Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study.

OBJECTIVE: To examine the association of ultra-processed food consumption with all cause mortality and cause specific mortality. DESIGN: Population based cohort study. SETTING: Female registered nurses from 11 US states in the Nurses' Health Study (1984-2018) and male health professionals from all 50 US states in the Health Professionals Follow-up Study (1986-2018). PARTICIPANTS: 74 563 women and 39 501 men with no history of cancer, cardiovascular diseases, or diabetes at baseline. MAIN OUTCOME MEASURES: Multivariable Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals for the association of ultra-processed food intake measured by semiquantitative food frequency questionnaire every four years with all cause mortality and cause specific mortality due to cancer, cardiovascular, and other causes (including respiratory and neurodegenerative causes). RESULTS: 30 188 deaths of women and 18 005 deaths of men were documented during a median of 34 and 31 years of follow-up, respectively. Compared with those in the lowest quarter of ultra-processed food consumption, participants in the highest quarter had a 4% higher all cause mortality (hazard ratio 1.04, 95% confidence interval 1.01 to 1.07) and 9% higher mortality from causes other than cancer or cardiovascular diseases (1.09, 1.05 to 1.13). The all cause mortality rate among participants in the lowest and highest quarter was 1472 and 1536 per 100 000 person years, respectively. No associations were found for cancer or cardiovascular mortality. Meat/poultry/seafood based ready-to-eat products (for example, processed meat) consistently showed strong associations with mortality outcomes (hazard ratios ranged from 1.06 to 1.43). Sugar sweetened and artificially sweetened beverages (1.09, 1.07 to 1.12), dairy based desserts (1.07, 1.04 to 1.10), and ultra-processed breakfast food (1.04, 1.02 to 1.07) were also associated with higher all cause mortality. No consistent associations between ultra-processed foods and mortality were observed within each quarter of dietary quality assessed by the Alternative Healthy Eating Index-2010 score, whereas better dietary quality showed an inverse association with mortality within each quarter of ultra-processed foods. CONCLUSIONS: This study found that a higher intake of ultra-processed foods was associated with slightly higher all cause mortality, driven by causes other than cancer and cardiovascular diseases. The associations varied across subgroups of ultra-processed foods, with meat/poultry/seafood based ready-to-eat products showing particularly strong associations with mortality.

Ultra-processed food consumption and mortality among patients with stages I-III colorectal cancer: a prospective cohort study.

Background: Ultra-processed foods (UPFs) are emerging as a risk factor for colorectal cancer (CRC), yet how post-diagnostic UPF intake may impact CRC prognosis remains unexplored. Methods: Data collected from food frequency questionnaires were used to estimate intakes of total UPFs and UPF subgroups (serving/d) at least 6 months but less than 4 years post-diagnosis among 2498 patients diagnosed with stages I-III CRC within the Nurses' Health Study and Health Professionals Follow-up Study during 1980-2016. Hazard ratios (HR) and 95% confidence intervals (CIs) of all-cause, CRC- and cardiovascular disease (CVD)-specific mortality in association with UPF consumption were estimated using an inverse probability weighted multivariable Cox proportional hazards regression model, adjusted for confounders. Findings: The mean (SD) age of patients at diagnosis was 68.5 (9.4) years. A total of 1661 deaths were documented, including 321 from CRC and 335 from CVD. Compared to those in the lowest quintile (median = 3.6 servings/d), patients in the highest quintile (median = 10 servings/d) of post-diagnostic UPF intake had higher CVD mortality (HR = 1.65, 95% CI = 1.13-2.40) but not CRC or all-cause mortality. Among UPF subgroups, higher consumption of fats/condiments/sauces was associated with a higher risk of CVD-specific mortality (highest vs. lowest quintile of intake, HR = 1.96, 95% CI = 1.41-2.73), and higher intake of ice cream/sherbet was associated with an increased risk of CRC-specific mortality (highest vs. lowest quintile, HR = 1.86, 95% CI: 1.33-2.61). No statistically significant association was found between UPF subgroups and overall mortality. Interpretation: Higher post-diagnostic intake of total UPFs and fats/condiments/sauces in CRC survivors is associated with higher CVD mortality, and higher ice cream/sherbet intake is linked to higher CRC mortality. Funding: US National Institutes of Health and the American Cancer Society.

