Is this advertisement designed to appeal to you? Adolescents' views about Instagram advertisements promoting ultra-processed products.

OBJECTIVE: Examine the key elements that characterise social media advertisements targeted at adolescents by asking adolescents which features of Instagram ads promoting ultra-processed products make them designed to appeal to adolescents. DESIGN: Instagram ads promoting ultra-processed products and brands were selected from a database in which ads had been classified regarding whether they were primarily targeted at adolescents from an adult perspective. Adolescents completed a sorting task in small groups and were requested to reach a consensus through discussions and sticky notes regarding whether sixty ads were designed to appeal to them. The sorting task was analysed using content analysis based on inductive coding. SETTING: One private secondary school and two after-school clubs. PARTICIPANTS: Convenience sample of 105 Uruguayan adolescents aged 11-17 years. RESULTS: Ten categories were identified regarding the reasons for sorting ads as (not) designed to appeal to adolescents: product type, graphic design, explicit references to age groups, language, activities or themes, memes, celebrities, characters, promotions and novelty. Product type emerged as a key element, with adolescents perceiving ads as designed to appeal to them simply because they promoted specific products. CONCLUSIONS: This research contributes to the validation of criteria defined in previous studies and can be used for the development of tools to monitor the prevalence and power of adolescent-targeted digital marketing. However, the importance attributed to type of product suggests that regulations should not exclusively focus on exposure to digital marketing specifically targeted at adolescents but also on exposure to marketing in general.

Effects of front-of-package nutrition labelling systems on objective understanding and purchase intention in Panama: results from a multi-arm parallel-group randomised controlled trial.

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.

Coping strategies of food insecure households with children and adolescents in Uruguay, a high-income Latin American country: A qualitative study through the lens of Bourdieu's theories of capitals and practice.

Food insecurity has been associated with negative short, medium, and long-term health consequences, which are more detrimental for children and adolescents. These effects may depend on the coping strategies developed to deal with food shortages. The present research aimed at exploring coping strategies in food insecure households with children and adolescents in Uruguay, incorporating sociological theoretical insights from Bourdieu. A qualitative approach based on individual semi-structured interviews was used. A total of 40 interviews were conducted with adults who had parental responsibilities of children and adolescents and who received different types of food assistance, between July and December 2022, in four cities. Results showed that adults tend to develop a wide range of coping strategies aimed at: reducing food expenditure, increasing the availability of money for purchasing food, increasing food availability and/or rationing the food available in the household. Some of the strategies were implemented regardless of the severity of food insecurity, whereas others were characteristic of the moderate and severe levels of the construct. Evidence to support the mediation effect of coping strategies on health outcomes was found. Discourses suggested that lower accumulation of economic and cultural capital may be aligned with the adoption of less socially accepted mechanisms to access to food. Expressions of a specific habitus aimed at securing food were identified among participants with more deprivations. Taken together, the findings suggest that coping strategies may not be a universal or invariant sequence according to the severity of food insecurity and stress the importance of considering households' resources and local context for the development of strategies to improve access to food.

Health-related cues on the packages of processed and ultra-processed products: prevalence and policy implications.

The information included on food packages has a crucial role in influencing consumer product associations and purchase decisions. In particular, visual and textual cues on processed and ultra-processed products can convey health-related associations that influence consumer healthiness perception and purchase decisions. In this context, the present work aimed to explore the use of health-related cues on the packages of processed and ultra-processed products sold in Uruguay to provide insights for policy making. A total of 3813 products from thirty-four different food categories found in four of the most important supermarket chains in Uruguay were surveyed. The textual and visual information included on the packages as well as the nutritional composition of the products were analysed. Results showed that 67 % of the products included at least one health-related cue. Pictures of culinary ingredients, natural and minimally processed foods were the most frequent health-related cue, followed by references to naturalness and claims related to critical nutrients. The prevalence of health-related cues largely differed across product categories, ranging from 100 to 17 %. The relationship between the presence of health-related cues on the packages and the excessive content of nutrients associated with non-communicable diseases was assessed using a gradient boosting model, which showed limited predictive ability. This suggests that the inclusion of health-related cues on food packages was not strongly related to the nutritional composition of products and therefore cannot be regarded as a healthiness indicator. These results stress the need to develop stricter labelling regulations to protect consumers from misleading information.

Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system.

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Dimensions of food-related wellbeing and their relative importance among New Zealand consumers: A quasi-replication and extension approach.

Research into perceived wellbeing (WB) can improve understanding of consumer food choices and support development of strategies to promote healthier and more sustainable eating habits. In this research, using online studies, food-related WB was explored among New Zealand consumers. In a "quasi-replication" of Jaeger, Vidal, Chheang, and Ares (2022), Study 1 uncovered word associations to different WB-related terms ('Sense of wellbeing,' 'Lack of wellbeing,' 'Feeling good,' 'Feeling bad/unhappy,' 'Satisfied with life,' and 'Dissatisfied with life') with 912 participants in a between-subjects design. The results confirmed the multidimensional nature of WB, and the need to consider positive and negative aspects of food-related WB, as well as differences linked to physical, emotional, and spiritual WB. Drawing on Study 1, 13 characteristics of food-related WB were identified, and in Study 2 their importance for feeling a 'Sense of wellbeing' and 'Satisfied with life' was determined with 1206 participants using a between-subjects design. In a further extension, Study 2 also adopted a product-specific perspective and explored the associations of, and importance, for 16 different foods and beverages to food-related WB. Based on Best-Worst Scaling and penalty/lift analysis, the four most important characteristics overall were 'Is good quality,' 'Is healthy,' 'Is fresh,' and 'Is tasty,' with the nuance that healthiness contributed most to feeling a 'Sense of wellbeing' while good quality contributed most to feeling 'Satisfied with life.' The associations to individual foods and beverages underscored that food-related WB is a complex construct arising from an overall evaluation of the different effects of foods (including physical health, social and spiritual aspects of food consumption) and their short-term effects on food-related behaviour. Contextual and individual differences in perceptions of WB in relation to food deserve further investigation.

Use of nutritional warning labels at the point of purchase: An exploratory study using self-reported measures and eye-tracking.

Nutritional warning labels are gaining relevance in the region of the Americas as a policy tool to reduce information asymmetry and encourage healthier food choices. However, empirical evidence about consumer experiences with warning labels after implementation is still scarce. In this context, the aim of the present work was to explore the use of nutritional warning labels after policy implementation in Uruguay, using a combination of eye-tracking and self-reported data. The study was conducted in three supermarkets, in two regional capitals, 19 months after the entry into force of the policy. A total of 224 participants were intercepted while entering the facilities of the supermarket and asked to wear a mobile eye-tracker while making their food purchases. Then, they were asked a series of questions about their awareness and use of warning labels. Although participants reported high awareness and understanding of the labels, active search and use at the point of purchase was low. Only 6% of the consumers declared having actively searched for the warning labels and 7% fixated their gaze on the labels. The majority of the participants (72%) who declared having seen the warnings on a product, purchased it anyway. However, 56% declared having changed their food choice decisions as a consequence of the implementation of the policy. Participants' accounts about reasons for (not) taking into account the warning labels provide relevant insights for the development of strategies to encourage citizens to increase policy effectiveness and encourage healthier food choices.

The content of Instagram posts featuring ultra-processed products through the lens of the heuristic-systematic model.

Digital marketing has seen a rapid rise in the last decade as a consequence of the increased popularity of social media. However, few studies so far have analyzed the prevalence and persuasive power of digital marketing of ultra-processed products. The present study aimed at: (i) analyzing the content of Instagram posts of ultra-processed products through the lens of the heuristic-systematic model, and (ii) evaluating the influence of the content of the posts on user interactions. A search for Instagram accounts of ultra-processed products was performed using a master list of products commercialized in the two most popular online supermarkets in Uruguay. For each of the identified Instagram accounts, all the content posted in a 6-month period was recorded (August 15th, 2020 to February 15th, 2021). The posts were analyzed using content analysis based on inductive coding, and gradient boosting models (GBMs) were used to address the second study objective. A total of 2178 Instagram posts promoting specific ultra-processed products or brands were identified. The posts included a diverse set of cues to trigger both systematic and heuristic processing. References to the pleasure derived from product consumption as well as health-related cues were most prevalent. The GBM showed that references to contests and raffles and invitations to interact encouraged users to engage with the posts through posting comments. Taken together, results stress the need to implement comprehensive regulatory approaches to reduce exposure to and the power of digital marketing of ultra-processed products given the harmful health-related consequences associated with excessive consumption of such products.

