Efficacy of different front-of-package labeling systems in changing purchase intention and product healthfulness perception for food products in Argentina.

Objectives: To identify the front-of-package scheme-Multiple Traffic Light (MTL), Nutri-Score (NS), and black octagon Warning System (WS)-most effective in reducing purchase intention and perceived product healthfulness of drinking yogurts, cookies and cheese spreads, and to assess the joint influence of nutrient claims on the effects. Methods: Randomized-controlled experiment. A within-subjects factorial design was used to evaluate the influence of three independent factors on perceived product healthfulness and purchase intention. A total of 704 adults in Argentina were shown three mock-up products and asked to indicate which product they would buy choosing between pairs of products from different categories and to rate product healthfulness on a 7-point Likert scale. Results: The WS was the most effective in reducing purchase intention in drinking yogurts (OR:0.16, 95%CI: 0.09;0.28), cookies (OR:0.10, 95%CI: 0.05;0.18) and cheese spreads (OR:0.10, 95%CI: 0.05;0.18), and the perception of healthfulness (WS Mean score 3,63 vs No label 4,24, p<0.001), regardless of the participants' gender, age, and level of education. NS was inefficacious in reducing product healthfulness perception, while MTL had significantly increased how healthful the product was perceived (p<0.001). Nutrient claims increased purchase intention and perception of healthfulness, thus reducing the effectiveness of front-of-package labels (p<0.001). Conclusions: In line with growing evidence, our findings support that WS perform better than NS and MTL in reducing purchase intention and healthfulness perception of products with excessive amounts of critical nutrients associated with the greatest burden of diseases. Front-of-package WS are expected to facilitate the population in Argentina to make healthier decisions.

Food marketing and gender among children and adolescents: a scoping review.

BACKGROUND: Pervasive marketing of unhealthy foods is a contributing factor to the growth of the global epidemic of childhood and adolescent overweight and obesity. Sex and gender differences come into play in the design of and responses to these marketing strategies, contributing to the perpetuation of stereotyped behavior and generating disparities in food choices and health. The purpose of this paper is to review the current literature regarding gender differences in food marketing design and perception among children and adolescents to facilitate evidence-based policy dialogues to address gender-based health disparities in NCD prevention. METHODS: Scoping review of articles published in scientific journals in English and Spanish, from 2003 to 2018, that addressed the influence of food marketing among children and adolescents including a gender perspective. The methodological quality of each article was assessed following criteria specific to each study design. RESULTS: From a total of 37 articles (39 studies) included in the review, 17 were experimental and 22 had descriptive, cross-sectional designs. Twenty-one studies were found to have low methodological quality, while 10 and 8 were of medium and high quality, respectively. A total of 23 studies among children and adolescents found gender-based differences. Differences were found in the following dimensions: food marketing on intake; responses to specific marketing; perceptions and attitudes towards food marketing and marketing regulation initiatives; exposure to food advertising and gendered marketing content. The evidence was not conclusive in any of the dimensions. CONCLUSIONS: The evidence suggests that food marketing has a similar impact on the consumption of unhealthy foods on boys and girls, but boys were found to be exposed to food advertising more intensively and their preferences to be more affected by this exposure, coinciding with a male-dominant advertising content. Limitations of these studies include taking gender as an unproblematic construct equivalent to biological sex and the lack of studies focused on developing countries. As gender is a cross-sectional dimension that interacts with other factors driving health disparities, an integrated gender perspective is needed to develop effective, evidence-based policies to control food marketing and tackle the childhood overweight and obesity pandemic.

Measuring cost and affordability of current vs. healthy diets in Argentina: an application of linear programming and the INFORMAS protocol.

BACKGROUND: Food cost and affordability is one of the main barriers to improve the nutritional quality of diets of the population. However, in Argentina, where over 60% of adults and 40% of children and adolescents are overweight or obese, little is known about the difference in cost and affordability of healthier diets compared to ordinary, less healthy ones. METHODS: We implemented the "optimal approach" proposed by the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS). We modelled the current diet and two types of healthy diets, one equal in energy with the current diet and one 6.3% lower in energy by linear programming. Cost estimations were performed by collecting food product prices and running a Monte Carlo simulation (10,000 iterations) to obtain a range of costs for each model diet. Affordability was measured as the percentage contribution of diet cost vs. average household income in average, poor and extremely poor households and by income deciles. RESULTS: On average, households must spend 32% more money on food to ensure equal energy intake from a healthy diet than from a current model diet. When the energy intake target was reduced by 6.3%, the difference in cost was 22%. There are no reasonably likely situations in which any of these healthy diets could cost less or the same than the current unhealthier one. Over 50% of households would be unable to afford the modelled healthy diets, while 40% could not afford the current diet. CONCLUSIONS: Differential cost and affordability of healthy vs. unhealthy diets are germane to the design of effective public policies to reduce obesity and NCDs in Argentina. It is necessary to implement urgent measures to transform the obesogenic environment, making healthier products more affordable, available and desirable, and discouraging consumption of nutrient-poor, energy-rich foods.

