¿Cuál es el efecto de los impuestos a bebidas azucaradas sobre su consumo en la población general? / What is the effect of beverage taxes sugars on its consumption in the general population?

INTRODUCCIÓN: La malnutrición por exceso, junto con las enfermedades crónicas no transmisibles, se han convertido en un importante problema de salud pública mundial, con un 39% de la población adulta con sobrepeso, y un 13% obesidad (1). Una dieta insuficiente, alta en calorías, grasas y azúcares, está estrechamente relacionada con enfermedades crónicas no transmisibles (cáncer, diabetes, hipertensión, enfermedades cardiovasculares, entre otras)(2,3). Así mismo, se ha descrito que una dieta saludable podría prevenir una de cada cinco muertes a nivel mundial, independiente del sexo, edad o nivel socioeconómico(2). Chile presenta una de las prevalencias más altas de sobrepeso y obesidad en adultos globalmente con un 75%, según los datos de la última Encuesta Nacional de Salud (ENS) (4). Un 82% de la carga de enfermedad en Chile está dada por las enfermedades crónicas no transmisibles, como diabetes, cáncer, hipertensión y enfermedades cardiovasculares (5). Como ejemplo, la diabetes en Chile causó 3.426 muertes en el año 2014 y su prevalencia en personas mayores de 15 años alcanza al 10%, mientras que la prevalencia de hipertensión llega al 28% y al 27% las enfermedades cardiovasculares (5). El gasto público total relacionado con obesidad en Chile es de un 3%, lo que equivale al 0,5% del Producto Interno Bruto (PIB) chileno, equivalente a 455 mil millones de pesos anuales (6,7). RESUMEN DE LOS HALLAZGOS: A partir de la metodología descrita anteriormente, se identificaron inicialmente 466 revisiones sistemáticas. De estas, se excluyeron 450 por disenso o duplicados y se incluyeron finalmente 16 revisiones sistemáticas (RS) (17­32) publicadas entre 2010 y 2020. A los estudios primarios evaluados por estas RS se le aplicaron los mismos criterios de inclusión y exclusión presentados en el recuadro de metodología. Del total de estudios incluidos por las RS, 51 estudios primarios reportados en 54 referencias (33­86) evaluaron los efectos de los impuestos en el consumo de bebidas azucaradas. Una vez evaluado el diseño y la metodología de los estudios primarios identificados, 29 estudios fueron excluidos del análisis dado que no cumplían con los criterios EPOC para estimar el efecto de la intervención (87). Cuatro estudios eran transversales (43,48,53,56), 19 estudios eran de modelamiento (33­35,37­42,44­46,49,51,52,55,57,59,60,84,85) y 6 estudios no contaban con los suficientes puntos de datos (data points) o no identificaban claramente la fecha de la intervención como para poder incorporarlos en el análisis (36,50,54,58,61,82). Los estudios transversales se excluyeron dado que es difícil atribuir causalidad a los resultados provenientes de ellos (87) y en el caso de los estudios de modelación, se consideró que frente a la disponibilidad de evidencia directa, la inclusión de este tipo de estudios -que "predice" la evidencia- no aplicaría (88). Con estos criterios, se consideraron finalmente 22 estudios primarios (47,62­81,83,86), de los cuales 3 son ensayos controlados aleatorizados (ECAs)(68,70,72) y 19 corresponden a estudios observacionales (principalmente series de tiempo interrumpido y antes-después controlados)(47,62­67,69,71,73­81,83,86). El diseño original de dos de los estudios evaluados corresponde a un ensayo aleatorizado (83,86), sin embargo, los estudios evaluaron más de una intervención y su aleatorización no fue de acuerdo a la exposición o no a impuestos, por lo que para este informe se les ha considerado como estudios observacionales. Los hallazgos aquí presentados se han separado de acuerdo a tipo de outcome, diseño de estudio, y país, estado o ciudad donde se aplicó el impuesto. Cada hallazgo contiene además una tabla resumen con los resultados, mostrando la certeza en la evidencia de cada uno de los desenlaces encontrados. CONSIDERACIONES DE IMPLEMENTACIÓN: Para el análisis de las consideraciones de implementación, durante la selección de títulos, resúmenes y texto completo de esta síntesis, se realizó una selección de revisiones sistemáticas que pudieran entregar