Nutrition and health claims in products directed at children via television in Spain in 2012

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Original article

Nutrition and health claims in products directed at children via television in Spain in 2012

Miguel Ángel Royo-Bordonada

^a,∗

, María José Bosqued-Estefanía

^a

, Javier Damián

^b

, Lázaro López-Jurado

^a

, María Ángeles Moya-Geromini

^a

aNationalSchoolofPublicHealth,InstituteofHealthCarlosIII,Madrid,Spain

bDepartmentofAppliedEpidemiology,NationalCenterofEpidemiology,Madrid,Spain

a r t i c l e i n f o

Articlehistory:

Received29October2015 Accepted11January2016 Availableonline11February2016

Keywords:

Nutritionmarketing Nutritionclaim Healthclaim Nutrientprofiling Foodadvertising

a b s t r a c t

Objective:Todescribetheuseofnutritionandhealthclaimsinproductsdirectedatchildrenviatelevision inSpainandtoanalysetheirnutrientprofile.

Methods:Across-sectionalstudyoftelevisionfoodadvertisementsover7daysinfiveSpanishtelevision channelspopularamongchildren.Theproductswereclassifiedascore,non-coreormiscellaneous,and aseitherhealthyorlesshealthy,accordingtotheUnitedKingdomNutrientProfileModel.Weregistered allclaimscontainedontheproduct(packagingandlabelling)anditsadvertisement.Wecalculatedthe frequencydistributionsofhealthandnutritionclaims.

Results:Duringthe420hoursofbroadcasting,169foodproductswereidentified,28.5%inthedairygroup and60.9%inthenon-corecategory.Atotalof53.3%ofproductscontainednutritionclaimsand26.6%

containedhealthclaims;62.2%oftheproductswithclaimswerelesshealthy.Low-fatdairyproducts werethefoodcategorycontainingthehighestpercentageofhealthandnutritionclaims.

Conclusion:OverhalfofallfoodproductsmarketedtochildrenviatelevisioninSpainmadesometype ofnutritionorhealthclaim.Mostoftheseproductswerelesshealthy,whichcouldmisleadSpanish consumers.

Alegacionesnutricionalesydesaludenproductosdirigidos ani ˜nosportelevisiónenEspa ˜naen2012

Palabrasclave:

Marketingnutricional Alegaciónnutricional Alegacióndesalud Perfilnutricional Publicidadalimentaria

re s um e n

Objetivo:Describirlafrecuenciadeusodealegacionesnutricionalesydesaludenproductosdirigidosa ni˜nosportelevisiónenEspa˜nayanalizarsuperfilnutricional.

Métodos:Estudio descriptivo transversal de publicidad alimentaria en cinco canales de televisión espa˜nolespopularesentre losni˜nos durante7días. Losproductosseclasificaroncomo esenciales, noesencialesymisceláneos,ycomosaludablesomenos saludables,segúnelperfilnutricionaldel ReinoUnido.Seregistraronlasalegacionesnutricionalesodesaludpresentesenelproductooelanuncio correspondiente,ysecalculósudistribucióndefrecuencias.

Resultados:Durantelas420horasdeemisiónseidentificaron169productosalimentarios,el28,5%del grupolácteosyel60,9%noesenciales.El53,3%delosproductospresentabanalegacionesnutricionales yel26,6%alegacionesdesalud.El62,2%delosproductosconalegacionesfueronmenossaludables.Los productoslácteosbajosengrasafueronlacategoríaalimentariaqueconteníaelporcentajemásaltode alegacionesnutricionalesydesalud.

Conclusión:MásdelamitaddelosproductosalimentariosanunciadosparaniñosportelevisiónenEspaña presentabanalegacionesnutricionalesodesalud.Lamayoríadeesosproductoseranmenossaludables, pudiendoinduciraconfusiónalosconsumidoresespañoles.

Introduction

Through its influence on children’s food preferences, pur- chasesandconsumption, intensiveadvertisingofenergy-dense,

∗ Correspondingauthor.

