Breastfeeding, first-food systems and corporate power: a case study on the market and political practices of the transnational baby food industry in Brazil.

BACKGROUND: The exploitative marketing of commercial milk formula (CMF) reduces breastfeeding, and harms child and maternal health globally. Yet forty years after the International Code of Marketing of Breast-Milk Substitutes (The Code) was adopted by WHO member states, many countries are still to fully implement its provisions into national law. Furthermore, despite The Code, worldwide CMF markets have markedly expanded. In this paper, we adopt Brazil as a case study to understand the power of the baby food industry's marketing and corporate political activity, and how this influences the country's 'first-food system' in ways that promote and sustain CMF consumption. METHODS: We used a case study design, drawing data from from documents and key informant interviews (N = 10). RESULTS: Breastfeeding rates plummeted in Brazil to a historic low in the 1970s. A resurgence in breastfeeding from the mid-1980s onwards reflected strengthening political commitment for a national policy framework and breastfeeding protection law, resulting in-turn, from collective actions by breastfeeding coalitions, advocates, and mothers. Yet more recently, improvements in breastfeeding have plateaued in Brazil, while the industry grew CMF sales in Brazil by 750% between 2006 and 20. As regulations tightened, the industry has more aggressively promoted CMF for older infants and young children, as well as specialised formulas. The baby food industry is empowered through association with powerful industry groups, and employs lobbyists with good access to policymakers. The industry has captured the pediatric profession in Brazil through its long-standing association with the Brazilian Society of Pediatrics. CONCLUSION: Brazil illustrates how the baby food industry uses marketing and political activity to promote and sustain CMF markets, to the detriment of breastfeeding. Our results demonstrate that this industry requires much greater scrutiny by regulators.

Role of different nutrient profiling models in identifying targeted foods for front-of-package food labelling in Brazil.

OBJECTIVE: To compare the degree of strictness and agreement of different nutrient profiling models (NPM) used to identify which foods would be required to show front-of-package (FOP) warning labels. DESIGN: Using data of 11 434 packaged foods found in the five largest food retailers in Brazil, we used two published NPM: the Pan American Health Organization (PAHO) model and the NPM used in the Chilean nutritional FOP labelling policy, and compared them with a NPM proposed by the Brazilian National Health Surveillance Agency (Anvisa). The proportion of foods that would be required to show FOP warning labels was calculated overall and by food category. We also tested whether a modified version of the PAHO NPM would behave similarly to the original version. SETTING: Brazil. RESULTS: Two-thirds of the packaged products (62 %) would receive FOP warning labels under the PAHO NPM, as compared with 45 % of products using the proposed Anvisa NPM and 41 % if the Chilean NPM was applied. The PAHO NPM identified more foods high in critical nutrients such as sweetened dairy and non-dairy beverages, canned vegetables and convenience foods. Overall agreement between models was considered good with kappa coefficient ranging from 0·57 to 0·92 but was lower for some food categories. CONCLUSIONS: We found variations in the degree of strictness and agreement between assessed NPM. The PAHO NPM identified more foods and beverages high in sugar which are among the top contributors to sugar and energy intake in Brazil.

Advertising patterns of a fast-food chain on social media in Brazil.

OBJECTIVE: To investigate the advertising patterns on the posts of a fast-food chain in Brazil on three social media platforms in 2019. DESIGN: An exploratory cross-sectional study. SETTING: Advertising strategies on the posts of a major fast-food chain on their official Facebook, Instagram and YouTube accounts. The strategies were investigated according to the INFORMAS protocol for food promotion monitoring. Principal component analysis (PCA) was employed to identify advertising patterns in each platform. PARTICIPANTS: 305 advertisements. RESULTS: Four advertising patterns were identified in the PCA of Facebook and Instagram. In both platforms, the components for kids and product exaltation were similar. On Facebook, a pattern corresponding to economic appeal was identified as price and discount, while on Instagram, this pattern also included a practical approach. On Facebook, the fourth component was named celebrity, while on Instagram it was celebrity/innovation since on this second social media the component also included the 'new brand development' variable. On YouTube, three advertising patterns were identified in PCA. Similar to the other platforms, the first and the second patterns were called for kids and price and discount, and the third component referred to both celebrity and commemorative dates. CONCLUSIONS: The advertising patterns of the fast-food chain on three social media platforms were commonly directed to children and addressed price, discounts and the celebrities' universe. The findings of this study corroborate other data in the literature regarding unhealthy food advertising on social media. This study discusses the urgency of regulating food advertising content on this medium.

