,… and often for products under the same name (Figure 2). So, even if the generic recommendation in FBDG is to limit the consumption of those products that are -for most of them – salted and/or sugary and/or fat, Nutri-Score may help consumers identifying products that present the least unfavourable composition.

Figure 2. Differences of nutritional quality between products from the same category

The Nutri-Score appears also of interest to compare similar product with the same name on packaging (e.g. “cheese pizza”, “chocolate biscuit,…) but presenting major differences in their nutritional quality depending on the brand (Figure 3). Even if consumption of pizza has to be limited overall, it is important to allow consumers to identify the brand with the best Nutri-Score. This aspect could notably encourage firms to reformulate their products.

Figure 3: Differences of nutritional quality between similar products

Once again, Nutri-Score does not assert that cheese pizzas (or even any kind of pizzas) are healthy, but it helps consumers that have decided to eat one, to choose the product with the less unfavourable composition (ranking better with Nutri-Score). 

Another major point to take into consideration when raising the issue concerning the coordination between FoP nutrition labeling with FBDGs, is that general recommendations encourage the consumption of unprocessed or minimally processed foods in most of the European countries, promoting home-made meals. However, in the current European food environment, the amount of time spent cooking and the use of fresh raw foods to prepare meals – rather than mixing industrial ingredients – tends to decrease. The trends in food supply highlight industrially-produced convenient and ready-to-use ingredients and meals as a fast-growing market. Given these trends, Nutri-Score appears again as a complementary strategy to help consumers choosing foods available on the market with the least nutritionally unfavourable or better nutritional quality at the point of purchase, especially for populations who don’t cook meals from fresh products by lack of time, desire or financial resources will not cook meals from fresh products….

Yes, we all agree that the ideal is for consumers to make his own sandwich or tomato soup with fresh and good nutritional elements, but if for lack of time or desire or means they buy a prepared industrial sandwich or a canned soup, it is better that he chooses the products of higher nutritional quality, which is what the Nutri-Score is meant for!

Overall consistency between Nutri-Score and dietary guidelines and discriminating power of the Nutri-Score

The distribution of the score based on the Food Standard Agency Nutrient Profiling System modified by the French High Council for Public Health (FSAm-NSP), underpinning the computation of Nutri-Score has been studied in several food composition databases from food supply in Europe, and especially in 9 countries (France, Belgium, Spain, Germany, Switzerland, Italy, the UK, the Netherland, Sweden) (https://nutriscore.blog/2019/07/15/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-swede/).

The classification of the different food groups using the Nutri-Score displayed an overall consistency with nutritional recommendations (Figure 4): 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 consistency was also displayed within food groups: in the starchy food group, legumes, pasta and rice were consistently better classified than breakfast cereals; in dairy, milk and yogurt were better classified than cheese. Composite dishes displayed a very large distribution, highlighting the variability of the products in this specific category. Finally, in beverages, while a majority of fruit juices were classified as C, soft drinks were classified as E, consistently with nutritional recommendations (only water is in A).

To help consumers being aware of the differences in nutritional quality of foods and to allow comparisons across foods, it is important that FoPLs have a good discriminating power with a sufficient number of categories in the Nutri-Score diplayed for each food group. The analysis showed that in all food markets of the studied countries, the variability in food composition was captured by the Nutri-Score: foods were classified in more than 3 categories of the Nutri-Score, both for food groups and for subgroups of foods.


Figure 4: Classification of the different food groups using the Nutri-Score

Requirement for a communication/education strategy to confirm the complementarity between FBDG and Nutri-Score

So, alignment of Nutri-Score with dietary guidelines appears globally consistent for a very large majority of foods present on the food market. Due to the high variability within both food categories to promote and food categories to limit, Nutri-Score provides a supplementary information to orient consumers toward foods with a better nutritional composition (with less unfavourable nutrients and /or more favorable elements). Even if there may be some misclassifications (which can be resolved by minor modification of the components in the algorithm), Nutri-Score appears as a complementary tool to FBDG. However it is necessary to accompany the dissemination of FBDG and the implementation of Nutri-Score on food packagings with communication material reminding the way both need to operate. Concretely for consumers: 1) it is recommended to follow the FBDG indicating which food groups should be promoted or limited to reach overall healthy dietary patterns, including a preference for minimally processed home-made foods, and then 2) for each food group, if  pre-packed foods have to be selected, it is advised to use the Nutri-Score to choose those with better nutritional quality in the category or in the brand, and adapt the amount/frequency of consumption.

General nutritional recommendations are similar in all European countries (even if their dissemination strategies may differ). Besides, Nutri-Score cannot vary depending on the country (in particular in the EU where the free movement of goods forbids discrepancies in the single market). However, the communication and education strategies about how to use both FBDG and Nutri-Score should be adapted to the different cultural contexts taking into consideration the specificities of dietary habits.  Communication and education on that point need to mobilize all the concerned actors: nutrition and public health institutions, nutritionists and dietitians, health professional, teachers, field actors,…

Nutri-Score (as all FOP Label) is not 100 % perfect. For instance, it does not take into account the presence of additives or pesticides. This is linked to the impossibility, given current scientific knowledge, of developing a synthetic indicator covering all the different health dimensions of foods. Indeed the level of evidence concerning the links with health differs greatly according the dimension considered. The accumulation of numerous epidemiological, clinical and experimental studies now provides a documented and robust level of evidence of health impact for several nutritional components (nutrients/foods).  This is the case for salt, sugar, dietary fiber, etc., i.e. elements included in the Nutri-Score. For the other dimensions, in particular those referring to food additives, neoformed compounds or contaminants (pesticides, antibiotics, endocrine disruptors, etc.), while some hypotheses of their impact on health have been raised, levels of evidence are still limited (especially due to the lack of long-term human studies so far). Public health and nutritional research is actively working on these aspects and will bring additional elements in the coming years that could serve for optimization of the Nutri-Score in the future, once sufficient level of evidence have been reached. But for the moment, it is 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. So as part of an effective public health nutrition policy, it is recommended to to choose foods with better Nutri-Scores, with no additives or the shortest list (information provided in the list of ingredients) and to prefer unprocessed/minimally processed foods and, if possible, organic foods (with a certifying logo).

Even if Nutri-Score will have to be improved and updated in the future based on scientific and public health argument, it is important to remember that its algorithm has been validated, demonstrating in several cohort studies that it is associated at the individual level with nutrition-related health outcomes  (cancers, cardiovascular diseases, obesity, metabolic syndrome,…). This validation of the nutrient profiling system underpinning Nutri-Score and the demonstration of the efficiency of its graphic format on the nutritional quality of food purchases justify the implementation of Nutri-Score on food packaging in synergy with FBDG. This is important because, without information on the nutritional quality of foods, the consumer is at the mercy of marketing from certain food companies that use different strategies (heavily marketed products, advertisements, subtle evocations on packs…) to push the consumption of some products that should be limited. Moreover, the demand for healthier alternatives additionally drives the industry to meet it, flooding the market with industrially-produced heavily marketed foods with health and nutrition claims that consumers struggle to independently evaluate. Given these trends, Nutri-Score appears as a real help for consumers in choosing healthier foods at the point of purchase in complement to FBDG.

Nutri-Score: ¡Sí, la presión de los consumidores y la ciencia pueden doblegar a los industriales e incluso a las grandes multinacionales!

Pr Serge Hercberg, Dra Pilar Galán, Manon Egnell, Dra Mathilde Touvier, Dra Chantal Julia
Equipe de Recherche en Epidémiologie Nutritionnelle (Inserm/INRA/CNAM/Université Sorbonne Paris Nord)

¡Hace seis años, esto parecía una batalla desigual, David contra Goliat! En efecto, cuando, en enero de 2014, emerge en un informe para la Ministra de Sanidad francesa la idea de un logotipo gradual de 5 colores destinado a posicionar en la cara frontal de los envases para informar a los consumidores sobre la calidad nutricional de los alimentos, esto provocó inmediatamente un obstruccionismo unánime de los potentes operadores económicos. Pese a que, con su formato basado en colores (del verde al rojo) superpuestos de letras (de A a E) y su expediente científico extremadamente sólido, Nutri-Score se presentaba como una herramienta sencilla y comprensible para todos  y  respondía a la demanda de las asociaciones de consumidores para una información nutricional más clara. Durante cuatro años, los grandes grupos de presión han hecho todo, o casi todo, para impedir que se aplique esta medida de salud pública. Pero los diferentes actores de la sociedad implicados se movilizaron para convencer y demostrar el interés de esta herramienta: los científicos, los profesionales de la salud, los consumidores que impulsan acciones ciudadanas, peticiones y múltiples expresiones en los medios de comunicación… Esta fuerte movilización permitió reforzar la voluntad política del Ministerio de Salud, que culminó con la firma, el 31 de octubre de 2017, de un decreto interministerial que formalizaba la adopción del Nutri-Score. En esta ocasión, tres industriales (Fleury Michon, Danone y Mc Cain) y tres distribuidores (Intermarché, Auchan y Leclerc) fueron las primeras empresas en adherir a Nutri-Score. Gracias a la presión societal, otras empresas acabaron siguiéndoles: 33 en febrero de 2018, 116 en junio de 2019 y hoy más de 300 grandes, pequeñas y medianas empresas se han comprometido.

Pero desde 2016, la batalla ha salido del hexágono y los grupos de presión opuestos a Nutri-Score continúan movilizándose, esta vez, a nivel de Europa. Seis grandes multinacionales de la agroalimentaria (Coca-Cola, PepsiCo, Nestlé, Mars, Unilever, Mondelez) se asociaron en marzo de 2017 (en lo que se ha denominado el Big6) para proponer su alternativa comuna al logotipo  Nutri-Score, el logotipo «Evolved Nutrition Label», sin sorpresa, beneficiaba a sus productos y tenía por objeto marginalizar Nutri-Score e impedir su despliegue. Pero, también en Europa, la demanda societal se expresó claramente apoyando Nutri-Score,  la Oficina Europea de Asociaciones de Consumidores (BEUC) y de ONGs como Food Watch denuncian los intentos de desestabilización. Ante los resultados de los trabajos científicos y al rechazo  de los consumidores, en noviembre de 2018, el Big6 terminó, en noviembre de 2018, dio marcha atrás. Pero a pesar de la suspensión de su logotipo, ninguna de las empresas del Big6 ni ninguna de las otras grandes empresas (Kellogg’s, Ferrero, Kraft,…) adhirieron a Nutri-Score…

La presión social, retransmitida por los medios de comunicación, poniendo el tema de Nutri-Score en el debate público. Esta fuerte movilización terminó por dar resultado logrando doblegar algunos de los grandes grupos que dentro o fuera del Big 6 se oponían fuertemente a la Nutri-Score. Así ocurrió primero con Nestlé (en noviembre de 2019) y luego con Kellogg’s (en enero de 2020) y, muy recientemente con Pepsico (en febrero de 2020). Todas estas empresas destacaron en su comunicación pública que ya no era posible no tener en cuenta la demanda de los consumidores que plebiscitan a favor y exigen la adopción de Nutri-Score.

No podemos sino acoger con satisfacción el hecho que finalmente estas grandes multinacionales hayan aceptado jugar la transparencia nutricional y adherir al Nutri-Score. Esta es una buena noticia, teniendo en cuenta el número de marcas que representan y el tipo de productos que comercializan, que no siempre son los mejores en la escala de Nutri-Score. El hecho de que Nestlé muestre Nutri-Score en todos sus productos, incluidos helados, confitería, barras de chocolate, chocolate o cremas, y que Pepsico registra en la Agencia Nacional de Salud Pública francesa  sus marcas Benenuts (aperitivos) o Lays (chips) que mostrarán puntuaciones Nutri-score D y E en numerosos de sus productos, demuestra que la demanda de los consumidores, cuando se expresa con fuerza, lleva a las empresas a jugar el juego de la transparencia, incluso en productos para los que durante mucho tiempo  no quisieron  alertar al consumidor sobre su composición nutricional.

La historia de Nutri-Score demuestra que la presión de los consumidores y de la sociedad civil puede acabar por presionar a las grandes multinacionales a reconsiderar sus posiciones y adherirse a una medida de salud pública que inicialmente rechazaban. No podemos sino felicitar a las empresas que finalmente han aceptado dar el paso. Esto refuerza la convicción de que la presión social debe seguir ejerciéndose sobre las grandes multinacionales como Coca-Cola, Ferrero, Mars, Mondelez, Unilever, Kraft, General Mills y otras empresas que siguen negando la evidencia de la ciencia y la salud pública y continúan indiferentes a la demanda de los consumidores. Este es también el interés de la petición en curso, lanzada por las asociaciones de consumidores europeas (www.pronutriscore.org)  para exigir a la Comisión Europea que haga obligatorio el Nutri-Score en Europa. Es un signo claro de la determinación de los consumidores lanzada a las empresas que todavía se niegan a jugar el juego de la transparencia nutricional en sus productos…

Por una vez, y eso es bastante raro en el campo de la salud pública, constatar que la batalla desigual de David contra Goliat, acaba ganando contra los lobbies. Aunque la victoria no sea completa, esta evolución anima a los consumidores y a los actores implicados en la defensa de la salud pública a luchar de consuno para  hacer cambiar las cosas, haciendo surgir de manera fuerte la demanda societal. ¡Nutri-Score, una historia alentadora para futuras batallas de salud pública!

