Through its influence on children's food preferences, purchases and consumption, intensive advertising of energy-dense, nutrient-poor (EDNP) food and beverages is one of the factors lying at the core of the current childhood obesity epidemic.1 Although advertising makes use of an integrated multi-channel approach, television continues to be the principal avenue for promotion of food and drinks for children.2 In Spain, television registered the highest turnover in 2012, accounting for 39.2% of all investment in conventional media.3 The leading non-conventional media are personalised mailing and point-of-sale advertising, through information contained on product presentation (labels, packaging and display stands) which is designed to stimulate impulse buying. It has been estimated that children in Spain receive an average of 4000 hits per year of television advertisements of EDNP food and beverages.4 Two studies on samples of products with nutrition and health claims detected that most of the statements made were ambiguous and in up to 40% of cases were in breach of some law.5,6 Another study, conducted in 2008 on a sample of foods and drinks advertised on television, found that half of the advertisements of EDNP products made use of such claims.7

Nutritional marketing, through the use of nutrition and health claims that draw attention to the nutritional qualities or alleged health benefits of certain products, has appealed to many consumers, and shown itself capable of influencing their perceptions about such products’ nutritional quality and healthiness.8,9 There are experimental studies that show how the presence of nutrition claims induced a group of parents -and particularly the majority who did not read the information contained in the nutrition labelling- to choose EDNP products for their children.10,11 Similarly, two experimental studies both found that pre-adolescents perceived products with nutrient claims as being healthier and tastier, and were more likely to choose EDNP products carrying such claims.12,13

To respond to citizens’ interest in the relationship between diet and health, and prevent the use of fraudulent or misleading nutrition marketing, in 2006 the European Commission promulgated the Regulation on nutrition and health claims made on foods.14 This Regulation envisages the future establishment of nutrient profiles: these would evaluate the overall nutritional value of a given product, through analysis of its ingredients and nutritional composition, and so prevent consumers from being misled by nutrition and/or health claims in food and drinks containing high levels of some nutrient whose excessive consumption might be harmful to health. To date, however, no such nutrient profiles have been established at European level. In addition to adopting European legislation, Spain has seen a number of laws passed and voluntary agreements concluded with the food industry, which govern advertising and nutrition and, to a greater or lesser degree, affect advertising containing health claims.15 The aim has been to reinforce the public's right to truthful information in this field. Even so, despite this profusion of statutory rules and regulations, no nutrient profile has yet been drawn up at a national level. Consequently, here in Spain, there is the possibility of nutrition and/or health claims being authorised in products which are high in fat, salt and/or sugar (HFSS), provided that they meet the criterion stipulated in the regulation pertaining to the claim made.

The United Kingdom nutrient profiling model (UKNPM),16 which was drawn up by the Food Standards Agency to regulate food advertising targeted at children and has shown good concordance with alternative nutrient profiles,17 is one of the models that could be considered for identifying products which are or are not likely, according to their nutrient profiles, to display nutrition or health claims. Accordingly, this study had a twofold aim: firstly, to describe the frequency of use of nutrition and health claims in products directed at children via television in Spain; and secondly, to analyse the nutrient profile of such products by applying the UKNPM, in line with the recommendations of the international network for food and obesity/non-communicable disease research, monitoring and action support.18

In the food and drink advertisements aired during the course of the 420hours of broadcasting recorded, 169 different products were identified, 60.9% in the non-core, 32% in the core and 7.1% in the miscellaneous category. Dairy products, with 48 items (28.5% of the total), were the most frequent food item in the sample, with 62.5% of these corresponding to the core category by virtue of being low-fat. The next most frequent food items were: 1) cakes, muffins, cookies, high-fat crackers, pies and pastries; 2) chocolate and confectionery; and 3) high-fat, high-sugar and high-salt spreads, oils, high-fat savoury sauces, canned and dehydrated meal helpers and soups, accounting for 9.5%, 8.9% and 8.3% of products respectively, all in the non-core category (Table 1).

