Ultra-processed foods, dietary diversity and micronutrient intakes in the Australian population.

PURPOSE: This cross-sectional study aimed to assess the association between ultra-processed foods consumption and dietary diversity and micronutrient intake in Australia. METHODS: As part of the Nutrition and Physical Activity Survey (2011-2012), 12,153 participants aged 2 years and above were recruited and interviewed. Dietary intake data were collected by two 24-h dietary recalls using the Automated Multiple-Pass Method. The NOVA classification system was used to group the food items based on the extent and purpose of industrial food processing. The mean micronutrient contents were calculated for the total diet, and for two diet fractions; one made up entirely of ultra-processed foods (NOVA group 4) and the other consisting of all non-ultra-processed foods (aggregation of NOVA food groups 1 to 3). The mean micronutrient content in the ultra-processed and non-ultra-processed food diet fractions were compared. Dietary diversity was measured using the ten Food Group Indicators (FGI) of the Food and Agriculture Organization and was defined as the sum number of FGIs per individual. Multiple linear regression models were used to assess the association between the quintiles of energy contribution of ultra-processed foods, dietary diversity, and micronutrient intake. RESULTS: A negative association was found between quintiles of energy contribution of ultra-processed foods and dietary diversity (ß = - 0.43; p < 0.001). The overall micronutrient content was lower in the diet fraction dominated by ultra-processed foods compared to the non-ultra-processed food diet fraction in the study population. The dietary contents of vitamins A, E, C, B9, B12, zinc, calcium, iron, magnesium, potassium, and phosphorus were reduced significantly with increased consumption of ultra-processed foods, even after adjustment for sociodemographic factors and dietary diversity. CONCLUSION: The quintiles of energy contribution of ultra-processed foods were negatively associated with dietary diversity and micronutrient intake in Australia.

Ultra-processed foods consumption and diet quality among preschool children and women of reproductive age from Argentina.

OBJECTIVE: To assess the association between the consumption of ultra-processed foods (UPF) and diet quality among preschool children and women of reproductive age from Argentina. DESIGN: Cross-sectional and nationally representative survey. The food items were classified according to the NOVA system. Consumption of fruits, vegetables, legumes, nuts, seeds and wholegrains was estimated, and the energy and nutrients related to non-communicable disease (NCD) intake. Linear regression was used to assess the associations. SETTING: Argentina. PARTICIPANTS: Children aged 2-5 years (n 7022), female adolescent aged 10-19 years (n 2165) and women aged 20-49 years (n 4414). RESULTS: UPF represented more than a quarter of total energy intake, 27 % in children, 31 % in female adolescents and 26 % in women. Across all age groups, the major contributors to UPF consumption were cookies and pastries (about 6·0-7·0 %), soft drinks (about 2·7-3·7 %), candies (about 1·8-4·6 %), and juices (about 1·3-1·7 %). The consumption of fresh vegetables, fresh fruits and legumes was negatively associated with UPF consumption. A significant positive association was found between the dietary share of UPF and the dietary content of NCD-promoting nutrients such as free sugars and total saturated and trans-fats. In contrast, a significant negative association was found with the content of NCD-protective such as fibre and protein. CONCLUSIONS: UPF were associated with lower consumption of healthy foods and higher intake of nutrients related to NCD in children and women of reproductive age in Argentina. It is necessary to design food policies that simultaneously reduce the consumption of UPF while promoting the intake of fresh and whole foods to improve the dietary quality.

Ultra-processed foods consumption reduces dietary diversity and micronutrient intake in the Mexican population.

