(C) PLOS One [1]. This unaltered content originally appeared in journals.plosone.org.
Licensed under Creative Commons Attribution (CC BY) license.
url:https://journals.plos.org/plosone/s/licenses-and-copyright

------------



Evaluation of the Mexican warning label nutrient profile on food products marketed in Mexico in 2016 and 2017: A cross-sectional analysis

['Alejandra Contreras-Manzano', 'Center For Research On Nutrition', 'Health', 'National Institute Of Public Health', 'Cuernavaca', 'Morelos', 'Carlos Cruz-Casarrubias', 'Ana Munguía', 'Alejandra Jáuregui', 'Jorge Vargas-Meza']

Date: 2022-05

The 3 implementation phases of the Mexican NP were useful to identify healthy food products. In contrast, the Peru Phase 1, Brazil, and Chile Phase 1 NP models may have limited usefulness for the classification of foods according to the content of ingredients of concern. The results of this study may inform countries seeking to adapt and evaluate existing NP models for use in population-specific applications.

Nutrition content data of 38,872 packaged food products available in the Mexican market were collected in 2016 and 2017. The evaluation of the Mexican NP, including its 3 implementation phases of increasing stringency (2020, 2023, and 2025), was conducted by comparing the percentage of products classified as “healthy” (without warnings) or “less healthy” (with 1 or more warnings), as well as the number and type of warnings assigned to food products, against the PAHO NP. Using the calibration method, we compared the classifications produced by the PAHO model against those produced by the NP models of Ecuador, Chile (3 phases), Peru (2 phases), Uruguay, and Brazil. Kappa coefficients and Pearson correlations were estimated, and proportion tests were performed. We found that the 3 implementation phases of the Mexican NP had near to perfect agreement in the classification of healthy foods (Mexico NP models: 19.1% to 23.8%; PAHO model: 19.7%) and a strong correlation (>91.9%) with the PAHO model. Other NPs with high agreement with the PAHO model were the Ecuador (89.8%), Uruguay (82.5%), Chile Phase 3 (82.3%), and Peru Phase 2 (84.2%) NPs. In contrast, the Peru Phase 1, Brazil, and Chile Phase 1 NP models had the highest percentage of foods classified as healthy (49.2%, 47.1%, and 46.5%, respectively) and the lowest agreement with the PAHO model (69.9%, 69.3%, and 73%, respectively). Study limitations include that warnings considered by the Mexican NP models were evaluated as if all the warnings were octagon seals, while 2 out of the 7 were rectangular warnings (caffeine and non-nutritive sweeteners), and that our data are limited by the quality of the information reported in the list of ingredients and the nutrition facts table of the products.

Different nutrient profiles (NPs) have been developed in Latin America to assess the nutritional quality of packaged food products. Recently, the Mexican NP was developed as part of the new warning label regulation implemented in 2020, considering 5 warning octagons (calories, sugar, sodium, saturated fats, and trans fats) and 2 warning rectangles (caffeine and non-nutritive sweeteners). The objective of this cross-sectional study was to evaluate the Mexican NP and other NPs proposed or used in Latin America against the Pan American Health Organization (PAHO) model.

Introduction

A nutrient profile (NP) is a tool that classifies foods and beverages according to their nutritional composition, e.g., whether products contain excessive amounts of ingredients of concern (sugar, sodium, and saturated and trans fats) and calories [1,2]. This tool allows the formulation and application of strategies related to the prevention and control of obesity and overweight [3,4], such as the use of front-of-package labels on processed foods, regulations for health or nutrition claims, regulation of unhealthy food marketing to children, food taxes, and restrictions on the foods and beverages available or sold in and outside schools [5,6].

