Influence of qualitative menu labeling on diners' food choices: A controlled quasi-experiment in self-service buffet restaurants.

Menu labeling is a strategy to promote healthier food choices in restaurants. This study aimed to analyze the influence of a qualitative menu labeling on the healthfulness of diners' food choices in self-service buffet restaurants. A controlled quasi-experiment comparing parallel groups at baseline and intervention periods was conducted in a control restaurant and an intervention restaurant. Qualitative labels provided information on the name and ingredients list of the dish, highlighting the use of organic vegetables. The same food menu was served in both restaurants. Menu labeling was implemented at the intervention restaurant for six dishes each day, three considered healthier and three less healthy. Dishes were weighed at the beginning and at the end of the service to estimate the average portion size (g) of diners, during five consecutive days at baseline and intervention. Diners who had lunch at the intervention restaurant were invited to participate in a survey on the use of menu labels. Of the 153 interviewed diners, 31% reported noticing menu labels. Of these, 57% said menu labeling had influenced their food choices at the restaurant. No changes in portion sizes were observed between baseline and intervention periods within control and intervention restaurants. However, it was found that the provision of qualitative menu labeling sparked the interest of restaurant managers in improving meal quality and modifying recipes to eliminate ultra-processed ingredients. Thus, the implementation of the proposed menu labeling model can promote healthier food choices through the reformulation of culinary recipes. However, it is essential to adopt strategies to enable its direct impact.

Estado de las Políticas de regulación para el consumo de azúcar y para la comida chatarra en 3 países de América Latina / Regulatory policies for sugar consumption and junk food in 3 Latin American countries

Introducción: El consumo de bebidas azucaradas y alimentos no saludables es un problema de Salud Pública y de las Políticas Públicas que buscan reducir el impacto de las Enfermedades No Trasmisibles (ENT) en América Latina. Objetivo: identificar las Políticas Públicas generadas en Colombia, Argentina y Chile para la regulación del consumo de azúcar y comida chatarra. Materiales y Métodos: Análisis exploratorio a través de una revisión de literatura y revisión de documentos normativos. Resultados: Colombia en el año 2021 sancionó la Ley 2120 denominada "Ley de Comida Chatarra", que promueve el acceso a información necesaria para fomentar entornos alimentarios saludables y prevenir las ENT, que incluye nuevas normas para el etiquetado de alimentos y describir sus características al consumidor y así limitar el consumo de alimentos procesados y ultraprocesados. Chile fue pionero en el desarrollo de los sellos de advertencia y desde el año 2014, aplica un impuesto adicional a las bebidas no alcohólicas. Argentina en 2021, sancionó la ley que obliga a la industria de alimentos a disponer de etiquetas en los envases que alerten al consumidor sobre los excesos de azúcares, grasas y sodio Conclusiones: Los tres países investigados cuentan con políticas de etiquetado de alimentos procesados, y en Chile existen impuestos a las bebidas azucaradas. Es importante estudiar el impacto de dichas políticas en la prevalencia y severidad de las ENT y de la caries.

Abstract: The consumption of sugar-sweetened beverages and unhealthy foods is a public health problem that has become a regulatory issue for the public policies aimed at reducing the impact of Non Communicable Diseases (NCDs) in Latin America. Objective: to identify the Public Policies in Colombia, Argentina and Chile for the regulation of the consumption of sugar and junk food. Materials and methods. Exploratory analysis through a literature and policy documents review. Results: In 2021, Colombia approved the Law 2120 called "Junk Food Law" promoting public access to information for a healthy food environment to prevent NCDs. It includes food labeling for overweight and obesity prevention and establishes a specific labeling regulation for processed and ultra-processed food and sweet drink products. Chile was pioneer in the development of warning stamps on food packages and since 2014 also taxes sweet non-alcoholic beverages. In 2021, Argentina approved a law to add labels on food packages to alert consumers about excess of sugars, fats and sodium. Conclusions: The three investigated countries have labeling policies for processed food, and Chile puts taxes on sugary drinks. It is important to study the impact of these policies on NCD prevalence, severity and on dental caries.

