<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03761342</url>
  </required_header>
  <id_info>
    <org_study_id>NUSMart NM</org_study_id>
    <nct_id>NCT03761342</nct_id>
  </id_info>
  <brief_title>Evaluating the Relative Effectiveness of Two Front-of-pack Nutrition Labels</brief_title>
  <acronym>NUSMart NM</acronym>
  <official_title>Multiphase Evaluation of Healthier Choice Symbol (HCS) Logo: Aim 4. A Randomized Controlled Trial Evaluating the Relative Effectiveness of Two Front-of-pack Nutrition Labels</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Duke-NUS Graduate Medical School</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>National Medical Research Council (NMRC), Singapore</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>Duke-NUS Graduate Medical School</source>
  <oversight_info>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      In efforts to promote a healthy diet, the Singapore Health Promotion Board (HPB) has&#xD;
      attempted to use Front-of-Pack (FOP) labelling to supplement traditional nutrition labelling.&#xD;
      The Healthier Choice Symbol (HCS) identifies food items within a specific category of foods&#xD;
      as healthier choices. The original logos were enhanced to include additional information&#xD;
      focusing on particular macronutrients, taking one of two themes; it either indicates that a&#xD;
      product contains more of a healthier ingredient, or less of a less healthy ingredient.&#xD;
&#xD;
      However, there is a lack of scientific evidence on the role of the existing symbols in&#xD;
      assisting consumers make healthier food purchasing decisions. Thus far, studies have&#xD;
      established that the United Kingdom's Multiple Traffic Lights (MTL) label, and the new French&#xD;
      Nutri-Score (NS) label, are amongst the top performers. However, there is little consensus on&#xD;
      which is the most effective FOP label to promote diet quality. Thus, the investigators&#xD;
      propose to conduct the following:&#xD;
&#xD;
      Use a three arm randomized controlled trial (RCT) and an experimental fully functional&#xD;
      web-based grocery store to test two competing approaches of front-of-pack (FOP) labelling on&#xD;
      measures of diet quality: 1) United Kingdom's Multiple Traffic Lights label (MTL) or 2)&#xD;
      France's Nutri-Score (NS) labelling scheme.&#xD;
&#xD;
      The investigators hypothesize that diet quality as measured by the Alternative Healthy Eating&#xD;
      Index (AHEI-2010) (primary outcome) will be highest in the NS arm, followed by MTL, and&#xD;
      lowest in the no logo control arm.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Research Aims &amp; hypotheses:&#xD;
&#xD;
      To use a three arm randomized controlled trial (RCT), and an experimental online grocery&#xD;
      store developed by the team, to test two competing approaches of front-of-pack (FOP)&#xD;
      nutrition labelling on measures of diet quality: 1) Multiple Traffic Lights (MTL) and 2)&#xD;
      Nutri-Score (NS).&#xD;
&#xD;
      All participants will experience three different shopping conditions:&#xD;
&#xD;
        1. Arm 1: A control arm that mirrors a traditional web-grocery store with no HCS or other&#xD;
           FOP labels.&#xD;
&#xD;
        2. Arm 2: Similar to Arm 1, with additional MTL labels displayed on all products FOP. A&#xD;
           60-second introductory video briefly explaining the MTL scheme will be shown before&#xD;
           participants shop as they are assumed not to have pre-existing knowledge of the label.&#xD;
&#xD;
        3. Arm 3: Similar to Arm 2, with Nutri-Score labels instead of MTL labels displayed on all&#xD;
           products FOP. As with the MTL, a 60-second introductory video briefly explaining the NS&#xD;
           scheme will be shown before participants shop.&#xD;
&#xD;
      The investigators hypothesize the following:&#xD;
&#xD;
      Primary Aim: Diet quality as measured by Alternative Healthy Eating Index Scores (AHEI-2010)&#xD;
      will be highest (best) in Arm 3, followed by Arms 2 and 1 (worst).&#xD;
&#xD;
      The investigators further hypothesize a similar ordering (Arm 3 best and Arm 1 worst) for the&#xD;
      following secondary outcomes:&#xD;
&#xD;
      Total and per serving values of the following:&#xD;
&#xD;
        1. Energy (kCal)&#xD;
&#xD;
        2. Sugar (g)&#xD;
&#xD;
        3. Total fat (g)&#xD;
&#xD;
        4. Saturated fat (g)&#xD;
&#xD;
        5. Sodium (g)&#xD;
&#xD;
        6. Fiber (g)&#xD;
&#xD;
        7. Protein (g) And&#xD;
&#xD;
        8. Average Nutri-Score across all products purchased where A=5 and E=1, and&#xD;
&#xD;
        9. Cost per calorie and per shopping trip.&#xD;
&#xD;
      The investigators will test these hypotheses in total, and separately for foods and beverages&#xD;
      given Singapore's focus on reducing intake of sugar-sweetened beverages. The investigators&#xD;
      will also test whether the impact of FOP labelling is moderated by mood and level of hunger&#xD;
