Nutri-Score y ultra-procesamiento: dos dimensiones diferentes, complementarias y no contradictorias / Nutri-Score and ultra-processing: two different, complementary, non-contradictory dimensions

Al logotipo nutricional Nutri-Score se le ataca a veces porque clasifica como A y B algunos alimentos ultraprocesados. Esto no es sorprendente si se tiene en cuenta que la calidad nutricional (evaluada por Nutri-Score) y el ultraprocesamiento (evaluado por la clasificación NOVA) no abarcan las mismas «dimensiones de salud» de los alimentos, sino que cada una de ellas puede impactar en la salud por mecanismos específicos propios. Al mismo tiempo que cubren dimensiones diferentes y complementarias, sigue existiendo una asociación global entre el grado de transformación y la calidad nutricional de los alimentos. Dentro de los alimentos ultraprocesados existen diferencias en términos de número, tipo y dosis de aditivos, pero también en términos de calidad nutricional, por lo que Nutri-Score permite, dentro de la amplia categoría de productos ultraprocesados (como en todas las categorías de la clasificación NOVA), distinguir su calidad nutricional, lo que es primordial en términos de impacto sobre la salud. Cualquiera que sea el nivel de procesamiento de los alimentos, se ha demostrado que el consumo de alimentos mejor clasificados por Nutri-Score es beneficioso para la salud y tiene un menor riesgo de patologías crónicas. Esto es importante porque, incluso si se recomienda reducir el consumo de alimentos ultraprocesados, para aquellos que no quieren o no pueden evitar consumirlos o para quienes es complicado cocinar (por razones de tiempo, facilidad, preferencia, etc.) la elección de un alimento mejor clasificado en la escala Nutri-Score tiene un impacto favorable en el plano de la salud. En consecuencia, Nutri-Score y el ultraprocesamiento deben considerarse como dos dimensiones diferentes y complementarias

The front-of-pack nutritional labeling system Nutri-Score is sometimes under attack because it classifies as A and B certain ultra-processed foods. In fact, this is not surprising given that nutritional quality (assessed by Nutri-Score) and ultra-processing (assessed by the NOVA classification) do not cover the same "health dimensions" in foods but rather different dimensions likely to affect health through specific mechanisms. Although they cover different and complementary dimensions, there is nevertheless an overall association between the degree of processing and nutritional quality of foods. But within the group of ultra-processed foods there are differences in the number, type and doses of additives, as well as differences in nutritional quality. Therefore Nutri-Score allows, within the category of ultra-processed foods (as for all categories of the NOVA classification), to differentiate the nutritional quality of foods, which is essential in terms of health impact. Indeed, regardless of the level of food processing, it has been shown that consuming foods that are better ranked on the Nutri-Score scale is associated with a health benefit and a lower risk of chronic diseases. This is important because, even if it is recommended to reduce the consumption of ultra-processed foods, for those who do not want to or cannot avoid consuming them, for those for whom cooking is difficult (for reasons of time, ease, taste, etc.), the choice of foods better ranked on the Nutri-Score scale has a positive impact on health. Nutri-Score and ultra-transformation must be considered two different and complementary dimensions

[Nutri-Score and ultra-processing: two different, complementary, non-contradictory dimensions]. / Nutri-Score y ultra-procesamiento: dos dimensiones diferentes, complementarias y no contradictorias.

