A new classification of foods based on the extent and purpose of their processing

Food metabolomics: from farm to human

Metabolomics, one of the latest components in the suite of systems biology, has been used to understand the metabolism and physiology of living systems, including microorganisms, plants, animals and humans. Food metabolomics can be defined as the application of metabolomics in food systems, including food resources, food processing and diet for humans. The study of food metabolomics has increased gradually in the recent years, because food systems are directly related to nutrition and human health. This review describes the recent trends and applications of metabolomics to food systems, from farm to human, including food resource production, industrial food processing and food intake by humans.

Street Food Environment in Maputo (STOOD Map): a Cross-Sectional Study in Mozambique

BACKGROUND

Street food represents a cultural, social, and economic phenomenon that is typical of urbanized areas, directly linked with a more sedentary lifestyle and providing a very accessible and inexpensive source of nutrition. Food advertising may contribute to shaping consumers' preferences and has the potential to drive the supply of specific foods.

OBJECTIVE

The purpose of this study is to characterize the street food offerings available to the urban population of Maputo, the capital city of Mozambique, and the billboard food advertising in the same setting.

METHODS

People selling ready-to-eat foods, beverages, or snacks from venues such as carts, trucks, stands, and a variety of improvised informal setups (eg, shopping carts, trunks of cars, sides of vans, blankets on the sidewalk, etc) will be identified in the district of KaMpfumu. We will gather information about the actual food being sold through direct observation and interviews to vendors, and from the billboard advertising in the same areas. A second phase of the research entails collecting food samples to be analyzed in a specialized laboratory. The street food environment will be characterized, overall and according to socioeconomic and physical characteristics of the neighborhood, using descriptive statistics and spatial analysis. The study protocol was approved by the National Committee for Bioethics for Health in Mozambique.

RESULTS

Data collection, including the identification of street food vending sites and billboard advertising, started on October 20, 2014, and lasted for 1 month. The collection of food samples took place in December 2014, and the bromatological analyses are expected to be concluded in August 2015.

CONCLUSIONS

The district of KaMpfumu is the wealthiest and most urbanized in Maputo, and it is the area with the highest concentration and variety of street food vendors. The expected results may yield important information to assess the nutritional environment and the characteristics of the foods to which a great majority of the urban population living or working in Maputo are exposed. Furthermore, this study protocol provides a framework for a stepwise standardized characterization of the street food environment, comprising 3 steps with increasing complexity and demand for human and technical resources: Step 1 consists of the evaluation of food advertising in the streets; Step 2 includes the identification of street food vendors and the characterization of the products available; and Step 3 requires the collection of food samples for bromatological analyses. This structured approach to the assessment of the street food environment may enable within-country and international comparisons as well as monitoring of temporal trends.

Ultra-processed foods have the worst nutrient profile, yet they are the most available packaged products in a sample of New Zealand supermarkets

Objective

To examine the availability of packaged food products in New Zealand supermarkets by level of industrial processing, nutrient profiling score (NPSC), price (energy, unit and serving costs) and brand variety.

Design

Secondary analysis of cross-sectional survey data on packaged supermarket food and non-alcoholic beverages. Products were classified according to level of industrial processing (minimally, culinary and ultra-processed) and their NPSC.

Setting

Packaged foods available in four major supermarkets in Auckland, New Zealand.

Subjects

Packaged supermarket food products for the years 2011 and 2013.

Results

The majority (84 % in 2011 and 83 % in 2013) of packaged foods were classified as ultra-processed. A significant positive association was found between the level of industrial processing and NPSC, i.e. ultra-processed foods had a worse nutrient profile (NPSC=11·63) than culinary processed foods (NPSC=7·95), which in turn had a worse nutrient profile than minimally processed foods (NPSC=3·27), P<0·001. No clear associations were observed between the three price measures and level of processing. The study observed many variations of virtually the same product. The ten largest food manufacturers produced 35 % of all packaged foods available.

Conclusions

In New Zealand supermarkets, ultra-processed foods comprise the largest proportion of packaged foods and are less healthy than less processed foods. The lack of significant price difference between ultra- and less processed foods suggests ultra-processed foods might provide time-poor consumers with more value for money. These findings highlight the need to improve the supermarket food supply by reducing numbers of ultra-processed foods and by reformulating products to improve their nutritional profile.

A Novel Dietary Assessment Method to Measure a Healthy and Sustainable Diet Using the Mobile Food Record: Protocol and Methodology

The world-wide rise in obesity parallels growing concerns of global warming and depleting natural resources. These issues are often considered separately but there may be considerable benefit to raising awareness of the impact of dietary behaviours and practices on the food supply. Australians have diets inconsistent with recommendations, typically low in fruit and vegetables and high in energy-dense nutrient-poor foods and beverages (EDNP). These EDNP foods are often highly processed and packaged, negatively influencing both health and the environment. This paper describes a proposed dietary assessment method to measure healthy and sustainable dietary behaviours using 4-days of food and beverage images from the mobile food record (mFR) application. The mFR images will be assessed for serves of fruit and vegetables (including seasonality), dairy, eggs and red meat, poultry and fish, ultra-processed EDNP foods, individually packaged foods, and plate waste. A prediction model for a Healthy and Sustainable Diet Index will be developed and tested for validity and reliability. The use of the mFR to assess adherence to a healthy and sustainable diet is a novel and innovative approach to dietary assessment and will have application in population monitoring, guiding intervention development, educating consumers, health professionals and policy makers, and influencing dietary recommendations.

Weight gain and reduced energy expenditure in low-income Brazilian women living in slums: a 4-year follow-up study

The present study aimed to investigate the possible changes in anthropometric and biochemical parameters in low-income women living in the outskirts of Maceió (northeast Brazil), and to explore the possible role of dietary intake and physical activity in these changes. A prospective longitudinal study was conducted in a cohort of mothers of malnourished children who attended the Center for Nutritional Recovery and Education, an outreach programme of the Federal University of Alagoas. Socio-economic, anthropometric, biochemical and dietary intake data were assessed at baseline and after a follow-up period of 4 years. Energy expenditure (using doubly labelled water) and physical activity (using triaxial accelerometers) were assessed only in a subgroup of women after 4 years. A total of eighty-five women were assessed. Participants showed an altered biochemical profile, increased systolic blood pressure, decreased thyroid hormone levels, and body-weight gain. However, dietary intakes of the participants did not include large quantities of highly processed and high-glycaemic index foods. The energy intake of the participants did not differ from their total energy expenditure (7990·3 (7173·7–8806·8)v. 8798·1 (8169·0–9432·4) kJ, respectively;P= 0·084). Multivariate analyses showed a significant effect of time spent watching television (β = 0·639 (0·003 to 1·275);P= 0·048) and dietary diversity score (β = − 1·039 ( − 2·010 to − 0·067);P= 0·036) on weight gain. The present study indicates that poor women, who are mothers of malnourished children and have a reasonably balanced dietary intake, exhibit weight gain and are at risk of developing chronic diseases.

Aspects of the built environment associated with obesity in children and adolescents: A narrative review

OBJECTIVE: To perform a narrative literature review to describe the availability of food retailers (groceries and eateries) and their association with obesity in schoolchildren and adolescents. METHODS: The review included studies published from 2003 to 2013 listed in three databases with data on the child's school and/or home surroundings. RESULTS: There was a higher concentration of fast foods near the schools, especially high schools, public schools, or schools located in low-income regions. Moreover, children and adolescents living in areas further from convenience stores had better diets. CONCLUSION: Acknowledging the relationship between built environment and obesity by establishing scientific evidence is necessary for developing specific strategies that help to control the spread of obesity in this age group, aiming to construct healthier spaces.

