Effectiveness of alcohol warning labels for at-risk groups and the general public: A policy-informing randomized experiment in Chile.

OBJECTIVE: The World Health Organization recommends using health-risk warnings on alcoholic beverages. This study examines the impact of separate or combined warning labels for at-risk groups and the general population on alcohol purchase decisions. METHODS: In 2022, 7758 adults who consumed alcohol or were pregnant/lactating women (54.0 % female, mean age = 40.6 years) were presented with an online store's beverage section and randomly assigned to one of six warning labels in a between-subjects experimental design: no-warning, pregnant/lactating, drinking-driving, general cancer risk, combined warnings, and assorted warnings across bottles. The main outcome, the intention to purchase an alcoholic vs. non-alcoholic beverage, was examined with adjusted risk differences using logistic regressions. RESULTS: Participants exposed to the general cancer risk warning decreased their alcoholic choices by 10.4 percentage points (pp.) (95 % CI [-0.139, -0.069], p < 0.001, OR = 0.561), while those in the pregnancy/lactation warning condition did it by 3.8 pp. (95 % CI [-0.071, -0.005], p = 0.025, OR = 0.806). The driving-drinking warning had no significant effect. Participants exposed to the combined warnings label, or the assorted warnings reduced alcohol purchase decisions by 6.1 pp. (95 % CI [-0.095, -0.028], p < 0.001, OR = 0.708) and 4.3 pp. (95 % CI [-0.076, -0.010], p = 0.011, OR = 0.782), respectively. Cancer warning outperformed other labels and was effective for subgroups such as pregnant/lactating women, young adults, and low-income individuals. CONCLUSIONS: General cancer risk warnings are more effective at reducing alcohol purchase decisions compared to warning labels for specific groups or labels using multiple warnings. In addition to warning labels, other policies should be considered for addressing well-known alcohol-related risks (e.g., drinking and driving).

Self-reported decreases in the purchases of selected unhealthy foods resulting from the implementation of warning labels in Mexican youth and adult population.

BACKGROUND: Front-of-package nutritional warning labels (WLs) are designed to facilitate identification and selection of healthier food choices. We assessed self-reported changes in purchasing different types of unhealthy foods due to WLs in Mexico and the association between the self-reported reductions in purchases of sugary beverages and intake of water and sugar-sweetened beverages. METHODS: Data came from 14 to 17 year old youth (n = 1,696) and adults ≥ 18 (n = 7,775) who participated in the Mexican arm of the 2020-2021 International Food Policy Study, an annual repeat cross-sectional online survey. Participants self-reported whether the WLs had influenced them to purchase less of each of nine unhealthy food categories due to WLs. Among adults, a 23-item Beverage Frequency Questionnaire was used derive past 7-day intake of water and sugary beverages analyzed to determine the relationship between self-reported reductions in purchasing sugary drinks due to the WLs. Multilevel mixed-effects logistic regression models were fitted to estimate the percentage of participants who self-reported reducing purchases within each food group, and overall. Sociodemographic characteristics associated with this reduction were investigated as well. RESULTS: Overall, 44.8% of adults and 38.7% of youth reported buying less of unhealthy food categories due to the implementation of WL, with the largest proportion reporting decreased purchases of cola, regular and diet soda. A greater impact of WLs on the reported purchase of unhealthy foods was observed among the following socio-demographic characteristics: females, individuals who self-identified as indigenous, those who were overweight, individuals with lower educational levels, those with higher nutrition knowledge, households with children, and those with a significant role in household food purchases. In addition, adults who reported higher water intake and lower consumption of sugary beverages were more likely to report reduced purchases of sugary drinks due to the WLs. Adults who reported greater water intake and lower sugary beverages intake were significantly more likely to report buying fewer sugary drinks due to the WLs. CONCLUSION: Our findings suggest that implementation of WLs has reduced perceived purchases of unhealthy foods in Mexico. These results underscore the potential positive impact of the labeling policy particularly in subpopulations with lower levels of education and among indigenous adults.

Pragmatic Carbohydrate Quality Metrics in Relation to Glycemic Index, Glycemic Load, and Front-of-Pack Warning Labels in Grain Foods.