What to expect from the price of healthy and unhealthy foods over time? The case from Brazil.

OBJECTIVE: To measure change in price of food groups over time (1995-2030) in Brazil, considering the Brazilian Dietary Guidelines' recommendations. DESIGN: Data from the Household Budget Survey (2008-2009 HBS) and the National System of Consumer Price Indexes (NSCPI) were used to create a data set containing monthly prices for the foods and beverages most consumed in the country (n 102), from January 1995 to December 2017. Data on price of foods and beverages from 2008-2009 HBS (referring to January 2009) were used to calculate real price over time using the monthly variation in prices from NSCPI. All prices were deflated to December 2017. Foods and beverages were classified following the Brazilian Dietary Guidelines' recommendations. The monthly price for each food group and subgroup was used to analyse changes in prices from 1995 to 2017 and to forecast prices up to 2030 using fractional polynomial models. SETTING: Brazil. PARTICIPANTS: National estimates of foods and beverages purchased for Brazil. RESULTS: In 1995, ultra-processed foods were the most expensive group (R$ 6·51/kg), followed by processed foods (R$ 6·44/kg), then unprocessed or minimally processed foods and culinary ingredients (R$ 3·45/kg). Since the early 2000s, the price of ultra-processed foods underwent successive reductions, becoming cheaper than processed foods and reducing the distance between it and the price of the other group. Forecasts indicate that unhealthy foods will become cheaper than healthy foods in 2026. CONCLUSIONS: Food prices in Brazil have changed unfavourably considering the Brazilian Dietary Guidelines' recommendations. This may imply a decrease in the quality of the population's diet.

Ultra-processed food and beverage advertising on Brazilian television by International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support benchmark.

OBJECTIVE: To analyse the extent and nature of food and beverage advertising on the three major Brazilian free-to-air television (TV) channels. DESIGN: Cross-sectional study. A protocol developed for the International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support was applied for data collection. A total of 432 h of TV programming was recorded from 06.00 to 24.00 hours, for eight non-consecutive and randomly selected days, in April 2018. All TV advertisements (ads) were analysed, and food-related ads were classified according to the NOVA classification system. Descriptive analyses were used to describe the number and type of ads, food categories and the distribution of ads throughout the day and time of the day. SETTING: The three most popular free-to-air channels on Brazilian TV. PARTICIPANTS: The study did not involve human subjects. RESULTS: In total, 14·2 % (n 1156 out of 7991) of ads were food related (858 were specific food items). Approximately 91 % of food items ads included ultra-processed food (UPF) products. The top three most promoted products were soft drinks, alcoholic beverages and fast-food meals. Alcoholic beverage ads were more frequently broadcast in the evening. CONCLUSION: The high risk of exposure of the Brazilian population to UPF ads should be considered a public health concern given the impact of unhealthy food advertising on people's food choices and health.

Nutritional quality of foods and non-alcoholic beverages advertised on Brazilian free-to-air television: a cross-sectional study.