Estado nutricional e hábitos alimentares de dependentes químicos em tratamento ambulatorial

Objetivo Identificar o estado nutricional e hábitos alimentares de pacientes masculinos em recuperação de dependência química em acompanhamento ambulatorial de uma unidade de adição. Métodos Estudo transversal com 25 pacientes adultos em tratamento ambulatorial para dependência química. Foram aferidos parâmetros antropométricos (peso, estatura, circunferência da cintura e índice de massa corporal) e de composição corporal (bioimpedância elétrica), e foram investigados hábitos alimentares (Questionário de Frequência Alimentar – QFA). As variáveis categóricas são apresentadas como frequências e percentuais e as variáveis contínuas, como média e desvio-padrão ou como mediana e intervalo interquartil. Resultados Observou-se índice de massa corporal médio de 27,73 ± 4,15 kg/m2, com prevalência de sobrepeso de 80% e obesidade de 8%. A média da circunferência da cintura foi de 96,60 ± 9,84 cm e a de percentual de gordura corporal, de 23,24 ± 6,44. A maior parte da amostra estudada [20 (80%)] refere realizar quatro ou mais refeições por dia e 72% referiram aumento do consumo alimentar no período de abstinência. A preferência por alimentos específicos no período de abstinência foi relatada por 12 (48%) pacientes. Em relação ao consumo de alimentos ultraprocessados, destaca-se o consumo diário de pão francês (68%), pães brancos de forma (16%), sucos artificiais (48%), refrigerantes (32%), queijo amarelo (36%), embutidos com alto teor de gordura (36%) e balas e chicletes (32%). Conclusão Os resultados mostram prevalência elevada de sobrepeso e obesidade, além de medida de circunferência da cintura alterada, relato de aumento da ingestão alimentar e consumo diário e semanal elevado de alimentos ultraprocessados.

Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households?

BACKGROUND

"Processed foods" are defined as any foods other than raw agricultural commodities and can be categorized by the extent of changes occurring in foods as a result of processing. Conclusions about the association between the degree of food processing and nutritional quality are discrepant.

OBJECTIVE

We aimed to determine 2000-2012 trends in the contribution of processed and convenience food categories to purchases by US households and to compare saturated fat, sugar, and sodium content of purchases across levels of processing and convenience.

DESIGN

We analyzed purchases of consumer packaged goods for 157,142 households from the 2000-2012 Homescan Panel. We explicitly defined categories for classifying products by degree of industrial processing and separately by convenience of preparation. We classified >1.2 million products through use of barcode-specific descriptions and ingredient lists. Median saturated fat, sugar, and sodium content and the likelihood that purchases exceeded maximum daily intake recommendations for these components were compared across levels of processing or convenience by using quantile and logistic regression.

RESULTS

More than three-fourths of energy in purchases by US households came from moderately (15.9%) and highly processed (61.0%) foods and beverages in 2012 (939 kcal/d per capita). Trends between 2000 and 2012 were stable. When classifying foods by convenience, ready-to-eat (68.1%) and ready-to-heat (15.2%) products supplied the majority of energy in purchases. The adjusted proportion of household-level food purchases exceeding 10% kcal from saturated fat, 15% kcal from sugar, and 2400 mg sodium/2000 kcal simultaneously was significantly higher for highly processed (60.4%) and ready-to-eat (27.1%) food purchases than for purchases of less-processed foods (5.6%) or foods requiring cooking/preparation (4.9%).

CONCLUSIONS

Highly processed food purchases are a dominant, unshifting part of US purchasing patterns, but highly processed foods may have higher saturated fat, sugar, and sodium content than less-processed foods. Wide variation in nutrient content suggests food choices within categories may be important.

Consumption of ultra-processed foods and their impact on the diet of young adults

OBJECTIVE To evaluate the consumption of ultra-processed foods, its associated factors, and its influence on nutrient intake in young adults. METHODS In 2004-2005, the individuals belonging to the Pelotas birth cohort of 1982 were identified for a home interview. A total of 4,297 individuals were interviewed and 4,202 individuals were included in the study (follow-up rate of 77.4%). Diet was assessed using a questionnaire on dietary intake and the percentage of daily caloric intake attributed to ultra-processed foods as well as the intake of macro- and micronutrients were estimated. The association between cohort characteristics and the consumption of ultra-processed foods was assessed using linear regression. Analysis of variance and Pearson's Chi-square test were used to evaluate the association between the quintiles of the consumption of ultra-processed food, nutrient intake and adequacy of nutrient intake, respectively. RESULTS The consumption of ultra-processed foods corresponded to 51.2% of the total caloric intake. The consumption of ultra-processed foods was higher among women, individuals with higher education, and individuals who were never poor and eutrophic. The increased consumption of ultra-processed foods was positively correlated with the consumption of fat, cholesterol, sodium, iron, calcium, and calories (p < 0.001) and was negatively correlated with the consumption of carbohydrates, protein, and dietary fiber (p < 0.001). CONCLUSIONS The high consumption of ultra-processed foods and its positive correlation with the intake of sodium, cholesterol, and fats underscores the need to perform interventions aimed at decreasing the intake of this food group.

Fontes alimentares de macronutrientes em amostra probabilística de adultos brasileiros

Uma vez disponíveis, as informações de Ingestão Alimentar (IA) podem permitir o desenvolvimento de estratégias para intervir, acompanhar e explorar padrões dietéticos com métodos estatísticos mais sofisticados. Assim, o objetivo do presente artigo foi documentar as características quantitativas da IA em adultos em um inquérito domiciliar em Niterói, RJ. Realizou-se recordatório de 24 horas de um dia típico. Os alimentos mais ingeridos (> 50%) foram arroz branco, café, feijão, açúcar refinado e pão francês. Leite integral foi mais ingerido do que leite desnatado ou semidesnatado. Carne de vaca foi mais ingerida que carne de frango, peixe ou porco. Mais adultos ingeriram refrigerantes do que sucos, e frutas tiveram ingestão relativamente alta (63,3%). A combinação de arroz, feijão, carne e pão francês foi responsável por 25% da ingestão de energia, proteínas e carboidratos, e 17% da ingestão de lipídeos. Um total de 65 alimentos correspondeu a 90% da ingestão de energia e macronutrientes. O presente estudo gerou uma lista de alimentos mais frequentemente ingeridos, que é bastante semelhante ao que foi observado em inquérito anterior realizado em São Paulo, capital, o que pode servir como base para a geração de um questionário de frequência alimentar único para a população urbana do sudeste brasileiro.

Nutrient profile of 23 596 packaged supermarket foods and non-alcoholic beverages in Australia and New Zealand

OBJECTIVE

To compare the nutrient profile of packaged supermarket food products available in Australia and New Zealand. Eligibility to carry health claims and relationship between nutrient profile score and nutritional content were also evaluated.

DESIGN

Nutritional composition data were collected in six major Australian and New Zealand supermarkets in 2012. Mean Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC) scores were calculated and the proportion of products eligible to display health claims was estimated. Regression analyses quantified associations between NPSC scores and energy density, saturated fat, sugar and sodium contents.

