Diet QualityNCT05018026
Understanding Grocery Shopping Behaviour
A study testing Nutri-Grade labels in people with Diet Quality, run by Duke-NUS Graduate Medical School at 1 site in Singapore.
Trial summary
This study aims to systematically evaluate the effect of Singapore's new front-of-pack non-alcoholic beverage labels, called Nutri-Grade, on the consumption of processed beverages. Read more about this study
- Who is it for?
- Ages 21 years and olderHealthy volunteers can take part
- Conditions the study is for
- Diet Quality
- What is being tested?
- Nutri-Grade labels
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 110 participants
- Where
- 1 siteSingapore
- Study dates
- 1 Sep 2021to 31 Jan 2022
- 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
- Age 21 and above
- Must be the primary weekly grocery shopper in their household
- Must have an account with our appointed online grocery service provider or is willing to create one.
Who cannot join
- Non-Singapore resident
- Non-primary grocery shopper in their household
- Less than 21 years old
- Doesn't have an account with our appointed online grocery service provider and is unwilling to create one.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: A Randomized Trial and Impact Evaluation of Singapore's New Food Labels Aimed to Address the War on Diabetes
This study aims to systematically evaluate the effect of Singapore's new front-of-pack non-alcoholic beverage labels, called Nutri-Grade, on the consumption of processed beverages. Using a fully functional grocery webstore, the investigators wish to assess the causal effect of the new labels on food and beverage purchase, sugar intake, and overall diet quality and examine how this effect varies by shoppers' income and education level.
The investigators' hypotheses about the effects of these new food labels, measured by the grams of sugar per serving (primary) of finalized shopping baskets, are as follows:
- Hypotheses 1: The new sugar-sweetened beverage (SSB) labels will shift consumers toward healthier products. Sugar-sweetened beverages are any liquids that have been sweetened with one or more of the different forms of added sugars.
- Hypotheses 2: The new SSB labels will reduce overall sugar and calories purchased and increase overall diet quality.
- Hypotheses 3: Effects will be greater for those with low income/low education as they are least familiar with the nutrition facts panel and thus most likely to benefit from the new information.
Read the detailed description
- Experimental Design and Procedures The aim of this study is to use a 2 x 2 within-subject crossover design with an online grocery store, to systematically evaluate the effect of the new SSB front-of-pack labels, Nutri-Grade, on diet quality and examine how this effect varies by shoppers' income and education level. To this end, the investigators will be using two different versions of an online experimental grocery store called NUSMart, designed for research purposes. The two versions are described below.
- Overview of Experimental Design
The investigators will recruit Singapore residents aged 21 years or older. Prospective participants will be asked to complete an online screener to determine their eligibility to participate in the study. Those who do not consent or are deemed ineligible will be notified of their ineligibility with an on-screen message.
If interested and eligible, the applicant will then be asked to complete a registration form containing name, mobile number, and email address. Contact information for the Duke-NUS study team will be provided to allow questions to be asked at any point in the consent process and throughout the study. Upon completion of the registration form, NUSMart will create the participant account and a unique ID number (CID) for use throughout the study. Participants will receive an automated email with their unique login details.
Participants will be directed to read the Participant Information Sheet and provide consent. The investigators will provide information on study protocols and participation details without disclosing the intervention arms explicitly, to maintain the integrity of participant responses and hence to ensure validity of results. It will be deleterious to the study to reveal the labels or the differences between study arms before participants complete both shops as this will likely confound participant responses. The consent form will state that in each of the shops there is a 50% chance that the participant will have to make actual purchases i.e. buy the groceries in the cart they checked out. In reality, it will be randomly decided earlier whether shopping trip 1 or 2 is the real shop. This will be achieved via a collaboration with a local online grocery provider, FairPrice.
After obtaining consent, participants will be asked to fill in a baseline survey to collect demographic and health characteristics. The baseline questionnaire includes a question as to whether any household members have a medical condition, such as diabetes or hypertension, which requires limiting the types of foods they eat.