Nutri-Score: Yes, the synergy of consumer pressure and scientific data can bend manufacturers… even large multinationals!

Pr Serge Hercberg, Dr Pilar Galan, Manon Egnell, Dr Mathilde Touvier, Dr Chantal Julia
Equipe de Recherche en Epidémiologie Nutritionnelle (Inserm/INRAe/CNAM/Université Sorbonne Paris Nord)

Six years ago, it was like an unequal contest, David against Goliath! When in January 2014, an official report to the French Minister of Health proposed the idea of a summary, graded 5-colors front-of-pack label to inform consumers about the nutritional quality of foods, it was immediately a general outcry from powerful economic operators. Yet with its color-coded format (from green to red) associated to letters (from A to E) and its extremely solid scientific background, the Nutri-Score is a simple and easily understandable tool, responding to the demand of consumer associations for clearer nutritional information. During four years, almost everything was done by powerful lobbies to prevent the implementation of this public health measure. But different actors of the society mobilized to convince and demonstrate the interest of this tool: scientists, health professionals, but also consumer associations, who fostered citizens’ actions, petitions and multiple communications in the media… This strong mobilization has strengthened the political will of the Ministry of Health and led to the signing on October 31st, 2017 of an inter-ministerial decree formalizing the Nutri-Score adoption as the official French front-of-pack label. On this occasion, three industrialists (Fleury Michon, Danone and Mc Cain) and three retailers (Intermarché, Auchan and Leclerc) were the first companies to pledge for the Nutri-Score. Under societal pressure, some companies have followed: 33 in February 2018, 116 in June 2019 and today more than 300 large, small and medium-sized agro-food companies officially endorse the Nutri-Score.

But since 2016, the battle has expanded outside of the French hexagon. Lobbies opposed to the Nutri-Score mobilized, this time, at the European level. Six large food multinationals (Coca-Cola, Pepsico, Nestlé, Mars, Unilever, Mondelez) joined their forces in March 2017 (in what was called the Big6) to propose their common alternative to the Nutri-Score, namely the Evolved Nutrition Label, which was unsurprisingly advantageous for their products and aimed at marginalizing the Nutri-Score and prevent its dissemination. But, here again, in Europe, the societal demand was clearly expressed with, among other things, the involvement of the European Bureau of Consumer Associations (BEUC) and NGOs such as FoodWatch which supported the Nutri-Score and denounced the attempts to destabilize it. Faced with the results of scientific works and consumer rejection, the Big6 finally backed down in November 2018. But despite the suspension of their logo, none of the Big6 companies or any of other large companies (Kellogg’s, Ferrero, Kraft, etc.) announced at that point their uptake of the Nutri-Score…

However, societal pressure continued, relayed by the media which placed the issue of the Nutri-Score in the public debate. This strong mobilization payed off and brought down some of the major groups that, in the Big 6 or elsewhere, had strongly opposed the Nutri-Score. First, this was the case for Nestlé (in November 2019), then for Kellogg’s (in January 2020) and most recently for Pepsico (in February 2020): all declared their adoption of the Nutri-Score. All these companies have highlighted in their public communication the fact that it is no longer possible to ignore the demand of consumers who strongly ask for the adoption of the Nutri-Score. We can only be delighted that these large multinationals have finally agreed to play the game of nutritional transparency and adhere to the Nutri-Score. This is good news considering the number of brands they represent and the type of products they sell, which are not always the most favorably placed on the Nutri-Score scale. The fact that Nestlé displays the Nutri-Score on all its products including ice creams, confectionery, chocolate bars, chocolate or dessert creams, and that Pepsico registers its Benenuts (aperitive snacks) or Lays (crisps) brands, which will display Nutri-Score D and E on many products, shows that consumer demand, when strongly expressed, can lead companies to agree to transparency, even on products for which, for a long time, they did not want to alert the consumer about their poor nutritional composition.

The history of the Nutri-Score shows that pressure from consumers and civil society can eventually push large multinationals to reverse their positions and embrace a public health measure that they initially rejected. We can only congratulate the companies that have finally agreed to make the move. This reinforces the conviction that societal pressure must continue to be exerted on large multinationals such as Coca-Cola, Ferrero, Mars, Mondelez, Unilever, Kraft, General Mills and others who continue to deny the evidence of science and public health and remain deaf to consumer demand. It is also in the interest of the current petition, launched by European consumer associations (www.pronutriscore.org), to require that the European Commission make the Nutri-Score mandatory in Europe. This is a strong sign of the determination of consumers against manufacturers that still refuse display full nutritional transparency on their products…

For once, and it is quite rare in the field of public health, the clay pot was not broken by the iron pot of lobbies. Even if the victory is not complete, this evolution encourages the consumers and actors involved in the defense of public health to fight together to shift the lines, making societal demand strongly emerge. The Nutri-Score, an encouraging story for future public health battles!

Nutri-Score : Oui la pression des consommateurs et la science peuvent faire plier les industriels et même les grandes multinationales !

Pr Serge Hercberg, Dr Pilar Galan, Manon Egnell, Dr Mathilde Touvier, Dr Chantal Julia
Equipe de Recherche en Epidémiologie Nutritionnelle (Inserm/INRAe/CNAM/Université Sorbonne Paris Nord)

Il y a 6 ans, cela ressemblait au combat du pot de terre contre le pot de fer, David contre Goliath ! En effet, lorsqu’en janvier 2014, a émergé dans un rapport à la Ministre de la Santé, l’idée d’un logo graduel à 5 couleurs destiné à être apposé sur la face avant des emballages pour informer les consommateurs sur la qualité nutritionnelle des aliments, ce fut immédiatement une levée de bouclier unanime des puissants opérateurs économiques. Pourtant avec son format coloriel (du vert au rouge) couplé à des lettres (de A à E) et son dossier scientifique extrêmement solide, le Nutri-Score se présentait comme un outil simple et compréhensible par tous répondant à la demande des associations de consommateurs pour une information nutritionnelle plus claire. Pendant 4 ans, tout a été fait, ou presque, par des puissants lobbys afin d’empêcher que cette mesure de santé publique ne soit mise en place. Mais les différents acteurs de la société concernés se sont mobilisés pour convaincre et démontrer l’intérêt de cet outil: les scientifiques, les professionnels de santé, les consommateurs à l’origine d’actions citoyennes, de pétitions et de multiples expressions dans les médias… Cette forte mobilisation a permis de renforcer la volonté politique du ministère de la santé aboutissant à la signature le 31 octobre 2017 d’un arrêté interministériel officialisant l’adoption du Nutri-Score. A cette occasion, trois industriels (Fleury Michon, Danone et Mc Cain) et trois distributeurs (Intermarché, Auchan et Leclerc) ont été les premières entreprises à adhérer au Nutri-Score. Sous la pression sociétale, d’autres entreprises finiront par suivre : 33 en février 2018, 116 en juin 2019 et aujourd’hui plus de 300 grandes, petites et moyennes entreprises se sont engagées.

Mais depuis 2016, la bataille est sortie de l’hexagone et les lobbys opposés au Nutri-Score se sont mobilisés, cette fois, au niveau de l’Europe. Six grosses multinationales alimentaires (Coca-Cola, PepsiCo, Nestlé, Mars, Unilever, Mondelez), se sont associées en mars 2017 (dans ce qui a été surnommé le Big6) pour proposer leur alternative commune au Nutri-Score, le logo « Evolved Nutrition Label », qui, sans grande surprise, avantageait leurs produits et visait à marginaliser le Nutri-Score et empêcher qu’il ne se déploie. Mais, là encore, en Europe, la demande sociétale s’est clairement exprimée avec, entre autres, l’implication du Bureau Européen des Associations de Consommateurs (BEUC) et des ONGs comme Food Watch qui ont soutenu le Nutri-Score et dénoncé les tentatives de déstabilisation. Confronté aux résultats des travaux scientifiques et au refus des consommateurs, le Big6 a fini, en novembre 2018, par faire marche arrière. Mais malgré la suspension de leur logo, aucune des entreprises du Big6 ni aucune des autres grandes entreprises (Kellogg’s, Ferrero, Kraft,…) n’ont annoncé leur adhésion au Nutri-Score…
Mais la pression sociétale a continué à s’exercer de façon constante, relayée par les médias installant la question du Nutri-Score dans le débat public. Cette forte mobilisation a fini par être payante aboutissant à faire plier certains des grands groupes qui dans le Big 6 ou en dehors s’étaient opposés fortement au Nutri-Score. Cela a d’abord été le cas de Nestlé (en novembre 2019) puis de Kellogg’s (en janvier 2020) et tout récemment Pepsico (en février 2020). Toutes ces sociétés ont mis en avant dans leur communication publique le fait qu’il n’était plus possible de ne pas prendre en compte la demande des consommateurs qui plébiscitent et exigent l’adoption du Nutri-Score. On ne peut que se réjouir que ces très grosses multinationales aient fini par accepter de jouer le jeu de la transparence nutritionnelle et adhérer au Nutri-Score. C’est une bonne nouvelle compte-tenu du nombre de marques qu’elles représentent et le type de produits qu’ils commercialisent qui ne sont pas toujours les mieux placés sur l’échelle du Nutri-Score. Le fait que Nestlé affiche le Nutri-Score sur tous ses produits dont des glaces, des confiseries, des barres chocolatées, du chocolat ou des crèmes dessert, et que Pepsico enregistre ses marques Benenuts  (produits apéritifs) ou Lays (chips), qui afficheront sur de nombreux produits des Nutri-Score D et E, démontre que la demande des consommateurs, quand elle est fortement exprimée, amène les entreprises à jouer le jeu de la transparence, même sur des produits pour lesquels, pendant longtemps, ils n’ont pas souhaité alerter le consommateur sur leur composition nutritionnelle.


L’histoire du Nutri-Score démontre que la pression des consommateurs et de la société civile peut finir par pousser de grandes multinationales à revenir sur leurs positions et adhérer à une mesure de santé publique qu’ils rejetaient au départ. On ne peut que féliciter les sociétés qui ont fini par accepter de franchir le pas. Cela renforce la conviction que la pression sociétale doit continuer à se faire sur les grandes multinationales telles que Coca-Cola, Ferrero, Mars, Mondelez, Unilever, Kraft, General Mills et sur les autres sociétés qui continuent à nier l’évidence de la science et de la santé publique et restent sourdes à la demande des consommateurs. C’est également l’intérêt de la pétition en cours, lancée par des associations de consommateurs européennes (http://www.pronutriscore.org), pour exiger de la commission européenne qu’elle rende obligatoire le Nutri-Score en Europe. C’est un signe fort de la détermination des consommateurs lancé aux entreprises qui refusent encore de jouer le jeu de la transparence nutritionnelle sur leurs produits…

Pour une fois, et c’est assez rare dans le domaine de la santé publique, le pot de terre n’a pas été brisé par le pot de fer des lobbys. Même si la victoire n’est pas complète, cette évolution encourage les consommateurs et acteurs impliqués dans la défense de la santé publique à se battre de concert pour faire bouger les lignes, en faisant émerger de façon forte la demande sociétale. Le Nutri-Score, une histoire encourageante pour les batailles de santé publique à venir !

Une version courte de ce texte a été publiée dans la Parisien Dimanche du 16 février 2020

No a la instrumentalización política del Nutri-Score en Italia por el Sr. Matteo Salvini (1) ¡ No a la negación de la ciencia y de la salud pública!

Serge Hercberg, Pilar Galan, Manon Egnell, Chantal Julia, Mathilde Touvier
Equipe de Recherche en Epidémiologie Nutritionnelle, Inserm/Inra/Cnam/ Université Paris 13

Durante una serie de entrevistas de prensa realizadas sobre diversos soportes mediáticos y de intervenciones en las redes sociales, el Sr. Matteo Salvini1 acusa el logotipo de información nutricional Nutri-Score de ser el soporte de una operación secreta dirigida por la Unión Europea contra la alimentación mediterránea y los productos «made in Italy». (https://twitter.com/matteosalvinimi/status/1202197787347173376?s=20).

Cette image a un attribut alt vide ; le nom du fichier est salvini2.jpg

Para apoyar su tesis «complotista», el Sr. Salvini aporta afirmaciones inexactas y ejemplos de aplicación de Nutri-Score truncados y falsos. Demuestra hasta qué punto no conoce el Nutri-Score e intenta desviarlo para servir a intereses que no tienen nada que ver con la ciencia y la salud pública. Por otra parte, los eurodiputados de la Lega recuperan sus pseudo-argumentos y, bajo el impulso de la Sra. Silvia Saldone, depositan una pregunta escrita a la Comisión sobre  el «riesgo que representaría el colocar el Nutri-Score para los productos alimenticios italianos » (http://www.europarl.europa.eu/doceo/document/P-9-2019-004228_EN.html).

