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Avila-Montiel D, Vilchis-Gil J, Miranda-Lora AL, Velázquez-López L, Klünder-Klünder M. The Effects of an Educational Intervention About Front-of-Package Labeling on Food and Beverage Selection Among Children and Their Caregivers: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e54783. [PMID: 38557591 PMCID: PMC11019414 DOI: 10.2196/54783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Overweight and obesity pose a global public health challenge and have a multifactorial origin. One of these factors includes obesogenic environments, which promote ultraprocessed foods characterized by being high in calories, saturated fats, added sugars, and sodium. In Mexico, it has been estimated that 30% of the total energy consumed comes from processed foods. The Modification to the Official Mexican Standards introduces nutritional information through black octagonal seals that alert consumers about products with excessive amounts of some components for a better food selection in the population. However, the effects of warning labels on processed food selection and purchases among children remain unknown. OBJECTIVE We aimed to evaluate the impact of a digital educational intervention focusing on front-of-package warning labels on the food selection and purchasing behavior of elementary schoolchildren and their caregivers. METHODS Children from 4 elementary schools in Mexico City, 2 public and 2 private schools, will participate in a randomized controlled trial. The schools will be chosen by simple random sampling. Schools will be randomized into 2 groups: intervention and control. In the control group, the dyads (caregiver-schoolchildren) will receive general nutritional education, and in the intervention group, they will receive guidance on reading labels and raising awareness about the impact of consuming ultraprocessed products on health. The educational intervention will be conducted via a website. Baseline measurements will be taken for both groups at 3 and 6 months. All participants will have access to an online store through the website, allowing them to engage in exercises for selecting and purchasing food and beverages. In addition, other measures will include a brief 5-question exam to evaluate theoretical understanding, a 24-hour reminder, a survey on food habits and consumption, application of a food preference scale, anthropometric measurements, and recording of school lunch choices. RESULTS Registration and funding were authorized in 2022, and we will begin data collection in September 2024. Recruitment has not yet taken place, but the status of data analysis and expected results will be published in April 2025. CONCLUSIONS The study is expected to contribute to evaluating whether reinforcing front-of-package warning labels with education enhances its effects and makes them more sustainable. Conducting this study will allow us to propose whether or not it is necessary to develop new intervention strategies related to front-of-package labeling for a better understanding of the population, improved food choices, and better health outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT06102473; https://clinicaltrials.gov/study/NCT06102473. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54783.
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Affiliation(s)
- Diana Avila-Montiel
- Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gómez, CDMX, Mexico
| | - Jenny Vilchis-Gil
- Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gómez, CDMX, Mexico
| | - América Liliana Miranda-Lora
- Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gómez, CDMX, Mexico
| | - Lubia Velázquez-López
- Clinical Epidemiology Research Unit Dr. Carlos Mac Gregor Sánchez Navarro, Mexican Social Security Institute, CDMX, Mexico
| | - Miguel Klünder-Klünder
- Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gómez, CDMX, Mexico
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Contreras-Manzano A, White CM, Nieto C, Quevedo KL, Vargas-Meza J, Hammond D, Thrasher JF, Barquera S, Jáuregui A. Self-reported decreases in the purchases of selected unhealthy foods resulting from the implementation of warning labels in Mexican youth and adult population. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.22.23298843. [PMID: 38045333 PMCID: PMC10690347 DOI: 10.1101/2023.11.22.23298843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
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 14-17 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 ten 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 purchases of unhealthy foods in Mexico. These results underscore the positive impact of the labeling policy particularly in subpopulations with lower levels of education and among indigenous adults.
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Digital marketing of commercial breastmilk substitutes and baby foods: strategies, and recommendations for its regulation in Mexico. Global Health 2023; 19:8. [PMID: 36726118 PMCID: PMC9890409 DOI: 10.1186/s12992-023-00908-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 01/16/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Parents are exposed to breastmilk substitutes and baby foods marketing on the internet and social media, which hinders adequate breastfeeding and complementary feeding. This study identifies digital marketing strategies for breastmilk substitutes, specifically commercial milk formula and baby foods used by the industry to influence infant and young children's feeding practices in Mexico and proposes regulatory recommendations that can be useful for similar countries. METHODS Qualitative study based on the CLICK monitoring framework developed by the World Health Organization, adapted for digital marketing of commercial milk formula and baby foods. Semi-structured interviews (n = 53) with key actors were conducted between November 2020 and March 2021, and used grounded theory for the analysis and interpretation with the MAXQDA 20 software. RESULTS Commercial milk formula and baby food companies use digital media to contact and persuade parents to use their products by sending electronic newsletters with advertising. Companies hire influencers to market their products because there is no regulation prohibiting the advertisement of breastmilk substitutes on social media, and promote formula among health professionals inviting them to participate in sponsored webinars on infant nutrition, ignoring conflict of interest and the International Code of Marketing of Breastmilk Substitutes. Parents trust formula and baby food advertisements, which use emotional messages and health and nutrition claims to encourage their consumption. Health professionals consider that claims contribute to the indiscriminate use of formula, and some actors propose the use of plain packaging for these products. CONCLUSIONS Breastmilk substitutes companies promote their products in digital media using unethical strategies that fail to comply with the International Code of Marketing of Breastmilk Substitutes. They generate strong conflicts of interest with health professionals, taking advantage of legal framework gaps and the lack of monitoring and effective sanctions for non-compliers. Updating the legal framework and monitoring compliance, including digital media, is urgently needed to protect children's right to breastfeeding, healthy nutrition and life, and the rights of women to health and informed decision-making.