BACKGROUND: Currently, 30% of the total energy intake in the Mexican diet comes from ultra-processed foods. Although its consumption is associated with high intakes of added sugar and saturated fats and low intakes of dietary fibre, there is no evidence regarding its association with dietary diversity and micronutrient intake. The present study evaluated the association between ultra-processed foods consumption with dietary diversity and micronutrient intake in Mexico. METHODS: Ultra-processed foods items were identified in a 24-h recall from a sample of 10,087 participants aged ≥ 1 year. The minimum dietary diversity (MDD) was established by using the Food and Agriculture Organization 10 food group indicators with unprocessed, minimally processed and processed foods. The study conducted multiple linear regression models to evaluate the association between quintiles of energy contribution of ultra-processed foods with dietary diversity and micronutrient intake. RESULTS: A high consumption of ultra-processed foods was associated with a low dietary diversity and micronutrients intake. The association between ultra-processed foods and MDD was not linear (47.1%, 57.1%, 52.5%, 45.0% and 28.0% of participants achieved the MDD). On the other hand, the association was linear and negatively associated with: niacin, pantothenic acid, pyridoxine, folate, vitamin B12 , vitamin C, vitamin E, zinc, calcium, magnesium, potassium and phosphorus (p < 0.05). CONCLUSIONS: These findings are relevant in the context of the double burden of malnutrition currently faced in Mexico. Increasing dietary diversity and micronutrient intake is essential by discouraging ultra-processed foods consumption. However, other strategies are also needed to promote the dietary diversity and increase the consumption of unprocessed and minimally processed foods.

Evaluating intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model.

PURPOSE: To investigate intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model. METHODS: Dietary intakes of 12,153 participants from the Australian Health Survey (2011-12) aged 2 + years were evaluated. Food items reported during a 24 h recall were classified using the NOVA system. The Pan-American Health Organization Nutrient Profile Model (PAHO NPM) was applied to identify processed and ultra-processed products with excessive content of critical nutrients. Differences in mean intakes and prevalence of excessive intakes of critical nutrients for groups of the population whose diets were made up of products with and without excessive content in critical nutrients were examined. RESULTS: The majority of Australians consumed daily at least three processed and ultra-processed products identified as excessive in critical nutrients according to the PAHO NPM. Individuals consuming these products had higher intakes of free sugars (ß = 8.9), total fats (ß = 11.0), saturated fats (ß = 4.6), trans fats (ß = 0.2), and sodium (ß = 1788 for adolescents and adults; ß = 1769 for children 5-10 years; ß = 1319 for children aged < 5 years) (p ≤ 0.001 for all nutrients) than individuals not consuming these foods. The prevalence of excessive intake of all critical nutrients also followed the same trend. CONCLUSION: The PAHO NPM has shown to be a relevant tool to predict intake levels of nutrients linked to non-communicable diseases in Australia and, therefore, could be used to inform policy actions aimed at increasing the healthiness of food environments.

[Processed and ultra-processed products and their relationship to quality of diet in childrenProdutos processados e ultraprocessados e sua relação com a qualidade da dieta em crianças]. / Productos procesados y ultraprocesados y su relación con la calidad de la dieta en niños.

Objective: Estimate the impact on quality in the early childhood diet (ages 2 to 4 years) in Uruguay, resulting from consumption of products containing excessive amounts of critical nutrients associated with noncommunicable diseases (NCDs) (free sugars, total fats, saturated fats, and sodium), according to the Pan American Health Organization (PAHO) Nutrient Profile Model. Methods: A 24-hour dietary recall survey was used with a representative sample of 401 participants from the 2018 Nutrition, Child Development, and Health Survey. The NOVA classification system was used to categorize foods according to the nature and purposes of the industrial processes they undergo. Foods were then analyzed using the PAHO Nutrient Profile Model, enabling identification of products with excessive amounts of these nutrients. Results: Fifty percent of children consumed three or more products with an excess of some of the nutrients linked to NCDs. About 9 out of 10 children consume products with an excess of at least one of the critical nutrients studied. Conclusion: Diets that do not contain ultra-processed and processed products with excess free sugars, total fats, saturated fats, or sodium were the best choice for children aged 2 to 4 years. Based on PAHO criteria, the consumption of products with excess critical nutrients (and of each additional gram of these products) significantly worsens diet quality, and impedes adherence to World Health Organization recommendations.