INTRODUCTION: The front-of-pack nutritional labeling system Nutri-Score is sometimes under attack because it classifies as A and B certain ultra-processed foods. In fact, this is not surprising given that nutritional quality (assessed by Nutri-Score) and ultra-processing (assessed by the NOVA classification) do not cover the same "health dimensions" in foods but rather different dimensions likely to affect health through specific mechanisms. Although they cover different and complementary dimensions, there is nevertheless an overall association between the degree of processing and nutritional quality of foods. But within the group of ultra-processed foods there are differences in the number, type and doses of additives, as well as differences in nutritional quality. Therefore Nutri-Score allows, within the category of ultra-processed foods (as for all categories of the NOVA classification), to differentiate the nutritional quality of foods, which is essential in terms of health impact. Indeed, regardless of the level of food processing, it has been shown that consuming foods that are better ranked on the Nutri-Score scale is associated with a health benefit and a lower risk of chronic diseases. This is important because, even if it is recommended to reduce the consumption of ultra-processed foods, for those who do not want to or cannot avoid consuming them, for those for whom cooking is difficult (for reasons of time, ease, taste, etc.), the choice of foods better ranked on the Nutri-Score scale has a positive impact on health. Nutri-Score and ultra-transformation must be considered two different and complementary dimensions.

INTRODUCCIÓN: Al logotipo nutricional Nutri-Score se le ataca a veces porque clasifica como A y B algunos alimentos ultraprocesados. Esto no es sorprendente si se tiene en cuenta que la calidad nutricional (evaluada por Nutri-Score) y el ultraprocesamiento (evaluado por la clasificación NOVA) no abarcan las mismas "dimensiones de salud" de los alimentos, sino que cada una de ellas puede impactar en la salud por mecanismos específicos propios. Al mismo tiempo que cubren dimensiones diferentes y complementarias, sigue existiendo una asociación global entre el grado de transformación y la calidad nutricional de los alimentos. Dentro de los alimentos ultraprocesados existen diferencias en términos de número, tipo y dosis de aditivos, pero también en términos de calidad nutricional, por lo que Nutri-Score permite, dentro de la amplia categoría de productos ultraprocesados (como en todas las categorías de la clasificación NOVA), distinguir su calidad nutricional, lo que es primordial en términos de impacto sobre la salud. Cualquiera que sea el nivel de procesamiento de los alimentos, se ha demostrado que el consumo de alimentos mejor clasificados por Nutri-Score es beneficioso para la salud y tiene un menor riesgo de patologías crónicas. Esto es importante porque, incluso si se recomienda reducir el consumo de alimentos ultraprocesados, para aquellos que no quieren o no pueden evitar consumirlos o para quienes es complicado cocinar (por razones de tiempo, facilidad, preferencia, etc.) la elección de un alimento mejor clasificado en la escala Nutri-Score tiene un impacto favorable en el plano de la salud. En consecuencia, Nutri-Score y el ultraprocesamiento deben considerarse como dos dimensiones diferentes y complementarias.

Taste and Health Information on Fast Food Menus to Encourage Young Adults to Choose Healthy Food Products: An Experimental Study.

Currently, a great number of people have an unhealthy dietary intake, leading to chronic diseases. Despite the high prevalence of obesity and people being overweight, only a few strategies to promote healthier food products have been proven effective. Therefore, the objective of this study was to test the effect of the presence of health information and its integration into a fast food menu context on young adults' healthy food choices. An experimental between-subjects design consisting of three conditions-subtle, explicit, and no health information-was conducted among 142 participants aged 18 to 24 (Mage: 21.49, SD = 1.77). The results showed that when health information about healthy products was provided, the level of integration of the information into the menu context had an effect. More specifically, participants exposed to explicit health information about healthy products provided on the fast food menu were more likely to choose a healthy food product compared to participants exposed to subtle integrated health information. No interaction effect for moderating factors was found. In line with the healthy food promotion model, the findings suggest that the provision of explicit health information on healthy products stimulates healthy food choices in a fast food environment.

Child Social Media Influencers and Unhealthy Food Product Placement.