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Aceves-Martins M, López-Cruz L, García-Botello M, Godina-Flores NL, Gutierrez-Gómez YY, Moreno-García CF. Cultural factors related to childhood and adolescent obesity in Mexico: A systematic review of qualitative studies. Obes Rev 2022; 23:e13461. [PMID: 35587773 PMCID: PMC9541705 DOI: 10.1111/obr.13461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
Culture and culturally specific beliefs or practices may influence perceptions and decisions, potentially contributing to childhood obesity. The objective of this study is to identify the cultural factors (expressed through decisions, behaviors, individual experiences, perceptions, attitudes, or views) related to childhood and adolescent obesity in Mexico. Ten databases and one search engine were searched from 1995 onwards for qualitative studies. The Sunrise Enabler Model, described within the Cultural Care Theory, guided this review. Sample, the phenomenon of interest, study design, and evaluation data were extracted, and the Critical Appraisals Skills Programme tool was used to assess the quality of the included studies. Twenty-four studies were included. Of these, 12 studies included children or adolescents, 12 included parents, eight included schoolteachers, four included school staff (other than teachers), four included food vendors, and one included policymakers. Cultural values, beliefs, lifeways (especially food and food costumes), kinship, and social factors (particularly immediate and extended family) strongly influenced childhood and adolescent obesity-related lifestyles in Mexico. Most cultural factors related to childhood obesity in Mexico identified in this review may be modifiable and amenable to practical interventions.
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Affiliation(s)
| | - Lizet López-Cruz
- Universidad Europea del Atlantico, Parque Cientifico y Tecnologico de Cantabria, Santander, Spain
| | | | - Naara L Godina-Flores
- Nutrition Department, School of Medicine and Health Sciences, Tecnológico de Monterrey, Mexico City, Mexico
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Sagaceta-Mejía J, Tolentino-Mayo L, Cruz-Casarrubias C, Nieto C, Barquera S. Understanding of front of package nutrition labels: Guideline daily amount and warning labels in Mexicans with non-communicable diseases. PLoS One 2022; 17:e0269892. [PMID: 35749373 PMCID: PMC9231753 DOI: 10.1371/journal.pone.0269892] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022] Open
Abstract
One strategy for the prevention and treatment of non-communicable diseases (NCDs) is the implementation of the front-of-pack labeling (FoPL) in foods and beverages. In 2020, Mexico adopted the warning label system (WL) as a new public health policy, whose aim is to help consumers make healthier food choices. Previously, the Guideline Daily Amount (GDA) was the labelling used it. This paper aims to compare the understanding of two FoPL, the GDA and the WL, through the identification of unhealthy products in Mexicans with NCDs. We analyzed data from 14,880 Mexican adults older than 20 years old with NCDs (overweight-obesity (OW/O), self-reported diabetes mellitus 2 (DM2), or/and hypertension (HT), or/and dyslipidemia (Dys)). Participants were randomly assigned to one of two groups: the GDA labeling or WL. Each group had to respond to a survey and had to classify food products images as healthy or unhealthy according to the labelling system to which they were assigned. The correct classification was determined according to the criteria of Chile’s labeling nutrient profile stage 3. To evaluate the correct classification in each one of the groups we evaluated the differences in proportions. Logistic regression models were used to assess the likelihood to correctly classify the product according to participants’ number of diseases and WL information, taking GDA label as a reference. Participants who used the information contained in the GDA label misclassified food product labels in greater proportion (70%), mostly participants with three or more NCDs (participants with OW/O+ HT+ Dys, represent 42.3% of this group); compared with those who used WL (50%). The odds of correct classification of food products using WL image were two times greater compared to GDA image in participants with NCDs; being greater in participants with three or more NCDs. The study results highlight the usefulness of WL as it helps Mexicans with NCDs to classify unhealthy food products more adequately compared with GDA.
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Affiliation(s)
- Janine Sagaceta-Mejía
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Lizbeth Tolentino-Mayo
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
- * E-mail:
| | - Carlos Cruz-Casarrubias
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Claudia Nieto
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Simón Barquera
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
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Aceves-Martins M, López-Cruz L, García-Botello M, Gutierrez-Gómez YY, Moreno-García CF. Interventions to Prevent Obesity in Mexican Children and Adolescents: Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:563-586. [PMID: 34725762 PMCID: PMC9072495 DOI: 10.1007/s11121-021-01316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 10/26/2022]
Abstract
The prevalence of overweight and obesity has been rising among Mexican children and adolescents in the last decades. To systematically review obesity prevention interventions delivered to Mexican children and adolescents. Thirteen databases and one search engine were searched for evidence from 1995 to 2021. Searches were done in English and Spanish to capture relevant information. Studies with experimental designs, delivered in any setting (e.g., schools or clinics) or digital domains (e.g., social media campaigns) targeting Mexican children or adolescents (≤ 18 years) and reporting weight outcomes, were included in this review. In addition, the risk of bias was appraised with the Effective Public Health Practice Project Quality Assessment Tool. Twenty-nine studies with 19,136 participants (3-17 years old) were included. The prevalence of overweight and obesity at baseline ranged from 21 to 69%. Most of the studies (89.6%) were delivered in school settings. The duration ranged from 2 days to 3 school years, and the number of sessions also varied from 2 to 200 sessions at different intensities. Overall, anthropometric changes varied across studies. Thus, the efficacy of the included studies is heterogeneous and inconclusive among studies. Current evidence is heterogeneous and inconclusive about the efficacy of interventions to prevent obesity in Mexican children and adolescents. Interventions should not be limited to educational activities and should include different components, such as multi-settings delivery, family inclusion, and longer-term implementations. Mixed-method evaluations (including robust quantitative and qualitative approaches) could provide a deeper understanding of the effectiveness and best practices.
