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Fontanelli MDM, Batista LD, Martinez-Arroyo A, Mozaffarian D, Micha R, Rogero MM, Fisberg RM, Sarti FM. Pragmatic Carbohydrate Quality Metrics in Relation to Glycemic Index, Glycemic Load, and Front-of-Pack Warning Labels in Grain Foods. Foods 2024; 13:1299. [PMID: 38731670 PMCID: PMC11083290 DOI: 10.3390/foods13091299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
The challenges in the characterization of the nutritional quality of grain foods comprise obstacles to public health actions toward promotion of healthier grain-based foods. The present study investigated how carbohydrate metrics related to glycemic index (GI), glycemic load (GL), and warning labels of grain foods consumed by individuals living in São Paulo, Brazil. Information on intake of grain foods at individual level was obtained using 24 h recalls within a cross-sectional population-based survey conducted in 2015. There were 244 unique grain products reported by individuals in the survey, assessed through four metrics of carbohydrate quality, considering contents per 10 g of total carbohydrate: (1) ≥1 g fiber, (2) ≥1 g fiber and <1 g free sugars, (3) ≥1 g fiber and <2 g free sugars, and (4) ≥1 g fiber, and <2 g free sugars per 1 g of fiber. Outcomes included GI, GL, and inclusion of warning labels proposed by the Brazilian National Health Surveillance Agency (ANVISA), the Chilean Ministry of Health (1st and 3rd stages), and the Pan American Health Organization (PAHO). Metrics identified products with lower mean GI (-12.8 to -9.0 [p-values < 0.001]), and GL (-12.5 to -10.3 [p-values < 0.001]). Warning systems showed a certain degree of discrimination between products according to the metrics (p-value < 0.01 each); however, >50% of products with good nutritional quality according to the carbohydrate metrics still would receive warnings. Findings suggest that carbohydrate metrics identified products with lower GI and GL, and current warning labels may not adequately capture overall nutritional quality of grain foods.
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Affiliation(s)
| | - Lais Duarte Batista
- School of Public Health, University of São Paulo, São Paulo 05508-030, SP, Brazil; (L.D.B.); (M.M.R.); (R.M.F.)
| | - Angela Martinez-Arroyo
- Food Behavior Research Center (CEIC), Faculty of Pharmacy, School Nutrition and Dietetics, University of Valparaíso, Valparaíso 2381850, Chile;
| | - Dariush Mozaffarian
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA; (D.M.); (R.M.)
| | - Renata Micha
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA; (D.M.); (R.M.)
- Department of Food Science and Nutrition, University of Thessaly, 38334 Volos, Greece
| | - Marcelo Macedo Rogero
- School of Public Health, University of São Paulo, São Paulo 05508-030, SP, Brazil; (L.D.B.); (M.M.R.); (R.M.F.)
| | - Regina Mara Fisberg
- School of Public Health, University of São Paulo, São Paulo 05508-030, SP, Brazil; (L.D.B.); (M.M.R.); (R.M.F.)
| | - Flavia Mori Sarti
- School of Arts, Sciences and Humanities (EACH), University of São Paulo, São Paulo 03828-000, SP, Brazil;
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Mota BEF, de Alcântara IC, de Souza PM, Souza GGL, Mais LA, Menezes CC, David IA. Commentary: Editorial: Strengthening food labeling policies in Brazil. Front Nutr 2023; 10:1331250. [PMID: 38144427 PMCID: PMC10739461 DOI: 10.3389/fnut.2023.1331250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Bruna Eugênia Ferreira Mota
- Laboratory of Psychophysiology, Institute of Exact and Biological Sciences, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Iasmim Cristiane de Alcântara
- Laboratory of Psychophysiology, Institute of Exact and Biological Sciences, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Perciliany Martins de Souza
- Laboratory of Psychophysiology, Institute of Exact and Biological Sciences, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Gabriela Guerra Leal Souza
- Laboratory of Psychophysiology, Institute of Exact and Biological Sciences, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Laís Amaral Mais
- Healthy and Sustainable Diets Program, Brazilian Institute for Consumer Defense (IDEC), São Paulo, Brazil
| | - Camila Carvalho Menezes
- Department of Food, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Isabel Antunes David
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal University Fluminense, Niterói, Brazil
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Canella DS, Pereira Montera VDS, Oliveira N, Mais LA, Andrade GC, Martins APB. Food additives and PAHO's nutrient profile model as contributors' elements to the identification of ultra-processed food products. Sci Rep 2023; 13:13698. [PMID: 37648698 PMCID: PMC10468485 DOI: 10.1038/s41598-023-40650-3] [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: 01/23/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
The NOVA classification system categorizes foods according to the extent and purpose of industrial processing. Ultra-processed food products (UPF) are frequently composed of excessive amounts of sugars, salt, oils, and fats, and cosmetic additives designed to make them palatable and/or appealing. We aimed to describe the presence of critical nutrients in excess and cosmetic additives in packaged foods and beverages and to evaluate the proportion of UPF that can be correctly identified through the presence of critical nutrients in excess or the presence of cosmetic additives in food products. A total of 9851 items available in Brazilian supermarkets containing lists of ingredients and nutrition facts panels were analyzed. Cosmetic additives and critical nutrients in excess, according to Pan American Health Organization (PAHO)'s nutrient profile model, were assessed. All food items were categorized into the four NOVA classification groups. Relative frequencies of items with at least one critical nutrient in excess and one type of cosmetic additive were estimated. For UPF, 82.1% had some cosmetic additive, and 98.8% had some cosmetic additive or a nutrient in excess. This combined criterion allowed the identification of 100.0% of sweet cookies, salted biscuits, margarine, cakes and sweet pies, chocolate, dairy beverages, and ice cream. Combining the presence of cosmetic additives and the PAHO's nutrient profile model contributes to the identification of UPF.
