Food Consumption Inequalities in Primary Care in a Large Metropolis.

The aim of this study was to examine the association between health vulnerability and food consumption according to the NOVA classification within primary care in a major Brazilian city. A cross-sectional study was conducted among adults over 20 years old. These participants were part of a representative sample from the Health Academy Program (PAS) in Belo Horizonte, Brazil. We evaluated socio-demographic variables, self-reported illnesses, perceived health and quality of life, and the length of participation in PAS. Health vulnerability was gauged through the Health Vulnerability Index (HVI), which is calculated for each census sector and classified as low, medium, and high/very high. On the other hand, food consumption was determined by evaluating the average consumption described in a 24 h diet recall (24HR) and categorizing it under the NOVA classification: culinary preparations, processed foods, and ultra-processed foods (UPFs). The average calorie intake was 1429.7 kcal, primarily from culinary preparations (61.6%) and UPFs (27.4%). After adjustments, individuals residing in high/very high-HVI areas consumed more culinary preparations (ß = 2.7; 95%CI: 4.7; 0.7) and fewer UPFs (ß = -2.7; 95%CI: -4.7; -0.7) compared to those from low-vulnerability areas. PAS participants residing in more vulnerable areas reported healthier dietary habits, consuming more homecooked meals and fewer UPFs. These findings underscore the importance of concentrating efforts on promoting and preserving healthy eating habits and emphasizing the value of home cooking in the most vulnerable regions.

Differential dietary intake and contribution of ultra-processed foods during pregnancy according to nutritional status.

Introduction: Frequent consumption of ultra-processed foods (UPFs) during pregnancy is linked to excess intake of added sugar, fat, and sodium and inadequacy of several micronutrients. Diet quality during pregnancy should be maximized as inadequate levels of key nutrients and excessive intake of energy and added sugar might influence mother-child health. We aimed to estimate the contribution (% of total calories) of ultra-processed products to the total energy intake by pre-gestational body mass index (BMI) categories and Hb status during pregnancy in participants from the MAS-Lactancia Cohort. Methods: Pre-gestational weight, hemoglobin levels, 24-h dietary intake recall interviews, and sociodemographic data were collected during the second and third trimesters of pregnancy. Reported consumed foods were categorized using the NOVA classification, and the contribution of calories from each NOVA category was estimated using the Mexican Food Database. We estimated medians and interquartile ranges (p25 and p75) for dietary intake and energy contributions. The comparison of intake between the second and third trimesters was done using the Wilcoxon test. In addition, a quantile regression model with an interaction between pre-gestational BMI and Hb levels status in tertiles over the percentage of energy from UPFs was adjusted by age and socioeconomic status. Results: The contribution to total energy intake from UPFs was 27.4% in the second trimester and 27% in the third trimester (with no statistical difference). The percentage of energy intake from UPFs was higher in women who started pregnancy with obesity and presented the lowest levels of Hb (1st tertile), 23.1, 35.8, and 44.7% for the 25th, 50th, and 75th percentiles, respectively, compared to those with normal BMI and the highest tertile of Hb levels: 18, 29.0, and 38.6% for the 25th, 50th, and 75th percentiles, respectively. Conclusion: In conclusion, UPF intake in pregnant women is similar to the general population and was higher for those with pre-gestational obesity and the lowest tertile of Hb levels. UPF contributes also to sugar, saturated fat, and sodium, which may adversely affect the health of mothers and their offspring.

Stress and the Consumption of Ultra-Processed Foods during COVID-19's Social Distancing: Are Mental Disorders Mediators in This Association? ELSA-Brasil Results.

The COVID-19 pandemic exacerbated various determinants of mental disorders. Several behavioral changes were observed given this increase, including harmful health consequences, such as excessive consumption of ultra-processed foods (UPFs). To assess this relationship, we investigated the meditational role of symptoms of mental disorders (anxiety and depression) in the association between stress resulting from social distancing during the COVID-19 pandemic and the consumption of UPFs in 3884 Brazilian public employees in a supplementary study of the ELSA-Brasil study. Structural equation models (SEMs) were estimated to assess the direct and indirect effects mediated by symptoms of mental disorders. The results suggested a significant and positive mediational effect of the symptoms of mental disorders on the association between the stress resulting from social distancing and the consumption of UPFs. These findings contribute to informing the need for policies and early interventions in potentially stressful situations, with a focus on the promotion of mental health, and may thus help prevent or reduce the consumption of unhealthy foods.

