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Article ; Online: Legitimacy of Front-of-Pack Nutrition Labels

Morgane Fialon / Lydiane Nabec / Chantal Julia

International Journal of Health Policy and Management, Vol 11, Iss 11, Pp 2574-

Controversy Over the Deployment of the Nutri-Score in Italy

2022 Volume 2587

Abstract: Background Front-of-pack nutrition labels (FoPLs) aim at increasing transparency and consumers’ awareness of the nutritional composition of pre-packed food products in order to improve the nutritional quality of their food choices. Nevertheless, the ... ...

Abstract	Background Front-of-pack nutrition labels (FoPLs) aim at increasing transparency and consumers’ awareness of the nutritional composition of pre-packed food products in order to improve the nutritional quality of their food choices. Nevertheless, the legitimacy of the Nutri-Score - the FoPL officially adopted in France and several other European countries - is subject to both technical and political controversy, particularly in Italy. In this study, we investigated how and by whom the legitimacy of the Nutri-Score, recognized by several institutional authorities, could be deconstructed within a specific system of norms, values and beliefs among Italian stakeholders.Methods A netnography completed with qualitative interviews with eight Italian and French nutrition and public health experts were carried out to highlight the dimensions (pragmatic, normative and cognitive) in which the NutriScore’s legitimacy is being challenged among the stakeholders involved in FoPLs’ implementation in Italy. The degree of influence and the position of these stakeholders on the debate around the Nutri-Score were assessed through the Stakeholder Theory (SHT), using their respective level of power, legitimacy and urgency. Furthermore, we compared the Italian and the French contexts on the issue.Results The direct implication of political parties and media outlets in framing the Italian debate around Nutri-Score as well as the high influence of corporate unions, led to a different political outcome than in France. Results also show that the deconstruction of the legitimacy of the Nutri-Score in Italy pertained mainly to its pragmatic dimension according to the Italian public health experts. Nevertheless, its two other dimensions (normative and cognitive) are also questioned by high-influence stakeholders.Conclusion Due to the limited mobilization of scientific expertise over the issue, the debate in Italy stayed centered around the “attack” of the Nutri-Score to the Italian way of life, mixing up concepts such as Made in Italy ...
Keywords	front-of-pack ; nutri-score ; stakeholder theory ; italy ; legitimacy ; Public aspects of medicine ; RA1-1270
Subject code	940
Language	English
Publishing date	2022-11-01T00:00:00Z
Publisher	Kerman University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Front-of-pack Nutri-Score labelling in France

Chantal Julia / Fabrice Etilé / Serge Hercberg

The Lancet Public Health, Vol 3, Iss 4, Pp e164- (2018)

an evidence-based policy

2018

Keywords	Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2018-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Behavioural risk patterns in adolescents with excess weight participating in the PRALIMAP-INÈS trial

Chantal Julia / Abdou Omorou / Edith Lecomte / Johanne Langlois / Mathilde Touvier / Serge Hercberg / Serge Briançon / Emmanuelle Kesse-Guyot / Francis Guillemin / the PRALIMAP-INÈS Trial Group

Public Health Nutrition, Vol 26, Pp 96-

2023 Volume 105

Abstract: Abstract Objective: To investigate clustering of risk behaviours in adolescents with excess weight. Design: Cross-sectional analysis of baseline data from the PRALIMAP-INÈS trial. Information on food frequency consumption (fruit, vegetables, sugary ... ...

Abstract	Abstract Objective: To investigate clustering of risk behaviours in adolescents with excess weight. Design: Cross-sectional analysis of baseline data from the PRALIMAP-INÈS trial. Information on food frequency consumption (fruit, vegetables, sugary products and beverages), physical activity, sedentary behaviour (week and weekend days), smoking and alcohol consumption (current frequency and intoxication episodes) and socio-demographic data was collected using self-reported questionnaires. Behavioural risk factors were entered as categorical variables in a two-step clustering procedure: multiple correspondence analysis followed by hierarchical clustering. Associations between cluster membership and socio-demographic variables were investigated using multivariable multinomial logistic regression. Setting: French PRALIMAP-INÈS trial. Participants: Adolescents with excess weight. Results: A total of 1391 participants (13–18 years old, 58·2 % female) were included in the analysis, which resulted in the identification of four groups of participants, including, respectively, 543 (39·0 %), 373 (26·8 %), 246 (17·7 %) and 229 (16·5 %) participants. Clusters 1 and 4 showed associations of rather healthy behaviours (high physical activity and low consumption of sugary products; high consumption of fruit and vegetables, respectively), while clusters 2 and 3 showed associations of rather unhealthy behaviours (high sedentary behaviour and low consumption of fruit and vegetables; smoking and alcohol consumption, respectively). Both social status and family structure were associated with cluster membership. Conclusions: Risk behaviour patterns in adolescents with excess weight were clustered in both healthier and less healthy ways, with a complex interplay with socio-demographic factors.
Keywords	Dietary patterns ; Addictive behaviour ; Adolescents ; Overweight ; Obesity ; Public aspects of medicine ; RA1-1270 ; Nutritional diseases. Deficiency diseases ; RC620-627
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Cambridge University Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Dietary circadian rhythms and cardiovascular disease risk in the prospective NutriNet-Santé cohort