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Affiliation(s)
- Daniela Silva Canella
- Institute of Nutrition, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil.
- Center for Epidemiological Research in Nutrition and Health (Nupens), University of São Paulo (USP), São Paulo, Brazil.
| | | | - Natália Oliveira
- Postgraduate Program in Food, Nutrition and Health, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
- Nutritional Epidemiology Observatory, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Laís Amaral Mais
- Brazilian Institute for Consumer Defense (IDEC), São Paulo, Brazil
| | - Giovanna Calixto Andrade
- Center for Epidemiological Research in Nutrition and Health (Nupens), University of São Paulo (USP), São Paulo, Brazil
| | - Ana Paula Bortoletto Martins
- Center for Epidemiological Research in Nutrition and Health (Nupens), University of São Paulo (USP), São Paulo, Brazil
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Silva ARCS, Braga LVM, Anastácio LR. Coexistence of high content of critical nutrients and claims in food products targeted at Brazilian children. REVISTA PAULISTA DE PEDIATRIA 2023; 41:e2021355. [DOI: 10.1590/1984-0462/2023/41/2021355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/27/2022] [Indexed: 12/23/2022]
Abstract
ABSTRACT Objective: This study aimed to evaluate food labels targeted at children and identify the concomitant presence of claims and high levels of critical nutrients and/or the presence of sweeteners. As a secondary objective, it aimed to list different types of claims and check which marketing strategies are most used. Methods: We collected 409 products, from 8 popular food groups targeted at children, in Brazilian market (i.e., fruit drinks, dairy drinks, sandwich cookies, cakes, breakfast cereals, jellies, corn snacks, and yogurts). The contents of critical nutrients (e.g., sugar, total fat, saturated fat, and trans-fat, and sodium) and presence/absence of sweetener were calculated, considering Pan American Health Organization (PAHO) parameters. Then, we verified the presence and types of claims in these products. Results: Overall, 265 (64.7%) labels presented claims. In three of the eight categories (i.e., breakfast cereals, dairy drinks, and yogurt), all products with claims (50, 34, and 34 products, respectively) had one or more nutrients in harmful concentrations (critical nutrients above PAHO’s nutritional profile and/or presence of sweeteners). In the other categories, only one product (of 63 sandwich cookies and 26 breakfast cereals with claims) and three products (of 22 cakes and 28 jellies with claims) had no nutrient in critical concentration. The presence of claims, like “rich/source” of micronutrient, was predominant in seven of the eight food groups. Conclusion: In the present study, there was a high presence of claims, of different types, in foods targeted at children, which, for the most part, also have excess of at least one critical nutrient, according to PAHO.
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The Potential Impact of Different Taxation Scenarios towards Sugar-Sweetened Beverages on Overweight and Obesity in Brazil: A Modeling Study. Nutrients 2022; 14:nu14235163. [PMID: 36501192 PMCID: PMC9737639 DOI: 10.3390/nu14235163] [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: 11/08/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
The adoption of fiscal policies based on the specific taxation of sugar-sweetened beverages (SSBs) has been recommended by international health agencies, as they are measures that potentially reduce consumption. This study is an ex ante risk comparison that estimates the impact of three tax scenarios (20, 25, and 30%) with a 100% pass-on rate to SSBs on the prevalence of high weight and obesity in the Brazilian population. Data on the consumption habits, weight, and height of 46,164 adults aged 20 years or over from Brazilian recent national surveys were used. The shift in consumption after taxation was estimated based on the price elasticity of the demand. The percentage changes in overweight for 20, 25, and 30% taxation were 1.84% (95%CI: 1.82; 1.86), 1.89% (95%CI: 1.87; 1.90), and 2.25% (95%CI: 2.24; 2.27), respectively. The change in the prevalence of obesity was 1.93% (95%CI: 1.87; 2.00), 2.90% (95%CI: 2.80; 3.02), and 4.16% (95%CI: 4.01; 4.32), respectively. Taxes on SSBs may have a more favorable result among the heaviest consumers, who are young adults (20-29 years), especially men, thereby promoting a greater reduction in the prevalence of high weight and obesity.