OBJECTIVES: We aimed to determine the frequency with which kid influencers promote branded and unbranded food and drinks during their YouTube videos and assess the nutritional quality of food and drinks shown. METHODS: Researchers used Socialbakers data to identify the 5 most-watched kid influencers (ages 3 to 14 years) on YouTube in 2019. We searched for 50 of their most-watched videos and 50 of their videos that featured food and/or drinks on the thumbnail image of the video. We coded whether kid influencers consumed or played with food or toys, quantified the number of minutes food and/or drinks appeared, and recorded names of branded food and/or drinks. We assessed the nutritional quality of foods using the Nutrient Profile Model and identified the number of drinks with added sugar. RESULTS: A sample of 418 YouTube videos met the search criteria, and 179 of those videos featured food and/or drinks. Food and/or drinks were featured in those videos 291 times. Kid influencers' YouTube videos were collectively viewed >48 billion times, and videos featuring food and/or drinks were viewed 1 billion times. Most food and/or drinks were unhealthy branded items (n = 263; 90.34%; eg, McDonald's), followed by unhealthy unbranded items (n = 12; 4.1%; eg, hot dogs), healthy unbranded items (n = 9; 3.1%; eg, fruit), and healthy branded items (n = 7; 2.4%; eg, Yoplait yogurt). CONCLUSIONS: Kid influencers generate millions of impressions for unhealthy food and drink brands through product placement. The Federal Trade Commission should strengthen regulations regarding product placement on YouTube videos featuring young children.

The influence of current food and nutrition trends on dietitians' perceptions of the healthiness of packaged food.

OBJECTIVE: To investigate the influence of current food and nutrition trends on dietitians' perceptions of the healthiness of packaged foods. DESIGN: This observational study used a cross-sectional survey. Participants rated (strongly disagree to strongly agree) the extent to which a range of factors, independent of the energy, nutrient and ingredient content, influenced their perceptions of the healthiness of packaged foods. Two open-ended questions allowed for participants to list additional items they considered important. SETTING: Online survey. PARTICIPANTS: Australian dietitians (n 117). RESULTS: The greatest consensus was a positive influence of the fit within the core food groups and presence of seasonal ingredients, and a negative influence of an increasing number of additives. Mixed opinions were obtained for GM ingredients, locally sourced ingredients, labelling of animal welfare and organic certification. Nutritional indicators received a split where almost half of participants disagreed/strongly disagreed that they positively influenced their perception of healthiness. Content analysis of open-ended responses (n 53, 45 %) revealed four broad categories as important in considering healthiness: 'a whole food approach', 'marketing and labelling', 'product information' and 'context of diet'. A small number of responses (count of 6, 5 %) reported that packaging, advertising and features such as celebrity endorsement were a negative influence. CONCLUSIONS: Dietitians have a broad concept of the healthiness of packaged foods, which incorporates elements of food safety, wholeness of the ingredients and marketing. Providing unified messages to the consumer can help to build the public perception of dietitians as experts in nutrition advice and counselling.

Nutritional Quality of Fast Food Kids Meals and Their Contribution to the Diets of School-Aged Children.

International data indicate that children and adolescents obtain around one third of their daily food intake from products consumed outside their home. Food products from restaurants are usually higher in calories and lower in nutritional value than those prepared home. We evaluated the nutritional quality in kids' meals from three fast food chains and two movie theaters and compared them with nutritional recommendations for Mexican school-age population. Results showed that the menu options marketed for school-age children have higher caloric contributions than those recommended, in addition to a deficient nutritional quality. The contribution of caloric and of almost all macronutrients for all mealtimes is not only high but even above 100% or 200% of the mean recommended daily intake (reaching to more than 400% of the recommendations of carbohydrates and lipids of preschool age group). In particular, the snack main dish (popcorn), provides over 100% of the mean energy intake recommendations for the three school age groups and for preschool age group, this contribution could reach to 270%. Therefore, regulations regarding nutritional recommendations should exist for these types of commercialized food products for school-age children, along with mandatory and clear labeling that allows consumers to be able to make better choices for their kids.

Experimental Studies of Front-of-Package Nutrient Warning Labels on Sugar-Sweetened Beverages and Ultra-Processed Foods: A Scoping Review.

