Building Capacity and Advancing Regulatory Measures to Improve Food Environments in the Region of the Americas.

Noncommunicable diseases (NCDs) are the main cause of death globally (70%) and in the Region of the Americas (80%), and poor diets are a leading driver of NCDs. In response, the Pan American Health Organization (PAHO)/World Health Organization (WHO) introduced a set of evidence-based regulatory measures to help countries improve diets through the reduced consumption of processed and ultra-processed foods. This paper aims to describe the needs of and propose actions for key actors to advance these measures.

The increasing trend in the consumption of ultra-processed food products is associated with a diet related to chronic diseases in Colombia-Evidence from national nutrition surveys 2005 and 2015.

Introduction: Ultra-processed food products (UPF) have been related to chronic diseases (CD). Public health politics has been establishing strategies to decrease the consumption of these products in the country.

Objectives: i) To assess the trend of the consumption of UPF between 2005 and 2015.

Impact of textual warnings on emotional brain responses to ultra-processed food products.

Background And Objectives: Ultra-processed food products (UPF) have been associated with numerous non-communicable diseases. Despite this, the addictive nature of UPF, and the aggressive marketing strategies used to promote them, has created a strong emotional connection between UPF and consumers, and supports their increasing UPF global consumption. In view of the emotional link that consumers often have with UPF, modulating emotional reactions to UPF (by using strategies such as textual warnings) is important in changing consumers' behavior.

Building capacity in reducing population dietary sodium intake in the Americas.

Objective: To present some resources developed as part of the technical support of the Pan American Health Organization (PAHO) to Member States to reduce population dietary sodium intake, and to discuss the main challenges and opportunities to accelerate action toward sodium intake reduction in the Americas.

Methods: Sources of information include a mapping of salt reduction policies conducted in 2019, reports from working group meetings, interviews conducted in 2020 and 2021 in seven countries, and technical documents developed around the Updated PAHO Regional Sodium Reduction Targets.

Results: These tools show that, despite progress, challenges to succeed in this agenda persist.

Development and application of the TFA macrosimulation model: a case study of modelling the impact of trans fatty acid (TFA) elimination policies in Brazil.

Introduction: The consumption of trans-fatty acids (TFA) is directly associated with cardiovascular disease risk and is responsible for a significant health burden globally. The policy strategies for reducing TFA include limiting their content in foods and eliminating partially hydrogenated oils (PHO) in the market. This study aims to describe a comparative risk assessment macrosimulation model and to apply this tool to estimate the potential reductions in CVD mortality gained from the compared scenarios of TFA reduction/elimination in Brazil.

Evaluating progress and addressing actions to eliminate industrially produced trans-fatty acids in the Americas.

Objective: To evaluate the progress toward the 2023 target for the elimination of industrially produced trans-fatty acids (IP-TFA) in the Region of the Americas and to highlight the achievements of the four strategic lines of action from the Plan of Action for the Elimination of IP-TFA 2020-2025.

Methods: A survey based on the World Health Organization (WHO) REPLACE package was used to collect data. The REPLACE package outlines six strategic action areas to support the prompt, complete, and sustained elimination of IP-TFA from the food supply.

Comparing taxes as a percentage of sugar-sweetened beverage prices in Latin America and the Caribbean.

Background: Excise taxes can be used to reduce the consumption of sugar-sweetened beverages (SSBs), an important preventable risk factor for noncommunicable diseases. This study aimed to compare novel standardized indicators of the level of taxes applied on SSBs as a percentage of the price across beverage categories in Latin America and the Caribbean.

Methods: We used a method developed by the Pan American Health Organization and adapted from the World Health Organization's tobacco tax share.

Regulatory measures for the protection of adequate and healthy diet in Brazil: a 20-year analysis.

Regulatory measures are among the strategies for the promotion of adequate and healthy diet recommended by the Brazilian National Food and Nutrition Policy (PNAN). Although other actions in the promotion of adequate and healthy diet have made strides in Brazil, regulatory measures have made slow progress. The study aimed to identify and describe factors related to the development and implementation of the principal regulatory measures for the protection of adequate and healthy diet in Brazil in the last 20 years.

[Nutrient profile of food products exempted from the application of front-ofpackage warnings during the first stage of the Healthy Eating Law in Peru: case studyPerfil nutricional de produtos alimentícios isentos da aplicação de advertências na parte frontal da embalagem durante a primeira etapa da Lei de Alimentação Saudável no Peru: estudo de caso].

Objective: Identify the nutritional profile of food products exempted from presenting one or more front-ofpackage nutritional warnings during the first stage of Law 30,021 on the Promotion of Healthy Eating for Children and Adolescents in Peru.

Methods: Data were collected on 188 products from points of sale in the city of Lima. The convenience sample included products that until September 17, 2021 were exempted by the legislation from presenting any of the warning labels for sugar, sodium, or saturated fats.

