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Thiboonboon K, Lourenco RDA, Cronin P, Khoo T, Goodall S. Economic Evaluations of Obesity-Targeted Sugar-Sweetened Beverage (SSB) Taxes-A Review to Identify Methodological Issues. Health Policy 2024; 144:105076. [PMID: 38692186 DOI: 10.1016/j.healthpol.2024.105076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 04/06/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Economic evaluations of public health interventions like sugar-sweetened beverage (SSB) taxes face difficulties similar to those previously identified in other public health areas. This stems from challenges in accurately attributing effects, capturing outcomes and costs beyond health, and integrating equity effects. This review examines how these challenges were addressed in economic evaluations of SSB taxes. METHODS A systematic review was conducted to identify economic evaluations of SSB taxes focused on addressing obesity in adults, published up to February 2021. The methodological challenges examined include measuring effects, valuing outcomes, assessing costs, and incorporating equity. RESULTS Fourteen economic evaluations of SSB taxes were identified. Across these evaluations, estimating SSB tax effects was uncertain due to a reliance on indirect evidence that was less robust than evidence from randomised controlled trials. Health outcomes, like quality-adjusted life years, along with a healthcare system perspective for costs, dominated the evaluations of SSB taxes, with a limited focus on broader non-health consequences. Equity analyses were common but employed significantly different approaches and exhibited varying degrees of quality. CONCLUSION Addressing the methodological challenges remains an issue for economic evaluations of public health interventions like SSB taxes, suggesting the need for increased attention on those issues in future studies. Dedicated methodological guidelines, in particular addressing the measurement of effect and incorporation of equity impacts, are warranted.
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Affiliation(s)
- Kittiphong Thiboonboon
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia.
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
| | - Paula Cronin
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
| | - Terence Khoo
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
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Rey-García J, Mérida DM, Donat-Vargas C, Sandoval-Insausti H, Rodríguez-Ayala M, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P. Less Favorable Nutri-Score Consumption Ratings Are Prospectively Associated with Abdominal Obesity in Older Adults. Nutrients 2024; 16:1020. [PMID: 38613053 PMCID: PMC11013145 DOI: 10.3390/nu16071020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/23/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Nutri-Score is a front-of-package (FOP) labeling designed to assist consumers in selecting healthier options at the point of purchase and ultimately enhance their health. This study aims to evaluate the association between the Nutri-Score system and incident abdominal obesity (AO) in community-dwelling older adults. A prospective cohort of 628 individuals aged ≥ 60 were recruited in Spain between 2008-2010 and were reexamined between 2015-2017. Dietary intake was evaluated utilizing a validated computerized dietary history. Food was categorized based on the Nutri-Score system into five levels from A (green, representing the best quality) to E (red, representing the poorest quality). A five-color Nutri-Score dietary index (5-CNS DI) in g/day/kg was calculated for each participant. AO was determined by a waist circumference (WC) of ≥102 cm for men and ≥88 cm for women. Logistic regression models were adjusted for the main potential confounders. During a mean six-year follow-up, 184 incident cases of AO occurred. The odds ratio (OR) and 95% confidence interval (CI) for AO, when comparing the highest and lowest quartiles of the 5-CNS DI, were 2.45 (1.17-5.14), with a p-value for trend of 0.035. In sensitivity analyses, the OR was 2.59 (1.22-5.52, p-trend: 0.032) after adjustment for WC at baseline, and 1.75 (0.74-4.18, p-trend: 0.316) after adjustment for ultra-processed food consumption. In conclusion, less favorable food-consumption ratings in the Nutri-Score are associated with incident AO in the elderly. These findings support the use of this FOP system to potentially improve metabolic health.
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Affiliation(s)
- Jimena Rey-García
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, 28034 Madrid, Spain;
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
| | - Diana María Mérida
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
| | - Carolina Donat-Vargas
- ISGlobal-Institut de Salut Global de Barcelona, 08036 Barcelona, Spain;
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | | | - Montserrat Rodríguez-Ayala
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
- Department of Microbiology and Parasitology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - José Ramón Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
- IMDEA-Food Institute, Campus de Excelencia Internacional (CEI)/Universidad Autónoma de Madrid (UAM) + Consejo Superior de Investigaciones Científicas (CSIC), 28049 Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (D.M.M.); (M.R.-A.); (J.R.B.); (F.R.-A.)
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
- IMDEA-Food Institute, Campus de Excelencia Internacional (CEI)/Universidad Autónoma de Madrid (UAM) + Consejo Superior de Investigaciones Científicas (CSIC), 28049 Madrid, Spain
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Nie T, Huang S, Yang Y, Hu A, Wang J, Cheng Z, Liu W. A review of the world's salt reduction policies and strategies - preparing for the upcoming year 2025. Food Funct 2024; 15:2836-2859. [PMID: 38414443 DOI: 10.1039/d3fo03352j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Excessive consumption of dietary sodium is a significant contributor to non-communicable diseases, including hypertension and cardiovascular disease. There is now a global consensus that regulating salt intake is among the most cost-effective measures for enhancing public health. More than half of the countries worldwide have implemented multiple strategies to decrease salt consumption. Nevertheless, a report on sodium intake reduction published by the World Health Organization revealed that the world is off-track to meet its targeted reduction of 30% by 2025. The global situation regarding salt reduction remains concerning. This review will center on domestic and international salt reduction policies, as well as diverse strategies, given the detrimental effects of excessive dietary salt intake and the existing global salt intake scenario. Besides, we used visualization software to analyze the literature related to salt reduction research in the last five years to explore the research hotspots in this field. Our objective is to enhance public awareness regarding the imperative of reducing salt intake and promoting the active implementation of diverse salt reduction policies.
