Ultra-processed food consumption and mortality among patients with stages I-III colorectal cancer: a prospective cohort study.

Background: Ultra-processed foods (UPFs) are emerging as a risk factor for colorectal cancer (CRC), yet how post-diagnostic UPF intake may impact CRC prognosis remains unexplored. Methods: Data collected from food frequency questionnaires were used to estimate intakes of total UPFs and UPF subgroups (serving/d) at least 6 months but less than 4 years post-diagnosis among 2498 patients diagnosed with stages I-III CRC within the Nurses' Health Study and Health Professionals Follow-up Study during 1980-2016. Hazard ratios (HR) and 95% confidence intervals (CIs) of all-cause, CRC- and cardiovascular disease (CVD)-specific mortality in association with UPF consumption were estimated using an inverse probability weighted multivariable Cox proportional hazards regression model, adjusted for confounders. Findings: The mean (SD) age of patients at diagnosis was 68.5 (9.4) years. A total of 1661 deaths were documented, including 321 from CRC and 335 from CVD. Compared to those in the lowest quintile (median = 3.6 servings/d), patients in the highest quintile (median = 10 servings/d) of post-diagnostic UPF intake had higher CVD mortality (HR = 1.65, 95% CI = 1.13-2.40) but not CRC or all-cause mortality. Among UPF subgroups, higher consumption of fats/condiments/sauces was associated with a higher risk of CVD-specific mortality (highest vs. lowest quintile of intake, HR = 1.96, 95% CI = 1.41-2.73), and higher intake of ice cream/sherbet was associated with an increased risk of CRC-specific mortality (highest vs. lowest quintile, HR = 1.86, 95% CI: 1.33-2.61). No statistically significant association was found between UPF subgroups and overall mortality. Interpretation: Higher post-diagnostic intake of total UPFs and fats/condiments/sauces in CRC survivors is associated with higher CVD mortality, and higher ice cream/sherbet intake is linked to higher CRC mortality. Funding: US National Institutes of Health and the American Cancer Society.

Relationship Between Ultra-Processed and Minimally Processed Food Intake and Cardiovascular Health Among US Women of Reproductive Age.

Objectives: Ultra-processed food (UPF) intake is associated with worse cardiovascular health (CVH), but associations between unprocessed/minimally processed foods (MPFs) and CVH are limited, especially among women of reproductive age (WRA). Materials and Methods: For 5,773 WRA (20-44 years) in National Health and Nutrition Examination Survey (NHANES) 2007-2018, we identified UPFs and MPFs using the Nova classification and based on 24-hour dietary recalls. We calculated usual percentages of calories from UPFs and MPFs using the National Cancer Institute's usual intake method. Seven CVH metrics were scored, and CVH levels were grouped by tertile. We used multivariable linear and multinomial logistic regression to assess associations between UPFs and MPFs and CVH. Results: The average usual percentage of calories from UPFs and MPFs was 57.2% and 29.3%, respectively. There was a graded, positive association between higher UPF intake and higher odds of poor CVH: adjusted odds ratios (aORs) for the lowest versus highest CVH were 1.74 (95% confidence interval: 1.51-2.01), 2.67 (2.07-3.44) and 4.66 (3.13-6.97), respectively, comparing quartile 2 (Q2)-Q4 to the lowest quartile (Q1) of UPF intake. Higher MPF intake was associated with lower odds of poor CVH: aORs for the lowest CVH were 0.61 (0.54-0.69), 0.39 (0.31-0.50), and 0.21 (0.14-0.31). Patterns of association remained consistent across subgroups and in sensitivity analyses. Conclusions: Higher UPF intake was associated with worse CVH, while higher MPF intake was associated with better CVH among WRA in the United States. Our analyses highlight an opportunity for WRA to improve nutrition and their CVH.

Consumption of Ultraprocessed Foods and Body Fat Distribution Among U.S. Adults.