"I Like the One With Minions": The Influence of Marketing on Packages of Ultra-Processed Snacks on Children's Food Choices.

Objective: This study aimed to assess the most consumed school snacks using the free listing and understand how marketing strategies on food labels influenced children's perceptions of snacks via focus groups. Design: The study design involved free lists and semi-structured focus group interviews. Setting: São Paulo, Brazil. Participants: A total of 69 children were involved in this study. Phenomenon of Interest: Children's perceptions of food labels. Analysis: Food groups mentioned on the free lists were analyzed for their frequency and priority of occurrence. The focus groups were analyzed through content analysis. Results: Juices and chips were the most salient snacks, with availability and flavor as reasons for their consumption. Children found images on labels appealing, which created a desire for the food, although could be deceptive. Snacks perceived as healthy were encouraged by parents, and children could more easily convince them to buy snacks with health claims. Colors and brands were important to catch children's attention and make the snack recognizable. Television commercials and mascots reinforced marketing strategies on labels. Conclusions and Implications: Our results point to the need for public health strategies to deal with the obesity epidemic through creating and implementing specific legislation to regulate food labels to discourage the consumption of unhealthy snacks and prohibit food marketing targeted at children.

Brazilian Consumers' Perception towards Food Labeling Models Accompanying Self-Service Foods.

The study aimed to evaluate consumers' perception of self-service foods' nutrition labels. This qualitative and quantitative assessment was performed with potential consumers at food services. Four food labeling formats, traditional, simplified, traffic-light, and warning, were proposed to evaluate three types of sandwiches: simple, chicken, and hamburger. Data were collected via an online survey from April to May 2020. The study included 413 subjects. The respondents preferred the traffic-light format, but there was a good understanding and acceptability of all four models. The traffic-light and warning nutrition labeling models, which showed health warnings, led to a reduction in the choice of the Simple Sandwich and the Hamburger. Most respondents (96.1%, n = 397) agreed that it is necessary to complement the information on food labels with ingredients and the number of calories per serving. Therefore, it is essential to have legislation regulating such issues. Consumers' choices improved with the increase in the information placed on the products. This research demonstrated that nutrition labels explain what exists currently and that consumers require such information. Thus, food labeling may positively influence consumers' choices.

Influence of sugar label formats on consumer understanding and amount of sugar in food choices: a systematic review and meta-analyses.

CONTEXT: Reducing population intakes of sugar has become a focus of many national and international public health policies. Packaged foods and beverages are key contributors to sugar intakes, and food labels can be an effective tool to reduce sugar consumption. OBJECTIVE: The aim of this systematic review was to examine the influence of sugar label formats on 2 outcomes: consumers' understanding of sugar information, and the amount of sugar in consumers' food choices. DATA SOURCES: Scopus, Web of Science, PubMed, CAB Abstracts, SciELO, and the Cochrane Library databases were searched up until February 4, 2020. STUDY SELECTION: Randomized experiments or quasi-experiments were included if they investigated the influence of sugar label formats on consumers' understanding of sugar information or on the amount of sugar in consumers' food choices. DATA EXTRACTION: Data were extracted independently by 2 authors. Mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs) plus 95%CIs were used to describe between-group differences for intervention label formats using random-effects models. RESULTS: Twenty-three studies, which examined 39 comparisons, were included. Label formats using "high in sugar" interpretative texts (traffic light labels [MD 41.6; 95%CI 37.9-45.4] and warning signs [OR 1.33; 95%CI 1.0-1.78]) were most effective in increasing consumers' understanding of the sugar content in packaged foods. Health warning messages (SMD -0.32; 95%CI -0.43 to -0.22), graphical depictions of sugar content in teaspoons (SMD -0.32; 95%CI -0.48 to -0.17), and warning signs (SMD -0.24; 95%CI -0.35 to -0.13) were most effective for influencing consumers to choose products with lower sugar content. CONCLUSIONS: Formats that provide an interpretation of sugar information, particularly those indicating if a product is high in sugar, were more helpful than only numerical information for improving consumer understanding and promoting food choices with less sugar. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42018081222.

Supermarket Circulars Promoting the Sales of 'Healthy' Foods: Analysis Based on Degree of Processing.

