Ley 20.606: Efectos en el conocimiento de etiquetado nutricional en consumidores de un supermercado en Valparaíso de Chile: estudio descriptivo, cuanticualitativo, antes y después de 5 meses de la implementación de la ley  <span class="so-article-trans-title" dir="auto"> Translated title: Law 20,606: How it affects the knowledge about nutritional labeling of users of a supermarket in Valparaiso, Chile: a descriptive, quanti-qualitative study of before the implementation of the law and 5 months later </span>

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Abstract

Resumen Introducción El objetivo fue describir los cambios en la lectura, conocimientos e interpretación de los rótulos del etiquetado nutricional de los alimentos en los consumidores de un supermercado de Valparaíso, antes y después de la entrada en vigencia de la ley 20.606, entre junio y diciembre del año 2016. Material y Métodos Estudio descriptivo, no experimental, enfoque cuanti-cualitativo. Muestra por conveniencia de 200 consumidores del mismo supermercado a los cuales se les aplicó un cuestionario antes y después de la puesta en marcha de la ley con preguntas sobre conocimiento e interpretación de los rótulos "ALTO EN". Las respuestas se ordenaron en: i) contienen gran cantidad del nutriente/alto en el nutriente; ii) cantidad riesgosa para la salud; iii) más de lo necesario/sobre el nivel permitido; iv) tiene añadido el nutriente; v) no sé/no entiendo; vi) otros. Los cambios se evaluaron con diferencia de proporciones con un 95% de intervalo de confianza. Resultados El incremento en la lectura del etiquetado nutricional (11%) no fue significativo. Respecto al conocimiento e interpretación de los rótulos por los consumidores fue significativo para "ALTO EN CALORÍAS" en i y iii; para "ALTO EN SODIO" en i, ii y v; para "ALTO EN AZÚCAR" en ii y iii; y para "ALTO EN GRASAS SATURADAS" en i. Un 62% dejó de elegir algún alimento por la cantidad de rótulos del envase. El 34% señaló la necesidad de mayor educación sobre el nuevo etiquetado. Conclusiones Se generan cambios en la comprensión de los sellos "ALTOS EN" en el nuevo etiquetado, la lectura y la elección de los alimentos. Los consumidores indican que falta educación alimentaria y nutricional. A nivel de política de salud se requieren estudios cualitativos e indicadores para la evaluación de la comprensión e interpretación de los sellos a mediano y largo plazo y educación alimentaria y nutricional.

Translated abstract

Abstract Introduction The aim was to describe changes on the reading, knowledge and interpretation of the nutritional labeling of foods among consumers of a supermarket in Valparaiso, before and after the entry into force of Law 20,606, during June and December of 2016. Material and Methods Descriptive, non-experimental study, with a quantitative-qualitative approach. A convenience sample of 200 consumers who attended the same supermarket was surveyed using a questionnaire. The survey mode was an interview before and after the entry into force of the Law. The questionnaire included questions aimed to evaluate the knowledge and interpretation of the labels "HIGH IN". Responses were categorized as: i) It contains a great amount of the nutrient/is high in the nutrient; ii) The amount represents a risk for health; iii) It contains more than necessary/above the allowed level; iv) It has such nutrient added; v) I don't know/don't understand; vi) Other responses. Changes were assessed taking into account difference between proportions and confidence interval was set to 95%. Results There was no significant increase in the reading of the nutritional labeling (11%). Respecting the knowledge and interpretation of the labels, knowledge increased significantly regarding the label "HIGH IN CALORIES" in i and iii; regarding "HIGH IN SODIUM" in i, ii and v; regarding "HIGH IN SUGARS" in ii and iii; and regarding "HIGH IN SATURATED FATS" in i. Responses showed that 62% stated they have stopped consuming a certain food because of the number of stamps that the label contained and 34% indicated the need for more education on the new labeling. Conclusions There were changes in the consumers' understanding of labels indicating "HIGH IN" of the new labeling system; reading of the labels and food choice were also modified. Consumers indicated that food and nutritional education is required. At the health policy level, qualitative studies and indicators are required to assess the understanding and interpretation of the seals in the medium and long term and food and nutrition education.

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Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Mohammad Forouzanfar, Ashkan Afshin, Lily T Alexander … (2017)

Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation.