Policies that require front-of-package (FoP) nutrient warnings are becoming increasingly common across the globe as a strategy to discourage excess consumption of sugary drinks and ultra-processed food. However, a better understanding of the pathway through which FoP nutrient warnings work, as well as a review of how outcomes being measured in recent studies map onto this pathway, are needed in order to inform policy on the most effective FoP label design for reducing purchases of ultra-processed foods. This scoping review describes a conceptual model for how FoP nutrient warnings affect consumer behavior, examines which of these outcomes are currently being measured, and summarizes evidence from randomized controlled experiments. Twenty-two studies which experimentally tested nutrient warnings against a control label or other labeling systems were included for full-text review. Our conceptual model includes attention; comprehension, cognitive elaboration, and message acceptance; negative affect and risk perception; behavioral intentions, and behavioral response, along with other elements such as external factors and interpersonal communications. We found that many studies focused on outcomes such as attention, comprehension, and behavioral intentions, but considerable gaps in the evidence remain, particularly for intermediary steps on the pathway to behavioral change, such as negative affect and social interactions. FoP nutrient warnings were visually attended to by consumers, easy to understand, helped consumers identify products high in nutrients of concern, and discouraged them from purchasing these products, although other labeling systems were perceived as containing more information and performed better at helping consumers rank the healthfulness of products. More research is needed to understand whether and how nutrient warnings work in the real world to discourage consumer purchases of sugary drinks and ultra-processed food.

Microbial Quality of Ready-to-Eat Foods Sold in School Cafeterias in Chongqing, China.

ABSTRACT: The microbiological quality of ready-to-eat (RTE) foods from school cafeterias in Chongqing, People's Republic of China, was evaluated and compared with a guideline published by a provincial health commission. These RTE foods were divided into five types based on their preparation processes and potential risks: 1, general cooked and hot-held foods; 2, cooked meats; 3, heated aquatic products; 4, fresh fruits or vegetables; and 5, cooked foods with postcooking handling (e.g., cutting, cooling, or addition of ingredients or condiments). Food types 1 through 3 (subjected to thermal processes and hot-held) were microbiologically safer than types 4 and 5 (prepared by nonthermal process or with postcooking processes). None of the samples of types 1 through 3 were unsatisfactory based on their aerobic plate counts (APC) and total coliforms (TC), whereas 43.1% of type 4 and 8.3 and 71.7% of type 5 samples were unsatisfactory due to high counts of TC and high APC and TC, respectively. Two, 12, and 50 samples of types 2, 4, and 5, respectively, were unacceptable due to high levels of Staphylococcus aureus. Bacillus cereus and Vibrio parahaemolyticus were detected, but levels were below the unacceptable limits. None of the samples were positive for Salmonella, Listeria monocytogenes, or Escherichia coli O157. The bacterial profile can be used by policy makers and epidemiologists for microbiological risk assessments, which may be conducive to developing interventions to control hazards, improve food hygiene, and develop safety management systems for school cafeterias in China.

Nutritional Qualities of Commercial Meal Kit Subscription Services in Australia.

People are cooking at home less often and relying more on food prepared outside of the home, which is often of less nutritional value than home-cooked meals. The foodservice industry has endeavored to address barriers with the introduction of commercial meal kit subscription services (MKSSs). We aimed to assess and compare the nutritional qualities of MKSSs available in Australia. Average nutritional qualities per serve of 12 recipes (from four weekly boxes of three meals serving two people) were analyzed from five MKKSs (Dinnerly, HelloFresh™, MarleySpoon™, Pepper Leaf, Thomas Farms Kitchen). On average, MKSSs provided adequate serves of core foods, particularly of vegetables (2.3 ± 1.6-3.1 ± 1.8 serves per serve). Energy content ranged between 2891 ± 539 and 3904 kJ ± 890 per serve. All MKKSs were high in fat (39.5 ± 9.5-59.6 ± 11.2% of energy) and sodium (723 ± 404-1426 ± 688 mg per serve). All MKSSs met suggested dietary target level of dietary fiber for women, but none for men. If MKSS providers can modify recipes to reduce added salt and fat and increase dietary fiber, they have the potential to provide both men and women with nutritious meals that more closely align with the dietary guidelines for the prevention of chronic disease, especially if meals are used as an alternative to energy-dense nutrient-poor takeaway and convenience foods.

