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Background Food systems highly contribute to anthropogenic greenhouse gas emissions and shifting towards more environmentally friendly diets is urgently needed. Enabling consumers to compare the environmental impact of food products at point-of-purchase with front-of-pack labelling could be a promising strategy to trigger more environmentally friendly food choices. This strategy remained to be tested. Methods The effect of a new traffic-light front-of-pack environmental label on food choices was tested in a 2-arm randomised controlled trial in a virtual reality supermarket. Participants ( n  = 132) chose food products to compose two main meals for an everyday meal scenario and for an environmentally friendly meal scenario with or without the label. The environmental label (ranging from A: green/lowest impact, to E: red/highest impact) was based on the Environmental Footprint (EF) single score calculation across food categories. The effect of the label on the environmental impact of food choices in each scenario was tested using linear mixed models. Results In the everyday meal scenario, the environmental impact of meals was lower in the label condition than in the no label condition (-0.17 ± 0.07 mPt/kg, p  = 0.012). This reduction was observed at no nutritional, financial nor hedonic cost. The effectiveness of the label can be attributed to a change in the food categories chosen: less meat-based and more vegetarian meals were chosen with the label. In the environmentally friendly meal scenario, we demonstrated that the label provided new information to the participants as they were able to further reduce the environmental impact of their food choices with the label (-0.19 ± 0.07 mPt/kg, p  = 0.005). Conclusions Implementing a front-of-pack environmental label on food products in real supermarkets could increase awareness of the environmental impact of food and contribute to drive more environmentally friendly food choices. Trial registration The study protocol was pre-registered prior to data collection at Clinicaltrials.gov (NCT04909372).

Purpose. While the consumption of ultra-processed foods is steadily increasing, there is a growing interest in more sustainable diets that would include more plant protein. We aimed to study associations between the degree of food processing, patterns of protein intake, diet quality and cardiometabolic risk.Methods. Using the NOVA classification, we assessed the proportion of energy from unprocessed/minimally processed foods (MPFp), processed foods (PFp) and ultra-processed foods (UPFp) in the diets of 1774 adults (18-79y) from the latest cross-sectional French national survey (INCA3, 2014-2015). We studied the associations between MPFp, PFp and UPFp with protein intakes, diet quality (using the PANDiet scoring system, the global (PDI), healthful (hPDI) and unhealthful (uPDI) plant-based diet indices) and the risk of cardiometabolic death (using the EpiDiet model). Results. MPFp was positively associated with animal protein intake and plant-protein diversity, whereas PFp was positively associated with plant protein intake and negatively with plant-protein diversity. The PANDiet was positively associated with MPFp (β=0.14, P<0.0001) but negatively with UPFp (β=-0.05, P<0.0001). These associations were modified by adjustment for protein intakes and plant-protein diversity. As estimated with comparative risk assessment modeling between extreme tertiles of intake, mortality from cardiometabolic diseases would be decreased with higher MPFp (e.g. by 31% for ischemic heart diseases) and increased with UPFp (by 42%) and PFp (by 11%).Conclusions. In the French population, in contrast with UPFp, a higher MPFp was associated with a higher animal protein intake, a better plant-protein diversity, a higher diet quality and a markedly lower cardiometabolic risk.

Background Changing the food environment is an important public health lever for encouraging sustainable food choices. Targeting the availability of vegetarian main meals served in cafeterias substantially affects food choice, but acceptability has never been assessed. We examined the effects of an availability intervention at a French university cafeteria on students’ main meal choices, meal offer satisfaction and liking. Methods A four-week controlled trial was conducted in a university cafeteria in Dijon, France. During the two-week control period, vegetarian main meals constituted 24% of the offer. In the subsequent two-week intervention period, this proportion increased to 48%, while all the other menu items remained unchanged. Students were not informed of the change. Student choices were tracked using production data, and daily paper ballots were used to assess student satisfaction with the meal offer and liking of the main meal they chose (score range [1;5]). Nutritional quality, environmental impact, and cost of production of meal choices were calculated for each lunchtime. Food waste was measured over 4 lunchtimes during control and intervention periods. An online questionnaire collected student feedback at the end of the study. Results Doubling availability of vegetarian main meals significantly increased the likelihood of choosing vegetarian options (OR = 2.57, 95% CI = [2.41; 2.74]). Responses of the paper ballots ( n  = 18,342) indicated slight improvements in meal offer satisfaction from 4.05 ± 0.92 to 4.07 ± 0.93 ( p  = 0.028) and in liking from 4.09 ± 0.90 to 4.13 ± 0.92 ( p  < 0.001) during control and intervention periods, respectively. The end-of-study questionnaire ( n  = 510) revealed that only 6% of students noticed a change the availability of vegetarian main meals. The intervention led to a decrease in the environmental impact of the main meals chosen, a slight decrease in nutritional quality, a slight increase in meal costs and no change in food waste. Conclusions Doubling availability of vegetarian main meals in a university cafeteria resulted in a twofold increase in their selection, with students reporting being more satisfied and liking the main meals more during the intervention period. These results suggest that serving an equal proportion of vegetarian and nonvegetarian main meals could be considered in French university cafeterias to tackle environmental issues. Trial registration Study protocol and analysis plan were pre-registered on the Open Science Framework ( https://osf.io/pf3x7/ ).

A 2-arm randomised control trial (with and without labels) will be conducted to test the effects of an environmental label on food choices in a virtual supermarket. A sample of 130 participants will take part in two shopping tasks: 1/ selection of 3 products to prepare a home-made dish, and 2/ selection of a ready-to-eat dish. These two tasks will be repeated for two scenarios: 1/ participants will be asked to select the foods for usual meals, and 2/ participants will be asked to select the foods for environmentally-friendly meals. This experimental design will allow to compare food choices in the presence vs. the absence of an environmental label and to investigate whether the label is informative and likely to help individuals to choose more environmental-friendly food options when explicitly asked to do so.