Evaluating the Relative Effectiveness of Two Front-of-pack Nutrition Labels

NCT03761342 | Completed

• 1 other identifier: NUSMart NM
• Study Type: interventional
• Target: 154
• Locations: 1 country
• Sites: 1

Brief Summary

In efforts to promote a healthy diet, the Singapore Health Promotion Board (HPB) has attempted to use Front-of-Pack (FOP) labelling to supplement traditional nutrition labelling. The Healthier Choice Symbol (HCS) identifies food items within a specific category of foods as healthier choices. The original logos were enhanced to include additional information focusing on particular macronutrients, taking one of two themes; it either indicates that a product contains more of a healthier ingredient, or less of a less healthy ingredient. However, there is a lack of scientific evidence on the role of the existing symbols in assisting consumers make healthier food purchasing decisions. Thus far, studies have established that the United Kingdom's Multiple Traffic Lights (MTL) label, and the new French Nutri-Score (NS) label, are amongst the top performers. However, there is little consensus on which is the most effective FOP label to promote diet quality. Thus, the investigators propose to conduct the following: Use a three arm randomized controlled trial (RCT) and an experimental fully functional web-based grocery store to test two competing approaches of front-of-pack (FOP) labelling on measures of diet quality: 1) United Kingdom's Multiple Traffic Lights label (MTL) or 2) France's Nutri-Score (NS) labelling scheme. The investigators hypothesize that diet quality as measured by the Alternative Healthy Eating Index (AHEI-2010) (primary outcome) will be highest in the NS arm, followed by MTL, and lowest in the no logo control arm.

Conditions

Diet Habit; Diet Modification; Food Selection; Food Preferences; Nutrition Poor

Keywords

Front-of-pack label; Nutrition label; Diet Quality; Online grocery store; Diet

Outcome Measures

Primary Outcomes (1)

• Diet Quality per shopping trip

  Diet quality per shopping trip, as measured by an index of diet quality, the Alternative Healthy Eating Index (AHEI-2010). The Alternate Healthy Eating Index-2010 (AHEI-2010) is an updated measure of diet quality from the original Alternate Healthy Eating Index. It was constructed based on foods and nutrients predictive of chronic disease risk that incorporates current scientific evidence on diet and health. All AHEI-2010 components are scored from 0 (worst) to 10 (best), for a total of 11 components. The total AHEI-2010 score ranges from 0 (nonadherence) to 110 (perfect adherence). Higher scores on the AHEI-2010 are strongly associated with lower risk of major chronic disease as well as risk of CVD, diabetes, heart failure, colorectal and estrogen-receptor-negative breast cancer, and total and cardiovascular mortality.

  Once a week for three weeks

Secondary Outcomes (17)

• Total Energy in kilocalories

  Once a week for three weeks

• Total Sugar in grams

  Once a week for three weeks

• Total fat in grams

  Once a week for three weeks

• Saturated fat in grams

  Once a week for three weeks

• Sodium in milligrams

  Once a week for three weeks

Study Arms (3)

Control

NO INTERVENTION

A control arm that mirrors a traditional web-grocery store with no but with no FOP labels.

Multiple Traffic Light Labels

EXPERIMENTAL

Similar to Arm 1, with Multiple Traffic Light labels displayed on all products FOP. A 60-second introductory video briefly explaining the MTL scheme will be shown before each shop in this Arm.

Behavioral: Multiple Traffic Light Label

Nutri-Score

EXPERIMENTAL

Similar to Arm 2, with Nutri-Score labels instead of MTL labels displayed on all products FOP. A 60-second introductory video briefly explaining the NS scheme will be shown to shoppers in this condition.

Behavioral: Nutri-Score Label

Interventions

Multiple Traffic Light Label BEHAVIORAL

The United Kingdom's Multiple Traffic Light label has repeatedly demonstrated effectiveness and has been widely implemented in Europe. The label shows how much calories, fats, saturated fats, sugar and salt are present in a product, with associated traffic light signals for high (red), medium (amber) and low (green) percentages for each attribute.

Multiple Traffic Light Labels

Nutri-Score Label BEHAVIORAL

In late 2017, France began voluntary implementation of one FOP label, termed Nutri-Score, adapted from its predecessor, the 5-colour Nutrition Label. Consumer acceptability and understanding of the NS label has been demonstrated in several studies. It provides a letter score as a composite grade of a product's nutrition quality from A (best) to E (worst).

Nutri-Score

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Singapore resident
• Aged 21 years or older.
• Existing registered RedMart customer.

You may not qualify if:

• Non-Singapore Resident.
• Less than 21 years old.
• Not an existing registered RedMart customer.

Sponsors & Collaborators

• Duke-NUS Graduate Medical School: lead
• National Medical Research Council (NMRC), Singapore: collaborator

Study Sites (1)

Duke-NUS Medical School

Singapore, 169857, Singapore

Location

MeSH Terms

Conditions

Feeding Behavior; Food Preferences; Malnutrition

Condition Hierarchy (Ancestors)

Behavior, Animal; Behavior; Nutrition Disorders; Nutritional and Metabolic Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: While participants will be made aware that there are different versions of NUSMart, the exact details of the arms will not be revealed to ensure validity of results. It will be deleterious to the study to reveal the differences between study arms as that would likely confound participant responses. Since there are 3 shopping conditions (unknown to participants), each participant will be randomly assigned at baseline to 1 of 6 groups that vary the sequence of shopping conditions and which shops will result in an actual food delivery.
• Purpose: OTHER
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: November 28, 2018
• First Posted: December 3, 2018
• Study Start: July 31, 2018
• Primary Completion: December 3, 2018
• Study Completion: December 3, 2018
• Last Updated: January 3, 2019

Record last verified: 2019-01

Data Sharing

• IPD Sharing: Will not share

Locations

SG (1)