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Affiliation(s)
- Ting Nie
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Siqi Huang
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Yuxin Yang
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Anna Hu
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Jianing Wang
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Zeneng Cheng
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
| | - Wenjie Liu
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
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Jia J, Van Horn L, Linder JA, Ackermann RT, Kandula NR, O'Brien MJ. Menu Calorie Label Use and Diet Quality: a Cross-Sectional Study. Am J Prev Med 2023; 65:1069-1077. [PMID: 37433378 PMCID: PMC11192142 DOI: 10.1016/j.amepre.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Menu calorie labeling has been implemented in food service businesses to promote healthy food choices; however, evidence is limited on whether label use is associated with healthier dietary intake. This study examined the association between menu calorie label use and diet quality and whether it varied by weight status. METHODS Adults in the National Health and Nutrition Examination Survey 2017-2018 who visited restaurants were included. Menu calorie label use was categorized as did not notice labels, noticed labels, and used labels. Diet quality was measured using the Healthy Eating Index 2015 (maximum score 100) by two 24-hour diet recalls. The association between menu calorie label use and diet quality was examined using multiple linear regression and tested for effect modification by weight status. Data were collected during 2017-2018 and analyzed during 2022-2023. RESULTS Of 3,312 participants (representing 195,167,928 U.S. adults), 43% did not notice labels, 30% noticed labels, and 27% used labels. Using labels was associated with 4.0 points (95% CI 2.2, 5.8) higher Healthy Eating Index 2015 scores than not noticing labels. Healthy Eating Index 2015 scores in those using labels were higher for adults with normal BMI (3.4 points; 95% CI=0.2, 6.7), overweight (6.5 points; 95% CI=3.6, 9.5), and obesity (3.0 points; 95% CI=1.0, 5.1) (p-interaction=0.0004) than those who did not notice labels. CONCLUSIONS Using menu calorie labels was associated with modestly healthier diet quality than not noticing labels, regardless of weight status. This suggests that providing caloric information may help some adults with food decisions.
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Affiliation(s)
- Jenny Jia
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Linda Van Horn
- Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey A Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ronald T Ackermann
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Namratha R Kandula
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J O'Brien
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Alcaire F, Machín L, Curutchet MR, Giménez A, Ares G. Parent Experiences With Warning Labels After Policy Implementation in Uruguay. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:823-832. [PMID: 37804264 DOI: 10.1016/j.jneb.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To explore the perception and experiences of parents of children and adolescents during the first year of the mandatory implementation of nutritional warning labels in Uruguay. DESIGN Qualitative research based on semistructured interviews. SETTING Montevideo, Uruguay. PARTICIPANTS Twenty-eight parents of children and adolescents. PHENOMENON OF INTEREST Perception of and experiences with warning labels, a front-of-pack nutrition labeling scheme that has become increasingly popular in Latin America. ANALYSIS Content analysis of the transcripts based on a deductive-inductive approach. RESULTS Interview transcripts evidenced high awareness, acceptance, and understanding of warning labels among parents of children and adolescents. Most participants reported considering warnings for decision making and changing their purchase decisions because of their implementation, particularly when choosing foods for their children. They reported their children were aware of and understood warnings but did not tend to take them into account when choosing foods. CONCLUSIONS AND IMPLICATIONS Results from the present work contribute to the growing body of literature showing the effectiveness of warning labels. Lack of interest or perceived benefits and structural barriers emerged as key motives for not using the warnings when making purchasing decisions, suggesting the need to develop additional strategies to increase policy effectiveness.
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Affiliation(s)
- Florencia Alcaire
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Pando, Canelones, Uruguay
| | - Leandro Machín
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Montevideo, Uruguay
| | | | - Ana Giménez
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Pando, Canelones, Uruguay
| | - Gastón Ares
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Pando, Canelones, Uruguay; Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Montevideo, Uruguay.
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Varela P, De Rosso S, Ferreira Moura A, Galler M, Philippe K, Pickard A, Rageliene T, Sick J, van Nee R, Almli VL, Ares G, Grønhøj A, Spinelli S, van Kleef E. Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system. Nutr Res Rev 2023:1-21. [PMID: 37746804 DOI: 10.1017/s0954422423000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.
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Affiliation(s)
| | - Sofia De Rosso
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France
| | | | | | - Kaat Philippe
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France
| | | | | | - Julia Sick
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Florence, Italy
| | - Roselinde van Nee
- Wageningen University, Marketing & Consumer Behaviour Group, Wageningen, The Netherlands
| | | | - Gastón Ares
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | | | - Sara Spinelli
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Florence, Italy
| | - Ellen van Kleef
- Wageningen University, Marketing & Consumer Behaviour Group, Wageningen, The Netherlands
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Velázquez AL, Vidal L, Antúnez L, Alcaire F, Varela P, Ares G. Children's reaction to sugar reduced dairy desserts in the context of the implementation of nutritional warning labels: An exploratory study. Food Res Int 2023; 170:113001. [PMID: 37316071 DOI: 10.1016/j.foodres.2023.113001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/16/2023]
Abstract
The aim of the present work was to explore children's reaction to sugar reduction in the context of the implementation of nutritional warnings in Uruguay. The study was composed of two sessions involving three evaluation conditions: tasting without package information, package evaluation without tasting, and tasting with package information. A total of 122 children, ages ranging between 6 and 13 years old (47% girls) were involved in the study. In the first session, children's hedonic and emotional response to a regular and a sugar-reduced chocolate dairy dessert (without other sweeteners) was evaluated. In the second session, children first evaluated their expected liking, emotional associations and choice of packages differing in the presence of warning labels for excessive sugar content and cartoon character (2x2 design). Finally, they tasted the selected sample in the presence of the package and evaluated their liking, emotional associations, and intention to re-taste it. Although sugar reduction led to a significant reduction in overall liking, the dessert with 40% sugar reduction showed a mean overall score of 6.5 in a 9-point hedonic scale and was described using positive emoji (, , ). When the desserts were tasted with package information, no significant differences in the expected overall liking of the regular and sugar-reduced dessert were found. Regarding the effect of packaging elements, the presence of a warning label highlighting excessive content of sugar did not have a significant effect on children's choice. Instead, children's choices were defined by the presence of a cartoon character. Results from the present work provide additional evidence about the feasibility of reducing the sugar content and sweetness of dairy products targeted at children and stress the need to regulate the use of cartoon characters on products with an unfavorable nutritional profile. Methodological recommendations for sensory and consumer research with children are also discussed.
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Affiliation(s)
- Ana Laura Velázquez
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000 Pando, Canelones, Uruguay; Graduate Program in Chemistry, Facultad de Química, Universidad de la República, Uruguay
| | - Leticia Vidal
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000 Pando, Canelones, Uruguay
| | - Lucía Antúnez
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000 Pando, Canelones, Uruguay
| | - Florencia Alcaire
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000 Pando, Canelones, Uruguay
| | | | - Gastón Ares
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000 Pando, Canelones, Uruguay.
