Evaluating the Relative Effectiveness of Two Front-of-pack Nutrition Labels (NUSMart NM)

January 1, 2019 updated by: Eric A. Finkelstein, Duke-NUS Graduate Medical School

Multiphase Evaluation of Healthier Choice Symbol (HCS) Logo: Aim 4. A Randomized Controlled Trial Evaluating the Relative Effectiveness of Two Front-of-pack Nutrition Labels

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.

Study Overview

Detailed Description

Research Aims & hypotheses:

To use a three arm randomized controlled trial (RCT), and an experimental online grocery store developed by the team, to test two competing approaches of front-of-pack (FOP) nutrition labelling on measures of diet quality: 1) Multiple Traffic Lights (MTL) and 2) Nutri-Score (NS).

All participants will experience three different shopping conditions:

  1. Arm 1: A control arm that mirrors a traditional web-grocery store with no HCS or other FOP labels.
  2. Arm 2: Similar to Arm 1, with additional MTL labels displayed on all products FOP. A 60-second introductory video briefly explaining the MTL scheme will be shown before participants shop as they are assumed not to have pre-existing knowledge of the label.
  3. Arm 3: Similar to Arm 2, with Nutri-Score labels instead of MTL labels displayed on all products FOP. As with the MTL, a 60-second introductory video briefly explaining the NS scheme will be shown before participants shop.

The investigators hypothesize the following:

Primary Aim: Diet quality as measured by Alternative Healthy Eating Index Scores (AHEI-2010) will be highest (best) in Arm 3, followed by Arms 2 and 1 (worst).

The investigators further hypothesize a similar ordering (Arm 3 best and Arm 1 worst) for the following secondary outcomes:

Total and per serving values of the following:

  1. Energy (kCal)
  2. Sugar (g)
  3. Total fat (g)
  4. Saturated fat (g)
  5. Sodium (g)
  6. Fiber (g)
  7. Protein (g) And
  8. Average Nutri-Score across all products purchased where A=5 and E=1, and
  9. Cost per calorie and per shopping trip.

The investigators will test these hypotheses in total, and separately for foods and beverages given Singapore's focus on reducing intake of sugar-sweetened beverages. The investigators will also test whether the impact of FOP labelling is moderated by mood and level of hunger at the time of purchase, and by education or income level.

Study Type

Interventional

Enrollment (Actual)

154

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Singapore, Singapore, 169857
        • Duke-NUS Medical School

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

21 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

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

Exclusion Criteria:

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Control
A control arm that mirrors a traditional web-grocery store with no but with no FOP labels.
Experimental: Multiple Traffic Light Labels
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.
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.
Experimental: Nutri-Score
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.
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).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Diet Quality per shopping trip
Time Frame: Once a week for three weeks
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 Outcome Measures

Outcome Measure
Measure Description
Time Frame
Total Energy in kilocalories
Time Frame: Once a week for three weeks
Total Energy (kCal)
Once a week for three weeks
Total Sugar in grams
Time Frame: Once a week for three weeks
Total Sugar (g)
Once a week for three weeks
Total fat in grams
Time Frame: Once a week for three weeks
Total Fat (g)
Once a week for three weeks
Saturated fat in grams
Time Frame: Once a week for three weeks
Saturated Fat (g)
Once a week for three weeks
Sodium in milligrams
Time Frame: Once a week for three weeks
Sodium (mg)
Once a week for three weeks
Fiber in grams
Time Frame: Once a week for three weeks
Fiber (g)
Once a week for three weeks
Protein in grams
Time Frame: Once a week for three weeks
Protein (g)
Once a week for three weeks
Energy per serving in kilocalories per serving
Time Frame: Once a week for three weeks
Energy per serving (kCal per serving)
Once a week for three weeks
Sugar per serving in grams per serving
Time Frame: Once a week for three weeks
Sugar per serving (g per serving)
Once a week for three weeks
Total fat per serving in grams per serving
Time Frame: Once a week for three weeks
Total fat per serving (g per serving)
Once a week for three weeks
Saturated fat per serving in grams per serving
Time Frame: Once a week for three weeks
Saturated fat per serving (g per serving)
Once a week for three weeks
Sodium per serving in milligrams per serving
Time Frame: Once a week for three weeks
Sodium per serving (mg per serving)
Once a week for three weeks
Fiber per serving in grams per serving
Time Frame: Once a week for three weeks
Fiber per serving (g per serving)
Once a week for three weeks
Protein per serving in grams per serving
Time Frame: Once a week for three weeks
Protein per serving (g per serving)
Once a week for three weeks
Average Nutri-Score across all products purchased
Time Frame: Once a week for three weeks
The Nutri-Score label was developed by the Equipe de Recherche en Epidémiologie Nutritionnelle (EREN) research team based on the British Food Standards Agency nutrient profiling system, and presents the overall nutritional quality for each food and beverage on a five-point color-coded scale from A is green (best) to E in red (worst). Average Nutri-Score across all products purchased is recoded to a score of A=5, B=4, C=3, D=2 and E=1. Maximum possible score is 5 (all A) and the lowest possible score is 1 (all E). A higher score represents higher nutritional quality.
Once a week for three weeks
Cost per calorie in dollars per kilocalorie
Time Frame: Once a week for three weeks
Cost per calorie is calculated as total spend divided by total kilocalories ($ per kCal)
Once a week for three weeks
Total spend in dollars
Time Frame: Once a week for three weeks
Total spend ($)
Once a week for three weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

July 31, 2018

Primary Completion (Actual)

December 3, 2018

Study Completion (Actual)

December 3, 2018

Study Registration Dates

First Submitted

November 28, 2018

First Submitted That Met QC Criteria

November 29, 2018

First Posted (Actual)

December 3, 2018

Study Record Updates

Last Update Posted (Actual)

January 3, 2019

Last Update Submitted That Met QC Criteria

January 1, 2019

Last Verified

January 1, 2019

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • NUSMart NM

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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