ABSTRACT

Objectives.

To estimate the number of processed and ultra-processed beverages and foods that provide nutritional information on their packaging, and to describe the characteristics of this information, as well as to determine the presence of nutritional information on products with octagons.

Materials and methods.

Photographs were taken of the labels of 4404 processed and ultra-processed beverages and foods marketed in supermarkets in Metropolitan Lima. The information on the label was collected and registered in the mobile and web version of the Food Label Information Program (FLIP). We analyzed variables related to the nutritional information, the way in which such information is declared and the information in beverages and foods with octagons.

Results.

Only 71.4% of the products had some type of nutritional information. Of these, 13.8% provided the nutritional information as a text and not in a table, and only 56.3% declared it per 100 grams or milliliters. Of the total number of foods with the octagon “Contains trans fats”, only 19.2% declared their content.

Conclusions.

More than a quarter of the beverages and packaged foods in the Peruvian market did not provide nutritional information of any kind, and of those that did, only one did so in different formats and units. In addition, we found that a proportion of beverages and foods for each type of octagon did not declare information of the nutrient that is mentioned in the octagon.

Keywords:
Nutritional Labeling; Nutritional Facts; Industrialized Foods; Peru

KEY MESSAGES

1. Motivation for the study. Peruvian Law No. 30021 establishes the use of warning octagons for foods with high content of critical nutrients (sugar, sodium, saturated and trans fats); however, the declaration of nutritional information is not mandatory.
2. Main findings. Of a total of 4404 processed and ultra-processed foods marketed in supermarkets in Lima, only 71.4% declared some type of nutritional information. In addition, only 46.0% declared information on the content of critical nutrients regulated by Law No. 30021.
3. Implications. There is a need for a mandatory and standardized declaration of nutritional information on packaged foods marketed in Peru, in order to allow the population to make healthy decisions when choosing their food and to monitor the correct use of warning octagons.

Keywords:
Nutritional Labeling; Nutritional Facts; Industrialized Foods; Peru

INTRODUCTION

In recent years, the consumption of processed and ultra-processed foods and beverages has increased worldwide ¹1. Organización Panamericana de la Salud. Alimentos y bebidas ultraprocesados en América Latina: ventas, fuentes, perfiles de nutrientes e implicaciones. Washington, D.C.: OPS; 2019. Disponible en: https://iris.paho.org/handle/10665.2/51523.
https://iris.paho.org/handle/10665.2/515... . These types of products are characterized by high amounts of critical nutrients (saturated fats, sugar, sodium and trans fats), whose excess consumption is a risk factor for developing chronic noncommunicable diseases ²2. Organización Panamericana de la Salud. Consumo de productos ultraprocesados y procesados con exceso de nutrientes asociados con enfermedades crónicas no transmisibles y la alimentación insalubre en las Américas (No OPS/NMH/RF/21-0036). Washington, D.C.: OPS; 2022. Disponible en: https://iris.paho.org/handle/10665.2/55547.
https://iris.paho.org/handle/10665.2/555... . In Peru, sales of ultra-processed foods increased by 8.9% between 2009 and 2014 (from 294 to 320 kcal per capita/day), while those of ultra-processed beverages increased by 6.7% (from 114 to 121 kcal per capita/day) ¹1. Organización Panamericana de la Salud. Alimentos y bebidas ultraprocesados en América Latina: ventas, fuentes, perfiles de nutrientes e implicaciones. Washington, D.C.: OPS; 2019. Disponible en: https://iris.paho.org/handle/10665.2/51523.
https://iris.paho.org/handle/10665.2/515... .

In response to this situation, the Peruvian government established policies to promote healthy eating ³3. Congreso de la República del Perú. Ley de Promoción de la Alimentación Saludable Para Niños, Niñas y Adolescentes. Congreso de la República del Perú; Lima, Perú: 2013. Disponible en: http://www.leyes.congreso.gob.pe/Documentos/Leyes/30021.pdf.
http://www.leyes.congreso.gob.pe/Documen...

