Improvements to the Nutri-Score to address challenges identified in a Nordic setting.

Background: Front-of-pack nutrition labelling is an important policy tool for public health. The Nutri-Score classifies foods according to nutritional quality from A (high quality) to E (low quality). We have previously identified inconsistencies between Nutri-Score and the Norwegian food-based dietary guidelines. The objective was to propose revisions to the Nutri-Score 2023 algorithms and determine if the revised algorithms better align with the Nordic Nutrition Recommendations 2023 (NNR2023) and the Keyhole label.

Methods: Items in the Norwegian pre-packed foods databases Tradesolution ( = 26,033) and Unil ( = 577) were classified using the Nutri-Score 2023 algorithms. To address carbohydrate quality, a penalty for low-fibre content was introduced, and the sugar scale compressed. The protein cap was removed for fish products to reward their nutritional quality. To improve the scoring of high-fat foods, the scale for saturated fat was extended, fat content determined the inclusion in the algorithm for fats, rather than food categories, and favourable fat quality in oils was rewarded through a fat quality component. Data from the databases guided the identification of specific thresholds. The distribution of Nutri-Score was calculated before and after applying the revisions.

Results: In total, 5.5% of all products received a less favourable Nutri-Score with the revised carbohydrate quality components. Most refined pastas and flour shifted shifted from A to B or C, whilst whole grain pasta largely remained A. Sugar-rich breakfast cereals shifted from B to C or D. For fish, 11% (1% of all products) were moved from D or E to C or D. The variation in scores for cheese and creams increased. Around 5% of all products were affected by the revisions related to fat quality.

Conclusions: The proposed revisions make the Nutri-Score more coherent with the NNR2023 and the Keyhole label. The proposed revisions also hold relevance for other European countries and should therefore be considered in the next revision of the Nutri-Score.