Food advertising on Argentinean television: are ultra-processed foods in the lead?

OBJECTIVE: To describe the number of processed and ultra-processed food (PUPF) advertisements (ads) targeted to children on Argentinean television (TV), to analyse the advertising techniques used and the nutritional quality of the foods advertised, and to determine the potential exposure of children to unhealthy food advertising in our country. DESIGN: Five free-to-air channels and the three most popular children's cable networks were recorded from 07.00 to 22.00 hours for 6 weeks. Ads were classified by target audience, type of product, advertised food categories and advertising strategies used. The NOVA system was used to classify food products according to industrial food processing level. Nutritional quality was analysed using the Pan American Health Organization's nutrient profile model. SETTING: Buenos Aires, Argentina. Results are considered applicable to most of the country. SUBJECTS: The study did not involve human subjects. RESULTS: Of the sample of food ads, PUPF products were more frequently advertised during children's programmes (98·9 %) v. programmes targeted to the general audience (93·7 %, χ 2=45·92, P<0·01). The top five food categories were desserts, dairy products, non-alcoholic sugary beverages, fast-food restaurants, and salty snacks. Special promotions and the appearance of cartoon characters were much more frequent in ads targeting children. Argentinean children are estimated to be exposed to sixty-one ads for unhealthy PUPF products per week. CONCLUSIONS: Our study showed that Argentinean children are exposed to a high number of unhealthy PUPF ads on TV. The Argentinean Government should build on this information to design and implement a comprehensive policy to reduce exposure to unhealthy food marketing that includes TV and other communication channels and places.

Data on the Facebook marketing strategies used by fast-food chains in four Latin American countries during the COVID-19 lockdowns.

OBJECTIVES: During the COVID-19 pandemic, most countries implemented lockdowns that motivated changes in the dietary patterns, physical activity, and body mass index (BMI) of consumers worldwide, as well as the emergence of new food marketing strategies in social media. We sought to design and validate a methodology for monitoring and evaluating the Facebook marketing strategies of multinational fast-food chains in response to the COVID-19 pandemic. DATA DESCRIPTION: We developed three datasets. First, a dataset with the Uniform Resource Locators (URLs) of 1015 Facebook posts of five fast-food chains present in Argentina, Bolivia, Guatemala, and Peru. Second, a dataset of 106 content-analyzed posts we used in a pilot to determine intercoder reliability using statistical tests. Third, a dataset of a final sample of the 1015 content-analyzed posts that we used to determine the variables most frequently used. Following a mixed-methods approach, we developed 29 variables that recorded general information, as well as the marketing strategies we identified in the posts, including 14 COVID-19 specific variables. These data should help to monitor the social media marketing strategies that fast-food chains have introduced during the COVID-19 lockdowns, thus providing initial evidence about how they could be contributing to an unhealthy food environment.

Changes in the Sodium Content of Foods Sold in Four Latin American Countries: 2015 to 2018.

In 2015, the Pan American Health Organization (PAHO) published sodium targets for packaged foods, which included two distinct levels: one "regional" and one "lower" target. Changes to the sodium content of the food supply in Latin American Countries (LAC) has not been evaluated. A repeated cross-sectional study used food label data from 2015 (n = 3859) and 2018 (n = 5312) to determine changes in the proportion of packaged foods meeting the PAHO sodium targets and the distribution in the sodium content of foods in four LAC (Argentina, Costa Rica, Paraguay, Peru). Foods were classified into the 18 food categories in the PAHO targets. The proportion of foods meeting the regional targets increased from 82.9% to 89.3% between 2015 and 2018 (p < 0.001). Overall, 44.4% of categories had significant decreases in mean sodium content. Categories with a higher proportion of foods meeting the regional and lower targets in 2018 compared to 2015 (p < 0.05) were breaded meat and poultry, wet and dry soups, snacks, cakes, bread products, flavored cookies and crackers, and dry pasta and noodles. While positive progress has been made in reducing the sodium content of foods in LAC, sodium intakes in the region remain high. More stringent targets are required to support sodium reduction in LAC.

Nutritional quality, child-oriented marketing and health/nutrition claims on sweet biscuit, breakfast cereal and dairy-based dessert packs in Argentina.

As children are particularly vulnerable to marketing, this study analyzes marketing techniques and health/nutrition claims in food packaging and evaluates the nutritional quality in three food categories: sweet biscuits, breakfast cereals and dairy-based desserts. This descriptive study analyzed marketing techniques and claims included in food packaging (n = 301) in one of the largest retailers in Argentina. Trained researchers coded data following an adapted version of the INFORMAS protocol to account for local food packaging regulations. Nutritional quality was assessed using both Pan American Health Organization Nutrient Profile (PAHO NPM) and the WHO Regional Office for Europe Nutrient Profile (WHO Euro NPM) models. Under the PAHO model, 87% (n 262) of the product sample presented excess content of at least one nutrient ("less healthy" products), and 91% (n = 273) should not be marketed to children according to the WHO Euro model. Almost 40% of less healthy food products displayed nutrition claims on their package. Characters or celebrity endorsements, which are particularly attractive to children, featured in 32% of less healthy products, being more frequent in less healthy food products than in healthier ones. Results indicate that packaging for food products with low nutritional value often includes powerful marketing elements in Argentina, which renders young children very vulnerable to obesogenic influence. Moreover, the real nutritional value of the products analyzed were often at odds with the health claims shown on its package. Food labeling policies must be improved in Argentina to guarantee people's health protection against deceptive advertising.