Estratificação de risco para diabetes tipo 2 com base no Findrisc e fatores associados / Risk stratification for type 2 diabetes according to the Findrisc and associated factors / Estratificación del riesgo para diabetes tipo 2 según el Findrisc y factores asociados

Os objetivos deste estudo são estratificar os usuários de um centro de atenção primária segundo o risco de desenvolver diabetes mellitus tipo 2 (DM2), utilizando o Escore Finlandês de Risco de Diabetes (Findrisc), e avaliar fatores associados ao risco elevado de desenvolver DM2. Trata-se de um estudo transversal, com amostra aleatória de duzentos adultos, não diabéticos, de um centro de saúde escola. Utilizou-se regressão logística para investigar fatores associados ao escore elevado (≥ 15 pontos) no Findrisc. Observou-se que 33,5% apresentavam risco discretamente aumentado, 17% risco moderado e 34,5% risco alto/muito alto para desenvolver DM2. Aqueles com menor escolaridade (OR: 3,21; IC: 1,52-6,77) e com histórico de hipercolesterolemia (OR: 2,47; IC: 1,27-4,81) exibiram maior chance de apresentar escore elevado. Em conclusão, a frequência de indivíduos com risco alto/muito alto de desenvolver DM2 foi elevada na população estudada, e o menor nível de escolaridade e o histórico de hipercolesterolemia estavam associados ao escore elevado no Findrisc.

The aim of this study was to stratify users of a primary care center according to the risk of developing type II diabetes mellitus (T2DM) using the Finnish Diabetes Risk Score (FINDRISC) questionnaire and to assess factors associated with elevated risk for T2DM. We conducted a cross-sectional study, with a random sample of 200 non-diabetic adults attending a school primary care center. Logistic regression was used to investigate factors associated with elevated FINDRISC scores (≥ 15 points). We observed that 33.5% of subjects had a slightly elevated risk, 17.0% moderate risk, and 34.5% high/very high risk of developing T2DM. Those with a low level of education (OR: 3.21; 95%CI: 1.52-6.77) and with a history of hypercholesterolemia (OR: 2.47; 95%CI: 1.27-4.81) were more likely to have an elevated score. In conclusion, the frequency of individuals at high/very high risk of developing T2DM was high in the population studied, and the lower level of education and history of hypercholesterolemia were associated with elevated FINDRISC score.

El objetivo de este estudio fue estratificar a los usuarios de un centro de atención primaria según el riesgo de desarrollar diabetes mellitus tipo 2 (DM2) mediante el cuestionario Finnish Diabetes Risk Score (FINDRISC), así como evaluar los factores asociados con un mayor riesgo de desarrollar DM2. Se trata de un estudio transversal con una muestra aleatoria de 200 adultos no diabéticos de un centro clínico de salud. Se utilizó regresión logística para investigar los elevados factores asociados con FINDRISC (≥ 15 puntos). Se observó que el 33,5% de los sujetos presentaron un riesgo ligeramente aumentado, el 17,0% riesgo moderado y el 34,5% riesgo alto/muy alto de desarrollar DM2. Aquellos con menos nivel educativo (OR: 3,21; IC: 1,52-6,77) y con antecedentes de hipercolesterolemia (OR: 2,47; IC: 1,27-4,81) tenían mayor probabilidad de tener un puntaje elevado. Se concluye que la frecuencia de individuos con riesgo alto/muy alto de desarrollar DM2 fue alta en la población estudiada, y que el menor nivel educativo y antecedentes de hipercolesterolemia se asociaron con un puntaje elevado en el FINDRISC.