Científicos italianos preocupados por la salud de la población han reaccionado y han publicado  el 13 de diciembre de 2019 una Tribuna para restablecer la verdad sobre Nutri-Score y su interés en términos de salud pública (https://ww.scienzainrete.it/articolo/nutri-score-perch%C3%A9-non-dobbiamo-Averne-paura/2019-12-13).

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Y en la misma línea, los creadores de Nutri-Score han querido responder a las diferentes acusaciones del Sr.  Salvini.

Nutri-Score es una herramienta de salud pública desarrollada por científicos independientes y no por «tecnócratas europeos»

Nutri-Score no es una creación de «tecnócratas de la Unión Europea», como afirma el Sr. Salvini, ya que ha sido desarrollado por investigadores especialistas en Nutrición y Salud Pública de la Universidad París 13 (Francia). Se trata de académicos e investigadores vinculados  al Instituto Francés de Salud e Investigación Médica (INSERM), al Instituto Nacional de Investigación Agronómica (INRA) y al Conservatorio Nacional de Artes y Oficios (CNAM), sin  vínculos de interés y que trabajan desde hace muchos años sobre las medidas que deberían  aplicarse para mejorar el estado nutricional y la salud de las poblaciones.

Por otra parte, todos los comités de expertos nacionales e internacionales recomiendan el establecimiento de un sistema complementario de información nutricional sobre la cara frontal de los envases de los alimentos; medida que la OMS considera, desde hace varios años, como eficaz para ayudar a los consumidores a adoptar comportamientos alimentarios más favorables a la salud.

Es en este marco que fue desarrollado Nutri-Score. Destinado a ser colocado en la parte frontal de los envases de alimentos, con un doble objetivo:  1) ayudar a los consumidores a evaluar, con una simple ojeada en el momento de su acto de compra, la calidad nutricional global de los alimentos para ayudarles a comparar los alimentos entre ellos y orientar sus elecciones y sus comportamientos para mejorar su salud, 2) incitar a los industriales a reformular la composición nutricional de los alimentos que fabrican para que se posicionen mejor  en la escala del Nutri-Score, en comparación con sus concurrentes, mejorando así de manera global la calidad nutricional de la oferta alimentaria.   

Nutri-Score se basa en bases científicas muy sólidas (más de 40 estudios publicados en revistas internacionales con comité de lectura) que han validado el algoritmo que sirve de base al cálculo del Nuti-Score (particularmente sobre sus efectos sobre la prevención de enfermedades crónicas como los cánceres, las enfermedades cardiovasculares, la obesidad… , y sobre la mortalidad) y ha demostrado su eficacia para ayudar a los consumidores a orientar sus decisiones de compra hacia alimentos más saludables (https://solidarites-sante.gouv.fr/prevention-en-sante/preserver-sa-sante/nutrition/article/articles-scientifiques-et-documents-publies-relatifs-au-nutri-score). Estos trabajos han puesto también de manifiesto su superioridad con respecto a otros logotipos existentes o a otros logotipos apoyados por lobbies o diversos grupos de presión. Su formato coloreado (que van del verde al rojo) asociado a letras (de A a E) lo convierte en la práctica en una herramienta sencilla, intuitiva y comprensible para todos. Colocado en todos los envases de alimentos, un modelo de simulación reconocido internacionalmente, basándose en el beneficio observado por el Nutri-Score sobre la calidad nutricional de las compras, ha permitido mostrar que la presencia de Nutri-Score estaría asociada a una reducción de la mortalidad por enfermedades crónicas relacionadas con la nutrición de alrededor del 3,4 % en Francia (https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-019-0817-2).

Teniendo en cuenta los principales problemas de salud pública relacionados con la nutrición (obesidad, diabetes, enfermedades cardiovasculares, cánceres,…) y basándose en datos científicos y de salud pública que lo validan,  Nutri-Score ha sido aplicado por ciertos  Estados europeos con el apoyo de las agencias de salud pública y de las sociedades científicas de expertos y a la demanda de los consumidores que también lo apoyan. Fue adoptado por Francia (en octubre de 2017), Bélgica (en abril de 2018), España (en noviembre de 2018), Alemania (en septiembre de 2019) y Holanda (en noviembre de 2019). Se está debatiendo en muchos otros países europeos.

Hay que tener en cuenta que, contrariamente a lo que afirma el Sr. Salvini, Nutri-Score nunca ha sido apoyado por la Comisión Europea que,  debido a su Reglamento sobre la Información de los consumidores (INCO) votado en 2011 y  que entró en vigor en 2014 (con una presión eficaz de los grupos de los lobbies),  prohíbe  hasta la fecha de hoy a los estados miembros de imponer de forma  obligatoria un logotipo (como Nutri-Score) en la cara frontal de los envases de los alimentos. El actual Reglamento de la UE es un obstáculo, ya que sólo permite a los Estados miembros adoptar el Nutri-Score (o cualquier otro logotipo) de forma voluntaria. Hay que señalar que las asociaciones de consumidores europeas han lanzado una Iniciativa Ciudadana Europea (pronutriscore.org) para forzar a la Comisión Europea a revisar su Reglamento INCO lo cual permitiría que el Nutri-Score sea obligatorio. Por lo tanto, son los consumidores, con el apoyo de científicos y expertos en salud pública, y no la UE, quienes piden hoy que el Nutri-Score sea extendido en toda Europa y se transforme en obligatorio para todos los productos.

Nutri-Score no se opone en absoluto a la alimentación mediterránea. ¡Al contrario!

Las afirmaciones expresadas por el Sr. Salvini y los eurodiputados de la Lega, argumentando que Nutri-Score pretende destruir la alimentación mediterránea. Evidentemente, Nutri-Score no es un arma contra la alimentación mediterránea que, en su versión original, es un modelo alimentario apoyado por todos los nutricionistas (especialmente los que diseñaron y desarrollaron el Nutri-Score) y que se  integra en las recomendaciones nutricionales de casi toda Europa, del Norte al Sur. Para apoyar su teoría, el Sr. Salvini destaca el hecho de que Nutri-Score clasifica el Pecorino Romano, el Gorgonzola, el Prosciutto, el jamón San Daniele y el aceite de oliva, en las categorías menos favorables desde el punto de vista nutricional. Estos ejemplos son su bae para decir que Nutri-Score se opone a la alimentación mediterránea… Esto es totalmente absurdo por varias razones:

a) La alimentación mediterránea no se limita a comer Pecorino romano, Gorgonzola, Prosciutto o jamón San Daniele… La Piramide Universela de la Dieta Mediterranea (véase la figura) hace hincapié que la alimentación mediterránea se caracteriza por un consumo abundante de frutas, hortalizas, legumbres, cereales (sobre todo completos), un consumo moderado de pescado y un consumo limitado de productos lácteos y bajo de carnes, embutidos y productos azucarados, grasos y salados; y privilegia entre las grasas añadidas el aceite de oliva  pero no recomienda su consumo ad libitum… La alimentación mediterránea no hace, en ningún caso, como sugiere el señor Salvini, la promoción de los quesos y de los embutidos (¡sean italianos o no!). No son pilares importantes de la pirámide de la alimentación mediterránea. Esto es totalmente coherente con la clasificación aportada por el Nutri-Score que clasifica más favorablemente los alimentos o platos poco grasos, dulces o salados, ricos en fibra, frutas y hortalizas, legumbres y frutos de cáscara. Cuando se comparan las recomendaciones de la pirámide que caracterizan la dieta mediterránea con la Nutri-Score, se observa la buena convergencia.

b) Si los quesos y los embutidos (y no sólo italianos) se clasifican en su mayoría en D y, a veces, en E, esto se explica por el hecho de que contienen cantidades no despreciables de grasas saturadas y sal y además son calóricas… Pero como todos los productos clasificados como D o E con Nutri-Score, los quesos y embutidos pueden consumirse perfectamente en el marco de una alimentación equilibrada. Informar a los consumidores sobre la realidad de la calidad nutricional de estos alimentos tradicionales no excluye su consumo, pero, por supuesto, un consumo en cantidades/frecuencias limitadas, lo cual es totalmente coherente con los principios del modelo de alimentación mediterránea y con la significación de su clasificación en la escala Nutri-Score.

c) Por último, la pasta, el risotto, la polenta, las múltiples salsas y Sughi e incluso algunas pizzas se califican A o B en el sistema Nutri-Score, y representan igualmente ¡la riqueza de la alimentación tradicional italiana!

d) Con respecto al aceite de oliva, ¡no es rojo/E como afirma el Sr. Salvini! ¡Está clasificado C, es decir, la mejor puntuación para las grasas añadidas e incluso para los aceites vegetales! Las recomendaciones de salud pública en Italia y en otros lugares no sugieren consumir el aceite de oliva sin límite (es una materia grasa 100% grasa que es calórica como las demás) pero recomiendan  a los consumidores a privilegiarla con respecto a otros aceites vegetales y sobre todo con respecto a las materias grasas de origen animal. A ello contribuye el Nutri-Score que clasifica el aceite de oliva con la mejor puntuación posible (C) para los aceites vegetales (con el de colza y de nuez) y, por tanto, es mejor clasificado que los aceites de soja, girasol, maíz (clasificados D), el de coco o palma (clasificados como E) y la mantequilla (clasificada como E).

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Nutri-Score no clasifica los alimentos sanos o malsanos, pero ayuda a comparar la calidad nutricional en valor relativo de los alimentos cuya comparación es pertinente

No tiene sentido comparar el aceite de oliva con la Coca-Cola Light. ¡La cuestión no se plantea  en absoluto de esta manera para los consumidores en el momento de su compra o de su consumo de alimentos!  En efecto, es muy poco probable que el consumidor considere aliñar su ensalada con Coca-Cola o refrescarse con aceite de oliva… En realidad, el consumidor necesita poder comparar la calidad nutricional de los alimentos que tienen pertinencia para sustituirse en su consumo, su uso o sus condiciones de compra. Si quiere elegir un aceite verá fácilmente en los estantes de los supermercados, gracias a la visualización de Nutri-Score, que el aceite de oliva es el mejor clasificado por el Nutri-Score. También verá para elegir una bebida, que el agua es la única clasificada en A y que las sodas clásicas se clasifican en E…

Hay que tener en cuenta que la finalidad de un logotipo nutricional como Nutri-Score no es clasificar, como piensa el Sr. Salvini, los alimentos, en valor absoluto, en «alimentos sanos» o «alimentos no sanos», como haría un logotipo binario (bien contra mal). Tal finalidad para un logotipo nutricional sería totalmente discutible, ya que esta propiedad está vinculada a la cantidad del alimento consumida y a la frecuencia de su consumo, pero también al equilibrio alimentario global de las personas (el equilibrio nutricional no se obtiene sobre el consumo de una sola ingesta alimentaria, ni siquiera sobre una comida o sobre un día…). Por supuesto, estos conceptos complejos no pueden resumirse con un logotipo nutricional asignado a un producto específico de una marca específica… No, la finalidad de Nutri-Score es proporcionar a los consumidores una información, en valor relativo, que les permita, con un simple vistazo, poder comparar la calidad nutricional de los alimentos, esto ya es muy importante para orientar sus decisiones en el momento del acto de compra. Pero esta comparación entre alimentos sólo tiene sentido si es pertinente, sobre todo si se refiere a alimentos que el consumidor tiene que comparar en la vida real (en el momento de su acto de compra o de su consumo). Por otra parte, por definición, Nutri-Score no inventa nada, solo transcribe en forma sintética los elementos de la composición nutricional que figuran en la etiqueta nutricional presente en la parte posterior del envase.

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

  1. De alimentos de la misma categoría, por ejemplo en la familia de cereales de desayuno, comparar mueslis versus cereales chocolatados, versus cereales chocolatados y rellenos; o galletas secas vs galletas con frutas vs las galletas chocolateadas; o lasaña con carne, a lasaña con salmón, o lasaña con espinacas; o diferentes platos preparados a base de pasta; o diferentes tipos de pizza; o diferentes tipos de bebidas (agua, zumos, bebidas a base de frutas, refrescos…). En cada una de estas categorías, la puntuación Nutri-Score pueden variar de A a E, proporcionando una información útil para los consumidores a la hora de elegir.
  • De un mismo tipo de alimento propuesto por diferentes marcas (por ejemplo, comparar cereales chocolatados y rellenos de una marca con su «equivalente» de otra marca o galletas chocolatadas de diferentes marcas). Una vez más, la puntuación Nutri-Score puede variar de A a E, lo cual es también una información útil para ayudar a los consumidores a reconocer los alimentos de mejor calidad nutricional.
  • De alimentos pertenecientes a familias diferentes a condición que sean realmente relevantes en sus condiciones de uso o consumo (y que a menudo están cercanos en los estantes de supermercados): yogur en comparación con cremas lácteas; cereales de desayuno en comparación con galletas, pan o bollería…

En este marco, como han demostrado numerosos estudios científicos, Nutri-Score funciona perfectamente bien y se ajusta al modelo tradicional de la alimentación mediterránea, al que las recomendaciones en la mayoría de los países quieren alcanzar. Hay que señalar además que España, país mediterráneo, y Francia (que también tiene en el sur una cultura gastronómica mediterránea), que formulan recomendaciones de salud pública en favor de la promoción de la alimentación mediterránea, ¡ han adoptado Nutri-Score!