Effect of a lifestyle intervention among pregnant women with overweight on neonatal adiposity: A randomized controlled clinical trial.

BACKGROUND: The excess neonatal adiposity is considered a risk factor for the development of childhood obesity and the birth weight is a marker of health throughout life. AIMS: To evaluate the effect of a lifestyle intervention conducted among pregnant women with overweight on neonatal adiposity and birth weight. METHODS: A total of 350 pregnant women were recruited and randomly allocated into the control (CG) and intervention (IG) groups. Pregnant women in the IG were invited to participate in three nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed foods, following the NOVA food classification system, which categorizes foods according to the extent and purpose of industrial processing, and the regular practice of physical activity. Neonatal adiposity was estimated using a previously validated anthropometric model. Adjusted linear regression models were used to measure the effect. RESULTS: Adopting the modified intention-to-treat principle, data from 256 neonates were analyzed for birth weight, and data from 163 for body composition estimation. The treatment had no effect on the proportion of fat mass [ß 0.52 (95 % CI -1.03, 2.06); p = .51], fat-free mass [ß -0.50 (95 % CI -2.45, 1.45); p = .61] or birth weight [ß 53.23 (95 % CI -87.19, 193.64); p = .46]. CONCLUSIONS: In the present study, the lifestyle counselling used had no effect on neonatal adiposity or birth weight. Future studies should investigate the effect of more intensive interventions.

Contribution of Ultra-Processed Foods to Weight Gain Recurrence 5 Years After Metabolic and Bariatric Surgery.

BACKGROUND: The aim of this study was to evaluate evolution of ultra-processed food intake and recurrent weight gain in patients who underwent Roux-en-Y gastric bypass. MATERIALS AND METHODS: This study is an observational longitudinal study that evaluated patients who underwent metabolic and bariatric surgery at four time points: before surgery and at 3, 12, and 60 months after surgery. Anthropometric and dietary intake data were collected through two 24-h dietary recalls. All foods consumed were classified according to degree of processing. Recurrent weight gain was considered the difference between current weight and nadir weight. RESULTS: The sample consisted of 58 patients with a mean age of 38.7 ± 8.9 years and 68% female. After 60 months, mean excess weight loss and recurrent weight gain were 73.6 ± 27.2% and 22.5 ± 17.4%. Calorie and macronutrient intake decreased significantly between the pre-surgery period, and 3 and 12 months post-surgery; however, there was no significant difference after 60 months. In relation to food groups or macronutrients, no difference was observed between the pre-surgery period and 60 months post-surgery. The contribution of unprocessed or minimally processed foods to calorie intake gradually decreased after 3 months post-surgery. CONCLUSION: The profile of dietary intake after 60 months of metabolic and bariatric surgery tends to approach that of the pre-surgery period. The contribution of unprocessed and minimally processed foods to calorie intake decreased after 60 months, while ultra-processed food contribution increased.

Carcass traits and morphometry, typification of the Longissimus dorsi muscle and non-carcass components of hair lambs: can biscuit bran completely replace corn? A machine learning approach.

Biscuit bran (BB) is a co-product with worldwide distribution, with Brazil as the second largest cookie producer in the world with 1,157,051 tons. We evaluate the impact of completely replacing corn with BB on the characteristics and morphometry of carcass of purebred and crossbred Morada Nova lambs using machine learning techniques as an auxiliary method. Twenty male lambs from two genetic groups (GG) were used: purebred red-coated Morada Nova (MNR) and crossbred MNR × white-coated Morada Nova (MNF1). Supervised and unsupervised machine learning techniques were used. No interaction (P > 0.05) was observed between diets (D) and genetic groups (GG) and no simple isolated effect was observed for carcass characteristics, qualitative-quantitative typification of the Longissimus dorsi muscle, weight of non-carcass components, weight and yield of commercial cuts and carcass morphometric measurements. The formation of two horizontal clusters was verified: (i) crossed lambs with corn and BB and (ii) purebred lambs fed corn and BB. Vertically, three clusters were formed based on carcass and meat characteristics of native lambs: (i) thermal insulation, body capacity, true yield, and commercial cuts; (ii) choice, performance, physical carcass traits, and palatability; and (iii) yield cuts and non-carcass components. The heatmap also allowed us to observe that pure MN lambs had a greater body capacity when fed BB, while those fed corn showed superiority in commercial cuts, true yields, and non-carcass components. Crossbred lambs, regardless of diet, showed a greater association of physical characteristics of the carcass, performance, palatability, and less noble cuts. Crossbred lambs, regardless of diet, showed a greater association of physical characteristics of the carcass, performance, palatability, and less noble cuts. BB can be considered an alternative energy source in total replacement of corn. Integrating of machine learning techniques is a useful statistical tool for studies with large numbers of variables, especially when it comes to analyzing complex data with multiple effects in the search for data patterns and insights in decision-making on the farm.