Monitoring Sodium Content in Processed Foods in Argentina 2017-2018: Compliance with National Legislation and Regional Targets.

Sodium intake in Argentina has been estimated to be at least double the dose of 2000 mg/day recommended by WHO, mostly coming from processed foods. Argentina is one of the few countries in the world that have regulated sodium content in certain food products. This study presents an assessment of sodium content in a selection of food groups and categories as reported in the nutrient information panels. We surveyed 3674 food products, and the sodium content of 864 and 1375 of them was compared to the maximum levels according to the Argentinean law and the regional targets, respectively. All food categories presented high variability of sodium content. Over 90% of the products included in the national sodium reduction law were found to be compliant. Food groups with high median sodium, such as condiments, sauces and spreads, and fish and fish products, are not included in the national law. In turn, comparisons with the lower regional targets indicated that almost 50% of the products analyzed had sodium contents above the recommended values. This evidence suggests that enhancing sodium reduction in processed foods may be a necessity for public health objectives and it is also technically feasible in Argentina.

Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries.

Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty-two countries contributed data, captured between 2008 and 2017. Advertisements were coded for the nature of foods and beverages, using the 2015 World Health Organization (WHO) Europe Nutrient Profile Model (should be permitted/not-permitted to be advertised). Peak viewing times were defined as the top five hour timeslots for children. On average, there were four times more advertisements for foods/beverages that should not be permitted than for permitted foods/beverages. The frequency of food/beverages advertisements that should not be permitted per hour was higher during peak viewing times compared with other times (P < 0.001). During peak viewing times, food and beverage advertisements that should not be permitted were higher in countries with industry self-regulatory programmes for responsible advertising compared with countries with no policies. Globally, children are exposed to a large volume of television advertisements for unhealthy foods and beverages, despite the implementation of food industry programmes. Governments should enact regulation to protect children from television advertising of unhealthy products that undermine their health.

Analysis of a voluntary initiative to reduce sodium in processed and ultra-processed food products in Argentina: the views of public and private sector representatives.

The Less Salt, More Life program was the first voluntary salt reduction initiative in Argentina. This article analyzes the perspectives of the stakeholders involved in this voluntary agreement between the Ministry of Health and the food industry to gradually reduce sodium content in processed foods. This exploratory case study used a qualitative approach including 29 in-depth interviews with stakeholders from the public and private sectors and identified the role of the different stakeholders and their perceptions regarding the challenges encountered in the policy process that contribute to the debate on public-private partnerships in health policies. The article also discusses the initiative's main challenges and controversies.

Efficacy of different front-of-package labeling systems in changing purchase intention and product healthfulness perception for food products in Argentina / Eficacia de los diferentes sistemas de etiquetado frontal en Argentina para modificar la intención de compra y la percepción saludable de productos alimentarios / Eficácia de diferentes sistemas de rotulagem nutricional frontal para mudar a intenção de compra e a percepção de saudabilidade de produtos alimentícios na Argentina

ABSTRACT Objectives. To identify the front-of-package scheme—Multiple Traffic Light (MTL), Nutri-Score (NS), and black octagon Warning System (WS)—most effective in reducing purchase intention and perceived product healthfulness of drinking yogurts, cookies and cheese spreads, and to assess the joint influence of nutrient claims on the effects. Methods. Randomized-controlled experiment. A within-subjects factorial design was used to evaluate the influence of three independent factors on perceived product healthfulness and purchase intention. A total of 704 adults in Argentina were shown three mock-up products and asked to indicate which product they would buy choosing between pairs of products from different categories and to rate product healthfulness on a 7-point Likert scale. Results. The WS was the most effective in reducing purchase intention in drinking yogurts (OR:0.16, 95%CI: 0.09;0.28), cookies (OR:0.10, 95%CI: 0.05;0.18) and cheese spreads (OR:0.10, 95%CI: 0.05;0.18), and the perception of healthfulness (WS Mean score 3,63 vs No label 4,24, p<0.001), regardless of the participants' gender, age, and level of education. NS was inefficacious in reducing product healthfulness perception, while MTL had significantly increased how healthful the product was perceived (p<0.001). Nutrient claims increased purchase intention and perception of healthfulness, thus reducing the effectiveness of front-of-package labels (p<0.001). Conclusions. In line with growing evidence, our findings support that WS perform better than NS and MTL in reducing purchase intention and healthfulness perception of products with excessive amounts of critical nutrients associated with the greatest burden of diseases. Front-of-package WS are expected to facilitate the population in Argentina to make healthier decisions.

