title: Nutritional quality and child-oriented marketing of breakfast cereals in Guatemala.
abstract: OBJECTIVE
  Food marketing has been implicated as an important driver of obesity. However, few studies have examined food marketing in low- and middle-income countries (LMICs). This study documents the prevalence of advertising on cereal boxes in Guatemala and examines associations between various marketing strategies and nutritional quality.
  
  
  METHODS
  One box from all available cereals was purchased from a supermarket located in an urban area in Guatemala City, Guatemala. A content analysis was performed to document child-oriented marketing practices, product claims and health-evoking images. The Nutrient Profile Model (NPM) was used to calculate an overall nutrition score for each cereal (the higher the score, the lower the nutritional quality).
  
  
  RESULTS
  In all, 106 cereals were purchased, and half of the cereals featured child-oriented marketing (54, 50.9%). Cereals had a mean (±s.d.) of 5.10±2.83 product claims per cereal, and most cereals (102, 96.2%) contained health-evoking images. Child-oriented cereals had, on average, higher NPM scores (13.0±0.55 versus 7.90±0.74, P<0.001) and sugar content (10.1±0.48 versus 6.19±0.50 g/30 g, P<0.001) compared with non-child oriented cereals. Cereals with health claims were not significantly healthier than those without claims.
  
  
  CONCLUSIONS
  In Guatemala, cereals targeting children were generally of poor nutritional quality. Cereals displaying health claims were also not healthier than those without such claims. Our findings support the need for regulations restricting the use of child-oriented marketing and health claims for certain products.
authors: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors: J
authors: J
authors: Soo
authors: Cardiovascular Unit of Guatemala, Guatemala, Guatemala.|INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala, Guatemala.
authors: P
authors: P
authors: Letona
authors: Cardiovascular Unit of Guatemala, Guatemala, Guatemala.|INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala, Guatemala.
authors: V
authors: V
authors: Chacon
authors: Cardiovascular Unit of Guatemala, Guatemala, Guatemala.|Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St Louis, MO, USA.
authors: J
authors: J
authors: Barnoya
authors: Departments of Social and Behavioral Sciences and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors: C A
authors: CA
authors: Roberto
mesh_terms: D000293:Adolescent; D062408:Breakfast / Q000523:psychology; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D002523:Edible Grain; D019649:Food Industry; D005515:Food Labeling / Q000331:legislation & jurisprudence / Q000379:methods*; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D040541:Marketing / Q000379:methods*; D009753:Nutritive Value