The potential of Nutri-Score to differentiate foods in regulating food marketing to children

PURPOSE: To evaluate the potential of Nutri-Score to identify foods unsuitable for marketing to children by assessing its agreement with two established nutrient profiling models: WHO-EURO 2023 and the Norwegian Regulation on Marketing (NORMA). Further, we explored the impact of additional criteria to improve agreement. Addition, we evaluated the agreement between a modified Nutri-Score, the «NewTools-score», and WHO-EURO 2023 and NORMA. METHODS: Products from the Norwegian food composition table (N = 1,944) were used to explore scenarios for Nutri-Score (and NewTools-score) against WHO-EURO and NORMA. The scenarios were: 1) All products scoring C-E not permitted for marketing, 2) Same as scenario 1, but with additional criteria for trans fatty acids, non-sugar sweeteners (NSS), and added sugar for beverages. For NORMA, a third scenario was tested as an extension of scenario 2, additionally banning selected food categories from marketing. Agreement was assessed through cross classification. RESULTS: Under scenario 1, 53% of products were classified as Nutri-Score C-E, and 47% and 23% not permitted for marketing under WHO-EURO and NORMA, respectively. Overall agreement between Nutri-Score C-E and WHO-EURO was 84%, and 66% with NORMA. However, Nutri-Score allowed some products within unhealthy food categories, e.g., ice creams with NSS. Applying additional criteria in scenarios 2 and 3 had important effects on banning such products. Results for the NewTools-score were almost identical. CONCLUSION: The Nutri-Score and the NewTools-score may be used for identifying a high proportion of products unsuitable for marketing to children. However, some additional criteria, including a complete ban from marketing in selected food categories, seems warranted to better protect children from exposure to marketing of unhealthy products.