4. Ministerio de Salud. Reglamento que establece el proceso de reducción gradual hasta la eliminación de las grasas trans en alimentos y bebidas no alcohólicas procesados industrialmente [Internet]. DECRETO SUPREMO No 033-2016-SA. Disponible en: https://busquedas.elperuano.pe/normaslegales/aprueban-el-reglamento-que-establece-el-proceso-de-reduccion-decreto-supremo-n-033-2016-sa-1409585-3/.
https://busquedas.elperuano.pe/normasleg... ^-55. Ministerio de Salud. Política Nacional Multisectorial de Salud al 2030 "Perú, país saludable" [Internet]. Decreto Supremo N° 026-2020-SA. MINSA, 2020. Disponible en: https://www.gob.pe/institucion/minsa/informes-publicaciones/1127209-politica-nacional-multisectorial-de-salud-al-2030.
https://www.gob.pe/institucion/minsa/inf... . One of these policies is the Law for the Promotion of Healthy Eating in Children and Adolescents (Law No. 30021) ³3. Congreso de la República del Perú. Ley de Promoción de la Alimentación Saludable Para Niños, Niñas y Adolescentes. Congreso de la República del Perú; Lima, Perú: 2013. Disponible en: http://www.leyes.congreso.gob.pe/Documentos/Leyes/30021.pdf.
http://www.leyes.congreso.gob.pe/Documen... . This law states that processed and ultra-processed foods and beverages that exceed the established parameters for critical nutrients must carry a frontal advertising warning in the form of black octagons (hereinafter “octagons”). These octagons indicate that the products are high in sodium, sugar and/or saturated fat, or that they contain trans fats ⁶6. Ministerio de Salud. Manual de Advertencias Publicitarias en el marco de lo establecido en Ley No 30021. Ley de promoción de la alimentación saludable para niños, niñas y adolescentes y su Reglamento aprobado por Decreto Supremo No 017-2017-sa [Internet]. DECRETO SUPREMO No 012-2018-SA. Disponible en: https://busquedas.elperuano.pe/download/url/aprueban-manual-de-advertencias-publicitarias-en-el-marco-de-decreto-supremo-n-012-2018-sa-1660606-1.
https://busquedas.elperuano.pe/download/... . However, the exact content of these nutrients, information on other nutrients and the energy content of the product should be included in the nutrition declaration.

In Peru, although there is a technical standard that specifies the characteristics and how the nutritional information of beverages and foods should be declared, it is only optional for all packaged products sold in the Peruvian market ⁷7. Instituto Nacional de Calidad. Norma Técnica Peruana Alimentos Envasados Etiquetado Nutricional NTP 209.652-2017. R.D. N° 011-2017-INACAL-DN. 3er edición. Lima, 29 marzo 2017.. One of the exceptions is the declaration of trans fat content, whose current regulation states that all products with trans fat must declare so on their label ⁸8. Ministerio de Salud. Proyecto de reglamento técnico que regula los límites de uso de ácidos grasos trans (AGT's) en los alimentos elaborados industrialmente y la información obligatoria que debe consignarse en el etiquetado [Internet]. Resolución Ministerial 625-2012/Minsa. MINSA, 2012. Disponible en: http://www.digesa.minsa.gob.pe/norma_consulta/RM625-2012-MINSA-GRASASTRANS.pdf.
http://www.digesa.minsa.gob.pe/norma_con... . Available evidence reveals that, in 2018, before the implementation of octagons, 23.9% (n=657) of a sample of 2748 beverages and packaged foods offered in a supermarket chain in Lima, did not declare nutrient content, nor energy content on their packaging ⁹9. Meza-Hernández M, Villarreal-Zegarra D, Saavedra-Garcia L. Nutritional Quality of Food and Beverages Offered in Supermarkets of Lima According to the Peruvian Law of Healthy Eating. Nutrients 2020, 12, 1508. doi: 10.3390/nu12051508.
https://doi.org/10.3390/nu12051508... .