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Affiliation(s)
- Magaly Aceves-Martins
- The Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Lizet López-Cruz
- Universidad Europea del Atlántico, Parque Científico Y Tecnológico de Cantabria, C/Isabel Torres 21, 39011, Santander, Spain
| | - Marcela García-Botello
- Universidad de Monterrey, Zona Valle Poniente, Av. Ignacio Morones Prieto 4500, 66238, San Pedro Garza García, N.L, Mexico
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Guerra G, Orozco E, Jiménez P, Ruckert A, Labonté R, Snyder NSD. Global health diplomacy in Mexico: insights from key actors in the field. Global Health 2021; 17:137. [PMID: 34857013 PMCID: PMC8637518 DOI: 10.1186/s12992-021-00789-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global health diplomacy (GHD) focuses on the actions taken by diverse stakeholders from different nations -governments, multilateral agents, and civil society- to phenomena that can affect population health and its determinants beyond national borders. Although the literature on conceptual advancements of GHD exists, empirical studies about how health becomes an issue of relevance for foreign policy are scarce. We present an analysis of the entry processes of health into the foreign policy and diplomatic domains in Mexico from the perspective of key informants of three different sectors. METHODS A purposive sample of high-rank representatives of three sectors involved in GHD was designed: Two from Health Sector (HS), four from Foreign Affairs Sector (FAS), and three from Non-governmental organizations (NGOs). Nine semi-structured interviews were conducted exploring the topics of: (1) Health concerns entering diplomatic and foreign policy; (2) Processes that allow actors to influence foreign policy and negotiation and; (3) Impact of multilateral negotiations on decision-making at the national level. RESULTS Our analysis suggests that GHD in Mexico is hierarchically driven by the FAS and health concerns only enter foreign policy when they are relevant to national priorities (such as trade or security). HS possesses a lesser degree of influence in GHD, serving as an instance of consultation for the FAS when deciding on health-related issues at global meetings (i.e., World Health Assembly). NGOs resort to lobbying, advocacy, networking, and coalition-working practices with other sectors (academy, think-tanks) to prevent harmful impacts on local health from multilateral decisions and as a mean to compensate its power asymmetry for influencing GHD processes in relation to the government. CONCLUSIONS GHD in Mexico occurs in a context of asymmetric power relationships where government actors have the strongest influence. However, NGOs' experience in raising awareness of health risks needs to be weighted by government decision-makers. This situation calls for capacity building on intersectoral communication and coordination to create formal mechanisms of GHD practices, including the professionalization and training on GHD among government agencies.
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Affiliation(s)
- German Guerra
- Centre for Health Systems Research, Global Health Program, National Institute of Public Health, Mexico City, Mexico
| | - Emanuel Orozco
- Centre for Health Systems Research, Global Health Program, National Institute of Public Health, Mexico City, Mexico
| | - Paulina Jiménez
- Centre for Health Systems Research, Global Health Program, National Institute of Public Health, Mexico City, Mexico
| | - Arne Ruckert
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Nelly Salgado de Snyder
- Centre for Health Systems Research, Global Health Program, National Institute of Public Health, Mexico City, Mexico.
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Aceves-Martins M, Godina-Flores NL, Gutierrez-Gómez YY, Richards D, López-Cruz L, García-Botello M, Moreno-García CF. Obesity and oral health in Mexican children and adolescents: systematic review and meta-analysis. Nutr Rev 2021; 80:1694-1710. [PMID: 34664672 PMCID: PMC9086795 DOI: 10.1093/nutrit/nuab088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Context A relationship between obesity and poor oral health has been reported. Objective To investigate the association between overweight/obesity and oral health in Mexican children and adolescents. Data Sources A literature search was conducted of 13 databases and 1 search engine for articles published from 1995 onward. Data Analysis A total of 18 publications were included. Evidence was inconclusive and varied according to sociodemographic factors or outcome measuring tools. The Decayed, Missing, and Filled Teeth and Filled Teeth Surfaces indices and the decayed extracted filled teeth index outcomes were included in a random effects model meta-analysis. Pooled estimates showed no statistically significant oral health differences (measured via the decayed extracted filled teeth or the Decayed, Missing, and Filled Teeth Surfaces indexes) among body mass index (BMI) categories. However, pooled estimates of 6 studies showed that children with higher BMI had worse oral health in permanent teeth (measured via the Decayed Missing Filled Teeth Index) than children with lower BMI (overall mean difference, –0.42; 95%CI, –0.74, –0.11). Conclusion Whether there is an association between poor oral health and high BMI is inconclusive; however, both co-exist among Mexican children. Therefore, health promotion and prevention efforts should address common risk factors and broader risk social determinants shared between noncommunicable diseases.