Effectiveness of nutritional counseling with overweight pregnant women on child growth at 6 months: A randomized controlled trial.

OBJECTIVE: Studies that have investigated the effect of nutritional counseling during the prenatal period on the follow-up outcomes of children at 6 mo have produced inconclusive results. The present study aimed to investigate the effect of nutritional counseling, based on the NOVA food classification, encouraging the consumption of fresh and minimally processed foods, with overweight adult pregnant women on infant growth at 6 mo of age. METHODS: A randomized controlled trial with 195 pairs of pregnant overweight women and their infants at 6 mo of age was conducted in a Brazilian municipality. The pregnant women were allocated to the control group (CG) or intervention group (IG) at the beginning of the pregnancy. The IG received three sessions of nutrition counseling throughout the pregnancy. Linear regression models were used to investigate the effect of the nutritional counseling on infant growth. RESULTS: One hundred ninety-five mother-infant pairs with complete data were included (96 CG, and 99 IG). The mean ± SD infant weight (g) at 6 mo was 7856.1 ± 1.1, and length (cm) was 67.0 ± 2.9. There were no differences in maternal and newborn characteristics between the groups. In the linear regression models, the counseling had no effect on anthropometric parameters of the infants at 6 mo of age: weight-for-length Z-score (ß 0.089 [95% CI -0.250; 0.427], P = 0.61); length-for-age Z-score (ß 0.032 [95% CI -0.299; 0.363], P = 0.85); weight-for-age Z-score (ß 0.070 [95% CI -0.260; 0.400], P = 0.68); BMI-age Z-score (ß 0.072 [95% CI -0.270; 0.414], P = 0.68). CONCLUSIONS: There was no effect on infant growth at 6 mo of age after the nutritional counseling during pregnancy. Future studies are needed to confirm this hypothesis.

Adherence to the ultra-processed dietary pattern and risk of depressive outcomes: Findings from the NutriNet Brasil cohort study and an updated systematic review and meta-analysis.

BACKGROUND & AIMS: We aimed to analyze the prospective association between adherence to the ultra-processed dietary pattern and risk of depressive outcomes using original data from the NutriNet Brasil cohort and via a systematic review and meta-analysis of observational studies that have investigated the same association. METHODS: In our original research analysis, we used data from 15,960 adults (≥18 y) participating in the NutriNet Brasil cohort study, free of depression or depressive symptoms during the baseline (77.5% women, 45.8 ± 13.0 y). The mean dietary share of ultra-processed foods (%Kcal/d), calculated from two baseline 24-h dietary recalls, was used to measure the adherence to the ultra-processed dietary pattern. New cases of depressive symptoms were assessed using the Patient Health Questionnaire-9 over the follow-up period (mean: 18.3 months). Cox proportional hazards models were used for the main analyses. In our systematic review and meta-analysis, we incorporated effect estimates from six prospective cohort studies that have examined the same association, including ours. RESULTS: In the adjusted model, each 10% increase in the dietary share of ultra-processed foods was associated with a 10% increase in the hazard of incident cases of depressive symptoms (HR:1.10; 95%CI: 1.07-1.14). This association was slightly attenuated in the models including potential mediators. In our meta-analysis of six prospective studies, high versus low exposure to ultra-processed foods was associated with a summary hazard ratio of depressive outcomes of 1.32; 95%CI: 1.19-1.46; I2: 71%. CONCLUSION: A higher adherence to the ultra-processed dietary pattern was associated with a higher risk of developing depressive outcomes in the NutriNet Brasil cohort and in the meta-analysis.