Nutri-Score: una herramienta de salud pública desarrollada en interés de los consumidores, aunque ello vaya en contra de los intereses comerciales de determinados grupos industriales

De hecho, Nutri-Score molesta a las grandes multinacionales y a los lobbies que se niegan a adoptarlo y siguen luchando contra él a nivel internacional. Si Nestlé terminó por doblegarse ante la demanda de los consumidores (después de varios años de batalla) los grandes grupos como Ferrero, Coca-Cola, PepsiCo, Mars, Mondelez, Unilever, Kellogg’s… todavía se niegan a colocarlo en sus envases.

Nutri-Score no clasifica peor los quesos italianos que los otros quesos en Europa, ya sean franceses, españoles, holandeses, alemanes, griegos o suizos: el Roquefort está clasificado E, el Azul de Auvernia E, Gouda E, Manchego D o E, Mimoleta E, Brie de Meaux D, Emmental D, Conté D, Saint Nectaire D, Camembert D, Feta D o E, … A señalar que entre los rarísimos quesos tradicionales clasificados C (uno de los mejores resultados para un queso), se encuentran los famosos quesos italianos Mozzarela, Burrata y Ricotta… Lo mismo se aplica a los embutidos italianos que no están específicamente atacados: si el jamón San Daniele está clasificado como D, es el caso también del jamón de Bayona francés o del jamón Serrano español,… En cuanto al salami, se encuentra al mismo nivel que la roseta de Lyon, el chorizo español y todos los demás embutidos en Europa.

Así pues, está claro que el Nutri-Score no pretende penalizar el «made in Italy», ni tampoco el «made in France» (los fabricantes de foie gras, roquefort, mantequilla, o salchichas de Estrasburgo podrían sentirse igualmente penalizados) o el «made in Spain» (con el jamón Serrano, el Manchego o el chorizo…). Nutri-Score aporta transparencia sobre la calidad nutricional de todos los alimentos y ayuda a los consumidores a orientar sus decisiones (sin decir nunca que un producto mal clasificado por Nutri-Score no debe ser consumido sino que debe ser resituado en el marco de una alimentación equilibrada…). Es totalmente falso dar a entender que Nutri-Score ha sido  desarrollado para perjudicar al «made in Italy» (o «made otros países») o que se trata de una construcción de Europa para atacar a los productos tradicionales italianos. ¡No, el Nutri-Score es «made in Salud Pública»!

En sus argumentos, el Sr. Salvini defiende el interés de algunos grupos industriales italianos, pero en ningún momento se preocupa por la salud de los consumidores italianos… Nutri-Score ha sido desarrollado para servir al  interés de los consumidores y responde a su demanda, aunque ello vaya en contra de determinados intereses económicos.

1 Ex Vicepresidente del Consejo de Ministros de Italia (junio de 2018 – septiembre de 2019); Senador desde enero de 2018; Secretario Federal de la Lega desde diciembre de 2013


No to the political instrumentalization of the Nutri-Score in Italy by Mr Matteo Salvini(1). No to the denial of science and public health!

Serge Hercberg, Pilar Galan, Manon Egnell, Chantal Julia, Mathilde Touvier
Equipe de Recherche en Epidémiologie Nutritionnelle, Inserm/Inra/Cnam/ Université Paris 13

During interviews given to various media outlets and interventions on social networks, Mr Matteo Salvini accuses the front-of-pack nutrition label Nutri-Score of being the support of an operation secretly led by the European Union against the Mediterranean diet and products «made in Italy» (https://twitter.com/matteosalvinimi/status/1202197787347173376?s=20).

Cette image a un attribut alt vide ; le nom du fichier est salvini2.jpg

To support his “conspiracy” theory, Mr Salvini relies on inaccurate declarations and incorrect and truncated examples of application of the Nutri-Score. It shows how unfamiliar he is with the Nutri-Score and he tries to subvert it to serve interests that have nothing to do with science and public health. His pseudo-arguments have also been taken up by Lega MEPs who, under the impetus of Silvia Saldone, submitted a written question to the Commission on the «Nutri-Score system: risks for Italian-made products» (http://www.europarl.europa.eu/doceo/document/P-9-2019-004228_EN.html).

Italian scientists concerned with the health of the population reacted and published on December 13th a statement to restore the truth about the Nutri-Score and its interest in terms of public health (https://www.scienzainrete.it/articolo/nutri-score-perch%C3%A9-non-dobbiamo-averne-paura/2019-12-13).


In the same line the designers of the Nutri-Score wanted to respond to the various accusations of Mr Salvini.

Nutri-Score is a public health tool developed by independent scientists and not by “European technocrats”

The Nutri-Score is not a creation of «technocrats of the European Union» as Mr Salvini claims, but was developed by researchers specialized in Nutrition and Public Health at the Paris 13 University (France). They are academics and researchers from the French National Health and Medical Research Institute (INSERM), the French National Institute for Agronomic Research (INRA) and the National Conservatory of Arts and Crafts (CNAM), independent of any conflict of interest and working these many years on investigating the public health measures which could be implemented to improve the nutritional and health status of populations.

The implementation of a complementary interpretative nutritional information system on the front of food packages is recommended by national and international expert committees, including WHO, which has for several years considered this type of labels to be an effective measure to help consumers adopt healthier eating behaviours.

It is within this context that the Nutri-Score was developed. Intended to be displayed on the front of package of foods, it has a dual objective: 1) to help consumers at the point of purchase identify, at a glance, the overall nutritional quality of foods and help them compare products and guide their choices toward healthier products and improve their behaviours, 2) to encourage manufacturers to reformulate the nutritional composition of the foods they produce, to be better positioned on the Nutri-Score scale compared to their competitors, and eventually improve the overall nutritional quality of the food supply.

The Nutri-Score is based on an extremely solid scientific background (more than 40 studies published in international peer-reviewed journals) that have validated the algorithm underlying its computation (including cohort studies testing the associations with the risk or prevention of chronic diseases such as cancer, cardiovascular disease, obesity…, and mortality) and demonstrated its effectiveness in helping consumers making healthier choices (https://solidarites-sante.gouv.fr/prevention-en-sante/preserver-sa-sante/nutrition/article/articles-scientifiques-et-documents-publies-relatifs-au-nutri-score). Various studies have also highlighted its superiority over other existing labels or labels supported by various lobbies. Its colour-coded format (from green to red) coupled with letters (from A to E) makes it a simple, intuitive and understandable tool for consumers. Based on its effects on the nutritional quality of purchases, if the label was displayed on all foods of the market, the Nutri-Score would be associated, in France, to a reduction in mortality from nutrition-related chronic diseases by 3.4% using an internationally recognized simulation model (https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-019-0817-2).

Given the major public health issues related to nutrition (obesity, diabetes, cardiovascular disease, cancers, etc.), the Nutri-Score has been implemented by some European States on the basis of the scientific and public health elements that validate it, the support of public health agencies and learned societies and the demand from consumers who support it. It was adopted by France (October 2017), Belgium (April 2018), Spain (November 2018), Germany (September 2019) and Holland (November 2019). It is currently being discussed in many other European countries.

It should be noted that contrary to what Mr Salvini says, the Nutri-Score has never been supported by the European Commission, which,  through its specific regulation on consumer information (INCO) voted in 2011 and implemented in 2014 (with effective pressure from lobbies) prohibit member-states from making a label (such as the Nutri-Score) mandatory on the front of food packages. The current EU regulation is blocking since it allows member-states to adopt the Nutri-Score (or any other label) only on a voluntary basis. It should be noted that European consumer associations have launched a European Citizens’ Initiative (pronutriscore.org) to force the European Commission to revise its INCO regulation to allow the Nutri-Score to become mandatory. It is therefore consumers, with the support of scientists and public health experts, and not the EU, who are now calling for the Nutri-Score to be rolled out throughout Europe and to become mandatory on all products.

The Nutri-Score is absolutely not opposed to the Mediterranean diet. On the contrary!

Among the arguments put forward by Mr Salvini and the Lega MPs, the « Nutri-Score would aim to destroy the Mediterranean diet ». Nonsense ! Obviously, the Nutri-Score is not a weapon against the Mediterranean diet which, in its original version, is a food model supported by all nutritionists (especially those who designed and developed the Nutri-Score) and included in the nutritional recommendations throughout most of Europe, from North to South. To support his theory, Mr Salvini highlights the fact that the Nutri-Score ranks Pecorino Romano, Gorgonzola, Prosciutto, San Daniele ham and olive oil in the less nutritionally favorable categories (i.e. D and E, according to him). With these examples, he asserts that the Nutri-Score aims to oppose the Mediterranean diet… This is totally absurd for several reasons:

a) The Mediterranean diet is not limited to eating Pecorino romano, Gorgonzola, Prosciutto or San Daniele ham… The Universal Piramide of Dieta Mediterranea (see figure) highlights that the Mediterranean diet is characterized by an abundant consumption of fruits, vegetables, pulses, cereals (especially whole-cereals), a moderate consumption of fish, a limited consumption of dairy products and a low consumption of meat, processed meat and sugary, fat and salty products; and favours olive oil among added fats without recommending its ad libitum consumption…

Therefore, the Mediterranean diet does not promote in any way, as Mr Salvini suggests, cheeses and deli meats (whether Italian or not!). They are not major pillars of the Mediterranean food pyramid. This is in total consistency with the classification provided by the Nutri-Score which classifies more favourably low-fat, -sweet and -salty foods or dishes rich in fiber, fruits and vegetables, legumes and nuts. When we compare the recommendations of the pyramid characterizing the Mediterranean diet and the Nutri-Score, we can note the good convergence.

b) If the majority of cheeses and processed meats (and not only Italian ones) are ranked D and sometimes E, this is explained by the fact that they contain significant amounts of saturated fats and salt and are also high in calories… But like all the products classified D or E with the Nutri-Score, cheeses and processed meats can be perfectly consumed as part of a balanced diet. Informing consumers about the reality of the nutritional quality of these traditional foods does not exclude their consumption but, they should be consumed in limited quantities/frequencies, which is fully consistent with the principles of the Mediterranean food model and with the significance of their ranking on the Nutri-Score scale.

c) However, pasta, risotto, polenta, multiple sauces and sughi and even some pizzas are rated A or B in the Nutri-Score system, and they also represent the richness of traditional Italian foods!d) Concerning olive oil, it is not red/E as stated by Mr Salvini! It is classified C, that correspond to the best score possible for added fats and even for vegetable oils! The public health recommendations in Italy and elsewhere do not suggest consuming olive oil without limits (it is a 100% fat product which is highly caloric like the others) but they encourage consumers to favour it over other vegetable oils and especially over animal fats. This is what the Nutri-Score contributes to, as jt classifies olive oil with the best possible score (C) for vegetable oils (with rapeseed oil and walnut oil) and therefore better ranked than soya, sunflower, corn oils (classified D), coconut or palm (classified E) and butter (classified E).

d) Concerning olive oil, it is not red/E as stated by Mr Salvini! It is classified C, that correspond to the best score possible for added fats and even for vegetable oils! The public health recommendations in Italy and elsewhere do not suggest consuming olive oil without limits (it is a 100% fat products that is caloric like the others) but they encourage consumers to favour it over other vegetable oils and especially over animal fats. This is what the Nutri-Score contributes to, as jt classifies olive oil with the best possible score (C) for vegetable oils (with rapeseed oil and walnut oil) and therefore better ranked than soya, sunflower, corn oils (classified D), coconut or palm (classified E) and butter (classified E).

The Nutri-Score does not classify foods as « healthy » or « unhealthy » but helps to compare the nutritional quality in relative value of foods that have relevance to be compared

Comparing olive oil to Coca Cola Light makes no sense. The question does not arise in this way for consumers at the point of purchase or food consumption! Indeed, it is very unlikely that consumers would consider seasoning their salad with Coca-Cola or refreshing themselves with olive oil… In reality, consumers need to be able to compare the nutritional quality of foods that are relevant to be substituted in their consumption, use or purchasing conditions. If they want to choose a bottle of oil they will easily see on supermarket shelves thanks to the display of the Nutri-Score, that olive oil is the best ranked compared to other oils. They will also see that water is the only beverage classified in A and that regular soft drinks are classified in E…


It should be kept in mind that the objective a front-of-pack nutrition label such as the Nutri-Score is not to classify, as Mr Salvini thinks, foods as “healthy food” or “unhealthy food”, in absolute value, as a binary logo would do (good vs bad). Such a purpose for a nutritional label would remain totally questionable because healthiness is linked to the amount of foods consumed and the frequency of its consumption, but also to the overall food balance of individuals (the nutritional balance is not achieved through the consumption of a limited food intake, or even over a meal or over a day… ). These complex concepts cannot, of course, be summarized by a nutritional label attributed to a specific brand product… No, the objective of the Nutri-Score is to provide information to consumers, in relative value, that allows them, at a glance, to compare the nutritional quality of foods. This is already very important to guide their choices at the time of purchases. But the comparison of nutritional quality of foods is of interest only if it is relevant, especially if it concerns foods which the consumer is confronted with comparing in real life (at the time of his act of purchase or consumption). Furthermore, by definition, the Nutri-Score does not invent anything, it only reproduces in synthetic form the elements of the nutritional composition which appear on the table of nutrition values present on the back of the packaging.