RESULTS

NPSC scores were derived for 23,596 packaged food products (mean score 7.0, range -17 to 53). Scores were lower (better nutrient profile) for foods in Australia compared with New Zealand (mean 6.6 v. 7.8). Overall, 45% of foods were eligible to carry health claims based on NPSC thresholds: 47% in Australia and 41% in New Zealand. However, less than one-third of dairy (32%), meat and meat products (28%) and bread and bakery products (27.5%) were eligible to carry health claims. Conversely, >75% of convenience food products were eligible to carry health claims (82.5%). Each two-unit higher NPSC score was associated with higher energy density (78 kJ/100 g), saturated fat (0.95 g/100 g), total sugar (1.5 g/100 g) and sodium (66 mg/100 g; all P values<0.001).

CONCLUSIONS

Fewer than half of all packaged foods available in Australia and New Zealand in 2012 met nutritional criteria to carry health claims. The few healthy choices available in key staple food categories is a concern. Improvements in nutritional quality of foods through product reformulation have significant potential to improve population diets.

Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010

Objective

To investigate how consumption of ultra-processed foods has changed in Sweden in relation to obesity.

Design

Nationwide ecological analysis of changes in processed foods along with corresponding changes in obesity. Trends in per capita food consumption during 1960–2010 were investigated using data from the Swedish Board of Agriculture. Food items were classified as group 1 (unprocessed/minimally processed), group 2 (processed culinary ingredients) or group 3 (3·1, processed food products; and 3·2, ultra-processed products). Obesity prevalence data were pooled from the peer-reviewed literature, Statistics Sweden and the WHO Global Health Observatory.

Setting

Nationwide analysis in Sweden, 1960–2010.

Subjects

Swedish nationals aged 18 years and older.

Results

During the study period consumption of group 1 foods (minimal processing) decreased by 2 %, while consumption of group 2 foods (processed ingredients) decreased by 34 %. Consumption of group 3·1 foods (processed food products) increased by 116 % and group 3·2 foods (ultra-processed products) increased by 142 %. Among ultra-processed products, there were particularly large increases in soda (315 %; 22 v. 92 litres/capita per annum) and snack foods such as crisps and candies (367 %; 7 v. 34 kg/capita per annum). In parallel to these changes in ultra-processed products, rates of adult obesity increased from 5 % in 1980 to over 11 % in 2010.

Conclusions

The consumption of ultra-processed products (i.e. foods with low nutritional value but high energy density) has increased dramatically in Sweden since 1960, which mirrors the increased prevalence of obesity. Future research should clarify the potential causal role of ultra-processed products in weight gain and obesity.

Which foods may be addictive? The roles of processing, fat content, and glycemic load

Objectives

We propose that highly processed foods share pharmacokinetic properties (e.g. concentrated dose, rapid rate of absorption) with drugs of abuse, due to the addition of fat and/or refined carbohydrates and the rapid rate the refined carbohydrates are absorbed into the system, indicated by glycemic load (GL). The current study provides preliminary evidence for the foods and food attributes implicated in addictive-like eating.

Design

Cross-sectional.

Setting

University (Study One) and community (Study Two).

Participants

120 undergraduates participated in Study One and 384 participants recruited through Amazon MTurk participated in Study Two.

Measurements

In Study One, participants (n = 120) completed the Yale Food Addiction Scale (YFAS) followed by a forced-choice task to indicate which foods, out of 35 foods varying in nutritional composition, were most associated with addictive-like eating behaviors. Using the same 35 foods, Study Two utilized hierarchical linear modeling to investigate which food attributes (e.g., fat grams) were related to addictive-like eating behavior (at level one) and explored the influence of individual differences for this association (at level two).

Results

In Study One, processed foods, higher in fat and GL, were most frequently associated with addictive-like eating behaviors. In Study Two, processing was a large, positive predictor for whether a food was associated with problematic, addictive-like eating behaviors. BMI and YFAS symptom count were small-to-moderate, positive predictors for this association. In a separate model, fat and GL were large, positive predictors of problematic food ratings. YFAS symptom count was a small, positive predictor of the relationship between GL and food ratings.

Conclusion

The current study provides preliminary evidence that not all foods are equally implicated in addictive-like eating behavior, and highly processed foods, which may share characteristics with drugs of abuse (e.g. high dose, rapid rate of absorption) appear to be particularly associated with “food addiction.”

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

Background

The global burden of non-communicable diseases partly reflects growing exposure to ultra-processed food products (UPPs). These heavily marketed UPPs are cheap and convenient for consumers and profitable for manufacturers, but contain high levels of salt, fat and sugars. This study aimed to explore the potential mortality reduction associated with future policies for substantially reducing ultra-processed food intake in the UK.

Methods and Findings

We obtained data from the UK Living Cost and Food Survey and from the National Diet and Nutrition Survey. By the NOVA food typology, all food items were categorized into three groups according to the extent of food processing: Group 1 describes unprocessed/minimally processed foods. Group 2 comprises processed culinary ingredients. Group 3 includes all processed or ultra-processed products. Using UK nutrient conversion tables, we estimated the energy and nutrient profile of each food group. We then used the IMPACT Food Policy model to estimate reductions in cardiovascular mortality from improved nutrient intakes reflecting shifts from processed or ultra-processed to unprocessed/minimally processed foods. We then conducted probabilistic sensitivity analyses using Monte Carlo simulation.

Results

Approximately 175,000 cardiovascular disease (CVD) deaths might be expected in 2030 if current mortality patterns persist. However, halving the intake of Group 3 (processed) foods could result in approximately 22,055 fewer CVD related deaths in 2030 (minimum estimate 10,705, maximum estimate 34,625). An ideal scenario in which salt and fat intakes are reduced to the low levels observed in Group 1 and 2 could lead to approximately 14,235 (minimum estimate 6,680, maximum estimate 22,525) fewer coronary deaths and approximately 7,820 (minimum estimate 4,025, maximum estimate 12,100) fewer stroke deaths, comprising almost 13% mortality reduction.

Conclusions

This study shows a substantial potential for reducing the cardiovascular disease burden through a healthier food system. It highlights the crucial importance of implementing healthier UK food policies.

Avaliação da alimentação complementar nos dois primeiros anos de vida: proposta de indicadores e de instrumento

O objetivo deste artigo é apresentar indicadores e instrumento para monitoramento da alimentação complementar entre crianças menores de dois anos no Brasil, descrevendo seu processo de formulação. Com base em um modelo teórico sobre atributos, componentes e marcadores de alimentação complementar construído neste estudo, foram sistematizadas as recomendações alimentares referentes a conceitos-chave desse modelo. Essas recomendações foram transformadas em indicadores. Um questionário foi construído com base nas variáveis desses indicadores. Foram realizadas duas oficinas com especialistas em alimentação complementar para discussão sobre os indicadores e o instrumento e quatro pré-testes com a população de interesse. São apresentados 18 indicadores referentes à oportunidade, à adequação nutricional e à segurança da alimentação complementar, e um questionário que permite a construção dos indicadores propostos. Ele pode ser aplicado em inquéritos com entrevistas face a face, por telefone ou em atividades de monitoramento do consumo alimentar em serviços de saúde. São necessárias pesquisas ulteriores para a validação deste questionário.