Is Ultra-Processed Food Intake Associated with a Higher Risk of Glaucoma? A Prospective Cohort Study including 19,255 Participants from the SUN Project.

OBJECTIVE: The aim of this study was to examine the relationship of ultra-processed food (UPF) intake with the incidence of glaucoma in a large sample of Spanish university graduates followed prospectively. METHODS: Prospective cohort study using data from the SUN Project. A final sample of 19,225 participants (60.1% women) was included in this study, with a mean age of 38.2 years (standard deviation (SD) = 12.4). Participants were followed-up for a mean time of 12.9 years (SD = 5.4). Dietary intake was measured using a 136-item semiquantitative food-frequency questionnaire. UPFs were defined based on the NOVA classification system. Glaucoma diagnosis was determined by asking the participants if they had ever been diagnosed with glaucoma by an ophthalmologist. This self-reported diagnosis of glaucoma has been previously validated. RESULTS: After adjusting for several covariates, participants with the highest UPF consumption were at higher risk of glaucoma (hazard ratio (HR) = 1.83; 95% confidence interval (CI) 1.06 to 3.17) when compared to participants in the lowest category of UPF consumption. Regarding subgroup analyses, a significant multiplicative interaction was found for age (p = 0.004) and omega 3:6 ratio (p = 0.040). However, an association between UPF consumption and glaucoma was only found in older participants (aged ≥ 55 years), in men, in the most physically active group, in the group of non- or former smokers, in those with a lower omega 3:6 ratio, and in those with a lower energy intake. Regarding the contribution of each type of UPF group, UPF coming from sweets showed a significant risky effect (HR = 1.51; CI 95% 1.07 to 2.12). CONCLUSIONS: This prospective cohort study shows that participants with a greater UPF consumption have a higher risk of developing glaucoma when compared to participants with a lower consumption. Our findings emphasize the relevance of monitoring and limiting the consumption of UPFs as a means of preventing glaucoma incidence.

Dietary intake in children and adolescents with food addiction: A systematic review.

Food addiction (FA) is characterized by behavioral changes related to the consumption of palatable foods, marked by dependence, impulsivity, and compulsion. Children and adolescents are more vulnerable to FA owing to their significant consumption of ultra-processed foods. This review aims to investigate the differences in dietary intake in pediatric populations with and without FA. We conducted a systematic literature review. PubMed, ScienceDirect, and PsycINFO databases were searched up to July 2023. Potentially eligible studies were independently checked by two researchers. The methodological quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross-sectional studies. Of the 4868 articles identified, six studies were included. All the included studies had high methodological quality. High consumption of calories and fat was observed in children and adolescents with FA. A diet quality analysis showed that the consumption of ultra-processed foods, such as sugary drinks, sweets, and chips, was related to FA. Given these findings, we concluded that FA in childhood may be associated with higher energy consumption and, consequently, higher intake of macronutrients. Few studies have examined the relationship between FA and food intake in childhood, and more studies are required.

Increased consumption of ultra-processed foods during pregnancy is associated with sociodemographic, behavioral, and obstetric factors: A cohort study.

A diet based on ultra-processed food (UPF) does not meet nutritional needs, especially during pregnancy. The aim of this study is to assess the change in UPF consumption from preconception to pregnancy and associated factors. Our hypothesis is that women tend to adopt a healthier eating pattern during pregnancy, decreasing the intake of UPF and increasing the intake of unprocessed/minimally processed foods. A prospective cohort study with 326 participants was carried out from 2016 to 2019 in 2 health units in Rio de Janeiro, Brazil. Pregestational food consumption assessed using the food frequency questionnaire in the prenatal interview in women up to 20 gestational weeks and gestational consumption in the interview 2 months after delivery. Food items classified according to the NOVA system. For the mean variation from preconception to gestational UPF consumption, we used the generalized estimating equations model with linear distribution. Control of confounding variables was based on the literature on factors associated with UPF consumption, using a 3-level hierarchical model. The proportion of UPF energy consumption was 28.9% in preconception and 33% during pregnancy. Older and more educated women had a lower mean variation in the consumption of UPF during the pregnancy. A higher average consumption of UPF observed among women physically inactive before pregnancy, who smoked during pregnancy, were multiparous, and with had a low pregestational weight. These results reflect similar behavior to that of the general population, aggravated by a significant increase during pregnancy. However, older and more educated women and those with healthy behaviors showed lower UPF intake in pregnancy.

