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El objetivo fue caracterizar el contenido de sodio en preparaciones de consumo frecuente fuera del hogar en tres zonas de Lima Metropolitana. Se realizó un estudio transversal para el cual se identificaron veinte preparaciones de consumo frecuente según el lugar de expendio. La determinación del contenido de sodio se obtuvo mediante espectroscopía de absorción atómica en preparaciones recolectadas en el 2019. La mediana del contenido de sodio en productos de venta ambulatoria fue 492,36 mg/100 g (RIQ: 83,93 - 918,78); 471,37 mg/100 g, en preparaciones tradicionales y típicas (RIQ: 76,04 - 765,39); y 471,06 mg/100 g (RIQ: 115,31 - 695,18), en comidas rápidas. El 65% de las preparaciones fueron consideradas altas en sodio según los parámetros peruanos, mientras que el 30% de las preparaciones también presentaron un alto contenido, de acuerdo con los parámetros del Reino Unido. La mayoría de las preparaciones expendidas y consumidas fuera del hogar presentan un elevado contenido de sodio. Es esencial involucrar a todos los actores que participan en la preparación de alimentos para el consumo fuera del hogar, con el fin de sensibilizarlos e incluirlos en la promoción de políticas enfocadas en la reducción del consumo de sodio.

Objetivos. Estimar la cantidad de bebidas y alimentos procesados y ultraprocesados que declaran información nutricional en su empaque y describir las características de esta información, así como determinar la presencia de información nutricional en los productos con octógonos. Materiales y métodos. Se tomaron fotografías del etiquetado de 4404 bebidas y alimentos procesados y ultraprocesados ofertados en supermercados de Lima Metropolitana. La información declarada en la etiqueta se recogió y se registró en la versión móvil y web del Programa de Información de Etiquetas de Alimentos (FLIP por sus siglas en inglés). Se analizaron las variables correspondientes a la declaración de información nutricional, la forma en que se declara dicha información y la declaración de la misma en bebidas y alimentos con octógonos. Resultados. De todos los productos recolectados solo el 71,4% declara algún tipo de información nutricional. De estos, el 13,8% declara la información nutricional en texto y no en tabla, además sólo 56,3% la declara por cada 100 gramos o mililitros. Del total de alimentos con el octógono «Contiene grasas trans», sólo 19,2% declara su contenido. Conclusiones. Más de la cuarta parte de bebidas y alimentos envasados expendidos en el mercado peruano no declaran información nutricional de ningún tipo, y de los que declaran, existe una que lo hace en diferentes formatos y unidades. Además, se halló que hay una proporción de bebidas y alimentos para cada tipo de octógono que no declaran la información del nutriente advertido en el mismo.

Abstract Background Sugar-sweetened beverage consumption is associated with obesity and chronic disease. In 2018, Peru increased the tax on high-sugar beverages (≥6 g of sugar per 100 mL) from 17 to 25%, yet little is known about pre-existing beverage trends or demographic characteristics associated with purchases in the country. The aim of this study was to explore beverage purchasing trends from 2016 to 2017 and examine variation in purchase volume by sociodemographic characteristics among urban households in Peru. Methods This study used monthly household purchase data from a panel of 5145 households from January 2016–December 2017 from Kantar WorldPanel Peru. Beverage purchases were categorized by type and tax status under the 2018 regulation (untaxed, lower-sugar taxed, high-sugar taxed). To assess beverage purchasing trends, per-capita volume purchases were regressed on a linear time trend, with month dummies for seasonality and clustered standard errors. Mean volume purchases by beverage tax status (total liters purchased per month), overall and by key demographic characteristics (education, socioeconomic status, and geographic region), were calculated. Mean volume by beverage type was assessed to identify the largest contributors to total beverage volume. Results The trends analysis showed a decline in total beverage volume of − 52 mL/capita/month (95% CI: − 72, − 32) during the 24-month study period. Over 99% of households purchased untaxed beverages in a month, while > 92% purchased high-sugar taxed beverages. Less than half of all households purchased low-sugar taxed beverages in a month and purchase volume was low (0.3 L/capita/month). Untaxed beverage purchases averaged 9.4 L/capita/month, while households purchased 2.8 L/capita/month of high-sugar taxed beverages in 2017. Across tax categories, volume purchases were largest in the high education and high socioeconomic (SES) groups, with substantial variation by geographic region. The highest volume taxed beverage was soda (2.3 L/capita/month), while the highest volume untaxed beverages were milk and bottled water (1.9 and 1.7 L/capita/month, respectively). Conclusions Nearly all households purchased high-sugar taxed beverages, although volume purchases of taxed and untaxed beverages declined slightly from 2016 to 2017. Households with high SES and high education purchased the highest volume of taxed beverages, highlighting the need to consider possible differential impacts of the tax policy change by sub-population groups.