The challenges in the characterization of the nutritional quality of grain foods comprise obstacles to public health actions toward promotion of healthier grain-based foods. The present study investigated how carbohydrate metrics related to glycemic index (GI), glycemic load (GL), and warning labels of grain foods consumed by individuals living in São Paulo, Brazil. Information on intake of grain foods at individual level was obtained using 24 h recalls within a cross-sectional population-based survey conducted in 2015. There were 244 unique grain products reported by individuals in the survey, assessed through four metrics of carbohydrate quality, considering contents per 10 g of total carbohydrate: (1) ≥1 g fiber, (2) ≥1 g fiber and <1 g free sugars, (3) ≥1 g fiber and <2 g free sugars, and (4) ≥1 g fiber, and <2 g free sugars per 1 g of fiber. Outcomes included GI, GL, and inclusion of warning labels proposed by the Brazilian National Health Surveillance Agency (ANVISA), the Chilean Ministry of Health (1st and 3rd stages), and the Pan American Health Organization (PAHO). Metrics identified products with lower mean GI (-12.8 to -9.0 [p-values < 0.001]), and GL (-12.5 to -10.3 [p-values < 0.001]). Warning systems showed a certain degree of discrimination between products according to the metrics (p-value < 0.01 each); however, >50% of products with good nutritional quality according to the carbohydrate metrics still would receive warnings. Findings suggest that carbohydrate metrics identified products with lower GI and GL, and current warning labels may not adequately capture overall nutritional quality of grain foods.

Fruitful changes? Exploring household fruit purchase decisions following comprehensive food policy regulations in Chile.

Changes in unprocessed healthy food purchases associated with the implementation of comprehensive food policy remain understudied. This study analyzes whether, following the announcement, modification, and implementation of Chile's Food Labeling and Advertising law targeting highly processed food (occurring in 2012, 2015, and 2016, respectively), households improved their fruit purchase decisions: purchase participation (i.e., buying likelihood) and purchase quantity. Expenditure data from a representative sample of Chilean households were employed, covering two consecutive survey waves conducted in 2011/2012 and 2016/2017. After controlling for socioeconomic factors (e.g., prices and income), results indicate that only purchase participation increased, providing weak support for positive spillover effects of a comprehensive food policy on fruit purchases. Subsample analyses reveal that this increase was driven by college-educated, childless, and low-income households and was stronger for sweeter and more convenient fruits. Considering that households in Chile do not meet health recommendations for daily fruit intake, additional policy efforts targeting healthy, unprocessed food consumption could be considered.

Robust Deep Neural Network for Learning in Noisy Multi-Label Food Images.

Deep networks can facilitate the monitoring of a balanced diet to help prevent various health problems related to eating disorders. Large, diverse, and clean data are essential for learning these types of algorithms. Although data can be collected automatically, the data cleaning process is time-consuming. This study aims to provide the model with the ability to learn even when the data are not completely clean. For this purpose, we extend the Attentive Feature MixUp method to enable its learning on noisy multi-label food data. The extension was based on the hypothesis that during the MixUp phase, when a pair of images are mixed, the resulting soft labels should be different for each ingredient, being larger for ingredients that are mixed with the background because they are better distinguished than when they are mixed with other ingredients. Furthermore, to address data perturbation, the incorporation of the Laplace approximation as a post-hoc method was analyzed. The evaluation of the proposed method was performed on two food datasets, where a notable performance improvement was obtained in terms of Jaccard index and F1 score, which validated the hypothesis raised. With the proposed MixUp, our method reduces the memorization of noisy multi-labels, thereby improving its performance.

Sticky Multicolor Mechanochromic Labels.

Sticky-colored labels are an efficient way to communicate visual information. However, most labels are static. Here, we propose a new category of dynamic sticky labels that change structural colors when stretched. The sticky mechanochromic labels can be pasted on flexible surfaces such as fabric and rubber or even on brittle materials. To enhance their applicability, we demonstrate a simple method for imprinting structural color patterns that are either always visible or reversibly revealed or concealed upon mechanical deformation. The mechanochromic patterns are imprinted with a photomask during the ultraviolet (UV) cross-linking of acrylate-terminated cholesteric liquid crystal oligomers in a single step at room temperature. The photomask locally controls the cross-linking degree and volumetric response of the cholesteric liquid crystal elastomers (CLCEs). A nonuniform thickness change induced by the Poisson's ratio contrast between the pattern and the surrounding background might lead to a color-separation effect. Our sticky multicolor mechanochromic labels may be utilized in stress-strain sensing, building environments, smart clothing, security labels, and decoration.

Quantitative Peptidomics Using Reductive Methylation of Amines.

