Use of added sugars in packaged foods sold in Brazil.

OBJECTIVE: Studies have shown that the consumption of added sugars may be associated with harmful health effects. The present study investigated the presence and types of added sugars in packaged foods. DESIGN: Cross-sectional analysis of the presence and types of added sugars in the ingredients lists of packaged foods sold in a major Brazilian supermarket. The nomenclature of ingredients classified as added sugars and their frequency were identified. Data were organised and analysed through descriptive statistics: absolute and relative frequencies of the presence of added sugars categorised by food groups were calculated, and ingredients were analysed by text mining using R statistical environment. SETTING: A supermarket in Florianópolis, a metropolis in southern Brazil. SUBJECTS: Packaged food products (n 4539) classified into eight groups. RESULTS: Of the 4539 products, 71 % had some type of added sugar. The group with the highest frequency of added sugars was 'products in which carbohydrates and fats are the main energy source' (93 %). Food groups containing predominantly salty foods had a high frequency of added sugars, such as 'meats and eggs' (61 %). In total, 179 different terms for added sugars were identified, of which sugar, maltodextrin and glucose syrup were the most frequent. CONCLUSIONS: Most of the packaged foods sold in Brazil contain added sugars, which may hamper adherence to the recommendation of limiting added sugars intake. The data may be useful for monitoring tendencies in the use of added sugars in packaged foods and as supplementary information to support the improvement of food label regulations.

Where are the low-calorie sweeteners? An analysis of the presence and types of low-calorie sweeteners in packaged foods sold in Brazil from food labelling.

OBJECTIVE: Studies have shown that consumption of low-calorie sweeteners (LCS) may be associated with harmful health effects. The current study investigated the presence and types of LCS added to packaged foods. DESIGN: Cross-sectional study analysing the presence and types of LCS in the ingredients lists of packaged foods sold at a major Brazilian supermarket. To identify types of LCS allowed for use in foods in Brazil, current legislation was consulted. Data were organised and analysed through descriptive statistics, presenting simple and relative frequencies of LCS presence categorised by food group. SETTING: Supermarket in Florianópolis, southern Brazil. SUBJECTS: Packaged food products (n 4539) from eight food groups. RESULTS: One or more LCS were found in 602 (13·3 %) of the packaged foods analysed. There were 1329 citations of LCS among these foods, with a mean of 2·2 sweeteners per food. Groups with the highest frequency of foods containing LCS were: products with energy derived from carbohydrates and fats (25·0 %); milk and dairy products (11·7 %); bakery products, cereals, legumes, roots and tubers (11·2 %); and fruits, juices, nectars and fruit drinks (8·3 %). CONCLUSIONS: There was high prevalence of packaged foods with LCS, especially in food groups that form the basis of the Brazilian diet. The study was the first to extensively analyse the presence and types of LCS in packaged foods available for sale in a Brazilian supermarket and can be useful to monitor the use of LCS in these foods, as well as to support future changes in legislation to label sugars.

A label survey to identify ingredients potentially containing GM organisms to estimate intake exposure in Brazil.

OBJECTIVE: To identify ingredients from products and by-products derived from GM crops in packaged food products and to analyse the presence of these ingredients in the foods most commonly consumed by the Brazilian population. DESIGN: Cross-sectional study. SETTING: A search of the scientific literature to identify the use of products and by-products derived from GM crops in foods in Brazil and a study of food labels in a supermarket belonging to one of the ten largest supermarket chains in Brazil. SUBJECTS: To identify the ingredients present in packaged food products and their nomenclatures, the labels of all packaged food products available for sale in a supermarket were analysed. Subsequently, the presence of potential GM ingredients in the foods most commonly consumed by the Brazilian population was analysed. RESULTS: A total of twenty-eight GM crops' by-products with applications in the food industry (from soyabeans, corn, cotton and a yeast) were identified. Such by-products are presented as food ingredients or additives on food labels with 101 distinct nomenclatures. Most of the variety (63·8 %) and the quantity (64·5 %) of the foods most commonly consumed by Brazilians may contain a least one GM ingredient. CONCLUSIONS: The presence of at least one potential GM ingredient was observed in more than half of the variety of foods most commonly consumed by the Brazilian population. Such ingredients were identified with distinct nomenclatures and incomplete descriptions, which may make it difficult to identify potential GM foods and confuse consumers when making food choices.