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POMERANZ JENNIFERL, CASH SEANB, MOZAFFARIAN DARIUSH. US Policies That Define Foods for Junk Food Taxes, 1991-2021. Milbank Q 2023; 101:560-600. [PMID: 37101340 PMCID: PMC10262384 DOI: 10.1111/1468-0009.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/28/2023] [Accepted: 03/02/2023] [Indexed: 04/28/2023] Open
Abstract
Policy Points Suboptimal diet is a leading cause of mortality and morbidity in the United States. Excise taxes on junk food are not widely utilized in the United States. The development of a workable definition of the food to be taxed is a substantial barrier to implementation. Three decades of legislative and regulatory definitions of food for taxes and related purposes provide insight into methods to characterize food to advance new policies. Defining policies through Product Categories combined with Nutrients or Processing may be a method to identify foods for health-related goals. CONTEXT Suboptimal diet is a substantial contributor to weight gain, cardiometabolic diseases, and certain cancers. Junk food taxes can raise the price of the taxed product to reduce consumption and the revenue can be used to invest in low-resource communities. Taxes on junk food are administratively and legally feasible but no definition of "junk food" has been established. METHODS To identify legislative and regulatory definitions characterizing food for tax and other related purposes, this research used Lexis+ and the NOURISHING policy database to identify federal, state, territorial, and Washington DC statutes, regulations, and bills (collectively denoted as "policies") defining and characterizing food for tax and related policies, 1991-2021. FINDINGS This research identified and evaluated 47 unique laws and bills that defined food through one or more of the following criteria: Product Category (20 definitions), Processing (4 definitions), Product intertwined with Processing (19 definitions), Place (12 definitions), Nutrients (9 definitions), and Serving Size (7 definitions). Of the 47 policies, 26 used more than one criterion to define food categories, especially those with nutrition-related goals. Policy goals included taxing foods (snack, healthy, unhealthy, or processed foods), exempting foods from taxation (snack, healthy, unhealthy, or unprocessed foods), exempting homemade or farm-made foods from state and local retail regulations, and supporting federal nutrition assistance objectives. Policies based on Product Categories alone differentiated between necessity/staple foods on the one hand and nonnecessity/nonstaple foods on the other. CONCLUSIONS In order to specifically identify unhealthy food, policies commonly included a combination of Product Category, Processing, and/or Nutrient criteria. Explanations for repealed state sales tax laws on snack foods identified retailers' difficulty pinpointing which specific foods were subject to the tax as a barrier to implementation. An excise tax assessed on manufacturers or distributors of junk food is a method to overcome this barrier and may be warranted.
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Affiliation(s)
| | - SEAN B CASH
- Tufts University Friedman School of Nutrition Science and Policy
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O’Mahony S, O’Donovan CB, Collins N, Burke K, Doyle G, Gibney ER. Reformulation of Processed Yogurt and Breakfast Cereals over Time: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3322. [PMID: 36834017 PMCID: PMC9964677 DOI: 10.3390/ijerph20043322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Poor diet is responsible for a quarter of European non-communicable disease (NCD)-related deaths. The reformulation of sugar, salt, and saturated fat in processed packaged foods offers an opportunity to reduce consumption of nutrients of concern and also support a reduction in energy intake. To date, there have been no publications measuring progress in food reformulation by compiling published evidence for a food category. The aim of this scoping review was to identify, characterize and summarise the findings of studies analysing the reformulation of processed yogurt and breakfast cereals. The review answered the research question: "What is the impact of food reformulation on the nutrient quality of yogurt and breakfast cereals available in the retail environment?" The research protocol was defined based on PRISMA-ScR guidelines. Five databases were searched in May 2022. Thirteen studies, published between 2010 and 2021 and completed across seven countries were eligible for inclusion. There were sufficient eligible studies to identify trends in sodium, salt, and sugar reduction in breakfast cereals. However, there was minimal or no reduction in energy, which may bring into question the use of food reformulation as part of an overall health strategy for obesity reduction.
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Affiliation(s)
- Sinead O’Mahony
- Food Safety Authority of Ireland, The Exchange, Georges Dock, D01 P2V6 Dublin, Ireland
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin (UCD), Belfield, D04 V1W8 Dublin, Ireland
- School of Agriculture and Food Science, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Clare B. O’Donovan
- Food Safety Authority of Ireland, The Exchange, Georges Dock, D01 P2V6 Dublin, Ireland
| | - Nuala Collins
- Food Safety Authority of Ireland, The Exchange, Georges Dock, D01 P2V6 Dublin, Ireland
| | - Kevin Burke
- Department of Mathematics and Statistics, University of Limerick, V94 T9PX Limerick, Ireland
| | - Gerardine Doyle
- College of Business, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
- UCD Geary Institute of Public Policy, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Eileen R. Gibney
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin (UCD), Belfield, D04 V1W8 Dublin, Ireland
- School of Agriculture and Food Science, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
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10
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Ares G, Antúnez L, Curutchet MR, Galicia L, Natero V, Giménez A, Otterbring T. Qualitative exploration of the reasons for not using nutritional warnings after policy implementation in Uruguay. Health Promot Int 2023; 38:6974787. [PMID: 36617288 DOI: 10.1093/heapro/daac174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Nutritional warnings have gained popularity, particularly in the region of the Americas, to facilitate the identification of products with excessive content of nutrients associated with non-communicable diseases and encourage healthier food choices. Although warnings have been shown to be effective, an in-depth understanding of the reasons why some consumers do not use them is still lacking. The aim of the present work was to explore self-reported use of nutritional warnings and to identify the reasons for not considering nutritional warnings for making food purchase decisions after policy implementation in Uruguay. A non-probabilistic sample of 858 Uruguayan participants was recruited using an advertisement on Facebook and Instagram. Through an online survey, self-reported use of nutritional warnings was asked using a closed-open ended questions. Participants who reported not considering warnings to make their purchase decisions were asked to explain the reasons why using an open-ended question. Responses were analysed using deductive coding, based on the Behavioural Drivers Model. Thirty seven percent of the participants stated that the warnings had not influenced their purchase decisions. Motives for not being influenced by the warnings were related to lack of interest, attitudes, lack of perceived self-efficacy, cognitive biases and limited rationality when making purchase decisions. In addition, structural barriers, such as availability, cost and trust in the food industry also emerged from participants' responses. Strategies to encourage the use of warnings should include communication campaigns and policies to address structural barriers related to the perceived availability and affordability of healthy foods.
