Resumen de evidencia para política: Estrategias de implementación de etiquetado nutricional de alimentos en restaurantes de comida rápida / Evidence brief for policy: strategies for the implementation of nutritional food labelling in fast-food restaurants

EL PROBLEMA: Chile presenta una de las prevalencias más altas de sobrepeso y obesidad a nivel mundial, alcanzando un 74,2% (39,8% sobrepeso, 31,2% obesidad, y 3,2% obesidad mórbida) según los datos de la última Encuesta Nacional de Salud (ENS).2 Para afrontar esta situación, en Chile se han implementado una serie de iniciativas como los impuestos a las bebidas azucaradas (aumentando los impuestos de 13% a 18% en aquellos productos con más de 6,25 g de azúcar por 100 ml de bebida y disminuyendo el impuesto de 13% a 10% en los productos con menos de 6,25 g de azúcar por 100 ml de bebida)3 , el Sistema Elige Vivir Sano del Ministerio de Desarrollo Social 4 y la ley de etiquetado frontal de alimentos con sellos con mensajes de advertencia nutricional (Ley 20.606)5 , el cual se implementó desde Junio 2016. Aunque la evidencia respecto del impacto de esta política en los hábitos de consumo y las decisiones de compra de alimentos por parte de la población no es totalmente concluyente,6 7 8 algunos grupos poblacionales (madres de niños pequeños) perciben que estas regulaciones están cambiando las percepciones, actitudes y algunos comportamientos hacia patrones de alimentación más saludables. Actualmente, la ley de etiquetado aplica exclusivamente a productos envasados, los que habitualmente son comprados en pequeños almacenes de barrio, ferias libres o supermercados. Sin embargo, una proporción importante de la población es consumidora de comida rápida ya sea de manera presencial ­ por ejemplo, acudiendo a locales independientes, a franquicias o a cadenas de comida rápida en centros comerciales ­ o a través de la compra remota y el reparto/entrega a domicilio de estos productos. Durante los últimos 2 años esta tendencia se ha intensificado dada las limitaciones a la movilidad impuestas - especialmente durante el año 2020 - para el manejo de la pandemia por COVID-19.10 Por lo tanto, es de interés del Ministerio de Salud explorar una posible extensión de la política de etiquetado frontal de advertencia, revisando la evidencia relacionada con la implementación de los etiquetados frontales de alimentos en otros ambientes de venta de alimentos como casinos, cafeterías y restaurantes de comida rápida. OPCIONES PARA ABORDAR EL PROBLEMA: A partir del problema identificado surge la posibilidad de extender la actual política de etiquetado frontal de alimentos empaquetados hacia locales de venta y consumo de comida rápida. De esta manera, las opciones de política para abordar el problema corresponden a alternativas de implementación de etiquetado nutricional. En este contexto, cabe precisar, en primer lugar, las definiciones de etiquetado de alimentos que serán utilizadas en este resumen de evidencia, para luego identificar las posibles opciones para abordar el problema. MÉTODOS: La metodología de la búsqueda sistemática de evidencia sobre las diferentes ubicaciones se describe en el Cuadro 1. Para cada opción se diseñó una estrategia de búsqueda en base a palabras claves sobre cada una de las ubicaciones de etiquetado nutricional, la que fue ejecutada en Epistemonikos. Además, se elaboró una segunda estrategia de búsqueda que incluyó todas las ubicaciones (ver Anexo 1). Las referencias identificadas con ambas estrategias, luego de eliminar duplicados, fueron cribadas por 2 investigadores de manera independiente. La selección de las revisiones sistemáticas y sus estudios primarios respondió a los siguientes criterios: 1. Evaluar el uso de etiquetados de nutrientes específicos interpretativos. 