Food and Beverage Options at Highway Rest Areas in North Carolina: A Mixed-Methods Audit and Geospatial Approach.

INTRODUCTION: Each year, millions of people purchase food at highway rest areas. Rest areas are potential sites for health promotion because they are operated by the public sector; they are frequently visited by professional truck drivers, who have a disproportionate burden of chronic disease; and they are easily accessible. To our knowledge, no research has systematically examined the healthfulness of food offerings at rest areas. The objective of this study was to determine the accessibility and healthfulness of food and beverages offered at highway rest areas in North Carolina using a mixed-methods audit and geospatial approach. METHODS: We conducted a cross-sectional audit of all rest areas offering foods and beverages in North Carolina (N = 30) in summer 2018. We used the Nutrition Environment Measures Survey-Vending (NEMS-V) to record the 1) type, price, and size of all foods and beverages and 2) healthfulness of items offered (based on NEMS-V categorization). Two researchers independently double coded NEMS-V data. We used geospatial analysis to examine proximity of rest areas to food stores. We analyzed data by using univariate and bivariate analysis. RESULTS: The mean number of vending machines per site was 8.0 (range, 2-12, standard deviation, 2.8). The healthfulness of offerings varied across sites. Most food items (88.1%; 2,922 of 3,315) and beverage items (63.7%; 1,567 of 2,459) were classified as least healthful. Cold beverage machines had a greater percentage of healthful items (38.2%; 778 of 2,036) than snack machines (11.4%; 374 of 3,270) (P < .001), mainly because of water and diet soda in beverage machines. CONCLUSION: Policy changes are needed to increase the number and presentation of healthful food options at highway rest areas. Policy changes could provide travelers with more healthful options conveniently located along their travel route.

Differences in energy and nutritional content of menu items served by popular UK chain restaurants with versus without voluntary menu labelling: A cross-sectional study.

BACKGROUND: Poor diet is a leading driver of obesity and morbidity. One possible contributor is increased consumption of foods from out of home establishments, which tend to be high in energy density and portion size. A number of out of home establishments voluntarily provide consumers with nutritional information through menu labelling. The aim of this study was to determine whether there are differences in the energy and nutritional content of menu items served by popular UK restaurants with versus without voluntary menu labelling. METHODS AND FINDINGS: We identified the 100 most popular UK restaurant chains by sales and searched their websites for energy and nutritional information on items served in March-April 2018. We established whether or not restaurants provided voluntary menu labelling by telephoning head offices, visiting outlets and sourcing up-to-date copies of menus. We used linear regression to compare the energy content of menu items served by restaurants with versus without menu labelling, adjusting for clustering at the restaurant level. Of 100 restaurants, 42 provided some form of energy and nutritional information online. Of these, 13 (31%) voluntarily provided menu labelling. A total of 10,782 menu items were identified, of which total energy and nutritional information was available for 9605 (89%). Items from restaurants with menu labelling had 45% less fat (beta coefficient 0.55; 95% CI 0.32 to 0.96) and 60% less salt (beta coefficient 0.40; 95% CI 0.18 to 0.92). The data were cross-sectional, so the direction of causation could not be determined. CONCLUSION: Menu labelling is associated with serving items with less fat and salt in popular UK chain restaurants. Mandatory menu labelling may encourage reformulation of items served by restaurants. This could lead to public health benefits.

'Oh God, I Have to Eat Something, But Where Can I Get Something Quickly?'-A Qualitative Interview Study on Barriers to Healthy Eating among University Students in Germany.