antecedentes para el análisis de la aplicabilidad de la evidencia al contexto local, consideraciones económicas, equidad y de monitoreo y evaluación. Además, se realizaron búsquedas complementarias de antecedentes nacionales. Consideraciones de Aplicabilidad: La evidencia analizada se basa en 3 ensayos controlados aleatorizados realizados en los Países Bajos y Estados Unidos y de 16 estudios observacionales (diseño de series de tiempo interrumpido o antes-después controlado) provenientes de 6 países donde efectivamente se aplicó un impuesto sobre las bebidas azucaradas (Chile, España, Francia, México, Reino Unido y Estados Unidos). En algunos casos el impuesto se aplicó a un estado o comunidad autónoma, mientras que en otros, se aplicó en todo el país. Esta síntesis de evidencia consideró como desenlace prioritario el consumo de bebidas azucaradas, lo que fue evaluado a través de la ingesta o de manera indirecta a través de las compras y ventas de este tipo de bebidas. No fue priorizado el impacto del impuesto sobre el estado de salud de las personas, entendido como sobrepeso, obesidad o enfermedades cardiovasculares, dado que el desarrollo de éstos es multifactorial y el efecto percibido de los impuestos podría estar sujeto a otros factores que aportan confusión, a juicio del solicitante. La unidad de análisis de los estudios seleccionados fueron adolescentes, personas adultas, hogares o población general, y ventas o compras en supermercados o tiendas. Consideraciones Económicas: Se ha descrito que los impuestos en alimentos y bebidas altos en nutrientes críticos podrían mostrar elasticidad-precio negativa en su consumo, lo que significa que la compra y consumo de estos disminuye en función al aumento de su precio (20,21). Al respecto, los estudios chilenos (67,69) no detectaron cambios importantes en el precio de las bebidas azucaradas tras la aplicación del impuesto. Una de las explicaciones de esto es que los fabricantes reaccionaron estratégicamente para absorber total o parcialmente la carga tributaria adicional, evitando que se transfiriera el impuesto al precio final de las bebidas azucaradas o que compensaron el aumento del precio con aquellas bebidas en las que se redujo dicho impuesto. Consideraciones de Equidad: Se debe tener en cuenta si la propuesta de gravamen tendrá un impacto en restricciones de libertad de selección de productos o si aumentará inequidades, afectando de forma desproporcionadas a algunos grupos. Se ha descrito que los impuestos a alimentos y bebidas podrían tener un efecto diferenciado por nivel socioeconómico (NSE), ya que frente a un aumento en el precio, es más probable que las personas de menores ingresos disminuyan el consumo de bienes no esenciales (17). Sin embargo, en el caso de Chile se reportó el efecto contrario. Nakamura et al., 2018 reportó que la magnitud de la reducción de bebidas compradas con impuestos altos fue mayor para el grupo de NSE alto que para el grupo de NSE medio y estadísticamente insignificante para el grupo de NSE bajo (69). Del mismo modo, Caro et al., 2018 encontró que los hogares con un NSE alto tuvieron una mayor disminución en el volumen de compras de bebidas altas en azúcar (−6,4%) que los hogares con un NSE bajo (−1,6%), en relación con sus respectivos contrafactuales (67). Consideraciones de Monitoreo y Evaluación: Chile ya tiene experiencia con la implementación innovadora de impuestos a bebidas azucaradas (67,69), por lo que es crucial identificar cuáles han sido y siguen siendo los facilitadores, barreras y contratiempos que se identificaron en este proceso. Así mismo, y como lo plantea Caro et al (67) junto con Nakamura et al. (69), se recomienda efectuar evaluaciones a corto, mediano y largo plazo, desde el comienzo de la ejecución de los impuestos, idealmente, incluyendo un grupo control para las comparaciones. Para poder evaluar de mejor forma los efectos de los impuestos de bebidas azucaradas, es importante diseñar un plan de monitoreo integral de la implementación de los impuestos, en todas sus etapas. La evaluación de los impuestos debe contemplar datos diagnósticos o línea base del consumo de los líquidos que serán gravados y mediciones de seguimiento post implementación (10,101).