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Affiliation(s)
- Magaly Aceves-Martins
- M. Aceves-Martins is with The Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen, UK. N.L. Godina-Flores and Y.Y. Gutierrez-Gómez are with the Nutrition Department, School of Medicine and Health Sciences, Tecnológico de Monterrey, Col. Ejidos de Huipulco, Tlalpan, Mexico City, Mexico. D. Richards is with the School of Dentistry, University of Dundee, Park Place, Dundee, UK. L. López-Cruz is with the Universidad Europea del Atlantico, Parque Científico y Tecnologico de Cantabria, Santander, Cantabria, Spain. M. García-Botello is with the Universidad de Monterrey, Nuevo León, Mexico. C.F. Moreno-García is with the School of Computing, Robert Gordon University, Garthdee House, Aberdeen, Scotland, UK
| | - Naara L Godina-Flores
- M. Aceves-Martins is with The Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen, UK. N.L. Godina-Flores and Y.Y. Gutierrez-Gómez are with the Nutrition Department, School of Medicine and Health Sciences, Tecnológico de Monterrey, Col. Ejidos de Huipulco, Tlalpan, Mexico City, Mexico. D. Richards is with the School of Dentistry, University of Dundee, Park Place, Dundee, UK. L. López-Cruz is with the Universidad Europea del Atlantico, Parque Científico y Tecnologico de Cantabria, Santander, Cantabria, Spain. M. García-Botello is with the Universidad de Monterrey, Nuevo León, Mexico. C.F. Moreno-García is with the School of Computing, Robert Gordon University, Garthdee House, Aberdeen, Scotland, UK
| | - Yareni Yunuen Gutierrez-Gómez
- M. Aceves-Martins is with The Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen, UK. N.L. Godina-Flores and Y.Y. Gutierrez-Gómez are with the Nutrition Department, School of Medicine and Health Sciences, Tecnológico de Monterrey, Col. Ejidos de Huipulco, Tlalpan, Mexico City, Mexico. D. Richards is with the School of Dentistry, University of Dundee, Park Place, Dundee, UK. L. López-Cruz is with the Universidad Europea del Atlantico, Parque Científico y Tecnologico de Cantabria, Santander, Cantabria, Spain. M. García-Botello is with the Universidad de Monterrey, Nuevo León, Mexico. C.F. Moreno-García is with the School of Computing, Robert Gordon University, Garthdee House, Aberdeen, Scotland, UK
| | - Derek Richards
- M. Aceves-Martins is with The Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen, UK. N.L. Godina-Flores and Y.Y. Gutierrez-Gómez are with the Nutrition Department, School of Medicine and Health Sciences, Tecnológico de Monterrey, Col. Ejidos de Huipulco, Tlalpan, Mexico City, Mexico. D. Richards is with the School of Dentistry, University of Dundee, Park Place, Dundee, UK. L. López-Cruz is with the Universidad Europea del Atlantico, Parque Científico y Tecnologico de Cantabria, Santander, Cantabria, Spain. M. García-Botello is with the Universidad de Monterrey, Nuevo León, Mexico. C.F. Moreno-García is with the School of Computing, Robert Gordon University, Garthdee House, Aberdeen, Scotland, UK
| | - Lizet López-Cruz
- M. Aceves-Martins is with The Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen, UK. N.L. Godina-Flores and Y.Y. Gutierrez-Gómez are with the Nutrition Department, School of Medicine and Health Sciences, Tecnológico de Monterrey, Col. Ejidos de Huipulco, Tlalpan, Mexico City, Mexico. D. Richards is with the School of Dentistry, University of Dundee, Park Place, Dundee, UK. L. López-Cruz is with the Universidad Europea del Atlantico, Parque Científico y Tecnologico de Cantabria, Santander, Cantabria, Spain. M. García-Botello is with the Universidad de Monterrey, Nuevo León, Mexico. C.F. Moreno-García is with the School of Computing, Robert Gordon University, Garthdee House, Aberdeen, Scotland, UK
| | - Marcela García-Botello
- M. Aceves-Martins is with The Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen, UK. N.L. Godina-Flores and Y.Y. Gutierrez-Gómez are with the Nutrition Department, School of Medicine and Health Sciences, Tecnológico de Monterrey, Col. Ejidos de Huipulco, Tlalpan, Mexico City, Mexico. D. Richards is with the School of Dentistry, University of Dundee, Park Place, Dundee, UK. L. López-Cruz is with the Universidad Europea del Atlantico, Parque Científico y Tecnologico de Cantabria, Santander, Cantabria, Spain. M. García-Botello is with the Universidad de Monterrey, Nuevo León, Mexico. C.F. Moreno-García is with the School of Computing, Robert Gordon University, Garthdee House, Aberdeen, Scotland, UK
| | - Carlos Francisco Moreno-García
- M. Aceves-Martins is with The Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen, UK. N.L. Godina-Flores and Y.Y. Gutierrez-Gómez are with the Nutrition Department, School of Medicine and Health Sciences, Tecnológico de Monterrey, Col. Ejidos de Huipulco, Tlalpan, Mexico City, Mexico. D. Richards is with the School of Dentistry, University of Dundee, Park Place, Dundee, UK. L. López-Cruz is with the Universidad Europea del Atlantico, Parque Científico y Tecnologico de Cantabria, Santander, Cantabria, Spain. M. García-Botello is with the Universidad de Monterrey, Nuevo León, Mexico. C.F. Moreno-García is with the School of Computing, Robert Gordon University, Garthdee House, Aberdeen, Scotland, UK
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Pérez-Escamilla R, Vilar-Compte M, Rhodes E, Sarmiento OL, Corvalan C, Sturke R, Vorkoper S. [Implementación de políticas de prevención y control de la obesidad infantil en Estados Unidos y Latinoamérica: lecciones para la investigación y la práctica transfronterizas]. Obes Rev 2021; 22 Suppl 5:e13347. [PMID: 34708536 DOI: 10.1111/obr.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, EE. UU
| | - Mireya Vilar-Compte
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Ciudad de México, México
| | - Elizabeth Rhodes
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, EE. UU.,Yale School of Medicine, New Haven, Connecticut, EE. UU
| | - Olga L Sarmiento
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Camila Corvalan
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, EE. UU
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, EE. UU
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Aceves-Martins M, López-Cruz L, García-Botello M, Gutierrez-Gómez YY, Moreno-García CF. Interventions to Treat Obesity in Mexican Children and Adolescents: Systematic Review and Meta-Analysis. Nutr Rev 2021; 80:544-560. [PMID: 34339511 PMCID: PMC8829677 DOI: 10.1093/nutrit/nuab041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context Prevalence of overweight and obesity has been rising in the past 3 decades among Mexican children and adolescents. Objective To systematically review experimental studies evaluating interventions to treat obesity in Mexican children and adolescents (≤18 years old). Data Sources For this study, 13 databases and 1 search engine were searched. Data Analysis A total of 29 studies met the inclusion criteria. Overall, 2302 participants (age range, 8–16 years) from 11 states in Mexico were included. Most of the studies (n = 17 of 29) were provided in a clinical setting. A random-effect meta-analysis of 4 randomized controlled trials was conducted and a significant effect was found on body mass index reduction that favored the intervention group (−1.52; 95%CI, −2.15 to −0.89) for short-term (≤6 mo) interventions. Conclusions A multicomponent, multidisciplinary, and individualized intervention that includes dietary modifications, physical activity practice, behavioral strategies, and active parental involvement might help treat childhood obesity in Mexico. However, long-term results need to be produced to identify effectiveness pointers that might help establish an integrated, long-lasting care model to treat obesity.