Healthy eating can prevent individuals across all age groups from developing overweight/obesity and non-communicable diseases such as type 2 diabetes and cardiovascular disease. However, unhealthy eating habits (e.g., a high level of fast food consumption) have been found to be widespread among university students. Thus, it seems necessary to develop prevention strategies to improve students' eating habits. However, to ensure that such strategies are successful, it is important that they fit the needs of the target population. By conducting qualitative interviews with students (n = 20), we aimed to get a deeper understanding of barriers to healthy eating. Students were asked about barriers to healthy eating and to suggest possible ideas that could improve their eating behavior in the future. Our findings revealed that students are especially affected by time-related barriers (e.g., a lack of time due to university commitment) and environmental barriers (e.g., a lack of cheap, tasty, and healthy meal options at the university canteen). Time-related barriers were also related to motivational barriers (e.g., being too lazy to cook after a busy day at university). In addition, knowledge/information-related barriers, social-support-related barriers, and transition-related barriers emerged from our interviews. The variety of barriers addressed and the different views on some of these, indicate that various strategies seem to be needed to improve the eating behavior among university students and to prevent them from gaining weight and developing non-communicable diseases in the future.

Salt content of sauces in the UK and China: cross-sectional surveys.

OBJECTIVES: (1) To assess the changes in the salt content of sauces in the UK in the past 10 years; (2) to compare the salt content of sauces in China with equivalent products sold in the UK and (3) to calculate the proportion of sauce products meeting the salt targets set by the UK Department of Health (DoH). DESIGN: Cross-sectional surveys from the nutrition information panels of sauces. SETTING: Major retailers in London, Beijing and Shijiazhuang operating at data collection times. MAIN OUTCOME MEASURE: Salt content of sauces. RESULTS: Relative change in the median salt content of UK products ranged from -70.6% to +3.0% in sauces for which salt targets were set, whereas it ranged from -27.1% to +111.5% in sauces without targets. Median salt contents were on average 4.4-fold greater in Chinese sauces compared with their UK equivalents surveyed during the same period (2015-2017). Only 13.4% of the Chinese products met the UK 2017 salt targets, compared with 70.0% of UK products. CONCLUSION: In the UK, the target-based approach contributed to the reduction in the salt content of sauces over the course of the past 10 years. Currently, large variations in salt content exist within the same categories of sauces and 70% of the products have met DoH's 2017 targets, demonstrating that further reductions are possible and lower salt targets should be set. In China, salt content of sauces is extremely high with similarly large variations within same categories of sauces, demonstrating the feasibility of reducing their salt content. As processed foods (including sauces) are expected to become an important contributor to salt intake in China, national salt reduction efforts such as setting salt targets would be a valuable, proactive strategy.

An Evaluation of the Sodium Content and Compliance with the National Sodium Reduction Targets among Packaged Foods Sold in Costa Rica in 2015 and 2018.

High blood pressure is a leading cause of death in Costa Rica, with an estimated mortality rate of 30%. The average household sodium intake is two times higher than the World Health Organization recommendation. The consumption of processed foods is an important and growing contributor to sodium intake. The objective of this study was to describe the sodium content of packaged foods (mg/100 g) sold in Costa Rica in 2015 (n = 1158) and 2018 (n = 1016) and to assess their compliance with the national sodium reduction targets. All 6 categories with national targets were analyzed: condiments, cookies and biscuits, bread products, processed meats, bakery products, and sauces. A significant reduction in mean sodium content was found in only 3 of the 19 subcategories (cakes, tomato-based sauces, and tomato paste). No subcategories had statistically significant increases in mean sodium levels, but seasonings for sides/mains, ham, and sausage categories were at least 15% higher in sodium. Compliance with the national sodium targets among all foods increased from 80% in 2015 to 87% in 2018. The results demonstrate that it is feasible to reduce the sodium content in packaged foods in Costa Rica, but more work is needed to continually support a gradual reduction of sodium in packaged foods, including more stringent sodium targets.