Anna Palomar-Cros / Valentina A. Andreeva / Léopold K. Fezeu / Chantal Julia / Alice Bellicha / Emmanuelle Kesse-Guyot / Serge Hercberg / Dora Romaguera / Manolis Kogevinas / Mathilde Touvier / Bernard Srour

Nature Communications, Vol 14, Iss 1, Pp 1-

2023 Volume 12

Abstract: Abstract Daily eating/fasting cycles synchronise circadian peripheral clocks, involved in the regulation of the cardiovascular system. However, the associations of daily meal and fasting timing with cardiovascular disease (CVD) incidence remain unclear. ... ...

Abstract	Abstract Daily eating/fasting cycles synchronise circadian peripheral clocks, involved in the regulation of the cardiovascular system. However, the associations of daily meal and fasting timing with cardiovascular disease (CVD) incidence remain unclear. We used data from 103,389 adults in the NutriNet-Santé study. Meal timing and number of eating occasions were estimated from repeated 24 h dietary records. We built multivariable Cox proportional-hazards models to examine their association with the risk of CVD, coronary heart disease and cerebrovascular disease. In this study, having a later first meal (later than 9AM compared to earlier than 8AM) and last meal of the day (later than 9PM compared to earlier than 8PM) was associated with a higher risk of cardiovascular outcomes, especially among women. Our results suggest a potential benefit of adopting earlier eating timing patterns, and coupling a longer nighttime fasting period with an early last meal, rather than breakfast skipping, in CVD prevention.
Keywords	Science ; Q
Subject code	610
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Spatial determinants of excess all-cause mortality during the first wave of the COVID-19 epidemic in France

Hugo Pilkington / Thierry Feuillet / Stéphane Rican / Jeanne Goupil de Bouillé / Olivier Bouchaud / Johann Cailhol / Hélène Bihan / Pierre Lombrail / Chantal Julia

BMC Public Health, Vol 21, Iss 1, Pp 1-

2021 Volume 10

Abstract: Abstract Background The first wave of the COVID-19 pandemic in France was associated with high excess mortality, and anecdotal evidence pointed to differing excess mortality patterns depending on social and environmental determinants. In this study we ... ...

Abstract	Abstract Background The first wave of the COVID-19 pandemic in France was associated with high excess mortality, and anecdotal evidence pointed to differing excess mortality patterns depending on social and environmental determinants. In this study we aimed to investigate the spatial distribution of excess mortality during the first wave of the COVID-19 pandemic in France and relate it at the subnational level to contextual determinants from various dimensions (socioeconomic, population density, overall health status, healthcare access etc.). We also explored whether the determinants identified at the national level varied depending on geographical location. Methods We used available national data on deaths in France to calculate excess mortality by department for three age groups: 0–49, 50–74 and > 74 yrs. between March 1st and April 27th, 2020. We selected 15 variables at the department level that represent four dimensions that may be related to overall mortality at the ecological level, two representing population-level vulnerabilities (morbidity, social deprivation) and two representing environmental-level vulnerabilities (primary healthcare supply, urbanization). We modelled excess mortality by age group for our contextual variables at the department level. We conducted both a global (i.e., country-wide) analysis and a multiscale geographically weighted regression (MGWR) model to account for the spatial variations in excess mortality. Results In both age groups, excess all-cause mortality was significantly higher in departments where urbanization was higher (50–74 yrs.: β = 15.33, p < 0.001; > 74 yrs.: β = 18.24, p < 0.001) and the supply of primary healthcare providers lower (50–74 yrs.: β = − 8.10, p < 0.001; > 74 yrs.: β = − 8.27, p < 0.001). In the 50–74 yrs. age group, excess mortality was negatively associated with the supply of pharmacists (β = − 3.70, p < 0.02) and positively associated with work-related mobility (β = 4.62, p < 0.003); in the > 74 yrs. age group our ...
Keywords	COVID-19 ; Mortality ; Socioeconomic factors ; Delivery of health care ; Deprivation ; Inequality ; Public aspects of medicine ; RA1-1270
Subject code	310
Language	English
Publishing date	2021-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The impact of the Nutri-Score front-of-pack nutrition label on purchasing intentions of unprocessed and processed foods

