Conhecimento, autoeficácia e práticas profissionais relacionadas ao Guia Alimentar para a população brasileira na atenção primária à saúde / Knowledge, self-efficacy and professional practices related to the Dietary Guidelines for the Brazilian population in primary health care

Resumo Introdução fatores individuais parecem estar relacionados à utilização de novas recomendações e mudanças de prática profissional para ações de promoção à saúde. Objetivo avaliar a relação entre conhecimento, autoeficácia (AE) e utilização das recomendações do Guia Alimentar Brasileiro (GAB) nas práticas de equipes de Núcleos de Apoio à Saúde da Família (NASF-AB). Método recorte transversal de pós-intervenção de um ensaio comunitário controlado envolvendo 26 profissionais de saúde. Conhecimento e AE em utilizar as recomendações do GAB foram coletados por escalas validadas autoaplicáveis. A utilização do GAB na prática profissional foi mensurada mediante observação da rotina de trabalho dos NASF-AB e preenchimento de escala validada sobre as recomendações do GAB. Todos os escores variaram de 0 a 100. Resultados as pontuações médias nos escores de conhecimento, AE e utilização do GAB foram de 83,07 (DP = 18,29), 63,36 (DP = 19,07) e 4,33 (DP = 8,03), respectivamente. Houve correlação positiva e moderada entre AE e escore de utilização do GAB (r = 0,45; p = 0,03). Conhecimento sobre o GAB obteve fraca correlação com o escore de utilização (r = 0,34; p = 0,11). Diferença significativa foi obtida entre as médias do escore de utilização do GAB no grupo de elevada AE (5,13; p = 0,004; DP =1,55), em relação ao de baixa AE (3,40; p = 0,059; DP = 1,69), independentemente da categoria profissional. Conclusão neste estudo, a AE demonstrou estar moderadamente correlacionada com a adoção de novas práticas profissionais.

Abstract Background Individual factors appear related to the adoption of new recommendations and changes to professional practice for health promotion initiatives. Objective to evaluate the relationship between knowledge, self-efficacy (SE) and adoption of the Brazilian Dietary Guideline (BDG) recommendations in the practices of Family Health Support Center (NASF-AB) teams. Method a post-intervention cross-sectional sample from a controlled community trial involving 26 health professionals. Knowledge and SE in adopting the BDG recommendations were determined using a validated self- applicable scale. BDG adoption in professional practice was measured by observing the NASF-AB work routine and the scoring on the validated scale investigating GAB recommendation uptake. Scores ranged from 0 to 100 points. Results Average scores for knowledge, SE and BDG use were 83.07 (SD = 18.29), 63.36 (SD = 19.07) and 4.33 (SD = 8.03), respectively. There was a positive moderate correlation between SE and BDG utilization scores (r = 0.45; p = 0.03). Knowledge about BDG presented a weak correlation with the utilization score (r = 0.34; p = 0.11). Significant difference was observed between the averages of the BDG utilization score in the high SE group (5.13; p = 0.004; SD = 1.55), in relation to the low SE group (3.40; p = 0.059; SD = 1.69), regardless of professional category. Conclusion in this study, SE was moderately correlated with the adoption of new professional practices.

Electoral campaign contributions: an obstacle to sugary drink industry regulation in Brazil?

OBJECTIVE: To assess corporate electoral campaign contributions from industries related to sugary drinks production and the characteristics of the elected officials financed by the sector. DESIGN: Cross-sectional analysis of electoral campaign contributions from corporations related to sugary drinks production (sugary drink industries and sugary drink input industries) to candidates to the Chamber of Deputies, Brazil. SETTING: Elections to the 55th Congress (2015-2019), held in October 2014. PARTICIPANTS: Candidates to the Chamber of Deputies, Brazil. RESULTS: Forty-nine companies or corporate groups that produce sugary drinks and fifty-two corporations that produce inputs for sugary drinks manufacturing contributed to electoral campaigns of candidates in the 2014 Election. Contributions from this industry sector represented 7·3 % of all corporate contributions and helped finance 11·7 % of the candidates and 46·2 % of the elected officials. The transnationals Ambev and Coca-Cola were the first and second biggest donors, respectively. Revenues mediated by political parties, from sugary drink industries and from corporate members of some industry associations (Abir, Unica and CitrusBR), were more prevalent. Among elected officials, a significant association was found between being financed by the sector and representing the south-east region, having higher education level and referring themselves as being professional politicians. In the multivariate model, financed candidates were 27 % more likely to be elected. CONCLUSIONS: Corporations related to sugary drinks production have contributed to the electoral campaigns of almost half of the Federal Deputies in Brazil in 2014. This possibly facilitates access to decision-makers and could help buy influence on legislative proposals, including health-related food policies.