The health and wellness food sector grew 98% from 2009 to 2014 in Brazil, the world's fourth-biggest market. The trend has reached supermarket circulars, which recently started to feature whole sections advertising health and wellness-enhancing foods. This study identified food items advertised in circulars' specific sections of two Brazilian supermarket chains (one regional, one national) during a 10-week period. Foods were classified according to degree of food processing and presence/type of claims on their front-of-pack (FoP) labels. Comparison between groups of Unprocessed/Minimally Processed foods vs. Ultra-processed foods and presence/type of claims employed Pearson chi-square test. From the 434 alleged health and wellness-enhancing foods advertised, around half (51.4%) were classified as Ultra-processed. Presence of reduced and increased nutrient-content claims was significantly higher in labels of Ultra-processed foods. Most frequent claims addressed sugar and fibre content. Brazilian supermarket circulars were found to be promoting the sale of Ultra-processed foods in their health and wellness sections, leading to a situation that can mislead the consumer and bring negative health outcomes.

Actitudes de madres de preescolares ante la implementación de la ley de etiquetado nutricional en Chile / Attitudes of mothers of preschools in the implementation of the nutritional labeling law in Chile

Debido a los cambios en los estilos de vida y su reflejo en la prevalencia de malnutrición por exceso a nivel mundial, en Chile (2016) se aprobó la Ley sobre Composición de los Alimentos y su Publicidad. El objetivo de este estudio fue determinar las actitudes alimentarias en madres de preescolares de distinto nivel socioeconómico y el estado nutricional de sus hijos, frente a la publicidad de alimentos y bebidas a través de distintas formas de promoción comercial, así como su actitud ante la Ley 20.606. Se aplicó una encuesta validada, la cual incluye preguntas sobre las etiquetas en los envases de los alimentos. Se realizó un análisis descriptivo de las variables y se determinó si existía diferencias entre la distribución de las respuestas según NSE mediante la prueba Chi2 .Al consultar los lugares en los que han visto publicidad de alimentos, 72% de las madres refiere haberla visto en los supermercados y 48,5% en internet. Sólo 34, 8% refirió recordar algún comercial en particular, y al solicitarles que especificaran el comercial que recordaban, 45,3% nombró alguna bebida azucarada y 13,6% alguna de yogurt. Respecto a los sellos de advertencia presentes en los envases de los alimentos, 87% declaró que les gustaban o les parecían bien. Sólo 43,6% respondió que había dejado de comprar alimentos con dichos sellos. Estos resultados serán útiles para el diseño de intervenciones específicas para este importante grupo, ya que un cambio positivo en sus conductas actuales podría repercutir en la creación de hábitos saludables en sus hijos e hijas(AU)

Due to changes in lifestyles and its reflection on the worldwide prevalence of malnutrition due to excess, in Chile (2016) the Law on Food Composition and its Advertising was approved. The objective of this study was to determine the nutritional attitudes of 509 mothers of preschoolers of different socioeconomic levels and the nutritional status of their children, in front of the advertising of food and beverages through different forms of commercial promotion, as well as their attitude towards Law 20,606. A validated survey was applied, which includes questions about labels on food containers. A descriptive analysis of the variables was carried out to determine if there were differences between the distributions of the responses according to the SEL using the Chi2 test. When consulting the places where they have seen the food advertising, 72% of the mothers reported having seen it in the supermarkets and 48.5% on the internet. Only 34, 8% reported to remembering a particular commercial, and when asked to specify the commercial they remembered, 45.3% named a sugary drink and 13.6% some yogurt. Regarding the warning seals present on food containers, 87% stated that they liked them or they seemed good to them. Only 43.6% answered that they have stopped buying foods with these labels. These results will be useful for the design of specific interventions for this important group, since a positive change in their current behaviors could have an impact on the creation of healthy habits in their children(AU)

Use of added sugars in packaged foods sold in Brazil.