RESUMEN Objetivos. Determinar el sistema de etiquetado frontal -semáforo múltiple, Nutri-Score (NS) y sistema de advertencia con forma de octágono negro- más efectivo para reducir la intención de compra y la percepción saludable de yogures bebibles, galletitas y quesos para untar, y evaluar la influencia conjunta de las declaraciones nutricionales sobre los efectos del etiquetado frontal. Métodos. En el estudio, un ensayo controlado aleatorizado, se empleó un diseño factorial entre los sujetos para evaluar la influencia de tres factores independientes en la percepción saludable y la intención de compra. A un total de 704 adultos en Argentina se les mostraron tres prototipos de productos; se les pidió que indicaran qué producto comprarían eligiendo entre pares de diferentes categorías y que calificaran qué tan saludable era cada producto en una escala Likert de 7 puntos. Resultados. El sistema de advertencias con octágonos negros fue el más efectivo para reducir la intención de compra en yogures bebibles (OR: 0,16, IC 95%: 0,09; 0,28), galletitas (OR: 0,10, IC 95%: 0,05; 0,18) y quesos para untar (OR: 0,10, IC 95%: 0,05; 0,18) y para reducir la percepción saludable (puntuación promedio del sistema de advertencias: 3,63; ninguna etiqueta: 4,24, p<0,001), independientemente del sexo, la edad y el nivel de educación de los participantes. El Nutri-Score fue ineficaz para reducir la percepción saludable, mientras que el sistema de semáforo múltiple aumentó significativamente cuán saludable se percibió el producto (p<0,001). Las declaraciones nutricionales aumentaron la intención de compra y la percepción saludable, lo que redujo la eficacia de las etiquetas frontales en el envase (p<0,001). Conclusiones. En consonancia con la evidencia disponible, nuestros resultados respaldan que el sistema de advertencia con forma de octágono negro funciona mejor que el Nutri-Score y el semáforo múltiple en la reducción de la intención de compra y la percepción de saludable de productos con cantidades excesivas de nutrientes críticos asociados con la mayor carga de enfermedades. Se espera que el uso de los símbolos octagonales de advertencia en la parte frontal de los envases facilite la toma de decisiones más saludables para la población en Argentina.

RESUMO Objetivos. Identificar o modelo de rotulagem nutricional frontal - tipo semáforo (Multiple Traffic Light, MTL), Nutri-Score (NS) e octógonos pretos (Warning System, WS) - mais eficaz para reduzir a intenção de compra e a percepção de saudabilidade de iogurtes líquidos, biscoitos doces e pastas de queijo, bem como avaliar a influência conjunta das alegações nutricionais sobre tais efeitos. Métodos. Estudo experimental randomizado e controlado. Foi utilizado um delineamento fatorial de sujeito único para avaliar a influência de três fatores independentes sobre a percepção de saudabilidade e a intenção de compra dos produtos. A uma amostra de 704 adultos na Argentina foram mostrados três mock-ups de produtos, e foi solicitado aos participantes que indicassem qual produto eles comprariam (escolhendo entre pares de produtos de diferentes categorias) e que classificassem a saudabilidade do produto em uma escala tipo Likert de 7 pontos. Resultados. O sistema WS foi o mais eficaz em reduzir a intenção de compra dos iogurtes líquidos (odds ratio [OR]: 0,16, intervalo de confiança [IC] 95%): 0,09; 0,28), biscoitos doces (OR: 0,10, IC95%: 0,05; 0,18) e pastas de queijo (OR: 0,10, IC95%: 0,05; 0,18), bem como a percepção de saudabilidade (pontuação média: 3,63 com rotulagem WS x 4,24 sem rotulagem, p<0,001), independentemente do sexo, idade e escolaridade dos participantes. O sistema NS foi ineficaz em reduzir a percepção de saudabilidade dos produtos, e o MTL aumentou significativamente essa percepção (p<0,001). As alegações nutricionais aumentaram a intenção de compra e a percepção de saudabilidade, reduzindo assim a eficácia da rotulagem frontal (p<0,001). Conclusões. Corroborando um corpo crescente de evidências, nossas constatações indicam que o sistema WS de rotulagem frontal tem melhor desempenho do que os modelos NS e MTL na redução da intenção de compra e da percepção de saudabilidade de produtos com teor excessivo de nutrientes críticos associados a uma maior carga de morbidade. Espera-se que a rotulagem nutricional frontal do tipo WS favoreça a tomada de decisões mais saudáveis pela população da Argentina.