Corporations' use and misuse of evidence to influence health policy: a case study of sugar-sweetened beverage taxation.

BACKGROUND: Sugar sweetened beverages (SSB) are a major source of sugar in the diet. Although trends in consumption vary across regions, in many countries, particularly LMICs, their consumption continues to increase. In response, a growing number of governments have introduced a tax on SSBs. SSB manufacturers have opposed such taxes, disputing the role that SSBs play in diet-related diseases and the effectiveness of SSB taxation, and alleging major economic impacts. Given the importance of evidence to effective regulation of products harmful to human health, we scrutinised industry submissions to the South African government's consultation on a proposed SSB tax and examined their use of evidence. RESULTS: Corporate submissions were underpinned by several strategies involving the misrepresentation of evidence. First, references were used in a misleading way, providing false support for key claims. Second, raw data, which represented a pliable, alternative evidence base to peer reviewed studies, was misused to dispute both the premise of targeting sugar for special attention and the impact of SSB taxes on SSB consumption. Third, purposively selected evidence was used in conjunction with other techniques, such as selective quoting from studies and omitting important qualifying information, to promote an alternative evidential narrative to that supported by the weight of peer-reviewed research. Fourth, a range of mutually enforcing techniques that inflated the effects of SSB taxation on jobs, public revenue generation, and gross domestic product, was used to exaggerate the economic impact of the tax. This "hyperbolic accounting" included rounding up figures in original sources, double counting, and skipping steps in economic modelling. CONCLUSIONS: Our research raises fundamental questions concerning the bona fides of industry information in the context of government efforts to combat diet-related diseases. The beverage industry's claims against SSB taxation rest on a complex interplay of techniques, that appear to be grounded in evidence, but which do not observe widely accepted approaches to the use of either scientific or economic evidence. These techniques are similar, but not identical, to those used by tobacco companies and highlight the problems of introducing evidence-based policies aimed at managing the market environment for unhealthful commodities.

Local level estimates of food, drink and tobacco expenditure for Great Britain.

We present expenditure estimates for 106 product categories across Great Britain for the years 2008-2016. Estimates are at the Local Authority District level (n = 380) and the categories cover all food, drink and tobacco commodities. Reliable, local level expenditure estimates are crucial for understanding broader market trends, assessing economic stability and for projections. This is especially important for commodities such as alcohol, tobacco and unhealthy foods due to their role in the prevalence of non-communicable diseases. There has been relatively little research into local area spatial patterns of expenditure, with existing estimates often of insufficient resolution for informing planning decisions. We use spatial microsimulation to create an archive of expenditure datasets. This was achieved by linking socio-demographic foundations with detailed datasets on individual expenditure. Whilst initially developed to aid investigations into sociodemographic trends in the meat industry, the data have reuse potential in a number of disciplines, including public health, economics, retail geography and environmental management. The framework could be applied to other regions with appropriate data.

Lobbying against sugar taxation in the European Union: Analysing the lobbying arguments and tactics of stakeholders in the food and drink industries.

Aims: This study investigates the lobbying actors of the food and drink industry (FDI), their web lobbying arguments used in the sugar taxation debate and the tactics deployed when facing legislative restrictions on their products to curb the burden of non-communicable diseases in Europe. Methods: A stakeholder analysis was performed to identify the FDI's actors lobbying against sugar taxation within the EU Platform for Action on Diet, Physical Activity and Health during December 2015. Qualitative content analysis was applied to assess the FDI's web lobbying claims related to three main concepts (sugar as a product, sugar's association with non-communicable diseases and sugar taxation), guided by a framework for corporate political activity. Results: The web site content of a front organization and six FDI lobbyists was analysed. Some new strategies emerged alongside known corporate strategies ('questioning the effectiveness of regulation and promoting benefits of a withdrawal', 'promoting sugar's good traits and shift the blame away from it' and 'establishing relationships with trade unions'). The lobby tactics were similar to those previously applied by the tobacco industry in Europe, although the argument that sugar is a natural ingredient in many foods was unique to the FDI. Conclusions: The observed tactics and arguments presented by the FDI in opposition to sugar taxation have striking similarities with those previously used by the tobacco industry. An improved understanding of the stakeholders' mandate and resources and their most important tactics will strengthen the position of public health experts when debating sugar taxation with the FDI, which may contribute to improving population health.

Posicionamiento sobre los impuestos a alimentos no básicos densamente energéticos y bebidas azucaradas / Position paper on taxes to non-basic energy-dense foods and sugar-sweetened beverages

Resumen: En 2014, el gobierno mexicano implementó una política fiscal para disminuir el consumo de bebidas azucaradas y alimentos no básicos con alta densidad energética. Este documento resume y analiza los estudios que han evaluado el impacto observado y esperado de los impuestos a alimentos y bebidas no saludables en México. La implementación de impuestos ha logrado disminuir las compras de bebidas azucaradas en 7.6% y alimentos no básicos con alta densidad energética en 7.4%. La reducción de consumo de bebidas azucaradas podría reducir la obesidad en 2.5%, prevenir 20 000 casos de enfermedad cardiovascular y 189 000 casos de diabetes al año 2022, así como prevenir 2 000 muertes. Además, se espera que estos impuestos ayuden a reducir en 1 173 millones de dólares los costos de atención a la salud. Los impuestos a alimentos no saludables deben fortalecerse y permanecer como parte integral de la estrategia nacional dirigida a reducir la obesidad y las enfermedades crónicas en México.