The mandatory declaration of nutritional information is an important tool for consumers to obtain complete and detailed information on the nutrient content, in order to make better informed decisions ¹⁰10. World Health Organization. Implementing nutrition labelling policies: a review of contextual factors. Geneva: WHO; 2021. Licence: CC BY-NC-SA 3.0 IGO. Disponible en: https://www.who.int/publications/i/item/9789240035089., as well as to monitor compliance with regulations related to the nutritional content of foods. In addition, this information allows corroborating the veracity of the nutritional or health claims included in the labeling ¹¹11. Ten JA, Olalla MC, Hernandez A. Estudio de declaraciones nutricionales y saludables en los alimentos. Rev Esp Nutr Comunitaria. 2007; 13(3-4):163-175.. With regard to the information to be declared, the Codex Alimentarius states that nutritional information should indicate the energy value, content of macronutrients such as fats, proteins and carbohydrates, and particularly, saturated fats, trans fats, sugar and dietary fiber, as well as micronutrients such as vitamins and minerals, including sodium ¹²12. Organización de las Naciones Unidas para la Alimentación y la Agricultura. Directrices del Codex sobre etiquetado nutricional. Rev 1 - 1993. FAO, 1993. [Página web] Disponible en: https://www.fao.org/3/y2770s/y2770s06.htm.
https://www.fao.org/3/y2770s/y2770s06.ht... .

Following the implementation of new policies regarding nutrition labeling ¹³13. Alvarez-Cano J, Cavero V, Diez-Canseco F. Idas y venidas del diseño de la política de alimentación saludable en el Perú: análisis comparativo de sus documentos regulatorios. Rev Peru Med Exp Salud Publica [Internet]. 2022;39(4):480-8. doi: 10.17843/rpmesp.2022.394.11896.
https://doi.org/10.17843/rpmesp.2022.394... , our study aimed to estimate the amount of processed and ultra-processed foods and beverages offered in a supermarket chain in Lima in 2022 that declare nutritional information on the packaging as well as to describe their characteristics and determine the presence of nutritional information on products with octagons.

MATERIALS AND METHODS

Design

We carried out a descriptive cross-sectional study.

Sampling and data collection

We collected information from the labels of all processed and ultra-processed foods and beverages with barcodes offered in the selected stores between May and June 2022. Information was collected from three stores of a supermarket chain located in Metropolitan Lima targeted at different socioeconomic levels, seeking to capture the widest possible variety of products. The collection began in the store with the largest number and variety of products, in the next store only the products that were not found in the first store were collected, and in the last one, we collected information about the products that were not found in the first two stores.

Procedures

A team of eight previously trained field workers collected data on all processed and ultra-processed foods and beverages with barcodes, excluding fresh foods, minimally processed foods, ingredients (foods or beverages used in culinary preparations), alcoholic beverages and multiple packages (packages containing two or more different products). We used the FLIP application to register the products ¹⁴14. Ahmed M, Schermel A, Lee J, Weippert M, Franco-Arellano B, L'Abbé M. Development of the Food Label Information Program: A Comprehensive Canadian Branded Food Composition Database. Front Nutr. 2022;8:825050. doi: 10.3389/fnut.2021.825050.
https://doi.org/10.3389/fnut.2021.825050... , which was developed by the University of Toronto, Canada. This application, after being installed on a cell phone, scans the barcodes to create an identification code (ID), as well as taking photographs of each side of the package and storing them directly in the system. FLIP is a paid application, after coordination with its developers.

Each of the photos was reviewed at the end of every day of data collection, verifying that the information was legible. Subsequently, the following data were entered into the web version of FLIP: name of the product, producing company, product description, among other characteristics that allow identifying the product, list of ingredients, nutritional information, presence of octagons. Products were classified into two categories: a) food, when the net weight in grams was declared, and b) beverages, when the net weight in milliliters was declared. These categories distributed into subcategories as detailed in Table 1.

Once data was collected, the nutrient content was standardized to 100 g or 100 ml, including foods that require reconstitution, i.e., those products that require the addition of one or more ingredients to be consumed. We verified the quality of the data by identifying duplicate records using bar codes and comparing the data of all the records that did not comply with the Atwater validation ¹⁵15. Capuano E, Oliviero T, Fogliano V, Pellegrini N. Role of the food matrix and digestion on calculation of the actual energy content of food. Nutr Rev. 2018 Apr 1;76(4):274-289. doi: 10.1093/nutrit/nux072.
https://doi.org/10.1093/nutrit/nux072... with the corresponding photographs.

The Atwater validation consists of multiplying the macronutrient content (total carbohydrate, total fat, protein) by the corresponding Atwater factor (carbohydrate*4 + protein*4 + fat*9) and the sum of these products must coincide with the total energy, accepting a range of ± 20%.

Variables

We included the following variables:

In addition, we included information regarding the origin of the beverage or food, including the country where it was produced. Beverages and foods produced in Peru were classified as “national” and those produced in other countries as “imported”.

