Information search behaviour, understanding and use of nutrition labeling by residents of Madrid, Spain

OBJETIVES: To describe the information search behaviour, comprehension level, and use of nutritional labeling by consumers according to sociodemographic characteristics. STUDY DESIGN: Cross-sectional study of consumers recruited in five stores of the main supermarket chains in Madrid: a random sample of 299 consumers (response rate: 80.6%). METHODS: Interviewers collected information about the information search behaviour, comprehension, and use of nutritional labeling using a questionnaire designed for this purpose. Analyses examined the frequency of the variables of interest. Differences were tested using the Chi-square statistic. RESULTS: In this sample, 38.8% of consumers regularly read the nutritional labeling before making a purchase (45% of women vs 30% in men; P = 0.03) and the most common reason reported was choosing healthier products (81.3%). The proportion of people who were interested in additives and fats was the higher, (55% and 50%, respectively). Lack of time (38.9%), lack of interest (27.1%), and reading difficulties (18.1%) were the most common reasons given for not reading labels. Over half (52.4%) of consumers reported completely understanding the nutritional information on labels and 20.5% reported using such information for dietary planning. CONCLUSIONS: Reported information search behaviour, comprehension, and use of nutritional labeling were relatively high among consumers of the study, and their main goal was picking healthier products. However, not only are there still barriers to reading the information, but also the information most relevant to health is not always read or understood. Thus, interventions to increase nutritional labeling comprehension and use are required in order to facilitate the making of healthier choices by consumers

Alegaciones nutricionales y de salud en productos dirigidos a niños por televisión en España en 2012

OBJECTIVE: To describe the use of nutrition and health claims in products directed at children via television in Spain and to analyse their nutrient profile. METHODS: A cross-sectional study of television food advertisements over 7 days in five Spanish television channels popular among children. The products were classified as core, non-core or miscellaneous, and as either healthy or less healthy, according to the United Kingdom Nutrient Profile Model. We registered all claims contained on the product (packaging and labelling) and its advertisement. We calculated the frequency distributions of health and nutrition claims. RESULTS: During the 420hours of broadcasting, 169 food products were identified, 28.5% in the dairy group and 60.9% in the non-core category. A total of 53.3% of products contained nutrition claims and 26.6% contained health claims; 62.2% of the products with claims were less healthy. Low-fat dairy products were the food category containing the highest percentage of health and nutrition claims. CONCLUSION: Over half of all food products marketed to children via television in Spain made some type of nutrition or health claim. Most of these products were less healthy, which could mislead Spanish consumers.This project has been supported by the Spanish Health Research Fund of the Institute of Health Carlos III (Project ENPY 1015/13) and the Spanish Consumers Organization.S

The extent and nature of food advertising to children on Spanish television in 2012 using an international food-based coding system and the UK nutrient profiling model

OBJECTIVE: To examine the extent and nature of food television advertising directed at children in Spain using an international food-based system and the United Kingdom nutrient profile model (UKNPM). STUDY DESIGN: Cross-sectional study of advertisements of food and drinks shown on five television channels over 7 days in 2012 (8am-midnight). METHODS: Showing time and duration of each advertisement was recorded. Advertisements were classified as core (nutrient-rich/calorie-low products), non-core, or miscellaneous based on the international system, and either healthy/less healthy, i.e., high in saturated fats, trans-fatty acids, salt, or free sugars (HFSS), according to UKNPM. RESULTS: The food industry accounted for 23.7% of the advertisements (4212 out of 17,722) with 7.5 advertisements per hour of broadcasting. The international food-based coding system classified 60.2% of adverts as non-core, and UKNPM classified 64.0% as HFSS. Up to 31.5% of core, 86.8% of non-core, and 8.3% of miscellaneous advertisements were for HFSS products. The percentage of advertisements for HFSS products was higher during reinforced protected viewing times (69.0%), on weekends (71.1%), on channels of particular appeal to children and teenagers (67.8%), and on broadcasts regulated by the Spanish Code of self-regulation of the advertising of food products directed at children (70.7%). CONCLUSIONS: Both schemes identified that a majority of foods advertised were unhealthy, although some classification differences between the two systems are important to consider. The food advertising Code is not limiting Spanish children's exposure to advertisements for HFSS products, which were more frequent on Code-regulated broadcasts and during reinforced protected viewing time.This Project has been supported by the Spanish Health Research Fund of the Institute of Health Carlos III (Project grant number ENPY 1015/13) and the Spanish Consumers Organization (OCU)