Objetivo: Estimar o efeito do consumo de produtos que contêm quantidades excessivas de nutrientes críticos associados a doenças não transmissíveis (DCNTs) ­ açúcares livres, gorduras totais, gorduras saturadas e sódio ­, de acordo com o modelo de perfil nutricional da Organização Pan-Americana da Saúde (OPAS), na qualidade da dieta da primeira infância uruguaia (crianças de 2 a 4 anos). Métodos: Um recordatório alimentar de 24 horas foi aplicado a uma amostra representativa de 401 participantes da Pesquisa de Nutrição, Desenvolvimento Infantil e Saúde de 2018. Foi utilizada a classificação proposta pelo sistema NOVA para categorizar os alimentos de acordo com sua natureza e os processos industriais a que são submetidos. A análise foi feita com base no modelo de perfil nutricional da OPAS, que possibilitou identificar os produtos com teor excessivo dos nutrientes supracitados. Resultados: Das crianças avaliadas, 50% consumiram três ou mais produtos com excesso de algum dos nutrientes vinculados às DCNT. Aproximadamente 9 em cada 10 crianças consomem produtos com excesso de pelo menos um dos nutrientes críticos estudados. Conclusão: As dietas que não contêm produtos ultraprocessados e processados com excesso de açúcares livres, gordura total, gordura saturada e sódio foram a melhor opção para crianças de 2 a 4 anos. A ingestão de produtos com excesso de nutrientes críticos segundo a OPAS (e cada grama adicional consumido desses produtos) piora significativamente a qualidade da dieta e impede o cumprimento das recomendações da Organização Mundial da Saúde.

Ultra-processed foods drive to unhealthy diets: evidence from Chile.

OBJECTIVES: To assess the consumption of ultra-processed foods and its association with the overall dietary content of nutrients related to non-communicable diseases (NCD) in the Chilean diet and to estimate the population attributable fraction of ultra-processed food consumption on the unhealthy nutrient content. DESIGN: Cross-sectional analysis of dietary data collected through a national survey (2010). SETTING: Chile. PARTICIPANTS: Chilean population aged ≥2 years (n 4920). RESULTS: In Chile, ultra-processed foods represented 28·6 % of the total energy intake. A significant positive association was found between the dietary share of ultra-processed foods and NCD-promoting nutrients such as dietary energy density (standardised regression coefficient (ß) = 0·22), content of free sugars (ß = 0·45), total fats (ß = 0·26), saturated fats (ß = 0·19), trans fats (ß = 0·09) and Na:K ratio (ß = 0·04), while a significant negative association was found with the content of NCD-protective nutrients such as K (ß = -0·19) and fibre (ß = -0·31). The content of Na (ß = 0·02) presented no significant association. Except for Na, the prevalence of inadequate intake of all nutrients (WHO recommendations) increased across quintiles of the dietary share of ultra-processed foods. With the reduction of ultra-processed foods consumption to the level seen among the 20 % lowest consumers (3·8 % (0-9·3 %) of the total energy from ultra-processed foods), the prevalence of nutrient inadequacy would be reduced in almost three-fourths for trans fats; in half for energy density (foods); in around one-third for saturated fats, energy density (beverages), free sugars and total fats; in near 20 % for fibre and Na:K ratio and in 13 % for K. CONCLUSIONS: In Chile, decreasing the consumption of ultra-processed foods is a potentially effective way to achieve the WHO nutrient goals for the prevention of diet-related NCD.

'I had never seen so many lobbyists': food industry political practices during the development of a new nutrition front-of-pack labelling system in Colombia.

OBJECTIVE: To identify and monitor food industry use of political practices during the adoption of nutrition warning labels (WL) in Colombia. DESIGN: Document analysis of publicly available information triangulated with interviews. SETTING: Colombia. PARTICIPANTS: Eighteen key informants from the government (n 2), academia (n 1), civil society (n 12), the media (n 2) and a former food industry employee (n 1). RESULTS: In Colombia, the food industry used experts and groups funded by large transnationals to promote its preferred front-of-pack nutrition labelling (FOPL) and discredit the proposed warning models. The industry criticised the proposed WL, discussing the negative impacts they would have on trade, the excessive costs required to implement them and the fact that consumers were responsible for making the right choices about what to eat. Food industry actors also interacted with the government and former members of large trade associations now in decision-making positions in the public sector. The Codex Alimentarius was also a platform through which the industry got access to decision-making and could influence the FOPL policy. CONCLUSIONS: In Colombia, the food industry used a broad range of political strategies that could have negatively influenced the FOPL policy process. Despite this influence, the mandatory use of WL was announced in February 2020. There is an urgent need to condemn such political practices as they still could prevent the implementation of other internationally recommended measures to improve population health in the country and abroad, nutrition WL being only of them.

