Formatos de informações sobre os açúcares na rotulagem de alimentos industrializados: estudo multimétodos do contexto brasileiro

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Nutrição, Florianópolis, 2021.O consumo excessivo de açúcares, especialmente aqueles adicionados em alimentos industrializados, é evidenciado globalmente e está relacionado ao agravamento de doenças crônicas não transmissíveis. Por isso, diretrizes da Organização Mundial da Saúde recomendam limitar o consumo desses açúcares. Para identificar os açúcares nos alimentos industrializados, o consumidor depende das informações disponíveis nos rótulos. Contudo, a legislação de rotulagem de alimentos em vigor no Brasil não prevê tal obrigatoriedade. O objetivo da tese foi avaliar as informações sobre os açúcares na rotulagem de alimentos industrializados e investigar formatos de rotulagem que sejam compreensíveis e auxiliem consumidores brasileiros nas suas escolhas alimentares. Foi realizado um estudo multimétodos dividido em três fases. A fase 1 envolveu adaptação, validação e aplicação de um método para estimar o conteúdo de açúcares de adição de alimentos industrializados considerando as informações disponíveis nos rótulos. O método adaptado foi aplicado em um banco de dados com informações de rótulos de 4.805 alimentos, dos quais 65% possuíam açúcares adicionados com valores médios apresentados por grupos de alimentos. Na fase 2 foi realizada revisão sistemática com metanálise de 23 estudos randomizados. Os formatos de declaração do conteúdo de açúcares em gramas na tabela de informação nutricional, aliado a algum formato interpretativo foram os mais eficazes no entendimento dos consumidores sobre açúcares e para estimular escolhas de alimentos com menos açúcares. A fase 3 contemplou a realização de um estudo de métodos mistos em duas etapas. Na primeira etapa ocorreu a realização de cinco grupos focais com uma amostra de 32 adultos jovens brasileiros que investigou a percepção sobre açúcares e sobre formatos de rotulagem de alimentos. Os participantes perceberam o atual formato de rotulagem de alimentos em vigor no Brasil como limitante para identificação dos açúcares e para auxílio nas escolhas alimentares, indicando quais mudanças poderiam ser realizadas para tornar o formato de rotulagem mais compreensível e útil. Na segunda etapa da fase 3 foi realizado um ensaio controlado randomizado online com 1.277 consumidores adultos brasileiros. Cinco formatos de rotulagem de alimentos sobre informações de açúcares foram testados. Foi evidenciada a necessidade de declaração do conteúdo de açúcares na tabela de informação nutricional para promover o entendimento dos consumidores sobre esses açúcares em alimentos industrializados. Contudo, não foi possível determinar qual formato seria mais adequado para estimular escolhas de alimentos com menor conteúdo de açúcares. Complementarmente, foi realizado estágio de doutorado sanduíche junto ao The George Institute for Global Health associado à University of New South Wales em Sidney, Austrália. Como conclusão, destaca-se a contribuição científica na adaptação de um método de estimativa de açúcares e a contribuição teórica e empírica na discussão dos modelos de rotulagens de açúcares no contexto brasileiro. Adicionalmente, recomenda-se o estabelecimento de ações que busquem reduzir o conteúdo de açúcares adicionados em alimentos industrializados, sem, contudo, estimular a substituição por componentes que possam ser prejudiciais à saúde, tais como os edulcorantes. Finalmente, ressalta-se a relevância de que a legislação de rotulagem de alimentos nacional considere obrigatória a declaração do conteúdo de açúcares nos rótulos para auxiliar os consumidores a entenderem melhor a composição dos alimentos industrializados e para estimular escolhas alimentares informadas e mais saudáveis.Abstract: Excessive sugar intake, particularly those ones added to the processed foods, is globally evidenced and is related to the worsening of chronic non-communicable diseases. For this reason, the World Health Organization guidelines recommends limiting the intake of these sugars. To identify sugars in the processed foods, consumers rely on the information available on the food labels. However, the current food labeling legislation in force in Brazil does not make this information mandated. The objective of this PhD thesis was to evaluate sugar labelling of processed foods and to investigate sugar labeling formats that are understandable and assist Brazilian consumers in their food choices. A multi-method study was carried out divided into three phases. Phase 1 involved the adaptation, validation and application of a method for estimating added sugar content of processed foods considering the information available on the food labels. The adapted method was applied to a database with information from 4,805 foods, of which 65% had sugars added with mean added sugar content presented by food groups. In Phase 2, a systematic review and meta-analysis was carried out with 23 randomized studies. Sugar labelling formats which displayed the sugar content in grams in the nutritional information table combined with an interpretation were the most effective on influencing consumers? understanding about sugars and to encourage food choices with less sugar content. Phase 3 included a mixed-methods study conducted in two stages. In the first stage, five focus groups were conducted with a sample of 32 young Brazilian adults to investigate the perception of them regarding sugars and food labeling formats. Participants perceived the current food labeling format in force in Brazil as limited for the identification of sugars in packaged foods and for helping them during their food choices. Participants have indicated some changes that could be done to make the food labels more understandable and useful. In the second stage of Phase 3, an online randomized controlled experiment was carried out with 1,277 adult Brazilians. Five sugar labeling formats have been tested. It was demonstrated the need on declaring the sugar content in the nutritional information table in order to promote consumers? understanding of these sugars in processed foods. However, it was not possible to determine which sugar label format would be most suitable to stimulate food choices with less sugar content. In addition, a doctoral internship was carried out at The George Institute for Global Health associated with the University of New South Wales in Sydney, Australia. In conclusion, it is highlighted the scientific contribution in adapting a method for estimating added sugar of packaged foods and the theoretical and empirical contributions in the discussion of sugar labeling formats in the Brazilian context. Additionally, the establishment of actions that seek to reduce the content of added sugars in packaged foods, without stimulating the replacement by components that may be harmful to health, such as sweeteners is recommended. Finally, it is highlighted the relevance of a Brazilian food labeling legislation that considers the declaration of sugar content on food labels to help consumers better understand the composition of processed foods and to encourage informed and healthier food choices