Nutritional warnings are used as a public health strategy to address obesity. Peru approved in 2013 and implemented in 2019 a law requiring nutritional warnings on the marketing and packaging of processed foods high in sugar, sodium, saturated fat, and containing trans-fat. The complexity behind the design and approval of these policies over six years provides unique learnings, that inform the obesity prevention context, especially when proposed policies face strong opposition from powerful stakeholders. Our study aims to describe the milestones and key stakeholders' roles and stances during the nutritional warnings policy design in Peru, and to identify and analyze the main drivers of policy change that explain its approval. In 2021, interviews were conducted with 25 key informants closely involved in its design. Interviews were analyzed using the Kaleidoscope Model as a theoretical framework. Relevant policy documents and news were also analyzed. Milestones for this policy included the approval of the Law, Regulation, and Manual. Policy supporters were mainly from Congress, civil society advocates, and Health Ministers. Opponents came from Congress, ministries linked to the economic sector, the food industry, and media. Across the years, warnings evolved from a single text, to traffic lights, to the approved black octagons. Main challenges included the strong opposition of powerful stakeholders, the lack of agreement for defining the appropriate evidence supporting nutritional warning parameters and design, and the political instability of the country. Based on the Kaleidoscope Model, the policy successfully targeted a relevant problem (unhealthy eating decisions) and had powerful advocates who effectively used focusing events to reposition the warnings in the policy agenda across the years. Negotiations weakened the policy but led to its approval. Importantly, government veto players were mostly in favor of the policy, which enabled its final approval despite the strong opposition.

In June 2019, mandatory front-of-package warning labels (FOPL) were implemented in Peru. The aim of the study was to describe changes in marketing strategies on packaging: marketing techniques (MT), health claims (HC), and nutritional claims (NC) on the packaging of products frequently consumed by children before and after the FOPL implementation. Product photos were taken pre- (March 2019) and post-implementation (March-October 2020) in three supermarkets in Lima, Peru. Following INFORMAS protocols and Peruvian Technical Norms, the presence of MT, HC, and NC was assessed on all package sides. Products were classified as “high-in” and “not high-in” based on the regulation threshold for critical nutrients. Differences in the proportion of products with each strategy in both periods were evaluated. Also, a subsample of products was matched according to the barcode and exact McNemar test was used to compare proportions of strategies pre/post-implementation. We included 883 and 1,035 products in pre- and post-implementation, respectively. In both periods, MT appeared on almost 70% of all products. The presence of HC increased significantly only for beverages (24.5–38.1%, p < 0.001). In both phases, NC were commonly used on beverages (>80%). Overall, the prevalence of “high-in” products using MT increased (73.6–82.1%, p = 0.007), while use of HC increased among “not high-in” products (32.9–41.6%, p < 0.001). There is a high frequency of MT on all products and NC on beverages. The increase in MT in “high-in” products may be an industry response to minimize the impact of the FOPL on food choices and sales. New regulatory aspects regarding labeling should be implemented to strengthen the current policy.