Calorie and Nutrient Profile of Combination Meals at U.S. Fast Food and Fast Casual Restaurants.

INTRODUCTION: The nutrient profile of combination meals in large chain restaurants is not well understood. METHODS: Combination meals from 34 U.S. fast food and fast casual restaurants (lunch/dinner, n=1,113; breakfast, n=366) were identified from online menus in 2017-2018 and corresponding nutrition information for each menu item was obtained from a restaurant nutrition database (MenuStat). Three options for each combination meal were analyzed: (1) default (as advertised on menu), (2) minimum (low-calorie option), and (3) maximum (high-calorie option). In 2018, meal nutrient composition was compared with the Healthier Restaurant Meal Guidelines, and linear models examined to what extent each meal component (entrée, side, beverage) drove differences in nutrients across meal options. RESULTS: There was substantial variation across the default, minimum, and maximum options of lunch/dinner combination meals for calories (default,: 1,193 kilocalories;, minimum,: 767 kilocalories;, maximum,: 1,685 kilocalories), saturated fat (14 g, 11 g, 19 g), sodium (2,110 mg, 1,783 mg, 2,823 mg), and sugar (68 g, 10 g, 117 g). Most default meals exceeded the Healthier Restaurant Meal Guidelines for calories (97%) and sodium (99%); fewer exceeded the standards for saturated fat (50%) and total sugar (6%). Comparing the maximum and default lunch/dinner combination meals, beverages were the largest driver of differences in calories (178 kilocalories, 36% of difference) and sugar (46 g, 93% of difference), and entrées were the largest driver of differences in saturated fat (3 g, 59% of difference) and sodium (371 g, 52% of difference). Results were similar for breakfast meals. CONCLUSIONS: Combination meals offered by large U.S. chain restaurants are high in calories, sodium, saturated fat, and sugar, with most default meals exceeding recommended limits for calories and sodium.

Commercially produced complementary foods in Bandung City, Indonesia, are often reported to be iron fortified but with less than recommended amounts or suboptimal forms of iron.

Commercially produced complementary foods (CPCF) that are iron fortified can help improve iron status of young children. We conducted a review of 217 CPCF sold in 42 stores in Bandung, Indonesia, in 2017. There were 95 (44%) infant cereals, 71 (33%) snacks or finger foods (biscuits or cookies, puffs, and noodles or crackers), 35 (16%) purees, and 16 (7%) other foods for which we obtained label information. Nearly 70% of CPCF reported iron content on their labels, but only 58% of products were reported to be fortified with iron according to ingredient lists. Among iron-fortified products, only one fifth indicated a specific type of iron used as the fortificant, but all of these were recommended by the World Health Organization for fortifying complementary foods. Infant cereal was more likely to contain added iron (81%) compared with snacks or finger food (58%) and purees (14%) and had higher iron content per median serving size (cereal = 3.8 mg, snacks or finger food = 1.3 mg, mixed meals = 2.7 mg, and purees = 0.9 mg). Infant cereal was most likely to meet the recommended daily intakes for iron (41% for infants 6-12 months of age and 66% for children 12-36 months) compared with snacks or finger food (infants = 14%, children = 22%), mixed meals (infants = 28%, children = 46%), or purees (infants = 9%, children = 15%). Regulations on fortification of complementary foods need to specify minimum levels and forms of iron and require reporting in relation to requirements by child age and serving size. Monitoring and enforcement of regulations will be essential to ensure compliance.

