Ci a ion: Fe nandez-Alonso, J.;
Lamas-Mendoza, M.d.M.;
Rod iguez-Sanchez, N.; Galloway,
S.D.R.; G a ina, L. Assessing he
Validi y o F on -o -Pack Nu i ion
Labels o E alua ing he Heal hiness
o Medi e anean Food Choices: A
Global Compa ison. Nu ien s 2024,
16, 2925. h ps://doi.o g/
10.3390/nu16172925
Academic Edi o s: Rosa M.
Lamuela-Ra en os and Mike Reid
Recei ed: 2 June 2024
Re ised: 8 Augus 2024
Accep ed: 28 Augus 2024
Published: 1 Sep embe 2024
Copy igh : © 2024 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
nu ien s
A icle
Assessing he Validi y o F on -o -Pack Nu i ion Labels o
E alua ing he Heal hiness o Medi e anean Food Choices:
A Global Compa ison
Julia Fe nandez-Alonso 1, Ma ía del Ma Lamas-Mendoza 1,2,3 , Nidia Rod iguez-Sanchez 4,
S ua D. R. Galloway 4and Ley e G a ina 1,2,*
1Nu sing I Depa men , Facul y o Medicine and Nu sing, Uni e si y o he Basque Coun y UPV/EHU,
Bº Sa iena s/n, 48940 Leioa, Spain; [email p o ec ed] (J.F.-A.);
ma iadelma [email p o ec ed] (M.d.M.L.-M.)
2Biobizkaia Basque Heal h Resea ch Ins i u e, 48903 Ba akaldo, Spain
3Osakide za Basque Heal h Se ice, Bilbao-Basu o In eg a ed Heal hca e O ganisa ion, Basu o Uni e si y
Hospi al, 48013 Bilbao, Spain
4Physiology, Exe cise and Nu i ion Resea ch G oup, Facul y o Heal h Sciences and Spo , Uni e si y o
S i ling, S i ling FK9 4LA, UK; nidia. od iguezsanchez@s i .ac.uk (N.R.-S.);
s.d. .galloway@s i .ac.uk (S.D.R.G.)
*Co espondence: ley [email p o ec ed]; Tel.: +34-678034558
Abs ac : In esponse o g owing public heal h conce ns, go e nmen s wo ldwide ha e implemen ed
a ious nu i ion labelling schemes o p omo e heal hie ea ing habi s. This s udy aimed o assess
he consis ency and e ec i eness o hese labels in an ou -o -home con ex , speci ically ocusing on
es au an , hospi ali y, and ins i u ional ood se ice se ings. In o al, 178 di e en dishes om Spain
we e analysed using labels om he Mazocco me hod, he UK’s a ic ligh sys em, he Heal h S a
Ra ing (Aus alia), Nu i-Sco e (F ance), mul iple a ic ligh s (Ecuado ), and wa ning labels (Chile
and U uguay). The esul s demons a ed a gene ally low le el o ag eemen among hese labels
(K < 0.40), indica ing no able a iabili y and a lack o consensus, which could hinde consume s’
abili y o make in o med ood choices in ou -o -home se ings. Nu i-Sco e classi ied he highes
numbe o dishes as unheal hy (38%). This s udy unde sco es he need o an easy- o-unde s and
labelling sys em ailo ed o each coun y’s culina y and socio-cul u al con ex s o imp o e consume
decision-making in a ious dining en i onmen s. Fu u e esea ch should ocus on de eloping and
es ing quali a i e me hods o mo e accu a ely gauge he nu i ional quali y o cooked dishes in
di e se ou -o -home se ings, he eby enhancing public heal h ou comes. By add essing he speci ic
needs o he home, es au an s, hospi ali y, and ins i u ional ood se ices, ailo ed labelling schemes
could signi ican ly imp o e consume s’ abili y o make heal hie ood choices.
Keywo ds: on -o -pack label; Nu i-sco e; ood labelling; heal hy ood choice; wa ning labels; a ic
ligh labels
1. In oduc ion
An unheal hy die , cha ac e ised by high le els o sodium, suga , and sa u a ed
a y acids (SFAs), is a well-es ablished isk ac o o obesi y and nume ous o he heal h
p oblems [
1
,
2
]. In ecen yea s, he p e alence o o e weigh and obesi y has inc eased, and
his has been linked o an inc ease in meals ea en away om home [
3
]. Va ious nu i ion
labels ha e been de eloped wo ldwide o p omo e heal hie ood choices when ea ing
away om home, aimed a helping consume s educe hei in ake o hese unheal hy
componen s. F on -o -Pack (FOP) labelling, in pa icula , has been shown o be an e ec i e
ool in enhancing consume unde s anding and acili a ing heal hie ood choices [
4
],
demons a ing ha FOP labels can po en ially imp o e public heal h in he long e m [
5
–
7
].
Nu ien s 2024,16, 2925. h ps://doi.o g/10.3390/nu16172925 h ps://www.mdpi.com/jou nal/nu ien s
Nu ien s 2024,16, 2925 2 o 14
In ha sense, he FOP labelling o oods p o ides consume s easy access o essen ial
nu i ional in o ma ion, ega dless o hei lack o p e ious nu i ion knowledge. How-
e e , he e is a g ea con o e sy ega ding he op imal design o FOP labels [
8
]. Each
FOP label can use a di e en nu ien p o iling sys em, designed o assess he nu i ional
alue o oods based on a ious c i e ia and algo i hms ha conside di e en nu i ional
componen s and ing edien s. These sys ems can a y in how hey weigh and ca ego ize
he nu ien s, leading o di e ences in how he FOP labelling p esen s he nu i ional
in o ma ion on ood p oduc s. These a ia ions allow he labels o be ailo ed o each
labelling sys em’s speci ic con ex s and objec i es. Va ious s udies sugges ha he FOP
labels ha use colou coding, such as he a ic ligh sys em used in he Uni ed Kingdom
(UK), a e mo e easily unde s ood by consume s [
8
–
12
]. This FOP label sys em assigns
g een, ambe , and ed colou s o a dish o ood, wi h g een being he heal hies , based on i s
a , SFAs, suga s, o sal [
13
]. O he au ho s claim ha he La in Ame ican wa ning labels,
which use a black seal o indica e he p esence o excessi e sal and SFAs, among o he
componen s, a e equally e ec i e and easy o ead [
8
,
10
,
14
]. Resea ch indica es ha hese
labels a e highly e ec i e ools o iden i ying unheal hy ood p oduc s due o he high
p esence o subs ances such as a and suga s. Mo eo e , he absence o his indica o is
su icien and help ul o consume s o iden i y heal hie op ions [
15
] and o be e ec i e in
encou aging ood choices [
16
]. In Eu ope, he Nu i-Sco e sys em has been es ablished in
ecen yea s, and i uses bo h le e s and colou s o e alua e ood and d ink [
6
,
17
]. This FOP
label has been he subjec o many published scien i ic s udies demons a ing i s e icacy,
ele ance, and use ulness o consume s and public heal h [
18
]. In Oceania, he Heal h S a
Ra ing (HSR) sys em assigns a sco e using s a s, whe e a highe numbe o s a s indica es
g ea e heal hiness [
19
,
20
]. This sys em encou ages he e o mula ion o p ocessed p od-
uc s, making hem heal hie , pa icula ly educ ions in sodium and inc eases in die a y
ib e [21].
These FOP labels a e based on Codex Alimen a ius guidelines o ensu e ha hey
a e ele an and e ec i e in speci ic cul u al and egional con ex s [
22
]. The Codex Ali-
men a ius ollows s anda ds ha ensu e oods a e sa e and can be deli e ed o consume s.