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Affiliation(s)
| | - Lizet López-Cruz
- Universidad Europea del Atlantico, Parque Científico y Tecnologico de Cantabria, Santander, Spain
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Pérez-Escamilla R, Vilar-Compte M, Rhodes E, Sarmiento OL, Corvalan C, Sturke R, Vorkoper S. Implementation of childhood obesity prevention and control policies in the United States and Latin America: Lessons for cross-border research and practice. Obes Rev 2021; 22 Suppl 3:e13247. [PMID: 33951275 PMCID: PMC8365637 DOI: 10.1111/obr.13247] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
Progress has been made in the development and widespread implementation of effective interventions to address childhood obesity, yet important challenges remain. To understand how the United States and Latin American countries achieved success in implementing obesity policies and programs (PAPs) and identify improvement opportunities using implementation science principles. We identified three comparative case studies: (1) front-of-food package labeling (Mexico and Chile); (2) Open Streets/play streets (Colombia and the United States); and (3) the Baby-Friendly Hospital Initiative (Brazil and the United States). Information from multiple sources (e.g., scientific and gray literature and key informant interviews) was synthesized to describe barriers, facilitators, and progress of PAPs across RE-AIM framework dimensions. Evidence-based advocacy along with political will and evidence of scalability and impact were key for successful launch and implementation of all PAPs. Diverse adaptations of PAP design and implementation had to be done across contexts. Stronger process and impact monitoring and evaluation systems that track equity indicators are needed to maximize the population benefits of these PAPs. Implementation science offers an important contribution toward addressing knowledge gaps, enhancing obesity policy dialogue, and producing transferable lessons across the Americas and, therefore, should be used for research and evaluation during PAP development and throughout the implementation and maintenance phases.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Mireya Vilar-Compte
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Mexico City, Mexico
| | - Elizabeth Rhodes
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Camila Corvalan
- Institute of Nutrition, Universidad de Chile, Santiago, Chile
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
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12
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Noguera MD, Moyano D. Conocimientos, percepciones y uso del rotulado de alimentos y bebidas en un grupo de adolescentes de Argentina. Rev Salud Publica (Bogota) 2021. [DOI: 10.15446/rsap.v23n2.102276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción El rotulado de alimentos es una herramienta importante para mejorar la nutrición y fortalecer la ciudadanía de los consumidores en las primeras etapas de la vida y en la adolescencia.
Objetivo Explorar los conocimientos, percepciones y el uso del rotulado de alimentos y bebidas en un grupo de adolescentes de la Provincia de Buenos Aires, Argentina, para el año 2019.
Metodología Diseño cualitativo con enfoque fenomenológico. La recolección de datos se realizó a través de una encuesta semiestructurada y grupos focales con selección de 29 estudiantes. Los resultados fueron analizados mediante la técnica de análisis de contenido.
Resultados El rótulo de alimentos tuvo baja utilización. El grupo de adolescentes reconoció la importancia que tendría su uso en la salud de las personas. Se observó una baja potencial utilización a futuro. Se encontraron diferencias de género en la percepción sobre la importancia que se le asigna a la alimentación. Los adolescentes realizaron recomendaciones de posibles mejoras de las etiquetas que incluya una perspectiva inclusiva.
Conclusión El nivel de conocimientos, el uso efectivo del rotulado de alimentos y la potencial utilización a futuro por parte de los/las adolescentes fue baja. Se recomienda repensar el diseño y generar estrategias de salud pública dirigidas a promover el uso de etiquetados nutricionales en grupos y contextos específicos.
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Morales-Avilez D, Cruz-Casarrubias C, Tolentino-Mayo L, Encalada-Torres L, Abril-Ulloa V. Evaluation of the Accurateness of the Nutritional Labels of Processed and Ultra-Processed Products Available in Supermarkets of Ecuador. Nutrients 2020; 12:nu12113481. [PMID: 33202737 PMCID: PMC7697297 DOI: 10.3390/nu12113481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/03/2022] Open
Abstract
Nutrition labeling is a public health tool that allows consumers to choose healthier foods and beverages. For this reason, there are protocols in place to monitor the food environment. The purpose of this study was to evaluate the consistency of nutrition labeling on packages for processed and ultra-processed products (UPPs) found at the main supermarkets in Cuenca, Ecuador. We conducted a descriptive cross-sectional study in which we identified label components on the packages of 1725 foods and beverages—including the nutrition table, statement on sweeteners, ingredient list, and the traffic light (TL) label—and determined the degree of consistency between the indicators reported on the traffic light label and those obtained from the information in the nutrition table. We found that 24% of products had inconsistencies in the traffic light label, and 10.9% of products had inconsistencies in the indicator for sugar specifically. The majority of inconsistencies were in the medium indicators for sugar (K = 0.68) and fat (0.75). The products with a medium indicator for sugar had a 1.98 (p < 0.05, 95% CI 1.15, 3.39) times higher chance of having inconsistencies in comparison with the low indicator. Health authorities must create new guidelines to allow for continued monitoring of the nutrition and traffic light labels on products accessible to consumers.
