The time has come for a Canadian Nutri-Score

Cardiovascular disease is the leading cause of death in Western Europe and North America, accounting for one-third of all deaths. An unbalanced diet is responsible for approximately 30% of deaths directly related to cardiovascular disease. A study published this year reports that poor nutrition is responsible for nearly 1.6 million premature deaths from cardiovascular disease in the European region (Figure 1).

In Canada, Statistics Canada recently reported that  “From 2015 to 2021, the prevalence of high blood pressure, heart disease, and obesity increased, while the number of people meeting physical activity guidelines and consuming sufficient fruits and vegetables decreased.” It also notes that for the third consecutive year, life expectancy at birth for Canadians declined.

Preventive nutrition policies are therefore a major public health issue for these conditions, whose prevalence remains high and will worsen due to the aging population. To address this, France adopted the Nutri-Score in 2017, followed in subsequent years by six other European countries. The Nutri-Score is a logo that provides quick information on the nutritional quality of foods and beverages to help consumers make comparisons and to encourage them to make better-quality nutritional choices. At the same time, it encourages manufacturers to improve the quality of their products. In 2022, the Organisation for Economic Co-operation and Development (OECD) estimated that implementing the Nutri-Score system across all OECD countries would prevent approximately 1.6 million deaths from cardiovascular disease by 2050. This figure does not include the expected benefits for cancer prevention. In the Americas, only Chile implemented a mandatory nutritional labelling system based on black and white octagons in 2016 (see our article on this topic). 

In France, the Nutri-Score is now a familiar part of consumers’ everyday environment and is widely accepted by the French public, with 94% in favour of its inclusion on packaging in 2020, and one in two French people reporting having changed at least one purchasing habit thanks to the Nutri-Score. Mandatory labelling is currently hampered by European law and industry lobbying. However, scientific evidence reinforces its relevance and clearly demonstrates the beneficial impact of the Nutri-Score on the health of residents in participating European countries, as was well reported in a recent article in French. The change in legislation is planned within the framework of the European Commission’s Farm to Fork strategy.

The Nutri-Score system has five categories: from A (dark green, highest nutritional quality) to E (red, lowest nutritional quality). A category is assigned to a food or beverage based on an algorithm calculated from its composition per 100g in terms of energy, sugars, saturated fatty acids, and salt (to be limited) and protein, fruits, vegetables, and legumes (to be encouraged). The new version of the algorithm that generates the Nutri-Score is in effect in France. The changes lead to a stricter classification of products, except for a few targeted groups. Sugary and salty products are ranked lower because they receive more penalty points. This impacts sugary breakfast cereals, for example. In recent years, under the influence of the Nutri-Score, these products have been reformulated by manufacturers, thus halving their sugar content. By simultaneously reducing their salt content and adding whole wheat, a source of fibre, these products have gradually moved from class C to B, and then just below the threshold for A. Also, in the new classification system, red meat (excessive consumption is considered a high risk factor for certain cancers) is now ranked lower than poultry or fish. For beverages, only water remains classified as A. Sweetened beverages with very low sugar content (approximately <2 g/100 mL) move to B, while those with high sugar content remain in D or E. Beverages containing sweeteners such as aspartame are no longer classified as B but as C, and even D or E if they also contain sugar. Skimmed and semi-skimmed milks are classified as B, the most favourable class for beverages, with water being the only one classified as A. They are now differentiated from whole milk, which is classified as C. Sweetened milk drinks (i.e., flavoured milks), as well as flavoured drinking yogurts, are mainly classified as D and E. Plant-based drinks (e.g., soy, oat, rice, almond, etc.) are classified from B to E according to their nutritional characteristics.

All these changes are based on advances in scientific research. In an article published in November 2024 in The Lancet Regional Health-Europe, a team of international experts reported an increased risk of cardiovascular disease (heart attacks and strokes) associated with the consumption of foods with lower scores on the new 2024 version of the Nutri-Score scale within the European EPIC (European Prospective Investigation into Cancer and Nutrition) cohort. This pivotal study included 345,533 participants from the cohort, distributed across seven European countries and followed for 12 years. This study, confirming the validity of the Nutri-Score, follows two studies published in 2018 and 2020 in the same population, focusing on cancer risk and mortality. A brief summary of this study in French has just been published. Numerous other studies (more than 150) published in international scientific journals have demonstrated the validity of the Nutri-Score both for characterizing the nutritional quality of foods and for its effectiveness in helping consumers choose products with better nutritional quality. The links between consuming foods with lower Nutri-Score ratings and an increased risk of cardiovascular disease had previously only been observed in French studies (SU.VI.MAX and NutriNet-Santé cohorts). Since then, independent studies conducted in France, the United Kingdom, Spain, and Italy have observed similar associations with an increased risk of various chronic diseases and premature mortality.

The Nutri-Score will need to continue evolving as research progresses. Consumer information on nutritional composition must be accompanied by information indicating whether the food is ultra-processed or not (NOVA-4 class). The harmful effects of ultra-processed food on health are now beyond doubt, even when nutritional recommendations are followed, as recently reported. There is the possibility of graphically combining the Nutri-Score with a parallel classification logo or by outlining the current logo in black if the food is ultra-processed. This latter type of representation has already demonstrated that it allows consumers to simultaneously consider these two complementary aspects of food and to guide their choices towards healthier options.

The Nutri-Score update allows for greater consistency and alignment with recent nutritional recommendations in Europe, benefiting both consumers and public health. These nutritional recommendations are very similar to current guidelines in Canada. The overall health of Europeans in recent years has improved compared to findings reported by Statistics Canada for Canadians, with life expectancy continuing to rise in Europe, particularly in countries that have adopted the Nutri-Score. The question then becomes: why don’t we have Nutri-Scores on our food? Prevention is the cornerstone of public health, and a political stance in this direction would lend coherence to the public health pronouncements of our leaders. Our healthcare system, on the one hand, and the obligation of our governments to protect the health of Canadians, on the other, can no longer afford to ignore concrete public health actions such as the simple and effective implementation of the Nutri-Score in the food industry.