In all, 53.3% of products (n=90) carried nutrition claims and 26.6% (n=45) carried health claims, with the figures being 63% and 37% respectively for core products, 50.5% and 21.4% respectively for non-core products and 33.3% and 25% respectively for miscellaneous products. With the single exception of the sports drink, Powerade ION 4, all the products that contained health claims also contained some type of nutrition claim, with the result that a total of 91 products overall made nutrition and/or health claims. The products registering the highest frequencies of nutrition or health claims were cereals and baby and toddler milk formula brands (100%), crumbed or battered meat and alternatives and high-fat frozen meals (83.3%), low-fat dairy products (76.7%), and fruit juices and fruit drinks (66.7%) (Table 1).

Among the 91 products (53.8% of the 169 products identified) containing some type of claim, most featured health claims, 49%, followed by claims relating to vitamins and minerals, nutrients, natural product and low-fat product, 48%, 38%, 24% and 18% respectively (Table 2). A total of 62.2% of products with claims were EDNP, with this figure being 100% for claims relating to high unsaturated-fat content, 79.5% for claims relating to source of vitamins and minerals, 37.5% for claims relating to low-fat, and 14.3% for claims relating to low-sugar.

Table 3 shows the food categories with the highest percentages of each type of claim. Low-fat dairy products ranked first in terms of health claims, with a figure of 33%, and accounted for most of the nutrition claims, with the exception of those relating to proteins, omega-3 fatty acids and unsaturated fats. Biscuits, cakes and pastries registered the highest percentage of claims about the product being a source of unsaturated fats, 43%. In terms of being a source of fibre, however, biscuits, cakes and pastries registered the same percentage of claims as did low-fat products, 21%. A total of 33% of claims about the food being a source of proteins corresponded to dairy products, with an equivalent figure being registered by spreads, oils and sauces. Lastly, 33% of claims of the product being a source of omega-3 corresponded to baby milk formula brands.

Our results show that over half of all food products marketed to children via television in Spain made some type of nutrition or health claim, and nearly two-thirds of those making claims were EDNP, according to the UKNPM. The products having the highest percentage of claims were cereals. Nonetheless, in absolute terms most of the claims were contained in dairy products, given that these were the most numerous, accounting for almost one third of all products in the sample. The most frequent nutrition claims, present in half of the products, were those relating to vitamin and mineral content, and 80% of the products which contained these were EDNP.

In a study undertaken from 2008 to 2009, Spain ranked as one of the European Union countries having the highest penetration of nutrition claims; and this was with figures of less than one third of products,26 i.e., very much lower than those seen in our study. The restriction of the product sample in the above European study to only 5 food categories, as opposed to the 22 covered by us, might partly account for the differences observed, since a study conducted in Ireland with a product sample of 17 food categories, reported figures very similar to ours, i.e., 47.3% of products contained nutrition claims and 17.8% contained health claims27 versus 53.3% and 26.6% in our study. Another possible explanation for the differences lies in the fact that the sample used in our study consisted of products directed at children, since our figures are very like those of a similar study undertaken in Spain in 2008, with products advertised on television during time slots designated as protected for child viewing and/or having a large child audience.7 Indeed, a study undertaken in the USA showed that the presence of nutrition claims and other types of nutrition marketing techniques is up to 40% more frequent in products advertised for children,28 with absolute figures similar to those of our study; and according to two studies conducted in Canada and Australia on products targeted at children, the percentages that contained nutrition claims, 62.7%29 and 63.7%30 respectively, were even higher than that of our study.

Although half non-core products included nutrition claims, a finding similar to what was seen in the above-mentioned Australian study,30 ideally speaking only core products should contain nutrition or health claims. At least, this was the intention behind the European Regulation14 when it envisaged the future establishment of nutrient profiles to authorise the use of claims, something that today, almost a decade later, is still pending implementation. The consequence of this regulatory vacuum is that almost two thirds of products with nutrition claims marketed to children in Spain failed to meet the UKNPM criteria, thus surpassing the figures of 52% observed in the previous study conducted in Spain,7 55% observed in a study on dairy products conducted in Germany, France and the UK,17 and 1% observed in an Australian study which used a nutrient profile model based on that of the UK,31 though in the latter two studies the products covered were not specifically directed at children. In the above Canadian study,29 62% of products directed at children and containing claims were of poor nutritional quality, owing to their high fat, salt and/or sugar content, a figure very similar to that of 62.9% reported by us, which suggests that the nutrient profile of products with claims is worse when they are targeted at children.