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Affiliation(s)
- Diana Morales-Avilez
- Research Group Public Health, Food and Physical Activity in the Life Cycle, Medical Sciences Faculty, University of Cuenca, Av. 12 abril. Campus Paraíso, Cuenca 010104, Ecuador; (D.M.-A.); (L.E.-T.)
| | - Carlos Cruz-Casarrubias
- Center for Health and Nutrition Research, Mexican National Institute of Public Health Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico; (C.C.-C.); (L.T.-M.)
| | - Lizbeth Tolentino-Mayo
- Center for Health and Nutrition Research, Mexican National Institute of Public Health Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico; (C.C.-C.); (L.T.-M.)
- El Colegio de Chihuahua, Partido Díaz 4723, Progresista, Ciudad Juárez, 32310 Chihuahua, Mexico
| | - Lorena Encalada-Torres
- Research Group Public Health, Food and Physical Activity in the Life Cycle, Medical Sciences Faculty, University of Cuenca, Av. 12 abril. Campus Paraíso, Cuenca 010104, Ecuador; (D.M.-A.); (L.E.-T.)
| | - Victoria Abril-Ulloa
- Research Group Public Health, Food and Physical Activity in the Life Cycle, Medical Sciences Faculty, University of Cuenca, Av. 12 abril. Campus Paraíso, Cuenca 010104, Ecuador; (D.M.-A.); (L.E.-T.)
- Correspondence: ; Tel.: +593-999924289
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Hernandez Santana A, Waleska Bodden Andrade S, Rojas Aleman D, Enríquez JP, Di Iorio AB. Evaluation of the Nutritional Quality of Processed Foods in Honduras: Comparison of Three Nutrient Profiles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197060. [PMID: 32992498 PMCID: PMC7579440 DOI: 10.3390/ijerph17197060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/05/2020] [Accepted: 09/16/2020] [Indexed: 12/24/2022]
Abstract
Obesity is considered a global pandemic. Different countries have worked to implement front-of-package (FOP) labeling systems that define thresholds for critical nutrients (CN) as part of their public health policies. The objective of this study is to identify the proportion of Processed (PF) and Ultra-Processed (UPF) Foods marketed in Honduras, which meet or fall short of the criteria of three Nutrient Profile Models (NPM): PAHO (2016), Chile (2017) and the Central American Technical Regulation Proposal-Nutritional Warning Front Labeling (CATRP-NWFL 2017). This study is descriptive; 1009 products from 206 brands were collected nationwide. Descriptive statistics were performed. The mean CN compliance with the three models was 49.3% for sodium, 30.6% for sugars, 63.1% and 96% for saturated and trans fats. The PAHO and Chilean (NPM) similarly concentrated on the lower compliance with the established criteria, unlike the CATRP, which has less stringent criteria. This is the first assessment of CN content in PF and UPF in Honduras under three different NPMs. We highlight the importance of defining or adopting criteria for the implementation of NWFL as information for the consumer and thereby contribute to reducing the risks of obesity and related diseases.
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Affiliation(s)
- Adriana Hernandez Santana
- Human Nutrition Laboratory, Department of Food Science and Technology, Zamorano University, San Antonio de Oriente, Francisco Morazan, Tegucigalpa 11101, Honduras;
- Correspondence: ; Tel.: +504-33896283
| | | | - Dina Rojas Aleman
- Zamorano University, San Antonio de Oriente, Francisco Morazan, Tegucigalpa 11101, Honduras;
| | - Jean Pierre Enríquez
- Masters Program in Sustainable Tropical Agriculture, Graduate Department, Zamorano University, Tegucigalpa 11101, Honduras;
| | - Adriana Beatriz Di Iorio
- Human Nutrition Laboratory, Department of Food Science and Technology, Zamorano University, San Antonio de Oriente, Francisco Morazan, Tegucigalpa 11101, Honduras;
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Torres-Álvarez R, Barrán-Zubaran R, Canto-Osorio F, Sánchez-Romero LM, Camacho-García-Formentí D, Popkin BM, Rivera JA, Meza R, Barrientos-Gutiérrez T. Body weight impact of the sugar-sweetened beverages tax in Mexican children: A modeling study. Pediatr Obes 2020; 15:e12636. [PMID: 32282131 DOI: 10.1111/ijpo.12636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/29/2020] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND In Mexico, a 10% tax to sugar-sweetened beverages was implemented in 2014. Projections of the potential health effect of this tax in children are not available. OBJECTIVE To estimate the 1-year effect of the tax on the body weight of children 5 to 17 years old, and estimated alternative scenarios with higher tax rates (20%, 30%, and 40%). METHODS We used a dynamical mathematical model, recalibrated to the Mexican population. Input data were obtained from the Mexican National Health and Nutrition Survey 2006 and 2012. We estimated the expected average weight reduction, stratified by category of sugar-sweetened beverages consumption. RESULTS With a 10% tax, we estimated an overall weight reduction of 0.26 kg for children and 0.61 kg for adolescents; in high consumers, the reduction could reach 0.50 and 0.87 kg, respectively. Higher tax rates would produce larger weight decreases; in high consumers a 40% tax would result in a reduction of 1.99 kg for children and 3.50 kg for adolescents. CONCLUSION The tax represents an effective component of any child or adolescent weight control program, and must be considered as part of any integrated population-level program for children and adolescent obesity prevention.