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Affiliation(s)
- Gastón Ares
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n. C.P. 91000, Pando, Canelones, Uruguay
| | - Lucía Antúnez
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n. C.P. 91000, Pando, Canelones, Uruguay
| | | | - Luis Galicia
- Ministerio de Salud Pública, 18 de Julio 1892, CP 11200, Montevideo, Uruguay
| | - Virginia Natero
- Ministerio de Salud Pública, 18 de Julio 1892, CP 11200, Montevideo, Uruguay
| | - Ana Giménez
- Sensometrics and Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n. C.P. 91000, Pando, Canelones, Uruguay
| | - Tobias Otterbring
- Department of Management, School of Business and Law, University of Agder, Kristiansand, Norway
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Saavedra-Garcia L, Meza-Hernández M, Diez-Canseco F, Taillie LS. Reformulation of Top-Selling Processed and Ultra-Processed Foods and Beverages in the Peruvian Food Supply after Front-of-Package Warning Label Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:424. [PMID: 36612748 PMCID: PMC9819345 DOI: 10.3390/ijerph20010424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Front-of-package warning label (FOPWL) policies incentivize the food industry to reduce the content of regulated nutrients in products. We explored changes in the content of nutrients of concern (sugar, saturated fat, trans fat, and sodium) and the percentage of products in the Peruvian food supply that would carry a FOPWL before and after Peru’s implementation of FOPWLs. Longitudinal data on the top-selling foods and beverages (n = 94) were collected at three time points: three months before the implementation of the policy, four months after, and two years after. Using the nutritional information declared on products’ labels, we compared quantities of nutrients of concern and the percentage of foods that would carry a FOPWL at each time point. Between the first and the third data collection, a decrease in the median sugar content of beverages was observed (from 9.0 to 5.9 g/100 mL, p = 0.005), accompanied by an increase in the use of nonnutritive sweeteners. This change drove the reduction of the percentage of beverages that would carry a FOPWL (from 59 to 31%, p = 0.011). Among foods, decreases were observed in saturated fat (from 6.7 to 5.9 g/100 g, p = 0.002). The percentage of foods that would carry a FOPWL according to their nutritional profile declined from before to after implementation of the policy (from 82 to 62%, p < 0.001). The study shows that the industry reformulated products in Peru after implementation of its FOPWL policy.
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Affiliation(s)
- Lorena Saavedra-Garcia
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - Mayra Meza-Hernández
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
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Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review. Nutrients 2022; 15:nu15010055. [PMID: 36615712 PMCID: PMC9823488 DOI: 10.3390/nu15010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This systematic review aims to identify and characterize existing national sugar reduction initiatives and strategies in the Eastern Mediterranean Region. For this purpose, a systematic review of published and grey literature was performed. A comprehensive list of search terms in the title/abstract/keyword fields was used to cover the four following concepts (1) sugar, (2) reduction OR intake, (3) policy and (4) EMR countries. A total of 162 peer-reviewed documents were identified, until the 2nd of August 2022. The key characteristics of the identified national strategies/initiatives included the average sugar intake of each country's population; sugar levels in food products/beverages; implementation strategies (taxation; elimination of subsidies; marketing regulation; reformulation; consumer education; labeling; interventions in public institution settings), as well as monitoring and evaluation of program impact. Twenty-one countries (95%) implemented at least one type of sugar reduction initiatives, the most common of which was consumer education (71%). The implemented fiscal policies included sugar subsidies' elimination (fourteen countries; 67%) and taxation (thirteen countries 62%). Thirteen countries (62%) have implemented interventions in public institution settings, compared to twelve and ten countries that implemented food product reformulation and marketing regulation initiatives, respectively. Food labeling was the least implemented sugar reduction initiative (nine countries). Monitoring activities were conducted by four countries only and impact evaluations were identified in only Iran and Kingdom of Saudi Arabia (KSA). Further action is needed to ensure that countries of the region strengthen their regulatory capacities and compliance monitoring of sugar reduction policy actions.
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Bercholz M, Ng SW, Stacey N, Swart EC. Decomposing consumer and producer effects on sugar from beverage purchases after a sugar-based tax on beverages in South Africa. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101136. [PMID: 35358759 PMCID: PMC9288974 DOI: 10.1016/j.ehb.2022.101136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 02/05/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
Growing global concern about obesity and diet-related non-communicable diseases has raised interest in fiscal policy as a tool to reduce this disease burden and its social costs, especially excise taxes on sugar-sweetened beverages (SSBs). Of particular interest have been nutrient-based taxes to improve diet quality. These can incentivize producers to reformulate existing products and introduce healthier alternatives into their ranges. In 2018, South Africa adopted a sugar-based tax on SSBs, the Health Promotion Levy (HPL). Early findings suggest that purchases of higher-sugar taxable beverages fell and purchases of no- and lower-sugar beverages increased, alongside significant reductions in the sugar content of overall beverage purchases. However, underlying these changes are consumption shifts as well as product reformulation and changes in producers' product portfolios. Drawing on a household scanner dataset, this study employed a descriptive approach to decompose changes in the sugar content of households' non-alcoholic beverage purchases into producer factors (reformulation and product entry and exit) and consumer factors (product switching and volume changes as a result of price changes, changing preferences, or other factors). We look at these factors as the tax was announced and implemented across a sample of over 3000 South African households, and then by Living Standard Measures (LSM) groups (middle vs. high). The sugar content of beverage purchases fell by 4.9 g/capita/day overall, a 32% decrease. Taken in isolation, consumer switching and volume changes together led to a reduction equivalent to 71% of the total change, while reformulation accounted for a decrease equal to 34% of that change. Middle-LSM households experienced larger reductions than high-LSM households due to larger changes on the consumer side. For both LSM groups, reformulation-led reductions mostly occurred after implementation, and most changes came from taxable beverage purchases. As sugary drink tax designs evolve with broader implementation globally, understanding both supply- and demand-side factors will help to better assess the population and equity potential of these policies.
