This systematic review aimed to summarise the level of quality and accuracy of nutrition-related information on websites and social media and determine if quality and accuracy varied between websites and social media or publishers of information.

This systematic review was registered with PROSPERO (CRD42021224277). CINAHL, MEDLINE, Embase, Global Health and Academic Search Complete were systematically searched on 15 January 2021 to identify content analysis studies, published in English after 1989, that evaluated the quality and/or accuracy of nutrition-related information published on websites or social media. A coding framework was used to classify studies’ findings about information quality and/or accuracy as poor, good, moderate or varied. The Academy of Nutrition and Dietetics Quality Criteria Checklist was used to assess the risk of bias.

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From 10 482 articles retrieved, sixty-four were included. Most studies evaluated information from websites (n 53, 82·8 %). Similar numbers of studies assessed quality (n 41, 64·1 %) and accuracy (n 47, 73·4 %). Almost half of the studies reported that quality (n 20, 48·8 %) or accuracy (n 23, 48·9 %) was low. Quality and accuracy of information were similar on social media and websites, however, varied between information publishers. High risk of bias in sample selection and quality or accuracy evaluations was a common limitation.

Online nutrition-related information is often inaccurate and of low quality. Consumers seeking information online are at risk of being misinformed. More action is needed to improve the public’s eHealth and media literacy and the reliability of online nutrition-related information.

Take-away foods account for a significant proportion of dietary intake among young adults (18–35 years). Young adults want nutrition information at the point-of-purchase (POP); however, it is either unavailable, perceived as ineffective or difficult to use. The present study examined whether symbols on university food outlet menus identifying healthier options would increase their sales and consumer’s awareness of these symbols, purchasing factors and barriers to eating healthy foods.

Repeated-measures, comparison group, quasi-experimental study.

Two carefully matched university food outlets were analysed to determine the targeted items. Tick symbols ✓ were placed next to the targeted items in the experimental outlet. No changes were made at the comparison outlet. Customers were surveyed at the experimental outlet. Food sales were collected for 4 weeks from both outlets at baseline and during the intervention. Food sales were also collected from the experimental outlet 10 weeks later.

Food outlet patrons.

Significant increases in food sales were observed during observation 3 compared with observation 1 (P = 0·0004) and observation 2 (P = 0·0002). Sixty-eight per cent of respondents noticed the symbols, and of that, 30 % reported being influenced. Taste was the most common purchasing factor, and people were less likely to select taste as a factor if they were influenced by the symbols (P = 0·04).

Identifying healthier options with a symbol at the POP increased sales over time. Several purchasing factors (price, taste and healthy food availability) need to be addressed to improve the food selection of young adults.

To assess the effects of nutritional warnings during the first month after the date of full compliance by the food industry in Uruguay in terms of citizen awareness, self-reported use and ability to understand nutritional information.

The present work encompassed two online studies, conducted before (Study 1) and during the first month after the date of full compliance by the food industry (Study 2). An after-only design was used to assess awareness of the policy, exposure to nutritional warnings on food packages and self-reported use of warnings for making purchase decisions in Study 2. An after-only with control group experimental design was used to assess the effect of nutritional warnings on understanding of nutrition information in Studies 1 and 2.

Uruguay, one of the Latin American countries, that has recently implemented nutritional warnings.

A non-probabilistic sample of 1772 participants was recruited using Facebook advertisements targeted at Uruguayan adult users.

High awareness and self-reported use of nutritional warnings during the first month after the date of full compliance in Uruguay were observed. In addition, the before and after comparison showed that the implementation of warnings increased citizens’ ability to use nutritional information to compare products and to identify products with excessive content of sugar, fat, saturated fat and sodium.

The current study confirms results from experimental studies and provides additional evidence to support the implementation of nutritional warnings as one of the public policies that can contribute to tackle obesity and non-communicable diseases.

To evaluate the impact of message framing on attitudes towards messages aimed at promoting the use of nutritional warnings, behavioural intention and actual behaviour, evaluated through visual attention to nutritional warnings and the choice of a snack product during a real choice task.