Abstract: In 2014 the Mexican government implemented taxes to reduce the consumption of sugar-sweetened beverages and nonessential energy-dense foods. In this manuscript, we analyze the scientific evidence linking the consumption of these products to chronic diseases, and summarize the studies that have evaluated the observed and expected impact of food taxes in Mexico. The implementation of taxes to unhealthy foods has reduced purchases of sugar-sweetened beverages in 7.6% and nonessential energy-dense foods in 7.4%. A reduction in consumption could decrease obesity prevalence by 2.5%; prevent 20 000 cardiovascular disease events; 189 000 diabetes cases; and 20 000 cardiovascular deaths. Additionally, this impact could save nearly 1 173 million dollars from healthcare costs. Taxes to unhealthy foods should be strengthened up and remain as an integral part of the national strategy to reduce obesity and chronic diseases in Mexico.

Productivity loss associated with the consumption of sugar-sweetened beverages in Mexico.

The objective of the study was to estimate the productivity loss by premature death, absenteeism and presenteeism attributable to sugar sweetened beverage (SSB) consumption in Mexico in 2014. We used population attributable fractions due to SSBs for diabetes, cardiovascular diseases and cancers. We gathered information from a variety of publicly available sources: mortality data from the National Institute of Statistics and Geography; hospital discharges and outpatient visits from the Health Ministry; and productivity (measured in wages earned) from the National Occupation and Employment Survey. We estimated a total productivity loss of 1426.6 million USD attributable to SSB consumption. 56.9% of the attributable productivity loss was due to premature mortality and 41.1% was reduced productivity through presenteeism. Diabetes was the main cause of productivity loss (92.1% of premature death-related productivity loss and 99.8% from presenteeism). SSB consumption leads to a considerable loss of productivity in Mexico. Findings emphasize the need to strengthen fiscal policies to reduce or eliminate these indirect costs associated with SSB consumption.

The effect of sugar-sweetened beverage price increases and educational messages on beverage purchasing behavior among adults.

There is a paucity of evidence regarding the impact of sugar sweetened beverage (SSB) price increases on beverage consumption, using individual-level data, for the population overall and for different socioeconomic groups. This study aimed to predict the impact of altered beverage prices and educational messages on consumer purchasing behavior. 2020 adults representative of the Australian population by age, gender and income completed a discrete choice experiment online in 2016. Each subject completed 20 choice scenarios in a hypothetical convenience store setting where subjects chose between seven SSB and non-SSB beverage options or a no beverage option. Beverage prices and volumes varied between scenarios. Half of participants (n = 1012) were randomly exposed to an educational poster discouraging SSB consumption prior to completing choice scenarios. We used discrete choice models to predict purchases under several policy proposals, overall and for income and SSB consumption frequency sub-groups. Compared to baseline prices, a 10% SSB price increase was predicted to reduce SSB purchases by 15.0% [95%CI -15.2, -14.7], and increase purchases of non-SSBs by +11.0% [95%CI 10.8, 11.2] and no beverage by +15.5% [95%CI 15.1, 15.9]. Effects were greater with a 20% SSB price increase. Across all policy scenarios, the highest income quintile had a similar absolute and slightly greater relative decrease in SSB purchases compared to the lowest quintile. Educational poster exposure reduced SSB choice for all groups, with a greater reduction in the lower compared to higher income group, and additively increased response to price changes. Our results support the use of population-wide SSB pricing and educational interventions to reduce demand across all income groups.

Cadmium and lead in cocoa powder and chocolate products in the US Market.

Cocoa powder and chocolate products are known to sometimes contain cadmium (Cd) and lead (Pb) from environmental origins. A convenience sample of cocoa powder, dark chocolate, milk chocolate, and cocoa nib products was purchased at retail in the US and analysed using inductively coupled plasma mass spectrometry to assess Cd and Pb concentrations. Cd and Pb were evaluated in relation to the percent cocoa solids and to the reported origin of the cocoa powder and chocolate products. Cd ranged from 0.004 to 3.15 mg/kg and Pb ranged from

Should we tax unhealthy food and drink?

The global burden of obesity leads to significant morbidity and has major economic implications. In April 2018, Britain will join a growing number of countries attempting to tackle this using fiscal measures when the UK Soft Drinks Industry Levy is introduced. We review recent evidence from natural experiments of the impact of health-related food and drink taxes on consumer behaviour, and discuss the possible consequences of these approaches on purchases and health. We highlight some of the potential indirect consequences and the importance of robust prospective evaluation.