Condições higiênicossanitárias de alimentos comercializados em food trucks / Hygienic sanitary conditions of food marketed in food trucks

A alimentação em food trucks popularizou-se principalmente no Brasil e ainda é um fenômeno crescente, impulsionado por esse tipo de refeições práticas e rápidas, incentivando o empreendedorismo, o objetivo deste estudo foi avaliar as condições higiênicossanitárias de food trucks da região de Campinas - SP. Os estabelecimentos foram avaliados por meio de aplicação de check list, buscando verificar o nível de conhecimento e as atitudes dos manipuladores em relação à segurança dos alimentos e às práticas de higiene. No total, foram avaliados 15 estabelecimentos, no qual, 10 estabelecimentos se enquadravam no G1 (atendimento dos requisitos de 76% á 100%), 4 estabelecimentos no G2 (51% á 75%) e 1 estabelecimento se enquadrou no G3 (0-50% dos itens atendidos). O estudo demonstrou que os manipuladores estão atentos a necessidade da higienização e segurança dos alimentos, porém treinamentos contínuos são necessários.

Sodium Content of Processed Foods Available in the Mexican Market.

BACKGROUND: Sodium intake is related to several adverse health outcomes, such as hypertension and cardiovascular diseases. Processed foods are major contributors to the population's sodium intake. The aim of the present study was to determine sodium levels in Mexican packaged foods, as well as to evaluate the proportion of foods that comply with sodium benchmark targets set by the United Kingdom Food Standards Agency (UK FSA) and those set by the Mexican Commission for the Protection of Health Risks (COFEPRIS). We also evaluated the proportion of foods that exceeded the Pan American Health Organization (PAHO) targets. METHODS: This was a cross-sectional study that comprised data collected from the package of 2248 processed foods from selected supermarkets in Mexico. RESULTS: Many processed food categories contained an excessive amount of sodium. Processed meats, ham, bacon and sausages, had the highest concentrations. The proportion of foods classified as compliant in our sample was lower for international targets (FSA UK and PAHO) compared to the Mexican COFEPRIS criteria. CONCLUSIONS: These data provided a critical baseline assessment for monitoring sodium levels in Mexican processed foods.

Serving Size and Nutrition Labelling: Implications for Nutrition Information and Nutrition Claims on Packaged Foods.

The presentation of nutrition information on a serving size basis is a strategy that has been adopted by several countries to promote healthy eating. Variation in serving size, however, can alter the nutritional values reported on food labels and compromise the food choices made by the population. This narrative review aimed to discuss (1) current nutrition labelling legislation regarding serving size and (2) the implications of declared serving size for nutrition information available on packaged foods. Most countries with mandatory food labelling require that serving size be presented on food labels, but variation in this information is generally allowed. Studies have reported a lack of standardisation among serving sizes of similar products which may compromise the usability of nutrition information. Moreover, studies indicate that food companies may be varying serving sizes as a marketing strategy to stimulate sales by reporting lower values of certain nutrients or lower energy values on nutrition information labels. There is a need to define the best format for presenting serving size on food labels in order to provide clear and easily comprehensible nutrition information to the consumer.

Compliance in 2017 With Federal Calorie Labeling in 90 Chain Restaurants and 10 Retail Food Outlets Prior to Required Implementation.

OBJECTIVES: To examine early compliance with the delayed federal calorie labeling regulation that requires posting calories on menus and menu boards at retail food chains with 20 or more establishments nationally. METHODS: We explored implementation of calorie labeling at 90 of the largest US chain restaurants and the 10 highest-grossing supermarket chains from May to December 2017. We contacted corporate offices and at least 2 locations for each chain, made site visits when possible, and supplemented these efforts with targeted Internet searches. RESULTS: Overall, 71 (79%) restaurant chains partially or fully implemented labeling, as did 9 (90%) supermarket chains. Fast-food and fast-casual restaurants fully implemented labeling at a modestly higher rate than did full-service restaurants. CONCLUSIONS: Most of the retail food chains we assessed implemented calorie labeling policies in advance of the May 2018 compliance date. Public Health Implications. Although implementation of federal calorie labeling has been delayed repeatedly in the 8 years since the passage of the legislation, retail food chains have demonstrated a high rate of compliance with calorie labeling in advance of the required May 2018 implementation date. Despite reports from some retail food industries that compliance will be difficult, current implementation shows the feasibility of complying.