Premature Deaths Attributable to the Consumption of Ultraprocessed Foods in Brazil.

INTRODUCTION: Ultraprocessed foods have been associated with an increased risk of noncommunicable diseases, such as diabetes, cardiovascular diseases, and cancer as well as all-cause mortality. The study aimed to estimate premature deaths attributable to the consumption of ultraprocessed food in Brazil. METHODS: A comparative risk assessment model was developed on the basis of RRs from a recent meta-analysis, national food consumption for 2017-2018, and demographic and mortality data for 2019. Population attributable fractions for all-cause mortality were then estimated within each sex and age stratum according to the distribution of the ultraprocessed food contribution to the total energy of the diet. Analysis was conducted in February 2022-April 2022. RESULTS: The contribution of ultraprocessed foods to the total energy intake of the diet across sex and age stratum of Brazilian adults ranged from 13% to 21% of the total energy intake. A total of 541,160 adults aged 30‒69 years died in 2019. The consumption of ultraprocessed foods was responsible for approximately 57,000 premature deaths (95% uncertainty interval=33,493, 82,570) or 10.5% of all premature deaths in adults aged 30‒69 years. Reducing the contribution of ultraprocessed foods to the total energy intake by 10%‒50% could potentially prevent 5,900 deaths (95% uncertainty interval=2,910, 10,613) to 29,300 deaths (95% uncertainty interval=16,514, 44,226), respectively. CONCLUSIONS: The consumption of ultraprocessed foods represents a significant cause of premature death in Brazil. Reducing ultraprocessed food intake would promote substantial health gains for the population and should be a food policy priority to reduce premature mortality.

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.

Ultra-processing. An odd 'appraisal'.

It is now generally agreed that the impact of the current nature, purpose and extent of food processing on human well-being, health and disease needs to be better understood and explained, in order to improve public health. The special issue of Public Health Nutrition devoted to the concept of ultra-processing of food, and the NOVA classification of which ultra-processed foods are one category, is a great step forward in this work. Coincidentally, a polemical 'critical appraisal' of ultra-processing was recently published in another journal. Debate and discussion are an essential part of the scientific endeavour. In this commentary, we correct inaccurate statements made about NOVA in the 'appraisal,' rebut points raised, and discuss the larger issue of scientific responsibility for publishing opposing views on controversial topics.

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.

Percepção e atitudes maternas em relação às orientações de profissionais de saúde referentes a práticas alimentares no primeiro ano de vida / Maternal perception and attitudes regarding healthcare professionals' guidelines on feeding practices in the child's first year of life

OBJETIVO: Avaliar a percepção e as atitudes maternas relacionadas à adesão às orientações de profissionais de saúde sobre aleitamento materno e alimentação complementar e fatores associados. MÉTODOS: Análise transversal de dados de ensaio de campo randomizado, em que foram sorteadas 20 Unidades de Saúde (US) de Porto Alegre-RS das oito gerências distritais de saúde do município. Gestantes atendidas nestas US foram selecionadas e, aos 6-9 meses de idade das crianças, foram obtidos, em visitas domiciliares, dados quanto à percepção materna de adesão às orientações dos profissionais e de consequências das práticas alimentares na saúde da criança. Análises de associação foram realizadas por meio de Regressão de Poisson. RESULTADOS: Foram obtidos dados de 631 binômios mãe-criança. Conforme a percepção das mães, 47% relataram não seguir orientações recebidas nas US. Dentre essas, 45,7% não reconhecem a importância da alimentação para a saúde da criança. A percepção de adesão às orientações dos profissionais foi associada com maiores prevalências de aleitamento materno exclusivo (AME), introdução de alimentos sólidos (IAS) após quatro meses e introdução de alimentos não recomendados após seis meses, além de maior renda familiar. Observaram-se maiores prevalências de AME e IAS após quatro meses (p < 0,05) entre as mães que acreditam na importância da alimentação para a saúde da criança. CONCLUSÃO: Houve elevada prevalência de mães que não seguem as orientações dos profissionais de saúde e a percepção de que a alimentação não influencia a saúde da criança pode ser uma barreira para melhorias nas práticas alimentares na infância.

OBJECTIVE: To evaluate the maternal perceptions and attitudes related to adherence to healthcare professionals' guidelines on breastfeeding and complementary feeding, and associated factors. METHODS:A cross-sectional analysis of data from a randomized field trial was performed, in which 20 health centers (HCs) were selected in the city of Porto Alegre, state of Rio Grande do Sul, from eight Health Management Districts of the city. Pregnant women were selected from these HCs, and when the children were aged between six and nine months, data regarding the maternal perception of adherence to professional advice and consequences of feeding practices on child health were obtained during home visits. Association analyses were performed using Poisson regression. RESULTS: Data were collected from 631 mother-child binomials. According to the mothers' perception, 47% reported not following instructions received in the HC. Among these, 45.7% did not recognize the importance of eating habits for the child's health. The perception of adherence to professional advice was associated with higher prevalence of exclusive breastfeeding (EBF), introduction of solid food (ISF) after four months, introduction of non-recommended foods after six months, and higher family income. A higher prevalence of EBF and ISF was observed after four months (p < 0.05) among mothers who believed in the importance of feeding habits for the child's health. CONCLUSION: There was a high prevalence of mothers who did not follow the advice of health professionals; the perception that food does not affect the child's health can be a barrier to the improvement of eating habits in childhood.

Maternal perception and attitudes regarding healthcare professionals' guidelines on feeding practices in the child's first year of life.

OBJECTIVE: To evaluate the maternal perceptions and attitudes related to adherence to healthcare professionals' guidelines on breastfeeding and complementary feeding, and associated factors. METHODS: A cross-sectional analysis of data from a randomized field trial was performed, in which 20 health centers (HCs) were selected in the city of Porto Alegre, state of Rio Grande do Sul, from eight Health Management Districts of the city. Pregnant women were selected from these HCs, and when the children were aged between six and nine months, data regarding the maternal perception of adherence to professional advice and consequences of feeding practices on child health were obtained during home visits. Association analyses were performed using Poisson regression. RESULTS: Data were collected from 631 mother-child binomials. According to the mothers' perception, 47% reported not following instructions received in the HU. Among these, 45.7% did not recognize the importance of eating habits for the child's health. The perception of adherence to professional advice was associated with higher prevalence of exclusive breastfeeding (EBF), introduction of solid food (ISF) after four months, introduction of non-recommended foods after six months, and higher family income. A higher prevalence of EBF and ISF was observed after four months (p < 0.05) among mothers who believed in the importance of feeding habits for the child's health. CONCLUSION: There was a high prevalence of mothers who did not follow the advice of health professionals; the perception that food does not affect the child's health can be a barrier to the improvement of eating habits in childhood.