Brazil's nutrition labeling regulation: Challenges ahead on the path to guaranteeing consumer's right to adequate information

Effect of nutrition warning, brand, and claims on the perception of product healthiness by Brazilian consumers

In response to the rise of Non-communicable Diseases, public policies, such as Front-of-package (FOP) nutrition labeling, have been implemented to clarify information on food labels and promote healthier eating habits. Brazil adopted black magnifier warning label in 2020, which consists of a black rectangle with a magnifier glass followed by the expression "High in" for three critical nutrients: added sugar, saturated fat and/or sodium. This study aims to evaluate the effect of black magnifier warning label, brand, and claims on Brazilian consumers' perceived healthiness. To achieve this, four products were considered: chocolate flavored milk, granola, mate tea, and cookies. A total of 448 Brazilian consumers took part in an online survey. For each product category, a series of packages were designed considering the following 2-level factors: brand (familiar vs. unfamiliar), black magnifier warning label (presence vs. absence), visual claim (presence vs. absence) and textual claim (presence vs. absence). Participants were shown eight pairs of packages from two of four products and were asked to select the healthiest product in each pair. The data were analyzed using a mixed logit model with random parameters, and conjoint analysis was conducted to estimate the main effects, average coefficients, and standard errors. A significance level of 5 % was considered. For all product categories, the presence of the warnings reduced perceived healthiness of products. On the other hand, the presence of familiar brand and nutritional marketing claims had a greater effect on the perceived healthiness compared to black magnifier. These results demonstrate the effectiveness of warning labels, but the need to regulate claims for strengthening label policies in the Brazilian context.

Nutrient Profiling Models in Low- and Middle-Income Countries Considering Local Nutritional Challenges: A Systematic Review

Micronutrient deficiencies, undernutrition, and overweight/obesity are prevalent in low- and middle-income countries (LMICs). Nutrient profiling models (NPMs), initially developed to help reduce the prevalence of diet-related chronic diseases in Western countries, could be one solution to promote nutrient-dense foods in LMICs. This study reviewed government-endorsed NPMs implemented in LMICs and assessed their key components in relation to country-specific nutritional challenges. The peer-reviewed and grey literature were systematically reviewed to identify government-endorsed NPMs implemented in LMICs to promote healthier choices among adults. Their key metrics, including scope, components, units, and validation method, were extracted. The prevalence of undernutrition; overweight/obesity; and iron, vitamin A, and iodine deficiencies were extracted from the Global Health Observatory and the Global Burden of Disease study. NPMs have been implemented in 16 LMICs to encourage healthier choices, mostly through front-of-pack labeling schemes. Warning Label schemes are used to strongly discourage the consumption of energy-dense products in countries where overnutrition affects most of the population, such as Latin American LMICs. A "Keyhole" front-of-pack labeling scheme was implemented only in North Macedonia. It limits sugar, fat, and salt while promoting fibers, fruits, vegetables, nuts, and legumes to prevent overnutrition and diet-related chronic diseases. "Choices" schemes that focus on positive messages have been implemented in Southeast Asia and Zambia where over- and undernutrition coexist. "Choices" criteria encourage the consumption of category-specific vitamins and minerals, in addition to advocating limiting certain nutrients. In LMICs, NPMs focus on discouraging the consumption of sugar, fat, and salt. Additionally, NPMs promote category-specific micronutrients in countries where undernutrition remains prevalent or food components associated with a reduced risk of diet-related chronic diseases, including whole grains and fibers, in countries where overnutrition is the main nutrition-related public health issue. This study was registered at PROSPERO as CRD42023468807.

Brazilian Front-of-Package Labeling: A Product Compliance Analysis 12 Months after Implementation of Regulations

This study investigated the presence of front-of-package labeling on food products in major retailers in Brazil after its implementation in 2022. Carried out from May to October 2023, we analyzed 2145 products of brands present in five Brazilian states. A total of 541 products presented front-of-package warnings. The categories varied in their adherence to front-of-package labeling, highlighting a prevalence of combined warnings, such as high in added sugar and high in saturated fat on sweet biscuits and chocolates. Sausages showed a high prevalence of high in sodium and high in saturated fat warnings. Beverages stood out as high in added sugar, while fats, dairy products, frozen preparations, seasonings, and sauces presented diversity in the warnings. Other products, such as panettone, showed a high presence of alerts. The study demonstrated the widespread presence of front-of-package labeling on ultra-processed products highly consumed by the Brazilian population. Considering the alarming presence of these foods in the Brazilian diet, it is concluded that front-of-package nutrition labeling is crucial to inform and raise awareness among consumers, allowing healthier choices and potentially contributing to a reduction in chronic diseases and the costs associated with treatment in the health system.