BACKGROUND: Evidence shows that foods marketed on television are often low-nutrient-dense foods associated with poor nutritional diet quality, obesity and non-communicable diseases. However, little research has been undertaken in Brazil around this issue. This study assessed the nutritional profile of foods and non-alcoholic beverages advertised on Brazilian television by applying the Pan American Health Organization (PAHO) and the World Health Organization (WHO/Europe) nutrient profiling models. METHODS: Cross-sectional study based on the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) protocol. A total of 432 h on the three major Brazilian free-to-air TV channels was recorded from April 1st to 30th 2018. Recordings were done for eight non-consecutive and randomly selected days from 6 am to 12 am (midnight). All food-related ads were coded using a systematic approach and classified according to the PAHO and the WHO/Europe nutrient profile models as "eligible"/"not eligible" for marketing restrictions. Absolute and relative frequencies were used to describe absolute numbers and proportions of food and beverage advertisements. The nutritional profile of foods was compared by day, time of the day and types of TV program. For each advertisement, the parent company of promoted food products, supermarkets and restaurants was identified. RESULTS: A total of 1610 food and beverage ads were broadcast, representing 18.1% of the total ads shown on selected channels. Over 80.0% of all foods and beverages advertised on Brazilian TV channels did not meet the PAHO and the WHO/Europe nutritional quality standards and were considered eligible for marketing restrictions. The proportion of unhealthy food ads was significantly higher on weekends, in the afternoon, and during soap operas programming. Altogether, 10 transnational and local food and beverage companies, two large international fast food chains and two of Brazil's largest supermarket retailers accounted for almost 90% of all unhealthy food ads shown. CONCLUSIONS: The findings of the present study indicate a high exposure of the Brazilian population to unhealthy food marketing and an inefficient enforcement of existing regulations. Further research to monitor population exposure to unhealthy food marketing and understand the policy inertia that is preventing policy progress, is highly recommended.

Maternal pressure to eat: Associations with maternal and child characteristics among 2-to 8-year-olds in Brazil.

Maternal pressure for the child to eat may have counterproductive effects on child's eating behavior, such as impairing their ability to self-regulate intake and generating greater refusal of the pressured foods. Associated factors with this feeding practice are still poorly studied. The aim of this study was to investigate the relationship between the use of pressure to eat by mothers and anthropometric, sociodemographic and behavioral characteristics of mothers and their children. Nine hundred and twenty seven mothers of 2-to-8-year-old children participated in the study. The maternal use of pressure to eat was measured using the Brazilian version of the Comprehensive Feeding Practices Questionnaire (CFPQ) along with supplementary questions on maternal responsibility and concern about child feeding and child weight status, and anthropometric and sociodemographic information. Data was analyzed using descriptive, bivariate and multivariate analyses. The final multivariate logistic regression model revealed that maternal use of pressure to eat was independently associated with maternal greater concern about the child eating too little when the mother was not around (OR = 2.40, p ≤ 0.001), and child (OR = 0.86, p = 0.008) and mother lower BMI weight (OR = 0.93, p = 0.001). The results found in this study point out to the importance of interventions in the routine of pediatric health services, directed to the maternal behavior of pressure for the child to eat. The actions should mainly consider maternal concerns about child feeding, and maternal and child weight status. These findings also contribute to the expansion of data in the literature on the factors associated with this food practice and for future research on the subject. The results found in this study are risk factors for maternal practice of pressure to eat and support the construction of new ways to deepen the knowledge of the subject in future research, such as the influence of mother and child weight and subjective aspects in the practice of pressure to eat.

Sociodemographic, anthropometric and behavioural risk factors for ultra-processed food consumption in a sample of 2-9-year-olds in Brazil.

OBJECTIVE: The present study aimed to identify food patterns among 2-9-year-olds and investigate sociodemographic, anthropometric and behavioural predictors of less healthy dietary patterns. DESIGN: Cross-sectional study. Parents of 2-9-year-olds completed an FFQ and factor analysis was applied to identify dietary patterns. Parents also completed questionnaires assessing sociodemographic, anthropometric and behavioural characteristics of parents and children, including parental feeding practices. SETTING: Participants were recruited from private schools of Campinas and São Paulo, SP, Brazil, between April and June 2014. SUBJECTS: Parents of 2-9-year-olds (n 929). RESULTS: Two dietary patterns emerged: 'traditional food' and 'ultra-processed food'. Lower maternal education (OR=2·05, P=0·010) and higher maternal weight status (OR=1·43, P=0·044) were associated with a greater likelihood of the ultra-processed food pattern. Lower perceived parental responsibility for adequacy of food group intake (OR=2·41, P=0·020), and lower scores on the parental feeding practices of 'Healthy Eating Guidance' (OR=1·83, P<0·001) and 'Monitoring' (OR=2·52, P<0·001), were also associated with the presence of this pattern, as was higher child's screen use during mealtimes (OR=1·61, P=0·004). CONCLUSIONS: The present study is the first to evaluate associations between less healthy dietary patterns of Brazilian 2-9-year-olds and parental feeding practices. Our findings highlight sociodemographic, anthropometric and behavioural factors within families that could be used to target tailored policies to at-risk populations.