INTRODUCTION: The association between ultraprocessed food consumption and body composition and potential variations by sociodemographic factors is unclear. This study aims to examine the cross-sectional associations of ultraprocessed food consumption with imaging markers of body fat distribution in a nationally representative sample of U.S. adults, overall and by sociodemographic strata. METHODS: A total of 9,640 men and nonpregnant women aged 20-59 years were included from 4 cycles (2011-2012, 2013-2014, 2015-2016, 2017-2018) of the National Health and Nutrition Examination Survey with valid 24-hour dietary recalls and available whole-body dual-energy x-ray absorptiometry scans. Ultraprocessed foods were identified using the NOVA classification, with percentage energy from ultraprocessed food assessed in quintiles. Primary outcomes were absolute percentage fat (total, android, gynoid), and secondary ones were percentage fat (head, arm, leg, trunk), total abdominal fat (area, mass, volume), subcutaneous adipose tissue (area, mass, volume), and visceral adipose tissue (area, mass, volume). Multivariable-adjusted generalized linear regressions estimated independent relationships of ultraprocessed food intake with body composition overall and by sociodemographic subgroups. Analyses were conducted in September 2022 and January 2023. RESULTS: Ultraprocessed food consumption accounted for more than half (55.5%) of daily energy consumption in this sample. Adults in the highest quintile (>72.1% energy) had 1.60 higher total percentage fat (95% CI=0.94, 2.26), 2.08 higher android percentage fat (95% CI=1.26, 2.89), and 1.32 higher gynoid percentage fat (95% CI=0.71, 1.93) than those in the lowest quintile of ultraprocessed food consumption (<39.4% energy) (all p-trend<0.001). Consistent findings were observed for secondary outcomes. Associations of ultraprocessed food intake with total percentage fat, android percentage fat, and gynoid percentage fat varied by age, sex, race and ethnicity, education, and income. Among those in the highest quintile of ultraprocessed food consumption compared with the lowest quintile counterpart, total percentage fat was 1.85 (95% CI=0.86, 2.84) higher for non-Hispanic White adults and 1.57 (95% CI=0.68, 2.46) higher for Hispanic adults (p-trends<0.001), whereas no difference was observed among non-Hispanic Black adults (-0.22; 95% CI= -0.93, 1.36) (p-trend=0.47) and non-Hispanic Asian adults (0.93; 95% CI= -0.57, 2.42) (p-trend=0.04) (p-interaction=0.001). Associational patterns were similar for android percentage fat and gynoid percentage fat. CONCLUSIONS: In a national U.S. sample, higher intake of ultraprocessed food was associated with greater body fat, in particular android fat, and this relationship was most prominent in certain population subgroups. These cross-sectional findings call for prospective and interventional studies to assess the impact of ultraprocessed food on body composition in different populations.

Identifying and Estimating Ultraprocessed Food Intake in the US NHANES According to the Nova Classification System of Food Processing.

BACKGROUND: The degree of food processing may be an important dimension of diet in how it relates to health outcomes. A major challenge is standardizing food processing classification systems for commonly used datasets. OBJECTIVES: To standardize and increase transparency in its application, we describe the approach used to classify foods and beverages according to the Nova food processing classification in the 24-h dietary recalls from the 2001-2018 cycles of What We Eat in America (WWEIA), NHANES, and investigate variability and potential for Nova misclassification within WWEIA, NHANES 2017-2018 data via various sensitivity analyses. METHODS: First, we described how the Nova classification system was applied to the 2001-2018 WWEIA, NHANES data using the reference approach. Second, we calculated the percentage energy from Nova groups [1: unprocessed or minimally processed foods, 2: processed culinary ingredients, 3: processed foods, and 4: ultraprocessed foods (UPFs)] for the reference approach using day 1 dietary recall data from non-breastfed participants aged ≥1 y from the 2017-2018 WWEIA, NHANES. We then conducted 4 sensitivity analyses comparing potential alternative approaches (e.g., opting for more vs. less degree of processing for ambiguous items) to the reference approach, to assess how estimates differed. RESULTS: The energy contribution of UPFs using the reference approach was 58.2% ± 0.9% of the total energy; unprocessed or minimally processed foods contributed 27.6% ± 0.7%, processed culinary ingredients contributed 5.2% ± 0.1%, and processed foods contributed 9.0% ± 0.3%. In sensitivity analyses, the dietary energy contribution of UPFs ranged from 53.4% ± 0.8% to 60.1% ± 0.8% across alternative approaches. CONCLUSIONS: We present a reference approach for applying the Nova classification system to WWEIA, NHANES 2001-2018 data to promote standardization and comparability of future research. Alternative approaches are also described, with total energy from UPFs differing by ∼6% between approaches for 2017-2018 WWEIA, NHANES.

