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.

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.

Momentos alimentarios y consumo de productos ultraprocesados durante el día, Antioquia, Colombia / Food moments and comsumption of ultraprocessed products during the day, Antioquia, Colombia

Introducción. La acelerada transición nutricional en Latinoamérica ha modificado los patrones alimentarios, favoreciendo dietas con mayor participación de productos industrializados y alto aporte de nutrientes relacionados con enfermedades crónicas como grasas (saturadas, trans), sodio, azúcar libre y densidad de energía. Objetivo. Describir los momentos alimentarios de consumo de productos comestibles ultraprocesados (PCUP) durante el día en Antioquia, Colombia. Materiales y métodos. Estudio descriptivo transversal, usando datos de consumo de alimentos del Perfil Alimentario y Nutricional de Antioquia 2019 y del Perfil de Seguridad Alimentaria y Nutricional de Medellín 2015, en población general, muestra de 13494 individuos. Los alimentos se clasificaron según NOVA y se agruparon en subcategorías. Se calculó la media de energía consumida y su desviación estándar (confianza del 95%) para las categorías NOVA y subcategorías, además su distribución en los momentos alimentarios. Resultados. Para la población de Medellín (capital de Antioquia), en promedio el 54,7% de la energía venia de alimentos no procesados, 17,3% de ingredientes culinarios, y 20,4% de PCUP. En la población de Antioquia, 56,0% de la energía se obtuvo de alimentos no procesados, 18,8% de ingredientes culinarios y 17,0% de PCUP. En los momentos alimentarios principales (desayuno, almuerzo y cena) los alimentos no procesados tienen mayor aporte energético. Mientras que los momentos alimentarios con mayor porcentaje de energía proveniente de PCUP fueron la media mañana, el algo y la merienda. Conclusiones. Para los antioqueños el mayor riesgo de consumo de PCUP relacionados con la obesidad y las enfermedades crónicas se presenta entremedio de las comidas principales(AU)

Introduction. The accelerated nutritional transition in Latin America has modified dietary patterns, favoring diets with a greater participation of industrialized products and a high contribution of nutrients related to chronic diseases such as fats (saturated, trans), sodium, free sugar, and energy density. Objective. To describe the dietary moments of consumption of ultra-processed foods (UPF) during the day in Antioquia, Colombia. Materials and methods. Cross-sectional descriptive study using food consumption data from the Food and Nutrition Profile of Antioquia 2019 and the Food and Nutrition Security Profile of Medellín 2015, in general population, sample of 13,494 individuals. Foods were classified according to NOVA and grouped into subcategories. The mean energy consumed and its standard deviation (95% confidence), were calculated for the NOVA categories and subcategories, as well as its distribution at feeding times. Results. for the population of Medellín (capital of Antioquia), on average 54.7% of the energy came from unprocessed foods, 17.3% from culinary ingredients, and 20.4% from UPF. In the population of Antioquia, 56.0% of the energy was obtained from unprocessed foods, 18.8% from culinary ingredients, and 17.0% from UPF. At the main eating moments (breakfast, lunch, and dinner) unprocessed foods have a greater energy contribution. While the food moments with the highest percentage of energy coming from UPF were mid-morning snacks and snacks. Conclusions. For Antioqueños the greatest risk of consuming UPFs related to obesity and chronic diseases occurs between main meals(AU)

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.

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.

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.

Trend of Ultraprocessed Product Intake Is Associated with the Double Burden of Malnutrition in Mexican Children and Adolescents.

BACKGROUND: Ultraprocessed products (UPPs) have been associated with unfavorable health outcomes; however, until now, they have not been associated with the coexistence of undernutrition and overnutrition, known as the double burden of malnutrition (DBM) at the individual level. METHODS: Cross-sectional analyses were performed on data collected from children and adolescents participating in the 2006 and 2016 Mexican National Health and Nutrition Surveys. The food and beverages reported in the food frequency questionnaire (SFFQ) were classified as UPPs as defined by the NOVA classification system. Associations of UPPs with anemia, excess weight, and the DBM were estimated with logistic regression models. A pseudo-panel was generated using the cohorts of children born from 1997 to 2001 to estimate the effect of the UPPs on anemia, excess weight, and the DBM. RESULTS: The consumption of UPPs (% energy) was higher in 2016 (children 30.1% and adolescents 28.3%) than in 2006 (children 27.3% and adolescents 23.0%) in both age-groups. The higher contribution of UPPs was positively associated with excess weight and the DBM in children's lower tertile of socioeconomic status (SES) and the DBM in higher tertile of SES in adolescents. The pseudo-panel analysis shows the positive association between UPPs and DBM in lower SES. CONCLUSIONS: These results provide evidence of the association between the consumption of UPPs and the DBM and excess weight in children and adolescents.