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Borges CA, Khandpur N, Neri D, Duran AC. Comparing Latin American nutrient profile models using data from packaged foods with child-directed marketing within the Brazilian food supply. Front Nutr 2022; 9:920710. [PMID: 36532519 PMCID: PMC9755586 DOI: 10.3389/fnut.2022.920710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/08/2022] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVES This study aimed to examine and compare the extent to which different nutrient profile models (NPMs) from Latin America (LA) identify packaged foods and beverages with child-directed marketing sold in Brazil as being high in nutrients associated to the risk of non-communicable diseases (NCDs). MATERIALS AND METHODS In this cross-sectional study, we evaluated 3,464 foods found in the five largest Brazilian supermarkets. Child-directed marketing was coded using the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol. Differences in medians of sugar, saturated fats, and sodium per 100 kcal in foods, with the presence and absence of child-directed marketing, were tested using the Mann-Whitney test. We compared six NPMs in LA and examined to what extent they targeted these products using prevalence ratios. Analyses were performed overall and by the degree of food processing according to the Nova food classification. RESULTS We found 1,054 packages with child-directed marketing. Among these, candies, cakes and pies, sauces and creams, and sugar-sweetened beverages were significantly higher in sugar, saturated fat, and sodium per 100 kcal than products that are not targeted at children (p < 0.05). Compared with PAHO and the Mexico models, the Brazilian NPMs would allow three times more ultra-processed foods to omit warnings for sodium (p < 0.05). The Uruguayan NPM also flagged fewer ultra-processed foods high in sodium (p < 0.05). The Brazilian model also allows four times more sugar-sweetened beverages and six times more dairy drinks to omit warnings for sugar than the Mexico and PAHO models. In comparison to all other NPMs, the Brazilian model showed the worst performance in identifying baked goods as high in sodium. Chile, Uruguay, and Peru models would also target significantly less sugar-sweetened beverages and high in at least one critical nutrient than PAHO and Mexico models. CONCLUSION Compared with other NPMs in LA, the NPM criteria adopted in Brazil are more permissive and less likely to inform consumers of the poor nutritional quality of ultra-processed foods and beverages with child-directed marketing.
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Affiliation(s)
- Camila Aparecida Borges
- Center for Epidemiological Research in Nutrition and Health, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Food Studies and Research, State University of Campinas, São Paulo, Brazil
| | - Neha Khandpur
- Center for Epidemiological Research in Nutrition and Health, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, School of Public Health, Harvard University, Boston, MA, United States
| | - Daniela Neri
- Center for Epidemiological Research in Nutrition and Health, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Ana Clara Duran
- Center for Food Studies and Research, State University of Campinas, São Paulo, Brazil
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Mais LA, Borges CA, Khandpur N, Duran AC, Martins APB. Brazil's nutrition labeling regulation: Challenges ahead on the path to guaranteeing consumer's right to adequate information. Front Nutr 2022; 9:921519. [PMID: 36483931 PMCID: PMC9724590 DOI: 10.3389/fnut.2022.921519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2024] Open
Affiliation(s)
- Laís Amaral Mais
- Brazilian Institute for Consumer Defense (Idec), São Paulo, Brazil
| | - Camila Aparecida Borges
- Center for Epidemiological Studies for Nutrition and Health, University of São Paulo (Nupens, USP), São Paulo, Brazil
- Center for Food Studies and Research, University of Campinas (NEPA, Unicamp), Campinas, Brazil
| | - Neha Khandpur
- Center for Epidemiological Studies for Nutrition and Health, University of São Paulo (Nupens, USP), São Paulo, Brazil
- Department of Nutrition, University of São Paulo (USP), São Paulo, Brazil
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Ana Clara Duran
- Center for Epidemiological Studies for Nutrition and Health, University of São Paulo (Nupens, USP), São Paulo, Brazil
- Center for Food Studies and Research, University of Campinas (NEPA, Unicamp), Campinas, Brazil
| | - Ana Paula Bortoletto Martins
- Brazilian Institute for Consumer Defense (Idec), São Paulo, Brazil
- Center for Epidemiological Studies for Nutrition and Health, University of São Paulo (Nupens, USP), São Paulo, Brazil