Here again it is important to remind that the Nutri-Score allows to compare nutritional quality:

  1. of foods belonging to the same category, for example in the breakfast cereal family, comparing mueslis versus chocolate cereals versus chocolate and filled cereals; compare dry cookies versus fruit cookies versus chocolate cookies; or meat lasagna, salmon lasagna, spinach lasagna; or different pasta dishes; different types of pizzas; or different types of drinks (water, fruit juice, fruit drinks, sodas, etc. ). In each of these categories, the Nutri-Scores can vary from A to E, which provides useful information for consumers during their choices,
  2. of the same type of foods from different brands (e.g., comparing chocolate and filled cereal from one brand to its “equivalent” of another brand or chocolate cookies from different brands). Again, the Nutri-Scores can vary from A to E, which is also useful information to help consumers recognize foods of better nutritional quality,
  3. of foods belonging to different families provided that there is a real relevance in their conditions of use or consumption (and which are often close in supermarket shelves) : yogurts compared to desserts; breakfast cereals compared to cookies, bread or pastries…

In this context, as many scientific studies have demonstrated, the Nutri-Score works perfectly well and is in line with the traditional model of the Mediterranean diet towards which the recommendations in most countries tend. It should be noted that Spain, a typical Mediterranean country, and France (which also has a Mediterranean gastronomic culture in the south), which make public health recommendations aiming to promote the Mediterranean diet, have adopted the Nutri-Score!

The Nutri-Score: a public health tool developed in the interest of consumers even if it goes against the commercial interests of some industrial groups

In fact, the Nutri-Score disturbs large multinational food companies and lobbies that refuse to adopt it and continue to fight its implementation at the international level. If Nestlé has finally complied with consumer demand (after several years of fighting) the big foods companies like Ferrero, Cocacola, Pepsico, Mars, Mondelez, Unilever, Kellogg’s… still reject it.

Italian cheeses are not classified worse by the Nutri-Score than other cheeses from European countries, whether French, Spanish, Dutch , German, Greek or Swiss: Roquefort is classified E, Bleu d’Auvergne E, Gouda E, Manchego D or E, Mimolette E, Brie de Meaux D, Emmental D, Conté D, Saint-Nectaire D, Camembert D, Fêta D or E, … Note that among the rare traditional cheeses classified C (the best score for cheese), we find the famous Italian cheeses Mozzarela, Burrata and Ricotta… Similarly Italian processed meats are not specifically targeted: if San Daniele ham ranks D, this is also the case for the French Bayonne ham or the Spanish Serrano ham, etc. As for salami, it finds itself at the same level as the rosette of Lyon, the Spanish chorizo and all the others sausages in Europe…

So it is clear that the Nutri-Score does not aim to penalize the products «made in Italy», nor «made in France» (the manufacturers of Foie gras, Roquefort, butter, or sausages of Strasbourg could also feel penalized) or « made in Spain » (with Serrano ham, manchego or chorizo, etc.). It only aims to provide transparency on the nutritional quality of foods and help consumers to guide their choices (without ever saying that a product should not be consumed but that it should be placed as part of a balanced diet…). It is totally incorrect to suggest that the Nutri-Score was developed to harm “made in Italy” products (or “made anywhere else”!) or would be a construction of Europe to attack traditional Italian products ! No, the Nutri-Score is only “made in Public Health”!

In his arguments, Mr Salvini defends the interests of certain Italian industrial groups but is never concerned about the health of Italian consumers… The Nutri-Score has been developed for the benefit of consumers and responds to their demand, even if it goes against some economic interests.

1] Mr Matteo Salvini is former Vice-president of the Council of Italian Ministers (June 2018 – September 2019); Senator since January 2018; Federal Secretary of the Lega since December 2013

Non à l’instrumentalisation politique du Nutri-Score en Italie par Monsieur Matteo Salvini [1]. Non au déni de la science et de la santé publique !

Serge Hercberg, Pilar Galan, Manon Egnell, Chantal Julia, Mathilde Touvier

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.


A l’occasion d’interviews données sur divers supports médiatiques et d’interventions sur les réseaux sociaux, Monsieur Matteo Salvini accuse le logo d’information nutritionnelle Nutri-Score d’être le support d’une opération secrètement pilotée par l’Union Européenne contre l’alimentation méditerranéenne et les produits « made in Italy » (https://twitter.com/matteosalvinimi/status/1202197787347173376?s=20).

Cette image a un attribut alt vide ; le nom du fichier est salvini2.jpg

Pour soutenir sa thèse « complotiste », Monsieur Salvini  s’appuie sur des affirmations inexactes et des exemples d’application du Nutri-Score tronqués  et faux. Il démontre à quel point il ne connait pas le Nutri-Score et essaye de le détourner pour servir des intérêts qui n’ont rien à voir avec la science et la santé publique. Ses pseudo-arguments sont d’ailleurs repris par des eurodéputés de la Lega qui, sous l’impulsion de Mme Silvia Saldone, ont déposé une question écrite à la Commission sur le « risque pour les produits alimentaires italiens que représenterait l’affichage du Nutri-Score » (http://www.europarl.europa.eu/doceo/document/P-9-2019-004228_EN.html).

Des scientifiques italiens concernés par la santé de la population ont souhaité réagir et ont publié le 13 décembre 2019 une Tribune pour rétablir la vérité sur le Nutri-Score et son intérêt en termes de santé publique (https://www.scienzainrete.it/articolo/nutri-score-perch%C3%A9-non-dobbiamo-averne-paura/2019-12-13).


Dans la même ligne que nos collègues italiens, les scientifiques concepteurs du Nutri-Score ont souhaité répondre aux différentes accusations de Monsieur Salvini.

Nutri-Score est un outil de santé publique développé par des scientifiques indépendants et non par des « technocrates européens »

Le Nutri-Score n’est pas une création de « technocrates de l’Union Européenne » comme l’affirme Monsieur Salvini, mais a été développé par des chercheurs spécialisés en Nutrition et Santé Publique de l’Université Paris 13 (France). Il s’agit d’universitaires et de chercheurs rattachés à l’Institut Français de la Santé et de la Recherche Médicale (INSERM), à l’Institut National de la Recherche Agronomique (INRA) et au Conservatoire National des Arts et Métiers (CNAM), indépendants de tous liens d’intérêt et travaillant depuis de longues années sur les mesures à mettre en œuvre pour améliorer l’état nutritionnel et l’état de santé des populations.

La mise en place d’un système d’information nutritionnelle complémentaire sur la face avant des emballages des aliments est d’ailleurs recommandée par tous les comités d’experts nationaux et internationaux, dont l’OMS qui considère depuis plusieurs années qu’il s’agit d’une mesure efficace permettant d’aider les consommateurs à adopter des comportements alimentaires plus favorables à la santé.

C’est dans ce cadre que le Nutri-Score a été développé. Destiné à être affiché sur la face avant des aliments, il possède un double objectif :

1) aider les consommateurs à juger, d’un simple coup d’œil, au moment de leur acte d’achat, de la qualité nutritionnelle globale des aliments pour les aider à les comparer entre eux et orienter leurs choix et leurs comportements pour améliorer leur santé,

2) inciter les industriels à reformuler la composition nutritionnelle des aliments qu’ils produisent pour être mieux positionnés sur l’échelle du Nutri-Score, par rapport à leurs concurrents, et améliorer ainsi de manière globale la qualité nutritionnelle de l’offre alimentaire.

Le Nutri-Score repose sur des bases scientifiques extrêmement  solides (plus de 40 études publiées dans des revues internationales à comité de lecture) qui ont validé l’algorithme sous-tendant le calcul du Nutri-Score (notamment par rapport aux effets sur la prévention des maladies chroniques comme les cancers, les maladies cardio-vasculaires, l’obésité…,  et par rapport à la mortalité) et démontré son efficacité pour aider les consommateurs à orienter leurs choix vers des aliments plus favorables à leur santé (https://solidarites-sante.gouv.fr/prevention-en-sante/preserver-sa-sante/nutrition/article/articles-scientifiques-et-documents-publies-relatifs-au-nutri-score ). Ces travaux ont également mis en évidence sa supériorité par rapport aux autres logos existants ou soutenus par des lobbys ou des groupes de pressions divers. Son format coloriel (du vert au rouge) couplé à des lettres (de A à E) en fait un outil simple, intuitif et compréhensible par tous. Affiché sur tous les aliments, s’appuyant sur les effets observés du Nutri-Score sur la qualité nutritionnelle des achats, un modèle de simulation reconnu internationalement a permis de montrer que le Nutri-Score serait associé, en France, à une réduction de la mortalité par maladies chroniques liées à la nutrition d’environ 3,4 % (https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-019-0817-2).

Compte-tenu des grands enjeux de santé publique liés à la nutrition (obésité, diabète, maladies cardio-vasculaires, cancers,….), le Nutri-Score a été mis en place par des Etats européens sur la base des éléments scientifiques et de santé publique qui le valident, du soutien des agences de santé publique et des sociétés savantes d’Experts et de la demande des consommateurs qui le plébiscitent. Il a été adopté par la France (en octobre 2017), la Belgique (en avril 2018),  l’Espagne  (en novembre 2018), l’Allemagne (en septembre 2019) et la Hollande (en novembre 2019). Il est en cours de discussion dans de nombreux autres pays européens.

A noter que contrairement à ce qu’avance Monsieur Salvini, le Nutri-Score n’a jamais été soutenu par la Commission Européenne qui, d’ailleurs, par son règlement sur l’information des consommateurs (INCO) voté en 2011 et mis en place en 2014 (avec une pression efficace des lobbys) interdit à ce jour aux états-membres de rendre un logo (comme Nutri-Score) obligatoire sur la face avant des emballages des aliments. Le règlement européen en vigueur est bloquant puisqu’il ne permet aux états-membres d’adopter le Nutri-Score (ou tout autre logo) que sur une base volontaire. A noter que les associations de consommateurs européennes ont lancé une Initiative Citoyenne Européenne (pronutriscore.org) pour forcer la Commission Européenne à revoir son règlement INCO pour permettre que le Nutri-Score devienne obligatoire. Ce sont donc les consommateurs, avec le soutien des scientifiques et experts en santé publique, et non l’UE qui réclament aujourd’hui que le Nutri-Score soit déployé dans toute l’Europe et qu’il devienne obligatoire sur tous les produits.

Nutri-Score ne s’oppose absolument pas à l’alimentation méditerranéenne. Au contraire !

Parmi les arguments avancés par Monsieur Salvini et les eurodéputés de la Lega, le Nutri-Score viserait à détruire l’alimentation méditerranéenne. Bien évidemment le Nutri-Score n’est absolument pas une arme contre l’alimentation méditerranéenne qui, dans sa version originale, est un modèle alimentaire soutenu par tous les nutritionnistes (notamment ceux qui ont conçu et développé le Nutri-Score) et repris dans les recommandations nutritionnelles dans quasiment toute l’Europe, du Nord au Sud. Pour soutenir sa théorie, Monsieur Salvini met en avant le fait que le Nutri-Score classe le Pecorino Romano, le Gorgonzola, le Prosciutto, le jambon San Daniele et l’huile d’olive dans les catégories moins favorables sur le plan nutritionnel. Ces exemples lui suffisent pour dire que Nutri-Score vise à s’opposer à l’alimentation méditerranéenne… Ceci est totalement absurde pour plusieurs raisons :

a) L’alimentation méditerranéenne ne  se limite pas à manger du Pecorino romano, du Gorgonzola, du Prosciutto ou du jambon San Daniele… La Piramide Universela de la Dieta Mediterranea (voir figure ci-dessous) met bien en évidence que l’alimentation méditerranéenne est caractérisée par la consommation en abondance de fruits, légumes, légumineuses, céréales (surtout complètes), une consommation modérée de poisson et une consommation limitée de produits laitiers et faible de viandes, charcuteries et des produits sucrés, gras et salés ; et privilégie l’huile d’olive parmi les matières grasses ajoutées mais n’en recommande pas une consommation ad libitum…
L’alimentation méditerranéenne ne fait donc en aucun cas, comme Monsieur Salvini le laisse entendre, la promotion des fromages et des charcuteries (qu’ils soient italiens ou non !). Ils ne sont pas des piliers majeurs de la pyramide de l’alimentation méditerranéenne.
Ceci est en totale cohérence avec la classification apportée par le Nutri-Score qui classe plus favorablement les aliments ou plats peu gras, sucrés ou salé, riches en fibres, fruits et légumes, légumineuses et fruits à coque. Lorsque l’on compare les recommandations de la pyramide caractérisant l’alimentation méditerranéenne et le Nutri-Score, on note la bonne convergence.

b) Si les fromages et les charcuteries (et pas seulement italiens) sont classés pour la majorité en D et parfois en E, ceci s’explique par le fait qu’ils contiennent des quantités non négligeables de graisses saturées et de sel et sont également caloriques… Mais comme tous les produits classés D ou E avec le Nutri-Score, les fromages et charcuteries peuvent parfaitement être consommés dans le cadre d’une alimentation équilibrée. Informer les consommateurs sur la réalité de la qualité nutritionnelle de ces aliments traditionnels n’exclut pas de les consommer mais, bien sûr, en quantités/fréquences limitées, ce qui est totalement en cohérence avec les principes du modèle de l’alimentation méditerranéenne et avec la signification de leur classement sur l’échelle du Nutri-Score.

c) Enfin, les pâtes, le risotto, la polenta, les multiples sauces et sughi et même certaines pizzas sont notés A ou B dans le système Nutri-Score, et elles représentent tout autant la richesse de l’alimentation traditionnelle italienne !

d) Concernant l’huile d’olive, elle n’est pas rouge/E comme affirmé par Monsieur Salvini ! Elle est classée C, c’est-à-dire le meilleur score pour les matières grasses ajoutées et même pour les huiles végétales ! Les recommandations de santé publique en Italie comme ailleurs ne suggèrent pas de consommer l’huile d’olive sans limite (c’est une matière grasse 100% grasse qui est calorique comme les autres) mais elles poussent les consommateurs à la privilégier par rapport aux autres huiles végétales et surtout par rapport aux matières grasses animales. C’est ce à quoi contribue le Nutri-Score qui classe l’huile d’olive avec le meilleur score possible (C) pour les huiles végétales (avec l’huile de colza et l’huile de noix) et donc  mieux classée que les huiles de soja, tournesol, maïs (classées D), que celles de coco ou palme (classées E) et que le beurre (classé E).  

