Hypothetical impact of the Mexican front-of-pack labeling on intake of critical nutrients and energy.

BACKGROUND: Since 2020 in Mexico, front-of-pack warning labels (FOPWL) have been implemented in processed products. Evidence supports warning labels allow consumers to identify unhealthy products. We aimed to evaluate the hypothetical impact of the FOPWL regulation on the Mexican population's intake of critical nutrients and energy, based on the replacement of food and beverages using 4 hypothetical scenarios which represented the phases of the regulation. METHODS: Dietary data were collected using a standardized 24-h dietary recall from the 2016 Mexican National Health and Nutrition Survey (n = 4184). To evaluate the hypothetical impact of FOPWL, the nutritional content of critical nutrients in processed products was evaluated according to the Mexican Official Standard 051 (NOM-051). Then, we replaced products with several warning labels (WL) with those with a fewer number of them or with non-processed food. For the replacement, 4 hypothetical scenarios were established: scenario 1: the current consumption of the Mexican Population, scenario 2: the replacement during the first phase of the norm, scenario 3: the replacement in the second phase and scenario 4: the replacement in the last phase. We estimated the means, confidence intervals (CI 95%), and the mean percentage change of energy, saturated fat, trans-fat, added sugars, and sodium intake during the second, third, and the fourth scenarios. RESULTS: According to the norm, in the second scenario, the majority of the products presented a label for energy (52.6%) whereas in the third (56.4%) and fourth (61.2%) scenarios were for sodium. In contrast, trans-fat was the least labeled nutrient in all the scenarios (from 2.1 to 4.1%). In the fourth scenario, we observed a reduction of the intake of energy intake to 15.4% as well as saturated fat (- 20%, CI 95% - 18.4; - 21.6), trans-fat (- 8.2%, CI 95% - 6.4; - 10.1) and sodium (- 12.7%, CI 95% - 11.3; - 14.1). The most important reduction was observed for added sugars intake (until - 54.1%, CI 95% - 51; - 57.1). CONCLUSIONS: FOPWL could be an effective strategy to decrease energy consumption and nutrients of concern. If consumers use the FOPWL, it would be an important change in critical nutrients intake. These results support that FOPWL might help the Mexican population to choose healthier nutrition alternatives.

Hacia el diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México.

OBJETIVO: Describir el proceso de diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México. Material y métodos. Se conformó un equipo de trabajo entre especialistas en salud y la Secretaría de Educación Pública. Se establecieron las bases científicas de Vida Saludable, se seleccionaron y evaluaron materiales para Vida Saludable, y se revisaron contenidos vigentes de salud incluidos en otras asignaturas. RESULTADOS: Alimentación, actividad física e higiene y limpieza fueron definidos como los tres ejes temáticos para Vida Saludable. Se aprobaron 3 de 228 insumos para usarse en Vida Saludable y 71.7% de los con-tenidos vigentes en educación básica sobre salud requieren ediciones. CONCLUSIONES: Vida Saludable es un parteaguas hacia la alfabetización en materia de salud en educación básica en México, que se alinea con la agenda global para preservar la salud humana y planetaria.

Objective understanding of front of pack warning labels among Mexican children of public elementary schools. A randomized experiment.