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Affiliation(s)
- Maxime Bercholz
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates.
| | - Nicholas Stacey
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom; SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa; DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
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Consumer Motives for Choosing Fruit and Cereal Bars—Differences Due to Consumer Lifestyles, Attitudes toward the Product, and Expectations. Nutrients 2022; 14:nu14132710. [PMID: 35807890 PMCID: PMC9268435 DOI: 10.3390/nu14132710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
Fruit and cereal bars are the response to the changing needs of consumers seeking health-promoting and convenient products. A cross-sectional study was conducted using the CAWI (Computer-Assisted Web Interview) method, with 1034 respondents consuming products of this kind. The aims of the study were (1) to identify consumer segments based on the importance they attached to the selected attributes of fruit and cereal bars and (2) to characterize the identified segments in terms of frequency and reasons for the consumption of fruit and cereal bars, views on their impact on health, and consumer behavior related to the selected lifestyle elements. Five distinct consumer clusters were identified. Involved and Health-oriented were more likely to consume bars, perceiving them as nutritious products, with a positive impact on health. Frugal and Visual consumed fruit and cereal bars the least frequently. They paid little attention to choosing healthier products in daily diet and physical activity. The Information seekers consumed bars to reduce stress and to improve their mood.
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Dunford EK, Farrand C, Huffman MD, Raj TS, Shahid M, Ni Mhurchu C, Neal B, Johnson C. Availability, healthiness, and price of packaged and unpackaged foods in India: A cross-sectional study. Nutr Health 2021; 28:571-579. [PMID: 34931930 DOI: 10.1177/02601060211039124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Vulnerable populations are the most prone to diet-related disease. The availability, healthiness, and price of foods have established associations with diet-related disease in communities. However, data describing this in India are sparse, particularly in urban slums and rural areas. Aim: To quantify and compare availability, healthiness, and price of packaged and unpackaged foods and beverages in India, and to identify opportunities to improve diets and health of vulnerable populations. Methods: Nutrition data and price were collected on foods and beverages available at 44 stores in urban, urban slum, and rural areas in four states in India between May and August 2018. Healthiness was assessed using the Australasian Health Star Rating system and product retail prices were examined. Comparisons in the findings were made across state, community area type, and adherence to current and draft Indian food labeling regulations. Results: Packaged foods and beverages (n = 1443, 89%) were more prevalent than unpackaged (n = 172, 11%). Unpackaged products were healthier than packaged (mean Health Star Rating = 3.5 vs 2.0; p < 0.001) and lower in price (median price per 100 g/ml: 13.42 Indian rupees vs 25.70 Indian rupees; p < 0.001), a pattern observed across most community area types and states. 96% of packaged products were compliant with current Indian labeling regulations but only 23% were compliant with proposed labeling regulations. Conclusions: Unpackaged products were on average much healthier and lower in price than packaged foods and beverages. Food policies that support greater availability, accessibility and consumption of unpackaged foods, while limiting consumption of packaged foods, have enormous potential for sustaining the health of the Indian population.
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Affiliation(s)
- Elizabeth K Dunford
- Food Policy Division, 211065The George Institute for Global Health, University of New South Wales, Australia.,Department of Nutrition, 2331Gillings Global School of Public Health, 12244The University of North Carolina at Chapel Hill, USA
| | - Clare Farrand
- Food Policy Division, 211065The George Institute for Global Health, University of New South Wales, Australia
| | - Mark D Huffman
- Food Policy Division, 211065The George Institute for Global Health, University of New South Wales, Australia.,Feinberg School of Medicine, Northwestern University, USA
| | | | - Maria Shahid
- Food Policy Division, 211065The George Institute for Global Health, University of New South Wales, Australia
| | - Cliona Ni Mhurchu
- Food Policy Division, 211065The George Institute for Global Health, University of New South Wales, Australia.,National Institute for Health Innovation, 62710University of Auckland, New Zealand
| | - Bruce Neal
- Food Policy Division, 211065The George Institute for Global Health, University of New South Wales, Australia.,School of Public Health, 156430Imperial College London, UK
| | - Claire Johnson
- Food Policy Division, 211065The George Institute for Global Health, University of New South Wales, Australia
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Latka C, Kuiper M, Frank S, Heckelei T, Havlík P, Witzke HP, Leip A, Cui HD, Kuijsten A, Geleijnse JM, van Dijk M. Paying the price for environmentally sustainable and healthy EU diets. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2021. [DOI: 10.1016/j.gfs.2020.100437] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The drivers, trends and dietary impacts of non-nutritive sweeteners in the food supply: a narrative review. Nutr Res Rev 2020; 34:185-208. [PMID: 33148371 DOI: 10.1017/s0954422420000268] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Poor diets, including excess added sugar consumption, contribute to the global burden of disease. Subsequently, many nutrition policies have been implemented to reduce added sugar intake and improve population health, including taxes, education, labelling and environmental interventions. A potential consequence of these policy actions is the substitution of added sugars with non-nutritive sweeteners (NNS) in a variety of foods and beverages. NNS are used to reduce the energy and sugar content of foods and beverages while maintaining their palatability. Evidence of the toxicological risks of NNS is inconsistent, though concerns have been raised over the potential substitution effects of ultra-processed foods containing NNS for whole foods. This review aimed to provide an overview of current NNS food supply and consumption patterns, assess added sugar-reduction policies and their impact on NNS, and determine the impact of NNS on food choice, energy intake and diet quality. NNS are widely available in a variety of products, though most commonly in carbonated beverages, dairy products, confectionery, table-top sweeteners and fruit drinks. However, the longitudinal trends of different product categories, and differences between geographies and economy-income levels, require further study. Few studies have examined NNS consumption trends globally, though an increase in NNS consumption in beverages has been observed in some regions. Research examining how the increased availability of low-sugar, NNS-containing products affects global dietary patterns is limited, particularly in terms of their potential substitution effects.