Following a between-subjects design, participants were exposed to loss-framed nutrition messages, gain-framed nutrition messages or non-nutrition-related messages (control group). After evaluating the messages, participants were asked to select a snack product as a compensation for their participation. The experiment was conducted using an eye tracker.

Montevideo (Uruguay).

Convenience sample of 201 people (18–51 years old, 58 % female).

The average percentage of participants who fixated their gaze on the nutritional warnings during the choice task was slightly but significantly higher for participants who attended to nutrition messages (regardless of their framing) compared with the control group. Participants who attended to loss-framed messages fixated their gaze on the warnings for the longest period of time. In addition, the healthfulness of the snack choices was higher for participants exposed to nutrition-related messages compared with the control group.

Results from the present work suggest that nutrition messages aimed at increasing awareness of nutritional warnings may increase consumers’ visual attention and encourage more heathful choices. The framing of the messages only had a minor effect on their efficacy.

Nutritional warnings have recently been suggested as a simplified front-of-pack nutrition labelling scheme to facilitate citizens’ ability to identify unhealthful products and discourage their consumption. However, citizens’ perspective on this policy is still under-researched. The objective of the present work was to study how citizens perceive nutritional warnings and to evaluate public support of this policy, with the goal of deriving recommendations for the design of policy measures accompanying the introduction of nutritional warnings.

An online survey with 1416 Uruguayan citizens, aged 18–75 years, 61 % female, was conducted. Participants had to answer a series of questions (open-ended and multiple-choice) related to their perception of warnings as a front-of-package nutrition labelling scheme.

Participants showed a positive attitude towards nutritional warnings, which were regarded as easy to understand and to identify on food packages. The majority of respondents emphasized that they would take nutritional warnings into account when making their food choices, stating that they would allow them to make informed choices and, consequently, to increase the quality of their diet and their health status. Health motivation appeared as a crucial driver for taking nutritional warnings into consideration.

A high level of public support for nutritional warnings was observed. Responses can be used to derive a range of recommendations for a policy mix that should synergistically support the introduction of nutritional warnings and encourage citizens to take them into account when making their food purchases.

Warnings have recently been proposed as a new type of directive front-of-pack (FOP) nutrition labelling scheme to flag products with high content of key nutrients. In the present work, this system was compared with the two most common FOP nutrition labelling schemes (Guideline Daily Amounts (GDA) and traffic-light system) in terms of goal-directed attention, influence on perceived healthfulness and ability to differentiate between products.

Goal-directed attention to FOP labels was evaluated using a visual search task in which participants were presented with labels on a computer screen and were asked to indicate whether labels with high sodium content were present or absent. A survey with 387 participants was also carried out, in which the influence of FOP labels on perceived healthfulness and ability to identify the healthful alternative were evaluated.

Warnings improved consumers’ ability to correctly identify a product with high content of a key nutrient within a set of labels compared with GDA and received the highest goal-directed attention. In addition, products with high energy, saturated fat, sugar and/or sodium content that featured warnings on the label were perceived as less healthful than those featuring the GDA or traffic-light system. Warnings and the traffic-light system performed equally well in the identification of the most healthful product.

Results from the present work suggest that warnings have potential as directive FOP nutrition labels to improve consumer ability to identify unhealthful products and highlight advantages compared with the traffic-light system.

To determine the presence of nutrition labels on pre-packaged food products, as well as to analyse the types of presentation.

This was a descriptive study. The following characteristics were analysed: (i) presence and placement of the nutrition declaration (either as front-of-pack (FOP) or back-of-pack (BOP)); (ii) content of the presented information; (iii) presence of nutrition and health claims; and (iv) legibility of the written information.

Three different types of retailers in Belgrade, Serbia.

A total of 2138 pre-packaged food products from ten categories.