Howe e , hese FOP sys ems ha e mainly been used o p e-packaged ood sold in shops
o p ocessed p oduc s [
23
] and no in he con ex o meals away om home. The ex ension
o hese p inciples o cooked dishes ca e ed a any ood se ice, whe e he consume can
choose which one o consume om among se e al o e ed, needs o be ho oughly in es i-
ga ed as i is eme ging as an a ea o in e es . Thus, a ecen s udy by Yang Y e al. (2024)
e alua ed he FOP labels in online meal se ices and explo ed hei po en ial applica ion
in he ood se ice sec o [
24
]. Ano he well-known in e en ion in away- om-home
dining es ablishmen s is menu labelling, which consis s o making nu i ional in o ma ion
abou he oods se ed a ailable a he poin o o de ing o pu chase [
25
]. This has been
associa ed wi h se ing lowe a and lowe sal i ems in popula UK chain es au an s [
26
].
Mo eo e , menu labelling policies ha e been implemen ed in chain es au an s, usually
ocusing on displaying he ene gy con en [
27
]. Howe e , calo ie labelling on he oods
pu chased o consumed in eal-wo ld se ings showed mixed esul s in se e al sys em-
a ic e iews, concluding ha hei impac s a e limi ed [
28
–
30
]. Ne e heless, al hough
Food-Based Die a y Guidelines exis o in o m consume beha iou ega ding meals and
cooked dishes, he planning, poli ical, and inancial suppo o hei implemen a ion
in di e en sec o s, such as es au an s and ood se ices, a e s ill insu icien , limi ing
hei eal impac [
31
]. Addi ionally, an in e na ional compa a i e analysis o he die a y
guidelines om a ious coun ies shows ha , while all p o ide ecommenda ions on ui s,
ege ables, ce eals, legumes, dai y, mea s, and oils, he e a e no able di e ences in he
ecommended amoun s. These a ia ions unde sco e he need o adap he guidelines o
speci ic cul u al and egional con ex s o make hem p ac ical and ele an [
32
]. The e
is s ill no na ional policy on heal h logos on menus wo ldwide, bu some ha e s a ed
o pu sodium wa ning icons nex o es au an menu i ems ha con ain high sodium
alues [
33
]. Knowing ha assessing he nu i ional alue o cooked dishes o en equi es
Nu ien s 2024,16, 2925 3 o 14
complex, quan i a i e, and ime-consuming me hods, such as weighing ing edien s and
analysing hei nu i ional con en h ough speci ic nu i ional so wa e [
34
,
35
], he e is
s ill he need o a clea and easily unde s andable sys em o labelling he heal h ulness o
cooked dishes o guide consume s’ ood choices and con ibu e o heal h ou comes [
36
].
The e o e, conside ing he signi ican impac hese in e en ions can ha e on consume
choice and heal h, FOP labelling could se e as a aluable ool o p o iding mo e de ailed
in o ma ion abou he nu i ional quali y o he dishes chosen by consume s. Implemen ing
FOP labels on p epa ed and cooked meals, especially in ou -o -home se ings such as
es au an s, hospi ali y, and ins i u ional ood se ices, can o e consume s an accessible
ool o assess he heal hiness o hei meal choices. This app oach no only acili a es mo e
in o med decision-making bu also has he po en ial o p omo e heal hie ea ing habi s and
posi i ely impac public heal h ou comes.
The e o e, o de e mine he ela ionship be ween he di e en weigh ings and ca e-
go iza ions o he nu ien s o he same obse ed ood o dish in ou -o -home con ex s,
we p opose using nu i ion labelling esou ces, such as he FOP labels implemen ed in
se e al coun ies. Such analysis could p o ide mo e eliable in o ma ion abou he heal h-
iness o di e en dishes and acili a e he compa ison and adap a ion o in e na ional
labelling sys ems o local con ex s, ensu ing accu a e assessmen s o he ood o e ed and
consumed in se ings like es au an s and ins i u ional ood se ices. Al hough he e has
been some esea ch on he e ec i eness o hese labelling sys ems based on consume
opinions [9–11,19]
and ood p o essionals [
6
], s udies compa ing he conco dance o FOP
labels applied o di e en cooked dishes a e sca ce. Thus, his s udy aims o compa e he
deg ee o ag eemen o a ious FOP labels used globally o iden i y he mos eliable FOP
labels o e alua ing he nu i ional quali y o dishes in ou -o -home con ex s and helping
consume s make in o med decisions abou he heal hiness o hei chosen meals.
2. Me hods
2.1. Design and Sample
In his desc ip i e c oss-sec ional s udy, many dishes o e ed by he School o Food
and Ca e ing a a uni e si y campus in Spain we e chosen o analyse hei nu i ional
quali y. The dishes o e ed du ing a andomly selec ed week each mon h ac oss en mon hs
we e conside ed. In o al, 178 di e en dishes we e analysed, di ided in o 68 main cou ses,
59 second cou ses, and 51 desse s. The nu i ional quali y o each cou se was analysed and
compa ed using se e al me hods: he me hod based on he s udy by Mazocco e al. [
12
];
he UK’s a ic ligh labelling sys em ( om he UK) [
37
]; he Heal h S a Ra ing (HSR;
Aus alia) [
20
]; Nu i-Sco e (F ance) [
7
]; mul iple a ic ligh s (Ecuado ) [
38
]; and wa ning
seals, including hose om Chile [2] and U uguay [39]. Table 1p esen s he di e en FOP
labels analysed (all alid o cooked dishes), he a iables hey s udy, and hei espec i e
isualisa ion me hods. This s udy did no equi e app o al om any e hics commi ee as i
used published seconda y da a, and no da a in ol ed human da a.
Table 1. O e iew o a ious F on -o -Pack (FOP) labels: labelling sys em and a iables.
F on o Pack Labelling Sys em Va iables Image Example
Mazzoco me hod [12] Colou ca d Na con en and ene gy
Nu ien s 2024, 16, x FOR PEER REVIEW 3 o 14
wa ning icons nex o es au an menu i ems ha con ain high sodium alues [33]. Know-
ing ha assessing he nu i ional alue o cooked dishes o en equi es complex, quan i a-
i e, and ime-consuming me hods, such as weighing ing edien s and analysing hei nu-
i ional con en h ough speci ic nu i ional so wa e [34,35], he e is s ill he need o a
clea and easily unde s andable sys em o labelling he heal h ulness o cooked dishes o
guide consume s’ ood choices and con ibu e o heal h ou comes [36]. The e o e, consid-
e ing he signi ican impac hese in e en ions can ha e on consume choice and heal h,
FOP labelling could se e as a aluable ool o p o iding mo e de ailed in o ma ion abou
he nu i ional quali y o he dishes chosen by consume s. Implemen ing FOP labels on
p epa ed and cooked meals, especially in ou -o -home se ings such as es au an s, hospi-
ali y, and ins i u ional ood se ices, can offe consume s an accessible ool o assess he
heal hiness o hei meal choices. This app oach no only acili a es mo e in o med deci-
sion-making bu also has he po en ial o p omo e heal hie ea ing habi s and posi i ely
impac public heal h ou comes.
The e o e, o de e mine he ela ionship be ween he diffe en weigh ings and ca e-
go iza ions o he nu ien s o he same obse ed ood o dish in ou -o -home con ex s,
we p opose using nu i ion labelling esou ces, such as he FOP labels implemen ed in
se e al coun ies. Such analysis could p o ide mo e eliable in o ma ion abou he heal h-
iness o diffe en dishes and acili a e he compa ison and adap a ion o in e na ional la-
belling sys ems o local con ex s, ensu ing accu a e assessmen s o he ood offe ed and
consumed in se ings like es au an s and ins i u ional ood se ices. Al hough he e has
been some esea ch on he effec i eness o hese labelling sys ems based on consume
opinions [9–11,19] and ood p o essionals [6], s udies compa ing he conco dance o FOP
labels applied o diffe en cooked dishes a e sca ce. Thus, his s udy aims o compa e he
deg ee o ag eemen o a ious FOP labels used globally o iden i y he mos eliable FOP
labels o e alua ing he nu i ional quali y o dishes in ou -o -home con ex s and helping
consume s make in o med decisions abou he heal hiness o hei chosen meals.