Le Nutri-Score ne classe pas les aliments en sains ou malsains mais aide à comparer la qualité nutritionnelle en valeur relative d’aliments qui ont une pertinence à être comparés

Comparer l’huile d’olive au Coca Cola Light n’a aucun sens. La question ne se pose absolument pas de cette façon pour les consommateurs au moment de leur acte d’achat ou de leur consommation alimentaire ! En effet, il est très peu probable que le consommateur envisage d’assaisonner sa salade avec du Coca-Cola ou de se rafraîchir avec de l’huile d’olive… En réalité, le consommateur a besoin de pouvoir comparer la qualité nutritionnelle des aliments qui ont une pertinence à se substituer dans leur consommation, leur usage ou leurs conditions d’achat. S’il souhaite choisir une huile il verra facilement sur les rayons de supermarchés grâce à l’affichage du Nutri-Score que l’huile d’olive est la mieux classée par le Nutri-Score. Il verra également pour choisir une boisson, que l’eau est la seule classée en A et que les sodas classiques sont classés en E….

Il faut garder à l’esprit que la finalité d’un logo nutritionnel comme Nutri-Score n’est pas de classer, comme le pense Monsieur Salvini, les aliments en « aliments sains » ou « aliments non sains », en valeur absolue, comme le ferait un logo binaire (bien vs mal). Une telle finalité pour un logo nutritionnel resterait totalement discutable car cette propriété est liée à la quantité consommée de l’aliment et la fréquence de sa consommation, mais également à l’équilibre alimentaire global des individus (l’équilibre nutritionnel ne se faisant pas sur la consommation d’une prise alimentaire, ni même sur un repas ou sur un jour…). Ces notions complexes ne peuvent, bien sûr, être résumées par un logo nutritionnel attribué à un produit spécifique d’une marque donnée… Non, la finalité du Nutri-Score est de fournir aux consommateurs une information, en valeur relative qui leur permet, en un simple coup d’œil, de pouvoir comparer la qualité nutritionnelle des aliments, ce qui est déjà très important pour orienter leurs choix au moment de l’acte d’achat. Mais cette comparaison n’a d’intérêt que si elle est pertinente, notamment si elle porte sur des aliments que le consommateur est confronté à comparer dans la vraie vie (au moment de son acte d’achat ou de sa consommation). Par ailleurs, par définition, le Nutri-Score n’invente rien, il ne fait que retranscrire sous forme synthétique les éléments de la composition nutritionnelle qui figurent sur l’étiquette nutritionnelle présente à l’arrière de l’emballage.

Là encore il est bon de rappeler que le Nutri-Score permet de comparer la qualité nutritionnelle :

1) d’aliments appartenant à la même catégorie, par exemple dans la famille des céréales petit déjeuner, comparer des mueslis versus des céréales chocolatées, versus des céréales chocolatées et fourrées; comparer des biscuits secs vs des biscuits aux fruits vs des biscuits chocolatés ; ou bien des lasagnes à la viande, à celle au saumon, aux épinards ; ou encore les différents plats préparés à base de pâtes ; les différents types de pizzas; ou différents types de boissons (eau, jus de fruits, boissons à base de fruits, sodas,…). Dans chacune de ces catégories les Nutri-Scores peuvent varier de A à E, ce qui fournit une information utile pour les consommateurs pour leurs choix,

2) d’un même type d’aliment proposé par des marques différentes (par ex: comparer des céréales chocolatées et fourrées d’une marque par rapport à son « équivalent » d’une autre marque ou des biscuits chocolatés de différentes marques). Là encore, les Nutri-Scores peuvent varier de A à E, ce qui est également une information utile pour aider les consommateurs à reconnaitre les aliments de meilleure qualité nutritionnelle,

3) d’aliments appartenant à des familles différentes à conditions qu’il y ait une réelle pertinence dans leurs conditions d’usage ou de consommation (et qui sont souvent proches dans les rayons de supermarchés) : des yaourts par rapport à des crèmes desserts ; des céréales petit déjeuner par rapport à des biscuits, du pain ou des viennoiseries…

Dans ce cadre, comme l’ont montré de nombreuses études scientifiques, le Nutri-Score fonctionne parfaitement bien et va bien dans le sens du modèle traditionnel de l’alimentation méditerranéenne vers lequel les recommandations dans la plupart des pays veulent tendre. A noter d’ailleurs que l’Espagne, pays méditerranéen, et la France (qui a également dans le sud une culture gastronomique méditerranéenne), qui font des recommandations de santé publique allant dans le sens de la promotion de l’alimentation méditerranéenne ont adopté le Nutri-Score !

Nutri-Score : un outil de santé publique développé dans l’intérêt des consommateurs même si cela va à l’encontre des intérêts commerciaux de certains groupes industriels

En fait, le Nutri-Score dérange les grandes multinationales et les lobbys qui refusent de l’adopter et continuent à le combattre au niveau international. Si Nestlé a fini par plier face à la demande des consommateurs (après plusieurs années de bataille) les grands groupes comme Ferrero, CocaCola, PepsiCo, Mars, Mondelez, Unilever, Kellogg’s… refusent encore de l’afficher.

Les fromages italiens ne sont pas plus mal classés par le Nutri-Score que les autres fromages en Europe, qu’ils soient français, espagnols, hollandais , allemands, grecs ou suisses: le Roquefort est classé E, le Bleu d’Auvergne E, le Gouda E, le Manchego D ou E, la Mimolette E, le Brie de Meaux D, l’Emmental D, le Conté D, le Saint-Nectaire D, le Camembert D, la Fêta D ou E, …  A noter d’ailleurs que parmi les très rares fromages traditionnels classés C (un des meilleurs scores pour un fromage), on retrouve les célèbres fromages italiens Mozzarela, Burrata et Ricotta… Il en est de même pour la charcuterie italienne qui n’est pas spécifiquement visée: si le jambon San Daniele est classé D, c’est également le cas du jambon de Bayonne français ou du jambon Serrano espagnol,… Quand au salami, il se retrouve au même niveau que la rosette de Lyon, le chorizo espagnol et tous les autres saucissons en Europe…

Donc il est clair que le Nutri-Score ne vise pas à pénaliser le « made in Italy », pas plus que  le « made in France » (les fabricants de  foie gras, le roquefort, le beurre, ou les saucisses de Strasbourg pourraient se sentir également pénalisés) ou le « made in Spain » (avec le jambon Serrano, le manchego ou le chorizo…).  Il vise à donner une transparence sur la qualité nutritionnelle de l’ensemble des aliments et aider les consommateurs à orienter leurs choix (sans jamais dire qu’un produit mal classé ne doit pas être consommé mais qu’il doit être replacé dans le cadre d’une alimentation équilibrée…). Il est totalement faux de laisser entendre que le Nutri-Score a été développé pour porter préjudice au « made in Italy » (ou « made ailleurs » !) ou serait une construction de l’Europe pour attaquer les produits traditionnels italiens. Non le Nutri-Score est « made in Santé Publique » !

Dans ses arguments,  Monsieur Salvini défend l’intérêt de certains groupes industriels italiens mais à aucun moment ne se préoccupe de la santé des consommateurs italiens…Le Nutri-Score a été développé pour l’intérêt des consommateurs et répond à leur demande, même si cela va à l’encontre de certains intérêts économiques.

[1] Monsieur Matteo Salvini est ancien Vice-Président du Conseil des Ministres Italiens (juin 2018 – septembre 2019), Sénateur depuis janvier 2018, Secrétaire Fédéral de la Ligue depuis décembre 2013

Appel de 200 scientifiques pour soutenir l’initiative citoyenne européenne PRO-NUTRISCORE : « Pour que le logo nutritionnel Nutri-Score devienne obligatoire en Europe ! »

Apposé sur la face avant des emballages des aliments, le logo nutritionnel Nutri-Score a pour objectifs de permettre aux consommateurs de juger, en un simple coup d’œil, de la qualité nutritionnelle globale des aliments au moment de leur acte d’achat, tout en incitant les industriels, sous la pression de l’évolution de leurs ventes, à améliorer la composition nutritionnelle des aliments qu’ils produisent au travers de reformulations

Son côté coloriel (du vert au rouge) couplé à des lettres (de A à E) en fait un outil simple et intuitif, compréhensible par tous. Malgré sa simplicité, il s’appuie sur le calcul d’un algorithme défini sur des bases de santé publique et validé, intégrant le contenu des aliments en éléments négatifs (calories, sucres simples, acides gras saturés et sodium) et en élément positifs (fibres, pourcentage de fruits et légumes et protéines).

Adopté en octobre 2017 en France (en Belgique et en Espagne en 2018 et en Allemagne il y a quelques jours), le Nutri-Score est un outil qui a démontré sa capacité à orienter les consommateurs vers des choix alimentaires plus favorables à la santé. L’intérêt du Nutri-Score et sa supériorité par rapport à d’autres logos nutritionnels souvent proposés par différents groupes de pression a été très largement démontré par plus de 40 travaux publiés dans des revues scientifiques internationales.

Pour que le Nutri-Score soit réellement efficace, il doit être affiché sur tous les aliments mis à la disposition des consommateurs pour leur permettre de comparer la qualité nutritionnelle des aliments entre eux. Malheureusement, du fait de la réglementation européenne sur l’Information des Consommateurs (INCO) qui a pris effet en décembre 2014, les états-membres n’ont pas la possibilité de rendre obligatoire l’apposition d’un logo nutritionnel comme le Nutri-Score sur les emballages des produits alimentaires. L’apposition du Nutri-Score dépend donc aujourd’hui uniquement de la bonne volonté des industriels. Si certaines entreprises ont accepté de jouer le jeu de la transparence nutritionnelle et l’affichent sur une base volontaire, d’autres y sont toujours opposés.

Pour rendre obligatoire l’affichage du Nutri-Score, il faut donc modifier le règlement européen INCO.  C’est le sens de l’Initiative Citoyenne Européenne (ICE) intitulée « PRO-NUTRISCORE ». Lancée à l’initiative de 7 associations de consommateurs son objet est de pousser la Commission Européenne à imposer l’étiquetage simplifié « Nutri-Score » sur les produits alimentaires, pour garantir une information nutritionnelle de qualité à tous les  consommateurs européens et protéger leur santé.

Pour que le processus officiel en cours, enregistré par la Commission Européenne aille à son terme, il est nécessaire de  rassembler, en moins d’une année, un million de signatures réparties dans au moins 7 pays européens.   
En cliquant sur le lien http://www.pronutriscore.org, chaque citoyen/consommateur est dirigé sur le serveur parfaitement 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 officielle sur les initiatives citoyennes européennes.

Les professionnels de Santé, de la Nutrition et de la Santé Publique et tous les acteurs impliqués dans le champ de la prévention des maladies chroniques ne peuvent que soutenir cette initiative citoyenne européenne 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. Grâce à cette mobilisation, 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 de pouvoir intégrer, s’ils le souhaitent, cette dimension dans leur acte d’achat.

Pour faire pression sur la Commission européenne afin qu’elle rende le Nutri-Score obligatoire en Europe, et ainsi obtenir une avancée concrète s’agissant de l’information des consommateurs et améliorer la santé publique des européens, il faut donc une mobilisation forte.

 
Comme nous, signez la pétition « Pronutriscore » sur le site officiel de la Commission européenne : www.pronutriscore.org

Liste des 200 premiers signataires (Collectif scientifique Pro-NutriScore)

Serge Hercberg, Professeur de Nutrition, Université Paris 13, Département de santé publique Hôpital Avicenne, AP-HP, Equipe de Recherche en Epidémiologie Nutritionnelle Inserm/Inra/Cnam/Université Paris 13, ancien président du PNNS

François Bourdillon, ancien Directeur Général de Santé publique France.