BACKGROUND: Warning Labels (WL) highlight excessive amounts of critical nutrients in order to discourage consumption of unhealthful packaged food products. This study aimed to evaluate among Mexican school children, the objective understanding of traditional and numeric WL (aimed at small products) considered by the Mexican regulation, and whether cartoon characters influenced the understanding of WL. We also tested some communication strategies to facilitate the correct use of the WL. METHODS: We carried out a randomized experiment in July 2019 in public elementary schools from Morelos, Mexico. Participants aged 6-13 years, were randomly assigned to one of four groups: 1) Nutrient Facts Panel (NF) (n = 120), 2) Nutrient Facts Panel with cartoon characters (NF + C) (n = 83), considered the control groups, 3) Warning Labels (WL) (n = 109), and 4) Warning Labels with cartoon characters (WL + C) (n = 96). After allocation, children assigned to both WL groups (WL or WL + C), were randomly required to watch two posters simultaneously or a video explaining how to correctly interpret WLs. Logistic regression models adjusted by sex, age and cluster (school) were fitted. RESULTS: The percentage of children correctly choosing the healthiest or the unhealthiest option was higher for WL groups (56.8, 95%CI; 40.8-72.8) compared to NF groups (24.3, 95%CI; 20.4-28.3, p < 0.05). The understanding of traditional WL was higher (28.7, 95%CI: 22.8-35.4) than the numeric WL (19, 95%CI: 14.2-25.0, p < 0.05). But, correct answers for identifying healthy and unhealthy products were higher for numeric WL than for NF groups. Cartoon characters reduced the percentage of correct answers for choosing unhealthiest products (WL + C: 48.9, 95%CI: 25.6-72.4 vs WL: 58.7, 95%CI: 36.4-81.1, p < 0.05). The video was 2.23 times more helpful than the posters to the correct interpretation of the WL (p < 0.05). CONCLUSIONS: In scholar Mexican children, traditional and numeric WL were useful to identify healthier and unhealthier packaged products in comparison to NF, suggesting that both WL formats may effectively communicate the excessive content of nutrients of concern among children. Cartoon characters may reduce the objective understanding of the WL, underscoring the need to regulate advertising directed to children along with the implementation of front-of-pack labeling.

Understanding of front of package nutrition labels: Guideline daily amount and warning labels in Mexicans with non-communicable diseases.

One strategy for the prevention and treatment of non-communicable diseases (NCDs) is the implementation of the front-of-pack labeling (FoPL) in foods and beverages. In 2020, Mexico adopted the warning label system (WL) as a new public health policy, whose aim is to help consumers make healthier food choices. Previously, the Guideline Daily Amount (GDA) was the labelling used it. This paper aims to compare the understanding of two FoPL, the GDA and the WL, through the identification of unhealthy products in Mexicans with NCDs. We analyzed data from 14,880 Mexican adults older than 20 years old with NCDs (overweight-obesity (OW/O), self-reported diabetes mellitus 2 (DM2), or/and hypertension (HT), or/and dyslipidemia (Dys)). Participants were randomly assigned to one of two groups: the GDA labeling or WL. Each group had to respond to a survey and had to classify food products images as healthy or unhealthy according to the labelling system to which they were assigned. The correct classification was determined according to the criteria of Chile's labeling nutrient profile stage 3. To evaluate the correct classification in each one of the groups we evaluated the differences in proportions. Logistic regression models were used to assess the likelihood to correctly classify the product according to participants' number of diseases and WL information, taking GDA label as a reference. Participants who used the information contained in the GDA label misclassified food product labels in greater proportion (70%), mostly participants with three or more NCDs (participants with OW/O+ HT+ Dys, represent 42.3% of this group); compared with those who used WL (50%). The odds of correct classification of food products using WL image were two times greater compared to GDA image in participants with NCDs; being greater in participants with three or more NCDs. The study results highlight the usefulness of WL as it helps Mexicans with NCDs to classify unhealthy food products more adequately compared with GDA.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud.

La creciente epidemia de obesidad ha sido uno de los retos más importantes de salud pública en México durante los últimos años. Con apoyo de la Federación Mundial de Obesidad, en 2021 formamos un grupo de profesionales para identificar y resumir las acciones prioritarias en las que puede enfocarse nuestro país para hacer frente a esta epidemia. Al proceso de desarrollo y discusión de este grupo se sumaron más de 1 000 profesionales de la salud para retomar recomendaciones de documentos y guías de alto nivel previamente publicados. En conmemoración del Día Mundial de la Obesidad, en este 2022 se presenta esta postura como insumo para el desarrollo de acciones en el ámbito profesional y de los diferentes sectores, en la que se incluyen 10 recomendaciones de acción, desde la perspectiva poblacional hasta la atención individualizada, y se enfatiza en la importancia de la participación social, de las intervenciones integrales con visión centrada en la persona y de la sostenibilidad planetaria, además de mejorar la educación y las campañas de difusión, propiciar un ambiente promotor de entornos activos y blindar de conflictos de interés los esfuerzos de prevención y control. La postura hace un llamado para abordar la obesidad de manera seria, con base en la evidencia científica, oportuna e integral, con enfoque de curso de vida, de forma ética y sensible, y sin perpetuar las barreras del estigma de peso en la sociedad.