Food industry political practices in Chile: "the economy has always been the main concern".

BACKGROUND: In the business literature, the term "corporate political activity" (CPA) refers to the political strategies undertaken by corporations to protect or expend their markets, by influencing, directly or indirectly, the policy process. There is evidence that food industry actors use such political practices, which poses a significant threat to public health. Our study objective was to identify the political practices of the food industry in Chile. RESULTS: In Chile, food industry actors supported community initiatives, particularly those targeted at children and those focused on environmental sustainability. Food industry actors also funded research through prizes, scholarships, and by supporting scientific events. Food industry actors lobbied against the development and implementation of a front-of-pack nutrition labelling policy, including with support from the Ministries of Economy, Agriculture and Foreign Affairs. Food industry actors, for example, claimed that there would be unintended negative consequences for society and the economy, and that the policy would breach trade agreements. The same arguments were used against a proposed tax increase on sugar-sweetened beverages. Food industry actors stressed their crucial role in the Chilean economy and claimed to be part of the solution in the prevention and control of obesity, with a particular focus on their efforts to reformulate food products, and their support of physical activity initiatives. Interviewees noted that the political influence of the food industry is often facilitated by the neo-liberal and market-driven economy of Chile. Nevertheless, this system was questioned through social protests that started in the country during data collection. CONCLUSIONS: In Chile, food industry actors used numerous action- and argument-based CPA practices which may influence public health policy, research, and practice. Despite strong influence from the food industry, Chile adopted a front-of-pack nutrition labelling policy. While the country has some measures in place to manage the interactions between government officials or public health professionals, and the industry, there is still a need to develop robust mechanisms to address undue influence from corporations.

"The architecture of the state was transformed in favour of the interests of companies": corporate political activity of the food industry in Colombia.

BACKGROUND: In Colombia, public health policies to improve food environments, including front-of-pack nutrition labelling and marketing restrictions for unhealthy products, are currently under development. Opposition to these policies by the food industry is currently delaying and weakening these efforts. This opposition is commonly known as 'corporate political activity' (CPA) and includes instrumental (action-based) strategies and discursive (argument-based) strategies. Our aim was to identify the CPA of the food industry in Colombia. METHODS: We conducted a document analysis of information available in the public domain published between January-July 2019. We triangulated this data with interviews with 17 key informants. We used a deductive approach to data analysis, based on an existing framework for the CPA of the food industry. RESULTS: We identified 275 occurrences of CPA through our analysis of publicly available information. There were 197 examples of instrumental strategies and 138 examples of discursive strategies (these categories are not mutually exclusive, 60 examples belong to both categories). Interview participants also shared information about the CPA in the country. The industry used its discursive strategies to portray the industry in a 'better light', demonstrating its efforts in improving food environments and its role in the economic development of the country. The food industry was involved in several community programmes, including through public private initiatives. The industry also captured the media and tried to influence the science on nutrition and non-communicable diseases. Food industry actors were highly prominent in the policy sphere, through their lobbying, close relationships with high ranking officials and their support for self-regulation in the country. CONCLUSIONS: The proximity between the industry, government and the media is particularly evident and remains largely unquestioned in Colombia. The influence of vulnerable populations in communities and feeling of insecurity by public health advocates is also worrisome. In Colombia, the CPA of the food industry has the potential to weaken and delay efforts to develop and implement public health policies that could improve the healthiness of food environments. It is urgent that mechanisms to prevent and manage the influence of the food industry are developed in the country.

Association of all forms of malnutrition and socioeconomic status, educational level and ethnicity in Colombian children and non-pregnant women.