OBJECTIVE: Studies have shown that the consumption of added sugars may be associated with harmful health effects. The present study investigated the presence and types of added sugars in packaged foods. DESIGN: Cross-sectional analysis of the presence and types of added sugars in the ingredients lists of packaged foods sold in a major Brazilian supermarket. The nomenclature of ingredients classified as added sugars and their frequency were identified. Data were organised and analysed through descriptive statistics: absolute and relative frequencies of the presence of added sugars categorised by food groups were calculated, and ingredients were analysed by text mining using R statistical environment. SETTING: A supermarket in Florianópolis, a metropolis in southern Brazil. SUBJECTS: Packaged food products (n 4539) classified into eight groups. RESULTS: Of the 4539 products, 71 % had some type of added sugar. The group with the highest frequency of added sugars was 'products in which carbohydrates and fats are the main energy source' (93 %). Food groups containing predominantly salty foods had a high frequency of added sugars, such as 'meats and eggs' (61 %). In total, 179 different terms for added sugars were identified, of which sugar, maltodextrin and glucose syrup were the most frequent. CONCLUSIONS: Most of the packaged foods sold in Brazil contain added sugars, which may hamper adherence to the recommendation of limiting added sugars intake. The data may be useful for monitoring tendencies in the use of added sugars in packaged foods and as supplementary information to support the improvement of food label regulations.

Added sugars: Definitions, classifications, metabolism and health implications / Açúcares de adição: definições, classificações,metabolismo e implicações à saúde

ABSTRACT The sugars added to foods have been featured in recent scientific research, including the publication of the World Health Organization recommendation to limit consumption of added sugars, based on studies on weight gain and dental caries. However, it is possible that there is evidence of an association between excessive consumption and other pathologies, but scientific studies have yet to investigate these associations. Moreover, there is no consensus on the descriptions and definitions of these sugars, with several terms and components used to designate them. In Brazil, there are few studies investigating added sugars, identifying a lack of discussion on this subject. This paper presents a literature review of sugars added to foods, from their definitions and classifications to the metabolism and health effects. The search was performed without limiting dates in the following databases: Web of Science, Scopus, PubMed and SciELO, as well as in national and international official sites. Keywords in Portuguese and English related to sugars added to foods were used, in combination with terms related to systematic review and meta-analysis studies, in order to find research linking added sugars consumption with health damage. The literature indicates that there is a relationship between excessive consumption of added sugars and various health outcomes, including weight gain, type 2 diabetes Mellitus, cancer, and cardiovascular diseases. The different descriptions of sugars in foods may confuse both food consumers and researchers, since each term includes different components. Thus, it is suggested to use the standardized term "added sugar" as the most suitable term for the broader population to understand, because it indicates that those sugars are not natural food components.

RESUMO Os açúcares adicionados aos alimentos estão em destaque em pesquisas científicas recentes, inclusive em decorrência da publicação da Organização Mundial da Saúde com recomendações de limitação do seu consumo, baseando-se em estudos sobre ganho de peso e cárie dental. Entretanto, é possível que haja evidências de associação do consumo excessivo com outras patologias, mas não foram encontrados estudos que as reúnam. Além disso, ainda não há consenso científico quanto às denominações e definições desses açúcares. No Brasil, há poucos estudos que investigaram os açúcares de adição, identificando-se escassez de discussão a respeito. Diante disso, este artigo apresenta uma revisão de literatura sobre os açúcares adicionados aos alimentos, desde suas definições e classificações até o metabolismo e efeitos à saúde. A busca de informações foi realizada nos bancos de dados: Web of Science, Scopus, PubMed e SciELO, bem como em sites de órgãos oficiais nacionais e internacionais. Foram utilizados unitermos em português e inglês relacionados aos açúcares de adição e a estudos de revisão sistemática e metanálise, para identificação de pesquisas que associam seu consumo a prejuízos à saúde. A literatura aponta relação do consumo excessivo desses açúcares a diversos desfechos em saúde, incluindo ganho de peso, diabetes mellitus tipo 2, câncer e doenças cardiovasculares. As diferentes denominações dos açúcares nos alimentos podem confundir tanto os consumidores quanto os pesquisadores, uma vez que cada termo traz a inserção de componentes distintos. Assim, sugere-se padronização no uso do termo açúcares de adição, que parece ser o mais adequado para o entendimento da população, uma vez que indica que aquele açúcar não é natural do alimento.