Manon Egnell / Pilar Galan / Morgane Fialon / Mathilde Touvier / Sandrine Péneau / Emmanuelle Kesse-Guyot / Serge Hercberg / Chantal Julia

International Journal of Behavioral Nutrition and Physical Activity, Vol 18, Iss 1, Pp 1-

post-hoc analyses from three randomized controlled trials

2021 Volume 12

Abstract: Abstract Background The Nutri-Score summary graded front-of-pack nutrition label has been identified as an efficient tool to increase the nutritional quality of pre-packed food purchases. However, no study has been conducted to investigate the effect of ... ...

Abstract	Abstract Background The Nutri-Score summary graded front-of-pack nutrition label has been identified as an efficient tool to increase the nutritional quality of pre-packed food purchases. However, no study has been conducted to investigate the effect of the Nutri-Score on the shopping cart composition, considering the type of foods. The present paper aims to investigate the effect of the Nutri-Score on the type of food purchases, in terms of the relative contribution of unpacked and pre-packed foods, or the processing degree of foods. Methods Between September 2016 and April 2017, three consecutive randomized controlled trials were conducted in three specific populations – students (N = 1866), low-income individuals (N = 336) and subjects suffering from cardiometabolic diseases (N = 1180) – to investigate the effect of the Nutri-Score on purchasing intentions compared to the Reference Intakes and no label. Using these combined data, the proportion of unpacked products in the shopping carts, as well as the distribution of products across food categories taking into account the degree of processing (NOVA classification) were assessed by trials arm. Results The shopping carts of participants simulating purchases with the Nutri-Score affixed on pre-packed foods contained higher proportion of unpacked products – especially raw fruits and meats, i.e. with no FoPL –, compared to participants purchasing with no label (difference of 5.93 percentage points [3.88–7.99], p-value< 0.0001) or with the Reference Intakes (difference of 5.27[3.25–7.29], p-value< 0.0001). This higher proportion was partly explained by fewer purchases of pre-packed processed and ultra-processed products overall in the Nutri-Score group. Conclusions These findings provide new insights on the positive effect of the Nutri-Score, which appears to decrease purchases in processed products resulting in higher proportions of unprocessed and unpacked foods, in line with public health recommendations.
Keywords	Front-of-pack nutrition label ; Purchasing behavior ; Pre-packed foods ; processed foods ; Nutritional diseases. Deficiency diseases ; RC620-627 ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Randomised controlled trial in an experimental online supermarket testing the effects of front-of-pack nutrition labelling on food purchasing intentions in a low-income population

Pilar Galan / Serge Hercberg / Chantal Julia / Raphaël Porcher / Emmanuelle Kesse-Guyot / Mathilde Touvier / Manon Egnell / Pauline Ducrot

BMJ Open, Vol 11, Iss

2021 Volume 2

Abstract: Background The Nutri-Score, a front-of-pack nutrition label, has been adopted in 2017 in France but its impact on low-income populations is unknown, and they are more at risk of having unhealthy diets. The present study assessed the effects of the Nutri- ... ...

