Do Brazilian consumers intend to use food labels to make healthy food choices? An assessment before the front-of-package labelling policy.

Front-of-package labelling is a measure that can facilitate consumption of healthier foods. This study examined the predictors of consumers' intentions to use food labelling to make healthy food choices and prevent non-communicable diseases before the implementation of the front-of-package labelling policy in Brazil. An extended theory of planned behaviour incorporating knowledge and food literacy served as the theoretical foundation. First, experts (n = 6) and the target population (n = 30) validated the questionnaire, and the validation data were analysed using content validity coefficients (CVC). An online questionnaire was administered to 783 participants, and data were collected between May and October 2022. Partial least squares structural equation modelling (PLS-SEM) was used to test the prediction hypothesis. The questionnaire showed adequate content validity, with all indicators of CVC ≥ 0.75. In the PLS-SEM attitudes (p < 0.001), subjective norms (p < 0.001), knowledge (p < 0.001), and food literacy (p < 0.001) positively predicted the intention to use food labels to make healthy food choices, confirming the main hypothesis. Also, Food literacy and knowledge predicted all constructs of the theory of planned behaviour (p < 0.001). The results highlight the importance of providing nutritional knowledge and food literacy, developing nutritional skills and abilities to encourage consumers to make healthy food choices, and to strengthen other policies such as front-of-package labelling.

Sweetener Purchases in Chile before and after Implementing a Policy for Food Labeling, Marketing, and Sales in Schools.

Background: Chile's landmark food labeling and advertising policy led to major reductions in sugar purchases. However, it is unclear whether this led to increases in the purchases of nonnutritive sweeteners (NNS). Objectives: The objective of this study was to assess the changes in NNS and caloric-sweetened (CS) products purchased after the law's first phase. Methods: Longitudinal data on food and beverage purchases from 2,381 households collected from January 1, 2015 to December 31, 2017, were linked to nutritional information and categorized into added sweetener groups (unsweetened, NNS-only, CS-only, or NNS with CS). Logistic random-effects models and fixed-effects models were used to compare the percentage of households purchasing products and the mean volume purchased by sweetener category to a counterfactual based on pre-regulation trends. Results: Compared with the counterfactual, the percentage of households purchasing any NNS beverages (NNS-only or NNS with CS) increased by 4.2 percentage points (pp) (95% CI: 2.8, 5.7; P < 0.01). This increase was driven by households purchasing NNS-only beverages (12.1 pp, 95% CI: 10.0, 14.2; P < 0.01). The purchased volume of beverages with any NNS increased by 25.4 mL/person/d (95% CI: 20.1, 30.7; P < 0.01) or 26.5%. Relative to the counterfactual, there were declines of -5.9 pp in households purchasing CS-only beverages (95% CI: -7.0, -4.7; P < 0.01). Regarding the types of sweeteners purchased, we found significant increases in the amounts of sucralose, aspartame, acesulfame K, and steviol glycosides purchased from beverages. Among foods, differences were minimal. Conclusions: The first phase of Chile's law was associated with an increase in the purchases of beverages containing NNS and decreases in beverages containing CS, but virtually no changes in foods.

Did the sweetness of beverages change with the Chilean Food Labeling and Marketing Law? A before and after study.

There has been a rapid proliferation of policies around the globe to reduce sugar consumption, yet there is little understanding as to whether these policies have led to changes in the overall sweetness of products, which is essential for understanding long-term effects on food preferences and intake. For example, the implementation of Chile's Law on Food Labeling and Advertising led to decreases in the sugar content of non-alcoholic packaged beverages and increases in non-nutritive sweeteners (NNS) use in these beverages. Given that NNS have greater sweetness intensity than sugars, it is unclear what was the net effect of these changes on the sweetness of purchased beverages. Using longitudinal household purchase data (n > 2,000 households), we measured the changes in the sweetness of beverage purchases after implementing the first phase of the Chilean law and examine if there were differences by key family sociodemographic variables. We developed three sweetness indices: (1) NNS sweetness, including the sweetness of the six NNS most consumed by Chileans; (2) total sugars sweetness, including the sweetness from total sugars; and (3) total sweetness, combining the sweetness from NNS and sugars. Using fixed-effects models, we compared the observed post-law purchases to a counterfactual based on pre-law trends. We found that NNS sweetness increased relative to the counterfactual, while total sugars sweetness decreased after the law. However, the absolute changes in NNS sweetness were almost entirely offset by the decreases in total sugar sweetness, leading to no change in the total sweetness of beverage purchases. Additionally, there were no differences in the sweetness changes by family sociodemographics. Our findings indicate that Chilean consumers are exposed to similar sweetness levels in their beverages after the law. Future research should explore whether sweetness also remained consistent in dietary intake.

The WHO South-East Asia Region Nutrient Profile Model Is Quite Appropriate for India: An Exploration of 31,516 Food Products.

