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A group of researchers from Duke-NUS Medical School has developed a novel digital toolkit aimed at assisting consumers in making healthier grocery choices online. This innovation could significantly impact the global battle against chronic diseases like heart disease, stroke, and diabetes.
In their recent study published in the American Journal of Preventive Medicine, the researchers demonstrated that incorporating strategic digital features—such as color-coded nutritional quality indicators and prompts for healthier alternatives—within an online grocery shopping platform markedly improved the nutritional quality of shoppers’ selections.
The study highlights the potential effectiveness of front-of-package (FOP) labels, which have shown limited ability to enhance diet quality on their own when paired with additional interventions.
The research included a randomized trial conducted on NUSMart, an online grocery store developed by the Duke-NUS team. Participants were divided into two groups and asked to place three orders over a period of three to six weeks. The control group accessed a standard version of NUSMart, while the experimental group utilized a version enhanced with additional digital features, including:
Traffic light nutritional quality indicators: The FOP labels mimicked traffic light signals to inform shoppers of food products’ nutritional quality through three color categories: green (optimal), amber, and red marked with an “X” to denote items to avoid.
These color bands were determined based on the food products’ Nutri-Score (NS) points, which reflect various nutritional factors like energy, sugar, sodium, and fat content for every 100g/ml. The points were then converted into a five-letter grading scale, where A represents the healthiest choice and E the least healthy.
Organizing groceries by nutritional value: Utilizing the NS points, healthier items were prominently displayed first, while the control version of NUSMart listed items alphabetically.
Real-time feedback on cart nutrition: Participants received updates on their grocery cart’s nutritional quality through a pie chart representing the proportion of items in each color category. They also could compare their selections against a reference cart tailored for healthy shopping based on past data.
Recommendations for healthier substitutes: Shoppers were presented with up to four healthier alternatives, maintaining similar prices and characteristics to their selected items, allowing for easy substitutions with just a click.
These features resulted in a significant enhancement of the nutritional quality of participants’ grocery carts, elevating their NS grade from C to B. This improvement surpassed outcomes from previous studies that focused solely on the use of FOP labels, leading to reductions in caloric intake (12.86 kcal), total fat (1.21g), saturated fat (0.85g), sugar (0.82g), and sodium (156.64mg) in purchased items.
Crucially, the study noted that the utilization of these four digital features consistently influenced healthier food choices during all three orders.
Assistant Professor Soye Shin from Duke-NUS’ Health Services and Systems Research Programme, the lead author of the study, remarked on the implications of their findings: “As online grocery shopping continues to grow, we aimed to create low-cost, scalable online tools that can guide consumers toward healthier options at the point of purchase. Our results indicate the potential of these digital features to enhance dietary habits and health outcomes.”
The research further emphasizes the benefits of introducing dietary quality labels in initiatives such as Singapore’s Nutri-Grade labeling program, which currently focuses on beverages but is set to expand into other food categories.
Senior author Professor Eric Finkelstein of Duke-NUS’ Health Services and Systems Research Programme expressed optimism about the findings, stating: “While these results are promising, our next objective is to collaborate with retailers to integrate these features into current online platforms. Only then can we realize the full potential of this approach.”
The researchers plan to widen their study to include participants from low socio-economic backgrounds and those with limited nutritional knowledge. They also aim to explore whether this multi-faceted intervention strategy can yield long-term health benefits for consumers.
Professor Patrick Tan, Senior Vice-Dean for Research at Duke-NUS, noted the broader impact of the study: “This research illustrates how strategic, evidence-based interventions—when applied effectively—can empower individuals to make healthier choices daily. It also demonstrates how academic research can yield practical tools that positively influence population health outcomes.”
Duke-NUS continues to lead in advancing biomedical research and translational innovations, with this study representing its ongoing commitment to enhancing global health through systematic research and scientific discoveries.
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