Marketing techniques in television advertisements of food and drinks directed at children in Spain, 2012

OBJECTIVES: To analyse marketing techniques used in television advertisements of food and drinks (AFDs) directed to children, and their nutritional quality. METHODS: This is a cross-sectional study of television AFDs directed to children in Spain over 7 days in 2012. Primary appeal, persuasive and nutritional marketing techniques, and links to Internet were registered. The foods were classified according to their nutritional quality using an international codification system and the UK nutrient profile model. Frequency of AFDs using marketing techniques and percentages for unhealthy products were calculated. RESULTS: Taste and fun were the main primary appeals used. Persuasive and nutritional marketing techniques and links to Internet were used in 61%, 68.5% and 65.2% of AFDs, respectively. These techniques were more common during weekdays, enhanced protection time slots and on channels with particular appeal to children. More than two-thirds of AFDs using these techniques were for unhealthy products, reaching 96.2% of AFDs with premium offers and gifts. CONCLUSIONS: There is an extensive use of marketing techniques in television AFDs directed to children in Spain. Most products advertised were unhealthy, so stronger governmental regulations are required.This project was supported by the Spanish Health Research Fund of the Institute of Health Carlos III (Project ENPY 1015/13).S

Vending Machines of Food and Beverages and Nutritional Profile of their Products at Schools in Madrid, Spain, 2014-2015

BACKGROUND: Policies restricting access to sugary drinks and unhealthy foods in the school environment are associated with healthier consumption patterns. In 2010, Spain approved a Consensus Document regarding Food at Schools with nutritional criteria to improve the nutritional profile of foods and drinks served at schools. The objective of this study was to describe the frequency of food and drink vending machines at secondary schools in Madrid, the products offered at them and their nutritional profile. METHODS: Cross-sectional study of a random sample of 330 secondary schools in Madrid in 2014-2015. The characteristics of the schools and the existence of vending machines were recorded through the internet and by telephone interview. The products offered in a representative sample of 6 vending machines were identified by in situ inspection, and its nutritional composition was taken from its labeling. Finally, the nutritional profile of each product was analyzed with the United Kingdom profile model, which classifies products as healthy and less healthy. RESULTS: The prevalence of vending machines was 17.3%. Among the products offered, 80.5% were less healthy food and drinks (high in energy, fat or sugar and poor in nutrients) and 10.5% were healthy products. CONCLUSIONS: Vending machines are common at secondary schools in Madrid. Most products are vending machines are still less healthy. Fundamento: Las políticas restrictivas del acceso a bebidas azucaradas y alimentos no saludables en el entorno escolar se asocian con patrones de consumo más saludables. En 2010 se aprobó en España el Documento de Consenso sobre la Alimentación en los Centros Educativos con criterios nutricionales para mejorar el perfil nutricional de los alimentos y bebidas ofertados. El objetivo de este estudio fue describir la frecuencia de máquinas expendedoras de bebidas y alimentos y perfil nutricional de sus productos en los Institutos de Enseñanza Secundaria (IES) de Madrid.Métodos: Estudio transversal sobre una muestra aleatoria de 330 IES de la Comunidad de Madrid durante el curso 2014-2015. A través de internet y por entrevista telefónica se registraron las características de los centros y la existencia o no de máquinas expendedoras en ellos. Los productos ofertados en una muestra representativa de 6 máquinas expendedoras se obtuvieron mediante inspección in situ y su composición nutricional se tomó del eti-quetado. Por último, el perfil nutricional de los productos se analizó con el modelo del Reino Unido, que clasifica los productos en saludables y menos saludables. Resultados: La prevalencia de máquinas expendedoras fue del 17,3%. El 80,5% de sus productos fueron menos saludables, altamente energéticos, ricos en grasa o azúcar y pobres en micronutrientes. El 10,5% resultaron ser productos saludables.Conclusión: Las máquinas expendedoras son frecuentes en los IES de Madrid y la mayoría de sus productos tienen un mal perfil nutricional. Palabras clave:Obesidad infantil. Máquinas expendedoras de alimen-tos. Escuela secundaria. Recomendaciones alimentarias.S