The rapid rise in prevalence of overweight/obesity, as well as high prevalence of type 2 diabetes and other nutrition-related noncommunicable diseases, has led the Food Safety and Standards Authority of India (FSSAI) to propose a front-of-package labeling (FOPL) regulation. An effective FOPL system applies a nutrient profile model that identifies foods high in sugar, sodium, and saturated fat that would receive a warning label for consumers to effectively discern between more and less healthy foods. Previous Nutrition Alchemy data collected by the food industry (n = 1306 products) estimated that approximately 96% of foods in India would have at least one warning label based on the FSSAI proposed FOPL. This near universal coverage of warning labels may be inaccurate and misleading. To address this, the current study compared two nutrient profile models, the WHO South-East Asia Region Organization (SEARO) and the Chilean Warning Octagon (CWO) Phase 3, applied to food products available in the Indian market from 2015-2020, collected through Mintel Global New Products Database (n = 10,501 products). Results suggest that 68% of foods and beverages would have at least one ' high-in' level warning label. This study highlights the need to include a more comprehensive sample of food products for assessing the value of warning labels.

Changes in Nutrient Declaration after the Food Labeling and Advertising Law in Chile: A Longitudinal Approach.

Chile has implemented several strategies to decrease the burden of obesity and chronic diseases. The Food Labeling and Advertising Law (Law 20.606) requires a front-of-package "high in" warning label when energy and nutrients of concern (ENC) (total sugar, saturated fats, sodium) exceed established limits. This study aims to evaluate the impact of Law 20.606 on the ENC declaration of packaged foods in Chile, before and after the law implementation. We analyzed food nutritional labeling declarations from 70% of the most consumed packaged foods in Chile. Data collection was conducted in 2013 and 2019 in Santiago. Pictures from all sides of the package were taken from 476 products, classified into 16 food groups. All food groups had changes in the ENC declaration during the study period. Total sugar content showed the highest reduction (-15.0%; p = 0.001). Dairy, confitures and similar and sugary beverages had the greatest reduction in energy and total sugar content (p < 0.01). Energy, total sugar and sodium front of package "high in" simulation was significantly reduced in dairy, sugary beverages, flour-based foods, confitures and similar, fish and seafoods, fats and oils, spices, condiments and sauces and sugars (p < 0.05). We observed that companies reformulated products to adapt to the new regulation.

Choosing a front-of-package warning label for Brazil: A randomized, controlled comparison of three different label designs.

INTRODUCTION: Warning labels (WLs) are the newest paradigm of nutrient-based, front-of-package labels (FOP) that have been consistently shown to be more effective at informing consumer purchases than other FOP labels. Their effectiveness may be attributed to their design and the consistency in the information they communicate. The present study assessed designs effects of WLs in improving understanding and perceptions among 2419 Brazilian adults. METHODS: Participants were randomly assigned to one of four study arms in an online, randomized, controlled experiment: (1) the Triangular WL 'A lot of /Muito' (Muito); (2) Triangular WL 'High in/Alto em' (Alto); (3) the Chilean WL 'High in/Alto em' (Chile); and (4) a control condition (no WL). Participants responded to a series of questions, while viewing images of 9 products, that assessed their understanding of the nutrient content of the product, its healthfulness, and their intentions to purchase. All aggregate differences in responses between study arms were estimated using oneway-ANOVAs. RESULTS: WLs were superior to the list of ingredients and the nutrition facts panel in improving participant understanding and perceptions of the nutrient profile of products, particularly in helping identify nutrients in excess. Alto was significantly better than the control at identifying which of the two products contained an excess of nutrients and at improving consumer understanding of nutrient content across different indicators. Alto, followed by Muito, was also better at communicating that fewer WLs signified a healthier product. The Muito WL was significantly more visible to participants than the Chile WL. There were no differences between study arms in shifting consumer purchase intentions. CONCLUSIONS: In this study, WLs were an important addition to the current nutrition label. The triangular symbol, the white background and the signal word, 'High in/ Alto em' showed consistently better results than the signal word 'A lot of/ Muito' and the octagonal symbol. These design elements serve to make WLs more visible to consumers, capturing their attention and informing their food evaluations, and may have greater potential to influence appropriate for a Brazilian audience.

Nutrition Quality of Packaged Foods in Bogotá, Colombia: A Comparison of Two Nutrient Profile Models.

BACKGROUND: Front-of-package warning labels are an increasingly common policy and have been implemented to inform consumers of the nutritional quality of ultra-processed foods. This study examined the proportion of Colombian products that could be subjected to such regulations. METHODS: Two nutrition profile models were compared: the Pan American Health Organization (PAHO) model, and the nutrient profile established under the Chilean food labeling and advertising law (Chilean model). Products (n = 6708) exceeding nutrient criteria based on each model were identified as subject to regulation. RESULTS: A total of 80.2% (PAHO model) to 66.4% (Chilean model) of foods met the criteria for regulation. The categories with the highest proportion of regulated products were meats (97.3% PAHO model; 87.5% Chilean model), sweets (95.6% PAHO) and snacks (Chilean model). The category with the lowest proportions of regulated products were cereals (47.3% PAHO model) and miscellaneous foods and fish/seafood (39.0% and 39.5%, respectively, Chilean model). CONCLUSIONS: Under both the PAHO and Chilean nutrient profile models, the majority of packaged foods available in Bogotá would be eligible to receive front-of-package warning labels. These results suggest a warning label law could have a major impact on the Colombian food supply, especially in the context of the growing prevalence of diet-related chronic diseases in Colombia.