Relationships between parent feeding behaviors and parent and child characteristics in Brazilian preschoolers: a cross-sectional study.

BACKGROUND: Eating habits formed in early childhood are influenced by parental feeding behaviors, warranting investigation of predictors and correlates of parent feeding. We aimed to describe relationships between parental feeding practices and parent and child characteristics in a sample of Brazilian preschoolers. METHODS: Four hundred and two parents of preschoolers enrolled in private schools of São Paulo and Campinas, Brazil, completed a Brazilian version of the Comprehensive Feeding Practices Questionnaire, as well as questions about parental attitudes, child food intake, other obesity-associated behaviors, and socioeconomic and demographic characteristics. We ran bivariate logistic regression models examining associations between independent variables and each feeding practice. Next, we ran multiple logistic regression models predicting each parental feeding practice. RESULTS: Greater 'Restriction for Weight Control' and 'Restriction for Health' were associated with lower maternal education (OR = 2.42 (CI 95% 1.07-5.48) and 2.79 (CI 95% 1.25-6.22), respectively), and with higher concern about child overweight (OR = 2.46, CI 95% 1.64-3.69 for 'Restriction for Weight Control', only), while greater 'Pressure' was associated with greater concern about child underweight (OR = 2.30, CI 95% 1.53-3.47) and lower maternal BMI (OR = 0.94, CI 95% 0.88-1.00). Greater use of 'Emotion Regulation/ Food as Reward' was associated with lower maternal education (OR = 2.22, CI 95% 1.05-4.71). In analyses of positive feeding practices, lesser use of 'Healthy Eating Guidance' and 'Monitoring' was associated with greater intake of less healthy foods in children (OR = 1.53 (CI 95% 1.01-2.32) and OR = 1.94 (CI 95% 1.27-2.97), respectively), and greater use of screen devices (OR = 1.59 (CI 95% 1.04-2.44) and OR = 1.57 (CI 95% 1.03-2.39), respectively). Lesser use of 'Healthy Eating Guidance' was additionally associated with higher maternal BMI (OR = 1.09, CI 95% 1.03-1.16), and lesser use of 'Monitoring' with lesser perceived parent responsibility for child feeding (OR = 1.68, CI 95% 1.12-2.52). CONCLUSIONS: Our results demonstrate diverse socioeconomic, anthropometric and behavioral correlates of parent feeding in a large Brazilian sample of parents of preschoolers.

Ethnic differences in parental feeding behaviors in UK parents of preschoolers.

Childhood obesity is prevalent among ethnic minorities in the UK but little is known about parent feeding practices in these populations. We administered questionnaires assessing parental feeding behaviors and perceptions and concerns relating to child weight to White British (n = 271), South Asian (n = 59), and Black Afro-Caribbean (n = 42) parents of UK 3-5 year-olds. Child BMI z-scores were determined from measured heights and weights. South Asian and Black Afro-Caribbean parents exhibited greater pressure to eat than White British parents. Black Afro-Caribbean parents additionally scored higher on instrumental feeding and lower on monitoring, while South Asian parents scored higher on emotional feeding. Black Afro-Caribbean parents reported the greatest concern about both child overweight and underweight. Ethnic differences were unchanged by controlling for perceptions and concerns relating to child weight, or for actual BMI z, parent education, or household income. Exploratory analyses suggested some evidence for sex differences within ethnic groups. For example, South Asian parents of daughters scored higher than White British parents of daughters on emotional feeding, with no ethnic differences apparent for parents of sons. Our findings support considering variation in parent feeding behaviors and weight-related attitudes by parental ethnicity and child sex when developing obesity interventions.

