Does Nutri-Score Reliably Identify High-Sugar Foods Marketed to Children? A Cross-Sectional Study with Implications...

Background/Objectives: Front-of-pack labelling systems such as Nutri-Score are promoted as public health tools to guide consumers towards healthier food choices. However, their capacity to accurately signal sugar content in child-targeted foods-a key determinant of dental caries risk-remains poorly characterised. This study aimed to evaluate whether Nutri-Score category reliably reflects sugar content in pre-packaged foods marketed to children, and to discuss the implications for paediatric oral health. Methods: A cross-sectional observational study analysed the nutritional labels of 100 pre-packaged foods directed at the paediatric population, all displaying a Nutri-Score label, selected from three major supermarket chains in Valencia, Spain. Products were grouped into eight predefined food categories. Sugar content (g/100 g or 100 mL), Nutri-Score category (A-E), and ordinal position of sugar in the ingredients list were recorded. Global association between Nutri-Score grade and sugar content was evaluated using Spearman's rank correlation coefficient; category-level analyses used the Kruskal-Wallis or Mann-Whitney U test as appropriate. Results: A moderate statistically significant positive correlation was found between Nutri-Score grade and sugar content across all 100 products (ρ = 0.515, p < 0.001). In the exploratory category-level analyses, suggestive differences were observed in biscuits (H = 8.72, p = 0.033), milks and milk drinks (H = 9.02, p = 0.029), and desserts (H = 8.31, p = 0.016); none of these p-values survived Bonferroni correction for multiple comparisons (adjusted α = 0.006). Notably, some products rated A and B contained high sugar levels: one A-rated breakfast cereal reached 22.4 g/100 g, and the highest B-rated product (a flavoured milk drink) contained 22.1 g/100 g. No significant association was detected in cereals, breads, dairy products, juices, or frozen foods. Conclusions: Nutri-Score demonstrated limited discriminatory ability to identify high-sugar child-targeted foods consistently across food categories. These findings support recommending that paediatric dental practitioners advise caregivers to evaluate sugar content and ingredients lists beyond front-of-pack grading. Further regulatory refinement of the algorithm to specifically weight added sugar exposure in child-targeted products may be warranted.