Efficacy of different front-of-package labeling systems in changing purchase intention and product healthfulness perception for food products in Argentina

[ABSTRACT]. Objectives. To identify the front-of-package scheme—Multiple Traffic Light (MTL), Nutri-Score (NS), and black octagon Warning System (WS)—most effective in reducing purchase intention and perceived product health- fulness of drinking yogurts, cookies and cheese spreads, and to assess the joint influence of nutrient claims on the effects. Methods. Randomized-controlled experiment. A within-subjects factorial design was used to evaluate the influence of three independent factors on perceived product healthfulness and purchase intention. A total of 704 adults in Argentina were shown three mock-up products and asked to indicate which product they would buy choosing between pairs of products from different categories and to rate product healthfulness on a 7-point Likert scale. Results. The WS was the most effective in reducing purchase intention in drinking yogurts (OR:0.16, 95%CI: 0.09;0.28), cookies (OR:0.10, 95%CI: 0.05;0.18) and cheese spreads (OR:0.10, 95%CI: 0.05;0.18), and the perception of healthfulness (WS Mean score 3,63 vs No label 4,24, p<0.001), regardless of the participants’ gender, age, and level of education. NS was inefficacious in reducing product healthfulness perception, while MTL had significantly increased how healthful the product was perceived (p<0.001). Nutrient claims increased purchase intention and perception of healthfulness, thus reducing the effectiveness of front-of-package labels (p<0.001). Conclusions. In line with growing evidence, our findings support that WS perform better than NS and MTL in reducing purchase intention and healthfulness perception of products with excessive amounts of critical nutrients associated with the greatest burden of diseases. Front-of-package WS are expected to facilitate the population in Argentina to make healthier decisions.

[RESUMEN]. Objetivos. Determinar el sistema de etiquetado frontal -semáforo múltiple, Nutri-Score (NS) y sistema de advertencia con forma de octágono negro- más efectivo para reducir la intención de compra y la percepción saludable de yogures bebibles, galletitas y quesos para untar, y evaluar la influencia conjunta de las declara- ciones nutricionales sobre los efectos del etiquetado frontal. Métodos. En el estudio, un ensayo controlado aleatorizado, se empleó un diseño factorial entre los sujetos para evaluar la influencia de tres factores independientes en la percepción saludable y la intención de com- pra. A un total de 704 adultos en Argentina se les mostraron tres prototipos de productos; se les pidió que indicaran qué producto comprarían eligiendo entre pares de diferentes categorías y que calificaran qué tan saludable era cada producto en una escala Likert de 7 puntos. Resultados. El sistema de advertencias con octágonos negros fue el más efectivo para reducir la intención de compra en yogures bebibles (OR: 0,16, IC 95%: 0,09; 0,28), galletitas (OR: 0,10, IC 95%: 0,05; 0,18) y que- sos para untar (OR: 0,10, IC 95%: 0,05; 0,18) y para reducir la percepción saludable (puntuación promedio del sistema de advertencias: 3,63; ninguna etiqueta: 4,24, p<0,001), independientemente del sexo, la edad y el nivel de educación de los participantes. El Nutri-Score fue ineficaz para reducir la percepción salud- able, mientras que el sistema de semáforo múltiple aumentó significativamente cuán saludable se percibió el producto (p<0,001). Las declaraciones nutricionales aumentaron la intención de compra y la percepción saludable, lo que redujo la eficacia de las etiquetas frontales en el envase (p<0,001). Conclusiones. En consonancia con la evidencia disponible, nuestros resultados respaldan que el sistema de advertencia con forma de octágono negro funciona mejor que el Nutri-Score y el semáforo múltiple en la reducción de la intención de compra y la percepción de saludable de productos con cantidades excesivas de nutrientes críticos asociados con la mayor carga de enfermedades. Se espera que el uso de los símbolos octagonales de advertencia en la parte frontal de los envases facilite la toma de decisiones más saludables para la población en Argentina.

[RESUMO]. Objetivos. Identificar o modelo de rotulagem nutricional frontal – tipo semáforo (Multiple Traffic Light, MTL), Nutri-Score (NS) e octógonos pretos (Warning System, WS) – mais eficaz para reduzir a intenção de compra e a percepção de saudabilidade de iogurtes líquidos, biscoitos doces e pastas de queijo, bem como avaliar a influência conjunta das alegações nutricionais sobre tais efeitos. Métodos. Estudo experimental randomizado e controlado. Foi utilizado um delineamento fatorial de sujeito único para avaliar a influência de três fatores independentes sobre a percepção de saudabilidade e a intenção de compra dos produtos. A uma amostra de 704 adultos na Argentina foram mostrados três mock-ups de produtos, e foi solicitado aos participantes que indicassem qual produto eles comprariam (escolhendo entre pares de produtos de diferentes categorias) e que classificassem a saudabilidade do produto em uma escala tipo Likert de 7 pontos. Resultados. O sistema WS foi o mais eficaz em reduzir a intenção de compra dos iogurtes líquidos (odds ratio [OR]: 0,16, intervalo de confiança [IC] 95%): 0,09; 0,28), biscoitos doces (OR: 0,10, IC95%: 0,05; 0,18) e pastas de queijo (OR: 0,10, IC95%: 0,05; 0,18), bem como a percepção de saudabilidade (pontuação média: 3,63 com rotulagem WS x 4,24 sem rotulagem, p<0,001), independentemente do sexo, idade e escolaridade dos participantes. O sistema NS foi ineficaz em reduzir a percepção de saudabilidade dos produtos, e o MTL aumentou significativamente essa percepção (p<0,001). As alegações nutricionais aumentaram a intenção de compra e a percepção de saudabilidade, reduzindo assim a eficácia da rotulagem frontal (p<0,001). Conclusões. Corroborando um corpo crescente de evidências, nossas constatações indicam que o sistema WS de rotulagem frontal tem melhor desempenho do que os modelos NS e MTL na redução da intenção de compra e da percepção de saudabilidade de produtos com teor excessivo de nutrientes críticos associados a uma maior carga de morbidade. Espera-se que a rotulagem nutricional frontal do tipo WS favoreça a tomada de decisões mais saudáveis pela população da Argentina.