Factors associated with diet changes during the COVID-19 pandemic period in Brazilian adults: Time, skills, habits, feelings and beliefs.

This study aimed to identify individual, household and sociodemographic factors associated with changes in food consumption that lead to changes in the diet quality, in the context of the COVID-19 pandemic concerning Brazilian adults. Improvements or worsening in diet quality (IDQ or WDQ) were verified using an exploratory online survey which investigated whether participants (n = 4780) increased or decreased their consumption of food subgroups that mark positive or negative food patterns. Respondents also agreed or disagreed with their beliefs about food safety, cooking skills, family support, home characterization, feelings and behaviors. All factors of influence on the IDQ or WDQ groups were always compared against the general participants (who did not change their diet sufficiently to be classified into these groups). Individuals from the IDQ group spent more time on food (81.4% versus 62.0%), started to cook more often (91.4%), were more confident with their cooking skills (p < 0.01) and positive feelings were at least 2.5 times more prevalent. Adjusted analysis showed the chance to improve diet was 1.39 higher among those who did not feel overworked and increased 1.07 in each additional cooking chore shared between household members. For each additional positive feeling, the odds were 1.41 to IDQ and 0.67 to WDQ. Moreover, for each additional negative feeling the chances for WDQ were 1.21 and 0.90 for IDQ. Those in the WDQ group were more unaware of issues related to contagion during meals, they were not afraid of eating food prepared outside their home and agreed that industrialized food is safer (OR = 1.85). These results highlight the associated factors in improving or worsening diet patterns as a consequence of the COVID-19 pandemic, supporting messages presented in Dietary Guidelines.

Associations between ultraprocessed food consumption and total water intake in the US population.

BACKGROUND: Longitudinal studies have shown significant dose-response associations between dietary share of ultraprocessed foods and the incidence of several noncommunicable diseases and all-cause mortality. Several attributes of ultraprocessed foods are potential mechanisms for their link with health outcomes, including their typically unbalanced nutrient profile, high glycemic loads, high energy intake rate, and the presence of food additives, neoformed substances, and substances released by synthetic packaging materials. However, no studies have assessed the plausibility of reduced water intake as an additional association of diets rich in ultraprocessed foods. OBJECTIVE: To assess the association between ultraprocessed food consumption and total water intake. DESIGN: This cross-sectional secondary analysis used data from the National Health and Nutrition Examination Survey, cycles 2011 to 2016, in the United States. PARTICIPANTS/SETTINGS: This study included 24,505 participants aged ≥1 year who completed the first 24-hour dietary recall interview. MAIN OUTCOMES MEASURES: The main outcome evaluated was the mean of total water intake. STATISTICAL ANALYSIS: Crude and adjusted linear regressions were applied to investigate the association between quintiles of the dietary share of ultraprocessed foods and the total water intake. RESULTS: A significant linear reduction in the daily mean total water intake was observed across ultraprocessed food quintiles, amounting to 706 mL between the lower and the upper quintiles. Important increases across quintiles were observed for the intake of sugar-sweetened and artificially sweetened drinks, whereas important reductions occurred for unsweetened drinks, plain water, and water present in solid foods and dishes. CONCLUSIONS: Reduced total water intake and an imbalance between sources of water that favors energy-dense and nutrient-poor sources were associated with increased consumption of ultraprocessed food, suggesting that decreased total water consumption might be a negative outcome of diets rich in ultraprocessed foods. This relationship should be further investigated in longitudinal or clinical trials.

Dietary guidelines training may improve health promotion practice: Results of a controlled trial in Brazil.

BACKGROUND: The double burden of malnutrition points to an urgent need to develop strategies to promote healthy diets. Health professionals are key elements for health promotion and must be prepared to deal with these issues in health services. AIM: This study aimed to evaluate the impact of an educational intervention based on Brazilian Dietary Guidelines in the practice of multidisciplinary teams working in primary health care. METHODS: A controlled trial comprising pre- and post-tests was conducted with four multidisciplinary healthcare teams. The intervention group received 16 hours of training on the Brazilian Dietary Guidelines. The professionals' practices were evaluated by direct observation, before and after the intervention, for two months at each timepoint. Data on dietary counselling were collected using a previously validated scale. The Kruskal-Wallis test was used for intragroup comparison at T0 versus T1, and the intergroup effects of the intervention were estimated by generalized linear regression analysis with a 95% confidence interval. RESULTS: The regression with the interaction term between the intervention group and time showed a positive effect of the educational intervention on professionals' practices in the intervention group in the crude and adjusted models (coefficient = 1.36 and p = 0.020). Brazilian Dietary Guidelines application significantly increased in non-nutritionist professionals' practices (p = 0.007) and in activities not related to nutrition (p = 0.028) in the intervention group over time (T1-T0). No significant differences were found in the control group. CONCLUSION: The intervention proved to be effective in promoting changes in health professionals' practices, demonstrating the strength of the strategy for dissemination of nutrition guidelines in primary health care.