2. Me hods
2.1. Design and Sample
In his desc ip i e c oss-sec ional s udy, many dishes offe ed by he School o Food
and Ca e ing a a uni e si y campus in Spain we e chosen o analyse hei nu i ional
quali y. The dishes offe ed du ing a andomly selec ed week each mon h ac oss en
mon hs we e conside ed. In o al, 178 diffe en dishes we e analysed, di ided in o 68 main
cou ses, 59 second cou ses, and 51 desse s. The nu i ional quali y o each cou se was
analysed and compa ed using se e al me hods: he me hod based on he s udy by Ma-
zocco e al. [12]; he UK’s affic ligh labelling sys em ( om he UK) [37]; he Heal h S a
Ra ing (HSR; Aus alia) [20]; Nu i-Sco e (F ance) [7]; mul iple affic ligh s (Ecuado )
[38]; and wa ning seals, including hose om Chile [2] and U uguay [39]. Table 1 p esen s
he diffe en FOP labels analysed (all alid o cooked dishes), he a iables hey s udy,
and hei espec i e isualisa ion me hods. This s udy did no equi e app o al om any
e hics commi ee as i used published seconda y da a, and no da a in ol ed human da a.
Table 1. O e iew o a ious F on -o -Pack (FOP) labels: labelling sys em and a iables.
F on o Pack Labelling Sys em Va iables
Mazzoco me hod [12] Colou ca d Na con en and ene gy
UK [37]Colou s: g een, ambe ,
and ed
Fa , sa u a ed a s, suga s,
and sal
Nu ien s 2024, 16, x FOR PEER REVIEW 4 o 14
UK [37] Colou s: g een, ambe ,
and ed Fa , sa u a ed a s, suga s, and sal
Heal h S a Ra ing [20] S a s: om 0.5 o 5
To al ene gy, o al suga s, and sa u-
a ed a y acids ( isk componen s)
Fib e, ui s and ege ables, nu s, leg-
umes, and p o ein (heal hy compo-
nen s)
Nu i-Sco e [7]
Colou s (da k g een,
ligh g een, yellow, ligh
o ange, and ed) and le -
e s (A–E)
Ene gy, o al a , sa u a ed a y acids
,
suga s, p o ein, sal , ib e, Na, ui s,
ege ables, legumes, nu s, and oli e
oil
Mul iple a ic ligh s
om Ecuado [38]
Colou s (g een, yellow,
and ed) Fa , suga , and sal
Chilean wa ning labels
[2] High con en labels Added suga s, Na, sa u a ed a s, and
calo ies
U uguayan wa ning
s amps [39] High con en labels Na, suga , a , and sa u a ed a y ac-
ids
Na: sodium.
2.2. Calcula ion o he Weigh o he Dishes
To calcula e he FOP labels, i was necessa y o es ima e he weigh o each dish. The
websi e h ps://ja ondo.hos ele ialeioa.ne /es/can eens/ xopi ea (accessed on 1 June 2020)
was used, indica ing each dish’s menus, ecipes, and ing edien s. The ing edien s pe
se ing we e added up, and he weigh a ia ions o he ood du ing cooking we e con-
side ed and calcula ed [40].
2.3. Dish E alua ion Tools
2.3.1. Mazocco Me hod
This labelling sys em classi ies he whole pla e ollowing he same guidelines as he
UK affic ligh sys em [12]. Speci ically, his e alua ion classi ies he ene gy densi y and
Na con en in o high ene gy densi y ( om 4 o 9 kcal/g), medium ene gy densi y ( om
1.5 o 4 kcal/g), low ene gy densi y ( om 0.7 o 1.5 kcal/g), and e y low ene gy densi y
( om 0 o 0.6 kcal/g). Subsequen ly, acco ding o he c i e ia o he “UK Food S anda ds
Agency” [13], i classi ies he Na concen a ion pe 100 g in o high Na con en (>600 mg
Na), medium Na con en ( om 120 o 600 mg Na), and low Na con en (≤120 mg Na).
Following bo h c i e ia, each le el (high, medium, and low) is assigned, like UK affic
ligh s, wi h a colou ( ed, ambe , and g een, espec i ely). The inal colou o he dish
ollows he ollowing pa e n: i he dish has wo ca ego ies wi h he same colou , ha
colou is es ablished as he p edominan colou o he dish, bu , in he case o wo colou s
(g een and yellow, g een and ed, o yellow and ed), he colou ha is u hes om
Nu ien s 2024,16, 2925 4 o 14
Table 1. Con .
F on o Pack Labelling Sys em Va iables Image Example
Heal h S a Ra ing [20] S a s: om 0.5 o 5
To al ene gy, o al suga s, and
sa u a ed a y acids ( isk
componen s)Fib e, ui s and
ege ables, nu s, legumes, and
p o ein (heal hy componen s)
Nu ien s 2024, 16, x FOR PEER REVIEW 4 o 14
UK [37] Colou s: g een, ambe ,
and ed Fa , sa u a ed a s, suga s, and sal
Heal h S a Ra ing [20] S a s: om 0.5 o 5
To al ene gy, o al suga s, and sa u-
a ed a y acids ( isk componen s)
Fib e, ui s and ege ables, nu s, leg-
umes, and p o ein (heal hy compo-
nen s)
Nu i-Sco e [7]
Colou s (da k g een,
ligh g een, yellow, ligh
o ange, and ed) and le -
e s (A–E)
Ene gy, o al a , sa u a ed a y acids
,
suga s, p o ein, sal , ib e, Na, ui s,
ege ables, legumes, nu s, and oli e
oil
Mul iple a ic ligh s
om Ecuado [38]
Colou s (g een, yellow,
and ed) Fa , suga , and sal
Chilean wa ning labels
[2] High con en labels Added suga s, Na, sa u a ed a s, and
calo ies
U uguayan wa ning
s amps [39] High con en labels Na, suga , a , and sa u a ed a y ac-
ids
Na: sodium.
2.2. Calcula ion o he Weigh o he Dishes
To calcula e he FOP labels, i was necessa y o es ima e he weigh o each dish. The
websi e h ps://ja ondo.hos ele ialeioa.ne /es/can eens/ xopi ea (accessed on 1 June 2020)
was used, indica ing each dish’s menus, ecipes, and ing edien s. The ing edien s pe
se ing we e added up, and he weigh a ia ions o he ood du ing cooking we e con-
side ed and calcula ed [40].
2.3. Dish E alua ion Tools
2.3.1. Mazocco Me hod
This labelling sys em classi ies he whole pla e ollowing he same guidelines as he
UK affic ligh sys em [12]. Speci ically, his e alua ion classi ies he ene gy densi y and
Na con en in o high ene gy densi y ( om 4 o 9 kcal/g), medium ene gy densi y ( om
1.5 o 4 kcal/g), low ene gy densi y ( om 0.7 o 1.5 kcal/g), and e y low ene gy densi y
( om 0 o 0.6 kcal/g). Subsequen ly, acco ding o he c i e ia o he “UK Food S anda ds
Agency” [13], i classi ies he Na concen a ion pe 100 g in o high Na con en (>600 mg
Na), medium Na con en ( om 120 o 600 mg Na), and low Na con en (≤120 mg Na).