The correlation between supermarket size and national obesity prevalence

Background

Supermarkets provide healthy and affordable food options while simultaneously heavily promoting energy-dense, nutrient-poor foods and drinks. Store size may impact body weight via multiple mechanisms. Large stores encourage purchasing of more food in a single visit, and in larger packages. In addition they provide greater product choice (usually at lower prices) and allow greater exposure to foods of all types. These characteristics may promote purchasing and consumption. Our objective was to assess the relationship between supermarket size and obesity, which has rarely been assessed.

Results

Data on supermarket size (measured as total aisle length in metres) was from 170 stores in eight developed countries with Western-style diets. Data for national obesity prevalence was obtained from the UK National Obesity Observatory. We found a strong correlation between average store size and national obesity prevalence (r = 0.96).

Conclusions

Explanations for the association between store size and national obesity prevalence may include larger and less frequent shopping trips and greater choice and exposure to foods in countries with larger stores. Large supermarkets may represent a food system that focuses on quantity ahead of quality and therefore may be an important and novel environmental indicator of a pattern of behaviour that encourages obesity.

Consumption of ready-made meals and increased risk of obesity: findings from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study

The consumption of ready-made meals, such as pre-packaged dishes, available at grocery stores and fast-food restaurants, is a habit related to our modern fast-paced lives. No study has examined the association of daily ready-made meal consumption with diet quality or health-related outcomes. The present study aimed to investigate the association between self-reported ready-made meal consumption and diet quality, as measured by compliance with dietary recommendations and with a set of adiposity measures, in a nationally representative sample of 1352 subjects, aged 18–69 years, participating in the nationwide population-based ORISCAV-LUX (Observation of Cardiovascular Risk Factors in Luxembourg) survey. The daily consumption of ready-made meals was calculated as follows: frequency of consumption × portion size × number of portions consumed. The sum of the daily consumption values of the eleven pre-packaged dishes included in the FFQ represented the total daily consumption of ready-made meals (g/d) for each participant. About 97 % of the participants reported daily consumption of ready-made meals. The intake was highly prevalent in men living alone and varied according to education level. Ready-made meal consumption provided >7 % of total daily energy. The fractions (%) of macro- and micronutrients derived from daily consumption of ready-made meals varied from 10 % for total cholesterol to 0·65 % for total fibre. Increased consumption of ready-made meals was found to be independently associated with abdominal obesity. On controlling for age, sex, socio-economic status and lifestyle factors, daily consumption of ready-made meals was found to be associated with higher energy intake and with poor compliance with national nutritional recommendations, and hence it could plausibly increase the risk of central obesity and fat deposition.

Dietary patterns of Brazilian adolescents: results of the Brazilian National School-Based Health Survey (PeNSE)

The objectives of this study were to identify dietary patterns in Brazilian adolescents, describe their distributions in Brazil's State capitals and Federal District, and analyze the correlations with the Municipal Human Development Index (HDI-M). The study analyzed a sample of 60,954 ninth-graders from public and private schools who participated in the National School-Based Health Survey (PeNSE) in 2009. Cluster analysis was used to characterize dietary patterns. Three patterns were identified: healthy (27.7%), unhealthy (34.6%), and mixed (37.7%). Adolescents in the country's Southeast, South, and Central West regions showed a higher proportion of the healthy eating pattern. HDI-M showed a positive correlation with the healthy pattern and a negative correlation with the mixed pattern. The identification of different dietary patterns within and between regions and according to HDI-M highlights the need for better knowledge of each local context in terms of both the magnitude of events and the examination of determinants within these different realities.

Brain evolution, the determinates of food choice, and the omnivore's dilemma

A coevolutionary paradigm using a biocultural perspective can help to unravel the complex interactions that led to the contemporary pattern of eating. Evolutionary history helps to understand the adaptation of diet and its nutritional implications. Anatomical and behavioral changes linked to changing dietary patterns in the Paleolithic resulted in an adaptive framework that affects modern diet. The evolution of an expanding brain, a shrinking large intestine, and lengthening small intestine necessitated a demand for nutritionally dense foods. The key to these changes is an understanding of the response to the omnivore's dilemma. Omnivores in their search for new items to feed their varied diet (neophilia) have a challenge when they fear (neophobia) novel items that may be poisonous and can cause death. The inborn mechanism initiates palate fatigue (sensory-specific satiety) ensuring a variety of foods will be eaten. Variety will limit the impact of toxins ingested and provide a more balanced diet. The development of cuisine, a momentous event in history, mediated the conflict, and changed the course of human evolution. The cuisine, a biocultural construct, defines which items found in nature are edible, how these products are transformed into food, the flavors used to add a sensory dimension to foods, and rules of eating or etiquette. Etiquette defines how, when, and with whom we eat. Patterns of eating in the modern setting are the end product of the way that Homo sapiens evolved and resolved the omnivore's dilemma. Control of fire and cooking expanded the range of available foods by creating a class of foods that are "predigested." An essential element to the evolution of the human diet was the transition to agriculture as the primary mode of subsistence. The Neolithic revolution dramatically narrowed the dietary niche by decreasing the variety of available foods, with the shift to intensive agriculture creating a dramatic decline in human nutrition. The recent industrialization of the world food system has resulted in a nutritional transition in which developing nations are simultaneously experiencing undernutrition and obesity. In addition, an abundance of inexpensive, high-density foods laden with sugar and fats is available to a population that expends little energy to obtain such large numbers of calories. Furthermore, the abundant variety of ultraprocessed foods overrides the sensory-specific satiety mechanism leading to overconsumption.

Diet quality assessment indexes

Various indices and scores based on admittedly healthy dietary patterns or food guides for the general population, or aiming at the prevention of diet-related diseases have been developed to assess diet quality. The four indices preferred by most studies are: the Diet Quality Index; the Healthy Eating Index; the Mediterranean Diet Score; and the Overall Nutritional Quality Index. Other instruments based on these indices have been developed and the words 'adapted', 'revised', or 'new version I, II or III' added to their names. Even validated indices usually find only modest associations between diet and risk of disease or death, raising questions about their limitations and the complexity associated with measuring the causal relationship between diet and health parameters. The objective of this review is to describe the main instruments used for assessing diet quality, and the applications and limitations related to their use and interpretation.

Sodium content and labelling of processed and ultra-processed food products marketed in Brazil

OBJECTIVE

To analyse the Na content and labelling of processed and ultra-processed food products marketed in Brazil.

DESIGN

Cross-sectional study.

SETTING

A large supermarket in Florianopolis, southern Brazil.

SUBJECTS

Ingredient lists and Na information on nutrition labels of all processed and ultra-processed pre-prepared meals and prepared ingredients, used in lunch or dinner, available for sale in the supermarket.

RESULTS

The study analysed 1416 products, distributed into seven groups and forty-one subgroups. Five products did not have Na information. Most products (58.8 %; 95 % CI 55.4, 62.2 %) had high Na content (>600 mg/100 g). In 78.0 % of the subgroups, variation in Na content was at least twofold between similar products with high and low Na levels, reaching 634-fold difference in the 'garnishes and others' subgroup. More than half of the products (52.0 %; 95 % CI 48.2, 55.6 %) had at least one Na-containing food additive. There was no relationship between the appearance of salt on the ingredients list (first to third position on the list) and a product's Na content (high, medium or low; P=0.08).