A number of different approaches have been used for quantitative peptidomics. In this protocol, we describe the method in which peptides are reacted with formaldehyde and sodium cyanoborohydride, which converts primary and secondary amines into tertiary amines. By using different combinations of regular reagents, deuterated reagents (2H), and reagents containing deuterium and 13C, it is possible to produce five isotopically distinct forms of the methylated peptides, which can be quantified by mass spectrometry. Peptides with free N-termini that are primary amines incorporate two methyl groups using this procedure, which differ by 2 Da for each of the five isotopic combinations. Peptides that contain unmodified lysine residues incorporate additional pairs of methyl groups, leading to larger mass differences between isotopic forms. The reagents are commercially available, relatively inexpensive, and chemically stable.

Evaluation of marketing authorization and labels of medicines in 2021 WHO Model List of Essential Medicines for Children in China, the Russian Federation and Brazil.

OBJECTIVE: This work compares the marketing authorization, labels and dosage forms of medicines in the WHO Model List of Essential Medicines for Children (EMLc) in China, the Russian Federation and Brazil to urge policymakers to pay more attention to paediatric medication. METHODS: Medicines were selected from the 8th EMLc. By searching relevant databases, which include different types of medical information in China, the Russian Federation and Brazil, the marketing authorization, labels and dosage forms of paediatric medicines in the three countries were evaluated. RESULTS: A total of 485 drug products containing 312 active pharmaceutical ingredients listed in the WHO EMLc were evaluated. Among them, 344 products were approved for use in China, 286 in the Russian Federation and 264 in Brazil. Out of the 344 approved medicines, 317 (92.15%) were authorized for paediatric use in China, 224 (78.32%) in the Russian Federation and 218 (82.58%) in Brazil. In terms of guidance information labelling on drug labels, 75.08%, 83.04% and 88.07% of paediatric drugs approved in China, the Russian Federation and Brazil, respectively, clearly indicated the usage and dosage for paediatric use. Additionally, injections and tablets were the most prevalent dosage forms in these three countries. CONCLUSION: There is still scope for enhancing the marketing authorization and development of dosage forms for paediatric medicines in the three countries. Furthermore, additional measures are being implemented to enhance the information provided on drug labels for children, particularly in China.

Perspective: Mexico's Experience in Building a Toolkit for Obesity and Noncommunicable Diseases Prevention.

Noncommunicable diseases (NCDs) are a leading cause of death and disability worldwide, with a higher risk of death in low- and middle-income countries. Diet and excess weight are risk factors for NCDs. In Mexico, the prevalence of overweight and obesity increased dramatically in the last 30 y and is among the highest in the world. To address this public health problem, governments and public health professionals have several policy instruments available. In this study, we present the policy instruments currently approved in Mexico, which include fiscal, informational, and authoritative tools that aim to improve the food environment and promote healthy behaviors (taxes, school food guidelines, front-of-pack labeling, marketing regulations, and dietary guidelines). These types of interventions are important in regions like Latin America, where social inequities and poor access to information are common, and individual healthy choices are often limited. These interventions target the environments in which individuals live, study, work, and seek entertainment, while limiting access to unhealthy choices and offering information to promote healthy alternatives. The Mexican experience in design, implementation, and evaluation of policies to improve the food environment can be useful for other low- and middle-income countries facing similar challenges.

Advertising and Eco-Labels as Influencers of Eco-Consumer Attitudes and Awareness-Case Study of Ecuador.

This study examined the impact of green advertising and eco-labels on the attitudes and environmental awareness of millennials purchasing eco-friendly products in shopping centers across Ecuador. The research utilized a quantitative, correlational, cross-sectional methodology with 430 millennials participating. A 20-item survey was administered face-to-face at shopping centers in Quito and Guayaquil, Ecuador. The validity of the research model was established through Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM), employing SPSS 20 and AMOS 24 for statistical evaluations. Findings reveal that green advertising significantly shapes environmental attitudes (ß: 0.245) and awareness (ß: 0.110), as well as directly influences the purchasing behavior (ß: 0.154) towards green products. While eco-labels do not exert a direct effect on purchasing behavior (ß: 0.128), they significantly inform attitudes (ß: 0.406) and ecological awareness (ß: 0.277) of millennials who purchase organic products. This paper is among the pioneering research to delineate the correlation between green advertising elements and the purchasing patterns of green products among millennials in a developing nation. It concludes that marketing strategies centered on green advertising and eco-labels do affect millennials' attitudes and environmental consciousness, but only advertising has a direct impact on purchasing behaviors, contrary to eco-labels. The research bears social significance as it affirms that millennials are attentive to environmental issues and are actively engaged in promoting sustainability.

Assessing transnational spillover effects of Mexico's front-of-package nutritional labeling system among Mexican Americans in the US.

