Diet HabitNUSMart NMNCT03761342
Evaluating the Relative Effectiveness of Two Front-of-pack Nutrition Labels
A study testing Multiple Traffic Light Label and Nutri-Score Label in people with Diet Habit and Diet Modification, run by Duke-NUS Graduate Medical School at 1 site in Singapore.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 21 years and olderHealthy volunteers can take part
- Conditions the study is for
- Diet Habit, Diet Modification, Food Selection
- What is being tested?
- Multiple Traffic Light Label and Nutri-Score Label
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 154 participants
- Where
- 1 siteSingapore
- Study dates
- 31 Jul 2018to 3 Dec 2018
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 21 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Singapore resident
- Aged 21 years or older.
- Existing registered RedMart customer.
Who cannot join
- Non-Singapore Resident.
- Less than 21 years old.
- Not an existing registered RedMart customer.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: 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:
Read more
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.
Read the 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:
- Arm 1: A control arm that mirrors a traditional web-grocery store with no HCS or other FOP labels.
- 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.
- 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:
- Energy (kCal)
- Sugar (g)
- Total fat (g)
- Saturated fat (g)
- Sodium (g)
- Fiber (g)
- Protein (g) And
- Average Nutri-Score across all products purchased where A=5 and E=1, and
- 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.
- Conditions
- Diet Habit, Diet Modification, Food Selection, Food Preferences, Nutrition Poor
- Being tested
- Multiple Traffic Light Label, Nutri-Score Label
- Keywords
- Front-of-pack label, Nutrition label, Diet Quality, Online grocery store, Diet
- Medical subject headings
- Feeding Behavior, Food Preferences, Malnutrition
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Multiple Traffic Light LabelBehavioural
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.
Nutri-Score LabelBehavioural
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).
| Study group | Role | What they receive |
|---|---|---|
| Control | No intervention | A control arm that mirrors a traditional web-grocery store with no but with no FOP labels. |
| Multiple Traffic Light Labels | Experimental | 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. Receives: Behavioral: Multiple Traffic Light Label |
| Nutri-Score | Experimental | 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. Receives: Behavioral: Nutri-Score Label |
What is being measured
The primary outcome is the main question the study is designed to answer.
Diet Quality per shopping trip
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.
Measured: Once a week for three weeks
Secondary outcomes (17)
Total Energy in kilocalories
Total Energy (kCal)
Measured: Once a week for three weeks
Total Sugar in grams
Total Sugar (g)
Measured: Once a week for three weeks
Total fat in grams
Total Fat (g)
Measured: Once a week for three weeks
Saturated fat in grams
Saturated Fat (g)
Measured: Once a week for three weeks
Sodium in milligrams
Sodium (mg)
Measured: Once a week for three weeks
Fiber in grams
Fiber (g)
Measured: Once a week for three weeks
Protein in grams
Protein (g)
Measured: Once a week for three weeks
Energy per serving in kilocalories per serving
Energy per serving (kCal per serving)
Measured: Once a week for three weeks
Sugar per serving in grams per serving
Sugar per serving (g per serving)
Measured: Once a week for three weeks
Total fat per serving in grams per serving
Total fat per serving (g per serving)
Measured: Once a week for three weeks
Saturated fat per serving in grams per serving
Saturated fat per serving (g per serving)
Measured: Once a week for three weeks
Sodium per serving in milligrams per serving
Sodium per serving (mg per serving)
Measured: Once a week for three weeks
Fiber per serving in grams per serving
Fiber per serving (g per serving)
Measured: Once a week for three weeks
Protein per serving in grams per serving
Protein per serving (g per serving)
Measured: Once a week for three weeks
Average Nutri-Score across all products purchased
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.