La publicidad alimentaria dirigida a menores en España

La publicidad alimentaria de productos altamente energéticos y pobres en nutrientes influye en las preferencias, las peticiones de compra y los hábitos alimentarios de los menores, contribuyendo a la epidemia de obesidad y la aparición precoz de factores de riesgo de enfermedades crónicas. La OMS recomienda reducir el impacto negativo de la publicidad de alimentos y bebidas ricos en grasas, 0 azúcares y sal en los hábitos alimentarios de los menores, actuando sobre el poder de las técnicas de marketing y los niveles de exposición. En España, pese a la existencia del código PAOS, regulador de la publicidad alimentaria dirigida a menores, en torno a dos tercios de los anuncios en horario infantil y más de la mitad de los que usan marketing nutricional son de productos altos en grasas, azúcares y/o sal. En la lucha contra la obesidad infantil y sus consecuencias conviene regular el contenido nutricional de la publicidad alimentaria dirigida a menores (al menos hasta 16 años) en todos los programas y horarios con una audiencia infantil significativa

Evaluation of compliance with the Spanish Code of self-regulation of food and drinks advertising directed at children under the age of 12 years in Spain, 2012

OBJECTIVE: To evaluate compliance levels with the Spanish Code of self-regulation of food and drinks advertising directed at children under the age of 12 years (Publicidad, Actividad, Obesidad, Salud [PAOS] Code) in 2012; and compare these against the figures for 2008. STUDY DESIGN: Cross-sectional study. METHODS: Television advertisements of food and drinks (AFD) were recorded over 7 days in 2012 (8am-midnight) of five Spanish channels popular to children. AFD were classified as core (nutrient-rich/low-calorie products), non-core (nutrient-poor/rich-calorie products) or miscellaneous. Compliance with each standard of the PAOS Code was evaluated. AFD were deemed to be fully compliant when it met all the standards. RESULTS: Two thousand five hundred and eighty-two AFDs came within the purview of the PAOS Code. Some of the standards that registered the highest levels of non-compliance were those regulating the suitability of the information presented (79.4%) and those prohibiting the use of characters popular with children (25%). Overall non-compliance with the Code was greater in 2012 than in 2008 (88.3% vs 49.3%). Non-compliance was highest for advertisements screened on children's/youth channels (92.3% vs. 81.5%; P < 0.001) and for those aired outside the enhanced protection time slot (89.3% vs. 86%; P = 0.015). CONCLUSIONS: Non-compliance with the PAOS Code is higher than for 2008. Given the lack of effectiveness of self-regulation, a statutory system should be adopted to ban AFD directed at minors, or at least restrict it to healthy products.S

Quality of food products announced on television before and after the plan to improve their composition, 2017-2020

[ES] Objetivo: Comparar la calidad nutricional de los alimentos y bebidas anunciados por televisión en España antes y después del plan para mejorar su composición. Método: Se grabaron las emisiones por televisión digital terrestre (TDT) en horario infantil de los canales más populares. Se registraron los productos anunciados en los cortes comerciales y su composición nutricional. Se comparó su distribución de frecuencias por categorías alimentarias y su adherencia al perfil nutricional de la Organización Mundial de la Salud en 2017 y 2020. Resultados: En 256 horas de emisión se identificaron 173 productos (78 en 2017 y 95 en 2020). Los más anunciados fueron los chocolates (26,9% en 2017 y 22,1% en 2020). El 76,3% de los productos anunciados eran no saludables (76,9% en 2017 y 75,8% en 2020; p=0,86). Conclusiones: El perfil nutricional de los productos anunciados por televisión, mayoritariamente no saludables, no cambió tras la implantación del plan para mejorar su composición. Es preciso regular la publicidad alimentaria para proteger a los niños. [EN] Objective: To compare the nutritional quality of the foods and beverages advertised on television in Spain, before and after the plan to improve their composition. Method: DTT broadcasts of the more popular channels were recorded in children's hours. Every advertised products in commercial breaks were registered and their nutritional data collected. We compared the distribution of frequencies by food categories and their adherence to the nutritional standards of the World Health Organization in 2017 and 2020. Results: In 256h of broadcasting we identified 173 products (78 in 2017 and 95 in 2020). The most advertised products were chocolates (26.9% in 2017 and 22.1% in 2020). 76.3% of the products advertised were unhealthy (76.9% in 2017 vs. 75.8% in 2020; p=0.86). Conclusions: The nutritional profile of the foods and drinks advertised on television, mostly unhealthy, did not change after the implementation of the plan to improve their composition. A regulation is needed to protect children from food advertising.Este estudio ha recibido financiación del Instituto Mixto de Investigación Escuela Nacional de Sanidad (IMIENS: Resolución de la convocatoria de ayudas para la realización de Proyectos de Investigación Conjuntos, publicada en BICI n.◦ 2 de 16 de octubre de 2017).S

