Publication bias and Nutri-Score: A complete literature review of the substantiation of the effectiveness of the front-of-pack logo Nutri-Score

The front-of-pack label Nutri-Score is currently proposed as the system of choice in seven EU countries. However, there is still much scientific debate about the validation and efficacy of Nutri-Score and there is much discussion about author affiliation and study outcome. To address these issues, we conducted a complete PubMed search on Nutri-Score which resulted in n=180 results and selected all papers that address the relevance of the evidence for the validation of Nutri-Score (n=104). Our main observations are that the large majority of studies that support the Nutri-Score are carried out by the developers of Nutri-Score. In contrast, the majority (61%) of studies that are carried out independently from the developers of Nutri-Score showed unfavourable results. A second observation is that even though the theoretical effect of Nutri-Score is validated on a multi-nutrient algorithm (FSA-NPS), there is no real-life evidence of any beneficial effects of Nutri-Score on this algorithm in a complete supermarket range. In conclusion, there is insufficient scientific evidence to support the use of Nutri-Score as an effective public health tool. Overall, the available evidence is limited and biased, and more research is needed to substantiate or disprove the effectiveness of Nutri-Score.