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Reformulation of Packaged Foods and Beverages in the Colombian Food Supply. Nutrients 2020; 12:nu12113260. [PMID: 33114419 PMCID: PMC7692620 DOI: 10.3390/nu12113260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 01/21/2023] Open
Abstract
Public discussion, advocacy, and legislative consideration of policies aimed at reducing consumption of processed foods, such as sugar-sweetened beverage (SSB) taxes and mandatory front-of-package (FOP) warning labels, may stimulate product reformulation as a strategy to prevent regulation. In Colombia, there have been major legislative pushes for SSB taxes and FOP labels, although neither has passed to date. In light of the ongoing policy debate and successful implementation of similar policies in Peru and Chile, we explored manufacturer reformulation in the Colombian food supply. We compared the quantities of nutrients of concern (including sugar, sodium, and saturated fat) from the nutrition facts panels of the same 102 packaged foods and 36 beverages from the top-selling brands in Colombia between 2016 and 2018. Our analyses showed a substantial decrease in median sugar content of beverages, from 9.2 g per 100 mL to 5.2 g per 100 mL, and an increase in the percentage of beverages containing non-nutritive sweeteners (NNS), from 33% to 64% (p = 0.003). No meaningful changes in the quantities of nutrients of concern among foods were observed. Our findings suggest little reformulation has occurred in Colombia in the absence of mandatory policies, except for the substitution of sugar with NNS among beverages.
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Gómez-Donoso C, Martínez-González MÁ, Perez-Cornago A, Sayón-Orea C, Martínez JA, Bes-Rastrollo M. Association between the nutrient profile system underpinning the Nutri-Score front-of-pack nutrition label and mortality in the SUN project: A prospective cohort study. Clin Nutr 2020; 40:1085-1094. [PMID: 32768318 DOI: 10.1016/j.clnu.2020.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Front-of-pack nutrition labelling is a key public health policy that can be adopted as part of a comprehensive set of measures to promote healthy diets. The Nutri-Score, a five-colour summary label based on a modified version of the British Food Standards Agency Nutrient Profiling System (FSAm-NPS), is being considered for implementation in several European countries including Spain. This study aimed to prospectively assess the association between the FSAm-NPS and mortality rate in a Spanish cohort of university graduates. METHODS Analyses included 20 503 participants (mean [SD] age: 38 [12] years) from the SUN cohort. Dietary intake was assessed at baseline and after 10-years of follow-up with a validated semi-quantitative food-frequency questionnaire. The FSAm-NPS was calculated for each food/beverage based on their amount of energy, saturated fat, sugar, sodium, fibre, protein, fruits, vegetables, legumes, nuts, rapeseed, walnut and olive oils per 100 g of product. The FSAm-NPS Dietary Index (DI) was computed as an energy-weighted mean of the FSAm-NPS scores of all foods and beverages consumed by each participant. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality according to baseline and updated FSAm-NPS DI scores. RESULTS Over a median follow-up of 10.9 years, 407 participants died. A higher baseline FSAm-NPS DI score, reflecting consumption of foods with lower nutritional quality and hence less favourable Nutri-Score rating, was directly associated with all-cause mortality (HR Q4 versus Q1 = 1.82; 95% CI: 1.34 to 2.47; p-trend<0.001) and cancer mortality (HR: 2.44; 95% CI: 1.54 to 3.85; p-trend<0.001). No association was found for cardiovascular mortality. CONCLUSIONS The consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher rate of all-cause and cancer mortality in a large prospective cohort of Spanish, middle-aged university graduates. These findings further support the implementation of Nutri-Score in Euro-Mediterranean countries.
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Affiliation(s)
- Clara Gómez-Donoso
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Carmen Sayón-Orea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - J Alfredo Martínez
- Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Department of Nutrition, Food Sciences and Physiology, Faculty of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; Madrid Institute for Advanced Studies in Food (IMDEA Food), CEI UAM+CSIC, Madrid, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
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Reyes M, Smith Taillie L, Popkin B, Kanter R, Vandevijvere S, Corvalán C. Changes in the amount of nutrient of packaged foods and beverages after the initial implementation of the Chilean Law of Food Labelling and Advertising: A nonexperimental prospective study. PLoS Med 2020; 17:e1003220. [PMID: 32722710 PMCID: PMC7386631 DOI: 10.1371/journal.pmed.1003220] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/24/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In June 2016, the first phase of the Chilean Food Labelling and Advertising Law that mandated front-of-package warning labels and marketing restrictions for unhealthy foods and beverages was implemented. We assess foods and beverages reformulation after this initial implementation. METHODS AND FINDINGS A data set with the 2015 to 2017 nutritional information was developed collecting the information at 2 time periods: preimplementation (T0: January-February 2015 or 2016; n = 4,055) and postimplementation (T1: January-February 2017; n = 3,025). Quartiles of energy and nutrients of concern (total sugars, saturated fats, and sodium, per 100 g/100 mL) and the proportion of products with energy and nutrients exceeding the cutoffs of the law (i.e., products "high in") were compared pre- and postimplementation of the law in cross-sectional samples of products with sales >1% of their specific food or beverage groups, according to the Euromonitor International Database; a longitudinal subsample (i.e., products collected in both the pre- and postimplementation periods, n = 1,915) was also analyzed. Chi-squared, McNemar tests, and quantile regressions (simple and multilevel) were used for comparing T0 and T1. Cross-sectional analysis showed a significant decrease (T0 versus T1) in the proportion of product with any "high in" (from 51% [95% confidence interval (CI) 49-52] to 44% [95% CI 42-45]), mostly in food and beverage groups in which regulatory cutoffs were below the 75th percentile of the nutrient or energy distribution. Most frequent reductions were in the proportion of "high in" sugars products (in beverages, milks and milk-based drinks, breakfast cereals, sweet baked products, and sweet and savory spreads; from 80% [95% CI 73-86] to 60% [95% CI 51-69]) and in "high in sodium" products (in savory spreads, cheeses, ready-to-eat meals, soups, and sausages; from 74% [95% CI 69-78] to 27% [95% CI 20-35]). Conversely, the proportion of products "high in" saturated fats only decreased in savory spreads (p < 0.01), and the proportion of "high in" energy products significantly decreased among breakfast cereals and savory spreads (both p < 0.01). Quantile analyses showed that most of the changes took place close to the cutoff values, with only few exceptions of overall left shifts in distribution. Longitudinal analyses showed similar results. However, it is important to note that the nonexperimental nature of this study does not allow to imply causality of these findings. CONCLUSIONS Our results show that, after initial implementation of the Chilean Law of Food Labelling and Advertising, there was a significant decrease in the amount of sugars and sodium in several groups of packaged foods and beverages. Further studies should clarify how food reformulation will impact dietary quality of the population.