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Tomaz LA, Pereira CG, Braga LVM, Prates SMS, Silva ARCS, Soares APDC, de Faria NC, Anastácio LR. From the most to the least flexible nutritional profile: Classification of foods marketed in Brazil according to the Brazilian and Mexican models. Front Nutr 2022; 9:919582. [PMID: 36204372 PMCID: PMC9531871 DOI: 10.3389/fnut.2022.919582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Nutrient profiling is the science of classifying or ranking foods according to their nutritional composition, for reasons related to disease prevention and health promotion. To be effective, policies such as front-of-pack nutrition labeling (FoPNL) must have an adequate nutritional profile model, since it will determine which products will be eligible to receive a FoPNL. This study aimed to determine the percentage of packaged food and drink products available in Brazil that would be subject to FoPNL under two different legislations: Brazilian and Mexican. This is a cross-sectional study in which we collected information on food products (photos of the ingredients list, the front label, the barcode, and the nutrition facts table) from one of the largest stores of a supermarket chain in the city of Belo Horizonte-MG, Brazil, from March to May 2021 (~6 months after the publication of the Brazilian legislation about FoPNL and a year and a half before the legislation came into force). The products were classified in relation to the BNPM (added sugars, saturated fats, and sodium) and the MNPM (energy, free sugars, saturated fats, trans fats, sodium, non-sugar sweeteners, and caffeine). A total of 3384 products were collected and, after applying the exclusion criteria, 3,335 products were evaluated. Of these, 2,901 would be eligible to receive FoPNL in Brazil and 2,914 would be eligible to receive FoPNL in Mexico. According to the BNPM, 56.7% (95% CI 54.9; 58.5%) of the products were “high in” critical nutrients, 27.1% (95% CI 25.5; 28.7%) of the products in added sugars, 26.7% (95% CI 25.2; 28.4%) of the products in saturated fats, and 21.4% (95% CI 19.9; 22.9%) of the products in sodium. As for the MNPM, 96.8% (95% CI 96.1; 97.4%) of them were “high in” up to five critical nutrients and up to two warning rectangles (caffeine and non-sugar sweeteners), 45.8% (95% CI 44.0; 47.6%) of them in free sugars, 43.7% (95% CI 41.9; 45.5%) of them in saturated fats, and 47.9% (95% CI 46.1; 49.7%) of them in sodium. We concluded that the eligibility to receive FoPNL by BNPM and MNPM was relatively similar between products; however, almost all products would have at least one FoPNL and/or warning rectangles according to Mexican legislation, and nearly half of them would have at least one FoPNL, considering BNPM. The MNPM is much more restrictive than the BNPM. The Nutrient Profile Model (NPM) that regulates FoPNL, and other health policies, must be carefully defined to ensure that foods are properly classified according to their healthiness.
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Li Y, Wang H, Zhang P, Popkin BM, Coyle DH, Ding J, Dong L, Zhang J, Du W, Pettigrew S. Nutritional Quality of Pre-Packaged Foods in China under Various Nutrient Profile Models. Nutrients 2022; 14:nu14132700. [PMID: 35807879 PMCID: PMC9268697 DOI: 10.3390/nu14132700] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 02/02/2023] Open
Abstract
This study used various nutrient profile models (NPMs) to evaluate the nutritional quality of pre-packaged foods in China to inform future food policy development. Nutrition data for pre-packaged foods were collected through FoodSwitch China in 2017-2020. The analyses included 73,885 pre-packaged foods, including 8236 beverages and 65,649 foods. Processed foods (PFs) and ultra-processed foods (UPFs) accounted for 8222 (11.4%) and 47,003 (63.6%) of all products, respectively. Among the 55,425 PFs and UPFs, the overall proportion of products with an excessive quantity of at least one negative nutrient was 86.0% according to the Chilean NPM (2019), 83.3% for the Pan American Health Organization NPM (PAHO NPM), and 90.6% for the Western Pacific Region NPM for protecting children from food marketing (WPHO NPM), respectively. In all NPMs, 70.4% of PFs and UPFs were identified as containing an excessive quantity of at least one negative nutrient, with higher proportions of UPFs compared to PFs. Food groups exceeding nutrient thresholds in most NPMs included snack foods, meat and meat products, bread and bakery products, non-alcoholic beverages, confectionery, and convenience foods. In conclusion, PFs and UPFs accounted for three-fourths of pre-packaged foods in China, and the majority of PFs and UPFs exceeded the threshold for at least one negative nutrient under all three NPMs. Given the need to prevent obesity and other diet-related chronic diseases, efforts are warranted to improve the healthiness of foods in China through evidence-based food policy.
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Affiliation(s)
- Yuan Li
- The George Institute for Global Health, Beijing 100600, China; (Y.L.); (J.D.); (L.D.)
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; (D.H.C.); (S.P.)
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China; (H.W.); (J.Z.); (W.D.)
| | - Puhong Zhang
- The George Institute for Global Health, Beijing 100600, China; (Y.L.); (J.D.); (L.D.)
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; (D.H.C.); (S.P.)
- Correspondence: ; Tel.: +86-10-8280-0577
| | - Barry M. Popkin
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA;
| | - Daisy H. Coyle
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; (D.H.C.); (S.P.)
| | - Jingmin Ding
- The George Institute for Global Health, Beijing 100600, China; (Y.L.); (J.D.); (L.D.)
| | - Le Dong
- The George Institute for Global Health, Beijing 100600, China; (Y.L.); (J.D.); (L.D.)
| | - Jiguo Zhang
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China; (H.W.); (J.Z.); (W.D.)
| | - Wenwen Du
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China; (H.W.); (J.Z.); (W.D.)
| | - Simone Pettigrew
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; (D.H.C.); (S.P.)