Evaluation of the Mexican warning label nutrient profile on food products marketed in Mexico in 2016 and 2017: A cross-sectional analysis.

BACKGROUND: Different nutrient profiles (NPs) have been developed in Latin America to assess the nutritional quality of packaged food products. Recently, the Mexican NP was developed as part of the new warning label regulation implemented in 2020, considering 5 warning octagons (calories, sugar, sodium, saturated fats, and trans fats) and 2 warning rectangles (caffeine and non-nutritive sweeteners). The objective of this cross-sectional study was to evaluate the Mexican NP and other NPs proposed or used in Latin America against the Pan American Health Organization (PAHO) model. METHODS AND FINDINGS: Nutrition content data of 38,872 packaged food products available in the Mexican market were collected in 2016 and 2017. The evaluation of the Mexican NP, including its 3 implementation phases of increasing stringency (2020, 2023, and 2025), was conducted by comparing the percentage of products classified as "healthy" (without warnings) or "less healthy" (with 1 or more warnings), as well as the number and type of warnings assigned to food products, against the PAHO NP. Using the calibration method, we compared the classifications produced by the PAHO model against those produced by the NP models of Ecuador, Chile (3 phases), Peru (2 phases), Uruguay, and Brazil. Kappa coefficients and Pearson correlations were estimated, and proportion tests were performed. We found that the 3 implementation phases of the Mexican NP had near to perfect agreement in the classification of healthy foods (Mexico NP models: 19.1% to 23.8%; PAHO model: 19.7%) and a strong correlation (>91.9%) with the PAHO model. Other NPs with high agreement with the PAHO model were the Ecuador (89.8%), Uruguay (82.5%), Chile Phase 3 (82.3%), and Peru Phase 2 (84.2%) NPs. In contrast, the Peru Phase 1, Brazil, and Chile Phase 1 NP models had the highest percentage of foods classified as healthy (49.2%, 47.1%, and 46.5%, respectively) and the lowest agreement with the PAHO model (69.9%, 69.3%, and 73%, respectively). Study limitations include that warnings considered by the Mexican NP models were evaluated as if all the warnings were octagon seals, while 2 out of the 7 were rectangular warnings (caffeine and non-nutritive sweeteners), and that our data are limited by the quality of the information reported in the list of ingredients and the nutrition facts table of the products. CONCLUSIONS: The 3 implementation phases of the Mexican NP were useful to identify healthy food products. In contrast, the Peru Phase 1, Brazil, and Chile Phase 1 NP models may have limited usefulness for the classification of foods according to the content of ingredients of concern. The results of this study may inform countries seeking to adapt and evaluate existing NP models for use in population-specific applications.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

resumen está disponible en el texto completo

Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

Access to Healthy Wheat and Maize Processed Foods in Mexico City: Comparisons across Socioeconomic Areas and Store Types.

The contributions of processed foods to the overweight and obesity problem in Latin America are well known. Engagement with the private and public sectors on possible solutions requires deeper insights into where and how these products are sold and the related implications for diet quality. This article characterizes the diversity of wheat and maize processed foods (WMPFs) available to consumers in Mexico City. Data were gathered across nine product categories at different points of sale (supermarkets, small grocery stores, convenience stores) in high and low socioeconomic (SE) areas. We assessed WMPFs based on Nutri-Score profile, price, and health and nutrition claims. Roughly 17.4% of the WMPFs were considered healthy, of which 62.2% were pastas and breads. Availability of healthy WMPFs was scarce in most stores, particularly in convenience stores Compared to supermarkets in the low SE area, those in the high SE area exhibited greater variety in access to healthy WMPFs across all product categories. In the low SE area, healthy WMPFs were priced 16-69% lower than unhealthy WMPFs across product categories. The extensive variety of unhealthy WMPFs, the limited stock of healthy WMPFs in most retail outlets, and the confusing health and nutrition claims on packaging make it difficult for urban consumers to find and choose healthy WMPFs.