Corrigendum: Changes in Obesity Prevalence Attributable to Ultra-Processed Food Consumption in Brazil Between 2002 and 2009.

[This corrects the article DOI: 10.3389/ijph.2022.1604103.].

Associations between ultra- or minimally processed food intake and three adiposity indicators among US adults: NHANES 2011 to 2016.

OBJECTIVE: Ultraprocessed food (UPF) intake is associated with BMI, but effects on regional adipose depots or related to minimally processed food (MPF) intake are unknown. METHODS: Data included 12,297 adults in the National Health and Nutrition Examination Survey (NHANES), 2011 to 2016. This study analyzed associations between usual percentage of kilocalories from UPFs and MPFs and three adiposity indicators: supine sagittal abdominal diameter to height ratio (SADHtR, estimates visceral adiposity); waist circumference to height ratio (WHtR, estimates abdominal adiposity); and BMI, using linear and multinomial logistic regression. RESULTS: Standardized ß coefficients per 10% increase in UPF intake were 0.0926, 0.0846, and 0.0791 for SADHtR, WHtR, and BMI, respectively (all p < 0.001; p > 0.26 for pairwise differences). For MPF intake, the ß coefficients were -0.0901, -0.0806, and -0.0688 (all p < 0.001; p > 0.18 pairwise). Adjusted odds ratios (95% CI) for adiposity tertile 3 versus tertile 1 (comparing UPF intake quartiles 2, 3, and 4 to quartile 1) were 1.33 (1.22-1.45), 1.67 (1.43-1.95), and 2.24 (1.76-2.86), respectively, for SADHtR; 1.31 (1.19-1.44), 1.62 (1.37-1.91), and 2.13 (1.63-2.78), respectively, for WHtR; and 1.27 (1.16-1.39), 1.53 (1.31-1.79), and 1.96 (1.53-2.51), respectively, for BMI. MPF intake showed inverse associations with similar trends in association strength. CONCLUSIONS: Among US adults, abdominal and visceral adiposity indictors were positively associated with UPFs and inversely associated with MPFs.

Association between ultra-processed food consumption and cognitive performance in US older adults: a cross-sectional analysis of the NHANES 2011-2014.

PURPOSE: This study evaluated the association between ultra-processed food (UPF) consumption and cognitive performance among older US adults. METHODS: This cross-sectional study assessed 3632 participants aged 60+ years from the National Health and Nutrition Examination Survey (NHANES) 2011-14. Cognitive performance was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Word Learning test, Animal Fluency test, and the Digit Symbol Substitution test (DSST). Dietary intake was assessed using two 24-h diet recalls. Food items were classified according to the NOVA system, a classification based on the nature, extent, and purpose of industrial food processing. Linear regression models were used to evaluate the association of dietary share of UPF (% of daily energy intake) (categorized as tertiles) and cognitive test scores, adjusting for socio-demographic variables, physical activity, smoking status, and chronic diseases (cardiovascular diseases, diabetes, and depression). Models excluding participants with pre-existing diseases were carried out to address potential reverse causality. RESULTS: On average, UPF accounted for 53% of total energy intake, ranging from 33 to 70% across extreme tertiles. Inverted U-shape association between UPF consumption and Animal fluency and DSST was observed. No significant associations were observed between the UPF intake tertiles and the cognitive test results. Nonetheless, UPF consumption was significantly associated with worse performance in Animal Fluency in older adults without pre-existing diseases (P < 0.05). CONCLUSION: UPF consumption was associated with worse performance in Animal Fluency among older people without pre-existing diseases. Decreasing UPF consumption may be a way to improve impaired cognition among older adults.

Changes in Obesity Prevalence Attributable to Ultra-Processed Food Consumption in Brazil Between 2002 and 2009.