Ultra-processed Foods and Risk of Crohn's Disease and Ulcerative Colitis: A Prospective Cohort Study.

BACKGROUND & AIMS: The rising incidence of inflammatory bowel disease in regions undergoing Westernization has coincided with the increase in ultra-processed food (UPF) consumption over the past few decades. We aimed to examine the association between consumption of UPFs and the risk of Crohn's disease (CD) and ulcerative colitis (UC). METHODS: We performed a prospective cohort study of 3 nationwide cohorts of health professionals in the United States-the Nurses' Health Study (1986-2014), the Nurses' Health Study II (1991-2017), and the Health Professionals Follow-up Study (1986-2012). We employed Cox proportional hazards models with adjustment for confounders to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for CD and UC according to self-reported consumption of UPFs. RESULTS: The study included 245,112 participants. Over 5,468,444 person-years of follow-up, we documented 369 incident cases of CD and 488 incident cases of UC. The median age at diagnosis was 56 years (range, 29-85 years). Compared with participants in the lowest quartile of simple updated UPF consumption, those in the highest quartile had a significantly increased risk of CD (HR, 1.70; 95% CI, 1.23-2.35; Ptrend = .0008). Among different UPF subgroups, ultra-processed breads and breakfast foods; frozen or shelf-stable ready-to-eat/heat meals; and sauces, cheeses, spreads, and gravies showed the strongest positive associations with CD risk (HR per 1 standard deviation increase in intake, 1.18 [95% CI, 1.07-1.29], 1.11 [95% CI, 1.01-1.22], and 1.14 [95% CI, 1.02-1.27], respectively). There was no consistent association between UPF intake and UC risk. CONCLUSIONS: Higher UPF intake was associated with an increased risk of incident CD. Further studies are needed to identify specific contributory dietary components.

Association of ultra-processed food consumption with colorectal cancer risk among men and women: results from three prospective US cohort studies.

OBJECTIVE: To examine the association between consumption of ultra-processed foods and risk of colorectal cancer among men and women from three large prospective cohorts. DESIGN: Prospective cohort study with dietary intake assessed every four years using food frequency questionnaires. SETTING: Three large US cohorts. PARTICIPANTS: Men (n= 46 341) from the Health Professionals Follow-up Study (1986-2014) and women (n=159 907) from the Nurses' Health Study (1986-2014; n=67 425) and the Nurses' Health Study II (1991-2015; n=92 482) with valid dietary intake measurement and no cancer diagnosis at baseline. MAIN OUTCOME MEASURE: Association between ultra-processed food consumption and risk of colorectal cancer, estimated using time varying Cox proportional hazards regression models adjusted for potential confounding factors. RESULTS: 3216 cases of colorectal cancer (men, n=1294; women, n=1922) were documented during the 24-28 years of follow-up. Compared with those in the lowest fifth of ultra-processed food consumption, men in the highest fifth of consumption had a 29% higher risk of developing colorectal cancer (hazard ratio for highest versus lowest fifth 1.29, 95% confidence interval 1.08 to 1.53; P for trend=0.01), and the positive association was limited to distal colon cancer (72% increased risk; hazard ratio 1.72, 1.24 to 2.37; P for trend<0.001). These associations remained significant after further adjustment for body mass index or indicators of nutritional quality of the diet (that is, western dietary pattern or dietary quality score). No association was observed between overall ultra-processed food consumption and risk of colorectal cancer among women. Among subgroups of ultra-processed foods, higher consumption of meat/poultry/seafood based ready-to-eat products (hazard ratio for highest versus lowest fifth 1.44, 1.20 to 1.73; P for trend<0.001) and sugar sweetened beverages (1.21, 1.01 to 1.44; P for trend=0.013) among men and ready-to-eat/heat mixed dishes among women (1.17, 1.01 to 1.36; P for trend=0.02) was associated with increased risk of colorectal cancer; yogurt and dairy based desserts were negatively associated with the risk of colorectal cancer among women (hazard ratio 0.83, 0.71 to 0.97; P for trend=0.002). CONCLUSIONS: In the three large prospective cohorts, high consumption of total ultra-processed foods in men and certain subgroups of ultra-processed foods in men and women was associated with an increased risk of colorectal cancer. Further studies are needed to better understand the potential attributes of ultra-processed foods that contribute to colorectal carcinogenesis.