Eligible participants who have completed to this point will enter a participant waiting list, where the study team will manually enroll the participant as active according to the capacity of the study team. Once participants have successfully enrolled in the study they will be informed by email, and are expected to complete two grocery shops (one shop per week) on NUSMart. Participants are expected to complete one shop in one sitting. The investigators will apply a within person design and randomize the order of the two shops. Participants will receive email and text reminders each week to complete their order.
Each participant will be told that they must buy at least one beverage product and that they will make the payment using their credit card \& receive their grocery orders. This real-shopping experiment ensures the credibility of the results. Each participant will therefore shop a total of 2 times during the study. This will include 1 shop within each shopping condition (Arm 1 and Arm 2).
During the study, participants will be asked to purchase their weekly groceries the amount of which is similar to their typical grocery shopping for their households, with a specified minimum spend at each shop. A wheel of purchase will be used to determine which one of the 2 shops will the participant actually pay for and receive ordered goods for. Upon completion of their second shop, participants will be asked to fill in a short post-study survey asking for their feedback on the interventions. Participants who successfully complete both shops and all other surveys will be considered as having completed the study. Participants will be provided with the debriefing sheet via email after study completion. For the participants who wish to withdraw midway into the study, the debriefing sheet will be sent to them as soon as possible after they withdraw.
- Conditions
- Diet Quality
- Being tested
- Nutri-Grade labels
- Keywords
- Nutri-Grade labels, Diet quality, Sugar-sweetened beverages, Online grocery shopping
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Nutri-Grade labelsBehavioural
All beverage products in the arm are displayed with the Nutri-Grade label. This label was proposed by the Ministry of Health in Singapore to be implemented at the end of 2021. It will apply to all pre-packaged non-alcoholic beverages sold in Singapore. It will have four color-coded grades wherein Grade A, corresponding to the lowest sugar and saturated fat thresholds, will be in green and Grade D, corresponding to the highest sugar and saturated fat thresholds, will be in red.
| Study group | Role | What they receive |
|---|---|---|
| Arm 1 (Control Arm) | No intervention | A default NUSMart that mirrors a conventional web-grocery store in Singapore where some healthier products are displayed with Singapore's Healthier Choice Symbol (HCS) logos (Control). |
| Arm 2 (Nutri-Grade Arm) | Experimental | Similar to Arm 1 except that beverages will be displayed with a color-coded and graded Nutri-Grade label. Receives: Behavioral: Nutri-Grade labels |
What is being measured
The primary outcome is the main question the study is designed to answer.
Sugar Levels
Grams of sugar per serving
Measured: After completion of data collection, an average of about 5 months
Secondary outcomes (3)
Calorie Intake
Calorie intake per serving and per shopping trip (kcal)
Measured: After completion of data collection, an average of about 5 months
Purchased Beverage Quality
The proportion of Nutri-Graded C and D beverage servings purchased
Measured: After completion of data collection, an average of about 5 months
Overall Diet Quality
Overall diet quality as measured by the average Nutri-Score weighted by the number of serving size. Nutri-Score is an individual dietary index based on the British Food Standard Agency Nutrient Profiling System.
Measured: After completion of data collection, an average of about 5 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Aug 2021
- Study start1 Sep 2021
- Primary completion31 Dec 2021
- Study completion31 Jan 2022
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Diet QualityStudies 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
- Health services research
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 110 participants (actual)
Sponsor and investigators
- Lead sponsor
- Duke-NUS Graduate Medical School
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Soye Shin, Duke-NUS Graduate Medical School
- Investigators
- Soye Shin, PhD, Principal investigator, Duke-NUS Graduate Medical School
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05018026
- Sponsor's protocol ID
- Duke-NUS-KPFA/2020/0042
- Status last verified
- Mar 2022
- First submitted
- 13 Aug 2021
- Last updated
- 23 Mar 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Shin S, Puri J, Finkelstein E. A randomized trial to evaluate the impact of Singapore's forthcoming Nutri-grade front-of-pack beverage label on food and beverage purchases. Int J Behav Nutr Phys Act. 2023 Feb 15;20(1):18. doi: 10.1186/s12966-023-01422-4.
