BACKGROUND Chile's Law of Food Labeling and Advertising, implemented in 2016, was the first national regulation to jointly mandate front-of-package warning labels, restrict child-directed marketing, and ban sales in schools of all foods and beverages containing added sugars, sodium, or saturated fats that exceed set nutrient or calorie thresholds. The objective of this study is to evaluate the impact of this package of policies on household beverage purchases. METHOD AND FINDINGS In this observational study, monthly longitudinal data on packaged beverage purchases were collected from urban-dwelling households (n = 2,383) participating in the Kantar WordPanel Chile Survey from January 1, 2015, to December 31, 2017. Beverage purchases were linked to nutritional information at the product level, reviewed by a team of nutritionists, and categorized as "high-in" or "not high-in" according to whether they contained high levels of nutrients of concern (i.e., sugars, sodium, saturated fat, or energy) according to Chilean nutrient thresholds and were thus subject to the law's warning label, marketing restriction, and school sales ban policies. The majority of high-in beverages were categorized as such because of high sugar content. We used fixed-effects models to compare the observed volume as well as calorie and sugar content of postregulation beverage purchases to a counterfactual based on preregulation trends, overall and by household-head educational attainment. Of households included in the study, 37% of household heads had low education (less than high school), 40% had medium education (graduated high school), and 23% had high education (graduated college), with the sample becoming more educated over the study period. Compared to the counterfactual, the volume of high-in beverage purchases decreased 22.8 mL/capita/day, postregulation (95% confidence interval [CI] -22.9 to -22.7; p < 0.001), or 23.7% (95% CI -23.8% to -23.7%). High-educated and low-educated households showed similar absolute reductions in high-in beverage purchases (approximately 27 mL/capita/day; p < 0.001), but for high-educated households this amounted to a larger relative decline (-28.7%, 95% CI -28.8% to -28.6%) compared to low-educated households (-21.5%, 95% CI -21.6% to -21.4%), likely because of the high-educated households' lower level of high-in beverage purchases in the preregulation period. Calories from high-in beverage purchases decreased 11.9 kcal/capita/day (95% CI -12.0 to -11.9; p < 0.001) or 27.5% (95% CI -27.6% to -27.5%). Calories purchased from beverages classified as "not high-in" increased 5.7 kcal/capita/day (95% CI 5.7-5.7; p < 0.001), or 10.8% (10.8%-10.8%). Calories from total beverage purchases decreased 7.4 kcal/capita/day (95% CI -7.4 to -7.3; p < 0.001), or 7.5% (95% CI -7.6% to -7.5%). A key limitation of this study is the inability to assess causality because of its observational nature. We also cannot determine whether observed changes in purchases are due to reformulation or consumer behavioral change, nor can we parse out the effects of the labeling, marketing, and school sales ban policies. CONCLUSIONS Purchases of high-in beverages significantly declined following implementation of Chile's Law of Food Labeling and Advertising; these reductions were larger than those observed from single, standalone policies, including sugar-sweetened-beverage taxes previously implemented in Latin America. Future research should evaluate the effects of Chile's policies on purchases of high-in foods, dietary intake, and long-term purchasing changes.

中文翻译：

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智利食品标签和广告法对2015年至2017年购买含糖饮料的评估：一项前后研究。

背景技术智利于2016年实施的《食品标签和广告法》是首个共同强制包装前警告标签，限制以儿童为导向的销售并禁止在学校内销售所有含糖，钠和其他食品的饮料的国家法规。或超过设定的营养或卡路里阈值的饱和脂肪。这项研究的目的是评估这一政策对家庭饮料购买的影响。方法和发现在这项观察性研究中，从2015年1月1日至2017年12月31日参与Kantar写字板智利调查的城市居民家庭（n = 2,383）收集包装饮料购买的每月纵向数据。由营养师小组审查的产品一级的营养信息，并根据智利的营养素阈值，根据它们是否含有高水平的关注营养素（例如糖，钠，饱和脂肪或能量）归类为“高含量”或“非高含量”，因此要接受法律的警告标签，行销限制和学校销售禁令政策。由于含糖量高，大多数高价饮料被归类为此类饮料。我们使用固定效应模型，根据预先调节趋势，总体水平和按户主的教育程度，将观察到的数量以及调节后饮料购买的卡路里和糖含量与假想产品进行比较。在这项研究中，有37％的户主是低学历的学生（低于高中），有40％的学历是中等教育的（高中毕业的），23％的人具有高等教育程度（已毕业的大学），并且样本在研究期间受过更高的教育。与反事实相比，高价饮料的购买量减少了22.8 mL /人均/天，调节后（95％置信区间[CI] -22.9至-22.7； p <0.001）或23.7％（95％CI -23.8） ％至-23.7％）。高学历和低学历家庭的高饮饮料购买量绝对减少量相似（约27毫升/人均/天； p <0.001），但对于高学历家庭而言，相对下降幅度更大（-28.7％， 95％CI -28.8％至-28.6％），而低学历家庭（-21.5％，95％CI -21.6％至-21.4％），这可能是由于高学历家庭的高饮料水平较低在预调节期内进行购买。高价饮料购买的热量减少了11。9 kcal /人均/天（95％CI -12.0至-11.9; p <0.001）或27.5％（95％CI -27.6％至-27.5％）。从归类为“非高含量”饮料中购买的卡路里增加了5.7 kcal /人均/天（95％CI 5.7-5.7； p <0.001）或10.8％（10.8％-10.8％）。购买饮料的总热量降低了7.4 kcal /人均/天（95％CI -7.4至-7.3； p <0.001）或7.5％（95％CI -7.6％至-7.5％）。这项研究的主要局限性是由于其观察性质而无法评估因果关系。我们也无法确定观察到的购买变化是由于重新制定还是消费者行为的变化，我们也无法解析标签，营销和学校销售禁令政策的影响。结论在执行智利的《食品标签和广告法》后，高价饮料的购买量显着下降。这些减少幅度大于单一，独立政策所观察到的减少幅度，包括先前在拉丁美洲实施的含糖饮料税。未来的研究应评估智利政策对高价食品的购买，饮食摄入和长期购买变化的影响。