Cooking Skills Index: Development and reliability assessment / Índice de Habilidades Culinárias: desenvolvimento e avaliação de confiabilidade

Abstract Objective Describe the development and the reliability assessment of an index that evaluates the confidence in performing cooking skills considered relevant in Brazil. Methods The development of the Cooking Skills Index was based on the self-efficacy beliefs and its theoretical reference was the Dietary Guidelines for the Brazilian Population. It measures, from zero to 100, the degree of confidence in performing ten cooking skills considered as facilitators for the implementation of Brazilian Dietary Guidelines recommendations. Experts (face validity) evaluated the index. A pilot study (n=10) and a test-retest (n=51) was conducted by telephone interviews and computerized assistance with adults responsible for food preparation at home in São Paulo. Reliability was assessed by Cronbach's alpha, quadratic weighted kappa and prevalence and bias adjusted kappa. Results The Cooking Skills Index was coherent with the adopted theoretical framework according to the experts. It was fast and easy to apply to the participants. It showed a good internal consistency (Cronbach's alpha >0.70) and an acceptable to excellent reproducibility (weighted kappa=0.55, adjusted kappa=0.89). Conclusion The Cooking Skills Index has a good reliability and is therefore recommended to evaluate cooking skills confidence in Brazilian studies developed in contexts similar to those of this study.

Resumo Objetivo Descrever o desenvolvimento de um instrumento que avalia a confiança no desempenho de habilidades culinárias consideradas relevantes no Brasil, e avaliar sua confiabilidade. Métodos O Índice de Habilidades Culinárias foi desenvolvido com base na crença de autoeficácia e tendo como referencial teórico o Guia Alimentar para a População Brasileira. Ele mensura, com uma escala entre zero e 100, o grau de confiança das pessoas quanto ao desempenho de dez habilidades culinárias consideradas facilitadoras da implantação das recomendações do Guia Alimentar brasileiro. O índice passou por apreciação de especialistas (validade de face). E, após, por estudo piloto (n=10) e teste-reteste (n=51), conduzidos com aplicação das questões - via entrevistas telefônicas e com auxílio de sistema informatizado - a adultos responsáveis pela alimentação em casa residentes em São Paulo. Avaliou-se a confiabilidade pelo cálculo do alpha de Cronbach e do kappa ponderado quadrático e kappa ajustado para prevalência e viés. Resultados O Índice de Habilidades Culinárias foi considerado coerente com os referenciais adotados pelos especialistas, e de rápida e fácil aplicação pelos participantes; mostrou boa consistência interna (alpha de Cronbach >0,70) e reprodutibilidade aceitável a excelente (kappa ponderado 0,55; kappa ajustado 0,89). Conclusão O Índice de Habilidades Culinárias possui boa confiabilidade, podendo ser utilizado em estudos brasileiros que avaliem confiança no desempenho de habilidades culinárias em contextos similares ao deste estudo.

Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: evidence from a nationally representative cross-sectional study.

OBJECTIVES: To compare ultra-processed food consumption across sociodemographic groups and over time (2007-2008, 2009-2010, 2011-2012) in the USA. DESIGN: Cross-sectional study. SETTING: National Health and Nutrition Examination Survey (NHANES) 2007-2012. PARTICIPANTS: All individuals aged ≥2 years with at least one 24-hour dietary recall were included (n=23 847). MAIN OUTCOME MEASURES: Average dietary contribution of ultra-processed foods (expressed as a percentage of the total caloric value of the diet), obtained after classifying all food items according to extent and purpose of industrial food processing using NOVA classification. DATA ANALYSIS: Linear regression was used to evaluate the association between sociodemographic characteristics or NHANES cycles and dietary contribution of ultra-processed foods. RESULTS: Almost 60% of calories consumed in the period 2007-2012 came from ultra-processed foods. Consumption of ultra-processed foods decreased with age and income level, was higher for non-Hispanic whites or non-Hispanic blacks than for other race/ethnicity groups and lower for people with college than for lower levels of education, all differences being statistically significant. Overall contribution of ultra-processed foods increased significantly between NHANES cycles (nearly 1% point per cycle), the same being observed among males, adolescents and high school education-level individuals. CONCLUSIONS: Ultra-processed food consumption in the USA in the period 2007-2012 was overall high, greater among non-Hispanic whites or non-Hispanic blacks, less educated, younger, lower-income strata and increased across time.