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An evaluation of Chile’s Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study

Lindsey Smith Taillie, Marcela Reyes, M. Arantxa Colchero … (2020)

Background Chile’s Law of Food Labeling and Advertising, implemented in 2016, was the first national regulation to jointly mandate front-of-package warning labels, restrict child-directed marketing, and ban sales in schools of all foods and beverages containing added sugars, sodium, or saturated fats that exceed set nutrient or calorie thresholds. The objective of this study is to evaluate the impact of this package of policies on household beverage purchases. Method and findings In this observational study, monthly longitudinal data on packaged beverage purchases were collected from urban-dwelling households (n = 2,383) participating in the Kantar WordPanel Chile Survey from January 1, 2015, to December 31, 2017. Beverage purchases were linked to nutritional information at the product level, reviewed by a team of nutritionists, and categorized as “high-in” or “not high-in” according to whether they contained high levels of nutrients of concern (i.e., sugars, sodium, saturated fat, or energy) according to Chilean nutrient thresholds and were thus subject to the law’s warning label, marketing restriction, and school sales ban policies. The majority of high-in beverages were categorized as such because of high sugar content. We used fixed-effects models to compare the observed volume as well as calorie and sugar content of postregulation beverage purchases to a counterfactual based on preregulation trends, overall and by household-head educational attainment. Of households included in the study, 37% of household heads had low education (less than high school), 40% had medium education (graduated high school), and 23% had high education (graduated college), with the sample becoming more educated over the study period. Compared to the counterfactual, the volume of high-in beverage purchases decreased 22.8 mL/capita/day, postregulation (95% confidence interval [CI] −22.9 to −22.7; p < 0.001), or 23.7% (95% CI −23.8% to −23.7%). High-educated and low-educated households showed similar absolute reductions in high-in beverage purchases (approximately 27 mL/capita/day; p < 0.001), but for high-educated households this amounted to a larger relative decline (−28.7%, 95% CI −28.8% to −28.6%) compared to low-educated households (−21.5%, 95% CI −21.6% to −21.4%), likely because of the high-educated households’ lower level of high-in beverage purchases in the preregulation period. Calories from high-in beverage purchases decreased 11.9 kcal/capita/day (95% CI −12.0 to −11.9; p < 0.001) or 27.5% (95% CI −27.6% to −27.5%). Calories purchased from beverages classified as “not high-in” increased 5.7 kcal/capita/day (95% CI 5.7–5.7; p < 0.001), or 10.8% (10.8%–10.8%). Calories from total beverage purchases decreased 7.4 kcal/capita/day (95% CI −7.4 to −7.3; p < 0.001), or 7.5% (95% CI −7.6% to −7.5%). A key limitation of this study is the inability to assess causality because of its observational nature. We also cannot determine whether observed changes in purchases are due to reformulation or consumer behavioral change, nor can we parse out the effects of the labeling, marketing, and school sales ban policies. Conclusions Purchases of high-in beverages significantly declined following implementation of Chile’s Law of Food Labeling and Advertising; these reductions were larger than those observed from single, standalone policies, including sugar-sweetened-beverage taxes previously implemented in Latin America. Future research should evaluate the effects of Chile’s policies on purchases of high-in foods, dietary intake, and long-term purchasing changes.

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Structural responses to the obesity and non‐communicable diseases epidemic: Update on the Chilean law of food labelling and advertising

Camila Corvalán, Marcela Reyes, María Luisa Garmendia … (2018)

Chile approved the law of food labelling and advertising in 2012; this law aims to address the obesity epidemic, particularly in children. The implementation details were published in 2015, and the law was implemented finally in 2016, as described in the current article. Regulated foods were defined based on a specially developed nutrient profiling, which considered natural foods as gold standard. For liquid foods, amounts of energy, sugars, saturated fats, and sodium in 100 mL of cow's milk were used as cut-offs. For solid foods, values within the 90th - 99th percentile range for energy and critical nutrients were selected as cut-off within a list of natural foods. A stop sign stating "High in " was chosen as warning label for packaged regulated foods. Regulated foods were also forbidden to be sold or offered for free at kiosks, cafeterias, and feeding programme at schools and nurseries. Besides, regulated foods cannot be promoted to children under 14 years. A staggered implementation of the regulation was decided, with nutrients cut-offs becoming increasingly stricter over a 3-year period. These regulatory efforts are in the right direction but will have to be sustained and complemented with other actions to achieve their ultimate impact of halting the obesity epidemic.

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Journal

Journal ID (publisher-id): renhyd

Title: Revista Española de Nutrición Humana y Dietética

Abbreviated Title: Rev Esp Nutr Hum Diet

Publisher: Academia Española de Nutrición y Dietética (Pamplona, Navarra, Spain )

ISSN (Print): 2173-1292

ISSN (Electronic): 2174-5145

Publication date (Print and electronic): December 2020

Volume: 24

Issue: 4

Pages: 311-323

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[1] Valparaíso Valparaíso orgnameUniversidad de Playa Ancha de Ciencias de la Educación orgdiv1Centro de Estudios Avanzados Chile

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Publisher ID: S2174-51452020000400003 Publisher ID: S2174-5145(20)02400400003

DOI: 10.14306/renhyd.24.4.979

SO-VID: cbe2f7c5-013a-4d6f-b3c1-1ca15fd7f93a

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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Date accepted : 20 July 2020

Date received : 30 December 2019

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Figures: 0, Tables: 0, Equations: 0, References: 43, Pages: 13

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Most cited references 41

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

An evaluation of Chile’s Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study

Structural responses to the obesity and non‐communicable diseases epidemic: Update on the Chilean law of food labelling and advertising

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