2. Que el ámbito en donde se realicen las investigaciones sea en restaurantes, cafeterías, cadenas o locales de comida rápida. 3. Incluir información respecto a alguno de los desenlaces considerados relevantes por el equipo elaborador y la contraparte: a. Consumo (ingesta calórica): cantidad de calorías ingeridas. b. Compras o ventas de productos con etiquetado nutricional: considera cambios en el volumen o proporción de productos vendidos/comprados (ej. cambio en la compra o venta de alimentos poco nutritivos o saludables), cambios en la frecuencia de compras de productos etiquetados y cambios en la cantidad de calorías compradas. c. Visibilidad del etiquetado: si el cliente identifica la presencia de una etiqueta asociada al producto que desea adquirir. d. Comprensión del etiquetado: si una vez que el cliente visualiza el etiquetado, logra comprender la información que contiene. e. Cambios de actitud del usuario (reporte subjetivo de cambios en la compra o consumo o en la intención de compra/consumo) y cambios en el comportamiento de la industria. f. Aceptabilidad o valoración de la política: evaluada subjetivamente por los clientes/consumidores. g. Costos. 4. Incluir comparaciones entre alguna(s) de las opciones de ubicación del etiquetado nutricional y una alternativa sin etiquetado. Es decir, un equivalente que permitiera "aislar" el efecto de la ubicación específica de etiquetado: por ejemplo, menú con etiquetado versus menú sin etiquetado. RESULTADOS De 674 resultados obtenidos inicialmente, se identificaron once revisiones sistemáticas [1 - 11] que respondían a la pregunta de interés (ver Figura 3). De éstas, nueve abordaron la opción de menú [2, 3, 5, 6, 7, 8, 9, 10, 11], seis la opción de soportes [1, 3, 4, 6, 10, 11], cuatro la opción de ambiente [1, 4, 6, 10], cuatro la de paquete contenedor del producto [1, 4, 6, 10] y dos la de etiquetado nutricional en contextos de venta virtual [2, 5]. CONSIDERACIONES DE IMPLEMENTACIÓN: Dado que gran parte de la literatura relacionada con los aspectos de implementación de los etiquetados nutricionales en establecimientos de comida rápida tienen un abordaje genérico, sin diferenciar entre las diferentes ubicaciones del etiquetado, las consideraciones de implementación se presentan de manera general para los diferentes grupos de interés. El análisis de barreras y facilitadores se basó principalmente en los resultados de una revisión sistemática identificada en la búsqueda inicial de este resumen de evidencia, la cual fue excluida del análisis de hallazgos de evidencia dado que no presentó evidencia de efectividad o impacto [24]. El objetivo de esta revisión sistemática fue sintetizar la evidencia de las barreras y facilitadores percibidos respecto de la implementación de intervenciones de etiquetado en los menús desde la perspectiva de la industria alimentaria. No hubo restricciones respecto del formato o esquema de etiquetado en los menús, tipos de estudios, lenguaje o año de publicación. La revisión identificó 17 estudios primarios, 8 de ellos utilizaron métodos cuantitativos para la recolección de datos, 7 utilizaron métodos cualitativos y 2 métodos mixtos. La mayoría de los estudios (n = 15) se realizaron en países de altos ingresos [24].