Ultra-processed foods, protein leverage and energy intake in the USA.

OBJECTIVE: Experimental studies have shown that human macronutrient regulation minimizes variation in absolute protein intake and consequently energy intake varies passively with dietary protein density ('protein leverage'). According to the 'protein leverage hypothesis' (PLH), protein leverage interacts with a reduction in dietary protein density to drive energy overconsumption and obesity. Worldwide increase in consumption of ultra-processed foods (UPF) has been hypothesized to be an important determinant of dietary protein dilution, and consequently an ecological driving force of energy overconsumption and the obesity pandemic. The present study examined the relationships between dietary contribution of UPF, dietary proportional protein content and the absolute intakes of protein and energy. DESIGN: National representative cross-sectional study. SETTING: National Health and Nutrition Examination Survey 2009-2010. SUBJECTS: Participants (n 9042) aged ≥2 years with at least one day of 24 h dietary recall data. RESULTS: We found a strong inverse relationship between consumption of UPF and dietary protein density, with mean protein content dropping from 18·2 to 13·3 % between the lowest and highest quintiles of dietary contribution of UPF. Consistent with the PLH, increase in the dietary contribution of UPF (previously shown to be inversely associated with protein density) was also associated with a rise in total energy intake, while absolute protein intake remained relatively constant. CONCLUSIONS: The protein-diluting effect of UPF might be one mechanism accounting for their association with excess energy intake. Reducing UPF contribution in the US diet may be an effective way to increase its dietary protein concentration and prevent excessive energy intake.

Consumo de alimentos ultraprocessados e qualidade nutricional da dieta na população americana / Ultra-processed food consumption and diet quality in the American population

Introdução: O sistema alimentar atual despreza a cultura alimentar, a produção local e desvaloriza o uso do tempo com o preparo e consumo de alimentos, criando espaço e oportunidades para a penetração dos alimentos ultraprocessados. Nos Estados Unidos, os dados de estudos epidemiológicos em nutrição apontam para a elevada prevalência de obesidade e perda da qualidade da alimentação na população. Objetivo: Estudar o consumo de alimentos ultraprocessados nos Estados Unidos e o impacto desse consumo na qualidade da dieta da população americana. Métodos: Foram utilizados dados do consumo alimentar, de 23.847 indivíduos com dois anos de idade ou mais, de três ciclos da National Health and Nutrition Examination Survey, 2007-2008, 2009-2010 e 2011-2012.Todos alimentos consumidos foram alocados em um dos quatro grupos da classificação NOVA. Alimentos ultraprocessados foram definidos como formulações industriais feitas predominantemente de substâncias extraídas diretamente de alimentos (óleos, gorduras, açúcar), derivadas de constituintes de alimentos (gorduras hidrogenadas, amido modificado) ou sintetizadas em laboratório a partir de matérias orgânicas (corantes, aromatizantes, realçadores de sabor). Exemplos incluem guloseimas em geral, chocolates, sorvetes, bolachas doces e salgadas, salgadinhos de pacote, refrigerantes, hambúrgueres e outras refeições de fast food. A descrição do consumo alimentar da população americana foi feita segundo a participação média dos grupos e subgrupos de alimentos na dieta, expressada como porcentagem do valor calórico total da dieta; em seguida, o mesmo foi feito por sexo e faixa etária. A evolução, ao longo dos três períodos estudados, da participação média no valor calórico total da dieta foi descrita para o grupo de alimentos ultraprocessados e seus 15 subgrupos. Modelos de regressão foram aplicados para estimar a relação entre variáveis socioeconômicas e a participação de ultraprocessados nas calorias totais da dieta. Também foi verificado o impacto do consumo de produtos ultraprocessados na qualidade da dieta. Resultados: O consumo energético médio diário dos americanos foi de 2051,7 kcal, sendo 58,7 por cento das calorias provenientes de alimentos ultraprocessados. A participação de ultraprocessados foi maior na dieta de crianças e adolescentes. As associações entre as variáveis socioeconômicas e o consumo de alimentos ultraprocessados foram significativas, embora com coeficientes de regressão de pequena magnitude. A associação entre raça/etnia e a participação de alimentos ultraprocessados na dieta revelou as maiores disparidades sociais. No curto período decorrido entre as três pesquisas estudadas, houve aumento significativo da participação de alimentos ultraprocessados na dieta, principalmente entre crianças e adolescentes, indivíduos do sexo masculino e pessoas com escolaridade intermediária. Ao contrastar o primeiro com o último quinto de participação de ultraprocessados, o conteúdo de açúcar adicionado dobrou e, na mesma direção, aumentou a densidade energética da dieta. Além disso, foram reduzidos o conteúdo de fibras, em um terço, e o consumo de água total, em um quarto. Conclusão: Os resultados indicam que são necessárias políticas públicas para barrar o consumo elevado de alimentos ultraprocessados em todos estratos da população americana. Tais medidas podem ser efetivas na melhora da qualidade da dieta dessa população, levando à diminuição da densidade energética, do açúcar adicionado, aumento de fibras e água, o que pode, consequemente, auxiliar no combate à obesidade no país

