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

Duran, Ana Clara; Ricardo, Camila Zancheta; Mais, Laís Amaral; Martins, Ana Paula Bortoletto

doi:10.1017/s1368980019005056

Cited by 27 publications

(58 citation statements)

References 35 publications

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“…These systems not only apply labels to different nutrients (e.g., Chile's model includes a calories label, whereas PAHO includes labels for total fats, trans fats, and non-caloric sweeteners), but also use different algorithms or reference values to determine which products receive label(s). These different nutrient profile models will influence what nutrients are included and how many products are covered [85][86][87][88], with potentially major differences in what receives a warning label depending on the food category. In addition, other labeling systems incorporate nutrients of benefit into their summary score calculations, with the underlying assumption that some beneficial nutrients like vitamins, fiber, or fruit and vegetable content offset the negative effects of other critical nutrients, such as sugar or sodium.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…2019), as did the survey of 11 434 products available on the Brazilian market (Duran et al . 2020).…”

Section: Discussionmentioning

confidence: 99%

“…The term ‘critical nutrients’ is similar to ‘nutrients of concern’, another term also described in scientific papers (Harcombe, 2019; Murphy et al, 2020). However, in this paper, the term ‘critical nutrients’ is used throughout the text to follow the trend of recent Latin American publications about Nutritional Profile Models (NPMs) and FOP labelling (Duran et al, 2020; Kanter, Reyes, Swinburn, et al, 2019; Kanter, Reyes, Vandevijvere, et al, 2019; Ministerio de Salud, 2017; Torres‐Schiaffino e Saavedra‐Garcia, 2020) and also to follow the standardisation of this term, proposed by Pan American Health Organization (PAHO)’s NPM report (World Health Organization, 2015a).…”

Section: Introductionmentioning

confidence: 99%

“…A previous survey, based on approximately 11,000 foods marketed throughout the country, revealed that the PAHO model identified the most products with a high content of critical nutrients (Brasil, 2018; Duran et al, 2020). However, no studies have been carried out looking at the profile of these nutrients, according to the different NPM, for foods targeted at children and marketed in Brazil.…”

Section: Introductionmentioning

confidence: 99%

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A comparison of four different Nutritional Profile models in their scoring of critical nutrient levels in food products targeted at Brazilian children

2021

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The implementation of front‐of‐pack labelling to assist consumers in making healthier food choices requires an appropriate Nutritional Profile Model (NPM) to be defined. However, four different models have been proposed in Brazil: the Pan American Health Organization (PAHO), the Brazilian Association of Food Industries (ABIA) and National Health Surveillance Agency (ANVISA) less (1) and more restrictive (2) models. The present study aimed to use the information provided on the labels of eight ultra‐processed food categories selected from the most popular group of foods targeted at Brazilian children, to score critical nutrient levels according to the four different NPMs and compare the proportion of products categorised as ‘high’, ‘medium’ or ‘low’ according to each one. Labels (n = 409) were collected in supermarkets in Belo Horizonte‐MG, Brazil. Data were tabulated, and a comparison of the ‘high’ content of the four nutrients, total sugars, total and saturated fats and sodium, according to the four NPMs, was performed. Agreement between ‘high’, ‘medium’ and ‘low’ scores according to the different NPMs, in comparison with the PAHO model, was performed using the Kappa test. Of all ‘fruit’ drinks, 95% were considered as ‘high’ in total sugars by the PAHO model, while only 5% were categorised as ‘high’ by the ABIA and ANVISA 1 models. For total sugars, no product in the cakes, breakfast cereals and yogurts categories and only 5.7% of the sandwich cookies were categorised as ‘high’ by the ABIA model, while 100% of sandwich cookies were categorised as having a ‘high’ total sugars content by the PAHO and ANVISA models. Similar findings were observed for breakfast cereals, yogurts and corn snacks for the proportion of products scoring ‘high’ for saturated fats and sodium. Kappa's concordance analysis showed moderate to excellent agreement between the PAHO and ANVISA 2 models. It was observed that the PAHO model indicated more foods with a ‘high’ content of critical nutrients. We conclude that the ABIA model is more permissive when compared to the other models and the PAHO model more restrictive.

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“…Culinary ingredients, as sugar, salt, oils, butter, and milk creams were only included if the product had the addition of another critical nutrient in excessive amounts (for instance, butter made with milk cream and salt is eligible to be regulated and receives a warning sign for high content of sodium if this nutrient is in excess-however, it does not receive a warning sign related to the high content of fats). For this modified PAHO NPM, we used the same targeted five nutrients (free sugar, total fats, saturated fats, trans fat, and sodium) as well as nonnutritive sweeteners and applied the same threshold levels as the PAHO NPM, and the model behaved similarly to the originally proposed PAHO NPM in terms of identifying foods high in critical nutrients [32].…”

Section: Classification Of Products According To Their Nutritional Prmentioning

confidence: 99%

Conflicting Messages on Food and Beverage Packages: Front-of-Package Nutritional Labeling, Health and Nutrition Claims in Brazil

et al. 2019

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We assessed the prevalence of front-of-package (FoP) claims in the Brazilian packaged food supply and examined whether foods with claims were more likely to be high in critical nutrients. Using data from a random 30% subsample of 11,434 foods and beverages collected in the five largest food retailers in Brazil in 2017 (n = 3491), we classified claims into nutrition, health, and environment. We examined whether foods with claims were more likely to be high in critical nutrients using 95% confidence intervals. Claims were found in 41.2% of the products. Nutrition claims were the most prevalent (28.5%), followed by health (22.1%), and environment-related claims (5.2%). More than 85% of the breakfast cereals, granola bars, and nectars contained claims, which were found in 51% of the dairy beverages. Foods with nutrition claims were more likely to be high in critical nutrients (65.3%; 95% CI 62.3, 68.2% vs. 54.1% 95% CI 52.1, 56.0). Products with health (52.9%; 95% CI 49.3, 56.4% vs. 58.5%; 95% CI 56.6, 60.3) and environment-related claims (33.5%; 95% CI 27.0, 40.8% vs. 58.6%; 95% CI 56.9, 60.2%) were less likely to be high in critical nutrients. FoP claims are prevalent in Brazil, and nutrition claims are more likely to have a poorer nutritional profile. Policymakers should consider restricting the presence of claims on unhealthy products.

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

Cited by 27 publications

References 35 publications

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

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

A comparison of four different Nutritional Profile models in their scoring of critical nutrient levels in food products targeted at Brazilian children

Conflicting Messages on Food and Beverage Packages: Front-of-Package Nutritional Labeling, Health and Nutrition Claims in Brazil

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