E-mailaddress:[email protected](M.A.Royo-Bordonada).

nutrient-poor(EDNP)foodandbeveragesisoneofthefactorslying atthecoreofthecurrentchildhoodobesityepidemic.¹ Although advertisingmakesuseofanintegratedmulti-channelapproach, television continues to be the principal avenue for promotion of foodand drinks for children.² In Spain,television registered thehighestturnoverin2012,accountingfor39.2%ofallinvest- mentinconventionalmedia.³Theleadingnon-conventionalmedia are personalisedmailing and point-of-sale advertising,through

http://dx.doi.org/10.1016/j.gaceta.2016.01.004

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M.A.Royo-Bordonadaetal./GacSanit.2016;30(3):221–226 information containedonproduct presentation (labels,packag-

inganddisplay stands)whichis designed tostimulate impulse buying.It hasbeenestimated thatchildren in Spainreceivean averageof4000hitsperyearoftelevisionadvertisementsofEDNP foodandbeverages.⁴ Twostudies onsamplesofproductswith nutritionandhealthclaimsdetectedthatmostofthestatements madewereambiguousandinupto40%ofcaseswereinbreach ofsomelaw.^5,6Anotherstudy,conductedin2008onasampleof foodsand drinksadvertisedontelevision,foundthathalfofthe advertisementsofEDNPproductsmadeuseofsuchclaims.⁷

Nutritionalmarketing,throughtheuseofnutritionandhealth claimsthatdrawattentiontothenutritionalqualitiesoralleged health benefitsofcertain products, hasappealedto manycon- sumers,andshownitselfcapableofinfluencingtheirperceptions aboutsuchproducts’nutritionalqualityandhealthiness.^8,9There areexperimentalstudiesthatshowhowthepresenceofnutrition claimsinduceda group ofparents -and particularlythemajor- itywhodidnotreadtheinformationcontainedinthenutrition labelling-tochooseEDNPproductsfortheirchildren.^10,11Simi- larly,two experimentalstudiesbothfoundthatpre-adolescents perceivedproductswithnutrient claimsasbeinghealthier and tastier,andweremorelikely tochooseEDNPproductscarrying suchclaims.^12,13

Torespondtocitizens’interestintherelationshipbetweendiet andhealth,andpreventtheuseoffraudulentormisleadingnutri- tionmarketing,in2006theEuropeanCommissionpromulgatedthe Regulationonnutritionandhealthclaimsmadeonfoods.¹⁴This Regulationenvisagesthefutureestablishmentofnutrientprofiles:

thesewouldevaluatetheoverallnutritionalvalueofagivenprod- uct,throughanalysisofitsingredientsandnutritionalcomposition, andsopreventconsumersfrombeingmisledbynutritionand/or healthclaimsinfoodanddrinks containinghighlevelsofsome nutrientwhoseexcessiveconsumptionmightbeharmfultohealth.

Todate,however,nosuchnutrientprofileshavebeenestablished atEuropeanlevel.In additiontoadopting Europeanlegislation, Spainhasseenanumberoflawspassedandvoluntaryagreements concludedwiththefoodindustry,whichgovernadvertisingand nutritionand,toagreaterorlesserdegree,affectadvertisingcon- taininghealthclaims.¹⁵Theaimhasbeentoreinforcethepublic’s righttotruthfulinformationinthisfield.Evenso,despitethispro- fusionofstatutoryrulesandregulations,nonutrientprofilehasyet beendrawnupatanationallevel.Consequently,hereinSpain,there isthepossibilityofnutritionand/orhealthclaimsbeingauthorised inproductswhicharehighinfat,saltand/orsugar(HFSS),provided thattheymeetthecriterionstipulatedintheregulationpertaining totheclaimmade.