PubMed 36793058
Study at a glance
From the registry record, last updated by the sponsor on 23 Mar 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized Trial and Impact Evaluation of Singapore's New Food Labels Aimed to Address the War on Diabetes
- ClinicalTrials.gov ID
- NCT05018026
- Acronym / sponsor ID
- Duke-NUS-KPFA/2020/0042
- Conditions
- Diet Quality
- Keywords
- Nutri-Grade labels, Diet quality, Sugar-sweetened beverages, Online grocery shopping
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 110 participants (actual)
- Lead sponsor
- Duke-NUS Graduate Medical SchoolUniversity, hospital or other
- Study start
- 1 Sep 2021 (actual)
- Primary completion
- 31 Dec 2021 (actual)
- Study completion
- 31 Jan 2022 (actual)
- First posted
- 24 Aug 2021 (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.
This study aims to systematically evaluate the effect of Singapore's new front-of-pack non-alcoholic beverage labels, called Nutri-Grade, on the consumption of processed beverages. Using a fully functional grocery webstore, the investigators wish to assess the causal effect of the new labels on food and beverage purchase, sugar intake, and overall diet quality and examine how this effect varies by shoppers' income and education level.
The investigators' hypotheses about the effects of these new food labels, measured by the grams of sugar per serving (primary) of finalized shopping baskets, are as follows:
- Hypotheses 1: The new sugar-sweetened beverage (SSB) labels will shift consumers toward healthier products. Sugar-sweetened beverages are any liquids that have been sweetened with one or more of the different forms of added sugars.
- Hypotheses 2: The new SSB labels will reduce overall sugar and calories purchased and increase overall diet quality.
- Hypotheses 3: Effects will be greater for those with low income/low education as they are least familiar with the nutrition facts panel and thus most likely to benefit from the new information.
Detailed description
- Experimental Design and Procedures The aim of this study is to use a 2 x 2 within-subject crossover design with an online grocery store, to systematically evaluate the effect of the new SSB front-of-pack labels, Nutri-Grade, on diet quality and examine how this effect varies by shoppers' income and education level. To this end, the investigators will be using two different versions of an online experimental grocery store called NUSMart, designed for research purposes. The two versions are described below.
- Overview of Experimental Design
The investigators will recruit Singapore residents aged 21 years or older. Prospective participants will be asked to complete an online screener to determine their eligibility to participate in the study. Those who do not consent or are deemed ineligible will be notified of their ineligibility with an on-screen message.
If interested and eligible, the applicant will then be asked to complete a registration form containing name, mobile number, and email address. Contact information for the Duke-NUS study team will be provided to allow questions to be asked at any point in the consent process and throughout the study. Upon completion of the registration form, NUSMart will create the participant account and a unique ID number (CID) for use throughout the study. Participants will receive an automated email with their unique login details.
Participants will be directed to read the Participant Information Sheet and provide consent. The investigators will provide information on study protocols and participation details without disclosing the intervention arms explicitly, to maintain the integrity of participant responses and hence to ensure validity of results. It will be deleterious to the study to reveal the labels or the differences between study arms before participants complete both shops as this will likely confound participant responses. The consent form will state that in each of the shops there is a 50% chance that the participant will have to make actual purchases i.e. buy the groceries in the cart they checked out. In reality, it will be randomly decided earlier whether shopping trip 1 or 2 is the real shop. This will be achieved via a collaboration with a local online grocery provider, FairPrice.
After obtaining consent, participants will be asked to fill in a baseline survey to collect demographic and health characteristics. The baseline questionnaire includes a question as to whether any household members have a medical condition, such as diabetes or hypertension, which requires limiting the types of foods they eat.