Australian Consumers Are Willing to Pay for the Health Star Rating Front-of-Pack Nutrition Label.

The Australia and New Zealand Ministerial Forum on Food Regulation has supported the recommendations set out in the 2019 Health Star Rating System Five Year Review Report. Specifically, the forum supported, in principle, Recommendation 9, to mandate the Health Star Rating if clear uptake targets were not achieved while the system is voluntary. Given that mandatory labelling is being considered, it is important to investigate how much consumers value the Health Star Rating in order to understand potential consumer uptake and inform industry. The aim of this study was to assess consumers' valuation of the Health Star Rating system by analysing their willingness to pay for a packaged food product with the Health Star Rating label, utilising a double-bounded dichotomous choice contingent valuation approach. The results indicate that almost two-thirds of Australian household grocery shoppers were willing to pay more for a product with the Health Star Rating, on average up to an additional 3.7% of the price of the product. However, public health nutrition benefits associated with consumers' willingness to pay more for products with the Health Star Rating is currently limited by the lack of guarantee of the systems' accuracy. Given consumer support, a well validated and comprehensive Health Star Rating labelling system can potentially improve health outcomes, cost effectiveness and reduce environmental impacts.

Development of Criteria for a Positive Front-of-Package Food Labeling: The Israeli Case.

Efforts to shape the food environment are aimed at reducing diet-related co-morbidities. Front-of-package labeling (FOPL) may support the consumers to make an informed decision at the point of purchase and encourage industry to reformulate food products. The Israeli Ministry of Health (MOH) implemented a unique FOPL system, using two colors: A mandatory warning (red) label alongside a voluntary positive (green) label. An independent Scientific Committee, from academia, the healthcare system, and MOH was appointed to determine the core principles for the positive FOPL. The criteria were based on the Mediterranean diet principles, with adjustments to the Israeli dietary habits, focusing on the health advantages of the food and considering its processing level. The food products eligible for positive FOPL are foods in their natural form or with added spices or herbs, or those that underwent minimal processing, with no food additives. Based on population consumption data, 19.8% of food products were eligible for positive FOPL; of them, 54% were fruits and vegetables, 20% dairy, and 14% grains. An evaluation plan is needed to assess the degree of acceptance of the positive FOPL by the industry, retailers, and the public, and its impact on food consumption and on public health.

Barriers and facilitators to implementation of menu labelling interventions from a food service industry perspective: a mixed methods systematic review.

BACKGROUND: Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry. METHODS: Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the 'best fit' framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR). RESULTS: Seventeen studies met the eligibility criteria, with the majority rated as average quality (n = 10). The most frequently cited barriers were coded to the CFIR constructs 'Consumer Needs & Resources' (e.g. lack of customer demand for/interest in menu labelling, risk of overwhelmed/confused customers) and 'Compatibility' with organisation work processes (e.g. lack of standardised recipes, limited space on menus). Frequently cited facilitators were coded to the CFIR constructs 'Relative Advantage' of menu labelling (e.g. improved business image/reputation) and 'Consumer Needs & Resources' (e.g. customer demand for/interest in menu labelling, providing nutrition information to customers). An adapted framework consisting of a priori and new constructs was developed, which illustrates the relationships between domains. CONCLUSION: This review generates an adapted CFIR framework for understanding implementation of menu labelling interventions. It highlights that implementation is influenced by multiple interdependent factors, particularly related to the external and internal context of food businesses, and features of the menu labelling intervention. The findings can be used by researchers and practitioners to develop or select strategies to address barriers that impede implementation and to leverage facilitators that assist with implementation effort. TRIAL REGISTRATION: Systematic review registration: PROSPERO CRD42017083306.

Conflicting Messages on Food and Beverage Packages: Front-of-Package Nutritional Labeling, Health and Nutrition Claims in Brazil.

We assessed the prevalence of front-of-package (FoP) claims in the Brazilian packaged food supply and examined whether foods with claims were more likely to be high in critical nutrients. Using data from a random 30% subsample of 11,434 foods and beverages collected in the five largest food retailers in Brazil in 2017 (n = 3491), we classified claims into nutrition, health, and environment. We examined whether foods with claims were more likely to be high in critical nutrients using 95% confidence intervals. Claims were found in 41.2% of the products. Nutrition claims were the most prevalent (28.5%), followed by health (22.1%), and environment-related claims (5.2%). More than 85% of the breakfast cereals, granola bars, and nectars contained claims, which were found in 51% of the dairy beverages. Foods with nutrition claims were more likely to be high in critical nutrients (65.3%; 95% CI 62.3, 68.2% vs. 54.1% 95% CI 52.1, 56.0). Products with health (52.9%; 95% CI 49.3, 56.4% vs. 58.5%; 95% CI 56.6, 60.3) and environment-related claims (33.5%; 95% CI 27.0, 40.8% vs. 58.6%; 95% CI 56.9, 60.2%) were less likely to be high in critical nutrients. FoP claims are prevalent in Brazil, and nutrition claims are more likely to have a poorer nutritional profile. Policymakers should consider restricting the presence of claims on unhealthy products.

Labelling changes in response to a tax on sugar-sweetened beverages, United Kingdom of Great Britain and Northern Ireland.