Policies to Prevent Obesity and Promote Healthier Diets: A Critical Selective Review.

BACKGROUND: Obesity has risen dramatically in recent decades in the US and most other countries of the world. This has led to a search for public policies and other interventions that can prevent obesity and improve diets. However, there remain considerable uncertainty and confusion about the effectiveness of many potential policies. CONTENT: This review assesses the strength of the research evidence for 4 commonly proposed policies to prevent obesity and improve diets: (a) taxes on sugar-sweetened beverages (SSBs); (b) calorie labels on restaurant menus; (c) restricting food advertising to youth; and (d) excluding energy-dense foods from the Supplemental Nutrition Assistance Program (SNAP). SUMMARY: The existing literature has many limitations. Often, the research designs are weak, with small nonrepresentative samples and only short-run follow-up. However, a number of studies are of sufficiently high quality to be informative, and on the basis of that evidence, there appears to be no magic bullet to prevent and reduce obesity. Thus, a suite of these policies may be needed for a meaningful impact.

Effect of a price discount and consumer education strategy on food and beverage purchases in remote Indigenous Australia: a stepped-wedge randomised controlled trial.

BACKGROUND: Evidence is mounting that price discounts can be effective in improving diet. This study examined the effectiveness of a 20% price discount on food and drink purchases with and without consumer education in remote Indigenous Australia. METHODS: A 20% discount on fruit, vegetables, water, and artificially sweetened soft drinks was applied for 24 weeks in 20 communities in remote Indigenous Australia where the community store was managed by the Arnhem Land Progress Aboriginal Corporation (ALPA) or Outback Stores (OBS) in a stepped-wedge randomised trial. Communities were randomly allocated to a fixed framework of five sets of four stratified by store association; ten stores (two in each set) were randomly assigned to receive consumer education. A store from each of the ALPA and OBS store groups (contained in separate opaque envelopes) was selected, and stores in turn continued to be consecutively allocated to the fixed store set framework, starting with the first store slot in the first store set, until all stores had been allocated. The effect of the discount on the weight of fruit and vegetables purchased (the primary endpoint) was assessed using weekly store sales data and mixed models per protocol. We did sensitivity analyses by repeating the analyses with the outliers included and repeating the analyses for the primary outcome measure removing each store one at a time. This trial was registered with Australian New Zealand Clinical Trials Registry, number ACTRN12613000694718. FINDINGS: Weekly store sales data on all food and drink products sold in 20 stores were collected from July 1, 2012, to Dec 28, 2014. Price discount alone was associated with a 12·7% (95% CI 4·1-22·1) increase in purchases in grams of fruit and vegetables combined (primary outcome), and a 19·8% (6·2-35·1) increase post discount (after vs before); an effect of 12 g and 18 g per capita per day. Sensitivity analyses did not modify the results for the primary outcome measure. INTERPRETATION: A 20% discount can only increase fruit and vegetable purchases to help protect against obesity and diet related disease to a certain extent. Large discounts might have a greater impact than small discounts. Creative merchandising approaches to consumer education could also be considered alongside fiscal interventions to achieve marked improvements in diet. FUNDING: Australian National Health and Medical Research Council.

Cambios en los patrones de gasto en alimentos y bebidas de hogares mexicanos (1984-2014) / Pattern changes in food and beverages expenditure in Mexican households (1984-2014)

Resumen: Objetivo: Analizar la proporción del gasto y de su frecuencia en alimentos y bebidas consumidos dentro y fuera del hogar, en los ámbitos nacional y regional en México entre 1984 y 2014. Material y métodos: Se analizaron datos de la Encuesta Nacional de Ingresos y Gastos de los Hogares (ENIGH) 1984, 1994, 2005 y 2014 sobre el gasto monetario de los hogares en alimentos y bebidas. Se utilizaron estadísticas descriptivas tales como porcentajes, tasas de crecimiento y tablas de contingencia. Resultados: Se encontraron cambios en patrones del gasto alimentario a nivel nacional y regional. Aumentó la proporción del gasto y de su frecuencia en bebidas no alcohólicas, alimentos preparados, comidas fuera de casa y cereales. Disminuyó la proporción del gasto y de su frecuencia en aceites y grasas, frutas, vegetales y azúcares y mieles. Conclusiones: Los cambios detectados pueden estar relacionados con transformaciones políticas, económicas, sociales y culturales manifestadas en las últimas décadas.