Evaluación de la comprensión objetiva de 5 modelos de etiquetado frontal de alimentos en consumidores argentinos: resultados de un estudio comparativo / Assessment of the objective understanding of 5 models of Front-of-Package labels in argentine consumers: results from a comparative study

La obesidad y las enfermedades no transmisibles (ENT), se hallan en aumento en Argentina. Mantener una alimentación poco saludable es considerado uno de los factores de riesgo más importante en el desarrollo de dichas enfermedades. Los etiquetados en el frente de un envase (ENFE) son una herramienta útil para orientar al consumidor acerca de la calidad nutricional de los productos y para realizar compras más saludables. La eficiencia de los ENFE depende de la facilidad con que la información es entendida correctamente. El objetivo de este estudio fue evaluar la comprensión objetiva de los consumidores argentinos con respecto a cinco ENFE [Sistema de clasificación de estrellas de salud (HSR), semáforos múltiples (MTL), Nutri-Score, ingesta de referencia (RI), Símbolos de Advertencias]. Durante el 2018 se reclutaron 1001 participantes argentinos a quienes, a través de una encuesta online se les pidió clasificar 3 productos de tres categorías de alimentos (pizza, bizcochuelos/budines y cereales de desayuno) de acuerdo a su calidad nutricional. Luego de esta actividad, se les asignó al azar, uno de los cinco ENFE y se les pidió que volvieran a clasificar los mismos alimentos, pero esta vez con el etiquetado en el envase. El cambio en la capacidad de clasificar correctamente los productos en las dos tareas fue evaluado utilizando una regresión logística ordinal. Para las tres categorías de alimentos, Nutri-Score mostró un mejor desempeño, seguido de MTL, HSR, Símbolos de Advertencias y RI. Nutri-Score surgió como el ENFE más eficiente para transmitir la información sobre la calidad nutricional de los alimentos para los consumidores argentinos(AU).

Obesity and non-communicable diseases (NCDs) are on the increase in Argentina. Maintaining an unhealthy diet is considered one of the most important risk factors in the development of these diseases. Front-of-package labels (FOPLs) are a useful tool to guide the consumer about the nutritional quality of the products as well as making healthier choices when buying. The efficiency of the FOPLs depends on the ease with which the information they provide is correctly understood. The objective of this study was to evaluate the objective understanding of Argentine consumers regarding five FOPLs [Health Star Rating System (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RI), Warning Symbols]. During 2018, 1001 Argentine participants were recruited and, through an online survey, they were asked to classify 3 products from three categories of food (pizza, sponge cake and breakfast cereals) according to their nutritional quality. After this activity, they were randomly assigned one of the five FOPLs and asked to re-classify the same foods, but this time with the labeling on the packaging. The change in the ability to correctly classify the products in the two tasks was evaluated using an ordinal logistic regression. For the three food categories, Nutri-Score showed a better performance, followed by MTL, HSR, Warning Symbols and RI. Nutri-Score emerged as the most efficient FOPL to transmit information on the nutritional quality of food for Argentine consumers(AU).

Are Front-of-Package Warning Labels More Effective at Communicating Nutrition Information than Traffic-Light Labels? A Randomized Controlled Experiment in a Brazilian Sample.

BACKGROUND: Brazil is currently debating the implementation of front-of-package labels. This study tested if Warning labels (WLs) improved consumer understanding, perceptions, and purchase intentions compared to Traffic-Light labels (TLLs) in 1607 Brazilian adults. METHODS: In this online, randomized controlled experiment participants saw images of 10 products and answered questions twice-once in a no-label, control condition and then again in a randomly assigned label condition. The relative differences in responses between WLs and TLLs between control and label conditions were estimated using one-way ANOVAs or Chi-square tests. RESULTS: Presenting WLs on products compared to TLLs helped participants: (i) improve their understanding of excess nutrient content (27.0% versus 8.2%, p < 0.001); (ii) improve their ability to identify the healthier product (24.6% versus 3.3%, p < 0.001); (iii) decrease perceptions of product healthfulness; and (iv) correctly identify healthier products (14.0% versus 6.9%, p < 0.001), relative to the control condition. With WLs, there was also an increase in the percentage of people: (v) expressing an intention to purchase the relatively healthier option (16.1% versus 9.8%, p < 0.001); and (vi) choosing not to buy either product (13.0% versus 2.9%, p < 0.001), relative to the control condition. The participants in the WL condition had significantly more favorable opinions of the labels compared to those in the TLL group. CONCLUSIONS: WLs would be more effective at improving consumer food choices.