The United Kingdom nutrient profiling model (UKNPM),¹⁶ whichwasdrawnupbytheFoodStandardsAgencytoregulate foodadvertisingtargetedatchildrenandhasshowngoodconcord- ancewithalternativenutrientprofiles,¹⁷isoneofthemodelsthat couldbeconsideredforidentifyingproductswhichareorarenot likely,accordingtotheirnutrientprofiles,todisplaynutritionor healthclaims.Accordingly,thisstudyhadatwofoldaim:firstly, todescribethefrequency ofuseof nutrition andhealth claims inproductsdirectedatchildrenviatelevisioninSpain;andsec- ondly,toanalysethenutrientprofileofsuchproductsbyapplying theUKNPM,inlinewiththerecommendationsoftheinternational networkforfoodandobesity/non-communicablediseaseresearch, monitoringandactionsupport.¹⁸

Methods Studydesign

We conducted a cross-sectional study of television food advertising directed at children in Spain, by recording 7 days’

broadcasting(MondaytoSunday)bynation-widechannelstarget- ingthechild-youthpopulation(Boing,DisneyChannelandNeox) andtwogeneralistchannelswiththehighestchild-audienceview- ingindices(Channels3and 5).¹⁹ Thebroadcastswererecorded fromJanuarytoApril2012,excluding Easterholidays,during a child-audiencetimeslot(8pm-12midnight)thathadbeenmod- ified by replacing the 6 pm-8 pm time slot, which had hardly anyaudience,withthe10pm-12midnighttimeslot,whichregis- teredthelastdailychild-audienceviewingpeakinSpain.²⁰Trained researchers watched therecordings and listedall the products advertisedincommercialfoodanddrinkcommunications.Food productplacementwasnotregisteredduetoitsvariablenature.

Theinformationregardinghealthclaimsandnutritionalprofileof thelistedproductswasregisteredbythesameresearcher.

Data-collectionandstudyvariables

1). Internationalfood-basedcodingsystem

Advertisedproductswerepurchasedandclassifiedintothefol- lowingthreecategoriesaccordingtoaninternationalfood-based codingsystem:core(nutrient-rich/calorie-lowproducts);non-core (highinsaturatedfats,trans-fattyacids,freesugarsorsalt,and/or energy-dense);andmiscellaneous.²¹Inthecaseofproductswith differentvarietiesorflavours,wecodedthebrandthatwasmost representative ormost easilyidentifiable in theadvertisement.

Whenallornoneofthevarietieswereshown,wechosetheone knowntohavethehighestconsumptioninthegeneralpopulation, e.g.,thesemi-skimmedvarietyfordairyproducts,themostpopular inSpain.²²Finally,whenonlythebrand’snameorlogowasshown, thecompany’smostrepresentativeproductwasregistered.

2). Nutritionandhealthclaims

PursuanttotheEuropeanRegulationonnutritionandhealth claimsmadeonfoods,a“nutritionclaim”isdefinedasanyclaim whichstates,suggestsorimpliesthatafoodhasparticularbenefi- cialnutritionalpropertiesduetoitsenergycontributionornutrient content,anda “healthclaim”asanyclaim thatstates,suggests orimpliesthat arelationshipexistsbetweena foodcategory, a foodoroneofitsconstituentsandhealth.¹⁴Duetotheirlowfre- quency,claimsofreduction ofriskofdiseasewerepooled with theremaininghealthclaims.AstheRegulationisnotapplicableto alcoholicbeverageswithanalcoholicstrengthbyvolumeofover 1.2%,thelatterwereexcludedfromthestudy.Todetectthepres- enceofnutritionandhealthclaimsintheproductsadvertised,both thepresentationofeach foodproduct(packagingandlabelling) andthecontentofthepertinenttelevisionadvertisement(graphic, spokenorwritten,etc.)werethoroughlyanalysed.

3). UnitedKingdomNutrientProfilingModel

EachfoodproductwasexaminedusingtheUKNPM,amodel thatevaluatesthenutritionalcompositionofthefood/drinkadver- tisedbyanalysingitshealthy(fibre,protein,andvegetables,fruit andnuts)andlesshealthycomponents(calories,sugars,saturated fatsandsalt)per100g.Ifthemodel’salgorithmassignsascoreof lessthan4forfoodorlessthan1fordrinks,theproductisclassi- fiedashealthy;inallothercasesitisclassifiedaslesshealthy(i.e., EDNP).¹⁶

We collected nutritional composition information from the productlabelsthemselves.Whentheproductcouldnotbelocated, weobtainedtheinformationfromthecompany’swebsiteorby requestingitfromthemanufacturer.For24ofthe169products,we referredtoSpanishandinternationalfood-compositiondatabases eithertocompletethedataforoneormorecomponents,usually gramsofsaturatedfat,sugars,fibreorsalt,oralternativelyinthe caseofalreadyreconstitutedproducts,suchaspasta.^23,24

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M.A.Royo-Bordonadaetal./GacSanit.2016;30(3):221–226

Table1

Nutritionandhealthclaimsbyfoodcategory,inproductsadvertisedontelevisionforchildreninSpain,2012.

