Evolution of household availability of added sugars and their sources in Brazil: analysis of Household Budget Surveys from 2002 to 2017.

The objective of this study was to describe the evolution of household purchase of added sugars and their main food sources in Brazil. Nationally representative data from the Household Budget Surveys from 2002-2003, 2008-2009 and 2017-2018 were used. Energy and added sugar quantities were estimated by means of per capita food quantities. The items considered as food sources were: (1) table sugar: refined sugar and other energetic sweeteners and (2) processed and ultra-processed foods with added sugar: soft drinks; other drinks; sweets, candies and chocolates; cookies; cakes and pies and other foods. The parameters estimated were: mean share of added sugar in total energy and, for food sources, the share of added sugar in total sugar intake and the impact of variations in sources of added sugar between 2008 and 2017. There was a regular share of energy from added sugar to total energy intake between 2002 and 2008 but a reduced share in 2017. Between 2008 and 2017, there was a decrease in the share of refined sugar and other sweeteners and soft drinks to total sugar intake and an increased share of all other items. High-income households had a lower share of refined sugar and other energetic sweeteners, but a higher share of soft drinks, sweets, candies and chocolates. The decrease in added sugar in 2017 was mainly due to the lower share of soft drinks. In conclusion, Brazilians' total intake of added sugar was decreased, mostly owing to reduced consumption of sugar from soft drinks.

Association between ultra-processed food and snacking behavior in Brazil.

PURPOSE: Ultra-processed food may play a role in facilitating snacking behavior because of their convenience and low satiety potential. This study aimed to describe the association between consumption of ultra-processed foods and frequency of snacking. METHODS: We analyzed data from 46,164 participants (≥ 10 years old) in the 2017-2018 Brazilian Household Budget Survey. Dietary data were collected by 24-h dietary recalls over one or two days for each participant. We estimated energy intake, ultra-processed food consumption, and level of snacking. We measured the association between ultra-processed food consumption and level of snacking using multinomial logistic regression, stratified by age group (adolescents, 10-19 years old; adults, 20-64 years old; elders, 65 or older). RESULTS: We found a statistically significant tendency of increased daily energy intake and consumption of snacks and that ultra-processed food consumption was positively associated with the level of snacking for all age groups. For adolescents, adults, and elders in the highest quintile of ultra-processed food consumption as a share of their entire diet, the relative risk ratio (95% CI) of having more than two snacks per day compared to no snacks was 14.21 (9.09-22.21), 4.44 (3.54-5.57), and 4.21 (2.67-6.64), respectively, when compared to the lowest quintile. CONCLUSION: Higher consumption of ultra-processed food was associated with snacking behavior, and the strength of this association was stronger among adolescents. Efforts to mitigate ultra-processed food attributes that facilitate snacking should be incorporated into strategies to promote healthier food choices, especially among adolescents.

Adherence to the EAT-Lancet sustainable diet and ultra-processed food consumption: findings from a nationwide population-based study in Brazil.

OBJECTIVE: To evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet in a representative sample of the Brazilian population. DESIGN: The study used data from the Brazilian National Dietary Survey 2017-2018 and employed linear regression models to evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet, as measured by the Nova food system and Planetary Health Diet Index (PHDI), respectively. SETTING: Nationally representative sample of the Brazilian population. PARTICIPANTS: The study included 46 164 Brazilians ≥ 10 years old. RESULTS: The average PHDI total score was 45·9 points (95 % CI 45·6, 46·1). The ultra-processed food consumption was, with dose-response, inversely associated with the adherence to the EAT-Lancet diet. The PHDI total score was 5·38 points lower (95 % CI -6·01, -4·75) in individuals in the highest quintile of consumption of ultra-processed foods, as compared to those in the first quintile. The PHDI score was also inversely associated with the share of processed culinary ingredients and processed foods and positively associated with the share of unprocessed or minimally processed foods. CONCLUSIONS: Our study showed an inverse relationship between the consumption of ultra-processed foods and the adherence to a healthy and sustainable diet.

The adherence to school meals is associated with a lower occurrence of obesity among Brazilian adolescents.