A nutrition declaration was found on 65·9 % of all tested products. It was displayed on the back of the packaging of 62·7 % of products and on the front of the packaging of 19·1 % of products. BOP was the most commonly observed in breakfast cereals, soft drinks, milk and instant soups (in total over 90 %), and the least common in meat products (21·5 %). FOP was predominantly displayed on breakfast cereals (65·0 %) and the least frequently on milk products (2·4 %). The ‘Big 4’ (energy value, protein, carbohydrate and fat contents) and the ‘Big 4 with additional information’ figured on 40·9 % of products. The ‘Big 8’ (‘Big 4’ plus sugar, saturated fat, fibre and sodium contents) and the ‘Big 8 with additional information’ were present less frequently (20·5 %). Nutrition claims and health claims appeared on very few products (6·6 % and 6·3 %, respectively). The proportion of products with insufficient legibility was 31·5 %.

Nutrition labelling in Belgrade, Serbia is not satisfactory. Mandatory regulations may be the best way to improve the current situation.

Energy (calorie) ranges currently appear on menu boards for customized menu items and will likely appear throughout the USA when menu-labelling legislation is implemented. Consumer welfare advocates have questioned whether energy ranges enable accurate energy estimates. In four studies, we examined: (i) whether energy range information improves energy estimation accuracy; (ii) whether misestimates persist because consumers misinterpret the meaning of the energy range end points; and (iii) whether energy estimates can be made more accurate by providing explicit information about the contents of items at the end points.

Four studies were conducted, all randomized experiments.

Study 1 took place outside a Chipotle restaurant. Studies 2 to 4 took place online.

Participants in study 1 were customers exiting a Chipotle restaurant (n 306). Participants in studies 2 (n 205), 3 (n 290) and 4 (n 874) were from an online panel.

Energy ranges reduced energy misestimation across different menu items (studies 1–4). One cause of remaining misestimation was misinterpretation of the low end point’s meaning (study 2). Providing explicit information about the contents of menu items associated with energy range end points further reduced energy misestimation (study 3) across different menu items (study 4).

Energy range information improved energy estimation accuracy and defining the meaning of the end points further improved accuracy. We suggest that when restaurants present energy range information to consumers, they should explicitly define the meaning of the end points.

To study consumer knowledge and use of food labels.

A cross-sectional study employing both quantitative and qualitative methods. Intercept interviews were conducted with 1832 consumers at supermarket sites selected using a stratified random sampling procedure. This information was triangulated with twenty-one focus group discussions.

New Delhi and Hyderabad, two metro-cities from north and south India.

Adolescent (10–19 years), adult (20–59 years) and elderly (≥60 years) consumers.

While the national urban literacy rate is 84 %, about 99 % of the study participants were educated. About 45 % reported that they buy pre-packaged foods once weekly and about a fifth buy them every day. Taste, quality, convenience and ease of use are the main reasons for buying pre-packaged foods. Although 90 % of consumers across the age groups read food labels, the majority (81 %) looked only for the manufacturing date or expiry/best before date. Of those who read labels, only a third checked nutrition information and ingredients. Nutrient information on labels was not often read because most consumers either lacked nutrition knowledge or found the information too technical to understand. About 60 % read quality symbols. A positive association was found between education level and checking various aspects of food labels. Women and girls concerned about ‘fat’ and ‘sugar’ intake read the nutrition facts panel.

The intention of promoting healthy food choices through use of food labels is not being completely met. Since a majority of people found it difficult to comprehend nutrition information, there is a need to take up educational activities and/or introduce new forms of labelling.

Nutrition information aims to reduce information asymmetries between manufacturers and consumers. To date, however, it remains unclear how nutrition information that is shown on the front of the packaging should be designed in order to increase both visual attention and the tendency to make healthful food choices. The present study aimed to address this gap in research.

An experimental laboratory study applying mobile eye-tracking technology manipulated the presence of two directive cues, i.e. health marks and traffic light colour-coding, as part of front-of-package nutrition information on actual food packages.