Qualitative exploration of the reasons for not using nutritional warnings after policy implementation in Uruguay.

Nutritional warnings have gained popularity, particularly in the region of the Americas, to facilitate the identification of products with excessive content of nutrients associated with non-communicable diseases and encourage healthier food choices. Although warnings have been shown to be effective, an in-depth understanding of the reasons why some consumers do not use them is still lacking. The aim of the present work was to explore self-reported use of nutritional warnings and to identify the reasons for not considering nutritional warnings for making food purchase decisions after policy implementation in Uruguay. A non-probabilistic sample of 858 Uruguayan participants was recruited using an advertisement on Facebook and Instagram. Through an online survey, self-reported use of nutritional warnings was asked using a closed-open ended questions. Participants who reported not considering warnings to make their purchase decisions were asked to explain the reasons why using an open-ended question. Responses were analysed using deductive coding, based on the Behavioural Drivers Model. Thirty seven percent of the participants stated that the warnings had not influenced their purchase decisions. Motives for not being influenced by the warnings were related to lack of interest, attitudes, lack of perceived self-efficacy, cognitive biases and limited rationality when making purchase decisions. In addition, structural barriers, such as availability, cost and trust in the food industry also emerged from participants' responses. Strategies to encourage the use of warnings should include communication campaigns and policies to address structural barriers related to the perceived availability and affordability of healthy foods.

Age, time orientation and risk perception are major determinants of discretionary salt usage.

The present work explored the relationship between discretionary salt usage and personal characteristics, using boosted regression trees (BRT). Specifically, the focus was on how socio-demographic characteristics and personality traits linked to risk perception and time orientation impact on discretionary salt consumption patterns. For this purpose, an online cross-sectional survey with a convenience sample of 498 Uruguayan participants was carried out. Participants completed the consideration of future consequences (CFC) scale adapted for eating behaviour, a short survey about discretionary salt consumption patterns and indicated their degree of agreement with statements measuring perceived risk of sodium consumption. Finally, socio-demographic data were collected. BRT were applied to build predictive models that related discretionary salt usage to socio-demographic characteristics, the two factors of the CFC-Food scale (consideration of the future and consideration of the immediate consequences of eating behaviour), and the two factors of the perceived risk of sodium consumption scale (severity of perceived risks and risk compensation). Age, time orientation and perceived risk were the most relevant explanatory variables for discretionary salt usage. Older people had a lower likelihood of adding salt to food, either at home or when eating out. In addition, individuals who tend to be present rather than future oriented, as well as those with low perception of risk severity and susceptibility were more likely to add salt to foods. Results from the present work suggest that communication campaigns to reduce discretionary salt intake should mainly focus on stressing the short-term health benefits of reducing sodium intake and raising perceived susceptibility.

Consumer conceptualisations of food-related wellbeing: An exploration of wellbeing-related terms in four industrialised countries.

Perceived (or subjective) wellbeing is regarded as key to understanding consumer food choices and the development of strategies to promote desirable eating habits. Yet, in-depth understanding of the specific factors that contribute to people's perceived wellbeing across cultures is lacking. These factors motivated the present research that used word associations to conduct an exploratory analysis of consumer conceptualisations of food-related wellbeing (WB). Adults (n = 4945) living in the United Kingdom, Australia, Singapore or Germany, and speaking respectively, English or German, took part in the study. Health, pleasure, food quality, positive emotions and social aspects of food consumption were the main associations with food-related wellbeing. Absence hereof was associated with unhealthiness, disgust, negative emotions and poor mental health. The differences in these main associations emphasised the importance of exploring wellbeing, as well as lack hereof. Not doing so leads to an incomplete understanding of this multidimensional construct. The research was conducted with four terms related to wellbeing (each in their positive and negative versions): 'sense of wellbeing' and 'lack of wellbeing', 'feeling good' and 'feeling bad/unhappy', 'satisfied with life' and 'dissatisfied with life' and 'fulfilled in life' and 'unfulfilled in life'. Because these different terms gave rise to different wellbeing associations, researchers in this area must choose their empirical approach with care. The terms 'sense of wellbeing' and 'feeling good' tended to more frequently give rise to health-related associations. Conversely, 'satisfied with life' and 'fulfilled in life' tended to more frequently give rise to positive spiritual and emotional associations of food-related wellbeing. The main conceptualisations of food-related wellbeing were cross-culturally similar, but extension of the present research to other Asian countries was recommended based on several differences between Singaporean participants and those from other countries. In ethnically diverse countries like Singapore, further within-country investigations of different cultures will also have merit.