Notificação dos açúcares de adição em rótulos de alimentos industrializados comercializados no Brasil

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Nutrição, Florianópolis, 2016.Os açúcares de adição são açúcares e xaropes adicionados aos alimentos e bebidas durante o processamento industrial, à preparação culinária ou à mesa. Acumulam-se evidências de que o consumo excessivo desses açúcares de adição na dieta está associado ao aumento do risco de várias doenças, incluindo a cárie dental, a obesidade e as doenças cardiovasculares. Assim, a Organização Mundial da Saúde (OMS) orienta a limitação no consumo de açúcares de adição por adultos e crianças. Os alimentos industrializados são a principal fonte de seu consumo, contudo, no Brasil, não há atualmente obrigatoriedade de rotulagem da quantidade de açúcares de adição na informação nutricional desses alimentos, sendo a lista de ingredientes a única forma de identificá-los. O presente estudo objetivou investigar como os açúcares de adição são notificados na lista de ingredientes dos rótulos de alimentos industrializados comercializados no Brasil. Realizou-se um estudo transversal do tipo censo, descritivo e analítico, no qual foram analisados todos os alimentos industrializados disponíveis para venda em um supermercado pertencente a uma das dez maiores redes de supermercados do Brasil. Foram coletadas informações sobre a identificação (nome comercial, marca, sabor, fabricante), bem como o registro fotográfico, com posterior obtenção da lista de ingredientes de todos os alimentos. Identificaram-se as nomenclaturas dos ingredientes que eram açúcares de adição ou passíveis de contê-los na lista de ingredientes e sua frequência de citação. Os alimentos foram categorizados em grupos de acordo com a divisão estabelecida pela legislação brasileira de rotulagem de alimentos, RDC nº 359/2003. Analisou-se a prevalência dos alimentos industrializados com presença de açúcares de adição ou ingredientes passíveis de contê-los segundo os grupos da legislação, os ingredientes mais frequentes no banco de dados e aqueles que se associavam aos açúcares utilizando a técnica de mineração de texto com uso do pacote text mining por meio da linguagem R. Além disso, realizou-se análise da diferença na prevalência dos alimentos com presença de açúcares de adição e ingredientes passíveis de contê-los entre os grupos da RDC nº359/2003 por meio do teste de Qui-quadrado com uso do software Stata, versão 11.0. Foram analisados 4.539 alimentos, dos quais 70 % apresentavam açúcares de adição ou ingredientes passíveis de contê-los (IPAA) em sua lista de ingredientes e houve a identificação de 262 diferentes nomenclaturas para designá-los. Os tipos de açúcares de adição mais frequentes foram açúcar, seguido de maltodextrina, e xarope de glicose. Os IPAA mais frequentes foram gelatina, chocolate e polpa de tomate. O açúcar foi o ingrediente mais prevalente nos alimentos industrializados, seguido pelos aromatizantes, sal e corantes. Em sete dos oito grupos alimentares da RDC nº 359/2003 houve presença de açúcares de adição em mais da metade de seus alimentos. Grupos de alimentos predominantemente salgados, como os grupos II (verduras, hortaliças e conservas vegetais), V (carnes e ovos) e VIII (molhos, temperos prontos, caldos, sopas e pratos preparados), apresentaram elevada frequência de alimentos contendo açúcares de adição e IPAA. Houve diferença de frequência estatisticamente significativa (pAbstract : Added sugars are sugars and syrups added to food products and drinks during industrial processing, food preparation, or at the table. Research has accumulated evidence that excessive consumption of these added sugars in the diet is associated with increased risk of many illnesses, including dental cavities, obesity and cardiovascular diseases. As a consequence, the World Health Organization (WHO) guides the limitation in the consumption of added sugars by adults and children. Industrialized food products are the main source of their consumption, however, there is