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- Nutr-HIA Improving nutrition labelling in Portugal health impact assessment : final reportPublication . Graça, Pedro; Silva, Andreia Jorge; Vieira, Carlota Pacheco; Sena, Catarina; Gregório, Maria João; Nogueira, Paulo Jorge; Virgolino, Ana; Fernandes, João Paulo; Santos, Osvaldo; Santos, Rodrigo; Alarcão, VioletaExecutive Summary | Background: Scientific evidence shows that mandatory nutrition declaration can be difficult to understand by consumers. According to a previous study conducted in the Portuguese population, 40% of Portuguese consumers did not understand the nutrition information presented on food labels. To face this misunderstanding, several countries have implemented consumer-friendly front-of-pack nutrition labelling based on the scientific evidence available for their national contexts. The use of interpretative front-of-pack nutrition labels (FOP-NL) is considered one of the best options to promote healthy food choices and consequently to prevent and control non-communicable diseases. In Portugal, a Government-endorsed policy on interpretative nutrition labelling is not yet implemented. However, several national economic operators from the food sector are already using different FOP-NL. The coexistence of multiple nutrition labelling systems in food products in Portugal in an unregulated way can be not favorable for the consumer understanding and, the FOP-NL systems used by the different food industry operators can not be the most adapted for the Portuguese consumers. Thus, there is a need to evaluate the impact of different FOP-NL in terms of their contribution to promote better informed food choices and promote healthy food habits. The final goal is to provide scientific evidence that could support a set of evidence-based recommendations that can be used by policymakers’ decision concerning the implementation of a proper approach on nutrition labelling.
- Effectiveness of interpretive front-of-pack nutritional labelling schemes on the promotion of healthier food choicesPublication . Feteira-Santos, Rodrigo; Fernandes, João Paulo; Virgolino, Ana; Alarcão, Violeta; Sena, Catarina; Vieira, Carlota P.; Gregório, Maria João; Nogueira, Paulo Jorge; Costa, Andreia; Graça, Pedro; Santos, OsvaldoAims: Interpretive front-of-package nutrition labelling can contribute to healthier food habits. This systematic review aimed to examine the effectiveness of interpretive front-of-package nutrition labelling schemes on consumers’ food choices, namely at the moment of food purchase, and to analyse if this potential front-of-package nutrition labelling’s effect varies according to different socioeconomic groups. Methods: Electronic databases (Cochrane Library, PubMed, Scopus, and Web of Science) search was performed to identify peer-reviewed articles describing longitudinal studies evaluating the effect of front-of-package nutrition labelling schemes on consumers’ food choices, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Equity 2012 Extension guidelines. No publication-period or language restrictions were applied. PROGRESS-Plus framework was used to report if and how socioeconomic factors were considered in analyses of front-of-package nutrition labelling-related interventions’ effect. Results: Nine studies were selected for narrative synthesis (seven randomized controlled trials and two cross-over trials). When compared with no-interpretive-label conditions, front-of-package nutrition labelling showed a positive impact for nutritional content understanding, healthiness perception of products, selection of products with better nutritional quality, and purchase intention. However, there is no robust evidence of superiority of a specific front-ofpackage nutrition labelling scheme’s effect, neither on consumers’ understanding of nutritional content nor on food choices. An evaluation of the studies following the PROGRESS-Plus framework revealed that socioecononomic status and education were the most frequently used dimensions, when assessing the effect of interpretative front-of-pack nutrition labels. More evidence is necessary to determine the role of front-of-pack nutrition labels in decreasing inequalities between different population subgroups, namely among the most vulnerable subgroups, on the promotion of healthy food choices. Conclusion: Well controlled longitudinal studies, following a real-world evidence approach, are needed to clarify front-of-package nutrition labelling’s impact on consumers’ food choices, namely at purchase points, taking into account the most vulnerable population subgroups, such as those with lower literacy and/or financial resources.
