Mandatory Nutri-Grade front-of-pack labels for beverages have been found in a study to redirect household consumers towards healthier drinks [1] , as well as encourage manufacturers to reformulate their products to include less sugar. Sugary drinks are a major driver of excess sugar intake and chronic disease risk.
The study comes at a timely juncture, with the Ministry of Health (MOH) looking to extend Nutri-Grade label requirements and advertising prohibitions to key dietary sources of sodium and saturated fat in 2027.
The study, conducted by researchers from Duke-NUS Medical School and published in the American Journal of Public Health , found that subsequent purchases of pre-packaged beverages by households had reduced sugar content by 18 per cent or 3.1 grams per day. They also found that purchases of less healthy drinks, or those with a ‘C’ or ‘D’ grade, reduced by 44 per cent.
Researchers analysed household scanner data—records of consumer pre-packaged beverage purchases captured via barcode scans through participants scanning items at home—from April 2019 to March 2024 to assess changes in sugary beverage purchases and product formulations. Working like a traffic light system for drinks, Nutri-Grade labels, which were implemented in December 2022, affect consumer behaviour with “red lights”—where a Grade ‘D’ encourages them to switch lanes to a “green light” (Grade ‘A’ or ‘B’). For consumers who are trying to make healthy lifestyle changes, that can mean swapping a Grade C drink for a Grade B one—small daily changes that add up across a population. Labels steer consumers, while thresholds steer manufacturers.
In response to the labelling system, the study found that manufacturers reformulated their products to reduce sugar content and move beverages below key sugar thresholds. Overall, reformulation lowered sugar content by 21 per cent. There was a 6 per cent increase, across all beverage reformulations, in the prevalence of non-sugar sweetener use.
Reformulation efforts also extended to dairy-containing drinks, as observed by an increase in lactose and decrease in saturated fat levels.
Principal investigator and Assistant Professor Soye Shin from Duke-NUS’ Health Services Research and Population Health (HSRPH) Programme at the time of the study, said:
“Nutri-Grade is doing what front-of-pack labels are meant to do: change what people buy and push companies to reduce sugar. That’s a meaningful population-level win. However, the market adapts simultaneously, with some products improving their grade by replacing sugar with other sweeteners. This shows why labelling policies may benefit from periodic updates in response to industry practices.”
Under the Nutri-Grade system, beverages are assigned a color-coded grade from A (healthiest) to D (least healthy), based on thresholds for sugar and saturated fat. Products graded C or D must display Nutri-Grade labels, and D-graded beverages are prohibited from advertising. Beverages with non-sugar sweeteners would not be given a grade A even if they do not contain sugar.
In addition, improvements in sugar reduction were observed across all households, with higher-income and nutritionally literate households showing larger reductions.
A co-author of the study, Ms Tan Yan Ning , formerly a research assistant at HSRPH, now a Duke-NUS MD student, stated:
“We noted that consumers purchased less Grade C and D beverages and more Grade A and B beverages. We also saw stronger effects among households with higher nutrition knowledge. This points to a need to strengthen nutrition literacy alongside policy measures such as Nutri-Grade labelling.”
Nutritional knowledge of consumers was measured through a validated questionnaire, where the researchers differentiated between groups of consumers with higher and lower scores.
The study is distinct from others, as research on front-of-pack labels rarely measures how both consumers and manufacturers respond. Follow-up research could extend to evaluating out of home beverage purchases and tracking the impact of these measures on longer-term consumption patterns and health outcomes.
Professor Lok Shee Mei , Duke-NUS' Interim Vice-Dean for Research, noted:
“This study shows that mandatory labelling can shift the market at scale—changing what people buy and what companies sell. The findings also highlight opportunities to strengthen nutrition literacy and for the industry to consider more ways to reformulate. Altogether, this helps Singapore fine-tune Nutri-Grade and provide practical lessons for other countries considering front-of-pack labelling.”
Duke-NUS is a global leader in medical education and a biomedical research powerhouse, combining basic scientific research with translational know-how to bring a better understanding to common diseases and develop new treatment approaches to improve the lives of people in Singapore and beyond.
[1] These include unsweetened beverages, dairy products and plain water.
American Journal of Public Health
Evaluating the Impact of Singapore’s Nutri-Grade Beverage Labels on Prepackaged Beverage Purchases and Product Nutrient Composition: A Before–After Study, 2019–2024
17-Jun-2026