April 2025 Issue
Food Labeling: Decoding Nutri-Score
By Sophia Condic, MS, RDN
Today’s Dietitian
Vol. 27 No. 4 P. 16
A New Way to Understand Nutrition Quality
For some, reading nutrition facts can be like reading a new language. This is understandable since there’s a lot of information on packaged foods. Some individuals may also have trouble reading or seeing the nutrition facts, and it can be hard to understand the nutrient quality of packaged foods.
To help address this worldwide problem, some countries in Europe have chosen to use a color-coded nutrient quality ranking score on packaged foods called Nutri-Score. Nutri-Score, which is based on the British Food Standards Agency nutrient profiling system (FSAm-NPS), was originally implemented in France in 2017.1,2 Although Nutri-Score is voluntary, as of 2021, countries such as Belgium, Germany, Luxembourg, the Netherlands, Spain, and Switzerland are all using Nutri-Score.1,2 Due to increasingly widespread use, in 2023, the European Scientific Committee proposed to have Nutri-Score revised to meet the dietary guidelines of these countries.2
Nutri-Score Breakdown
This ranking system was created to help consumers better understand nutrient quality on packaged foods at a glance. Presented on the front of the packaged food, the color-coded rankings for Nutri-Score go from A to E.2 A score of “A” conveys so-called high nutrient quality, while a score of “E” indicates low nutrient quality.1
Scores are determined by “the amount of nutrients that should be limited” and by “the amount of nutrients and foods that should be encouraged” for every 100 g or 100 mL of food.2 According to Sante Publique France, which is a national agency for public health in France, saturated fats, sugar, and salt could negatively affect a score, while fiber, protein, fruits, vegetables, nuts, and oils like rapeseed, walnut, and olive could positively affect a score.3,2
An assessment report issued by Sante Publique France in 2021 stated that over 400 food brands were putting Nutri-Score on their packaged foods as of July 2020.4 The report also discussed a national survey that was conducted from 2018 to 2020 in which 94% of the participants indicated that they were in favor of Nutri-Score.4
Along with France, other countries in Europe have seen success with Nutri-Score. A recent study conducted by Deschasaux-Tanguy and colleagues examined the relationship between the 2023 version of Nutri-Score and the risk for cardiovascular events for over 345,000 participants across seven European countries.5 Diet recalls were completed for all participants, and from there, Nutri-Score was used to calculate the score for each food from the diet recall.5 The team concluded that participants who had a lower nutrient quality score through Nutri-Score had a higher risk of a cardiovascular event.5
Another study focused on over 49,000 participants who were diagnosed with cancer, particularly breast, prostate, and colorectum.1 Similar to the study conducted by Deschasaux-Tanguy and colleagues, all participants completed a diet recall; however, to assess the nutrient quality, a score was calculated through FSAm-NPS.1 As the FSAm-NPS score goes up, the nutrient quality goes down.1 Researchers determined that a higher FSAm-NPS score was associated with an increased risk for developing cancer.1 Even though Nutri-Score cannot determine the prevalence of a disease, it may increase awareness of the health impact of nutrition for consumers and food companies.
As Nutri-Score soars throughout Europe, it has led some to wonder how or if something similar could be implemented in the United States.
US Implementation
Some suggest that food companies in the United States may benefit from having a ranking score like Nutri-Score front and center on their products. They argue it could urge food companies to more frequently consider nutrition quality in their packaged foods. The World Health Organization reported that Nutri-Score “encourages the food industry to improve the nutritional quality of the food supply,”1 and food companies may have incentive to make their food products more nutrient-dense. Brands with better rankings may inspire more trust from consumers, who may be more likely to purchase their products.
A system like this may also help consumers make healthier lifestyle choices that better reflect the Dietary Guidelines for Americans. One of the 2020–2025 guidelines recommends that nutrient-dense foods should be encouraged over foods that have added sugars, saturated fat, sodium, and alcohol.6 If developed in the United States, the score could be tailored to meet the dietary guidelines. However, it might be challenging to update packaged foods to reflect new guidelines as they come out.
Potential Drawbacks
Although Nutri-Score has shown promise in Europe, there are some concerns and limitations to consider. Nutri-Score excludes many key nutrients from the scoring process and may, therefore, fail to capture the full nutritional impact of a food. According to Włodarek and Dobrowski, Nutri-Score doesn’t consider vitamins, minerals, and essential fatty acids in their score.7 Furthermore, another study by Panczyk and colleagues reiterated that overlooking vitamins, minerals, and essential fatty acids was a limitation of Nutri-Score.8 While surveying the participants in their study, the researchers stated that some participants believed that Nutri-Score needs to better communicate that a packaged food with a favorable score may, in excess, still increase the risk of preventable diseases.8 Some nutrition experts worry that Nutri-Score may foster unhealthy “black or white” eating patterns and could increase risk for disordered eating behavior in certain people.
