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• W1966231761 abstract "In 1990, when the Nutrition Labeling and Education Act1Nutrition Labeling and Education Act. 1990. Pub L No. 101-535, 104 Stat 2353. Library of Congress website. http://thomas.loc.gov/cgi-bin/bdquery/z?d101:HR03562:@@@D&summ2=3&|TOM:/bss/d101query.html. Accessed November 30, 2013.Google Scholar was enacted, there was a clear need for standardized information on food product packaging. This legislation, an amendment of the Federal Food, Drug and Cosmetic Act of 1938,2Federal Food, Drug and Cosmetic Act of 1938. 52 USC § 1040. US Food and Drug Administration website. http://www.fda.gov/opacom/laws/fdcact/fdctoc.htm. Accessed November 30, 2013.Google Scholar was intended to enable consumers to make more informed food choices to build a healthy diet. In addition to the new requirement for nutrition labeling on most packaged foods, and the creation of uniform definitions used in nutrient content claims, the Nutrition Labeling and Education Act revised health claim regulations allowing manufacturers to print approved health claims on the front of food and beverage product packaging if certain criteria were met. The American Heart Association's Heart-Check Food Certification Program,3American Heart Association. Heart-check food certification program. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HeartSmartShopping/Heart-Check-Mark-Food-Certification_UCM_300133_Article.jsp. Accessed November 30, 2013.Google Scholar launched in 1995, was among the first front-of-package labeling systems. Participating manufacturers who had submitted an application and received approval could place an American Heart Association Heart Check on the front of package if the food met US Food and Drug Administration (FDA) regulations for a heart health claim4US Department of Health and Human Services, Food and Drug Administration. Code of Federal Regulations, Title 21. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?cfrpart=101. Accessed November 30, 2013.Google Scholar and American Heart Association's specific criteria. Consumer interest in understanding how to identify healthful foods continues to increase,5US Food and Drug Administration. 2008 Health and diet survey. http://www.fda.gov/Food/FoodScienceResearch/ConsumerBehaviorResearch/ucm193895.htm. Accessed November 30, 2013.Google Scholar, 6Food Marketing Institute and Prevention MagazineShopping for Health. Rodale, Inc., Emmaus, PA2012Google Scholar, 7International Food Information Council Foundation. 2012 Food & Health Survey: Consumer Attitudes Toward Food Safety, Nutrition & Health. May 2012. http://www.foodinsight.org/Content/3840/2012%20IFIC%20Food%20and%20Health%20Survey%20Report%20of%20Findings%20(for%20website).pdf. Accessed November 30, 2013.Google Scholar as manufacturers and retailers have been adding interpretive symbols and fact-based icons (collectively known as “systems”) to product packages and shelf tags. Although these systems were created to help consumers make informed, healthful food choices, the formats, colors, and amount and type of information provided, including summary nutrition ratings, nutrient-specific disclosures about public health concerns, and dietary recommendations, often varied.8Kellogg's. How to read a nutrition label. http://www.kelloggs.com/en_US/the-benefits-of-cereal/how-to-read-a-nutrition-label.html. Accessed November 30, 2013.Google Scholar, 9PepsiCo. Responsible marketing. Nutrition labeling. http://www.pepsico.com/Purpose/Human-Sustainability/Responsible-Marketing. Accessed November 30, 2013.Google Scholar, 10Kraft Foods. Healthy living. http://www.kraftrecipes.com/healthy-living-ideas/main.aspx. Accessed November 30, 2013.Google Scholar, 11American Beverage Association. Clear on calories. http://www.ameribev.org/nutrition–science/clear-on-calories/. Accessed November 30, 2013.Google Scholar, 12NuVal. http://www.nuval.com/scores. Accessed March 14, 2014.Google Scholar, 13Sutherland L.A. Kaley L.A. Fischer L. Guiding stars: The effect of a nutrition navigation program on consumer purchases at the supermarket.Am J Clin Nutr. 2010; 91: 1090S-1094SCrossref PubMed Scopus (158) Google Scholar, 14Guiding Stars Licensing Company. http://guidingstars.com/. Accessed November 30, 2013.Google Scholar, 15Sacks G. Rayner M. Winburn S. Impact of front-of-pack ‘traffic-light’ nutrition labelling on consumer food purchases in the UK.Health Promot Int. 2009; 24: 344-352Crossref PubMed Scopus (217) Google Scholar The FDA addressed this reality in 2007 via public hearings and requested research on the effectiveness of front-of-package systems.16US Food and Drug AdministrationFood labeling: Use of symbols to communicate nutrition information, consideration of consumer studies and nutritional criteria. Public hearing; request for comments.Fed Reg. 2007; 72: 39815-39818Google Scholar, 17US Food and Drug AdministrationFront-of-pack and shelf tag nutrition symbols; establishment of