This study aimed to verify the association between adherence to meals from the Brazilian National School Feeding Program (PNAE) and obesity indicators among adolescents. Data from 12,373 students attending public schools from the 2015 National Survey of School Health were used. Adherence to school meals was assessed using a self-administered questionnaire and classified as null (zero/rarely), low (1-2×/week), moderate (3-4×/week), and high (5×/week). Weight and height were measured and classified based on the World Health Organization's reference for Z-scores of body mass index (BMI) for age, overweight (≥ + 1 Z-score) and obesity (≥ + 2 Z-score). Linear and Poisson regression models adjusted for potential confounding factors (gender, race/ethnicity, age, region, goods score, maternal education, living with parents, eating outside of school profile and physical activity) were performed to assess the association between adherence to school meals and the indicators (Z-score, overweight and obesity). The prevalence of high adherence was 21.6% and obesity, 8%. An inverse and dose-response association were observed between adherence to the PNAE meals and obesity indicators. Adolescents with high adherence to school meals (5×/week) had a 0.10 lower BMI Z-score (coefficient = -0.10, CI -0.17;-0.03), 11% less prevalence of overweight (PR = 0.89, CI 0.80;0.99) and 24% less prevalence of obesity (PR = 0.76, CI 0.62;0.93) than those with a lower adherence (<5×/week). Our results showed that the adherence to PNAE meals may contribute to obesity prevention in Brazil.

School meals consumption is associated with a better diet quality of Brazilian adolescents: results from the PeNSE 2015 survey.

OBJECTIVE: To assess the association between the consumption of school meals offered by the National School Feeding Program (PNAE, in the Portuguese acronym) and the diet quality of adolescents aged 11 to 19 years from Brazilian public schools. DESIGN: Cross-sectional. SETTING: Public schools in Brazil. PARTICIPANTS: A sample of 12 260 adolescents aged 11 to 19 years from 2015 National School Health Survey. High consumption of PNAE school meals were considered when the adolescents consumed school meals 5 d/week. Food consumption data were obtained from a 7-d FFQ and converted into three diet quality assessment scores, namely (1) consumption of healthy foods; (2) consumption of unhealthy foods and (3) overall diet quality. Crude and adjusted linear regression models were used to test the association between high consumption to school meals (daily consumption) and each diet quality score. RESULTS: More than one-fifth of the adolescents (21·5 %) reported high consumption of school meals. High consumption of school meals was directly associated with the score of the overall diet quality (adjusted coefficient = 0·18; 95 % CI 0·07, 0·30) and healthy food consumption (adjusted coefficient = 0·42; 95 % CI 0·26, 0·57), and inversely associated with the unhealthy food consumption score (adjusted coefficient = -0·23; 95 % CI -0·35, -0·10). CONCLUSION: Our results showed that the consumption of PNAE meals may contribute to healthy eating promotion in Brazil.

Ultra-processed food consumption drives excessive free sugar intake among all age groups in Australia.

OBJECTIVE: To analyze the contribution of ultra-processed foods to the intake of free sugars among different age groups in Australia. METHODS: Dietary intakes of 12,153 participants from the National Nutrition and Physical Activity Survey (2011-12) aged 2+ years were evaluated. Food items collected through two 24-h recalls were classified according to the NOVA system. The contribution of each NOVA food group and their subgroups to total energy intake was determined by age group. Mean free sugar content in diet fractions made up exclusively of ultra-processed foods, or of processed foods, or of a combination of un/minimally processed foods and culinary ingredients (which includes table sugar and honey) were compared. Across quintiles of the energy contribution of ultra-processed foods, differences in the intake of free sugars, as well as in the prevalence of excessive free sugar intake (≥ 10% of total energy) were examined. RESULTS: Ultra-processed foods had the highest energy contribution among children, adolescents and adults in Australia, with older children and adolescents the highest consumers (53.1% and 54.3% of total energy, respectively). The diet fraction restricted to ultra-processed items contained significantly more free sugars than the two other diet fractions. Among all age groups, a positive and statistically significant linear association was found between quintiles of ultra-processed food consumption and both the average intake of free sugars and the prevalence of excessive free sugar intake. CONCLUSION: Ultra-processed food consumption drives excessive free sugar intake among all age groups in Australia.