Following bo h c i e ia, each le el (high, medium, and low) is assigned, like UK affic
ligh s, wi h a colou ( ed, ambe , and g een, espec i ely). The inal colou o he dish
ollows he ollowing pa e n: i he dish has wo ca ego ies wi h he same colou , ha
colou is es ablished as he p edominan colou o he dish, bu , in he case o wo colou s
(g een and yellow, g een and ed, o yellow and ed), he colou ha is u hes om
Nu i-Sco e [7]
Colou s (da k g een,
ligh g een, yellow, ligh
o ange, and ed) and
le e s (A–E)
Ene gy, o al a , sa u a ed
a y acids, suga s, p o ein,
sal , ib e, Na, ui s,
ege ables, legumes, nu s, and
oli e oil
Nu ien s 2024, 16, x FOR PEER REVIEW 4 o 14
UK [37] Colou s: g een, ambe ,
and ed Fa , sa u a ed a s, suga s, and sal
Heal h S a Ra ing [20] S a s: om 0.5 o 5
To al ene gy, o al suga s, and sa u-
a ed a y acids ( isk componen s)
Fib e, ui s and ege ables, nu s, leg-
umes, and p o ein (heal hy compo-
nen s)
Nu i-Sco e [7]
Colou s (da k g een,
ligh g een, yellow, ligh
o ange, and ed) and le -
e s (A–E)
Ene gy, o al a , sa u a ed a y acids
,
suga s, p o ein, sal , ib e, Na, ui s,
ege ables, legumes, nu s, and oli e
oil
Mul iple a ic ligh s
om Ecuado [38]
Colou s (g een, yellow,
and ed) Fa , suga , and sal
Chilean wa ning labels
[2] High con en labels Added suga s, Na, sa u a ed a s, and
calo ies
U uguayan wa ning
s amps [39] High con en labels Na, suga , a , and sa u a ed a y ac-
ids
Na: sodium.
2.2. Calcula ion o he Weigh o he Dishes
To calcula e he FOP labels, i was necessa y o es ima e he weigh o each dish. The
websi e h ps://ja ondo.hos ele ialeioa.ne /es/can eens/ xopi ea (accessed on 1 June 2020)
was used, indica ing each dish’s menus, ecipes, and ing edien s. The ing edien s pe
se ing we e added up, and he weigh a ia ions o he ood du ing cooking we e con-
side ed and calcula ed [40].
2.3. Dish E alua ion Tools
2.3.1. Mazocco Me hod
This labelling sys em classi ies he whole pla e ollowing he same guidelines as he
UK affic ligh sys em [12]. Speci ically, his e alua ion classi ies he ene gy densi y and
Na con en in o high ene gy densi y ( om 4 o 9 kcal/g), medium ene gy densi y ( om
1.5 o 4 kcal/g), low ene gy densi y ( om 0.7 o 1.5 kcal/g), and e y low ene gy densi y
( om 0 o 0.6 kcal/g). Subsequen ly, acco ding o he c i e ia o he “UK Food S anda ds
Agency” [13], i classi ies he Na concen a ion pe 100 g in o high Na con en (>600 mg
Na), medium Na con en ( om 120 o 600 mg Na), and low Na con en (≤120 mg Na).
Following bo h c i e ia, each le el (high, medium, and low) is assigned, like UK affic
ligh s, wi h a colou ( ed, ambe , and g een, espec i ely). The inal colou o he dish
ollows he ollowing pa e n: i he dish has wo ca ego ies wi h he same colou , ha
colou is es ablished as he p edominan colou o he dish, bu , in he case o wo colou s
(g een and yellow, g een and ed, o yellow and ed), he colou ha is u hes om
Mul iple a ic ligh s
om Ecuado [38]
Colou s (g een, yellow,
and ed) Fa , suga , and sal
Nu ien s 2024, 16, x FOR PEER REVIEW 4 o 14
UK [37] Colou s: g een, ambe ,
and ed Fa , sa u a ed a s, suga s, and sal
Heal h S a Ra ing [20] S a s: om 0.5 o 5
To al ene gy, o al suga s, and sa u-
a ed a y acids ( isk componen s)
Fib e, ui s and ege ables, nu s, leg-
umes, and p o ein (heal hy compo-
nen s)
Nu i-Sco e [7]
Colou s (da k g een,
ligh g een, yellow, ligh
o ange, and ed) and le -
e s (A–E)
Ene gy, o al a , sa u a ed a y acids
,
suga s, p o ein, sal , ib e, Na, ui s,
ege ables, legumes, nu s, and oli e
oil
Mul iple a ic ligh s
om Ecuado [38]
Colou s (g een, yellow,
and ed) Fa , suga , and sal
Chilean wa ning labels
[2] High con en labels Added suga s, Na, sa u a ed a s, and
calo ies
U uguayan wa ning
s amps [39] High con en labels Na, suga , a , and sa u a ed a y ac-
ids
Na: sodium.
2.2. Calcula ion o he Weigh o he Dishes
To calcula e he FOP labels, i was necessa y o es ima e he weigh o each dish. The
websi e h ps://ja ondo.hos ele ialeioa.ne /es/can eens/ xopi ea (accessed on 1 June 2020)
was used, indica ing each dish’s menus, ecipes, and ing edien s. The ing edien s pe
se ing we e added up, and he weigh a ia ions o he ood du ing cooking we e con-
side ed and calcula ed [40].
2.3. Dish E alua ion Tools
2.3.1. Mazocco Me hod
This labelling sys em classi ies he whole pla e ollowing he same guidelines as he
UK affic ligh sys em [12]. Speci ically, his e alua ion classi ies he ene gy densi y and
Na con en in o high ene gy densi y ( om 4 o 9 kcal/g), medium ene gy densi y ( om
1.5 o 4 kcal/g), low ene gy densi y ( om 0.7 o 1.5 kcal/g), and e y low ene gy densi y
( om 0 o 0.6 kcal/g). Subsequen ly, acco ding o he c i e ia o he “UK Food S anda ds
Agency” [13], i classi ies he Na concen a ion pe 100 g in o high Na con en (>600 mg
Na), medium Na con en ( om 120 o 600 mg Na), and low Na con en (≤120 mg Na).
Following bo h c i e ia, each le el (high, medium, and low) is assigned, like UK affic
ligh s, wi h a colou ( ed, ambe , and g een, espec i ely). The inal colou o he dish
ollows he ollowing pa e n: i he dish has wo ca ego ies wi h he same colou , ha
colou is es ablished as he p edominan colou o he dish, bu , in he case o wo colou s
(g een and yellow, g een and ed, o yellow and ed), he colou ha is u hes om
Chilean wa ning
labels [2]High con en labels Added suga s, Na, sa u a ed
a s, and calo ies
Nu ien s 2024, 16, x FOR PEER REVIEW 4 o 14
UK [37] Colou s: g een, ambe ,
and ed Fa , sa u a ed a s, suga s, and sal
Heal h S a Ra ing [20] S a s: om 0.5 o 5
To al ene gy, o al suga s, and sa u-
a ed a y acids ( isk componen s)
Fib e, ui s and ege ables, nu s, leg-
umes, and p o ein (heal hy compo-
nen s)
Nu i-Sco e [7]
Colou s (da k g een,
ligh g een, yellow, ligh
o ange, and ed) and le -
e s (A–E)
Ene gy, o al a , sa u a ed a y acids
,
suga s, p o ein, sal , ib e, Na, ui s,
ege ables, legumes, nu s, and oli e
oil
Mul iple a ic ligh s
om Ecuado [38]
Colou s (g een, yellow,
and ed) Fa , suga , and sal
Chilean wa ning labels
[2] High con en labels Added suga s, Na, sa u a ed a s, and
calo ies
U uguayan wa ning
s amps [39] High con en labels Na, suga , a , and sa u a ed a y ac-
ids
Na: sodium.