docket; request for comments and information.Fed Reg. 2010; 75 (22, 602-622, 606)Google Scholar In 2009, Congress directed the Centers for Disease Control and Prevention to evaluate and make recommendations about front-of-package systems and symbols.18Explanatory Statement Submitted by Mr. Obey, Chairman of the House Committee on Appropriations, Regarding HR 1105, Omnibus Appropriations Act, 2009. Division F-Labor, Health and Human Services and Education, and Related Agencies Appropriations, p. 1398. http://www.gpo.gov/fdsys/pkg/CPRT-111JPRT47494/pdf/CPRT-111JPRT47494-DivisionF.pdf. Accessed December 17, 2013.Google Scholar, 19House Report 111-366, Conference Report to accompany H.R. 328, ordered to be printed December 8, 2009, p. 1021. http://www.gpo.gov/fdsys/pkg/CRPT-111hrpt366/pdf/CRPT-111hrpt366.pdf. Accessed December 17, 2013.Google Scholar The Centers for Disease Control and Prevention joined forces with the FDA and US Department of Agriculture to commission the Institute of Medicine to address this charge. The resulting Phase I report by the Institute of Medicine in 201020Institute of Medicine, Committee on Examination of Front-of-Package Nutrition Ratings Systems and Symbols. examination of front-of-package nutrition ratings systems and symbols: Phase I report. Washington, DC: National Academies Press; 2010. http://www.iom.edu/Reports/2010/Examination-of-Front-of-Package-Nutrition-Rating-Systems-and-Symbols-Phase-1-Report.aspx. Accessed December 17, 2013.Google Scholar noted that more work was needed to determine appropriate criteria for front-of-package labeling systems and how best to convey information in such systems. Subsequent to the completion of the study presented in this article, the Institute of Medicine Phase II report21Institute of Medicine. Examination of front-of-package nutrition rating systems and symbols: Promoting healthier choices. Washington, DC: National Academies Press; 2011. http://www.iom.edu/Reports/2011/Front-of-Package-Nutrition-Rating-Systems-and-Symbols-Promoting-Healthier-Choices.aspx. Accessed December 17, 2013.Google Scholar was published, which recommended development and consumer testing of a single, interpretive symbol for the front-of-package combined with fact-based calorie and serving size information. The importance of helping consumers make informed food choices and select a healthful diet has never been more vital because the incidence of diet-related disease persists. Obesity is increasing again after reaching a plateau in 2008,22Fryar CD, Carroll MD, Ogden CL. Prevalence of overweight, obesity and extreme obesity among adults: United States, trends 1960-1962 through 2009-2010. NCHS Health E-Stat. Hyattsville, MD: National Center for Health Statistics; 2012. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/data/hestat/obesity_adult_09_10/obesity_adult_09_10.pdf. Accessed November 30, 2013.Google Scholar, 23Ogden C.L. Carroll M.D. Kit B.K. Flegal K.M. Prevalence of obesity in the United States, 2009-2010.NCHS Data Brief. 2012; 82 (Centers for Disease Control and Prevention website) (Accessed November 30, 2013): 1-8http://www.cdc.gov/nchs/data/databriefs/db82.pdfPubMed Google Scholar as is diabetes.24Centers for Disease Control and Prevention. 2011 National Diabetes Fact Sheet: Diagnosed and undiagnosed diabetes in the United States, all ages, 2010. http://www.cdc.gov/diabetes/pubs/estimates11.htm#. Accessed November 30, 2013.Google Scholar ∗According to 2010 Centers for Disease Control and Prevention data, 28.5 million people, or 8.3% of the US population, have diabetes (18.8 million diagnosed, estimated 7 million undiagnosed), and 35.7% of the US adult population and 17% (12.5 million) of children aged 2 to 19 years are obese. Because nutrition information on food product packaging is among the factors that affect consumer purchase decisions5US Food and Drug Administration. 2008 Health and diet survey. http://www.fda.gov/Food/FoodScienceResearch/ConsumerBehaviorResearch/ucm193895.htm. Accessed November 30, 2013.Google Scholar, 6Food Marketing Institute and Prevention MagazineShopping for Health. Rodale, Inc., Emmaus, PA2012Google Scholar—72% of consumers reported seeing the front-of-package symbols or icons and 67% reported they used symbols or icons to inform a food product purchase decision5US Food and Drug Administration. 