The most frequently used nutrition claims were those relating to vitamin and mineral content, a finding similar to that of the previous Spanish study7 and the Canadian study on products directed at children;29 in contrast, in another Canadian study on pre-packaged foods marketed by leading grocery chains, claims relating to low-fat content ranked first.32 The predominance of claims relating to vitamin and mineral content in products directed at children is worrying, since 4 out of every 5 products that contained these claims were EDNP. These claims are typical in fortified products for children, such as breakfast cereals, which are usually EDNP, with figures equal or close to that of 100% of cases observed in Spain33 and other comparable countries, such as the USA34 and Germany.35 In the German product sample, the likelihood of products not complying with the requirements of the nutrient profile was observed to be higher in cereals marketed to children and in those that contained some type of claim. Although 100% of the breakfast cereals in our study bore some type of nutrition claim, the principal source of claims relating to vitamins and minerals was dairy products, with 41% of these, exceeding the figure of 30% seen in the Canadian study32 due to the fact that these were most numerous products in our sample.

The habitual presence of nutrition and/or health claims in products directed at children, in tandem with the poor nutrient profile of these, largely EDNP, can be assumed to be misleading Spanish consumers, since the main reason reported by the latter for reading food labelling was to choose healthier products.36 Indeed, the presence of claims has been observed to lead children and parents alike to perceive these products as being more nutritional and healthier, show a greater willingness to buy them, and be induced to choose EDNP products.11–13,37 Compulsory nutrition information on nutrition labelling could go some way to mitigate the misleading nature of these claims, though the health “halo” associated with products bearing claims might nonetheless inhibit consumers from consulting the nutrition information contained on the labelling.38 A recent study undertaken in Spain showed that most consumers did not usually read the nutrition labelling, with almost half of them reporting that they did not fully understand the nutrition information.36 Furthermore, an experimental study showed that the presence of nutrition claims induced the majority of parents who had not read the nutrition-labelling information to choose EDNP products for their children.10 A consumer's friendly front-of-pack nutrition label, like the keyhole labelling scheme in Nordic countries and the traffic-light nutrition system in UK,39 could serve to prevent this confusion. In Spain, however, only the Eroski supermarket co-operative, acting at the instance of its consumers’ association, uses the traffic light on its house brands.

This study's main limitation resides in the fact that it was restricted to products advertised on television, so that it might not be representative of all products directed at children. In addition, limiting the recording period to the months of January to April meant that seasonal products, such as ice-cream or typical Christmas items, were not represented. Even so, our sample included products drawn from the vast majority of food categories in the international food-based coding system.21 Moreover, the size and diversity of the product sample were similar or greater than those of like studies conducted in Australia and Canada, which used a major supermarket chain to select products directed at children.29,30

In conclusion, most of these products marketed to children via television in Spain making some type of nutrition or health claim were less healthy, which could be misleading Spanish consumers. As the European Commission Regulation envisages, to prevent the potential pernicious effect of nutrition and health claims on children's eating habits, use should be made of nutrient profiles that enable products which meet minimal nutrition criteria to be identified, such as the UKNPM, the tables used by Food Standards Australia New Zealand,31 or the model recently developed by the WHO Regional Office for Europe.40

Carlos Álvarez-Dardet.

The corresponding author on behalf of the other authors guarantee the accuracy, transparency and honesty of the data and information contained in the study, that no relevant information has been omitted and that all discrepancies between authors have been adequately resolved and described.

M.A. Royo conceived the study and wrote the first draft of the manuscript. J. Damian and M.J. Bosqued participated in the management and analysis of the data. M.A. Moya y L. López participated in the study desing and data collection. All authors contributed to the revision and approval of the final manuscript.

This project has been supported by the Spanish Health Research Fund of the Institute of Health Carlos III (Project ENPY 1015/13) and the Spanish Consumers Organization.

None.