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An evaluation of Chile's Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study.
PLOS Medicine ( IF 10.5 ) Pub Date : 2020-02-11 , DOI: 10.1371/journal.pmed.1003015 Lindsey Smith Taillie 1, 2 , Marcela Reyes 3 , M Arantxa Colchero 4 , Barry Popkin 1, 2 , Camila Corvalán 3
PLOS Medicine ( IF 10.5 ) Pub Date : 2020-02-11 , DOI: 10.1371/journal.pmed.1003015 Lindsey Smith Taillie 1, 2 , Marcela Reyes 3 , M Arantxa Colchero 4 , Barry Popkin 1, 2 , Camila Corvalán 3
Affiliation
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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：
对 2015 年至 2017 年智利食品标签和广告法对含糖饮料购买的评估：一项前后研究。
背景 智利于 2016 年实施的《食品标签和广告法》是第一部联合强制要求在包装正面贴上警告标签、限制针对儿童的营销以及禁止在学校销售所有含有添加糖、钠的食品和饮料的国家法规。 ，或超过设定的营养或卡路里阈值的饱和脂肪。本研究的目的是评估这一系列政策对家庭饮料购买的影响。方法和结果 在这项观察性研究中，从 2015 年 1 月 1 日至 2017 年 12 月 31 日参与凯度 WordPanel 智利调查的城市居民家庭 (n = 2,383) 中收集了包装饮料购买量的月度纵向数据。饮料购买量相互关联产品层面的营养信息，由营养师团队审核，并根据是否含有高含量的关注营养素（即糖、钠、饱和脂肪）分为“高含量”或“非高含量”或能源）根据智利的营养阈值，因此受到法律的警告标签、营销限制和学校销售禁令政策的约束。大多数高含量饮料因含糖量高而被归类为高含量饮料。我们使用固定效应模型，将观察到的监管后饮料购买量以及卡路里和糖含量与基于监管前趋势的反事实进行比较，总体上以及按家庭户主的教育程度。在研究纳入的家庭中，37%的户主受教育程度较低（高中以下），40%的户主受教育程度中等（高中毕业），23%的户主受教育程度较高（大学毕业），并且样本的受教育程度不断提高在学习期间。 与反事实相比，监管后，高含量饮料的购买量/人/天减少了 22.8 毫升（95% 置信区间 [CI] -22.9 至 -22.7；p < 0.001），即 23.7%（95% CI - 23.8％至-23.7％）。高学历和低学历家庭在高含量饮料购买方面表现出类似的绝对减少（约 27 毫升/人/天；p < 0.001），但对于高学历家庭来说，这相当于更大的相对下降（-28.7%） ， 95% CI -28.8% 至 -28.6%）与低教育家庭（-21.5%， 95% CI -21.6% 至 -21.4%）相比，可能是因为高教育家庭的高收入水平较低管制前期间的饮料购买。购买高含量饮料的卡路里减少了 11.9 kcal/人/天（95% CI -12.0 至 -11.9；p < 0.001）或 27.5%（95% CI -27.6% 至 -27.5%）。从“含量不高”的饮料中购买的卡路里增加了 5.7 kcal/人/天 (95% CI 5.7-5.7；p < 0.001)，即 10.8% (10.8%-10.8%)。饮料购买总量减少了 7.4 kcal/人/天（95% CI -7.4 至 -7.3；p < 0.001）或 7.5%（95% CI -7.6% 至 -7.5%）。这项研究的一个主要限制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否是由于重新配制或消费者行为变化造成的，也无法解析标签、营销和学校销售禁令政策的影响。结论 智利食品标签和广告法实施后，高含量饮料的购买量显着下降；这些减少幅度比单一、独立政策（包括拉丁美洲之前实施的含糖饮料税）所观察到的减少幅度要大。 未来的研究应评估智利政策对高含量食品购买、膳食摄入和长期购买变化的影响。
更新日期：2020-02-11
中文翻译：
对 2015 年至 2017 年智利食品标签和广告法对含糖饮料购买的评估：一项前后研究。
背景 智利于 2016 年实施的《食品标签和广告法》是第一部联合强制要求在包装正面贴上警告标签、限制针对儿童的营销以及禁止在学校销售所有含有添加糖、钠的食品和饮料的国家法规。 ，或超过设定的营养或卡路里阈值的饱和脂肪。本研究的目的是评估这一系列政策对家庭饮料购买的影响。方法和结果 在这项观察性研究中，从 2015 年 1 月 1 日至 2017 年 12 月 31 日参与凯度 WordPanel 智利调查的城市居民家庭 (n = 2,383) 中收集了包装饮料购买量的月度纵向数据。饮料购买量相互关联产品层面的营养信息，由营养师团队审核，并根据是否含有高含量的关注营养素（即糖、钠、饱和脂肪）分为“高含量”或“非高含量”或能源）根据智利的营养阈值，因此受到法律的警告标签、营销限制和学校销售禁令政策的约束。大多数高含量饮料因含糖量高而被归类为高含量饮料。我们使用固定效应模型，将观察到的监管后饮料购买量以及卡路里和糖含量与基于监管前趋势的反事实进行比较，总体上以及按家庭户主的教育程度。在研究纳入的家庭中，37%的户主受教育程度较低（高中以下），40%的户主受教育程度中等（高中毕业），23%的户主受教育程度较高（大学毕业），并且样本的受教育程度不断提高在学习期间。 与反事实相比，监管后，高含量饮料的购买量/人/天减少了 22.8 毫升（95% 置信区间 [CI] -22.9 至 -22.7；p < 0.001），即 23.7%（95% CI - 23.8％至-23.7％）。高学历和低学历家庭在高含量饮料购买方面表现出类似的绝对减少（约 27 毫升/人/天；p < 0.001），但对于高学历家庭来说，这相当于更大的相对下降（-28.7%） ， 95% CI -28.8% 至 -28.6%）与低教育家庭（-21.5%， 95% CI -21.6% 至 -21.4%）相比，可能是因为高教育家庭的高收入水平较低管制前期间的饮料购买。购买高含量饮料的卡路里减少了 11.9 kcal/人/天（95% CI -12.0 至 -11.9；p < 0.001）或 27.5%（95% CI -27.6% 至 -27.5%）。从“含量不高”的饮料中购买的卡路里增加了 5.7 kcal/人/天 (95% CI 5.7-5.7；p < 0.001)，即 10.8% (10.8%-10.8%)。饮料购买总量减少了 7.4 kcal/人/天（95% CI -7.4 至 -7.3；p < 0.001）或 7.5%（95% CI -7.6% 至 -7.5%）。这项研究的一个主要限制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否是由于重新配制或消费者行为变化造成的，也无法解析标签、营销和学校销售禁令政策的影响。结论 智利食品标签和广告法实施后，高含量饮料的购买量显着下降；这些减少幅度比单一、独立政策（包括拉丁美洲之前实施的含糖饮料税）所观察到的减少幅度要大。 未来的研究应评估智利政策对高含量食品购买、膳食摄入和长期购买变化的影响。
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