How and why ultra-processed foods harm human health.

The analysis of food using a perspective centred on nutrients seems inadequate for understanding the dietary transition and its impact on the growth of obesity and chronic diseases. Industrial food processing is now proposed as the key to explain the relationship between food and health. The NOVA food classification considers the degree and the purpose of food processing, which includes physical, biological and chemical processes used after foods are separated from nature, and before being consumed or prepared as dishes and meals. NOVA has four food groups: (1) unprocessed and minimally processed foods; (2) processed culinary ingredients; (3) processed foods and (4) ultra-processed foods, which are formulations made mostly or entirely from substances derived from group 1 foods and additives, with little if any intact group 1 food. Many investigations linking high ultra-processed food consumption with deterioration of diets and adverse health outcomes are reinforced by prospective studies, systematic reviews and meta-analyses. There are various plausible explanations of why diets high in ultra-processed foods are harmful. Their production and consumption continue to rise worldwide. Efficient and effective public policies and actions that reduce production and consumption of ultra-processed products are needed, to protect human health now and in future.

Consumption of critical nutrients and sweeteners related to the risk of chronic diseases in the population of Antioquia, according to the degree of food processing / Consumo de nutrientes críticos y edulcorantes relacionados con el riesgo de enfermedades crónicas en la población antioqueña, según grado de procesamiento de los alimentos

ABSTRACT OBJECTIVE To analyze the consumption of critical nutrients and other sweeteners, according to the degree of food processing in the population of Antioquia. METHODS Cross-Sectional Study. The dietary intake of 4,382 participants of the Perfil Alimentario y Nutricional de Antioquia 2019 (Antioquia Food and Nutrition Profile 2019) was evaluated. Processed foods (PF) and ultra-processed products (UPP) reported by 24-hour recall were classified according to the Nova system. The Nutrient Profile Model (NPM) of the Pan American Health Organization (PAHO) was used. The amount of PF and UPP consumed with excess of critical nutrients related to chronic diseases (CD) was measured. The difference in average intake, the prevalence of excess intake, and the likelihood of inadequacy between groups with and without excess dietary content were assessed. RESULTS Nearly 50% of the PF and UPP consumed had excess in at least one critical nutrient. The population consumed daily one or more products with excess in free sugar (73.3%), total fat (75.2%), saturated fat (77.0%), sodium (83.9%), and/or sweeteners (36.8%). Those who consumed products with excessive amounts had a higher intake of total fat (> 5.8%); saturated fat (> 3.8%); and sodium (> 698.7 mg) in adults and adolescents, in children 5-10 years (> 659.2 mg), and in children under 5 years (> 498 mg). Those who consumed products with excessive amounts presented the greatest possibilities of dietary inadequacy. CONCLUSION The population of Antioquia that consumes PF and UPP with excessive amounts of free sugars, total fat, saturated fat, sodium, and/or sweeteners presents an unbalanced diet. Reducing the consumption of these products and returning to a natural and/or minimally processed diet may be an effective strategy to achieve the nutrient intake recommendations prioritized by PAHO in the population of Antioquia.