CONCLUSIONS

Most food products had high Na content, with great variation between similar products, which presents new evidence for reformulation opportunities. There were inconsistencies in Na labelling, such as lack of nutritional information and incomplete ingredient descriptions. The position of salt on the ingredients list did not facilitate the identification of high-Na foods. We therefore recommend a reduction in Na in these products and a review of Brazilian legislation.

Food Classification Systems Based on Food Processing: Significance and Implications for Policies and Actions: A Systematic Literature Review and Assessment

This paper is the first to make a systematic review and assessment of the literature that attempts methodically to incorporate food processing into classification of diets. The review identified 1276 papers, of which 110 were screened and 21 studied, derived from five classification systems. This paper analyses and assesses the five systems, one of which has been devised and developed by a research team that includes co-authors of this paper. The quality of the five systems is assessed and scored according to how specific, coherent, clear, comprehensive and workable they are. Their relevance to food, nutrition and health, and their use in various settings, is described. The paper shows that the significance of industrial food processing in shaping global food systems and supplies and thus dietary patterns worldwide, and its role in the pandemic of overweight and obesity, remains overlooked and underestimated. Once food processing is systematically incorporated into food classifications, they will be more useful in assessing and monitoring dietary patterns. Food classification systems that emphasize industrial food processing, and that define and distinguish relevant different types of processing, will improve understanding of how to prevent and control overweight, obesity and related chronic non-communicable diseases, and also malnutrition. They will also be a firmer basis for rational policies and effective actions designed to protect and improve public health at all levels from global to local.

[Place and type of meals consumed by adults in medium sized cities]

OBJECTIVE

To describe the meals consumed by adults living in a midsize city in the South of Brazil, according to the place and preparation.

METHODS

A population-based cross-sectional study was conducted in Pelotas, Southern Brazil, in 2012. The two-stage sampling design used the 2010 census tracts as primary sampling units. Data were collected on the place of meals (at home or out) and on the kind of preparations consumed at home (homemade, snacks, take away food) covering the two days prior to the interview, using a standardized questionnaire.

RESULTS

The study included 2,927 adults, of which 59.0% were female, 60.0% were below 50 years of age and 58.0% were in work. Data were collected on 11,581 meals consumed on the two days preceding the interview, 25.0% were consumed outside of the home at lunchtime, and 10.0% at dinnertime. Considering home meals, most participants reported eating food prepared at home at both lunch and dinner. The majority of out-of-home meals (64.0% for lunch and 61.0% for dinner) were consumed in the work place, mostly based on food prepared at home. Individuals eating out of home were mostly male, young and highly educated. The occupational categories that ate at restaurants more often were trade workers, businessmen, teachers and graduate professionals.

CONCLUSIONS

Despite the changes in eating patterns described in Brazil in recent years, residents of medium-sized towns still mostly eat at home, consuming homemade food.

The consumption of unhealthy foods by Brazilian children is influenced by their mother's educational level

OBJECTIVE

To evaluate the association between the consumption of unhealthy foods in children under one year and the education level of the mothers, data obtained from participants of the II Survey on the prevalence of breastfeeding in the Brazilian capitals and the Federal District in 2008 was analyzed.

METHODS

During the second stage of the campaign for multi-vaccination, a questionnaire on food consumption in the last 24 hours was given to mothers or guardians of children under one year old. We analyzed the consumption of unhealthy foods according to age group, maternal education, region of residence and breastfeeding status. The state capitals and the Federal District were grouped according to the five macro-regions of the country (North, Northeast, Southeast, South and West). Processed juice, soda, coffee, cookies/salted snacks and sugar and/or honey were defined as unhealthy foods. Prevalence ratios (RP) for the association between the consumption of unhealthy foods and maternal education were estimated using Poisson regression models.

RESULTS

The study included 34,366 children. The consumption of sweet foods started early and was predominant until the age of six months; after this age, the consumption of biscuits and/or snacks became more prevalent. The consumption of these foods also differs in relation to the macro-region of residence. Consumption of unhealthy foods was higher among mothers with lower education levels.

CONCLUSIONS

The consumption of unhealthy foods by Brazilian children under one year old was high, indicating a need for developing effective strategies to combat the consumption of unhealthy foods in Brazilian children as a way of preventing obesity and other future disorders.

Ultra-processed food products and obesity in Brazilian households (2008-2009)

Background

Production and consumption of industrially processed food and drink products have risen in parallel with the global increase in overweight and obesity and related chronic non-communicable diseases. The objective of this study was to analyze the relationship between household availability of processed and ultra-processed products and the prevalence of excess weight (overweight plus obesity) and obesity in Brazil.

Methods

The study was based on data from the 2008–2009 Household Budget Survey involving a probabilistic sample of 55,970 Brazilian households. The units of study were household aggregates (strata), geographically and socioeconomically homogeneous. Multiple linear regression models were used to assess the relationship between the availability of processed and ultra-processed products and the average of Body Mass Index (BMI) and the percentage of individuals with excess weight and obesity in the strata, controlling for potential confounders (socio-demographic characteristics, percentage of expenditure on eating out of home, and dietary energy other than that provided by processed and ultra-processed products). Predictive values for prevalence of excess weight and obesity were estimated according to quartiles of the household availability of dietary energy from processed and ultra-processed products.

Results

The mean contribution of processed and ultra-processed products to total dietary energy availability ranged from 15.4% (lower quartile) to 39.4% (upper quartile). Adjusted linear regression coefficients indicated that household availability of ultra-processed products was positively associated with both the average BMI and the prevalence of excess weight and obesity, whereas processed products were not associated with these outcomes. In addition, people in the upper quartile of household consumption of ultra-processed products, compared with those in the lower quartile, were 37% more likely to be obese.

Conclusion

Greater household availability of ultra-processed food products in Brazil is positively and independently associated with higher prevalence of excess weight and obesity in all age groups in this cross-sectional study.

Processed and Ultra-processed Food Products: Consumption Trends in Canada from 1938 to 2011

Purpose

A classification of foods based on the nature, extent, and purpose of industrial food processing was used to assess changes in household food expenditures and dietary energy availability between 1938 and 2011 in Canada.

Methods

Food acquisitions from six household food budget surveys (1938/1939 , 1953, 1969, 1984, 2001, and 2011) were classified into unprocessed or minimally processed foods, processed culinary ingredients, and ready-to-consume processed or ultra-processed products. Contributions of each group to household food expenditures, and to dietary energy availability (kcal per capita) were calculated.

Results

During the period studied, household expenditures and dietary energy availability fell for both unprocessed or minimally processed foods and culinary ingredients, and rose for ready-to-consume products. The caloric share of foods fell from 34.3% to 25.6% and from 37% to 12.7% for culinary ingredients. The share of ready-to-consume products rose from 28.7% to 61.7%, and the increase was especially noteworthy for those that were ultra-processed.

Conclusions

The most important factor that has driven changes in Canadian dietary patterns between 1938 and 2011 is the replacement of unprocessed or minimally processed foods and culinary ingredients used in the preparation of dishes and meals; these have been displaced by ready-to-consume ultra-processed products. Nutrition research and practice should incorporate information about food processing into dietary assessments.

Consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community

OBJECTIVE

The present study describes the consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community and examines its associations with physical activity, sedentary behaviours and BMI.

DESIGN

A two-stage cross-sectional design was used. In Stage 1 (n 42), 24 h recalls enabled the identification of sweetened products. In Stage 2 (n 192), an FFQ was administered to measure the daily consumption of these products and to collect sociodemographic and behavioural data. Sweetened products were defined as processed culinary ingredients and ultra-processed products for which total sugar content exceeded 20% of total energy.