Foodcategories Nutritionclaims Healthclaims^a

Frequency Frequency Frequency

N % N %^b N %^b

Core 54 31.95 34 63.0 20 37.0

Vegetablesandvegetableproductswithoutaddedsugar 2 1.18 1 50.0 0 0.0

Bottledwater 2 1.18 0 0.0 0 0.0

Low-sugarandhigh-fibrebreakfastcereals(≤20gsugar/100gand≥5gdietaryfibre/100g) 2 1.18 2 100.0 2 100.0

Babyfoods(excludingbabymilkformulabrands) 2 1.18 1 50.0 1 50.0

Fruitandfruitproductswithoutaddedsugar 2 1.18 0 0.0 0 0.0

Meatandalternatives(notcrumbedorbattered;includingfish,legumes,eggs,nutsand nutproducts,andpeanutbutter,excludingsugar-coatedandsaltednuts)

8 4.73 4 50.0 1 12.5

Soups(≤2gfat/100g,excludingdehydrated),saladsandsandwiches,frozenmeals(≤10g fat/serving),andlow-fatsavourysauce(≤10gfat/100gfat)

1 0.59 1 100.0 0 0.0

Breads(includinghigh-fibre,low-fatcrackers),rice,pastaandnoodles 5 2.96 2 40.0 1 20.0

Low-fat/reduced-fatmilk,yogurt,custard(≤3gfat/100g),cheese(≤15gfat/100g)and alternatives(includingprobioticdrinks)

30 17.75 23 76.7 15 50.0

Non-core 103 60.95 52 50.5 22 21.4

Fruitjuiceandfruitdrinks 3 1.78 2 66.7 0 0.0

Crumbedorbatteredmeatandalternatives,andhigh-fatfrozenmeals(>10gfat/serving) 6 3.55 5 83.3 0 0.0

Cakes,muffins,cookies,high-fatcrackers,piesandpastries 16 9.47 6 37.5 4 25.0

Sugar-sweeteneddrinks,includingsoftdrinks,cordials,sportsdrinksandflavour additions(includingdietvarieties)

6 3.55 2 33.3 2 33.3

Snackfoods,includingchips,extrudedsnacks,popcorn,snackandgranolabars, sugar-sweetenedfruitandvegetableproducts,andsugar-coatedorsaltednuts

9 5.33 4 44.4 1 11.1

High-sugarorlow-fibrebreakfastcereals(>20gsugar/100gor<5gdietaryfibre/100g) 7 4.14 7 100.0 1 14.3 Full-fatmilk,yogurt,custard,dairydesserts(>3gfat/100g),andcheeseandalternatives 18 10.65 10 55.6 6 33.3 High-fat,high-sugarandhigh-saltspreads(excludingpeanutbutter),oils,high-fatsavoury

sauces(>10gfat/100g),cannedanddehydratedmealhelpersandsoups(>2gfat/100g)

14 8.28 8 57.1 4 28.6

Chocolateandconfectionery(includingregularandsugar-freechewinggumandsugar) 15 8.88 8 53.3 4 26.7

Fast-foodrestaurantsormeals(including“healthy”alternatives) 9 5.33 0 0.0 0 0.0

Miscellaneous 12 7.1 4 33.3 3 25.0

Babyandtoddlermilkformulabrands 3 1.78 3 100.0 3 100.0

Teaandcoffee 7 4.14 0 0.0 0 0.0

Other(ketchupsauce,softdrinkswithoutsugar) 2 1.18 1 50.0 0 0.0

Total 169 100 90 53.3 45 26.6

aAlltheproductsthatcontainedahealthclaim,alsocontainedatleastonenutritionclaim,exceptforthesportsdrink,PoweradeION4,whichonlycontainedahealth claim.

bPercentageofproductswithnutritionorhealthclaimswithineachfoodcategory.