Participants wore mobile eye-tracking glasses during a simulated shopping trip. After the ostensible study had finished, they chose one snack (from an assortment of fifteen snacks) as a thank you for participation. All products were labelled with nutrition information according to the experimental condition.

Consumers (n 160) who were mainly responsible for grocery shopping in their household participated in the study.

The results showed that, in the absence of traffic light colouring, health marks reduced attention to the snack food packaging. This effect did not occur when the colouring was present. The combination of the two directive cues (v. presenting traffic light colours only) made consumers choose more healthful snacks, according to the nutrient profile.

Public policy makers may recommend retailers and manufacturers implement consistent front-of-pack nutrition labelling that contains both health marks and traffic light colouring as directive cues. The combination of the cues may increase the likelihood of healthful decision making.

Food prepared and consumed away from home accounts for a significant proportion of dietary intake among Canadians. Currently, Canadians receive little or no nutrition information when eating in restaurant and fast-food outlets. The present study examined the impact of nutrition information on menus in hospital cafeterias on noticing and perceived influence of nutrition information and on food consumption.

Cross-sectional surveys.

Exit surveys (n 1003) were conducted in two hospital cafeterias. The ‘intervention’ site featured energy (calorie), sodium and fat content on digital menu boards, as well as a health logo for ‘healthier’ items. The intervention site had also revised its menu items to improve the nutrient profiles. The ‘control’ site provided limited nutrition information at the point of sale.

Cafeteria patrons recruited using the intercept technique.

Significantly more respondents at the intervention site reported noticing nutrition information (OR = 7·6, P < 0·001) and using nutrition information to select their food items (OR = 3·3, P < 0·001) compared with patrons at the control site, after adjusting for sociodemographic factors. Patrons at the intervention site consumed significantly less energy (−21 %, P < 0·001), sodium (−23 %, P < 0·001), saturated fat (−33 %, P < 0·001) and total fat (−37 %, P < 0·001) than patrons at the control site.

A nutritional programme, including nutrition information on menus and improved nutrition profile of food offerings, was associated with substantial reductions in energy, sodium and fat consumption. The results are consistent with a positive impact of menu labelling.

A few studies link out-of-home eating to higher energy consumption, overweight and obesity in both adults and children. The present study was undertaken to investigate the nutritional value of meals available in a university cafeteria, in order to develop a target nutritional tool to help consumers make a more conscious nutritional choice.

A cross-sectional study.

In a university cafeteria in Pavia, northern Italy, the recipes and ingredients of each meal served during the whole year were obtained from the cooks. Energy, protein, fat, carbohydrate and fibre contents were computed for each meal standardized portion. Thirteen pyramid figures, subdivided into three coloured levels, were used to depict the energy and nutrient content of each meal.

Four hundred randomly selected customers were interviewed on the cafeteria nutritional proposal.

Foods available in the cafeteria consisted of 216 items and were distributed in the pyramids according to their energy content: the lowest ones at the bottom (green level) and the highest ones at the top (red level), passing through an orange level in the middle. Energy values ranged from 460 kJ (110 kcal) for a portion of dressed vegetables to 5021 kJ (1200 kcal) for a pizza. The depicted pyramids were displayed in the cafeteria, so that customers could choose their meal according to its nutritional value. The meals’ nutritional content information was perceived very helpful for customers’ nutritional choices.

Availability of nutrition information in the cafeteria was well accepted by the customers who could plan their meals according to a more balanced diet.

The purpose of the present study was to investigate the nutrition information needs of the Pacific Islander and African migrant communities of Logan.

The present study was structured as a needs assessment and used qualitative research methods. An integrative review was used to gather and analyse data relating to comparative and normative needs, while semi-structured interviews were undertaken for the felt and expressed needs.

Logan City, Queensland, Australia.

African and Pacific Islander migrants and health and social service providers within the Logan region.

The study identified the need for more accessible means of information delivery such as visual and face-to-face methods or hands-on demonstrations. The study found that information should be delivered in a staged approach on topics including food safety, Australian foods, healthy eating and diet–disease relationships, according to a migrant’s length of residence in Australia.