Positive impact of a cooking skills intervention among Brazilian university students: Six months follow-up of a randomized controlled trial.

OBJECTIVES: The purpose of this study was to determine the effects of the Nutrition and Culinary in the Kitchen (NCK) Program to evaluate the improvement of cooking skills and healthy eating of university students. METHODS: A randomized controlled trial with six months follow-up was used incorporating an intervention group (IG) and a control group (CG). The IG participated in the NCK program over a six-week period, three hours weekly, based on five hands-on cooking classes and one food market visit, while CG continued their usual activities. Outcome measures included changes in relation to a) accessibility and availability of fruits and vegetables (AAFV); b) cooking attitudes (CA); c) cooking behaviors at home (CBH); d) cooking behaviors away from home (CBAH) e) produce consumption self-efficacy (SEPC); f) self-efficacy for using cooking techniques (SECT); g) self-efficacy for using fruits, vegetables, and seasonings (while cooking) (SEFVS); and h) knowledge of cooking terms and techniques (CTT). An online self-completed validated survey was answered, at three time points: baseline (T1), after intervention (T2) and six months after intervention (T3). Statistical analyses were conducted to evaluate changes in outcomes within and between groups over time. RESULTS: 76 students completed the online questionnaire at the 3 time points. Findings revealed a statistically significant increase (p < 0.05) in all outcomes evaluated in the IG, except for CBH and CBAH. This effect was sustained at T3 (p < 0.001). Results were similar to the adjusted model (p < 0.001), thus, indicating that IG changes, when compared to CG, were due to the intervention effect. CONCLUSION: NCK culinary intervention program demonstrated efficacy for the increased on AAFV, CA, SEPC, SECT, SEFVS and CTT with university students.

Nutrition and Culinary in the Kitchen Program: a randomized controlled intervention to promote cooking skills and healthy eating in university students - study protocol.

BACKGROUND: Community-based intervention studies that aim at developing cooking skills have increased in the scientific literature and are related to healthier food practices. However, methodological limitations are observed and only a few studies have university students as the target. The university entrance period has been related to negative changes in eating habits among young people and it represents an important period for developing interventions for health promotion. This study describes the study protocol and the evaluation framework for the Nutrition and Culinary in the Kitchen program. This program aims to develop cooking skills in university students, and is based on the Cooking with a Chef program in the United States. METHODS: This ongoing, randomized controlled intervention was designed with a six month follow-up study. The intervention consisted of three-hour weekly classes during a six week period with printed materials provided. Five of the classes were hands-on cooking and one was a tour to a popular food market. There were eight primary outcome measures: changes in relation to i) accessibility and availability of fruits and vegetables; ii) cooking attitudes; iii) cooking behaviors at home; iv) cooking behaviors away from home; v) produce consumption self-efficacy; vi) self-efficacy for using basic cooking techniques; vii) self-efficacy for using fruits, vegetables, and seasonings (while cooking); and viii) knowledge of cooking terms and techniques. Secondary outcomes included changes in body mass index and in personal characteristics related to cooking. Repeated measures were collected through the application of an online self-completed survey, at baseline, after intervention and six months after intervention. A sample of 80 university students (40: intervention group; 40: control group) was estimated to detect a mean change of 1.5 points in cooking knowledge, with study power of 80%, and 95% level of confidence, plus 20% for random losses and 10% for confounding factors. The control group participants have continued with their usual activities. Data analyses will evaluate the intervention effect on changes in outcomes within and between groups, as well as explore relations with personal characteristics. DISCUSSION: This method provides new evidence about whether or not a culinary intervention targeting university students has an impact on the improvement of cooking skills and healthy eating practices. TRIAL REGISTRATION: Brazilian Clinical Trials Registry - RBR-8nwxh5 ( http://www.ensaiosclinicos.gov.br/rg/RBR-8nwxh5/ ).

