Assessment of ultra processed foods consumption in Senegal: validation of the Nova-UPF screener.

BACKGROUND: Ultra-processed foods (UPF), as proposed by the Nova food classification system, are linked to the development of obesity and several non-communicable chronic diseases and deaths from all causes. The Nova-UPF screener developed in Brazil is a simple and quick tool to assess and monitor the consumption of these food products. The aim of this study was to adapt and validate, against the 24-hour dietary recall, this short food-based screener to assess UPF consumption in the Senegalese context. METHODS: The tool adaptation was undertaken using DELPHI methodology with national experts and data from a food market survey. Following the adaptation, sub-categories were renamed, restructured and new ones introduced. The validation study was conducted in the urban area of Dakar in a convenience sample of 301 adults, using as a reference the dietary share of UPF on the day prior to the survey, expressed as a percentage of total energy intake obtained via 24-hour recall. Association between the Nova-UPF score and the dietary share of UPF was evaluated using linear regression models. The Pabak index was used to assess the agreement in participants' classification according to quintiles of Nova-UPF score and quintiles of the dietary share of UPF. RESULTS: The results show a linear and positive association (p-value < 0.001) between intervals of the Nova-UPF score and the average dietary share of UPF. There was a near perfect agreement in the distribution of individuals according to score's quintiles and UPF dietary share quintiles (Pabak index = 0.84). CONCLUSION: The study concluded that the score provided by the Nova-UPF screener adapted to the Senegalese context is a valid estimate of UPF consumption.

The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing.

Given evident multiple threats to food systems and supplies, food security, human health and welfare, the living and physical world and the biosphere, the years 2016-2025 are now designated by the UN as the Decade of Nutrition, in support of the UN Sustainable Development Goals. For these initiatives to succeed, it is necessary to know which foods contribute to health and well-being, and which are unhealthy. The present commentary outlines the NOVA system of food classification based on the nature, extent and purpose of food processing. Evidence that NOVA effectively addresses the quality of diets and their impact on all forms of malnutrition, and also the sustainability of food systems, has now accumulated in a number of countries, as shown here. A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence 'ultra-processed'). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower-middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view. We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.

Quantifying associations of the dietary share of ultra-processed foods with overall diet quality in First Nations peoples in the Canadian provinces of British Columbia, Alberta, Manitoba and Ontario.

OBJECTIVE: To quantify associations of the dietary share of ultra-processed foods (UPF) with the overall diet quality of First Nations peoples. DESIGN: A cross-sectional analysis of data from the First Nations Food, Nutrition and Environment Study, designed to contribute to knowledge gaps regarding the diet of First Nations peoples living on-reserve, south of the 60th parallel. A multistage sampling of communities was conducted. All foods from 24 h dietary recalls were categorized into NOVA categories and analyses were performed to evaluate the impact of UPF on diet quality. SETTING: Western and Central Canada. SUBJECTS: First Nations participants aged 19 years or older. RESULTS: The sample consisted of 3700 participants. UPF contributed 53·9 % of energy. Compared with the non-UPF fraction of the diet, the UPF fraction had 3·5 times less vitamin A, 2·4 times less K, 2·2 times less protein, 2·3 times more free sugars and 1·8 times more Na. As the contribution of UPF to energy increased so did the overall intakes of energy, carbohydrate, free sugar, saturated fat, Na, Ca and vitamin C, and Na:K; while protein, fibre, K, Fe and vitamin A decreased. Diets of individuals who ate traditional First Nations food (e.g. wild plants and game animals) on the day of the recall were lower in UPF. CONCLUSIONS: UPF were prevalent in First Nations diets. Efforts to curb UPF consumption and increase intake of traditional First Nations foods and other fresh or minimally processed foods would improve diet quality and health in First Nations peoples.

Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study.