      at the time of purchase, and by education or income level.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">July 31, 2018</start_date>
  <completion_date type="Actual">December 3, 2018</completion_date>
  <primary_completion_date type="Actual">December 3, 2018</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Crossover Assignment</intervention_model>
    <primary_purpose>Other</primary_purpose>
    <masking>Single (Participant)</masking>
    <masking_description>While participants will be made aware that there are different versions of NUSMart, the exact details of the arms will not be revealed to ensure validity of results. It will be deleterious to the study to reveal the differences between study arms as that would likely confound participant responses. Since there are 3 shopping conditions (unknown to participants), each participant will be randomly assigned at baseline to 1 of 6 groups that vary the sequence of shopping conditions and which shops will result in an actual food delivery.</masking_description>
  </study_design_info>
  <primary_outcome>
    <measure>Diet Quality per shopping trip</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Diet quality per shopping trip, as measured by an index of diet quality, the Alternative Healthy Eating Index (AHEI-2010). The Alternate Healthy Eating Index-2010 (AHEI-2010) is an updated measure of diet quality from the original Alternate Healthy Eating Index. It was constructed based on foods and nutrients predictive of chronic disease risk that incorporates current scientific evidence on diet and health. All AHEI-2010 components are scored from 0 (worst) to 10 (best), for a total of 11 components. The total AHEI-2010 score ranges from 0 (nonadherence) to 110 (perfect adherence). Higher scores on the AHEI-2010 are strongly associated with lower risk of major chronic disease as well as risk of CVD, diabetes, heart failure, colorectal and estrogen-receptor-negative breast cancer, and total and cardiovascular mortality.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Total Energy in kilocalories</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Total Energy (kCal)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Total Sugar in grams</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Total Sugar (g)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Total fat in grams</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Total Fat (g)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Saturated fat in grams</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Saturated Fat (g)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Sodium in milligrams</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Sodium (mg)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Fiber in grams</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Fiber (g)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Protein in grams</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Protein (g)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Energy per serving in kilocalories per serving</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Energy per serving (kCal per serving)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Sugar per serving in grams per serving</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Sugar per serving (g per serving)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Total fat per serving in grams per serving</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Total fat per serving (g per serving)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Saturated fat per serving in grams per serving</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Saturated fat per serving (g per serving)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Sodium per serving in milligrams per serving</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Sodium per serving (mg per serving)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Fiber per serving in grams per serving</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Fiber per serving (g per serving)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Protein per serving in grams per serving</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Protein per serving (g per serving)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Average Nutri-Score across all products purchased</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>The Nutri-Score label was developed by the Equipe de Recherche en Epidémiologie Nutritionnelle (EREN) research team based on the British Food Standards Agency nutrient profiling system, and presents the overall nutritional quality for each food and beverage on a five-point color-coded scale from A is green (best) to E in red (worst). Average Nutri-Score across all products purchased is recoded to a score of A=5, B=4, C=3, D=2 and E=1. Maximum possible score is 5 (all A) and the lowest possible score is 1 (all E). A higher score represents higher nutritional quality.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Cost per calorie in dollars per kilocalorie</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Cost per calorie is calculated as total spend divided by total kilocalories ($ per kCal)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Total spend in dollars</measure>