currently no enforcement to label the quantity of added sugars in the nutrition facts of these food products. As a result, the list of ingredients is the only way to identify them. The present study aimed at investigating how added sugars are notified in the list of ingredients of industrialized food products commercialized in Brazil. To reach such a goal, a cross-sectional, descriptive and analytical study of the type census was carried out. All industrialized food products available for purchase in a supermarket from one of the ten largest supermarket chains in Brazil were analyzed. Information was collected about the identification of the food products (commercial name, brand, flavor, manufacturer) as well as the photographic record, with the posterior collection of the list of ingredients of all products. The nomenclatures of the ingredients related to added sugars or susceptible to contain added sugars were identified as well as their citation frequency. The food products were categorized into groups according to the division established by the Brazilian food labeling law, RDC 359/2003. The prevalence of industrialized food products with presence of added sugars or susceptible to contain added sugars was analyzed according to the groups determined by the law. The most frequent ingredients in the data base and the ones associated to sugars were analyzed by means of the text mining technique implemented in R language. Additionally, the analysis of difference in the prevalence of added sugars and ingredients susceptible to contain them among the groups from RDC nº359/2003 was done by means of the chi-square test on Stata software, version 11.0. Four thousand, five hundred and thirty-nine food products (4.539) were analyzed. From the total, 70 % presented added sugars or ingredients susceptible to contain them in their list of ingredients, and 262 different nomenclatures were identified to designate them. The types of added sugars that were more frequent were: sugar, followed by maltodextrin, and glucose syrup. The most frequent ingredients susceptible to contain added sugars were gelatin, chocolate and tomato pulp. Sugar was the most prevalent ingredient in industrialized food products, followed by flavoring agents, salt and coloring agents. In seven from the eight food groups established by RDC 359/2003, more than half of their food products presented added sugars. Groups of predominantly salty food products, such as groups II (vegetables and bottled vegetables), V (meats and eggs) and VIII (sauces, ready-made seasonings, gravies, soups, and ready meals), presented a high frequency of added sugars or ingredients susceptible to contain added sugars in their products. There was a statistically significant difference (p<0.01) in frequency among the groups established by RDC 359/2003 and the presence of added sugars and ingredients susceptible to contain ones in the analyzed industrialized products. Group VII (sugars and products with energy derived from carbohydrates and fats) demonstrated 244.7 times (148 %) more presence of these nutrients than group VI (meats and eggs), with less prevalence. Therefore, this study shows that large part of the industrialized products available for purchase in Brazil presented added sugars in their composition, what may hamper the adherence to the recommendations of limited consumption of sugars proposed by WHO. In addition, the diversity of nomenclatures that refer to added sugars and ingredients susceptible to contain ones may lead customers to consume them without proper knowledge, mainly resulting from terms of difficult comprehension, such as the term maltodextrin. In this context, the present study suggests the revision of the Brazilian legislation on food labeling in two ways. First, by making the quantitative declaration of added sugars in the nutrition facts table mandatory, in order to facilitate the consumers? quantification of consumption. Second, by establishing clearer rules as regards the standardization of the nomenclature of the ingredients