OBJECTIVES: To investigate the contribution of ultra-processed foods to the intake of added sugars in the USA. Ultra-processed foods were defined as industrial formulations which, besides salt, sugar, oils and fats, include substances not used in culinary preparations, in particular additives used to imitate sensorial qualities of minimally processed foods and their culinary preparations. DESIGN: Cross-sectional study. SETTING: National Health and Nutrition Examination Survey 2009-2010. PARTICIPANTS: We evaluated 9317 participants aged 1+ years with at least one 24 h dietary recall. MAIN OUTCOME MEASURES: Average dietary content of added sugars and proportion of individuals consuming more than 10% of total energy from added sugars. DATA ANALYSIS: Gaussian and Poisson regressions estimated the association between consumption of ultra-processed foods and intake of added sugars. All models incorporated survey sample weights and adjusted for age, sex, race/ethnicity, family income and educational attainment. RESULTS: Ultra-processed foods comprised 57.9% of energy intake, and contributed 89.7% of the energy intake from added sugars. The content of added sugars in ultra-processed foods (21.1% of calories) was eightfold higher than in processed foods (2.4%) and fivefold higher than in unprocessed or minimally processed foods and processed culinary ingredients grouped together (3.7%). Both in unadjusted and adjusted models, each increase of 5 percentage points in proportional energy intake from ultra-processed foods increased the proportional energy intake from added sugars by 1 percentage point. Consumption of added sugars increased linearly across quintiles of ultra-processed food consumption: from 7.5% of total energy in the lowest quintile to 19.5% in the highest. A total of 82.1% of Americans in the highest quintile exceeded the recommended limit of 10% energy from added sugars, compared with 26.4% in the lowest. CONCLUSIONS: Decreasing the consumption of ultra-processed foods could be an effective way of reducing the excessive intake of added sugars in the USA.

A nutrition/health mindset on commercial Big Data and drivers of food demand in modern and traditional systems.

Building greater reciprocity between traditional and modern food systems and better convergence of human and economic development outcomes may enable the production and consumption of accessible, affordable, and appealing nutritious food for all. Information being key to such transformations, this roadmap paper offers a strategy that capitalizes on Big Data and advanced analytics, setting the foundation for an integrative intersectoral knowledge platform to better inform and monitor behavioral change and ecosystem transformation. Building upon the four P's of marketing (product, price, promotion, placement), we examine digital commercial marketing data through the lenses of the four A's of food security (availability, accessibility, affordability, appeal) using advanced consumer choice analytics for archetypal traditional (fresh fruits and vegetables) and modern (soft drinks) product categories. We demonstrate that business practices typically associated with the latter also have an important, if not more important, impact on purchases of the former category. Implications and limitations of the approach are discussed.

Processed and ultra-processed food products: consumption trends in Canada from 1938 to 2011.

PURPOSE: A classification of foods based on the nature, extent, and purpose of industrial food processing was used to assess changes in household food expenditures and dietary energy availability between 1938 and 2011 in Canada. METHODS: Food acquisitions from six household food budget surveys (1938/1939 , 1953, 1969, 1984, 2001, and 2011) were classified into unprocessed or minimally processed foods, processed culinary ingredients, and ready-to-consume processed or ultra-processed products. Contributions of each group to household food expenditures, and to dietary energy availability (kcal per capita) were calculated. RESULTS: During the period studied, household expenditures and dietary energy availability fell for both unprocessed or minimally processed foods and culinary ingredients, and rose for ready-to-consume products. The caloric share of foods fell from 34.3% to 25.6% and from 37% to 12.7% for culinary ingredients. The share of ready-to-consume products rose from 28.7% to 61.7%, and the increase was especially noteworthy for those that were ultra-processed. CONCLUSIONS: The most important factor that has driven changes in Canadian dietary patterns between 1938 and 2011 is the replacement of unprocessed or minimally processed foods and culinary ingredients used in the preparation of dishes and meals; these have been displaced by ready-to-consume ultra-processed products. Nutrition research and practice should incorporate information about food processing into dietary assessments.

Consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community.

OBJECTIVE: The present study describes the consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community and examines its associations with physical activity, sedentary behaviours and BMI. DESIGN: A two-stage cross-sectional design was used. In Stage 1 (n 42), 24 h recalls enabled the identification of sweetened products. In Stage 2 (n 192), an FFQ was administered to measure the daily consumption of these products and to collect sociodemographic and behavioural data. Sweetened products were defined as processed culinary ingredients and ultra-processed products for which total sugar content exceeded 20% of total energy. SETTING: Three Catholic Middle Eastern churches located in Montreal, Canada. SUBJECTS: Normoglycaemic men and women (18-60 years old). RESULTS: Twenty-six sweetened products represented an average consumption of 75·4 g total sugars/d or 15·1% of daily energy intake (n 190, 56% women). Soft drinks, juices, sweetened coffee, chocolate, cookies, cakes and muffins were the main sources of consumption and mostly consumed between meals. Age (exp (ß) = 0·99; P < 0·01), physical activity (exp (ß) = 1·08; P < 0·01) and recreational computer use (exp (ß) = 1·17; P < 0·01) were independently associated with sweetened product consumption. The association between sweetened product consumption and physical activity was U-shaped. BMI was not significantly associated with sweetened product consumption but all participants regardless of BMI were above the WHO recommendation for free sugars. CONCLUSIONS: Being physically active and spending less time using a computer may favour a reduced consumption of sweetened products. Very active individuals may, however, overconsume such products.