The consumption of ultra-processed foods according to eating out occasions.

OBJECTIVE: To describe out-of-home consumption according to the purpose and extent of industrial processing and also evaluate the association between eating out and ultra-processed food consumption, taking account of variance within and between individuals. DESIGN: Cross-sectional study. SETTING: Brazil. PARTICIPANTS: The study was based on the Individual Food Intake of the Brazilian Household Budget Survey, carried out with 34 003 individuals aged 10 years or more, between May 2008 and May 2009. All food items were classified according to food processing level. The habit of eating out was evaluated through the frequency of days each individual reported eating out, described according to sociodemographic characteristics. The contribution of food energy per group and subgroup was estimated according to the frequency of eating out. In addition, multilevel modelling was employed to evaluate the association between eating out and ultra-processed food consumption. RESULTS: In Brazil, culinary preparations accounted for most of the energy eaten out. However, it was possible to observe a higher contribution of ultra-processed foods, especially sugary beverages and ready-to-eat meals, as the frequency of out-of-home consumption increased. Compared with food consumption exclusively at home, eating out increased the consumption of ultra-processed foods by 0·41 percentage points within and between individuals. CONCLUSION: In Brazil, the same individual and different individuals had greater consumption of ultra-processed foods when they ate out of home compared with when they ate at home. So, it is necessary to implement public policies which discourage the out-of-home consumption of ultra-processed foods and that provide affordable and accessible less-processed food options.

Parents' cooking skills confidence reduce children's consumption of ultra-processed foods.

Ultra-processed foods are industrial formulations requiring little if any preparation before consumption. Their consumption is increasing in many countries and one of the possible determinants is the decrease in home cooking. As parents are key for family meals, we analysed the influence of parents' cooking skills confidence on children's consumption of ultra-processed foods at dinner. This is a cross-sectional study with 657 child-parent pairs from nine private schools in São Paulo, Brazil. Food consumption data were collected using two children's dinner dietary recalls while the Cooking Skills Index was used to collect parents' cooking skills, measuring their confidence in their own skills related to cooking 'from scratch', according to the Dietary Guidelines for the Brazilian Population. Food items were classified according to the NOVA classification system, considering the nature, extension and purpose of food processing. We used linear regression models to test associations between parents' cooking skills confidence and the contribution of ultra-processed foods to total energy intake at dinner, adjusting for socio-demographic variables. Parents' mean age was 38.3 and children's mean age was 7.8. These parents were mostly women, white, married, employed, with full secondary education and per capita household incomes up to ~ USD 320.00/month. They reached an average of 78.8 points (SD 14.8) in the Cooking Skills Index. Children's mean energy intake at dinner was 672.2 kcal (31.3% from ultra-processed foods). The increase in parents' cooking skills confidence was directly associated with decrease in consumption of ultra-processed foods (ß = -0.17; p = 0.007), which remained after adjustment (ß = -0.15; p = 0.026). These findings suggest that parents' cooking skills confidence potentially protect their children against ultra-processed foods, indicating the need for revaluing cooking to promote healthy eating.

Ultra-processed Food Consumption by Pregnant Women: The Effect of an Educational Intervention with Health Professionals.

Objectives Nutrition during pregnancy is related with many maternal and child outcomes. To investigate the consumption of ultra-processed foods is one of the newest methods to evaluate food consumption, but these studies in pregnant women are rare. Methods We conducted a non-randomized controlled educational intervention on healthy eating and physical activity during pregnancy in primary health care units of Botucatu, São Paulo, Brazil. The sample comprised two groups of pregnant women with low obstetric risk, an intervention group (n = 181) and a control group (n = 172). The health professionals that assisted the pregnant women from the intervention group were trained to promote five healthy food practices during the prenatal care appointments: consumption of three fruits; two portions of vegetables; two portions of beans, at least 5 days per week; and restriction of soft drinks and industrially processed cookies. All pregnant women answered two 24-h dietary recalls per trimester, one face-to-face, another by telephone. The foods consumed by pregnant women were classified according Nova. The impact of the intervention on the ultra-processed food consumption was evaluated by multilevel linear regression analysis. Results A quarter of the energy consumed by the pregnant women provided from ultra-processed foods. The intervention reduced these percentage of energy between the first and second trimester of pregnancy by 4.6 points (p = 0.015). This effect was not observed in the third trimester of pregnancy. Conclusions for Practice Training health care professionals to promote healthy food practices is a viable and sustainable alternative to reduce ultra-processed foods during pregnancy.