Nutri-Score hasn’t been around long enough to determine the longer-term effects of using this approach. More longitudinal studies are needed. These studies may also need to show how the system can be adapted for those with specialized diets.
Another potential issue with Nutri-Score relates to the health halo effect. Nutri-Score is not a mandatory labeling system but instead a voluntary one. Consumers may assume a packaged food with a positive Nutri-Score is healthier than a packaged food with no Nutri-Score, even if the latter is just as healthy. Without a Nutri-Score, a packaged food may appear less healthy. One possible solution would be to require all packaged foods to carry a Nutri-Score. According to Food Navigator Europe, this change could “reduce the health halo effect of less healthy products” and could provide “an extra incentive to food companies to make their products healthier.”9
Final Thoughts
Even if everyone was on board with implementing a Nutri-Score system in the United States, it would take time. This proposed program would need to be backed by evidence-based research and multiple trial studies before being presented to the public. Policies and lawmakers would need to support this program for it to take root.
RDs may also be skeptical about the practical benefits for their clients. A system such as this may be over-generalized and could negatively alter how people perceive diet culture and healthful eating behaviors. This ranking system might be difficult for RDs to recommend for those who need medical nutrition therapy and specialized diets. However, there may be positive lessons gleaned from attempts at generalized nutrition labeling. Public health programs like Nutri-Score have the power to initiate change for better and for worse. As new studies are published, RDs can follow how this ranking system challenges the status quo on the nutrient quality of packaged foods. Even if a program like this never comes to the United States, Nutri-Score has given RDs the opportunity to continue a discussion with other nutrition professionals and their clients in asking the question: How do we best communicate nutrition messaging for a diverse public audience? n
— Sophia Condic, MS, RDN, is a Michigan-based dietitian who’s currently working in a community clinic. She earned a Bachelor of Integrative Studies at Oakland University and completed the Coordinated Program in Dietetics and a Master of Science in Clinical Dietetics at Grand Valley State University. She has previously written for Today’s Dietitian, Under30Experiences, and for the Dietitians in Business and Communications Practice Group through the Academy of Nutrition and Dietetics.
References
1. The Nutri-Score: a science-based front-of-pack nutrition label. World Health Organization website. https://www.iarc.who.int/wp-content/uploads/2021/09/IARC_Evidence_Summary_Brief_2.pdf. Accessed January 8, 2025.
2. Nutri-Score. Sante Publique France website. https://www.santepubliquefrance.fr/en/nutri-score. Updated November 20, 2024. Accessed January 8, 2025.
3. About. Sante Publique France website. https://www.santepubliquefrance.fr/a-propos. Updated May 3, 2021. Accessed January 8, 2025.
4. Nutri-Score: assessment report after three-year of Nutri-Score implementation. Sante Publique France website. https://sante.gouv.fr/IMG/pdf/nutri-score_follow-up_report_3_years_26juillet2021.pdf. Accessed January 13, 2025.
5. Deschasaux-Tanguy M, Huybrechts I, Julia C, et al. Nutritional quality of diet characterized by the Nutri-Score profiling system and cardiovascular disease risk: a prospective study in 7 European countries. Lancet Reg Health Eur. 2024;46:101006.
6. Top 10 things you need to know about the Dietary Guidelines for Americans, 2020–2025. Dietary Guidelines website. https://www.dietaryguidelines.gov/2020-2025-dietary-guidelines-online-materials/top-10-things-you-need-know. Accessed January 13, 2025.
7. Włodarek D, Dobrowolski H. Fantastic foods and where to find them — advantages and disadvantages of Nutri-Score in the search for healthier food. Nutrients. 2022;14(22):4843-4858.
8. Panczyk M, Dobrowolski H, Sinska BI, et al. Food front-of-pack labelling and the Nutri-Score nutrition label — Poland-wide cross-sectional expert opinion study. Foods. 2023;12(12):2346-2363.
9. Southey F. Nutri-Score blocks “health-halo” effects caused by claims on sugar, but should such claims be allowed at all? Food Navigator Europe website. https://www.foodnavigator.com/Article/2022/08/18/nutri-score-blocks-health-halo-effects-caused-by-claims-on-sugar-but-should-such-claims-be-allowed-at-all/. Updated August 18, 2022. Accessed January 15, 2025.