Validation of the comprehensive feeding practices questionnaire in parents of preschool children in Brazil.

BACKGROUND: Recent national surveys in Brazil have demonstrated a decrease in the consumption of traditional food and a parallel increase in the consumption of ultra-processed food, which has contributed to a rise in obesity prevalence in all age groups. Environmental factors, especially familial factors, have a strong influence on the food intake of preschool children, and this has led to the development of psychometric scales to measure parents' feeding practices. The aim of this study was to test the validity of a translated and adapted Comprehensive Feeding Practices Questionnaire in a sample of Brazilian preschool-aged children enrolled in private schools. METHODS: A transcultural adaptation process was performed in order to develop a modified questionnaire (43 items). After piloting, the questionnaire was sent to parents, along with additional questions about family characteristics. Test-retest reliability was assessed in one of the schools. Factor analysis with oblique rotation was performed. Internal reliability was tested using Cronbach's alpha and correlations between factors, discriminant validity using marker variables of child's food intake, and convergent validity via correlations with parental perceptions of perceived responsibility for feeding and concern about the child's weight were also performed. RESULTS: The final sample consisted of 402 preschool children. Factor analysis resulted in a final questionnaire of 43 items distributed over 6 factors. Cronbach alpha values were adequate (0.74 to 0.88), between-factor correlations were low, and discriminant validity and convergent validity were acceptable. CONCLUSIONS: The modified CFPQ demonstrated significant internal reliability in this urban Brazilian sample. Scale validation within different cultures is essential for a more comprehensive understanding of parental feeding practices for preschoolers.

Factors associated with avoidable hospitalisation of children younger than 2 years old: the 2006 Brazilian National Demographic Health Survey.

INTRODUCTION: Ambulatory Care Sensitive Conditions (ACSC) are conditions for which hospitalisation is thought to be avoidable with the use of effective preventive care and early disease management. The objective of this study was to estimate the rate of avoidable hospitalisations in children younger than 24 months of age participating in a Brazilian national representative survey and to identify the risk factors for such hospitalisations. METHODS: We analysed data from a cross-sectional study of 1901 children from the 2006 Brazilian National Demographic Health Survey of Women and Children (NDHS). The children's socioeconomic, biological and maternal characteristics, nutritional status, and access to healthcare were tested; variables with p < 0.20 were selected to fit a Poisson regression. RESULTS: The prevalence of avoidable hospitalisation was 11.8% (95% Confidence Interval [CI], 9.0, 15.2); the prevalence was higher in the Southeast (40.1%) and Northwest (21.7%) macro-regions. The multivariate model identified five risk factors for avoidable hospitalisation: male gender (Prevalence Ratio [PR] = 1.48, p = 0.004), low socioeconomic level (PR = 1.51, p = 0.005), children from mothers younger than 20 years of age (PR = 1.41, p = 0.031), not breastfed within the first hour of life (PR = 1.29, p = 0.034), and neonatal hospitalisation (PR = 1.66, p = 0.043). CONCLUSIONS: To decrease the costs associated with avoidable hospitalisations, health managers and professionals should focus their efforts on providing effective primary healthcare to families of low socioeconomic levels, particularly prenatal and paediatric care, as well as encouraging breastfeeding and supporting young mothers. Strategies to improve children's health by controlling such hospitalisations in Brazil should consider all residence areas and geopolitical macro-regions.

Food price trends during the COVID-19 pandemic in Brazil.