Comparison of the nutritional content of products, with and without nutrient claims, targeted at children in Brazil.

Many children's food products highlight positive attributes on their front-of-package labels in the form of nutrient claims. This cross-sectional study investigated all retailed packaged foods (n 5620) in a major Brazilian supermarket, in order to identify the availability of products targeted at children, and to compare the nutritional content of products with and without nutrient claims on labels. Data on energy, carbohydrate, protein, fibre, Na and total and SFA content, along with the presence and type of nutrient claims, were obtained in-store from labels of all products. Products targeted at children were identified, divided into eight food groups and compared for their nutritional content per 100 g/ml and the presence of nutrient claims using the Mann-Whitney U test (P<0·05). Of the 535 food products targeted at children (9·5 % of all products), 270 (50·5 %) displayed nutrient claims on their labels. Children's products with nutrient claims had either a similar or worse nutritional content than their counterparts without nutrient claims. The major differences among groups were found in Group 8 (e.g. sauces and ready meals), in which children's products bearing nutrient claims had higher energy, carbohydrate, Na and total and SFA content per 100 g/ml than products without nutrient claims (P<0·05). This suggests that, to prevent misleading parents who are seeking healthier products for their children, the regulation on the use of nutrient claims should be revised, so that only products with appropriate nutrient profiles are allowed to display them.

Sodium content on processed foods for snacks.

OBJECTIVE: To assess the Na content reported on the labels of processed foods sold in Brazil that are usually consumed as snacks by children and adolescents. DESIGN: Cross-sectional study that assessed Na content and serving size reporting on processed food labels. SETTING: A supermarket that is part of a large chain in Brazil. SUBJECTS: All foods available for sale at the study's location and reported in the literature as snacks present in the diets of Brazilian children and adolescents. RESULTS: Of the 2945 processed foods, 87 % complied with the reference serving sizes, although variability in reporting was observed in most of the food subgroups. In addition, 21 % of the processed foods had high Na levels (>600 mg/100 g) and 35 % had medium Na levels (>120 and ≤600 mg/100 g). The meats, oils, fats and seeds groups as well as the prepared dishes had higher percentages of foods classified as high Na (81 %, 58 % and 53 %, respectively). CONCLUSIONS: Most of the processed foods had high or medium Na content. We emphasize the importance of revising Brazilian nutrition labelling legislation to standardize reference serving sizes to avoid variation. Besides, we point out the potential for reducing Na levels in most processed foods, as evidenced by the variability in Na content within subgroups. Finally, we have identified the need to develop a method to classify Na levels in processed foods with specific parameters for children and adolescents.

Sodium content and labelling of processed and ultra-processed food products marketed in Brazil.

OBJECTIVE: To analyse the Na content and labelling of processed and ultra-processed food products marketed in Brazil. DESIGN: Cross-sectional study. SETTING: A large supermarket in Florianopolis, southern Brazil. SUBJECTS: Ingredient lists and Na information on nutrition labels of all processed and ultra-processed pre-prepared meals and prepared ingredients, used in lunch or dinner, available for sale in the supermarket. RESULTS: The study analysed 1416 products, distributed into seven groups and forty-one subgroups. Five products did not have Na information. Most products (58.8 %; 95 % CI 55.4, 62.2 %) had high Na content (>600 mg/100 g). In 78.0 % of the subgroups, variation in Na content was at least twofold between similar products with high and low Na levels, reaching 634-fold difference in the 'garnishes and others' subgroup. More than half of the products (52.0 %; 95 % CI 48.2, 55.6 %) had at least one Na-containing food additive. There was no relationship between the appearance of salt on the ingredients list (first to third position on the list) and a product's Na content (high, medium or low; P=0.08). CONCLUSIONS: Most food products had high Na content, with great variation between similar products, which presents new evidence for reformulation opportunities. There were inconsistencies in Na labelling, such as lack of nutritional information and incomplete ingredient descriptions. The position of salt on the ingredients list did not facilitate the identification of high-Na foods. We therefore recommend a reduction in Na in these products and a review of Brazilian legislation.