Objectives: To quantify the impact of temporal changes in the consumption of ultra-processed foods on obesity trends in Brazil between 2002 and 2009. Methods: We analyzed data from two Household Budget Surveys carried out in 2002/2003 (n = 182,333) and 2008/2009 (n = 190,159), which provided information on household food acquisition and individuals' weight and height. We examined the association between ultra-processed foods consumption and obesity and quantified the fraction of increase in obesity prevalence attributable to the rise in the consumption of ultra-processed foods. Results: From 2002 to 2009, there was an increase in the obesity prevalence from 9.9% (95% CI 9.3; 10.4) to 13.2% (12.8; 13.7) while the contribution of ultra-processed foods to total energy consumption raised from 14.3% (13.4; 15.1) to 17.3% (16.5; 18.1). Ultra-processed foods consumption was positively associated with obesity prevalence. More than one quarter (28.6%) of the increase in obesity prevalence was attributable to the rise in the consumption of ultra-processed foods in the period. Conclusion: We found that the rise in the consumption of ultra-processed foods played a major role on the increase of obesity epidemic in Brazil.

Score of ultra-processed food consumption and its association with sociodemographic factors in the Brazilian National Health Survey, 2019.

This is a cross-sectional population-based study that describes the score of ultra-processed food consumption, applied in the Brazilian National Health Survey performed in 2019, and its association with sociodemographic factors in Brazilian adults (18 years or older). The score of ultra-processed food consumption was calculated by adding up the positive answers about the consumption on the previous day of 10 subgroups of ultra-processed foods frequently consumed in Brazil. The distribution of the score in the population was presented as a count. Poisson regression models were used to evaluate the crude and adjusted associations of scores equal to or higher than five subgroups of ultra-processed foods with urban/rural area, geographic region, sex, age group, schooling level, and wealth index. About 15% of the Brazilian adults reached scores equal to or higher than five. After adjustment for confounders, the prevalence of consuming five or more subgroups of ultra-processed foods decreased linearly with age, increased linearly with wealth quintiles and it was higher in urban areas, in the Southeast and South regions (compared to the others) and in men. Public policies that reduce the consumption of ultra-processed foods with emphasis on strata of the population at the greatest risk are essential and monitoring the score of ultra-processed food consumption across studies and populations will be important to assess the success of these policies.

Ultra-processed food intake and diet carbon and water footprints: a national study in Brazil.

OBJECTIVE: To study the association between ultra-processed food consumption and carbon and water footprints of the Brazilian diet. METHODS: Cross-sectional analysis on data collected in 2008-2009 on a probabilistic sample of the Brazilian population aged ≥ 10 years (n = 32,886). Individual food intake was assessed using two 24-hour food records, on non-consecutive days. The environmental impact of individual diets was calculated by multiplying the amount of each food by coefficients that quantify the atmospheric emissions of greenhouse gases in grams of carbon dioxide equivalent (carbon footprint) and freshwater use in liters (water footprint), both per gram or milliliter of food. The two coefficients consider the food life cycle 'from farm to fork.' Crude and adjusted linear regression models and tests for linear trends assessed the association between the ultra-processed food contribution to total energy intake (quintiles) and the diet carbon and water footprints. Potential confounders included age, sex, education, income, and region. Total energy intake was assessed as a potential mediation variable. RESULTS: In the crude models, the dietary contribution of ultra-processed foods was linearly associated with the carbon and water footprints of the Brazilian diet. After adjustment for potential confounders, the association remained significant only regarding the diet water footprint, which increased by 10.1% between the lowest and highest quintile of the contribution of ultra-processed foods. Additional adjustment for total energy intake eliminated this association indicating that the dietary contribution of ultra-processed foods increases the diet water footprint by increasing energy intake. CONCLUSIONS: The negative impact of ultra-processed foods on the diet water footprint, shown for the first time in this study, adds to the negative impacts of these foods, already demonstrated regarding dietary nutrient profiles and the risk for several chronic non-communicable diseases. This reinforces the recommendation to avoid ultra-processed foods made in the official Brazilian Dietary Guidelines and increasingly in dietary guidelines of other countries.

Consumption of Ultraprocessed Foods and Diet Quality Among U.S. Children and Adults.