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Nutritional Description of Foods with Low- and No-Calorie Sweeteners in Spain: The BADALI Project. Nutrients 2022; 14:nu14132686. [PMID: 35807866 PMCID: PMC9268128 DOI: 10.3390/nu14132686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 12/10/2022] Open
Abstract
The use of low- and no-calorie sweeteners (LNCS) in foods has increased in recent years in response to the negative effects of free sugar on health. However, the health impact of LNCS is still unclear. Studies of the prevalence of LNCS in foods have been published previously, including in Spain. However, the use of health (HCs) and nutrition claims (NCs) to promote these foods and a full nutritional characterization are largely lacking. For this purpose, we used the BADALI database with 4218 foods present in the Spanish market. Our results show that 9.3% of foods have LNCS (including both intense and polyols). Sucralose and acesulfame K were the intense sweeteners most frequently used (52.4% and 48.2%, respectively), whereas maltitol was the preferred polyol (20.3%). Of all foods with LNCS, 30% also had added sugar. Many more foods with LNCS presented HCs and NCs than those without. Sugar was the nutrient most frequently claimed in NCs for LNCS-containing foods, whereas vitamins were for those without these sweeteners. NCs compliance with regulation was similar in both conditions (60.1% for foods without and 63.9% for foods with LNCS). As expected, foods with LNCS had less total sugar content and energy. Surprisingly, the nutrient profile of yogurts with LNCS changed completely: less total and saturated fat, whereas more proteins and sodium. Biscuits with LNCS contained more fibre. The results of our study reveal that the prevalence of LNCS is becoming high in some food types in Spain and that foods containing LNCS are more frequently promoted with HCs/NCs. In addition, it confirms the general reduction in energy and sugar content expected in foods with LNCS. Furthermore, it suggests a reformulation of products beyond sugar content.
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Contreras-Manzano A, Cruz-Casarrubias C, Munguía A, Jáuregui A, Vargas-Meza J, Nieto C, Tolentino-Mayo L, Barquera S. Evaluation of the Mexican warning label nutrient profile on food products marketed in Mexico in 2016 and 2017: A cross-sectional analysis. PLoS Med 2022; 19:e1003968. [PMID: 35442949 PMCID: PMC9067899 DOI: 10.1371/journal.pmed.1003968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 05/04/2022] [Accepted: 03/16/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Different nutrient profiles (NPs) have been developed in Latin America to assess the nutritional quality of packaged food products. Recently, the Mexican NP was developed as part of the new warning label regulation implemented in 2020, considering 5 warning octagons (calories, sugar, sodium, saturated fats, and trans fats) and 2 warning rectangles (caffeine and non-nutritive sweeteners). The objective of this cross-sectional study was to evaluate the Mexican NP and other NPs proposed or used in Latin America against the Pan American Health Organization (PAHO) model. METHODS AND FINDINGS Nutrition content data of 38,872 packaged food products available in the Mexican market were collected in 2016 and 2017. The evaluation of the Mexican NP, including its 3 implementation phases of increasing stringency (2020, 2023, and 2025), was conducted by comparing the percentage of products classified as "healthy" (without warnings) or "less healthy" (with 1 or more warnings), as well as the number and type of warnings assigned to food products, against the PAHO NP. Using the calibration method, we compared the classifications produced by the PAHO model against those produced by the NP models of Ecuador, Chile (3 phases), Peru (2 phases), Uruguay, and Brazil. Kappa coefficients and Pearson correlations were estimated, and proportion tests were performed. We found that the 3 implementation phases of the Mexican NP had near to perfect agreement in the classification of healthy foods (Mexico NP models: 19.1% to 23.8%; PAHO model: 19.7%) and a strong correlation (>91.9%) with the PAHO model. Other NPs with high agreement with the PAHO model were the Ecuador (89.8%), Uruguay (82.5%), Chile Phase 3 (82.3%), and Peru Phase 2 (84.2%) NPs. In contrast, the Peru Phase 1, Brazil, and Chile Phase 1 NP models had the highest percentage of foods classified as healthy (49.2%, 47.1%, and 46.5%, respectively) and the lowest agreement with the PAHO model (69.9%, 69.3%, and 73%, respectively). Study limitations include that warnings considered by the Mexican NP models were evaluated as if all the warnings were octagon seals, while 2 out of the 7 were rectangular warnings (caffeine and non-nutritive sweeteners), and that our data are limited by the quality of the information reported in the list of ingredients and the nutrition facts table of the products. CONCLUSIONS The 3 implementation phases of the Mexican NP were useful to identify healthy food products. In contrast, the Peru Phase 1, Brazil, and Chile Phase 1 NP models may have limited usefulness for the classification of foods according to the content of ingredients of concern. The results of this study may inform countries seeking to adapt and evaluate existing NP models for use in population-specific applications.