Reducing salt intake is one of the most cost-effective interventions to improve population health due to the subsequent reductions in blood pressure. Countries are introducing programs to lower salt consumption. Such programs usually focus on reducing salt in packaged foods and meals alongside campaigns to change consumer behavior. Thus, this paper provides an overview of the rationale for and evidence supporting the use of salt substitutes. Cur­rent approaches to salt reduction are insufficient, and more innovative solutions need to be identified. There is good evidence that salt substitutes, where some of the sodium is replaced with potassium, are effective to lower sodium total intake. The main challenge is to understand the pathways to market for salt substitutes. How do we implement programs to promote salt substitutes in different countries? What levels of government intervention are required? With more research and government investment, salt substitutes could be a game changer for increasing the impact of strategies to reduce population salt intake.

El objetivo del estudio fue describir la oferta y la publicidad de alimentos y bebidas en instituciones educativas y entornos escolares de 15 colegios públicos y privados de Lima en 2019. Se realizaron observaciones inopinadas y se registraron los alimentos ofrecidos, la presencia de advertencias publicitarias, octógonos y la publicidad en quioscos y cafeterías. A la hora de salida se observó la venta ambulatoria de alimentos. Todas las escuelas ofrecían productos ultraprocesados, el 73,3% vendía alimentos con octógonos y el 60% tenía publicidad de alimentos procesados y ultraprocesados. En el 86,7% de los colegios había vendedores ambulantes de alimentos, varios de los alimentos eran productos ultraprocesados. Los resultados sugieren un ambiente alimentario no saludable dentro y alrededor de las escuelas, y el incumplimiento de la regulación actual. Resulta necesario mejorar la difusión y supervisión de la política alimentaria, y construir con las escuelas estrategias para promover una alimentación saludable.

Las enfermedades no transmisibles (ENT) son causa importante de carga de enfermedad en el Perú así como en otros países en desarrollo. Las respuestas para el control de las ENT requieren de investigación multidisciplinaria, tanto a nivel local como internacional. Desde hace más de 10 años, CRONICAS: Centro de Excelencia en Enfermedades Crónicas, de la Universidad Peruana Cayetano Heredia, realiza investigación en el campo de las ENT en el Perú. En el presente artículo se describen algunos estudios realizados, incluyendo los estudios epidemiológicos PERU MIGRANT, y la cohorte CRONICAS. También se presentan resultados de revisiones sistemáticas y resultados de intervenciones frente a las ENT. A través de estos estudios llevados a cabo por el centro CRONICAS se señalan potenciales áreas para afrontar las ENT en países en desarrollo.

In 2015, the Pan American Health Organization (PAHO) published sodium targets for packaged foods, which included two distinct levels: one “regional” and one “lower” target. Changes to the sodium content of the food supply in Latin American Countries (LAC) has not been evaluated. A repeated cross-sectional study used food label data from 2015 (n = 3859) and 2018 (n = 5312) to determine changes in the proportion of packaged foods meeting the PAHO sodium targets and the distribution in the sodium content of foods in four LAC (Argentina, Costa Rica, Paraguay, Peru). Foods were classified into the 18 food categories in the PAHO targets. The proportion of foods meeting the regional targets increased from 82.9% to 89.3% between 2015 and 2018 (p < 0.001). Overall, 44.4% of categories had significant decreases in mean sodium content. Categories with a higher proportion of foods meeting the regional and lower targets in 2018 compared to 2015 (p < 0.05) were breaded meat and poultry, wet and dry soups, snacks, cakes, bread products, flavored cookies and crackers, and dry pasta and noodles. While positive progress has been made in reducing the sodium content of foods in LAC, sodium intakes in the region remain high. More stringent targets are required to support sodium reduction in LAC.