- Impact of different front-of-pack nutrition labels on online food choicesPublication . Santos, Osvaldo; Alarcão, Violeta; Santos, Rodrigo; Fernandes, João Paulo; Virgolino, Ana; Sena, Catarina; Vieira, Carlota Pacheco; Gregório, Maria João; Nogueira, Paulo Jorge; Graça, Pedro; Costa, AndreiaFront-of-pack nutrition labels (FOP-NL) are efficient tools for increasing consumers' awareness of the nutritional quality of food products, prompting healthier food choices. The main goal of this study was to evaluate the impact of four FOP-NL schemes - Traffic Light label (TL), Guideline Daily Amounts (%GDA), Nutri-Score (NS) and Health Star Rating (HSR) - on consumers' selection of food products according to perceived nutritional quality. A cross-sectional open-label crossover randomized controlled study was carried out among Portuguese consumers. A web-based questionnaire was used to assess participants' a) preferences regarding FOP-NLs and b) capacity to select healthy products in a food selection task using the information from FOP-NL schemes. When performing the selection task, participants had the option to indicate that they could not decide simply based on the presented FOP-NL (requiring more information). Overall, 357 adults participated in the study. Regarding consumers' preferences, TL received the most favorable responses, while NS received the fewest. All FOP-NLs performed better than the no-nutritional label control condition in the food selection task. The highest proportion of correct choices was obtained for TL (72.3%), followed by HSR (70.9%), %GDA (70.0%) and NS (62.2%), though no significant differences were found among FOP-NLs. Percentages of respondents indicating not being able to answer due to lack of information affected the proportion of correct choices, with 10.3% for TL, 12.9% for %GDA, 14.6% for HSR, and 25.8% for NS, indicating they were unable to choose without additional information. Although no particular FOP-NL system stood out as the most significantly effective, TL was the most preferred by Portuguese adults. Long-term real-world evidence is necessary to assess the impact of FOP-NL systems on individuals’ food choices.
- Is olive oil good for you? A systematic review and meta-analysis on anti-inflammatory benefits from regular dietary intakePublication . Fernandes, João Paulo; Fialho, Mónica; Santos, Rodrigo; Plácido, Catarina Peixoto; Madeira, Teresa; Sousa-Santos, Nuno; Virgolino, Ana; Santos, Osvaldo; Carneiro, António VazThe prevalence of non-communicable diseases is rapidly increasing, and evidence shows that diet and lifestyle are key areas of intervention to decrease their burden. Olive oil is considered one of the key nutritional components responsible for the benefits of the Mediterranean diet, which is characterized by the use of olive oil in meals as the main source of fat; a high consumption of water, fruits, nuts, vegetables, legumes, whole grains, spices, and herbs; a moderate consumption of dairy products (mainly cheese and yogurt), fish, poultry, and red wine; and a reduced consumption of red meat and processed foods. The aim of this review was to summarize evidence from randomized controlled trials on the effect of regular dietary intake of olive oil on three inflammatory markers: C-reactive protein, interleukin-6, and tumor necrosis factor-a. Reviewed RCTs reveal beneficial effects of olive oil by reducing levels of inflammation markers. Olive oil taken on a regular basis can be a good dietary fat alternative, especially to manage IL-6. However, further research is required to clarify the effects of olive oil consumption on inflammation, comparing to other fats. Moreover, olive oil daily dosage, different time-lenght intervention and follow-up periods should be taken into consideration.
- Looking ahead : health impact assessment of front-of-pack nutrition labelling schema as a public health measurePublication . Feteira-Santos, Rodrigo; Alarcão, Violeta; Santos, Osvaldo; Virgolino, Ana; Fernandes, João Paulo; Vieira, Carlota Pacheco; Gregório, Maria João; Nogueira, Paulo Jorge; Costa, Andreia; Graça, PedroThis study aimed to describe the underlying process, used methods and major recommendations emerging from a comprehensive and prospective health impact assessment of the endorsement of a front-of-pack nutrition labelling (FOP-NL) system by the Portuguese health authorities. A mixed-methods approach was used to gather information on the impact of four FOP-NL schemes on consumers’ selection of food products according to the perception of their nutritional quality, combining a systematic literature review, focus groups (FG), in-depth individual interviews, and an open-label crossover randomized controlled study. The relevance of FOP-NL as a public health promotion policy has emerged as a consensual idea among either FGs’ participants (i.e., consumers and experts), or interviewed stakeholders. Although all of the evaluated FOP-NLs result better than no system on promoting the choice of the healthiest product, the effectiveness of easy-to-interpret FOP-NL among vulnerable groups raised concerns related to the need of integrating specific nutritional information to promote a better self-management of chronic diseases, and related to the level of literacy of consumers, which could impair the usage of FOP-NL. Educational campaigns addressing skills to use FOP-NL is recommended. Furthermore, a monitoring strategy should be considered to evaluate the long-term effectiveness of this policy in promoting healthier food choices, and in reducing diet-related non-communicable diseases burden.