OBJECTIVE: In 2020, Mexico implemented innovative front-of-package nutrition warning labels (FoPWLs) for packaged foods to increase the salience and understanding of nutrition information. This study evaluated Mexican Americans' self-reported exposure to Mexican FoPWLs and self-reported effects of FoPWLs on purchasing behavior. METHODS: The 2021 International Food Policy Study surveyed online panels of adult Mexican Americans in the US (n = 3361) to self-report on buying food at Mexican-oriented stores, noticing Mexican FoPWLs, and being influenced by FoPWLs to purchase less of eight different unhealthy foods (each assessed separately). After recoding the frequency of buying foods in Mexican stores and noticing FoPWLs (i.e., "often" or "very often" vs. less often), logistic models regressed these outcomes on sociodemographics, adjusting for post-stratification weights. RESULTS: Most participants (88.0%) purchased foods in Mexican stores. Of these, 64.1% reported noticing FoPWLs, among whom many reported that FoPWLs influenced them to buy fewer unhealthy foods (range = 32% [snacks like chips] - 44% [colas]). Participants were more likely to buy foods in Mexican stores and notice FoPWLs if they were younger, had ≥two children at home vs no children (AOR = 1.40, 95%CI = 1.15-1.71; AOR = 1.37, 95%CI = 1.03-1.80, respectively), and more frequently used Spanish (AOR = 1.91, 95%CI = 1.77-2.07; AOR = 1.87, 95%CI = 1.69-2.07). Also, high vs. low education (AOR = 1.51, 95%CI = 1.17-1.94) and higher income adequacy (AOR = 1.37, 95%CI = 1.25-1.51) were positively associated with noticing FoPWLs. Being female and more frequent Spanish use were consistently associated with reporting purchase of fewer unhealthy foods because of FoPWLs. CONCLUSIONS: Many Mexican Americans report both exposure to Mexican FOPWLs and reducing purchases of unhealthy foods because of them.

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.

Tautological formal explanations: does prior knowledge affect their satisfiability?

It is known that formal explanations with categorical labels are more satisfying than explicit tautologies. However, would they still be more satisfying if they are implicitly tautological themselves? In two experiments, we compared the degree of satisfaction between tautological formal explanations, explicit tautologies, and proper explanations. Additionally, we examined whether participants knew the correct definitions for the labels used in the formal explanations. Finally, we asked whether cultural and linguistic differences can play a role in the treatment of formal explanations with categorical labels. To this end, the first experiment involved Chilean students (N = 50), and the second experiment involved Russian students (N = 51). It was found that formal explanations, despite their intentional tautology, were still rated as more convincing compared to explicit tautologies (but less convincing than proper explanations). Furthermore, this effect did not depend on participants' previous knowledge (the label's definitions) or linguistic and cultural background. Taking all this into account, we consider this effect as a relatively universal psychological phenomenon and relate our findings to existing theories of formal explanations.

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.

Video-Based Human Activity Recognition Using Deep Learning Approaches.

Due to its capacity to gather vast, high-level data about human activity from wearable or stationary sensors, human activity recognition substantially impacts people's day-to-day lives. Multiple people and things may be seen acting in the video, dispersed throughout the frame in various places. Because of this, modeling the interactions between many entities in spatial dimensions is necessary for visual reasoning in the action recognition task. The main aim of this paper is to evaluate and map the current scenario of human actions in red, green, and blue videos, based on deep learning models. A residual network (ResNet) and a vision transformer architecture (ViT) with a semi-supervised learning approach are evaluated. The DINO (self-DIstillation with NO labels) is used to enhance the potential of the ResNet and ViT. The evaluated benchmark is the human motion database (HMDB51), which tries to better capture the richness and complexity of human actions. The obtained results for video classification with the proposed ViT are promising based on performance metrics and results from the recent literature. The results obtained using a bi-dimensional ViT with long short-term memory demonstrated great performance in human action recognition when applied to the HMDB51 dataset. The mentioned architecture presented 96.7 ± 0.35% and 41.0 ± 0.27% in terms of accuracy (mean ± standard deviation values) in the train and test phases of the HMDB51 dataset, respectively.

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.