[Mothers and food advertising directed at children: perceptions and experiences]. / Las madres y la publicidad de alimentos dirigida a niños y niñas: percepciones y experiencias.

The objective of this study is to analyze how food advertising is perceived by mothers from different socioeconomic sectors of the Metropolitan Area of Buenos Aires, Argentina. Between May and November 2015, eight focus groups were conducted with the participation of 49 mothers of different education levels living in the study area. The results show how the purchasing decisions of mothers are influenced by the requests of their children, which are in turn prompted by food advertising and promotion. The study also shows how food advertising and promotion are combined with other environmental factors (greater supply of food products, "more demanding" children) that affect the decision-making process of mothers regarding their children's nutrition and foster the consumption of certain unhealthy products. This situation was observed in all the focus groups, without differences among education levels.

Evaluación de los sistemas de perfiles nutricionales para la definición de una política de etiquetado frontal en Argentina / Evaluation of nutrient profiling systems for the definition of a front-of-pack labelling policy in Argentina

INTRODUCCIÓN: La Organización Mundial de la Salud (OMS) recomienda validar los sistemas de perfiles nutricionales (SPN) tomando como referencia las Guías Alimentarias del país donde se aplican. El objetivo fue evaluar el nivel de acuerdo y exigencia de los SPN latinoamericanos respecto a las Guías Alimentarias para la Población Argentina (GAPA). MÉTODOS: Se evaluó la calidad nutricional de un listado de alimentos según los SPN de la región diseñados para políticas de etiquetado frontal (EF). Se analizó el nivel de acuerdo (índice kappa y Gwet's) y de exigencia (porcentaje de alimentos a limitar) entre las clasificaciones de los SPN y los mensajes de las GAPA. RESULTADOS: Se evaluó un total de 1703 alimentos clasificados en 8 grupos y 48 categorías. Los SPN con mayor nivel de acuerdo con las GAPA fueron el SPN de la Organización Panamericana de la Salud (OPS) (Gwet's=0,663) y el SPN Uruguay (Gwet's=0,651), seguidos por el SPN Chile (Gwet's=0,558) y el SPN Ecuador (Gwet's=0,410) y, por último, el SPN Perú (Gwet's=0,373) y el SPN Bolivia (Gwet's=0,350). En el análisis del nivel de exigencia se observó que al menos uno de los SPN (OPS, Uruguay o Chile) era más exigente que las GAPA en 14 categorías y menos en 4. DISCUSIÓN: Los SPN de OPS y Uruguay son los que más se adecúan a los estándares nutricionales de las GAPA. Este estudio constituye un insumo clave para desarrollar un SPN nacional basado en evidencia científica, que asegure la efectividad de una política de EF

Sodium content in processed foods in Argentina: compliance with the national law.

BACKGROUND: Despite the body of evidence that documents the unfavorable effects of excessive sodium consumption on blood pressure and cardiovascular health, public health efforts to decrease sodium consumption have been limited to a few countries. Argentina is the first country in Latin America to regulate sodium content of processed foods by means of a national law. The objective of this cross-sectional quantitative study is to provide a baseline comparison against the reduction targets set by the national law before its entry into force. METHODS: Data were collected in February 2014 in a leading supermarket chain located in Buenos Aires. Nutrient data from package labels were analysed for 1,320 products within 14 food groups during the study period. To compare sodium concentration levels with the established maximum levels we matched the collected food groups with the food groups included in the law resulting in a total of 292 products. Data analysis was conducted using SPSS version 20 software. RESULTS: Food groups with the highest median sodium content were sauces and spreads (866.7 mg/100 g), meat and meat products (750 mg/100 g) and snack foods (644 mg/100 g). Categories with the highest sodium content were appetizers (1,415 mg/100 g), sausages (1,050 mg/100 g) and ready-made meals (940.7 mg/100 g). We also found large variability within products from the same food categories. Products included in the national law correspond to 22.1% (n=292) of the surveyed foods. From the 18 food groups, 15 showed median sodium values below the established targets. Products exceeding the established maximum levels correspond to 15.1% (n=44) of the products included in the analysis. CONCLUSIONS: This study is the first analysis of food labels to determine sodium concentrations of processed foods in Argentina and to provide a baseline against the national law standards. Upon the completion of this analysis, maximum levels have been achieved by most of the food groups included in the law. Thus, the introduction of further reductions for the existing maximum levels and the establishment of sodium targets for all relevant product categories not included in the law should be considered as the next steps in the process.