OBJECTIVE: To examine the association of all forms of malnutrition and socioeconomic status (SES), educational level and ethnicity in children <5 years, non-pregnant adolescent women (11-19 years) and non-pregnant adult women (20-49 years) in Colombia. DESIGN: Cross-sectional analysis of data from the 2010 Colombian National Nutrition Survey. The prevalence of malnutrition was compared across categories of SES, educational level and ethnicity. SETTING: Colombia. PARTICIPANTS: The sample for the current analysis comprised children <5 years, non-pregnant adolescent women (11-19 years) and non-pregnant adult women (20-49 years). RESULTS: In children <5 years, a low SES and maternal educational level were significantly associated with a lower prevalence of overweight/obesity compared with high levels of SES and maternal education, that is, the prevalence of overweight/obesity was 1·4 and 1·6 times lower in categories of low SES and educational levels, respectively. In contrast, the prevalence of wasting, stunting and anaemia was higher in the lowest SES and maternal educational categories (the prevalence was between 1·1 and 1·8 times higher for these indicators). In women, the lowest SES (11 and 19 years) and educational levels (20 and 49 years) exhibited a higher prevalence in all forms of malnutrition compared with their counterparts in the highest categories (i.e. overweight/obesity, stunting and anaemia). Additionally, indigenous or Afro-Colombian children and women had the highest prevalence of malnutrition in comparison with other ethnicities. CONCLUSIONS: These results suggest that public policies should address all forms of malnutrition that occur in the most vulnerable populations in Colombia using multiple strategies.

Ultra-processed foods: what they are and how to identify them.

The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).

Association between ultra-processed food consumption and the nutrient profile of the Colombian diet in 2005.

OBJECTIVE: To evaluate the consumption of ultra-processed food and drink products and its association with the nutrient profile of the Colombian diet in 2005. MATERIALS AND METHODS: Food consumption based on 24-hour dietary records from 38 643 men and women was classified into four NOVA groups according to the extent and purpose of food processing. RESULTS: Ultra-processed food and drink products represented 15.9% of the total energy daily intake, compared to 63.3% from minimally processed food, 15.8% from processed culinary ingredients, and 4.9% from processed food. Non-ultra-processed food items had a healthier nutritional profile compared to ultra-processed items in terms of contribution to total calories from protein, carbohydrates, total fat, saturated fat, free sugar, fiber and energy density. CONCLUSIONS: Ultra-processed food products have a less healthy nutrient profile than non-ultra-processed ones. An increase in the consumption of these foods must be prevented within Colombia.

OBJETIVO: Evaluar el consumo de alimentos y bebidas ultraprocesadas y su asociación con el perfil nutricional dentro de la Encuesta Nacional de Nutrición de 2005 en Colombia. MATERIAL Y MÉTODOS: El consumo de alimentos basados en registros alimentarios de 24 horas de 38 643 individuos se clasificó en cuatro grupos de NOVA. RESULTADOS: Los productos de alimentos y bebidas ultraprocesados representaron 15.9% de la ingesta diaria total de energía, en comparación con 63.3% de los alimentos mínimamente procesados, 15.8% de los ingredientes culinarios procesados y 4.9% de los procesados. Los alimentos mínimamente procesados tenían un perfil nutricional más saludable en comparación con los artículos ultraprocesados en términos de contribución a las calorías totales, de proteínas, carbohidratos, grasa total, grasa saturada, azúcar libre, densidad de fibra y densidad de energía. CONCLUSIONES: Los alimentos ultraprocesados tienen un perfil nutricional menos saludable que los alimentos no procesados.

Ultra-processed foods and added sugars in the Chilean diet (2010).