Benoit Vallet, ancien Directeur Général de la Santé (Ministère de la Santé)

Joël Ménard, Professeur Emérite de Santé Publique, Faculté de Médecine de Paris-Descartes, ancien Directeur Général de la Santé (Ministère de la Santé)

William Dab, Professeur d’Hygiène et Sécurité, CNAM, ancien Directeur Général de la Santé (Ministère de la Santé)

Roger Salamon, Professeur de Sante Publique, Université de Bordeaux, ancien président du Haut Conseil de la Santé Publique (HCSP)

Laurent Chambaud, Directeur de l’Ecole des Hautes Etude en Santé Publique

Francoise Barre-Sinoussi, Lauréate 2008 du Prix Nobel de Médecine ou Physiologie

André Laurent Parodi, Professeur, Président honoraire de l’Académie nationale de Médecine et de l’Académie vétérinaire de France

Thanh Le Luong, ancienne directrice de l’Institut national de prévention et d’éducation pour la santé (INPES)

Irène Frachon, Pneumologue, CHU de Brest

Stéphane Schneider, Professeur de Nutrition, Université Côte d’Azur, Vice-Président de la Société Francophone Nutrition Clinique et Métabolisme, Président de la Commission Scientifique Spécialisée Nutrition Toxicologie, INRA

Pierre Déchelotte, Professeur de Nutrition, Chef du Département de Nutrition CHU de Rouen et directeur UMR INSERM 1073

Chantal Julia, Maître de conférence des universités en NUtrition- Praticien hospitalier (MCU-PH), Université Paris 13, Hôpital Avicenne, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN)

André Grimaldi, Professeur de diabétologie CHU Pitié Salpêtrière

Sébastien Czernichow, Professeur de Nutrition, Université de Paris, Hôpital Européen Georges Pompidou, AP-HP

Didier Quilliot, Professeur de Nutrition, CHRU de Nancy, Unité Inserm U1256

Pierre-Henri Ducluzeau, Professeur de Nutrition, Diabétologue, Centre Hospitalo-Universitaire de Tours, INRA Tours

Vincent Rigalleau, Professeur de Nutrition-Diabétologie, CHU de Bordeaux

René Valero,  Professeur de Nutrition, chef du service de Nutrition, Maladies Métaboliques et Endocrinologie, CHU Conception, Marseille

Paul Valensi, Professeur de Nutrition, Chef de Service d’endocrinologie-diabétologie-nutrition, Université Paris Nord, APHP, Bondy-Bobigny-Sevran

Olivier Ziegler Professeur de Nutrition CHRU de Nancy

Pilar Galan, Médecin nutritionniste, Directrice de Recherche INRA, Equipe de Recherche en Epidémiologie Nutritionnelle Inserm/Inra/Cnam/Université Paris 13

Pascal Crenn, Professeur Hepatogastroenterologie-Endocrinologie Diabetologie Nutrition, Université Paris Saclay/APHP

Pierre Yves Benhamou, Professeur Chef de service, Endocrinologie Diabétologie Nutrition, CHU de Grenoble

Béatrice Morio-Liondore, Directrice de Recherche INRA, Laboratoire CarMeN, INRA U1397 INSERM U1060 Université de Lyon

Mathilde Touvier, Directrice de Recherche INSERM, Directrice de l’Equipe de Recherche en Epidémiologie Nutritionnelle, Inserm/Inra/Cnam/Université Paris 13  

Luc Cynober, Professeur de Nutrition, Université de Paris et Service de Biochimie, Hôpital Cochin

Marie-Christine Beauvieux, Maitre de Conférence -Praticien Hospitalier en nutrition, CHU de Bordeaux

David Jacobi, Professeur de Nutrition, l’institut du thorax, Nantes Université et CHU de Nantes

Claire Carette, Médecin Nutritionniste, Hôpital européen Georges Pompidou, Paris

Ronan Roussel, Professeur de médecine à l’Université de Paris, Chef de service d’endocrinologie-diabétologie-nutrition à l’hôpital Bichat, APHP, Paris

Etienne Larger, Professeur, Endocrinologie diabétologie, maladies des métabolismes Chef de Service, Service de diabétologie, Hôpital Cochin, APHP.Centre-Université de Paris

Marie-Claude Brindisi, MCU-PH en Nutrition, Université de Bourgogne, CHU François Mitterrand,  Dijon

Corinne Bouteloup, gastroentérologue, maître de conférence en nutrition, CHU de Clermont-Ferrand ; Unité de Nutrition Humaine UMR1019 UCA-INRA »

Sybil Charriere, Maitre de Conférence -Praticien Hospitalier en nutrition – Hospices civils de Lyon

Marie-Astrid Piquet, Professeur en Nutrition, CHU de Caen

Dominique Darmaun, Professeur de Nutrition, CHU de Nantes, directeur adjoint UMR PhAN (NRA/Université de Nantes)

Alain Pradignac, Professeur de Nutrition, Unité de Nutrition Thérapeutique, CHU Hautepierre Hôpitaux Universitaires de Strasbourg

Sophie Béliard-Lasserre, MCU-PH en Nutrition, Assistance publique des hôpitaux de Marseille et Aix Marseille université, France

Ghislain Grodard, Diététicien nutritionniste, chargé de projet INSERM CIC 1431, Président de l’Association Française des Diététiciens Nutritionnistes (AFDN)

Jean Claude Desport, Professeur de Nutrition, CHU et Faculté de Médecine, Limoges

Jean-Louis Guéant, Professeur des Universités-Praticien Hospitalier du CHRU de Nancy et directeur de l’unité Inserm-Université de Lorraine UMRS 1256 Nutrition-Génétique-Exposition aux Risques Environnementaux

Roberto Mallone, Professeur, PU-PH Université de Paris et APHP Hôpital Cochin Paris, Service de Diabétologie et Immunologie Clinique

Catherine Atlan, Maître de conférences des Universités Nutrition, Chef de Service Endocrinologie , Centre Hospitalier de Luxembourg

Najate Achamrah, Maître de conférence des universités – Praticien hospitalier (MCU-PH), Département de Nutrition, CHU de Rouen, INSERM U1073, Rouen Normandie Université

Pierre Jesus, Médecin Nutritionniste, MCU-PH, Unité de Nutrition et Centre Spécialisé de l’Obésité, CHU de Limoges

Baillot-Rudoni Sabine, Praticien Hospitalier, Endocrinologie et Maladies Métaboliques, CHU Bocage Central, Dijon

Stéphane Besançon Directeur Général ONG Santé Diabète

Jean-Paul Lallès, Directeur de recherche INRA (Département d’Alimentation humaine), Directeur du Centre de Recherche en Nutrition Humaine Ouest, 44093 Nantes

Patricia Parnet, Directrice de recherche INRA, Directrice de l’unité de recherche Physiopathologie des Adaptations Nutritionnelles, Université de Nantes-INRA, CHU Nantes

Denis Lairon, Nutritionniste, Directeur de Recherche émérite, Marseille

Emmanuel Rusch, Professeur de Santé Publique, Directeur EA7505 Education Ethique Santé, Université de Tours, Président de la Société Française de Santé Publique

Florence Richard, Professeur de Santé publique à l’Université de Lille, Secrétaire Générale du Collège Universitaire des Enseignants de Santé Publique

Thierry Lang, Professeur de Santé Publique, Université de Toulouse.

Philippe Ravaud, Professeur de Santé Publique, Paris Descartes, Directeur du CRESS Paris

Bruno Falissard, Professeur, Directeur du Centre de Recherche en Epidemiologie et Santé des Populations  (CESP), Inserm, Villejuif

Pierre Lombrail, Professeur de santé publique, Université paris 13 ; chef du service de santé publique, hôpitaux universitaires paris seine st-denis, APHP

François Baudier, médecin de santé publique et nutritionniste, Président de la Fédération nationale d’éducation et de promotion de la santé (Fnes)

Gérard Dubois, Professeur de Santé Publique, Amiens, membre de l’Académie nationale de Médecine

Serge Briançon, Professeur émérite de santé publique; université de Lorraine, Nancy

Francois Dabis, Professeur de Santé Publique, Université de Bordeaux

Marcel Goldberg, Professeur de santé publique émérite, Université de Paris

Laurence Meyer, Professeure de Santé Publique, Université Paris-Sud Paris-Saclay

Olivier Ganry, Professeur de Santé Publique, CHU Amiens

Guy Launoy, Professeur de Santé Publique, Université Caen Normandie

Francis Guillemin, Professeur de santé publique, Directeur de l’Ecole de santé publique de Nancy, Université de Lorraine

Maxime Gignon, Professeur des Universités et Praticien Hospitalier en Santé Publique, Université de Picardie Jules Verne et CHU d’Amiens-Picardie.

Philippe Amouyel, Professeur de Santé Publique, Université de Lille

Philippe Quénel, Professeur à l’Ecole des Hautes Etudes en Santé Publique (EHSP), président du Conseil scientifique de Santé Publique France

Jacques Bénichou, Professeur de Santé Publique, CHU et Université de Rouen

Bernard Burnand, Professeur émérite de santé publique, Unisanté – Centre universitaire de médecine générale et santé publique Lausanne & Université de Lausanne

Jean-François Viel, Professeur de santé publique, Université de Rennes 1

Philippe Broët, Professeur de Santé Publique, Université Paris-Saclay

Nelly Agrinier, Professeure d’épidémiologie, économie de la santé et prévention, Université de Lorraine, APEMAC; CHRU-Nancy, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy

Simone Mathoulin-Pelissier, Professeure de Santé publique, Inserm U1219, Université de Bordeaux

Isabelle Boutron, Professeure d’Épidémiologie, Université de Paris ; Centre d’épidémiologie clinique, Hôpital Hôtel Dieu, AP-HP ; Equipe de recherche METHODS du Centre de Recherche Epidémiologie Statistiques (CRESS) université de Paris/Inserm/Inra

Gerard Breart, Professeur de santé publique, Paris

Grammatico-Guillon Leslie, Maître de conférence des universités – Praticien hospitalier, Service de santé publique épidémiologie et économie de la santé, CHU de Tours

Marianne Savès, Maître de conférence des universités – Praticien hospitalier en santé publique, Université de Bordeaux, Pôle Santé publique du CHU de Bordeaux

Jean-Claude Desenclos, Directeur scientifique, Santé publique France

Yves Charpak, Expert en Santé Publique, Paris

Linda Cambon, enseignant chercheur en santé publique, Université de Bordeaux

Philippe Michel, Président de la commission « système de santé et sécurité des patients » du HCSP, Membre du conseil scientifique de la CNAM, Président fondateur de l’Institut Français de l’Expérience Patient

Anne Tallec, Directrice de l’Observatoire régional de la santé des Pays de la Loire, corédactrice du rapport du HCSP Pour une politique nutritionnelle de santé publique en France

Albert Hirsch, Professeur honoraire Université Denis Diderot Paris 7, administrateur de la Ligue contre le cancer

Manuel Rodrigues, Oncologue médical, Institut Curie, Paris; Président de la Société Française du Cancer

Pascale Grosclaude, Medecin de santé publique, Directrice du Registre des cancers du Tarn

Catherine Hill, Epidémiologiste Institut Gustave Roussy

Pierre Senesse, médecin  et gastroentérologue, Institut régional du Cancer Montpellier

Julien Taieb, Professeur Chef du service de gastro-entérologie et d’oncologie digestive, Hôpital Européen Georges Pompidou, APHP

Daniel Benamouzig, Sociologue, Directeur de recherche au CNRS, Sciences Po, Paris

Karine Gallopel-Morvan, Professeure des Universités (marketing social), Ecole des Hautes Etudes en Santé Publique

Fabien Girandola, Professeur de Psychologie Sociale, Université d’Aix-Marseille

Brigitte Dormont, Économiste de la santé, Professeur à l’université Paris Dauphine, Directrice du Laboratoire d’Economie et de Gestion des Organisations de Santé (LEGOS)

Fabrice Etilé, Économiste, INRA, École d’Economie de Paris

Didier Courbet, Professeur de Sciences de l’Information et de la Communication à Aix-Marseille Université

Lydiane Nabec, Professeur des Universités, Marketing Social, Université Paris-Sud / Paris-Saclay

Manuel Zacklad, Professeur du CNAM en Sciences de l’Information et de la Communication – Directeur du laboratoire Dicen-IdF

Henri Bergeron, Directeur de Recherches au CNRS, Professeur à Sciences Po, Paris

Olivier Chassany, Professeur de Thérapeutique, Unité de Recherche Clinique en Economie de la Santé, Hôpital Hôtel-Dieu & Université de Paris

Alain Furber, Professeur de Cardiologie et Maladies Vasculaires, Chef de service de Cardiologie CHU Angers, Président de la Fédération Française de Cardiologie

Daniel Thomas, Professeur de Cardiologie, Président d’honneur de la Fédération Française de Cardiologie

Philippe Gabriel Steg, Département de Cardiologie, Hôpital Bichat, APHP, Université de Paris, INSERM U1148

François Paillard, Cardiologue, CHU de Rennes, 1er vice-président de la Fédération Française de Cardiologie