2.2. Calcula ion o he Weigh o he Dishes
To calcula e he FOP labels, i was necessa y o es ima e he weigh o each dish. The
websi e h ps://ja ondo.hos ele ialeioa.ne /es/can eens/ xopi ea (accessed on 1 June 2020)
was used, indica ing each dish’s menus, ecipes, and ing edien s. The ing edien s pe
se ing we e added up, and he weigh a ia ions o he ood du ing cooking we e con-
side ed and calcula ed [40].
2.3. Dish E alua ion Tools
2.3.1. Mazocco Me hod
This labelling sys em classi ies he whole pla e ollowing he same guidelines as he
UK affic ligh sys em [12]. Speci ically, his e alua ion classi ies he ene gy densi y and
Na con en in o high ene gy densi y ( om 4 o 9 kcal/g), medium ene gy densi y ( om
1.5 o 4 kcal/g), low ene gy densi y ( om 0.7 o 1.5 kcal/g), and e y low ene gy densi y
( om 0 o 0.6 kcal/g). Subsequen ly, acco ding o he c i e ia o he “UK Food S anda ds
Agency” [13], i classi ies he Na concen a ion pe 100 g in o high Na con en (>600 mg
Na), medium Na con en ( om 120 o 600 mg Na), and low Na con en (≤120 mg Na).
Following bo h c i e ia, each le el (high, medium, and low) is assigned, like UK affic
ligh s, wi h a colou ( ed, ambe , and g een, espec i ely). The inal colou o he dish
ollows he ollowing pa e n: i he dish has wo ca ego ies wi h he same colou , ha
colou is es ablished as he p edominan colou o he dish, bu , in he case o wo colou s
(g een and yellow, g een and ed, o yellow and ed), he colou ha is u hes om
U uguayan wa ning
s amps [39]High con en labels Na, suga , a , and sa u a ed
a y acids
Nu ien s 2024, 16, x FOR PEER REVIEW 4 o 15
UK [37] Colou s: g een, ambe ,
and ed Fa , sa u a ed a s, suga s, and sal
Heal h S a Ra ing [20] S a s: om 0.5 o 5
To al ene gy, o al suga s, and sa u-
a ed a y acids ( isk componen s)
Fib e, ui s and ege ables, nu s, leg-
umes, and p o ein (heal hy compo-
nen s)
Nu i-Sco e [7]
Colou s (da k g een,
ligh g een, yellow, ligh
o ange, and ed) and le -
e s (A–E)
Ene gy, o al a , sa u a ed a y acids
,
suga s, p o ein, sal , ib e, Na, ui s,
ege ables, legumes, nu s, and oli e
oil
Mul iple a ic ligh s
om Ecuado [38]
Colou s (g een, yellow,
and ed) Fa , suga , and sal
Chilean wa ning labels
[2] High con en labels Added suga s, Na, sa u a ed a s, and
calo ies
U uguayan wa ning
s amps [39] High con en labels Na, suga , a , and sa u a ed a y ac-
ids
Na: sodium.
2.2. Calcula ion o he Weigh o he Dishes
To calcula e he FOP labels, i was necessa y o es ima e he weigh o each dish. The
websi e h ps://ja ondo.hos ele ialeioa.ne /es/can eens/ xopi ea (accessed on 1 June 2020)
was used, indica ing each dish’s menus, ecipes, and ing edien s. The ing edien s pe
Na: sodium.
2.2. Calcula ion o he Weigh o he Dishes
To calcula e he FOP labels, i was necessa y o es ima e he weigh o each dish.
The websi e h ps://ja ondo.hos ele ialeioa.ne /es/can eens/ xopi ea (accessed on 1 June
2020) was used, indica ing each dish’s menus, ecipes, and ing edien s. The ing edien s
pe se ing we e added up, and he weigh a ia ions o he ood du ing cooking we e
conside ed and calcula ed [40].
2.3. Dish E alua ion Tools
2.3.1. Mazocco Me hod
This labelling sys em classi ies he whole pla e ollowing he same guidelines as he
UK a ic ligh sys em [
12
]. Speci ically, his e alua ion classi ies he ene gy densi y and
Na con en in o high ene gy densi y ( om 4 o 9 kcal/g), medium ene gy densi y ( om
1.5 o
4 kcal/g),
low ene gy densi y ( om 0.7 o 1.5 kcal/g), and e y low ene gy densi y
( om 0 o 0.6 kcal/g). Subsequen ly, acco ding o he c i e ia o he “UK Food S anda ds
Agency” [
13
], i classi ies he Na concen a ion pe 100 g in o high Na con en (>600 mg Na),
medium Na con en ( om 120 o 600 mg Na), and low Na con en
(≤120 mg Na).
Following
bo h c i e ia, each le el (high, medium, and low) is assigned, like UK a ic ligh s, wi h
a colou ( ed, ambe , and g een, espec i ely). The inal colou o he dish ollows he
ollowing pa e n: i he dish has wo ca ego ies wi h he same colou , ha colou is
es ablished as he p edominan colou o he dish, bu , in he case o wo colou s (g een and
yellow, g een and ed, o yellow and ed), he colou ha is u hes om indica ing ha
he dish is heal hy is conside ed o p edomina e. The colou s we e subsequen ly eplaced
Nu ien s 2024,16, 2925 5 o 14
by 1, 2.5, o 5 depending on whe he hey we e ed, yellow o g een, espec i ely, and he
mean was calcula ed.
2.3.2. UK’s T a ic Ligh Labelling Sys em
This guide ( om now on “UK”) was de eloped o suppo communica ion and in o -
ma ion o he consume h ough nu i ional labelling wi h colou s: g een, ambe , o ed,
g een being he heal hies and ed he leas heal hy [
41
]. The pa ame e s e alua ed a e he
ene gy in Kcal and Kj pe 100 g o ml pe se ing. As he dishes a e cooked, a ecei es a
g een sco e i i con ains
≤
3.0 g/100 g, yellow i i con ains > 3 g o
≤17.5 g/100 g,
and
ed > 17.5 g/100 g.
The SFAs a e g een a
≤
1.5 g/100 g, yellow om >1.5 g o
≤5 g/100 g,
and ed i >25%. The suga s ecei e a g een wi h
≤
5.0 g/100 g, yellow wi h >5 g o
≤22.5 g/100 g,
o ed wi h >22.5 g/100 g. Finally, sal has a g een i
≤
0.3 g/100 g, yellow
wi h >0.3 g o
≤
1.5 g/100 g, and ed i >1.5 g/100 g [
37
]. Subsequen ly, he colou s we e
eplaced by 1, 2.5, o 5 depending on whe he hey we e ed, yellow, o g een, espec i ely,
and he a i hme ic mean was aken.
2.3.3. Heal h S a Ra ing (HSR)
The HSR is a labelling sys em ha has been implemen ed by he Aus alian go e n-
men in conjunc ion wi h indus y, public heal h, and a ious consume o ganisa ions since
2014. The algo i hm a es he nu i ional p o ile o packaged oods and assigns hem a
a ing om ½ s a o 5 s a s (poin s) in 10 inc emen s o hal a s a each. Thus, bo h “ isk”
componen s ( o al ene gy, o al suga s, SFAs, and Na) and “heal hy” componen s ( ib e,
ui and ege able con en , nu s, legumes, and p o ein) a e e alua ed. The mo e s a s he
ood has, he heal hie he consume ’s ood choice [
20
]. In his case, being a single nume ic
a iable, i was unnecessa y o subs i u e he esul o calcula e he mean.
2.3.4. Nu i-Sco e
Nu i-Sco e labelling is ep esen ed by a i e-colou scale (da k g een, ligh g een,
yellow, ligh o ange, and ed o da k o ange) [
11
]. Fo each ood, he colou is based on i s
sco e: da k g een ( om
−
15 o
−
1 poin s); ligh g een ( om 0 o 2 poin s); yellow ( om
3 o 10 poin s); ligh o ange ( om 11 o 18 poin s); and da k o ange, almos ed ( om
19 poin s).