OBJECTIVE: To assess the consumption of ultra-processed foods and analyse its association with the content of added sugars in the Chilean diet. DESIGN: Cross-sectional study of national dietary data obtained through 24 h recalls and classified into food groups according to the extent and purpose of food processing (NOVA classification). SETTING: Chile. SUBJECTS: A probabilistic sample of 4920 individuals (aged 2 years or above) studied in 2010 by a national dietary survey (Encuesta Nacional de Consumo Alimentario). RESULTS: Ultra-processed foods represented 28·6 (se 0·5) % of total energy intake and 58·6 (se 0·9) % of added sugars intake. The mean percentage of energy from added sugars increased from 7·7 (se 0·3) to 19·7 (se 0·5) % across quintiles of the dietary share of ultra-processed foods. After adjusting for several potential sociodemographic confounders, a 5 percentage point increase in the dietary share of ultra-processed foods determined a 1 percentage point increase in the dietary content of added sugars. Individuals in the highest quintile were three times more likely (OR=2·9; 95 % CI 2·4, 3·4) to exceed the 10 % upper limit for added sugars recommended by the WHO compared with those in the lowest quintile, after adjusting for sociodemographic variables. This association was strongest among individuals aged 2-19 years (OR=3·9; 95 % CI 2·7, 5·9). CONCLUSIONS: In Chile, ultra-processed foods are important contributors to total energy intake and to the consumption of added sugars. Actions aimed at limiting consumption of ultra-processed foods are being implemented as effective ways to achieve WHO dietary recommendations to limit added sugars and processed foods, especially for children and adolescents.

Zinc Deficiency in Latin America and the Caribbean.

BACKGROUND: Zinc deficiency affects multiple vital functions in the life cycle, especially growth. Limited information is available on the magnitude of zinc deficiency in Latin America and the Caribbean. OBJECTIVE: To examine the latest available information on both the prevalence of zinc deficiency and the risk of zinc deficiency in Latin America and the Caribbean. METHODS: The prevalence of zinc deficiency was identified through a systematic review looking for the latest available data on serum zinc concentrations from surveys or studies with national representativeness conducted in Latin America and the Caribbean. The risk of zinc deficiency in Latin America and the Caribbean was estimated based on dietary zinc inadequacy (according to the 2011 National Food Balance Sheets) and stunting in children under 5 years of age. RESULTS: Only four countries had available national biochemical data. Mexican, Colombian, Ecuadorian, and Guatemalan children under 6 years of age and women 12 to 49 years of age had a high prevalence of zinc deficiency (19.1% to 56.3%). The countries with the highest risk of zinc deficiency (estimated prevalence of inadequate zinc intake > 25% plus prevalence of stunting > 20%) were Belize, Bolivia, El Salvador, Guatemala, Haiti, Honduras, Nicaragua, and Saint Vincent and the Grenadines. Zinc dietary inadequacy was directly correlated with stunting (r = 0.64, p < .001). CONCLUSIONS: Prevalence data from the four available Latin America and Caribbean national surveys indicate a high prevalence of zinc deficiency in children under 6 years of age and women 12 to 49 years of age. High rates of both estimated zinc dietary inadequacy and stunting were also reported in most Latin America and Caribbean countries.

Interpretation of Serum Retinol Data From Latin America and the Caribbean.

BACKGROUND: In recent decades, the general socioeconomic situation in Latin America and the Caribbean countries has improved, and many vitamin A programs have been implemented in an attempt to reduce vitamin A deficiency in the region. OBJECTIVE: To examine vitamin A status in Latin America and the Caribbean based on serum retinol concentrations and to contrast available data published before and after 1998. METHODS: A systematic review was performed. National surveys or representative studies that reported vitamin A status were selected. RESULTS: Ten national surveys and six representative studies were identified. Data for children under 6 years of age indicate that Guatemala and Nicaragua have practically eradicated vitamin A deficiency (less than 2% prevalence of serum retinol < 20 µg/dL). In Costa Rica, Cuba, El Salvador, and Panama, the prevalence of vitamin A deficiency ranged from 2.8% to 9.4%. In Peru, Honduras, Argentina, Ecuador, and Brazil, vitamin A deficiency is a moderate public health problem (prevalence from 14.0% to 17.4%), while in Colombia, Mexico, and Haiti it is a severe public health problem (prevalence from 24.3% to 32.0%). Disadvantaged groups (indigenous people and those of Afro-Colombian descent) have the highest rates of deficiency. The prevalence of vitamin A deficiency is under 20% in school-children and adult women. When data published before and after 1998 for children under 6 years of age were compared, most Central American countries had a reduction in the prevalence of vitamin A deficiency (p < .05), whereas in South American countries, the prevalence of vitamin A deficiency increased over time (p < .05). CONCLUSIONS: The prevalence of vitamin A deficiency in children under 6 years of age has decreased in many Central American countries, but vitamin A deficiency still remains a public health problem in numerous Latin America and Caribbean countries, especially among disadvantaged and vulnerable groups. Because of issues with the accuracy of the serum retinol biomarker reflecting body stores, these results must be interpreted with caution.

