Complementary roles of Nutri-Score and NOVA in assessing pre-packaged food products available in Southeast Asia from an online food database

Abstract

Aim: This study characterized pre-packaged foods in Southeast Asia using Nutri-Score, NOVA, and Multiple Traffic Light systems; cross-classified products by Nutri-Score and NOVA; and assessed their ability to discriminate products by nutrient content. Methods: Data were obtained from Open Food Facts in October 2024. Of 29,789 products identified in Southeast Asia, duplicates and products with incomplete information were excluded, resulting in 4,668 pre-packaged food products from eight Southeast Asian countries. Salt, sugar, total fat, and saturated fat contents were evaluated using the Multiple Traffic Light system. Nutri-Score data were available for 4,565 products, while 2,068 products had complete information for both Nutri-Score and NOVA and were included in cross-classification analysis. Spearman correlation analyses examined relationships among Nutri-Score, NOVA, and nutrient profiles. Results: Most products were of lower nutritional quality, with 52% classified as Nutri-Score D or E and 71% categorized as ultra-processed (NOVA 4). Multiple Traffic Light classification showed that beverages and sweet products had the highest proportion high in sugar, while beverages, cereals, and dish meals were most frequently high in salt. Sweets and snacks were the main contributors to products high in total fat and saturated fat. Cross-classification showed that as Nutri-Score decreased from A to E, the prevalence of ultra-processed foods consistently increased, while NOVA 1 became nearly negligible, indicating a trend between poorer nutritional quality and higher processing. Nutri-Score showed weak-to-moderate positive correlations with sugar (r=0.355,p<0.001), saturated fat (r=0.364,p<0.001), and salt (r=0.190,p<0.001). NOVA showed weaker but significant correlations with sugar (r=0.149,p<0.001) and salt (r=0.138,p<0.001). Conclusions: Nutri-Score was associated with nutrient-rich foods, while NOVA highlighted processing levels. Combined use offers a more comprehensive evaluation than either system alone. Integrating nutrient profiling and processing classification in front-of-pack labeling may guide consumer choices and public health efforts to reduce diet-related NCDs in Southeast Asia.

Keywords

front-of-pack labeling systems / Nutri Score / NOVA classification / ultra-processed food / Multiple Traffic Light (MTL) system

References

[1] Murray CJL. Findings from the Global Burden of Disease Study 2021. Lancet. 2024;403:2259-62.

[2] Noncommunicable diseases [Internet]. World Health Organization; c2025 [cited 2025 Jul 12]. Available from: https://www.who.int/news—room/fact—sheets/detail/noncommunicable—diseases

[3] Lipoeto NI, Geok Lin K, Angeles—Agdeppa I. Food consumption patterns and nutrition transition in South—East Asia. Public Health Nutr. 2012;16:1637-43.

[4] Li Y, Wang H, Zhang P, Popkin BM, Coyle DH, Ding J, et al. Nutritional Quality of Pre—Packaged Foods in China under Various Nutrient Profile Models. Nutrients. 2022;14:2700.

[5] Phulkerd S, Samsiripong W, Borazon EQ, Teh WS, Saptari AF, Sameeha MJ, et al. A comparative analysis of food retail policy landscape in four Southeast Asian countries. Lancet Reg Health—Southeast Asia. 2025;43:100691.

[6] Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra—processing. Public Health Nutr. 2017;21:5-17.

[7] Poti JM, Mendez MA, Ng SW, Popkin BM. Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households? Am J Clin Nutr. 2015;101:1251-62.

[8] Martínez Steele E, Baraldi LG, Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra—processed foods and added sugars in the US diet: evidence from a nationally representative cross—sectional study. BMJ Open. 2016;6:e009892.

[9] Processed Foods and Health—The Nutrition Source[Internet]. Harvard T.H. Chan School of Public Health; [cited 2025 Jul 12]. Available from: https://nutritionsource.hsph.harvard.edu/processed—foods/

[10] Guiding principles and framework manual for front of pack labelling for promoting healthy diets[Internet]. World Health Organization; [cited 2025 Jul 12]. Available from: https://www.who.int/publications/m/item/guidingprinciples—labelling—promoting—healthydiet

[11] Martini D, Marangoni F, Banterle A, Donini LM, Riccardi G, Poli A, et al. Relationship between front—of—pack labeling and nutritional characteristics of food products: An attempt of an analytical approach. Front Nutr. 2022;9:963592.

[12] Fedde S, Büttner—Koc S, Plähn V, Bosy—Westphal A. Implementation of the Nutri—Score. First results and a comparison with the NOVA classification. Ernahr Umsch. 2022;69:48-55.

[13] Malam S, Clegg S, Kirwan S, McGinigal S, Raats MM, Shepherd R, et al. Comprehension and use of UK nutrition signpost labelling schemes. London: Food Standards Agency; 2009.