Themodelwasnotapplicabletofood-chainmenus(e.g.,McDon- ald’s,HappyMeal)becausetheseincludefoodanddrinksthatare scoreddifferently.Insuchcases,wechosetoincludethehamburger asthemenu’smostrepresentativeitem.Productsfromsomefood chains,suchasKFCandPan’s&Company,andsomeproducts,such asall-naturaltunafishpâté,werenotexaminedduetoalackof sufficientnutritionalinformationforanalysis.Whereverpossible, however,wefoundproductscomparabletotheonesadvertised, e.g.,forTelepizzaweusedtheinformationfromahamandcheese pizzamadebytheCasaTarradellasbrand.

4). Analysis

Descriptiveanalyseswereperformedtodetermine:thepropor- tionofproductscarryingclaims,bothoveralland foreach food category;andtheproportionofEDNPproducts,accordingtothe UKNPM,amongthosecarryingclaims.Forhealthclaimsandeachof thenutrientclaims,wealsocalculatedthefoodcategoriesthatmost frequentlycarriedsuchclaims.Allanalyseswereperformedusing theMicrosoftExcelspreadsheetandStatav.13computersoftware package.²⁵

Results

Inthefoodanddrinkadvertisementsairedduringthecourse ofthe420hoursofbroadcastingrecorded,169differentproducts wereidentified,60.9%inthenon-core,32%inthecoreand7.1%in themiscellaneouscategory.Dairyproducts,with48items(28.5%

ofthetotal),werethemostfrequentfooditeminthesample,with 62.5%ofthesecorrespondingtothecorecategorybyvirtueofbeing

low-fat.Thenextmostfrequentfooditemswere:1)cakes,muffins, cookies,high-fatcrackers,piesandpastries;2)chocolateandconfectionery;and3)high-fat,high-sugarandhigh-saltspreads,oils, high-fatsavourysauces,cannedanddehydratedmealhelpersand soups,accountingfor9.5%,8.9%and8.3%ofproductsrespectively, allinthenon-corecategory(Table1).

Inall,53.3% ofproducts(n=90)carried nutritionclaimsand 26.6% (n=45)carried healthclaims, withthefiguresbeing63%

and37%respectivelyforcoreproducts,50.5%and21.4%respectively for non-core products and 33.3% and 25% respectively for miscellaneous products. With the single exception of the sports drink, Powerade ION 4, all the products that contained healthclaimsalsocontainedsometypeofnutrition claim,with the result that a total of 91 products overall made nutrition and/or health claims. The products registering thehighest fre- quencies of nutrition or health claims were cereals and baby and toddler milk formula brands (100%), crumbed or battered meatandalternativesandhigh-fatfrozenmeals(83.3%),low-fat dairy products(76.7%), and fruitjuices and fruitdrinks (66.7%) (Table1).

Amongthe91products(53.8%ofthe169productsidentified) containingsometypeofclaim,mostfeaturedhealthclaims,49%, followedbyclaimsrelating tovitaminsand minerals,nutrients, naturalproductandlow-fatproduct,48%,38%,24%and18%respectively(Table2).Atotalof62.2%ofproductswithclaimswereEDNP, withthisfigurebeing100%forclaimsrelatingtohighunsaturated- fat content,79.5%for claimsrelating tosourceof vitaminsand minerals,37.5%forclaimsrelatingtolow-fat,and14.3%forclaims relatingtolow-sugar.

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Table2

FrequencyandnutrientprofileofproductswitheachtypeofclaiminSpain,2012.