Data analysis

We carried out a univariate analysis to determine the absolute and relative frequencies of each of the variables of interest (foods and beverages declaring nutritional information, characteristics of the nutritional information declared in the labeling, and presence of nutritional information in foods and beverages with octagons). The analyses were performed in Stata version 15 (StataCorp, College Station, TX, USA) was.

Ethical criteria

The protocol was exempted from review by the Institutional Ethics Committee of the Universidad Peruana Cayetano Heredia (CAREG-ORVEI-016-22). Information regarding the supermarkets where the study was carried out will be provided upon request.

RESULTS

A total of 4404 packaged products were analyzed, of which 81.0% (n=3579) were categorized as solid foods and 19.0% (n=825) as beverages. Of the total products, 90.7% (n=3996) were ready-to-eat, while 9.3% (n=408) required reconstitution.

We found that 71.8% (n=3161) of the products declared some nutritional information, and only 46.0% (n=2026) declared information on the four critical nutrients prioritized in the Peruvian regulation. The proportion of products declaring nutritional information for each category and subcategory is shown in Table 2.

Of the total number of beverages and foods that reported information regarding its origin(n=4402), 26.9% (n=1186) were imported and 73.1% (n=3216) were national. We found that 86.3% (n=1023) of the total imported beverages and foods reported nutritional information, while only 66.4% (n=2137) of the total national products (n=2137) did so. However, the proportion of beverages and foods declaring information on the four prioritized critical nutrients is similar between imported (45.1%) and national (46.3%) products (Table 3).

The subcategories of solid foods with the lowest proportion of products declaring some nutritional information were meats, meat products and eggs (38.0%) followed by ready-to-eat prepared meals (48.4%), canned fruits and vegetables (54.1%), snacks (59.4%) and condiments and dry spices (64.8%). Artificial juices and nectars (78.1%) were the least reported beverages.

The nutritional information reported on each food or beverage is presented in different ways. Of the total of 3161 products that declared information, 85.3% used tables, 13.8% used text and 0.9% used other forms, such as images (Supplementary Material 1).

Regarding units of measurement, 84.2% of the 3161 products declared its contents per serving, while 56.3% per 100 grams or 100 milliliters. In addition, 73.7% stated the percentage daily value.

Some the products did not maintain consistency between the amount of energy and macronutrients declared, in this regard we found that of the 2992 products declaring energy and macronutrients, 166 products (5.4%) did not comply with the Atwater validation (Table 4), the most frequent error being the lack of consistency between the total amount of kilocalories with the caloric intake of each nutrient. Examples of this error can be found in Supplementary Material 2.

On the other hand, of the total of 4404 beverages and foods collected, 55% (n=2431) contained at least one frontal advertising warning (octagons) on the label. Table 5 details the number of foods and beverages with octagons according to each of the four critical nutrients, and how many claim nutritional information for the nutrient warned in the octagon. Of the total number of foods with the octagon for trans fats (n=52), only 19.2% declared information on trans fat content, while of the total with the octagon for sodium (n=988), only 49.7% declare the sodium content on the package.

DISCUSSION

The Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) have published normative documents to encourage countries to take actions aimed at educating the population on healthy food choices ¹⁰10. World Health Organization. Implementing nutrition labelling policies: a review of contextual factors. Geneva: WHO; 2021. Licence: CC BY-NC-SA 3.0 IGO. Disponible en: https://www.who.int/publications/i/item/9789240035089.^,1616. Organización de las Naciones Unidas para la Alimentación y la Agricultura. La nueva etiqueta de información nutricional, ¿en qué le beneficia? FAO, 25 de febrero del 2022. [Página web]. Disponible en: https://www.fda.gov/food/new-nutrition-facts-label/la-nueva-etiqueta-de-informacion-nutricional.
https://www.fda.gov/food/new-nutrition-f... . These documents state that the nutritional information on the packages should include the energy value, macronutrients, nutrients such as saturated fats, trans fats, and dietary fiber, as well as micronutrients (vitamins and minerals). However, our findings reveal that only 71.4% of beverages and processed and ultra-processed foods declared some nutritional information, 70.8% declare the energy value and only 68.5% declared information regarding the three main macronutrients (carbohydrates, proteins and fats), all of which could be due to the fact that the declaration of nutritional information is not mandatory in Peru ⁷7. Instituto Nacional de Calidad. Norma Técnica Peruana Alimentos Envasados Etiquetado Nutricional NTP 209.652-2017. R.D. N° 011-2017-INACAL-DN. 3er edición. Lima, 29 marzo 2017..