'Even if you don't pay attention to it, you know it's there': A qualitative exploration of adolescents' experiences with digital food marketing.

Adolescents are particularly vulnerable to digital food marketing. However, research on adolescents' recall, awareness, and opinions of this type of marketing is still scarce. Accordingly, the present study aimed to conduct an in-depth examination of adolescents' experiences with digital food marketing. A convenience sample of 209 adolescents was recruited at two private educational institutions and a public health facility in Montevideo, the capital city of Uruguay. Semi-structured group interviews were conducted, recorded in audio and transcribed. The transcripts were analyzed using content analysis based on a deductive-inductive approach. Results showed that participants were highly exposed to digital food marketing, as they all remembered having seen advertisements, with those of fast-food restaurants and food-ordering apps being the most frequently mentioned. According to the adolescents' accounts, images, colors, music, oversized portions, product novelty, price promotions and celebrities were the most memorable aspects of food advertisements. Participants recognized the effect of advertisements on product awareness and wanting, and, to a lesser extent, on actual purchase and consumption behavior. Factors that were thought to mediate the impact of digital marketing on food choice were also identified. In the final part of the interviews, participants proposed strategies to reduce the effect of digital marketing on their food choices, which included both regulatory approaches to reduce exposure to digital marketing of unhealthy foods and behavior change communication. Together, the current findings provide insights for the development of multifaceted strategies to reduce the effects of digital food marketing on the eating habits of adolescents.

Fecal descriptor in honey: indole from a floral source as an explanation.

BACKGROUND: Animal odor, is one of the most common aroma defects described in the honey odor aroma wheel. It comprises two secondary descriptors: 'fecal' and 'cowshed'. However, the compounds responsible for these honey defects have not been fully identified. In this context, the aim of this work was to identify the compounds responsible for the aromatic defect 'fecal' in Uruguayan honeys by means of gas chromatography coupled to olfactometry (GC-O). RESULTS: Samples of honey described by beekeepers as having fecal aroma were analyzed by GC-O and gas chromatography coupled to mass spectrometry (GC-MS). Through GC-O, it was possible to establish the region of the chromatogram corresponding to the fecal descriptor, while the GC-MS analysis allowed to identify indole as the compound responsible for the fecal descriptor. The content of indole in the analyzed samples ranged between 132 and 414 µg kg-1 . The melissopalynological analysis indicated the presence of Scutia buxifolia ('quebracho' or 'coronilla') pollen in all samples studied. The volatile profile of Scutia buxifolia flowers was evaluated during the full day, enabling the identification of indole as one of its components. The detection threshold value for indole in honey was experimentally determined as 64 µg kg-1 of honey, a value lower than the concentration found in the evaluated samples. CONCLUSION: Results from the study allowed the identification of indole as the compound responsible for the 'fecal' aroma defect in Scutia buxifolia honeys. © 2022 Society of Chemical Industry.

COVID-washing of ultra-processed products: the content of digital marketing on Facebook during the COVID-19 pandemic in Uruguay.

OBJECTIVE: To explore the use of references to the COVID-19 pandemic as part of the marketing strategies used on Facebook to promote ultra-processed products. DESIGN: A search for Facebook accounts of ultra-processed products was performed using a master list of products commercialised in two online supermarkets in Uruguay. For each of the identified Facebook accounts, all the content posted from the confirmation of the first cases of COVID-19 in Uruguay, on 14 March 2020, until 1 July 2020 was recorded. Posts including mentions to COVID-19, social distancing measures or their consequences were identified and analysed using content analysis. SETTING: Uruguay, Latin America. RESULTS: A total of 135 Facebook accounts were identified, which generated a total of 1749 posts related to ultra-processed products, from which 35 % included references to COVID-19. The majority of the posts included references to prevention measures. Approximately one-third of the posts included proposals of activities to do at home, most of which were linked to a healthy lifestyle. Tips for coping with quarantine and descriptions of the charitable work undertaken by brands were also identified. CONCLUSIONS: Results from the present work provide evidence that industries of ultra-processed products have taken advantage of the COVID-19 pandemic to promote their products, create positive associations with the brands and improve their image as part of their digital marketing strategies.