OBJECTIVE: To evaluate the changes in sugar and energy labelling of carbonated sugar-sweetened soft drinks after the implementation of a tax on sugar-sweetened drinks in the United Kingdom of Great Britain and Northern Ireland. METHODS: We visited nine main supermarkets before (May 2014) and after (April 2018) the tax came into effect and obtained data from product packaging and nutrition information panels of carbonated sugar-sweetened soft drinks. We used the paired t-test to assess differences in sugar and energy content of the same products between 2014 and 2018. FINDINGS: We obtained data from 166 products in 2014 and 464 products in 2018, of which 83 products were the same in both years. Large variations in stated sugar content were found between the different carbonated sugar-sweetened soft drinks in both 2014 and 2018 for all products and for the 83 products. The mean sugar content of the 83 products decreased by 42% between 2014 and 2018, from 9.1 g/100 mL (standard deviation, SD: 3.3) to 5.3 g/100 mL (SD: 3.5; P < 0.001). The mean energy content decreased by 40%, from 38 kcal/100 mL (SD: 13) in 2014 to 23 kcal/100 mL (SD: 15) in 2018 (P < 0.001). CONCLUSION: The significant decreases in the labelling of sugar and energy content of carbonated sugar-sweetened soft drinks after the levy came into effect suggest this tax has been effective. The sugar content of drinks still varied considerably in 2018, suggesting further reductions in sugar content of these drinks is possible. The levy thresholds should be reduced and the tax increased to drive further reformulation of soft drinks to reduce their sugar content.

Health Warnings on Sugar-Sweetened Beverages: Simulation of Impacts on Diet and Obesity Among U.S. Adults.

INTRODUCTION: Overconsumption of sugar-sweetened beverage (SSB) is a significant contributor to obesity. Policymakers have proposed requiring health warnings on SSBs to reduce SSB consumption. Randomized trials indicate that SSB warnings reduce SSB purchases, but uncertainty remains about how warnings affect population-level dietary and health outcomes. METHODS: This study developed a stochastic microsimulation model of dietary behaviors and body weight using the 2005-2014 National Health and Nutrition Examination Surveys, research on SSB health warnings, and a validated model of weight change. In 2019, the model simulated a national SSB health warning policy's impact on SSB intake, total energy intake, BMI, and obesity among U.S. adults over 5 years. Sensitivity analyses varied assumptions about: (1) how warning efficacy changes over time, (2) the magnitude of warnings' impact on SSB intake, and (3) caloric compensation. RESULTS: A national SSB health warning policy would reduce average SSB intake by 25.3 calories/day (95% uncertainty interval [UI]= -27.0, -23.6) and total energy intake by 31.2 calories/day (95% UI= -32.2, -30.1). These dietary changes would reduce average BMI by 0.64 kg/m2 (95% UI= -0.67, -0.62) and obesity prevalence by 3.1 percentage points (95% UI= -3.3%, -2.8%). Obesity reductions persisted when assuming warning efficacy wanes over time and when using conservative estimates of warning impact and caloric compensation. Benefits were larger for black and Hispanic adults than for white adults, and for adults with lower SES than for those with higher SES. CONCLUSIONS: A national SSB health warning policy could reduce adults' SSB consumption and obesity prevalence. Warnings could also narrow sociodemographic disparities in these outcomes.

Research and regulatory gaps for the substantiation of protein content claims on foods.

Protein claims provide guidance to consumers seeking protein-rich foods. Protein claim regulations differ globally, and both Canada and the United States require protein quality assessments. A tripartite workshop identified the need to (i) harmonize, (ii) update existing amino acid composition and digestibility databases, (iii) develop non-animal bioassays, and (iv) evaluate the impact of protein claims on human health. The Protein-Digestibility Corrected Amino Acid Score method is recommended for current regulatory use in Canada.

Assessment of an e-training tool for college students to improve accuracy and reduce effort associated with reading nutrition labels.

Objective: Nutrition labels are often underutilized due to the time and effort required to read them. We investigated the impact of label-reading training on effort, as well as accuracy and motivation. Participants: Eighty college students (21 men and 59 women). Methods: The training consisted of a background tutorial on nutrition followed by three blocks of practice reading labels to decide which of two foods was the relatively better choice. Label-reading effort was assessed using an eye tracker and motivation was assessed using a 6-item scale of healthy food-choice empowerment. Results: Students showed increases in label-reading accuracy, decreases in label-reading effort, and increases in empowerment. Conclusions: The nutrition label e-training tool presented here, whether used alone or as part of other wellness and health programs, may be an effective way to boost students' label-reading skills and healthy food choices, before they settle into grocery shopping habits.

Serving Size and Nutrition Labelling: Implications for Nutrition Information and Nutrition Claims on Packaged Foods.