Abstract: Objective: To analyze the proportion of expenditure and its frequency in food and beverages consumed inside and outside of households, at national and regional level, in Mexico between 1984 and 2014. Materials and methods: It analyzes data of household expenditure of food and beverages taken from the National Survey of Mexican Household Income and Expenditures 1984, 1994, 2005 and 2014. It conducted descriptive statistics analyses such as percentages, growth rates and crosstabs. Results: There were changes in food expenditure patterns at national and regional level. The proportion of expenditure and its frequency increased in non-alcoholic beverages, prepared food, meals made outside home and cereals. The proportion of expenditure and its frequency decreased in oils and fats, fruits, vegetables, sugar and honeys. Conclusion: These changes can be related to political, economic, social and cultural transformations experienced in the last decades.

Effectiveness of sugar-sweetened beverages taxes to reduce obesity: evidence brief for policy / Efectividad de los impuestos a bebidas azucaradas para reducir niveles de obesidad: resumen de evidencia para políticas.

The high prevalence of obesity in Chile, along with the increasing consumption of sugary drinks in the country, has made apparent the need to propose fiscal measures, through taxes on specific foods, as a complementary alternative to approach this problem. Since 2014, an additional 5% increase in the tax on sugar-sweetened nonalcoholic beverages has been in effect in Chile, an amount that may be insufficient to produce an impact on obesity levels. The evidence of the effectiveness of fiscal measures upon sugary beverages, in terms of price modification, generally reflects a high transfer of the tax to the final consumers, which is variable according to local conditions. After the analysis of the literature, a sensitivity of the demand to the changes in prices of sugary drinks was evidenced, by means of negative elasticity close to -1, for different groups observed, besides a decrease in the consumption of these products. On the other hand, effects on body weight after the application of these taxes were analyzed by several simulation studies, reporting a decrease on prevalence of obesity between 0.99% and 2.4%. Within the acceptability of a fiscal measure of this nature, there were variable support figures between 36% and 60% among general population. Regarding possible negative effects on employment, an international study even evidenced a rise in the figures for employment in two locations following the application of a tax on sugary drinks. The research showed that there is evidence to support the implementation of a fiscal measure upon sugary beverages in Chile; however, there is a lack of local simulation studies to explore the possible effects and implications of a new tax of this kind in the country. Taxation measures upon foods seem to be both viable and effective alternatives to address the problem of obesity in Chile, but they should be considered as part of an overall strategy with the clear goal of reducing the prevalence of national obesity.

La alta prevalencia de obesidad en Chile en conjunto con el creciente consumo de bebidas azucaradas en el país, han permitido plantear las medidas fiscales por medio de los impuestos a alimentos específicos, como una alternativa complementaria de abordaje a este problema. Desde 2014 se encuentra en vigencia en Chile un alza adicional de 5% del impuesto a las bebidas analcohólicas azucaradas, magnitud eventualmente insuficiente para producir impacto en los niveles de obesidad. La evidencia de efectividad de las medidas fiscales a bebidas azucaradas en términos de modificación de precio, en general muestra un alto traspaso del impuesto al consumidor, lo que varía según condiciones locales. El análisis de la literatura, reveló una sensibilidad de la demanda a los cambios de precios de las bebidas azucaradas por medio de elasticidades negativas cercanas a -1 para distintos grupos observados, junto con la disminución en el consumo de estos productos. Por su parte, los efectos en peso corporal tras la aplicación de estos impuestos fueron analizados por diversos estudios de simulación. Éstos reportaron disminución de prevalencia de obesidad entre 0,99% y 2,4%. En relación a la aceptabilidad de una medida fiscal de esta naturaleza se presentaron cifras variables de apoyo entre 36 y 60% en población general. Respecto a los eventuales efectos negativos en empleos, un estudio internacional incluso demostró un alza en las cifras de empleo en dos estados tras la aplicación de un impuesto a bebidas azucaradas. La búsqueda bibliográfica demostró que existe evidencia para fundamentar la implementación de una medida fiscal a bebidas azucaradas en Chile. Sin embargo, faltan estudios de simulación locales que permitan explorar los eventuales efectos e implicancias de un nuevo impuesto de este tipo en el país. Las medidas fiscales a alimentos parecen ser alternativas viables y efectivas para abordar el problema de la obesidad en Chile, pero deben considerarse como parte de una estrategia integral, con el fin de lograr un impacto final en la disminución de prevalencia de obesidad en el país.

