A comparative assessment of two different front-of-package nutrition label designs: A randomized experiment in Brazil.

This study compares the effectiveness of different front-of-package label designs in a Brazilian sample (n = 1384). Eligible adults were randomized to one of two study arms and viewed images of snacks with either a triangular warning label (TL) or a rectangular 'high in' label with a magnifying glass (ML). They responded to a series of questions that captured label usefulness, understanding, and purchase intentions. Compared to participants in the ML arm, those in the TL arm agreed that the TL communicated important information [Mean (SD) - 5.47 (0.07) vs 4.49 (0.08), p-value <0.001], was a useful tool [Mean (SD) - 6.12 (0.06) vs 5.75 (0.07), p-value <0.001], and was easier to understand as measured subjectively [Mean (SD) - 4.96 (0.07) vs 4.44 (0.08), p-value <0.001]. However, both the TL and the ML performed similarly in communicating nutrient information as measured by the objective understanding of nutrient content [57.09% vs 54.65%, p-value 0.259]. The ML performed marginally better at improving purchase intentions [Mean (SD) - 2.57 (0.07) vs 2.79 (0.08), p-value <0.049]. The current study adds to the growing evidence base on the pathways through which FoP labels, particularly 'high in' labels, might influence consumer perceptions and behavior. It is also one of the first studies to provide evidence on the utility of the ML design for Brazil.

Prevalence of Low-Calorie Sweeteners and Related Front-of-Package Claims in the Brazilian Packaged Food Supply.

BACKGROUND: Low-calorie sweeteners (LCSs) are increasingly being used worldwide, including in foods and beverages commonly consumed by children. OBJECTIVE: To examine the prevalence of LCSs in packaged foods and beverages sold in Brazil, whether LCSs are added to products with advertising directed to children, and whether foods and beverages with LCSs include front-of-package (FoP) LCS-related health and nutrition claims. DESIGN: Cross-sectional study. SETTING: A sample (n = 11,434) of packaged foods and beverages sold by the top 5 largest Brazilian food retailers was examined to identify LCSs and added sugars, and a subsample (n = 3491) was examined to determine the presence of advertising directed to children and FoP LCS-related claims in foods and beverages with LCSs. MAIN OUTCOME AND MEASURES: The prevalence of foods and beverages with different types of LCSs in the Brazilian food supply, among ultra-processed foods and beverages and among foods and beverages with added sugars, were measured. Foods and beverages with advertising directed to children were checked to see if these products had LCSs and how many products with LCSs had FoP labels with LCS-related claims. STATISTICAL ANALYSES: Mean and 95% CIs were used to determine the overall prevalence of foods and beverages with LCSs and in the different assessed stratifications. RESULTS: The prevalence of LCSs was 9.3% (95% CI 8.8-9.9) in Brazilian packaged foods and beverages, 14.6% (95% CI 13.8-15.4) in ultra-processed products alone, and 5.7% (95% CI 4.2-7.7) in foods and beverages with advertising directed to children. About 83% of food and beverage with LCSs were also sweetened with added sugars. LCSs were most frequently added to nonalcoholic sweetened beverages, breakfast cereals, and granola bars. Forty percent of foods and beverages with LCS did not present any FoP LCS-related claim. CONCLUSION: This study shows that LCSs are present in 15% of ultra-processed foods and beverages in Brazil, largely used in combination with added sugars, and are found in foods and beverages with advertising directed to children. Clearer FoP information regarding the presence of LCSs, in particular in products with advertising directed to children, can help consumers make more informed choices regarding LCS consumption.