The presentation of nutrition information on a serving size basis is a strategy that has been adopted by several countries to promote healthy eating. Variation in serving size, however, can alter the nutritional values reported on food labels and compromise the food choices made by the population. This narrative review aimed to discuss (1) current nutrition labelling legislation regarding serving size and (2) the implications of declared serving size for nutrition information available on packaged foods. Most countries with mandatory food labelling require that serving size be presented on food labels, but variation in this information is generally allowed. Studies have reported a lack of standardisation among serving sizes of similar products which may compromise the usability of nutrition information. Moreover, studies indicate that food companies may be varying serving sizes as a marketing strategy to stimulate sales by reporting lower values of certain nutrients or lower energy values on nutrition information labels. There is a need to define the best format for presenting serving size on food labels in order to provide clear and easily comprehensible nutrition information to the consumer.

The Nutritional Quality of Gluten-Free Products for Children.

OBJECTIVES: To examine the nutritional quality of gluten-free (GF) products specifically marketed for children. METHODS: All child-targeted food products were purchased from 2 major supermarket chains in Calgary, Alberta, Canada. Using the Pan American Health Organization Nutrient Profile Model, the nutritional quality of products with a GF claim was compared with those without such a claim. A secondary analysis further compared the nutrient profile of child-targeted GF products to their product "equivalents." RESULTS: Overall, child-targeted GF products had lower levels of sodium, total fat, and saturated fat but also had less protein and a similar percentage of calories from sugar compared with child-targeted products without a GF claim. According to the Pan American Health Organization criteria, both GF products and "regular" products designed for children can be classified as having poor nutritional quality (88% vs 97%; P < .001). When analyzed in light of their product equivalents without a GF claim, both had similarly high levels of sugar (79% vs 81%; P < .001). CONCLUSIONS: GF supermarket foods that are targeted at children are not nutritionally superior to regular child-targeted foods and may be of greater potential concern because of their sugar content. The health halo often attributed to the GF label is not warranted, and parents who substitute GF products for their product equivalents (assuming GF products to be healthier) are mistaken. Parents of children with gluten intolerance and/or sensitivity, along with parents who purchase GF products for other health reasons, need to carefully assess product labels when making purchases.

Cost-Effectiveness of Product Reformulation in Response to the Health Star Rating Food Labelling System in Australia.

The Health Star Rating (HSR) system is a voluntary front-of-pack labelling (FoPL) initiative endorsed by the Australian government in 2014. This study examines the impact of the HSR system on pre-packaged food reformulation measured by changes in energy density between products with and without HSR. The cost-effectiveness of the HSR system was modelled using a proportional multi-state life table Markov model for the 2010 Australian population. We evaluated scenarios in which the HSR system was implemented on a voluntary and mandatory basis (i.e., HSR uptake across 6.7% and 100% of applicable products, respectively). The main outcomes were health-adjusted life years (HALYs), net costs, and incremental cost-effectiveness ratios (ICERs). These were calculated with accompanying 95% uncertainty intervals (95% UI). The model predicted that HSR-attributable reformulation leads to small changes [corrected] in mean population energy intake (voluntary: -0.98 kJ/day; mandatory: -11.81 kJ/day). [corrected]. These are likely to result in changes in mean body weight (voluntary: -0.01 kg [95% UI: -0.012 to -0.006]; mandatory: -0.11 kg [95% UI: -0.14 to -0.07, and HALYs gained [corrected] (voluntary: 4207 HALYs gained [corrected] [95% UI: 2438 to 6081]; mandatory: 49,949 HALYs gained [95% UI: 29,291 to 72,153]). The HSR system [corrected] could be considered cost-effective relative to a willingness-to-pay threshold of A$50,000 per HALY (incremental cost effectiveness ratio for voluntary: [corrected] A$1728 per HALY [95% UI: dominant to 10,445] and mandatory: A$4752 per HALY [95% UI: dominant to 16,236]).

Awareness of the Link between Alcohol Consumption and Cancer across the World: A Review.