Food Classification Systems Based on Food Processing: Significance and Implications for Policies and Actions: A Systematic Literature Review and Assessment.

This paper is the first to make a systematic review and assessment of the literature that attempts methodically to incorporate food processing into classification of diets. The review identified 1276 papers, of which 110 were screened and 21 studied, derived from five classification systems. This paper analyses and assesses the five systems, one of which has been devised and developed by a research team that includes co-authors of this paper. The quality of the five systems is assessed and scored according to how specific, coherent, clear, comprehensive and workable they are. Their relevance to food, nutrition and health, and their use in various settings, is described. The paper shows that the significance of industrial food processing in shaping global food systems and supplies and thus dietary patterns worldwide, and its role in the pandemic of overweight and obesity, remains overlooked and underestimated. Once food processing is systematically incorporated into food classifications, they will be more useful in assessing and monitoring dietary patterns. Food classification systems that emphasize industrial food processing, and that define and distinguish relevant different types of processing, will improve understanding of how to prevent and control overweight, obesity and related chronic non-communicable diseases, and also malnutrition. They will also be a firmer basis for rational policies and effective actions designed to protect and improve public health at all levels from global to local.

International differences in cost and consumption of ready-to-consume food and drink products: United Kingdom and Brazil, 2008-2009.

This paper tests the hypothesis that one important factor determining household availability of ready-to-consume products is their cost relative to the rest of the diet. National food expenditure surveys in the UK (2008) and Brazil (2008-09) were used. Purchased food quantities were converted into dietary energy (calories) and classified into three groups: (1) foods that are unprocessed or minimally processed; (2) processed culinary ingredients; and (3) ready-to-consume products, either processed or ultra-processed. The contribution of these groups to diets in each country was calculated as a percentage of total energy. Relative cost of ready-to-consume products in each country was calculated by dividing their cost by the cost of the rest of the diet (foods plus culinary ingredients). Linear regression analysis was used to test the association between the UK to Brazil ratios of the caloric share of different ready-to-consume products, and of the relative cost of these products. The caloric share of ready-to-consume products in the UK (63.4%) was well over double that of Brazil (27.7%), whereas their cost relative to the rest of the diet was 43% lower. The lower the relative cost of ready-to-consume products in the UK (compared with Brazil), the higher their relative consumption (R(2)=0.38, p<0.01).

Persisting problems related to race and ethnicity in public health and epidemiology research.

A recent and comprehensive review of the use of race and ethnicity in research that address health disparities in epidemiology and public health is provided. First it is described the theoretical basis upon which race and ethnicity differ drawing from previous work in anthropology, social science and public health. Second, it is presented a review of 280 articles published in high impacts factor journals in regards to public health and epidemiology from 2009-2011. An analytical grid enabled the examination of conceptual, theoretical and methodological questions related to the use of both concepts. The majority of articles reviewed were grounded in a theoretical framework and provided interpretations from various models. However, key problems identified include a) a failure from researchers to differentiate between the concepts of race and ethnicity; b) an inappropriate use of racial categories to ascribe ethnicity; c) a lack of transparency in the methods used to assess both concepts; and d) failure to address limits associated with the construction of racial or ethnic taxonomies and their use. In conclusion, future studies examining health disparities should clearly establish the distinction between race and ethnicity, develop theoretically driven research and address specific questions about the relationships between race, ethnicity and health. One argue that one way to think about ethnicity, race and health is to dichotomize research into two sets of questions about the relationship between human diversity and health.