2008 Health and diet survey. http://www.fda.gov/Food/FoodScienceResearch/ConsumerBehaviorResearch/ucm193895.htm. Accessed November 30, 2013.Google Scholar—and there is a wide range of systems with varying criteria, consumer research is needed to determine an easy-to-use, understandable, accessible format.16US Food and Drug AdministrationFood labeling: Use of symbols to communicate nutrition information, consideration of consumer studies and nutritional criteria. Public hearing; request for comments.Fed Reg. 2007; 72: 39815-39818Google Scholar, 17US Food and Drug AdministrationFront-of-pack and shelf tag nutrition symbols; establishment of docket; request for comments and information.Fed Reg. 2010; 75 (22, 602-622, 606)Google Scholar Dietetics practitioners' understanding of outcomes of labeling system research is important, given their critical role in helping consumers make healthful food choices. The International Food Information Council Foundation designed a study to examine consumer comprehension, ease of understanding, and interpretation of nutrition information in the uniformly formatted, voluntary front-of-package labeling system that was under consideration by the Grocery Manufacturers Association and the Food Marketing Institute. This research was used to inform the framework for the Facts Up Front25FactsUpFront.org. http://factsupfront.com/. Accessed November 30, 2013.Google Scholar program, which is currently implemented by the two groups. From August 14 to October 12, 2010, a professional marketing research firm, contracted by the International Food Information Council Foundation, conducted an interactive online survey of primary grocery shoppers. The sample was drawn from a web panel of >4,000,000 people representing hundreds of demographic, socioeconomic, and lifestyle attributes. The sample, 7,363 men and women aged 18 to 70 years, was screened to be reflective of the US population (2007-2008 US Census estimates)26US Census Bureau. American Community Survey. http://www.census.gov/acs/www/. Accessed November 30, 2013.Google Scholar with respect to household income, age, and education level (Table 1, available online at www.andjrnl.org). Participants were required to have purchased and consumed both product types from one of two groupings—breakfast cereals and frozen entrées, or salad dressings and savory snacks—within the past 3 months. Respondents received an incentive for participation. This survey evaluated the relative effectiveness of four versions of front-of-package nutrition information in one consistently formatted, fact-based system (Figure 1) that mirrors several aspects of the Nutrition Facts label, including use of a neutral background with black print, and focused on nutrients to encourage or limit, per the 2005 Dietary Guidelines for Americans27US Departments of Agriculture and Health and Human ServicesDietary Guidelines for Americans, 2005.6th ed. US Government Printing Office, Washington, DC2005Google Scholar (Figures 1 and 2). This system complied with the current Code of Federal Regulations for nutrition labeling.4US Department of Health and Human Services, Food and Drug Administration. Code of Federal Regulations, Title 21. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?cfrpart=101. Accessed November 30, 2013.Google Scholar Using a fact-based system that presents nutrient values without value judgment helped to ensure that the information would not be deemed misleading. Products were obtained from grocery store shelves. To avoid participant bias for or against particular brands, evidence of branding was removed from product packaging. The serving sizes and the Nutrition Facts label were reviewed to ensure compliance with food labeling regulations.4US Department of Health and Human Services, Food and Drug Administration. Code of Federal Regulations, Title 21. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?cfrpart=101. Accessed November 30, 2013.Google Scholar Version 1 served as the control, displaying no nutrition information on the front of package (Figure 1). Version 2 displayed only calories on the front of package. Version 3 displayed calories and three nutrients to limit (saturated fat, sodium, and sugars) on the front of package. Finally, version 4 displayed calories, three nutrients to limit, and either one nutrient to encourage on savory snack and salad dressing products, or three nutrients to encourage on cereal and frozen entrée products. In order to be displayed on the front of package, nutrients to encourage are required by food labeling regulations to meet at least 10% of the Daily Value (DV). Therefore, with nutrient variability from product to product, it was necessary to display different nutrients to encourage on different products, and to display only one nutrient to encourage on savory snacks and salad dressings (Figure 2, footnote c).Figure 2Rationale and description of information on the four versions of the front-of-package icon system for four product categories for an interactive online survey of primary grocery shoppers.Attributes and characteristics of front-of-package versionsLevelDescriptionLoadaAll versions presented Nutrition Facts label information. Presentation of the information on the front of package required that the same nutrients be included in the Nutrition Facts label.Version 1: ControlNo front-of-package information: Zero iconsAligns with US Food and Drug Administration proposal to make calories more prominent on label28US Food and Drug AdministrationFood labeling; prominence of calories. Advance notice of proposed rulemaking.Fed Reg. 2005; 70: 17008-17010Google ScholarVersion 