A systematic assessment of the revised Nutri-Score algorithm: Potentials for the implementation of front-of-package nutrition labeling across Europe

Front-of-package nutrition labeling (FOPNL) is an important public health tool, and the introduction of harmonized FOPNL in Europe is one of the most ambitious food labeling changes in decades. Nutri-Score (NS) has been considered for implementation across Europe. However, NS is subject to strong opposition, particularly from the food industry and some agricultural sectors (such as cheese and cured meat), but also from some nutrition scientists and public health professionals, which highlights that the system is not sufficiently aligned with food-based dietary guidelines and the latest scientific literature. These concerns were recently addressed in a revised version of NS (NS2023), aiming to overcome the limitations of its predecessor (NS2021). Our aim was to assess whether these limitations were addressed and to investigate their alignment with dietary guidelines. A systematic literature review identified 20 limitations of NS, assigned to 3 groups (Food-based, Component-based, and Other Dimensions of Food Quality). Subsequent assessment of NS employed a large representative branded food database of 19,510 pre-packed foods. Alignment with dietary guidelines was assessed based on agreement with the WHO Europe nutrient profile (WHOE). NS2023 was shown as notably stricter compared to NS2021 (7% fewer products received the higher grades A or B) and more aligned with WHOE (kappa NS2021 = .59, kappa NS2023 = .65). Overall, most (65%) of the limitations were addressed to some extent; these were mostly Food-based limitations, followed by Component-based, whereas the Other Dimension of Food Quality (processing, sustainability, portion sizes) remained mostly unaddressed. We can conclude that the revised NS2023 increased its potential for implementation across Europe. Our review identified all limitations, relevant or not, which were mentioned in the scientific literature. Therefore, some mentioned limitations may never be solvable in the scope of nutrient profiling. Others could be further addressed by adaptation of the visual presentation, but increased complexity of the labeling message would also reduce the potential of the FOPNL to support consumers in healthier food choices. Additional research is also necessary to explore the potential impact of the revised NS2023 on food reformulation and its perception among consumers. Revised Nutri-Score addressed majority of the limitations of its predecessor and became stricter nutrient profiling model. It improved alignment with dietary guidelines and increased its potential for front-of-package nutrition labelling harmonization in Europe. image