Estimated effects of the implementation of the Mexican warning labels regulation on the use of health and nutrition claims on packaged foods.

BACKGROUND: The use of health and nutrition claims on front-of-pack labels may impact consumers' food choices; therefore, many countries have established regulations to avoid misinformation. This study describes the prevalence of health and nutrition claims on the front-of-pack of food products in retail stores in Mexico and estimate the potential effects of the Official Mexican Standards 051 (new regulation that includes specifications for implementing warning labels and other packaging elements such as health and nutrition claims on less healthy foods) on the prevalence of these claims. METHODS: This is a cross-sectional study in which health and nutrition claims, nutrition information panels, and the list of ingredients of all foods and beverages available in the main retail stores in Mexico City were collected. The products were grouped by level of processing according to the NOVA food system classification. Claims were classified using the internationally harmonized INFORMAS taxonomy. According to the criteria of the new Mexican front-of-pack labelling regulation, the effect on the reduction on the prevalence of health and nutrition claims was estimated by type of food and by energy and nutrients of concern thresholds. RESULTS: Of 17,264 products, 33.8% displayed nutrition claims and 3.4% health claims. In total, 80.8% of all products in the Mexican market were classified as "less healthy"; 48.2% of products had excess calories, 44.6% had excess sodium, and 40.7% excess free sugars. The new regulation would prevent 39.4% of products with claims from displaying health and nutrition claims (P < 0.001); the largest reduction is observed for ultra-processed foods (51.1%, P < 0.001). The regulation thresholds that resulted in the largest reduction of claims were calories (OR 0.62, P < 0.001) and non-sugar sweeteners (OR 0.54, P < 0.001). CONCLUSIONS: The new Mexican front-of-pack labelling regulation will prevent most processed and ultra-processed foods from displaying health and nutrition claims and will potentially improve information on packaging for consumers.

Perfil nutricional y estrategias de publicidad en el empaque de alimentos procesados de trigo y maíz en la Ciudad de México / Nutrient profile and marketing strategies of processed wheat and maize products in Mexico City

Resumen: Objetivo: Evaluar la asociación entre el perfil nutricional y las estrategias de publicidad de alimentos procesados de trigo y maíz (APTM) ofertados en puntos de venta de la Ciudad de México. Material y métodos: Se recolectó información del contenido nutricional y tipos de publicidad para doce categorías de APTM en 58 puntos de venta localizados en zonas de niveles socioeconómicos (NSE) bajo y alto. Resultados: El 8.5 y 10.7% de APTM en NSE bajo y alto fueron saludables, respectivamente. ≤12% de los APTM fueron saludables, excepto harinas (~30%) y pastas (~95%). Entre ambos NSE, de 28.3% a 31.9% de APTM usaron personajes, de 46.5% a 50.1% promociones y de 38.2% a 41.3% claims. Se encontraron asociaciones significativas (p<0.001) en el uso de publicidad de APTM no saludables en ambas zonas de NSE. Conclusiones: La mayoría de los APTM en venta fueron no saludables, y se ofertaron más en el NSE bajo. En ambos NSE la mayoría de APTM no saludables usa estrategias publicitarias para estimular su consumo.

Abstract: Objective: To evaluate the nutrient profile and marketing techniques (MT) of processed wheat and maize foods (PWMF) sold in food retail outlets of Mexico City. Materials and methods: We collected information on nutrient content and MT for PWMF across twelve food categories from 58 retail outlets in high and low income areas of Mexico City. Results: Roughly 8.5% and 10.7% of PWMF, in low and high income areas were healthy, respectively. The ≤12% of PWMF were healthy, except for flours (~33%) and pastas (≥95%). Across both income areas, 28.3%-31.9% of WMPF employed characters, 46.5%-50.1% promotions and 38.2%-41.3% claims. A significant association (p<0.001) was found between the use of MT and unhealthy PWMF in both areas. Conclusion: The majority of PWMF available in the food retail sector were considered unhealthy, which were being more offered in low income areas. Across income areas, the majority of unhealthy WMPF employed MT to encourage consumption.