INTRODUCTION: Consumption of ultraprocessed foods has been linked with higher intake of added sugars, sodium, and unhealthful fats, but the associations of ultraprocessed foods with overall diet quality and major food groups are not well known. METHODS: Data were derived from the National Health and Nutrition Examination Survey (2015-2018), including 9,758 adults (aged ≥20 years) and 5,280 children (aged 2-19 years) with 24-hour dietary recalls (≥1), with analysis performed in 2020. Ultraprocessed foods were identified using the NOVA classification, with intake (% energy) assessed in quintiles. Diet quality was assessed using the validated American Heart Association 2020 continuous primary and secondary diet scores and Healthy Eating Index 2015. Poor diet was defined as <40% adherence to the American Heart Association secondary score. Generalized linear regressions estimated relationships between ultraprocessed food intake and diet quality. RESULTS: Compared with the lowest quintile of ultraprocessed food consumption (<39.1% energy), the American Heart Association primary score in adults was progressively lower in Quintile 2 (-1.99, 95% CI= -2.73, -1.25), Quintile 3 (-3.60, 95% CI= -4.47, -2.72), Quintile 4 (-5.29, 95% CI= -6.28, -4.30), and Quintile 5 (-7.24, 95% CI= -8.13, -6.36; >70.7% energy). Corresponding values in children were -2.05 (95% CI= -3.01, -1.09), -2.97 (95% CI= -4.16, -1.79), -3.82 (95% CI= -5.20, -2.44), and -6.22 (95% CI= -7.20, -5.25; >79.0% energy). The estimated proportion of children having poor diet progressively increased from 31.3% (95% CI=26.2%, 36.5%) in Quintile 1 up to 71.6% (95% CI=68.1%, 75.1%) in Quintile 5. Corresponding proportions of adults having poor diet increased from 18.1% (95% CI=14.3%, 22.0%) in Quintile 1 up to 59.7% (95% CI=55.3%, 64.1%) in Quintile 5. Findings were similar using the American Heart Association secondary score and Healthy Eating Index 2015 score. CONCLUSIONS: Higher ultraprocessed food consumption is associated with substantially lower diet quality among children and adults.

Relationship Between Ultraprocessed Food Intake and Cardiovascular Health Among U.S. Adolescents: Results From the National Health and Nutrition Examination Survey 2007-2018.

PURPOSE: Studies of the association between ultraprocessed foods (UPF) and cardiovascular disease risk factors have been mainly focused on the adult population. This study examined the association between usual percentage of calories (%kcal) from UPF and the American Heart Association's seven cardiovascular health (CVH) metrics among U.S. adolescents aged 12-19 years. METHODS: We used data from the National Health and Nutrition Examination Survey 2007-2018 (n = 5,565). The NOVA food system was used to classify UPF according to the extent and purpose of food processing. Each CVH metric was given a score of 0, 1, or 2 (poor, intermediate, or ideal health, respectively). Scores of six metrics were summed (excluding diet) to categorize CVH as low (0-7), moderate (8-10), or high (11-12). The National Cancer Institute's methods were used to estimate usual %kcal from UPF. Multivariable linear regression and multinomial logistic regression were used to evaluate the association between UPF and CVH. RESULTS: Among youth, 12.1% had low CVH, 56.3% moderate, and 31.6% high. The mean usual %kcal from UPF was 65.7%. Every 5% increase in calories from UPF was associated with .13 points lower CVH scores (p < .001). Comparing Q2, Q3, and Q4 to Q1 of UPF intake, the adjusted odds ratios for low versus high CVH were 1.43 (95% confidence interval 1.16-1.76), 1.86 (1.29-2.66), and 2.59 (1.49-4.55), respectively. The pattern of association was largely consistent across subgroups. CONCLUSIONS: U.S. adolescents consume about two thirds of daily calorie from UPF. There was a graded inverse association between %kcal from UPF and CVH score.

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.