Impact of a Cooking Intervention on the Cooking Skills of Adult Individuals with Type 2 Diabetes Mellitus: A Pilot Study.

OBJECTIVE: To investigate the impact of the Nutrition and Culinary in the Kitchen (NCK) Program on the cooking skills of Brazilian individuals with type 2 diabetes mellitus (T2DM). METHODS: A randomized controlled intervention study was performed, with intervention and control groups. The intervention group participated in weekly sessions of the NCK Program for six weeks (including two in-person practical cooking and three online cooking workshops). The cooking recipes were adapted by replacing high glycemic index ingredients with low and medium glycemic index alternatives. Of note, the recipes did not contain added sugars or sweeteners, were based on the use of fresh or minimally processed foods, herbs, and spices, and were sensorially tested by individuals with T2DM before use in the intervention. The study outcomes were participant score changes on the seven scales. A validated online instrument was administered to the control and intervention groups at baseline (T1) and post-intervention (T2). Parametric and non-parametric tests were used to assess the differences between the T1 and T2 parameters. RESULTS: Of the 60 individuals enrolled, 44 answered the questionnaire at both times. The findings revealed a 45.37% ± 93.57% increase in Knowledge of Cooking Terms in the intervention group, whereas the control group showed a 3.82% ± 16.17% reduction (p = 0.008). There was an increase in all the other cooking skills and healthy eating scales from T1 to T2 in the intervention group, but the differences were not significant. CONCLUSIONS: The development of cooking skills can contribute to increasing culinary knowledge and the availability of time to cook at home. The results contribute to the planning of health actions aimed at individuals with DM2 through culinary interventions and public food and nutrition policies.

Market-driven fortification of vitamins and minerals in packaged foods targeted at children in Brazil.

This study aimed to characterise the market-driven fortification of vitamins and minerals in packaged foods targeted at children in Brazil. We analysed 535 food labels using data collected in a census-type method (n = 5620) of food labels in a Brazilian supermarket in 2013. Micronutrients declared in nutrition claims and the ingredients list (synthetic compounds) were considered to be added for commercial purposes. Analysis of the ingredients list and nutrition claims showed that market-driven fortification of vitamins and minerals was present in 27.1% of foods. The main vitamins and minerals were vitamins A, B complex, C, D, calcium, iron and zinc. The food groups 'Milk and dairy products' and 'Sugars, sugary foods and snacks' had the highest frequencies of micronutrients declared in the ingredients list. Calcium, iron, phosphorus, zinc and all vitamins, except B7, were found to be added for commercial purposes. Micronutrients were found to be commonly added to packaged foods as a marketing strategy directed at parents and their children. Future studies should assess the amount of vitamins and minerals added to packaged foods targeted at children and whether intakes of vitamins and minerals in children are potentially excessive.

Availability and price of food products with and without trans fatty acids in food stores around elementary schools in low- and medium-income neighborhoods.

The purpose of this exploratory, descriptive, and cross-sectional study was to investigate the relationship between the price and availability of food products with and without trans fatty acids in food stores near elementary schools located in low- and medium-income neighborhoods of a Brazilian city. The supply of products containing trans fatty acids was higher in both regions, and these products were also cheaper. It is noteworthy that this availability may influence food choices and, consequently, the health status of children and adolescents, since this population is more likely to buy less-healthy foods when these are more available, accessible, and financially attractive.

Gauging food and nutritional care quality in hospitals.

BACKGROUND: Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. METHODS: Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and hospital food service quality (FSQ). HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. RESULTS: Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02) and per dietitian (p < 0.01). The mean compliance with NCQ criteria in public and private institutions was 51.8% and 41.6%, respectively. The percentage of public and private health institutions in conformity with FSQ criteria was 42.4% and 49.1%, respectively. Most of the actions comprising each corpus, NCQ and FSQ, varied considerably between the two types of institution. NCQ was positively influenced by hospital type (general) and presence of a clinical dietitian. FSQ was affected by institution size: large and medium-sized hospitals were significantly better than small ones. CONCLUSIONS: Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.