Energy contribution of NOVA food groups and sociodemographic determinants of ultra-processed food consumption in the Mexican population.

OBJECTIVE: To identify the energy contributions of NOVA food groups in the Mexican diet and the associations between individual sociodemographic characteristics and the energy contribution of ultra-processed foods (UPF). DESIGN: We classified foods and beverages reported in a 24 h recall according to the NOVA food framework into: (i) unprocessed or minimally processed foods; (ii) processed culinary ingredients; (iii) processed foods; and (iv) UPF. We estimated the energy contribution of each food group and ran a multiple linear regression to identify the associations between sociodemographic characteristics and UPF energy contribution. SETTING: Mexican National Health and Nutrition Survey 2012. SUBJECTS: Individuals ≥1 years old (n 10 087). RESULTS: Unprocessed or minimally processed foods had the highest dietary energy contribution (54·0 % of energy), followed by UPF (29·8 %), processed culinary ingredients (10·2 %) and processed foods (6·0 %). The energy contribution of UPF was higher in: pre-school-aged children v. other age groups (3·8 to 12·5 percentage points difference (pp)); urban areas v. rural (5·6 pp); the Central and North regions v. the South (2·7 and 8·4 pp, respectively); medium and high socio-economic status v. low (4·5 pp, in both); and with higher head of household educational level v. without education (3·4 to 7·8 pp). CONCLUSIONS: In 2012, about 30 % of energy in the Mexican diet came from UPF. Our results showed that younger ages, urbanization, living in the North region, high socio-economic status and high head of household educational level are sociodemographic factors related to higher consumption of UPF in Mexico.

Household availability of ultra-processed foods and obesity in nineteen European countries.

OBJECTIVE: To assess household availability of NOVA food groups in nineteen European countries and to analyse the association between availability of ultra-processed foods and prevalence of obesity. DESIGN: Ecological, cross-sectional study. SETTING: Europe. SUBJECTS: Estimates of ultra-processed foods calculated from national household budget surveys conducted between 1991 and 2008. Estimates of obesity prevalence obtained from national surveys undertaken near the budget survey time. RESULTS: Across the nineteen countries, median average household availability amounted to 33·9 % of total purchased dietary energy for unprocessed or minimally processed foods, 20·3 % for processed culinary ingredients, 19·6 % for processed foods and 26·4 % for ultra-processed foods. The average household availability of ultra-processed foods ranged from 10·2 % in Portugal and 13·4 % in Italy to 46·2 % in Germany and 50·4 % in the UK. A significant positive association was found between national household availability of ultra-processed foods and national prevalence of obesity among adults. After adjustment for national income, prevalence of physical inactivity, prevalence of smoking, measured or self-reported prevalence of obesity, and time lag between estimates on household food availability and obesity, each percentage point increase in the household availability of ultra-processed foods resulted in an increase of 0·25 percentage points in obesity prevalence. CONCLUSIONS: The study contributes to a growing literature showing that the consumption of ultra-processed foods is associated with an increased risk of diet-related non-communicable diseases. Its findings reinforce the need for public policies and actions that promote consumption of unprocessed or minimally processed foods and make ultra-processed foods less available and affordable.

The share of ultra-processed foods determines the overall nutritional quality of diets in Brazil.