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Affiliation(s)
- Marcela Reyes
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Lindsey Smith Taillie
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Barry Popkin
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Rebecca Kanter
- Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Stefanie Vandevijvere
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
- Scientific Institute of Public Health (Sciensano), Department of Epidemiology and Public Health, Brussels, Belgium
| | - Camila Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
- * E-mail:
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Ethical Considerations for Food and Beverage Warnings. Physiol Behav 2020; 222:112930. [PMID: 32434747 DOI: 10.1016/j.physbeh.2020.112930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/16/2020] [Indexed: 02/08/2023]
Abstract
Several countries have implemented warnings on unhealthy foods and beverages, with similar policies under consideration in the U.S. and around the world. Research demonstrating food warnings' effectiveness is emerging, but limited scholarship has evaluated the ethics of food warning policies. Using a public health ethics framework for evaluating obesity prevention policies, we assessed the ethical strengths and weaknesses of food warnings along multiple dimensions: 1) Health behaviors and physical health, 2) Psychosocial well-being, 3) Social and cultural values, 4) Informed choice, 5) Equality, 6) Attributions of responsibility, 7) Liberty, and 8) Privacy. Our analysis identifies both ethical strengths and weaknesses of food warnings, including that: 1) warnings are likely to generate important benefits including increased consumer understanding and informed choice, healthier purchases, and potential reductions in obesity prevalence; 2) warnings evoke negative emotional reactions, but these reactions are an important mechanism through which food warnings encourage healthier behaviors and promote informed choice; 3) warnings appear unlikely to have ethically unacceptable effects on social and cultural values, attributions of responsibility, liberty, or privacy. Current research suggests we continue to pursue food warnings as a policy option for improving public health while simultaneously conducting additional research on the ethics of these policies. Future research is especially needed to clarify warnings' effects on stigma and to characterize the balance and distribution of costs of and benefits from implementing warning policies.
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Vandevijvere S, Vermote M, Egnell M, Galan P, Talati Z, Pettigrew S, Hercberg S, Julia C. Consumers' food choices, understanding and perceptions in response to different front-of-pack nutrition labelling systems in Belgium: results from an online experimental study. ACTA ACUST UNITED AC 2020; 78:30. [PMID: 32266069 PMCID: PMC7119293 DOI: 10.1186/s13690-020-00404-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/02/2020] [Indexed: 11/25/2022]
Abstract
Background Front-of-pack nutrition labels (FoPLs) are increasingly implemented by governments internationally to support consumers to make healthier food choices. Although the Nutri-Score FOPL has officially been implemented in Belgium since April 2019, no study has been conducted before its implementation to compare the effectiveness of different FOPLs. Methods The aim of this study was to compare food choices, objective understanding and perceptions of Belgian consumers in response to five different FOPLs, currently implemented in different countries internationally, namely the Health Star Ratings (HSR), the Multiple Traffic Lights (MTL), Nutri-Score, Guideline Daily Amounts (GDA), and Warning symbols. During the summer 2019, 1007 Belgian consumers were recruited and randomized to one of the five different FOPLs. Through an online questionnaire they were asked to choose one of three different foods within each of three categories (pizzas, cakes, breakfast cereals), as well as rank those same three foods according to nutritional quality, in the condition without as well as with FOPL. In addition, various questions were asked on their perceptions in relation to the FOPL they were exposed to. Results Perceptions of consumers were favorable for all FOPLs with no significant differences between the different FOPLs. There were no significant differences in food choices among the different FOPLs, but Nutri-Score performed best for ranking food products according to nutritional quality. Conclusions While there were no significant differences among different FOPLs for food choices and perceptions, the Nutri-Score was the most effective FOPL in informing Belgian consumers of the nutritional quality of food products.
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Affiliation(s)
- Stefanie Vandevijvere
- 1Sciensano (Scientific Institute of Public Health), J. Wytsmanstraat 14, 1050 Brussel, Belgium
| | - Marie Vermote
- 1Sciensano (Scientific Institute of Public Health), J. Wytsmanstraat 14, 1050 Brussel, Belgium
| | - Manon Egnell
- 2INSERM (Institut National de la Santé et de la Recherche Médicale), Paris, France
| | - Pilar Galan
- 3INRA (Institut National de la Recherche Agronomique), Paris, France
| | - Zenobia Talati
- 4The George Institute for Global Health, Sydney, Australia
| | | | - Serge Hercberg
- 2INSERM (Institut National de la Santé et de la Recherche Médicale), Paris, France
| | - Chantal Julia
- 2INSERM (Institut National de la Santé et de la Recherche Médicale), Paris, France
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Brown KA, Harris F, Potter C, Knai C. The future of environmental sustainability labelling on food products. Lancet Planet Health 2020; 4:e137-e138. [PMID: 32353291 PMCID: PMC7616205 DOI: 10.1016/s2542-5196(20)30074-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/12/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Kerry Ann Brown
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.
