Sweetener Purchases in Chile before and after Implementing a Policy for Food Labeling, Marketing, and Sales in Schools

Influence of the cautionary legend on non-nutritive sweetener (NNS) on preference and healthfulness perception

In 2020, Mexico's Congress mandated front-of-package warning labels (FOPWL) and two cautionary legends; one of which for non-nutritive sweeteners (NNS) with a statement "Contains NNS. Avoid in children". The aim of the study was to assess the influence of the "excess in sugar" warning label (WL) and NNS cautionary legend on preference and healthfulness perception of fruit-based beverages among parents of 5-10 year-olds. Also, to test if parents' preferences and perceptions differed by nutrition knowledge and previous knowledge on NNS. Data from the EPHA niñ@s (Study of the Perception and Dietary Habits in Children, for its acronym in Spanish) cohort were analyzed (n = 844). Parents were asked to choose between 100% juice and nectar with added sugars above the cut-off point, and between the latter and nectar with NNS marketed as "light", and to rate how healthy they considered each product at two different timepoints. At time 1, products were shown without the FOPWL; at time 2, nectar with excess sugar had the "excess sugar" WL and nectar with NNS had the cautionary legend on NNS. General Linearized Models (GLM) were used to assess changes in preference and perceived healthiness. Interaction terms assessed the impact of nutrition knowledge and NNS awareness. The study found that FOPWL significantly shifted parental preferences towards 100% juice over nectar with "excess sugar" (15.4% increase, p<0.001), and the latter over nectar with NNS (21.8% increase, p<0.001). Similarly, the FOPWL decreased the perceived healthiness of both nectar with "excess sugars" and nectar with NNS. The effect of labels on healthfulness perception was strongest among parents with low to medium nutrition knowledge and no prior knowledge of NNS. The inclusion of FOPWL seems to aid parents in making better-informed decisions regarding the nutritional quality of beverages for their children.

Decreases in purchases of energy, sodium, sugar, and saturated fat 3 years after implementation of the Chilean food labeling and marketing law: An interrupted time series analysis

BACKGROUND

In 2016, Chile implemented a multiphase set of policies that mandated warning labels, restricted food marketing to children, and banned school sales of foods and beverages high in nutrients of concern ("high-in" foods). Chile's law, particularly the warning label component, set the precedent for a rapid global proliferation of similar policies. While our initial evaluation showed policy-linked decreases in purchases of high-in, a longer-term evaluation is needed, particularly as later phases of Chile's law included stricter nutrient thresholds and introduced a daytime ban on advertising of high-in foods for all audiences. The objective is to evaluate changes in purchases of energy, sugar, sodium, and saturated fat purchased after Phase 2 implementation of the Chilean policies.

METHODS AND FINDINGS

This interrupted time series study used longitudinal data on monthly food and beverage purchases from 2,844 Chilean households (138,391 household-months) from July 1, 2013 until June 25, 2019. Nutrition facts panel data from food and beverage packages were linked at the product level and reviewed by nutritionists. Products were considered "high-in" if they contained added sugar, sodium, or saturated fat and exceeded nutrient or calorie thresholds. Using correlated random-effects models and an interrupted time series design, we estimated the nutrient content of food and beverage purchases associated with Phase 1 and Phase 2 compared to a counterfactual scenario based on trends during a 36-month pre-policy timeframe. Compared to the counterfactual, we observed significant decreases in high-in purchases of foods and beverages during Phase 2, including a relative 36.8% reduction in sugar (-30.4 calories/capita/day, 95% CI -34.5, -26.3), a 23.0% relative reduction in energy (-51.6 calories/capita/day, 95% CI -60.7, -42.6), a 21.9% relative reduction in sodium (-85.8 mg/capita/day, 95% CI -105.0, -66.7), and a 15.7% relative reduction in saturated fat (-6.4 calories/capita/day, 95% CI -8.4, -4.3), while purchases of not-high-in foods and drinks increased. Reductions in sugar and energy purchases were driven by beverage purchases, whereas reductions in sodium and saturated fat were driven by foods. Compared to the counterfactual, changes in both high-in purchases and not high-in purchases observed in Phase 2 tended to be larger than changes observed in Phase 1. The pattern of changes in purchases was similar for households of lower versus higher socioeconomic status. A limitation of this study is that some results were sensitive to the use of shorter pre-policy time frames.

CONCLUSIONS

Compared to a counterfactual based on a 36-month pre-policy timeframe, Chilean policies on food labeling, marketing, and school food sales led to declines in nutrients of concern during Phase 2 of implementation, particularly from foods and drinks high in nutrients of concern. These declines were sustained or even increased over phases of policy implementation.

Assessing the Policy Implications of Different Definitions for Added Sugars: An Analysis Across the Australian Packaged Food and Beverage Supply

Background

In recent years, various definitions of "added sugars" have emerged across jurisdictions. Although it is clear how these definitions differ, there is limited understanding of the policy implications associated with these variations.

Objective

To test the potential policy implications of different definitions of "added sugars" on the Australian packaged food supply, we developed a method to estimate the content of "added sugars" in packaged foods and applied this to 3 different definitions of "added sugars": (i) United States Food and Drug Administration (US FDA) added sugar definition, (ii) the World Health Organization (WHO) free sugar definition, and (iii) a comprehensive definition that was developed from a review of the evidence on "added sugars."

Methods

Using a representative sample of 25,323 Australian packaged foods, the "added sugar" content and proportion of products that contain "added sugar" under the 3 definitions were estimated. In addition, a comparative analysis exploring the impact of the US FDA definition (least comprehensive) vs. the comprehensive definition was conducted to understand potential implications of adopting different regulatory definitions in Australia.

Results

The US FDA definition identified the lowest number and proportion of products with any "added sugars" at 14,380 products (representing 56.8% of all products), followed by the WHO free sugar definition at 15,168 products (59.9%) and the comprehensive definition at 16,260 products (64.2%). The mean estimates for "added sugars" were 8.5 g/100 g, 8.7 g/100 g, and 9.6 g/100 g for the US FDA, WHO, and comprehensive definitions, respectively. Compared with the US FDA definition, the comprehensive definition captured an additional 7.4% of products, largely driven by nonalcoholic beverages, special foods and fruit, vegetables, nuts, and legumes.

Conclusions

Despite small variations in different "added sugars" definitions, their application has some significant policy implications. Findings highlight the importance of applying a comprehensive regulatory definition that adequately captures all sugars that have been linked to poor health.