2: Some informationCalories only: One iconAligns with the 2005 Dietary Guidelines for Americans27US Departments of Agriculture and Health and Human ServicesDietary Guidelines for Americans, 2005.6th ed. US Government Printing Office, Washington, DC2005Google ScholarVersion 3: More informationCalories+nutrients to limitbNutrients to limit did not include trans fat. In 2003, the US Food and Drug Administration began requiring that trans fat be included in the Nutrition Facts label.31 As a result, most products were reformulated to decrease or eliminate it. Therefore, the amount in the food supply was negligible and the amount indicated likely would be zero. (saturated fat, sodium, and sugars): Four iconsAligns with the 2005 Dietary Guidelines for Americans for nutrients to encourage or limit27US Departments of Agriculture and Health and Human ServicesDietary Guidelines for Americans, 2005.6th ed. US Government Printing Office, Washington, DC2005Google Scholar or the Code of Federal Regulations for required nutrients on the Nutrition Facts label4US Department of Health and Human Services, Food and Drug Administration. Code of Federal Regulations, Title 21. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?cfrpart=101. Accessed November 30, 2013.Google ScholarVersion 4: Most informationCalories+nutrients to limitbNutrients to limit did not include trans fat. In 2003, the US Food and Drug Administration began requiring that trans fat be included in the Nutrition Facts label.31 As a result, most products were reformulated to decrease or eliminate it. Therefore, the amount in the food supply was negligible and the amount indicated likely would be zero. (saturated fat, sodium, and sugars) and nutrients to encouragecNutrients to encourage varied by product: fiber, vitamin A, and folate for breakfast cereals; protein, iron, and vitamin A for frozen entrées; vitamin A, vitamin C, or calcium for salad dressings; and vitamin C or iron for savory snacks. Nutrients to encourage on the front of package had to meet the definition of a “good source” of the nutrient (ie, contain at least 10% of the Daily Value).4 (protein, fiber, vitamin A, vitamin C, calcium, iron, or folate): Five to seven iconsProduct packaging testeddAll products were actual products. All front-of-package labeling not related to the front-of-package icon scheme tested, including brand name and any claims, was removed to prevent bias. The name of the product was included. Screen shots included both the front and back panels of the products.Products used to display front-of-package nutrient information were consistent with the products the US Food and Drug Administration used in its study methodology29Fraser LM. US Food and Drug Administration, Center for Food Safety and Applied Nutrition. FDA's consumer research studies of FOP labeling. February 2, 2010. Institute of Medicine website. http://www.iom.edu/∼/media/Files/Activity%20Files/Nutrition/NutritionSymbols/Leslye%20Fraser.pdf. Accessed November 30, 2013.Google Scholar, 30US Food and Drug AdministrationAgency information collection activities; submission for Office of Management and Budget Review; comment request; experimental studies of nutrition symbols on food packages.Fed Reg. 2009; 74: 62786-62792Google ScholarBreakfast cerealsProduct 1: Bran flakes (enriched bran flakes cereal)Product 2: Crispy honey oats and flakes with almonds (frosted corn and wheat flakes with rolled oat and granola clusters and almonds)Product 3: Bunch of cinnamon squares (sweetened wheat and rice cereal)Nutrients to encourage: fiber, vitamin A, and folateFrozen entréesProduct 1: Sesame chicken (seasoned, white meat chicken on a bed of noodles with green beans and red bell peppers)Product 2: Cheese manicotti (in a meaty marinara sauce, topped with mozzarella and parmesan cheeses)Product 3: Homestyle macaroni and cheese bake (sharp cheddar cheese, macaroni, and bread crumb topping)Nutrients to encourage: protein, vitamin A, and ironSalad dressingsProduct 1: Classic Italian—Nutrient to encourage: Vitamin CProduct 2: Deluxe French—Nutrient to encourage: Vitamin AProduct 3: Chunky blue cheese—Nutrient to encourage: CalciumSavory snacksProduct 1: Multigrain tortilla chips (authentic style)—Nutrient to encourage: IronProduct 2: Potato chips (classic)—Nutrient to encourage: Vitamin CProduct 3: Popcorn (salted)—Nutrient to encourage: IronNutrition information tiersConsistent with FDA methodology,29Fraser LM. US Food and Drug Administration, Center for Food Safety and Applied Nutrition. FDA's consumer research studies of FOP labeling. February 2, 2010. Institute of Medicine website. http://www.iom.edu/∼/media/Files/Activity%20Files/Nutrition/NutritionSymbols/Leslye%20Fraser.pdf. Accessed November 30, 2013.Google Scholar, 30US Food and Drug AdministrationAgency information collection activities; submission for Office of Management and Budget Review; comment request; experimental studies of nutrition symbols on food packages.Fed Reg. 2009; 74: 