The increasing trend in the consumption of ultra-processed food products is associated with a diet related to chronic diseases in Colombia-Evidence from national nutrition surveys 2005 and 2015.

INTRODUCTION: Ultra-processed food products (UPF) have been related to chronic diseases (CD). Public health politics has been establishing strategies to decrease the consumption of these products in the country. OBJECTIVES: i) To assess the trend of the consumption of UPF between 2005 and 2015. (ii) its association with sociodemographic factors and the overall dietary content of nutrients related to CD in 2015. (iii) to estimate the Population Attributable Fraction of unhealthy nutrient intake in Colombia in 2015 due to ultra-processed food consumption. METHODS: We used data from the first (2005) and the last (2015) National Surveys of the Nutritional Status in Colombia. Food consumption was assessed using a 24-hour food recall. The NOVA classification classified the food items according to the extent and purpose of industrial processing. RESULTS: The consumption of processed and UPF increased in Colombia between 2005 and 2015. In 2015, no significant differences were found in the consumption of UPF between men and women but significant differences by age, wealth index, area of residence, and ethnicity (p<0.001). A significant positive association was found between the dietary share of UPF and the content of CD-related nutrients such as free sugars, total fats, saturated fats, trans-fats, and sodium. The prevalence of excessive intake of all CD-related nutrients (according to WHO recommendations) increased across quintiles of the dietary share of UPF. With the reduction of UPF consumption to the level seen among the 20% lowest consumers [1.0% (0-4.5%) of the total energy from UPF], the prevalence of excessive nutrient intake was almost three-fourths lower for trans fats; around one third lower for free sugar and saturated fats, 26% lower for sodium and 15% lower for total fat. CONCLUSIONS: In Colombia, the increasing trend in the consumption of UPF is associated with increasing intake of CD-related nutrients. Thus, reducing the consumption of UPF is a potentially effective way to achieve the nutritional goals of the WHO for the prevention of CD.

Less than adequate vitamin D status and intake in Latin America and the Caribbean:a problem of unknown magnitude.

BACKGROUND: The prevalence of vitamin D deficiency in Latin America and the Caribbean is unknown. OBJECTIVE: To examine the prevalence data available on vitamin D deficiency in Latin America and the Caribbean. METHODS: A systematic review was conducted in 2011. Studies using biochemical biomarkers and dietary intake estimation were included. Studies conducted in apparently healthy individuals, independently of age, latitude, skin pigmentation, and season of the year at the time of blood collection, were included. RESULTS: A total of 243 studies were identified. The final number of selected studies was 28, including two National Health Surveys (Mexico and Argentina). There are studies that report the vitamin D status of specific subgroups conducted in Argentina, Brazil, Chile, Colombia, Ecuador, Guatemala, and Mexico. However, the small sample sizes in these studies and thus the low national representativeness of the reported data do not allow for an accurate assessment of vitamin D status at the regional level. In the majority of the countries with available data, we observed that vitamin D insufficiency was classified as a mild, moderate, or severe public health problem. The only country with a nationally representative sample was Mexico, which found 24%, 10%, 8%, and 10% prevalence rates of vitamin D insufficiency (25-hydroxyvitamin D < 50 nmol/L) in preschoolers, schoolchildren, adolescents, and adults, respectively. The prevalence of vitamin D deficiency (25-hydroxyvitamin D < 20 nmol/L) was less than 1% for all groups. CONCLUSIONS: There is some indication that vitamin D insufficiency may be a public health problem in Latin America and the Caribbean, but the exact magnitude is currently unknown.

Validation of the NOVA score for the consumption of ultra-processed foods by young women of Medellín, Colombia.