SETTING

Three Catholic Middle Eastern churches located in Montreal, Canada.

SUBJECTS

Normoglycaemic men and women (18-60 years old).

RESULTS

Twenty-six sweetened products represented an average consumption of 75·4 g total sugars/d or 15·1% of daily energy intake (n 190, 56% women). Soft drinks, juices, sweetened coffee, chocolate, cookies, cakes and muffins were the main sources of consumption and mostly consumed between meals. Age (exp (β) = 0·99; P < 0·01), physical activity (exp (β) = 1·08; P < 0·01) and recreational computer use (exp (β) = 1·17; P < 0·01) were independently associated with sweetened product consumption. The association between sweetened product consumption and physical activity was U-shaped. BMI was not significantly associated with sweetened product consumption but all participants regardless of BMI were above the WHO recommendation for free sugars.

CONCLUSIONS

Being physically active and spending less time using a computer may favour a reduced consumption of sweetened products. Very active individuals may, however, overconsume such products.

Qualitative analysis of the contributions of nutritionists to the development of an online instrument for monitoring the food intake of schoolchildren

BACKGROUND

The Consumo Alimentar e Atividade Fisica de Escolares (CAAFE) questionnaire is an online research tool that has been developed to enable the self-report of physical activity and diet by Brazilian schoolchildren aged 7-10 years. Formative research was conducted with nutritionists during the development of the web-based questionnaire. The suggestions and insights obtained were used to design a tool to monitor schoolchildren's food consumption based on the concept of healthy and unhealthy food indicators. The present study aimed to report the focus group discussions conducted with nutritionists concerning the CAAFE questionnaire.

METHODS

Focus group discussions were conducted using a semi-structured questionnaire, and these were then analysed thematically.

RESULTS

Twenty-four nutritionists participated (four focus groups; average per group: six people); the majority (n = 22) had experience with 7-10-year-old children. Four themes emerged: (i) healthy and unhealthy food indicators; (ii) suggestions for the online instrument; (iii) potential applications; and (iv) challenges for its construction.

CONCLUSIONS

Comments made by nutritionists enabled the construction of an instrument that is able to answer questions related to food consumption in schools and at home.

Sources of excessive saturated fat, trans fat and sugar consumption in Brazil: an analysis of the first Brazilian nationwide individual dietary survey

OBJECTIVE

To examine the patterns of consumption of foods high in solid fats and added sugars (SoFAS) in Brazil.

DESIGN

Cross-sectional study; individual dietary intake survey. Food intake was assessed by means of two non-consecutive food records. Foods providing >9·1% of energy from saturated fat, or >1·3% of energy from trans fat, or >13% of energy from added sugars per 100 g were classified as high in SoFAS.

SETTING

Brazilian nationwide survey, 2008-2009.

SUBJECTS

Individuals aged ≥10 years old.

RESULTS

Mean daily energy intake was 8037 kJ (1921 kcal), 52% of energy came from SoFAS foods. Contribution of SoFAS foods to total energy intake was higher among women (52%) and adolescents (54%). Participants in rural areas (43%) and in the lowest quartile of per capita family income (43%) reported the smallest contribution of SoFAS foods to total energy intake. SoFAS foods were large contributors to total saturated fat (87%), trans fat (89%), added sugar (98%) and total sugar (96%) consumption. The SoFAS food groups that contributed most to total energy intake were meats and beverages. Top SoFAS foods contributing to saturated fat and trans fat intakes were meats and fats and oils. Most of the added and total sugar in the diet was supplied by SoFAS beverages and sweets and desserts.

CONCLUSIONS

SoFAS foods play an important role in the Brazilian diet. The study identifies options for improving the Brazilian diet and reducing nutrition-related non-communicable chronic diseases, but also points out some limitations of the nutrient-based criteria.

Consumption of ultra-processed foods and likely impact on human health. Evidence from Canada

OBJECTIVE

To investigate consumption of ultra-processed products in Canada and to assess their association with dietary quality.

DESIGN

Application of a classification of foodstuffs based on the nature, extent and purpose of food processing to data from a national household food budget survey. Foods are classified as unprocessed/minimally processed foods (Group 1), processed culinary ingredients (Group 2) or ultra-processed products (Group 3).

SETTING

All provinces and territories of Canada, 2001.

SUBJECTS

Households (n 5643).

RESULTS

Food purchases provided a mean per capita energy availability of 8908 (se 81) kJ/d (2129 (se 19) kcal/d). Over 61·7 % of dietary energy came from ultra-processed products (Group 3), 25·6 % from Group 1 and 12·7 % from Group 2. The overall diet exceeded WHO upper limits for fat, saturated fat, free sugars and Na density, with less fibre than recommended. It also exceeded the average energy density target of the World Cancer Research Fund/American Institute for Cancer Research. Group 3 products taken together are more fatty, sugary, salty and energy-dense than a combination of Group 1 and Group 2 items. Only the 20 % lowest consumers of ultra-processed products (who consumed 33·2 % of energy from these products) were anywhere near reaching all nutrient goals for the prevention of obesity and chronic non-communicable diseases.

CONCLUSIONS

The 2001 Canadian diet was dominated by ultra-processed products. As a group, these products are unhealthy. The present analysis indicates that any substantial improvement of the diet would involve much lower consumption of ultra-processed products and much higher consumption of meals and dishes prepared from minimally processed foods and processed culinary ingredients.

Brazilian obesity prevention and control initiatives

Obesity prevalence in the Brazilian adult population is 12.5% among men and 16.9% among women. Obesity control has been a subject of concern in Brazilian health policies since the publication of the National Food and Nutrition Policy in 1999. The initiatives include a comprehensive national intersectorial plan for obesity prevention and control focused on confronting its social and environmental causes, development of a food and nutrition education framework aimed at intersectorial public policies in the food and nutritional security field, promotion and provision of healthy food in school environments (linked to family farming), structuring nutrition actions in primary healthcare in the national healthcare system, promoting community physical activity, food regulation and control, and encouragement of public participation and food control. We conclude that several initiatives have been developed in Brazil to deal with the challenge of implementing an intergovernmental, intersectorial response to reverse the rising overweight and obesity rates. The success of this response will depend on a governance model that promotes joint and integrated action by different sectors and active participation of society to consolidate the actions, places and laws that protect health and promote healthy lifestyles.

Validation of an adapted version of the nutrition environment measurement tool for stores (NEMS-S) in an urban area of Brazil

OBJECTIVE

To validate an adapted instrument that assesses the nutritional environment of food stores in Brazilian urban areas.

METHODS

The instrument measured aspects of food environment such as availability, prices, and quality. The Harvard Healthy Eating Pyramid and the degree of processing were used to define healthy foods. The sample included 44 food stores in 3 census tracts in the city of Santos. Inter-rater reliability and stability coefficient were obtained with measurements performed by different individuals at different times. Internal consistency and construct validity were assessed by Cronbach α and the known-groups comparison method, respectively.

RESULTS

Inter-rater reliability was high. The mean intra-class correlation coefficient was 0.98 and the mean kappa was 0.77. Cronbach α values ranged from .68 to .93.