François Carré, Professeur de Cardiologie et physiologiste de l’exercice musculaire. Chef du service de Médecine du Sport de l’Hôpital Pontchaillou, Université Rennes 1-INSERM U1099

Jean-Philippe Empana, Médecin Epidémiologiste, Directeur de recherche INSERM, Centre de recherche cardiovasculaire de Paris, Université de Paris

Marilucy Lopez-Sublet, médecin, service de médecine interne, ESH centre, CHU Avicenne (AP-HP) et secrétaire générale de la Société Française d’Hypertension Artérielle

Michel Azizi, Professeur de Médecine Vasculaire, Université de Paris, Chef de Service, Centre de Soins, de Recherche et Enseignement en Hypertension Artérielle et Coordonateur du Centre d’Investigations Cliniques 1418 Inserm-APHP, Hôpital Européen Georges Pompidou

Jacques Blacher, Professeur de thérapeutique, université Paris-Descartes ; chef du centre de Diagnostic et de thérapeutique, Hotel-Dieu, AP-HP, Paris

Caroline Dourmap, Centre de Prévention cardiovasculaire, CHU de Rennes

Dominique Turck, Professeur de pédiatrie à l’université de Lille, ancien coordonnateur du Comité de nutrition de la Société française de pédiatrie

Régis Hankard, Professeur de Pédiatrie, Unité Mobile de Nutrition, Directeur du Pôle Alimentation, Université de Tours

Frédéric Gottrand, Professeur de Pédiatrie, CHU Lille, Université de Lille, LIRIC UMR995, F-59000 Lille, France

Daniel Floret, Professeur émérite de Pédiatrie, Université Claude Bernard Lyon

Jean-Pierre Hugot, Professeur de Pédiatrie, Hopital Robert Debré, Paris

Arnaud De Luca, Pédiatre, Nutritionniste, Coordonnateur médical du CSO, CHRU de Tours, Inserm UMR1069, Tours

Stéphane Leteurtre, Professeur en Réanimation Pédiatrique, CHU de Lille

Helene Thibault, Pédiatre, responsable du centre spécialisé obésité pédiatrique du CHU de Bordeaux et du Reppop Aquitaine

Véronique Nègre, Pédiatre, Présidente APOP (Association pour la Prise en charge et la prévention de l’Obésité en Pédiatrie)

Jean-Loup Salzmann, Professeur des Universités, Ancien Président de l’Université Paris 13 et de la Conferénce des Président d’Université

Bernard Levy, Professeur de Médecine Université Paris 7 et chef de service honoraire Hôpital Lariboisière/St Louis

Xavier Jeunemaitre, Professeur de Génétique, Hôpital Européen Georges Pompidou, Doyen de la Faculté de Santé – Université de Paris

Jean- Christophe Thalabard, Professeur émérite, UFR Médecine Université de Paris

Jacqueline Capeau Professeur Emérite de la Faculté de Médecine Sorbonne Université

Vincent Renard, Professeur de médecine générale, Université Paris Est Créteil, Président du Collège National des Généralistes Enseignants

Olivier Saint-Lary, Professeur de médecine générale, Université Versailles Saint-Quentin en Yvelines, Président du conseil scientifique du Collège National des Généralistes Enseignants

Rémy Slama, Directeur de Recherches Inserm, épidémiologiste environnemental

Michel Seve, Professeur de Biochimie, Doyen de la Faculté de Pharmacie, Université Grenoble Alpes / CHU Grenoble Alpes

Robert Barouki, Professeur de Biochimie à la Faculté de Médecine Paris Descartes, Directeur de l’unité Inserm 1124, Paris

Xavier Coumoul, professeur de Biochimie à l’université de Paris, directeur de l’équipe METATOX de l’unité INSERM UMR-S 1124

José Cohen, Professeur de biologie cellulaire, Faculté de médecine Henri Mondor, Université Paris Est Créteil

Patrice Faure  Professeur des universités, Université Grenoble Alpes et praticien hospitalier, chef de service en Biochimie, exploration des vitamines et oligoéléments, Centre hospitalier Grenoble Alpes

Jean-Louis Mas, Professeur de Neurologie, Université de Paris, Inserm U1266

Thomas de Broucker, Service de Neurologie, Centre Hospitalier de Saint-Denis, Saint-Denis

Jean-Fabien Zazzo, Ancien Anesthésiste-réanimateur (AP-HP), Nutritioniste, Personnalité qualifiée au comité de suivi du PNNS 2 et 3, Expert au GT Nutrivigilance de l’ANSES

Bernard Basset, médecin, vice-président de l’ANPAA

Amine Benyamina, Professeur, PUPH Université Paris Sud, psychiatre, Président de la fédération française d’Addictologie

Cédric Lemogne, Professeur de psychiatrie à l’Université Paris Descartes ; responsable de l’unité de Psychiatrie de liaison de l’Hôpital européen Georges-Pompidou ; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris

Antoine Pelissolo, Professeur de psychiatrie, HU Henri-Mondor et UPEC, Créteil

Jean-François Toussaint, Professeur de Physiologie, Université de Paris, Directeur de l’IRMES (Institut de Recherche bioMédicale et d’Epidémiologie du Sport), Paris

Martine Duclos, PU-PH Physiologie, CHU Clermont-Ferrand, UNH, INRA-UMR1019, directrice de l’Observatoire National de l’Activité Physique et de la sédentarité

Philippe-Jean Bousquet. Médecin de santé publique, Boulogne-Billancourt

Cyrille Delpierre, Epidémiologiste,  Directeur de Recherche Inserm,  UMR1027, Faculté de médecine, Toulouse

Clair-Yves Boquien, Scientifique, Nantes Université, INRA,  UMR 1280, PhAN, Centre de Recherche en Nutrition Humaine – Ouest, Nantes

Dominique Roulot-Marullo, Professeur d’Hépatologie, Université Paris 13

Thomas Aparicio, Professeur d’Hépato-Gastroentérologie, Université de Paris, Hôpital Saint Louis, APHP, Vice-Président de la Fédération Francophone de Cancérologie Digestive

Chantal Halimi,  Gastroentérologue, Paris

Muriel Binn, Gastroentérologue, Paris

Claire Blard-Méjean, médecin, Comité de Liaison Alimentation Nutrition (CLAN), Mâcon.

Marie Aline Charles, Directrice de recherche INSERM, CRESS, Paris

Denis Malvy, médecin, Professeur des universités, INSERM 1219 & Université de Bordeaux, Bordeaux

Jean-Pierre Astruc, Président de l’université Paris 13

Raphaëlle Varraso, Chercheur Inserm, épidémiologiste respiratoire et de la nutrition, UVSQ, Villejuif

Jean Godard, Spécialiste en médecine générale, Président de la Plateforme Territoriale d’Appui Caux Dieppe Vallées.

Bénédicte Stengel, Directeur de recherche INSERM, CESP, Paris

Jean-Marie Barbier, Professeur de formation des adultes au Cnam         

Gonzague Jourdain, Chercheur épidémiologiste, Institut de recherche pour le développement (IRD), Marseille

Alain Braillon, médecin des hopitaux, CHU Sud, Amiens

Nathanaël Lapidus, Enseignant chercheur en santé publique, Sorbonne Université / Inserm UMR-S 1136

Didier Letourneur, Directeur de Recherche CNRS, Directeur INSERM U1148-Université Paris 13-Université de Paris

Nicole Ngo Giang Huong, Chercheure, Institut de recherche pour le développement (IRD)

Luc Ginot, médecin de santé publique, Directeur de la Santé Publique, ARS Ile-de-France

Agathe Billette de Villemeur, médecin de santé publique et épidémiologiste.

Kévin Jean, Epidémiologiste, maître de conférences au Conservatoire national des Arts et Métiers, Paris.

Sandrine Péneau, Maîtresse de Conférences, Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle Inserm/Inra/Cnam/Université Paris 13

Nicole Le Moual, Epidémiologiste, Ingénieur de Recherche Inserm,  UMRS 1168, UVSQ, Villejuif

Aurélie Malgras, médecin nutritionniste , CHRU de Nancy

Camille Vatier, MCU-PH, Service d’Endocrinologie, Hôpital Saint-Antoine, AP-HP Sorbonne Université

Claude Forest, Directeur de Recherche Inserm, Paris

Bernard Page, Service Réanimation, Hôpital Ambroise Paré, Université Paris Saclay

Pauline Bonniaud-Blot, endocrino-pédiatre, CSO pédiatrique, CHU Dijon

Isabelle Millot, médecin de santé publique, directrice de l’Instance régionale d’éducation et de promotion de la santé (Ireps) Bourgogne – Franche-Comté

André Briend, Médecin Nutritionniste

Marie Ahouanto-Chaspoul, Médecin référent en pratiques cliniques préventives, ARS – Délégation Départementale de Paris

Florent Arinal, pharmacien, MPH, Agence Nationale de Sécurité du Médicament

Yves Martin-Prével, directeur de recherche à l’IRD, épidémiologiste en nutrition publique, Directeur du Département Santé et Sociétés de l’IRD

Marion Subiros, Pharmacien épidémiologiste à la cellule Mayotte de Santé publique France

Philippe Msellati, médecin épidémiologiste, Directeur de recherche émérite, IRD, Montpellier

Sébastien Colson, infirmier puériculteur, Maître de conférence, Faculté des sciences médicales et paramédicales, Aix-Marseille Université

Corinne Lautier, Maitre de conférence en génétique moléculaire, à l’université de Montpellier

Basile Chaix, Directeur de recherche Inserm, épidémiologiste environnement-santé

Henri Dubois, Médecin Inspecteur de Santé Publique en retraite 

Laurent Debrauwer, Ingénieur de Recherche INRA, UMR 1331 Toxalim, directeur de plateforme de toxicologie analytique, Toulouse

Jean-Paul Guthmann, Médecin épidémiologiste, Santé publique France.

Paule Latino-Martel, Directrice de recherche, CRESS, Réseau NACRe.

Jean-François Etard, Directeur de recherche à l’IRD

Jean-Pierre Ferley, médecin de santé publique, Directeur de l’Observatoire régional de la santé de Nouvelle-Aquitaine

Leopold Fezeu, Maitre de conférence en Nutrition, Université Paris 13, EREN, Bobigny

Barbara Heude, Chercheuse Inserm, Equipe de recherche sur les déterminants précoces de la santé, Université de Paris, CRESS

Marie Pierre Tavolacci, médecin épidémiologiste Centre d’Investigation Clinique 1404, CHU de Rouen, INSERM 1073, Université Rouen-Normandie

Claudine Berr, Epidémiologiste, Directeur de recherche Inserm, UMR1061, Université de Montpellier

Philippe Fayemendy, Médecin nutritionniste, Unité de Nutrition, CHU de Limoges

Catherine Prost-Squarcioni, Dermatologue, Professeur en Histologie, responsable du Centre de Référence Maladies Rares MALIBUL, APHP et Université Paris 13

Caroline Carrière, Coordinatrice prévention, épidémiologie et éducation thérapeutique – Réseau de prévention et de Prise en charge de l’Obésité Pédiatrique (RéPPOP) Aquitaine

Léo Donzel Godinot, pharmacien de santé publique, Unité de soutien aux actions de prévention, Service de soutien méthodologique et d’innovation en prévention, CHU de Bordeaux

Joel Ladner, Département d’Epidémiologie et de Promotion de la Santé), INSERM UMR 1073, CHU de Rouen Normandie – Université de Rouen-Normandie

Jonathan Bernard, chargé de recherche en épidémiologie, Inserm, Paris

Anne Briançon, Maitre de Conférences des Universités en physiologie, Faculté de Pharmacie, Université Grenoble Alpes

Marina Alexandre, Praticien Hospitalier, Service de Dermatologie, Hôpital Avicenne

Sylvaine Cordier, Directrice de Recherches Emérite INSERM, IRSET, Rennes

Nathalie Bajos, Directrice de recherche INSERM

Catherine Sermet, Directrice de recherche, IRDES, Paris

Florent de de Vathaire, Directeur de  Recherche INSERM, Epidémiologiste

Pascal Guénel, Directeur de Recherche Inserm, Centre de recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Saclay

Michel Cot, Médecin épidémiologiste et directeur de recherche à l’IRD, UMR 261 MERIT, IRD et Université de Paris

Ramona Zaharia, Praticien Hospitalier, Service d’Endocrinologie Diabétologie Nutrition, AP-HP.Université Paris Saclay

Marion Bretault, Praticien Hospitalier, Service d’Endocrinologie Nutrition, Unité de Nutrition, Hôpital Ambroise Paré, Centre Spécialisé Obésité Ile de France Centre

Aurélie Bourmaud, MCU-PH Epidémiologie, prévention, économie de la santé, Unité d’Epidemiologie Clinique, Hôpital Robert Debré, Paris

Gilles Grangé, Gynecologue-obstétricien, Maternité Port Royal, AP-HP.Centre – Université de Paris

Nora Moumjid, Membre de la Commission Maladies Chroniques, Haut Conseil pour la Santé Publique

Caroline Francois, médecin, Coordinatrice médicale IHAB France

À la Une

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
Page break

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

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  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.
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