Energy, added sugar, and saturated fat contributions of taxed beverages and foods in Mexico / Contribución de energía, azúcar añadido y grasa saturada de las bebidas y alimentos con impuesto en México

Abstract: Objective: To estimate the dietary contribution of taxed beverages and foods. Materials and methods: Using 24-hour diet recall data from the Ensanut 2012 (n=10 096), we estimated the contribution of the items which were taxed in 2014 to the total energy, added sugar, and saturated fat intakes in the entire sample and by sociodemographic characteristics. Results: The contributions for energy, added sugar, and saturated fat were found to be 5.5, 38.1, and 0.4%, respectively, for the taxed beverages, and 14.4, 23.8, and 21.4%, respectively, for the taxed foods. Children and adolescents (vs. adults), medium and high socioeconomic status (vs. low), urban area (vs. rural), and North and Center region (vs. South) had higher energy contribution of taxed beverages and foods. The energy contribution was similar between males and females. Conclusions: These taxes covered an important proportion of Mexicans' diet and therefore have the potential to improve it meaningfully.

Resumen: Objetivo: Estimar la contribución dietética de las bebidas y alimentos con impuesto. Material y métodos: Con el recordatorio de 24-horas de la Ensanut 2012 (n=10 096), estimamos la contribución de los productos con impuesto en 2014 al consumo total de energía, azúcar añadido y grasa saturada en toda la muestra y por sociodemográficos. Resultados: La contribución de energía, azúcar añadido y grasa saturada fue 5.5, 38.1 y 0.4%, respectivamente, para bebidas con impuesto y 14.4, 23.8 y 21.4%, respectivamente, para alimentos con impuesto. Los niños y adolescentes (vs. adultos), nivel socioeconómico medio y alto (vs. bajo), área urbana (vs. rural), y región Norte y Centro (vs. Sur) tuvieron una contribución de energía mayor de bebidas y alimentos con impuesto. La contribución fue similar entre hombres y mujeres. Conclusión: Estos impuestos cubren una proporción importante de la dieta mexicana y por lo tanto tienen el potencial de mejorarla de manera relevante.

Policy lessons from health taxes: a systematic review of empirical studies.

BACKGROUND: Taxes on alcohol and tobacco have long been an important means of raising revenues for public spending in many countries but there is increasing interest in using taxes on these, and other unhealthy products, to achieve public health goals. We present a systematic review of the research on health taxes, and aim to generate insights into how such taxes can: (i) reduce consumption of targeted products and related harms; (ii) generate revenues for health objectives and distribute the tax burden across income groups in an efficient and equitable manner; and (iii) be made politically sustainable. METHODS: Six scientific and four grey-literature databases were searched for empirical studies of 'health taxes' - defined as those intended to increase the costs of manufacturing, distributing, retailing and/or consuming health-damaging products. Since reviews already exist of the evidence relating to traditional alcohol and tobacco excise taxes, we focus on other taxes such as taxes on retailers and manufacturers of unhealthy products, and consumer taxes targeting unhealthy foods, such as sugar-sweetened beverages. RESULTS: Ninety-one peer-reviewed and 11 grey-literature studies met our inclusion criteria. The review highlights a recent, rapid rise in research in this area, most of which focuses on high-income countries and on taxes on food products or nutrients. Findings demonstrate that high tax rates on sugar-sweetened beverages are likely to have a positive impact on health behaviours and outcomes, and, while taxes on products reduce demand, they add to fiscal revenues. Common concerns about health taxes are also discussed. CONCLUSIONS: If the primary policy goal of a health tax is to reduce consumption of unhealthy products, then evidence supports the implementation of taxes that increase the price of products by 20% or more. However, where taxes are effective in changing health behaviours, the predictability of the revenue stream is reduced. Hence, policy actors need to be clear about the primary goal of any health tax and frame the tax accordingly - not doing so leaves taxes vulnerable to hostile lobbying. Conversely, earmarking health taxes for health spending tends to increase public support so long as policymakers follow through on specified spending commitments. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42016048603.

Cambios en los precios de bebidas y alimentos con impuesto en áreas rurales y semirrurales de México / Changes in prices of taxed sugar-sweetened beverages and nonessential energy dense food in rural and semi-rural areas in Mexico

Resumen: Objetivo: Analizar cambios en precios asociados con la implementación de los impuestos a bebidas azucaradas y alimentos no básicos con alta densidad energética implementados en 2014. Material y métodos: Se recolectaron precios en áreas rurales y semiurbanas en diciembre de 2013, y abril y diciembre de 2014. Se analizaron cambios en precios por tipo de bebidas y alimento con impuesto usando modelos de efectos fijos y estratificando por región, tipo de establecimiento y tamaño de presentación. Resultados: El impuesto a bebidas azucaradas no pasó por completo a los precios; en promedio, los precios aumentaron 0.73 pesos por litro. Para alimentos con alta densidad energética, el impuesto pasó igual o mayor al monto del impuesto para galletas, barras de cereal y cereales de caja. Conclusión: El potencial efecto de los impuestos en consumo podría ser menor al esperado en áreas rurales dado que los impuestos no pasaron por completo a los precios.