Randomized controlled trial protocol: A quanti-quali approach for analyzing the results of an intervention on the waiting list for bariatric surgery / Protocolo de estudo controlado randomizado: abordagem quanti-quali para análise de resultados de uma intervenção em fila de espera para cirurgia bariátrica

ABSTRACT Objective This article aims to describe the protocol of a randomized clinical trial and the baseline results of the study of a one-year interdisciplinary intervention in users of the public health system in the bariatric surgery waiting list. Methods A randomized, single-blind clinical trial will be conducted including 88 participants recruited on an outpatient clinic of the public health system. Participants were randomized into the control group (n=44), receiving the usual treatment; and into the intervention group (n=44), participating in the educational intervention. Participants had their food intake, negative affectivity and physical inactivity/sedentary behavior assessed, as well as anthropometric and body composition measurements; their blood samples were collected; and also had different physical capacity tests. Results Of the 157 participants invited, 27 had severe functional limitations, one was under-age, and four declined the study due to associated diseases. Eighty-eight participants were randomized: 44 for the Control Group and 44 for the Intervention Group. When comparing the demographic and biochemical characteristics, there were no differences between groups except for serum glucose (GC=110.4±46.8mg/dL and GI93.1±16.9mg/dL, p=0.039). Conclusion This study protocol describes the methodology used in the study of educational intervention for the promotion of health care of patients on the waiting list for bariatric surgery. It shows that there is similarity between the baseline comparison groups. Registro Brasileiro de Ensaios Clínicos (Brazilian Clinical Trials Registry), RBR-775y3d.

RESUMO Objetivo Descrever protocolo de ensaio clínico randomizado e resultados de linha de base dos efeitos de intervenção interdisciplinar de um ano, com usuários do sistema público de saúde na fila de espera para cirurgia bariátrica. Métodos Será conduzido um ensaio clínico randomizado, uni-cego, com 88 participantes recrutados em ambulatório do sistema público de saúde e randomizados entre o grupo controle (n=44) que recebe o tratamento habitual e entre o grupo de intervenção (n=44) que participa da intervenção educativa. Os participantes tiveram o consumo alimentar, afetividade negativa e inatividade física/comportamento sedentário avaliados, bem como medidas antropométricas e de composição corporal, amostras de sangue e testes de capacidade física. Resultados Dos 157 participantes convidados, 27 apresentaram limitações funcionais graves, 1 era menor de 18 anos e 4 declinaram devido a doenças associadas. Oitenta e oito participantes foram randomizados: 44 para o Grupo Controle e 44 para o Grupo Intervenção. Quando comparados quanto as características demográficas e bioquímicas, não houve diferença entre os grupos, exceto para glicose sérica (GC=110,4±46,8mg/dL e GI93,1±16,9mg/dL; p=0,039). Conclusão Este protocolo de estudo descreve a metodologia utilizada no estudo de intervenção educativa para a promoção do cuidado integral com pacientes em espera para cirurgia bariátrica. Mostra que há semelhança entre os grupos de comparação na linha de base. Registro Brasileiro de Ensaios Clínicos RBR- 775y3d.