Overweight/obesity is associated with food choices related to rice and beans, colors of salads, and portion size among consumers at a restaurant serving buffet-by-weight in Brazil.

The present study investigated the prevalence of overweight/obesity and its relationship with behavioral and food choice characteristics among consumers at a restaurant serving buffet-by-weight in the city of Florianopolis, southern Brazil, during lunch time. An analytical cross-sectional survey of 675 consumers aged 16-81 years was conducted. The measures included anthropometric, socio-demographic, and behavioral characteristics, as well as portion size and a photographic record of the plate chosen by the consumer. The results indicated a prevalence of overweight/obesity in the sample of 33.8%. Overall, after an adjustment for other variables (sex, age, schooling, marital status, and food choice variables), overweight/obesity was positively associated with not choosing rice and beans (PR=1.11) and larger portion sizes (PR=1.08 for a portion size of 347-462 g and PR=1.16 for a portion size of 463 g or more). Moreover, choosing 1-2 colors of salads showed a positive association when compared with choosing 3 or more colors of salads (PR=1.06). Efforts in helping consumers make healthier food choices when eating out and thereby possibly reduce weight gain should address those aspects along with socio-demographic factors.

Consumers' Response to Sugar Label Formats in Packaged Foods: A Multi-Methods Study in Brazil.

Providing information about the sugar content of packaged foods on product labels is an important strategy to lower consumers' sugar intake. This study assessed the effect of exposure to different sugar labels on consumers' understanding of the sugar content of foods and their food choices. In the first phase, five focus groups were conducted with a convenience sample of Brazilian adults to explore their perceptions about food labelling in general and sugar labelling in particular. Based on the qualitative results, four sugar label formats were developed and subsequently tested in a five-arm study on 1,277 adults via a randomised controlled online survey. The formats were: (i) no sugar information-control, (ii) total and added sugar content displayed in the Nutrition Information Panel (NIP), (iii) a front-of-package (FoP) octagonal warning for "high-in-sugar" products, (iv) a FoP magnifying glass warning for "high-in-sugar" products, and (v) a "high-in-sugar" warning text embedded on the NIP. Participants from the focus groups reported being confused about the meaning of "sugar" and "added sugar" on food labels and indicated that more interpretive labels, such as the FoP warnings, would help them choose products with low sugar content. In the experiment, all intervention sugar label formats improved participants' understanding of the sugar content of the tested food products, with the FoP warnings (iii and iv) showing the best results. While non-significant differences among label conditions were observed for food choices, the FoP octagonal warning prompted participants to choose high-in-sugar products less often. Given current public policy agendas aiming to reduce added sugar intake, there is a need to strengthen food labelling policies and nutrition disclosure policies that target the display of added sugar and build consumer awareness in using these tools to avoid high-in-sugar products.

University Students' Knowledge and Perceptions About Concepts, Recommendations, and Health Effects of Added Sugars.

It is recommended to limit added sugars to below 10% of the daily energy intake, as excessive consumption has been associated with several chronic non-communicable diseases. This exploratory qualitative study used focus groups to investigate the knowledge and perception of Brazilian university students about added sugars concepts, consumption recommendations, and health effects. Focus groups were led by a moderator using a semi-structured discussion guide. The focus groups were recorded, transcribed verbatim, and subjected to thematic analysis. Five focus groups were conducted with a total of 32 participants (50% women, mean age 23 years). Participants could not distinguish added sugars from sugars naturally present in foods and were unaware of the health impacts associated with excessive added sugar consumption, except for the risk of diabetes. Although most participants reported limiting sugar consumption, they had no knowledge of official consumption recommendations. Given that current public policy agendas aim to reduce added sugar intake, there is a need to strengthen strategies for disseminating information on added sugar concepts, recommendations, health effects and how to identify them in the foods products.

Food additives in childhood: a review on consumption and health consequences.