Current perspectives on food: from nutritionism to healthy, supportive, and sustainable food / Perspectivas actuales sobre alimentación: del nutricionismo a la alimentación saludable, solidaria y sustentable

Abstract Of the many discourses on nutrition and food, two opposing perspectives stand out. On the one hand, "nutritionism" emerged strongly in the last decades, reducing the concept of food to the presence or absence of nutrients and the concept of health to the absence of diseases, a discourse that has influenced modern nutritional and food sciences, as well as the conceptualization of the current corporate food regime. On the other hand, "healthy, supportive, and sustainable food" is a re-emerging perspective associated with the traditional ancestral food system and is founded on the principle of common good since millennia ago. This paper presents a reflection on these two perspectives, taking into account the historical scenario and the socio-political context that characterize them, in order to contribute to the recognition of a food paradigm consistent with the Millennium Development Goals and the human right to food. In addition, this reflection aims to assess the progress that has been made in Colombia to achieve healthy, supportive, and sustainable eating practices in the general population.

Resumen Entre los múltiples discursos sobre nutrición y alimentación, hay dos perspectivas opuestas que se destacan: por una parte, el "nutricionismo", que emergió con gran protagonismo en las últimas décadas y reduce el concepto de alimentación a la presencia o no de nutrientes, y el de salud, a la ausencia de enfermedades, discurso que ha influenciado las ciencias nutricionales y alimentarias modernas y la conceptualización del actual régimen alimentario corporativo, y por otra parte, la "alimentación saludable, solidaria y sustentable", una perspectiva reemergente asociada al sistema alimentario tradicional ancestral constituido a partir de la ética del bien común desde hace miles de años. El presente artículo presenta una reflexión sobre estas dos perspectivas, teniendo en cuenta el panorama histórico y el entorno sociopolítico que las caracterizan, con el propósito de contribuir al reconocimiento de un paradigma alimentario que esté en línea con los objetivos de desarrollo del milenio y con el derecho humano a la alimentación. Además, esta reflexión pretende valorar los avances que se han realizado en Colombia para lograr una alimentación saludable, solidaria y sustentable en la población general.

[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.

Productos procesados y ultraprocesados y su relación con la calidad de la dieta en niños

[RESUMEN]. Objetivo. Estimar el efecto que representa en la calidad de la dieta de la primera infancia uruguaya —niños de 2 a 4 años— el consumo de productos que contienen cantidades excesivas de nutrientes críticos asociados a las enfermedades no transmisibles (ENT) (azúcares libres, grasas totales, grasas saturadas y sodio), según el modelo de perfil de nutrientes de la Organización Panamericana de la Salud (OPS). Métodos. Se utilizó un recordatorio de ingesta de alimentos durante 24 horas en una muestra representativa de 401 participantes de la Encuesta de Nutrición, Desarrollo Infantil y Salud del año 2018. Se usó la clasificación de alimentos propuesta por el sistema NOVA para categorizarlos según su naturaleza y los procesos industriales a los que son sometidos. A partir de esto se lo analizó con base en el modelo de perfil de nutrientes de la OPS, lo cual permitió identificar los productos con contenido excesivo de estos nutrientes. Resultados. El 50 % de los niños consumieron tres o más productos con exceso de alguno de los nutrientes vinculados con las ENT. Aproximadamente 9 de cada 10 niños consumen productos con exceso de al menos uno de los nutrientes críticos estudiados. Conclusión. Las dietas que no contienen productos ultraprocesados y procesados con exceso de azúcares libres, grasas totales, grasas saturadas y sodio fueron la mejor opción para los niños de 2 a 4 años. La ingesta de productos con exceso de nutrientes críticos según la OPS (y cada gramo adicional consumido de tales productos) empeora la calidad de la dieta de manera significativa, e impide que se cumpla con las recomendaciones de la Organización Mundial de la Salud.

[ABSTRACT]. 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.

[RESUMO]. 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.

Policy action initiatives against obesity in Colombia: a literature review using the NOURISHING framework methodology Colombian policy actions against obesity / Iniciativas de acción de política contra la obesidad en Colombia: una revisión de la literatura a partir de la metodología del marco NOURISHING

