The presentation of nutrition information on a serving size basis is a strategy that has been adopted by several countries to promote healthy eating. Variation in serving size, however, can alter the nutritional values reported on food labels and compromise the food choices made by the population. This narrative review aimed to discuss (1) current nutrition labelling legislation regarding serving size and (2) the implications of declared serving size for nutrition information available on packaged foods. Most countries with mandatory food labelling require that serving size be presented on food labels, but variation in this information is generally allowed. Studies have reported a lack of standardisation among serving sizes of similar products which may compromise the usability of nutrition information. Moreover, studies indicate that food companies may be varying serving sizes as a marketing strategy to stimulate sales by reporting lower values of certain nutrients or lower energy values on nutrition information labels. There is a need to define the best format for presenting serving size on food labels in order to provide clear and easily comprehensible nutrition information to the consumer.

There was high prevalence of packaged foods with LCS, especially in food groups that form the basis of the Brazilian diet. The study was the first to extensively analyse the presence and types of LCS in packaged foods available for sale in a Brazilian supermarket and can be useful to monitor the use of LCS in these foods, as well as to support future changes in legislation to label sugars.

Context Reducing population intakes of sugar has become a focus of many national and international public health policies. Packaged foods and beverages are key contributors to sugar intakes, and food labels can be an effective tool to reduce sugar consumption. Objective The aim of this systematic review was to examine the influence of sugar label formats on 2 outcomes: consumers’ understanding of sugar information, and the amount of sugar in consumers’ food choices. Data Sources Scopus, Web of Science, PubMed, CAB Abstracts, SciELO, and the Cochrane Library databases were searched up until February 4, 2020. Study Selection Randomized experiments or quasi-experiments were included if they investigated the influence of sugar label formats on consumers’ understanding of sugar information or on the amount of sugar in consumers’ food choices. Data Extraction Data were extracted independently by 2 authors. Mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs) plus 95%CIs were used to describe between-group differences for intervention label formats using random-effects models. Results Twenty-three studies, which examined 39 comparisons, were included. Label formats using “high in sugar” interpretative texts (traffic light labels [MD 41.6; 95%CI 37.9–45.4] and warning signs [OR 1.33; 95%CI 1.0–1.78]) were most effective in increasing consumers’ understanding of the sugar content in packaged foods. Health warning messages (SMD −0.32; 95%CI −0.43 to −0.22), graphical depictions of sugar content in teaspoons (SMD −0.32; 95%CI −0.48 to −0.17), and warning signs (SMD −0.24; 95%CI −0.35 to −0.13) were most effective for influencing consumers to choose products with lower sugar content. Conclusions Formats that provide an interpretation of sugar information, particularly those indicating if a product is high in sugar, were more helpful than only numerical information for improving consumer understanding and promoting food choices with less sugar. Systematic Review Registration PROSPERO registration number CRD42018081222.

A B S T R A C TThe sugars added to foods have been featured in recent scientific research, including the publication of the World Health Organization recommendation to limit consumption of added sugars, based on studies on weight gain and dental caries. However, it is possible that there is evidence of an association between excessive consumption and other pathologies, but scientific studies have yet to investigate these associations. Moreover, there is no consensus on the descriptions and definitions of these sugars, with several terms and components used to designate them. In Brazil, there are few studies investigating added sugars, identifying a lack of discussion on this subject. This paper presents a literature review of sugars added to foods, from their definitions and classifications to the metabolism and health effects. The search was performed without limiting dates in the following databases: Web of Science, Scopus, PubMed and SciELO, as well as in national and international official sites. Keywords in Portuguese and English related to sugars added to foods were used, in combination with terms related to systematic review and meta-analysis studies, in order to find research linking added sugars consumption with health damage. The literature indicates that there is a relationship between excessive consumption of added sugars and various health outcomes, including weight gain, type 2 diabetes Mellitus, cancer, and cardiovascular diseases. The different descriptions of sugars in foods may confuse both food consumers and researchers, since each term includes different components. Thus, it is suggested to use the standardized term "added sugar" as the most suitable term for the broader population to understand, because it indicates that those sugars are not natural food components.

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