| | - Francesca Harris
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Christina Potter
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Cécile Knai
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
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Pivk Kupirovič U, Hristov H, Hribar M, Lavriša Ž, Pravst I. Facilitating Consumers Choice of Healthier Foods: A Comparison of Different Front-of-Package Labelling Schemes Using Slovenian Food Supply Database. Foods 2020; 9:foods9040399. [PMID: 32244547 PMCID: PMC7230759 DOI: 10.3390/foods9040399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 11/14/2022] Open
Abstract
Summary indicator front-of-package nutrition labelling schemes are gaining momentum. In Europe, an example of such a scheme is Nutri-Score, which was first introduced in France. Supported by additional research, the scheme has the potential to expand into other countries. Such a scenario opens a series of questions related to the use of Nutri-Score in the territories with pre-existing food labelling schemes. A key question is whether different nutrition labelling schemes would provide conflicting information for consumers when applied to same foods. The goal of our study was, therefore, to evaluate the alignment of different front-of-package nutrition labelling schemes. The study was conducted using cross-sectional data on the composition of selected categories of prepacked foods with high penetration nutrition/health claims and symbols in the Slovenian food supply. We evaluated a variety of existing front-of-package nutrition labelling schemes: three interpretive nutrition rating systems (Nutri-Score, Health Star Rating (HSR), Traffic light system), four health symbols (Protective Food symbol, Choices, Finnish heart, and Keyhole symbol), and also three nutrient profile models developed for other purposes (Office of Communications (United Kingdom, Ofcom), World Health Organization Regional office for Europe (WHOE) and Food Standards Australia New Zealand (FSANZ)). Overall, our results indicate that interpretive nutrition rating systems (i.e., Nutri-Score) are mostly less strict than the nutrient profiles of tested health symbols. A risk of conflicting information would happen in a scenario where food is eligible to carry a health symbol, but is at the same time rated to have lower nutritional quality by an accompanying interpretive nutrition rating system. When Protective Food symbol and Nutri-Score are used together, this would occur for 5% of foods in our sample. To avoid such risks, schemes for health symbols could be adapted to be stricter than interpretive nutrition rating systems used in the same territory/market, but such adaptations are challenging and should be well planned. While our study showed that, in most cases, Nutri-Score is a less strict model than tested health symbols, the rating-system approach might offer useful support and incentive for food producers towards gradual food reformulation.
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Affiliation(s)
- Urška Pivk Kupirovič
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia; (U.P.K.); (H.H.); (M.H.); (Ž.L.)
| | - Hristo Hristov
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia; (U.P.K.); (H.H.); (M.H.); (Ž.L.)
| | - Maša Hribar
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia; (U.P.K.); (H.H.); (M.H.); (Ž.L.)
| | - Živa Lavriša
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia; (U.P.K.); (H.H.); (M.H.); (Ž.L.)
| | - Igor Pravst
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia; (U.P.K.); (H.H.); (M.H.); (Ž.L.)
- University of Ljubljana, Biotechnical Faculty, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
- VIST – Higher School of Applied Sciences, Gerbičeva cesta 51A, SI-1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-590-68871; Fax: +386-130-07981
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Nutritional Content, Labelling and Marketing of Breakfast Cereals on the Belgian Market and Their Reformulation in Anticipation of the Implementation of the Nutri-Score Front-Of-Pack Labelling System. Nutrients 2020; 12:nu12040884. [PMID: 32218115 PMCID: PMC7230794 DOI: 10.3390/nu12040884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 12/27/2022] Open
Abstract
Objective: Breakfast cereals are frequently consumed in Belgium, especially among children. We investigated the nutritional content, labelling and marketing of breakfast cereals and the changes in nutrient content and reformulation in anticipation of the implementation of the Nutri-Score front-of-pack label. Design: Pictures were taken of cereal packages. The WHO-Europe nutrient profiling tool was used to classify cereals into ‘permitted’/‘not-permitted’ to be marketed to children, while the nutritional quality was assessed using Nutri-Score. The proportion of cereals with nutrition and health claims and/or promotional characters on the front-of-pack was compared between permitted and not-permitted cereals and between different Nutriscore categories using Chi-squared tests. The average nutrient contents per 100g were compared between 2017 and 2018 using paired t-tests. Setting: Belgium. Participants: All breakfast cereals in the major supermarkets (n = 7) in 2017 and 2018. Results: Overall, 330 cereals were included. About 77.2% of cereals were not permitted to be marketed to children but, of those, 22.0% displayed promotional characters. More claims (68.9% of all claims) were found on ‘not-permitted’ compared with ‘permitted’ cereals, particularly nutrition claims. Most claims were displayed on cereals with the allocated Nutri-Score A (42.0%) and C (37.0%). A significant reformulation of cereals was found between 2017 and 2018, with reductions in total sugar (−5%) (p < 0.001) and sodium (−20%) (p = 0.002) and increases in fibre (+3%) (p = 0.012) and proteins (+2%) (p = 0.002). Conclusion: Breakfast cereals on the Belgian market are predominantly unhealthy and frequently carry claims and promotional characters. Minimal reformulation occurred over one year. Policy recommendations include restrictions on claims and marketing for not-permitted cereals.
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Akaichi F, Revoredo Giha C, Glenk K, Gil JM. How Consumers in the UK and Spain Value the Coexistence of the Claims Low Fat, Local, Organic and Low Greenhouse Gas Emissions. Nutrients 2020; 12:E120. [PMID: 31906308 PMCID: PMC7019742 DOI: 10.3390/nu12010120] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 01/22/2023] Open
Abstract
This study investigates the substitution and complementary effects for beef mince attributes drawing on data from large choice experiments conducted in the UK and Spain. In both countries, consumers were found to be willing to pay a price premium for the individual use of the labels "Low Fat" (UK: €3.41, Spain: €1.94), "Moderate Fat" (UK: €2.23, Spain: €1.57), "Local" (UK: €1.54, Spain: €1.61), "National" (UK: €1.33, Spain: €1.37), "Organic" (UK: €1.02, Spain: €1.09) and "Low Greenhouse Gas Emissions (GHG)" (UK: €2.05, Spain: €0.96). The results showed that consumers in both countries do not treat desirable food attributes as unrelated. In particular, consumers in Spain are willing to pay a price premium for the use of the labels "Local", "Organic" and "Low GHG" on beef mince that is also labelled as having low or moderate fat content. By contrast, consumers in the UK were found to discount the coexistence of the labels "Low Fat" and "Organic", "Low Fat" and "Low GHG" and "Moderate Fat" and "Low GHG". The results, however, suggest that in the UK the demand for beef mince with moderate (low) fat content can be increased if it is also labelled as "Organic" or "Low GHG" ("Local").
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Affiliation(s)
- Faical Akaichi
- Department of Rural Economy, Environment and Society, Scotland’s Rural College, Edinburgh EH9 3JG, UK; (C.R.G.); (K.G.)
| | - Cesar Revoredo Giha
- Department of Rural Economy, Environment and Society, Scotland’s Rural College, Edinburgh EH9 3JG, UK; (C.R.G.); (K.G.)
| | - Klaus Glenk
- Department of Rural Economy, Environment and Society, Scotland’s Rural College, Edinburgh EH9 3JG, UK; (C.R.G.); (K.G.)
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