In recent decades, overweight or obesity have increased dramatically in middle- and low-income countries; a situation which consolidates chronic non-communicable diseases (NCD) as one of the leading causes of mortality and disability worldwide. Currently, half the people in Peru over the age of 15 years are overweight, and one fifth suffer from obesity. The situation is worsening and increasingly affects people in poverty, who frequently benefit from food supplement programs designed to combat food insecurity and malnutrition. There is an urgent worldwide need to find policies and programs that help fight the problem of obesity at the population level, a task that is still pending. In this article, we review the current epidemic of overweight and obesity in Peru and the world and its most significant consequences and causes, with an emphasis on access to and availability of foods. We describe the largest food supplement programs and synthesize the research on interventions in order to reflect on how their findings might help social programs work as a platform to reduce obesity and prevent NCD in Peru.

Consumption of ultra-processed foods has increased alarmingly, representing a risk to children’s health. Different techniques in marketing to kids (M2K) used on food labels are influencing the purchasing decisions of these products. This study aims to provide useful information about M2K found in labeling of food products sold in a supermarket chain in Lima, Peru and to determine its relationship with critical nutrient content. This was an observational, correlational, descriptive study. Data were collected by photographing the front-of-pack (FoP) of 2747 product labels sold in three supermarkets in Lima, but only those that met all the inclusion criteria were evaluated (n = 1092). A relationship was found between the use of techniques in marketing to kids and the level of critical nutrient regarding saturated fat (PR = 0.56; CI95%: 0.52–0.63), total sugar (PR = 1.70; CI95%: 1.64–1.77), and sodium (PR = 1.05; CI95%: 1.03–1.07). Particularly with sugar, the presence of M2K is a risk factor. New regulatory policies for the use of these food labeling techniques should be implemented to improve children’s health at the population level.

The purpose of this paper was to determine the foods and beverages offered in the city of Lima, Peru, that would be subject to front-of-package warning labels (octagons) according to the thresholds for the two phases (6 and 39 months after the approval) for nutrients of concern (sugar, sodium, saturated fat, and trans-fat) included in the Peruvian Law of Healthy Eating. An observational, descriptive cross-sectional study was conducted that evaluated the nutritional composition of processed and ultra-processed foods that are sold in a supermarket chain in Lima. Of all the processed and ultra-processed foods captured, foods that report nutritional information and do not require reconstitution to be consumed were included. A descriptive analysis was carried out by food categories to report the nutrient content and the percentage of foods that would be subject to front-of-package warning labels. Results: A total of 1234 foods were evaluated, according to the initial thresholds that became effective 6 months after the law was implemented; 35.9% of foods had two octagons; 34.8% had one octagon; 15.8% had no octagons; 12% had three octagons; and no products had four octagons. At 39 months, when the final and more restrictive thresholds become effective, 4.8% did not have octagons. The majority of processed and ultra-processed foods that are sold in a Peruvian supermarket chain carry at least one octagon, and more than 10% of them carry octagons for three of the four nutrients of concern.

Background: Salt intakes in Latin America currently double the World Health Organization’s recommendation of 5 g/day. Various strategies to reduce the population’s salt consumption, such as raising awareness using social marketing, have been recommended. This study identified parents’ perceptions of salt consumption to inform a social marketing strategy focused on urban areas in Peru. Methods: Using a sequential exploratory methods design, parents of pre-school children, of high and low socioeconomic status, provided qualitative data in the form of interviews and focus groups. Following this, quantitative data was obtained via questionnaires, which were sent to all parents. The information was analyzed jointly. Results: 296 people (mean age 35.4, 82% women) participated, 64 in the qualitative and 232 in the quantitative phase of the study. Qualitative data from the first phase revealed that the majority of mothers were in charge of cooking, and female participants expressed that cooking was “their duty” as housewives. The qualitative phase also revealed that despite the majority of the participants considered their salt intake as adequate, half of them mentioned that they have tried to reduce salt consumption, and the change in the flavor of the food was stated as the most difficult challenge to continue with such practice. Quantitative data showed that 67% of participants would be willing to reduce their salt intake, and 79.7% recognized that high salt intake causes hypertension. In total, 84% of participants reaffirmed that mothers were in charge of cooking. There were no salient differences in terms of responses provided by participants from high versus low socioeconomic groups. Conclusions: The results point towards the identification of women as a potential target-audience of a social marketing strategy to promote reductions in salt intake in their families and, therefore, a gender-responsive social marketing intervention is recommended.