Marketing of commercial foods for infant and young children in Uruguay: sugary products, health cues on packages and fun social products on Facebook.

OBJECTIVE: To analyse the content of the marketing of commercial foods for infants and young children on packages and social media. DESIGN: Commercial foods targeted at children, regarded as potential breast-milk substitutes according to the Uruguayan breast-feeding standard, were considered: dairy products; teas, juices and bottled waters; glucose solutions; cereals and mixtures of fruits and vegetables. All the products sold at forty-four retail outlets were purchased. A Facebook search was performed to identify accounts of these products. For each account, all the content posted by the brands between July 2017 and July 2019 was recorded. The visual and textual information included in the packages and Facebook posts was analysed using content analysis. Products were classified using the nutrient profile model of the Pan American Health Organization. SETTING: Montevideo, Uruguay. RESULTS: Seventy-six unique commercial foods targeted at infants and young children were identified, 96 % of which were excessive in sugar. Packages frequently included textual and visual elements to convey health-related associations, including images of fruits and vegetables, nutrient content claims and endorsement logos. Ten Facebook accounts were identified, which generated 302 posts. Parents and caregivers were the main target audience of the posts, which mainly included content related to fun and social aspects of food consumption. Additionally, the posts frequently conveyed the idea that products would contribute to children's growth and development. CONCLUSIONS: Results suggest the need to implement comprehensive regulations on the marketing of commercial foods targeted at children, regarded as potential breast-milk substitutes according to the Uruguayan breast-feeding standard.

Listening to the voices of adolescents for the design of strategies to promote healthy eating: an exploratory study in a Latin American country.

OBJECTIVE: To explore adolescents' views about the foods they consume and to identify their ideas about strategies to encourage healthier eating habits. DESIGN: Individual questionnaires based on open-ended questions and group discussions (6-8 participants) were used to address the objectives. Data were analysed using content analysis based on deductive-inductive coding. SETTING: Montevideo and its metropolitan area (Uruguay, Latin America). PARTICIPANTS: Totally, 102 adolescents (aged between 11 and 15 years, 52 % female) recruited at two educational institutions. RESULTS: Adolescents reported frequently consuming ultra-processed products and fast food although they were perceived as bad for their health, whereas they reported an infrequent consumption of fruits and vegetables. Multifaceted strategies to promote healthy eating habits emerged from adolescents' accounts, including public awareness campaigns, nutrition education programmes, nutrition label standards and regulations, and changes in food availability and affordability. CONCLUSIONS: Results from the present work suggest that co-creation with adolescents may be an effective way to inform the development of strategies to promote healthier eating habits. The strategies suggested by adolescents were mainly focused on behaviour change communication, who emphasised the importance of social media and the involvement of celebrities and influencers. The need for educational and communication strategies to raise awareness of the social and environmental drivers of eating patterns among adolescents was identified.

Analysis of the policy process for the implementation of nutritional warning labels in Uruguay.

OBJECTIVE: To analyse the process for the development and implementation of mandatory nutritional warning labels in Uruguay, in order to inform future nutrition policy making and strategic engagement by public health actors. DESIGN: The study design drew on policy analysis methodology and case study research methodology. Two main sources of information were selected and analysed for the current study: eighteen official documents from the Uruguayan government and 259 news reports, published between June 2017 and February 2021. SETTING: Uruguay, Latin America. RESULTS: The Uruguayan Ministry of Public Health led a cross-sectoral working group composed of diverse governmental stakeholders, international organisations and the academia to develop the front-of-package nutrition labelling policy. A robust evidence-based approach, based on rigorous scientific knowledge generated in the country, was followed. However, changes in the systemic governing coalition as a consequence of a change in government led to a delay in the entry into force and changes in the regulation. The food industry was the main opponent to the warning label regulation and relied on widely reported corporate political activities to influence the policy process: information and messaging, legal action, policy substitution, opposition, fragmentation and destabilisation. CONCLUSIONS: Key insights to inform future policy action in Uruguay and other jurisdictions were derived. Results stressed the importance of an evidence-based approach for policy design and the early engagement with actors from all the political system.

