Front-of-pack labeling and perceived nutritional quality in adults with and without chronic disease: results from a quasi-experimental study

Introduction: Noncommunicable diseases (NCDs) are a leading global health concern, linked to poor dietary choices and misperceptions about food healthfulness. Front-of-pack labeling (FOPL) systems, such as Nutri-Score (NS) and Warning Labels (WL), aim to guide healthier food choices, yet their effectiveness in populations with chronic conditions remains underexplored. Methods: We conducted a quasi-experimental online study among 5,140 adults in Spain, including individuals with and without NCDs. Participants evaluated the perceived nutritional quality of five commonly consumed foods under three different FOPL in the following order: no label (control), NS, and WL. The participants assessed each product in a randomized order within each label conditions to minimize order and learning effects. Results: < 0.001). NS tended to reduce the proportion of participants identifying products as low nutritional quality, particularly for items with a health halo such as yogurts and whole-wheat bread, while WL consistently increased the identification of products as low nutritional quality across all food types, including those traditionally perceived as healthy. This pattern was observed in both NCD and non-NCD groups. Discussion: While NS may inadvertently reinforce health halos for certain products, WL appear more effective in correcting misperceptions and promoting accurate assessments of nutritional quality in comparison to NS and no FOPL. These findings support the use of WL as a more impactful FOPL strategy for guiding informed food choices, particularly among individuals with chronic health conditions.