Score of ultra-processed food consumption and its association with sociodemographic factors in the Brazilian National Health Survey, 2019 / Escore de consumo de alimentos ultraprocessados e sua associação com fatores sociodemográficos na Pesquisa Nacional de Saúde, 2019 / Puntuación para el consumo de comida ultraprocesada y su asociación con factores sociodemográficos en la Encuesta Nacional de Salud, 2019

This is a cross-sectional population-based study that describes the score of ultra-processed food consumption, applied in the Brazilian National Health Survey performed in 2019, and its association with sociodemographic factors in Brazilian adults (18 years or older). The score of ultra-processed food consumption was calculated by adding up the positive answers about the consumption on the previous day of 10 subgroups of ultra-processed foods frequently consumed in Brazil. The distribution of the score in the population was presented as a count. Poisson regression models were used to evaluate the crude and adjusted associations of scores equal to or higher than five subgroups of ultra-processed foods with urban/rural area, geographic region, sex, age group, schooling level, and wealth index. About 15% of the Brazilian adults reached scores equal to or higher than five. After adjustment for confounders, the prevalence of consuming five or more subgroups of ultra-processed foods decreased linearly with age, increased linearly with wealth quintiles and it was higher in urban areas, in the Southeast and South regions (compared to the others) and in men. Public policies that reduce the consumption of ultra-processed foods with emphasis on strata of the population at the greatest risk are essential and monitoring the score of ultra-processed food consumption across studies and populations will be important to assess the success of these policies.

Estudo transversal de base populacional com objetivo de descrever o escore de consumo de alimentos ultraprocessados, avaliado na Pesquisa Nacional de Saúde em 2019, e sua associação com fatores sociodemográficos em adultos brasileiros (com 18 anos ou mais). O escore de consumo de alimentos ultraprocessados foi calculado, somando as respostas positivas a perguntas sobre o consumo no dia anterior de dez subgrupos de alimentos ultraprocessados, consumidos frequentemente no Brasil. A distribuição da pontuação na população foi apresentada na forma de contagem. Foram utilizados modelos de regressão de Poisson para avaliar as associações brutas e ajustadas para pontuações iguais ou maiores de subgrupos de ultraprocessados, de acordo com situação (urbana/rural), macrorregião, sexo, grupo etário, escolaridade e índice de riqueza. Cerca de 15% dos adultos brasileiros obtiveram pontuações iguais ou superiores a cinco. Após ajustar para fatores de confusão, a prevalência do consumo de cinco ou mais subgrupos de ultraprocessados diminuiu de maneira linear com a idade, aumentou de maneira linear com os quintis de renda e foi mais alta nas áreas urbanas, nas regiões Sul e Sudeste e em homens. São necessárias políticas públicas que reduzam o consumo de alimentos ultraprocessados, com ênfase nos segmentos da população com maior risco. Para avaliar o sucesso dessas políticas, será importante monitorar os níveis de consumo de ultraprocessados entre os diversos estudos e populações.

El objetivo de este estudio transversal, de base poblacional, es describir la puntuación para el consumo de comida ultraprocesada y su asociación con factores sociodemográficos en adultos brasileños (con 18 años de edad o más). Los datos proceden de la Encuesta Nacional de Salud llevada a cabo en 2019. La puntuación para el consumo de comida ultraprocesada se calculó sumando las respuestas positivas a preguntas sobre el consumo el día previo de 10 subgrupos de comidas ultraprocesadas frecuentemente consumidas en Brasil. La distribución de la puntuación en la población se presentó como un dato de conteo. Fueron utilizados modelos de regressioón de Poison para evaluar las asociaciones crudas y ajustadas de puntuaciones iguales a o superiores a cinco subgrupos de comidas ultraprocesadas con áreas urbanas/rurales, región geográfica, sexo, grupo de edad, nivel de escolaridad, e índice de riqueza. Alrededor de un 15% de los adultos brasileños alcanzaron puntuaciones iguales o mayores que cinco. Tras el ajuste para los factores de confusión, la prevalencia del consumo de cinco o más subgrupos de comidas ultraprocesadas decrecío, aumentando linealmente con los quintiles de riqueza y era superior en las áreas urbanas, en las regiones Sur y Sudeste (comparadas con las otras) y en hombres. Son necesarias políticas públicas para reducir el consumo de comidas ultraprocesadas con enfásis en los estratos poblacionales en mayor riesgo. Monitorear la puntuación del consumo de comida ultraprocesada a través de estudios y poblaciones será importante para evaluar el éxito de estas políticas.