Do nutritional warnings encourage healthier choices on food ordering websites? An exploratory experimental study in Uruguay.

OBJECTIVE: To evaluate if the inclusion of nutritional warnings in food ordering websites can discourage consumers from purchasing foods with excessive content of nutrients associated with non-communicable diseases (NCD). DESIGN: Participants were randomly assigned to one of the two experimental conditions: control (n 225) or nutritional warnings (n 222). Nutritional warnings corresponded to separate black octagonal signs containing the word 'Excess' followed by the corresponding nutrient: total fat, saturated fat, sugars and sodium. Participants were asked to purchase a lunch for themselves using a simulated food ordering website. SETTING: Online study in Uruguay. PARTICIPANTS: Convenience sample of 447 Uruguayan participants, recruited using social media. RESULTS: In the control condition, 76 % of the participants selected a dish or a beverage with excessive content of at least one nutrient in the simulated food ordering website. When nutritional warnings were included, this percentage significantly decreased to 62 % (P = 0·002). In addition, nutritional warnings caused a significant reduction in the percentage of participants who selected dishes with excessive content of total fat: 50 % v. 62 % (P = 0·012). CONCLUSIONS: Results from the present work provide preliminary evidence that the inclusion of nutritional warnings in food ordering websites could discourage consumers from selecting dishes and beverages with excessive content of nutrients associated with NCD.

Are the recommendations of paediatricians about complementary feeding aligned with current guidelines in Uruguay?

OBJECTIVE: To explore Uruguayan paediatricians' personal recommendations about complementary feeding and to assess if they are aligned with current guidelines and scientific evidence. DESIGN: A questionnaire composed of open-ended questions was used to explore foods recommended to start complementary feeding, foods regarded as the most important during the first meals, recommendations for delayed introduction of foods and foods that should be avoided. Reasons underlying the recommendations were also explored. SETTING: Montevideo, the capital city of Uruguay (Latin America). PARTICIPANTS: A total of 212 paediatricians were recruited during a National Pediatrics Conference, organised by the Uruguayan Society of Pediatrics. RESULTS: The recommendations about complementary feeding provided by paediatricians to parents and caregivers in Uruguay seemed not to be fully aligned with the guidelines provided by the Ministry of Health. Paediatricians recommend a rigid food introduction sequence, characterised by the early introduction of soft pureed vegetables and fruits, followed by meat and the delayed introduction of allergenic foods. Food diversity and the concept of ultra-processed were not frequently identified in the responses. CONCLUSIONS: Results stress the importance of developing educational and communication approaches targeted at paediatricians to contribute to the uptake of updated recommendations regarding complementary feeding.

Immediate effects of the implementation of nutritional warnings in Uruguay: awareness, self-reported use and increased understanding.

OBJECTIVE: To assess the effects of nutritional warnings during the first month after the date of full compliance by the food industry in Uruguay in terms of citizen awareness, self-reported use and ability to understand nutritional information. DESIGN: The present work encompassed two online studies, conducted before (Study 1) and during the first month after the date of full compliance by the food industry (Study 2). An after-only design was used to assess awareness of the policy, exposure to nutritional warnings on food packages and self-reported use of warnings for making purchase decisions in Study 2. An after-only with control group experimental design was used to assess the effect of nutritional warnings on understanding of nutrition information in Studies 1 and 2. SETTING: Uruguay, one of the Latin American countries, that has recently implemented nutritional warnings. PARTICIPANTS: A non-probabilistic sample of 1772 participants was recruited using Facebook advertisements targeted at Uruguayan adult users. RESULTS: High awareness and self-reported use of nutritional warnings during the first month after the date of full compliance in Uruguay were observed. In addition, the before and after comparison showed that the implementation of warnings increased citizens' ability to use nutritional information to compare products and to identify products with excessive content of sugar, fat, saturated fat and sodium. CONCLUSIONS: The current study confirms results from experimental studies and provides additional evidence to support the implementation of nutritional warnings as one of the public policies that can contribute to tackle obesity and non-communicable diseases.