[14] Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, et al. Ultra—processed foods: what they are and how to identify them. Public Health Nutr. 2019;22:936—41.

[15] Srour B, Hercberg S, Galan P, Monteiro CA, Szabo de Edelenyi F, Bourhis L, et al. Effect of a new graphically modified Nutri—Score on the objective understanding of foods’ nutrient profile and ultraprocessing: a randomised controlled trial. BMJ Nutr Prev Health. 2023;6:108—18.

[16] Baker P, Friel S. Food systems transformations, ultra—processed food markets and the nutrition transition in Asia. Glob Health. 2016;12:80.

[17] Peters S, Verhagen H. An Evaluation of the Nutri—Score System along the Reasoning for Scientific Substantiation of Health Claims in the EU—A Narrative Review. Foods. 2022;11:2426.

[18] Pettigrew S, Coyle D, McKenzie B, Vu D, Lim SC, Berasi K, et al. A review of front—of—pack nutrition labelling in Southeast Asia: Industry interference, lessons learned, and future directions. Lancet Reg Health—Southeast Asia. 2022;3:100017.

[19] Open Food Facts—world’s largest open food database[Internet]. European Citizen Science Platform; [cited 2025 Jul 13]. Available from: https://eu—citizen.science/project/430

[20] Romero Ferreiro C, Lora Pablos D, Gómez de la Cámara A. Two Dimensions of Nutritional Value: Nutri—Score and NOVA. Nutrients. 2021;13:2783.

[21] Sarda B, Kesse—Guyot E, Deschamps V, Ducrot P, Galan P, Hercberg S, et al. Consistency of the Initial and Updated Version of the Nutri—Score with Food—Based Dietary Guidelines: A French Perspective. J Nutr. 2024;154:1027—38.

[22] Understanding food labels[Internet]. British Nutrition Foundation; [cited 2025 Aug 20]. Available from: https://www.nutrition.org.uk/creating—a—healthy—diet/food—labelling/

[23] Guide to creating a front of pack (FoP) nutrition label for pre—packed products sold through retail outlets[Internet]. Department of Health & Food Standards Agency & devolved administrations in Scotland, Northern Ireland and Wales & British Retail Consortium; [cited 2025 Aug 20]. Available from: https://assets.publishing.service.gov.uk/media/5a80cd03ed915d74e33fc7c5/FoP_Nutrition_labelling_UK_guidance.pdf

[24] Regulation (EC) No 1924/2006 on nutrition and health claims made on foods. European Parliament and Council; c2014 [cited 2026 Jan 14]. Available from: http://data.europa.eu/eli/reg/2006/1924/2014—12—13

[25] Ropero AB, Borrás F, Rodríguez M, Beltrá M. Nutritional Description of Processed Foods with Fibre—Related Nutrition Claims in Spain: The BADALI Project. Nutrients. 2023;15:3656.

[26] Fibre [Internet]. British Dietetic Association (BDA); [cited 2026 May 14]. Available from: https://www.bda.uk.com/resource/fibre.html

[27] van der Bend DLM, van Eijsden M, van Roost MHI, de Graaf K, Roodenburg AJC. The Nutri—Score algorithm: Evaluation of its validation process. Front Nutr. 2022;9:974003.

[28] Braesco V, Souchon I, Sauvant P, Haurogné T, Maillot M, Féart C, et al. Ultra—processed foods: how functional is the NOVA system? Eur J Clin Nutr. 2022;76:1245-53.

[29] Martinez—Steele E, Khandpur N, Batis C, Bes—Rastrollo M, Bonaccio M, Cediel G, et al. Best practices for applying the Nova food classification system. Nat Food. 2023;4:445-8.

[30] European Food Safety Authority (EFSA). The food classification and description system FoodEx 2 (revision 2). EFSA Support Publ. 2015;12:804E.

[31] Angelino D, Dinu M, Gandossi B, Pellegrini N, Martini D ; SINU Young Working Group. Processing and Nutritional Quality of Breakfast Cereals Sold in Italy: Results from the Food Labelling of Italian Products (FLIP) Study. Nutrients. 2023;15:2013.

[32] Onifade Y, Diouf A, Faye MH, Fall F, Sacks G, Idohou—Dossou N, et al. Nutritional quality and on—package marketing of pre—packaged foods and non—alcoholic beverages for sale in Senegalese supermarkets. BMC Public Health. 2025;25:1238.

[33] Valenzuela A, Zambrano L, Velásquez R, Groff C, Apablaza T, Riffo C, et al. Discrepancy between Food Classification Systems: Evaluation of Nutri—Score, NOVA Classification and Chilean Front—of—Package Food Warning Labels. Int J Environ Res Public Health. 2022;19:14631.

[34] Julia C, Etilé F, Hercberg S. Front—of—pack Nutri—Score labelling in France: an evidence—based policy. Lancet Public Health. 2018;3:e164.