62786-62792Google Scholar nutrient levels printed on the labels were adjusted (rounded up or down) to clarify high/medium/and low levels of calories and nutrients to encourage represented at least 10% of the DV within product feasibilityProduct 1Lower in calories, saturated fat, total sugars, and sodiumHigher (good source) in vitamins, minerals, protein, and/or fiberProduct 2Mid-level in nutrient contentProduct 3Highest in nutrients that should be limited and lowest in nutrients that should be encouragedColorColor was not used for front-of-package icons in order to prevent biasBlack, white, and grayUsed for the icons to coordinate with the Nutrition Facts label4US Department of Health and Human Services, Food and Drug Administration. Code of Federal Regulations, Title 21. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?cfrpart=101. Accessed November 30, 2013.Google Scholar and to present the information in a neutral/nonbiased, factual formatPresentation of nutrition informationPresentation and order of information aligned with the Code of Federal Regulations for presenting information on the Nutrition Facts label4US Department of Health and Human Services, Food and Drug Administration. Code of Federal Regulations, Title 21. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?cfrpart=101. Accessed November 30, 2013.Google ScholarAbsolute numbersCalories and sugarsPercent of Daily ValueVitamin A, vitamin C, calcium, iron, and folateAbsolute numbers and percent of Daily ValueSaturated fat, sodium, fiber, and proteina All versions presented Nutrition Facts label information. Presentation of the information on the front of package required that the same nutrients be included in the Nutrition Facts label.b Nutrients to limit did not include trans fat. In 2003, the US Food and Drug Administration began requiring that trans fat be included in the Nutrition Facts label.31US Food and Drug AdministrationFood labeling: Trans fatty acids in nutrition labeling; consumer research to consider nutrient content and health claims.Fed Reg. 2003; 68: 41434-41506Google Scholar As a result, most products were reformulated to decrease or eliminate it. Therefore, the amount in the food supply was negligible and the amount indicated likely would be zero.c Nutrients to encourage varied by product: fiber, vitamin A, and folate for breakfast cereals; protein, iron, and vitamin A for frozen entrées; vitamin A, vitamin C, or calcium for salad dressings; and vitamin C or iron for savory snacks. Nutrients to encourage on the front of package had to meet the definition of a “good source” of the nutrient (ie, contain at least 10% of the Daily Value).4US Department of Health and Human Services, Food and Drug Administration. Code of Federal Regulations, Title 21. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?cfrpart=101. Accessed November 30, 2013.Google Scholard All products were actual products. All front-of-package labeling not related to the front-of-package icon scheme tested, including brand name and any claims, was removed to prevent bias. The name of the product was included. Screen shots included both the front and back panels of the products. Open table in a new tab The 7,363 participants were randomly assigned to view and answer questions about only one of the four front-of-package versions displayed on six products within one set of product categories (ie, breakfast cereals and frozen entrées, or salad dressings and savory snacks). The resulting groups were found to be demographically similar (Table 1, available online at www.andjrnl.org). The product category pairings allowed respondents assigned to version 4 to see comparable numbers of icons for nutrients to encourage. Three products in each category represented three “tiers” of nutritional content—those meeting higher, medium, and lower levels of nutrients to encourage or limit (Figure 2). (Note: The tiers were not identified for participants.) Within each section, the order of products presented and questions asked was rotated. The questionnaire was tested to confirm rotating and skipping patterns worked correctly. It was field tested with 800 subjects to ensure survey language was understood by respondents and to assess internal validity and directionality. Deemed valid, these 800 interviews were used as part of the total sample. The questionnaire contained fill-in-the-blank, multiple choice, rating, and open-ended questions. Respondents had to acknowledge receipt of the marketing firm's privacy/confidentiality policy before participating. Participants were informed that their names and responses would remain confidential and study results would be reported in total. The questionnaire began with demographic, socioeconomic, and shopping questions (Table 1, available online at www.andjrnl.org), which doubled as a screening device. For one product in each category, five questions addressed identification of nutrient amounts; four questions addressed %DV per serving (Table 