These poin s a e gi en o oods acco ding o hei con en in ene gy (KJ/100 g
o 100 mL), o al a (g/100 g o 100 mL), SFAs (g/100 g o 100 mL), suga s (g/100 g o
100 mL),
p o ein (g/100 g o 100 mL), sal (g/100 g o 100 mL), ib e (g/100 g o 100 mL),
Na (mg/100 g o 100 mL), and inally a g oup o ui s, ege ables, legume, nu s, and oli e
oil (%/100 g o 100 mL). The a ibu ion o colou s is achie ed wi h a poin scale om −5
(o lowe ) o 19 (o highe ). Whole ui is le ou o his me hod, being a missing alue [
7
].
The colou da k g een, which ecei es an A alue in Nu i-Sco e, being he heal hies alue,
was eplaced by he sco e 5; he colou ligh g een, which ecei es a B alue, by he sco e 4;
he colou yellow, which ecei es a C alue, by he sco e 3; he colou ligh o ange, which
ecei es a D alue, by he sco e 2; and inally, he colou da k o ange almos ed, which
ecei es an E alue (conside ed he leas heal hy), was eplaced by he sco e 1.
2.3.5. Mul iple T a ic Ligh s om Ecuado
The sys em ( om now on, “Ecuado ”) used is in colou s and ho izon al ba s: a ed ba
o p oduc s wi h “HIGH” a (
≥
20 g/100 g), suga (
≥
15 g/100 g), o sal
(≥600 mg/100 g)
con en ; a yellow colou ba o “MEDIUM” a (>3 g - <20 g/100 g), suga
(>5 g - <15 g/100 g),
o sal (>120 g - <600 g/100 g) con en ; and a g een colou ba o “LOW” con en in
a
(≤3 g/100 g),
suga (
≤
5 g/100 g), o sal (
≤
120 mg/100 g) [
38
]. Subsequen ly, he
colou s we e eplaced by 1, 2.5, o 5 depending on whe he hey we e ed, yellow o g een,
espec i ely, and he a i hme ic mean was aken.
Nu ien s 2024,16, 2925 6 o 14
2.3.6. Chilean Wa ning Labels
The labels ( om now on, “Chile”) a e es ablished when he nu ien limi s es ablished
by he Food Sani a y Regula ions a e exceeded and/o he ood has added suga s, sodium,
o a . The limi s o he solid ood s amp a e ma ked as 10 g/100 g o he “HIGH SUGARS”
s amp, 4 g/100 g o he “HIGH SATURATED FAT” s amp, 275kcal/100g o he “HIGH
CALORIES” s amp, and 400 mg/100 g o “HIGH SODIUM” [
2
]. In his case, he p esence
o each seal was e alua ed wi h a alue o 1 ( ed) in each o he sec ions and wi h a alue
o 5 (g een) o each absence o he seal. Subsequen ly, he a i hme ic mean was calcula ed.
2.3.7. U uguayan Wa ning Labels
In 2018, U uguay es ablished ha packaged oods mus ca y app op ia e nu i ion
labelling ( om now “U uguay”), including wa ning s amps when some nu ien con en s
exceeded he es ablished dec ee. The e o e, a wa ning s amp is shown when he sodium
con en is highe han 8 mg Na pe 1 kcal o 500 mg pe 100 g o ood; he suga con en
is highe han 20% o he o al calo ic alue om suga s and 3 g pe 100 g; he a con en
is highe han 35% o he o al calo ic alue; o he SFA con en is highe han 12% o he
o al calo ic alue [
39
]. As wi h he Chilean wa ning labels, he p esence o each seal was
e alua ed wi h a alue o 1 ( ed) in each sec ion and a 5 (g een) o each absence o a seal.
Subsequen ly, he a i hme ic mean was calcula ed.
2.4. S a is ical Analysis
In o de o compa e he di e en FOP labels, all he alues needed o be numbe ed by
a eam o heal h pe sonnel and s a is icians (nu i ionis , biochemis , and nu se). As he
highe alue was 5, his alue was di ided by 3 nume ic sec ions o ma ch he a ic ligh
colou s. In his anking, he a i hme ic means om 1 o 2.39 we e conside ed o ecei e a
alue o “1” ( he colou ed in Figu e 1), om 2.4 o 3.739 a alue o “2.5” ( he colou yellow
in Figu e 1), and om 3.74 o 5 a alue o “5” ( he colou g een in Figu e 1). The ep oducibil-
i y and he p opo ion o obse ed ag eemen s we e calcula ed using he kappa index (K),
which is gi en a alue om 0 o 1. The alue 0 means no ag eemen , 0–0.20 insigni ican
ag eemen , 0.21–0.40 medium ag eemen , 0.41–0.60 mode a e,
0.61–0.80 subs an ial,
and
0.81–1 almos pe ec . A alue o less han 0 indica es disag eemen [42].
Nu ien s 2024, 16, x FOR PEER REVIEW 6 o 14
2.3.6. Chilean Wa ning Labels
The labels ( om now on, “Chile”) a e es ablished when he nu ien limi s es ab-
lished by he Food Sani a y Regula ions a e exceeded and/o he ood has added suga s,
sodium, o a . The limi s o he solid ood s amp a e ma ked as 10 g/100 g o he “HIGH
SUGARS” s amp, 4 g/100 g o he “HIGH SATURATED FAT” s amp, 275kcal/100g o he
“HIGH CALORIES” s amp, and 400 mg/100 g o “HIGH SODIUM” [2]. In his case, he
p esence o each seal was e alua ed wi h a alue o 1 ( ed) in each o he sec ions and wi h
a alue o 5 (g een) o each absence o he seal. Subsequen ly, he a i hme ic mean was
calcula ed.
2.3.7. U uguayan Wa ning Labels
In 2018, U uguay es ablished ha packaged oods mus ca y app op ia e nu i ion
labelling ( om now “U uguay”), including wa ning s amps when some nu ien con en s
exceeded he es ablished dec ee. The e o e, a wa ning s amp is shown when he sodium
con en is highe han 8 mg Na pe 1 kcal o 500 mg pe 100 g o ood; he suga con en is
highe han 20% o he o al calo ic alue om suga s and 3 g pe 100 g; he a con en is
highe han 35% o he o al calo ic alue; o he SFA con en is highe han 12% o he
o al calo ic alue [39]. As wi h he Chilean wa ning labels, he p esence o each seal was
e alua ed wi h a alue o 1 ( ed) in each sec ion and a 5 (g een) o each absence o a seal.
Subsequen ly, he a i hme ic mean was calcula ed.
2.4. S a is ical Analysis
In o de o compa e he diffe en FOP labels, all he alues needed o be numbe ed
by a eam o heal h pe sonnel and s a is icians (nu i ionis , biochemis , and nu se). As he
highe alue was 5, his alue was di ided by 3 nume ic sec ions o ma ch he affic ligh
colou s. In his anking, he a i hme ic means om 1 o 2.39 we e conside ed o ecei e a
alue o “1” ( he colou ed in Figu e 1), om 2.4 o 3.739 a alue o “2.5” ( he colou
yellow in Figu e 1), and om 3.74 o 5 a alue o “5” ( he colou g een in Figu e 1). The
ep oducibili y and he p opo ion o obse ed ag eemen s we e calcula ed using he
kappa index (K), which is gi en a alue om 0 o 1. The alue 0 means no ag eemen , 0–
0.20 insigni ican ag eemen , 0.21–0.40 medium ag eemen , 0.41–0.60 mode a e, 0.61–0.80
subs an ial, and 0.81–1 almos pe ec . A alue o less han 0 indica es disag eemen [42].