Ultra-processed food intake and diet carbon and water footprints: a national study in Brazil

ABSTRACT OBJECTIVE To study the association between ultra-processed food consumption and carbon and water footprints of the Brazilian diet. METHODS Cross-sectional analysis on data collected in 2008-2009 on a probabilistic sample of the Brazilian population aged ≥ 10 years (n = 32,886). Individual food intake was assessed using two 24-hour food records, on non-consecutive days. The environmental impact of individual diets was calculated by multiplying the amount of each food by coefficients that quantify the atmospheric emissions of greenhouse gases in grams of carbon dioxide equivalent (carbon footprint) and freshwater use in liters (water footprint), both per gram or milliliter of food. The two coefficients consider the food life cycle 'from farm to fork.' Crude and adjusted linear regression models and tests for linear trends assessed the association between the ultra-processed food contribution to total energy intake (quintiles) and the diet carbon and water footprints. Potential confounders included age, sex, education, income, and region. Total energy intake was assessed as a potential mediation variable. RESULTS In the crude models, the dietary contribution of ultra-processed foods was linearly associated with the carbon and water footprints of the Brazilian diet. After adjustment for potential confounders, the association remained significant only regarding the diet water footprint, which increased by 10.1% between the lowest and highest quintile of the contribution of ultra-processed foods. Additional adjustment for total energy intake eliminated this association indicating that the dietary contribution of ultra-processed foods increases the diet water footprint by increasing energy intake. CONCLUSIONS The negative impact of ultra-processed foods on the diet water footprint, shown for the first time in this study, adds to the negative impacts of these foods, already demonstrated regarding dietary nutrient profiles and the risk for several chronic non-communicable diseases. This reinforces the recommendation to avoid ultra-processed foods made in the official Brazilian Dietary Guidelines and increasingly in dietary guidelines of other countries.

Carbon footprint of the Brazilian diet.

OBJECTIVE: To estimate the carbon footprint of the Brazilian diet and of sociodemographic strata of this population. METHODS: Carbon footprint of the diet was estimated based on data from two 24-hour diet records, obtained in 2008 and 2009, from a probabilistic sample of the Brazilian population aged 10 years and over (n = 34,003) and on environmental impact coefficients of food and culinary preparations consumed in Brazil (gCO2e/kg). Means with 95% confidence intervals of food consumption (kcal/person/day) and the carbon footprint of the diet (gCO2e/person/day and in gCO2e/2,000kcal) were calculated for the population as a whole and for strata according to sex, age, income, education, macro-regions and Federative Unit. Linear regression models were used to identify significant differences (p < 0.05) in the dietary carbon footprint of different sociodemographic strata. RESULTS: The average carbon footprint of the Brazilian diet was 4,489gCO2e/person/day. It was higher for males, for the age group from 20 to 49 years and for the North and Midwest regions, and tended to increase with income and education. The pattern of association of footprint with sociodemographic variables did not change substantially with adjustment for differences in the amount of food consumed, except for a reduction in the relative excess of the footprint among males and an increase in the relative excess of the footprint in the Midwest region. CONCLUSION: The carbon footprint of the Brazilian diet exceeds by about 30% the footprint of the human diet, which could simultaneously meet the nutritional requirements of a healthy diet and the global goal of containing the increase in the planet's average temperature. The pattern of association of this footprint with sociodemographic variables can help identify priority targets for public actions aimed at reducing the environmental impacts of food consumption in Brazil.

Consumption of ultra-processed foods and its association with sociodemographic factors in the adult population of the 27 Brazilian state capitals (2019).