There have been several attempts to make nutrition labeling mandatory and standardized in Peru. The proposed amendments to Law No. 30021 ¹⁷17. Congreso de la República. Dictamen recaído en las observaciones del presidente de la República a la autógrafa derivada de los proyectos de Ley 865/2016-CR, 1519/2016-CR, 1700/2016-CR, 1959/2017-CR y 2036/2017-CR, que proponen la Ley que modifica la Ley 30021, Ley de promoción de la alimentación saludable para niños, niñas y adolescentes. Dictamen 25-2017-2018 / CSP-CR. Lima, 2018. Disponible en: https://www.leyes.congreso.gob.pe/Documentos/2016_2021/Dictamenes/Proyectos_de_Ley/00865DC21MAY20180524.pdf.
https://www.leyes.congreso.gob.pe/Docume... that did not materialize. The declaration of nutritional information is mandatory and standardized in most countries from the European Union and Mercosur, as well as in the United States of America, Chile, Colombia, Ecuador, Mexico, among others ¹⁸18. Kliemann N, Kraemer MVS, Scapin T, Rodrigues VM, Fernandes AC, Bernardo GL, et al. Serving Size and Nutrition Labelling: Implications for Nutrition Information and Nutrition Claims on Packaged Foods. Nutrients. 2018; 10(7):891. doi: 10.3390/nu10070891.
https://doi.org/10.3390/nu10070891... ^,1919. Ministério da saúde, Agencia Nacional de Vigilancia Sanitaria. Resolução da diretoria colegiada - RDC Nº 429. Ministério da saúde. Brasil, 2020. Disponible en: https://extranet.who.int/nutrition/gina/sites/default/filesstore/BRA%202020%20-%20RESOLU%C3%87%C3%83O%20DA%20DIRETORIA%20COLEGIADA.pdf.
https://extranet.who.int/nutrition/gina/... .

Mandatory and standardized nutrition information provides consumers with clear and reliable information on the nutritional content of packaged foods ¹⁰10. World Health Organization. Implementing nutrition labelling policies: a review of contextual factors. Geneva: WHO; 2021. Licence: CC BY-NC-SA 3.0 IGO. Disponible en: https://www.who.int/publications/i/item/9789240035089..

Studies from Europe and the United States on young adults with access to higher education found that the use of nutrition information on packaging was associated with healthier diets, i.e., with a lower intake of fat, sugar and sodium ²⁰20. Buyuktuncer Z, Ayaz A, Dedebayraktar D, Inan-Eroglu E, Ellahi B, Besler HT. Promoting a Healthy Diet in Young Adults: The Role of Nutrition Labelling. Nutrients 2018, 10, 1335. doi: 10.3390/nu10101335.
https://doi.org/10.3390/nu10101335... ; and with attitudes towards healthier food choices ²¹21. Christoph MJ, An R, Ellison B. Correlates of nutrition label use among college students and young adults: a review. Public Health Nutr. 2016;19(12):2135-48. doi: 10.1017/S1368980015003183.
https://doi.org/10.1017/S136898001500318... . Thus, the promotion of the use and correct interpretation of nutritional information increases consumers’ knowledge about nutrition and, consequently, favors healthier choices ¹⁰10. World Health Organization. Implementing nutrition labelling policies: a review of contextual factors. Geneva: WHO; 2021. Licence: CC BY-NC-SA 3.0 IGO. Disponible en: https://www.who.int/publications/i/item/9789240035089.^,2222. Instituto Nacional de Defensa de la Competencia y de la Protección de la Propiedad Intelectual. Documento de trabajo. El perfil del consumidor en el Perú: Un enfoque de protección. INDECOPI. Lima, abril 2021. Disponible en: https://www.indecopi.gob.pe/documents/51084/126949/Perfil_Consumidor_PeruUrbano_2021/ab1b1b0f-f808-b038-b71e-4effc15afff8.
https://www.indecopi.gob.pe/documents/51... . However, in Peru, a study with almost 300 university students found that, although 79% understand it, only 4% (n=12) participants checked the nutrition labeling ²³23. Somocurcio L. Influencia del etiquetado de alimentos procesados en el comportamiento del consumidor universitario peruano [Tesis para optar Título profesional de Licenciada en Administración]. Lima: Universidad del Pacifico. Lima, 2021. Disponible en: https://repositorio.up.edu.pe/handle/11354/3271.
https://repositorio.up.edu.pe/handle/113... . A first step in order to strengthen the use of nutrition labeling is the mandatory declaration of nutritional information on all packaged foods and beverages marketed in Peru, as well as by using informative campaigns to stimulate its comprehension and correct interpretation when buying said products.

