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OBJECTIVE: To assess the effect of different front-of-package (FOPL) schemes on the objective understanding of the nutritional content and intention to purchase products, in Panama. DESIGN: Single-blinded multi-arm parallel-group randomised controlled trial. SETTING: Supermarkets across Panama. Participants were exposed to two-dimensional images of 15 mock-up products presented at random and balanced orders. Participants assigned to the intervention groups were exposed to mock-ups featuring one FOPL scheme: black octagonal warning labels (OWL), traffic-light labelling (TFL), or guideline daily amounts (GDA). Control group was not exposed to any FOPL scheme. PARTICIPANTS: Adult supermarket shoppers (n=1200). Participants were blinded to group assignment. RESULTS: Similar number of participants were randomised to and analysed in each group: OWL (n=300), TFL (n=300), GDA (n=300), and control (n=300). The odds for choosing to purchase the least harmful or none of the options more often was the highest in the OWL group. Compared to the control group, two times higher in the OWL group (OR 2·13, 95% confidence interval 1·60-2·84), and 57% higher in the TFL (1·57, 1·40-2·56), with no changes in the GDA (0·97, 0·73-1·29). OWL also resulted in the highest odds for correctly identifying the least harmful option, and for correctly identifying a product with excessive amounts of sugars, sodium and/or saturated fats. CONCLUSIONS: OWL performed best in helping shoppers to correctly identify when a product contained excessive amounts of nutrients of concern, to correctly identify the least harmful option, and to decide to purchase the least harmful or none of the options, more often.

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RESUMEN Antecedentes: El exceso de peso en escolares de Panamá es una creciente preocupación de salud pública. Objetivo: Evaluar el efecto de una intervención de educación alimentaria y nutricional (EAN) contra el exceso de peso en escuelas públicas de distritos de mayor pobreza en Panamá. Materiales y métodos: Estudio cuasi experimental con mediciones pre-test y post-test, analítico, prospectivo y con grupo control. El estudio se realizó con 331 escolares (6-11 años), divididos en grupo tratamiento (n1= 209) y grupo control (n2= 122). La intervención EAN duró siete semanas, enero-febrero 2018. Se obtuvieron variables sociodemográficas, de seguridad alimentaria y datos antropométricos (peso y talla) con las que se calculó el puntaje z del índice de masa corporal para el sexo y edad (zIMC), considerando exceso de peso cuando fue ≥1 desviación estándar (DE). Resultado: Participaron 331 escolares, media y DE para edad de 9,2±1,6 años (53% femenino). Media y DE en período pre y post intervención para zIMC de 0,66±1,2 y 0,68±1,3 DE (prueba t; p= NS). La media y DE del delta de zIMC en grupo control y tratamiento fue 0,06±0,65 y 0,01±0,75 DE, respectivamente; no se observó diferencia significativa por grupo internvención y control luego de ajustar por ubicación geográfica y sexo (MANOVA; p= 0,4930). El 36,6% presentó exceso de peso (zIMC>1DE), sin diferencia significativa luego de la intervención (34,4%). Conclusión: esta propuesta de intervención de EAN de corta duración no modificó el estado nutricional, pero es una herramienta importante que ayuda a concientizar a la población escolar sobre el tipo de alimentación que debe llevar para modificar estilos de vida.

ABSTRACT Background: Overweight in Panamanian school-age children is an increasing public health concern. Objective: To evaluate the effect of a short-term food and nutritional education intervention for the prevention of overweight in public schools of poor districts of Panama. Materials and methods: A quasi-experimental analytical prospective study (pre and pro-test) was conducted. The study was conducted with 331 students (6-11 years) divided into either: intervention (n= 209) or control group (n= 122). The intervention lasted seven weeks in January-February 2018. Sociodemographics, food security, and anthropometry (weight and height) were measured and body mass index z score for sex and age (BAZ) were calculated, considering overweight when z-score was ≥1. Result: The mean and standard deviation (SD) for age was 9.2±1.6 years (53% female). Mean and SD in BMIz pre and post intervention was 0.66±1.2 and 0.68±1.3 SD (t test; p= NS), respectively. The mean and SD of the change in BMIz for the control and treatment group was 0.06±0.65 and 0.01±0.75 SD, respectively; no significant difference was observed by intervention and control groups after adjusting for geographic location and sex (MANOVA; p= 0.493). Overweight was present in 36.6% of the sample at baseline and no significant difference was observed after intervention (34.4%). Conclusion: This short-term food and nutritional education did not modify nutritional status. However, it is an important tool that helps raise awareness among the school population about healthy eating habits and lifestyles.

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INTRODUCCIÓN: La ingesta de comida en la calle es una práctica muy común en personas que trabajan. Hay una gran oferta de comida callejera; Las frutas son siempre parte de esta oferta y se pueden encontrar en diferentes presentaciones. OBJETIVO: Analizar la frecuencia del consumo de fruta en las vías públicas de América Latina. MATERIAL Y MÉTODOS: Se realizó un estudio transversal utilizando un cuestionario de 15 preguntas en formato Google Docs, que fue validado por el método Delphi y aplicado en 11 países: Argentina, Brasil, Chile, Colombia, Costa Rica, Guatemala, Panamá, Paraguay, Perú, Portugal y Uruguay. RESULTADOS: Se encuestó a 8885 personas, más del 50% consume alimentos en la vía pública. Entre los países más consumidores, se destacan Colombia (78%) y Guatemala (76%), seguido de Perú (66%). Con respecto al consumo de fruta en la vía pública, se observa que existe un mayor consumo en Portugal (61%), seguido de Colombia (55%) y Guatemala (51%), y los países con menor consumo son Argentina (26%) y Uruguay (20%). El consumo de fruta en la calle es el mismo en ambos sexos en la mayoría de los países. Por otro lado, en Portugal, Colombia, Argentina, Costa Rica y Chile, el mayor consumo corresponde a personas con educación superior (universitaria o de posgrado). CONCLUSIONES: El consumo de alimentos en la calle es alto en todos los países, incluido el consumo de frutas. Esto puede transformarse en una oportunidad para alentar su consumo, pero los puestos de la calle deben ajustarse a los requisitos necesarios para ofrecer alimentos seguros

INTRODUCTION: The street food intake is a very common practice in working people. There is a great supply of street food; fruits are always part of this offer and can be found in different presentations Objetive: To analyze the frequency of fruit consumption in public roads in Latin America. MATERIAL AND METHODS: A cross-sectional study was carried out using a questionnaire of 15 questions in Google Docs format, which was validated by Delphi method and applied in 11 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Panama, Paraguay, Peru, Portugal and Uruguay. RESULTS: It was surveyed 8885 people, over 50% consume food on public roads; among the most consuming countries, it is highlighted Colombia (78%) and Guatemala (76%), followed by Peru (66%). With respect to fruit consumption on public roads, it is observed that there is higher consumption in Portugal (61%), followed by Colombia (55%) and Guatemala (51%), and the countries with less consumption are Argentina (26%) and Uruguay (20%). Fruit consumption in the street is the same in both sexes in the most countries. On the other hand, in Portugal, Colombia, Argentina, Costa Rica and Chile, the highest consumption correspond to people with higher education (university or post-graduate). CONCLUSION: Street food consumption is high in all countries, including consumption of fruits. This can be transformed into an opportunity to encourage their consumption, but street posts must be adjusted to the necessary requirements to offer safe food

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