Seasonal effects on physical activity levels in adults living in Southern Brazil

Há pouca consistência na literatura sobre o efeito sazonal nos níveis de atividade física (NAF) na população. Realizou-se um estudo longitudinal para avaliar o efeito da sazonalidade nos NAFs em 120 adultos de uma região temperada do Sul do Brasil. A atividade física (AF) foi avaliada em dois períodos (verão e inverno) de 2007, com base na seção de AF no tempo de lazer e como forma de deslocamento do International Physical Activity Questionnaire (IPAQ). As medianas dos NAFs foram comparadas entre as duas estações usando Sign Test. Para comparar a proporção de ativos e inativos no verão e no inverno utilizou-se o McNemar Test. A mediana do NAF Total no tempo de lazer foi maior no verão do que no inverno (383,75 vs. 210 MET-min/sem) (p=0,02). A porcentagem de pessoas inativas no verão e no inverno foi, respectivamente, 37,5% e 49,2% (p=0,04). As pessoas com 9 a 11 anos de escolaridade e pertencentes à classe B foram as que sofreram maiores reduções nos NAFs do verão para o inverno. Nossos resultados apontam para a necessidade de planejamento e estratégias para promover AF regular, especialmente no inverno.

There are no consistent findings about the seasonal effects on the physical activity levels (PAL) of the population. We conducted a study aimed at evaluating seasonal effects on physical activity levels among adults living in a temperate region of Brazil. A longitudinal study was carried out in a sample of 120 adults living in Southern Brazil. Physical activity was evaluated using the leisure-time and transport-related physical activity sections of the International Physical Activity Questionnaire (IPAQ) in two periods (summer and winter) of the year 2007. Median values of PAL (MET-min/week) were compared between the two seasons using Sign Test. McNemar Test was used for physical activity as dichotomous. Total Leisure-Time median values were higher in summer compared to winter (383.75 vs. 210 MET-min/wk, respectively; p=0.02). Overall, 37.5% of the subjects were classified as inactive during Summer compared to 49.2% during Winter (p=0.04). Subjects with 9 to 11 years of education, belonging to socioeconomic status B were more likely to decrease PAL in Winter compared to Summer. There must be planning and strategies to promote regular PA, particularly in winter.

Seasonal effect on nutrient intake in adults living in Southern Brazil / Efeito da sazonalidade sobre a ingestão de nutrientes em adultos residentes no Sul do Brasil

The objective of this study was to investigate the effect of seasonality on nutrient intake in healthy adults from the southernmost metropolitan area of Brazil. The dietary intake (24-hour dietary recall on six different days) in a sample of 162 adults (114 women), aged 20 to 69, was obtained during the year 2007. The nutrient intake was averaged for each season and adjusted for energy intake using the residual method. The effect of season on energy, macro and micro-nutrient intake was investigated based on the Generalized Estimate Equations (GEE) model. There were statistically significant differences between seasons for carbohydrate and total fat intake after controlling for gender, age, education, and interactions. In summer carbohydrate intake was higher than other seasons while the total fat intake was lower. These findings highlight the importance of considering seasonal variations not only for evaluating dietary intake but also nutrition and public health policy recommendations, particularly in adult populations living in temperate regions.

Avaliar o efeito da sazonalidade sobre a ingestão de nutrientes em adultos residentes em Porto Alegre e Região Metropolitana, no Sul do Brasil. A ingestão alimentar foi obtida por meio de recordatórios alimentares de 24 horas em uma amostra de 162 adultos, com idade entre 20 e 69 anos. A ingestão média de nutrientes para cada estação do ano foi ajustada pela energia total usando o método dos resíduos. O efeito das estações do ano sobre a ingestão de energia, macro e micro-nutrientes foi analisado com base no modelo de Equações de Estimação Generalizado (GEE). Houve diferenças estatisticamente significativas entre as estações do ano para a ingestão de carboidratos e gordura total após ajuste para sexo, idade, educação e interações. No verão a ingestão de carboidrato foi maior do que nas outras estações e a ingestão de gordura foi menor. Os resultados sugerem que o efeito da variação sazonal sobre a ingestão de nutrientes deve ser considerado em estudos de avaliação da ingestão dietética e recomendações, especialmente em adultos residentes em zonas temperadas como a região Sul do Brasil.