CONCLUSIONS AND IMPLICATIONS

The instrument can be useful in the development of interventions to promote healthy eating through actions focused on healthy food availability in Brazilian communities.

Monitoring and benchmarking population diet quality globally: a step-wise approach

INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support) aims to monitor and benchmark the healthiness of food environments globally. In order to assess the impact of food environments on population diets, it is necessary to monitor population diet quality between countries and over time. This paper reviews existing data sources suitable for monitoring population diet quality, and assesses their strengths and limitations. A step-wise framework is then proposed for monitoring population diet quality. Food balance sheets (FBaS), household budget and expenditure surveys (HBES) and food intake surveys are all suitable methods for assessing population diet quality. In the proposed 'minimal' approach, national trends of food and energy availability can be explored using FBaS. In the 'expanded' and 'optimal' approaches, the dietary share of ultra-processed products is measured as an indicator of energy-dense, nutrient-poor diets using HBES and food intake surveys, respectively. In addition, it is proposed that pre-defined diet quality indices are used to score diets, and some of those have been designed for application within all three monitoring approaches. However, in order to enhance the value of global efforts to monitor diet quality, data collection methods and diet quality indicators need further development work.

Participacao crescente de produtos ultraprocessados na dieta brasileira (1987-2009)

OBJETIVO Estimar tendências temporais do consumo domiciliar de itens alimentícios no Brasil, levando em conta a extensão e o propósito do seu processamento industrial. MÉTODOS Os dados analisados são provenientes de Pesquisa de Orçamentos Familiares realizadas no Brasil em 1987-1988, 1995-1996, 2002-2003 e 2008-2009. Foram analisadas amostras probabilísticas dos domicílios das áreas metropolitanas em todos os períodos mencionados e, nas duas amostras mais recentes, a abrangência foi nacional. As unidades de análise foram registros de aquisições de agregados de domicílios. Os itens alimentícios foram divididos segundo extensão e propósito de seu processamento industrial em: alimentos in natura ou minimamente processados, ingredientes culinários processados e produtos alimentícios prontos para consumo, processados ou ultraprocessados. A quantidade adquirida de cada item foi convertida em energia. Estimaram-se a disponibilidade diária total per capita de calorias e a contribuição dos grupos de alimentos em cada pesquisa. Calcularam-se estimativas por quintos de renda para as pesquisas nacionais. Variações temporais foram testadas por teste de diferença de médias e modelos de regressão linear. RESULTADOS Houve aumento significativo da participação de produtos prontos para o consumo (de 23,0% para 27,8% das calorias), graças ao aumento no consumo de produtos ultraprocessados (de 20,8% para 25,4%) entre 2002-2003 e 2008-2009. Houve redução significativa na participação de alimentos e de ingredientes culinários nesse período. O aumento da participação de produtos ultraprocessados ocorreu em todos os estratos de renda. Observou-se aumento uniforme da participação calórica de produtos prontos para o consumo em áreas metropolitanas, novamente à custa de produtos ultraprocessados e acompanhada por reduções na participação de alimentos in natura ou minimamente processados quanto de ingredientes culinários. CONCLUSÕES Produtos ultraprocessados apresentam participação crescente na dieta brasileira, evidenciada desde a década de 1980 nas áreas metropolitanas e confirmada para todo o País na década de 2000.

International differences in cost and consumption of ready-to-consume food and drink products: United Kingdom and Brazil, 2008-2009

This paper tests the hypothesis that one important factor determining household availability of ready-to-consume products is their cost relative to the rest of the diet. National food expenditure surveys in the UK (2008) and Brazil (2008-09) were used. Purchased food quantities were converted into dietary energy (calories) and classified into three groups: (1) foods that are unprocessed or minimally processed; (2) processed culinary ingredients; and (3) ready-to-consume products, either processed or ultra-processed. The contribution of these groups to diets in each country was calculated as a percentage of total energy. Relative cost of ready-to-consume products in each country was calculated by dividing their cost by the cost of the rest of the diet (foods plus culinary ingredients). Linear regression analysis was used to test the association between the UK to Brazil ratios of the caloric share of different ready-to-consume products, and of the relative cost of these products. The caloric share of ready-to-consume products in the UK (63.4%) was well over double that of Brazil (27.7%), whereas their cost relative to the rest of the diet was 43% lower. The lower the relative cost of ready-to-consume products in the UK (compared with Brazil), the higher their relative consumption (R(2)=0.38, p<0.01).

Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries

The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public-private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public-private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.

Custo da alimentação e densidade energética da dieta no Brasil, 2008-2009

Este estudo tem por objetivo avaliar a relação entre o custo da alimentação e a densidade energética da dieta consumida nos domicílios brasileiros. Utilizaram-se dados da Pesquisa de Orçamentos Familiares (POF-2008/2009) para identificação dos alimentos com consumo mais relevante e seus preços. Tais alimentos foram agrupados, resultando em uma cesta de 67 produtos. Empregou-se a programação linear para composição de cestas isoenergéticas, minimizando o afastamento da dieta média encontrada nos domicílios. Foram impostos limites para quantidade de inclusão dos itens e contribuição energética dos grupos de alimentos; e uma redução no custo médio da dieta foi aplicada a intervalos de R$0,15 até o menor custo possível. Identificou-se associação inversa entre densidade energética e preço da dieta (p < 0,05), e, no menor custo possível, obteve-se o valor máximo de densidade energética. Verificou-se que restrições no custo da alimentação resultaram na seleção de dietas com maior densidade energética, indicando que o custo da alimentação pode conduzir à adoção de dietas inadequadas no Brasil.

Marco legal do Programa Nacional de Alimentação Escolar: uma releitura para alinhar propósitos e prática na aquisição de alimentos

Este ensaio pretende discutir a aquisição de alimentos para o Programa Nacional de Alimentação Escolar à luz do seu marco legal vigente, na perspectiva de promover hábitos alimentares saudáveis e culturalmente articulados que contribuam para a promoção das condições de saúde da população escolar brasileira e para o desenvolvimento local. Apresentase análise da legislação em vigor do Programa Nacional de Alimentação Escolar, evidenciando a intencionalidade de influenciar o sistema alimentar brasileiro e o padrão alimentar de sua população a partir da alimentação escolar, destacandose as lacunas que desafiam a efetivação de mudanças substanciais na execução do programa. Partindo dessa análise e com base no elevado e crescente consumo de alimentos ultraprocessados no Brasil, e considerando as desvantagens desses alimentos diante de alimentos pouco ou não processados, desenvolvese proposta para orientar a construção de uma pauta de alimentos que seja consistente com o marco legal vigente do programa e com seus objetivos. Argumentase que a predominância de alimentos pouco ou não processados na alimentação escolar pode ser estratégia para o resgate do patrimônio alimentar saudável e para o fortalecimento do desenvolvimento local se resultar da aproximação com a agricultura familiar.