RESUMEN OBJETIVO Analizar el consumo de nutrientes críticos y otros edulcorantes, según el grado de procesamiento de los alimentos en la población Antioqueña. MÉTODOS En este estudio transversal, se evaluó el consumo alimentario de 4,382 participantes del Perfil Alimentario y Nutricional de Antioquia 2019. Los alimentos procesados (AP) y productos ultraprocesados (PUP) informados por recordatorio de 24 horas se clasificaron según sistema Nova. Se usó el Modelo de Perfil de Nutrientes (MPN) de la Organización Panamericana de la Salud (OPS). Se midió la cantidad de AP y PUP consumidos con exceso en nutrientes críticos, relacionados con las enfermedades crónicas (EC). Se evaluó la diferencia en el consumo promedio, la prevalencia del consumo excesivo, y las posibilidades de inadecuación entre los grupos que tenían una dieta con y sin contenido excesivo. RESULTADOS Cerca del 50% de los AP y PUP consumidos presentaba exceso en al menos un nutriente crítico. La población consumió diariamente uno o más productos con exceso en azúcar libre (73.3%), grasa total (75.2%), grasa saturada (77.0%), sodio (83.9%) y/o edulcorantes (36.8%). Quienes consumían productos con cantidades excesivas tenían una mayor ingesta de grasas totales (> 5.8%); grasas saturadas (> 3.8%); y sodio (> 698.7 mg) en adultos y adolescentes, en niños de 5-10 años (> 659.2 mg), y en menores de 5 años (> 498 mg). Quienes consumieron productos con cantidades excesivas presentaron las mayores posibilidades de inadecuación en la dieta. CONCLUSIÓN La población antioqueña que consume AP y PUP con cantidades excesivas de azúcares libres, grasas totales, grasas saturadas, sodio y/o edulcorantes, presenta una dieta desbalanceada. Reducir el consumo de estos productos y volver a una dieta natural y/o mínimamente procesada puede ser una estrategia efectiva para alcanzar las recomendaciones de ingesta de nutrientes priorizados por OPS en la población antioqueña.

Association of Food Consumption According to the Degree of Processing and Sociodemographic Conditions in Older Adults.

Several factors can impact food consumption in older adults, including those of sociodemographic, physiological, and chronic non-communicable diseases. This study aimed to evaluate the association of food consumption according to its degree of processing with sociodemographic conditions in community-dwelling older adults. Food intake was evaluated from 24-h recall data. All food items were classified according to the degree of processing into four groups as follows: in natura or minimally processed, culinary ingredients, processed, and ultra-processed foods. Food groups were considered dependent variables in a quantile regression model, adjusting for sex, age, schooling, ethnicity, and number of residents. Women and individuals with higher levels of education had lower consumption of in natura or minimally processed foods and higher consumption of ultra-processed foods. The yellow or indigenous ethnicity presented the lowest consumption of processed foods; older people who lived with three or more individuals had the highest consumption of culinary ingredients, whereas the older people who lived with one to two people had the highest consumption of processed foods and the lowest consumption of ultra-processed. These groups may be the target of educational and public policies to improve diet quality and contribute to quality of life in older ages.

The Influence of Lifestyle on High-Density Lipoprotein Concentration among Mexican Emerging Adults.

Previous studies have highlighted the role of lifestyle on HDL-C concentrations in adults. To our knowledge, the health and nutritional status of emerging adults have been understudied. The present study aimed to explore the most important lifestyle factors, including micronutrient intake adequacy and the percentage of energy from food processing, according to HDL-C concentrations in emerging adults. In this context, a cross-sectional analysis was conducted on 261 Mexican emerging adults who were apparently healthy. Lifestyle factors were collected through a structured survey and the prevalence of micronutrient intake inadequacy was estimated using the estimated average requirement cut-point method. The percentage of energy from ultra-processed foods was assessed using the NOVA system. HDL-C was determined using the enzymatic colorimetric method. Statistical analyses were conducted in SPSS. The results revealed that lifestyle factors do not differ according to HDL-C status. The participants showed a poor nutritional diet that was energy-dense and micronutrient-inadequate. Nearly half of their energy came from processed and ultra-processed foods. Most participants did not meet the recommendations for key nutrients (ϖ3 fatty acids and phytosterols) that promote a healthy lipid status. In conclusion, regardless of their HDL-C levels, emerging adults exhibited lifestyle-related risk factors. The persistence of these findings over time could contribute to the development of metabolic disorders in the future. It is crucial to increase understanding and to develop effective nutritional interventions during this critical phase of life.

Sobre a Soberania Sanitária no Complexo Industrial da Saúde / On Sanitary Sovereignty in the Health Industrial Complex

Resumo O artigo discute o lugar do Complexo Industrial da Saúde na iniciativa governamental de uma nova industrialização no Brasil. Para isso, aborda eventuais caminhos que a iniciativa reserva para os seus diversos componentes. Começa discutindo a propriedade desse processo mirar uma "soberania sanitária" como objetivo. Em seguida, aponta a necessária articulação da indústria na saúde com a política geral de industrialização. Ressalta o papel do Estado e do setor privado nesse processo e ressalta a presença do SUS e do Ministério da Saúde. Finalmente, aponta as condições de competição entre o Complexo Industrial da Saúde e o oligopólio industrial global.