Introduction: The current food system despises food culture, local production and create space and opportunities for penetration of food ultraprocessados on the diet. Data from epidemiological studies in United States shows the high prevalence of obesity and loss of diet quality, which could be related with the consumption of ultra-processed food. Objective: The study aims to evaluate the consumption of ultra-processed food in the United States and their impact on the diet quality. Methods: Cross-sectional study conducted with data from National Health and Nutrition Examination Survey, 2007-2008, 2009-2010 e 2011-2012.The sample, representative of American population, involved 23.847 individuals from 2 years or older. Food consumption data were collected through two 24-hour food records. The consumed food items were classified according to NOVA classification. Ultra-processed foods were defined as industrial formulations that are predominantly made from substances that are extracted from foods (sugar, oils and fats), derived from food constituents (hydrogenated fats, modified starch) or synthesized in a laboratory form organic materials (flavors, colours, flavor enhancers). Examples included confectionery, soft drinks, cookies, crackers, chips, hamburgers, sausages, nuggets or sticks and other pre-prepared frozen dishes. The description of food consumption of US population was expressed as the caloric share of the four food groups and stratified by sex and age group. Short trend, within the period studied, was estimated for the ultra-processed food consumption and its 15 subgroups. Linear regression models were applied to assess the association between the socioecomic variables and quintiles of consumption of ultra-processed foods, as well as to assess the influence of consumption of ultra-processed foods on the diet quality. Results: The average daily energy intake of Americans was 2051.7 kcal; ultra-processed food comprised 58.7 per cent of this intake. Children and adolescents presented the higher energy share of ultraprocessados in the diet. The associations between socioeconomic variables and the consumption of food ultraprocessados were significant, although the small magnitude in regression coefficients. The largest differences in ultra-processed energy consumption was between the classes of race/ethnicity, showing social disparities. In the short period studied, it was observed a significant increase in the share of ultraprocessados foods in the diet, especially among children and adolescents, males and people with intermediate education. Contrasting the first with the last fifth of ultraprocessados share, increased the content of added sugar and also energy density of the diet. In addition, the increase of consumption of ultra-processed food reduced the fiber content in a third and the intake of total water in a fourth. Conclusion: The results from this study give support to public polices to create barriers on the consumption of ultra-processed food in US. The results also highlight the negative impact of ultra-processed food consumption on the diet quality. Decreasing the share of ultra-processed food on diet would lead to less added sugar and energy density content on diet and more fiber and water consumption

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.

Impact of ultra-processed foods on micronutrient content in the Brazilian diet.

OBJECTIVE To evaluate the impact of consuming ultra-processed foods on the micronutrient content of the Brazilian population's diet. METHODS This cross-sectional study was performed using data on individual food consumption from a module of the 2008-2009 Brazilian Household Budget Survey. A representative sample of the Brazilian population aged 10 years or over was assessed (n = 32,898). Food consumption data were collected through two 24-hour food records. Linear regression models were used to assess the association between the nutrient content of the diet and the quintiles of ultra-processed food consumption - crude and adjusted for family income per capita. RESULTS Mean daily energy intake per capita was 1,866 kcal, with 69.5% coming from natural or minimally processed foods, 9.0% from processed foods and 21.5% from ultra-processed foods. For sixteen out of the seventeen evaluated micronutrients, their content was lower in the fraction of the diet composed of ultra-processed foods compared with the fraction of the diet composed of natural or minimally processed foods. The content of 10 micronutrients in ultra-processed foods did not reach half the content level observed in the natural or minimally processed foods. The higher consumption of ultra-processed foods was inversely and significantly associated with the content of vitamins B12, vitamin D, vitamin E, niacin, pyridoxine, copper, iron, phosphorus, magnesium, selenium and zinc. The reverse situation was only observed for calcium, thiamin and riboflavin. CONCLUSIONS The findings of this study highlight that reducing the consumption of ultra-processed foods is a natural way to promote healthy eating in Brazil and, therefore, is in line with the recommendations made by the Guia Alimentar para a População Brasileira (Dietary Guidelines for the Brazilian Population) to avoid these foods.