Describing the situational contexts of sweetened product consumption in a Middle Eastern Canadian community: application of a mixed method design

Little is known about the situational contexts in which individuals consume processed sources of dietary sugars. This study aimed to describe the situational contexts associated with the consumption of sweetened food and drink products in a Catholic Middle Eastern Canadian community. A two-stage exploratory sequential mixed-method design was employed with a rationale of triangulation. In stage 1 (n = 62), items and themes describing the situational contexts of sweetened food and drink product consumption were identified from semi-structured interviews and were used to develop the content for the Situational Context Instrument for Sweetened Product Consumption (SCISPC). Face validity, readability and cultural relevance of the instrument were assessed. In stage 2 (n = 192), a cross-sectional study was conducted and exploratory factor analysis was used to examine the structure of themes that emerged from the qualitative analysis as a means of furthering construct validation. The SCISPC reliability and predictive validity on the daily consumption of sweetened products were also assessed. In stage 1, six themes and 40-items describing the situational contexts of sweetened product consumption emerged from the qualitative analysis and were used to construct the first draft of the SCISPC. In stage 2, factor analysis enabled the clarification and/or expansion of the instrument's initial thematic structure. The revised SCISPC has seven factors and 31 items describing the situational contexts of sweetened product consumption. Initial validation of the instrument indicated it has excellent internal consistency and adequate test-retest reliability. Two factors of the SCISPC had predictive validity for the daily consumption of total sugar from sweetened products (Snacking and Energy demands) while the other factors (Socialization, Indulgence, Constraints, Visual Stimuli and Emotional needs) were rather associated to occasional consumption of these products.

Implantação da cantina escolar saudável em escolas do Distrito Federal, Brasil

OBJETIVO: Desenvolver e aplicar uma metodologia para avaliar a implantação da cantina escolar saudável em escolas do Distrito Federal. MÉTODOS: Um estudo descritivo e avaliativo sobre uma intervenção educativa realizado em 2006, por meio de um curso de capacitação para proprietários de cantinas, em que foram avaliados a implantação dos Dez Passos da Cantina Escolar Saudável e o perfil de funcionamento da cantina em três momentos (antes do curso, seis meses e dois anos depois). Para avaliação das preparações, criou-se um sistema de classificação em mais ou menos saudáveis. RESULTADOS: Foram capacitados 35 proprietários de cantina; dentre eles, nove participaram dos três momentos de avaliação. Houve uma maior aplicação dos Dez Passos da Cantina Escolar Saudável e um maior oferecimento de lanches mais saudáveis do 1º para o 2º momento, entretanto o 3º momento de avaliação não manteve o mesmo comportamento. Apesar da descontinuidade observada no processo de acompanhamento da intervenção, os participantes buscaram um maior contato com outras cantinas interessadas no desenvolvimento de uma cantina saudável (p=0,002). CONCLUSÃO: O curso de capacitação apresentou resultados positivos, principalmente a curto prazo, entretanto o processo de acompanhamento durante um ano para esse público não foi o suficiente para garantir a sustentabilidade das ações. Para a efetiva implantação e manutenção da cantina saudável é fundamental o acompanhamento sistemático desse processo, apoiado no envolvimento da comunidade escolar e em legislação específica.

A vida não pode ser feita só de sonhos: reflexões sobre publicidade e alimentação saudável

Neste ensaio apresentamos algumas reflexões sobre publicidade e alimentação saudável no mundo contemporâneo onde o consumo exerce papel de grande relevância. Buscamos enfatizar dois aspectos, entre tantos outros ainda por serem explorados na literatura científica do campo alimentar-nutricional: a hegemonia do paradigma biomédico e a fragmentação da vida humana quando campanhas publicitárias anunciam alimentos associando-os à ideia de alimentação saudável. Consideramos que não podemos viver somente como naquela publicidade onde nossos desejos são acionados, sem limites, onde mundo é só de sonhos e o objetivo principal é vender mais e lucrar mais, ainda que para isso se tenha feito uso de estratégias de disseminação de algumas informações de cunho biomédico-nutricional. O encontro entre alimentação e saúde, ou seja, alimentação saudável, deve pressupor, no nosso entendimento, a valorização da ação do sujeito, inclusive por meio de informações qualificadas e contextualizadas na vida social de modo a que se possa desenhar projetos de felicidade. Um sujeito fortalecido em sua identidade, íntegro e total que, entre sonhos e concretudes, pode ousar a buscar o conhecer e o pensar sobre si mesmo no mundo, sobre sua alimentação e sua saúde.

The impact of transnational "big food" companies on the South: a view from Brazil

In an article that forms part of the PLoS Medicine series on Big Food, Carlos Monteiro and Geoffrey Cannon provide a perspective from Brazil on the rise of multinational food companies and the displacement of traditional food systems, and offer suggestions for the public health response.

[Suicide and nutrition: a bio-psychosocial approach]

This article proposes a new bio-psychosocial perspective on the links between mental health, more specifically suicide, and nutrition. We first discuss the links between nutrition, its social role and suicide. The act of eating is studied as a social integrator and regulator, in the light of Durkheim's theorization. Nutrition is also examined as self-destruction, with particular cases of "diet-related suicide." De-structuring of meals and alienating foods are identified as contributing factors to the de-structuring of "nutrition models." We then discuss the place of food within the psychopathology, and finally, the links between biological parameters reflected in food and suicide risk. Avenues of research and intervention along this bio-psychosocial approach are also proposed.

Regional and socioeconomic distribution of household food availability in Brazil, in 2008-2009

OBJECTIVE

To describe the regional and socioeconomic distribution of household food availability in Brazil.

METHODS

Data from the 2008-2009 Household Budget Survey on food and beverage acquisition for household consumption, conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics), were analyzed. The amounts of foods, recorded during seven consecutive days in the 55,970 sample households, were converted into calories and nutrients. Food quality indicators were constructed and analyzed according to the regional and socioeconomic strata of the Brazilian population.

RESULTS

The amount of energy from protein was adequate in all regional and socioeconomic strata. On the other hand, an excess of free sugars and fats was observed in all regions of the country, especially in the Southern and Southeastern regions. The proportion of saturated fats was high in urban areas and consistent with the greater contribution of animal-derived products. Limited availability of fruits and vegetables was found in all regions. An increase in the fat content and reduction in carbohydrate content of the diet were observed with the increase in income.

CONCLUSIONS

The negative characteristics of the Brazilian diet observed at the end of the first decade of the 21st century indicate the need to prioritize public policies for the promotion of healthy eating.

Ações de alimentação e nutrição na atenção básica: a experiência de organização no Governo Brasileiro

O artigo descreve a experiência do governo brasileiro na organização das ações de Alimentação e Nutrição ao que cabe à Atenção Básica. As ações são desenvolvidas por meio da Vigilância Alimentar e Nutricional, com o uso do Sistema de Vigilância Alimentar e Nutricional como principal ferramenta; Ações de Promoção à Saúde e da Alimentação Saudável, com a implementação do Guia Alimentar para a População Brasileira, da Estratégia Nacional para a Alimentação Complementar Saudável, do Programa Saúde na Escola e Ações de controle e prevenção da Obesidade, Doenças Crônicas e deficiências de micronutrientes, com foco na anemia ferropriva e hipovitaminose A. As ações de Alimentação e Nutrição na Atenção Básica foram fortalecidas com a inserção do nutricionista nas equipes dos Núcleos de Apoio à Saúde da Família - equipes multidisciplinares que garantem o matriciamento das ações de Alimentação e Nutrição às equipes de Atenção Básica. A intersetorialidade é uma das vertentes das ações de Alimentação e Nutrição na Atenção Básica, tanto com atendimento as famílias beneficiárias do Programa Bolsa Família como com a integração das ações dos diferentes setores (Saúde, Educação, Assistência Social e Trabalho) no território. Configura-se como desafio a consolidação, expansão e universalização das ações propostas para a atenção básica no Brasil.