Use of advertising strategies to target children in sugar-sweetened beverages packaging in Mexico and the nutritional quality of those beverages.

BACKGROUND: A product package can be a powerful marketing tool to persuade and attract consumers at the point-of-sale. Evidence shows that most advertised products have low nutritional quality. Currently, Mexico has incorporated advertising regulations on food and beverage packaging. OBJECTIVES: To analyze the advertising strategies used to target children on packaging and to assess the nutritional quality of sugar-sweetened beverages available in the Mexican market. METHODS: Photographs of 2380 beverages available in retail stores in Mexico City from January to March 2017 were analyzed. Beverages were classified as displaying child-directed strategies or nondirected strategies. Nutrition quality was evaluated using the Pan American Health Organization nutrient profile model. RESULTS: The use of characters was the most frequent strategy among beverages with child-directed strategies (82.0%). The evaluation of nutrition quality found that 88.0% (P < .001) of sugar-sweetened beverages with child-directed strategies were excessive in free sugars and 56.9% (P < .001) contained other sweeteners. Beverages with more than two advertising strategies have the highest proportion of excessive free sugars (93.4%, 95% CI 82.8-98.6). CONCLUSIONS: The use of characters and other visual strategies were frequently used in the packaging of sugar-sweetened beverages with child-directed strategies. In addition, these beverages are excessive in free sugars and contain a large number of products with other sweeteners.

Evaluation of the Accurateness of the Nutritional Labels of Processed and Ultra-Processed Products Available in Supermarkets of Ecuador.

Nutrition labeling is a public health tool that allows consumers to choose healthier foods and beverages. For this reason, there are protocols in place to monitor the food environment. The purpose of this study was to evaluate the consistency of nutrition labeling on packages for processed and ultra-processed products (UPPs) found at the main supermarkets in Cuenca, Ecuador. We conducted a descriptive cross-sectional study in which we identified label components on the packages of 1725 foods and beverages-including the nutrition table, statement on sweeteners, ingredient list, and the traffic light (TL) label-and determined the degree of consistency between the indicators reported on the traffic light label and those obtained from the information in the nutrition table. We found that 24% of products had inconsistencies in the traffic light label, and 10.9% of products had inconsistencies in the indicator for sugar specifically. The majority of inconsistencies were in the medium indicators for sugar (K = 0.68) and fat (0.75). The products with a medium indicator for sugar had a 1.98 (p < 0.05, 95% CI 1.15, 3.39) times higher chance of having inconsistencies in comparison with the low indicator. Health authorities must create new guidelines to allow for continued monitoring of the nutrition and traffic light labels on products accessible to consumers.

Perfil nutricional y estrategias de publicidad en el empaque de alimentos procesados de trigo y maíz en la Ciudad de México.

Objetivo. Evaluar la asociación entre el perfil nutricional y las estrategias de publicidad de alimentos procesados de trigo y maíz (APTM) ofertados en puntos de venta de la Ciudad de México. Material y métodos. Se recolectó información del contenido nutricional y tipos de publicidad para doce categorías de APTM en 58 puntos de venta localizados en zonas de niveles socioeconómicos (NSE) bajo y alto. Resultados. El 8.5 y 10.7% de APTM en NSE bajo y alto fueron saludables, respectivamente. ≤12% de los APTM fueron saludables, excepto harinas (~30%) y pastas (~95%). Entre ambos NSE, de 28.3% a 31.9% de APTM usaron personajes, de 46.5% a 50.1% promociones y de 38.2% a 41.3% claims. Se encontraron asociaciones significativas (p<0.001) en el uso de publicidad de APTM no saludables en ambas zonas de NSE. Conclusiones. La mayoría de los APTM en venta fueron no saludables, y se ofertaron más en el NSE bajo. En ambos NSE la mayoría de APTM no saludables usa estrategias publicitarias para estimular su consumo.

[Understanding and use of the front-of-pack Guideline Daily Amounts nutritional labeling of industrialized food and beverages in Mexico.] / Comprensión y uso del etiquetado frontal nutrimental Guías Diarias de Alimentación de alimentos y bebidas industrializados en México.