Eligible participants who have completed to this point will enter a participant waiting list, where the study team will manually enroll the participant as active according to the capacity of the study team. Once participants have successfully enrolled in the study they will be informed by email, and are expected to complete two grocery shops (one shop per week) on NUSMart. Participants are expected to complete one shop in one sitting. The investigators will apply a within person design and randomize the order of the two shops. Participants will receive email and text reminders each week to complete their order.
Each participant will be told that they must buy at least one beverage product and that they will make the payment using their credit card \& receive their grocery orders. This real-shopping experiment ensures the credibility of the results. Each participant will therefore shop a total of 2 times during the study. This will include 1 shop within each shopping condition (Arm 1 and Arm 2).
During the study, participants will be asked to purchase their weekly groceries the amount of which is similar to their typical grocery shopping for their households, with a specified minimum spend at each shop. A wheel of purchase will be used to determine which one of the 2 shops will the participant actually pay for and receive ordered goods for. Upon completion of their second shop, participants will be asked to fill in a short post-study survey asking for their feedback on the interventions. Participants who successfully complete both shops and all other surveys will be considered as having completed the study. Participants will be provided with the debriefing sheet via email after study completion. For the participants who wish to withdraw midway into the study, the debriefing sheet will be sent to them as soon as possible after they withdraw.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Arm 1 (Control Arm) | No intervention | –A default NUSMart that mirrors a conventional web-grocery store in Singapore where some healthier products are displayed with Singapore's Healthier Choice Symbol (HCS) logos (Control). |
| Arm 2 (Nutri-Grade Arm) | Experimental | Behavioral: Nutri-Grade labelsSimilar to Arm 1 except that beverages will be displayed with a color-coded and graded Nutri-Grade label. |
Who may qualify
- Ages
- 21 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Singapore resident
- Age 21 and above
- Must be the primary weekly grocery shopper in their household
- Must have an account with our appointed online grocery service provider or is willing to create one.
Key exclusion criteria (4 listed)
- Non-Singapore resident
- Non-primary grocery shopper in their household
- Less than 21 years old
- Doesn't have an account with our appointed online grocery service provider and is unwilling to create one.
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 |
|---|---|---|
| Nutri-Grade labelsAll beverage products in the arm are displayed with the Nutri-Grade label. This label was proposed by the Ministry of Health in Singapore to be implemented at the end of 2021. It will apply to all pre-packaged non-alcoholic beverages sold in Singapore. It will have four color-coded grades wherein Grade A, corresponding to the lowest sugar and saturated fat thresholds, will be in green and Grade D, corresponding to the highest sugar and saturated fat thresholds, will be in red. | Behavioural | Arm 2 (Nutri-Grade Arm) |
Primary outcome
Sugar Levels
Time frame: After completion of data collection, an average of about 5 months
Grams of sugar per serving
3 secondary outcomes
Calorie Intake
Time frame: After completion of data collection, an average of about 5 months
Purchased Beverage Quality
Time frame: After completion of data collection, an average of about 5 months
Overall Diet Quality
Time frame: After completion of data collection, an average of about 5 months
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 23 Mar 2022.
- Derived from this study: PubMed 36793058Shin S, Puri J, Finkelstein E. A randomized trial to evaluate the impact of Singapore's forthcoming Nutri-grade front-of-pack beverage label on food and beverage purchases. Int J Behav Nutr Phys Act. 2023 Feb 15;20(1):18. doi: 10.1186/s12966-023-01422-4.
- 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.
Soye Shin, PhD principal investigator
Duke-NUS Graduate Medical School
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Nutri-Grade labels in people with Diet Quality, 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 4 inclusion and 4 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 23 Mar 2022. 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?
Sugar Levels (time frame: After completion of data collection, an average of about 5 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05018026, which also lists 1 linked publication.
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 23 Mar 2022.