2, available online at www.andjrnl.org); two questions addressed product comparisons (Table 3, available online at www.andjrnl.org); and four questions asked about ease of answering identification and comparison questions (Table 4). Participants next answered a multiple-choice question about which product (one of three in the category) they perceived was the best choice with respect to nutritional value (Table 3, available online at www.andjrnl.org); in an open-ended question, respondents were asked to explain their rationale.Table 4Percentage of primary household grocery shopper respondents reporting use of four versions of the front-of-package system for four food categories as “very easy”aThe question was stated as follows: “In general, how easy was it for you to figure out the answers you provided for the previous series of questions (eg, number of calories per serving, number of grams of fiber per serving, etc)? Very easy to figure out; somewhat easy to figure out; not too easy to figure out; not at all easy to figure out.” in an interactive online survey (n=7,363)bSurvey respondents (n=7,363) were randomized to view and answer questions about six products within two of four product categories (breakfast cereals and frozen entrées or salad dressings and savory snacks) that specifically displayed only one of the four available front-of-package versions.cFront-of-package versions varied in amount and type of information: version 1 contained no front-of-package information and version 4 contained the most front-of-package information.Key evaluation measuresPercentage of Total Sample Who Reported “Very Easy”aThe question was stated as follows: “In general, how easy was it for you to figure out the answers you provided for the previous series of questions (eg, number of calories per serving, number of grams of fiber per serving, etc)? Very easy to figure out; somewhat easy to figure out; not too easy to figure out; not at all easy to figure out.”Version 1: None (n=1,832)Version 2: Calories only (n=1,850)Version 3: Calories+nutrients to limitdNutrients to limit: saturated fat, sodium, and total sugars. (n=1,830)Version 4: Calories+nutrients to limitdNutrients to limit: saturated fat, sodium, and total sugars.+nutrients to encourageeNutrients to encourage: fiber, vitamin A, and folate for breakfast cereals; protein, vitamin A, and iron for frozen entrées; vitamin A, vitamin C, or calcium for salad dressings; and vitamin C or iron for savory snacks. (n=1,851)←%→Breakfast cerealsNutrition information (on 1 package)71717482xSignificantly different from version 1 at P<0.05. Comparisons are made horizontally.ySignificantly different from version 2 at P<0.05. Comparisons are made horizontally.zSignificantly different from version 3 at P<0.05. Comparisons are made horizontally.% DVf%DV=percent daily value. nutrition information (on 1 package)78797590xSignificantly different from version 1 at P<0.05. Comparisons are made horizontally.ySignificantly different from version 2 at P<0.05. Comparisons are made horizontally.zSignificantly different from version 3 at P<0.05. Comparisons are made horizontally.Lowest calories per serving (among 3 packages)8690xSignificantly different from version 1 at P<0.05. Comparisons are made horizontally.90xSignificantly different from version 1 at P<0.05. Comparisons are made horizontally.92xSignificantly different from version 1 at P<0.05. Comparisons are made horizontally.Lowest sodium per serving (among 3 packages)838088xSignificantly different from version 1 at P<0.05. Comparisons are made horizontally.ySignificantly different from version 2 at P<0.05. Comparisons are made horizontally.91xSignificantly different from version 1 at P<0.05. Comparisons are made horizontally.ySignificantly different from version 2 at P<0.05. Comparisons are made horizontally.Frozen entréesNutrition information (on 1 package)828287xSignificantly different from version 1 at P<0.05. Comparisons are made horizontally.ySignificantly different from version 2 at P<0.05. Comparisons are made horizontally.96xSignificantly different from version 1 at P<0.05. Comparisons are made horizontally.ySignificantly different from version 2 at P<0.05. Comparisons are made horizontally.zSignificantly different from version 3 at P<0.05. Comparisons are made horizontally.%DV nutrition information (on 1 package)78798194xSignificantly different from version 1 at P<0.05. Comparisons are made horizontally.ySignificantly different from version 2 at P<0.05. Comparisons are made horizontally.zSignificantly different from version 3 at P<0.05. Comparisons are made horizontally.Lowest calories per serving (among 3 packages)8691xSignificantly different from version 1 at P<0.05. Comparisons are made h" @default.
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• W1966231761 title "The Impact of Variations in a Fact-Based Front-of-Package Nutrition Labeling System on Consumer Comprehension" @default.
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