OBJECTIVE: Evaluate the use, subjective and objective under-standing of the GDA frontal labeling to assist the population towards making healthy decisions regarding the products they consume. MATERIALS AND METHODS: The use of nu-tritional information contained in products ́ packages (GDA, nutritional information table, and list of ingredients), as well as the subjective and objective comprehension of the GDA. RESULTS: A total of 43 157 people were interviewed. Amid the labels, the nutritional table was read more frequently (11.1%). 24.6% (IC95%: 23.9-25.3) and 41.2% (IC95%: 40.4-42.1) of the interviewees classified products correctly as not healthy and high in sodium, respectively. These outcomes were smaller between the elderly, lower socioeconomic levels, lower educational levels, and rural areas. CONCLUSIONS: The results show that the GDA labeling is not useful to support the vulnerable population to make healthy decisions.

OBJETIVO: Evaluar el uso y la comprensión subjetiva y ob-jetiva del etiquetado frontal Guías Diarias de Alimentación (GDA) para ayudar a la población a tomar decisiones salu-dables respecto a los productos que consume. MATERIAL Y MÉTODOS: Se evaluó el uso de la información nutrimental disponible en el empaque (GDA, tabla de información nu-trimental y lista de ingredientes), así como la comprensión subjetiva y objetiva del GDA, en personas mayores de 20 años. Resultados. Se entrevistó a 43 157 personas. La tabla. RESULTADOS: Se entrevistó a 43 157 personas. La tabla nutrimental fue la etiqueta más utilizada (11.1%). Apenas 24.6% (IC95%: 23.9-25.3) y 41.2% (IC95%: 40.4-42.1) clasificó correctamente el producto como nada saludable o alto en sodio, respectivamente. Estas proporciones fueron menores en adultos mayores, personas con menor nivel educativo, nivel socioeconómico bajo y área rural. CONCLUSIONES: Los resultados muestran que el etiquetado GDA no es útil para apoyar a la población vulnerable a realizar elecciones saludables.

Comprensión y uso del etiquetado frontal nutrimental Guías Diarias de Alimentación de alimentos y bebidas industrializados en México / Understanding and use of the front-of-pack Guideline Daily Amounts nutritional labeling of industrialized food and beverages in Mexico

Resumen: Objetivo: Evaluar el uso y la comprensión subjetiva y objetiva del etiquetado frontal Guías Diarias de Alimentación (GDA) para ayudar a la población a tomar decisiones saludables respecto a los productos que consume. Material y métodos: Se evaluó el uso de la información nutrimental disponible en el empaque (GDA, tabla de información nutrimental y lista de ingredientes), así como la comprensión subjetiva y objetiva del GDA, en personas mayores de 20 años. Resultados: Se entrevistó a 43 157 personas. La tabla nutrimental fue la etiqueta más utilizada (11.1%). Apenas 24.6% (IC95%: 23.9-25.3) y 41.2% (IC95%: 40.4-42.1) clasificó correctamente el producto como nada saludable o alto en sodio, respectivamente. Estas proporciones fueron menores en adultos mayores, personas con menor nivel educativo, nivel socioeconómico bajo y área rural. Conclusiones: Los resultados muestran que el etiquetado GDA no es útil para apoyar a la población vulnerable a realizar elecciones saludables.

Abstract: Objective: Evaluate the use, subjective and objective understanding of the GDA frontal labeling to assist the population towards making healthy decisions regarding the products they consume. Materials and methods: The use of nutritional information contained in products´ packages (GDA, nutritional information table, and list of ingredients), as well as the subjective and objective comprehension of the GDA labeling, were assessed among people older than 20 years old. Results: A total of 43 157 people were interviewed. Amid the labels, the nutritional table was read more frequently (11.1%). 24.6% (IC95%: 23.9-25.3) and 41.2% (IC95%: 40.4-42.1) of the interviewees classified products correctly as not healthy and high in sodium, respectively. These outcomes were smaller between the elderly, lower socioeconomic levels, lower educational levels, and rural areas. Conclusions: The results show that the GDA labeling is not useful to support the vulnerable population to make healthy decisions.