Food price trends during the COVID-19 pandemic in Brazil.

The present study aims to analyze the trends in food price in Brazil with emphasis on the period of the Covid-19 pandemic (from March 2020 to March 2022). Data from the Brazilian Household Budget Survey and the National System of Consumer Price Indexes were used as input to create a novel data set containing monthly prices (R$/Kg) for the foods and beverages most consumed in the country between January 2018 and March 2022. All food items were divided according to the Nova food classification system. We estimated the mean price of each food group for each year of study and the entire period. The monthly price of each group was plotted to analyze changes from January 2018 to March 2022. Fractional polynomial models were used to synthesize price changes up to 2025. Results of the present study showed that in Brazil unprocessed or minimally processed foods and processed culinary ingredients were more affordable than processed and ultra-processed foods. However, trend analyses suggested the reversal of the pricing pattern. The anticipated changes in the prices of minimally processed food relative to ultra-processed food, initially forecasted for Brazil, seem to reflect the impact of the Covid-19 pandemic on the global economy. These results are concerning as the increase in the price of healthy foods aggravates food and nutrition insecurity in Brazil. Additionally, this trend encourages the replacement of traditional meals for the consumption of unhealthy foods, increasing a health risk to the population.

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.

Role of different nutrient profiling models in identifying targeted foods for front-of-package food labelling in Brazil.

OBJECTIVE: To compare the degree of strictness and agreement of different nutrient profiling models (NPM) used to identify which foods would be required to show front-of-package (FOP) warning labels. DESIGN: Using data of 11 434 packaged foods found in the five largest food retailers in Brazil, we used two published NPM: the Pan American Health Organization (PAHO) model and the NPM used in the Chilean nutritional FOP labelling policy, and compared them with a NPM proposed by the Brazilian National Health Surveillance Agency (Anvisa). The proportion of foods that would be required to show FOP warning labels was calculated overall and by food category. We also tested whether a modified version of the PAHO NPM would behave similarly to the original version. SETTING: Brazil. RESULTS: Two-thirds of the packaged products (62 %) would receive FOP warning labels under the PAHO NPM, as compared with 45 % of products using the proposed Anvisa NPM and 41 % if the Chilean NPM was applied. The PAHO NPM identified more foods high in critical nutrients such as sweetened dairy and non-dairy beverages, canned vegetables and convenience foods. Overall agreement between models was considered good with kappa coefficient ranging from 0·57 to 0·92 but was lower for some food categories. CONCLUSIONS: We found variations in the degree of strictness and agreement between assessed NPM. The PAHO NPM identified more foods and beverages high in sugar which are among the top contributors to sugar and energy intake in Brazil.

Arguments used by trade associations during the early development of a new front-of-pack nutrition labelling system in Brazil.

OBJECTIVE: To analyse the arguments used by the food industry during the early development of the new nutrition front-of-pack labelling (FOPL) in Brazil. DESIGN: A thematic qualitative analysis was performed using an inductive approach. All data were collected and analysed between December 2018 and April 2019. Data included documents published by the Brazilian government, including industry's contributions to a technical public consultation, as well as industry material and newspaper articles. SETTING: Brazil. PARTICIPANTS: Seven trade associations and one industry group. RESULTS: During the early stages of the FOPL policy development, food industry actors presented themselves as legitimate actors, by highlighting their economic contribution to the country, their role in safeguarding consumers' right to choose and their range of solutions in addressing the non-communicable disease epidemic. They also questioned the policy process by criticising the role of the Brazilian Health Regulatory Agency and the science that informed the policy. Finally, food industry actors highlighted the supposedly lack of coherence between national, regional and international policies, as well as other socio-economic risks. A small set of evidence published in non-academic, non-peer-reviewed reports was used by industry actors to support these arguments. CONCLUSIONS: Collectively, these arguments reinforced the position of the food industry as a necessary part of the discussion on FOPL and shifted the blame away from unhealthy products to individual behaviours. It is crucial that public health initiatives, such as the introduction of a new FOPL, are no co-opted and negatively influenced by economic actors who may try to delay the policy process.

Analysing persuasive marketing of ultra-processed foods on Brazilian television.