Persisting problems related to race and ethnicity in public health and epidemiology research / Problemas persistentes relacionados à raça e etnia na pesquisa em saúde pública e epidemiologia / Problemas persistentes relacionados con la raza y etnia en la investigación en salud pública y epidemiología

A recent and comprehensive review of the use of race and ethnicity in research that address health disparities in epidemiology and public health is provided. First it is described the theoretical basis upon which race and ethnicity differ drawing from previous work in anthropology, social science and public health. Second, it is presented a review of 280 articles published in high impacts factor journals in regards to public health and epidemiology from 2009-2011. An analytical grid enabled the examination of conceptual, theoretical and methodological questions related to the use of both concepts. The majority of articles reviewed were grounded in a theoretical framework and provided interpretations from various models. However, key problems identified include a) a failure from researchers to differentiate between the concepts of race and ethnicity; b) an inappropriate use of racial categories to ascribe ethnicity; c) a lack of transparency in the methods used to assess both concepts; and d) failure to address limits associated with the construction of racial or ethnic taxonomies and their use. In conclusion, future studies examining health disparities should clearly establish the distinction between race and ethnicity, develop theoretically driven research and address specific questions about the relationships between race, ethnicity and health. One argue that one way to think about ethnicity, race and health is to dichotomize research into two sets of questions about the relationship between human diversity and health.

Realizou-se revisão recente e abrangente da utilização de raça e etnia em pesquisas dedicadas às disparidades de saúde em epidemiologia e saúde pública. Foi descrita a base teórica sobre qual raça e etnia diferem nos métodos de trabalhos em ciência, antropologia social e de saúde pública. A revisão foi feita com base na seleção de artigos publicados em periódicos de alto fator de impacto no que diz respeito à saúde pública e epidemiologia, no período de 2009-2011. O total de artigos selecionados foi de 280. A revisão foi baseada sobre um conjunto de questões conceituais, teóricas e metodológicas relacionadas ao uso de ambos os conceitos. A maioria dos artigos revisados foi fundamentada em um referencial teórico e desde interpretações de vários modelos. No entanto, os principais problemas identificados incluem: a) falha de pesquisadores para diferenciar conceitos de raça e etnia; b) utilização indevida de categorias raciais para atribuir etnia; c) falta de transparência nos métodos utilizados para avaliar ambos os conceitos; e d) falta de limites de endereços associada à construção de taxonomias raciais ou étnicas e a sua utilização. Concluiu-se que os futuros estudos que objetivem examinar as disparidades de saúde devem estabelecer claramente a distinção entre raça e etnia, desenvolver pesquisas com orientação teórica que trata de questões específicas sobre as relações entre raça, etnia e saúde. Argumenta-se que uma maneira de pensar sobre raça, etnia e saúde é dicotomizar a pesquisa em dois conjuntos de questões sobre a relação entre a diversidade humana e da saúde.

Se realizó revisión reciente y amplia de la utilización de raza y etnia en investigaciones dedicadas a las disparidades de salud en epidemiología y salud pública. Se describió la base teórica sobre cual raza y etnia difieren en los métodos de trabajos en ciencia, antropología social y de salud pública. La revisión fue hecha con base en la selección de artículos publicados en revistas de alto factor de impacto en lo que se refiere a la salud pública y epidemiología, en el período de 2009-2011. El total de artículos seleccionados fue de 280. La revisión se basó en un conjunto de aspectos conceptuales, teóricos y metodológicos relacionados con el uso de ambos conceptos. La mayoría de los artículos revisados estuvo fundamentada en un referencial teórico y con interpretaciones de varios modelos. Sin embargo, los principales problemas identificados incluyen a) falla de investigadores para diferenciar conceptos de raza y etnia; b) utilización inadecuada de categorías raciales para atribuir etnia; c) falta de transparencia en los métodos utilizados para evaluar ambos conceptos; y d) falta de límites de direcciones asociada a la clasificación y uso de taxonomías raciales o étnicas. Se concluye que los futuros estudios que tengan como objetivo examinar las disparidades de salud deben establecer claramente la distinción entre raza y etnia, desarrollar investigaciones con orientación teórica? que trata de aspectos específicos sobre las relaciones entre raza, etnia y salud. Se argumenta que una manera de pensar sobre raza, etnia y salud es dicotomizar la investigación en dos conjuntos de aspectos sobre la relación entre la diversidad humana y la salud.