Abstract	Background The Nutri-Score, a front-of-pack nutrition label, has been adopted in 2017 in France but its impact on low-income populations is unknown, and they are more at risk of having unhealthy diets. The present study assessed the effects of the Nutri-Score on the nutritional quality of purchasing intentions among low-income individuals, compared with the current French labelling situation: references intakes (RIs) and no label, using a three-arm parallel-group randomised controlled trial.Methods Low-income active adults from the NutriNet-Santé cohort (household income below €1200/month) were asked to perform a shopping task in an experimental online supermarket after being randomised in one of the three conditions (Nutri-Score, RIs or no labelling). The main outcome was the overall nutritional quality of the virtual shopping cart, assessed with the French-modified Food Standards Agency Nutrient Profiling System (FSAm-NPS), and secondary outcomes were the nutrient content of the shopping carts. 524 subjects were randomised, and 336 included in the analyses.Results The Nutri-Score resulted in the highest overall nutritional quality of the shopping cart, as reflected by a FSAm-NPS score (1.86 (SD 3.59) points) significantly lower (reflecting higher nutritional quality) than the RIs (3.21 (SD 4.14) points, p≤0.05) but not significantly lower than no label (2.60 (SD 3.09) points, p=0.3). The Nutri-Score also resulted into significantly lower contents in calories and saturated fatty acids in the shopping cart, compared with the RIs only (p≤0.05).Conclusion The implementation of the front of pack nutrition label Nutri-Score, adopted in France and in different European countries, appears to have the potential to encourage purchasing intentions of foods from higher nutritional quality among low-income individuals, compared with the RIs label promoted by food manufacturers.Trial registration number: NCT02769455
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2021-02-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Adherence to the 2017 French dietary guidelines and adult weight gain

Dan Chaltiel / Chantal Julia / Moufidath Adjibade / Mathilde Touvier / Serge Hercberg / Emmanuelle Kesse-Guyot

PLoS Medicine, Vol 16, Iss 12, p e

A cohort study.

2019 Volume 1003007

Abstract: BACKGROUND:The French dietary guidelines were updated in 2017, and an adherence score to the new guidelines (Programme National Nutrition Santé Guidelines Score 2 [PNNS-GS2]) has been developed and validated recently. Since overweight and obesity are key ...

Abstract	BACKGROUND:The French dietary guidelines were updated in 2017, and an adherence score to the new guidelines (Programme National Nutrition Santé Guidelines Score 2 [PNNS-GS2]) has been developed and validated recently. Since overweight and obesity are key public health issues and have been related to major chronic conditions, this prospective study aimed to measure the association between PNNS-GS2 and risk of overweight and obesity, and to compare these results with those for the modified Programme National Nutrition Santé Guidelines Score (mPNNS-GS1), reflecting adherence to 2001 guidelines. METHODS AND FINDINGS:Participants (N = 54,089) were recruited among French adults (≥18 years old, mean baseline age = 47.1 [SD 14.1] years, 78.3% women) in the NutriNet-Santé web-based cohort. Mean (SD) score was 1.7 (3.3) for PNNS-GS2 and 8.2 (1.6) for mPNNS-GS1. Selected participants were those included between 2009 and 2014 and followed up to September 2018 (median follow-up = 6 years). Collected data included at least three 24-hour dietary records over a 2-year period following inclusion, baseline sociodemographics, and anthropometric data over time. In Cox regression models, PNNS-GS2 was strongly and linearly associated with a lower risk of overweight and obesity (HR for quintile 5 versus quintile 1 [95% CI] = 0.48 [0.43-0.54], p < 0.001, and 0.47 [0.40-0.55], p < 0.001, for overweight and obesity, respectively). These results were much weaker for mPNNS-GS1 (HR for quintile 5 versus quintile 1 = 0.90 [0.80-0.99], p = 0.03, and 0.98 [0.84-1.15], p = 0.8, for overweight and obesity, respectively). In multilevel models, PNNS-GS2 was negatively associated with baseline BMI and BMI increase over time (β for a 1-SD increase in score [95% CI] = -0.040 [-0.041; -0.038], p < 0.001, and -0.00080 [-0.00094; -0.00066], p < 0.001, respectively). In "direct comparison" models, PNNS-GS2 was associated with a lower risk of overweight and obesity, lower baseline BMI, and lower BMI increase over time than mPNNS-GS1. Study ...
Keywords	Medicine ; R
Subject code	796
Language	English
Publishing date	2019-12-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Impact of the Nutri-Score front-of-pack nutrition label on purchasing intentions of individuals with chronic diseases

Pilar Galan / Sandrine Péneau / Serge Hercberg / Chantal Julia / Raphaël Porcher / Philippe Ravaud / Isabelle Boutron / Emmanuelle Kesse-Guyot / Mathilde Touvier / Manon Egnell / Pauline Ducrot / Leopold Fezeu

BMJ Open, Vol 12, Iss

results of a randomised trial

2022 Volume 8

Abstract: Objective To our knowledge, the effect of front-of-pack nutrition labels such as the Nutri-Score on food purchases has never been assessed among individuals suffering from nutrition-related chronic diseases specifically, while dietary modifications are ... ...

