Nutrition quality of packaged food and beverages in Costa Rica: an input for crafting harmonious school food environment policies

The objective of this study was to compare the proportion and types of foods and beverages that would be subject to regulation according to two nutrient profiles: the Costa Rica School Decree (CRSD) and the Pan American Health Organization (PAHO) profile, and to provide recommendations for future policy design. The CRSD regulates the content of energy, sugar, total and saturated fats, and sodium, whereas the PAHO model regulates free sugar, total, saturated, and trans fats, sodium, and the presence of non-nutritive sweeteners. In this cross-sectional study, we analyzed the content of calories, sodium, sugars, and saturated fats in packaged products (n = 2,216) collected in 2015 and determined the proportion of non-compliant products according to both nutrient profiles. The agreement for non-compliant/compliant products was estimated, and the median number of nutrients in excess was compared. According to the Costa Rica School Decree, 85.2% of foods and 66.1% of beverages would be classified as non-compliant. A larger proportion of products was classified as non-compliant according to the PAHO profile (91.9% of foods and 70.9% of beverages). Chocolates and marshmallows, cookies, and crackers had the highest median number of nutrients in excess (three to four), followed by bakery items, nuts and seeds, and salty snacks (two to three). For beverages, the median number of nutrients in excess was one, according to both profiles. In conclusion, differences were found between the two nutrient profiles, which should be considered when discussing a future regulation on front-of-package (FOP) warning labels. In addition, the percentage of packaged products sold in Costa Rica that are excessive in critical nutrients, and therefore would be subject to a warning label, was high, representing a public health concern.