title: Nutrition labelling, marketing techniques, nutrition claims and health claims on chip and biscuit packages from sixteen countries.
abstract: OBJECTIVE
  Food packages were objectively assessed to explore differences in nutrition labelling, selected promotional marketing techniques and health and nutrition claims between countries, in comparison to national regulations.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Chip and sweet biscuit packages were collected from sixteen countries at different levels of economic development in the EPOCH (Environmental Profile of a Community's Health) study between 2008 and 2010.
  
  
  METHODS
  Seven hundred and thirty-seven food packages were systematically evaluated for nutrition labelling, selected promotional marketing techniques relevant to nutrition and health, and health and nutrition claims. We compared pack labelling in countries with labelling regulations, with voluntary regulations and no regulations.
  
  
  RESULTS
  Overall 86 % of the packages had nutrition labels, 30 % had health or nutrition claims and 87 % displayed selected marketing techniques. On average, each package displayed two marketing techniques and one health or nutrition claim. In countries with mandatory nutrition labelling a greater proportion of packages displayed nutrition labels, had more of the seven required nutrients present, more total nutrients listed and higher readability compared with those with voluntary or no regulations. Countries with no health or nutrition claim regulations had fewer claims per package compared with countries with regulations.
  
  
  CONCLUSIONS
  Nutrition label regulations were associated with increased prevalence and quality of nutrition labels. Health and nutrition claim regulations were unexpectedly associated with increased use of claims, suggesting that current regulations may not have the desired effect of protecting consumers. Of concern, lack of regulation was associated with increased promotional marketing techniques directed at children and misleadingly promoting broad concepts of health.
authors.affiliation: 1Population Health Research Institute,McMaster University,Hamilton,Canada.
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Mayhew
authors.affiliation: 2London School of Hygiene and Tropical Medicine,London,UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Lock
authors.affiliation: Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
authors.affiliation: 4Division of Nutrition,St John's Research Institute,Bangalore,India.
authors.forename: Sumathi
authors.initials: S
authors.lastname: Swaminathan
authors.affiliation: 5Research Division,Dante Pazzanese Institute of Cardiology,São Paulo,Brazil.
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Marcilio
authors.affiliation: 6Department of Community Health Sciences,Aga Khan University,Karachi,Pakistan.
authors.forename: Romaina
authors.initials: R
authors.lastname: Iqbal
authors.affiliation: 1Population Health Research Institute,McMaster University,Hamilton,Canada.
authors.forename: Mahshid
authors.initials: M
authors.lastname: Dehghan
authors.affiliation: 1Population Health Research Institute,McMaster University,Hamilton,Canada.
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.affiliation: 1Population Health Research Institute,McMaster University,Hamilton,Canada.
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
mesh_terms: D003430:Cross-Sectional Studies; D005515:Food Labeling / Q000592:standards*; D018857:Food Packaging; D007390:International Agencies; D040541:Marketing / Q000592:standards*; D018673:Nutrition Policy; D009753:Nutritive Value
keywords: Food marketing; Health claim; Nutrition claim; Nutrition labelling
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