Evaluation of the Nutri-Score and potential improvements to the score in the NewTools Project

Abstract Background The Nutri-Score is a summary score for nutritional quality ranking foods from A/dark green to E/dark orange, and it is implemented as a front-of-pack label in several European countries. The aim of our project was to evaluate the performance of Nutri-Score from a Norwegian perspective and to develop and evaluate potential improvements to the score. Methods The Nutri-Score was calculated for foods on the Norwegian market and performance was assessed by exploring the variance of scores within food categories, alignment with dietary recommendations and nutrition experts’ ranking of foods by healthiness, and by collecting and reviewing different food system actors’ feedback. The score was amended to solve identified challenges. Nutri-Score and the revised score were evaluated for their alignment with nutrition experts’ rankings, with diet quality indices, and their associations with health outcomes in a cohort study (MoBa). Results The Nutri-Score showed acceptable performance, but some challenges were identified. Minor changes to the score were proposed to better capture carbohydrate and fat quality and to reward the content of fish, which improved the alignment with the Nordic Nutrition Recommendations and nutrition experts’ rankings. In the cohort study, the mean score of the participants’ diets strongly correlated with a score measuring adherence to dietary guidelines and a better score was also associated with lower likelihood of new-onset hypertension. Alignment with additional diet quality indices is currently studied in the Norwegian diet survey, Norkost-4. Conclusions The Nutri-Score was found to perform well, but some minor improvements are suggested to enhance alignment with dietary guidelines and acceptability of the score from a Norwegian perspective. Ranking nutritional quality in a single summary score can be used for multiple purposes, for example in research and evaluation of food environments or in front-of-pack nutrition labelling. Key messages • Nutri-Score is a summary score for nutritional quality of foods and a front-of-pack food label. • Challenges to the Nutri-Score were identified and improvements proposed for better alignment with Nordic Nutrition Recommendations.