OBJECTIVE: To estimate the dietary share of ultra-processed foods and to determine its association with the overall nutritional quality of diets in Brazil. DESIGN: Cross-sectional. SETTING: Brazil. SUBJECTS: A representative sample of 32 898 Brazilians aged ≥10 years was studied. Food intake data were collected. We calculated the average dietary content of individual nutrients and compared them across quintiles of energy share of ultra-processed foods. Then we identified nutrient-based dietary patterns, and evaluated the association between quintiles of dietary share of ultra-processed foods and the patterns' scores. RESULTS: The mean per capita daily dietary energy intake was 7933 kJ (1896 kcal), with 58·1 % from unprocessed or minimally processed foods, 10·9 % from processed culinary ingredients, 10·6 % from processed foods and 20·4 % from ultra-processed foods. Consumption of ultra-processed foods was directly associated with high consumption of free sugars and total, saturated and trans fats, and with low consumption of protein, dietary fibre, and most of the assessed vitamins and minerals. Four nutrient-based dietary patterns were identified. 'Healthy pattern 1' carried more protein and micronutrients, and less free sugars. 'Healthy pattern 2' carried more vitamins. 'Healthy pattern 3' carried more dietary fibre and minerals and less free sugars. 'Unhealthy pattern' carried more total, saturated and trans fats, and less dietary fibre. The dietary share of ultra-processed foods was inversely associated with 'healthy pattern 1' (-0·16; 95 % CI -0·17, -0·15) and 'healthy pattern 3' (-0·18; 95 % CI -0·19, -0·17), and directly associated with 'unhealthy pattern' (0·17; 95 % CI 0·15, 0·18). CONCLUSIONS: Dietary share of ultra-processed foods determines the overall nutritional quality of diets in Brazil.

Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults.

OBJECTIVES: The aim of this study was to evaluate the relationship between the consumption of ultra-processed foods and obesity indicators among Brazilian adults and adolescents. METHODS: We used cross-sectional data on 30,243 individuals aged ≥10 years from the 2008-2009 Brazilian Dietary Survey. Food consumption data were collected through 24-h food records. We classified food items according to characteristics of food processing. Ultra-processed foods were defined as formulations made by the food industry mostly from substances extracted from foods or obtained with the further processing of constituents of foods or through chemical synthesis, with little if any whole food. Examples included candies, cookies, sugar-sweetened beverages, and ready-to-eat dishes. Regression models were fitted to evaluate the association of the consumption of ultra-processed foods (% of energy intake) with body-mass-index, excess weight, and obesity status, controlling for socio-demographic characteristics, smoking, and physical activity. RESULTS: Ultra-processed foods represented 30% of the total energy intake. Those in the highest quintile of consumption of ultra-processed foods had significantly higher body-mass-index (0.94 kg/m(2); 95% CI: 0.42,1.47) and higher odds of being obese (OR=1.98; 95% CI: 1.26,3.12) and excess weight (OR=1.26; 95% CI: 0.95,1.69) compared with those in the lowest quintile of consumption. CONCLUSION: Our findings support the role of ultra-processed foods in the obesity epidemic in Brazil.

Dietary guidelines to nourish humanity and the planet in the twenty-first century. A blueprint from Brazil.

OBJECTIVE: To present and discuss the dietary guidelines issued by the Brazilian government in 2014. DESIGN: The present paper describes the aims of the guidelines, their shaping principles and the approach used in the development of recommendations. The main recommendations are outlined, their significance for the cultural, socio-economic and environmental aspects of sustainability is discussed, and their application to other countries is considered. SETTING: Brazil in the twenty-first century. SUBJECTS: All people in Brazil, now and in future. RESULTS: The food- and meal-based Brazilian Dietary Guidelines address dietary patterns as a whole and so are different from nutrient-based guidelines, even those with some recommendations on specific foods or food groups. The guidelines are based on explicit principles. They take mental and emotional well-being into account, as well as physical health and disease prevention. They identify diet as having cultural, socio-economic and environmental as well as biological and behavioural dimensions. They emphasize the benefits of dietary patterns based on a variety of natural or minimally processed foods, mostly plants, and freshly prepared meals eaten in company, for health, well-being and all relevant aspects of sustainability, as well as the multiple negative effects of ready-to-consume ultra-processed food and drink products. CONCLUSIONS: The guidelines' recommendations are designed to be sustainable personally, culturally, socially, economically and environmentally, and thus fit to face this century. They are for foods, meals and dietary patterns of types that are already established in Brazil, which can be adapted to suit the climate, terrain and customs of all countries.