    <time_frame>Once a week for three weeks</time_frame>
    <description>Total spend ($)</description>
  </secondary_outcome>
  <number_of_arms>3</number_of_arms>
  <enrollment type="Actual">154</enrollment>
  <condition>Diet Habit</condition>
  <condition>Diet Modification</condition>
  <condition>Food Selection</condition>
  <condition>Food Preferences</condition>
  <condition>Nutrition Poor</condition>
  <arm_group>
    <arm_group_label>Control</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>A control arm that mirrors a traditional web-grocery store with no but with no FOP labels.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Multiple Traffic Light Labels</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Similar to Arm 1, with Multiple Traffic Light labels displayed on all products FOP. A 60-second introductory video briefly explaining the MTL scheme will be shown before each shop in this Arm.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Nutri-Score</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Similar to Arm 2, with Nutri-Score labels instead of MTL labels displayed on all products FOP. A 60-second introductory video briefly explaining the NS scheme will be shown to shoppers in this condition.</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Multiple Traffic Light Label</intervention_name>
    <description>The United Kingdom's Multiple Traffic Light label has repeatedly demonstrated effectiveness and has been widely implemented in Europe. The label shows how much calories, fats, saturated fats, sugar and salt are present in a product, with associated traffic light signals for high (red), medium (amber) and low (green) percentages for each attribute.</description>
    <arm_group_label>Multiple Traffic Light Labels</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Nutri-Score Label</intervention_name>
    <description>In late 2017, France began voluntary implementation of one FOP label, termed Nutri-Score, adapted from its predecessor, the 5-colour Nutrition Label. Consumer acceptability and understanding of the NS label has been demonstrated in several studies. It provides a letter score as a composite grade of a product's nutrition quality from A (best) to E (worst).</description>
    <arm_group_label>Nutri-Score</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Singapore resident&#xD;
&#xD;
          -  Aged 21 years or older.&#xD;
&#xD;
          -  Existing registered RedMart customer.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Non-Singapore Resident.&#xD;
&#xD;
          -  Less than 21 years old.&#xD;
&#xD;
          -  Not an existing registered RedMart customer.&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>21 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <location>
    <facility>
      <name>Duke-NUS Medical School</name>
      <address>
        <city>Singapore</city>
        <zip>169857</zip>
        <country>Singapore</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Singapore</country>
  </location_countries>
  <verification_date>January 2019</verification_date>
  <study_first_submitted>November 28, 2018</study_first_submitted>
  <study_first_submitted_qc>November 29, 2018</study_first_submitted_qc>
  <study_first_posted type="Actual">December 3, 2018</study_first_posted>
  <last_update_submitted>January 1, 2019</last_update_submitted>
  <last_update_submitted_qc>January 1, 2019</last_update_submitted_qc>
  <last_update_posted type="Actual">January 3, 2019</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Duke-NUS Graduate Medical School</investigator_affiliation>
    <investigator_full_name>Eric A. Finkelstein</investigator_full_name>
    <investigator_title>Professor</investigator_title>
  </responsible_party>
  <keyword>Front-of-pack label</keyword>
  <keyword>Nutrition label</keyword>
  <keyword>Diet Quality</keyword>
  <keyword>Online grocery store</keyword>
  <keyword>Diet</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Malnutrition</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03761342
org study id: NUSMart NM
nct id: NCT03761342
lead sponsor: 
collaborator: 
is fda regulated drug: No
is fda regulated device: No
In efforts to promote a healthy diet, the Singapore Health Promotion Board (HPB) has
      attempted to use Front-of-Pack (FOP) labelling to supplement traditional nutrition labelling.
      The Healthier Choice Symbol (HCS) identifies food items within a specific category of foods
      as healthier choices. The original logos were enhanced to include additional information
      focusing on particular macronutrients, taking one of two themes; it either indicates that a
      product contains more of a healthier ingredient, or less of a less healthy ingredient.