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Affiliation(s)
- Alejandra Contreras-Manzano
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Carlos Cruz-Casarrubias
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Ana Munguía
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Alejandra Jáuregui
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Jorge Vargas-Meza
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Claudia Nieto
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Lizbeth Tolentino-Mayo
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Simón Barquera
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Delgado Zegarra J, da Silva Gomes F. [Nutrient profile of food products exempted from the application of front-ofpackage warnings during the first stage of the Healthy Eating Law in Peru: case studyPerfil nutricional de produtos alimentícios isentos da aplicação de advertências na parte frontal da embalagem durante a primeira etapa da Lei de Alimentação Saudável no Peru: estudo de caso]. Rev Panam Salud Publica 2021; 45:e153. [PMID: 34934415 PMCID: PMC8678099 DOI: 10.26633/rpsp.2021.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/15/2021] [Indexed: 12/17/2022] Open
Abstract
Objective Identify the nutritional profile of food products exempted from presenting one or more front-ofpackage nutritional warnings during the first stage of Law 30,021 on the Promotion of Healthy Eating for Children and Adolescents in Peru. Methods Data were collected on 188 products from points of sale in the city of Lima. The convenience sample included products that until September 17, 2021 were exempted by the legislation from presenting any of the warning labels for sugar, sodium, or saturated fats. An assessment was made of the proportion of products that would be required to apply one or more warning labels when the second stage of the legislation takes effect. It was also calculated how many products exempted from the application of warning labels contain excess sugar, sodium, or saturated fats, according to the criteria of the Pan American Health Organization (PAHO). Results 76.1% of the products exceeded at least one of the thresholds for sugar, sodium, or saturated fats that entered in force in September 2021. The proportion of products that the law exempts from warnings and that contain excess sugar, sodium, or saturated fats according to PAHO will be 4.2, 3.4, and 2.3 times lower, respectively, in the second stage. Conclusion During the first stage of the law's entry into force, 58%, 42%, and 28.2% of the products exempted from the presentation of warning labels contained excess sugar, saturated fats, or sodium, respectively, according to PAHO.
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Affiliation(s)
- Jaime Delgado Zegarra
- Instituto de Consumo de la Universidad de San Martín de Porres Instituto de Consumo de la Universidad de San Martín de Porres Lima Perú
| | - Fabio da Silva Gomes
- Organización Panamericana de la Salud Organización Panamericana de la Salud Washington D.C. Estados Unidos de América
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Fagundes Grilo M, Taillie LS, Zancheta Ricardo C, Amaral Mais L, Bortoletto Martins AP, Duran AC. Prevalence of low-calorie sweeteners and related front-of-package claims in the Brazilian packaged food supply. J Acad Nutr Diet 2021; 122:1296-1304. [PMID: 34954081 DOI: 10.1016/j.jand.2021.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/28/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Low-calorie sweeteners (LCS) are increasingly being used worldwide, including in foods and beverages commonly consumed by children. OBJECTIVE To examine the prevalence of LCS in packaged foods and beverages sold in Brazil, whether LCS are added to products with advertising directed to children, and whether foods and beverages with LCS include front-of-package (FoP) LCS-related health and nutrition claims. DESIGN Cross-sectional study. SETTING A sample (n = 11,434) of packaged foods and beverages sold by the top five largest Brazilian food retailers was examined to identify LCS and added sugars and a subsample (n = 3,491) was examined to determine the presence of advertising directed to children and FoP LCS-related claims in foods and beverages with LCS. MAIN OUTCOME AND MEASURES The prevalence of foods and beverages with different types of LCS in the Brazilian food supply, among ultra-processed foods and beverages and among foods and beverages with added sugars were measured. Foods and beverages with advertising directed to children were checked to see if these products had LCS, and how many products with LCS had FoP labels with LCS-related claims. STATISTICAL ANALYSES Mean and 95% confidence intervals were used to determine the overall prevalence of foods and beverages with LCS and in the different assessed stratifications. RESULTS The prevalence of LCS was 9.3% (95% CI 8.8, 9.9) in Brazilian packaged foods and beverages, 14.6% (95% CI 13.8, 15.4) in ultra-processed products alone, and 5.7% (95% CI 4.2, 7.7) in foods and beverages with advertising directed to children. About 83% of food and beverage with LCS were also sweetened with added sugars. LCS were most frequently added to nonalcoholic sweetened beverages, breakfast cereals, and granola bars. Forty percent of foods and beverages with LCS did not present any front-of-package LCS-related claim. CONCLUSION This study shows that LCS are present in 15% of ultra-processed foods and beverages in Brazil, largely used in combination with added sugars, and are found in foods and beverages with advertising directed to children. Clearer FoP information regarding the presence of LCS, in particular in products with advertising directed to children, can help consumers make more informed choices regarding LCS consumption.
