RESUMO
OBJECTIVE: To assess the effect of different front-of-package (FOPL) schemes on the objective understanding of the nutritional content and intention to purchase products, in Panama. DESIGN: Single-blinded multi-arm parallel-group randomised controlled trial. SETTING: Supermarkets across Panama. Participants were exposed to two-dimensional images of 15 mock-up products presented at random and balanced orders. Participants assigned to the intervention groups were exposed to mock-ups featuring one FOPL scheme: black octagonal warning labels (OWL), traffic-light labelling (TFL), or guideline daily amounts (GDA). Control group was not exposed to any FOPL scheme. PARTICIPANTS: Adult supermarket shoppers (n=1200). Participants were blinded to group assignment. RESULTS: Similar number of participants were randomised to and analysed in each group: OWL (n=300), TFL (n=300), GDA (n=300), and control (n=300). The odds for choosing to purchase the least harmful or none of the options more often was the highest in the OWL group. Compared to the control group, two times higher in the OWL group (OR 2·13, 95% confidence interval 1·60-2·84), and 57% higher in the TFL (1·57, 1·40-2·56), with no changes in the GDA (0·97, 0·73-1·29). OWL also resulted in the highest odds for correctly identifying the least harmful option, and for correctly identifying a product with excessive amounts of sugars, sodium and/or saturated fats. CONCLUSIONS: OWL performed best in helping shoppers to correctly identify when a product contained excessive amounts of nutrients of concern, to correctly identify the least harmful option, and to decide to purchase the least harmful or none of the options, more often.
RESUMO
RESUMEN Antecedentes: El exceso de peso en escolares de Panamá es una creciente preocupación de salud pública. Objetivo: Evaluar el efecto de una intervención de educación alimentaria y nutricional (EAN) contra el exceso de peso en escuelas públicas de distritos de mayor pobreza en Panamá. Materiales y métodos: Estudio cuasi experimental con mediciones pre-test y post-test, analítico, prospectivo y con grupo control. El estudio se realizó con 331 escolares (6-11 años), divididos en grupo tratamiento (n1= 209) y grupo control (n2= 122). La intervención EAN duró siete semanas, enero-febrero 2018. Se obtuvieron variables sociodemográficas, de seguridad alimentaria y datos antropométricos (peso y talla) con las que se calculó el puntaje z del índice de masa corporal para el sexo y edad (zIMC), considerando exceso de peso cuando fue ≥1 desviación estándar (DE). Resultado: Participaron 331 escolares, media y DE para edad de 9,2±1,6 años (53% femenino). Media y DE en período pre y post intervención para zIMC de 0,66±1,2 y 0,68±1,3 DE (prueba t; p= NS). La media y DE del delta de zIMC en grupo control y tratamiento fue 0,06±0,65 y 0,01±0,75 DE, respectivamente; no se observó diferencia significativa por grupo internvención y control luego de ajustar por ubicación geográfica y sexo (MANOVA; p= 0,4930). El 36,6% presentó exceso de peso (zIMC>1DE), sin diferencia significativa luego de la intervención (34,4%). Conclusión: esta propuesta de intervención de EAN de corta duración no modificó el estado nutricional, pero es una herramienta importante que ayuda a concientizar a la población escolar sobre el tipo de alimentación que debe llevar para modificar estilos de vida.
ABSTRACT Background: Overweight in Panamanian school-age children is an increasing public health concern. Objective: To evaluate the effect of a short-term food and nutritional education intervention for the prevention of overweight in public schools of poor districts of Panama. Materials and methods: A quasi-experimental analytical prospective study (pre and pro-test) was conducted. The study was conducted with 331 students (6-11 years) divided into either: intervention (n= 209) or control group (n= 122). The intervention lasted seven weeks in January-February 2018. Sociodemographics, food security, and anthropometry (weight and height) were measured and body mass index z score for sex and age (BAZ) were calculated, considering overweight when z-score was ≥1. Result: The mean and standard deviation (SD) for age was 9.2±1.6 years (53% female). Mean and SD in BMIz pre and post intervention was 0.66±1.2 and 0.68±1.3 SD (t test; p= NS), respectively. The mean and SD of the change in BMIz for the control and treatment group was 0.06±0.65 and 0.01±0.75 SD, respectively; no significant difference was observed by intervention and control groups after adjusting for geographic location and sex (MANOVA; p= 0.493). Overweight was present in 36.6% of the sample at baseline and no significant difference was observed after intervention (34.4%). Conclusion: This short-term food and nutritional education did not modify nutritional status. However, it is an important tool that helps raise awareness among the school population about healthy eating habits and lifestyles.