Nutritional quality, child-oriented marketing and health/nutrition claims on sweet biscuit, breakfast cereal and dairy-based dessert packs in Argentina / Calidad nutricional, mercadotecnia orientada a la infancia y propaganda sobre salud/nutrición en galletas dulces, cereales para el desayuno y embalajes de postres lácteos en Argentina / Qualidade nutricional, marketing concentrado no público infantil e alegações nutricionais e de saúde nas embalagens de biscoitos, cereais matinais e sobremesas lácteas na Argentina

As children are particularly vulnerable to marketing, this study analyzes marketing techniques and health/nutrition claims in food packaging and evaluates the nutritional quality in three food categories: sweet biscuits, breakfast cereals and dairy-based desserts. This descriptive study analyzed marketing techniques and claims included in food packaging (n = 301) in one of the largest retailers in Argentina. Trained researchers coded data following an adapted version of the INFORMAS protocol to account for local food packaging regulations. Nutritional quality was assessed using both Pan American Health Organization Nutrient Profile (PAHO NPM) and the WHO Regional Office for Europe Nutrient Profile (WHO Euro NPM) models. Under the PAHO model, 87% (n 262) of the product sample presented excess content of at least one nutrient ("less healthy" products), and 91% (n = 273) should not be marketed to children according to the WHO Euro model. Almost 40% of less healthy food products displayed nutrition claims on their package. Characters or celebrity endorsements, which are particularly attractive to children, featured in 32% of less healthy products, being more frequent in less healthy food products than in healthier ones. Results indicate that packaging for food products with low nutritional value often includes powerful marketing elements in Argentina, which renders young children very vulnerable to obesogenic influence. Moreover, the real nutritional value of the products analyzed were often at odds with the health claims shown on its package. Food labeling policies must be improved in Argentina to guarantee people's health protection against deceptive advertising.

Los niños son particularmente vulnerables a la mercadotecnia; este estudio analiza las técnicas de mercadotecnia y la propaganda sobre salud/nutrición en los paquetes de comida, además de evaluar la calidad nutricional en tres categorías de comida: galletas dulces, cereales para el desayuno y postres lácteos. Este estudio descriptivo analizó las técnicas de mercadotecnia y propaganda incluida en los embalajes de galletas dulces, cereales para el desayuno y postres (n = 301) en uno de los distribuidores más grandes de Argentina. Investigadores cualificados codificaron los datos siguiendo una versión adaptada del protocolo INFORMAS, con el fin de evaluar la regulación respecto a los embalajes de comida local. La calidad nutricional fue evaluada usando tanto los modelos del Perfil Nutricional de la Organización Panamericana de la Salud (OPS NPM) y Organización Munidal de la Salud (OMS Euro NPM). Un 87% (n = 262) de la muestra del producto presentó un exceso de contenido de al menos un nutriente (productos "menos saludables"), según el OPS NPM, y un 91% (n = 273) de la muestra no debería haber sido etiquetada para niños, según el OMS Euro NPM. Casi un 40% de los productos menos saludables contaban con propaganda nutricional en sus embalajes. Personajes infantiles o el respaldo de famosos, que son particularmente atractivos para los niños, fueron destacados en un 32% de los productos menos sanos, y fueron más frecuentes entre los productos menos sanos que entre los más saludables. Los resultados indican que los embalajes de productos alimenticios con un valor nutricional bajo, a menudo incluyen elementos poderosos de mercadotecnia en Argentina, lo que provoca que los niños más jóvenes sean más vulnerables a la influencia obesogénica. Asimismo, el valor real nutricional de los productos analizados estuvo a menudo en conflicto con la propaganda sobre los beneficios para la salud mostrados en su embalaje. Las políticas de etiquetado deberían mejorar en Argentina para garantizar la protección a la salud de toda la población frente a la publicidad engañosa.