Product

All Lesshealthy(UKNPM)

Typeofclaim N %^a N %^b

Healthclaims 45 49.5% 26 59.1%

Sourceofvitaminsand/orminerals 44 48.4% 35 79.5%

Lowinorsourceofnutrients 35 38.5% 24 68.6%

Natural/Naturally 22 24.2% 8 36.4%

Low-fat 16 17.6% 6 37.5%

Sourceoffibre 14 15.4% 8 57.1%

Lowinsugar 14 15.4% 2 14.3%

Sourceofomega-3 9 9.9% 6 66.7%

Sourceofunsaturatedfats 7 7.7% 7 100.0%

Sourceofproteíns 6 6.6% 4 66.7%

Lowenergyvalue 1 1.1% 1 100.0%

Lowinsodium/salt 1 1.1% 0 0.0%

Total 91 56 62.2%

aPercentageofproductswitheachtypeofclaimoverallproductswithclaims.

b Percentageoflesshealthyproductsoverallproductswitheachtypeofclaim.Thedenominatorwas44forhealthclaimsand90fortotalclaimsrespectivelybecause all-naturaltunafishpâté,whichcontainedclaims,lackedsufficientnutritionalproductinformationavailableforUKNPManalysis.

Table3showsthefoodcategorieswiththehighestpercent- agesofeachtypeofclaim.Low-fatdairyproductsrankedfirstin termsof healthclaims,witha figureof 33%,andaccounted for mostofthenutritionclaims,withtheexception ofthoserelat- ingtoproteins,omega-3fattyacidsandunsaturatedfats.Biscuits, cakesandpastriesregisteredthehighestpercentageofclaimsabout theproductbeinga sourceofunsaturatedfats,43%.In termsof beingasourceoffibre,however,biscuits,cakesandpastriesregis- teredthesamepercentageofclaimsasdidlow-fatproducts,21%.

Atotalof33%ofclaimsaboutthefoodbeingasourceofproteins correspondedtodairyproducts, withanequivalentfigurebeing registeredbyspreads,oilsandsauces.Lastly,33%ofclaimsofthe productbeingasourceofomega-3correspondedtobabymilkfor- mulabrands.

Discussion

Ourresultsshowthatoverhalfofallfoodproductsmarketed tochildrenviatelevisioninSpainmadesometypeofnutritionor healthclaim,andnearlytwo-thirdsofthosemakingclaimswere EDNP,accordingtotheUKNPM.Theproductshavingthehighest percentageofclaimswerecereals.Nonetheless,inabsoluteterms mostoftheclaimswerecontainedindairyproducts, giventhat thesewerethemostnumerous,accountingforalmostonethird ofallproductsinthesample.Themostfrequentnutritionclaims, presentinhalfoftheproducts,werethoserelatingtovitaminand mineralcontent,and80%oftheproductswhichcontainedthese wereEDNP.

Inastudyundertakenfrom2008to2009,Spainrankedasone oftheEuropeanUnioncountrieshavingthehighestpenetrationof nutritionclaims;andthiswaswithfiguresoflessthanonethird ofproducts,²⁶i.e.,verymuchlowerthanthoseseeninourstudy.

TherestrictionoftheproductsampleintheaboveEuropeanstudy toonly5 foodcategories, asopposed to the22 covered byus, mightpartlyaccountforthedifferencesobserved,sinceastudy conductedinIrelandwithaproductsampleof17foodcategories, reportedfiguresverysimilartoours,i.e.,47.3%ofproductscon- tainednutritionclaimsand17.8%containedhealthclaims²⁷versus 53.3%and 26.6% inourstudy.Anotherpossibleexplanation for thedifferencesliesinthefactthatthesampleusedinourstudy consistedofproductsdirectedat children,since ourfiguresare verylikethoseofasimilarstudyundertakeninSpainin2008,with productsadvertisedontelevisionduringtimeslotsdesignatedas protectedforchildviewingand/orhavingalargechildaudience.⁷

Indeed,astudyundertakenintheUSAshowedthatthepresenceof nutritionclaimsandothertypesofnutritionmarketingtechniques isupto40%morefrequentinproductsadvertisedforchildren,²⁸ withabsolutefiguressimilartothoseofourstudy;andaccording totwostudiesconductedinCanadaandAustraliaonproductstar- getedatchildren,thepercentagesthatcontainednutritionclaims, 62.7%²⁹and63.7%³⁰respectively,wereevenhigherthanthatofour study.