Front-of-package labeling (FoPL) is a cost-effective strategy to promote healthy purchase decision-making in the population [3]. Recently, as a response to the growing epidemic of overweight and obesity in the Latin American region [7], several countries have adopted warning label systems. These are generally implemented in progressive phases to give the food and beverage industry the opportunity to reformulate their products in order to design new ones that do not exceed established thresholds for ingredients of concern [8]. For example, in 2016, Chile implemented warning labels for the first time in a 3-phase scheme (2016, 2018, and 2019) [9–11]. Chilean warning labels consist of black octagons with the legend “High in…” displayed on the front of the package for products with unhealthy levels of sugar, sodium, saturated fats, and/or calories [10]. Similar warning label systems have been adopted or are being considered in Peru (sugar, saturated fat, trans fat, and sodium), Uruguay (sugar, total fat, saturated fat, and sodium), Argentina (sugar, saturated fat, total fat, sodium, calories, non-nutritive sweeteners, and caffeine), and Brazil (sugar, saturated fat, and sodium) [12–15]. In 2014, Ecuador used its own NP to implement a traffic light system indicating whether a product contains relatively low (green), average (yellow), or high (red) levels of ingredients of concern (sugar, saturated fat, and sodium) [16]. In 2020, Mexico adopted new mandatory FoPL with warning octagons with the legend “Excess…” for calories and ingredients of concern (e.g. sugar, sodium, saturated fats, and trans fats) and warning rectangles for products that include added caffeine and non-nutritive sweeteners, along with the statement “avoid/not recommended in children” [17]. These national FoPL systems are implemented along with their own NP models, generally involving a 2- or 3-phase progressive implementation scheme, and some of them are based on the Pan American Health Organization (PAHO) NP model [17].

The PAHO model provides regional criteria for acceptable amounts of ingredients of concern (sodium, sugar, total fat, saturated fat, trans fat and non-nutritive sweeteners) in Latin America. However, NP models underpinning FoPL systems should be relevant for the national or regional food supply [18]. Therefore, regional criteria proposed by the PAHO model should be carefully adapted to ensure that the FoPL system is sensitive enough to classify products according to their healthfulness [18]. Classifications produced by the adapted NP models should also align with national dietary guidelines. In Mexico, sugar-sweetened beverages, particularly cola drinks, are partly responsible for the high prevalence of obesity and diabetes [19]; these drinks are consumed at high levels by the population, including children [20]. Therefore, adaptations of the PAHO model for use in Mexico included additional thresholds for calories and a warning for added caffeine, intake of which is not recommended among children [21]. Other adaptations included removing the total fat threshold of the PAHO model, since total fat includes healthy fatty acids, which are not common in the Mexican diet and whose intake needs to be promoted. The sodium threshold proposed by PAHO was also adapted considering the national market share in Mexico. In accordance with the Mexican FoPL regulation, which involves 3 implementation phases (2020, 2023, and 2025), 3 NPs were proposed, with stricter nutrient criteria for each progressive phase [8,17].

According to the World Health Organization (WHO), the validation of a NP “considers different methods aimed at answering the question of whether the nutrient profile model classifies foods correctly” [2]. Validation is also needed to increase the evidence supporting the model, and hence improve confidence in the model [1]. There are different approaches to evaluating a NP model, involving calibration, construct validity, assessment of predictive validity against health outcomes in individuals, and experimental studies [22–24]. The calibration approach involves comparing the classifications produced by a NP model against those from another designed for similar purposes [2]. Currently, there is no gold standard for classifying the NP of a food product. However, the PAHO model has been adopted as a reference for comparing new NPs in various Latin American studies [10–13]. Thus, for Latin American countries, the PAHO model may work as a reference NP model [1]. The PAHO model was developed without food and beverage industry interference, and was the result of rigorous work by an Expert Consultation Group based on scientific evidence [4]. It is also based on the WHO population nutrient intake goals to prevent obesity and related chronic noncommunicable diseases (NCDs) [25], and considers the updated goals of the WHO expert consultations on maximum recommended intake of ingredients of concern: sugar, fats, and sodium [26].

The objective of this study was to evaluate the Mexican NP by comparing the percentage of products classified as “healthy” and “less healthy” (e.g., when product had 1 or more warnings), as well as the number and type of warnings assigned to food products, against the PAHO model using the calibration method. We also compared the classifications produced by the PAHO model against those from the NP models of Chile, Ecuador, Peru, Uruguay, and Brazil.

[END]

[1] Url: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003968

(C) Plos One. "Accelerating the publication of peer-reviewed science."
Licensed under Creative Commons Attribution (CC BY 4.0)
URL: https://creativecommons.org/licenses/by/4.0/


via Magical.Fish Gopher News Feeds:
gopher://magical.fish/1/feeds/news/plosone/

You are viewing proxied material from magical.fish. The copyright of proxied material belongs to its original authors. Any comments or complaints in relation to proxied material should be directed to the original authors of the content concerned. Please see the disclaimer for more details.