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.

Ultra-processed foods and the nutritional dietary profile in Brazil.

OBJECTIVE To assess the impact of consuming ultra-processed foods on the nutritional dietary profile in Brazil. METHODS Cross-sectional study conducted with data from the module on individual food consumption from the 2008-2009 Pesquisa de Orçamentos Familiares (POF - Brazilian Family Budgets Survey). The sample, which represented the section of the Brazilian population aged 10 years or over, involved 32,898 individuals. Food consumption was evaluated by two 24-hour food records. The consumed food items were classified into three groups: natural or minimally processed, including culinary preparations with these foods used as a base; processed; and ultra-processed. RESULTS The average daily energy consumption per capita was 1,866 kcal, with 69.5% being provided by natural or minimally processed foods, 9.0% by processed foods and 21.5% by ultra-processed food. The nutritional profile of the fraction of ultra-processed food consumption showed higher energy density, higher overall fat content, higher saturated and trans fat, higher levels of free sugar and less fiber, protein, sodium and potassium, when compared to the fraction of consumption related to natural or minimally processed foods. Ultra-processed foods presented generally unfavorable characteristics when compared to processed foods. Greater inclusion of ultra-processed foods in the diet resulted in a general deterioration in the dietary nutritional profile. The indicators of the nutritional dietary profile of Brazilians who consumed less ultra-processed foods, with the exception of sodium, are the stratum of the population closer to international recommendations for a healthy diet. CONCLUSIONS The results from this study highlight the damage to health that is arising based on the observed trend in Brazil of replacing traditional meals, based on natural or minimally processed foods, with ultra-processed foods. These results also support the recommendation of avoiding the consumption of these kinds of foods.

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.

Comparing different policy scenarios to reduce the consumption of ultra-processed foods in UK: impact on cardiovascular disease mortality using a modelling approach.

BACKGROUND: The global burden of non-communicable diseases partly reflects growing exposure to ultra-processed food products (UPPs). These heavily marketed UPPs are cheap and convenient for consumers and profitable for manufacturers, but contain high levels of salt, fat and sugars. This study aimed to explore the potential mortality reduction associated with future policies for substantially reducing ultra-processed food intake in the UK. METHODS AND FINDINGS: We obtained data from the UK Living Cost and Food Survey and from the National Diet and Nutrition Survey. By the NOVA food typology, all food items were categorized into three groups according to the extent of food processing: Group 1 describes unprocessed/minimally processed foods. Group 2 comprises processed culinary ingredients. Group 3 includes all processed or ultra-processed products. Using UK nutrient conversion tables, we estimated the energy and nutrient profile of each food group. We then used the IMPACT Food Policy model to estimate reductions in cardiovascular mortality from improved nutrient intakes reflecting shifts from processed or ultra-processed to unprocessed/minimally processed foods. We then conducted probabilistic sensitivity analyses using Monte Carlo simulation. RESULTS: Approximately 175,000 cardiovascular disease (CVD) deaths might be expected in 2030 if current mortality patterns persist. However, halving the intake of Group 3 (processed) foods could result in approximately 22,055 fewer CVD related deaths in 2030 (minimum estimate 10,705, maximum estimate 34,625). An ideal scenario in which salt and fat intakes are reduced to the low levels observed in Group 1 and 2 could lead to approximately 14,235 (minimum estimate 6,680, maximum estimate 22,525) fewer coronary deaths and approximately 7,820 (minimum estimate 4,025, maximum estimate 12,100) fewer stroke deaths, comprising almost 13% mortality reduction. CONCLUSIONS: This study shows a substantial potential for reducing the cardiovascular disease burden through a healthier food system. It highlights the crucial importance of implementing healthier UK food policies.