Development of a food frequency questionnaire in a probabilistic sample of adults from Niterói, Rio de Janeiro, Brazil / Desenvolvimento de questionário de freqüência alimentar em amostra probabilística de adultos de Niterói, Rio de Janeiro, Brasil

With the purpose of generating a list of foods for a food-frequency questionnaire, data from 24h dietary recalls on a typical day from a probabilistic sample of 1,724 adults of Niterói, Rio de Janeiro, Brazil, were analyzed. The frequency of food intake, the total intake of energy and macronutrients and the relative contribution of each food item to total energy and macronutrient intake were calculated. The most frequently reported food items (> 50 percent of adults) were rice, coffee, beans, refined canesugar, and bread. Whole milk was consumed more frequently then skimmed milk or semi-skimmed milk. Beef was consumed by more adults than chicken, pork or fish. Approximately 90 percent of energy and macronutrients intake was explained by 65 food items. The list of food items generated in the present analysis is similar to those found in other samples of adults from urban areas in Brazil. It may be possible to generate a core list of common foods with addition of regional foods to be used nationally in urban areas of the country.

Com o objetivo de gerar uma lista de alimentos para questionário de freqüência alimentar (QFA), avaliou-se dados de recordatório alimentar de 24 horas de um dia típico em uma amostra probabilística de adultos, obtidos num inquérito domiciliar durante o ano de 2003. Verificou-se a freqüência dos alimentos ingeridos, calculou-se o total ingerido de energia e macronutrientes e a contribuição relativa de cada item alimentar no total de energia ou macronutrientes ingeridos. Os dados foram ponderados para representar a população adulta de Niterói, Rio de Janeiro, Brasil. Os alimentos mais ingeridos pelos adultos (> 50 por cento) foram arroz branco, café, feijão, açúcar refinado e pão francês. Um total de 65 alimentos é capaz de explicar aproximadamente 90 por cento da ingestão de energia e macronutrientes. A lista de alimentos gerada se assemelha a de outros estudos em amostras de adultos vivendo em regiões urbanas nacionais, e precisa ser validada em outras áreas urbanas do país. É possível que seja gerada uma lista de alimentos comuns, com inclusões de alimentos regionais para ser universalmente usada em QFA nas áreas urbanas do país.

Desafios na medição quantitativa da ingestão alimentar em estudos populacionais / Challenges in food intake assessment in population studies

A avaliação da ingestão alimentar em populações é uma medida cada vez mais presente em estudos epidemiológicos para a investigação da relação entre nutrição e doenças crônicas não transmissíveis já que as atuais recomendações indicam a necessidade de se manter uma vida ativa com controle da ingestão alimentar. A medida da ingestão alimentar quantitativa é geralmente feita por meio de recordatório (ou diário) alimentar de 24h ou por questionários semiquantitativos de freqüência alimentar. O presente artigo discute os principais fatores que envolvem a obtenção e a análise dessas informações, particularmente no que diz respeito à ingestão energética. Fica evidente a necessidade de aprimorar as condições de obtenção das informações sobre as porções ingeridas, as tabelas de composição química de alimentos e da estimativa do gasto energético para a determinação das recomendações energéticas.

The assessment of food intake in populations has been present in epidemiological studies involving the relationship between nutrition and non-communicable chronic diseases in accordance with the recommendation of maintenance of an active lifestyle with control of food intake. Quantitative food intake is measured via 24h recall (or diary) or semi-quantitative food frequency questionnaires. The present paper discusses the main factors involved in obtaining and analyzing such information, particularly in relation to energy intake. It is evident that there should be better estimates of food portions, food composition tables, and energy expenditure to determine energy requirements.