Sodium intake according to NOVA food classification in Brazil: trends from 2002 to 2018.

Excessive sodium intake is a major global public health issue and the identification of dietary sources and temporal trends in its consumption are a key to effective sodium reduction policies. This study aims to update estimates of sodium intake and its dietary sources in Brazil according to the NOVA food classification system. Records of 7-day food purchases of households from the Brazilian Household Budgets Survey of 2002-2003, 2008-2009, and 2017-2018 were converted into nutrients using food composition tables and the mean availability was estimated per 2,000kcal/day. Mean daily sodium available for consumption in Brazilian households has increased from 3.9 to 4.7g per 2,000kcal, from 2002-2003 to 2017-2018, over twice the recommended levels of sodium intake. From 2002-2003 to 2017-2018, the processed culinary ingredients, including table salt, represented the largest dietary source of sodium, although their participation in dietary sodium was reduced by 17% (66.6% to 55%), while the percentage of dietary sodium from processed foods increased by 20.3% and from ultra-processed foods increased by 47.6% (11.3% to 13.6% and 17% to 25.1%, respectively). In conclusion, the total household sodium availability remains high and has increased over time in Brazil, yet the participation of different dietary sources of sodium have gradually changed.

Who is consuming ultra-processed food in Canada? A cross-sectional analysis of the 2018/2019 International Food Policy Study.

High consumption of ultra-processed foods and drinks (UPF) has been linked to poor diet quality and an increased risk of non-communicable diseases. To inform public policies and interventions aimed at reducing UPF intake in Canada, updated information on UPF intake among different sociodemographic groups is needed. This study, using data from 5,872 adults aged 18 years and older from the International Food Policy Study (2018-2019), aims to estimate the dietary energy contribution of UPF and assess its variation among sociodemographic subgroups. All foods and drinks reported in a single 24-hour dietary recall were classified using the Nova system. We estimated the mean proportion of total daily energy from UPF and subcategories of UPF in the overall sample and among sociodemographic subgroups. Multivariable linear regression models evaluated the association between sociodemographic characteristics with the proportion of total daily energy from UPF. On average, adults consumed 45.2% of their total daily energy from UPF. UPF consumption was slightly higher among males than females (49.4% vs. 47.6%, p=0.039) and younger adults aged 19-30 years compared with older adults aged 51-64 years (50.0% vs. 47.2%, p=0.029), adjusting for a range of sociodemographic factors. Overall, UPF consumption was relatively high among adults in all sociodemographic subgroups, highlighting the need for policies to decrease UPF consumption in the entire population.

Characteristics associated with dietary patterns in Brazilian children under two years of age.

OBJECTIVE: To analyze the dietary patterns of Brazilian children under two years of age and assess their association with sociodemographic characteristics and health service use. METHODS: This is a cross-sectional study with data from the 2013 National Health Survey (PNS). Patterns were found for two age groups by principal component analysis and their correlation with characteristics of interest was tested by linear regression models. RESULTS: We found two dietary patterns for our groups. The first consisted of the consumption of fresh or minimally processed foods and the second, of ultra-processed foods. The greater adherence of children between six and 11 months to the first pattern was associated with higher per capita family income and urban residences in the most developed regions of Brazil. At 12 months or more, adherence related to white race/color, higher per capita family incomes, residence in more developed regions, and visits to private childcare. Adherence to the second pattern among children under one year of age was inversely associated with Yellow or Indigenous race/color, residence in the Brazilian Northeast, and childcare in specialized public or private services. At 12 months or more, greater adherence was directly associated with Black or Brown children who resided in more developed regions, and inversely associated with those living in the Brazilian Northeast. CONCLUSION: We found two opposite dietary patterns in Brazilian children under two years of age and that several social determinants modify their chance of adhering to these patterns.

Household availability of foods from Brazilian biodiversity.