Assessing nutritional composition and ingredients of packaged foods in Brazil: an in-store census method for creating a comprehensive food label database

BackgroundThe consumption of ultra-processed packaged foods has surged worldwide with important health implications. It is pertinent to study the composition of packaged foods through information provided on labels. However, there is limited methodological discussion in the field. This study aimed at discussing methodological evolution and challenges of in-store census methods for assessing the composition of packaged foods, and characterizing a Brazilian food label database.MethodsThe first Brazilian food label database reported in the scientific literature, based on data of in-store census method, was created in 2010 by the Nutrition in Foodservice Research Centre (NUPPRE at the Federal University of Santa Catarina). The in-store census method involves collecting primary data directly from the labels of packaged foods available for sale through retail food outlets. In 2020, the in-store census was carried out in partnership with the FoodSwitch Program. The NUPPRE/FoodSwitch Brazil 2020 database was developed in four steps: pre-data collection, data collection, data tabulation, and database construction and processing. The database was characterized by calculating the prevalence of foods per food group and foods that declared mandatory nutrition and health information on food labels according to Brazilian regulation.ResultsThe nutritional profile and ingredients of packaged foods was obtained from four food label censuses (2010, 2011, 2013 and 2020), supporting the Brazilian government on food labeling regulations and public policies. The experience prompted reflections about the methodological aspects of food label studies, and enabled improvements to the research process, such as a more accurate data collection, the inclusion of all packaged foods and beverages available for sale in the supermarket and the inclusion of more variables to the analysis. It is noteworthy the relevance of building nationwide food labeling databases. However, there are important challenges regarding the costs and efforts needed to maintain and update the data, especially in continental countries such as Brazil. The NUPPRE/FoodSwitch Brazil 2020 database consists of 7,828 packaged foods, 94% of the sampled brands sold nationwide. Most foods presented the mandatory information according to Brazilian regulation.ConclusionThis study proposed a series of methodological procedures to be carefully considered, designed, and executed during planning, data collection, data tabulation, and database processing. Greater rigor and detail are needed in the methods section of scientific articles, to aid replication

A best practice guide for conducting healthy food retail research:A resource for researchers and health promotion practitioners

Retail food environments play a pivotal role in influencing dietary behaviors, and therefore have huge potential as settings for promoting good nutrition and preventing obesity. Conducting research in retail settings can be challenging due to the varied motivations of the parties involved and the complex nature of retail environments. To improve the quality and consistency of research in this field, we have identified 16 thematic topics aimed at guiding researchers and public health practitioners on how to conduct healthy food retail research. A summary for each topic, encompassing existing methodologies, best practice examples, and knowledge gaps, was developed based on available literature and the collective experience and expertise of 32 multidisciplinary researchers from a high-income perspective engaged in healthy food retail research in a diverse range of retail settings. A summary checklist describing key considerations at each stage of conducting healthy food retail research was also developed.</p