Althoughhalfnon-coreproductsincludednutritionclaims,a findingsimilartowhatwasseenintheabove-mentionedAustralian study,³⁰ideallyspeakingonlycoreproductsshouldcontainnutri- tionorhealthclaims.Atleast,thiswastheintentionbehindthe EuropeanRegulation¹⁴whenitenvisagedthefutureestablishment ofnutrientprofilestoauthorisetheuseofclaims,somethingthat today,almostadecadelater,isstillpendingimplementation.The consequenceofthisregulatoryvacuumisthatalmosttwothirdsof productswithnutritionclaimsmarketedtochildreninSpainfailed tomeettheUKNPMcriteria,thussurpassing thefigures of52%

observedinthepreviousstudyconductedinSpain,⁷55%observed inastudyondairyproductsconductedinGermany,Franceandthe UK,¹⁷and1%observedinanAustralianstudywhichusedanutri- entprofilemodelbasedonthatoftheUK,³¹thoughinthelatter twostudiestheproductscoveredwerenotspecificallydirectedat children.IntheaboveCanadianstudy,²⁹62%ofproductsdirected atchildrenandcontainingclaimswereofpoornutritionalquality, owingtotheirhighfat,saltand/orsugarcontent,afigureverysimi- lartothatof62.9%reportedbyus,whichsuggeststhatthenutrient profileofproductswithclaimsisworsewhentheyaretargetedat children.

Themostfrequentlyusednutritionclaimswerethoserelatingto vitaminandmineralcontent,afindingsimilartothatoftheprevi- ousSpanishstudy⁷andtheCanadianstudyonproductsdirectedat children;²⁹incontrast,inanotherCanadianstudyonpre-packaged foodsmarketedbyleadinggrocerychains,claimsrelatingtolow- fatcontentrankedfirst.³²Thepredominanceofclaimsrelatingto vitaminandmineralcontentinproductsdirectedatchildreniswor- rying,since4outofevery5productsthatcontainedtheseclaims wereEDNP.Theseclaimsaretypicalinfortifiedproductsforchil- dren,suchasbreakfastcereals,whichareusuallyEDNP,withfigures equalorclosetothatof100%ofcasesobservedinSpain³³andother comparablecountries,suchastheUSA³⁴and Germany.³⁵Inthe Germanproductsample,thelikelihoodofproductsnotcomply- ingwiththerequirementsofthenutrientprofilewasobservedto behigherincerealsmarketedtochildrenandinthosethatcon-

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Table3 MainfoodcategoriesshowingeachtypeofclaimbyorderoffrequencyinSpain,2012a TypeofclaimLow-fatdairyproductsBiscuits,cakesand pastriesCerealshighinsugaror lowinfibreFull-fatdairyproductsSpreads,oilsand saucesChocolateand confectionaryBabymilkformula brands RankingPercentageaRankingPercentageaRankingPercentageaRankingPercentageaRankingPercentageaRankingPercentageaRankingPercentagea Healthclaims1333952213393947 Sourceofvitaminsand/or minerals12749216314576557 Lowinorsourceof nutrients131--532173946-- Natural/naturally132--35293535-- Low-fat1633636--213---- Sourceoffibre12112127-------- Lowinsugar143--------236-- Sourceofomega-3222----222311--133 Sourceofunsaturatedfats--143----314--229 Sourceofproteins217----133133---- aPercentageofclaimsofeachtypecontainedbyfoodproductcategory(wepresentthefoodcategoriesrankinghigherinorderoffrequencyforeachtypeofclaim).

tainedsometypeofclaim.Although100%ofthebreakfastcereals inourstudyboresometypeofnutritionclaim,theprincipalsource ofclaimsrelating tovitaminsandminerals wasdairy products, with41%ofthese,exceedingthefigureof30%seenintheCanadian study³²duetothefactthattheseweremostnumerousproductsin oursample.