OBJECTIVES: This study investigated the use of persuasive advertising strategies in ultra-processed food (UPF) advertisements broadcast on the three most popular free-to-air television channels in Brazil. METHODS: The programming of the selected channels was recorded on eight non-consecutive days from April 2018 (6:00 am-12:00 am). Information from each advertising piece was collected through an electronic questionnaire based on the INFORMAS protocol. Food products were classified according to the NOVA classification system. Marketing strategies were investigated in UPF advertisements and stratified into three groups. Principal component analysis was used to identify patterns of strategies. Linear regression models were employed to investigate the association between the patterns and food groups. RESULTS: In total, 90.77% of the food-related advertisements contained at least one UPF, and 96% of them included one or more persuasive advertising strategies. Five advertising patterns were identified and associated with the UPF food groups. CONCLUSIONS: The results showed that food advertising on Brazilian free television is marked by UPF, with the predominant use of persuasive advertising strategies, demonstrating a lack of enforcement of the current regulatory legislation in the country.

What to expect from the price of healthy and unhealthy foods over time? The case from Brazil.

OBJECTIVE: To measure change in price of food groups over time (1995-2030) in Brazil, considering the Brazilian Dietary Guidelines' recommendations. DESIGN: Data from the Household Budget Survey (2008-2009 HBS) and the National System of Consumer Price Indexes (NSCPI) were used to create a data set containing monthly prices for the foods and beverages most consumed in the country (n 102), from January 1995 to December 2017. Data on price of foods and beverages from 2008-2009 HBS (referring to January 2009) were used to calculate real price over time using the monthly variation in prices from NSCPI. All prices were deflated to December 2017. Foods and beverages were classified following the Brazilian Dietary Guidelines' recommendations. The monthly price for each food group and subgroup was used to analyse changes in prices from 1995 to 2017 and to forecast prices up to 2030 using fractional polynomial models. SETTING: Brazil. PARTICIPANTS: National estimates of foods and beverages purchased for Brazil. RESULTS: In 1995, ultra-processed foods were the most expensive group (R$ 6·51/kg), followed by processed foods (R$ 6·44/kg), then unprocessed or minimally processed foods and culinary ingredients (R$ 3·45/kg). Since the early 2000s, the price of ultra-processed foods underwent successive reductions, becoming cheaper than processed foods and reducing the distance between it and the price of the other group. Forecasts indicate that unhealthy foods will become cheaper than healthy foods in 2026. CONCLUSIONS: Food prices in Brazil have changed unfavourably considering the Brazilian Dietary Guidelines' recommendations. This may imply a decrease in the quality of the population's diet.

Consumers' opinions on warning labels on food packages: A qualitative study in Brazil.

This study aimed to assess consumers' uses of and opinions on the current Brazilian food label and their reaction to the introduction of a front-of-package warning label. We conducted 12 focus groups among a diverse sample of adult consumers, to broadly assess: (1) uses of and perceptions about the current food label, and (2) opinions about implementing a front-of-package warning label to guide food purchases. Data was analyzed with a triangulation of researchers using an exploratory content analysis, which allowed codes to emerge from the data. The frequency of codes across focus groups was compared by gender and socioeconomic status to explore differences by these sociodemographic factors. Codes were divided into six main themes: (1) "Reasons for using food labels"; (2) "Barriers to using food labels"; (3) "Requirements for a new label"; (4) "Perceived influence on consumption behaviors"; (5) "Perceived influence on child behaviors"; and (6) "Perceptions of the food manufacturers using of warning labels". Participants used food labels to check nutrient content and ingredient information but the format of these labels and the technicality of the content displayed often made the information inaccessible, particularly for those with low socioeconomic status. Most participants were supportive of the display of front-of-package warning labels on products and considered them useful to inform purchases. Women believed that they and their children would reduce the consumption of foods with front-of-package warning labels, while men reported more polarity in their intentions. For men and their children, front-of-package warning labels would result in either stopping food intake entirely or continued consumption without changes to the amount. The study results highlight the potential of front-of-package warning labels to support healthier behaviors in both consumers and their children.

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.