Promotion of ultra-processed foods in Brazil: combined use of claims and promotional features on packaging

ABSTRACT OBJECTIVE To assess the availability of different promotional strategies applied for UPF sales in Brazilian food retailers. METHODS Information available on food packaging was gathered from all packaged products sold in the five largest food retail chains in Brazil in 2017. UPF were identified using the NOVA food classification system. From this sample, data related to promotional characteristics, nutrition claims and health claims were collected and coded using the INFORMAS methodology. Additional claims referring to the Brazilian Dietary Guidelines were also collected. RESULTS This study evaluated the packaging of 2,238 UPF, of which 59.8% presented at least one promotional strategy. Almost one third denoted a simultaneous use of different promotional strategies in the same packaging. Nutrition claims were the most commonly found promotional strategy, followed by health claims and the use of characters. The food subgroups comprising the highest prevalence of promotional strategies on their labels were: noncaloric sweeteners (100.0%), breakfast cereals and granola bars (96.2%), juices, nectars and fruit-flavoured drinks (92.9%), other unsweetened beverages (92.9%), and other sweetened beverages (92.6%). CONCLUSIONS Considering the poor nutritional quality of UPF, the widespread presence of promotional features on their packaging highlights the need for marketing restrictions on this kind of product.

Mortality prediction of the nutrient profile of the Chilean front-of-pack warning labels: Results from the Seguimiento Universidad de Navarra prospective cohort study.

Background and aims: Front-of-Pack (FoP) nutrition labelling has been established as a policy, empowering consumers to choose healthy food options for preventing diet-related non-communicable diseases. This study aimed to evaluate the association between the nutrient profile underlying the Chilean warning label score and all-cause mortality and to conduct a calibration with the Nutri-Score in a large cohort of Spanish university graduates. Materials and methods: This prospective cohort study analysed 20,666 participants (8,068 men and 12,598 women) with a mean (standard deviation) age of 38 years (±12.4) from the SUN cohort. Dietary food intake was assessed by a validated semi-quantitative food-frequency questionnaire at baseline and after 10 years of follow-up. The warning label score was calculated by considering the threshold of nutrients (sugar, saturated fat, and sodium) and energy density per 100 g/ml of product, as established by Chilean Legislation. Participants were classified according to quartiles of consumption of daily label score: Q1 (≤5.0), Q2 (>5.0-7.1), Q3 (>7.1-9.8), and Q4 (>9.8). Time-dependent, multivariable-adjusted Cox models were applied. To compare the performance of the warning label score and Nutri-Score to predict mortality, we used the Akaike information criterion (AIC) and Bayesian information criterion (BIC) methods. Results: During a median of 12.2 years of follow-up, 467 deaths were identified. A higher score in the warning label values (lower nutritional quality) was associated with an increased risk of all-cause mortality [HR (95% CI) Q4 vs. Q1: 1.51 (1.07-2.13); p-trend = 0.010] and cancer mortality [HR (95% CI) Q4 vs. Q1: 1.91 (1.18-3.10); p-trend = 0.006]. However, no statistically significant association was found for cardiovascular mortality. Furthermore, the warning label score and Nutri-Score exhibited comparable AIC and BIC values, showing similar power of prediction for mortality. Conclusion: A diet with a higher warning label score (>9.8 per day) was a good predictor of all cases and cancer mortality in a large Spanish cohort of university graduates. Also, the warning label score was capable to predict mortality as well as the Nutri-Score. Our findings support the validity of the warning label score as a FoP nutrition labelling policy since it can highlight less healthy food products.

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.

Marketing techniques, health, and nutritional claims on processed foods and beverages before and after the implementation of mandatory front-of-package warning labels in Peru.

In June 2019, mandatory front-of-package warning labels (FOPL) were implemented in Peru. The aim of the study was to describe changes in marketing strategies on packaging: marketing techniques (MT), health claims (HC), and nutritional claims (NC) on the packaging of products frequently consumed by children before and after the FOPL implementation. Product photos were taken pre- (March 2019) and post-implementation (March-October 2020) in three supermarkets in Lima, Peru. Following INFORMAS protocols and Peruvian Technical Norms, the presence of MT, HC, and NC was assessed on all package sides. Products were classified as "high-in" and "not high-in" based on the regulation threshold for critical nutrients. Differences in the proportion of products with each strategy in both periods were evaluated. Also, a subsample of products was matched according to the barcode and exact McNemar test was used to compare proportions of strategies pre/post-implementation. We included 883 and 1,035 products in pre- and post-implementation, respectively. In both periods, MT appeared on almost 70% of all products. The presence of HC increased significantly only for beverages (24.5-38.1%, p < 0.001). In both phases, NC were commonly used on beverages (>80%). Overall, the prevalence of "high-in" products using MT increased (73.6-82.1%, p = 0.007), while use of HC increased among "not high-in" products (32.9-41.6%, p < 0.001). There is a high frequency of MT on all products and NC on beverages. The increase in MT in "high-in" products may be an industry response to minimize the impact of the FOPL on food choices and sales. New regulatory aspects regarding labeling should be implemented to strengthen the current policy.