OBJECTIVE: To discuss the context of scientific publications on the consumption of food additives by children and the possible health consequences in this age group. METHODS: A literature review, with a search carried out between April 2020 and April 2021 in the Web of Science, Scopus, PubMed and Google Scholar databases, as well as in websites of Brazilian and foreign official bodies. Official documents and studies published since 2000 were selected. Keywords related to food additives, children, food consumption, and health were used for the search. RESULTS: Food additives are substances intentionally added to foods for technological purposes. Processed foods are the main sources of additives in food and their consumption occurs since childhood. It is observed, however, that there are limitations inherent to the scientific method regarding the analysis of consumption and toxicity of food additives in humans, causing scarcity of data in the scientific literature. Additionally, existing data suggest that the additives have a higher toxic potential in children, considering that the body weight in this age group is lower than in adults. This context emphasizes the need to observe the precautionary principle, according to which risks of harm must be prevented. CONCLUSIONS: This is a scenario in which the literature points to a risk to people's health and, in particular, to children, about whom the duty of protection must be even greater, with absolute priority. Thus, the relevance of an expanded technical-scientific debate regarding the establishment of specific and stricter parameters for children is considered, regarding the consumption and toxicity of additives, as well as the different sources of exposure to these substances.

Trans-Fat Labeling in Packaged Foods Sold in Brazil Before and After Changes in Regulatory Criteria for Trans-Fat-Free Claims on Food Labels.

Consumption of industrially produced trans-fat acids (TFA) is a public health concern. Therefore, it is important that information on TFA in packaged foods be clearly informed to consumers. This study aimed to assess the evolution of TFA information presented in packaged foods sold in Brazil in 2010 and 2013, before and after the introduction of stricter regulatory requirements for TFA-free claims on food labels. A repeated cross-sectional study was performed through food label censuses of all packaged foods available for sale in two stores from the same supermarket chain, totaling 2,327 foods products in 2010 and 3,176 in 2013. TFA-free claims and information indicating TFA in the ingredients list and nutrition facts label were analyzed by descriptive statistics and Pearson's chi-square test. There was a 14% decrease in the use of ingredients containing or potentially containing industrially produced TFA (i-TFA), according to analysis of the ingredients list. However, when analyzing foods by groups, it was found that this decrease was significant only for group A (bakery goods, bread, cereals, and related products; from 59 to 35%, p < 0.001). By contrast, food group F (gravies, sauces, ready-made seasonings, broths, soups, and ready-to-eat dishes) showed a 5% increase in i-TFA. The use of specific terms for i-TFA decreased between 2010 and 2013, but there was an increase in the use of alternative terms, such as vegetable fat and margarine, which do not allow consumers to reliably identify whether a food product is a possible source of i-TFA. There was an 18% decrease in the use of TFA-free claims in products containing or potentially containing i-TFA. However, almost one-third of foods sold in 2013 were false negatives, that is, foods reported to contain 0 g of TFA in the nutrition facts label or with TFA-free claims but displaying specific or alternative terms for i-TFA in the ingredients list. The results indicate that adoption of stricter requirements for TFA-free claims on food labels in Brazil helped reduce the prevalence of such claims but was not sufficient to decrease i-TFA in industrialized foods sold in supermarkets.

Use of the term whole grain on the label of processed and ultra-processed foods based on cereals and pseudocereals in Brazil.