      However, there is a lack of scientific evidence on the role of the existing symbols in
      assisting consumers make healthier food purchasing decisions. Thus far, studies have
      established that the United Kingdom's Multiple Traffic Lights (MTL) label, and the new French
      Nutri-Score (NS) label, are amongst the top performers. However, there is little consensus on
      which is the most effective FOP label to promote diet quality. Thus, the investigators
      propose to conduct the following:

      Use a three arm randomized controlled trial (RCT) and an experimental fully functional
      web-based grocery store to test two competing approaches of front-of-pack (FOP) labelling on
      measures of diet quality: 1) United Kingdom's Multiple Traffic Lights label (MTL) or 2)
      France's Nutri-Score (NS) labelling scheme.

      The investigators hypothesize that diet quality as measured by the Alternative Healthy Eating
      Index (AHEI-2010) (primary outcome) will be highest in the NS arm, followed by MTL, and
      lowest in the no logo control arm.
Research Aims & hypotheses:

      To use a three arm randomized controlled trial (RCT), and an experimental online grocery
      store developed by the team, to test two competing approaches of front-of-pack (FOP)
      nutrition labelling on measures of diet quality: 1) Multiple Traffic Lights (MTL) and 2)
      Nutri-Score (NS).

      All participants will experience three different shopping conditions:

        1. Arm 1: A control arm that mirrors a traditional web-grocery store with no HCS or other
           FOP labels.

        2. Arm 2: Similar to Arm 1, with additional MTL labels displayed on all products FOP. A
           60-second introductory video briefly explaining the MTL scheme will be shown before
           participants shop as they are assumed not to have pre-existing knowledge of the label.

        3. Arm 3: Similar to Arm 2, with Nutri-Score labels instead of MTL labels displayed on all
           products FOP. As with the MTL, a 60-second introductory video briefly explaining the NS
           scheme will be shown before participants shop.

      The investigators hypothesize the following:

      Primary Aim: Diet quality as measured by Alternative Healthy Eating Index Scores (AHEI-2010)
      will be highest (best) in Arm 3, followed by Arms 2 and 1 (worst).

      The investigators further hypothesize a similar ordering (Arm 3 best and Arm 1 worst) for the
      following secondary outcomes:

      Total and per serving values of the following:

        1. Energy (kCal)

        2. Sugar (g)

        3. Total fat (g)

        4. Saturated fat (g)

        5. Sodium (g)

        6. Fiber (g)

        7. Protein (g) And

        8. Average Nutri-Score across all products purchased where A=5 and E=1, and

        9. Cost per calorie and per shopping trip.

      The investigators will test these hypotheses in total, and separately for foods and beverages
      given Singapore's focus on reducing intake of sugar-sweetened beverages. The investigators
      will also test whether the impact of FOP labelling is moderated by mood and level of hunger
      at the time of purchase, and by education or income level.
allocation: Randomized
intervention model: Crossover Assignment
primary purpose: Other
masking: Single (Participant)
masking description: While participants will be made aware that there are different versions of NUSMart, the exact details of the arms will not be revealed to ensure validity of results. It will be deleterious to the study to reveal the differences between study arms as that would likely confound participant responses. Since there are 3 shopping conditions (unknown to participants), each participant will be randomly assigned at baseline to 1 of 6 groups that vary the sequence of shopping conditions and which shops will result in an actual food delivery.
measure: Diet Quality per shopping trip
time frame: Once a week for three weeks
description: Diet quality per shopping trip, as measured by an index of diet quality, the Alternative Healthy Eating Index (AHEI-2010). The Alternate Healthy Eating Index-2010 (AHEI-2010) is an updated measure of diet quality from the original Alternate Healthy Eating Index. It was constructed based on foods and nutrients predictive of chronic disease risk that incorporates current scientific evidence on diet and health. All AHEI-2010 components are scored from 0 (worst) to 10 (best), for a total of 11 components. The total AHEI-2010 score ranges from 0 (nonadherence) to 110 (perfect adherence). Higher scores on the AHEI-2010 are strongly associated with lower risk of major chronic disease as well as risk of CVD, diabetes, heart failure, colorectal and estrogen-receptor-negative breast cancer, and total and cardiovascular mortality.
measure: Total Energy in kilocalories
time frame: Once a week for three weeks
description: Total Energy (kCal)
measure: Total Sugar in grams
time frame: Once a week for three weeks
description: Total Sugar (g)
measure: Total fat in grams
time frame: Once a week for three weeks
description: Total Fat (g)
measure: Saturated fat in grams
time frame: Once a week for three weeks
description: Saturated Fat (g)
measure: Sodium in milligrams
time frame: Once a week for three weeks
description: Sodium (mg)
measure: Fiber in grams
time frame: Once a week for three weeks
description: Fiber (g)
measure: Protein in grams
time frame: Once a week for three weeks
description: Protein (g)
measure: Energy per serving in kilocalories per serving
time frame: Once a week for three weeks
description: Energy per serving (kCal per serving)
measure: Sugar per serving in grams per serving
time frame: Once a week for three weeks
description: Sugar per serving (g per serving)
measure: Total fat per serving in grams per serving
time frame: Once a week for three weeks
description: Total fat per serving (g per serving)
measure: Saturated fat per serving in grams per serving
time frame: Once a week for three weeks
description: Saturated fat per serving (g per serving)
measure: Sodium per serving in milligrams per serving
time frame: Once a week for three weeks
description: Sodium per serving (mg per serving)
measure: Fiber per serving in grams per serving
time frame: Once a week for three weeks
description: Fiber per serving (g per serving)
measure: Protein per serving in grams per serving
time frame: Once a week for three weeks
description: Protein per serving (g per serving)
measure: Average Nutri-Score across all products purchased
time frame: Once a week for three weeks
description: The Nutri-Score label was developed by the Equipe de Recherche en Epidémiologie Nutritionnelle (EREN) research team based on the British Food Standards Agency nutrient profiling system, and presents the overall nutritional quality for each food and beverage on a five-point color-coded scale from A is green (best) to E in red (worst). Average Nutri-Score across all products purchased is recoded to a score of A=5, B=4, C=3, D=2 and E=1. Maximum possible score is 5 (all A) and the lowest possible score is 1 (all E). A higher score represents higher nutritional quality.
measure: Cost per calorie in dollars per kilocalorie
time frame: Once a week for three weeks
description: Cost per calorie is calculated as total spend divided by total kilocalories ($ per kCal)
measure: Total spend in dollars
time frame: Once a week for three weeks
description: Total spend ($)
arm group label: Control
arm group type: No Intervention
description: A control arm that mirrors a traditional web-grocery store with no but with no FOP labels.
arm group label: Multiple Traffic Light Labels
arm group type: Experimental
description: Similar to Arm 1, with Multiple Traffic Light labels displayed on all products FOP. A 60-second introductory video briefly explaining the MTL scheme will be shown before each shop in this Arm.
arm group label: Nutri-Score
arm group type: Experimental
description: Similar to Arm 2, with Nutri-Score labels instead of MTL labels displayed on all products FOP. A 60-second introductory video briefly explaining the NS scheme will be shown to shoppers in this condition.
intervention type: Behavioral
intervention name: Multiple Traffic Light Label
description: The United Kingdom's Multiple Traffic Light label has repeatedly demonstrated effectiveness and has been widely implemented in Europe. The label shows how much calories, fats, saturated fats, sugar and salt are present in a product, with associated traffic light signals for high (red), medium (amber) and low (green) percentages for each attribute.
arm group label: Multiple Traffic Light Labels
intervention type: Behavioral
intervention name: Nutri-Score Label
description: In late 2017, France began voluntary implementation of one FOP label, termed Nutri-Score, adapted from its predecessor, the 5-colour Nutrition Label. Consumer acceptability and understanding of the NS label has been demonstrated in several studies. It provides a letter score as a composite grade of a product's nutrition quality from A (best) to E (worst).
arm group label: Nutri-Score
criteria: 
gender: All
minimum age: 21 Years
maximum age: N/A
healthy volunteers: Accepts Healthy Volunteers
facility: 
country: Singapore
responsible party type: Principal Investigator
investigator affiliation: Duke-NUS Graduate Medical School
investigator full name: Eric A. Finkelstein
investigator title: Professor
mesh term: Malnutrition
sharing ipd: No