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Affiliation(s)
- Rossana Torres-Álvarez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rodrigo Barrán-Zubaran
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Francisco Canto-Osorio
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Luz M Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | | | - Barry M Popkin
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Juan A Rivera
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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16
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Braverman-Bronstein A, Camacho-García-Formentí D, Zepeda-Tello R, Cudhea F, Singh GM, Mozaffarian D, Barrientos-Gutierrez T. Mortality attributable to sugar sweetened beverages consumption in Mexico: an update. Int J Obes (Lond) 2020; 44:1341-1349. [PMID: 31822805 DOI: 10.1038/s41366-019-0506-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/12/2019] [Accepted: 12/01/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND In 2010, sugar sweetened beverages (SSBs) were estimated to cause 12% of all diabetes, cardiovascular disease (CVD) and obesity-related cancer deaths in Mexico. Using new risk estimates for SSBs consumption, we aimed to update the fraction of Mexican mortality attributable to SSBs, and provide subnational estimates by region, age, and sex. METHODS We used an established comparative risk assessment framework. All-cause mortality estimates were calculated from a recent pooled cohort analysis. Age- and sex-specific relative risks for SSBs-disease relationships were obtained from updated meta-analyses. Demographics and nationally representative estimates of SSBs intake were derived from the National Health and Nutrition Survey 2012; and mortality rates, from the National Institute of Statistics and Geography. Attributable mortality was calculated by estimating the population attributable fraction of each disease, with uncertainty in data inputs propagated through Monte Carlo probabilistic sensitivity analyses. RESULTS In Mexican adults 20 years and older, 6.9% (95%UI: 5.4-8.5) of all cause-mortality was attributable to SSBs, representing 40,842 excess deaths/year (95%UI: 31,950-50,138). Furthermore, 19% of diabetes, CVD and obesity-related cancer mortality was attributable to SSBs (95%UI: 11.0-26.5), representing 37,000 excess deaths/year (95%UI 21,240-51,045). Of these, 35.6% were diabetes-related (95%UI 16.4-52.0). Proportional burden was highest in the South (22.8%), followed by the Center (18.0%) and North (17.4%). Men aged 45-64-years in the Center region had highest proportional mortality (37.2%), followed by 20-44-year-old men living in the South (35.7%) and both men and women aged 20-44 living in the Center (34.4%). CONCLUSIONS Utilizing current evidence linking SSBs to cardiometabolic disease and obesity-related cancers, earlier estimates of Mexican mortality attributable to SSBs could have been underestimated. Mexico urgently needs stronger policies to reduce SSBs consumption and reduce these burdens.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Center for Population Health Research, National Institute of Public Health, Mexico, Av. Universidad 655, 62100, Cuernavaca, Mexico
| | - Dalia Camacho-García-Formentí
- Center for Population Health Research, National Institute of Public Health, Mexico, Av. Universidad 655, 62100, Cuernavaca, Mexico
| | - Rodrigo Zepeda-Tello
- Center for Population Health Research, National Institute of Public Health, Mexico, Av. Universidad 655, 62100, Cuernavaca, Mexico
| | - Frederick Cudhea
- Gerarld J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Gitanjali M Singh
- Gerarld J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Dariush Mozaffarian
- Gerarld J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Tonatiuh Barrientos-Gutierrez
- Center for Population Health Research, National Institute of Public Health, Mexico, Av. Universidad 655, 62100, Cuernavaca, Mexico.
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Sugar Content and Nutritional Quality of Child Orientated Ready to Eat Cereals and Yoghurts in the UK and Latin America; Does Food Policy Matter? Nutrients 2020; 12:nu12030856. [PMID: 32210128 PMCID: PMC7146401 DOI: 10.3390/nu12030856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 12/12/2022] Open
Abstract
Ready to eat breakfast cereals (REBCs) and yoghurts provide important nutrients to children's diets, but concerns about their high sugar content exist. Food reformulation could contribute to sugar reduction, but policies across countries are not uniform. We aimed to compare the sugar content and nutritional quality of child-orientated REBCs and yoghurts in Latin American countries with the UK. In a cross-sectional study, nutritional information, marketing strategies, and claims were collected from the food labels and packaging of products available in Guatemala, Mexico, Ecuador and the UK. Nutritional quality was assessed using the UK Ofcom Nutrient Profiling System. In total, 262 products were analysed (59% REBCs/41% yoghurts). REBCs in the UK had a lower sugar content (mean ± SD) (24.6 ± 6.4) than products in Ecuador (34.6 ± 10.8; p < 0.001), Mexico (32.6 ± 7.6; p = 0.001) and Guatemala (31.5 ± 8.3; p = 0.001). Across countries, there were no differences in the sugar content of yoghurts. A large proportion (83%) of REBCs and 33% of yoghurts were classified as "less healthy". In conclusion, the sugar content of REBCs in Latin America is higher than those of the UK, which could be attributed to the UK voluntary sugar reduction programme. Sugar reformulation policies are required in Guatemala, Mexico and Ecuador.