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Affiliation(s)
- Mariana Fagundes Grilo
- Graduate student, Graduate Program in Collective Health, School of Medical Sciences, University of Campinas (Unicamp), Tessalia Vieira de Camargo St., 126, Cidade Universitária, Campinas, Brazil 13083-887
| | - Lindsey Smith Taillie
- Assistant Professor, Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, University of North Carolina (UNC), Chapel Hill, Dauer Dr, 135 Chapel Hill, United States 27599
| | - Camila Zancheta Ricardo
- PhD student, Public Health Doctoral Program, School of Public Health, University of Chile, Independencia Av., 939, Región Metropolitana, Chile
| | - Laís Amaral Mais
- Researcher, Brazilian Institute for Consumer Defense (Idec), Dr. Costa Júnior St., 543, Água Branca, São Paulo, Brazil 05002-000
| | - Ana Paula Bortoletto Martins
- Researcher, Brazilian Institute for Consumer Defense (Idec), Dr. Costa Júnior St., 543, Água Branca, São Paulo, Brazil 05002-000
| | - Ana Clara Duran
- Research Scientist, Center for Food Studies and Research (NEPA), University of Campinas (Unicamp) University of Campinas (Unicamp), Albert Einstein Av., 291, Cidade Universitária, Campinas, Brazil 13083-852; Assistant Professor, Graduate Program in Collective Health, School of Medical Sciences, University of Campinas (Unicamp), Tessalia Vieira de Camargo St., 126, Cidade Universitária, Campinas, Brazil 13083-887; Research Fellow, Center for Epidemiological Studies in Nutrition and Health (NUPENS), University of São Paulo (USP). Dr Arnaldo Av., 715 São Paulo, Brazil 01246-904.
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Pandav C, Smith Taillie L, Miles DR, Hollingsworth BA, Popkin BM. The WHO South-East Asia Region Nutrient Profile Model Is Quite Appropriate for India: An Exploration of 31,516 Food Products. Nutrients 2021; 13:nu13082799. [PMID: 34444959 PMCID: PMC8400900 DOI: 10.3390/nu13082799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/29/2021] [Accepted: 08/07/2021] [Indexed: 11/16/2022] Open
Abstract
The rapid rise in prevalence of overweight/obesity, as well as high prevalence of type 2 diabetes and other nutrition-related noncommunicable diseases, has led the Food Safety and Standards Authority of India (FSSAI) to propose a front-of-package labeling (FOPL) regulation. An effective FOPL system applies a nutrient profile model that identifies foods high in sugar, sodium, and saturated fat that would receive a warning label for consumers to effectively discern between more and less healthy foods. Previous Nutrition Alchemy data collected by the food industry (n = 1306 products) estimated that approximately 96% of foods in India would have at least one warning label based on the FSSAI proposed FOPL. This near universal coverage of warning labels may be inaccurate and misleading. To address this, the current study compared two nutrient profile models, the WHO South-East Asia Region Organization (SEARO) and the Chilean Warning Octagon (CWO) Phase 3, applied to food products available in the Indian market from 2015-2020, collected through Mintel Global New Products Database (n = 10,501 products). Results suggest that 68% of foods and beverages would have at least one ' high-in' level warning label. This study highlights the need to include a more comprehensive sample of food products for assessing the value of warning labels.
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Affiliation(s)
- Chandra Pandav
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India;
| | - Lindsey Smith Taillie
- Department of Nutrition and Carolina Population Center, The University of North Carolina at Chapel Hill, CB #8120, 123 West Franklin Street, Chapel Hill, NC 27516, USA;
| | - Donna R. Miles
- Carolina Population Center, The University of North Carolina at Chapel Hill, CB #8120, 123 West Franklin Street, Chapel Hill, NC 27516, USA; (D.R.M.); (B.A.H.)
| | - Bridget A. Hollingsworth
- Carolina Population Center, The University of North Carolina at Chapel Hill, CB #8120, 123 West Franklin Street, Chapel Hill, NC 27516, USA; (D.R.M.); (B.A.H.)
| | - Barry M. Popkin
- Department of Nutrition and Carolina Population Center, The University of North Carolina at Chapel Hill, CB #8120, 123 West Franklin Street, Chapel Hill, NC 27516, USA;
- Correspondence: ; Tel.: +1-919-445-6931
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An Assessment of Government Capacity Building to Restrict the Marketing of Unhealthy Food and Non-Alcoholic Beverage Products to Children in the Region of the Americas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168324. [PMID: 34444077 PMCID: PMC8394636 DOI: 10.3390/ijerph18168324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022]
Abstract
The Pan American Health Organization (PAHO) Strategic Plan 2020–2025 committed to reduce children’s consumption of energy-dense nutrient-poor food and beverage products high in fat, sugar and salt (HFSS) and promote healthy eating patterns to reduce malnutrition in all forms. This paper describes the capacity-building needs in PAHO’s Member States to restrict the marketing of HFSS food and beverages to children. We asked Ministries of Health officials or national institutes/departmental representatives (n = 35) to complete a 28-item web-based survey (January to July 2020). Capacity-building needs were assessed using an adapted version of the World Health Organization’s government capacity-building framework with three modules: public health infrastructure, policies and information systems. Notable achievements for the PAHO’s Plan of Action were identified. State representatives reported strong infrastructure and information systems; however, policy improvements are needed to increase comprehensive national responses. These include using a constitutional health and human rights approach within the policies, policies that document conflict of interest from non-state actors, and strengthening regulatory oversight for digital media platforms. These findings provide baseline data and we suggest priorities for further action to strengthen national governments’ capacity-building and to accelerate the development, implementation, and monitoring systems to restrict the marketing of HFSS food and non-alcoholic beverages to children in the region of the Americas.