As crianças são particularmente vulneráveis ao marketing. O estudo analisa as técnicas publicitárias e alegações nutricionais e de saúde nas embalagens de alimentos e avalia a qualidade nutricional de três categorias de alimentos: biscoitos, cereais matinais e sobremesas lácteas. O estudo descritivo analisou as técnicas de marketing e as alegações impressas nas embalagens de biscoitos, cereais matinais e sobremesas lácteas (n = 301) em uma das maiores cadeias de varejo da Argentina. Pesquisadores treinados codificaram os dados de acordo com uma versão adaptada do protocolo INFORMAS para levar em conta a regulamentação argentina de rotulagem de alimentos. A qualidade nutricional foi avaliada com os modelos de Perfil de Nutrientes da Organização Pan-Americana da Saúde (OPAS NPM) e da Organização Mundial da Saúde (OMS Euro NPM). Ao todo, 87% (n = 262) das amostras dos produtos apresentavam um conteúdo excessivo de pelo menos um ingrediente (os produtos "menos saudáveis") de acordo com o OPAS NPM, enquanto 91% (n = 273) dos produtos não deveriam ser promovidos para crianças, de acordo com o OMS Euro NPM. Quase 40% dos produtos alimentícios menos saudáveis mostravam alegações nutricionais nas embalagens. Personagens conhecidos pelo público infantil, além do endosso de celebridades, que são particularmente atraentes para as crianças, foram destacados em 32% dos produtos menos saudáveis, e eram mais frequentes nos produtos menos saudáveis do que nos mais saudáveis. Os resultados indicam que as embalagens dos produtos alimentícios com menor valor nutritivo muitas vezes fazem uso de elementos poderosos de marketing na Argentina, deixando as crianças altamente vulneráveis à influência obesogênica. Muitas vezes o verdadeiro valor nutritivo dos produtos analisados não estava de acordo com as alegações de saúde nas embalagens. As políticas de rotulagem de alimentos devem ser melhoradas na Argentina para garantir a proteção da saúde da população inteira contra a publicidade enganosa.

Obstáculos y facilitadores percibidos para el consumo de frutas y verduras: Estudio Cualitativo / Perceived Barriers and Facilitators of Fruit and Vegetable Consumption in Argentina: A Qualitative Study

En Argentina, más de la mitad de la población adulta tiene sobrepeso y más del 95% no llega a consumir las cinco porciones diarias recomendadas de frutas y verduras (FV). El objetivo de este estudio fue explorar los determinantes sociales del consumo de FV entre la población adulta en el Área Metropolitana de Buenos Aires (AMBA). MÉTODOS: Se realizaron grupos focales con 40 hombres y mujeres de 25 a 60 años de edad en AMBA. El análisis y la comparación constante se utilizaron para identificar temas y subtemas. RESULTADOS: Las principales barreras percibidas para aumentar el consumo de vegetales fueron las limitaciones de tiempo en la preparación de las comidas, el conocimiento insuficiente sobre la preparación de comidas a base de vegetales, la habituación y la exposición a publicidades de alimentos ultraprocesados. Los costos fueron una preocupación principalmente para las compras de fruta. Las iniciativas dirigidas a aumentar la disponibilidad de FV en entornos escolares y laborales y proporcionar FV listas para comer fueron los principales facilitadores identificados para aumentar el consumo de FV. Las sugerencias incluyen programas educativos en la escuela y la restricción de la publicidad de alimentos poco saludables, entre otras. CONCLUSIONES: Es necesario diseñar políticas que promuevan el consumo

Analysis of a voluntary initiative to reduce sodium in processed and ultra-processed food products in Argentina: the views of public and private sector representatives / Análisis de una iniciativa voluntaria para reducir el sodio en productos procesados y ultra-procesados en Argentina: perspectivas de los representantes del sector público y privado / Análise de uma iniciativa voluntária para reduzir o teor de sódio em produtos alimentícios processados e ultra-processados na Argentina: as perspectivas de representantes dos setores público e privado

Abstract: The Less Salt, More Life program was the first voluntary salt reduction initiative in Argentina. This article analyzes the perspectives of the stakeholders involved in this voluntary agreement between the Ministry of Health and the food industry to gradually reduce sodium content in processed foods. This exploratory case study used a qualitative approach including 29 in-depth interviews with stakeholders from the public and private sectors and identified the role of the different stakeholders and their perceptions regarding the challenges encountered in the policy process that contribute to the debate on public-private partnerships in health policies. The article also discusses the initiative's main challenges and controversies.

El programa Menos Sal, Más Vida fue la primera iniciativa voluntaria para la reducción de la sal en Argentina. Este artículo analiza las perspectivas de los representantes del sector público y privado involucrados en este acuerdo voluntario, entre el Ministerio de Salud y la industria alimentaria, para reducir gradualmente el contenido de sodio en las comidas procesadas. Este estudio de caso se basó en una aproximación cualitativa, incluyendo 29 entrevistas en profundidad, con las partes interesadas del sector público y privado e identificó el papel de los mismos y sus percepciones respecto a los desafíos enfrentados durante el proceso, con el fin de contribuir al debate de las colaboraciones público-privadas en políticas de salud. El artículo también discute los principales desafíos y controversias.

O programa Menos Sal, Mais Vida foi a primeira iniciativa voluntária para reduzir o teor de sal em produtos alimentícios na Argentina. O artigo analisa as perspectivas dos atores envolvidos nesse acordo voluntário entre o Ministério da Saúde e a indústria alimentícia para reduzir gradualmente o teor de sódio nos alimentos processados. O estudo de caso exploratório utilizou uma abordagem qualitativa com 29 entrevistas em profundidade com representantes dos setores público e privado, e identificou o papel dos diversos atores e suas percepções quanto aos desafios enfrentados no processo político, contribuindo para o debate sobre parcerias público-privadas em políticas de saúde. O artigo também discute os principais desafios e controvérsias dessa iniciativa.