Our results show that nutritional information in Peru is declared in different ways and by using different units of measurement. The most common unit of measurement is the serving size, which, according to previous studies, influences consumers when choosing the portion size; larger serving sizes can induce people to eat more and therefore increase the energy intake ²⁴24. Van der Horst K, Bucher T, Duncanson K, Murawski B, Labbe D. Consumer Understanding, Perception and Interpretation of Serving Size Information on Food Labels: A Scoping Review. Nutrients 2019, 11, 2189. doi: 10.3390/nu11092189.
https://doi.org/10.3390/nu11092189... . Other studies have suggested that serving size claims may confuse consumers, who may interpret the declared serving size as the one they regularly consume ¹⁸18. Kliemann N, Kraemer MVS, Scapin T, Rodrigues VM, Fernandes AC, Bernardo GL, et al. Serving Size and Nutrition Labelling: Implications for Nutrition Information and Nutrition Claims on Packaged Foods. Nutrients. 2018; 10(7):891. doi: 10.3390/nu10070891.
https://doi.org/10.3390/nu10070891... . In addition, one study concluded that it is important to standardize serving size in Peru, since information per serving allows a better estimation of the amount of energy and nutrients consumed ²⁵25. Yang S, Gemming L, Rangan A. Large Variations in Declared Serving Sizes of Packaged Foods in Australia: A Need for Serving Size Standardisation? Nutrients 2018, 10, 139. doi: 10.3390/nu10020139.
https://doi.org/10.3390/nu10020139... . On the other hand, another study stated that nutritional information should be declared per 100g or ml, because it allows comparison of energy and nutrient content ²⁶26. Van der Bend DLM, Lissner L. Differences and Similarities between Front-of-Pack Nutrition Labels in Europe: A Comparison of Functional and Visual Aspects. Nutrients 2019; 11(3):626. doi: 10.3390/nu11030626.
https://doi.org/10.3390/nu11030626... . Thus, although there is evidence in favor of both measures, there is consensus on the importance of standardizing the declaration of nutritional information for better understanding.

The declaration of nutritional information, in addition to being mandatory and standardized, must include reliable information for the consumer. The fact that 5.5% of the products analyzed did not comply with the Atwater validation shows that the nutritional information described on their labels could be incorrect and, consequently, confuse or misinform the consumer. In this regard, a Chilean study found that 9.6% (n=92) of the products that declared nutritional information had some type of inaccuracy or error, the most common being the lack of consistency between the amount of partial fat in relation to total fat and the total calories versus the caloric intake of each nutrient ²⁷27. Urquiaga I, Lamarca M, Jiménez P, Echeverría G, Leighton F. ¿Podemos confiar en el etiquetado nutricional de los alimentos en Chile? Rev méd Chile [Internet]. 2014;142(6):775-781. doi: 10.4067/S0034-98872014000600012.
https://doi.org/10.4067/S0034-9887201400... . We found these same errors during our study, which reveals the importance of having systems that guarantee the accuracy and veracity of the information declared on packaged products.

As part of the implementation of the front-of-package warnings, the Peruvian government implemented the “Julieta checa la etiqueta” campaign aimed at promoting the reading and understanding of the octagons, as well as informing about the characteristics of the labels. However, this campaign did not mention that the information about the critical nutrient on the octagon could be found in the nutritional declaration ²⁸28. Instituto Nacional de Defensa de la Competencia y de la Protección de la Propiedad Intelectual. Julieta checa la etiqueta [Internet]. [Consultado 24 de enero 2023]. Disponible en: https://www.julietachecalaetiqueta.pe/home#julieta.
https://www.julietachecalaetiqueta.pe/ho... , which could have increased the use of nutrition labeling. The non-inclusion of the aforementioned statement in this campaign may have been due to the fact that a significant number of products with octagons do not declare the amount of the nutrient found in the octagon, which prevents the consumer from having information on the exact content of that nutrient and potentially reducing the impact sought by the labeling warnings.