There has been an increasing consumption of processed and ultra-processed foods, accompanied by growing concerns about the relationship between diet quality and health. Whole-grain foods, composed of cereals and pseudocereals, are recommended as part of a healthy diet, and food labeling is an important tool for consumers to identify the presence of whole grains in packaged foods. This study aimed to analyze the use of the term whole grain on the label of processed and ultra-processed foods based on cereals and pseudocereals (amaranth, quinoa, and buckwheat) in Brazil. Data were collected by a census of all food labels in a Brazilian supermarket. Foods were classified into eight groups according to Brazilian legislation and according to the presence or absence of the term whole grain. The prevalence of foods displaying the term whole grain or related expressions on the front label was assessed, and differences between groups were analyzed using Pearson's chi-squared test. Comparisons were also made in relation to the position of whole-grain ingredients in the ingredients list, given that Brazilian food labeling regulations require that ingredients be listed in descending order of weight on packaged foods. The level of significance was defined as p < 0.05. The sample included 1,004 processed and ultra-processed foods based on cereals and pseudocereals, 156 (15.6%) of which displayed the term whole grain and/or similar expressions on the front label. Of these, 98 (9.8%) contained the term whole grain, 25 (2.5%) displayed analogous expressions, and 33 (3.3%) contained the term whole grain concomitantly with analogous terms, identified in foods of the groups Bakery goods, bread, cereals, and related products and Sugars, sugary foods, and snacks. Half of the food products displaying the term whole grain or related expressions on the front label did not have a whole-grain ingredient listed in the first position of the ingredients list. The frequency of whole grains was even lower when analyzing the second and third ingredients. These findings reveal the existence of inaccurate information regarding the term whole grain or analogous expressions on the front label of cereal- and pseudocereal-based packaged foods. It is expected that these results will contribute to stimulating the food industry and regulatory bodies to improve the use of the term whole grain and related expressions on packaged food labels, given that, up to the moment of data collection, there were no regulatory requirements for these statements. Furthermore, the findings might contribute to improving the clarity of information available on food labels, thereby preventing consumer deception at the time of purchase.

How was the cooking skills and healthy eating evaluation questionnaire culturally adapted to Brazil?

The study described the cross-cultural adaptation process of the American Cooking Skills and Healthy Eating questionnaire to Brazil. Six stages were followed: Translation; Synthesis of translations; Back-translations; Expert Committee; Synthesis of final version; and the Pretest (self-administered online questionnaire in a Brazilian University). Participants responded to the translated questionnaire twice for test-retest. Conceptual, item, semantic, operational and measurement equivalences were evaluated between original and translated questionnaires, as well as the internal consistency and test-retest reliability. Item, conceptual, semantic equivalences between original and Brazilian questionnaires were reached before the Expert Committee stage. Specific cooking techniques and terms were adapted. Forty-eight students answered the questionnaire in the pre-test stage, achieving the operational and measurement equivalences with kappa's agreement from moderate to substantial, and satisfactory to excellent correlations between measures. Only two measures showed low internal consistency. The combination of stages and equivalences approaches used in this cross cultural adaptation study provided lessons for further Nutrition's researches, disclosing the complexity of cooking skills concepts.

The adaptation, validation, and application of a methodology for estimating the added sugar content of packaged food products when total and added sugar labels are not mandatory.

Nutrition policies recommend limiting the intake of added sugars. Information about added sugar content is not provided on packaged foods in Brazil, and even total sugar content information is often absent. This study aimed to (i) adapt a systematic methodology for estimating added sugar content in packaged foods when information on total and added sugar contents is not mandatory on labels, (ii) apply the adapted methodology to a Brazilian food composition database to estimate the extent of added sugar content in the national food supply, and (iii) assess the validity of the adapted methodology. We developed an 8-step protocol to estimate added sugar content using information provided on food labels. These steps included objective and subjective estimation procedures. Mean, median, and quartiles of the added sugar content of 4,805 Brazilian foods were determined and presented by food categories. Validity was assessed using a US database containing values of added sugar as displayed on the product labels. Objective estimation of added sugar content could be conducted for 3,119 products (64.9%), with the remainder 1,686 (35.1%) being assessed using subjective estimation. We found that 3,093 (64.4%) foods contained added sugar ingredients and the overall estimated median added sugar content was 4.7 g (interquartile range 0-29.3) per 100 g or 100 ml. The validity testing on US data for products with known added sugar values showed excellent agreement between estimated and reported added sugar values (ICC = 0.98). This new methodology is a useful approach for estimating the added sugar content of products in countries where both added and total sugar information are not mandated on food labels. The method can be used to monitor added sugar levels and support interventions aimed at limiting added sugar intake.