The present study aims to analyze the trends in food price in Brazil with emphasis on the period of the Covid-19 pandemic (from March 2020 to March 2022). Data from the Brazilian Household Budget Survey and the National System of Consumer Price Indexes were used as input to create a novel data set containing monthly prices (R$/Kg) for the foods and beverages most consumed in the country between January 2018 and March 2022. All food items were divided according to the Nova food classification system. We estimated the mean price of each food group for each year of study and the entire period. The monthly price of each group was plotted to analyze changes from January 2018 to March 2022. Fractional polynomial models were used to synthesize price changes up to 2025. Results of the present study showed that in Brazil unprocessed or minimally processed foods and processed culinary ingredients were more affordable than processed and ultra-processed foods. However, trend analyses suggested the reversal of the pricing pattern. The anticipated changes in the prices of minimally processed food relative to ultra-processed food, initially forecasted for Brazil, seem to reflect the impact of the Covid-19 pandemic on the global economy. These results are concerning as the increase in the price of healthy foods aggravates food and nutrition insecurity in Brazil. Additionally, this trend encourages the replacement of traditional meals for the consumption of unhealthy foods, increasing a health risk to the population.

Information on food additives on food labels in Brazil: a critical analysis.

Questions about the safety of food additives and their consumption have been raised in recent years. The increased exposure to these substances, either by intake of ultra-processed foods or by the broad use and combination of various categories of additives, may be related to higher risks to consumer health. This article comments on the results of a study that quantified and characterized food additives found on the labels of 9,856 packaged foods and beverages available in Brazilian supermarkets. The study adopted a field diary method to record and analyze nonconformities in the lists of ingredients. The objective of this article is to discuss the use of additives identified on the labels and the limitations of Brazilian legislation, which should guarantee the right to information and health.

Whole grain products in Brazil: the need for regulation to ensure nutritional benefits and prevent the misuse of marketing strategies.

OBJECTIVE: This study aims to evaluate the use of "whole grains" claims in food products marketed in Brazil and evaluate the nutrient profile of these products. METHODS: Data from 775 grain-based packaged foods collected in Brazil from April to July 2017 were analyzed. Based on the INFORMAS protocol for food labeling, the prevalence of packaged foods with "whole grains" claims was estimated. Information on the list of ingredients was analyzed to evaluate the presence and amount of whole or refined grains in six food groups. The nutrient profiles of the products with and without "whole grains" claims were compared using the Pan American Health Organization (PAHO) nutrient profile model. RESULTS: The packages of about 19% of the evaluated products showed "whole grains" claims in their front panel. Of these, 35% lacked any whole grains among their top three ingredients. Breakfast cereals, granola bars, bread, cakes and other bakery products, cookies, and pasta had higher amounts of refined flour than whole grain ingredients in their compositions.We found 66% of products with "whole grains" claims were high in nutrients of concern according to PAHO's criteria. CONCLUSION: Our results showed that over a third of the products in Brazil with "whole grains" claims lacked whole grains as one of their main ingredients. Most had a high content of nutrients associated with noncommunicable chronic disease risk factors, indicating the overestimation of their health benefits.

Promotion of ultra-processed foods in Brazil: combined use of claims and promotional features on packaging.

OBJECTIVE: To assess the availability of different promotional strategies applied for UPF sales in Brazilian food retailers. METHODS: Information available on food packaging was gathered from all packaged products sold in the five largest food retail chains in Brazil in 2017. UPF were identified using the NOVA food classification system. From this sample, data related to promotional characteristics, nutrition claims and health claims were collected and coded using the INFORMAS methodology. Additional claims referring to the Brazilian Dietary Guidelines were also collected. RESULTS: This study evaluated the packaging of 2,238 UPF, of which 59.8% presented at least one promotional strategy. Almost one third denoted a simultaneous use of different promotional strategies in the same packaging. Nutrition claims were the most commonly found promotional strategy, followed by health claims and the use of characters. The food subgroups comprising the highest prevalence of promotional strategies on their labels were: noncaloric sweeteners (100.0%), breakfast cereals and granola bars (96.2%), juices, nectars and fruit-flavoured drinks (92.9%), other unsweetened beverages (92.9%), and other sweetened beverages (92.6%). CONCLUSIONS: Considering the poor nutritional quality of UPF, the widespread presence of promotional features on their packaging highlights the need for marketing restrictions on this kind of product.