Impact of ultra-processed foods on micronutrient content in the Brazilian diet / Impacto de alimentos ultraprocessados sobre o teor de micronutrientes da dieta no Brasil

OBJECTIVE To evaluate the impact of consuming ultra-processed foods on the micronutrient content of the Brazilian population's diet.METHODS This cross-sectional study was performed using data on individual food consumption from a module of the 2008-2009 Brazilian Household Budget Survey. A representative sample of the Brazilian population aged 10 years or over was assessed (n = 32,898). Food consumption data were collected through two 24-hour food records. Linear regression models were used to assess the association between the nutrient content of the diet and the quintiles of ultra-processed food consumption - crude and adjusted for family incomeper capita.RESULTS Mean daily energy intake per capita was 1,866 kcal, with 69.5% coming from natural or minimally processed foods, 9.0% from processed foods and 21.5% from ultra-processed foods. For sixteen out of the seventeen evaluated micronutrients, their content was lower in the fraction of the diet composed of ultra-processed foods compared with the fraction of the diet composed of natural or minimally processed foods. The content of 10 micronutrients in ultra-processed foods did not reach half the content level observed in the natural or minimally processed foods. The higher consumption of ultra-processed foods was inversely and significantly associated with the content of vitamins B12, vitamin D, vitamin E, niacin, pyridoxine, copper, iron, phosphorus, magnesium, selenium and zinc. The reverse situation was only observed for calcium, thiamin and riboflavin.CONCLUSIONS The findings of this study highlight that reducing the consumption of ultra-processed foods is a natural way to promote healthy eating in Brazil and, therefore, is in line with the recommendations made by the Guia Alimentar para a População Brasileira (Dietary Guidelines for the Brazilian Population) to avoid these foods.

OBJETIVO Avaliar o impacto da ingestão de alimentos ultraprocessados sobre o teor de micronutrientes na alimentação da população brasileira.MÉTODOS Estudo transversal realizado com dados do módulo sobre consumo alimentar individual da Pesquisa de Orçamentos Familiares 2008-2009, aplicado a uma amostra representativa da população brasileira com dez ou mais anos de idade (n = 32.898). Informações sobre o consumo alimentar foram obtidas por dois registros diários da alimentação. Análises de regressão linear foram empregadas para descrever a direção e o significado estatístico da associação entre quintos do consumo relativo de alimentos ultraprocessados e o teor de micronutrientes na dieta, sem e com ajuste para renda familiar.RESULTADOS O consumo médio diário per capita de energia foi de 1.866 kcal, sendo 69,5% proveniente de alimentos in natura ou minimamente processados (incluídas as preparações culinárias feitas com base nesses alimentos), 9,0% de alimentos processados e 21,5% de alimentos ultraprocessados. Para 16 dos 17 micronutrientes estudados, o teor médio encontrado na fração do consumo alimentar relativa aos alimentos ultraprocessados foi inferior ao da fração relativa aos alimentos in natura ou minimamente processados. O teor de 10 micronutrientes presentes nos alimentos ultraprocessados não chegou à metade do observado nos alimentos in natura ou minimamente processados. O aumento da participação dos alimentos ultraprocessados na dieta mostrou-se inversa e significativamente associado ao teor de vitaminas B12, D, E, niacina e piridoxina e de cobre, ferro, fósforo, magnésio, selênio e zinco. Situação oposta foi observada apenas para cálcio, tiamina e riboflavina.CONCLUSÕES Os achados deste estudo mostram que a redução no consumo de alimentos ultraprocessados é um caminho natural para a promoção da alimentação saudável no Brasil e, portanto, apoiam a recomendação do Guia Alimentar para a População Brasileira quanto a se evitar o consumo desses alimentos.

Ultra-processed foods and the nutritional dietary profile in Brazil / Alimentos ultraprocessados e perfil nutricional da dieta no Brasil

OBJECTIVE To assess the impact of consuming ultra-processed foods on the nutritional dietary profile in Brazil.METHODS Cross-sectional study conducted with data from the module on individual food consumption from the 2008-2009 Pesquisa de Orçamentos Familiares (POF - Brazilian Family Budgets Survey). The sample, which represented the section of the Brazilian population aged 10 years or over, involved 32,898 individuals. Food consumption was evaluated by two 24-hour food records. The consumed food items were classified into three groups: natural or minimally processed, including culinary preparations with these foods used as a base; processed; and ultra-processed.RESULTS The average daily energy consumption per capita was 1,866 kcal, with 69.5% being provided by natural or minimally processed foods, 9.0% by processed foods and 21.5% by ultra-processed food. The nutritional profile of the fraction of ultra-processed food consumption showed higher energy density, higher overall fat content, higher saturated and trans fat, higher levels of free sugar and less fiber, protein, sodium and potassium, when compared to the fraction of consumption related to natural or minimally processed foods. Ultra-processed foods presented generally unfavorable characteristics when compared to processed foods. Greater inclusion of ultra-processed foods in the diet resulted in a general deterioration in the dietary nutritional profile. The indicators of the nutritional dietary profile of Brazilians who consumed less ultra-processed foods, with the exception of sodium, are the stratum of the population closer to international recommendations for a healthy diet.CONCLUSIONS The results from this study highlight the damage to health that is arising based on the observed trend in Brazil of replacing traditional meals, based on natural or minimally processed foods, with ultra-processed foods. These results also support the recommendation of avoiding the consumption of these kinds of foods.