An Assessment of Government Capacity Building to Restrict the Marketing of Unhealthy Food and Non-Alcoholic Beverage Products to Children in the Region of the Americas.

The Pan American Health Organization (PAHO) Strategic Plan 2020-2025 committed to reduce children's consumption of energy-dense nutrient-poor food and beverage products high in fat, sugar and salt (HFSS) and promote healthy eating patterns to reduce malnutrition in all forms. This paper describes the capacity-building needs in PAHO's Member States to restrict the marketing of HFSS food and beverages to children. We asked Ministries of Health officials or national institutes/departmental representatives ( = 35) to complete a 28-item web-based survey (January to July 2020).

Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool.

Background: With multi-stakeholder approaches central to efforts to address global health challenges, debates around conflict of interest (COI) are increasingly prominent. The World Health Organization (WHO) recently developed a proposed tool to support member states in preventing and managing COI in nutrition policy. We analysed responses to an online consultation to explore how actors from across sectors understand COI and the ways in which they use this concept to frame the terms of commercial sector engagement in health governance.

Effects of Menu Labeling Policies on Transnational Restaurant Chains to Promote a Healthy Diet: A Scoping Review to Inform Policy and Research.

There is insufficient evidence that restaurant menu labeling policies are cost-effective strategies to reduce obesity and diet-related non-communicable diseases (NCDs). Evidence suggests that menu labeling has a modest effect on calories purchased and consumed. No review has been published on the effect of menu labeling policies on transnational restaurant chains globally.

Development of a Responsible Policy Index to Improve Statutory and Self-Regulatory Policies that Protect Children's Diet and Health in the America's Region.

In 2010, 193 Member States of the World Health Organization (WHO) endorsed World Health Assembly Resolution WHA63.14 to restrict the marketing of food and beverage products high in fat, sugar and salt (HFSS) to children to prevent obesity and non-communicable diseases (NCDs). No study has examined HFSS marketing policies across the WHO regional office countries in the Americas.

[Association between food insecurity and hemoglobin and retinol levels in children treated in the Brazilian Unified National Health System in the city of Rio de Janeiro, Brazil].

This study analyzed the association between food insecurity and hemoglobin and retinol levels in children 6 to 59 months of age. This was a cross-sectional study in 2014 with a representative sample of children in this age bracket treated at basic health units in the city of Rio de Janeiro, Brazil. Analysis of food insecurity levels used the Brazilian Food Insecurity Scale, and venipuncture was performed for measurement of serum hemoglobin and retinol levels.

Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean.

Objective: To identify examples of the 'corporate political activity' (CPA) of the industry producing and selling ultra-processed food and drink products (UPP) in Latin America and the Caribbean.

Design: Searches were conducted on the national websites and social media accounts of large industry actors. Coding was deductive and based on a framework for classifying the CPA of the food industry.

History and challenges of Brazilian social movements for the achievement of the right to adequate food.

The historical struggles that Brazil faced to overcome malnutrition coincided with the empowerment of civil society and social movements which played a crucial role in the affirmation of health and food as social rights. After two decades under military dictatorship, Brazil went through a redemocratization process in the 1980s when activism emerged to demand spaces to participate in policy-making regarding the social agenda, including food and nutrition security (FNS). From 1988 onward institutional structures were established: the National Council of FNS (CONSEA) convenes government and civil society sectors to develop and monitor the implementation of policies, systems and actions.

[Household purchase of sodas and cookies reduces the effect of an intervention to promote the consumption of fruits and vegetables].

This study examines the influence of increasing household availability of sodas and cookies on the effects of an intervention to promote the consumption of fruits and vegetables. The study analyzed data from 70 families living in low-income communities in the city of Rio de Janeiro, Brazil, selected in a stratified probabilistic sample, and who completed a 30-day food record before and after the intervention. The intervention contributed to a significant increase in the household availability of fruit and vegetables (+2.

Lifestyle among former cancer patients in Brazil in 2013.

People who have been diagnosed with cancer tend to adopt healthier lifestyles. This study analyzes the prevalence of smoking, eating fruits and vegetables, exercise and the use of alcoholic beverages among individuals who reported to have been diagnosed with cancer in the PNS (Pesquisa Nacional de Saúde or National Health Survey). The prevalence and corresponding 95% confidence intervals were calculated for consuming fruits and vegetables, sedentary lifestyle (no exercise), use of alcoholic beverages, being overweight and tobacco use.

The Fraction of Cancer Attributable to Ways of Life, Infections, Occupation, and Environmental Agents in Brazil in 2020.

Many human cancers develop as a result of exposure to risk factors related to the environment and ways of life. The aim of this study was to estimate attributable fractions of 25 types of cancers resulting from exposure to modifiable risk factors in Brazil. The prevalence of exposure to selected risk factors among adults was obtained from population-based surveys conducted from 2000 to 2008.