Abstract Introduction: In Colombia, obesity is a public health problem that must be addressed by the government through policy action initiatives (PAIs), that is, governmental actions that may or may not be implemented. Objective: To identify PAIs and policy action evaluations (PAEs) against obesity formulated in Colombia since 2005 using the NOURISHING framework methodology. Materials and methods: The search for evidence was conducted between March and August 2019 (with an update in August 2020) as follows: PAIs in government and civil society organization websites. and PAEs in PubMed, SciELO and the Sinergia repository. PAIs were classified according to NOURISHING policy areas. Results: A total of 42 PAIs with 82 lines of action were found: 16 (24 lines) implemented, 17 (37 lines) not implemented, and 9 (21 lines) with insufficient information to determine their implementation (21 lines). These PAIs encompassed all the NOURISHING framework policy areas. The implemented PAIs have more lines of action in the "Harness food supply chain and actions across sectors" area (8/24), while those that have not been implemented have more lines in the "Restrict food and beverage advertising" area (10/37). There were 13 PAEs, and most of them were about food security PAIs focused on food supply (4/13). Conclusions: Colombia has PAIs against obesity that address all the policy areas of the NOURISHING framework. Implemented PAIs focus on food supply, while non-implemented PAIs focus on regulatory measures. A greater government commitment is required in the implementation of PAIs that allow improving the dietary habits of the Colombian population, which will help reduce obesity rates in the country in the medium and long term.

Resumen Introducción. En Colombia, la obesidad es un problema de salud pública que el gobierno debe abordar mediante iniciativas de acción de política (IAP), es decir, acciones gubernamentales que pueden estar implementadas o no. Objetivo. Identificar, mediante la metodología del marco NOURISHING, las IAP y las evaluaciones de acción de política (EAP) contra la obesidad formuladas en Colombia desde 2005. Materiales y métodos. La búsqueda de la evidencia se realizó entre marzo y agosto de 2019 (con una actualización en agosto de 2020) de la siguiente manera: IAP: en sitios web del gobierno y de organizaciones de la sociedad civil; EAP: en PubMed, SciELO y el repositorio Sinergia. Las IAP se clasificaron en las áreas de política del marco NOURISHING. Resultados. Se encontraron 42 IAP con 82 líneas de actuación: 16 (24 líneas) implementadas, 17 (37 líneas) no implementadas, y 9 (21 líneas) sin información suficiente para determinar su implementación (21 líneas). Las IAP abordan todas las áreas de política del marco NOURISHING. Las IAP implementadas tienen más líneas en el área "Habilitar acciones multisectoriales y de suministro de alimentos" (8/24), mientras que las no implementadas, en "Restringir la publicidad de alimentos y bebidas" (10/37). Se identificaron 13 EAP, donde la mayoría fueron sobre IAP en seguridad alimentaria orientadas al suministro de alimentos (4/13). Conclusiones. Colombia tiene IAP contra la obesidad que abarcan todas las áreas de política del marco NOURISHING. Las IAP implementadas se enfocan en el suministro de alimentos y las no implementadas, en medidas regulatorias. Se requiere un mayor compromiso del gobierno en la implementación de IAP sobre medidas regulatorias que permitan mejorar los hábitos alimentarios de la población colombiana, lo que, en el mediano y largo plazo, ayudará a reducir las tasas de obesidad en el país en el mediano y largo plazo.

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.

A Semi-quantitative Food Frequency Questionnaire Has Relative Validity to Identify Groups of NOVA Food Classification System Among Mexican Adults.

BACKGROUND: Ultra-processed foods are recognized as indicators of an unhealthy diet in epidemiological studies. In addition to ultra-processed foods, the NOVA food classification system identifies three other groups with less processing. Unprocessed foods that, together with minimally processed foods (MPF), make NOVA group 1, NOVA group 2 is processed culinary ingredients, and NOVA group 3 is processed foods. OBJECTIVE: To assess the relative validity of the semi-quantitative food frequency questionnaire (SFFQ) to estimate the energy intake for each group NOVA classification system by comparing it with two 24 h-dietary-recall (24DRs) Mexican adults. METHODS: We analyzed dietary information from 226 adults included <60 and ≥60 years with complete SFFQ and two 24DRs from the National Health and Nutrition Survey 2012. We reported mean differences, Spearman correlation coefficients, intra-class correlations coefficients, Bland-Altman plots, and weighted kappa between measures. RESULTS: The percentage energy intake from unprocessed and minimally processed foods group, Spearman correlation coefficients was 0.54 in adults <60 years and 0.42 in adults ≥60 years, while ultra-processed foods group was 0.67 and 0.48, respectively. The intra-class correlation coefficients in the unprocessed and minimally processed foods group was 0.51 in adults <60 years and 0.46 in adults ≥60 years, and for the ultra-processed foods group were 0.71 and 0.50, respectively. Bland-Altman plots indicated reasonably consistent agreement for unprocessed and minimally processed foods group and ultra-processed foods group in adults <60 years and adults in the ≥60 age group. Weighted kappa was 0.45 in the ultra-processed foods group to adults <60 years and was 0.36-≥60 years. CONCLUSION: The SFFQ had acceptable validity to rank the percentage of energy intake from unprocessed and minimally processed foods group and ultra-processed foods group in Mexican adults, both in adults under 60 years and who were 60 years old or older.