In resourced-constrained settings, daily cooking practices are still the norm. Replacing sodium in regular salt to produce potassium-enriched salts are potential alternative routes to reduce sodium intake, paired with the benefit associated with potassium intake. This change would likely have effects on palatability and taste of prepared foods, yet a threshold to discriminate sensorial changes can be determined. The main goal of this study was to assess if the use of potassium-enriched salt substitutes lead to perceived differences in taste utilizing a sensory discrimination test.A triangle taste test was conducted and participants were offered samples of cooked rice prepared with different salts. The only ingredient that differed in the preparation was the salt used: 100%NaCl (regular salt) and salts where sodium was replaced by 50%, 33% or 25% KCl (potassium-enriched salt). Comparisons were carried out according to the minimum number of correct judgments. A total of 156 subjects, 49% males, mean age 41.0 years (SD±15.5) years, participated in the study. Samples using 25% potassium-enrichment were indistinguishable in terms of taste from regular salt, whereas samples with 33% and 50% potassium-enrichment were distinguishable. Results were consistent when stratified by sex and age. Less than 10% of participants attributed the differences to bitterness or metallic flavor.The 25% potassium-enriched salt is indistinguishable from regular salt. These findings suggest a potential to achieve sodium intake reduction strategies in cooking practices by substituting regular salt with potassium-enriched salt without affecting palatability.

Introducción: La relación entre la composición corporal y el fenotipo delgado metabólicamente obeso (DMO), caracterizado por problemas metabólicos en personas con un IMC normal, ha sido poco estudiada en población latina. A pesar de que el IMC se utiliza ampliamente para evaluar las asociaciones entre sobrepeso, obesidad y la salud metabólica, presenta limitaciones en la diferenciación entre grasa y masa magra. El objetivo de este estudio fue analizar la asociación entre el porcentaje de grasa corporal (%GC) estimado a través de pliegues cutáneos y el diagnóstico de DMO en la población peruana. Metodología: Estudio analítico transversal con datos de la cohorte PERU MIGRANT. Se incluyeron participantes con IMC entre 18,5 a 24,9 kg/m² sin antecedentes de diabetes e hipertensión. El DMO se definió como ≥2 factores de riesgo cardio metabólicos. El punto de corte óptimo del %GC se obtuvo mediante la curva de la característica operativa del receptor (COR) y área bajo la curva con intervalos de confianza (IC) al 95%, estratificado por sexo y utilizando el índice de Youden. Se realizó un modelo lineal generalizado con enlace log y familia Poisson con varianza, obteniendo razones de prevalencia crudas y ajustadas (RPc y RPa) con IC95%. Resultados: Se incluyó 321 participantes en el estudio. El 54,52% eran mujeres y 9,66% tenía ≥60 años. La prevalencia del DMO fue 32,09% y varió significativamente según el sexo, grupo de edad y %GC. Los puntos de corte óptimos del %GC para DMO fueron 20,70% en hombres y 32,45% en mujeres. La regresión múltiple reveló que un alto %GC aumentó significativamente la RPa en 3,09 (IC95% 2,04-4,67) veces, tras ajustar por covariables. Conclusión: Este estudio confirma la relación entre el %GC estimado mediante pliegues cutáneos y el diagnóstico de DMO. Destaca la importancia de evaluar la composición corporal integralmente, incluso en personas delgadas, para prevenir eficazmente las alteraciones metabólicas asociadas.