In addition, this lack of information, as well as the lack of accuracy and truthfulness in nutrition labeling, prevents the competent entities from adequately monitoring the use of octagons and its effects, such as the reformulation of processed and ultra-processed beverages and foods by the industry ²⁹29. Saavedra-Garcia L, Meza-Hernández M, Diez-Canseco F, Taillie LS. Reformulation of Top-Selling Processed and Ultra-Processed Foods and Beverages in the Peruvian Food Supply after Front-of-Package Warning Label Policy. Int J Environ Res Public Health 2023; 20(1):424. doi: 10.3390/ijerph20010424.
https://doi.org/10.3390/ijerph20010424... .

We found that only 19.2% of the products with the trans fats octagon declared their content on their labeling, despite the regulation indicating that all packaged products containing trans fats must declare so ⁸8. Ministerio de Salud. Proyecto de reglamento técnico que regula los límites de uso de ácidos grasos trans (AGT's) en los alimentos elaborados industrialmente y la información obligatoria que debe consignarse en el etiquetado [Internet]. Resolución Ministerial 625-2012/Minsa. MINSA, 2012. Disponible en: http://www.digesa.minsa.gob.pe/norma_consulta/RM625-2012-MINSA-GRASASTRANS.pdf.
http://www.digesa.minsa.gob.pe/norma_con... . In addition, the National Institute for the Defense of Competition and Protection of Intellectual Property (INDECOPI) issued a resolution authorizing that products with less than 0.5 g of trans fat per serving may declare them as zero (0) in their nutritional statement, based on the Food and Drug Administration (FDA) standard of the United States of America, instead of making the Peruvian standard prevail, thus allowing the industry to avoid the octagon ³⁰30. Instituto Nacional de Defensa de la Competencia y de la Protección de la Propiedad Intelectual. Versión pública de la RESOLUCIÓN 0134-2021. INDECOPI. Lima, 2021. Disponible en: https://www.estudiorodrigo.com/wp-content/uploads/2021/05/doc_202110061803497418.pdf.
https://www.estudiorodrigo.com/wp-conten... . INDECOPI’s resolution directly affects the consumer, since products with trans fats may be hidden from consumers, giving untruthful information of their nutritional composition. Therefore, it is important to have a public policy that frames the regulations related to nutrition labeling in order to maintain consistency between them and ensure that all packaged products have standard, clear, complete and truthful nutritional information. In this way, consumers can make informed decisions regarding the foods they purchase and thus contribute to protecting the health of children and adolescents, who are exposed to beverages and foods with high contents of sugar, sodium and fat in the school environment ⁽³¹31. Saavedra-Garcia L, Meza-Hernández M, Yabiku-Soto K, Hernández-Vásquez A, Kesar HV, Mejia-Victorio C, Diez-Canseco F. Oferta y publicidad de alimentos y bebidas en instituciones educativas y entornos escolares de Lima Metropolitana. Un estudio exploratorio. Rev Peru Med Exp Salud Publica [Internet]. 2020;37(4):726. doi: 10.17843/rpmesp.2020.374.5838.
https://doi.org/10.17843/rpmesp.2020.374... .

Our study has some strengths, such as the large number of beverages and ultra-processed foods included in the analysis, as well as the fact that the information was recent, since data collection was carried out after the second phase of the octagons implementation. One of the limitations of our study is that we collected information from products available in three supermarkets in Lima, but retail stores, convenience stores or markets, and common food outlets in Peru were excluded, which means that we could not analyze every beverage and packaged food.

In conclusion, slightly more than a quarter of the products evaluated in this study did not declare any nutritional information. Those that do declare this type of information do so in different ways, and 5.5% did not do so in a clear or reliable manner. A significant number of products with octagons, particularly those containing trans fats and those high in sodium, did not declare the amount of the nutrient on the octagon, which does not complement the information provided by the octagons in case the consumer or the regulatory institution requires it. These results reveal the need for a mandatory and standardized declaration of nutritional information on packaged foods marketed in Peru.

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