Ultra-processed foods (UPFs) are associated with deterioration in dietary quality and the development of chronic diseases. The NOVA score, developed in Brazil to assess UPF consumption quickly and inexpensively, is adapted and validated here using a sample of 203 young women from Medellín, Colombia. Food consumption was evaluated using 24-hour dietary recall and with the NOVA-UPF score. Food items were classified using the NOVA categories. The energy consumed from UPFs and its percentage of the total energy consumed was estimated. The association between the NOVA-UPF score and the percentage of energy from UPF (%UPF/E) was evaluated. Both variables were categorized into quintiles and concordance was estimated using prevalence and bias-adjusted kappa (PABAK). A regression model was used to assess the association between the NOVA-UPF score and critical nutrients. The mean NOVA-UPF score among study participants was 4.5, with 27% of the total energy they consumed coming from UPFs. There was a positive, linear association between the NOVA-UPF score and %UPF/E (p < 0.001) and substantial agreement (PABAK = 0.75) in the classification of participants between UPF energy quintiles and NOVA-UPF score quintiles. The NOVA-UPF score was positively and significantly associated with sodium, total fat, and saturated fat intake. We conclude that the adapted NOVA-UPF score may help monitor the consumption of UPFs among young women in Medellín.

"A consistent stakeholder management process can guarantee the 'social license to operate'": mapping the political strategies of the food industry in Brazil.

In the past, food industry actors tried to delay and weaken public health efforts to promote adequate and healthy diets in Brazil. This study aimed to identify the political strategies used by food industry actors in Brazil. We undertook a document analysis of publicly available information and interviews with eighteen key informants in public health nutrition. Data collection and analysis were carried between October 2018 and January 2019. In Brazil, food industry actors interacted with health organizations, communities, and the media. They disseminated information on nutrition and physical activity by scientific events and schools. The food industry also had allies within the government and lobbied high ranking officials. Finally, food industry actors intimidated some public health professionals, including by threats of litigation, which had the effect of silencing them. These strategies were facilitated by the use of arguments, such as the crucial role that the food industry plays in the economy and its support to the United Nations Sustainable Development Goals. Personal responsibility, moderation, and education were cited as solutions to the obesity epidemic, and there was little discussion on the broader issue of inadequate and unhealthy diets. Food industry actors in Brazil used a diverse range of political strategies, which have the potential of negatively influencing public policy, research, and practice in the country. Learning about these strategies is an essential first step, and in response, it is crucial to develop robust mechanisms to address undue influence from corporations.

Estimation of Intake of Critical Nutrients Associated with Noncommunicable Diseases According to the PAHO/WHO Criteria in the Diet of School-Age Children in Montevideo, Uruguay.

PURPOSE: To estimate the effect of the consumption of products with an excessive amount of critical nutrients associated with NCDs, according to the PAHO Nutrient Profile Model on the quality of the diet of Uruguayan school-age children (4 to 12 years). METHODS: A 24 h recall of food intake was conducted in a representative sample of 332 participants in the evaluation of the School Feeding Program in 2018 in public schools in Montevideo, Uruguay. Food and preparations were categorized according to the NOVA food classification, according to the nature, extent, and purposes of the industrial processes they undergo. Later, they were analyzed according to the Pan American Health Organization Nutrient Profile Model (PAHO NPM) to identify processed and ultra-processed products with an excessive content of critical nutrients. RESULTS: Only 0.52% of children consumed exclusively natural foods, or culinary ingredients. Twenty-five per cent of children consumed ≥4 products categorized with an excessive content of free sugars, total fat, or saturated fat according to the PAHO NPM; in the case of excessive sodium, this was 40%. In general, children who included products with excessive free sugars, sodium, or saturated fat in their diet exceeded the limits established by the World Health Organization, and, as a result, their diet is of poorer nutritional quality compared to children who did not consume such products. CONCLUSION: Diets free of ultra-processed and processed products with excess free sugars, total fats, saturated fats, and sodium increased the chances of school-age children in Montevideo of meeting WHO nutrient intake recommendations. Meanwhile, intake of each additional gram of products with excessive critical nutrients according to PAHO NPM, significantly worsens diets, preventing children from meeting WHO recommendations.