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Duran AC, Mialon M, Crosbie E, Jensen ML, Harris JL, Batis C, Corvalán C, Taillie LS. Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States. Obes Rev 2021; 22 Suppl 3:e13237. [PMID: 34152071 PMCID: PMC8365715 DOI: 10.1111/obr.13237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/23/2022]
Abstract
The food environment is a major contributor to unhealthy diets in children and, therefore, to the increasing rates of obesity. Acclaimed by scholars across the world, Latin American countries have been leaders in implementing policies that target different aspects of the food environment. Evidence on the nature and to what extent children are exposed and respond to unhealthy food environments in the region and among Latinos in the United States is, however, deficient. The objective of this review is to use the integrated International Network for Food and Obesity/noncommunicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) framework to create healthy food environment to (i) compare the key elements of childhood obesity-related food environments in Latin America and for Latinos living in the United States; (ii) describe the evidence on solutions to improve childhood obesity-related food environments; and (iii) identify research priorities to inform solutions to fight childhood obesity in these populations. We found that an integrated body of evidence is needed to inform an optimal package of policies to improve food environments to which children in Latin America and Latino children in the United States are exposed and more efficiently translate policy solutions to help curb growing childhood obesity levels across borders.
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Affiliation(s)
- Ana Clara Duran
- Center for Food Studies and Research (NEPA)University of CampinasCampinasBrazil
- Center for Epidemiological Studies in Nutrition and HealthUniversity of São PauloSão PauloBrazil
| | - Melissa Mialon
- Trinity Business SchoolTrinity College DublinDublinIreland
| | - Eric Crosbie
- School of Community and Health SciencesUniversity of NevadaRenoNevadaUSA
| | - Melissa Lorena Jensen
- Rudd Center for Food Policy and ObesityUniversity of ConnecticutHartfordConnecticutUSA
- School of Nutrition, University of Costa RicaSan JoséCosta Rica
| | - Jennifer L. Harris
- Rudd Center for Food Policy and ObesityUniversity of ConnecticutHartfordConnecticutUSA
| | - Carolina Batis
- CONACYT, Health and Nutrition Research CenterNational Institute of Public HealthCuernavacaMexico
| | - Camila Corvalán
- Instituto de Nutricion y Tecnologia de AlimentosUniversity of ChileSantiagoChile
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Silva ARCS, Braga LVM, Anastácio LR. A comparison of four different Nutritional Profile models in their scoring of critical nutrient levels in food products targeted at Brazilian children. NUTR BULL 2021. [DOI: 10.1111/nbu.12490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Taillie LS, Hall MG, Popkin BM, Ng SW, Murukutla N. Experimental Studies of Front-of-Package Nutrient Warning Labels on Sugar-Sweetened Beverages and Ultra-Processed Foods: A Scoping Review. Nutrients 2020; 12:E569. [PMID: 32098363 PMCID: PMC7071470 DOI: 10.3390/nu12020569] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
Policies that require front-of-package (FoP) nutrient warnings are becoming increasingly common across the globe as a strategy to discourage excess consumption of sugary drinks and ultra-processed food. However, a better understanding of the pathway through which FoP nutrient warnings work, as well as a review of how outcomes being measured in recent studies map onto this pathway, are needed in order to inform policy on the most effective FoP label design for reducing purchases of ultra-processed foods. This scoping review describes a conceptual model for how FoP nutrient warnings affect consumer behavior, examines which of these outcomes are currently being measured, and summarizes evidence from randomized controlled experiments. Twenty-two studies which experimentally tested nutrient warnings against a control label or other labeling systems were included for full-text review. Our conceptual model includes attention; comprehension, cognitive elaboration, and message acceptance; negative affect and risk perception; behavioral intentions, and behavioral response, along with other elements such as external factors and interpersonal communications. We found that many studies focused on outcomes such as attention, comprehension, and behavioral intentions, but considerable gaps in the evidence remain, particularly for intermediary steps on the pathway to behavioral change, such as negative affect and social interactions. FoP nutrient warnings were visually attended to by consumers, easy to understand, helped consumers identify products high in nutrients of concern, and discouraged them from purchasing these products, although other labeling systems were perceived as containing more information and performed better at helping consumers rank the healthfulness of products. More research is needed to understand whether and how nutrient warnings work in the real world to discourage consumer purchases of sugary drinks and ultra-processed food.
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Affiliation(s)
- Lindsey Smith Taillie
- Department of Nutrition, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599, USA; (B.M.P.); (S.W.N.)
| | - Marissa G. Hall
- Department of Health Behavior, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599, USA;
| | - Barry M. Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599, USA; (B.M.P.); (S.W.N.)
| | - Shu Wen Ng
- Department of Nutrition, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599, USA; (B.M.P.); (S.W.N.)
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