OBJECTIVE: To describe the magnitude of consumption of ultra-processed foods in the adult population (≥ 18 years old) in the capitals of the 27 federative units of Brazil, as well as its association with sociodemographic variables. METHODS: Data used in this study stem from participants (n = 52,443) of the 2019 wave of the annual survey of the "National surveillance system for risk and protective factors for chronic diseases by telephone survey" (Vigitel). The consumption of ultra-processed foods was described based on a score, corresponding to the sum of positive responses to questions about consumption on the previous day of thirteen subgroups of ultra-processed foods frequently consumed in Brazil. Poisson regression models were used to describe the crude and adjusted associations between high consumption of ultra-processed foods (scores ≥ 5) and sex, age group, and level of education. RESULTS: The frequency of high consumption of ultra-processed foods was 18.2% (95% CI 17.4-19.0). With or without adjustment for other sociodemographic variables, this frequency was significantly lower in females and decreased linearly with age. In the crude analysis, there was an increase in the frequency of high consumption from the lower level to the intermediate level of education and a decrease in this consumption from the intermediate level to the upper level. In the analysis adjusted for sex and age, the frequency of high consumption of ultra-processed foods was significantly lower at the higher level of education (12 or more years of study), with no differences between the other levels. CONCLUSION: Ultra-processed foods are consumed with high frequency in the adult Brazilian population in the 27 capitals of the federation. Being male, younger and having less education than university are conditions that increase, independently, the consumption of these foods.

The burden of excessive saturated fatty acid intake attributed to ultra-processed food consumption: a study conducted with nationally representative cross-sectional studies from eight countries.

Cross-sectional nutritional survey data collected in eight countries were used to estimate saturated fatty acid intakes. Our objective was to estimate the proportion of excessive saturated fatty acid intakes (>10 % of total energy intake) that could be avoided if ultra-processed food consumption was reduced to levels observed in the first quintile of each country. Secondary analysis was performed of 24 h dietary recall or food diary/record data collected by the most recently available nationally representative cross-sectional surveys carried out in Brazil (2008-9), Chile (2010), Colombia (2005), Mexico (2012), Australia (2011-12), the UK (2008-16), Canada (2015) and the US (2015-16). Population attributable fractions estimated the impact of reducing ultra-processed food consumption on excessive saturated fatty acid intakes (above 10 % of total energy intake) in each country. Significant relative reductions in the percentage of excessive saturated fatty acid intakes would be observed in all countries if ultra-processed food consumption was reduced to levels observed in the first quintile's consumption. The reductions in excessive intakes ranged from 10⋅0 % (95 % CI 6⋅2-13⋅6 %) in Canada to 35⋅0 % (95 % CI 28⋅7-48⋅0 %) in Mexico. In all eight studied countries, all presenting more than 30 % of intakes with excessive saturated fatty acids, lowering the dietary contribution of ultra-processed foods to attainable, context-specific levels was shown to be a potentially effective way to reduce the percentage of intakes with excessive saturated fatty acids, which may play an important role in the prevention of non-communicable diseases, particularly cardiovascular diseases.

Nova score for the consumption of ultra-processed foods: description and performance evaluation in Brazil.

OBJECTIVE: To describe the Nova score for the consumption of ultra-processed foods (UPF) and evaluate its potential in reflecting the dietary share of UPF in Brazil. METHODS: This study was conducted in São Paulo with a convenience sample of 300 adults. Using a tablet, participants answered a 3-minute electronic self-report questionnaire on the consumption of 23 subgroups of UPF commonly consumed in Brazil, regarding the day prior the survey. Each participant score corresponded to the number of subgroups reported. The dietary share of UPF on the day prior to the survey, expressed as a percentage of total energy intake, was calculated based on data collected on a 30-minute complete 24-hour dietary recall administered by trained nutritionists. The association between the score and the dietary share of UPF was evaluated using linear regression models. The Pabak index was used to assess the agreement in participants' classification according to the fifths of Nova score and the fifths of dietary share of UPF. RESULTS: The average dietary share of UPF increased linearly and significantly with the increase of the Nova score for the consumption of ultra-processed foods. We found a substantial agreement in participants' classification according to the fifths of the distribution of scores and the fifths of the dietary share of UPF (Pabak index = 0.67). Age was inversely associated with a relatively high frequency of UPF consumption (upper fifth of the distribution) for both score and dietary share of UPF. CONCLUSION: The Nova score for the consumption of ultra-processed foods, obtained in a quick and practical manner, shows a good potential in reflecting the dietary share of UPF in Brazil.

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.