[35] Monteiro CA, Moubarac JC, Levy RB, Canella DS, Louzada MLDC, Cannon G. Household availability of ultra—processed foods and obesity in nineteen European countries. Public Health Nutr. 2017;21:18-26.

[36] Scrinis G, Monteiro CA. Ultra—processed foods and the limits of product reformulation. Public Health Nutr. 2017;21:247-52.

[37] Fardet A, Rock E. Ultra—Processed Foods and Food System Sustainability: What Are the Links? Sustainability. 2020;12:6280.

[38] Monteiro CA, Louzada ML, Steele—Martinez E, Cannon G, Andrade GC, Baker P, et al. Ultra—processed foods and human health: the main thesis and the evidence. Lancet. 2025;406:2667-84.

[39] Seto T, Grondin JA, Khan WI. Food Additives: Emerging Detrimental Roles on Gut Health. FASEB J. 2025;39:e70810.

[40] Wellens J, Vissers E, Dumoulin A, Hoekx S, Vanderstappen J, Verbeke J, et al. Cooking methods affect advanced glycation end products and lipid profiles: A randomized cross—over study in healthy subjects. Cell Rep Med. 2025;6:102091.

[41] Dalamaga M, Kounatidis D, Tsilingiris D, Vallianou NG, Karampela I, Psallida S, et al. The Role of Endocrine Disruptors Bisphenols and Phthalates in Obesity: Current Evidence, Perspectives and Controversies. Int J Mol Sci. 2024;25:675.

[42] Filardi T, Panimolle F, Lenzi A, Morano S. Bisphenol A and Phthalates in Diet: An Emerging Link with Pregnancy Complications. Nutrients. 2020;12:525.

[43] Clark MA, Springmann M, Hill J, Tilman D. Multiple health and environmental impacts of foods. Proc Natl Acad Sci. 2019;116:23357—62.

[44] Ultra—processed foods, diet quality and human health[Internet]. Food and Agriculture Organization of the United Nations; [cited 2025 Aug 20]. Available from: https://openknowledge.fao.org/server/api/core/bitstreams/5277b379—0acb—4d97—a6a3—602774104629/content

[45] Bucher T, Müller B, Siegrist M. What is healthy food? Objective nutrient profile scores and subjective lay evaluations in comparison. Appetite. 2015;95:408—14.

[46] Lobstein T, Davies S. Defining and labelling ‘healthy’ and ‘unhealthy’ food. Public Health Nutr. 2008;12:331-40.

[47] Dhemla S, Varma K. Health Risks of Excessive Sodium and the Role of Value Chain in India. Curr Res Nutr Food Sci J. 2015;3:165-76.

[48] Monteiro CA, Rezende LFM. Are all ultra—processed foods bad for health? Lancet Reg Health—Eur. 2024;46:101106.

[49] Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, et al. Ultra—Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019;30:67-77.e3.

[50] Lane MM, Gamage E, Du S, Ashtree DN, McGuinness AJ, Gauci S, et al. Ultra—processed food exposure and adverse health outcomes: umbrella review of epidemiological meta—analyses. BMJ. 2024;384:e077310.

[51] Taillie LS, Hall MG, Popkin BM, Ng SW, Murukutla N. Experimental Studies of Front—of—Package Nutrient Warning Labels on Sugar—Sweetened Beverages and Ultra—Processed Foods: A Scoping Review. Nutrients. 2020;12:569.

[52] Shin S, Puri J, Finkelstein E. A randomized trial to evaluate the impact of Singapore’s forthcoming Nutri—grade front—of—pack beverage label on food and beverage purchases. Int J Behav Nutr Phys Act. 2023;20:18.

[53] Robinson E, Forde CG. Concerns around evidence that food processing should be included in dietary guidance. Nat Med. 2026;32:465-7.

[54] Jones JM. Food processing: criteria for dietary guidance and public health? Proc Nutr Soc. 2018;78:4-18.

[55] DeCan CL, Thure KA. A Need for Front—of—Package Labeling in an Unhealthy Food Environment—Let’s Label It. JAMA Intern Med. 2025;185:753-4.

[56] Penzavecchia C, Todisco P, Muzzioli L, Poli A, Marangoni F, Poggiogalle E, et al. The influence of front—of—pack nutritional labels on eating and purchasing behaviors: a narrative review of the literature. Eat Weight Disord—Stud Anorex Bulim Obes. 2022;27:3037—51.

[57] Flexner N, Jones AC, Amies—Cull B, Cobiac L, Nilson E, L'Abbe MR. The potential health impact and healthcare cost savings of different sodium reduction strategies in Canada. BMC Public Health. 2025;25:2379.

[58] Flexner N, Ng AP, Ahmed M, Khandpur N, Acton RB, Lee JJ, et al. Estimating the dietary and health impact of implementing front—of—pack nutrition labeling in Canada: A macrosimulation modeling study. Front Nutr. 2023;10:1098231.