Changes in dietary markers during the covid-19 pandemic in Brazil.

OBJECTIVE: Evaluate changes in the Brazilian population's diet and its determinants during the covid-19 pandemic. METHODS: We used diet data collected by the Datafolha Institute in 2019 (n = 1,384), 2020 (n =1,214), and 2021 (n = 1,459) from independent and representative samples of the adult population (aged 18 to 55 years) from all socioeconomic classes and geographic regions of Brazil. Food consumption was measured by checking the consumption of 22 sets of food on the day before the survey. The third cycle also included questions about changes in eating habits during the pandemic. We estimated the prevalence of consumption of the food sets in each cycle of the survey and used statistical tests for comparisons of proportions between the three cycles. RESULTS: Between 2019 and 2020, we observed a significant increase in the consumption of cereals, milk, packaged snacks or salty cookies, and industrialized sauces, as opposed to a decrease in the consumption of eggs. Between 2019 and 2021 and between 2020 and 2021, on the other hand, there was a significant decrease in the consumption of cereals, vegetables, fruits, and industrialized fruit juices and an increase in the consumption of soda, sweets, cookies, sausages, industrialized sauces, and ready meals. When asked about the main changes in the purchase and preparation of meals, 46.3% of the respondents reported consuming more food prepared at home during the pandemic. Regarding changes in eating habits, 48.6% of the respondents reported a change in their eating habits during the pandemic. The main reasons for such changes were greater concern with health (39.1%) and self-reported decreased family income (30.2%). CONCLUSIONS: The covid-19 pandemic had a negative impact on the diet of the population, and increased consumption of ultra-processed foods was reported for that period.

Food additives and PAHO's nutrient profile model as contributors' elements to the identification of ultra-processed food products.

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.

"I Like the One With Minions": The Influence of Marketing on Packages of Ultra-Processed Snacks on Children's Food Choices.

Objective: This study aimed to assess the most consumed school snacks using the free listing and understand how marketing strategies on food labels influenced children's perceptions of snacks via focus groups. Design: The study design involved free lists and semi-structured focus group interviews. Setting: São Paulo, Brazil. Participants: A total of 69 children were involved in this study. Phenomenon of Interest: Children's perceptions of food labels. Analysis: Food groups mentioned on the free lists were analyzed for their frequency and priority of occurrence. The focus groups were analyzed through content analysis. Results: Juices and chips were the most salient snacks, with availability and flavor as reasons for their consumption. Children found images on labels appealing, which created a desire for the food, although could be deceptive. Snacks perceived as healthy were encouraged by parents, and children could more easily convince them to buy snacks with health claims. Colors and brands were important to catch children's attention and make the snack recognizable. Television commercials and mascots reinforced marketing strategies on labels. Conclusions and Implications: Our results point to the need for public health strategies to deal with the obesity epidemic through creating and implementing specific legislation to regulate food labels to discourage the consumption of unhealthy snacks and prohibit food marketing targeted at children.

Consumer perceptions of non-caloric sweeteners and the content of caloric and non-caloric sweeteners in ultra-processed products in Brazil.

Food industries are reformulating their products to lower total sugar and caloric content. Caloric sugars are often substituted by or combined with non-caloric sweeteners. Our study analyzed information about the presence, number and type, and content of different sweeteners displayed on the ingredient list of 10 key ultra-processed products (UPP), from 3 different categories. It also assessed consumers' opinions, perceptions and understanding of caloric and non-caloric sugars used in UPPs using data from 12 focus group discussions. Results indicate a large diversity in sweeteners, frequent use of a combination of multiple caloric and non-caloric sweeteners, often in the same product, and a lack of disclosure of the amounts of non-caloric sweeteners on the nutrition labels. Qualitative analysis reflected the inconsistency of information on nutrition labels and the challenges in compliance with regulations. Participants were unsure about the different types of sweeteners, examples of artificial sweeteners and their potential health consequences. Presenting clearer additive and nutrition information would facilitate consumer comprehension and support healthy food choices.