Figu e 1. G aphical ep esen a ion o he pe cen age esul s o dishes analysed acco ding o he
F on -o -Pack labels: Mazocco me hod, UK affic ligh , HSR, Nu i-Sco e, Ecuado , Chile, and
Figu e 1. G aphical ep esen a ion o he pe cen age esul s o dishes analysed acco ding o he
F on -o -Pack labels: Mazocco me hod, UK a ic ligh , HSR, Nu i-Sco e, Ecuado , Chile, and
U uguay. The colou RED indica es “unheal hy dishes”, YELLOW ep esen s “mode a ely heal hy
dishes”, and GREEN signi ies “heal hy dishes”. (A) O e iew o all dishes analysed; (B) analysis o
i s cou ses; (C) analysis o second cou ses; and (D) analysis o desse s.
Nu ien s 2024,16, 2925 7 o 14
3. Resul s
Table 2p esen s he nu i ional composi ion o he dishes analysed in his s udy. O he
533 dishes e alua ed, 355 we e epe i ions, esul ing in 178 unique dishes. On a e age, each
se ing con ained 558.6 kcal. Among he h ee cou ses, he second cou se dishes had he
highes a e age calo ie con en (795.9 kcal/se ing), as well as he mos a (55.7 g/se ing),
sa u a ed a (10.2 g/se ing), sal (1.4 g/se ing), and sodium (925.6 mg/se ing). On he
o he hand, he i s cou ses con ained he mos ib e (11.0 g/se ing), while desse s had
he highes simple suga con en (33.7 g/se ing).
Table 2. Nu i ional analysis o dishes examined by a ious F on -o -Pack labels.
Dishes Main Cou ses Second Cou ses Desse s
To al selec ed (n) 533 156 119 258
Duplica ed (n) 355 88 60 207
To al analysed (n) 178 68 59 51
To al (%) 38 33 29
Mean ±SD Mean ±SD Mean ±SD Mean ±SD
Kcal/se ing 558.6 ±310 472.9 ±167 795.9 ±396 403.0 ±148
Kcal/100 g 171.1 ±101 134.7 ±65.9 162.5 ±93.6 231.5 ±120
Fa (g/se ing) 31.6 ±30 19.7 ±14.1 55.7 ±40.9 20.3 ±13.3
Fa (g/100 g) 9.8 ±9.3 6.1 ±6.0 11.6 ±10.0 12.6 ±10.5
SFAs (g/se ing) 7.8 ±6.4 5.1 ±4.1 10.2 ±7.5 9.0 ±6.5
SFAs (g/100 g) 2.8 ±3.2 1.5 ±1.5 2.1 ±1.5 5.5 ±4.6
Suga s (g/se ing) 18.8 ±15.7 14.8 ±15.2 10.8 ±7.1 33.7 ±13.3
Suga s (g/100 g) 6.9 ±7.3 3.5 ±2.8 2.0 ±1.3 17.2 ±4.8
Fib e (g/se ing) 7.3 ±10.6 11.0 ±8.2 5.9 ±3.5 3.7 ±16.0
Fib e (g/100 g) 2.0 ±5.0 2.8 ±1.9 1.1 ±0.6 2.1 ±9.1
Sal (g/se ing) 0.7 ±1.6 0.7 ±2.0 1.4 ±1.5 0.0 ±0.0
Sal (g/100 g) 0.2 ±0.3 0.2 ±0.4 0.3 ±0.3 0.0 ±0.0
Na (mg/se ing) 610.6 ±697 662.3 ±883 925.6 ±539 171.8 ±113
Na (mg/100 g) 167.8 ±162 194.6 ±216 186.7 ±115 107.7 ±95.2
Da a a e p esen ed as mean and s anda d de ia ion (M ±SD). SFAs: sa u a ed a y acids.
Figu e 1shows he dis ibu ion o he analysed dishes ha a e “no heal hy”, “mode -
a ely heal hy”, and “heal hy” in pe cen ages. Panel A co esponds o he o al numbe o
analysed dishes. The Nu i-Sco e me hod iden i ies mos dishes as “no heal hy” (37%),
ollowed by U uguay (15%), while Ecuado does no iden i y any dishes in his ca ego y.
Rega ding he dishes classi ied as “mode a ely heal hy”, he Mazocco me hod iden i ies
61% compa ed o only 11% using he Chilean FOP labelling. Wi hin he “heal hy” ca ego y,
Chile has he FOP labels wi h he highes numbe o “heal hy” dish a ings, wi h 78% o
he dishes, in con as o Mazocco me hod, wi h only 33% o he o al dishes.
Panel B shows he FOP labelling me hod alues o he i s cou ses in he ca ego i-
sa ion by dish. In his case, he UK, he HSR, and Ecuado do no iden i y any dish as
“no heal hy”, compa ed o 15% o hose iden i ied by Nu i-Sco e. Rega ding he i s
cou ses wi hin he “mode a ely heal hy” ca ego y, he Mazocco me hod ca ego ises 48% o
i s cou ses as mode a ely heal hy, bu Chile only classi ies 6% in his ca ego y. Simila ly,
he e is a con as in he dishes classi ied as “heal hy”, wi h 91% by Chile and only 46% by
Mazocco me hod in his ca ego y.
Panel C shows he pe cen age o second cou ses ca ego ised by he me hods s udied.
Wi hin he ca ego y “no heal hy”, Nu i-Sco e inds 36% o dishes in his ca ego y, and
bo h he HSR and Ecuado do no classi y any dish. In he ollowing ca ego y, “mode a ely
heal hy”, Mazocco me hod is he FOP me hod ha classi ies he mos dishes (66%) in his
ange and Chile classi ies he leas (10%). Nex , wi hin he dishes conside ed by he FOP
labels as “heal hy”, Chile iden i ies 81% o dishes as “heal hy”, wi h Mazocco me hod a
he lowe end, wi h only 29% classi ied in his way.
Nu ien s 2024,16, 2925 8 o 14
Panel D shows he pe cen ages o he desse s ca ego ised by each FOP me hod. Nu i-
Sco e is he FOP me hod wi h he highes pe cen age o “no heal hy” desse s (68%) and
Mazocco me hod he lowes (8%). The Ecuado FOP me hod has no “no heal hy” desse s.
In he “mode a ely heal hy” ca ego y, Mazzoco me hod is he FOP me hod wi h 71% and
Chile wi h 18%. Finally, Chile is he FOP me hod ha classi ies mos desse s as “heal hy”,
wi h 57% o he desse s in his ca ego y, and Nu i-Sco e classi ies he leas in his ca ego y,
wi h only 6% o he desse s in his ange.
Table 3shows he K alues o assess he p opo ion o ag eemen obse ed. Rega ding
he o al numbe o dishes, he UK FOP labels show mode a e ag eemen wi h Ecuado
(K = 0.4921),
Chile (K = 0.5234), and U uguay (K = 0.404). Conside ing he i s cou ses,
he UK shows mode a e ag eemen wi h Ecuado (K = 0.5723) and U uguay (K = 0.4389).
On he o he hand, o second cou ses, he e is no ag eemen be ween Ecuado ’s FOP
labels, Mazocco (K =
−
0.059), and Nu i-Sco e (K =
−
0.0802). Howe e , Chile and he
UK and U uguay and Ecuado , wi h K alues o 0.5155 and 0.426, espec i ely, indica e
mode a e ag eemen . Finally, in desse s, Ecuado shows a mode a e ag eemen wi h he
UK
(K = 0.4096),
which, in u n, also shows a mode a e ag eemen wi h Chile (K = 0.5598).
Table 3. Associa ion and obse ed p opo ion o ag eemen calcula ed using he kappa index (K) o
a ious global F on -o -Pack labels.