Secondary school menu in Madrid (Spain): knowledge and adherence to the Spanish National Health System recommendations

OBJECTIVE: To establish the degree of knowledge and adherence to the Spanish National Health System recommendations on nutrition in schools in the Autonomous Community of Madrid. METHODS: Cross-sectional study of a random sample of 182 secondary schools from Madrid, during 2013-2014 school year. Information on the characteristics of the schools and the knowledge of the recommendations was collected by internet and telephone interviews, as well as a copy of the school menu. The average number of rations per week offered for each food item and the percentage of schools within the recommended range were calculated. The overall adherence was obtained as the mean of food items (0-12) within the range. RESULTS: 65.5% of the schools were unaware of the national recommendations. The supply of rice, pasta, fish, eggs, salad and fruit was lower than recommended, whereas for meat, accompaniment and other desserts was higher. The percentage of schools within the range for each food item varied between 13% and 95%. The mean of overall adherence was 6.3, with no differences depending on whether the menu was prepared or not at schools or there was or not a person in charge of nutrition standards. CONCLUSIONS: The degree of adherence to the recommendations was variable, being advised to increase the supply of cereals, eggs, fish, salad and fruit. Programs for dissemination and implementation of the recommendations, leaded by trained professionals, are required to improve the nutritional value of school menu.S

Nutrición en Salud Pública

Este libro es fruto de una revisión y actualización ampliadas de los manuales docentes de «Nutrición en Salud Pública» y «La alimentación y el consumidor», editados en 2007 y 2013 respectivamente por la Escuela Nacional de Sanidad del Instituto de Salud Carlos III.La salud pública es el arte y la ciencia de prevenir la enfermedad, prolongar la vida y promover la salud a través de los esfuerzos organizados de la sociedad. La nutrición es la ciencia que estudia la forma en que el organismo utiliza la energía de los alimentos para mantenerse y crecer, mediante el análisis de los procesos por los cuales ingiere, digiere, absorbe, transporta, utiliza y extrae los nutrientes esenciales para la vida, y su interacción con la salud y la enfermedad. Por tanto, la nutrición en salud pública (public health nutrition) es la ciencia que estudia la relación entre dieta y salud y sienta las bases para el diseño, ejecución y evaluación de intervenciones nutricionales a nivel comunitario y poblacional con el objeto de mejorar el estado de salud de las poblaciones. La pandemia de obesidad, una enfermedad estrechamente relacionada con la nutrición, es uno de ejemplos paradigmáticos del carácter multidisciplinar e intersectorial de la salud pública. Hace décadas, la obesidad era considerada una enfermedad endocrina, de tipo glandular, dentro del dominio biomédico del especialista en endocrinología. Después se pasó a considerar algunos factores personales de riesgo, como los hábitos alimentarios y de actividad física, entrando en el dominio de la medicina preventiva, que centra sus esfuerzos en los factores biomédicos individuales, como la ingesta de calorías o el sedentarismo, y del entorno familiar. La salud pública va más allá, considerando factores ambientales, sociales y culturales que afectan a las preferencias alimentarias y los hábitos de vida, como los sistemas de producción de alimentos y fijación del precio de los mismos, el uso de subsidios y tasas, la publicidad alimentaria, el nivel socioeconómico de las familias, el diseño urbanístico (cantidad de espacios verdes, parques, carriles bici) o los sistemas de transporte urbano, entre otros muchos. El abordaje de elementos tan variados requiere del concurso de especialistas en múltiples disciplinas: profesionales sanitarios, abogados, economistas, periodistas, urbanistas, sociólogos, etc. Aunque ningún individuo puede ser experto en todas las especialidades relacionadas con la salud pública, el profesional bien formado debe conocer el rol de cada una de esas disciplinas en la formulación de una intervención de salud pública, estar familiarizado con el lenguaje y los postulados básicos de dichas disciplinas, y haber practicado la implementación de intervenciones a cargo de equipos multidisciplinarios