The present study contributes to our understanding of the nutrition information needs of African and Pacific Islander migrant communities of Logan. These findings will enable the development of more appropriate nutrition information and health services for these Logan communities and other similar communities across Australia.

In the present study we investigated consumers’ visual attention to nutrition information on food products using an indirect instrument, an eye tracker. In addition, we looked at whether people with a health motivation focus on nutrition information on food products more than people with a taste motivation.

Respondents were instructed to choose one of five cereals for either the kindergarten (health motivation) or the student cafeteria (taste motivation). The eye tracker measured their visual attention during this task. Then respondents completed a short questionnaire.

Laboratory of the ETH Zurich, Switzerland.

Videos and questionnaires from thirty-two students (seventeen males; mean age 24·91 years) were analysed.

Respondents with a health motivation viewed the nutrition information on the food products for longer and more often than respondents with a taste motivation. Health motivation also seemed to stimulate deeper processing of the nutrition information. The student cafeteria group focused primarily on the other information and did this for longer and more often than the health motivation group. Additionally, the package design affected participants’ nutrition information search.

Two factors appear to influence whether people pay attention to nutrition information on food products: their motivation and the product’s design. If the package design does not sufficiently facilitate the localization of nutrition information, health motivation can stimulate consumers to look for nutrition information so that they may make a more deliberate food choice.

The objective of the present study was to examine associations between exposure to nutrition information as covered in mass media and daily fruit and vegetable (FV) consumption among adolescents.

Cross-sectional nutrition survey.

Vocational schools in Vienna, Austria.

A sample of 2949 ethnically diverse adolescents with mean age 17·3 (sd 1·7) years. An FFQ was used to assess usual FV consumption. Data on mass media exposure and sociodemographic characteristics were collected by means of a self-administered questionnaire. Multiple logistic regression analyses were used to control for potentially confounding variables.

Adolescents who reported exposure to nutrition information provided by booklets, the Internet or newspaper articles were more likely to eat FV daily. For example, the OR for daily fruit consumption (ORfru) was 1·6 (P < 0·001) when exposure to the Internet was reported after adjustment for age, gender, ethnicity, BMI and salary. No such associations were found for radio, television and magazines as sources of nutrition information. A negative impact on daily FV consumption was found for exposure to radio commercials (ORfru = 0·74, P = 0·04 and ORveg = 0·67, P = 0·03). Exposure to TV commercials had a negative impact on vegetable consumption (ORveg = 0·81, P = 0·05).

Newspaper articles, the Internet and booklets as a source of nutrition information are positively associated with daily FV consumption among adolescents, whereas radio commercials have a negative impact. Dissemination of ‘healthy eating’ slogans should make use of print media and the Internet.

Sometimes the suspicion is put forward that nutrition students show more disordered eating patterns, which may be among the motivating factors to study nutrition. At the same time, it is not clear whether the students’ increasing knowledge about diet and nutrition is associated with a more healthy eating behaviour or with an unhealthy obsession with food choices.

Cross-sectional comparison of nutrition students from German universities during the first year of their studies (n 123) and during higher semesters (n 96), with a control group from other study programmes (n 68 and n 46, respectively). Dietary restraint, disinhibition, the tendency towards orthorexia nervosa and healthy food choices were assessed using a questionnaire.

Nutrition students showed higher levels of dietary restraint than the control group. Disinhibition and orthorexia nervosa did not differ between nutrition students and controls. Orthorexic tendencies were lower in the more advanced nutrition students. Healthy food choices did not differ among students in the first year. More advanced nutrition students showed healthier food choices, whereas the corresponding controls showed slightly more unhealthy food choices.

Nutrition students, more than other students, tend to restrict their food intake in order to control their weight, but they do not have more disturbed or disordered eating patterns than other students. Moreover, during the course of their studies, they adopt slightly more healthy food choices and decrease their tendency to be obsessive in their eating behaviour.