To al Dishes (n= 178)
MAZOCCO UK HSR NUTRI-SCORE ECUADOR CHILE URUGUAY
MAZOCCO — — — — — — —
UK 0.2049 — — — — — —
HSR 0.2928 0.3367 — — — — —
NUTRI-SCORE 0.2318 0.1796 0.2252 — — — —
ECUADOR 0.1554 0.4921 0.2723 0.0835 — — —
CHILE 0.1608 0.5234 0.316 0.176 0.3783 — —
URUGUAY 0.1694 0.404 0.1945 0.1946 0.3759 0.3052 —
Fi s Dishes (n= 68)
MAZOCCO UK HSR NUTRI-SCORE ECUADOR CHILE URUGUAY
MAZOCCO — — — — — — —
UK 0.1521 — — — — — —
HSR 0.2087 0.2168 — — — — —
NUTRI-SCORE 0.285 0.1508 0.2149 — — — —
ECUADOR 0.07 0.5723 0.1247 0.1835 — — —
CHILE 0.0976 0.3083 0.1993 0.178 0.3083 — —
URUGUAY 0.2554 0.4389 0.3798 0.1551 0.3337 0.1831 —
Second Dishes (n= 59)
MAZOCCO UK HSR NUTRI-SCORE ECUADOR CHILE URUGUAY
MAZOCCO — — — — — — —
UK 0.0093 — — — — — —
HSR 0.1782 0.2223 — — — — —
NUTRI-SCORE 0.2643 0.0332 0.0707 — — — —
ECUADOR * −0.059 0.3891 0.1227 * −0.0802 — — —
CHILE 0.072 0.5155 0.2441 0.0157 0.3591 — —
URUGUAY 0.1324 0.3542 0.0499 0.1347 0.426 0.2761 —
Desse s (n= 51)
MAZOCCO UK HSR NUTRI-SCORE ECUADOR CHILE URUGUAY
MAZOCCO — — — — — — —
UK 0.3816 — — — — — —
HSR 0.3938 0.307 — — — — —
NUTRI-SCORE 0.0354 0.1056 0.1121 — — — —
ECUADOR 0.3831 0.4096 0.2317 * −0.0099 — — —
CHILE 0.2508 0.5598 0.2557 0.1115 0.3343 — —
URUGUAY 0.0743 0.3481 0.069 0.1223 0.3112 0.3493 —
*, alue lowe han 0. The alue 0 means no ag eemen ; alues 0–0.20, insigni ican ag eemen ; 0.21–0.40,
medium ag eemen ; 0.41–0.60, mode a e; 0.61–0.80, subs an ial; and 0.81–1, almos pe ec . A alue less han
0 indica es disag eemen .
4. Discussion
In his s udy, we compa ed he a ious F on -o -Pack (FOP) labels om di e en
coun ies ha a e applied o e alua e he heal hiness o cooked meals ea en away om
Nu ien s 2024,16, 2925 9 o 14
home. We obse ed ha he same dish can ecei e he heal hies o unheal hies a ing
depending on he FOP labelling me hod applied. Nu i-Sco e eme ged as he FOP label ha
classi ied mos dishes as “no heal hy”, whe eas he label used in Ecuado does no classi y
any dishes in his manne . The labelling used in Chile iden i ied mo e heal hy dishes, and
Mazocco me hod classi ied mo e dishes as yellow. The le el o ag eemen be ween he FOP
labels used was low, wi h mode a e ag eemen s ound only be ween he UK and Chile and
be ween Ecuado and U uguay.
Compa ing he di e en exis ing FOP labels is challenging due o a ying me hodolo-
gies and he numbe o a iables conside ed. The classi ica ion shown by Mazzoco e al. [
12
]
conside s wo ac o s, while Ecuado ’s label examines h ee; howe e , hey showed dis-
ag eemen in he esul s o he second cou se analyses. The FOP labels ha analyse ou
ac o s include he UK, Chile, and U uguay, all o which examine SFAs, suga s, and Na
(al hough he UK measu es sal ins ead o Na). This simila i y migh explain hei mode a e
ag eemen o e he numbe o dishes analysed. Con e sely, he HSR and Nu i-Sco e,
which assess he mos nu ien s (eigh and nine, espec i ely), exhibi ed a medium le el o
ag eemen wi h each o he and he o he FOP labels, despi e bo h including consuming
ui s, ege ables, and nu s.
Cu en ly, he HSR is he mos widely used labelling sys em in Oceania due o i s com-
p ehensi eness in measu ing he quali y o cooked dishes. Howe e , ou s udy sugges s
ha he e may be a mo e sui able FOP label o e alua ing menus o e ed in a Medi e -
anean coun y like Spain, as i has ye o iden i y any unheal hy i s and second cou ses
and lacks conco dance wi h he o he FOP labels e alua ed. The s udy by Dickie e al.
(2020) assessed oods ha Aus alians buy using he HSR and disco e ed ha his sys em
misleads consume s abou he heal hiness o many oods, inad e en ly g an ing a “heal h
halo” o almos h ee-qua e s o ul a-p ocessed oods displaying he HSR symbol [
43
].
Conside ing ha he die o Aus alian adul s is cha ac e ised by he low consump ion o
ui s, ege ables, g ains, ene gy, p o ein, ib e, and monounsa u a ed a y acids [
44
], hese
indings s and in con as o he posi i e e ec s a ibu ed o he HSR FOP labelling sys em
on Aus alian public heal h by o he esea che s [19,20].
Th ee La in Ame ica FOP labels we e analysed in his s udy: Chilean wa ning labels,
U uguayan wa ning s amps, and Ecuado ’s mul iple a ic ligh s. Despi e o igina ing
om he same con inen , an ag eemen was ound only be ween Ecuado and U uguay in
e alua ing second cou ses. Addi ionally, he Chilean wa ning s amps demons a ed a mod-
e a e le el o ag eemen wi h he UK’s sys em o o al dishes, as well as o main cou ses
and desse s, despi e di e ences in he p esen a ion on ood packaging (s amps s. colou
a ic ligh s). Bo h app oaches ha e p o en help ul in changing ea ing beha iou s; how-
e e , wa ning s amps ha e been mo e e ec i e in discou aging he pu chase o unheal hy
p oduc s [
45
,
46
] and educing he consump ion o suga -swee ened be e ages [
5
,
46
]. As
hese labels assess he con en o kilocalo ies, suga s, sodium, and SFAs, hei s aged in o-
duc ion has p omp ed a g adual educ ion in he inclusion o hese componen s in ood
p oduc s o a oid label inclusion [
2
,
5
,
14
]. Gi en he success and accep ance o he Chilean
s amps, Mexico has adop ed his sys em, adding a new s amp o “high in ans- a ” [
46
].
These indings a e consis en wi h hose o Senda e al. (2024), whose s udy emphasised
he impo ance o con inuous moni o ing and he e ec i e en o cemen o he wa ning
label egula ions ha ha e ecen ly been implemen ed in B azil. In addi ion, he s udy
highligh ed he impo ance o FOP labels in empowe ing consume s o make in o med
die a y choices consis en wi h hei o e all heal h and well-being [
47
]. Fu u e s udies
could assess he po en ial implemen a ion o hese labels in o he coun ies while adap ing
hem o each coun y’s nu i ional ecommenda ions.
In Eu ope, we examined he UK’s FOP labelling sys em, i s adap a ion by Mazocco
e al., and Nu i-Sco e. Al hough he UK labelling demons a ed g ea e ag eemen wi h
he La in Ame ican FOP labels, Nu i-Sco e p esen ed disc epancies wi h he Ecuado ian
labelling in e alua ing second cou ses and desse s wi hou any mode a e ag eemen wi h
o he labelling sys ems. Despi e he signi icance o i s o igin [
11
], nume ous die i ians and