Abstract: Objective: To estimate changes in prices associated with the implementation of the tax to sugar sweetened beverages (SSB) and to nonessential energy dense food in 2014. Materials and methods: Price data were collected in rural and semi-rural areas in December 2013, and April and December 2014. Fixed effects models were used to estimate changes in prices of beverages and nonessential energy dense food, stratified by region, retailer and package size. Results: The SSB tax did not pass completely through prices: prices increased on average 0.73 pesos per liter. For nonessential energy dense food, the tax passed completely or was overshifted for cookies, cereal bars and cereal boxes. Conclusion: The potential effect of the taxes on consumption could be attenuated in rural areas as the pass through prices was incomplete.

Food and beverage purchases in corner stores, gas-marts, pharmacies and dollar stores.

OBJECTIVE: Little is known about customer purchases of foods and beverages from small and non-traditional food retailers (i.e. corner stores, gas-marts, dollar stores and pharmacies). The present study aimed to: (i) describe customer characteristics, shopping frequency and reasons for shopping at small and non-traditional food retailers; and (ii) describe food/beverage purchases and their nutritional quality, including differences across store type. DESIGN: Data were collected through customer intercept interviews. Nutritional quality of food/beverage purchases was analysed; a Healthy Eating Index-2010 (HEI-2010) score for purchases was created by aggregating participant purchases at each store. SETTING: Small and non-traditional food stores that were not WIC-authorized in Minneapolis and St. Paul, MN, USA. SUBJECTS: Customers (n 661) from 105 food retailers. RESULTS: Among participants, 29 % shopped at the store at least once daily; an additional 44 % shopped there at least once weekly. Most participants (74 %) cited convenient location as the primary draw to the store. Customers purchased a median of 2262 kJ (540 kcal), which varied by store type (P=0·04). The amount of added sugar far surpassed national dietary recommendations. At dollar stores, participants purchased a median of 5302 kJ (1266 kcal) for a median value of $US 2·89. Sugar-sweetened beverages were the most common purchase. The mean HEI-2010 score across all stores was 36·4. CONCLUSIONS: Small and non-traditional food stores contribute to the urban food environment. Given the poor nutritional quality of purchases, findings support the need for interventions that address customer decision making in these stores.

Fluorescent Nanoparticles from Several Commercial Beverages: Their Properties and Potential Application for Bioimaging.

The presence of nanoparticles in beverages has raised great concern in terms of potential impacts to consumer health. Herein, carbon dots in beverages kvass, pony malta, pilsner beer, Vivant Storm, and Profit were identified. They were shown to have a strong fluorescence under the excitation of ultraviolet light. The emission peaks shift to longer wavelengths accompanied by a remarkable fluorescence intensity decrease. The carbon dots are in the nanosized range and roughly spherical in appearance. Elemental analysis by X-ray photoelectron spectroscopy demonstrated the composition of Kvass carbon dots to be C 83.17%, O 13.83%, and N 3.00%. No cytotoxicity was found at concentrations up to 20 mg/mL for human tongue squamous carcinoma cells, and they can be directly applied in both carcinoma and onion epidermal cell imaging. This work represents the first report of the carbon dots present in beverages, providing valuable insights into these nanoparticles for future biological imaging.

Trends in Sugar-Sweetened Beverages: Are Public Health and the Market Aligned or in Conflict?

Adverse health consequences of consuming sugar-sweetened beverages are frequently cited as an example of market failure, justifying government intervention in the marketplace, usually in the form of taxation. However, declining sales of sugar-sweetened beverages in Australia and a corresponding increase in sales of drinks containing non-nutritive sweeteners, in the absence of significant government regulation, appear to reflect market forces at work. If so, the public health challenge in relation to sugar-sweetened beverages may have less to do with regulating the market and more to do with harnessing it. Contrary to assertions that consumers fail to appreciate the links between their choice of beverage and its health consequences, the health conscious consumer appears to be driving the changes taking place in the beverage market. With the capacity to meet consumer expectations for convenience and indulgence without unwanted kilojoules, drinks containing non-nutritive sweeteners enable the "small change" in health behaviour that individuals are willing to consider. Despite the low barriers involved in perpetuating the current trend of replacing sugar-sweetened beverages with drinks containing non-nutritive sweeteners, some public health advocates remain cautious about advocating this dietary change. In contrast, the barriers to taxation of sugar-sweetened beverages appear high.