Thehabitualpresenceofnutritionand/orhealthclaimsinprod- uctsdirectedatchildren,intandemwiththepoornutrientprofile ofthese,largelyEDNP,canbeassumedtobemisleadingSpanish consumers,sincethemainreasonreportedbythelatterforreading foodlabellingwastochoosehealthierproducts.³⁶Indeed,thepres- enceofclaimshasbeenobservedtoleadchildrenandparentsalike toperceivetheseproductsasbeingmorenutritionalandhealthier, showagreaterwillingnesstobuythem,andbeinducedtochoose EDNPproducts.^11–13,37Compulsorynutritioninformationonnutri- tionlabellingcouldgosomewaytomitigatethemisleadingnature oftheseclaims,thoughthehealth“halo”associatedwithproducts bearingclaimsmightnonethelessinhibitconsumersfromconsul- tingthenutritioninformationcontainedonthelabelling.³⁸Arecent studyundertakeninSpainshowedthatmostconsumersdidnot usuallyreadthenutritionlabelling,withalmosthalfofthemrepor- tingthattheydidnotfullyunderstandthenutritioninformation.³⁶ Furthermore, an experimentalstudy showed that thepresence ofnutritionclaimsinducedthemajorityofparentswhohadnot readthenutrition-labellinginformationtochooseEDNPproducts fortheirchildren.¹⁰Aconsumer’sfriendlyfront-of-packnutrition label,likethekeyholelabellingschemeinNordic countriesand thetraffic-lightnutritionsysteminUK,³⁹couldservetoprevent thisconfusion.InSpain,however,onlytheEroskisupermarketco- operative,actingattheinstanceofitsconsumers’association,uses thetrafficlightonitshousebrands.

This study’s main limitation resides in the fact that it was restricted toproductsadvertisedontelevision,sothat itmight notberepresentativeofallproductsdirectedatchildren.Inaddi- tion,limiting therecording periodto themonthsof Januaryto April meantthat seasonal products, suchas ice-cream or typi- calChristmasitems,werenot represented.Evenso,oursample includedproductsdrawnfromthevastmajorityoffoodcategories intheinternationalfood-basedcodingsystem.²¹Moreover,thesize anddiversityoftheproductsampleweresimilarorgreaterthan those oflike studiesconducted inAustralia and Canada,which used a major supermarket chain toselect productsdirected at children.^29,30

Inconclusion,mostoftheseproductsmarketedtochildrenvia televisioninSpainmakingsometypeofnutritionorhealthclaim werelesshealthy,whichcouldbemisleadingSpanishconsumers.

AstheEuropeanCommissionRegulationenvisages,topreventthe potentialperniciouseffectofnutritionandhealthclaimsonchil- dren’seatinghabits,useshouldbemadeofnutrientprofilesthat enableproductswhichmeetminimalnutritioncriteriatobeiden- tified, such as the UKNPM,the tables used by Food Standards AustraliaNewZealand,³¹orthemodelrecentlydevelopedbythe WHORegionalOfficeforEurope.⁴⁰

Editorincharge CarlosÁlvarez-Dardet.

Transparencydeclaration

Thecorrespondingauthoronbehalfoftheotherauthorsguar- antee the accuracy, transparency and honesty of the data and informationcontainedinthestudy,thatnorelevantinformation hasbeenomittedandthatalldiscrepanciesbetweenauthorshave beenadequatelyresolvedanddescribed.

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Whatisknownaboutthetopic?

Nutritionandhealthclaimsthatdrawattentiontothenutri- tionalqualitiesorallegedhealthbenefitsofcertainproducts, have showncapable of influencing consumers perceptions aboutsuchproducts’nutritionalqualityandhealthiness.

Whatdoesthisstudyaddtotheliterature?

Overhalfofallfoodproductsmarketedtochildrenviatele- visioninSpainmadesometypeofnutritionorhealthclaim, andnearlytwo-thirdsofthosewereenergy-denseandnutrient poor,whichcouldbemisleadingSpanishconsumers.

Authorshipcontributions

M.A.Royoconceivedthestudyandwrotethefirstdraftofthe manuscript.J.DamianandM.J.Bosquedparticipatedintheman- agementandanalysisofthedata.M.A.MoyayL.Lópezparticipated inthestudydesinganddatacollection.Allauthorscontributedto therevisionandapprovalofthefinalmanuscript.

Funding

ThisprojecthasbeensupportedbytheSpanishHealthResearch FundoftheInstituteofHealthCarlosIII(ProjectENPY1015/13)and theSpanishConsumersOrganization.

Conflictsofinterest None.

Acknowledgements

TheauthorsthankZoilaVioletaBozaforherhelpindatacollec- tion.

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