Abstract The article discusses the place of the Health Industrial Complex in the government initiative for a new industrialization in Brazil. To this end, it discusses possible paths that the initiative reserves for its various components. It begins by discussing the appropriateness of this process to target "sanitary sovereignty" as an objective. Then, it points out the necessary articulation of the health industry with the general industrialization policy. It emphasizes the role of the State and the private sector in this process and emphasizes the presence of the SUS and the Ministry of Health. Finally, it points out the conditions of competition between the Health Industrial Complex and the global industrial oligopoly.

The degree of food processing can influence serum fatty acid and lipid profiles in women with severe obesity.

Background: The increase in the prevalence of obesity is associated with the increase in the consumption of ultra-processed foods and may be related to the increase in the disorders involving metabolism and the transport and storage of fatty acids. Objective: To evaluate the effect of processed food consumption according to the degree of processing on the serum fatty acid levels and lipid profile of women with severe obesity. Methods: This was a cross-sectional study. Data were collected from anthropometric assessments, the food frequency questionnaire (FFQ), and blood tests for lipidogram studies and serum fatty acid measurements. The foods consumed were identified through the FFQ and classified according to the degree of processing based on the NOVA rating, and the frequencies of consumption were transformed into scores, as proposed by Fornés methodology. Data were analyzed using IBM SPSS Statistics, version 21. The significance level for the analysis was set at 5%. Results: This study included 44 women with a mean age of 40.59 years and mean body mass index of 48.61 kg/m2. An inverse association was observed between the consumption of unprocessed and the occurrence of hypertriglyceridemia (p = 0.021) and levels of triglycerides (p = 0.047), total cholesterol (p = 0.030), and very low-density lipoprotein-cholesterol (p = 0.039). The consumption of processed foods was positively associated with the presence of hypertriglyceridemia (p = 0.044) and omega 6/3 ratio (p = 0.001) and negatively associated with total omega 3 levels (p = 0.011). The consumption of processed foods was positively associated with total cholesterol (p = 0.041) and negatively associated with the omega 3/6 ratio (p = 0.001). A negative correlation was found between the average consumption of ultra-processed foods (at least once a week) and serum level of high-density lipoprotein (p = 0.035). Conclusion: The consumption of processed and ultra-processed foods was associated with unfavorable lipid profiles and fatty acid levels in women with severe obesity. These results emphasize the importance of promoting the consumption of unprocessed food to mitigate metabolic disorders linked to processed food intake.

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.

A novel web-based 24-h dietary recall tool in line with the Nova food processing classification: description and evaluation.

OBJECTIVE: This paper describes the first web-based self-completed 24-h recall designed to categorise food intake according to Nova groups - Nova24h - and its agreement with a reference tool in estimating the dietary relative contribution of the four Nova food groups (% of total energy intake). DESIGN: Comparisons of estimates of dietary relative contributions of Nova groups obtained by Nova24h and one standard interviewer-led 24-h recall. SETTING: Nationwide adult cohort study in Brazil. PARTICIPANTS: The subjects were 186 participants of the NutriNet Brasil Cohort Study (n 186). RESULTS: No statistically significant differences were observed between the Nova24h and the reference tool mean contributions of unprocessed or minimally processed foods (52·3 % v. 52·6 %), processed culinary ingredients (11·6 % v. 11·9 %), processed foods (17·1 % v. 14·7 %) and ultra-processed foods (19·0 % v. 20·9 %). Intraclass correlation coefficients between individual estimates obtained for each Nova group showed moderate to good agreement (0·54-0·78). Substantial or almost perfect agreement between the tools was seen regarding the ability to rank participants according to quintiles of contribution of each Nova group (PABAK 0·69-0·81). CONCLUSIONS: Nova24h is a suitable tool for estimating the dietary relative energy contribution of Nova food groups in the NutriNet Brasil cohort. New studies are necessary to verify its adequacy in other populations.