Food biodiversity is characterized by the diversity of foods that compose a local, regional, or national ecosystem. Brazil has 20% of all the planet's biodiversity and the richest biomes in the world. Therefore, describing the participation of these foods in the Brazilian diet is relevant. Using a complex sample with data from 57,920 households collected by the Brazilian Institute of Geography and Statistics from 2017 to 2018, this study showed that, except for yerba mate, the availability of foods from Brazilian biodiversity is low, representing an average of 7.09g/per capita/day. Regarding biomes, the Caatinga had the highest availability of fruits (4.20g/per capita/day) while the Amazon had the highest availability of vegetables (1.52g/per capita/day). The results are unsatisfactory and lower than what is expected from a territory rich in biodiversity and a world-leading food system. A greater commitment is essential to promote actions that strengthen the consumption of these foods among Brazilians.

Intake of ultra-processed foods and sleep-related outcomes: A systematic review and meta-analysis.

The aim of this review article was to evaluate the association between the intake of ultra-processed foods and sleep-related outcomes through a systematic review and meta-analysis. Pubmed, LILACS, Scielo, Scopus, Embase, and Web of Science were searched on December 31, 2021, for studies that evaluated the association between ultra-processed foods and sleep-related outcomes (self-reported sleep duration and quality). Pooled odds ratios were assessed through a random-effects model; heterogeneity was evaluated using the I2 statistic. Fifteen cross-sectional studies were included; 14 showed that the high intake of ultra-processed foods was statistically significantly associated with sleep-related outcomes (sleep duration and quality). In the crude analysis, compared with low intake, high intake of ultra-processed foods increased the odds of sleep-related outcomes, with increased odds among children and/or adolescents, and null results among adults. When adjusted for cofounders, we found statistically significant results for all ages. The high intake of ultra-processed foods was associated with sleep-related outcomes, with moderate credibility of the evidence. Longitudinal studies and clinical trials confirming these findings are necessary.

Differences in food consumption of the Brazilian population by race/skin color in 2017-2018.

OBJECTIVE: To evaluate food consumption in Brazil by race/skin color of the population. METHODS: Food consumption data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Survey) 2017-2018 were analyzed. Food and culinary preparations were grouped into 31 items, composing three main groups, defined by industrial processing characteristics: 1 - in natura/minimally processed, 2 - processed, and 3 - ultra-processed. The percentage of calories from each group was estimated by categories of race/skin color - White, Black, Mixed-race, Indigenous, and Yellow- using crude and adjusted linear regression for gender, age, schooling, income, macro-region, and area. RESULTS: In the crude analyses, the consumption of in natura/minimally processed foods was lower for Yellow [66.0% (95% Confidence Interval 62.4-69.6)] and White [66.6% (95%CI 66.1-67.1)] groups than for Blacks [69.8% (95%CI 68.9-70.8)] and Mixed-race people [70.2% (95%CI 69.7-70.7)]. Yellow individuals consumed fewer processed foods, with 9.2% of energy (95%CI 7.2-11.1) whereas the other groups consumed approximately 13%. Ultra-processed foods were less consumed by Blacks [16.6% (95%CI 15.6-17.6)] and Mixed-race [16.6% (95%CI 16.2-17.1)], with the highest consumption among White [20.1% (95%CI 19.6-20.6)] and Yellow [24.5% (95%CI 20.0-29.1)] groups. The adjustment of the models reduced the magnitude of the differences between the categories of race/skin color. The difference between Black and Mixed-race individuals from the White ones decreased from 3 percentage points (pp) to 1.2 pp in the consumption of in natura/minimally processed foods and the largest differences remained in the consumption of rice and beans, with a higher percentage in the diet of Black and Mixed-race people. The contribution of processed foods remained approximately 4 pp lower for Yellow individuals. The consumption of ultra-processed products decreased by approximately 2 pp for White and Yellow groups; on the other hand, it increased by 1 pp in the consumption of Black, Mixed-race, and Indigenous peoples. CONCLUSION: Differences in food consumption according to race/skin color were found and are influenced by socioeconomic and demographic conditions.