Since 1988, the International Agency for Research on Cancer has classified alcohol as a Group 1 carcinogen, the highest level of risk. Growing evidence suggests that alcohol increases the risk of several types of cancer including breast, bowel, prostate, and liver, and accounts for a significant proportion of preventable cancers. Despite ample evidence of this relationship, public awareness is less clear. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed 32 studies examining lay awareness of alcohol as a risk factor for cancer in 16 countries. Our results show that awareness appears to be low and varies internationally; it is relatively higher in the United Kingdom, Morocco, and Australia. Methodologic differences in assessment obfuscate cross-country and cross-sample comparisons. In general, people are more likely to endorse alcohol as a risk factor when presented with a list of possible risk factors than when asked to list risk factors in an open-ended format. Attempts to increase awareness have been limited and constitute a significant public health need. We provide potential strategies to increase awareness, such as alcohol bottle labeling and fostering patient/physician discussions regarding the link. Cancer Epidemiol Biomarkers Prev; 27(4); 429-37. ©2018 AACR.

Incongruências no regulamento técnico para chocolate e produtos de cacau que interferem na qualidade do chocolate brasileiro e na saúde do consumidor / Incongruities in the technical regulations for chocolate and cocoa products that interfere with Brazilian chocolate quality and consumer health

[{"text": "O chocolate no Brasil é produzido com padrões inferiores às normas internacionais\r\ndo Codex Alimentarius, que estipulou para a sua composição,em\r\n1981, um índice mínimo de 35% de sólidos de cacau, atribuindo não menos\r\nde 18% para manteiga de cacau e 14% para massa de cacau. A Agência\r\nNacional de Vigilância Sanitária, como órgão responsável pela elaboração\r\ne publicação das normas brasileiras referentes ao chocolate e produtos de\r\ncacau, adotou em 2005 o índice mínimo de 25%, não especificando taxasaos\r\nsubprodutos, gerando especulações. Diante de metodologia básica e aplicada,\r\no presente trabalho baseou-se na leitura e análise de leis, projetos de\r\nlei, normas, relatórios de pesquisa, publicações em periódicos, dissertações,\r\nteses, entre outros, apoiada em pesquisa bibliográfica virtual,paraverificare\r\nindicaras incongruências no Regulamento Técnico para Chocolate e Produtos\r\nde Cacau contidas na RDC 264. Faz parte do objetivo deste estudo tentar\r\nevidenciaras consequências da Resolução para a saúde do consumidor, para\r\na qualidade do chocolate nacional\r\ne para a credibilidade da ANVISA\r\ncomo órgão promotor da qualidade\r\ne segurança alimentar. Pretende-se\r\ntambém apoiar a aprovação de Projetos\r\nde Lei que tramitam pelo Congresso\r\nNacional, que têm como objetivo\r\no ajuste da RDC 264 através\r\nde propostas de atualização do seu\r\nRegulamento Técnico, embasadasnas\r\nnormas de reconhecimento internacional,\r\nem prol da qualidade do\r\nchocolate nacional, do consumidor e\r\ndo comércio global.(AU)", "_i": "pt"}]

Development of functional agricultural products utilizing the new health claim labeling system in Japan.

In April 2015, Consumer Affairs Agency of Japan launched a new food labeling system known as "Foods with Function Claims (FFC)." Under this system, the food industry independently evaluates scientific evidence on foods and describes their functional properties. As of May 23, 2017, 1023 FFC containing 8 fresh foods have been launched. Meanwhile, to clarify the health-promoting effects of agricultural products, National Agriculture and Food Research Organization (NARO) implemented the "Research Project on Development of Agricultural Products" and demonstrated the risk reduction of osteoporosis of ß-cryptoxanthin rich Satsuma mandarins and the anti-allergic effect of the O-methylated catechin rich tea cultivar Benifuuki. These foods were subsequently released as FFC. Moreover, NARO elucidated the health-promoting effects of various functional agricultural products (ß-glucan rich barley, ß-conglycinin rich soybean, quercetin rich onion, etc.) and a healthy boxed lunch. This review focuses on new food labeling system or research examining functional aspects of agricultural products.

Nutrition labelling is a trade policy issue: lessons from an analysis of specific trade concerns at the World Trade Organization.