OBJETIVO Avaliar o impacto do consumo de alimentos ultraprocessados sobre o perfil nutricional da dieta.MÉTODOS Estudo transversal com dados obtidos do módulo sobre consumo alimentar de indivíduos da Pesquisa de Orçamentos Familiares 2008-2009. A amostra, representativa da população brasileira de 10 ou mais anos de idade, envolveu 32.898 indivíduos. O consumo alimentar foi avaliado por meio de dois registros alimentares de 24h. Os alimentos consumidos foram classificados em três grupos: in natura ou minimamente processados, incluindo preparações culinárias à base desses alimentos; processados; e ultraprocessados.RESULTADOS O consumo médio diário de energia per capita foi de 1.866 kcal, sendo 69,5% proveniente de alimentos: in natura ou minimamente processados, 9,0% de alimentos processados e 21,5% de alimentos ultraprocessados. O perfil nutricional da fração do consumo relativo a alimentos ultraprocessados mostrou maior densidade energética, maior teor de gorduras em geral, de gordura saturada, de gordura trans e de açúcar livre e menor teor de fibras, de proteínas, de sódio e de potássio, quando comparado à fração do consumo relativa a alimentosin natura ou minimamente processados. Alimentos ultraprocessados apresentaram, no geral, características desfavoráveis quando comparados aos alimentos processados. Maior participação de alimentos ultraprocessados na dieta determinou generalizada deterioração no perfil nutricional da alimentação. Os indicadores do perfil nutricional da dieta dos brasileiros que menos consumiram alimentos ultraprocessados, com exceção do sódio, aproximam este estrato da população das recomendações internacionais para uma alimentação saudável.CONCLUSÕES Os resultados indicam prejuízos à saúde decorrentes da tendência observada no Brasil de substituir refeições tradicionais baseadas em alimentosin naturaou minimamente processados por alimentos ultraprocessados e apoiam a recomendação para ser evitado o consumo desses alimentos.

Parent's social status and children's nutrition influence on the university entrance of young adults in the last two decades in Brazil.

INTRODUCTION: The analysis of social indicators and health status of parents and children is a preferred way to estimate the potential for social mobility in different societies or different periods in the same society. OBJECTIVE: To analyze the evolution of educational and nutritional status of the Brazilian families by an intergenerational approach. METHODS: A representative sample of the Brazilian population, consisting of parents (35 to 65 years old) and young adults (20 to 24 years old) obtained from three national surveys NHNS (1989), HBS (2003 and 2009). We performed a descriptive analysis and, for the sons, we calculated the probability of starting college using the multilevel logistic regression with random intercept model. RESULTS: The advance of the nutritional status of young people was statistically higher than to their parents (p < 0.005). Social conditions experienced in childhood and family status had great influence on their later school success. CONCLUSION: These data indicate improvements in social status controlled by the nutritional status, initiated in the period of 1989-2003. Although inequality persists in the country, the family's influence declined in the period 2003-2009.

Trends in spending on eating away from home in Brazil, 2002-2003 to 2008-2009.

The study aims to describe trends in food consumption away from home in Brazil from 2002-2003 to 2008-2009 and to analyze the influence of income on this behavior. The authors used data collected by the Household Budget Surveys conducted by the Brazilian Institute of Geography and Statistics (IBGE) in 2002-2003 and 2008-2009. The information analyzed in this study involves records of food and beverage purchases for consumption away from home. Trends in eating away from home were estimated for the total population and according to demographic and economic strata. The association between the share of food consumed away from home and income was studied using regression models to estimate income elasticity coefficients. The share of eating away from home increased 25% during the period, reaching 28% of total spending on food. Each 10% increase in mean per capita income leads to a 3.5% increase in the share of food consumed away from home. This suggests that income growth will result in future increases in the share of eating away from home.