Abstract	Objective To our knowledge, the effect of front-of-pack nutrition labels such as the Nutri-Score on food purchases has never been assessed among individuals suffering from nutrition-related chronic diseases specifically, while dietary modifications are generally part of their care. This study aimed to investigate the effect of the Nutri-Score on the nutritional quality of purchasing intentions among adults suffering from a cardiometabolic disease, compared with no label and the Reference Intakes (RIs), a label already implemented by some food manufacturers in France.Setting Secondary prevention—mainland France.Participants 2431 eligible participants were randomly assigned and 1180 participants (65.5% women, mean age 65.0±7.1 years) completed the shopping task and were included in the analyses.Intervention A three-arm randomised controlled trial using an experimental online supermarket was conducted in 2017. Participants with cardiometabolic diseases were invited to simulate food purchases with the Nutri-Score, the RIs or no label.Primary and secondary outcome measures The primary outcome was the nutritional quality of the shopping cart, estimated using the French-modified Food Standard Agency Nutrient Profiling System (FSAm-NPS), and secondary outcomes included the nutrient content of purchases.Results The mean (SD) FSAm-NPS score was significantly lower in the Nutri-Score arm (1.29 (3.61) points), reflecting a higher overall nutritional quality of purchasing intentions, compared with the RIs (1.86 (3.23) points) and no label (1.92 (2.90) points) arms (p=0.01). Moreover, the Nutri-Score led to significantly lower content in calories and saturated fatty acids compared with the two other arms. These differences resulted from participants avoiding some packaged products (sweets, dairy and starches) and purchasing larger amounts of fresh fruit and meat.Conclusions The Nutri-Score exhibited a significant higher nutritional quality of purchasing intentions, encouraging healthier food choices among individuals ...
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2022-08-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Bulgarian consumers’ objective understanding of front-of-package nutrition labels

Valentina A. Andreeva / Manon Egnell / Teodora Handjieva-Darlenska / Zenobia Talati / Mathilde Touvier / Pilar Galan / Serge Hercberg / Simone Pettigrew / Chantal Julia

Archives of Public Health, Vol 78, Iss 1, Pp 1-

a comparative, randomized study

2020 Volume 9

Abstract: Abstract Background Bulgaria continues to lag behind other EU Member States with respect to chronic disease morbidity and mortality prevention. Methods In line with efforts targeting the improvement of dietary practices, this comparative study assessed ... ...

Abstract	Abstract Background Bulgaria continues to lag behind other EU Member States with respect to chronic disease morbidity and mortality prevention. Methods In line with efforts targeting the improvement of dietary practices, this comparative study assessed objective understanding of five different front-of-package labels (FOPL) (Reference Intakes, Multiple Traffic Lights, Warning label, Nutri-Score, and Health Star Rating) in a sample of 1010 Bulgarian adults. Objective understanding was assessed by comparing the results of two nutritional quality ranking tasks (with and without FOPL) in an online randomized experiment featuring three food categories (pizza, cakes, breakfast cereals). Multivariable ordinal logistic regression models within and across food categories were fit. Results Compared with the Reference Intakes group, participants randomized to Nutri-Score exhibited the largest improvement in product ranking ability across food categories (OR = 2.33; 95% CI: 1.55–3.51), followed by those randomized to Health Star Rating (OR = 1.99; 95% CI: 1.32–3.00). Nutri-Score also performed best within two (pizza and breakfast cereals) of the three food categories. The Multiple Traffic Lights and Warning label groups did not display any significant improvement in objective understanding either within or across food categories compared with the Reference Intakes group. Conclusion Nutri-Score, which is a summary, interpretive, polychromatic FOPL, emerged as the most effective model in the Bulgarian context, with the potential to help consumers better understand the nutritional quality of food. The findings are of particular interest to public health policymakers in the region and across Europe, as the debate about an EU-wide FOPL model continues to gather momentum. Trial registration Registration number ACTRN12618001221246 . Trial registered at the Australian New Zealand Clinical Trials Registry.
Keywords	Front-of-package food label ; Nutrition labeling ; Diet ; Eastern Europe ; Public health ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2020-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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