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Nieto C, Jáuregui A, Contreras-Manzano A, Arillo-Santillan E, Barquera S, White CM, Hammond D, Thrasher JF. Understanding and use of food labeling systems among Whites and Latinos in the United States and among Mexicans: Results from the International Food Policy Study, 2017. Int J Behav Nutr Phys Act 2019; 16:87. [PMID: 31623663 PMCID: PMC6798377 DOI: 10.1186/s12966-019-0842-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity and chronic diseases could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating. This study evaluated adult consumer understanding and use of nutrition labeling systems in the US and Mexico, the most obese countries in the world. METHODS Adults from online consumer panels in the US (Whites n = 2959; Latinos n = 667) and in Mexico (n = 3533) were shown five food labeling systems: 1. Nutrition Facts Table (NFT) that shows nutrients of concern per serving; 2. Guideline Daily Amounts (GDA) that shows levels of nutrients of concern; 3. Multiple Traffic-Light (MTL) that color codes each GDA nutrient (green = healthy; yellow = moderately unhealthy; red = unhealthy); 4. Health Star Rating System (HSR) that rates foods on a single dimension of healthiness; 5. Warning Label (WL) with a stop sign for nutrients present in unhealthy levels. Participants rated each label on understanding ("easy"/"very easy to understand" vs "difficult"/"very difficult to understand"), and, for NFTs and GDAs, frequency of use ("sometimes"/"often" vs "never"). Mixed logistic models regressed understanding and frequency of use on indicators of labeling systems (NFT = ref), testing for interactions by ethnicity (US Latinos, US Whites, Mexicans), while controlling for sociodemographic and obesity-related factors. RESULTS Compared to the NFT, participants reported greater understanding of the WL (OR = 4.8; 95% CI = 4.4-5.3) and lower understanding of the HSR (OR = 0.34, 95% CI = 0.31-0.37) and the MTL (OR = 0.56, 95% CI = 0.52-0.61), with similar patterns across ethnic subgroups. Participants used GDAs less often than NFTs (OR = 0.48; 95%CI = 0.41-0.55), with the greatest difference among US Whites (OR = 0.10; 95%CI = 0.07-0.14). CONCLUSIONS Understanding and use of the GDA was similar to that of the NFT. Whites, Latinos, and Mexicans consistently reported the best understanding for WLs, a FOPL that highlights unhealthfulness of a product. Therefore, a FOPL summary indicator, such as WLs, may be more effective in both the US and Mexico for guiding consumers towards informed food choices.
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Affiliation(s)
- Claudia Nieto
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Alejandra Jáuregui
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Alejandra Contreras-Manzano
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Edna Arillo-Santillan
- Population Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
- School of Demography, ANU College of Arts and Social Sciences, The Australian National University, 9 Fellows Road Acton ACT 260, Canberra, Australia
| | - Simón Barquera
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Christine M. White
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - James F. Thrasher
- Population Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC 29208 USA
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Nieto C, Tolentino-Mayo L, Monterrubio-Flores E, Medina C, Patiño SRG, Aguirre-Hernández R, Barquera S. Nutrition Label Use Is Related to Chronic Conditions among Mexicans: Data from the Mexican National Health and Nutrition Survey 2016. J Acad Nutr Diet 2019; 120:804-814. [PMID: 31585829 DOI: 10.1016/j.jand.2019.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-communicable diseases, such as obesity, diabetes, and hypertension, can be prevented and treated through a balanced nutrient-rich diet. Nutrition labels have been recognized as crucial to preventing obesity and non-communicable diseases through a healthier diet. OBJECTIVE Our aim was to examine the association between nutrition label use and chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension) among an adult Mexican population. DESIGN This was a cross-sectional study that used data from the Mexican National Health and Nutrition Survey of 2016 (ENSANUT MC 2016). PARTICIPANTS/SETTING The participants were 5,013 adults aged 20 to 70 years old. Older adults (>70 years), illiterate participants, pregnant women, and participants with implausible blood pressure data were excluded from the sample. The survey was conducted from May to August 2016 in the participants' households. MAIN OUTCOME MEASURES We measured chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension). STATISTICAL ANALYSES PERFORMED Pearson χ2 test was used to examine the associations among the use of nutrition labels and sociodemographic characteristics and chronic conditions. Multiple logistic regression was used to determine the association between nutrition label use and chronic conditions adjusting for the effect of confounding variables like sex, age, body mass index, education level, marital status, ethnicity, residence area, region, and socioeconomic status. RESULTS From the total sample, 40.9% (95% CI 38.4% to 43.8%) reported using nutrition labeling. Respondents with overweight or obesity were less likely to use nutrition labels (odds ratio 0.74; P<0.05). Participants who self-reported diabetes had significantly lower odds of nutrition label use than participants who did not report to have diabetes (odds ratio 0.66; P<0.05). Participants having 3 chronic conditions had lower odds of nutrition label use (odds ratio 0.34; P<0.01) relative to having zero chronic conditions. CONCLUSIONS This study suggests an association between nutrition label use and chronic conditions (obesity and diabetes). These findings demonstrate that people with obesity, diabetes, and a combination of chronic conditions were less likely to use nutrition labels than people without these conditions.
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Barquera S, García-Chávez CG, Navarro-Rosenblatt D, Uauy R, Pérez-Escamilla R, Martorell R, Ramírez-Zea M, Sánchez-Bazán K. Postura de la Sociedad Latinoamericana de Nutrición (SLAN) sobre el manejo de conflicto de intereses. ACTA ACUST UNITED AC 2018; 60:592-597. [DOI: 10.21149/9657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/29/2018] [Indexed: 01/26/2023]
Abstract
Existe evidencia sólida de la existencia de relaciones entre la industria de alimentos y bebidas y la academia. Ésta sugiere que la investigación patrocinada por la industria es susceptible de conferir sesgos a su favor en los resultados. En América Latina, se han documentado ejemplos de estas situaciones en México, Brasil, Chile, Perú, Colombia y Ecuador, por citar a algunos países. Ante la necesidad urgente de estudiar y gestionar las relaciones entre la industria de alimentos y bebidas y el campo de investigación en salud y nutrición, en 2017 el Presidente de la Sociedad Latinoamericana de Nutrición (SLAN) designó a un Comité de Conflicto de Intereses (CCI). El CCI tuvo la encomienda de hacer una propuesta de postura sobre manejo de conflicto de intereses (CDI) de la SLAN. El presente artículo refleja los trabajos del CCI y la postura que adoptó la SLAN.
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