Interpretive nutrition labels provide simplified nutrient-specific text and/or symbols on the front of pre-packaged foods, to encourage and enable consumers to make healthier choices. This type of labelling has been proposed as part of a comprehensive policy response to the global epidemic of non-communicable diseases. However, regulation of nutrition labelling falls under the remit of not just the health sector but also trade. Specific Trade Concerns have been raised at the World Trade Organization's Technical Barriers to Trade Committee regarding interpretive nutrition labelling initiatives in Thailand, Chile, Indonesia, Peru and Ecuador. This paper presents an analysis of the discussions of these concerns. Although nutrition labelling was identified as a legitimate policy objective, queries were raised regarding the justification of the specific labelling measures proposed, and the scientific evidence for effectiveness of such measures. Concerns were also raised regarding the consistency of the measures with international standards. Drawing on policy learning theory, we identified four lessons for public health policy makers, including: strategic framing of nutrition labelling policy objectives; pro-active policy engagement between trade and health to identify potential trade issues; identifying ways to minimize potential 'practical' trade concerns; and engagement with the Codex Alimentarius Commission to develop international guidance on interpretative labelling. This analysis indicates that while there is potential for trade sector concerns to stifle innovation in nutrition labelling policy, care in how interpretive nutrition labelling measures are crafted in light of trade commitments can minimize such a risk and help ensure that trade policy is coherent with nutrition action.

The SENS algorithm-a new nutrient profiling system for food labelling in Europe.

BACKGROUND/OBJECTIVES: In response to the European regulation on nutrition and health claims, France proposed in 2008 the SAIN,LIM profiling system that classifies foods into four classes based on a nutrient density score called 'SAIN', a score of nutrients to limit called 'LIM', and one primary threshold on each score. We present here the SENS algorithm, a new nutrient profiling system adapted from the SAIN,LIM to be operational for simplified nutrition labelling in line with the European regulation on food information to consumers. SUBJECTS/METHODS: The main changes made to SAIN,LIM to get SENS were to introduce food categories and sub-categories ('Beverages', 'Added Fats' and 'Other Solid Foods' sub-categorised into 'cereals', 'cheese', 'other dairy products', 'eggs', 'fish' and 'others'), reduce the number of nutrients, introduce category-specific nutrients and category-specific weighting for some nutrients, replace French recommendations with European reference intakes, and add secondary thresholds. Each food and non-alcoholic beverage from the 2013-CIQUAL French composition database (n = 1065) was assigned one SENS class. Distribution of foods according to the four SENS classes was described by food groups (n = 26). RESULTS: The SENS classification was consistent with the recommendations to consume large amounts of whole grains, vegetables and fruits, and moderate intake of fats, sugars, meats, caloric beverages and salt. For most groups (19/26), foods were distributed across at least three SENS classes. CONCLUSIONS: The SENS is a nutrition-sensitive system that discriminates foods between and within food categories. It preserves the strengths of the initial SAIN,LIM while making it operational for simplified nutrition labelling in Europe.

Yellow Oleander Seed, or "Codo de Fraile" (Thevetia spp.): A Review of Its Potential Toxicity as a Purported Weight-Loss Supplement.

The Dietary Supplements and Health Education Act (DSHEA), passed by the United States Congress in October of 1994, defines herbal products as nutritional supplements, not medications. This opened the market for diverse products made from plants, including teas, extracts, essential oils, and syrups. Mexico and the United States share an extensive border, where diverse herbal products are available to the public without a medical prescription. Research undertaken in the neighboring cities of Ciudad Juarez, Mexico, and El Paso, Texas, USA, shows the use of herbs is higher in this border area compared to the rest of the United States. A portion of the population is still under the erroneous impression that "natural" products are completely safe to use and therefore lack side effects. We review the dangers of ingesting the toxic seed of Thevetia spp. (family Apocynaceae), commonly known as "yellow oleander" or "codo de fraile," misleadingly advertised on the Internet as an effective and safe dietary supplement for weight loss. Lack of proper quality control regarding herbs generates a great variability in the quantity and quality of the products' content. Herb-drug interactions occur between some herbal products and certain prescription pharmaceuticals. Certain herbs recently introduced into the U.S. market may not have been previously tested adequately for purity, safety, and efficacy. Due to the lack of reliable clinical data regarding the safe use of various herbal products currently available, the public should be made aware regarding the possible health hazards of using certain herbs for therapeutic purposes. The potentially fatal toxicity of yellow oleander seed is confirmed by cases reported from various countries, while the purported benefits of using it for weight loss have not been evaluated by any known clinical trials. For this reason, the use of yellow oleander seed as a dietary supplement should be avoided.