Measured: Once a week for three weeks
Cost per calorie in dollars per kilocalorie
Cost per calorie is calculated as total spend divided by total kilocalories ($ per kCal)
Measured: Once a week for three weeks
Total spend in dollars
Total spend ($)
Measured: Once a week for three weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Dec 2018
- Study start31 Jul 2018
- Primary completion3 Dec 2018
- Study completion3 Dec 2018
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Diet HabitStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 154 participants (actual)
Sponsor and investigators
- Lead sponsor
- Duke-NUS Graduate Medical School
- Sponsor type
- University, hospital or other
- Collaborators
- National Medical Research Council (NMRC), Singapore
- Responsible party
- Principal investigator, Eric A. Finkelstein, Duke-NUS Graduate Medical School
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03761342
- Sponsor's protocol ID
- NUSMart NM
- Acronym
- NUSMart NM
- Status last verified
- Jan 2019
- First submitted
- 28 Nov 2018
- Last updated
- 3 Jan 2019
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 3 Jan 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- 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
- ClinicalTrials.gov ID
- NCT03761342
- Acronym / sponsor ID
- NUSMart NM / NUSMart NM
- Conditions
- Diet Habit, Diet Modification, Food Selection, Food Preferences, Nutrition Poor
- Keywords
- Front-of-pack label, Nutrition label, Diet Quality, Online grocery store, Diet
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 154 participants (actual)
- Lead sponsor
- Duke-NUS Graduate Medical SchoolUniversity, hospital or other
- Collaborators
- National Medical Research Council (NMRC), Singapore
- Study start
- 31 Jul 2018 (actual)
- Primary completion
- 3 Dec 2018 (actual)
- Study completion
- 3 Dec 2018 (actual)
- First posted
- 3 Dec 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
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:
- Arm 1: A control arm that mirrors a traditional web-grocery store with no HCS or other FOP labels.
- 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.
- 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:
- Energy (kCal)
- Sugar (g)
- Total fat (g)
- Saturated fat (g)
- Sodium (g)
- Fiber (g)
- Protein (g) And
- Average Nutri-Score across all products purchased where A=5 and E=1, and
- 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 design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind (participant)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Control | No intervention | –A control arm that mirrors a traditional web-grocery store with no but with no FOP labels. |
| Multiple Traffic Light Labels | Experimental | Behavioral: Multiple Traffic Light LabelSimilar 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. |
| Nutri-Score | Experimental | Behavioral: Nutri-Score LabelSimilar 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. |
Who may qualify
- Ages
- 21 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Singapore resident
- Aged 21 years or older.
- Existing registered RedMart customer.
Key exclusion criteria (3 listed)
- Non-Singapore Resident.
- Less than 21 years old.
- Not an existing registered RedMart customer.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Multiple Traffic Light LabelThe 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. | Behavioural | Multiple Traffic Light Labels |
| Nutri-Score LabelIn 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). | Behavioural | Nutri-Score |
Primary outcome
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.
17 secondary outcomes
Total Energy in kilocalories
Time frame: Once a week for three weeks
Total Sugar in grams
Time frame: Once a week for three weeks
Total fat in grams
Time frame: Once a week for three weeks
Saturated fat in grams
Time frame: Once a week for three weeks
Sodium in milligrams
Time frame: Once a week for three weeks
Fiber in grams
Time frame: Once a week for three weeks
Protein in grams
Time frame: Once a week for three weeks
Energy per serving in kilocalories per serving
Time frame: Once a week for three weeks
Sugar per serving in grams per serving
Time frame: Once a week for three weeks
Total fat per serving in grams per serving
Time frame: Once a week for three weeks
Saturated fat per serving in grams per serving
Time frame: Once a week for three weeks
Sodium per serving in milligrams per serving
Time frame: Once a week for three weeks
Fiber per serving in grams per serving
Time frame: Once a week for three weeks
Protein per serving in grams per serving
Time frame: Once a week for three weeks
Average Nutri-Score across all products purchased
Time frame: Once a week for three weeks
Cost per calorie in dollars per kilocalorie
Time frame: Once a week for three weeks
Total spend in dollars
Time frame: Once a week for three weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Jan 2019.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Multiple Traffic Light Label and Nutri-Score Label in people with Diet Habit and Diet Modification, run by Duke-NUS Graduate Medical School at 1 site in Singapore.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 3 Jan 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Singapore. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Diet Quality per shopping trip (time frame: Once a week for three weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Jan 2019.