"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.

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.

Relative Validity of a Semi-Quantitative Food Frequency Questionnaire to Estimate Dietary Intake According to the NOVA Classification in Mexican Children and Adolescents.

BACKGROUND: Ultra-processed foods (UPFs) are associated with poor diet quality and chronic diseases. UPFs fall into 1 of the following 4 groups classified according to the extent and purpose of processing: group 1 is unprocessed or minimally processed foods (MPFs); group 2 is processed culinary ingredients; group 3 is processed foods; and group 4 is UPFs. OBJECTIVE: The aim of this study was to evaluate the relative validity of a semi-quantitative food frequency questionnaire (SFFQ) compared with two 24-hour dietary recalls (24DRs) `to estimate dietary intake per NOVA food group in Mexican children and adolescents. DESIGN: This study is a secondary analysis of dietary data from a subsample of children and adolescents who participated in the 2012 Mexican National Health and Nutrition Survey. PARTICIPANTS/SETTING: The study participants were 217 children (aged 5 through 11 years) and 165 adolescents (aged 12 through 19 years) with complete information for the SFFQ and two 24DRs. MAIN OUTCOME MEASURES: Daily averages of energy intake and percent of energy intake for each NOVA category were calculated using the SFFQ and two 24DRs. STATISTICAL ANALYSIS: To assess relative validity, the SFFQ was compared with two 24DRs to estimate dietary intake per NOVA food group. Mean differences, Spearman correlations, intraclass correlations coefficients (ICCs), and Bland-Altman plots for continuous variables and weighted κ for ordinal variables were calculated. RESULTS: For percentage of energy intake, ICCs in children and adolescents were moderate for MPFs (ICC = 0.47 and ICC = 0.56, respectively) and UPFs (ICC = 0.53 and ICC = 0.57, respectively). Bland-Altman plots indicated reasonably consistent agreement for UPFs and MPFs groups in children and adolescents. Classification by quintiles was acceptable in all groups. CONCLUSIONS: Data from this study indicated reasonable relative validity of the SFFQ to rank the percentage of energy intake from MPFs and UPFs in Mexican children and adolescents.

Minimum dietary diversity in Mexico: establishment of cutoff point to predict micronutrients adequacy.

OBJECTIVE: To establish the cutoff point for a Minimum Dietary Diversity (MDD) that most accurately predicts the Mean Probability Adequacy (MPA) of 11 micronutrients in the Mexican population, and estimate the population prevalence above it. SUBJECTS AND METHODS: We analyzed a 24 h-recall collected in a sample of 10,087 participants (≥1-year-old) from the 2012 Mexican National Health and Nutrition Survey. Foods were classified into ten food group indicators (FGIs) of the Food Agriculture Organization (FAO). The cutoff points of MDD were established as follows: (1) sum of the number of FGIs in the participant's diet; (2) micronutrient intake adequacy estimated by the probability approach method of the FAO; (3) Receiver operating characteristic curves generated by age groups to assess the performance of the number FGIs consumed in predicting the MPA. RESULTS: The cutoff points of MMD established by age groups were: ≥4 FGIs in preschool-aged children (75.94% of sensitivity and 72.55% of specificity); ≥5 FGIs in school-aged children (60.51% of sensitivity and 72.82% of specificity) and adolescents (70.01% of sensitivity and 59.38% of specificity); and six in adults (62.26% of sensitivity and 70.33% of specificity) and elders (66.67% of sensitivity and 73.33% of specificity). Based on these cutoff points, we observed that 75% of the preschool-aged children, ~60% of school-aged children and adolescents, and less than 40% of adults and elders were above the MDD. CONCLUSION: This study provides novel insight into the specific MDD cutoff point to predict micronutrient adequacy in the Mexican population.

Ultraprocessed food consumption and dietary nutrient profiles associated with obesity: A multicountry study of children and adolescents.

This study assessed associations between ultraprocessed food consumption and dietary nutrient profile linked to obesity in children and adolescents in Argentina, Australia, Brazil, Chile, Colombia, Mexico, the United Kingdom, and the United States using nationally representative data collected between 2004 and 2014. Linear regression models were used to evaluate associations between dietary share of ultraprocessed foods (country and age group-specific quintiles and a 10% share increase) and the energy density of diets and their content of free sugars and fiber. Ultraprocessed foods, defined by the NOVA system, ranged from 18% of total energy intake among preschool children in Colombia to 68% among adolescents in the United Kingdom. In almost all countries and age groups, increases in the dietary share of ultraprocessed foods were associated with increases in energy density and free sugars and decreases in fiber, suggesting that ultraprocessed food consumption is a potential determinant of obesity in children and adolescents. Effective global policy action to address growing ultraprocessed food consumption and childhood obesity is urgently needed.